Oncology I – NCLEX – Flashcards
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What does it mean that Alcohol and tobacco are co-carcinogenic?
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Using these two makes cancer develop much more rapidly. Tobacco is the number one cause of preventable cancer
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Why is a diet low in fiber considered a suspected dietary cause of cancer?
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Motility is decreased, there fore holding on to carcinogens longer Teach the pt. to eat a diet high in fiber - fruits, vegetables, and whole grain
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What are some other suspected dietary causes of cancer?
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Increased red meat, increased animal fat, nitrates (processed sandwich meat), preservatives and additives. Teach pt. to eat more natural foods, whole grain food, and foods that are organically grown
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Why is there a greater risk of cancer when someone is 60 or older?
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The older a person gets, the weaker the immune system. There is a greater risk for cancer in the immunosuppressed (why it is important to eat healthy to build up your immune system)
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What is the most important risk factor for cancer?
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Aging - Mutations, DNA can get messed up, then cancer can expose itself, more exposure to environmental toxins (increase cancer especially in the aged)
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What are some diet/exercise habit we should teach our pt.s to help lower their risks of cancer?
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Cruciferous veggies(broccoli, cauliflower, and cabbage); Vitamin A(Carrot - Anything with color); Vitamin C and D; Regular physical activity; and protect skin from the sun
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Name primary prevention of cancer. Name secondary prevention of cancer
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Sunscreen and no smoking. Using screening to detect cancer early when there is a greater chance for a cure or control
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How does irritation affect cancer?
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Chronic irritation brings about uncontrolled growth of abnormal cells EX: Mole continually being rubbed; smoking on the lung; Reflux disorders are irritants to the esophagus
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What are some preventative screenings for women we are most concerned with?
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Breast exam, Pelvic exam, and Colonoscopy
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Explain self breast exams
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Performed monthly over the age of 20. Best time to do a breast exam is just after the period is over (Days 7-12) of the menstrual cycle (Before the period there is too much swelling)
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What should we teach post menopausal and hysterectomy pts.?
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Teach them to remember a certain day of ever month
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When should clinical breast exams take place?
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Yearly in a doctors office for women >(greater than) 40 yrs old. Women between the ages of 20 to 39 need q 3yrs
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When should mammograms be starting?
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Yearly starting at age 40 with 2 views of each breast. Teach pts. not to have lotion, powder, or deodorant on before exam (Can be picked up on the mammogram as a calcium deposit-Calcium deposits normally report as cancer)
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When should pelvic exams be performed?
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Pap smear q 3yrs, if there has been no problem. Instruct pt. not to have sex and not to douche before the pap smear (Can distort the results)
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When should a Colonoscopy be performed?
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At age 50 and q 10 yrs after that - testing the stool may be done for primary cancer screeing
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What are the preventative screenings for men we are most concerned with?
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Breast exams, Testicular exam, Digital rectal exam and PSA, and Colonoscopy
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When should men perform self breast exams? When should the digital rectal exam and PSA be performed?
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Breast exam - same day q month Digital rectal exam and PSA - yearly for men over 50
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Explain the testicular exam
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Performed monthly - Testicular tumors grow very fast and the age group of testicular cancer s 15 to 36. Teach pt. how to perform and to make sure they do this monthly in the shower
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When and how often is the colonoscopy be performed?
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Starts at age 50 then q 10 yrs.if there is no problems
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What are the general S/S for cancer?
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C - change in bowel/bladder habits A - sore that does not heal U - Unusual bleeding/discharge T - thickening or lump in breast or elsewhere I - indigestion or difficulty swallowing O - Obvious change in wart or mole N - nagging cough or hoarseness
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If cancer invades the bone marrow what will this lead to?
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Can lead to anemia and thrombocytopenia
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NCLEX
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If get an anemia question, focus on Hypoxia. If get a thrombocytopenia question, focus on bleeding Bleeding precautions - Use electric razor, soft toothbrush Child - Quiet play NO IM with BLEEDING PRECAUTIONS
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What is Cachexia?
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Extreme wasting and malnutrition. Pt. is closer to death, not able to eat anymore and have lost lots of weight
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Generally explain radiation therapy
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Delivers a high dose of radiation to a localized area
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Explain internal radiation (Brachytherapy)
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The radioactive source is inside the pt. and the radiation is being emitted. WITH ALL BRACHYTHERAPIES - the pt. is emitting radiation for a period of time and is a hazard to others. There are two types: Sealed and Unsealed
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How does unsealed emit radiation?
