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NSG 320 (mcp) > Cancer > Flashcards

Cancer Flashcards

1
Q

What is CANCER

A

Cancer or malignant cells are those that are abnormal, do not serve a purpose, and are harmful to normal tissue.

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2
Q

What causes the problems associated with Cancer?

A

Many of the problems associated with cancer are caused by either cancer itself, or the treatment for cancer (or both).

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3
Q

If left untreated, even cancer of a non-vital organ or tissue can metastasize and cause some of the following problems (4)

A

1) Reduced blood-producing function
2) Altered GI function
3) Peripheral nerve, motor, and sensory deficits
4) Decreased respiratory and cardiac function

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4
Q

What is the goal of cancer management? (2)

A
  1. Cure or control cancer

2. Minimize side effects of treatment(s)

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5
Q

What is cancer management dependent on? (4)

A

1) Type,
2) location,
3) size and extent of cancer
4) Health of person

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6
Q

What treatments can we employ to manage cancer?

Which two treatments are we prioritizing?

A

1) Surgery
2) Radiation **
3) Chemotherapy **
4) Immunotherapy
5) Small Molecular Inhibitor Targeted Therapy
6) Hormone Therapy
* * Where we will focus our time/what we’re expected to understand

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7
Q

What are the 3 main nursing priorities related to cancer? (nursing diagnoses)

A
  1. Reduced WBCs –> Impaired Immunity –> Risk for Infection
  2. Reduced RBCs –> Poor Perfusion –> Fatigue/Oxygenation (Breathing)
  3. Reduced PLTs –> Poor Clotting –>
    * Risk for Bleeding*
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8
Q

What is myelosuppression? Cause? Results in?

A

The killing of healthy blood cells and temporary suppression of BM function (no replacement) caused by chemotherapy.

Results in: PANCYTOPENIA
Decreased WBCs (esp. neuts), RBCs, and PLTs
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9
Q

What causes neutropenia?

What are the risks of neutropenia and what is the most common causes?

A

Chemotherapy causes temporary suppression of the immune system

Dose-related Risk for Infection and Sepsis

Most infections are from an overgrowth of normal flora (Opportunistic Infections)

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10
Q

Infection Prevention involves

3 broad categories

A
  1. INFECTION PREVENTION
    - Hand Washing
    - Neutropenic precautions
  2. Nurse-Led Protocols (details later)
  3. Prevention & Early Recognition of Sepsis
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11
Q

Interventions for Neutropenia, AKA _____ involve (2 broad categories)

A

Neutropenic Precautions/Reverse Isolation

1. INFECTION PREVENTION
2. Pharmacological interventions
don’t need to know specifics

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12
Q

Neutropenia is defined as an ANC

A

ANC <500 cells/mm3 or < 1000 cells/mm3 with fever

Per Institute policy

this bothers me bc you’ll see this resulted in units of 10^3/mcL which would look like an ANC of 1.0 or 0.5.

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13
Q

Neutropenic Precautions:
Room + Visitor-related precautions (4)
Dietary Precautions (3)

A
  1. Private room
    - Mask on pt when outside of the room
  2. NO fresh plants or flowers
  3. NO Stagnant water
  4. LIMIT visitors and NO visitors who are sick

Dietary Precautions:

  1. NO raw veggies/fruits
  2. NO undercooked meat (sushi)
  3. NO PEPPER
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14
Q

Neutropenic Precautions:
Nursing Interventions (9)
What’s our #1 priority?

A
  1. Hand washing (#1 priority!)
  2. Avoid shared supplies
    - Need their own dedicated supply
  3. Monitor VS’s (esp. temp)
  4. Inspect mouth, skin, mucous membranes,
    and line sites daily.
  5. Hygiene w/ antibacterial soap DAILY
  6. Activity/Rest
  7. Coughing + deep Breathing
    - To prevent pneumonia/atelectasis
  8. NO indwelling catheters
    - UNLESS absolutely necessary
  9. Asepsis
  10. Report any changes to the Provider
    - Fever, Cough
    - Skin, mucous membranes
    - CVAD
    - Drainage
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15
Q

Infection Prevention:
What are Nurse-Led Protocols?
Name them. (4)
What is the goal?

A

Protocols that are implemented when S/S of infection are present that result in a specific order set.

  1. Obtain Cultures (“Pan” cultures)
    - Sputum, urine, blood cultures
  2. Diagnostics
    - CBC, lactic acid, etc.
  3. Antibiotic Administration
  4. Antibiotic Stewardship

Goal:
Prevention & Early Recognition of sepsis

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16
Q

Neutropenic Precautions

Home-care Patient Teaching (10)

A
  1. Handwashing
    - tell pt to teach visitors this too
  2. Hygiene: daily baths w/ antimicrobial soap
  3. Avoid crowds & sick people
  4. Avoid sharing personal items
  5. Dietary restrictions (we know dis)
  6. Wash dishes well (dishwasher); don’t
    reuse drinking cups
  7. Monitor temperature & S/S of infection
  8. No gardening
  9. No pet litter
  10. Condom use
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17
Q

Cancer-associated Risk for Bleeding is r/t:

A

Thrombocytopenia

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18
Q

Cancer + Risk for Bleeding:

A PLT count of

A

A PLT count of <50,000/mm3 can lead to prolonged bleeding.

