Adult Health- Cancer- Chapters 21 and 22 Flashcards
What is cancer?
Results when normal cells mutate into abnormal, deviant cells that perpetuate within the body…can affect any body tissue
What does hypertrophy mean?
.Growth that causes tissue to increase in size by enlarging each cell
What does hyperplasia mean?
.Growth that causes tissue to increase in size by increasing the number of cells
What does neoplasia mean?
Any new or continued cell growth not needed for normal development or replacement of dead and damaged tissues
What does carcinogenesis mean?
.takes years and depends on several tumor and patient factors. Three interacting factors influence cancer development: exposure to carcinogens, genetic predisposition, and immune function
What does oncogenesis mean?
. Cancer development
Describe mitosis.
.is for one cell to reproduce into two new daughter cells, each of which is identical to the parent cell that started
What is primary prevention?
concerned with reducing cancer risk in healthy people= health diet and exercise- don’t/quit smoking, use smoking, vaccines, avoid known carcinogens
What is secondary prevention?
prevention involves detection and screening to achieve early diagnosis and intervention-genetic testing, mammograms, , Self-breast exam, Self-testicular exam, Screening colonoscopy, Pap test
What does metastasis mean?
.spread of disease
What does chachexia mean?
, (extreme body wasting and malnutrition) develops from an imbalance between food intake and energy use
What does adjuvant mean?
sometimes called co-analgesics) are drugs that have a primary indication other than pain but are analgesic for some painful conditions
What does nadir mean?
period of greatest bone marrow suppression
What does cytotoxic mean?
are mostly those used in the treatment of cancer and autoimmune disorders. These drugs interfere with all rapidly dividing cells, especially the white blood cells (WBCs), which are responsible for providing immunity and protection against infection. The result is a decrease in the number of these important cells, especially the neutrophils, 345greatly increasing the patient’s risk for infection.
What does extravasation mean?
drugs that cause severe tissue damage if they escape into the subcutaneous tissue
What does vesicant mean?
drugs that cause severe tissue damage if they escape into the subcutaneous tissue (extravasation).
What does muscositis mean?
sores in mucous membranes) often develops in the entire GI tract, especially in the mouth (stomatitis refers to reactions that involve the other tissues and structures in the oral cavity
What does stomatitis mean?
sores in mucous membranes) often develops in the entire GI tract, especially in the mouth (stomatitis refers to reactions that involve the other tissues and structures in the oral cavity
What does alopecia mean?
Hair loss
What is the highest mortality rate cancer?
lung cancer
What is the number one cancer for males?
prostate
what is the number one cancer for women?
breast
What does anaplasia mean?
loss of specific appearance of parent cells… will become smaller and rounder with larger nucleus than normal cell
What are the characteristics of malignant cells?
anaplasia, loss of regulation rate of mitosis, loss of special function (serves not useful purpose), loss of contact inhibition (invades other cells and migrates), progression of deviant cells, ability to promote its own survival
Describe benign cells.
Local, cohesive Well-defined border Slow growth Encapsulated Pushes other tissues out of way Usually easily removed and does not recur
Describe malignant cells.
Invasive, non-cohesive Invades/destroys surrounding tissue Rapid growth Mets to distant sites Not always easy to remove, can recur
Describe the development of cancer.
Initiation
-Chemical carcinogens
-Physical carcinogens
-Genetic susceptibility
Promotion- proliferation of mitotic rate of the tissue of origin
Progression- evidence of clinical disease- evidence of regional spread and metastasis
Possible causes of cancer.
Viruses (table 21-7) Chemical Agents (table 21-6) Genetics Dietary Factors (chart 21-1) Hormones Immune system Age-related (chart 21-2
What does CAUTION mean?
