AC 2 4 Flashcards
Is cancer generally painless?
Yes; pain starts when it grows and starts pushing/putting pressure on something
What are some risk factors for cancer?
Genetics, smoking, drinking, dietary factors, chemical agents, sun, radiation, radon, hormonal, etc.
What are some characteristics of cancer cells?
Altered cell membrane
Nuclei large & irregular
Fragility
Frequent mitosis; need more glucose and oxygen
Why is pain control important in cancer patients?
Patients won’t/can’t tolerate treatment unless their pain is controlled
Primary cancer prevention includes
Wearing sunscreen
No smoking/drinking
Clean air
Eat balanced diet
PPE at workplace
What medication is used to prevent breast cancer?
Tamoxifen
When should secondary cancer prevention start?
When we suspect cancer
Secondary cancer prevention includes
Screening and testing
Includes self-examination, mammogram, etc.
When should primary cancer prevention start?
Should be an everyday practice. All the time.
When does tertiary cancer prevention start?
When you have cancer
Tertiary cancer prevention includes
Surgery and cancer treatment
Signs and symptoms of cancer include (CAUTION)
C - Change in bowel & bladder habits
A - Sore that does not heal
U - Unusual bleeding or discharge
T - Thickening or a lump in breast or else where
I - Indigestion or difficulty swallowing
O - Obvious change in wart or mole
N - Nagging cough or hoarseness
Why is ECHO important to obtain before starting chemo?
Because chemo can screw up the heart. So baseline needs to be obtained
Higher the number on cancer staging
More severe the cancer is; cure chance goes down
About how many numbers of cancer cells are there for us to start questioning for cancer?
About 200
What is ploidy?
Classifies tumor chromones as normal or abnormal
What needs to be done before planning for cancer treatment?
Cancer staging
What is carcinoma in situ aka stage 0?
Body has walled off the cancer cells. Will remove that part and patient will be good and cancer free (but will need screenings and monitoring)
What are some nurses’ role during cancer diagnosis?
Clarify any misconceptions and fears
Comfort patient during procedures
Assess for the test outcomes
Support family
What is an example of prophylactic surgical cancer treatment in relation to breast cancer?
Cancer on R. boob but remove both boobs to prevent getting cancer on L. boob
What are some nonsurgical cancer treatment/management?
Chemo
Radiation
Bone marrow transplantation
Hyperthermia
Biologic response modifiers
What’s one big thing to know about radiation treatment?
No matter how good and precise the machine is, radiation will still affect nearby organs.
Ex) man with prostate cancer might have urination/bowel issues from radiation
What is external radiation for?
Treating superficial lesions and deeper structures
Why is skin care important with radiation treatment?
Can cause redness, burn, nerve damage, etc. ask about sensation changes
What are some patient education related to external radiation treatment and skin care?
No lotions, especially alcohol containing ones
No ointments, powders, or soaps
DO NOT wash off skin markings
Why do you want to instruct patients to not remove skin markings for radiation treatment?
Because the markings line up with the machine to precisely target cancerous area
What do you want to do if a patient’s implant that is radioactive falls out?
Don’t touch it with bear hands.
Use tongs.
Contact a radiation tech (or specialist) if you don’t know what to do
Protect yourself
What’s brachytherapy?
Internal radiation treatment; high dose to localized area via implants, needles, seeds, beads or catheters
Why do patients receiving internal radiation treatment need to be in isolation?
Because they emit radiation. Radiation source is within the patient. Once they receive it, they are potential hazard for a period to others
If the half life of an internal radiation treatment is 8 days, how many days does this patient need to be in isolation?
8 days. No close contact with others.
What is a potential symptom a thyroid cancer patient could experience as a result of getting external radiation treatment?
Dysphagia
Healthcare workers wearing a radiation badge or monitoring device are to
Measure how much radiation they get so they are protected.
If they reach a certain amount they will be sent home and have rest period
Why is cluster care important when caring for a patient receiving radiation?
To minimize exposure to protect yourself
What kind of cells does chemo destroy?
Any rapidly growing cells. Doesn’t matter if it is cancerous or not
Can chemo kill you?
Yes. It kills rapidly growing cells. Your organs are full of rapidly growing cells
Can all nurses give chemo?
No. You have to be certified
Why is combination therapy commonly used when treating cancer?
Because all chemo drugs are different; it can be cell cycle specific, phase specific, or nonspecific.
That means different chemo kills cells at different stages.
Killing cells at different stages will be more effective
Why is chemo drug so dangerous and requires precise calculation?
Because there is a relatively small difference between a therapeutic dose and a toxic dose
What are some types of chemo?
Antimetabolites
Antitumor antibiotics
Nitrosureas
Alkylating agents (mustard gas type)
Plant alkaloids
Hormonal agents
How is chemo drug prepared?
