OCN Study Guide – Flashcards
347 test answers
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Hypocapnia
answer
reduced carbon dioxide in the blood
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Signs and Symptoms of pleural effusion
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tachypnea (fast breathing) decreased breath sounds dullness to percussion
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Define Lymphedema
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obstruction of lymphatic system that caused overload of lymph in the interstitial space
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Define Edema
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fluid in the interstitial space
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Cancer most commonly associated with lymphedema
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Breast
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Stage 1 Lymphedema
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less than 3 cm difference pitting edema
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Stage 2 Lymphedema
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3-5 cm difference skin stretched and shiny nonpitting
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Stage 3 Lymphedema
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greater than 5 cm difference skin discolored, stretched, firm nonpitting
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Lymphedema treatment
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compression garment manual lymphatic drainage elevation aerobic exercise with strength training low sodium diet
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Sentinel lymph node dissection
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removal of the first lymph node that contains cancer cells
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Hematoma
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abnormal collection of blood in tissues
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Pericardial effusion
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excess fluid around the heart
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Tumors associated with malignant pericardial effusions
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Lung
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High dose cyclophosphamide cardiac effects
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damaged cardiac endothelium
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Paclitaxel cardiac effects
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asymptomatic bradycardia
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5FU cardiac effects
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coronary artery spasm
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Anthracycline (Daunorubicin, doxorubicin, and epirubicin) cardiac effects
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cardiomyopathy
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Diagnostic test for pericardial effusion
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Echo
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Abnormalities of what electrolyte and what mineral interfere with cardiac function?
answer
Potassium and Calcium
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What med can be used to protect heart against effects of doxorubicin
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Dexrazoxane
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Spiral CT
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Diagnostic test for pulmonary emboli
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D-DImer test
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used to diagnose or rule out conditions that cause hypercoagulability (inappropriate clotting)
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DIC
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Accelerated activation of the coagulation cascade. Clots form in random places leaving the body open to bleeding without protection
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Platelet count, Fibrinogen level, D Dimer, FDP Titer
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Tests to diagnose DIC
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How to treat DIC
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Treat underlying cause
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What does FFP do?
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Contains all of the clotting factors except platelets. Used to supplement red blood cells when whole blood is not available or to correct a bleeding problem of unknown cause. It is also used to correct DIC.
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Most common cancer associated with DIC?
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Leukemia, specifically APL
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Signs/Symptoms of DIC
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bleeding from 3 unrelated sites hypoxia SOB fever mottled extremities
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Causes of DIC
answer
Delivery (of baby) Infection Cancer
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How does Heparin help DIC?
answer
Interferes with thrombin production. Maintain PTT at 1-2 times the normal level (18-28 seconds)
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S/S of septic shock
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Fever Tachycardia Hypotension
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Most common cause of sepsis
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Gram (-) bacteria
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DIC
answer
Accelerated activation of the coagulation cascade. Clots form in random places leaving the body open to bleeding without protection
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Platelet count, Fibrinogen level, D Dimer, FDP Titer
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Tests to diagnose DIC
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How to treat DIC
answer
Treat underlying cause
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What does FFP do?
answer
Contains all of the clotting factors except platelets. Used to supplement red blood cells when whole blood is not available or to correct a bleeding problem of unknown cause. It is also used to correct DIC.
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Most common cancer associated with DIC?
answer
Leukemia, specifically APL
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Signs/Symptoms of DIC
answer
bleeding from 3 unrelated sites hypoxia SOB fever mottled extremities
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Causes of DIC
answer
Delivery (of baby) Infection Cancer
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How does Heparin help DIC?
answer
Interferes with thrombin production. Maintain PTT at 1-2 times the normal level (18-28 seconds)
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S/S of septic shock
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Fever Tachycardia Hypotension
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Most common cause of sepsis
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Gram (-) bacteria
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Granulocytopenia
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failure of the bone marrow to make enough white blood cells (neutrophils)
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Highest risk factor for sepsis
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Prolonged granulocytopenia (less than 500/mm3)
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What cancer commonly produces TLS?