A PLT count of <20,000/mm3 can lead to spontaneous bleeding.

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19
Q

Cancer + Risk for Bleeding
Nursing Interventions/Assessments/Precautions
(4 broad categories)

A
  1. Bleeding Precautions
  2. Neurological assessments
  3. Injury Precautions
    - Fall Precautions
    - Line removals,
    - Avoid rectal temps/meds
  4. Treatments
    - PLT transfusion
    - Neumega (PLT-growth factor)
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20
Q

Cancer + Risk for Bleeding: Assessment
What assessment do we perform r/t our biggest concern?
Name the S/S of bleeding (6)

A
  1. Neurological assessment
    - Risk for Spontaneous brain bleed (SAH)!
S/S:
1. Petechiae 
2. Excessive bruising 
  - Internal bleeding--bruises on lower
    back/flank area 
3. Prolonged bleeding (after venipuncture)
  - PLT count checked before line removal
4. Blood in urine and stool
5. Hypotension
6. Tachycardia
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21
Q

Cancer + Risk for Bleeding:
5 General Interventions r/t Bleeding Precautions:

Which one is used to assess for internal bleeding?

A
  1. Lift sheets
  2. Use a Soft-Bristle toothbrush
  3. Assess IV sites
  4. Abdominal Girth measurement
    - Internal bleeding assessment
  5. Fall Precautions
22
Q

Cancer + Risk for Bleeding:

Bleeding Precautions r/t Venipuncture

A
  1. Assess IV sites
  2. Avoid IM injections/Venipunctures
  3. Promote Hemostasis
    • Apply pressure for 10 min. after
      - Use of Ice
23
Q

Cancer + Risk for Bleeding:
Bleeding Precautions
AVOID (3)
NO (3)

A

Avoid:

  1. Enemas
  2. Rectal thermometers/temps
  3. Rectal tubes/meds

NO:

  1. Electric razor
  2. NO dental floss
  3. Nose blowing
24
Q

Cancer + Fatigue

What causes cancer-related fatigue? (2)

A
  1. Anemia (BM suppression & Chemo effects)

2. Nutritional status

25
Q

Cancer + Fatigue

Describe cancer-related fatigue and how it may impact a patient’s life:

A

Far worse than ”everyday fatigue”
- May be considered worse than the side effects of cancer/ cancer Tx (N/V, pain)

May have a profound effect on ADLs and the Ability to perform ADLs

26
Q

Cancer + Fatigue:

3 Main Assessments

A
  1. Anemia Assessment
    - Neurological assessment
    - Spontaneous bleeding
    - Petechiae
  2. Nutritional status
    - I&O
  3. ADL assessment
27
Q

Cancer + Fatigue:

Nursing Interventions

A
  1. Exercise
    - Yoga, walking, etc.
  2. Assess for an underlying cause and treat
  3. Energy Conservation/ Activity Mx
    - Set Priorities
    - Plan ahead
    - Ask for help
    - Optimize sleep
  4. Massage
  5. Healing touch
28
Q

Cancer + Oxygenation:
Cause?

Interventions

A

Tumors in various locations of the CV/PV system that lead to HYPOXIA & POOR TISSUE OXYGENATION

Interventions:

  1. CV/Respiratory Assessments
  2. Oxygen
29
Q

What are some other big areas for nursing interventions? (4)

A
  1. GI-related issues
  2. Motor & Sensory Deficits
  3. Pain
  4. Psychosocial interventions
30
Q

Cancer + GI:

What causes GI issues r/t to cancer?

A

May be from:

  1. Cancer itself
  2. Chemotherapy
  3. Radiation
31
Q

Cancer + GI:

What are the 4 main GI issues related to cancer:

A
  1. Cachexia
  2. Mucositis/Stomatitis
  3. N/V
  4. Changes in taste
32
Q

Cancer + GI:
What is Cachexia?
What are our Interventions r/t for this and what’s an important consideration?

A

Cachexia: weakness and wasting of the body due to severe chronic illness.

Interventions related to NUTRITION!

  • Should be patient-specific!
    1. Protein and CHO-rich foods
    2. Small, frequent meals
    3. Nutritional supplements
33
Q

Cancer + GI: Mucositis & Stomatitis
What do we want to promote for these?

Interventions (6)

A

Assess, assess, assess!
Promote Hygiene!

  1. Cold therapy (ice/ice-pops)
    • Oral cryotherapy
  2. Mouth rinses/Medicated mouthwashes
    - Sodium bicarbonate
    - Lidocaine
    - Magic mouthwash
  3. Use non-irritating mouth cleansers
  4. NO floss
  5. Use a Soft bristle toothbrush
  6. Mucosal Protectants
34
Q

Cancer + GI: Nausea & Vomiting
What usually causes N/V?
Name the 4 types:

A

Main cause: Chemotherapy!

