question

Cancer Pathophysiology

answer

Refers to a class of diseases Cancer can be classified by: The tissue or blood cells where it starts The type

question

What are the two types of cancer?

answer

Solid tumors Hematologic malignancies

question

Types of Solid Tumors

answer

Sarcomas and Carcinomas

question

Sarcomas

answer

Begin in the connective tissues. the tissues that the body uses to connect or support other tissue Bone, Muscle, Tendons, Cartilage, Fat

question

Carcinomas

answer

Originate from the epithelial tissues that line organs These are the cancers that originate in the lining of organs like the lungs and liver, breast, colon, or prostate

question

Hematologic Malignancies

answer

Originate from blood or lymphatic cells Starts with one abnormal cell that starts growing and dividing out of control

question

Metastasis

answer

The traveling or extension of the primary cancer to other sites of the body

question

Metastasis occurs by...

answer

1. Direct invasion 2. Blood system 3. Lymphatic system

question

_______ is the #1 cause of preventable cancer

answer

Tobacco Chronic irritation from smoking can cause uncontrolled growth of abnormal cells Tobacco + Alcohol = co-carcinogenic (Makes it worse)

question

Dietary Causes of Cancer

answer

Low-Fiber diet (Retain carcinogens) Increased Red meat Increased animal fat Nitrites (Processed sandwich meats) Alcohol Preservatives and additives

question

Most Important risk factor for cancer

answer

AGING. That's why there is a higher incidence of cancer > age 60.

question

Additional Risk Factors for cancer

answer

Obesity, Physical inactivity, poor nutrition Immunosuppressed clients African Americans have highest risk for cancer followed by caucasians Heredity Exposure to UV rays Exposure to carcinogens Stress Previous history of other types of cancer or chemotherapy

question

Primary Prevention of Cancer

answer

These are ways to help PREVENT actual occurrence of cancer

question

Primary Prevention Examples

answer

No smoking Exercise and good nutrition Maintain normal body weight Limit or eliminate alcohol intake Vaccines for preventable viral exposures such as Hepatitis B and HPV Avoid exposure to known carcinogens (Wear sunscreen)

question

Secondary prevention of cancer

answer

Screenings to pick up cancer early, when there is greater chance of cure or control

question

Secondary Prevention for Female

answer

Breast self-awareness is recommended Beginning in 20s, women should be told about benefits and limitations of MONTHLY breast self-exams

question

Clinical Breast Exams

answer

20-39: Every 3 years 40+: Every year

question

What days of menstrual cycle are best for doing breast self-exam?

answer

Days 7 through 12 just after period.

question

Mammograms

answer

Annually starting at age 40, with two views of each breast Before a mammogram take off lotion, powder, and deodorant

question

Pap smears

answer

Begin at age 21 and are performed every 3 years if there are no problems.

question

Colonoscopy for Female

answer

Starts at age 50 and every 10 years if there are no problems

question

Stool Testing

answer

Testing the stool for fecal occult blood should be done YEARLY beginning at age 50, unless previous problems or a positive family history.

question

Secondary Prevention for the male

answer

Provide information on breast self-awareness and have YEARLY clinical testicular exams Testicular tumors grow VERY FAST so clinicians recommend MONTHLY testicular self-exams

question

Major age group for testicular cancer

answer

Young males aged 15-36

question

Tests for males at age 50

answer

Digital Rectal Exam and Prostate Specific Antigen are both checked annually after age 50. Colonoscopy at age 50 and then every 10 years like female. Yearly fecal occult blood testing like female.

question

Tertiary Prevention

answer

Focuses on the management of long term care for clients with complex treatments for cancer.

question

Examples of Tertiary prevention

answer

Support Groups Rehabilitation Programs

question

General Signs and Symptoms of Cancer (CAUTION)

answer

Change in bowel/bladder habits A sore that does not heal Unusual bleeding/discharge Thickening or lump in breast or elsewhere Indigestion or difficulty swallowing Obvious change in wart or mole Nagging cough or hoarseness

question

Other Signs/Symptoms of Cancer

answer

Cancer can invade bone marrow which can lead to Anemia, Leukopenia, and Thrombocytopenia Unexplained weight LOSS Cachexia: Extreme wasting and malnutrition Fever in leukemia is common Pain

question

________ is the #1 symptom that clients complain of with diagnosis of cancer

answer

Fatigue

question

Blood Tests for Cancer (3)

answer

Abnormal CBC and Differential (# of types of WBC in blood) We are most concerned about the neutrophil count. Elevated liver enzymes AST and ALT will tell you if liver is being damaged Tumor markers: Biomarkers that are increased in people with cancer.