Table of warning signs for cancer
- C-Change in bowel or bladder habits
- A- a sore that does not heal
- U- Unusual bleeding or discharge from the rectum, bladder, or vagina
- T- Thickening of breast tissue or a new lump in breast
- A- a lump in the testes
- I- Indigestion or trouble swallowing
- O- Obvious changes to moles or warts
- N- Nagging cough or hoarseness that persists for four to six weeks
What are some diagnostic studies for cancer?
biopsy, chest x-ray, cytology, bone marrow, MRI, mammorgram
What are some good lab values to indicate possible cancer markers?
CBC, LFT, CEA(colon cancer), PSA(prostate cancer),
What is a guaic stool?
testing for occult blood
Tell whether the following statement is true or false.
Primary prevention involves detection and screening to achieve early diagnosis and intervention
false- : Primary prevention is concerned with reducing the risks of cancer in healthy people. Secondary prevention involves detection and screening to achieve diagnosis and prompt intervention to halt the cancer process
Describe the classification of cancer.
Anatomic Site Histologic Analysis Extent of Disease --Clinical staging --TNM Classification system
Describe some prefixes of tumor classification.
Glio: glial cells (brain) ex. glioblastoma
Osteo/lipo: bone/fat cells ex. Osteosarcoma, Liposarcoma
Squamous: epithelial layer of tissue ex. Squamous cell carcinoma of skin, lung, cervix
Describe what TNM stands for.
T: presence and extent of primary tumor
N: absence or presence of lymph node metastasis
M: absence or presence of distant metastasis
Provide an example of TNM classification system.
Ex: T2, N2, M0 Moderately sized primary tumor present with moderate lymph node involvement, no distant mets found
Describe the grading of malignant tumors
Gx - Grade cannot be determined
G1 - Tumor cell well differentiated and closely resemble normal cells they arose from
G2-4 moderately differentiated…to poorly differentiated and retain no normal cell characteristics (hard to determine tissue origin)
What are the top 4 most common sites of metastasis?
Breast: bone, lung
Lung: brain
Colorectal: liver
Prostate: bone
What are the 3 ways of metastasis?
Lymphatic spread- check the “sentinal” lymph node- primary lymph node for draining
Hematogenous spread
Angiogenesis
What are the goals of cancer treatment?
Cure
Control
Palliation
What are some treatment options for cancer?
Surgery
Radiation
Chemotherapy
Biologic Therapy
Describe the role of surgery.
Diagnosis & Staging- biopsy, laporatic surgery to see what is going on
Treatment for Cure & Control- removing the mass and surrounding tissue-send it to the lab
Reconstruction
Prophylaxis- double mastectomy
Provide Palliation- debulk a tumor to help with pain
Describe the role of radiation therapy.
- Purpose is to destroy cancer cells with minimal effects on surrounding normal cells
- Three factors determining absorbed dose of radiation: intensity, duration and closeness
- Some tissues are more sensitive to RT than others: ex. Breast can tolerate > doses than liver
- Radiation delivery methods: External (teletherapy) vs Internal (brachytherapy)
- Chemo may be given first to ‘sensitize’ tumor to greater radiation damage
- Goals of Radiation: Cure, Control, & Palliation
What are some effects of radiation therapy?
Localized to area being irradiated, but acute and long-term reactions occur to surrounding cells
Tissues most affected: rapidly proliferating cells ex. Skin, epithelial lining GI tract- oral mucosa, taste buds, salivary glands, N/V/D
Bone marrow suppression and fatigue are common systemic effects
What are some side effects of radiation on the skin?
Erythema -redness Desquamation -Dark red to purple, Dry desquamation -Peeling, shedding, pruritis Wet desquamation -edema blisters
What is some nursing care for external radiation?
Avoid frequent washing, scratching treated areas, use only electric razors. Do not wash off treatment markings
Don’t disrupt blisters; inspect skin for changes, use sun screen, loose clothing
Do not apply lotions, soaps, deodorants, powder to treatment areas (unless prescribed)
Do not use heat or cold to affected areas
If weeping, apply gauze dressing, keep clean
Avoid the sun
What is some nursing care for internal radiation?