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Pt. and body fluids emit radiation
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Explain Unsealed radiation
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Isotope is given IV or PO. People receive this for Hyperthyroidism as well as cancer. They inject them with the isotopes and the pt. is radioactive for 24 to 48 hrs
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How does sealed emit radiation?
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Pt. emits radiation but the body fluids are not radioactive
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Explain Sealed radiation
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These are implanted close to or in the tumor EX: Cervical Cancer
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NCLEX
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In general, radiation implants emit radiation to the general environment. Understanding this will help to be a safe nurse, and pass the NCLEX
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What is similar with both sealed and unsealed radiation treatments?
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They stay in place for a couple of hours to a couple of days. There are also high dose and low dose forms
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What are some general precautions for low dose radiation that stay in for a few days?
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Time, Space, and Shielding. Nursing assignments should be rotated daily so that the nurse is not continuously exposed. Nurse should only care for one pt. with radiation implants in a given shift
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What are the precautions with internal radiation?
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Private room. Wear a film badge all the time - tells how much radiation the nurse is getting. DO NOT GIVE THE BADGE TO ANYONE ELSE
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Should we restrict visitors to pts. with internal radiation?
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Limit visitors to 30 min/day and must stay 6 ft from the source. These pts. do get depressed because they are by themselves most of the time. No visitors less than 16 yrs of age and not pregnant visitors (or pregnant nurses)
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What else should we, as nurses, do for the internal radiation pt.?
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Do as much as possible for the pt. with each visit. DO NOT keep going into the room. Wear gloves with risk of exposure to body fluids. Mark the room with instructions for specific isotope
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How can we prevent dislodgement of the implanted internal radiation device?
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Keep pt. on bed rest; Decrease dietary fiber - fiber will distend the bowel and could push out the device (Low fiber diet); Prevent bladder distention (most pts. will have a Foley to prevent this)
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What should we do if the implanted inter radiation device become dislodged?
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Have gloves on, pick it up with forceps and place in a led lined container. DO NOT take out of room. Call radiation and have them come and take it
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NCLEX
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When have an immunosuppressed pt., need to think of the types of pts. that will go into the room with them. NEVER allow someone with an infection or who could become infected (post surgery)
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Explain External Radiation (Teletherapy, beam radiation)
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Side effects are usually limited to exposed tissue. Will be radiated in the same spot for so many days and that spot will get really dry and the skin will start breaking down (Pt. will be symptomatic at the site)
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What are the general symptoms of external radiation?
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Erythema; shedding of the skin (think of this first w/Teletherapy); Altered taste; Fatigue (Big one); Pancytopenia (All blood products are decreased = "Pan" means q thing) so RBC, Platelets, WBC REMEMBER - S/S are location and close related
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Give an example of external radiation S/S
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Brain tumor - pt will lose hair, impaired taste, sore in the mouth (all local to where the pt. is being radiated)
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What should we know, and teach, to pts. about the markings for external radiation?
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DO NOT WASH off the marking and do not use lotion on them. Nothing on markings unless ordered by the HCP
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How should we protect the site of radiation?
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Must protect for 1 yr after completion of treatment. Teach good skin care, no lotions, powders, ointments with out doctor order
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How does Chemotherapy work?
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Works on the cell cycle. There are some Cell Cycle Specific drugs (work on specific cycles of the cell) and some Cell Cycle Non-specific drugs (work on the cell in any cycle they are in) May combine the drugs to increase the number of cells killed "Combination Chemotherapy"
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Explain the Chemo therapy cycle
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Usually scheduled q 3 to 4 wks. In between trying to recuperate, pt. should rest. This type can knock pts. out for a week. Must try to teach and encourage pts. to eat nutritious meals so their blood properties are built up (Some are so sick, can not even eat)
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How are most Chemo drugs administered?
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Through an IV port because their veins become so small they become hard to stick. Pt. will usually have a Port - these drugs can be very irritating if they infiltrate
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How are Chemo drugs absorbed?
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Many are absorbed through the skin and mucous membranes. Be very careful handling them - be sure to wear gloves and to read up and know about the drug so it can be handled correctly
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Why is alopecia associated with Chemo therapy?
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Not all chemo makes pts lose their hair. Chemo attacks cells that are dividing rapidly, like cancer cells, and hair follicle divide very rapidly
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What are some other side effects caused by Chemo?
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N/V; Mucositis (sores in the mouth - also called Stomatitis); Immunosuppression (Biggy); Anemia; and Thrombocytopenia
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What is a vesicant?
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A type of Chemo drug that if infiltration (extravasation) occurs will cause tissue necrosis - eats the tissue and destroys it
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What are the S/S of extravasation?