question

Positive Diagnostic Studies for cancer

answer

1. Chest X-ray 2. CT Scan 3. MRI 4. PET Scan (Brain Tumor) 5. Bone Marrow biopsy 6. Tissue biopsy 7. Imaging studies 8. Bronchoscopy (Lung cancer)

question

What do you need to think about with a client who is having a bronchoscopy?

answer

NPO before procedure and NPO until gag reflex returns. Watch for respiratory depression, hoarseness, dysphagia, or SQ emphysema

question

What is SQ Emphysema

answer

Air under the skin in the tissue. Sounds like rice krispies or popping bubble wrap

question

Is it normal or abnormal to have respiratory depression when they come back from bronchoscopy?

answer

ABNORMAL A DECREASED respiratory rate is normal but NOT respiratory depression (<12)

question

When is the best time to get a sputum specimen from a patient?

answer

Early morning!

question

Sputum Specimen

answer

Specimen is sterile so use sterile technique Client should rinse mouth with water first to decrease bacteria count in the mouth.

question

Total laryngectomy

answer

Removal of vocal cords, epiglottis, and thyroid cartilage. Epiglottis covers airway when you swallow. Client will have permanent tracheostomy

question

Total Laryngectomy Post-op care

answer

Best position post-op: Mid fowlers 35-45 degrees NG feedings to protect the suture line. (Peristalsis can disrupt the suture line) Monitor drains Frequent mouth care to decrease bacterial count in mouth NPO clients tend to get Pneumonia

question

If the trach is hemorrhaging what should the nurse do?

answer

CALL HEALTHCARE PROVIDER IMMEDIATELY Do not delay care Usually means the carotid artery rupture or rupture of innominate artery

question

Suctioning

answer

Hyper-oxygenate before and after suctioning Use STERILE Technique Stop advancing catheter when you meet resistance or the patient coughs

question

When do you apply suction?

answer

Apply intermittent suctioning ON THE WAY OUT. Do not suction longer than 10 SECONDS Watch for arrythmias

question

Which nerve can be stimulated by suctioning?

answer

Vagus nerve When the vagus nerve is stimulated the heart rate drops. Patient becomes hypoxic. Immediately stop suctioning and Hyperoxygenate.

question

Discharge care of tracheostomy

answer

When the client leaves the hospital, a bib will be used to cover the trach because it acts like a filter. No plastic, fibers, or powder placed over trach because that may block air. A humidified environment helps because there is no way to warm air into lungs via trach.

question

How does a client with total laryngectomy talk?

answer

Blom-Singer device Can the client with total laryngectomy... Whistle? No Drink through a straw? No Swim? No Smoke? Yes but not advised

question

Disease Staging: TNM System

answer

T: Size of TUMOR N: Are Lymph NODES involved M: Is METASTASIS present

question

Disease Grading

answer

Grading compares the cancer cells with the parent cell they evolved from. The LESS cancer cells look like the tissue they originated from the MORE Aggressive the cancer is. Grading is done on a 1-4 scale. The higher the score, the more malignant the cancer.

question

Goals of Treatment

answer

1. Cure 2. Control 3. Palliation (Comfort Care)

question

Adjuvant Therapy

answer

Two Therapies Together

question

Neoadjuvant Therapy

answer

Time specific therapies or one before the next.

question

Treatment plans are based on

answer

1. Recommended treatment plans for the diagnosis 2. Grade of cancer 3. What the client wants

question

Surgery Treatment (4)

answer

1. Prevention (Benign Lesion) 2. Diagnosis 3. Treatment 4. Reconstruction

question

When is reconstruction often used?

answer

Breast cancer. Mastectomy may be partial or total.

