Cancer Nursing :: Medical Surgical Nursing :: Review For Nursing Licensure Examination

Slide 1: Oncology Nursing Nurse Licensure Examination Review

Slide 2: Oncology defined Branch of medicine that deals with the study, detection, treatment and
management of cancer and neoplasia

Slide 3: “Root words” Neo- new Plasia- growth Plasm- substance Trophy- size +Oma- tumor
Statis- location

Slide 4: “Root words” A- none Ana- lack Hyper- excessive Meta- change Dys- bad, deranged

Slide 5: Characteristics of Neoplasia Uncontrolled growth of Abnormal cells 1. Benign 2.

Malignant 3. Borderline

Slide 6: Characteristics of Neoplasia BENIGN Well-differentiated Slow growth Encapsulated

Non-invasive Does NOT metastasize

Slide 7: Characteristics of Neoplasia MALIGNANT Undifferentiated Erratic and Uncontrolled

Growth Expansive and Invasive Secretes abnormal proteins METASTASIZES

Slide 10: Nomenclature of Neoplasia Tumor is named according to: 1. Parenchyma, Organ or
Cell Hepatoma- liver Osteoma- bone Myoma- muscle

Slide 11: Nomenclature of Neoplasia Tumor is named according to: 2. Pattern and Structure,
either GROSS or MICROSCOPIC Fluid-filled CYST Glandular ADENO Finger-like
PAPILLO Stalk POLYP

Slide 12: Nomenclature of Neoplasia Tumor is named according to: 3. Embryonic origin
Ectoderm ( usually gives rise to epithelium) Endoderm (usually gives rise to glands) Mesoderm
(usually gives rise to Connective tissues)

Slide 13: BENIGN TUMORS Suffix- “OMA” is used Adipose tissue- LipOMA Bone- osteOMA
Muscle- myOMA Blood vessels- angiOMA Fibrous tissue- fibrOMA

Slide 14: MALIGNANT TUMOR Named according to embryonic cell origin 1. Ectodermal,
Endodermal, Glandular, Epithelial Use the suffix- “CARCINOMA” Pancreatic AdenoCarcinoma
Squamos cell Carcinoma

Slide 15: MALIGNANT TUMOR Named according to embryonic cell origin 2. Mesodermal,
connective tissue origin Use the suffix “SARCOMA FibroSarcoma Myosarcoma AngioSarcoma

Slide 16: “PASAWAY” 1. “OMA” but Malignant HepatOMA, lymphOMA, gliOMA, 

melanOMA 2. THREE germ layers “TERATOMA”  3. Non-neoplastic but “OMA” Choristoma
  Hamatoma

Slide 17: CANCER NURSING Review of Normal Cell Cycle 3 types of cells 1. PERMANENT
cells- out of the cell cycle Neurons, cardiac muscle cell  2. STABLE cells- Dormant/Resting
(G0) Liver, kidney  3. LABILE cells- continuously dividing GIT cells, Skin, endometrium ,
Blood cells 
Slide 18: CANCER NURSING Cell Cycle G0------------------G1SG2M G0- Dormant or
resting G1- normal cell activities S- DNA Synthesis G2- pre-mitotic, synthesis of proteins for
cellular division M- Mitotic phase (I-P-M-A-T)

Slide 19: CANCER NURSING Proposed Molecular cause of CANCER: Change in the DNA
structure altered DNA function Cellular aberration  cellular death  neoplastic change Genes
in the DNA- “proto-oncogene” And “anti-oncogene”

Slide 20: CANCER NURSING Etiology of cancer 1. PHYSICAL AGENTS Radiation Exposure
to irritants Exposure to sunlight Altitude, humidity

Slide 21: CANCER NURSING Etiology of cancer 2. CHEMICAL AGENTS Smoking Dietary
ingredients Drugs

Slide 22: CANCER NURSING Etiology of cancer 3. Genetics and Family History Colon Cancer
Premenopausal breast cancer

Slide 23: CANCER NURSING Etiology of cancer 4. Dietary Habits  Low-Fiber  High-fat 
Processed foods  alcohol

Slide 24: CANCER NURSING Etiology of cancer 5. Viruses and Bacteria DNA viruses- HepaB,
Herpes, EBV, CMV, Papilloma Virus RNA Viruses- HIV, HTCLV Bacterium- H. pylori

Slide 25: CANCER NURSING Etiology of cancer 6. Hormonal agents DES OCP especially
estrogen

Slide 26: CANCER NURSING Etiology of cancer 7. Immune Disease AIDS

Slide 27: CANCER NURSING CARCINOGENSIS Malignant transformation IPP Initiation

Promotion Progression

Slide 28: CANCER NURSING CARCINOGENSIS INITIATION Carcinogens alter the DNA of
the cell Cell will either die or repair

Slide 29: CANCER NURSING CARCINOGENSIS PROMOTION Repeated exposure to

carcinogens Abnormal gene will express Latent period

Slide 30: CANCER NURSING CARCINOGENSIS PROGRESSION Irreversible period Cells

undergo NEOPLASTIC transformation then malignancy

Slide 31: CANCER NURSING Spread of Cancer 1. LYMPHATIC Most common  2.

