Introduction to Medical-Surgical Nursing, 6th ed.
25
Lesson Plans for
The Patient with Cancer
CHAPTER LESSON PLANS & OBJECTIVES
Lesson 25.1:
2. Explain the differences between benign and malignant tumors.
4. Describe measures to reduce the risk of cancer.
6. Explain the nursing care of patients undergoing each type of cancer therapy: surgery, radiation,
chemotherapy, and biotherapy.
Lesson 25.2:
5. List nursing responsibilities in the care of patients having diagnostic tests to detect possible cancer.
(cont.)
7. Assist in developing a nursing care plan for the terminally ill patient with cancer and the patient’s
family.
CHAPTER TEACHING FOCUS
• In this chapter, the student will be introduced to physical and psychological issues and concerns
related to the treatment of the patient with cancer.
• The student will become acquainted with the differences between benign and malignant tumors, tumor
2 Chapter 25 The Patient with Cancer _________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
CHAPTER PRETEST
Have the students answer these questions prior to covering this chapter to understand where they stand
in relation to the content.
1) Cancer is defined by the American Cancer Society as __________.
a) a terminal disease
b) a disease characterized by uncontrolled growth and spread of abnormal cells
c) any type of tumor
d) a growth of cells within the body
2) The main difference between benign and malignant tumors is __________.
a) pressure caused on surrounding structures
b) difference in appearance
c) the ability to spread to other areas
d) the location in which they occur
3) Cancers that appear at a higher rate than expected are called __________.
a) familial cancers
b) maternal cancers
c) fraternal cancers
d) oncofetal cancers
4) A tumor that has spread from its site of origin into nearby tissues is considered __________.
a) stage I
b) stage II
c) stage III
d) stage IV
5) The type of cancer that is within the top three most common cancers in both men and women is
__________.
a) lung cancer
b) leukemia
c) melanoma
d) colon cancer
6) Which of the following statements is an example of therapeutic communication for a patient with
cancer?
a) “I’m sure it will turn out all right.”
b) “Everything has a purpose.”
c) “You seem to be very worried.”
d) “My uncle had cancer and he lived to be 90.”
7) The most dangerous side effect of chemotherapy in cancer treatment is __________.
a) nausea and vomiting
b) bone marrow suppression
c) alopecia
d) stomatitis
8) An appropriate nursing intervention for a patient experiencing xerostomia would be which of the
following?
a) Encourage increased fluid intake.
b) Swab the mouth with glycerin swabs.
c) Medicate with an antiemetic.
d) There are no appropriate interventions.
9) An oncologic emergency exists when a patient develops intense pain, weakness, and altered
sensations in the limbs and results from __________.
a) hypercalcemia
b) superior vena cava syndrome
c) spinal cord compression
d) disseminated intravascular coagulation
10) Which of the following nursing diagnoses would be appropriate for a patient who is undergoing
testing to diagnose cancer?
a) Alteration in comfort
b) Anxiety
c) Dysfunctional grieving
d) Impaired nutrition
_________________________________________________________ Chapter 25 The Patient with Cancer 3
Introduction to Medical-Surgical Nursing, 6th ed.
Chapter Pretest Answers
CHAPTER BACKGROUND ASSESSMENT
Discuss these questions with your students prior to covering this chapter to understand where they stand
in relation to the content.
Question: What is a carcinogen? List three specific examples of carcinogens.
Question: What are three characteristics of a malignant tumor compared to a normal cell?
Answer: A normal cell has a very distinctive appearance depending on the tissue type, with a single
4 Chapter 25 The Patient with Cancer _________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 25.1
Instructor Preparation
Textbook Objectives Covered
1. List the most common sites of cancer in men and women.
3. Define terms used to name and classify cancer.
5. List nursing responsibilities in the care of patients having diagnostic tests to detect possible
cancer.
6. Explain the nursing care of patients undergoing each type of cancer therapy: surgery, radiation,
chemotherapy, and biotherapy.
Lesson Preparation Checklist
• Prepare lecture from TEACH lecture slides available on Evolve.
