Book Alone: Cancer Symptom Management

774 Pages·2013·32.25 MB·English

by  Connie Henke Yarbro

CANCER
SYMPTOM
MANAGEMENT
FOURTH EDITION
Edited by
Connie Henke Yarbro, RN, MS, FAAN
Adjunct Clinical Associate Professor
Sinclair School of Nursing
Editor, Seminars in Oncology Nursing
University of Missouri, Columbia
Columbia, Missouri
Debra Wujcik, PhD, RN, FAAN
Director, VICC Clinical Trials Shared Resource
Associate Professor, Vanderbilt School of Nursing
Vanderbilt Ingram Cancer Center
Nashville, Tennessee
Barbara Holmes Gobel, RN, MS, AOCN®
Operations Manager, Oncology Services
Northwestern Memorial Hospital
Past Editors
Adjuvant Faculty, Rush University College of Nursing Margaret Hansen Frogge, RN, MS
Chicago, Illinois Michelle Goodman, RN, MS
9781284025538_FMxx_ttlpg.indd 1 4/18/13 2:17 PM
World Headquarters
Jones & Bartlett Learning
5 Wall Street
Burlington, MA 01803
978-443-5000
[email protected]
www.jblearning.com
Jones & Bartlett Learning books and products are available through most bookstores and online booksellers. To contact Jones &
Bartlett Learning directly, call 800-832-0034, fax [phone], or visit our website, www.jblearning.com.
Substantial discounts on bulk quantities of Jones & Bartlett Learning publications are available to corporations, professional
associations, and other qualified organizations. For details and specific discount information, contact the special sales
department at Jones & Bartlett Learning via the above contact information or send an email to [email protected].
Copyright © 2014 by Jones & Bartlett Learning, LLC, an Ascend Learning Company
All rights reserved. No part of the material protected by this copyright may be reproduced or utilized in any form, electronic or
mechanical, including photocopying, recording, or by any information storage and retrieval system, without written permission
from the copyright owner.
The content, statements, views, and opinions herein are the sole expression of the respective authors and not that of Jones &
Bartlett Learning, LLC. Reference herein to any specific commercial product, process, or service by trade name, trademark,
manufacturer, or otherwise does not constitute or imply its endorsement or recommendation by Jones & Bartlett Learning, LLC
and such reference shall not be used for advertising or product endorsement purposes. All trademarks displayed are the trade-
marks of the parties noted herein. Cancer Symptom Management, Fourth Edition is an independent publication and has not been
authorized, sponsored, or otherwise approved by the owners of the trademarks or service marks referenced in this product.
There may be images in this book that feature models; these models do not necessarily endorse, represent, or participate in the
activities represented in the images. Any screenshots in this product are for educational and instructive purposes only. Any indi-
viduals and scenarios featured in the case studies throughout this product may be real or fictitious, but are used for instructional
purposes only.
The authors, editor, and publisher have made every effort to provide accurate information. However, they are not responsible
for errors, omissions, or for any outcomes related to the use of the contents of this book and take no responsibility for the use of
the products and procedures described. Treatments and side effects described in this book may not be applicable to all people;
likewise, some people may require a dose or experience a side effect that is not described herein. Drugs and medical devices are
discussed that may have limited availability controlled by the Food and Drug Administration (FDA) for use only in a research
study or clinical trial. Research, clinical practice, and government regulations often change the accepted standard in this field.
When consideration is being given to use of any drug in the clinical setting, the health care provider or reader is responsible for
determining FDA status of the drug, reading the package insert, and reviewing prescribing information for the most up-to-date
recommendations on dose, precautions, and contraindications, and determining the appropriate usage for the product. This is
especially important in the case of drugs that are new or seldom used.
Production Credits
Executive Publisher: William Brottmiller Composition: Lapiz, Inc.
Senior Acquisitions Editor: Nancy Anastasi Duffy Cover Design: Michael O’Donnell
Editorial Assistant: Rebecca Myrick Cover Image: © Ryan McVay/Photodisc/Getty Images
Associate Production Editor: Sara Fowles Printing and Binding: Courier Companies
Marketing Communications Manager: Katie Hennessy Cover Printing: Courier Companies
VP, Manufacturing and Inventory Control: Therese Connell
To order this product, use ISBN: 978-1-284-02740-2
Library of Congress Cataloging-in-Publication Data
Cancer symptom management / [edited by] Connie Henke Yarbro, Debra Wujcik, Barbara Holmes Gobel. — 4th ed.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-1-284-02553-8 (pbk.)
