question

Thrombocytopenia:

answer

deficiency of platelets in the blood. This causes bleeding into the tissues, bruising, and slow blood clotting after injury.

question

Nursing intervention for Thrombocytopenia: Assess client for and report signs and symptoms of unusual bleeding:

answer

petechiae, purpura, or ecchymoses gingival bleeding prolonged bleeding from puncture sites epistaxis, hemoptysis unusual joint pain frank or occult blood in stool, urine, or vomitus increase in abdominal girth menorrhagia restlessness, confusion decreasing B/P and increased pulse rate decrease in Hct and Hb levels.

question

Nursing intervention for Thrombocytopenia:

answer

Monitor platelet count and coagulation test results (e.g. bleeding time). Report abnormal values. If platelet count is low, coagulation test results are abnormal, or Hct and Hb levels decrease, test all stools, urine, and vomitus for occult blood. Report positive results. Avoid aspirin & NSAIDS

question

Nursing intervention for Thrombocytopenia: Implement Measures to prevent bleeding

answer

avoid giving injections whenever possible; consult physician about prescribing an alternative route for medications ordered to be given intramuscularly or subcutaneously when giving injections or performing venous and arterial punctures, use the smallest gauge needle possible apply gentle, prolonged pressure to puncture sites after injections, venous and arterial punctures, and diagnostic tests such as bone marrow aspiration take B/P only when necessary and avoid overinflating the cuff caution client to avoid activities that increase the risk for trauma (e.g. shaving with a straight-edge razor, using stiff bristle toothbrush or dental floss) whenever possible, avoid intubations (e.g. nasogastric) and procedures that can cause injury to rectal mucosa (e.g. taking temperatures rectally, inserting a rectal suppository or tube, administering an enema) pad side rails if client is confused or restless perform actions to reduce the risk for falls (e.g. keep bed in low position with side rails up when client is in bed, avoid unnecessary clutter in room, instruct client to wear slippers/shoes with nonslip soles when ambulating) instruct client to avoid blowing nose forcefully or straining to have a bowel movement; consult physician about an order for a decongestant and/or laxative if indicated administer the following if ordered: platelet-stimulating factor (oprelvekin [Neumega]) estrogen-progestin preparations to suppress menses platelets. Avoid aspirin & NSAIDS, wear close toe shoes when ambulating, no heat (causes vasodilation) apply cold

question

Nursing intervention for Thrombocytopenia: If bleeding occurs spontaneously:

answer

apply firm, prolonged pressure to bleeding area(s) if possible if epistaxis occurs, place client in high Fowler's position and apply pressure and ice pack to nasal area maintain oxygen therapy as ordered administer whole blood or blood products (e.g. platelets) as ordered.

question

Complication of Lung Cancer:

answer

Superior Vena Cava Syndrome (pressure on the superior vena cava by tumor)

question

Superior Vena Cava Syndrome is considered a:

answer

medical emergency

question

Signs ; symptoms of Superior Vena Cava Syndrome:

answer

facial edema, edema in neck, epistaxis, dyspnea, nose bleeds, purple from the nipples up

question

What is happening when the tumor puts pressure on the superior vena cava?

answer

Occludes blood flow to the brain (blocks flow) ; puts pressure on the airways

question

Nursing Interventions for Superior Vena Cava Syndrome:

answer

Nurses are in a key position to recognize SVCS early, allowing time for a clear histologic diagnosis prior to starting therapy. Nurses should be able to recognize those patients at high risk and be aware of the signs and symptoms of SVCS. Nursing care encompasses a variety of tasks: facilitation and coordination of diagnostic procedures, assessment of respiratory, cardiac and neurologic systems, administration of ordered therapies, emotional and psychosocial support for the patient and family, and education regarding treatment. Nurses can institute measures to help relieve dyspnea, including elevating the head of the bed, administering oxygen, and teaching energy conservation. Intravenous fluids should not be given through the upper extremities, necessitating central venous access. Additional nursing interventions should focus on the side effects caused by the treatment used (chemotherapy, radiation therapy). Through astute observation and an understanding of this complication, nurses can be instrumental in the diagnosis and treatment of SVCS.

