Blood/Cancer Flashcards

Question

What are potential complications for all types of leukemia?

Answer 1

serious infection bleeding renal dysfunction infertility tumor lysis syndrome from treatment nutritional depletion fluid and electrolyte imbalances fatigue mucositis depression, anxiety, grief

Answer 2

Preventing and managing infection and bleeding Managing mucositis Improving nutritional intake Easing pain and discomfort Maintaining fluid and electrolyte balance Improving self-care Managing anxiety and grief Providing education

Answer 3

Neoplasms of cells of lymphoid origin Usually starts in the lymph nodes but can involve lymphoid tissue in the spleen, GI tract, liver, or bone marrow Two major types: Hodgkin lymphoma Younger age, highly treatable Usually presents with swollen cervical lymph nodes Weight loss and sweats Non-Hodgkin lymphoma Middle to old age disease Swollen lymph nodes throughout body Higher mortality rate than Hodgkin disease

Answer 4

Relatively uncommon High cure rate 92% - 94% 5-year survival rate for early disease that is localized/regional (stage I or II) Two peaks of incidence Ages 15 – 34 After age 60 History of Epstein-Barr virus Family history of lymphoma Down syndrome (leukemias and lymphomas) Chronic immunosuppression

Answer 5

Initiates in a single node Predictable spread along the lymphatic system Malignant cell is the Reed-Sternberg cell Pathologic hallmark of disease Essential criterion for diagnosis Painless cervical lymph node enlargement Mild anemia Fatigue Anorexia Increased susceptibility to infections Cure is the goal Chemotherapy Radiation therapy HSCT for clients who have not responded to other treatment modalities

Answer 6

Group of cancers that originate in lymphoid tissue 85% B-cell lymphocytes 15% T-cell lymphocytes Unpredictable and erratic spread More common in men Incidence increases with age Average age at diagnosis is 66 years Prognosis varies with the type of NHL

Answer 7

Highly variable symptoms Night sweats weight loss swollen nodes to multiple areas chronic fevers fatigue Other symptoms depend upon enlarged lymph node size and site of the lymph nodes Goal of treatment: Usually try for remission, sometimes possible cure Chemotherapy Potential for tumor lysis syndrome (increased uric acid) Radiation therapy

Answer 8

Malignant disease of the plasma cells Plasma cells accumulate in the bone marrow and crowd out healthy blood cells Malignant plasma cells produce a specific, nonfunctional immunoglobulin (antibody) that is released into the blood “M protein” Immunoglobulins clog up the kidneys frequently resulting in renal failure Hypercalcemia develops from the bone destruction Persistent bone pain is a common symptom of the disease back pain elevated total protein

Answer 9

not curable immunotherapy chemo HSCT biphosphonate pain mngt infection control prevent fractures

Answer 10

Reduced platelet production in the bone marrow (leukemias, chemotherapy) Increased platelet destruction (Idiopathic thrombocytopenic purpura (ITP)) Increased platelet consumption (Disseminated intravascular coagulation (DIC)) Bleeding Petechiae on the skin Epistaxis Gingival bleeding Excessive bleeding from surgery or dental extractions

Answer 11

Inherited disorder that affects men and women equally reduced levels of vW factor Necessary for factor VIII activation Needed for platelet activation Clinical manifestations- vary Bleeding that involves the mucus membranes Often not noticed for years Easy bruising and petechiae Prolonged bleeding from cuts and surgical sites Heavy menstrual cycles Nose bleeds Bleeding with dental extractions Replacement therapies of IV vWF or Factor VIII Desmopressin/DDAVP (synthetic ADH): Prevents bleeding associated with surgical or dental procedures and provides a transient increase in vWF levels/activity in the body

Answer 12

Bleeding from hemophilia is from lack of a clotting factor in the coagulation cascade, preventing a fibrin clot to form vWD is a deficiency of a protein called von Willibrand factor, preventing formation of a platelet plug Hemophilia usually has deep bleeding into joints vWD has superficial bleeding such as gums, skin, lacerations

Answer 13

disseminated intravascular coagulation Systemic syndrome characterized by microthrombi and bleeding (excessive clotting and bleeding) Altered hemostasis mechanism causes massive clotting in microcirculation As clotting factors are consumed bleeding occurs Not a disease but a sign of an underlying disorder Common causes: sepsis, trauma (hemorrhage, burns, crush injuries), shock, cardiopulmonary arrest, cancer, obstetric complications, toxins, and allergic reactions Mortality rate can be > 80%

Answer 14

progressive decrease in platelet count due to consumption of platelets and Extensive thrombosis = Manifestations of thrombosis in the involved organs subtle bleeding that can develop into obvious hemorrhage Bleeding from mucous membranes, venipuncture sites, GI and GU tracts Occult internal bleeding Lab values reveal decreased platelets, increased INR, decreased fibrinogen, RBC fragments/anemia

Answer 15

Early identification of condition usually by thrombotic or hemorrhagic manifestations Treat underlying cause of the DIC Implement bleeding precautions Correct tissue ischemia Improve oxygenation Replace fluids and electrolytes Maintain blood pressure; administer vasopressors Replacement of coagulation factors and platelets occasionally done (not always) Administer heparin Inhibits formation of microthrombi and permits organ perfusion Provide emotional support