Private room/private bathroom
Label room as radioactive, use portable lead shield
Limit visitors to 30 min.; stay 6 feet away from patient; no children or pregnant women
Monitor pt for chills, fever, n/v, burning or necrosis near site of implant
Pt rest, avoid dislodging implant
What is some radiation safety for caregivers of internal radiation patients
Maintain greatest distance from pt possible
Spend minimal time close to radiation source
Shield self with lead gloves, apron
Handle bed linen as directed by hospital
Use long-handled forceps to place dislodged implants into lead container
Wear dosimeter to calculate exposure
Describe the phases of the cell cycle
These 5 stages of reproductive process occurs in both normal and malignant cells. These phases are very important when looking at chemotherapeutic drugs. Cell-cycle or phase-specific drugs exert effect within a specific phase of the cell cycle. These drugs have the greatest tumor-cell kill when given in divided but frequent doses. This allows the maximum no. of cells to be exposed to the drug at the specific time in their life cycle where they are vulnerable to the drug. Ex. Antimetabolites (5-FU), plant alkaloids (vincristine).
Cell-cycle or phase-nonspecific drugs exert effect in all phases of the cell cycle, including the G0 resting phase…effective in treating tumors with more slowly dividing cells. Ex. Alkylating agents (cisplatin), antitumor antibiotics (adriamycin,), hormonal therapies.
Describe the 4 phases of the cell cycle.
4 phases. G1: cells begin active phase for reproduction. RNA and protein synthesized- relatively dormant, some RNA & protein synthesis
S:synthesis DNA synthesized and the chromosomes in the cell are duplicated- DNA synthesis
G2: the cell prepares itself for mitosis- some RNA and protein synthesis
M: Mitosis is the division of the parent cell into two exact copies called daughter cells, each having identical genetic material. Then the cell to to the G1 phase and begin again or to the G0 phase (resting).
Why are the cell cycle stages important?
knowledge of cell cycle events is used in the development of chemotherapeutic agents, which are designed to disrupt the cancer cells during different stages of their cell cycle.
What are some routes of chemo administration?
Routes of administration: IV, Oral, intrathecal, intraperitoneal, intravesicular, intraventricular… p. 378
Problem of extravasation
Protection of caregivers
Describe care of extravasation.
If deposited in subcutaneous tissue can cause tissue necrosis, damage to tendons, nerves, blood vessels
Ex drugs: Adriamycin, vincristine, nitrogen mustard
Use central line if possible, check for blood return, watch for swelling, pain, redness at site
Close monitoring; use of cold, heat, antidotes if leaking does occur
What are some adverse effects of chemotherapy?
GI effects: nausea and vomiting, diarrhea, mucositis, and stomatitis
Hematopoietic effects: myelosuppression
Renal damage
Cardiopulmonary system: potential cardiac toxicities
Reproductive system: potential sterility, potential reproductive cell abnormalities
Neurologic effects “chemo-brain”
What does BARFS stand for?
B- bone marrow depression A- alopecia R -retching F- fear and anxiety S- stomattis
What are some labs related to myelosuppresion?
WBS, Hgb/Hct, platelets
What are the CBC norms?
Hemoglobin (Hgb) --- 13.2-16.2 gm/dL (Male) ---12.0-15.2 gm/dL (Female) Hematocrit (Hct) ---37-46% Female ---40-52% Male
White Blood Cell Count -4.1-10.9x103/µL
Platelets (plt) -140-450x103/µL
Describe neutropenia
Leukopenia Granulocytopenia (neutrophils) ANC (Absolute Neutrophil Count) ANC= WBC X (% Neutrophils (segs)+%Bands) -Less than 1500 (mild) -Less than 1000 (moderate) -Less than 500 (severe) -Mild neutropenia (1000
What is a nadir
the lowest expected WBC in a patient when they are on a particular chemo- some have an expected nadir
What is the platelet count for thrombocytopenia?
Mild: 50K-100K
Moderate: 20K-50K
Severe:
What are some oncology nursing diagnosis?