question

Post-op care following a mastectomy

answer

Bleeding -> Check dressings, front AND Back because pooling of blood may occur. If reconstruction using their own tissue is done they will also have an abdominal surgical site. Can harvest adipose tissue from other sites for reconstruction but the abdomen is the most common Hemovac or Jackson-Pratt drains Brush hair, squeeze tennis balls, climb walls, flex and extend elbows to PROMOTE NEW CIRCULATION

question

Associated nursing care if lymph nodes were removed with mastectomy

answer

There is now a reduced ability to fight off injection. Avoid procedures on the arm of the affected side for the LIFETIME of the client. No constriction, no BPs, no blouses with elastic, no watch, no IV or injections on the AFFECTED side. Wear gloves when gardening, watch small cuts, no nail biting and no sunburn.

question

Palliative Surgery

answer

Surgery to improve the client's quality of life when there is no cure

question

What is the #1 question clients ask after surgery with cancer?

answer

Did they get it all?

question

Successful surgery for cancer is dependent on 3 things

answer

Could the cancer be completely removed? Had the cancer already spread at the time of surgery? Was the surgeon able to get adequate margins (Amount of normal tissue around the tumor removed)?

question

Radiation Therapy

answer

Internal External Chemotherapy

question

Brachytherapy

answer

AKA Internal Radiation Used to get the radiation dose CLOSEST to the cancer or target tissue. With all types of brachytherapy, the client emits radiation for a period of time and is a hazard to others. Brachytherapy is either unsealed or sealed

question

Unsealed Brachytherapy

answer

Client and body fluids emit radiation This is like a radioisotope that is given IV or PO Radioactive for 24 to 48 hours

question

Sealed or Solid Brachytherapy

answer

Client emits radiation but body fluids are NOT radioactive Can be temporary or a permanent implant that is placed close to or inside the tumor.

question

General Radiation Precautions for internal radiation

answer

Remember: Time, Distance, and shielding Do not be around people especially children.

question

Nursing Precautions with Internal Radiation

answer

Nursing assignments should be rotated DAILY so that the nurse is not continuously exposed The nurse should only care for ONE client with a radiation implant in a given shift. Wear a film badge at all time to monitor radiation level Mark the room with instructions for specific isotope Wear gloves with risk of exposure to body fluids

question

Who do you room a patient with radiation therapy with?

answer

Trick question, NO ONE!

question

Visitor Precautions for internal radiation

answer

Restrict visitors Limit each visitor to 30 mins per day Visitors must stay at least 6 feet from source NO VISITORS less than 16 years of age NO pregnant visitors/nurses Mark the room with instructions for specific isotope

question

Preventing dislodgement of implant

answer

1. Keep client on bedrest 2. Decrease fiber in the diet 3. Prevent bladder distention

question

What do you do if the implant becomes dislodged and you see it?

answer

Gloves, Forceps, Lead lined container Then call radiation control

question

Post-Radiation Care

answer

Client is immunosuppressed still. Client cannot sleep in same bed with spouse/children because they still have radiation for 2-3 days. No public transportation No work Cannot share utensils or cook for others Multiple flushes of toilet!

question

Teletherapy

answer

AKA External Radiation A carefully focused beam of high energy rays is delivered by a machine outside of the body. Beware of damaging nearby organs or normal tissue The client is NOT radioactive Protect the site from sunlight and UV exposure for ONE YEAR after completion of therapy.

question

Side effects of External Radiation

answer

Side effects are usually limited to exposed tssues Erythema Shedding of skin Altered taste Fatigue (#1 complaint of radiation) Pancytopenia (RBC, WBC, Platelets decreased) S/S are location and dose related.

question

Is it okay to wash off radiation markings?

answer

NO

question

Is it okay to use lotion on radiation markings?

answer

NO unless you have physicians order. Same with powder and ointments.

question

Chemotherapy usage is based on 4 factors

answer

1. Which phase of the cell cycle the drug attacks 2. Time or how often the drug is given (Usually 3-4 weeks) 3. Growth fraction 4. Tumor burden Drugs that are cell cycle specific may be combined with non-specific drugs to increase the number of cells killed

question

Most common body system affected by side effects of chemotherapy (3)

answer

1. Blood system 2. GI system 3. Skin and Hair (Integumentary) Cells divide most rapidly in these systems.

question

Handling precautions for Chemotherapy

answer

Exposure can occur by: Drug contact with the skin or mucous membranes Inhalation Accidental injection or ingestion

question

Chemotherapy Full Precautions

answer

Chemotherapy Gown 2 pairs of chemotherapy gloves Goggles and/or mask if splashing or inhalation can occur

