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Cancer Flashcards

1
Q

What is cancer?

A
  1. LEADING cause of death WORLDWIDE!
  2. Second most common cause of death in the U.S.
  3. A malignant (unregulated) transformation of cell within a specific body system LEADING to uncontrolled cell growth (proliferation/autonomy) and differentiation (Anaplasia)
  4. Genetic & Immune factors
    - GENETIC alterations:
  5. Direct mutation to DNA –> carcinogen can damage the DNA and cells
  6. Gene varients
  7. Epidemic things like environment
  8. Modifiable & non-modifiable risk factors
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2
Q

What is the MOST significant adverse effect of CHEMOTHERAPY????

A

NEUTROPENIA (low WBC) = Infection!!!!!

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3
Q

What are the 4 causes of Cancer??

A
  1. Gene mutation
  2. Factors that cause DNA alterations
  3. Overwhelming immune surveillance
  4. Modifiable and non-modifiable risk
    - Modifiable: lifestyle and environment exposure to carcinogen
    - Non-modifiable: age & genetic predisposition
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4
Q

What are the 6 Common Risk Factors of Cancer???

A
  1. Advancing Age**
  2. Cigarette Smoking**
  3. Obesity
  4. Pathogens
  5. Lack of exercise
  6. Dietary factors:
  7. Lack of fruits and veggies
  8. ALCOHOL
  9. Meat concerns
  10. High fat
  11. Sugar
  12. Artificial sweeteners
  13. Salt & salt preserved foods
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5
Q

What are the 8 Characteristics of Cancer cells?

A
  1. Altered proliferation (autonomy)
  2. Lack of contact inhibition
  3. Lack of apoptosis
  4. Lack of “anchorage dependance”
  5. Possible rapid proliferation
  6. Migratory potential (Metastasis):
    - Blood
    - Lymph node
    - Direct invasion
    - Seeding: small cancer cells break off the primary tumor & go into the cavities (pleural & abdomen)
  7. Poor differentiation (Anaplasia)*
  8. Angiogenesis
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6
Q

What’s cellular dysplasia?

A

Cellular change in size, shape, & organization!

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7
Q

What’s neoplasia??

A

Uncontrolled proliferation

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8
Q

Can a benign neoplasia be problematic? Why?

A

YES! Even though benign neoplasm doesn’t have those cancer cell characteristics, they uncontrollably grow/proliferate and can cause, for ex in the brain, pressure and lead to headache and N/V

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9
Q

What are the 2 types of cancer???

A
  1. Solid Tumor Malignancies: from organs and grow into assess that invade normal tissue as they expand in size
  2. Hematological Malignancies: from cells of the hematopoietic cell line OR from secondary immune organs such as lymph nodes or spleen
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10
Q

What are the clinical manifestations of cancer?????**

A
  1. CAUTION symptoms
  2. Constitutional signs/general signs:
  3. FATIGUE
  4. UNEXPLAINED WEIGHT LOSS
  5. Fever
  6. Night Sweats
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11
Q

What are the TWO MOST general manifestations of Cancer???????***

A
  1. FATIGUE
  2. UNEXPLAINED WEIGHT LOSS!!
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12
Q

What are the Tumor specific symptoms????

A
  1. Primary tumors: tumor tht came first
  2. Secondary tumor: the one tht METASTATIS from the primary
  3. METABOLIC CHANGES (Paraneoplastic syndrome)** - where the tumor is producing weird substances
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13
Q

What are the 6 Common Complications of MALIGNANCY????***

A
  1. Anorexia/Cachexia Syndrome:
    - Treatment related
    - Psychological factors
    - Alterations in CNS role in appetite & satiety
    - Local effects of cancer
  2. HYPER-COAGULATION**
    - Thrombogenic tumor cells
    - Inflammatory influence
  3. EFFUSIONS*
    - Pleural space or pericardial sac
    - Manifestation of fluid in the pleural space: Dyspneic, increased RR with accessory muscle, unequal chest excursions, diminished breath sounds!!!!!!!!!!!!
    - Manifestation of fluid in the pericardial space: Heart can’t contract well & signs of low perfusion
    - Cancer in the blood, lymph, breast, lungs, prostate, & ovaries
  4. Fluid & Electrolye imbalance
  5. GLUCOSE metabolism abnormalities
  6. DEPRESSION!!!!!!!!****
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14
Q

What are the oncologic emergencies???