Risk for Infection Fluid & Electrolyte Imbalances Impaired Nutrition Impaired Skin Integrity Impaired Tissue Integrity (alopecia) Impaired Tissue Perfusion Pain Anticipatory Grieving Disturbed Body Image
With infection- if someone if extremely neutropenic - what do you do?
Wash hands- reverse PPE- want to protect them from us- no flowers or visitors, nothing in high bacterial count- no kids avoid crowds, avoiding undercooked food or sushi
With a patient who is bleeding with a plt count of 10,000
be careful with their turns or movement, IV sites or tubing watch for bleeding, using a soft tooth brush, no razors, watch for neuro changes, fall precaution,
What is the best way to handle alopecia and body disturbance”
education and getting them ready for the possibility, scarves, wigs, talking to hair dressers
What are some nursing considerations for infection?
VS
CBC
Invasive sites
Fever
What are some ways to reduce infection (chart 22-3, 22-4)
Avoid fresh fruits, raw meat, fish, fresh flowers, potted plants
Change fluids, lines, avoid invasive catheters
Excellent hand washing
Avoid people who are ill, coughing, sneezing
Avoid crowded places
Reverse isolation
Avoid invasive procedures
What are some interventions for risk for bleeding?
Assess
Minimize bleeding
Bleeding precautions
What are some nursing interventions for impaired skin integrity?
No soap, cosmetics, powders, lotions, ointments Lukewarm water Avoid rubbing Avoid shaving Avoid heat Avoid tight clothing
What are some nursing interventions for impaired oral mucous membrane?
Assess Brush with soft toothbrush Avoid commercial mouthwashes Use normal saline rinses or special ‘magic mouthwash’ Remove dentures Lip lubricant Avoid spicy foods Assess swallow and gag
What are some medicatons for chemo-induced N/V?
Serotonin antagonists: ex. Ondansetron (Zofran), granisetron (Kytril) and dolasetron (Anzemet) s.e HA, hypotension
Neurokinin receptor antagonist: Aprepitant (Emend) s.e. drug interactions
Prokinetic agent: metoclopramide (Reglan) s.e. drowsiness
Corticosteroids: dexamethasone (Decadron) s.e. edema, HTN
Benzodiazepines: lorazepam (Ativan) s.e. drowsiness, amnesia
What are some nursing interventions for impaired tissue integrity such as alopecia?
Talk to patient Preventative: plan ahead Cut long hair Avoid excessive shampoo,combing Wigs/scarves
What are some nursing interventions for imbalanced nutrition less than body requirements?
Assess Adjust diet Antiemetics before treatment! Fluid hydration Oral hygiene Pain relief Sights/odors/distraction
What are some more nursing interventions to manage nutritional problems?
Small, frequent meals
Encourage high-calorie/protein dense foods
Encourage fluids
Cold foods
Moisten foods with sauces/gravies
Parenteral/enteral nutrition
Appetite stimulants
Avoid acidic foods
If nauseated; avoid greasy, high fat foods
Utilize seasonings/herbs to enhance taste of food
What are some nursing interventions for fatigue?
Rest periods Adequate protein and calorie Participation in exercise programs Facilitate mobility Rearrange daily schedule
What are some interventions for pain and peripheral neuropathy?
Assess Analgesics Comfort and safety measures (chart 22-9) Collaboration Other strategies P. 27 CM on chronic cancer pain
What are some nursing interventions for anticipatory grieving?
Support Family intervention Spiritual support Professional counseling Progression through grief process
What are some nursing interventions for home care and self- care deficit?