question

Side Effects of Radiation: ( in a patient with SVCS)

answer

will vary depending on the areas included in the treatment field, and can include: skin irritation, dyspnea, cough, pneumonitis, mucositis, decrease in blood counts, appetite / taste changes, and fatigue.

question

Treatment for SVCS:

answer

Radiation Therapy Chemotherapy Medication Therapy Stent placement

question

Medications used to treat SVCS:

answer

corticosteroids, diuretics, and thrombolytic therapy.

question

thrombolytic therapy (medication therapy for SVCS) includes:

answer

heparin, warfarin, and/or tissue plasminogen activators.

question

Early signs ; symptoms of SVCS:

answer

Feeling of fullness in the head, nasal stuffiness, headache, shortness of breath, cough, chest pain, hoarseness and difficulty swallowing.

question

Late signs ; symptoms of SVCS:

answer

respiratory distress, headaches, syncope, visual changes, and mental status changes.

question

What types of lung cancer has the best prognosis?

answer

Non-small cell lung cancer

question

What is the inherited gene mutation the identifies families at significant risk for breast cancer ; ovarian cancer?

answer

BRCA 1 ; BRCA 2

question

1. What diseases is predominately a malignancy of of the lymphocytes?

answer

Chronic Lymphocytic Leukemia, Acute Lymphocytic Leukemia, Hodgkin's Lymphoma, Non-Hodgkin's Lymphoma ; B. Lymphoma KNOW THESE DISEASES. Anything with 'Lymph' in it

question

What is the difference between squamous cell carcinoma ; basal cell carcinoma?

answer

SCC is less aggressive, but faster growing and cause it invades local tissues. tends to bleed, ulcers (worse) BCC is more aggressive but does not grow as fast so SCC is the worst of the two SCC is rough, scaly lesion with central ulceration ; crusting. Bleeding possible. Localized, may metastasize. BCC: small waxy, nodule with superficial blood vessels, well defined borders. Erythema ; ulcerations. Invades local structures (nerves, bone, cartilage lymphatic ; vascular tissue) rarely metastatic but high rate of recurrence.

question

Squamous cell cancer (SCC):

answer

Squamous cell cancer (SCC) starts in the squamous cells in the upper part of the epidermis. It accounts for about 2 in 10 skin cancers. It most often starts on skin that has been exposed to the sun, like the face, ears, neck, lips, and backs of the hands. SCC is more likely than BCC to spread into deeper layers of the skin. It is also more likely to spread to other parts of the body, but this is not common

question

Basal Cell Carcinoma:

answer

About 8 of 10 skin cancers are basal cell cancers (BCCs). This is not only the most common type of skin cancer, but the most common type of cancer. BCC begins in the lowest layer of the epidermis, the basal cell layer. BCC usually begins on skin exposed to the sun, such as the head and neck.. BCC tends to grow slowly. It is very rare for BCC to spread to other parts of the body. But if it is not treated, it can grow into nearby areas and spread into the bone or other tissues under the skin. After treatment, BCC can come back (recur) in the same place on the skin. New basal cell cancers can also start in other places on the skin. As many as half of the people who have one BCC will get a new skin cancer within 5 year

question

What cancer is identified with patients having a philadelphia chromosome?

answer

chronic myelogenous leukemia and sometimes found in acute lymphocytic leukemia. KNOW THESE DISEASES

question

Complications of Hodgkin's Lymphoma:

answer

Pancytopenia pg. 1021 in ATI med surg

question

describe the cell type for multiple myeloma:

answer

formed by B cells- malignant plasma cells

question

describe the cell type for hodgkins lymphoma:

answer

formed by B cells (reed stem berg)

question

Classic signs & symptoms of pancreatic cancer:

answer

weight loss, palpable abdominal mass, enlarged gallbladder and liver, hepatomegaly, jaundice (late finding) clay or tan colored stools, dark, frothy urine, ascites (swelling, fluid in peritoneal space, pruritus (build up of bile salt), early satiety (feeling full) or anorexia Pancreatic Tumor: pain, jaundice, significant weight loss

question

Hodgkin's Lymphoma associated with:

answer

Reed stem berg from B lymphocytes

question

Difference between lymphoma ; multiple myeloma

answer

lymphoma: lymphocytes, myeloma malignant plasma cells

question

Difference between benin ; malignant:

answer

benign does not invade neighboring tissue. malignant can metastasize

question

Cervical cancer:

answer

bleeding ; pain with intercourse

question

screening for ovarian cancer:

answer

CA-125

question

Liver cancer is usually associated with:

answer

Hepatitis B or C-ATI

question

Test for Liver Cancer:

answer

alpha feta protein (can be a false positive) More definitive test:

question

Liver signs ; symptoms

answer

right upper quadrant -weight loss -anorexia -anemia (related to iron absorption) *remember vitamins are absorbed in the liver so monitor the lab tests

question

Surgical removal of the pancreas:

answer

whipple

question

Prostate Cancer:

answer

PCA is elevated (released during a cancer) the most common type of cancer for men. Retention.

question

Treatment for Prostate Cancer:

answer

hormone therapy: estrogen

question

Bladder Cancer:

answer

hair color has a chemical carcinogen

question

Intra (bladder cancer)

answer

monitor for blood in the urine-hematuria

question

Most common cancer in women:

answer

breast cancer, colorectal

question

Growth of Tumors:

answer

initiation, promotion (enhances the development of cancer) then you have a latent period, progression

question

Hodgkin's Lymphoma you should avoid drinking....

answer

alcohol

question

Cryotherapy/surgery:

answer

a procedure that uses extreme cold (liquid nitrogen) to destroy tissue. It is often used to treat skin lesions (skin growths or patches that do not look like the skin around them). The lesions can be benign (not cancerous) or precancerous. Cryotherapy can also be used to treat skin cancer that does not affect deep tissue.

question

Side effects of 5 fluorouracil:

answer

Pain, itching, burning, irritation, inflammation, dryness, swelling, tenderness at the site of application. This will heal once the treatment is complete.

question

What is 5 fluorouracil?

answer

anti-cancer ("antineoplastic" or "cytotoxic") chemotherapy drug. This medication is classified as an "antimetabolite." (cream, topical)

question

This topical cancer treatment will leave a lesion will weep, crust and erode:

answer

5 fluorouracil

question

after this procedure Skin becomes edematous & tender

answer

Cryosurgery

question

Patient teaching for 5 fluorouracil:

answer

PRIOR to use: make sure you are not pregnant or breastfeeding, do not use aspirin unless permitted by your doctor. During use : Use non-metal applicator or fingertips to apply cream. Use care when applying cream or solution around the eyes, nose, and mouth. Wash your hands immediately after applying this medication. Avoid sun exposure. Wear SPF 15 (or higher) sunblock and protective clothing. If you experience symptoms or side effects, be sure to discuss them with your health care team. They can prescribe medications and/or offer other suggestions that are effective in managing such problems.

question

Description of how Antimetabolites work:

answer

are cell-cycle specific. They attack cells at very specific phases in the cycle (inhibit cancer cells from further dividing, so they die)

question

What patients should expect after cyrosurgery:

answer

The treated area will become red soon after your procedure. It also may blister and swell. If this happens, do not break open the blister. You may also see drainage on the treated area. This is normal. The treated area will heal in about 7 to 10 days with minimal scarring, but it will take longer for the discoloration (pinkness, redness, or lighter or darker skin) to go away.