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High grade lymphoma
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Define Tumor Lysis Syndrome (TLS)
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metabolic imbalance that occurs with rapid tumor kill
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Lab results indicating DIC
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Increased D Dimer Increased FDP Decreased fibrinogen Decreased platelets
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Lab results indicitave of TLS
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Hyperkalemia (>5.0) Hyperphosphatemia (>4.5) Hyperuricemia (>8.0) Hypocalcemia (>10.5) Increased BUN (>20) Increased creatinine (>1.2) Increased LDH (>333)
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Lab tests done to monitor TLS
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K Phos Uric Acid Calcium LDH Renal function (BUN, Creatinine)
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How to treat severe hyperkalemia
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hypertonic glucose and insulin. Shifts extracellular K back into intracellular stores
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How does Allopurinol work?
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decreases uric acid production and decreases uric acid deposits in kidney
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How does Rasburicase work?
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catalyses the conversion of uric acid to allantoin
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S/S of hyperkalemia
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muscle weakness muscle cramps bradycardia tall T waves
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S/S of hypokalemia
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decreased reflexes irregular pulse fatigue N/V flat t wave V fib if severe
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Calcium normal range
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8.5-10.5 meq/L
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S/S of hypercalcemia
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fatigue lethargy muscle weakness impaired concentration confusion constipation polyuria/polydipsia
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S/S of hypocalcemia
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diarrhea neuromuscular irritability (Chvostek's sign) tingling of fingers and toes seizures
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Potassium normal range
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3.5-5.0 meq/L
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Sodium normal ranges
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135-145 meq/L
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S/S of hypernatremia
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polydipsia low grade fever dry skin dry/sticky mucous membrane
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S/S of mild hyponatremia
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anorexia HA N/V
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S/S of moderate hyponatremia
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nausea weakness anorexia fatigue muscle cramps
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S/S of severe hyponatremia
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seizures AMS
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First treatment for hyponatremia
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Fluid restrict 500-1000 ml per day
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Magnesium normal range
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1.8-2.4 mg/dl
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S/S of hypermagnesia
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lethargy flushing diaphoresis
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S/S of hypomagnesia
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similar to hypocalcemia neuromuscular and CNS changes seizures
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SIADH
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syndrome characterized by excessive release of antidiuretic hormone (ADH or vasopressin)
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Most common cause of SVC
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Cancer, especially non-Hodgkins and lung cancer
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Signs of SVCS
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JVD edema of face, neck, upper thorax dyspnea tachycardia
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SVCS diagnostic tests
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CT and MRI
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Tx of SVCS
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RT, chemo, steroids, surgery
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Superior Vena Cava Syndrome
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compromised venous drainage of the head, neck, upper extremities due to compression or obstruction of the vessel
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Most common cause of SVC
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Cancer, especially non-Hodgkins and lung cancer
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Signs of SVCS
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JVD edema of face, neck, upper thorax dyspnea tachycardia
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SVCS diagnostic tests
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CT and MRI
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Tx of SVCS
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RT, chemo, steroids, surgery
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Cushings Triad
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HTN bradycardia abnormal respirations
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Pupil changes in ICP
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unequal, dilated, pinpoint, nonreactive
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Cardiac tamponade definition
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excessive fluid in pericardial space decreases hearts ability to fill and pump
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Cardiac Tamponade s/s
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muffled heart sounds weak apical pulse mild tachycardia mild peripheral edema
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Pericardial effusion diagnostic test
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2-D echo
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Define spinal cord compression
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Compression of the thecal sac by a tumor in the epidural space
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Cauda Equina
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structure within the lower end of the spinal column, that consists of nerve roots and rootlets
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Most common loca for malignant invasion of spinal cord that cause SCC
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Outside of the spinal cord (extradural)
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Most common early symptom of SCC
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neck or back pain
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Progression of SCC symptoms
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pain motor weakness sensory loss motor loss
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Pain during SCC usually occurs during what position?
answer
Lying down supine
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Diagnostic tests for SCC
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Plain Xray bone scan MRI CT scan
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Antiangiogenesis factors
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suppress tumors ability to grow new blood vessels
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Cancer
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malignant disease with 3 characteristics 1. abnormal cell proliferation 2. unchecked local growth and invasion of surrounding tissue 3. ability to metastasize
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Sarcomas originate is what tissue?