I. Yarbro, Connie Henke. II. Wujcik, Debra. III. Gobel, Barbara Holmes.
[DNLM: 1. Neoplasms—nursing. 2. Neoplasms—complications. 3. Oncologic Nursing—methods.
4. Patient Care Management—methods. WY 156]
616.99’40231—dc23
2013001117
6048
Printed in the United States of America
17 16 15 14 13 10 9 8 7 6 5 4 3 2 1
Contents
Preface xv
Acknowledgments xvii
The Editors xix
Contributors xxi
Part I The Problem of Symptom Distress 1
1 Evidence-Based Symptom Management 3
Susan S. Tavernier, PhD, RN, APRN-CNS, AOCN®
Evidence-Based Practice, 3 Case Example: Distress Management, 6
Evidence-Based Practice and Diffusion Theory, 5 Conclusion, 8
Nursing Implications, 5 References, 8
Part II Alterations in Comfort 11
2 Arthralgias and Myalgias 13
Virginia R. Martin, MSN, RN, AOCN®
The Problem, 13 Degrees of Toxicity, 19
Incidence, 13 Symptom Management Strategies, 19
Etiology, 15 Therapeutic Approaches, 20
Emerging Etiology, 17 Nursing Implications, 22
Pathophysiology, 17 Patient Self-Care, 22
Symptom Assessment, 17 References, 22
Risk Factors, 18 Appendix 2A: Self-Care Guide: Muscle Aches and
Self-Assessment, 18 Joint Pain, 24
Objective Assessment, 18
3 Cancer-Related Fatigue 27
Sandra A. Mitchell, PhD, CRNP, AOCN®
The Problem, 27 Degrees of Toxicity, 32
Incidence, 28 Symptom Management Strategies, 33
Etiology, 28 Therapeutic Approaches, 33
Pathophysiology, 29 Nursing Implications, 36
Symptom Assessment, 29 Patient Self-Care, 37
Risk Factors, 29 References, 38
Self-Assessment, 30 Appendix 3A: Self-Care Guide: Fatigue, 42
Objective Assessment, 30
iii
iv Contents
4 Menopausal Symptoms 45
Sheryl Redlin Frazier, RN, MSN; Mary Egger, RN, MSN, WHNP
The Problem, 45 Nursing Implications, 58
Incidence, 45 Patient Self-Care, 59
Etiology, 45 References, 59
Pathophysiology, 47 Appendix 4A: Self-Care Guide: Managing the
Symptom Assessment, 47 Symptoms of Menopause: Hot Flashes and Night
Risk Factors, 47 Sweats, 62
Objective Assessment, 49 Appendix 4B: Self-Care Guide: Managing the
Symptom Management Strategies, 49 Symptoms of Menopause: Changes in the Female
Vasomotor Symptoms, 49 Anatomy, 64
Urogenital Effects and Sexual Dysfunction, 55 Appendix 4C: Self-Care Guide: Osteoporosis:
Osteoporosis, 56 Maximizing the Health of Your Bones, 66
Cardiovascular Disease, 58
5 Pain 69
Jeannine M. Brant, PhD, APRN, AOCN®
The Problem, 69 Symptom Management Strategies, 77
Incidence, 71 Preventive Strategies, 77
Etiology, 71 Therapeutic Approaches, 77
Pathophysiology, 72 Nursing Implications, 86
Cancer Pain Pathophysiology, 73 Patient Self-Care, 87
Symptom Assessment, 73 References, 87
Risk Factors, 73 Appendix 5A: Self-Care Guide: Pain, 90
Self-Assessment and Pain History, 74
Objective Assessment, 76
Degrees of Toxicity, 77
6 Sleep Disturbances 93
Ellyn E. Matthews, PhD, RN, AOCN®, AOCNS®; Ann M. Berger, PhD, APRN, AOCNS®, FAAN
The Problem, 93 Symptom Management Strategies, 102
Sleep Definition, States, and Stages, 93 Therapeutic Approaches, 102
Characteristics of Sleep Disturbances, 94 Nursing Implications, 105
Sleep Disturbances and Symptom Clusters, 95 Patient Self-Care, 105
Hypersomnia and Insomnia, 95 References, 107
Consequences of Impaired Sleep, 96 Appendix 6A: Self-Care Guide: Managing Sleep
Incidence, 96 Disturbances, 110
