question

Benign Tumors

answer

Cells well-differentiated; grows by expansion and does not infiltrate surrounding tissues; Rate of growth is slow; does not spread by metastasis; generally localized; does not usually cause tissue damage; does not usually cause death.

question

Malignant Tumors

answer

Cells are undifferentiated; Invades surrounding tissues; rate of growth is variable and depends on level of differentiation; often causes generalized effects such as amnesia, weakness, systemic inflammation, weight loss; often causes extensive tissue damage; usually causes death unless growth can be controlled.

question

Causes of tumors

answer

Viruses and bacteria (HPV, HBV, H.pylori); Physical agents (sunlight, radiation, chronic irritation); Chemical agents (Tobacco smoke, asbestos); Genetics; Dietary Factors ( Fats, alcohol, red/smoked/processed meats); Hormonal agents (DES, oral contraceptives, hormone replacement therapy.)

question

DES

answer

Synthetic hormone used in 50's and 60's to maintain pregnancy--> lead later to cancers of mother, children, and even grandchildren.

question

Primary Prevention

answer

Concerned with reducing the risks of disease through health promotion and risk reduction strategies.

question

Secondary Prevention

answer

Involves screening and early detection.

question

American Cancer Society Screening Guidelines for Early Detection of Cancer

answer

BSE: Women, age 20+ CBE: Women, age 20+ Mammography: Women, age 40+ Colonoscopy: Men and women, age 50+. Every 10 years. DCBE: Every 5 years. CT Colonography: Every 5 years. FOBT: Annual. Prostate: Men, age 50+ Pap test: Women, age 21-29, every 3 years. Women, age 30-65, every 5 years. Women over 65 discontinue.

question

Tumor Staging

answer

Determines the size of the tumor, the existence of local invasion, lymph node involvement, and distant metastasis.

question

Tx

answer

Tumor cannot be assessed.

question

T0

answer

No evidence of primary tumor.

question

Tis

answer

Carcinoma in situ.

question

T1, T2, T3, T4

answer

Increasing size, and/or local extent of the primary tumor.

question

Nx

answer

Regional lymph nodes cannot be assessed.

question

N0

answer

No regional lymph node metastasis.

question

N1, N2, N3

answer

Increasing involvement of regional lymph nodes

question

Mx

answer

Distant metastasis cannot be assessed.

question

M0

answer

No distant metastasis.

question

M1

answer

Distant metastasis.

question

CT Scan precautions.

answer

Metformin use, iodine allergy. Know kidney function BEFORE.

question

Biopsy Types

answer

Excisional, incisional, and needle.

question

Excisional biopsy.

answer

Used for small, easily accessible tumors of the skin, breast, and upper or lower GI and upper respiratory tracts. In many cases the surgeon can remove the entire tumor as well as the surrounding marginal tissues.

question

Incisional biopsy.

answer

Wedge of tumor is removed for analysis.

question

Needle biopsy.

answer

Performed to sample suspicious masses that are easily and safely accessible, such as some masses in the breasts, thyroid, lung, liver, and kidney. Often performed on outpatient basis and usually only require local anesthesia.

question

Surgery as primary treatment.

answer

Goal is to remove the entire tumor or as much as is feasible, as well as any involved surrounding tissue, including regional lymph nodes.

question

Prophylactic Surgery

answer

Removing nonvital tissues or organs that are at increased risk of developing cancer.

question

Palliative Surgery

answer

Performed in attempt to relieve complications of cancer, such as ulceration, obstruction, hemorrhage, pain, and malignant effusions.

question

Reconstructive Surgery

answer

May follow curative or radical surgery in an attempt to improve function or obtain a more desirable cosmetic effect.

question

Preoperative nursing management

answer

Nurse provides the pt and family with verbal and written information about the surgical procedure as well as other interventions that may take place intraoperatively.

question

Postop nursing management.

answer

Nurse assesses pt responses to surgery and monitors the pt for possible complications, such as infection, bleeding, thrombophlebitis, wound dehiscence, fluid and electrolyte imbalance, and organ dysfunction.

question

Teletherapy Radiation.