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Connective
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Proto-oncogenes definition
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gene that regulates normal cell growth and repair
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tumor suppressor gene
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gene that stops, inhibits, or suppresses cell division
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Neoadjuvant Therapy definition
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given before primary tx to control potential mets
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CA 125
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tumor marker in ovarian cancer, evaluates treatment
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Difference between benign and malignant tumors
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Malignant can metastasize
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Dysplasia
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loss of uniformity in the appearance of cells
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Define hematopoesis
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body's ability to regulate, produce, and develop cells
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Define immune surveillance
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The body's ability to scan for and destroy malignant or altered cells
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Hematopoesis begins with which cell?
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Pluripotent stem cells
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Monoclonal Antibodies Fab vs Fc
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Fab is the antigen binding site. Fc signals cells to destroy the cell it is bound to
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Which antineoplastic categories of drugs are nonspecific?
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Alkylating Nitrosureas Antitumor antibiotics Hormonal therapies
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What is AUC?
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Amount of drug exposure or total drug concentration over time.
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What percent of patients receiving below diaphragm RT have sterility?
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25%
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What dose of radiation will affect serility in: Males? Females?
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Males: 4 cGy temp 5 cGy permanent Females > 40 yrs, 20 cGy over 5-6 weeks < 40 yrs, 6 cGy
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Chemos that affect fertility
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Lomustine Doxorubicin Melphalan Cyclophosphamide 5FU Cytarabine
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What chemos are worst for use 1st trimester of pregnancy?
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Folic acid antagonists- MTX Antimetabolites - MTX, 5FU, Cytarabine, Gemcitabine Alkylating - Cyclophosphamide, Ifex, Melphalan, Thiotepa, Carmustine, Carboplatin, Cisplatin
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PLISSIT
answer
Permission to discuss Limitied Information Specific Suggestion Intensive Therapy
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Federal Rehab Act of 1973
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federally funded employers can't discriminate against handicapped
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COBRA
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Provides insurance for employees for 18 months and dependants for 36 months
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Social Security Disability Insurance Program
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If patient has paid in previously, they are eligible 6 months after being impaired
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Late effects of RT on Abdomen
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Adhesions Fibrosis
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Late effects of RT on Bladder
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Fibrosis Hyperplasia (increase in cells)
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Late effects of RT on CNS
answer
Stroke Blindness
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Late effects of RT on chest
answer
Breast Ca soft tissue sarcoma dysphagia pulmoanry fibrosis
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Late effects of RT of Head/Neck
answer
hypo or hyperthyroid mandibular osteonecrosis alopecia cavities decreased hearing
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Late effects of RT on Heart
answer
pericarditis CAD cardiomyopathy pericardial effusion MI
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Late effects of RT on Liver
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Fibrosis cirrhosis
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Late effects of RT on Ovaries
answer
failure premature menopause
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Late effects of RT on Skeletal
answer
Late fx osteonecrosis
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Late effects of RT on Skin
answer
fibrosis necrosis basal cell hyperpigmentation
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Late effects of RT on testicles
answer
oligospermia azoospermia decreased testosterone
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Late effects of RT on urinary
answer
fibrosis strictures
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Late effects of RT on testicles
answer
oligospermia azoospermia decreased testosterone
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Late effects of RT on urinary
answer
fibrosis strictures
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Late effects of RT on vagina
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fibrosis decreased vaginal secretions
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Myeloid cell line
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In hematopoiesis, myeloid describes any leukocyte that is not a lymphocyte.