Answer 16

idiopathic thrombocytopenic purpura: decreased lifespan of platelets, can be treated with corticosteroids or splenectomy thrombotic thrombocytopenic purpura: blood abnormally clots heparin induced thrombocytopenia: low platelet from heparin treatment

Answer 17

Indications: DVT and PE treatment, acute coronary syndrome, thrombosis prophylaxis Routes SC (prophylaxis) or IV Therapeutic aPTT 60 to 80 seconds Assess for signs of bleeding Monitor platelet count Antidote is protamine sulfate

Answer 18

Indications: DVT, PE, a-fib, mechanical heart valve Given PO Therapeutic INR 2-3 (3 to 4.5 for mechanical heart valve) Monitor for any bleeding Antidote is Vitamin K

Answer 19

Splenectomy Surgical removal of spleen, immunosuppressed following splenectomy, needs vaccines such as pneumococcal, meningococcal, and Hemophilus influenzae (Hib) Therapeutic apheresis Blood components are separated and removed via a centrifuge Blood is returned to client after cleansing Therapeutic phlebotomy Removal of certain amount of blood under controlled conditions Used for hemochromatosis to reduce ferritin and Hg levels Blood component therapy Blood separated into primary components: erythrocytes, platelets, plasma Components that are transfused depend on the condition being treated

Answer 20

Standard transfusion Transfusion from a compatible blood donor Autologous transfusions Client’s own blood is collected for future transfusions (elective surgery) Collected up to 6 weeks prior to surgery Designated and only used for the client Intraoperative blood salvage Type of autologous transfusion Sterile blood lost from a procedure is saved Blood is washed (saline), filtered, and returned to client via IV infusion Administered intraoperatively or postoperatively Reinfusion must occur within 6 hours of collection

Answer 21

STOP the transfusion Remove blood tubing from the IV Initiate an infusion of 0.9% sodium chloride Monitor client and vital signs Notify primary provider and implement prescribed treatments Return blood bag and administration set to the lab for testing Obtain any samples needed Document event and reaction Continue to monitor client

Answer 22

febrile: temp, chills, malaise hold transfusion, acetominophen, fluid, resume slowly hemolytic: fever, chills, flank pain, N/V, shock, dark urine Stop, IV fluids allergic: urticaria, pruritis, hives, rarely anaphylaxis stop, fluid, antihistamines and corticosteroids, resume slowly TRALI (transfusion related acute lung injury): dyspnea, hypoxemia, bilateral chest infiltrates, fever, cyanosis, hypotension (can occur within 6hrs of transfusion) stop, airway support, emergency TACO (transfusion-associated circulatory overload): dyspnea, edema, JVD, crackles, HTN, anxiety slow or stop blood, O2, diuretics, morphine

Answer 23

Fever Chills Low-back pain Tachycardia Hypotension Flushing Nausea Chest tightness or pain Tachypnea/dyspnea Anxiety/ impending sense of doom Hemoglobinuria

Answer 24

platelets stored at room temp transfuse within 4 hours

Answer 25

Epoetin alfa Administered SC or IV Usually given 3 times a week to stimulate bone marrow Commonly used to treat anemia in clients with acute renal failure Can dangerously elevate BP due to increased hemoglobin levels Monitor for an increase in blood pressure Monitor Hgb and Hct twice per week Monitor for cardiovascular event if Hgb increases too rapidly (> 1g/dL in 2 weeks)

Answer 26

cell is transformed by genetic mutation of cellular DNA abnormal collection of cells, not all tumors are cancers (some are benign) Metastasis: Abnormal cells invade surrounding tissue and gain access to lymph and blood vessels carrying them to other areas of the body Malignant cancer cells: cells or processes that are characteristic of cancer, such as metastasis, local and distant tissue destruction, unregulated growth Benign cancer cells: cells that are not cancerous, don't metastasize, only grow locally, no local tissue invasion or destruction, don't require chemo/radiation therapy, sometimes surgery

Answer 27

cellular proliferation: uncontrolled growth, ability to metastasize, no normal apoptosis cell characteristics: altered shape, structure or metabolism metastasis: lymphatic and/or hematogenous spread

Answer 28

Viruses and bacteria: HPV, hepatitis B & C, Epstein-Barr, HIV, Helicobacter pylori Physical factors: Sunlight, radiation, chronic irritation Chemical agents: Tobacco, Asbestos, pesticides, alcohol, air pollution Lifestyle factors: Obesity, insufficient physical activity Diet high in fat, red meat, processed meat, preservatives, additives, and low in fiber Hormones Air pollution Sexual lifestyles Race, genetic, and familial factors

Answer 29

Carcinoma: Epithelial tissue (glandular or squamous) 80% - 90% of all cancers Examples: skin, GI tract lining, lung, breast, prostate Sarcoma: Connective or supportive tissues Examples: bone, cartilage, fibrous tissue, muscle tissue Osteosarcoma or chondrosarcoma for example Leukemia Hematopoietic cells in the bone marrow Examples: WBCs: AML, CML, ALL OR CLL RBCs: Polycythemia vera Lymphoma Develop from lymphocytes Myeloma Plasma cells (initially B-cells)