question

Chemotherapy Excretion Precautions

answer

When handling body fluids wear TWO pairs of chemotherapy gloves and chemotherapy gown. Add a face shield if worried about splashing

question

Chemotherapy Disposal

answer

Yellow Rigid Chemotherapy waste container used for SHARPS and IV containers Yellow Chemotherapy waste bag used for gowns, gloves, and disposables

question

Managing Chemotherapy Spills

answer

Handle as a hazardous chemical spill Obtain a spill kit and use all protective equipment for clean up

question

Delivery methods of chemotherapy

answer

Most chemo drugs are given IV via a port Some chemo drugs can be given orally (Wear gloves!)

question

Vesicant

answer

Type of chemo drug that if it infiltrates will cause tissue necrosis Stay with client receiving vesicant PREVENTION IS #1 for extravasation

question

S/S of Extravasation

answer

Inadvertent infiltration of chemotherapy into the subcutaneous or subdermal tissues surrounding the intravenous or intra-arterial administration site. Pain Swelling NO BLOOD RETURN Stop the infusion immediately

question

Cold packs or warm moist heat with extravasation?

answer

Cold packs to help vasoconstrict and stop spreading

question

Biologic Response Modifiers

answer

BRMs enhance or use our own immune system to fight and kill the cancer Comparatively, chemotherapy acts DIRECTLY on cancer to kill it.

question

HPV Vaccine

answer

A type of BRM because it gives us immunity to HP virus to help prevent Cervical, Anal, and Oral cancers caused by human papillomavirus

question

The #1 risk for cervical cancer is

answer

HPV infection

question

Hormone Therapy

answer

Hormone therapy drugs slow down the growth of cancer such as prostate, endometrial (Uterus), and certain types of breast cancer. It blocks the body's ability to make hormones or interferes with the action of the hormone.

question

Steroids

answer

Steroids are used to INCREASE the effectiveness of chemotherapy

question

What is the most common treatment for hematologic cancers?

answer

Bone marrow and stem cell transplants! Occasionally transplants are needed when high doses of chemotherapy or radiation have destroyed too many blood cells and transplant is needed for "rescue"

question

Stem cell transplants

answer

Stem cells from the blood or the bone marrow can come from the client, a donor, or from an identical sibling Stem cells are given into a vein, similar to blood transfusion, and over time they settle in the bone marrow and produce healthy blood cells.

question

Complications of transplants

answer

Infection Graft vs Host disease

question

Signs of Host Rejection

answer

Abdominal pain or cramps N/V/D Jaundice or other liver problems Dark (Tea colored) urine Skin rash, itching, and redness on areas of skin Treat GVHD with anti-rejection drugs and steroids.

question

Body Image after cancer

answer

Alopecia May also experience huge sense of loss with mastectomy, amputation, or even a scar. We want them to LOOK AT the incision! Weight gain and puffiness from steroid therapy or weight loss can also affect body image.

question

What is the #1 cause of cancer related deaths?

answer

Infection

question

General Ways to prevent infection in cancer patient

answer

Private room Limit people in the room to visitors and nurses Own Supplies/Toiletries Wash hands Bathe warm moist areas usually TWICE DAILY (groin and under arms) Change dressings and IV tubing DAILY Cough and deep breathe Avoid crowds Wash hands after touching a pet No fresh flowers or potted plants (Bacteria) Avoid raw fruits and vegetables Drink only fresh water

question

Nursing Considerations for Monitoring Infection

answer

Watch for a slight increase in temperature. It may mean SEPSIS Tell oncology clients to come to the hospital for an oral temperature of 100.4 (38) or greater Monitor ANC

question

Neutropenia

answer

A decrease in the number of neutrophils (Mature WBCs) in the blood

question

What is the best way to assess neutropenia?