Etiology and Risk Factors, 97 Appendix 6B: Self-Care Guide: Daily Sleep
Pathophysiology, 98 Diary, 112
Symptom Assessment, 99
Subjective Assessment, 99
Objective Assessment, 101
Degrees of Toxicity, 101
Contents v
Part III Alterations in Protective Mechanisms 113
7 Hypersensitivity Reactions to Antineoplastic Drugs 115
Wendy H. Vogel, MSN, FNP, AOCNP®
The Problem, 115 Symptom Management Strategies, 124
Incidence, 115 Therapeutic Approaches, 124
Etiology, 115 Nursing Implications, 126
Pathophysiology, 117 Patient Self-Care, 127
Symptom Assessment, 120 References, 127
Risk Factors, 120 Appendix 7A: Self-Care Guide: Hypersensitivity
Self-Assessment, 121 Reaction to Antineoplastic Drugs, 129
Objective Assessment, 121
Degrees of Toxicity, 123
8 Infection 131
Laura J. Zitella, MS, RN, ACNP-BC, AOCN®
The Problem, 131 Symptom Management Strategies, 138
Incidence, 131 Therapeutic Approaches, 138
Etiology, 132 Nursing Implications, 148
Pathophysiology, 133 Patient Self-Care, 149
Sources of Infection, 134 References, 149
Symptom Assessment, 134 Appendix 8A: Self-Care Guide: Prevention of
Risk Factors, 134 Infection, 152
Self-Assessment, 134 Appendix 8B: Self-Care Guide: Food Safety, 154
Objective Assessment, 135 Appendix 8C: Self-Care Guide: Hand
Degrees of Toxicity, 136 Washing, 156
Part IV Alterations in Gastrointestinal Function 159
9 Constipation 161
Pamela J. Haylock, PhD, RN, FAAN; Carol Curtiss, MSN, RN-BC; Robert L. Massey, PhD, RN, CNAA
The Problem, 161 Symptom Management Strategies, 171
Prevalence, 162 Therapeutic Approaches, 171
Etiology and Pathophysiology, 162 Nursing Implications, 177
Normal Intestinal Physiology, 162 Patient Self-Care, 178
Mechanisms of Constipation, 162 References, 178
Constipation in the Person with Cancer, 163 Appendix 9A: Self-Care Guide: Prevention of
Symptom Assessment, 166 Constipation, 181
Self-Assessment, 166
Objective Assessment, 167
Degrees of Toxicity, 171
vi Contents
10 Diarrhea 185
Paula M. Muehlbauer, RN, MSN, AOCNS®; Rachael Christine Lopez, MPH, RD, CSO
The Problem, 185 Appendix 10A: Self-Care Guide: Weekly Bowel
Incidence and Etiology, 186 Pattern Diary, 206
Pathophysiology, 190 Appendix 10B: Self-Care Guidelines: Diarrhea
Symptom Assessment, 191 from Cancer Treatment, 207
Risk Factors, 191 Appendix 10C: Self-Care Guide: Dietary
Self-Assessment, 191 Guidelines to Prevent Exacerbation of
Objective Assessment, 191 Treatment-Induced Diarrhea by Food
Symptom Management Strategies, 193 Group, 209
Therapeutic Approaches, 194 Appendix 10D: Skin Care and Incontinence
Nursing Implications, 202 Guidelines: Taking Care of Your Skin, 211
Patient Self-Care, 203
References, 204
11 Nausea and Vomiting 213
Janelle Tipton, MSN, RN, AOCN®
The Problem, 213 Consideration of Vulnerable Populations, 229
Incidence, 214 Future Research, 229
Etiology, 214 Patient Self-Care, 231
Pathophysiology, 215 References, 231
Neural Structures, Transmitters, and Receptors Appendix 11A: Self-Care Guide: Nausea and
Involved in Emesis, 215 Vomiting from Chemotherapy, 234
Symptom Assessment, 216 Appendix 11B: Self-Care Guide: Nausea and
Risk Factors, 217 Vomiting from Radiation Therapy, 236
Self-Assessment, 219 Appendix 11C: Self-Care Guide: Nausea and
Objective Assessment, 219 Vomiting from Cancer or Other Causes, 238