Answer 30

Immunizations Healthy diet (limit alcohol, sugar, processed meats) Avoid tobacco Maintain healthy body weight Exercise Sunscreen Breast feed infants exclusively for the first 6 months of life Chemoprevention: use of medications or other substances to disrupt cancer development Cancer screening to identify precancerous lesion and early-stage cancer Self-examinations at home Mammogram annually, starting at age 45 Clinical breast exam every 3 years for ages 20 to 39, annually for 40 and up Colonoscopy starting at age 45 Fecal occult annually Prostate screening annually, at age 50 (40-45 for those at higher risk) Pap test start at age 25, then every 3 to 5 years Monitoring for and preventing recurrence of the primary cancer Screening for the development of second malignancies in cancer survivors

Answer 31

Staging determines the size of the tumor, the existence of local invasion, lymph node involvement, and distant metastasis T = anatomic size of the primary tumor N = extent of lymph node involvement M = presence or absence of metastasis Staging 0: Cancer in situ, non-invasive 1: Localized, within the tissue of origin 2: Limited local spread 3: Extensive local and regional spread 4: Metastasis

Answer 32

Pathologic classification of tumor cells Numeric value from I – IV (degree of cell differentiation) Differentiation: The degree to which the tumor cells retain the characteristics and function of the tissue of origin  Well-differentiated: Tumor cells closely resemble the tissue of origin in structure and function Poorly differentiated or undifferentiated: Tumor cells that do not resemble the tissue of origin in structure or function Grading X: Cannot be determined 1: Well-differentiated (most normal) 2: Cells more abnormal, moderately differentiated 3: Poorly differentiated (very abnormal) 4: Undifferentiated, cells very immature, grow quickly and spread, poor prognosis

Answer 33

prophylactic: removal of non-vital tissue/organs before developing cancer palliative: relieve symptoms, may not be a cure Reconstructive: improve function or cosmetic effect

Answer 34

About 60% of clients with cancer receive radiation therapy Cure, control, palliation Neoadjuvant: Administered to reduce tumor size in order to facilitate surgical resection Localized therapy Only tissues within the treatment field are affected Body tissues that undergo frequent cell division are most sensitive to radiation therapy (skin, GI, bone marrow, mucosa)

Answer 35

Most used form of radiation therapy Total radiation dose depends on sensitivity of target tissues, tumor size, radiation tolerance of surrounding normal tissues Total dose is delivered over several weeks in daily doses Client is not radioactive* Skin is marked with tattoo to guide beam Internal radiation (brachytherapy) Placement of radioactive sources within or immediately next to cancer site Provides highly targeted, intense dose of radiation Temporary or permanent High dose or low dose Causes the body fluids and waste to be contaminated with radiation Most clients remain in the hospital until therapy is complete

Answer 36

limit time visitors remain 6' away use lead barriers wear dosimeter badge Private room with door closed Radioactive sign on the door Wear a lead apron during client care Wear dosimeter badge Records personal amount of exposure Precautions if implant is dislodged Don’t touch! Use tongs to place radioactive substance in container Rotate care givers Encourage client self-care All linens and dressings kept in client’s room until radiation source is removed Ensure they are not lost Limit visitors Time limit of 30 minutes Maintain distance of 6 feet No pregnant visitors No children

Answer 37

High-dose series Radioactive material implanted for a short period of time (minutes) Once the radioactive material is removed, the client is not radioactive No precautions needed High-dose temporary implant Client remains hospitalized for the duration of treatment Time, distance, shielding Client may emit very low levels of radiation for weeks to months Avoid pregnant women and children Strain urine for the first 7-10 days to catch any seeds that may inadvertently pass Notify provider

Answer 38

Most often localized in region being irradiated Early toxicities usually begin within 2 weeks of starting treatment Skin: Alopecia, Erythema. Wet or dry desquamation Bone marrow: Pancytopenia Epithelial lining of GI tract Stomatitis/mucositis Xerostomia (dry mouth) Loss/change of taste N/V/D Systemic Fatigue Malaise Anorexia

Answer 39

Administration of systemic or local cytotoxic antineoplastic medications that damage the cell’s DNA or destroy rapidly dividing cells Causes harm to healthy, rapidly proliferating cells Toxic effects (stomatitis, diarrhea/vomiting, hair loss, leukopenia, thrombocytopenia, anemia)

Answer 40

Extravasation: Leakage from a vein into surrounding tissue Vesicant: Medication that causes inflammation, tissue damage and potential necrosis of tendons, muscles, nerves, and blood vessels if extravasation occurs Nursing actions for IV infiltration Follow hospital policy Stop infusion Administer antidote Notify provider Prevention is key! Check IV patency first prior to chemo administration

Answer 41

Wear gloves designated for handling chemo Long-sleeved disposable gowns Proper disposal in closed-system, puncture- and leak-proof containers labeled “hazardous: chemotherapy contaminated waste” Monitor for manifestations of exposure N/V Skin & eye irritation Nasal mucosal ulcerations Reproductive issues- trouble conceiving