Wearing PPE and under the hood
Port is used during IV chemotherapy. Patient has cancer on R. arm. Where would the port be placed?
Opposite side of where the cancer is; so L. side
Usually, but not always on opposite side
Why are GI related symptoms common in chemo side effects?
Because your GI tract cells are fast growing cells. Chemo targets those cells
What are some S/E of chemo?
GI - N/V/D, stomatitis, anorexia, mucostitis
Infection and hemorrhage
Kidney damage from dead cells (esp. from tumor lysis syndrome)
Cardiac toxicity, signs of CHF
Reduces lung function
Sterility or chromosomal abnormality in offspring
peripheral neuropathy, loss of DTR, paralytic ileus, hearing loss
What recommendation can you make to patients who want to have kids but are about to receive chemo?
Freeze egg/sperm
Why are infection and hemorrhage side effects of chemo?
Due to bone marrow suppression
Why is anorexia a problem when receiving chemo?
Patients need to eat to heal. If they don’t eat, it will take longer for them to recover
Fresh flowers, fruits, or vegetables are not allowed for chemo patients because
They are prone to infection. All those can cause infection
Why do you need to monitor kidney function closely when receiving chemo?
All the dead cells from chemo will be filtered through the kidney -> kidney damage
All the drugs they are getting are also filtered through the kidneys -> more damage
Chemo can make pee very acidic which if left untreated, can damage kidneys. What can be given to the patient to help with this?
Good hydration and allopurinol to alkalize urine
Why is aseptic technique important when caring for a patient receiving chemo?
Because of bone marrow suppression, their neutrophil count is low -> susceptible to infection.
What’s chemo brain?
Thinking and memory problems after cancer treatment. They will get over it but it may take a while
Patient education on alopecia (how to manage)
Keep scalp moist, use mild shampoos
Look Good-Feel Better program can be helpful
What are some things that patients with stomatitis or oral mucositis can use to rinse their mouth?
Magic mouthwash
Plain water
Salt water
What kind of mouth wash is not recommended for stomatitis/oral mucositis?
Commercial mouth rinses with alcohol
Lemon-glycerin swabs
These are too strong
What’s Nadir?
The lowest point that the blood counts fall to after chemo
What’s the most important thing staff and family need to do when caring for neutropenic patients?
Strict handwashing
What kind of diet is recommended for neutropenic patients?
Low microbial diet
Can you check rectal temperatures and give rectal suppositories, enemas, or examinations to patients with thrombocytopenia?
No. Risk of bleeding. Nothing up the ass.
Why would you give stool softeners to thrombocytopenia patients?
To avoid straining; increased risk of bleeding
No IM injections on thrombocytopenia patients. Why?
Risk of bleeding
What is Superior Vena Cava Syndrome (SVCS)?
Compression or invasion of SVC by tumor and/or enlarged lymph nodes
What are some symptoms of superior vena cava syndrome?
Progressive SOB
Cough
Facial swelling
Edema of neck, arms, hands, thorax
Tightness
Difficulty swallowing
Engorged & distended jugular
How is superior vena cava syndrome managed?
Radiation to shrink tumor and relieve symptoms
Chemo
Oxygen therapy
Anticoagulants
Diuretics
Why would anticoagulants be used when treating superior vena cava syndrome?
Bc superior vena cava is narrowed; blood clots can form. it’s no good
Why would diuretics be used to treat SVCS?
Obstruction of superior vena cava can cause fluid build up in upper body which leads to swelling. We need to get rid of extra fluids
Why do you want to watch fluid balance when managing SVCS?
To reduce upper body edema
What is tumor lysis syndrome?
Cells burst in large numbers due to cytotoxic therapies. when the cells burst, it release all the cell products into the bloodstream, causing electrolyte imbalance.
What electrolytes need to be monitored for tumor lysis syndrome?
Potassium (high)
Phosphorus (high)
Uric acid (high)
Calcium (low; secondary to high phosphorus)
Tumor lysis syndrome patients are at risk for
Renal failure (cell debris gets filtered)
Alterations in cardiac function (due to hyperkalemia)
What medication is given to tumor lysis syndrome patients?
Allopurinol (uric acid)
What patient education is needed for tumor lysis syndrome patients?
Adequate hydration to help with electrolyte balance and kidney stones from uric acid
Take allopurinol 2-4 days prior to chemo
Urine output for tumor lysis syndrome patients should be at least
150mL/hr
Why is Rheumatoid arthritis systemic?
Because it’s an autoimmune disease; It’s called rheumatic disease.
What is arthritis?
Inflammation of one or more joints; either inflammatory or non-inflammatory
Why is long term steroid use in osteoarthritis not recommended?
It’s only a temporary fix, can lead to hyperglycemia, increased risk of infection, and fractures
And cushing’s like symptoms