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Primary lymphoid organs
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Bone marrow - B Cells Thymus - T Cells
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Define Lymphoid cell line
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Develop T cells and B cells Key for all immune responses
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Define Humoral Immunity
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B cell immunity that is meditaed by
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Define Cell Mediated Immunity
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T cell driven immune response that does not involve antibodies or complement but involves activating macrophages, NK cells, antigen-specific cytotoxic T-lymphocytes, and the release of various cytokines in response to an antigen
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Define NK Cells
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kill cells by releasing small proteins that cause the target cell to die by apoptosis.
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Define Apoptosis
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programmed cell death
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Define Cytokines
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protein released by cells that has specific effect on the interactions, communications,
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Types of cytokines
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interleukins lymphokines cell signal molecules (tumor necrosis factor interferons (trigger inflammation and respond to infections
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Define Innate immunity
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immunity that occurs before the onset of infection
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Describe B cells
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Develop in bone marrow Differentiate into plasma cells, which produce immunoglobulins (IgG, IgA, IgM, IgE, IgD)
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Define phagocytes
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cells that engulf and consume pathogens
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Define interferons
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a type of cytokine limit spread of viral infections first resistance
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Can innate immunity target specific pathogens?
answer
No
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Define gene
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individual unit of hereditary info
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Genes responsible for family cancer syndrome are what gene?
answer
tumor suppressor gene
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How many chromosomes in human body?
answer
46 23 pairs
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What are autosomes when talking about genetics?
answer
Chromosomal pairs 1-22 Do not determine gender
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What are sex chromosomes?
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Chromosomes that decide sex Women are X X Men are XY
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Mutations in APC
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increases risk of colon cancer
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Mutations in PTEN
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increases risk of breast, thyroid, and endometrial cancer
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Mutations in p53
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increases risk of breast, leukemia, sarcoma and adrenal cancer
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Hallmark sign of hereditary cancer?
answer
Multiple cancers in one person
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Frameshift
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muttation where 1 bases are added or deleted
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Missense
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single base pair change mutations
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RNA Negative
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mutation with an abscence of RNA transcribed from gene
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Polymorphisms
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changes in DNA sequence often not disease related
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Translocation
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chromosomal abnormality where one chromosomal segament breaks off and attaches at another site
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Aneuploidy
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abnormal number of chromosomes
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In-Situ Cancer
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Noninvasive breast cancer
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Most common type of breast cancer
answer
invasive ductal carcinoma 70-80%
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Most aggressive breast cancer
answer
inflammatory breast cancer
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Least common sign of breast cancer?
answer
Pain
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Modified radical mastectomy
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removal of the entire breast and the lymphatic-bearing tissue in the armpit
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Can women with breast cancer have estrogen replacemtn therapy?
answer
No, women who have had HRT have 3 x the recurrence risk
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Most common sites of mets from breast cancer?
answer
IN ORDER Bone Lung Liver Brain
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What do biphosphonates do?
answer
prevent the loss of bone mass, used to treat osteoporosis, hypercalcemia, bone pain, and prevention of fractures
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What does Arimidex do?
answer
used to treat breast cancer in women who have gone through menopause. Stops estrogen production
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Clinical Trial Phase 0
answer
10-12 people Identify drugs that do not produce desired effect Limited doses Low doses Less risk Useful for molecularly target drugs Useful for drugs that require biomarker development
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Clinical Trial Phase 1
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20-25 people Evaluate tozicity Establish max dose without side effects Determine route (PO or IV) Variety of tumor types
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Clinical Trial Phase 2
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More than 100 people Determine if treatment has benefit Groups of patients with same tumors will be used Assess response rate
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Clinical Trial Phase 3
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100-1000's of people Compare new drug to current standard Establish efficacy by assessing survival and time to progression LAst step before FDA consideration Usually double blind trials
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Clinical Trial Phase 4
answer
Can it do anything else? Expand off label use Assess toxicity and long term effects Usually after FDA approval
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Most common cancer among women
answer
Breast
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Describe Invasive breast ca
answer
no longer contained by breast capable of metastases
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Most frequent site of breast cancer mets
answer
Bone
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What age should mammograms start?