HEMATOGENOUS Blood-borne, commonly to Liver and Lungs  3. DIRECT SPREAD
Seeding of tumors 

Slide 32: CANCER NURSING Body Defenses Against TUMOR 1. T cell System/ Cellular
Immunity Cytotoxic T cells kill tumor cells  2. B cell System/ Humoral immunity B cells can
produce antibody  3. Phagocytic cells Macrophages can engulf cancer cell debris 

Slide 33: CANCER NURSING Cancer Diagnosis 1. BIOPSY The most definitive  2. CT, MRI
3. Tumor Markers
Slide 34: CANCER NURSING Cancer Grading The degree of DIFFERENTIATION Grade 1-
Low grade Grade 4- high grade

Slide 35: CANCER NURSING Cancer Staging 1. Uses the T-N-M staging system T- tumor N-
Node M- Metastasis 2. Stage 1 to Stage 4

Slide 36: CANCER NURSING GENERAL MEDICAL MANAGEMENT 1. Surgery- cure,

control, palliate 2. Chemotherapy 3. Radiation therapy 4. Immunotherapy 5. Bone Marrow
Transplant

Slide 37: CANCER NURSING GENERAL Promotive and Preventive Nursing Management 1.
Lifestyle Modification 2. Nutritional management 3. Screening 4. Early detection

Slide 38: SCREENING 1. Male and female- Occult Blood, CXR, and DRE 2. Female- SBE,
CBE, Mammography and Pap’s Smear 3. Male- DRE for prostate, Testicular self-exam

Slide 39: Nursing Assessment Utilize the ACS 7 Warning Signals CAUTION C- Change in
bowel/bladder habits A- A sore that does not heal U- Unusual bleeding T- Thickening or lump in
the breast I- Indigestion O- Obvious change in warts N- Nagging cough and hoarseness

Slide 40: Nursing Assessment Weight loss Frequent infection Skin problems Pain Hair Loss
Fatigue Disturbance in body image/ depression

Slide 41: Nursing Intervention MAINTAIN TISSUE INTEGRITY Handle skin gently Do NOT
rub affected area Lotion may be applied Wash skin only with SOAP and Water

Slide 42: Nursing Intervention MANAGEMENT OF STOMATITIS Use soft-bristled toothbrush

Oral rinses with saline gargles/ tap water Avoid ALCOHOL-based rinses

Slide 43: Nursing Intervention  MANAGEMENT OF ALOPECIA Alopecia begins within 2

weeks of therapy  Regrowth within 8 weeks of termination  Encourage to acquire wig before
hair loss occurs  Encourage use of attractive scarves and hats  Provide information that hair
loss is temporary BUT anticipate change in texture and color

Slide 44: Nursing Intervention  PROMOTE NUTRITION  Serve food in ways to make it
appealing  Consider patient’s preferences  Provide small frequent meals  Avoids giving
fluids while eating  Oral hygiene PRIOR to mealtime  Vitamin supplements

Slide 45: Nursing Intervention  RELIEVE PAIN  Mild pain- NSAIDS Moderate pain- Weak
opiods  Severe pain- Morphine  Administer analgesics round the clock with additional dose
for breakthrough pain

Slide 46: Nursing Intervention  DECREASE FATIGUE  Plan daily activities to allow
alternating rest periods  Light exercise is encouraged  Small frequent meals

Slide 47: Nursing Intervention  IMPROVE BODY IMAGE  Therapeutic communication is

essential  Encourage independence in self-care and decision making  Offer cosmetic material
like make-up and wigs

Slide 48: Nursing Intervention  ASSIST IN THE GRIEVING PROCESS  Some cancers are
curable  Grieving can be due to loss of health, income, sexuality, and body image  Answer
and clarify information about cancer and treatment options  Identify resource people  Refer to
support groups

