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Pediatric Nursing > Adult Exam 4 > Flashcards

Adult Exam 4 Flashcards

1
Q

Cancer

A

Group of more than 200 diseases

Characterized by uncontrolled and unregulated growth of cells

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2
Q

Biology of Cancer

A

Two major dysfunctions:

  1. Defective cell proliferation (growth)
  2. Defective cell differentiation
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3
Q

Defect in Cellular Proliferation

A

Characterized by loss of contact inhibition

No regard for cell boundaries, divide indiscriminately and haphazardly

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4
Q

Defect in Cellular Differentiation

A

Two types of genes that can be affected by mutation are protooncogenes and tumor suppressor genes

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5
Q

Protooncogenes

A

Regulate normal cellular processes such as promoting growth

Genetic locks that keep cells functioning normally

Mutations can activate them to work as oncogenes

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6
Q

Tumor Suppressor Genes

A

Function to regulate cell growth

Mutations make them inactive

Result in loss of suppression of tumor growth

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7
Q

Stages of Cancer Development

A

Initiation, Promotion, Progression

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8
Q

Initiation

A

Mutation of a cell’s genetic structure

Any change in the usual DNA sequence

May be inherited or acquired

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9
Q

Carcinogens

A

Cancer-causing agents capable of producing cell alterations

Many are detoxified by protective enzymes and are harmlessly excreted

May be chemical, radiation, or viral

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10
Q

Promotion

A

Characterized by reversible proliferation of altered cells

Activities of promotion are reversible (obesity, smoking, alcohol, dietary fat)

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11
Q

Latent Period of Cancer

A

May range from 1-40 years

Length of latent period associated with mitotic rate of tissue of origin and environmental factors

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12
Q

Progression

A

Characterized by increased growth rate of tumor, invasiveness, and metastasis

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13
Q

Main Sites of Metastasis

A

Lungs, brain, bone, liver, and adrenal glands

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14
Q

Role of Immune System in Cancer

A

Immune response is to reject or destroy cancer cells

Some cancer cells have changes on their surface antigens (Tumor-Associated Antigens, TAAs)

Immunologic surveillance (response to TAAs)

Immunologic Escape (mechanism by which cancer cells evade immune system)

Oncofetal antigens

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15
Q

Benign Neoplasms

A

Similar to tissue of origin

Well differentiated

Slow growth rate

No local invasion, often encapsulated

No metastasis

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16
Q

Malignant Neoplasms

A

Abnormal cells, poorly differentiated

Slow to rapid growth rate

Local invasion present, infiltrative growth, usually no capsule

Frequent metastasis

Significant harm to host

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17
Q

Tumors can be classified by…

A

Anatomic site

Histology (grading severity)

Extent of disease (staging)

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18
Q

Anatomic Site Classification

A

Carcinomas originate from embryonal ectoderm (skin, glands), endoderm (mucous membranes)

Sarcomas originate from embryonal mesoderm (connective tissue, muscle, bone, fat)

Lymphomas and leukemias originate from hematopoietic system

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19
Q

Histologic Classification

A

Appearance of cells and degree of differentiation are evaluated to determine how closely cells resemble tissue of origin

Grade I (cells differ slightly, well differentiated)

Grade II (cells are more abnormal, moderately differentiated)

Grade III (cells are very abnormal and poorly differentiated)

Grade IV (cells are immature and primitive and undifferentiated, cell of origin is difficult to determine)

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20
Q

Clinical Staging Classifications

A

0: Cancer in situ

I: tumor limited to tissue of origin, localized tumor growth

II: limited local spread

III: extensive local and regional spread

IV: Metastasis

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21
Q

TNM Classification System

A

Anatomic extent of disease based on three parameters:

Tumor size and invasiveness (T)

Spread to lymph nodes (N)

Metastasis (M)

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22
Q

Diagnoses of Cancer

A 
Cytology studies
Chest x-ray
CBC, chemistry profile
Liver function studies
Endoscopic examinations
Bone marrow examination
Radiographic studies
Radioisotope scans
PET scan
Tumor markers
Genetic markers
Molecular receptor status
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23
Q

Definitive Diagnostic Test

A

Biopsy

Tissue may be obtained by needle/aspiration, incisional procedure, excisional procedure