A

Acute clinical complications that occur in the presence of malignancy!!!
1. The process of tumor growth and invasion of body organs
2. *Metabolic changes cells (Paraneoplastic syndrome)
3. *TREATMENT MODALITIES (like radiation and chemo) = TUMOR LYSIS SYNDROME!!!!!

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15
Q

What is tumor lysis syndrome and how can it be an oncologic emergencies????

A
  • Occurs when cancer cells are killed and burst open stuff
    1. Burst out lots of potassium (Hyperkalemia) and can cause Cardiovascular issues AND GI Hypermotility!!!!!
    2. Purines are released and will be converted to URIC ACID and can cause HYPERURECIMIA!! This can be damaging to the kidneys can cause KIDNEY FAILURE = elevated BUN and creatinine and decreased urine output
    3. Elevated phosphorus causing HYPOCALCEMIA!!! Can lead to Damage nerve (Numbness& Tingling/parathesia, Neuromuscular irritability, LARYNGEAL CONSTRICTION) AND DECREASED CONTRACTION OF THE HEART!!!!!!!!!!!
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16
Q

What are the MANAGEMENT interventions for TUMOR LYSIS SYNDROME????!!!!!!*****

A
  1. Prevention : ***HYDRATE & meds
  2. DIALYSIS*****
  3. Drug therapy:
    - Diuretics**
    - ALLOPURINAL (LEADING CAUSE OF STEVEN JOHNSON syndrome)***
    - Insulin/Dextrose
  4. Monitor EKG
  5. Monitor Electrolytes
  6. Monitor Renal function!!!!
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17
Q

What are the 3 DRUGS FOR TUMOR LYSIS SYNDROME????

A
  1. Diuretics**
  2. ALLOPURINAL (LEADING CAUSE OF STEVEN JOHNSON syndrome)***
  3. Insulin/Dextrose!!!
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18
Q

What is one of the drug of tumor lysis syndrome that causes a specific syndrome???

A

Allopurinal!!!!!!! Causes Steven Johnson Syndrome!!

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19
Q

What are the 3 cancer prevention methods???***

A

1) PRIMARY prevention:
1. Risk modification
- AVOID CARCINOGEN
- Active & maintain proper weight.
- Avoid too much sun exposure and Use SUNSCREEN
- AVOID ALCOHOL; women no more than 1 drink per day, men no more than 2 drinks
- RECOGNIZE family risk and CONSIDER prophylactic interventions for genetic mutation
2. Chemoprevention
3. Vaccination
2) SECONDARY prevention:
1. Screenings
2. Better Clinical outcomes and reduces number of cancer deaths
3) TERTIARY prevention:
1. Reduce morbidity and mortality once a disease has been diagnosed

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20
Q

Cancer increases risk of what???

A

Inflmattion = (&) clotting!!!!!!!!

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21
Q

What are the classification of Cancer?? THEN, What 2 goals are set????

A
  1. Helps to standardize diagnosis, prognosis, and treatment!!
  2. Based on: Grading and Staging (TNM system)
    - Grading (Grade1-4, degree of differentiation)
    - Staging (TNM system: T- tumor size and spread, N- node involvement, M- metastatic state)

THEN, GOALS ARE SET:
- therapies is determined by the HCP in order to PROLONG SURVIVAL and IMPROVE QUALITY OF LIFE

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22
Q

What’s the difference between Cure, Remission, Control, and Palliation??

A
  1. Cure- Free of Disease
  2. Remission- Disease free states, unclear if eradicated or controlled
  3. Control- not cured, just controllable
  4. Palliation- Relief of symptom
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23
Q

What are the treatment modalities of cancer??

A
  1. Surgical procedures, from prophylaxis to reconstruction
  2. Radiation
  3. Chemo
  4. NEOADJUVANT and ADJUVANT
  5. NEOadjuvant: BEFORE primary treatment!!! (Ex: chemo or radiation BEFORE getting surgery to shrink the tumor down is that surgeon will have easier time to get it out)
  6. Adjuvant: AFTER primary treatment!! (Ex: having surgery for ur cancer and then going into Chemo or Radiation)
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24
Q

What are the 3 types of Radiation??

