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NUR 201 Week 2 > Cancer > Flashcards

Cancer Flashcards

(4)

1
Q

Normal cell growth is well controlled by ?

A

Cellular regulation

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2
Q

Cancer or malignant cells are (normal/abnormal), serve no normal function, and have quite a few features

A

abnormal

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3
Q
  1. ? - is the change in appearance from the parent cell
  2. Have a larger nuclei-cytoplasmic ratio
  3. Serve no useful purpose
  4. Have loose adherence - do not make adhesion molecules; easily break off from the main tumor
A

Anaplasia

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4
Q
  1. Migration/metastasis
  2. Lack contact inhibition
  3. Rapid or continuous cell division - do not respond to apoptotic signals and have an unlimited lifespan (“immortal”)
  4. Abnormal chromosomes (chromosome # and/or structure is not normal [ ? ] )
A

aneuploidy

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5
Q

?

Are substances that effect the genes of a normal cell and change it to a cancer cell

A

Carcinogens

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6
Q

?

Is the change in gene expression by anything that can penetrate and mutate the DNA of a cell. This process can overexpress cell division or damage the suppressor genes which limit division

A

Initiation

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7
Q

During progression, the cells continue to multiply and divide. They also develop their own blood supply (?)

A

angiogenesis

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8
Q

A cluster of these cells create a primary tumor which arise from a parent tissue. This is also known as the tissue of origin and is used for classification

A
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9
Q

Secondary tumors occur when cancer cells move from the primary location and establish remote colonies. This is also known as ___

A

metastasis

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10
Q

True or False?

If a primary breast cancer spreads to the ribs or spine, the secondary tumor is considered bone cancer

A

False

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11
Q

Metastasis may spread by blood or the lymphatic system

A
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12
Q

True or False?

With grading, the cells that most resemble their parent tissue are most aggressive and considered “high-grade”

A

False

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13
Q

With ploidy, an increase in ___ usually increases the degree of malignancy

A

aneuploidy

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14
Q

(TNM) stands for __, __, ___; describes the anatomic extent of cancers

A

tumor, node(s), metastasis

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15
Q

A carcinogen can mutate a normal cell’s DNA and “switch off” the suppressor genes and allow ___-genes to overexpress and cause cancer

A

onco

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16
Q

True or False?

Cells that normally divide are at greater risk for cancer development

A

True

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17
Q

Examples of Carcinogens

Chemicals
> Tobacco chemicals, charred red meat from a grill

Physical
> Burns, chronic irritation, radiation

Oncoviruses
> Hepatitis B and C, Epstein-Barr, HPV

A

Other factors that influence risk - immune function, increased age, and genetic predisposition

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18
Q

Primary Prevention = ?

  • Using sunscreen
  • Smoking cessation
  • Using chemoprevention
  • Removal of at-risk tissues (i.e. colon polyps, pigmented skin lesions)
A

Avoidance (of known or potential carcinogens)

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19
Q

Secondary Prevention = ?

  • Mammography
  • Digital rectal exam (DRE)
  • Fecal occult blood testing
  • Checking for gene mutations (i.e. BRCA, colonoscopy)
A

Screening

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20
Q

Secondary Prevention = ?

  • Mammography
  • Digital rectal exam (DRE)
  • Fecal occult blood testing
  • Checking for gene mutations (i.e. BRCA, colonoscopy)
A

Screening

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21
Q

Some consequences of cancerous invasion

Hematological effects - marrow invasion or chemotherapy side effects

WBC - decrease production/function: increase risk of infection

RBC - decrease production/function: anemia, decreased O2 carrying capacity and fatigue

A

Platelets - decreased production: impaired clotting

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22
Q

GI effects

↑ metabolic requirements

↓ appetite, absorption

↑ risk of obstruction = cachexia and catabolism

A

Motor/sensory

  • Compression/invasion of motor nerves and/or skeletal system may effect movement and gait. Compression of sensory nerves may affect sensation and cause paresthesia or pain. Brain involvement may effect cognition
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23
Q

Reduced gas exchange

  • Compression/rupture of blood vessels and lung tissue
A

Management - Surgery types

  • Prophylactic
  • Palliative
  • Curative
  • Reconstructive
  • Biopsy/diagnostic
  • Cytoreductive
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24
Q

?