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24
Q

7 Warning Signs of Cancer

A 
C: change in bowel/bladder function
A: a sore that does not heal
U: unusual bleeding or discharge
T: thickening or lump
I: indigestion or difficulty swallowing
O: obvious change in wart/mole
N: nagging cough or hoarseness
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25
Q

Primary Factors that Determine what Cancer Treatment Therapy Is Used…

A

Cell type
Location and size of tumor
Extent of disease
Physiologic and psychologic status

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26
Q

Role of Surgery in Cancer Treatment

A

Consideration of surgical intervention involves assessment of tumor stage, technical feasibility of surgical resection, co-morbidities that may influence surgical risk, and expected postoperative functional outcomes

Objective is to remove all or as much resectable tumor as possible while sparing normal tissue

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27
Q

Goals of Chemotherapy

A

Can offer cure for some cancers, control other cancers for long periods of time, and in some instances offer palliative relief of symptoms

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28
Q

Chemotherapy Effect on Cells

A

Effective against dividing cells, so cancer cells escape death by staying in G0 phase

Problem: presence of drug-resistant resting and noncycling cells

As tumors get bigger, more cells become inactive and convert to G0

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29
Q

Classification of Chemotherapy Drugs

A

Classified by molecular structure and mechanism of action

Two major categories: Nonspecific and cell cycle phase-specific drugs

Typically given in combination

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30
Q

Cell Cycle Phase Nonspecific Drugs

A 
Alkylating agents
Nitrosoureas
Platinum drugs
Antitumor antibiotics
Corticosteroids
Hormone therapy
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31
Q

Cell Cycle Phase Specific Drugs

A

Antimetabolites
Mitotic inhibitors
Topoisomerase inhibitors

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32
Q

Chemotherapy Methods of Administration

A 
Oral
IM
IV (most common)
Intracavitary (intravesical, intraperitoneal)
Intrathecal/Intraventricular
Intraarterial
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33
Q

Preparation and Handling of Chemotherapy Agents

A

May pose an occupational hazard

Drugs may be absorbed through skin or inhalation

Only properly trained personnel should handle drugs

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34
Q

Chemotherapy Effects on Normal Tissue

A

Chemotherapy agents cannot distinguish between normal and cancer cells

Side effects are the result of the destruction of normal cells

General and drug-specific adverse effects are classified as acute, delayed, and chronic

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35
Q

Acute Toxicity of Chemotherapy

A

Occurs during and immediately after drug administration and includes anaphylactic and hypersensitivity reactions, extravasation or a flare reaction, anticipatory nausea and vomiting, and cardiac dysrhythmias

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36
Q

Delayed Effects of Chemotherapy

A

Include delayed nausea and vomiting, mucositis, alopecia, skin rashes, bone marrow suppression, and altered bowel function

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37
Q

Chronic Toxicities of Chemotherapy

A

Involve damage to organs such as the heart, liver, kidneys, and lungs

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38
Q

Radiation Therapy

A

Emission of energy from a source and travels through space or some material

Different types of ionizing radiation are used to treat cancer

Typically delivered once a day for 5 days a week for 2 to 8 weeks

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39
Q

Low-Energy Beams

A

Expend energy quickly

Penetrate a short distance

Useful for skin lesions

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40
Q

High-Energy Beams

A

Greater depth of penetration

Suitable for optimal dosing of internal targets while sparing the skin

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41
Q

Hypofractionated

A

High daily doses of radiation given with fewer fractions

42
Q

Hyperfractionated

A

Lower doses given more than once daily

43
Q

Accelerated Fractionation

A

Standard doses delivered twice daily over a shortened treatment time

44
Q

External Radiation

A

Teletherapy

Most common radiation treatment

Patient exposed to radiation from a megavolt machine

Gamma Knife Technology: Cobalt

Cyclotron: neutrons or protons

Linear Accelerator: ionizing radiation

45
Q

Internal Radiation

A

Brachytherapy

Implantation or insertion of radioactive materials into or close to tumor

Minimal exposure to healthy tissue

Commonly used in combination with external radiation

Patient emits radioactivity

Limit amount of time near patients being treated

46
Q

Common Side Effects of Radiation

A 
Bone marrow suppression
Fatigue
GI disturbances
Integumentary and mucosal reactions
Pulmonary effects
Reproductive effects
47
Q