Answer 42

GI hematopoietic fatigue cognitive impairment reproductive cardiopulmonary neurologic renal

Answer 43

Rinse the mouth with 0.9% sodium chloride, room-temperature water, or salt and soda water (not glycerin or alcohol based) Perform gentle flossing and brushing (soft-bristle toothbrush or foam swab) Rinse mouth before and after meals Take medications to control infections and decrease pain Choose soft, bland foods and supplements that are high in calories Ice cream, mashed potatoes, scrambled eggs, cooked cereal, bananas Avoid salty, spicy, acidic, tough, or hard foods Avoid drinking alcohol and using tobacco Drink at least 2 L of water a day

Answer 44

platelet count less than 20,000-50,000 ANC less than 1000 2500-5000 Private room with reverse isolation Handwashing Place a mask on client during transport No live plants, stagnant water, or contaminated equipment Keep dedicated equipment (BP, thermometer, stethoscope) in client’s room Avoid invasive procedures unless necessary Prevent exposure to people with known infections

Answer 45

rapid cell lysis from chemo causes increase in uric acid which is hard on the kidney allopurinol (gout med) monitor EF with echo monitor for s/s of HF: JVD, SOB, crackles monitor for pneumonia: SOB, chills, fever, cough

Answer 46

Monitor for loss of sensation in hands and feet, orthostatic hypotension, loss of taste, and constipation Early manifestations include numbness, tingling, and redness Teach client how to prevent injuries Inform the client about risk for ED and treatment options Protect the skin due to loss of sensation Insect the feet daily

Answer 47

Hemopoietic stem cell transplant Primarily used for hematologic cancers Types of HSCT Allogenic: From donor other than the client May be a family member Autologous: From the client Syngeneic: From an identical twin Myeloablative: Clients receive high-dose chemotherapy and occasionally total body irradiation Bone marrow cells destroyed sepsis bleeding

Answer 48

Immunotherapy Use of medications or biochemical mediators to stimulate or suppress parts of the immune system to kill cancer cells Example: monoclonal antibodies Cancer vaccines (HPV) Targeted therapies Example: monoclonal antibodies Target specific parts of cells to kill or prevent the spread of cancer cells Less negative effects on healthy cells

Answer 49

Oncologic emergency Results from obstruction of venous return and engorgement of vessels from the head and upper body Untreated may lead to facial edema and cerebral edema Most often associated with metastases from breast or lung cancers Clinical manifestations Dyspnea Erythema and edema of the upper body and face Epistaxis Nursing interventions Position in high-Fowler position to facilitate lung expansion Treatment High-dose radiation for emergency temporary relief IV corticosteroids to decrease swelling

Answer 50

Oncologic emergency from the chemotherapy Occurs when rapidly destroyed tumors release cellular content into the bloodstream faster than the body can process them Pretreated with allopurinol to reduce uric acid levels to prevent gout Clinical manifestations GI distress Flank pain Muscle cramps and weakness Seizures Mental status changes Complications Acute kidney injury Cardiac dysrhythmias Hyperkalemia Hyperphosphatemia Hyperuricemia Hypocalcemia

Answer 51

IVF fluid intake of 3L/day to flush out metabolites consume alkaline fluids to lower uric acid diuretics allopurinol for uric acid sodium polystyrene for potassium hemodialysis/ICU

Answer 52

Oncologic emergency Caused by metastases to epidural space and spinal cord resulting in compression Most often with cancers that metastasize to bone Manifestations Changes in sensation, muscle strength Reduced DTRs Worsening back pain Bowel or bladder changes Nursing Actions Administer high-dose corticosteroids to reduce inflammation around spinal cord Prepare the client for possible radiation therapy or emergency surgery

Answer 53

hypercalcemia Oncologic emergency Complication of breast, lung, head and neck cancers; leukemia and lymphoma; multiple myelomas and bony metastasis of any cancer Tumor cells release growth hormones that mimic PTH Medical and nursing interventions Identify at-risk client Increase daily fluid intake to 2 - 4 liters Administer 0.9% sodium chloride IV, loop diuretics, glucocorticoids (decreases absorption in gut), antiemetics, or phosphates

Answer 54

skin basal cell squamous cell malignant melanoma

Answer 55

80% of all skin cancers in the U.S. Rarely causes death Twice as common in men than in women Usually appears on sun exposed areas of the body Begins as a small waxy nodule with rolled, translucent, pearly borders May develop central ulceration and crusting as it grows (called a rodent ulcer) Rarely metastasizes to other area Recurrence is common

Answer 56

Second most common skin cancer in the U.S. 2-3x more common in men than women Less aggressive than melanoma but responsible for at least 15,000 deaths yearly Invasive carcinoma Metastasizes in 4% - 8% of cases Malignant proliferation that often arises from actinic keratosis (like rough sandpaper) Usually appears on sun damaged skin Rough, thickened, scaly tumor that may be asymptomatic or may bleed

Answer 57

Diagnosis made through biopsy Surgical excision: Mohs,Most accurate, Conserves healthy tissue Electrosurgery Cryosurgery Topical chemotherapy agents Prevention of recurrence