Removal of a precancerous polyp

A

Prophylactic

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25
? Offers confirmation of cancer
Biopsy/diagnostic
26
? Removal of tumor obstructing the intestine to improve quality of life; not a cure
Palliative
27
? Complete removal of cancer tissue
Curative
28
? De-bulking a tumor to improve odds of cure
Cytoreductive
29
? Breast implants after mastectomy
Reconstructive
30
List of a few anticipated post-op interventions... Physical rehab - PT/OT/ST Psychosocial - medications, mental health and support groups Wound care - nursing promotes early mobility, pain management, prevention of infection; teaching patients to look at and touch wounds for acceptance
31
True or False? The side effects of localized radiation to an intestinal tumor are usually systemic. It is typical that a client's hair on their head will fall out after treatment
False
32
True or False? Radiation therapy usually is given as a series of divided doses because of the varying responses of all cancer cells within the tumor
True
33
___ or internal radiation therapy, is located within the patient and is a potential hazard to the healthcare worker; these include unsealed PO or IV isotopes or sealed seed implants
Brachytherapy
34
? Is radiation delivered from outside the patient; therefore, the patient is not radioactive and healthcare workers are not at risk for radioactivity With this therapy, radiation beam patterns are determined based on the tumor location Position-fixing devices/markings are implemented. Body molds and tattoos may be implemented. DO NOT remove temporary tattoos!
External beam or teletherapy
35
10 items when caring for a patient with sealed radioactive implants 1. Private room and bath 2. Dosimeter film badge 3. Lead shield barrier 4. Signage - "Caution: Radioactive Material" 5. Lead apron
6. Keep the door closed to the room as much as possible 7. Limiting visitors to 1 half-hour per day; visitors to stay at least 6 feet from the source 8. Never touch radioactive source with bare hands. If dislodged, use long-handed forceps to retrieve it 9. After source is removed, dispose of dressings and linens in the usual manner 10. No pregnant nurses caring for these patients; no women who are pregnant or children <16 *More distance between you and patient and less time exposure are your friends*
36
Side effects of radiation - note that many side effects for radiation are common with chemotherapy Skin breakdown - desquamatization
37
Mucositis/xerostomia/tooth decay/breakage/taste, dietary changes Lozenges, saliva - substitutes, dental visits
Fatigue r/t bone marrow suppression or increased energy demands for healing Exercise, sleep nutrition
38
Nausea/vomiting Antiemetics, nutrition, hydration
Proctitis with diarrhea
39
Chemotherapy Used when cancer has spread beyond a local site (systemic) and effects all cells in the body by mostly **rapidly** dividing cells
40
___ is the time when bone marrow activity and WBC counts are lowest after chemotherapy It is common to use combination therapy using differing drug categories with differing ___ based on total body surface area of the client The **intravenous** route is the most common for chemotherapy and requires special training to administer
Nadir
41
True or False? Healthcare personnel who prepare and administer IV and PO chemotherapy medications need to wear PPE including double gloves
True Chemo can be absorbed through the healthcare provider's skin
42
? A new cancer that occurs in an individual as a result of previous treatment with radiation or chemotherapy
Secondary malignancy
43
Infiltration of vesicants can cause ___ which occurs when a drug leaks into the surrounding tissues at the IV site. Intervention includes knowing the institution's policies and procedures that are drug-specific. Increasingly, **implanted port** or **central line** methods of infusion are used to minimize this risk
extravasation
44
Hemorrhagic cystitis Chemoprotectants for bladder (Mesna) and kidney (Amifostine)
Cardiac muscle damage
45
Hemorrhagic cystitis Chemoprotectants for bladder (Mesna) and kidney (Amifostine)
Cardiac muscle damage
46
Myelosuppression * ↓ WBC increases risk for infection; managed with biologic response modifiers and growth factors to stimulate bone marrow ! Know prevention and care of infection (*key points*)
Often, neutropenic clients do not exhibit signs of infection and institution protocols are usually in line if there is suspected infection to draw cultures and start abx asap Common medications: Filgrastim (Neupogen), Pegfilgrastim (Neulasta) Temp >100°: HCP may initiate anti-infectives - Teach importance of mouth care, washing axillary and perianal areas at least q12h
47
↓ RBC = increase hypoxia and fatigue - Epoetin alfa (Epogen), darbepoetin alfa (Aranesp) - Transfusions, oxygen
↓ platelets (thrombocytopenia) = increase risk for bleeding - oprelvekin (Neumega) [risk of fluid retention] - Platelet transfusions - Bleeding with small trauma at **50,000** platelets/mm3 - Spontaneous bleed at **20,000** platelets/mm3 * Bleeding prevention strategies
48
Prevention of Injury for the Patient With Thrombocytopenia
Preventing Injury or Bleeding
49
Mucositis * Mouth care - May be dose-related - Prevention with cryotherapy
Alopecia - Cryotherapy is being studied in preventing this side effect
50
Nausea and vomiting * 1 or more antiemetics may be given before, during, and after chemotherapy
Cognitive function * "chemo brain" > Chemo doesn't usually cross the blood-brain barrier but may cause inflammation; the nurse provides cognitive training and rehabilitation resources
51
Peripheral Neuropathy * Risk for injury
52
Oncological Emergencies Sepsis ? Phenomena of increased clotting then decreased bleeding
Disseminated intravascular coagulation (DIC)
53
? Occurs due to increased fluid retention then dilution of potassium and electrolytes
Syndrome of inappropriate antidiuretic hormone (SIADH)
54
? Condition that involves pain, paralysis, impaired organ function - Palliative corticosteroids and radiation; surgery
Spinal cord compression (SCC)
55
? Occurs when tumor secretes **parathyroid** hormone releasing calcium from the bones Common manifestations: renal stones, bone pain, change in mental status, abdominal discomfort
Hypercalcemia
56
Hypercalcemia - Treatments * Aggressive IV normal saline to dilute calcium (! assess pt for volume overload) * Loop diuretics to remove calcium from urine * Calcitonin, biphosphonates, oral glucocorticoids, dialysis
57
? Occurs when there is a blockage of venous return from the **head**, **neck**, and **upper extremities** * **Facial edema, engorged blood vessels, erythema of upper trunk, SOB, stridor, decreased cardiac output, decreased BP, change in MS**
Superior vena cava syndrome
58
Palliative treatment * High dose radiation therapy to upper chest area for temporary release of airway obstruction * Metal stent placement in vena cava to relieve swelling
* Chemo as only option for long-term control of cancer causing the compression
59
? Is a sign of **effective** treatment Occurs when lysis releases **potassium** from the cells that can cause cardiac dysfunction. Uric acid crystals clog the kidneys and cause AKI
Tumor lysis syndrome (TLS)
60
* Treat with IV hydration, sodium polystyrene sulfonate (Kayexalate), glucose, and insulin to decrease potassium; allopurinol to decrease **uric acid**
* Drink 3000 mL a day leading up to and during treatment to help prevent TLS * Antiemetic regimen d/t N/V >chemo and may not feel like drinking fluids * Monitor daily weights and serum electrolyte values

NUR 201 Week 2 (3 decks)

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