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Pain - 1ST COMPLAINT; Swelling; No blood return
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Explain about vesicant treatment
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Any time giving Chemo, look it up to see if it is a vesicant. Must stay with pt. the entire infusion time (VERY DANGEROUS drug - must watch the site carefully) Sometimes there is so much destruction of the tissue it will call for grafts and surgery REMEMBER - number 1 thing to know is prevention
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NCLEX
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Stop the infusion and think vasoconstriction. To prevent spreading - Ice pack and call the doctor. Different drugs - either hot or cold depending upon the drug, but for NCLEX ONLY ICE PACK)
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What else can be given to a pt. with extravasation?
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The site around the area may be injected with bicarb to neutralize it. There is also vasoconstriction agents that can be injected
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What are some general ways to prevent infection?
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Pt. needs a private room; wash hands; Limit people (Visitors and nurses) in the room, change dressings and IV tubing daily. No fresh flowers, raw fruits and vegetable (bacteria), Avoid crowds, Do not share toilets, Drink only fresh water, wash hands after petting animals or shake someone's hand
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Can they use our supplies or should they use their own?
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Need to have own supplies in their room (cups, utensils) own q thing you can think of (DO NOT go to supply closet. Must bring supplies with them including BP cuff and stethoscope)
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How does coughing and deep breathing help fight infections with cancer pts.?
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Do not want them to get pneumonia. Already at a higher risk. We are over compensating this pt.
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How many times should moist warm areas on a cancer pt. be washed?
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x2/day (groin and under the arms. Breaks in the skin are a way for bacteria to get in. Must be careful with mucous membranes
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What should we do if a cup of water has been on bedside for 15 minutes what should we do?
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Consider it to be old and to have some type of bacteria in it. (Get pt. new water)
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What does a slight increase in the body temp mean?
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It may mean the pt. is septic. May not see a spike in temperature - look for low grade increases
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What is the most important lab value to look at for infection for cancer pts.?
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Absolute neutrophil count (WBC)
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What are the risk factors for Cervical Cancer?
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Number one - Human Papiloma Virus; repeated STD's (Chronic irritation); Multiple Sex partners - higher risk for HPV; Smoking and exposure to second hand smoke; Certain nutritional deficiencies - Folate, beta-carotene, Vit. C; Family History; Immunosuppression; Prolonged hormonal therapy
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What is DES and how does it possibly cause Cervical Cancer?
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DES is a synthetic form of estrogen that was prescribed to pregnant women during pregnancy to prevent miscarriage from 1940 to 1970
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How does sex possibly cause Cervical Cancer?
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Sex at a young age and multiple pregnancies
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Explain pre-invasive Cervical Cancer S/S
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Often asymptomatic in pre-invasive cancer. When it metastasizes, will become symptomatic.
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Explain Invasive Cervical Cancer S/S
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Classic symptom is painful vaginal bleeding
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Other general S/S
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Watery, blood tinged discharge; Pelvic pain(may occur with intercourse); Leg pain(along the sciatic nerve - due to pressure); Flank and back pain
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What is the cure rate for Cervical Cancer?
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100% if detected early
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How is Cervical Cancer diagnosed?
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Pap smear. Abnormal pap smear will repeat the test
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What are some types of treatment for Cervical Cancer?
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Electrosurgical excision; Laser; Cryosurgery; Radiation and Chemo (late stages)
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What is conization? (Cervical Cancer)
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Remove part of the cervix. This is for someone who wants to preserve their fertility. Will depend on how far advanced cancer is
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Does a Hysterectomy have to be performed for Cervical Cancer?
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If needs more than just part of the cervix (metastasized). It will also have to depend on how advanced the cancer is, or what stage they catch it in
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What are the risk factors for Uterine Cancer (Endometrial cancer)?
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Greater than 50 yrs. old; Taking estrogen therapy w/out progesterone; positive family history; late menopause; No pregnancy (null parity); Anyone who has fertility problems are at a greater risk of reproductive cancers
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What is the major symptom of Uterine Cancer (Endometrial Cancer)?
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Post menopausal bleeding. Teach post menopausal women to report vaginal bleeding immediately to HCP
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What are some other Signs and Symptoms of Uterine Cancer (Endometrial Cancer)?
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water, bloody vaginal discharge; low back/abdominal pain; pelvic pain
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What is CA-125 rule out (Uterine Cancer-Endometrial Cancer)?
