Chapter 11 Nursing Care of Patients with Cancer

Answers CHAPTER 11 NURSING CARE OF PATIENTS WITH CANCER 7. False. Only those needed for its specific functions are active. 8. False. 46. 9. False. Each cell has a full 46 chromosomes. 10. False. It is also necessary for repair of tissues. AUDIO CASE STUDY BENIGN VERSUS MALIGNANT TUMORS Michael Manages Side Effects of Chemotherapy Benign tumors typically grow slowly, cause minor tissue damage, remain localized, and seldom recur after treatment. Cells resemble tissue of origin. Malignant tumors often grow quickly, cause damage to surrounding tissue, spread to other parts of the body (metastasize), and recur after treatment. Cells are altered to be less like their tissue of origin. 1. Symptoms to be vigilant for include: • Thrombocytopenia: Watch for bleeding, bruising, hematuria, hematemesis, blood in stool. • Leukopenia: Watch for signs of infection, including fever, purulent drainage, cough, sore throat, dysuria, redness, swelling. • Anemia: Watch for fatigue, pallor, dyspnea. 2. Because red blood cells carry oxygen and fewer red blood cells are circulating in an anemic patient. 3. Mr. Woo is at risk for infection, and the apple must be washed or peeled first. Bacteria can reside on the skin. VOCABULARY 1. alopecia 2. anorexia 3. Leukopenia or neutropenia 4. xerostomia 5. palliative 6. Chemotherapy 7. cytotoxic 8. Neoplasm 9. metastasizes 10. benign 11. biopsy 12. cytoprotective CELLS 1. True 2. False. For one protein. 3. False. To the ribosomes. 4. True 5. False. On the messenger RNA. 6. True CRITICAL THINKING 1. Leukopenia: Use careful hand washing; teach Delmae and her family the importance of doing the same. Teach her to avoid crowds, people with infections, and bird, cat, or dog excreta. Instruct her to avoid eating fresh fruits or vegetables that cannot be peeled. Teach her signs and symptoms of infection to report. Make sure she talks to her health care provider about the risks of returning to work while on chemotherapy. 2. Thrombocytopenia: Teach Delmae the importance of avoiding injury to prevent bleeding. Avoid intramuscular injections. Teach her to watch for and report symptoms of bleeding, such as bruising, petechiae, or blood in urine, stool, or emesis. 3. Anemia: Provide a balanced diet, with supplements as prescribed. Administer oxygen as ordered for dyspnea. Provide opportunities to rest. Assist with blood transfusions as ordered. 4. Stomatitis: Offer soft, mild foods. Offer frequent sips of water. Provide a mouthwash such as diphenhydramine diluted in water or saline. Teach her to avoid hot, cold, spicy, and acidic foods. 5. Nausea and vomiting: Administer antiemetics as ordered. Use prophylactically, not just when nausea is present. Provide mouth care before meals. Provide small, frequent meals and room-temperature or cool foods. Serve meals in a clean, pleasant environment that is free from odors and unpleasant sights. Offer hard candy. Use music or relaxation as distractions. 1 2 Chapter 11 Answers 6. Alopecia: Offer an accepting attitude. Help Delmae locate a wig or other head covering if she wishes. Assure her that her hair will grow back. REVIEW QUESTIONS—CONTENT REVIEW The correct answers are in boldface. 1. (2) is correct. (1, 3, 4) are incorrect. 2. (3) is correct. (1, 2, 4) are incorrect. 3. (2) is correct. High-fat foods may increase the risk of some cancers. (1) is incorrect. Broccoli and cauliflower help reduce cancer risk. (3) is incorrect. Chicken and fish are low-fat meats that are healthy choices. (4) is incorrect. Cakes and breads are not problems unless they are high in fat or other high-risk ingredients. 4. (2) is correct. Remember the importance of time, distance, and shielding. (1) is incorrect. Leaving the patient alone for 24 hours is inappropriate. (3) is incorrect. Body fluids should not be touched, but it is not feasible to care for the patient and avoid touching altogether. (4) is incorrect. A “contaminated” sign will make the patient feel even more isolated and afraid. REVIEW QUESTIONS—TEST PREPARATION The correct answers are in boldface. 5. (3) is correct. A biopsy enables the pathologist to examine and positively identify the cancer. (1) is incorrect. Cultures diagnose infection. (2) is incorrect. X-rays can help locate a tumor but cannot determine whether it is benign or malignant. (4) is incorrect. A bronchoscopy may be done, but a biopsy is necessary to positively identify the cancer. 6. (1) is correct. Frequent mouth care will help prevent the discomfort and dryness that accompany mucositis. (2) is incorrect. Cold liquids may worsen mucositis. (3) is incorrect. High-carbohydrate foods will not help. (4) is incorrect. Juices are acidic and can irritate the mucous membranes. 7. (2) is correct. Petechiae are small hemorrhages into the skin. (1) is incorrect. Fever is a sign of infection. (3) is incorrect. Pain is not usually a sign of bleeding. (4) is incorrect. Vomiting is not a sign of bleeding unless it is bloody. 8. (1, 4, 5) are correct. Washing hands frequently is an excellent way to help prevent infection in the patient at risk. Colony-stimulating factors are provided to stimulate increased production of white blood cells and reduce the length or severity of leukopenia. Taking vital signs frequently and monitoring for signs of an infection is an important part of early detection, which helps reduce additional complications related to neutropenia. (2, 3, 6) are incorrect. Avoiding injections will help prevent bleeding but will do little to prevent infection. Visitors with infections should be discouraged, but the patient needs the support of family at this time. Fresh fruits and vegetables can transmit infection. 9. (4) is correct. Alternative methods for pain control can be helpful but should never be expected to substitute for analgesics in the patient with cancer. (1) is incorrect. Distraction should be used with, not instead of, medication. (2) is incorrect. The nurse must believe the patient’s report of pain. (3) is incorrect. Distraction can be effective when used with medication and in no way indicates that the patient’s pain is not real. 10. (3, 5, 6) are correct. The goal of hospice is to help patients achieve a comfortable death and to provide emotional or physical assistance to family members and other caregivers during the patient’s dying process. Respite care for family members may be provided, and follow-up counseling is available for up to a year after the patient’s death. (1, 2, 4) are not correct. They are all aimed at curing the patient’s cancer. If cure is the goal, a referral to hospice is inappropriate. 11. (3) is correct. Accurate identification of a cancer can only be done by biopsy; surgery is not always the treatment of choice. (1, 2, 4) are incorrect.