Assess self care deficit Assess support systems Family support Spiritual support Hospice care
What are interferons?
cell-produced proteins that slow tumor growth, stimulate growth on NK cells, induce cancer cells to have more normal function and appearance
What are interleukins?
help regulate inflammation and immunity- help immune system recognize and destroy abnormal cells
What are the side effects of BMRs?
inflammation, edema, fatigue, confusion, depression, peripheral neuropathy, skin abnormalities
What is a BMR? pg 387
modify patient’s responses to tumor cells- inferferons, interleukins
Describe the BMR for supportive care for cancer table. (22-5)
To help with chemotherapy induced myelosuppression ‘colony-stimulating factors’
Ex. Filgrastim (Neupogen)- for neutropenia
Epoetin alfa (Epogen)- for anemia
Oprelvekin (Neumega)- for thrombocytopenia
What is hormonal manipulation?
some hormones make tumors grow more rapidly, so by blocking the receptors to that hormone, it can decrease tumor growth; such as androgen/estrogen agonists or antagonists
What are some oncologic emergencies?
Sepsis and Disseminated intravascular coagulation (DIC)
Superior vena cava syndrome
Spinal cord compression
Syndrome of inappropriate secretion of antidiuretic hormone
Tumor lysis syndrome
Hypercalcemia
What is Dissiminated Intravascular Coagulation (DIC)?
An abnormal response of the normal clotting cascade stimulated by a disease process or disorder
Endothelial damage, tissue factors or toxins stimulate clotting cascade
Widespread clotting in microvasculature
Clotting factors are consumed faster than can be reproduced (hemorrhage)
What are some clinical manifestations of DIC?
Frank bleeding and oozing from injections or IV sites
Skin: Purpura, petechiae, bruising
GI: bleeding
Resp: Dyspnea, tachypnea, bloody sputum
Renal: Hematuria, ARF
Neuro: decreased LOC, mental status changes
Describe collaborative care for DIC
Evaluate Lab values: PT, PTT, CBC, fibrin split products, d-dimer
Administer fresh frozen plasma, platelets
Administer heparin to stop coagulation pathway
Assess for bleeding/bleeding precautions
Treat underlying cause- ex. Sepsis; give antibiotics
Explain spinal cord compression.
Compression of spinal cord from tumor, intervertebral collapse, metastatic cancers
Can cause permanent neurologic damage, morbidity and mortality
Treat with radiation to shrink tumor, or surgery to decompress cord
What are some nursing care things we can provide for spinal cord compression?
Perform ongoing neuro assessment Control pain Prevent complications of immobility Institute bladder/bowel regimen Provide supportive care for patient and family
What is tumor lysis syndrome?
Due to radiation or chemo induced cell destruction
Kidneys unable to excrete large volumes of released cellular metabolites
Leads to electrolyte imbalances: hyperkalemia, hypocalcemia, hyperuricemia, hyperphosphatemia
Pts at risk following radiation/chemo; up to one week after therapy completed
Describe some treatment or nursing care for tumor lysis syndrome.
Aggressive fluid hydration before and after cytotoxic therapy to increase urine volume
Diuretic therapy
Allopurinol therapy
Monitor electrolytes and treat abnormalities
Instruct patients on signs/symptoms indicating electrolyte distrubances
What is syndrome of inappropriate anto-diuretic hormone ( SIADH).
Increased secretion of antidiuretic hormone associated with small-cell lung ca, prostate and adrenal ca, and some chemo drugs
Kidney retains free water resulting in dilutional hyponatremia
Symptoms: nausea, muscle aches, neuro changes; lethargy, confusion, cerebral edema
What is superior vena cava syndrome?
Compression of SVC by tumor, enlarged lymph node, thrombus etc.
Obstructs venous circulation or drainage of head, neck, arms, thorax
Sx: dyspnea, facial swelling, edema of arms, neck, difficulty swallowing, chest pain
Treatment: treat underlying cause with chemo/RT, stent to occluded SVC
What is hypercalcemia?
- -High blood Ca levels can be dangerous; some severe problems include severe muscle weakness, paralytic ileus, dehydration and EKG changes
- -Most common in breast, lung, renal carcinoma, multiple myeloma, adult leukemia/lymphoma: PTH released from tumor causing bone to release CA
- -Treatment: IV hydration with NS, loop diuretics, bisphosphonates, calcitonin
What are some side effects of hormonal therapy?
masculinization/feminization effects- gynecomastia, testicular atrophy,/facial hair, acne, menses stop