Answer 58

White Americans are 20x more at risk for than Black Americans Average age of diagnosis is 65 years Change in a nevus (mole) or new growth on the skin Typically dark, red or blue/purple colored, and irregular in shape May have itching, rapid growth, ulceration, or bleeding Diagnosis made through biopsy Depth of melanoma and spread to lymph nodes determines prognosis Tumor staged using the TNM classification system

Answer 59

A: asymmetry B: border C: color D: diameter E: evolving

Answer 60

Surgery Tumor removal Reconstructive surgery Chemotherapy Radiation therapy Client education Clients diagnosed with melanoma have increased risk of developing a secondary melanoma

Answer 61

Usually performed if the PAP test reveals atypical cells/precancerous Examination of the tissues of the vagina and cervix using a microscope Can perform endocervical curettage if lesions are present Cone biopsy Excise a cone-shaped sample of tissues to remove harmful cells Can destroy cells using cryosurgery, lasers, or loop electrosurgical excision procedure (LEEP) Best done during the early phase of menstrual cycle (cervix is less vascular)

Answer 62

May experience temporary discomfort and cramping Rest 24 hours after the procedure Do not insert anything into the vagina (sexual intercourse, creams, tampons) for 2 weeks Do not lift heavy objects for 2 weeks Avoid aspirin Report excessive bleeding, fever, and foul-smelling drainage to the provider

Answer 63

Endometrial biopsy is the removal of a small piece of tissue from the endometrium Procedure that helps diagnose potential causes of abnormal uterine bleeding Used for the diagnosis of endometrial hyperplasia or uterine cancer Procedure: Rule out pregnancy before Empty bladder prior to procedure Administer analgesia as needed Obtain a consent Explain there will be some discomfort during procedure Vaginal spotting can occur for 1-2 days after (avoid intercourse or inserting anything into the vagina until resolved) Report fevers, purulent discharge, heavy vaginal bleeding, or severe pain

Answer 64

A test used to visualize the cervix, uterus, and fallopian tubes using contrast dye and x-rays Evaluates for infertility, fibroids, or tumors Pre-procedure: confirm last menstrual date, iodine allergy, consent form, ensure client voids, prepare for pelvic exam Procedure: Remain with client for support, arrange needed equipment Post-procedure: minimal bleeding and cramping to be expected; administer analgesics; report heavy bleeding, fevers, or purulent vaginal discharge

Answer 65

Cystocele: Weakening of the anterior vaginal wall resulting in bladder bulging into vagina Risks factors: Obesity, old age, multiple pregnancies, vaginal injury at childbirth, family history Can be palpated by the client or HCP within the vagina Findings: Stress incontinence, recurrent UTIs, vaginal fullness, painful intercourse, painful pelvic pain Diagnostics: pelvic exam reveals anterior vaginal bulging, bladder ultrasound may show residual urine

Answer 66

Weakening of the posterior vaginal wall resulting in the rectum bulging into vagina Risk factors: Obesity, old age, constipation, family history, complicated vaginal birth Findings: constipation, feeling of vaginal fullness, painful intercourse Diagnostics: vaginal exam reveals posterior bulging

Answer 67

Intravaginal estrogen: Treats/prevents atrophy of vaginal tissue Bladder training: Regular urination every 2-3 hours if incontinence is present Vaginal pessary: A vaginally-inserted device to provide support Kegel exercises: specific exercises to strengthen the pelvic muscles Contract circumvaginal and perirectal muscles, increase contractions to 10 seconds; relaxation for 10 seconds; perform 30-80x/daily; relax abdominal wall; perform laying, sitting, or standing Anterior colporrhaphy (cystocele) Vaginal or laparoscopic procedure to tighten pelvic muscles, supports bladder Monitor for infections, avoid straining, lifting (over 5 pounds), sitting or walking for long periods, and sexual intercourse for 6 weeks Posterior colporrhaphy (rectocele) Vaginal or laparoscopic procedure to tighten pelvic muscles Monitoring and restrictions similar as anterior colporrhaphy

Answer 68

Occurs in premenopausal women, often young adults Can also develop with the initiation of hormone replacement therapy (post-menopausal) Symptoms: tender breast lumps/cysts, especially upper outer breast Confirmed with breast ultrasound that reveals multiple cysts Fine needle aspiration can be done to reduce tender cysts Mammograms often not useful in young adults due to breast density Treatment: reduce salt prior to menses, avoid caffeine, supportive bra, ibuprofen/acetaminophen, warm/cool compresses, oral birth control pills, and diuretics

Answer 69

bone lung brain liver

Answer 70

Older age, family hx, early menarche, late menopause, HT/BCP, radiation, obesity, high-fat diet, alcohol intake, smoking BRCA1 and BRCA2- inherited mutations Silicone breast implants, antiperspirants, underwire bra, abortion breast feeding for 1 year physical activity healthy body weight

Answer 71

Ductal carcinoma in situ: cancer cells in duct without invasion to surrounding tissue lobular carcinoma: abnormal cells in milk-producing glands