answer
40
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Triple test for diagnosing breast cancer
answer
Physical Exam Mammography FNA
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Breast Cancer Staging Classification
answer
Stage 0 - In Situ Stage 1 - Under 2 cm with (-) nodes Stage 2 - 5 with (-) nodes Stage 3 - > 5 with ( ) or any size with breast wall extension Stage 4 - any distant mets
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Standard treatment for early breast cancer
answer
Breast conservation therapy with RT
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Gold standard for staging breast cancer
answer
axillary lymph node dissection
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Adjuvant therapy
answer
treatment given in addition to primary therapy
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Neoadjuvant therapy
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administration of therapeutic agents prior to the main treatment
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Common side effects of breast RT
answer
skin reactions fatigue
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What is the response rate of hormonal therapy in women with ER/PR ( ) tumors?
answer
50-70%
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Common chemos used in breast cancer
answer
Cytoxan Adriamycin Paclitaxel Docetaxel Epirubicin MTX 5FU
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Regimens that contain which type of chemo are seen as more successful in breast cancer?
answer
Anthracyclines
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What type of chemo are most effective for metastatic breast cancer?
answer
Taxanes
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Risk factors for breast cancer
answer
No children First pregnancy after 30 Early periods Late menopause Hormone replacement therapy
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Where do more than half of breast cancers occur?
answer
Upper outer quadrant
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CA 15-3 and CA 27-29
answer
tumor marker used to monitor response to treatment of invasive breast cancer
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CA 27-29
answer
tumor marker
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CEA
answer
tumor marker used to monitor the treatment of cancer patients, especially those with colon cancer
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Most aggressive type of lung cancer
answer
small cell lung cancer (SCLC)
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Which cancer is leading cause of death for men and women?
answer
Lung
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What risk factor accounts for 90% of lung cancers?
answer
Smoking
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Which cancers have highest incidence rates?
answer
Men - Prostate Women - Breast
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5 year survival rate for lung cancer.
answer
15%
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Which treatment option offers the best chance for cure of lung cancer?
answer
Surgery
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Diagnostic tests to stage lung cancer
answer
CXR CT or MRI Bronch
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Chemos used in SCLC
answer
Etoposide Cisplatin Carboplatin Cytoxan Doxorubicin Vincristine Ifex Combo are used most of the time
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What type of chemo is standard of care in NSCLC?
answer
Platinum based with Cisplatin or Carboplatin
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Why are most lung cancer patients good candidates for clinical trials?
answer
Low cure rates with current treatments.
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Why are ADH and ACTH levels sometimes higher in lung cancer patients, especially small cell?
answer
The tumor can release mimics of these hormones.
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When maintaining a chest tube, what 2 things would you report to MD?
answer
Bubbling in water seal chamber Air leak noises
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After lobectomy, what position should the patient not be in?
answer
The patient should not lay on operative side. Decreases expansion.
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After pneumonectomy, how should patient be positioned?
answer
On back or on operated side. DO NOT let patient lay on unoperated side.
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Tumor marker CEA
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Tumor marker elevated in colon cancer, can be used to monitor treatment or recurrence
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CA 19-9
answer
tumor marker for pancreatic cancer
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CA 27-29
answer
tumor marker for breast cancer
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Tumor marker AFP
answer
For testicular and primary liver
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Early symptoms of colorectal cancer
answer
change in bowel habits blood in stool
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Most common site of mets from colorectal cancer
answer
Liver
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Why are ADH and ACTH levels sometimes higher in lung cancer patients, especially small cell?
answer
The tumor can release mimics of these hormones.