Slide 49: Nursing Intervention  MANAGE COMPLICATION: INFECTION  Fever is the

most important sign (38.3)  Administer prescribed antibiotics X 2weeks  Maintain aseptic
technique  Avoid exposure to crowds  Avoid giving fresh fruits and veggie  Handwashing
 Avoid frequent invasive procedures

Slide 50: Nursing Intervention  MANAGE COMPLICATION: Septic shock  Monitor VS,
BP, temp  Administer IV antibiotics  Administer supplemental O2

Slide 51: Nursing Intervention  MANAGE COMPLICATION: Bleeding  Thrombocytopenia

(<100,000) is the most common cause  <20, 000 spontaneous bleeding  Use soft toothbrush
 Use electric razor  Avoid frequent IM, IV, rectal and catheterization  Soft foods and stool
softeners

Slide 52: Colon cancer

Slide 53: COLON CANCER Risk factors 1. Increasing age 2. Family history 3. Previous colon
CA or polyps 4. History of IBD 5. High fat, High protein, LOW fiber 6. Breast Ca and Genital
Ca

Slide 54: COLON CANCER Sigmoid colon is the most common site Predominantly
adenocarcinoma If early 90% survival 34 % diagnosed early 66% late diagnosis

Slide 55: COLON CANCER PATHOPHYSIOLOGY Benign neoplasm DNA alteration

malignant transformation malignant neoplasm  cancer growth and invasion  metastasis (liver)

Slide 56: COLON CANCER  ASSESSMENT FINDINGS 1. Change in bowel habits- Most
common 2. Blood in the stool 3. Anemia 4. Anorexia and weight loss 5. Fatigue 6. Rectal
lesions- tenesmus, alternating D and C

Slide 57: Colon cancer Diagnostic findings 1. Fecal occult blood 2. Sigmoidoscopy and
colonoscopy 3. BIOPSY 4. CEA- carcino-embryonic antigen

Slide 58: Colon cancer Complications of colorectal CA 1. Obstruction 2. Hemorrhage 3.

Peritonitis 4. Sepsis

Slide 59: Colon cancer MEDICAL MANAGEMENT 1. Chemotherapy- 5-FU 2. Radiation

therapy

Slide 60: Colon cancer SURGICAL MANAGEMENT Surgery is the primary treatment Based
on location and tumor size Resection, anastomosis, and colostomy (temporary or permanent)

Slide 61: Colon cancer NURSING INTERVENTION Pre-Operative care 1. Provide HIGH
protein, HIGH calorie and LOW residue diet 2.Provide information about post-op care and stoma
care 3. Administer antibiotics 1 day prior

Slide 62: Colon cancer NURSING INTERVENTION Pre-Operative care 4. Enema or colonic
irrigation the evening and the morning of surgery 5. NGT is inserted to prevent distention 6.
Monitor UO, F and E, Abdomen PE

Slide 63: Colon cancer NURSING INTERVENTION Post-Operative care 1. Monitor for
complications Leakage from the site, prolapse of stoma, skin irritation and pulmo complication
2. Assess the abdomen for return of peristalsis

Slide 64: Colon cancer NURSING INTERVENTION Post-Operative care 3. Assess wound
dressing for bleeding 4. Assist patient in ambulation after 24H 5.provide nutritional teaching
Limit foods that cause gas-formation and odor Cabbage, beans, eggs, fish, peanuts Low-fiber
diet in the early stage of recovery

Slide 65: Colon cancer NURSING INTERVENTION Post-Operative care 6. Instruct to splint the
incision and administer pain meds before exercise 7. The stoma is PINKISH to cherry red,
Slightly edematous with minimal pinkish drainage 8. Manage post-operative complication

Slide 67: Colon cancer NURSING INTERVENTION: COLOSTOMY CARE Colostomy begins
to function 3-6 days after surgery The drainage maybe soft/mushy or semi-solid depending on
the site

Slide 68: Colon cancer NURSING INTERVENTION: COLOSTOMY CARE BEST time to do
skin care is after shower Apply tape to the sides of the pouch before shower Assume a sitting or
standing position in changing the pouch

Slide 69: Colon cancer NURSING INTERVENTION: COLOSTOMY CARE Instruct to

GENTLY push the skin down and the pouch pulling UP Wash the peri-stomal area with soap and
water Cover the stoma while washing the peri- stomal area

Slide 70: Colon cancer NURSING INTERVENTION: COLOSTOMY CARE Lightly pat dry the
area and NEVER rub Lightly dust the peri-stomal area with nystatin powder