  1. Acute:
    - Occurs suddenly during chemo
  2. Anticipatory:
    - Triggered by thought, sight, smell
  3. Delayed:
    - Occurs 1-5 days after chemo
  4. Breakthrough
    - Occurs even w/ Tx of N/V
35
Q

Cancer + GI: Nausea & Vomiting
What is our #1 Priority?
What drug therapy did Messer mention?

A

ADEQUATE CONTROL of N/V

  1. Serotonin (5-HT3) antagonist drugs
    - Ondansetron
36
Q

Cancer + Motor & Sensory Deficits
What causes these deficits?

What can this result in? Describe it.

What’s this put patients at risk for?

A

Occurs with bone and brain metastasis, compressed nerves –> restricts mobility

Results in Peripheral Neuropathy

  • Loss of sensation in lower extremities
  • May be painful
  • Loss of balance
  • Injury to feet (unaware of injury)

RISK FOR INJURY!

37
Q

Cancer + Motor & Sensory Deficits
Assessment (3)
Interventions (3)

A

Assessment:

  1. Pain
  2. Mobility
  3. ADLs

Interventions:

  1. Promote optimization
  2. Offer assistance
  3. PT/OT referral
38
Q

Cancer + Pain

What kind of approach do we take?

A

Multimodal pain management

  1. Opioids
  2. Analgesics
  3. PT
  4. Healing touch
  5. Massage
  6. Acupuncture
  7. Aromatherapy
39
Q

Cancer + Psychosocial Care
Who can we include in Psychosocial management? (4)
What do we need to consider for family/caregivers?

A
  1. Support Services
  2. Case Manager
  3. Navigator
  4. Palliative Care

ASSESS Caregiver role strain!

40
Q

Cancer + Psychosocial

What do we want to assess? (7)

A
  1. Anxiety and depression
    - Fear of Recurrence
  2. Sleep Disturbances
  3. Physical Changes
  4. Effects of Reduced function/ADLs
  5. Sexual Dysfunction/ Fertility issues
  6. Work/ Inability to participate in normal roles
  7. Spiritual issues
41
Q

Cancer + Psychosocial + Physical Changes

Alopecia + Interventions

A

Loss of hair on all parts of the body (eyebrows, lashes, etc.)

Interventions:

  1. Protect scalp
    - wear hat while in the sun
  2. Coping assessment and Mx
42
Q

Cancer + Psychosocial

What kind of Cognitive changes may occur?

A

Chemo-brain (chemotherapy)

Brain tumor/ mets

43
Q

Cancer + Treatment
What is radiation?

What’s the most common type?

A

Use of high-energy radiation to treat cancer

Most common type: Gamma rays
then Beta rays for internal forms

44
Q

Cancer + Radiation Therapy

What are the goals for radiation therapy?

A

Goals:

  1. Cure
  2. Control
  3. Palliative
  4. Minimize destruction of normal tissue and maximize destruction of abnormal tissue.
    - Localized effects (with exception)
45
Q

Cancer + Radiation Therapy
How is it given?
Differentiate Exposure & Dose

What are the 3 considerations for Dose?

A

Typically given in a series of divided doses

  1. Exposure- amount delivered
  2. Dose- amount actually absorbed
    - Intensity
    - Duration
    - Closeness
46
Q

Cancer + Radiation Therapy

How is it administered? (2)

A
  1. Teletherapy

2. Brachytherapy

47
Q

Cancer + Radiation Therapy

What is Teletherapy?

A

External beam

48
Q

Cancer + Radiation Therapy
What is Brachytherapy?

What are the 2 Types?

What is a major consideration when caring for a patient receiving this therapy?

A

Internal device; Direct contact with cancer
- PO, IV, surgical insertion

  1. Unsealed: body fluids are also radioactive
  2. Sealed: Only the patient emits radiation

Patient emits radiation as long as the device is emitting radiation

49
Q

Cancer + Radiation Therapy

Brachytherapy Precautions

A
  1. Private room
  2. Sign on door
  3. Keep door closed
  4. Wear a lead apron while providing care
  5. Restrict time in the room
  6. Keep visitors 6 feet away/limit time
    - NO LONGER THAN 30 min
  7. Do not assign pregnant caregivers
  8. Special handling of bed linens and dressings
50
Q 
Cancer + Radiation Therapy
Side Effects (8)
A
  1. Skin changes (dermatitis)
  2. Hair loss
    - Usually at the site radiation was rec’d
  3. Altered taste
  4. Fatigue
  5. Inflammation
  6. Tissue Fibrosis/ scarring
  7. Secondary malignancies
  8. CV Disease
51
Q 
Cancer + Radiation Therapy
Patient Education (2)
A
  1. Do not remove markings
  2. Skincare
    - Specific to location and type of radiation
    - Avoid scrubbing areas
    - Use mild soaps, etc.

NSG 320 (mcp) (24 decks)

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