answer

Calculate an absolute neutrophil count (ANC) The ANC tells you exactly how many of your WBCs are neutrophils and indicates how well your client can handle an infection

question

Normal absolute neutrophil count

answer

2200 to 7700 cells/mm3

question

Nadir

answer

The lowest point Neutrophils are first line defense inside the body to protect us from infections Neutropenia + Infection -> -> -> Sepsis, Septic shock and death

question

Risk factors for Neutropenia

answer

Age: The very young and very old Advanced metastatic disease Malnourishment B12 and folic acid deficiences contribute to neutropenia Impaired tissue integrity Presence of other diseases (Diabetes, HPV, Heart disease) And in our case...Hematologic malignancies (Leukemias, Lymphomas, Myelomas)

question

Treatment of Neutropenia

answer

Prophylactic Antibiotics Implement Neutropenic precautions

question

Neutropenic Precautions

answer

Vital signs every 4 hours MINIMUM Private room with door closed and posted sign Antimicrobial soap for handwashing, not just regular soap NO INVASIVE PROCEDURES: No IM injections, rectal exam or rectal meds. No indwelling catheters and NG tubes. Limit use of acetaminophen!

question

What is the second leading cause of death in cancer clients?

answer

Deep Vein Thrombosis (VTE)

question

Why is malignancy a big risk for developing a DVT

answer

Prolonged bed rest Surgery Use of a central line External compression of vessels by the tumor Invasion of vessels by the tumors

question

What are we most afraid of with a DVT?

answer

Development of a pulmonary embolus

question

Thrombocytopenia

answer

Decrease in the number of circulating platelets in the blood Platelets are responsible for clotting.

question

Risk factors for thrombocytopenia

answer

Advanced metastatic disease Hematological malignancies Bleeding disorders such as hemophilia, liver disease, or ITP (Idoiopathic thrombocytopenia purpura AKA low levels of platelets) Bacterial infections Anticoagulant medicines Result of cancer treatments

question

Examples of anticoagulants

answer

Aspirin Clopidogrel Heparin Warfarin

question

Thrombocytopenia Assessment

answer

History Vital signs Pulse ox Change in LOC (Watch for ICP) Any complaints of headache or pupil changes Conjunctival hemorrhages (Bloodshot eyes) Petechiae, ecchymosis, and purpura Oozing from puncture sites or surgical sites Bleeding from the rectum, ears, nose, or mouth

question

Treatment for Thrombocytopenia

answer

Give them platelets!!!

question

Platelet Transfusions

answer

To control or prevent bleeding associated with thrombocytopenia

question

Platelet Transfusion Contraindication

answer

NEVER infuse cold platelets because the spleen will reject them

question

Red Blood Cell Transfusions

answer

For clients with symptomatic anemia We do not want Hgb/Hct to drop below 8 g/dl and 24%

question

What do we worry about with RBC and Platelet Transfusions?

answer

Want Cytomegalovirus (CMV) negative/CMV safe RBCs and Platelets! Test the RBCs and platelets to make sure they are negative for CMV.

question

How do we make RBC and platelets safe for transfusion

answer

Leukoreduction

question

________ is the most feared side effect of chemotherapy

answer

Nausea and Vomiting

question

Nausea/Vomiting

answer

Side effect of radiation Chemotherapy has a classification based on emetic risk

question

Nausea/Vomiting Prevention

answer

Give antiemetic meds before each treatment Use behavioral therapies such as guided imagery and music therapy Acupuncture/Acupressure may be used.

question

Antiemetic drugs

answer

Ondansetron Netupitant/palonosetron

question

Ondansetron

answer

Blocks the effects of serotonin Serotonin receptor antagonists all end in TRON e.g ondansetron, granisetron, dolasetron

question

Netupitant/palonosteron

answer

Oral combination antiemetic Prevents acute AND delayed N/V caused from chemotherapy. Great because only ONE dose is needed an hour before a round of chemotherapy.

question

Non-Pharmacologic treatments for N/V

answer

Ginger Aromatherapy: Peppermint, Lavender, Linen Acupuncture/Acupressure Distraction Relaxation techniques

question

Pain

answer

TREAT WITHOUT REGARD TO RISK FOR DEPENDNECE Pain is most often due to direct tumor involvement, but can also be the result of treatment such as mucositis or peripheral neuropathy

question

____________ are the gold standard for cancer pain

answer

Opioids There is NO ceiling on the dose of an opioid for a cancer client; it is client dependent

question

Other therapies for pain management

answer

Complementary or alternative therapy Acupressure/Acupuncture Cannabis (Marijuana) Distraction Therapy Hydrotherapy Massage

NCLEX Oncology – Flashcards

Unlock all answers in this set

Haven't found what you were looking for?

Search for samples, answers to your questions and flashcards