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Its a blood test to rule out ovarian involvement (may or may not be an indicator)
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What are some tests used to evaluate for metastasis? Uterine/Endometrial Cancer
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Chest x-ray; IVP (Intra Venous Pyelogram); BE (Barium Enema); CT; Liver and Bone Scans
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What is the most definitive diagnostic test for Uterine/Endometrial Cancer?
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D&C (Dilation and Currettage) and endometrial biopsy
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Explain TAH for the treatment of Uterine/Endometrial Cancer
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Total Abdominal Hysterectomy - Uterus and cervix only. Possible tubes (Bilateral Salpingectomy) and Ovaries (Bilateral Oopherectomy)
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Explain Radical Hysterectomy of Uterine/Endometrial Cancer
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May remove all of the pelvic organs. Pt. may end up with colostomy or an ileul conduit (may have to take out bladder also)
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When is the greatest time for Hemorrhage following a Radical Hysterectomy?
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During the first 24 hrs (In general - abdominal hysterectomy) Pelvic congestion of blood. Major complication of hysterectomy is hemorrhage
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NCLEX
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Abdominal Hysterectomy -> Think Hemorrhage Vaginal Hysterectomy -> Think infection
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When should the pt. void after these surgeries (TAH and Radical Hysterectomy)
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Must void in the next 8hrs. Will probably have a Foley
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If there is no Foley in place what must we check for? (TAH and Radical Hysterectomy)
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Bladder distention - Pt. may not recognize when need to void because still out of it from anesthesia. Must prevent abdominal distention after this surgery because we do not want tension on the suture line (Can lead to Dehision and Evisceration)
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NCLEX
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If pt. is eviscerating, DO NOT LEAVE THE PT. call someone for help. Place 4x4 sterile saline to keep area moist and call the doctor. DO NOT put pressure, not even slight pressure on it.
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What are some Nursing interventions post-op? (TAH or Radical Hysterectomy)
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Avoid high fowlers(it will make more blood go to the pelvis);Check abdominal and perineal area; Early ambulation(prevent pneumonia and thrombophlebitis)
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What should we teach the pts. before going home? (TAH or Radical Hysterectomy)
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Avoid sex, driving, girdles, and douches; Shower, no bath(promotes ascending infections) Any exercise, including lifting heavy objects and anything that will cause pelvic congestion (This includes picking up chidren) REMEMBER - It is possible for the pt. to hemorrhage 10 to 14 days after surgery
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Is it normal to have discharge after these surgeries? (TAH or Radical Hysterectomy)
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If it is whitish discharge. Worry if it changes color
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What other treatments are there for Uterine/Endometrial Cancer?
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Radiation-Intra-cavity radiation to prevent vaginal recurrence Chemotherapy-doxorubin(Adriamyacin) and cisplatin(Patinol-AQ)
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What is given to the pt. with Uterine/Endometrial Cancer that has a tumor that is Estrogen dependent?
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Estrogen Inhibitors - Medroxyprogesterone(Depo-Provera) and tamoxifen(Nolvadex/soltamox)
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Explain family history importance with Breast Cancer?
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Pt. has a 3 fold risk increase of developing breast cancer if a 1st degree relative had premenopausal breast cancer (mother, sister, daughter)
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What are some other risk factors for Breast Cancer?
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High dose radiation to the thorax before age 20(x-rays); Period before 12yrs.; Menopause after 50 yrs; Null parity (no pregnancy)First birth greater than 30yrs (the longer wait to have a baby, the greater the risk for reproductive types of cancers)
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What are the S/S of Breast Cancer?
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Change in appearance, dimpling, retraction, discharge from breast; Axillary lump; (when there is retraction of the nipple, it is the tumor pulling on the tissue)
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Where is 48% of breast tumors occur?
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Tail of Spence. Located in upper outer quadrant under the axillae
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What should we teach the pts. about breast and axillae exams?
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To perform these self exams in the shower - hand can slide more easy across the tissue
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What type of post-op care should we provide a pt. with Breast Cancer?
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Check for bleeding by checking the dressing. REMEMBER - Check the back for pooling of blood (hemovac, Jackson-pratt drain) When have drains or suctioning, look for increase in the amount
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What must we do with the affected side for breast cancer surgery?
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Elevate arm on the affected side because Lymph node may have been taken out and swelling will occur. Many times pts will come back from surgery with an ace compression bandage to decrease edema (depends on the HCP)
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NCLEX
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Stay away from the affected side for the lifetime of the pt.
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Explain the "No watch" that is used to protect the arm that was affected from breast cancer?
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No constriction, no BP or injections, wear gloves when gardening watch small cuts, no nail biting, no sunburn, no IV, no carrying purse on the arm.