Degrees of Toxicity, 220
Symptom Management Strategies, 221
Therapeutic Approaches, 221
Nursing Implications, 227
12 Malignant Ascites 241
Kim Slusser, RN, MSN, CHPN®
The Problem, 241 Patient Self-Care, 254
Incidence, 241 References, 254
Etiology, 242 Appendix 12A: Self-Care Guide: Malignant
Pathophysiology, 242 Ascites Self-Assessment, 256
Symptom Assessment, 244 Appendix 12B: Self-Care Guide: Ascites, 257
Risk Factors, 244 Appendix 12C: Self-Care Guide: Removing
Self-Assessment, 244 Ascites Fluid: Paracentesis, 259
Objective Assessment, 244 Appendix 12D: Self-Care Guide: Shunt
Degrees of Toxicity, 246 Care, 260
Symptom Management Strategies, 247 Appendix 12E: Self-Care Guide: Ascites Daily
Therapeutic Approaches, 247 Log, 262
Nursing Implications, 251
Contents vii
Part V Alterations in Genitourinary Function 263
13 Bladder Disturbances 265
Connie Henke Yarbro, RN, MS, FAAN; Donna L. Berry, RN, PhD, AOCN® FAAN
The Problem, 265 Symptom Management Strategies, 270
Incidence, 265 Therapeutic Approaches, 270
Etiology and Pathophysiology, 266 Nursing Implications, 275
Bladder Cancer, 267 Patient Self-Care, 275
Bladder Infection, 267 References, 275
Chemotherapy-Induced Cystitis, 267 Appendix 13A: Self-Care Guide:
Radiation Injury, 267 Bladder Diary, 277
Voiding Dysfunction, 267 Appendix 13B: Self-Care Guide:
Spinal Cord Injury, 268 Bladder Catheter Care, 278
Symptom Assessment, 268 Appendix 13C: Self-Care Guide: Irritative
Self-Assessment, 268 Bladder Symptoms, 280
Objective Assessment, 268 Appendix 13D: Self-Care Guide: Urinary
Degrees of Toxicity, 270 Incontinence, 282
Part VI Alterations in Cardiopulmonary Function 285
14 Bleeding and Thrombotic Complications 287
Anna Liza Rodriguez, MHA, MSN, RN, OCN®
The Problem, 287 Objective Assessment, 293
Incidence, 287 Degrees of Toxicity, 297
Etiology, 288 Symptom Management Strategies, 298
Pathophysiology, 290 Preventive Strategies, 298
Hypercoagulability of Malignancy, 290 Therapeutic Approaches, 300
Thrombotic Complications, 290 Nursing Implications, 310
Symptom Assessment, 291 Patient Self-Care, 310
Risk Factors, 291 References, 310
Self-Assessment, 292 Appendix 14A: Self-Care Guide: Bleeding, 314
15 Dyspnea 317
Margaret Joyce, PhD, ANP-BC, AOCN®
The Problem, 317 Palliative Approach, 322
Incidence, 317 Nursing Implications, 323
Etiology, 318 Patient Self-Care, 324
Pathophysiology, 318 References, 324
Symptom Assessment, 319 Appendix 15A: Self-Care Data Form: Weekly
Self-Assessment, 319 Breathing Log, 326
Objective Assessment, 319 Appendix 15B: Self-Care Guide: Shortness of
Degrees of Toxicity, 320 Breath (Dyspnea), 327
Symptom Management Strategies, 320
Therapeutic Approach, 320
viii Contents
16 Effusions 331
Diane G. Cope, PhD, ARNP, BC, AOCNP®
The Problem, 331 Pathophysiology of Pericardial Effusions, 339
Pleural Effusions, 331 Normal Pericardial Fluid Formation, 339
Incidence, 331 Abnormal Pericardial Fluid Formation, 340
Etiology, 331 Symptom Assessment of Pericardial
Pathophysiology of Pleural Effusions, 332 Effusions, 340
Normal and Abnormal Pleural Fluid Self-Assessment, 340
Formation, 332 Objective Assessment, 340
Symptom Assessment of Pleural Effusions, 333 Degrees of Toxicity, 341
Risk Factors, 333 Symptom Management Strategies for Pericardial
Self-Assessment, 333 Effusions, 341