answer

External beam. More localized; daily fractions accurately target the tumor. 28 treatments.

question

Bracytherapy radiation

answer

Dose is delivered to a localized area and involves needles, seeds, beads, catheters, or implants. Affects the skin, GI tract, and bone marrow. Caution around pregnant women and children.

question

Nursing management for Bracytherapy.

answer

Pt remains on bed rest for 72 hours and is log rolled to prevent displacement of any intracavitary delivery device. Low residue diets and antidiarrheal agents are provided to prevent BM's.

question

Protecting caregivers during Bracytherapy radiation.

answer

Limit pt visitors to 30min/day and to maintain a 6 foot distance from radiation source. Dosimeter badge-tells how much radiation you've been exposed to.

question

Extravasation

answer

Vesicant agents can cause tissue damage and possible necrosis.

question

Toxicity of chemotherapy: GI

answer

N/V can affect quality of life, nutrition, fluid and electrolyte status, functional ability, and compliance with treatment. Stomatitis and mucositis can be associated.

question

Toxicity of chemotherapy: Hematopoietic

answer

Bone marrow suppression. Blood counts are lowest 7-15 days after chemo has been administered.

question

Toxicity of chemotherapy: Renal

answer

Can lead to SIADH, decrease in renal perfuson, interstitial nephritis. Hyperkalemia, hyperphosphatemia, and hypocalcemia and obstructive nephropathy.

question

Toxicity of chemotherapy: Cardiovascular

answer

Pt's at increased risk: those over 65, history of preexisting cardiopulmonary disease, tobacco use, renal or hepatic dysfunction, and longer survival time.

question

Toxicity of chemotherapy: Neurologic

answer

Progressive motor axon damage can lead to loss of deep tendon reflexes, with muscle weakness, loss of balance and coordination, and paralytic ileus.

question

Nursing management for chemotherapy pt's.

answer

Assess nutritional and fluid status; cognitive status; decrease risk for bleeding and infection; extravasation; prevent N/V; Manage fatigue; protect self.

question

Indications of extravasation

answer

Absence of blood return from the IV catheter; resistance to flow of IV fluid; and burning or pain, dwelling, or redness at the site.

question

Hyperthermia

answer

Generation of temperatures greater than 106.7F to destroy cancerous tumors.

question

Targeted therapy

answer

Specifically target receptors, proteins, signal transduction pathways, and other processes to prevent the continued growth of cancer cells.

question

Cancer Vaccines

answer

Gardasil= prophylactic vaccine. (prevents disease). Therapeutic vaccines= kill existing cancer cells and provide long-lasting immunity against further cancer development. Autologous vaccines: made from the pt's own cancer cells. Allogenic vaccines: made from cancer cells that are obtained from other people who have a specific type of cancer.

question

Gene Therapy

answer

Tumor-directed: Introduction of a therapeutic gene into tumor cells in an attempt to destroy them. Active immunotherapy: administration of genes that will invoke the antitumor responses of the immune system. Adoptive imunotherapy: Administration of genetically altered lymphocytes that are programmed to cause tumor destruction.

question

Nursing care for other treatment modalities for cancer

answer

Maintain tissue integrity; promote nutrition; relieve pain; decrease fatigue; improve body image; assist in grieving process; monitor/manage complications; hospice.

question

Health history assessment in hematologic disorders

answer

Prior episodes of bleeding; prior blood clots; fatigue, weakness; dyspnea; prior radiation therapy; prior chemo; occupation hazards; diet history; alcohol consumption; use of herbal supplements; concurrent medications; family history/ethnicity

question

Physical assessment in hematologic disorders

answer

Skin- gray-tan; ruddy; bruised; petechiae; rash; bleeding;pallor; jaundice; conjunctival hemorrhage Oral cavity- petechiae; ulcers; enlarged and beefy red tongue; ulcers at corners of mouth; enlarged gums Lymph nodes- enlarged,firm and fixed. Resp- increased rate and depth. adventitious sounds. Cardiovascular- distended neck veins, edema, chest pain on exertion, murmurs, gallops; hypo-hypertension. GU-Hematuria; proteinuria Musculoskeletal- ribs tender to palpation; back pain; pain/swelling in knees, wrists, hands Abdominal- Enlarged spleen, liver; stool positive for occult blood CNS- Cranial nerve dysfunction; peripheral nerve dysfunction' visual changes, headache, alteration in mental status Gyn-Menorrhagia Constitutional- Fever, chills, sweats, asthenia.