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Why should the pt. be taught the "No Watch"? (Breast Cancer)
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Without Lymphatic system, no longer able to fight off infections (Breast and Lymph removal)
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What helps promote new circulation (Collateral Circulation) - Breast Cancer
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Teach pt. to brush hair, squeeze tennis balls, wall climbing, flex and extend elbow
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What must we encourage them to do day one post-op? (Breast Cancer)
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To do their exercises to prevent frozen shoulder and promote new circulation
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What do we want the pt. to do? Why? (Breast Cancer)
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Want the pt. to look at the incision (takes different amounts of time for different people) This is one way you can tell if they are adapting and coping by how well they look and help with dressing changes
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What do many women do at the same time of the surgery? (Breast Cancer)
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Many women go ahead and have breast augmentation at the same time - helps with body image
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What is "Reach for Recovery"?
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Support Group for Breast Cancer
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What is Lymphedema? What does the Lymph system do?
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Refers to swelling that generally occurs after the removal, or damage to, the Lymph nodes following cancer treatment. The Lymphatic system fights infection and promotes drainage (Why this extremity must be protected forever after surgery)
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After breast cancer surgery, what will happen with the arm on the affected side?
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May have to support the arm, depending on how many Lymph nodes were taken out. With time pt. will be able to hang their arm down - some do not, but most do
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What are some Chemotherapy drugs used to treat Breast Cancer?
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paclitaxel(taxol), doxorubicin(Adriamyacin)
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How does hormonal therapy help with breast cancer tumors?
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They lower estrogen effects on the cancer by various methods. (Breast tumors are estrogen dependent)
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Name some of the hormonal therapy drugs used in treatment for breast cancer?
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Estrogen receptor blocking agents - lamoxifen (Novadex/Soltamox) Estrogen Synthesis inhibitors - leuprolide (Lupron) and goserelin (Zoladex) These place pt. in a menopause state
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Is radiation also used in the treatment of breast cancer?
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Yes
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What is the leading cause of death world wide? What is the survival rate?
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Lung Cancer. Five year survival rate is 16% (not good)
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What is the number one risk factor for Lung Cancer?
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Smoking. When the pt. has stopped smoking for 15 yrs or more the incidence is almost like that of a non-smoker
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What are the two S/S that are often confused with TB?
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Hemoptysis (coughing up blood, or blood tinged sputum) and Dyspnea REMEMBER - TB has night sweats
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What are some other S/S of Lung Cancer?
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Hoarseness, cough, change in endurance, chest pain, pleuritic pain on inspiration, displaced trachea; May metastasize to the bone
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Explain the use of Bronchoscopy for determination of Lung Cancer
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Just go in and look. PT. must be NPO pre-op and remain NPO until gag reflex comes back (normal no to have a gag reflex first back from this procedure)
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What are some things that we must watch for after a Bronchoscopy for Lung Cancer?
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Respiratory depression (NOT NORMAL for a pt. to come back with respiratory depression), hoarseness, dysphagia, SQ emphysema (Air under the tissue "Rice Krispies" - MEDICAL EMERGENCY: Means the airway was perforated)
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NCLEX
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Slow respirations is different from depressed respirations. When see "Respiratory Depressed" it means less than x12/min. Respiratory rate should always be perfect, especially after an airway test
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When is the best time to collect a sputum specimen for a Lung Cancer Test?
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In the morning. It has been accumulating all night. This specimen is "STERILE" do not let the pt. touch the cup with their mouth
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Explain what the pt. should do for a sputum specimen for Lung Cancer
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Before they cough, they should rinse their mouth out with water to help decrease the bacterial count in the mouth. This helps the sputum not pick up bacteria from the mouth
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What are other tests for Lung Cancer?
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Chest X-ray; CT; MRI
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What is the main treatment for stage 1 and 2 of Lung Cancer
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Surgery - Lobectomy or Pneumonectomy
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Explain a Lobectomy
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Removal of a lobe, or part of the lung. This pt. will have chest tubes (do not want fluid accumulation). When positioning the pt. want the surgical side up (Want what is left of the lung to be able to expand)
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Explain a Pneumonectomy
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Removal of the entire lung. Position pt. on affected side - surgical side down, good lung up (if place on non-affected side will cause pneumonia) No chest tubes (If lung is gone will have no pleural space where the chest tubes would go)
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What positioning should we avoid with a Pnuemonectomy?
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Avoid severe lateral positioning (Mediastinal shift) Causes the Mediastinum to shift to the unaffected side. Mediastinal shift also causes compression of the lung on the unaffected side