• Student performance evaluation of all entry-level skills required for student comprehension of
principles underlying the care of the patient with cancer, including:
• Diagnostic tests and procedures for cancer
Materials and Supplies
• computer and PowerPoint
projector
Key Terms
• adjuvant (p. 393)
• alopecia (p. 395)
• alternative therapy (p. 400)
• neoadjuvant (p. 393)
• neoplasm (p. 385)
• neutropenia (p. 399)
_________________________________________________________ Chapter 25 The Patient with Cancer 5
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 25.1
Student Preparation
Assignments 2 hours
1
READ – Textbook (pp. 384-385)
REVIEW
• Figure 25-1: American Cancer Society estimates (p. 384)
• Table 25-3: Tumor Names by Anatomic Sites (p. 387)
ANSWER – Text
• Review Questions for the NCLEX Examination: 1 (p. 413)
2
READ – Textbook (pp. 385-386)
REVIEW
• Table 25-1: A Comparison Between Benign and Malignant Tumors (p. 386)
ANSWER – Study Guide
• Part IIF: 2 (p. 145)
• Part IIIG: 5-8 (p. 147)
• Part IIIH: 1-4 (p. 148)
3
READ – Textbook (pp. 386-387)
REVIEW
ANSWER – Study Guide
• Part IA: 1-9 (p. 143)
• Part ID: 1-4 (p. 144)
• Part IIF: 3, 4, 13 (p. 145)
4
READ – Textbook (pp. 387-389)
REVIEW
• Table 25-6: American Cancer Society Recommendations for Early Cancer Detection (p. 390)
ANSWER – Text
ANSWER – Study Guide
• Part IC: 1 (p. 144)
• Part IIF: 1 (p. 145)
6 Chapter 25 The Patient with Cancer _________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 25.1
5
READ – Textbook (pp. 389-393)
REVIEW
• Figure 25-2: Computed tomography (p. 393)
• Table 25-7: Diagnostic Tests and Procedures: Cancer (p. 391)
ANSWER – Text
ANSWER – Study Guide
• Part IIF: 14 (p. 145)
6
READ – Textbook (pp. 393-412)
REVIEW
• Figure 25-3: Radiation exposure decreases as distance from the source increases (p. 393)
• Figure 25-4: The radiation sign (p. 394)
• Table 25-8: Side Effects of Radiation Therapy (p. 396)
ANSWER – Text
• Review Questions for the NCLEX Examination: 6, 7, 9 (p. 413)
ANSWER – Study Guide
• Part IB: 1-3 (p. 144)
_________________________________________________________ Chapter 25 The Patient with Cancer 7
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 25.1
Lecture Outline 20 minutes
Slide 1
Chapter 25
The Patient with Cancer
1
&
2
Slide 2
Normal Body Cells
• A normal cell has the following characteristics
• Distinct, recognizable appearance typical of all cells from a particular tissue
• Has a single small nucleus
• The ability to perform a specific function when mature
TALKING POINTS:
• What is a neoplasm?
• Tumors may be benign or malignant.
Slide 3
Benign Tumors
• Relatively harmless
• Do not spread to other parts of the body
• Surgical removal of benign tumors often recommended
TALKING POINTS:
Slide 4
Malignant Tumors
• Characteristics of cancer cells
• Change in appearance from normal cells
• Inability to properly perform function of tissue of origin; may assume functions of other
cells
• Not readily recognized by other cells
TALKING POINTS:
• What is the basis for a diagnosis of cancer?
• Malignant tumors may press on normal tissues and compete with normal cells for
nutrients.
8 Chapter 25 The Patient with Cancer _________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 25.1
Slide 5
Malignant Tumors (cont.)
• Can invade nearby tissues or disperse cells to colonize distant parts of the body
• Regional invasion
• The movement of cancer cells into adjoining tissue
• Metastasis
TALKING POINTS:
• What are tumors found away from the original site of malignant cells called?
Slide 6
Malignant Transformation
• Factors that promote the transformation of normal cells to malignant cells are increasing
age, diet, hormones, and chronic irritation
• Carcinogens
• Substances that damage cell DNA, causing normal cells to become malignant
TALKING POINTS:
3
Slide 7
Classification of Tumors
• Anatomic site
• Type of tissue from which they developed
• Staging system for cancer
• TNM system
• T refers to the tumor
• N to regional lymph nodes
• M to distant metastases
TALKING POINTS:
• What does the term differentiation mean?