question

Bone marrow aspiration

answer

Aspiration of 5ml through special large needle. Taken from iliac crest, or occasionally from sternum. Site is cleansed and a local anesthetic is administered. Sterile dressing is applied for 5 min.minimal discomfort. No tub bath.

question

Bone marrow biopsy

answer

Sample cored out with special needle after small incision is made. Taken from iliac crest. May use conscious sedation. Sterile dressing applied for 5 min. May experience ache at site for 1-2 days, use mild analgesic. No tub bath.

question

Therapeutic Approaches to hematologic disorders.

answer

Splenectomy (because an enlarged spleen may be the site of excessive destruction of blood cells); have increased risk for infection. Apheresis Phlebotomy Blood component

question

Apheresis

answer

Blood is taken from the pt and passed through a centrifuge, where a specific component is separated from the blood and removed.

question

Phlebotomy

answer

Removal of a certain amount of blood under controlled conditions. Pt's with elevated Hct or excessive iron absorption can usually be managed by periodically removing 1 unit of whole blood.

question

PRBC's

answer

Are stored at 4 degrees Celsius and can safely be stored for up to 42 days.

question

Platelets

answer

Must be stored at room temperature, gently agitated while stored, and only last for 5 days.

question

Plasma

answer

Lasts for 1 year if it remains frozen.

question

Blood donation requirements

answer

110 lbs; oral temp below 99.6; pulse between 50 and 100; systolic BP should be 90-180, and diastolic 50-100; hmg should be at least 12.5 for women and 13.5 for men

question

Normal RBC range

answer

Female: 4-5 million Male: 4.5-5.5 million

question

Normal Hgb range

answer

Female: 12-16 Male:14-17

question

Normal Hct range

answer

Female: 36-48% Male: 42-52%

question

Normal WBC rnage

answer

4,000-10,000

question

Normal platelet range

answer

140,000-400,000

question

Directed donation

answer

Friends and family may donate blood for that patient.

question

Autologous donation

answer

A pt's own blood is collected for future transfusion. Ideally collected 4-6 weeks before surgery, typically 1 unit of blood is drawn each week. If the donor does not need it, it can be frozen for up to 10 years for future use.

question

Intraoperative blood salvage

answer

Blood lose into a sterile cavity is suctioned out into a cell-saver machine. The whole blood or PRBCs are washed, often with saline solution; filtered; and then returned to the pt as an IV infusion.

question

Hemodilution

answer

About 1-2 units of blood are removed from the pt through a venous or arterial line and simultaneously replaced with a colloid or crystalloid solution. The blood obtained is then reinfused after surgery. The pt loses fewer erythrocytes during surgery, because the added IV solutions dilute the concentration of erythrocytes and lower the Hct.

question

Blood transfusion

answer

Initiate 30 min after removal from blood bank; infuse slowly for first 15 min, no faster than 5ml/min; monitor for signs of reaction; observe ct frequently; transfuse within 4 hours; change tubing after every unit.

question

Febrile Nonhemolytic

answer

Formation of antibodies to donor leukocytes in the blood; most common reaction; non life-threatening; chills, fever, muscle stiffness

question

Acute hemolytic

answer

Donor blood is incompatible with recipient blood; life-threatening, rapid hemolysis occurs; fever, chills, nausea, chest tightness, dyspnea, anxiety, LBP.

question

Allergic reation to blood transfusion

answer

Sensitivity reaction to a plasma protein in the donor blood; urticaria, itching, flushing; admin. antihistamine; future transfusions-administer antihistamine or steroid before; wash blood component to remove any remaining proteins

question

Circulatory Overload

answer

Too much blood infused too quickly; dyspnea, orthopnea, tachycardia, anxiety, JVD, crackles; Stop transfusion, admin. diuretic, O2, morphine, position upright w/feet dependent. (prevent by admin. diuretic after or between transfusions!)