question

After care teaching for cyrosurgery:

answer

Starting the day after your procedure, wash the treated area gently with fragrance-free soap and water daily. Leave the treated area uncovered unless it has ulcers or drainage. If you see any drainage, apply petroleum jelly (Vaseline®) on the treated area and cover with a bandage (Band-Aid®) if necessary. If you have any bleeding, press firmly on the area with a clean gauze pad for 15 minutes. If the bleeding doesn't stop, repeat this step. If the bleeding still hasn't stopped after repeating this step, call your doctor's office. Do not use perfumed soaps, cosmetics, or lotions on the treated area(s) until it has healed. This will usually be at least 10 days after your procedure. You may have hair loss on the treated area. This depends on how deep the freezing went. The hair loss may be permanent. Once the treated area has healed, apply a broad-spectrum sunscreen with an SPF of at least 30 to the area to protect it from scarring. You may have discoloration (pinkness, redness, or lighter or darker skin) at the treated area for up to 1 year after your procedure. Some people may have it for even longer or it may be permanent

question

Reasons to call dr. after cryosurgery:

answer

A temperature of 100.4° F (38° C) or higher Chills Any of the following symptoms at your wound or the area around it: Redness or swelling that extends to areas of untreated skin Increasing pain or discomfort in the treated area Skin in the treated area that is hot or hard to the touch Increasing oozing, or drainage (yellow or green) from the treated area Foul odor Bleeding that does not stop after applying pressure Any questions or concerns Any problems you did not expect

question

What happens to the cells in Leukemia/ Lymphoma?

answer

-nonfunctional white blood cells -Lack ability to differentiate normally -immature stage of production -Excessive proliferation

question

What are the risk factors for Leukemia ; Lymphoma

answer

-Immunosuppression -Exposure to chemotherapy causing bone marrow suppression -Genetic factors -Ionizing radiation

question

Signs ; Symptoms of Acute Lymphocytic Leukemia: (ALL)

answer

-Rapid onset -Fatigue Pallor (anemia) -Infections (bone pain) -Lymphadenopathy (a disease affecting the lymph nodes) -Bruising/petechiae (Remember that the bone pain, lymphadenopathy ; brushing set ALL apart from CLL)

question

Signs ; Symptoms of Chronic Lymphocytic Leukemia: (CLL)

answer

-Affects people over 50 -B cells do not respond to antigen activation -Low antibody count -Fatigue -Weight loss -Fever -Night Sweats -Enlarged Lymph Nodes (Remember that the flu like symptoms set CLL apart from ALL as well as the weight loss)

question

Acute Myelogenous Leukemia: (AML)

answer

-Most common among adults, unchecked proliferation of myeloblasts. Blocked differentiation.

question

Acute Myelogenous Leukemia: (AML) signs ; symptoms:

answer

-Fatigue -Pallor (anemia) -Dyspnea (difficult or labored breathing) -Bone pain -Frequent infections Remember: difficulty breathing sets this part from other leukemias

question

4.Chronic Myelogenous Leukemia: (CML)

answer

-affects older males -chromosomal abnormality: PHILADELPHIA CHROMOSOME -makes a protein that allows a myeloid cell proliferation

question

Chronic Myelogenous Leukemia: (CML) signs ; symptoms:

answer

fatigue night sweats weight loss fever bone pain abdomen pain Enlarged spleen (causes abdomen pain?) Remember if there is weight loss, it is a chronic type of leukemia

question

Screening ; Diagnostic Tests for Leukemia:

answer

BONE marrow biopsy -Look at protein markers: this will differentiate myeloid or lymphoid (leukemia)

question

What confirms leukemia in a bone marrow biopsy?

answer

excessive blast cells

question

Treatment for leukemia:

answer

Induction Consolidation Maintenance Reinduction

question

BRCA 1 gives up to a _________% risk by age ________

answer

87%, age 70

question

BRCA 2 gives up to a _________% risk by age ________

answer

65%, age 70

question

Non-small cell lung cancers include:

answer

Squamous cell (epidermoid) carcinoma Adenocarcinoma Large cell (undifferentiated) carcinoma: denosquamous carcinoma (less common) sarcomatoid carcinoma (less common) *remember that non-small cell has the best prognosis

question

4. What cancer is associated with patients having Philadelphia chromosome?

answer

CML-Chronic Myelogenous Leukemia: makes a protein that allows myeloid cell proliferation which accumulates in bone marrow.

