CANCER/NEO-PLASM/NEW GROWTH

1. Cancer is also called neoplasm
2. Cancer is also defined as abnormal growth in the tissue either slow (benign) & or fast (malignant)
3. Cancer is the new growth, a tumor which is either cancerous or non-cancerous
4. Abnormal mass that is referred as a neoplasm or new growth. The cells of the neoplasm serve the no useful purpose and use nutrients and oxygen
5. Nursing involvement in the care of the patient education, assessment, monitoring, and treatment support and require knowledge of both the bio-medical and physiological components of the cancerous care.

Difference between the Benign & Malignant

Anaplasia= loss of distinctive characteristics of a cell associated with proliferate activity as in cancer.

Metastasis (Secondary Malignant)

1. Secondary malignant is also called Metastasis
2. Secondary Malignant is defined as the transfer of a disease from one part of the organ to the part throughout the blood vessels and lymph.
3. Metastasis may occurs due to the primary Malignant

Common sites of Metastasis are lungs, liver, brain and bone.

1. Connective
2. Muscular

1. Nerve

1. Hematological

1. Endothelial

Treatment of the neo-plasm:

At present three methods have proved their values in the treatment of the neo-plasm

1. Chemo-therapy
2. Radio-therapy
3. Surgery

The hope for cure of neo-plasm especially for malignant depends on the chemotherapy. In general, it can be said that as yet no drugs have been discovered to cure malignant tumor however, cancer chemotherapy may or may not offer some help to patients for home surgery and radiation are no longer beneficial. Chemotherapeutic agents at the time of surgery may reduce or slow up the appearance of secondary growth. In some patients pain and other symptoms are relieved for the time.

Chemotherapeutic agents are especially used for the lymphomea and leukemia, diffuse tumor usually not amenable to surgical therapy.

The rational for administrating chemotherapeutic drug is that they are capable and destroying young rapidly multiplying cells. It is believed that these drugs interfere with the manufacturing of nucleic acid that is necessary for the building of genetic structures in the cells. As a result cellular growth and building reproduction inhabited.

Specific agents used as chemotherapy

1. Poly-functional alkyl ting agents:

These poison destroy both cells either tumor cells or normal. It is believed that tumor cells are more sensitive to toxicity than normal cells, as a result cell growth and division is hindered.

The chief disadvantage of most of these drugs is destructive effect on the bone marrow, which is the body’s chief source of new born blood cells other side effect is vomiting, nausea and Stomatitis.

1. Antimetabolytes:

e.g.: Folic acid, purine antagonistic

These are the synthetic substance, similar to those that nourish the normal cells during its growth and development.

1. Steroids compounds:
2. ACTH: control on cortisol (kidney).
3. Castration: control on secretion on prostate gland.

These drugs changes the endocrine environment because tumor arising in organs usually under hormonal influences such as prostate and breast.

The patient receiving the type of therapy will be need to be observed by toxicity signs such as fluid retention, increases libido (the vital force or impulse which brings about purposeful action) and hirutism (excessive hair ness) as well as nausea and vomiting.

1. Miscellaneous drugs:

Antibiotics drugs such as Actynomycin-D, Mytomycin-C and Streptomycin.

Note:

None of above drug can cure Malignancy. They are efforts to make the physiology of the host cells less favorable for the growth of the cancer.

These drugs may be given orally, IV, IM depending on the drug and Carcinoma.

Side effects of the chemotherapeutic drugs:

1. Stomatitis
2. Neuro toxicity
3. Hepatic toxicity
4. Ocular toxicity
5. Diarrhea
6. Nephro toxicity
7. Bladder toxicity
8. Oto toxicity
9. Endocrinal changes
10. Pulmonary toxicity
11. Cardio toxicity

General Nursing & Medical care of the onco-patient (Cancerous-patient):

• To control the Carcinoma growth by surgery, radiation and chemotherapy
• Combats on local and systemic infection
• Correct existing enema and electrolytic imbalance
• Give the patient psychological support by the explaining the treatment by re-assurance, listen and observe the patient anxiety
• Administrator vitamin-B as prescribed and blood transmission is needed
• Give sedatives, anti-emetics, anti-histamines (allergic)
• Offer small frequent feeding of high caloric
• Increase fluid intake