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When maintaining a chest tube, what 2 things would you report to MD?
answer
Bubbling in water seal chamber Air leak noises
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After lobectomy, what position should the patient not be in?
answer
The patient should not lay on operative side. Decreases expansion.
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After pneumonectomy, how should patient be positioned?
answer
On back or on operated side. DO NOT let patient lay on unoperated side.
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Tumor marker CEA
answer
Tumor marker elevated in colon cancer, can be used to monitor treatment or recurrence
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CA 19-9
answer
tumor marker for pancreatic cancer
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CA 27-29
answer
tumor marker for breast cancer
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Tumor marker AFP
answer
For testicular and primary liver
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Early symptoms of colorectal cancer
answer
change in bowel habits blood in stool
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Most common site of mets from colorectal cancer
answer
Liver
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What percentage of colorectal cancer patients will have surgery?
answer
75%
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Most common symptom of esophageal cancer.
answer
Dysphagia
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What is gold standard for treatment of pancreatic cancer?
answer
Surgery
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Most common presenting symptom of gastric cancer?
answer
Weight loss
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Nursing teaching for patients with dumping syndrome.
answer
small, frequent meals low carbs high protein low fiber
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Most common presenting symptoms in liver cancer
answer
RUQ pain
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Tumor Marker a-FP
answer
Liver cancer
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Preferred initial therapy for anal cancer
answer
Chemoradiation
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Diagnostic tests for esophageal cancer
answer
esophagoscopy and biopsy esophagogram CT
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How is esophageal cancer staged?
answer
TNM
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Diagnostic tests for gastric cancer
answer
Barium study Biopsy
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Most common presenting symptom of endometrial cancer.
answer
Abnormal vaginal bleeding
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Tumor marker B-HCG
answer
for gestational trophoblastic disease (tumors in uterus)
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Most common symptom of patients in patients with testicular cancer
answer
Heavy feeling or mass in scrotum
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CA 125
answer
tumor marker elevated in 80% of ovarian cancer patients
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Seminoma is most responsive to what therapy?
answer
Radiation
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What tumor markers are used to measure treatment response in testicular cancer?
answer
B-HCG and a-FP
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Screening procedure most used to check for cervical cancer
answer
Pap smear
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Diagnostic procedures for cervical cancer
answer
Colposcopy HPV testing cervical biopsy cone biopsy leep
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Triad of symptoms in recurrent cervical cancer
answer
sciatic pain unilateral leg pain ureteral obstruction
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Risk factors for cervical cancer
answer
HPV ( ) sex during teen years multiple sex partners history of CIN
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Early signs of cervical cancer
answer
asymptomatic
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Late signs of cervical cancer
answer
pain referred to flank or leg urinary symptoms
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Which is most curable gynecologic cancer?
answer
Endometrial
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Most common sites for metastases in renal cell cancer
answer
Lymph Bone
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Chromosome 3p
answer
Abnormal in 80% of renal cell carcinoma
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Most common diagnostic test for RCC?
answer
KUB radiography
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Classic triad of symptoms for advanced RCC
answer
Flank pain Hematuria Flank mass
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When should prostate screening start?
answer
Age 50 for average risk Age 40 for African Americans and familial history
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What are screening tests for prostate cancer?
answer
DRE PSA
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Most frequent treatment for advance prostate cancer?
answer
Medical castration
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Most common presenting symptom of bladder cancer?
answer
Hematuria
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Diagnostic tests for bladder cancer
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IVP Cystoscopy
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Important nursing intervention for patients with nephrectomy?
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Teach deep breathing and incentive spirometry use
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Paralytic ileus
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Obstruction of the intestine due to paralysis of the intestinal muscles
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Screening tests for bladder cancer
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None. Also none for kidneys.
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Most common chemo to treat bladder cancer
answer
Mitomycin
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When used with surgery, what chemo doubles survival rates in bladder cancer?
answer
MVAC MTX Vinblastine Adriamycin Cisplatin
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Define ileal conduit
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urine reservoir created after bladder is removed
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Difference between ileal conduit and continent ileal reservoir.