question

How do you eliminate after an Ileal Conduit?

answer

Continuous drainage into external pouch

question

How do you eliminate after a Continent pouch?

answer

Intermittent self catheterization

question

How do you eliminate after a bladder reconstruction?

answer

Intermittent Self catheterization

question

What are the surgical Interventions for Urological Cancer:

answer

Ileal conduit Continent pouch Bladder Reconstruction ureterosigmoidostomy

question

How do you eliminate after a ureterosigmoidostomy?

answer

During Bowel Movement

question

16. Describe intravesical chemotherapy and understand what the nurse would monitor a patient for?

answer

is chemotherapy that is used to treat carcinoma that has not metastasized outside of the bladder. Used for bladder cancer, TB virus must be kept in bladder for 2 hours, sit when you pee so you do not splash. Mask and half a gallon of bleach for about 15 min before they pee. No sex for 24 hours. Jac's Notes: make them sit down to pee (prevent splashing) live bacteria N95 mask, put bleach in the toilet (15 min) do not introduce TB into the sewer system), do not let families, kids, or pregnant women use the same bathroom. They can't have sex for 24 hours because they can transmit it to their partner

question

What are the differences between intravesical and systemic treatments for urological cancer?

answer

Intravesical includes the medications MED and dwells in the bladder for 2 hours. M-mytomycin E-epirubcin D-doxorubicin Systemic Chemotherapy: includes the medications CCM C-cisplatin C-cisplatin ; 5 flourouracil M-mitomycin ; 5 flourouracil http://www.healthnetworks.health.wa.gov.au/cancer/docs/Administration_Intravesical_agents.pdf

question

Systemic Chemotherapy:

answer

uses anti-cancer drugs that are injected into a vein or given by mouth. These drugs travel through the bloodstream to all parts of the body.

question

Intravesical (blank space)

answer

With ___________therapy for bladder cancer, drugs are put directly into the bladder through a catheter, instead of being injected into a vein or swallowed. Both immunotherapy and chemotherapy drugs can be given this way.

question

17. What are the complications of Hodgkin's Disease:

answer

Pancytopenia: neutropenia-anc less than 2,000/mm3 increases risk of infection Thrombocytopenia: bleeding-RISK if count is 50,000 and spontaneous bleeding at 20,000 Anemia: fatigue & hypoxemia Now think like a nurse and ask yourself what are the signs & symptoms of these complications & what are the nursing interventions?

question

13. What is the purpose of a CA-125 test?

answer

test measures the amount of the protein CA 125 (cancer antigen 125) in your blood. A CA 125 test may be used to monitor certain cancers during and after treatment. In some cases, a CA 125 test may be used to look for early signs of ovarian cancer in women with a very high risk of the disease.

question

9. Describe the various phases related to the growth of tumors:

answer

a. Grade I: Cells differ slightly from normal cells and are well differentiated. b. Grade II: Cells are more abnormal and moderately differentiated. c. Grade III: Cells are very abnormal and poorly differentiated. d. Grade IV: Cells are immature and primitive and undifferentiated, cell of orgin is difficult to determine.

question

Varies Phases Related To Growth of tumors:

answer

a. Initiation: mutation of cell's genetic structure (due to chemical carcinogens, viral, radiation) b. Promotion: characterized by reversible proliferation of altered cells. Activities of promotion are reversible (obesity, smoking, alcohol, dietary fat) c. Latent period: ranges 1-40 years. Cells accumulate and reach critical mass that can be detected. d. Progression: increased growth rate of tumor, invasiveness, metastasis

question

Burkitt's Lymphoma is always associated with:

answer

Epstein Barr Virus

question

Staging of Cancer: What does the T, N, M stand for?