Answer 72

infiltrating ductal carcinoma Lump Skin dimpling Edematous thickening Pitting of breast skin (orange peel) inflammatory breast cancer Seldom presents as a lump May not be present on mammogram Clinical manifestations Swelling Redness Breast pain

Answer 73

Sentinel lymph node biopsy First node that receives drainage from primary tumor Use IV contrast Pathology completed when in surgery. If + for cancer, then axillary node dissection is needed Lumpectomy Breast conserving Excise tumor while achieving acceptable cosmetic result

Answer 74

Total mastectomy Removal of the breast and areolar tissue (no axillary nodes) Radical mastectomy Removal of breast tissue, nipple/areola, some axillary nodes, and muscle Modified radical mastectomy Muscle is left intact, lymph nodes removed

Answer 75

surgical complication of mastectomy Chronic swelling d/t interrupted lymph circulation Protein-rich fluid in the interstitial space S/S: Painful swelling, weakness, shoulder pain, tingling sensation in arm & shoulder No BP, injections/IV, blood draws in affected limb (place a sign above the client’s bed) Compressive arm sleeves used to reduce edema

Answer 76

Increase HOB to 30° Support operative arm(s) on a pillow Lie on the unaffected side to help relieve pain Wear a sling when OOB Offer emotional support and encourage the client to express feelings related to body image Drain care (usually left in for 1 to 3 weeks) Perform early hand exercises to prevent lymphedema and improve ROM

Answer 77

Hormonal therapy Most effective in cancer cells with estrogen receptors that can be inhibited Chemotherapy/Radiation Augment or replace mastectomy Chemotherapy includes a combination of several medications External beam or brachytherapy with radioactive seeds Target therapy Most effective for breast cancer with HER2/neu gene Trastuzumab & pertuzumab are signal transduction inhibitors They inhibit proteins that are signals for cancer cells to grow Selective estrogen receptor modulators (SERMs)— tamoxifen Used for those who are high risk for breast cancer or have advanced breast cancer Suppresses the growth of cancer cells Tamoxifen increases the risk of endometrial cancer (vaginal bleeding), DVT/PE (leg swelling or SOB); common side effect is hot flashes, reduced libido by creating menopause

Answer 78

age 68+ low testosterone BRCA1, BRCA2 Klinefleter syndrome gynecomastia

Answer 79

Leading cause of death in female reproductive cancers Frequently metastatic at the time of diagnosis BCPs and pregnancy reduce the risk of ovarian cancer Tumor markers: CA-125, alpha-fetoprotein, hCG Diagnosis is with pelvic ultrasound, CT scan, and tissue biopsy Risks: Early menarche and late menopause increase risk (more cycles) Nulliparity (more cycles) Family history of ovarian, breast cancer, or colon cancer BRCA-1 or BRCA-2 gene mutations Diabetes mellitus Endometriosis Findings: (non-specific) Abdominal/pelvic pain, abdominal bloating, abdominal mass, weight loss, vaginal bleeding, urinary urgency/frequency

Answer 80

Most common female reproductive cancer Usually occurs in elderly females (prolonged estrogen exposure) Avoid unopposed estrogen therapy if client has an intact uterus Risk factors: Personal history of breast or ovarian cancer, or PCOS Diabetes mellitus Obesity (estrogen production by fat cells) Estrogen replacement therapy (need progesterone if woman has a uterus) Nulliparity Use of tamoxifen Smoking Late age at menopause Findings: irregular or post-menopausal bleeding, pelvic/back pain Diagnosed by endometrial biopsy, pelvic ultrasound, increased CA-125 and alpha-fetoprotein Treatment: hysterectomy, brachytherapy/external beam radiation, chemotherapy

Answer 81

A recurrent lifelong viral infection More than 87% of infected individuals are unaware An STD that also may be transmitted by contact and that may be transmitted when the carrier is asymptomatic (viral shedding) Avoid sexual intercourse with active herpes, condoms the rest of the month Causes painful itching and burning herpetic lesions Outbreaks are associated with stress, sunburn, dental work, inadequate rest, and inadequate nutrition Herpes viral culture- fluid from lesion is collected Polymerase chain reaction (PRC) test- identifies genetic material from lesion Antibody test- ELISA blood test Treatment Antivirals (acyclovir) to reduce length of time to recovery Pregnant women need a cesarean delivery if active herpes

Answer 82

Painless ulcer on genitals, rectum, or mouth Bacterial disease with 3 stages Primary stage is a painless sore (chancre) All stages can be treated with penicillin Secondary stage occurs with body rash including palms and soles Latent stage occurs with rash resolving Tertiary syphilis can occur years later, affecting the blood vessels, brain, eyes, heart, nerves, and joints VDRL is the serologic screening test A treponemal antibody test is confirmatory

Answer 83

Common bacterial STI Clear vaginal or penile discharge, dysuria Many women are unaware of infection- asymptomatic Can lead to pelvic inflammatory disease/infertility Can result in ectopic pregnancies in the future Treated with antibiotics Standard STI precautions Use condoms Limit sexual partners Obtain screening test