Objective Assessment, 333 Therapeutic Approaches, 341
Diagnostic Evaluation, 333 Degrees of Symptom Severity, 343
Degrees of Toxicity, 334 Nursing Implications, 343
Symptom Management Strategies for Pleural Patient Self-Care for Pericardial Effusions, 344
Effusions, 335 References, 344
Therapeutic Approaches, 335 Appendix 16A: Self-Care Guide: Pleural Effusion
Degrees of Symptom Severity, 337 (Fluid Around the Lungs), 346
Nursing Implications, 337 Appendix 16B: Self-Care Guide: Pericardial
Patient Self-Care for Pleural Effusions, 338 Effusion (Fluid Around the Heart), 348
Pericardial Effusions, 338
Incidence, 338
Etiology, 339
Part VII Alterations in Nutrition 349
17 The Cancer Cachexia Syndrome 351
Regina S. Cunningham, PhD, RN, AOCN®
The Problem, 351 Patient Self-Care, 367
Incidence, 352 References, 368
Etiology, 352 Appendix 17A: Self-Care Guide: Weekly Food
Pathophysiology, 353 Diary, 370
The Effects of Cytokines, 353 Appendix 17B: Self-Care Guide:
Alterations in Skeletal Muscle, 353 Anorexia–Cachexia, 375
Alterations in Glucose and Fat Metabolism, 354 Appendix 17C: Self-Care Guide: Changes in
Pathophysiology of Related Symptoms, 354 Taste and Smell, 378
Symptom Assessment, 355 Appendix 17D: Self-Care Guide: Tube
Risk Factors, 355 Feeding, 380
Self-Assessment, 356 Appendix 17E: Self-Care Guide: Intravenous
Objective Assessment, 356 Feeding, 383
Degrees of Toxicity, 361
Symptom Management Strategies, 362
Therapeutic Approaches, 362
Nursing Implications, 367
Contents ix
18 Dysphagia 385
Dawn Camp-Sorrell, MSN, FNP, AOCN®
The Problem, 385 Patient Self-Care, 394
Pathophysiology, 386 References, 394
Head and Neck Cancer, 386 Appendix 18A: Self-Care Guide: Difficulty
Esophageal Stricture, 386 Swallowing: Exercises for the Tongue, 396
Post-Treatment Dysphagia, 387 Appendix 18B: Self-Care Guide: Food
Symptom Assessment, 387 Suggestions for the Person with Difficulty
Risk Factors, 387 Swallowing, 398
Self-Assessment, 387 Appendix 18C: Self-Care Guide: Tube
Objective Assessment, 388 Feeding, 399
Degrees of Toxicity, 390 Appendix 18D: Self-Care Guide: Difficulty
Symptom Management Strategies, 390 Swallowing: Precautions, 402
Therapeutic Approaches, 390
Complications of Dysphagia, 393
Nursing Implications, 394
19 Mucositis 403
Debra Wujcik, PhD, RN, FAAN
The Problem, 403 Symptom Management Strategies, 409
Incidence, 403 Therapeutic Approaches, 409
Etiology, 404 Nursing Implications, 413
Pathophysiology, 404 Patient Self-Care, 413
Symptom Assessment, 406 References, 413
Risk Factors, 406 Appendix 19A: Self-Care Guide: A Healthy
Self-Assessment, 407 Mouth, 416
Objective Assessment, 408 Appendix 19B: Self-Care Guide: Mucositis:
Degrees of Toxicity, 408 A Sore Mouth, 418
20 Xerostomia 421
Kerri A. Dalton, RN, MSN, OCN®; Tracy K. Gosselin, RN, PhD, AOCN®
The Problem, 421 Objective Assessment, 424
Incidence, 421 Degrees of Toxicity, 425
Etiology, 421 Symptom Management Strategies, 425
Pathophysiology, 422 Therapeutic Approaches, 426
Salivary Glands, 422 Nursing Implications, 430
Saliva, 423 Patient Self-Care, 433
Radiation Therapy: Impact on Salivary Gland References, 433
Function, 423 Appendix 20A: Self-Care Guide: Dry Mouth
Symptom Assessment, 423 (Xerostomia), 435
Risk Factors, 423
Self-Assessment, 423