answer

Tumor, Node, Metastasis

question

Staging of Cancer: TX-

answer

unable to evaluate primary tumor

question

Staging of Cancer: T0-

answer

no evidence of primary tumor

question

Staging of Cancer: tis-

answer

tumor in situ

question

Staging of Cancer: T1,T2,T3,T4-

answer

size & extent of tumor

question

Staging of Cancer: NX-

answer

unable to evaluate regional lymph nodes

question

Staging of Cancer: N0-

answer

no evidence of regional node involvement

question

Staging of Cancer: N1,N2,N3-

answer

number of nodes that are involved, or & or the extent of spread

question

Staging of Cancer: MX-

answer

unable to evaluate distant metastasis

question

Staging of Cancer: M0-

answer

no evidence of distant metastasis

question

Staging of Cancer: M1-

answer

presence of distant metastasis

question

Initiation Phase:

answer

mutation of cell's genetic structure (due to chemical carcinogens, viral, radiation)

question

Promotion Phase:

answer

characterized by reversible proliferation of altered cells. Activities of promotion are reversible (obesity, smoking, alcohol, dietary fat)

question

Latent Period:

answer

ranges 1-40 years. Cells accumulate and reach critical mass that can be detected.

question

Progression:

answer

increased growth rate of tumor, invasiveness, metastasis

question

Cancer Stages 0-4:

answer

0-Cancer in situ 1-Tumor limited to tissue of origin; localized tumor growth 2-Limited local spread 3-Extensive local regional spread 4- Metastasis

question

Cancer Stage 0:

answer

This stage describes cancer in situ, which means "in place." Stage 0 cancers are still located in the place they started and have not spread to nearby tissues. This stage of cancer is often highly curable, usually by removing the entire tumor with surgery.

question

Cancer Stage 1:

answer

This stage is usually a small cancer or tumor that has not grown deeply into nearby tissues. It also has not spread to the lymph nodes or other parts of the body. It is often called early-stage cancer.

question

Cancer Stage 2:

answer

These stages indicate larger cancers or tumors that have grown more deeply into nearby tissue. They may have also spread to lymph nodes but not to other parts of the body. (2 ; 3 together)

question

Cancer Stage 3:

answer

These stages indicate larger cancers or tumors that have grown more deeply into nearby tissue. They may have also spread to lymph nodes but not to other parts of the body. (2 ; 3 together)

question

Cancer Stage 4:

answer

This stage means that the cancer has spread to other organs or parts of the body. It may also be called advanced or metastatic cancer.

question

What drug therapy may be associated with the development of gynecomastia?

answer

Hormonal Therapy • GnRH- hormone therapy • Androgen antagonists(flutamide [Euxelin]) a. estrogens and androgen b. digitalis c. isoniazid (INH) d. ranitidine (Zantac) e. spirolactone (Aldactone). The use of heroin and marijuana can also cause gynecomastia *man boobies*

question

Drug to light interval:

answer

when the drug is given to when the light is applied.

question

What type of patients are most at risk for developing multiple myelomas?

answer

The disease is twice as common in men as in women and usually develops after 40 years of age, with and average of 65 years of age. More commonly in African Americans. Also, many people with monoclonal gammopathy or exposed to radiation from an atomic bomb will eventually develop MM.

question

Alpha fetoprotein may give you a ________positive because of _________ or ___________ so the definitive test for liver cancer is the ______ test. If this test is elevated, then it indicates _________ cancer with an elevated AFP.

answer

false positive cirrhosis or hepatitis CEA test liver cancer

question

CEA test stands for

answer

Carcinoembryonic antigen (tests for cancer)

question

Elevated CEA level

answer

more than 35 units/ml

question

Acute Myelogenous Leukemia: is most common in

answer

adults (according to ATI) Lewis says CML

question

Hemoglobin Level (Hgb):

answer

Females 12-16 g/dL Males: 14 to 18 g/dL (ATI + Slides) Female: 11.7-16.0 g/dL Male: 13.2-17.3 g/dL (Lab Book)

question

Hematocrit Level: Hct

answer

Females 37-47% Males 42-52% (ATI + Slides) Female: 35%-47% Male: 39%-50% (Lab Book)

question

CBC tip:

answer

look over the lab values and rationales as they apply to leukemia and lymphomas

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