Bone Marrow Suppression

A

Most common side effect of chemotherapy

Treatment-induced reductions in RBCs and WBCs can result in infection, hemorrhage, and overwhelming fatigue

48
Q

Nursing Management of GI Effects

A

Prophylactic administration of antiemetics

Assess for signs and symptoms of alkalosis, dehydration, and intake and output

Nonirritating, low-fiber, high-calorie, high-protein diet

Antidiarrheal, antimotility, and antispasmodic medications

Monitor for anorexia

49
Q

Dry Desquamation

A

Erythema is an acute response followed by dry desquamation

Dry reactions are uncomfortable and result in pruritus

Lubricate the skin with a nonirritating lotion emollient

50
Q

Wet Desquamation

A

If the rate of cell sloughing is faster than the ability of the new epidermal cells to replace dead cells, a wet desquamation occurs with exposure of the dermis and weeping of serous fluid

Wet reaction must be kept clean and protected from further damage

Generally produces pain, drainage, and increased risk of infection

51
Q

Nursing Management of Pulmonary Effects

A

May be progressive and irreversible

Cough, dyspnea, pneumonitis, pulmonary edema

Treatment includes bronchodilators, expectorants/cough suppressants, bed rest, oxygen

52
Q

Nursing Management of Cardiovascular Effects

A

Patients with preexisting coronary artery disease are more vulnerable

Radiation-induced heart disease is more likely in patients given high doses of radiation and doxorubicin

Herceptin is cardiotoxic

Commonly pericardial effusion

53
Q

Nursing Management of Reproductive Effects

A

Inform patients of expected sexual side effects

Use appropriate shielding

Encourage discussion of issues related to sexuality

Refer to counseling if needed

No way to repair ovarian function

54
Q

Late Effects of Radiation and Chemotherapy

A

Increased risk for leukemias and other secondary malignancies (multiple myeloma, non-Hodgkins lymphoma, various cancers)

Fibrosarcomas have been reported several years after radiation therapy

Secondary malignancies are usually resistant to therapy

55
Q

Biologic and Targeted Therapy

A

Effective alone or with surgery, radiation, and chemotherapy

Biologic: agents alter biologic response to tumor cells

Targeted: targets and binds cell receptors important to tumor growth

Include tyrosine kinase inhibitors, monoclonal antibodies, vascular endothelial growth factor receptor inhibitors, proteasome inhibitors

56
Q

Targeted Therapy

A

Works at sites on the cell surface, at the intracellular level, or in the extracellular domain

Interferes with cancer growth by targeting specific cell receptors and pathways that are important in tumor growth

57
Q

Tyrosine Kinase Inhibitors

A

Inhibits tyrosine kinase, the enzyme regulating cell proliferation and survival

Side effects include rash, dry skin, interstitial lung disease, infusion reaction, fatigue, fever, diarrhea

58
Q

Monoclonal Antibodies

A

Capable of binding to specific target cells to ultimately destroy them

Administered by infusion; can experience infusion-related symptoms, capillary leak syndrome, rare anaphylaxis

Fever, chills, urticaria, mucosal congestion, nausea, diarrhea, myalgias

59
Q

Angiogenesis Inhibitor

A

Binds vascular endothelial growth factor

Side effects include hypertension, colon bleeding and perforation, impaired wound healing, thromboembolism, hemorrhage

60
Q

Hematopoietic Growth Factors

A

Colony-stimulating factors

Glycoproteins that stimulate production, maturation, regulation, and activation of cells in hematologic system

May hasten recovery from bone marrow depression or reestablish bone marrow function

Can cause thromboembolic events

61
Q

Proteasome Inhibitor

A

Inhibits proteasome activity, which regulates cell growth

Side effects include bone marrow suppression, peripheral neuropathy, fatigue, diarrhea, nausea, vomiting

62
Q

Side Effects of Biologic and Targeted Therapy

A 
Flulike symptoms
Anorexia/weight loss
Fatigue, malaise, weakness
Nausea/vomiting
Photosensitivity
Tachycardia and orthostatic hypotension
CNS system effecs
Hepatotoxicity
Renal system side effects
63
Q

Hematopoietic Stem Cell Transplantation (HSCT)