question

Bacterial contamination

answer

Admin of contaminated blood component; fever, chills, hypotension-occurs after transfusion is complete. Prevent by administering within 4 hour time frame.

question

Transfusion-related acute lung injury

answer

Development of lung injury within 6 hours after blood transfusion; acute SOB, hypoxia, hypotension, fever, pulmonary edema. Requires aggressive supportive therapy.

question

Delayed hemolytic reaction

answer

Occurs within 14 days after transfusion; level of antibodies increased enough for reaction to occur; fever, anemia, increased bilirubin level, possible jaundice.

question

If reaction suspected...

answer

Stop transfusion immediately; maintain IV with NS; assess ct; notify PCP and blood bank; send blood container and tubing to blood bank. If hemolytic- obtain blood specimen and collect urine sample. DOCUMENT.

question

Classifications of anemia

answer

-Hypoproliferative (defective RBC production) -Bleeding (Resulting from RBC loss) -Hemolytic (resulting from RBC destruction)

question

Manifestations of anemia

answer

Weakness, general malaise, pallor of skin and mucous membranes; tongue smooth and red, or beefy and sore; angular cheilosis; nails brittle, ridged, and concave.

question

Assessing for anemia

answer

History, nutrition (iron, vit B12, vegetarian), cardiac status (decreased blood volume=increased cardiac workload) (tachycardia, palpitations, dyspnea, dizziness, orthopnea, DOE), GI status (N/V, coffee ground emesis, melena, anorexia), neurologic status (peripheral numbness/paresthesia, ataxia, poor coord., confusion)

question

Iron deficiency

answer

Most common type of anemia; caused from inadequate iron intake, blood loss, or alcholism; corrected by foods high in iron (meats, beans, leafy greens); oral iron preparation- ferrous sulfate

question

Pt education for taking oral iron supplements

answer

-take iron on empty stomach ( 1 hour before or 2 hours after a meal) -To prevent GI distress start with only one tablet per day for a few days, and then increase to two tablets per day, and then three. -Take vit. C to enhance iron absorption -Stools will become darker -Use a straw to prevent staining teeth when using a liquid preparation; rinse mouth thoroughly afterward.

question

Anemia w/renal disease

answer

associated with end-stage renal failure; significant anemia occurs when serum creatinine exceeds 3mg/100ml; caused by shortening of erythrocyte lifespan, deficiency of erythropoeietin, and loss of blood during hemodialysis; treat with epogen, procrit, or oral or IV iron supplements; monitor Hgb levels

question

Folic Acid deficiency

answer

Stores can be depleted within 4 months; found in green vegetables, liver, fruit juices, beans, breads, grains; caused from lack of uncooked vegetables, ETOH use, pregnancy, malabsorption; Management involves increase in diet and supplemental folic acid

question

Vitamin B12 deficiency

answer

Large stores found in body, make take years for symptoms to present; found in liver, meat, fish, poultry, milk, eggs, cheese; caused from inadequate diet, malabsorption in GI tract, lack of intrinsic factor, chronic use of PPI's; manifestations include same as anemia + paresthesia, loss of balance, confusion; diagnosed by schilling test;managed by increasing B12 in diet, and lifelong injections for pernicious anemia.

question

Schilling test

answer

Method for determining Vitamin B12 deficiency. Pt takes a small oral dose of radioactive vit. B12, followed in a few hours by a large, nonradioactive parenteral dose of vit. B12. If the oral vitamin is absorbed, more than 8% is excreted in the urine within 24 hours; therefore, if no radioactivity is present in the urine, the cause is GI malabsorption of the vitamin B12.

question

Polycythemia

answer

Increased volume of RBCs; Hct level is elevated, >55% in males; Occurs in response to reduced levels of O2 (heavy smoking, COPD, Cyanotic heart disease, living in high altitudes); management involves smoking cessation, managing COPD, and therapeutic phlebotomy.

question

Secondary polycythemia

answer

caused by excessive production of erythropoietin.