• When it is difficult to recognize the original type of tissue from which tumor cells came,
_________________________________________________________ Chapter 25 The Patient with Cancer 9
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 25.1
4
Slide 8
Risk Factors
• Genetic and environmental
• Changes in genetic information of a normal cell can cause alterations that lead to
malignancies
• Carcinogens
• Cigarette smoke, asbestos, and nitrites
TALKING POINTS:
• A single, specific cause of cancer has not been identified.
Slide 9
Seven Warning Signs
• The American Cancer Society has identified seven warning signs associated with many
common types of cancer
TALKING POINTS:
• What are the warning signs of cancer?
Slide 10
Prevention and Early Detection
• Health promotion
• Diet low in fat, calories, and preservatives, and high in fiber with at least five servings
of various fruits and vegetables daily
TALKING POINTS:
• Many behaviors associated with good health may reduce the risk of some cancers.
• What beverages and foods should be taken in limited quantities to help decrease the risk
of cancers?
10 Chapter 25 The Patient with Cancer _________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 25.1
Slide 11
Prevention and Early Detection (cont.)
• Avoidance of carcinogens
• Cigarette smoke
• Alcohol
• Intercourse with multiple partners
• A variety of chemicals and drugs
• Excessive sun exposure
• Identification of high-risk people
TALKING POINTS:
• Public education has focused attention on carcinogens, and people are becoming more
aware of the need to avoid them.
5
Slide 12
Diagnosis of Cancer
• Health history
• Physical examination
• Diagnostic procedures
TALKING POINTS:
• The health history and physical examination often provide the first clues to the presence
_________________________________________________________ Chapter 25 The Patient with Cancer 11
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 25.1
6
Slide 13
Surgery
• To diagnose and stage the cancer, relieve symptoms, maintain function, effect a cure, or
reconstruct affected structures
• May be extensive or simple
TALKING POINTS:
• Surgery is most likely to be curative when tumors are detected early, are slow-growing,
confined to one area, and do not invade vital body structures.
• What is a radical procedure?
• Adjuvant and neoadjuvant therapies are relatively recent approaches to cancer treatment.
Slide 14
Radiotherapy
• Ionizing radiation used in treatment of disease
• Treat cancer because malignant cells are more sensitive than are normal cells to radiation
• Immediate and delayed effects on cells
• Immediate: cell death due to damage to cell membrane
TALKING POINTS:
• What is the unit of measure for radiation doses?
• A tumor is considered radiosensitive if it can be destroyed by radiation at a dose that is
Slide 15
Radiotherapy (cont.)
• Caregiver safety
• The amount of radiation received by those who come in contact with the patient
depends on the time of exposure, distance from radiation source, and amount of
shielding between the caregiver and the source
TALKING POINTS:
12 Chapter 25 The Patient with Cancer _________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 25.1
Slide 16
Radiotherapy (cont.)
• External radiation
• Procedure
• Special x-ray machine delivers radiation to area
• Patient preparation
• Patient goes through a treatment simulation; includes CT scanning to determine
the exact location to be treated
TALKING POINTS:
• The source of the radioactivity is located outside the body.
• Who determines the number of radiation treatments given?
Slide 17
Radiotherapy (cont.)
• Internal radiation
• Introduction of radiation source into the body
• Patients emit radiation and do pose a threat to others until the source is removed or
excreted
TALKING POINTS:
• What are some sources of internal radiation therapy?
• When sealed-source radiation is used, the patient’s body fluids are not radioactive.
• One example of sealed-source radiation is cesium, which is contained in a sealed
Slide 18
Radiotherapy (cont.)
• Side effects
• Bone marrow suppression
• Alopecia
TALKING POINTS:
• What is the goal of the ideal radiation treatment?
• Normal cells that are most sensitive to radiation include those of the hair follicle, bone
_________________________________________________________ Chapter 25 The Patient with Cancer 13
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 25.1
Slide 19
Chemotherapy
• Chemical agents to treat disease
• Antineoplastic
• Destroy rapidly dividing cells; may be used alone or in combination with other forms of
treatment
• Types of antineoplastic drugs
• Cytotoxic agents
TALKING POINTS:
• In some cases, chemotherapy is curative.
Slide 20
Chemotherapy (cont.)