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conduit needs bag, reservoir does not
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Which is most effective single agent chemo for bladder cancer?
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Cisplatin
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How to prevent malodorous urine?
answer
Decrease alkaline beverages (soda) drink fluids high in vitamin C Avoid stinky food (fish, asparagus) Clean pouch using soap, water, vinegar
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Most common sites for metastases in renal cell cancer
answer
Lymph Bone
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Chromosome 3p
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Abnormal in 80% of renal cell carcinoma
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Most common diagnostic test for RCC?
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KUB radiography
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Classic triad of symptoms for advanced RCC
answer
Flank pain Hematuria Flank mass
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When should prostate screening start?
answer
Age 50 for average risk Age 40 for African Americans and familial history
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What are screening tests for prostate cancer?
answer
DRE PSA
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Most frequent treatment for advance prostate cancer?
answer
Medical castration
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Most common presenting symptom of bladder cancer?
answer
Hematuria
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Diagnostic tests for bladder cancer
answer
IVP Cystoscopy
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Important nursing intervention for patients with nephrectomy?
answer
Teach deep breathing and incentive spirometry use
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Paralytic ileus
answer
Obstruction of the intestine due to paralysis of the intestinal muscles
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Caution nephrectomy patient to avoid nephrotoxic drugs such as what?
answer
NSAIDS
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Screening tests for bladder cancer
answer
None. Also none for kidneys.
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Most common chemo to treat bladder cancer
answer
Mitomycin
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When used with surgery, what chemo doubles survival rates in bladder cancer?
answer
MVAC MTX Vinblastine Adriamycin Cisplatin
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Define ileal conduit
answer
urine reservoir created after bladder is removed
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Difference between ileal conduit and continent ileal reservoir.
answer
conduit needs bag, reservoir does not
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Which is most effective single agent chemo for bladder cancer?
answer
Cisplatin
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How to prevent malodorous urine?
answer
Decrease alkaline beverages (soda) drink fluids high in vitamin C Avoid stinky food (fish, asparagus) Clean pouch using soap, water, vinegar
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Ethnic group most at risk for nonmelanoma skin cancers
answer
Caucasian
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Chemotherapy with best results in treating malignant melanoma
answer
Dacarbazine (DTIC Dome)
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Most important feature when determining prognosis in malignant melanoma.
answer
Size and depth of lesion at time of diagnosis
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Most common sites of metastases from malignant melanoma
answer
Lymph Lung Brain
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What are nonmelanoma skin cancers?
answer
Basal and Squamos
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Features of malignant melanoma
answer
Asymmetry Uneven borders Color variegation > 6 mm in diameter
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Chemos used to treat malignant melanoma
answer
Dacarbazine Nitrosureas (Carmustine, Lomustine) temolozamide (Temodar) (PO)
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Squamos cell cancers are 90% of what type of cancer?
answer
Head and Neck
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Head and Neck cancer with highest survival rate
answer
Thyroid
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What are primary treatment modalities for managing head and neck tumors?
answer
Surgery and Radiation.
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When would you advise a patient with a trach to change to a laryngectomy tube?
answer
When the stoma begins to get narrow
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Most common infection of oropharynx
answer
Candidasis
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Major toxicity of cisplatin
answer
Nephrotoxicity **Also ototoxicity**
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Possible alterations in mobility after head and neck surgery
answer
shoulder droop atrophy of trapezius forward curve of spine limited ROM
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Most common presenting symptoms in clients with a brain tumor
answer
Seizure HA Unilateral Hemiparesis
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Most common types of malignant tumors com from which brain tissue
answer
Astrocytes - connective cell tissues
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Which oral alkylating agent is used to treat brain tumors?
answer
Temodar
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Which IV chemo is used to treat brain tumors?
answer
Carmustine
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Mets to the spine occur most frequently in what cancers?
answer
Breast Lung Prostate
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Diagnostic studies for brain tumors
answer
CT MRI
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What does ATRA treat?
answer
APL
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Which drug binds to CD33 antigen?
answer
Gemtuzumab (Mylotarg)
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Blast crisis
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LAst phase of CML when 30% of cells in blood or marrow are blasts.