A
  1. External Beam Radiation (Teletherapy)
  2. Internal Radiation Therapy (Brachytherapy)
  3. Radiopharmaceutical Therapy (Systematic therapy)
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25
Q

Which one of the 3 types of radiation therapy does NOT make the patient radioactive?????

A

EXTERNAL BEAM RADIATION (TELETHERAPY)!!!!!

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26
Q

What’s the MAIN common difference between Internal Radiation Therapy (Brachytherapy) and Radiopharmaceutical Therapy (Systematic Therapy)???????

A

Internal Radiation Therapy (Brachytherapy) emits radiation BUT waste products are NOT radioactive!!
While, Radiopharmaceutical Therapy causes waste products that are RADIOACTIVE!!!!

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27
Q

What is the External Beam Radiation (Teletherapy)?????

A

1) Distance therapy in divided doses
1. Shield vulnerable tissues if possible
2. Potential for damage of healthy tissues
2) AREA MARKED (Teach patient not to remove markings!!!)
3) The patient is NOT “Radioactive”!

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28
Q

Which radiation therapy need the area of the cancer to be “tattooed”??

A

External Beam Radiation (Teletherapy)

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29
Q

What is the patient care for External Beam Radiation (Teletherapy)?????***

A
  1. Provide a well-balanced diet that DOESN’T contain RED MEAT!!
  2. Manage fatigue by scheduling activities w/ rest periods in between AND using Energy-saving measurements!
  3. Wear SOFT CLOTHING and avoid TIGHT/constricting clothes
  4. DON’T expose the irradiated skin to the sun or heat!!!
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30
Q

What are the side effects of radiation therapy??????

A
  1. ** FATIGUE
  2. ** CHANGE IN TASTE SENSATION – METALLIC TASTE (or unpalatable taste)
  3. Hair loss (that’s permanent)
  4. SKIN inflammation
  5. GI tract Inflammation!
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31
Q

What are the assessments of anemia?

A

Signs of POOR PERFUSION!!!!!!!!
Pallor, sluggish, lightheadedness, fatigue, SOB with short exertion.

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32
Q

What are the CAUTION symptoms???

A

Changes in the bowel or Bladder Habits
A sore that doesn’t heal
Unusual bleeding or discharge
Thickening or lump in the breast or anywhere in the body
Indigestion (difficulty swallowing)
Obvious change in wart or mole
Nagging cough or hoarseness!!!

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33
Q

oh What is Paraneoplastic syndrome?

A

substances/weird stuff that a tumor is producing instead of the cancer itself, that causes metabolic changes. This is under Tumor Specific Symptoms of the Clinical Manifestations of Cancer!!!

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34
Q

What are the causes of Anorexia/Cachexia syndrome, a common complication of malignancy?????

A
  1. Treatment related
  2. Psychological factors
  3. Alterations in CNS role in appetite & satiety
  4. Local effects of cancer
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35
Q

What are the TWO MOST COMMON risk factors* of cancer????

A

Advancing age and Smoking!!!!

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36
Q

What are the common COMPLICATIONS of Malignancy????

A
  1. Anorexia/Cachexia syndrome
  2. Hyper-coagulation
  3. Effusions
    —-
  4. Fluid and electrolyte imbalances
  5. Glucose metabolism abnormalities
  6. DEPRESSION**
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37
Q

What may be present when there’s malignancy of cancer??? What is the definition???

A

Oncologic Emergencies!!! They are ACUTE clinical complications that occur in the presence of malignancy!!!!!

38
Q

What are the drugs that help with an oncologic emergency, Tumor lysis syndrome??????***

A
  1. Diuretics
  2. Allopurinal (Leading cause of Steven-Johnson’s Syndrome)
  3. Insulin/Dextrose
39
Q

What are the ACUTE complications of Malignancy?!!!?***

A

This is referring to Oncologic Emergencies!!!!!!!! Because oncologic emergencies are Acute complications that occur in the presence of malignancy!!!!!!!
1. The process of tumor growth AND invasion of body organs!!
2. Metabolic changes cells (Paraneoplastic syndrome)
3. Treatment modalities (chemo and radiation)

40
Q

Would screenings be primary, secondary, or tertiary prevention??????

A

SECONDARY!!!!!

41
Q

What are the assessments of Orpharyngeal Candiasis (Thrush)??????