question

Neutropenia

answer

Neutrophil count <2,000/mm3; caused from decreased production, increased destruction, and ineffective granulocytopoiesis; management depends on the casue (stop offending medication, administer colony stimulating factor-filgrastim SQ, neutropenic precautions)

question

Thrombocytopenia

answer

Caused by decreased platelet production, increased platelet destruction, or increased platelet consumption; manifestations- platelet<20,000=petechiae, nasal and gingival bleeding, excessive menstrual bleeding, excessive bleeding after surgery/dental extraction; managed by treating underlying cause and by platelet infusion

question

Immune Thrombocytopenic Purpura

answer

Autoimmune disorder characterized by the destruction of normal platelets by unknown stimulus; Antibodies formed and bind to platelets then destroyed by RES; possible causes- viral illness, HIV, medications, lupus, pregnancy; manifestations- asymptomatic, bleeding (easy bruising, heavy menses, petechiae, wet purpura)

question

Management of ITP

answer

Close observation only in platelet count <30,000-50,000; corticosteroid; IVIG; splenectomy; assess history; avoid constipation, valsalva maneuver, vigorous flossing of teeth, vigorous sexual activity, and use electric razr and soft-bristled toothbrush; avoid agents that interfere with platelet function

question

Acquired coagulation disorders

answer

Liver disease, vitamin K deficiency ( needed for synthesis of many coagulation factors), and anticoagulant therapy (use of warfarin, heparin)

question

Liver disease

answer

Liver dysfunction can diminish the ability for coagulation factors to be synthesized in the liver.

question

Warfarin antidote

answer

Vitamin K

question

Heparin antidote

answer

Protamine Sulfate

question

Disseminated Intravascular Coagulation

answer

Causes widespread tissue damage, hemolysis, and hypoxia; May be triggered by sepsis, trauma, cancer, chock, toxins, allergic reactions; initiates clotting factors w/formation of tiny clots; platelets and clotting factor used up; activation of fibrinolytic pathway; bleeding occurs; potentially life-threatening with a high mortality rate; high risk ct's involve ICU pt's.

question

DIC manifestations

answer

decrease in temperature and sensation, increase in pain; cyanosis in extremities, nose, earlobes; decrease in pulses, cap refill >3sec; hypoxia, dyspnea, chest pain with deep inspiration, decreased breath sounds; heartburn; decreased urine output, increased creatinine and BUN; decreased alertness and orientation, decreased pupillary reaction and response to commands and strength and movement ability

question

Lab values in DIC

answer

Increased aPTT, PT, TT, D-dimer, FDPs levels; decreased platelet count and fibrinogen levels

question

Management for DIC

answer

improve oxygenation, replace fluids, correct electrolyte imbalances, administer vasopressor drugs, transfusions-cryoprecipitate, FFP

question

Polycythemia Vera

answer

Bone marrow is hypercelluar leading to increased production of cells-mostly erythrocytes; ruddy complexion, splenomegaly, HA, dizziness, tinnitus, fatigue, parasthesia, blurred vision, angina, dyspnea, pruritus; complications- CVA, MI, bleeding; management-phlebotomy, chemo

question

Multiple myeloma

answer

Malignant disease of the plasma cell; immunoglobulins produced are nonfunctional; accumlate in the marrow space and lead to bone destruction (aslso pass through glomerulus and cause renal damage); manifestations- bone pain, bone lesions, osteoporosis, fractures, hypercalcemia, fatigue, recurrent infections; diagnostics- serum and urine monoclonal protein level, calcium level, x-rays, confirmed w/bone marrow biopsy

question

Multiple myeloma management

answer

Chemo, corticosteroids, radiation, HSCT; no cure

question

Multiple myeloma nursing interventions

answer

pain management; hydration; assess renal function; prevent infection; activity restrictions, use of brace, maintain mobility, symptoms of hypercalcemia, adequate hydration so UO is >3L/day, flu pneumonia vaccines, prophylactic antibiotic use. Bence Jones proteins-found in urine

Med-Surg Oncology & Hematology – Flashcards

Unlock all answers in this set

Haven't found what you were looking for?

Search for samples, answers to your questions and flashcards