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Which type of leukemia affects CNS?
answer
ALL
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Most common childhood leukemia
answer
ALL
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Define Consolidation therapy
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given after cancer has disappeared following the initial therapy, used to kill any cancer cells that may be left in the body
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What drug is used in chronic phase CML to control leukocytosis?
answer
Hydroxyurea
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What drug is used to treat CML in all phases?
answer
Gleevec
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Reed Sternberg cells
answer
shows in biopsy of patient with Hodgkins
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Most common cause of pain in MM
answer
Bone mets/lesions
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Tests done to measure response to MM treatment
answer
Blood tests Urine tests 24 hour urine- measure protein and creatinine Myeloma survey - detect skeletal lesions
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How to treat itching from Hodgkins
answer
Chemo or steroids
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Mets from osteosarcoma usually affect what area of the body?
answer
Lung
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S/S of osteosarcoma
answer
pain swelling
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Most frequently diagnosed HIV related cancer
answer
B cell
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Capillary leak syndrome
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condition in which fluid and proteins leak out of tiny blood vessels and flow into surrounding tissues, resulting in dangerously low blood pressure. Capillary leak syndrome may lead to multiple organ failure and shock
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Most common side effect of interferon therapy
answer
Fatigue
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Innate immunity
answer
Immunity that does not respond to specific antigens
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Principal toxicity of vincristine
answer
peripheral neuropathy
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Dose limiting toxicity of cisplatin
answer
nephrotoxicity
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Dose limiting toxicity for nitrogen mustard
answer
Myelosuppression
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Mesna
answer
chemoprotective against hemorrhagic cystitis
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Amifostine
answer
chemoprotectant against nephrotoxicity from cisplatin
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When do Carbo reactions happen
answer
After 6th cycles, mid cycle.
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Early complications of stem cell transplant
answer
N/V Infection
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Late complications of stem cell transplant
answer
Chronic GVHD Herpes
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Target organs of acute GVHD
answer
skin liver gut
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Target organs of chronic GVHD
answer
vagina eyes mouth
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veno-occlusive disease/sinusoidal obstruction syndrome
answer
some of the small veins in the liver are blocked as a complication of high-dose chemotherapy given before a bone marrow transplant (BMT) and is marked by weight gain due to fluid retention, increased liver size, and raised levels of bilirubin in the blood. 7-21 days after HSCT
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Long term side effects of HSCT
answer
Fatigue Weight loss Sexual Dysfunction Chronic GVHD Herpes Zoster
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Symptoms of VOD/SOS
answer
weight gain mental confusion RUQ pain
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Which chemos have greatest potential for producing a secondary malignancy?
answer
Alkylating agents
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Risk factors associated with pancreatic cancer
answer
smoking processed meats H pylori diabetes
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Primary Prevention
answer
protect healthy people from developing a disease educate screen immunize
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Tertiary prevention
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helping people manage complicated, long-term health problems and maximize QOL Rehab Support Groups
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Secondary Prevention
answer
happen after an illness or serious risk factors have already been dx. Goal is to halt or slow the progress of disease (if possible) in its earliest stages limiting long-term disability, prevent re-injury
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most common worldwide cancers
answer
lung stomach liver
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selective/prescriptive screening
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looks for specific problems within a high risk group
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a-FP tumor marker
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sensitive for germ cell or primary liver tumor
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CAUTION
answer
Change in bowel or bladder A sore that doesn't heal Unusual bleeding Thickening or lumps Indigestion Obvious changes in wart or mole Nagging cough
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CEA
answer
tumor marker for colon cancer
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CA 19-9
answer
pancreatic tumor marker
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