Answer 84

A bacterial infection affecting the urethra, vaginal, rectum, or throat Copious penile discharge, painful urination, vaginal discharge, and pelvic pain Can result in infertility in men and women Standard STI precautions Condoms, limit partners, testing for condition

Answer 85

Pelvic inflammatory disease Infection of the upper female reproductive tract Usually develops from a bacterial infection in the vagina or cervix Can result in scarring, infertility, and abscess formation Increases the risk of ectopic pregnancy and chronic pelvic pain later Gonorrheal and chlamydial organisms are common causes Some are associated with more than one infection S/S (asymptomatic, mild to severe) Fever Pain and tenderness (lower abdomen) Post coital bleeding Cervical motion tenderness Abnormal vaginal discharge

Answer 86

Mix of broad-spectrum antibiotics Cephalosporin injection (ceftriaxone), followed by PO doxycycline and metronidazole Treat sexual partners Acetaminophen and ice packs No future tampon use No baths May need surgery to remove adhesions or drain abscesses if severe

Answer 87

Dysfunction of the hypothalamic-pituitary ovarian axis Complex disorder, not well understood Highly associated with insulin resistance Elevated levels of testosterone Common disorder affecting 10 to 47% of women in the U.S. Two of the three criteria must be met for diagnosis Hyperandrogenism (increased facial hair) Chronic anovulation (irregular cycles) Polycystic ovaries on ultrasound

Answer 88

Weight loss Eat food with a low-glycemic index Medications Metformin- regulates periods & helps with weight loss Spironolactone- reduces hirsutism symptoms of excessive hair Oral contraceptives Infertility Clomiphene citrate Surgery To remove cysts

Answer 89

Benign smooth muscle tumors of the uterus Very common- 70-80% of women over 50 years old have fibroids Can be asymptomatic or cause abnormal, heavy/long menstrual bleeding and abdominal pain Complications Iron deficiency anemia Infertility Miscarriage Treatment Myomectomy Hysterectomy

Answer 90

Total hysterectomy: uterus and cervix are removed Subtotal hysterectomy: uterus removed; cervix is not Bilateral salpingo-oophorectomy: ovaries and fallopian tubes are removed Panhysterectomy: uterus, cervix, ovaries, and fallopian tubes are removed Radical hysterectomy: uterus, cervix, upper part of the vagina, and adjacent tissue including lymph nodes are removed

Answer 91

Indwelling urinary catheter inserted intraoperatively which is kept in place for 24 hr. Monitor vaginal bleeding Excessive bleeding 1 pad saturation in 4 hr. Priority assessment Monitor for signs of infection, atelectasis, paralytic ileus, wound dehiscence, DVT, bleeding, and hypovolemia

Answer 92

Well-balanced diet high in protein and vitamin C to promote wound healing If ovaries have been removed Menopausal manifestations HT may be an option Vaginal atrophy can cause itching and dryness- instruct client to use artificial lubrication Activity restrictions including no sexual intercourse for 4 to 6 weeks Avoid tampons Report symptoms of infection Report symptoms of DVT

Answer 93

Menorrhagia excessive menstrual bleeding (amount and duration), possibly with clots, saturate more than one tampon or pad per hour Metrorrhagia bleeding between menstrual periods, common in adolescents and those entering menopause Dysmenorrhea painful menstruation Amenorrhea is the absence of menses, can indicate pregnancy, thyroid disorder, or other disorder

Answer 94

Premenstrual dystrophic disorder (PMDD) severe form of PMS, unable to carry out daily activities

Answer 95

Overgrowth of endometrial tissue that extends outside of the uterus into the fallopian tubes, ovaries, and pelvis Results in bleeding, inflammation, and scarring infertility Manifestations Pelvic pain and painful intercourse (dyspareunia) Menorrhagia Pain with defecation Depressed mood Treatment Manage pain and limit the progression of implants Hormone therapy/BCP, steroids, GnRH agonists (see next slide) Pain is often unresponsive to NSAIDS Surgical options Severe cases Excision of endometrial implants and adhesions

Answer 96

Nafarelin Gonadotropin-releasing hormone (GnRH) agonist that decreases ovarian function (suppressed release of estrogen) Results in medical-induced menopause Administration is 1 spray into one nostril in the morning; 1 spray into the opposite nostril in the evening May lead to rhinitis and nasal irritation

Answer 97

Osteoporosis Increase calcium and vitamin D intake Avoid caffeine and tobacco Coronary artery disease Avoid obesity, tobacco, alcohol Treat hyperlipidemia, HTN, and DM since heart disease increases at menopause

Answer 98

Permanent physiologic cessation of menses associated with declining ovarian function Complete when there is no menses for 12 months Natural or surgically induced Laboratory testing FSH/LH increased Pelvic exam and pap to r/o cancers

Answer 99

CAD MI DVT Stroke breast, ovarian, endometrial cancer supresses hot flashes prevents atrophy of vaginal tissue reduses risk of osteoporosis Hx of breat cancer Hx of DVT impaired liver functions uterine cancer undiagnosed vaginal bleeding