• Side effects
• Bone marrow suppression
• Nausea and vomiting
• Alopecia
• Extravasation
TALKING POINTS:
• Antineoplastic drugs act on both normal cells and malignant cells.
• What organs may be at risk for toxic effects during chemotherapy?
Slide 21
Biotherapy
• Hematopoietic growth factors
• Colony-stimulating factors: stimulate the bone marrow to produce platelets, red, and
white blood cells
TALKING POINTS:
• How do hematopoietic growth factors reduce the risk of infection?
14 Chapter 25 The Patient with Cancer _________________________________________________________
LESSON 25.1
Bone Marrow and Stem Cell Transplantation
• Bone marrow transplantation: used after treatment of leukemia and lymphoma with
chemotherapy and/or radiation that destroys bone marrow
TALKING POINTS:
• If a patient donates his or her own stem cells or bone marrow before therapy, it is
classified as an autologous transplant.
• What is an allogenic stem cell transplant?
Slide 23
cancer and female hormones in the treatment of breast cancer.
Hormone Therapy
• Various treatments to suppress natural hormone secretion, block hormone actions, or
provide supplemental hormones
TALKING POINTS:
Slide 24
Complementary and Alternative Therapies
• Nontraditional treatments
• Relaxation techniques, guided imagery, music, meditation, herbal remedies, and
acupuncture
• Complementary therapy
TALKING POINTS:
• Research is being conducted by the National Center for Complementary and Alternative
Medicine in the National Institutes of Health to determine the therapeutic value of
physician?
Unproven Methods of Cancer Treatment
• American Cancer Society discourages treatments that have not been studied
TALKING POINTS:
• Studies have found that 6% to 9% of patients with cancer admit to using some
questionable method of cancer treatment.
• What are some examples of unproven treatments?
_________________________________________________________ Chapter 25 The Patient with Cancer 15
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 25.1
Slide 26
Question 1
• Characteristics of cancer cells include the following EXCEPT:
A. cells readily recognized by other cells.
B. may have abnormal proteins (called tumor markers) on cell surface.
C. random, disorganized, uncontrolled growth pattern.
D. ability to migrate from one tissue or organ to another.
TALKING POINTS:
Slide 27
Question 2
• Which of the following is a true statement about radiation?
A. Patients being treated with internal radiation do not pose a threat to others.
B. A tumor is considered radiosensitive if it can be destroyed by radiation at a dose that
is tolerated by surrounding normal tissue.
C. The immediate effect of radiation is alteration to DNA, which impairs the cell’s ability
to reproduce.
D. External radiation requires the introduction of the radioactive substance into the body.
TALKING POINTS:
Activities
Classroom Choose from below to make 30 minutes
Online
1
ASSESS BASELINE
• Have the class complete the Pretest. Collect
their work and use the results to guide how
you teach the class.
DISCUSS
• Discuss the leading sites of cancer
incidence and deaths for men and women,
as well as how the study of cancer, the push
for early diagnosis and treatment, and
attitudes toward cancer diagnosis have
ASSESS BASELINE
• Post the Pretest and the Background
Assessment online and have your class
complete them. Use the results to guide how
you teach the class.
16 Chapter 25 The Patient with Cancer _________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 25.1
2
DISCUSS
• Discuss normal body cells and outline the
characteristics of a normal cell.
• Discuss the differences between benign and
malignant tumors, and outline the
characteristics of a malignant cell.
• Discuss carcinogens, factors that promote
the transformation of normal cells to
malignant cells, and steps in malignant
transformation.
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Create a table
of five key differences among normal cells,
tumors, and benign cells.
3
DISCUSS
• Discuss classification of tumors (p. 394).
Describe how tumors are named by
anatomic site.
• Discuss the staging classification system
and define stages I, II, III, and IV.
• Divide the class into two teams. Using Table
25-3 (p. 387), call out different cancer
names and have the teams see if they can
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Describe the
TNM staging system for cancer. Define T, N,
and M, and explain how this system can
help a nurse develop a care plan for a
patient with cancer.
4
DISCUSS
• Discuss the warning signs of cancer.
Describe the use of the word CAUTION in
helping nurses remember the warning signs.
POST AND COMMENT
• Post the following discussion topic online
and have students comment. List the seven
warning signs of cancer.