Oncology med-surg – Flashcards
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What are the side effect of radiation therapy?
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Skin reactions Fatigue Altered taste/ Anorexia Mucositis Xerostomia (dry mouth) Radiation caries Esophagitis Dysphagia Nausea, vomiting, diarrhea Tenesmus Cystitis Urethritis Alopecia Myelosuppression Infertility
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Side effects of biological therapy: neupogen, neulasta, neumega, procrit?
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Flu-like syndrome - most common Skin rashes Tachycardia and orthostatic hypotension CNS Renal Hepatic
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what is molecular targeted therapy?
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Target the part of the cell that is aberrant or more abundant in cancer cells. Block the growth and spread of cancer by interfering with specific molecules that are involved with growth, progression, and spread of cancer.
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what is Herceptin?
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Treat breast cancer. It directed against HER-2 protein. HER-2 is expressed at high levels on the surface of some cancer cells
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what is Hormone Manipulation?
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-decrease hormones reach hormone sensitive-tumor -Hormone antagonist compete with natural hormones at the tumor receptor sites, prevent binding -Hormone inhibitors suppress the production of specific hormones in the normal hormone-producing organs
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What are the side effects of hormone therapy?
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-Androgens & anti-estrogen receptor drugs cause masculinity in women (facial/chest hair; menstrual changes; shrinking of breast tissue) -acne, fluid retention, DVT, liver dysfunction -Feminizing changes with estrogen use in men include (thinning, facial hair, smoother skin, gynecomastia, testicular & penile atrophy)
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What is photodynamic therapy?
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Selective destruction of cancer cells through a chemical reaction triggered by different types of laser light. Common in non-melanoma skin cancers, ocular tumors, GI tumors, and lung cancers
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what is oncological emergency?
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• Pericardial Effusions and Neoplastic Cardiac Tamponade • Superior Vena Cava Syndrome • Sepsis and Septic Shock • Spinal Cord Compression • Tumor Lysis Syndrome • Hypercalcemia and Hyperuricemia • SIADH
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what are the important documents for end of life?
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-advance directive: personal directive, advance directive, or advance decision, is a legal document in which a person specifies what actions should be taken for their health if they are no longer able to make decisions for themselves because of illness or incapacity -durable power of attorney for health care (DPOAHC) -durable power attorney (DPOA) -living will medical orders for life-sustaining treatment (MOLST)
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Nursing care for palliative care?
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• Pain Management • Shortness of breath; other breathing difficulties • Dysphagia • N & V, Anorexia • Constipation; other elimination problems • Prevention of pressure ulcers • Psychological and spiritual support of the patient and family
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what is sickle cell anemia?
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• ↓ paO2 → ↓ HbO2 → changes shape & deformability of RBC → "sickled" • Sickled cells are hyper adhesive → obstruct flow in microcirculation → hypoxia → cells die → hemolytic anemia • Chronically this can lead to stroke and other vasoocculsive events • sickled red cells crumpled together occluding small blood vessels
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What are the signs and symptoms of sickle cells anemia?
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stroke, blindness, pneumonia, acute chest syndrome, heart, liver, gallstones, chronic kidney disease, atrophic spleen, osteomyelitis, pain, skin ulcers
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what are the recognized patterns of sickle cell crisis?
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o Bone crisis o Large bones in arms and legs o Acute chest syndrome o Chest pain, non-productive cough, hemoptysis o Scarred lungs over time o Abdominal crisis o Constant unrelenting pain, N/V/D o Joint crisis o Permanent limited ROM and disability
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what are the treatment for sickle cell crisis?
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o Hydration, hydration, hydration o Oxygenation o rest o Transfusions o Opioids for pain relief o Hydroxyurea (Droxia)- used to increase the amount of Hgb F and decrease the amount of Hgb S
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what is leukemia?
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• A type of cancer with uncontrolled production of immature WBC in the bone marrow o Acute lymphocytic (ALL) o Chronic lymphocytic (CLL) o Acute myeloid (AML) o Chronic myeloid (CML) o Hairy cell leukemia
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What are the S&S of leukemia?
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o High fever with sudden onset o Abnormal bleeding o Easy bruising with minor trauma o Petechia o Prolonged menses low-grade fever o Pallor weakness o Weight loss o Night sweats
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what are the S&S of Acute Lymphoblastic Leukemia (ALL), Acute Myelogenous Leukemia (AML) & Acute Monocytic Leukemia (AML)?