Answer 100

prostate specific antigen test Protein produced by prostate that is found in the blood; sensitive but not specific to cancer Increased PSA levels may indicate cancer, BPH, acute urinary retention, acute prostatitis; UTI can elevate PSA for up to 6 weeks PSA value >4 ng/mL requires further evaluation Digital rectal exam

Answer 101

EPCA2 greater than 30 ng/mL transrectal ultrasound

Answer 102

penile doppler ultrasonography blood flow hold ED meds 2 days prior

Answer 103

begnign prostatic hyperplasia BPH-prostate enlarges and causes urinary symptoms Affects half of men over age 60 and 90% of men over age 85 Risk factors: Increased age Smoking ETOH use Sedentary lifestyle Obesity Western diet (high-fat, high-protein, high-carbs; low-fiber) DM Heart disease

Answer 104

Dihydrotestosterone (DHT)-lowering medications (finasteride) Decreases the amount of testosterone produced in the prostate gland decreasing the size of the prostate It can take 6 months for any therapeutic effect, not immediate at all Adverse effects: impotence, gynecomastia, decreased libido since blocks testosterone Teratogenic to male fetus (can be absorbed through the skin), women should handle medication with gloves Alpha-blocking agents (tamsulosin) Relaxes the bladder outlet and prostate gland stronger flow Educate the client to change position slowly (orthostatic hypotension) Works immediately to relax the valve

Answer 105

transurethral resection of the prostate releves urinary obstruction resectoscope inserted in urethra and trims away prostetic tissue Client will have a three-way catheter Allows for continuous bladder irrigation (CBI) to keep the catheter free of obstruction Adjust rate to keep the output pink or lighter (NEVER place on IV pump) If irrigation become bright-red (ketchup), increase CBI rate For obstructions: turn off the CBI and hand irrigate with 50 mL syringe of irrigation solution Record the amount of irrigation fluid instilled (large amounts) and the amount of return. The difference equals UOP The catheter may be taped tightly to the leg to create traction to prevent bleeding Catheter has a large balloon- 30 to 45 mL Client may have a continuous urge to urinate Instruct the client to not void around the catheter Avoid heavy lifting, strenuous exercise, straining, and sexual intercourse for 2-6 weeks Drink at least 12 glasses of water throughout the day (if appropriate) Avoid NSAIDS Avoid bladder stimulants Caffeine and alcohol If urine becomes bloody, stop activity and rest and increase fluid intake

Answer 106

Increases with age Age> 65 Familial predisposition Father, brother African-American race High fat/red meat, low fiber diet Gene mutations HPC1, BRCA-1, BRCA-2 bone

Answer 107

CV disease, endocrine disorders, cirrhosis, CKI, GU conditions, hematologic conditions, neurologic conditions, trauma to area, alcohol, smoking, medications, drug abuse Oral medications: sildenafil Side effects include headache, flushing, dyspepsia Take one hour before sexual intercourse Caution with retinopathy Contraindicated with any nitroglycerin use for heart disease penile implant: semirigid rod or inflatable negative pressure vaccuum

Answer 108

Inflammation/infection of the prostate gland Often associated with UTI Signs and symptoms Fever, chills Urethral discharge Perineal discomfort/pain Burning Urgency Frequency Hesitancy Boggy, tender prostate Elevated PSA, elevated WBC Treated with oral antibiotics for 3-5 weeks (cipro) ejaculate to reduce retention tamsulosin to promote relaxationo f bladder and prostate Comfort measures- analgesics, sitz baths Client teaching- antibiotic therapy, s/s of recurrent prostatitis Fluids encouraged to satisfy thirst but not forced- effective med level must remain in urine Avoid indwelling catheters- suprapubic may be needed for severe urinary retention

Answer 109

Infection of epididymis that spread from urethra, bladder, or prostate #1 cause is E. coli May be r/t UTI, STI, high-risk sexual practices Symptoms are tender and swollen area behind testicle Confirmed with urinalysis and urethral culture Treatment is with oral antibiotic therapy May take a month to fully recover Passage of sperm may be obstructed in chronic cases which may progress to infertility (if bilateral) Not r/t cancer at all

Answer 110

Infection/inflammation of the testes Can be associated with epididymitis Most associated with the mumps virus (prevented by the MMR) Symptoms Testicular enlargement and swelling Pain and tenderness Fever Headache Myalgias May result in future sterility Treatment Treat symptoms Ice packs to reduce scrotal edema Anti-inflammatories and analgesics

Answer 111

Spermatic cord twists, cutting off the testicle’s blood supply Leads to ischemia of the testicle Rapid onset of severe testicular pain Testicle is high-riding in the scrotum Confirmed with doppler ultrasound of scrotum Attempt can be made to manually rotate the testicle to normal Needs an emergency surgical detorsion Both testicles are stabilized in the scrotum

Answer 112

Most common cancer in men ages 15 to 35 Highly treatable and curable 95% cure rate (ATI, 2023) Risk factors Undescended testicles Positive family history Personal history of testicular cancer Caucasian American race HIV-positive painless mass in testes Orchiectomy- removal of testis Retroperitoneal lymph node dissection (open or lap) Performed after orchiectomy to diagnose & prevent lymphatic spread Chemotherapy Radiation therapy- only to affected testicle