1. Report patient’s reaction response
2. Control on diarrhea
3. Remove constipation by giving low residue or balanced diet
4. Give enema if required as suppository if needed
5. Take care of skin especially of perineal area
6. Apply oil or cream to radiation site.
7. Protect skin from sun-light, heat, injury and tight clothing
8. Advice for blood CP
9. Protect the patient from the infection
10. Evaluate the quality, intensity duration of pain as well as patient response to pain
11. Promote the general comfort of patient by turning, moving and rest
12. Administer drug as prescribed
13. Use specific drug for nausea and vomiting
14. Apply cold or hot compression if needed
15. Apply local anesthetic to relieve the pain
16. Prepare for alcohol injection to block narrow path
17. Control on the odor and remove odor
18. Encourage for good personal hygiene
19. Give normal saline irrigation to external areas if required
20. If administrator prescribed vaginal irrigation, when discharge of vaginal secretion of the patient
21. Keep perineal area shaved
22. Observe for increasing pulse rate
23. Observe the amount and color of the blood if bleeding
24. Apply digital pressure if site is accessible
25. Apply vaginal or rectum packing if required
26. Care the bladder frequently and incontinence
27. Maintain I/O chart
28. Insert catheter if all other measures fails
29. Encourage patient for fluid & regular meal for constipation
30. Reduce edema by ROM (range of motion)
31. Evaluate edematic extremity
32. Prevent the patient from bed sore by providing stimulation circulation
33. Assess the patient to cope with his/her situation
34. Develop a supportive relationship with patient (Psychotherapy)
35. Encourage the patient to make decision
36. Listen the patient attentively and answer the patient frequently and politely
37. Provide a daily schedule to the patient
38. Encourage the patient to be active
39. Maintain the patient optimal physical, mentally and emotionally satisfaction
40. Maintain a cheerful and optimistic attitude
41. Encourage for verbalization
42. Do little more for the patient
43. Include the family in the patient’s care.

Side effects of the chemotherapeutic drugs:

1. Stomatitis
2. Neuro-toxicity
3. Hepatic-toxicity
4. Ocular toxicity
5. Diarrhea
6. Nephro toxicity
7. Bladder toxicity
8. Oto toxicity
9. Hormonal changes
10. Pulmonary toxicity
11. Cardio toxicity

1. Esophageal Carcinoma Definition:

Carcinoma of the esophagus is unique in its geographic distribution. Both benign & malignant tumor occurs in the esophagus. Benign tumor are usually leimyomas, and extremely rare & usually asymptomatic. They require no intervention unless symptoms necessitate local excision. Malignant tumors of the esophagus are not common but they assume increased importance because of their virulence.

Location of esophagus:

Esophagus lies behind the trachea to which it adopts and in front of the vertebral column. Passing through the thorax it pierces the diaphragm to enter in abdomen where it communicates with the stomach. Its size is 9-10 inches.

Causes:
© Exact cause is idiopathic,
© Pre-disposing factors are: © Taking alcohol
© Usage of tobacco and opium © Excessive usage of beverages
© Induced caustic esophagus sphincter © Ultra-violet radiations

1. Tumor
2. Dysphagia
3. Odynophagia (typically)
4. Heart burn
5. Anorexia
6. Weight loss
7. Feeling mass in throat
8. Painful swallowing
9. Regurgitation
10. Hiccup
11. Chest pain
12. Supera-clavicular lymphodenopathy

Complication:

1. Hemorrhage
2. Esophageal perforation
3. Esophageal obstruction

Investigations:

1. Chest X-ray
2. CT scan
3. Barium esophagography
4. Bronchoscopy
5. Biopsy
6. MRI
7. Blood CP

Medical treatment:

1. Poly-functional alkyl ting agents:
2. Antimetabolytes:
3. e.g.: Folic acid, purine antagonistic
4. ACTH
5. Castration
6. Miscellaneous drugs:
7. Antibiotics drugs such as Actinomycin-D, Mytomycin

Surgical treatment:

1. Surgical, the resection of the esophagus provides the most rapid durable relief of the Dysphagia, the standard surgical Management including partial removal of the esophagus.
2. Esophagectomy
3. Esophagogastrotomy
4. Esophagoenterostomy

Radio-therapy:

1. The radiotherapy may be given for a short time to provide relief to pain. Nursing Management:
2. Please revise the general Nursing Management of the Neoplasm.