A
  1. Redness, Irritation, and, Pain
  2. Creamy white lesions
  3. Bleeding potential
  4. MAY crack/bleed at mouth corners!!!!!!
42
Q

What are the patient care for Orpharyngeal Candiasis (Thrush) AND 3 Patient teachings????

A

Patient Care:
1. Gentle oral hygiene, Avoiding Alcohol or Glycerin mouthwash or swabs, Use SOFT toothbrush and change regularly.
2. Clean dentures, LEAVE OUT IF PAINFUL
3. Avoid spicy, acidic food! Cold food rather than hot
4. MEDications: Viscous Lidocaine (numbing) and Nystatin (swish and swallow)
—
5. Examine mouth several times a day
6. Obtain a specimen for new lesions & Report to HCP
7. Give a TOPICAL ANESTHETIC PRIOR TO MEALS
8. ORAL HYGIENE BEFORE & AFTER MEAL. use LUBRICATING/MOISTURIZING agents to help DRY mouth

Patient Education:
1. Rinse Sodium Chloride with normal temp. Tap water/salt/soda
2. SOFT, BLAND FOOD that are HIGH IN CALORIES
3. DRINK AT LEAST 2 LITERS OF WATER EVERY DAY!

43
Q

Leading cause of cancer deaths in the world??????

A

LUNG CANCER!!!!!

44
Q

WHAT ARE THE TWO MEDS TO TREAT OR HELP ORPHARYNGEAL CANDIATIS????

A
  1. Viscous Lidocaine (for numbing), and
  2. Nystatin (swish and swallow)
45
Q

What should you give to someone who has orpharyngeal candiatis PRIOR TO MEALS??????**

A

Give a Topical anesthetic prior to meals!!!!!
And also Oral hygiene BEFORE and AFTER each meal

46
Q

What is septic shock????

A

Poorly perfused!!!!

47
Q

Do you restrict ALL VISITORS from a patient who is neutropenic?????? (EXAM))

A

NOO, NEVER!!!! ONLY RESTRICT VISITORS WHO ARE ILL!!!!!*******

48
Q

What are neoadjuvant and adjuvant therapies????? Give examples

A
  1. Neoadjuvant –> BEFORE primary treatment!! (EX: Chemo/radiation before getting surgery so that the tumor can shrink down and surgeon will have easier time taking it out)
  2. Adjuvant –> AFTER primary treatment!!! (EX: Surgery first, and then you get Chemo/radiation!)
49
Q

What med should you give PRIOR TO MEALS IN SOMEONE WHO HAVE ORPHARYNGEAL CANDIATIS (THRUST)??? What about one thing you should do before and after every meals???

A
  1. TOPICAL ANASTHETIC PRIOR TO MEALS
  2. ORAL HYGIENE BEFORE AND AFTER EACH MEALS!!!
50
Q

What kind of thing would you need to RINSE your mouth with when you have ORPHARYNGEAL CANDIATIS (THRUST)???

A

Rinse with Sodium Chloride, room temperature tap water/salt/soda water!!!

51
Q

What kind of mouthwash and swabs would you want to AVOID when someone has ORPHARYNGEAL CANDIATIS (THRUST)???

A

AVOID Alcohol and Glycerin based Mouthwash or swabs!!!!!!!!!!!

52
Q

What is Internal Radiation Therapy (Brachytherapy)?????? What are the patient care????? What are the care FOR Providers????

A
  1. Implants placed in the body, releases energy as it decays
  2. Patient EMITS radiation but waste products ARE NOT radioactive!!!
  3. ## The safety of patients, staff, and visitors are PRIORITY!!Patient Care:
  4. May require isolation
  5. Visitors restricted (Pregnancy woman CAN’T visit)!! Children too! Maintain 6 feet DISTANCE!!
  6. ** BOWEL PREP
  7. ## ** DOOR SHUT!!!Providers:
  8. Limit exposure
  9. Dosimeter badge
  10. Shielding!
  11. Lead pan
53
Q

What other name is Internal Radiation Therapy called??

A

Brachytherapy!!

54
Q

What other name is External Beam Radiation called??

A

TELEtherapy!!

55
Q

What prep do you need to do before Internal Radiation therapy (brachytherapy)????? What should you do about the door of their room???