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o Dyspnea o Malaise o Fatigue o Tachycardia o Palpitation o Systolic ejection murmur o Abdominal or bone pain o In meningeal leukemia, early symptoms include confusion, headache, and headache
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what are the diagnostic test for leukemia?
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o CBC o Decreased HbG, Hct o Platelets low & whole blood clotting time & aPTT is prolonged o Abnormal WBC, Can be low, normal or high o Bone Marrow Aspirate & Biopsy o Examine cells of aspirate o Full of blast phase cells (immature cells that are dividing) & proteins (antigens) on surface of leukemic cells ("markers") = + Leukemia o Chromosome Analysis o Imaging - Chest X-ray o Leukemic infiltrates w/in lung
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what are the nursing cares for leukemia?
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o Prevent infection o Skin care o Chest pulmonary hygiene o Minimizing injury o Provide mouth care o Provide high calorie, high vitamin diets o Neutropenic precautions o Strict hand washing o Prevent skin break down o Administer and monitor bld transfusion o Administer medications o Radiation
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what is Stem Cell Transplant for leukemia?
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Pre-Transplant o Conditioning o Wipe out the patient's own marrow (preparing for optimal graft uptake) o Give higher than normal doses of chemo and/or radiotherapy (get rid of cancer cells) o Usually 5-10 days Post-Transplant o Prevention of complications o Failure to engraft (donated stem cells fail to grow in marrow) o Graft versus host disease (mostly in allogenic transplants...seen as foreign & attack transplant) o Veno-occlusive disease (blockage of liver blood vessels by clotting and inflammation occurs) o Monitor signs of infection, Monitor for signs of bleeding
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what is hodgkin's lymphoma?
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cells in the lymphatic system grow abnormally and may spread beyond the lymphatic system
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what are the S&S of hodgkin's?
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Large but painless lymph nodes fever, heavy night sweats, weight loss
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what are the diagnostic test for Hodgkin's?
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o Biopsy reveals + Reed-Sternberg cells o Once + dx, staging done to determine extent of disease. o CBC, SMA12, Kidney & Liver function, ESR o Bone marrow aspirate o CT of neck, chest, abdomen & pelvis o PET if CT not conclusive
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What is Non-Hodgkin's lymphoma?
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• Includes all lymphoid cancers that do not have Reed-Sternberg cells. • Spread thru lymphatic system. High incidence in transplants and HIV
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what are the S&S of NHL?
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swollen lymph nodes, Painless cervical, axillary, inguinal or femoral nodes
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what are the diagnostic test for NHL?
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+Biopsy, have LP to evaluate CSF
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What is Multiple myeloma?
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• WBC cancer that involves mature B-lymphocyte • (plasma cell) • Cancerous cells produce antibodies = gamma globulins (gammopathy) • Result is decreased RBC, WBC & platelets • Anemia and risk for infection & bleeding • Also produce cytokines = increase cancer cell growth & destroy bone.
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what are the S&S of multiple myeloma?
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Fatigue, anemia, bone pain, pathologic fractures, recurrent bacterial infections & kidney dysfunction, easily bruises
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what are the diagnostic test for multiple myeloma?
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o + elevation serum protein or + monoclonal protein (paraprotein) o CBC. SMA12, coag panel o Bone marrow aspirate w/ more than 10% of marrow infiltrated w/ plasma cells, presence o Monoclonal protein in serum/urine and presence of osteolytic bone lesions
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what are the 7 signs of cancer CAUTION?
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Change in bowel/bladder A sore doesn't heal Unusual bleeding or discharge Thickening or lump in breasts Indigestion or difficulty swallow Obvious change in warts or moles Nagging cough or hoarseness
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what is neoplasia?
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Definition: Any new or continued cell growth not needed for normal development or replacement of dead and damaged tissue
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what is anaplasia?
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very poor differentiated, without specific shape
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what is dysplasia?
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poor differentiated, differ in size, shape, arrangement
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what is hyperplasia?
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increase in number via increase cell division
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what is metaplasia?
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one cell type changes to another cell type
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what are the steps of metastasis?
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o Malignant transformation: cell undergo malignant transformation o Tumor vascularization: tumor angiogenesis factor builds blood vessel into tumor o Blood vessel penetration: break holes in vessels and travel into bloodstream o Arrest and Invasion: invade new tissue
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what is paraneoplastic syndrome?