A

Bone marrow transplant (BMT)

Peripheral stem cell transplantation (PSCT)

Allows high doses for treatment

Highly toxic, procedure with many risks including death

Tumor cells are eradicated and bone marrow is rescued by infusing healthy cells

Sources of cells include bone marrow, peripheral blood, umbilical cord blood

64
Q

Autologous Transplantation

A

Patients receive their own stem cells back following myeloablative chemotherapy

65
Q

Stem Cells from Bone Marrow

A

Procedure is performed in the OR under general or spinal anesthesia

Multiple aspirations are carried out to obtain adequate number of stem cells

Marrow is processed to remove bone fragments

Cells are cryopreserved until infused

66
Q

Stem Cells from Peripheral Blood

A

Outpatient procedure

Cell separation equipment sorts stem cells out, and other cells are returned to the donor

Procedure takes 2-4 hours

Multiple collections may be needed

67
Q

Stem Cells from Cord Blood

A

Umbilical cord blood can be HLA-typed and cryopreserved

May have insufficient numbers of stem cells to permit transplant to adults

Research is ongoing

68
Q

Complications of HSCT

A

Bacterial, viral, and fungal infections are common

Graft-versus-Host disease: T lymphocytes from donor stem cells recognize recipient as foreign; attacks organs such as skin, liver, and GI tract

Peripheral blood stem cells cause fever and less severe complications

69
Q

Gene Therapy

A

Experimental therapy

Genetic material is introduced into cells to fight disease or replace missing genes to prevent the development of disease

70
Q

Nutritional Problems of Cancer

A

Malnutrition

Fat and muscle depletion

Nutritional counseling needed when 5% weight loss is noted

Altered taste sensation

71
Q

Infection Related to Cancer

A

Primary cause of death

Usual sites of infection include lungs, GU system, mouth, rectum, peritoneal cavity, blood

Occurs due to ulcerations, compression of vital organs by the tumor, neutropenia caused by disease or treatment

72
Q

Oncologic Emergencies

A

Life-threatening

Occur as the result of disease or treatment

Emergencies can be obstructive, metabolic, infiltrative

73
Q

Superior Vena Cava Syndrome

A

Obstructive emergency

Obstruction by tumor or thrombosis

Signs include facial/periorbital edema, distention of veins of head neck and chest, seizures, headache

74
Q

Spinal Cord Compression

A

Obstructive emergency

Tumor in epidural space of spinal cord

Signs include intense back pain, motor weakness, sensory paresthesia and loss, change in bowel or bladder function

75
Q

Third Space Syndrome

A

Obstructive emergency

Shifting of fluid from vascular space to interstitial space

Signs of hypovolemia, including hypotension, tachycardia, low central venous pressure, and decreased urine output

Treatment is replacement of fluids, electrolytes, and plasma protein

76
Q

Metabolic Oncologic Emergencies

A 
SIADH
Hypercalcemia
Tumor lysis syndrome
Septic shock
DIC

Caused by the production of ectopic hormones directly from the tumor or are secondary to metabolic alterations caused by the presence of the tumor or cancer treatment

77
Q

SIADH

A

Abnormal or sustained production

Cancer cells are able to manufacture, store, and release ADH

Treatment includes treating underlying malignancy and measures to correct the sodium-water imbalance, including fluid restriction, isotonic saline, oral salt tablets

Symptoms include weight gain without edema, weakness, anorexia, nausea, vomiting, personality changes, seizures, oliguria, decrease in reflexes, and coma

78
Q

Hypercalcemia

A

Parathyroid hormone-like substance secreted from cancer cells

Signs include apathy, depression, fatigue, weak muscles

Electrocardiogram changes, polyuria, nocturia, anorexia, nausea, vomiting

79
Q

Tumor Lysis Syndrome

A

Triggered by chemotherapy’s rapid destruction of large numbers of tumor cells

Increased serum phosphate causes calcium to decrease resulting in hypocalcemia

Can cause biochemical changes resulting in renal failure

Four hallmark signs: hyperuricemia, hyperphosphatemia, hyperkalemia, hypocalcemia

Usually occurs within 24-48 hours after chemotherapy

80
Q

Cardiac Tamponade

A

Infiltrative oncologic emergency

Fluid accumulation in pericardial sac, constriction of pericardium by tumor, or pericarditis