A
  1. ** BOWEL PREP
  2. ** DOOR SHUT!!!
56
Q

What should providers do in Internal Radiation Therapy (Brachytherapy)???

A
  1. Limit exposure
  2. Dosimeter badge
  3. Shielding!
  4. Lead pan
57
Q

What is Radiopharmaceutical Therapy (Systematic Therapy)??? What are the patient care????

A
  1. PO or IV (radionuclide iodine for thyroid ca)
  2. ## Patient’s waste products ARE RADIOACTIVE!!!!! CAUTION!!!!Patient Care:
  3. Flushing TWICE, and wash hands!!
  4. HYDRATE WELL!!!!
  5. Contact Concerns!!!!
58
Q

What other name is Radiopharmaceutical Therapy called??

A

Systematic therapy!!!

59
Q

Which radiation therapy is it that the patient’s waste products ARE radioactive?????

A

Radiopharmaceutical Therapy (Systematic Therapy)!!!!!!!

60
Q

What does CHEMOTHERAPY KILLS????? (EXAM)!!!!***

A

Kills RAPIDLY DIVIDING CELLS!!! The faster they divide, the better the drug will work!!!

61
Q

What are the VULNERABLE CELLS of Chemotherapy??????

A
  1. Hair
  2. Skin
  3. Epithelial lining of GI Tract
  4. SPERMATOCYTES**
  5. HEMATOPOIETIN!!!**
62
Q

What are the Administration Implications of Chemotherapy???!!!

A

1) NADIR = WBC count is LOWEST during this period of time!!! Nadir time varies between drug to drug!!! POTENTIALLY LIFE-THREATENING!!!
2) Take Care of the IV Site!
- 1. EXTRAVASTATION from vesicant is a MAJOR COMPLICATION!!!!!!
- 2. Always check for PATENCY prior to hanging IV
- 3. Restart if IV site is not patent!
- 4. Report if there’s leakage from the IV!
3) Route of Administration: Oral, IV, Intraarterial, intraventricular, skin, and intracavitary!
4) Certification, Handling of medications

63
Q

What are the 6 common Adverse effects of Chemotherapy????!!!

A
  1. Alopecia/hair loss
  2. Cognitive impairment/ “Chemo brain”
  3. Hyper-sensitivity (too sensitive to the drugs & may cause reactions!) give them:
    - Steroid
    - Anti-histamine
    - Epinephrine for severe reactions
  4. Neuropathy!!!!!!!!!
  5. Oral effects: mucositis, stomatitis
  6. ** NAUSEA/VOMITING, ANOREXIA!!!!!!!!
    - compassionate care: being still, cool air temp & cool wash cloths, bed pants empty, urinal out of sight, DIM LIGHTS, and if they don’t have appetite give them ice chips or popsicle to suck on!!!
    - Teaching: don’t eat their favorite bc it can remind them of the experience
64
Q

What are the 4 Reasons why Patient with cancer are at risk for MALNUTRITION????

A
  1. Increased METABOLIC demand
  2. Treatment modalities (cz of chemo)
  3. Psychological factors
  4. Local effects of cancer!
65
Q

How do we assess a patient Nutritional Status????

A
  1. Appetite Loss
  2. Weight loss, and low BMI (less than 18.5)
  3. Fatigue, weakness
  4. Skin, nail, hair changes
  5. Bowel habits
  6. Mouth ulcers, N/V
  7. Labs: CBC, Pre-albumin, & Albumin
66
Q

How do we promote DIETARY INTAKE???

A
  1. Managing primary inhibiting factors: Mouth ulcers, N/V, taste alteration
  2. Small, frequent meal
  3. Hydrate btwn meals
  4. High calorie, high protein, and nutrient dense foods!!!
  5. Environment
  6. Protein shake!!!!
  7. Tube feeding, TPN!
67
Q

What are the 3 Bone marrow suppressions as an adverse effects of CHEMO???

A
  1. Erythropenia and Anemia (Low RBC)
  2. Thrombocytopenia (Low platelets = risk for bleeding)
  3. Neutropenia (Low WBC = infection)
68
Q

What are the THREE DRUGS YOU GIVE when patients with CHEMOTHERAPY is having Reactions to the drugs (Hyper-sensitivity; which is one of the adverse effect tht comes with chemotherapy)??????***

A
  1. Steroids
  2. Anti-histamines
  3. Epinephrine (for severe reactions
69
Q

What are the patient care for Erythropenia and Anemia???????