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occurs when cancer-flighting agents of the immune system also attack parts of brain, spinal cord, peripheral nerves, muscles. experiences fatigue, loss appetite, mother/sensory deficit, decreased resp. pain, GI upset -HTN, hypokalemia, SIADH, cortisol production, hypercalcemia
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what is superior vena cava syndrome?
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narrow or blockage of the SVC, caused by cancer. Will see periorbital edema.
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What are the chemotherapy drugs?
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-Antimetabolites: interfere with enzymes or their reaction are necessary for DNA synthesis -Antitumor antibodies: interfere with deoxyribonucleic acid to prevent its further replication and the transcription of ribonucleic acid -Antimitotic agent: inhibits or blocks mitosis -Alkylating agent: transfer alkyl group to DNA base, results in cross linkage, abnormal pairing, DNA breakage -Topoisomerase inhibitor: interfere with topoisomerase change DNA structure -Platinum compounds: cause cross link of DNA
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what is extravasation?
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• Infiltration of IV antineoplastic agent into local tissue • Irritants: Cause pain and inflammation in SQ Tissue • Vesicants: Cause Cellular/Tissue damage if leakage into SQ Tissue
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what are the dose limiting toxicities?
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• Cardiotoxicity - Doxorubicin • Pulmonary Fibrosis - Bleomycin • Neurotoxicity - Vincristine • Hypersensitivity - Paclitaxel • Renal Toxicity - Cisplatin
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what is NADIR?
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• Time when bone marrow activity and WBC counts are at their lowest levels after chemotherapy • Occurs at different times for different chemotherapy drugs • Avoid using drugs with common nadirs
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what are the side effect of hematopoietic?
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• Anemia: Decreased RBC, Tx: Procrit, epogen, aranesp, Transfusion • Thrombocytopenia: Decreased Platelets, Tx: Neumega, Transfusion • Leukopenia/Neutropenia: Decreased WBC/ Neutrophils, Tx: Neupogen, Neulasta
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what are the side effects of GI?
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• Anorexia • Nausea • Vomiting • Mucositis • Stomatitis • Constipation • Diarrhea • Pancreatitis • Hepatic Toxicity
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what are the side effects of Integumentary?
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• Alopecia • Dermatitis • Nail Changes • Hyperpigmentation • Radiation Recall • Rash
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what are the side effects of reproductive?
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• Infertility • Changes in Libido • Erectile Dysfunction • Amenorrhea
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what are the antiemetic therapy for CINV?
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• Ondansetron (Zofran) • Granisetron (Kytril) • Granisetron transdermal (Sancuso) • Dolasetron (Anzemet) • Palonosetron (Aloxi)
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what are the two types of radiation therapy?
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o Beam (Teletherapy): radiation source external to patient and remote from the tumor site o Internal (Brachytherapy): radiation source must come into direct, continuous contact with the tumor tissues for a specific period of time. Permanent prostate brachytherapy involves placing radioactive seeds within the prostate to treat prostate cancer. The seeds, which are typically permanent, emit radiation that dissipates over a few months. During intra cavity brachytherapy, an applicator containing a radioactive substance is placed within the body, at or near the site where the tumor is located or was removed.
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what are the nursing care for Teletherapy?
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• Use hand to gently wash radiation area with soap & water and rinse soap thoroughly • Do not remove ink or markings • Pat dry - do not rub • Do not apply powder, lotion, ointments, or creams until prescribed • Wear soft clothing over radiated site • Avoid wearing belts, buckle, straps over area • Avoid exposure to sun and heat exposure
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what are the nursing cares for Brachytherapy?
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• Assign patient to a private room • Place "Caution: radioactive material" sign on the door • If portable lead shields are used place them between the patient and the door • Keep door closed at all times as much as possible • Wear a dosimeter film badge at all times while caring for patients with radioactive implants • Wear lead apron when caring for the patient & always keep apron facing the patient • Pregnant women and children younger than 16 years should not be allowed close to the patient • Limit visitors to 30minutes/day and must be at least 6 feet from source • Never touch radioactive source with bare hands • In rare events in which it becomes dislodged, use long-handled forceps to retrieve it • Deposit in radioactive container in patients room • Save all linens and dressings until radioactive source has been removed