Management aimed at decreasing fluid around the heart and includes surgical establishment of pericardial window, indwelling pericardial catheter

Manifestations include SOB, tachycardia, cough, dysphagia, hiccups, hoarseness, nausea, vomiting, excessive perspiration, decreased LOC, distant heart sounds, extreme anxiety

81
Q

Carotid Artery Rupture

A

Infiltrative oncologic emergency

Invasion of artery wall by tumor or erosion following surgery or radiation

Bleeding can manifest as minor oozing, spurting of blood

IV fluids and blood administered to stabilize for surgery

82
Q

Cancer Pain

A

Inadequate pain assessment is the single greatest barrier to effective cancer pain management

Fear of addiction is unwarranted

83
Q

Cancer Psychologic Support

A

Emphasis is placed on maintaining optimal quality of life

Positive attitude of patient, family, and health care providers can have a positive impact on quality of life

Common fears include disfigurement, emaciation, dependency, disruption of relationships, pain, financial depletion, abandonment, death

84
Q

Cancer Gerontologic Considerations

A

Clinical manifestations may be mistaken for age-related changes

More vulnerable to complications of cancer and cancer therapy

Functional status should be considered when a treatment plan is selected

85
Q

Skin Cancer

A

Most common cancer in the US

Includes both non-melanoma skin cancer and melanoma

86
Q

Risk Factors for Skin Cancer

A

Fair skinned, fair haired

People who sunburn

Chronic sun exposure

Exposure to chemicals

Adults over 50 years old

Males

Scars from severe burns

Chronic skin irritation

87
Q

Nonmelanoma Skin Cancers

A

Actinic Keratosis

Basal Cell Carcinoma

Squamous Cell Carcinoma

88
Q

Actinic Keratosis

A

Premalignant skin lesions

Squamous epithelium or mucous membranes

Irregularly shaped, flat, slightly erythematous papule, indistinct borders, keratotic scale or horn

Appears in sun exposed areas

Treatment is removal or topical agents

89
Q

Basal Cell Carcinoma

A

Most common type of skin cancer

Least deadly

Small, waxy nodule with pearly or translucent borders, may develop ulceration as it grows

Appears in sun exposed areas

Rarely metastasizes

Treatment is removal

90
Q

Squamous Cell Carcinoma

A

Potential to metastasize, more deadly

Firm flesh colored or erythematous papule, becomes ulcerated and painful as it grows

Appears in sun exposed areas

Treatment is removal, chemotherapy

91
Q

Melanoma

A

Skin cancer arising from melanocytes

When lesions confined to epidermis–flat and relatively benign

When lesions penetrate dermis–mix with blood and lymph and metastasize, develop raised or nodular appearance

Prognosis determined by tumor thickness, ulceration, metastasis, site, age, gender

92
Q

Melanoma Growth Phases

A

Radial Growth Phase: initial phase, grows parallel to skin surface, curable

Vertical Growth Phase: penetrates into dermis, grows rapidly, color and shape changes

93
Q

Melanoma Precursor Lesions

A

Dysplastic nevi

Congenital nevi

Lentigo maligna

94
Q

Dysplastic Nevi

A

Weird shaped moles

95
Q

Congenital Nevi

A

Higher likelihood of becoming cancerous because they’ve been there since birth

96
Q

Lentigo Maligna

A

Flat, kind of like age spots

97
Q

ABCDE Rule

A 
Asymmetry
Border irregularity
Color change
Diameter greater than 6 mm
Evolving in appearance
98
Q

Diagnosis of Malignant Melanoma

A

Shave-biopsied, shave-excised, electrocauterized

MelaFind

Tumor thickness–Breslow measurement (looks at depth), Clark level (looks at how invasive)

99
Q

Labs to Evaluate for Melanoma Metastasis

A

LFT
CBC
Chemistries
CXR

100
Q

Collaborative Care for Malignant Melanoma

A

Treatment determined by site of original tumor, stage of cancer, and patient’s age and general health

Includes surgical incision and adjuvant therapy

101
Q

Nursing Care for Malignant Skin Disorders

A

Reassurance and emotional support

Skin/wound care

Prevention measures

Monthly skin exams

Regular checkups

Pediatric Nursing (7 decks)

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