Slide 71: Colon cancer NURSING INTERVENTION: COLOSTOMY CARE Measure the
stomal opening The pouch opening is about 0.3 cm larger than the stomal opening Apply
adhesive surface over the stoma and press for 30 seconds

Slide 72: Colon cancer NURSING INTERVENTION: COLOSTOMY CARE Empty the pouch
or change the pouch when 1/3 to ¼ full (Brunner)   ½ to 1/3 full (Kozier)

Slide 73: Breast Cancer The most common cancer in FEMALES Numerous etiologies implicated

Slide 74: Breast Cancer RISK FACTORS 1. Genetics- BRCA1 And BRCA 2 2. Increasing age (
> 50yo) 3. Family History of breast cancer 4. Early menarche and late menopause 5. Nulliparity
6. Late age at pregnancy

Slide 75: Breast Cancer RISK FACTORS 7. Obesity 8. Hormonal replacement 9. Alcohol 10.
Exposure to radiation

Slide 76: Breast Cancer PROTECTIVE FACTORS 1. Exercise 2. Breast feeding 3. Pregnancy
before 30 yo

Slide 78: Breast Cancer ASSESSMENT FINDINGS 1. MASS- the most common location is the
upper outer quadrant 2. Mass is NON-tender. Fixed, hard with irregular borders 3. Skin dimpling
4. Nipple retraction 5. Peau d’ orange
Slide 79: Breast Cancer LABORATORY FINDINGS 1. Biopsy procedures 2. Mammography

Slide 80: Breast Cancer Breast cancer Staging TNM staging I - < 2cm II - 2 to 5 cm, (+) LN III -
> 5 cm, (+) LN IV- metastasis

Slide 81: Breast Cancer MEDICAL MANAGEMENT 1. Chemotherapy 2. Tamoxifen therapy 3.

Radiation therapy

Slide 82: Breast Cancer SURGICAL MANAGEMENT 1. Radical mastectomy 2. Modified

radical mastectomy 3. Lumpectomy 4. Quadrantectomy

Slide 83: Breast Cancer NURSING INTERVENTION : PRE-OP 1. Explain breast cancer and
treatment options 2. Reduce fear and anxiety and improve coping abilities 3. Promote decision
making abilities 4. Provide routine pre-op care: Consent, NPO, Meds, Teaching about breathing
exercise

Slide 84: Breast Cancer NURSING INTERVENTION : Post-OP 1. Position patient: Supine
Affected extremity elevated to reduce edema

Slide 85: Breast Cancer NURSING INTERVENTION : Post-OP 2. Relieve pain and discomfort
Moderate elevation of extremity IM/IV injection of pain meds Warm shower on 2nd day post-op

Slide 86: Breast Cancer NURSING INTERVENTION : Post-OP 3. Maintain skin integrity
Immediate post-op: snug dressing with drainage Maintain patency of drain (JP) Monitor for
hematoma w/in 12H and apply bandage and ice, refer to surgeon

Slide 87: Breast Cancer NURSING INTERVENTION : Post-OP 3. Maintain skin integrity
Drainage is removed when the discharge is less than 30 ml in 24 H Lotions, Creams are applied
ONLY when the incision is healed in 4-6 weeks

Slide 88: Breast Cancer NURSING INTERVENTION : Post-OP Promote activity Support
operative site when moving Hand, shoulder exercise done on 2ndday Post-op mastectomy
exercise 20 mins TID NO BP or IV procedure on operative site

Slide 89: Breast Cancer NURSING INTERVENTION : Post-OP Promote activity Heavy lifting
is avoided Elevate the arm at the level of the heart On a pillow for 45 minutes TID to relieve
transient edema

Slide 90: Breast Cancer NURSING INTERVENTION : Post-OP MANAGE COMPLICATIONS

Lymphedema 10-20% of patients Elevate arms, elbow above shoulder and hand above elbow
Hand exercise while elevated Refer to surgeon and physical therapist

Slide 91: Breast Cancer NURSING INTERVENTION : Post-OP MANAGE COMPLICATIONS

Hematoma Notify the surgeon Apply bandage wrap (Ace wrap) and ICE pack

Slide 92: Breast Cancer NURSING INTERVENTION : Post-OP MANAGE COMPLICATIONS

Infection Monitor temperature, redness, swelling and foul-odor IV antibiotics No procedure on
affected extremity

Slide 93: Breast Cancer NURSING INTERVENTION : Post-OP TEACH FOLLOW-UP care
Regular check-up Monthly BSE on the other breast Annual mammography