A
  1. Signs of Anemia: Sluggish, pallor, *Fatigue, Light-headedness, SOB w/ minimal exertion!
  2. Anemia-related fatigue: Give REST PERIODS in btwn of activities AND use ENERGY-SAVING measures!!!!
  3. Monitor Hgb
  4. Blood transfusion!
  5. Dietary supplements: Iron, Vit.B12, Folate!!!!!!!!!!***
  6. Supplemental O2
70
Q

What dietary supplements would you give to Erythropenia and Anemia????

A

Dietary supplements: Iron, Vit.B12, Folate!!!!!!!!!!***

71
Q

What is the compensatory response to Decreased Oxygen Carrying (in Erythropenia and Anemia)???????

A
  1. HR increases
  2. Vasoconstricts
  3. BP will go UP!!!!!
72
Q

What are the drugs for Erythropenia and Anemia???????

A
  1. Erythropoietin: Epogen, Procrit, Darbepoetin Alfa, and Epoetin Alfa!!!
  2. Ferrous Sulfate (iron supplement)
73
Q

What are the patient teachings to know about Erythropoietin drugs???? (Erythropenia and Anemia)

A

Erythropoietin: (Epogen, Procrit, Darbepoetin Alfa, and Epoetin Alfa)
1. ** Cancer growth: Head, Neck, Leukemia, Lymphoma
2. ** Elevate BP, Blood clots, Stroke, and Heart attack!!!!

74
Q

What are the patient teachings to know about Ferrous Sulfate???? (Erythropenia and Anemia)

A

Ferrous Sulfate (iron supplement):
1. AVOID FOODS: Dairy, Spinach, Coffee/tea, Whole grain bread & cereals
2. AVOID combining it with ANTACIDS and CALCIUM supplements!!!!
3. IRON pills can change the color of the stool to GREENISH or GRAYISH BLACK = NORMAL!!!!!
4. GI adverse effects are common: *Constipation, Diarrhea, N/V, Cramping

75
Q

What foods do you avoid with Ferrous Sulfate (Erythropenia and Anemia)????

A

AVOID FOODS: Dairy, Spinach, Coffee/tea, Whole grain bread & cereals

76
Q

What things do you AVOID combining with Ferrous Sulfate (Erythropenia and Anemia)?????

A

AVOID combining it with ANTACIDS and CALCIUM supplements!!!!

77
Q

What color can your stool normally change to when taking Ferrous Sulfate??

A

GREENISH or GRAYISH BLACK = NORMAL!!!!!

78
Q

What are the patient care for THROMBOCYTOPENIA???

A
  1. Monitor for PETEchia, ecchymosis, bleeding in the gums, nose bleeds, blood in the urine/stool
  2. BLEEDING PRECATION:
    - AVOID IV and Injections!!! IF must, then give the SMALLEST/BUTTERFLY gauge!!!
    - Apply pressure for 10 mins!
    - handle them gently
  3. Use ELECTRICAL razor and SOFT toothbrush
  4. AVOID BLOWING NOSE HARD/aggresively
  5. Ensure Dentures fit properly!!!
  6. ## Avoid doing contact sport or activity that can cause injury1!!
  7. AVOID INVASIVE PROCEDURES like putting NG tube or foley cath
  8. WOMEN WILL HAVE HEAVIER menstrual bleeding!!!
  9. BRUISING is more likely!!!
  10. AVOID NSAIDS !!!!!
  11. Platelets transfusion!
79
Q

WHICH “hemapotetic cells” or of condition of chemotherapy adverse effect would you put someone in BLEEDING PRECAUTION???

A

THROMBOCYTOPENIA!!!!!!

80
Q

WHAT DRUG WOULD YOU AVOID WITH SOMEONE WHO IS THROMBOCYTOPENIC??????****

A

NSAIDS!!!!!!!

81
Q

What is the drug for THROMBOCYTOPENIA????

A

Oprelvekin (NeuMEGA)

82
Q

What are the patient teachings to know about Oprelvekin (Neumega) [THROMBOCYTOPENIA]???

A

Adverse effects:
1. Fluid retention, Pulmonary edema, & Heart failure

83
Q

What are patient care for NEUTROPENIA???