DECISION MAKING

A. DEFINITION OF DECISION MAKING:

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DELEGATION

A. DEFINITION OF DELEGATION:

Delegation is defined as to give own’s power to others for decision making. Responsibility & authority is delegated to lowest level at what it can be completely discharged. It should be no cause of sub- ordinates to become over-loaded.

1. DELEGATION AUTHORITY & RESPONSIBILITY:

The leader is the responsible for failure or success of the team. At the same time each health worker is also responsible for the particular task of his/her special job. On the way of using authority is to delegate. It means to give it to others the power to make the decision.

1. ADVANTAGES OF DELEGATION:
   • To save time for others.
   • The workers on spot must be able to make decision
   • To save delayed time, long delayed decision
   • Workers enjoy their work
   • Workers become more skillful
2. DISADVANTAGES OF DELEGATION:
   • Work may not be done or less well due to lack of knowledge
   • Wrong decision may be taken by workers
   • Leader may pass all his/her work on followers.
   • If delegation is not done properly, then it is very harmful.
3. RULES FOR DELEGATION AUTHORITY & RESPONSIBILITY:
   • Classify exactly that what is delegated
   • Select the right person & make sure that he/she can do properly
   • Explain to others that I have delegated work & to whom
   • Do not interfere unless asked for
   • Give support as needed.

CONFLICTS

A. DEFINITION OF CONFLICTS:

It is a mental struggle resulting from opposite ideas is called conflict.

1. TYPES OF CONFLICTS:
   1. Intra-individual conflict
      • Frustration
      • Goal-conflict
      • Approach-approach conflict
      • Avoidance-avoidance conflict
      • Approach-avoidance conflict
   2. Inter-personal conflict
   3. Inter-group conflict
   4. Organizational conflict
2. STAGES OF CONFLICTS:

• Anticipation
• Open dispute
• Known & expressed difference
• Discussion

1. PERSONAL PROBLEM OF THE STAFF:

• Finance problem
• Child sickness problem
• Relative death problem
• Quarrel with his wife prodem
• Personal worries problem

1. HOW TO PREVENT FROM CONFLICTS:

• Frequent meeting of team members
• Allowing people to express views openly & telling the whole decide
• Sharing agreed objectives
• Distributing work freely
• Distributing work fairly having clear & detailed job description.

1. SETTING OF THE CONFLICTS:

• First, the leader should interview each person involved separates.
• Second, the leader must try to decide what is the real problem
• Third, the each person should be asked repeatly, how they stop the argument and whether willing to overcome.

When the real cause is understood & solution suggested, leader should participate the both sides for work again in fairly manner.

EVALUATION

A. DEFINITION OF EVALUATION:

It is an appraised work performance. It is a process of making judgment on the basis of assessment. Appraisal means to estimate the value (often use).

1. BASIC STEPS OF THE EVALUATION:
   • What is to be evaluated?
   • Collect the information(needed)
   • Compare your result with the objectives.
   • Judge whether and to what extra, the objective has been decided, whether continue the programme as such to change it or stop it.
2. IN SERVICE TRAINING PROGRAMME:
   • Method of training and learning
   • Individual reading
   • Small group learning in class-room
   • Learning new skills
   • Individual on job training
3. STEPS OF LEARNING SKILLS:
   • Learning skills usually begin with observation of the trainee
   • Initiates the action of the trainee
   • Skills have been acquired individual
   • Segments & the trainee must begin to practice skills as whole
   • Finally skills is practiced more or less automatically
   • It’s almost never lost.

1. GENERAL PLAN FOR THE WARD TO EVALUATE:

Generally plan of the ward facilities are:

• • Lighting
  • Ventilation
  • Artificial lighting
  • Night lighting
  • Walls & floors
  • Relative rooms
  • Cubicles
  • Call system
  • Toilet facility
  • Treatment facility
  • Waiting room
  • Emergency exit