A

NEUTROPENIA (low WBC)
1. Report FEVER if it reaches 100F!!!!!
2. Monitor skin & mucous membrane for breakdown!
3. Get cultures BEFORE starting antimicrobial!!
4. PUT patient in NEUTROPENIC PRECAUTIONS. they shouldn’t come out unless they need to (pt then would wear a mask)
5. WASH HANDS BEFORE ENTERING THE ROOM. NEVER ALLOW VISITORS WHO ARE ILL**
—
6. Avoid INVASIVE PROCEDURES like foley cath, IV or injections, Rectal temp
7. AVOID FRESH flower, fresh fruits, fresh veggies, undercooked meat, fish, eggs; Pepper & paprika!!
8. Keep dedicated equipment like BO machine, thermometer, and stethoscope in the room!!
—
9. Avoid YARD work, Gardening, and changing a Pet’s liter box!!! (wear gloves)
10. THROW DRINKS THAT HAVE BEEN SITTING in room temp more than 1 hour !!!!
11. WASH ALL DISHES AFTER EVERY USE IN HOT WATER
12. Wash toothbrush IN DISHWASHER or with bleach!!!
13. Never share toiletries or personal hygiene with other people!!!!
14. HYDRATE WELL!!!!!!!!***

84
Q

What is the drug for NEUTROPENIC patients????

A

Filgrastim (NeuPOGEN)

85
Q

What are the patient teachings to know about Filgrastim (Neupogen) [NEUTROPENIA]???!!!**

A

1) ADVERSE effects to monitor for: Pain in joints, legs, arms, and headache
2) MORE SERIOUS ADVERSE effects:
1. Capillary Leak Syndrome!!
2. RENAL DYSFUNCTION
3. Myelodysplastic Syndrome
4. Axillary Syndrome: Fever, Fatigue, Abd pain, Chest pain, and Back pain!!!!!

86
Q

What is sepsis (3)??????????!!!!

A
  1. Dysregulated (overaggressive) response to infection!!
  2. WIDESPREAD vasodilation and increased permeability!!
  3. Decreased cellular Perfusion (Septic Shock!!!!)
87
Q

What are early warning signs of SEPSIS????

A
  1. Altered mental status
  2. Increased RR
  3. Increased HR
  4. FEVER OR HYPOTHERMIA (cold temp)
  5. Decreased UOP (urinary output)
  6. Decreased BP!!!!!
88
Q

What are the 3 assessment findings of SEPTIC SHOCK????

A
  1. LOW BP that doesn’t respond to IVF!!!!
  2. Signs of LOW PERFUSION !!!
  3. Generalized & Pulmonary Edema!!!!!!
89
Q

What are LAB OF CONCERNS of Sepsis??? EXPLAIN EACH!!!!

A
  1. ELEVATED BUN & Creatinine –> Low perfusion of the kidneys.
  2. ELEVATED SERUM LACTATE –> bc since sepsis means low perfusion, there’s going to be no oxygen supplying the cells, which can cause the cells to undergo ANAEROBIC pathways and that leads to production of Lactic acid (metabolic acidosis)!!!
  3. METABOLIC ACIDOSIS —> (same as above explanation)
  4. ELEVATED POTASSIUM –> bc when there’s acidosis, potassium leaves out of the cell so tht acids can go inside n that creates hyperkalemia (hydrogen-potassium exchange system).
  5. ELEVATED COAGS (with DIC) –> when pt is in sepsis/inflammatory=clots, pt will start forming clots everywhere in the body!! @ some point, if we don’t turn this around, pt will start to bleed. (so combination of clotting and bleeding)
90
Q

What are the PATIENT CARE for Sepsis????

A

1) PRIMARY INTERVENSION: FLUIDSSSSSS!!!!!
2) Restore Intravascular volume!!!:
1. Normal Saline IV
2. How to know if patient is responding? BP WILL GO UP ***
3. What to do if patient is NOT responding? HCP will give vasopressors like Epinephrine and Norepinephrine!!!

3) THEN, Treat the Infection:
1. Broad spectrum abx
2. Cultures before starting antimicrobial

4) Supportive Care:
1. Oxygenation and Pulmonary support
2. Nutrition support
3. Skin care & breakdown prevention!!!!

91
Q
A

adult health (24 decks)

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