cancer Flashcards
differences
arise from primitive tissues (embryonic), result in leukemias, lymphomas, sarcomas, CNS tumors, not from lifestyle factors, respond well to treatment
general cm
mass/swell, pale and energy loss, easily bruise, persistant and localized pain/limp, prolonged unexplained fever/illness, HA freq with vomit, eye/vision change, excessive rapid weight loss
CNS tumors cm
based on location, size, stage
HA, v, clumsy, unsteady, cranial nerve neuropathy (blurred or double vision), head tilt, seizure, motor abnormality, weak, behavior or personality change, ftt, irritable, VS disturbance
CNS tumors tm
based on type
sx, radiotherapy >2yr, chemo, prognosis varies
CNS tumors nc
post op: position to decrease pressure where tumor was - midline, off operative site, reduce ICP (decrease stimulation), neck flexion, NPO (gag and swallow), comfort (NPO), eye care (cover or moist, may not be able to close)
promote return to optimal functioning
neuroblastoma cm
based on location and stage
often metastasize before diagnosis
neuroblastoma tm
based on stage
sx, biopsies, radiation, chemo, transplant (bone or stem cell), prognosis varies
lymphoma - hodgkin cm
painless enlargement of lymph, fever, night sweats, reed sternberg cells
complications: liver failure, secondary cancers, delayed puberty
lymphoma - hodgkin tm
radiation, long term chemo, hsct, transplant
lymphoma - hodgkin nc
significant pain in effected node following alcohol
lymphoma - nonhodgkin cm
diffused rather than nodular, poorly differentiated (B and T lymphocytes, uncontrolled growth), dissemination (fast), mediastinal involve and invasion of meninges (CNS)
complication: metastasis, secondary malignancy
pain, lymph swell (deeper - abd), d or c, cough, dyspnea, orthopnea, facial edema or venous engorgement (emergency)
lymphoma - nonhodgkin tm
chemo 3/4 stage
osteogenic sarcoma cm
long bones (legs) - metaphysis
pain, limp, decreased ROM
complications: metastasis, recurrence within 3 years
can mimick growing pains
osteogenic sarcoma tm
surgical resection or amputation, prosthetic, and chemo
osteogenic sarcoma nc
preop crucial, support, body image, pain (phantom limb)
ewing sarcoma cm
intermittent pain - worses to constant/severe, swell/red
systemic: fever, spinal cord compression, respiratory distress
ewing sarcoma tm
radiation, chemo (myeloblative, stem cell, surgical resection, avoid active play or weight bearing with treatment - fractures
rhabdomyosarcoma cm
vague s that are often common to childhood (ear ache)
very malignant
rhabdomyosarcoma tm
remove, radiation, chemo (long term)
wilms tumor (nephroblastoma) cm
abd mass (pain), malaise, anorexia, fever, gross hematuria, htn
long term survival
wilms tumor (neproblastoma) tm
nephrectomy and regional lymph nodes, chemo with or without radiation
wilms tumor (nephroblastoma) nc
handle and bathe careful (dont palpate), monitor BP and I+O
retinoblastoma cm
cats eye reflex (white eye), strabismus, red painful eye with glaucoma, blind (late)
may regress, secondary tumors, spread to brain and other eye, lymph, bone, liver, others
retinoblastoma tm
early and uni: irradiation, cryotherapy
bilateral: preserve useful vision in least affected
advanced: enucleation, chemo
retinoblastoma nc
post op - enucleation: large pressure dressing, dressing change - saline, abx)
family support - screen siblings q1-3 wks first year, protect other eye
testicular
not common, usually malignant
self examine!
tm: orchiectomy - chemo/radiation
leukemia complications
anemia, infection, bleeding (decrease platelets), spleen, liver and lymph - infiltration to enlarge
leukemia cm
stem cells produce immature wbc, fill bone marrow and lead to decreased rbc and platelets causing anemia, thrombocytopenia, and neutropenia
fever, pallor, bleed, lethargy, malaise, anorexia, large joint and bone pain
bone marrow failure: petechiae, frank bleeding, joint/bone pain, fatigue
CNS involvement: HA, persistant n/v, irritable, dizzy, seizure, behavior change, 6th cranial nerve palsy (eye tract)
leukemia tm
diagnose with bone marrow biopsy
treat s, combo chemo, cranial irradiation
leukemia nc
educate, treatment schedule, manage SE, prevent complications, coping skills, QOL, g+d maintain
chemo - remission induction
rapid, 3-4 weeks, oral steroids and IV chemo, kill active, sickest
chemo - consolidation
strengthen, remission, CNS prophylaxis, intrathecal and IV
chemo - intensification
destroy remaining
chemo - maintenance
prevent relapse, treat spread
chemo causes
kills normal and cancerous
short term: immunosuppression, infection, myelosuppression, n/v, oral mucositis, alopecia
long term: microdontia and missing teeth, hearing and vision changes, hematopoietic, immunologic or gonadal dysfunction, various alterations of systems, 2nd cancer
chemo - bone marrow suppression
admin blood safely, nc for anemia, nc for thrombocytopenia, colony stimulating factors, nc for neutropenia
chemo - alopecia
most adjust well, hat, scarves, wigs, will grow back (different color/texture)
chemo - n/v
antiemetics before chemo and q3-4 hours until drugs clear, avoid strong smells, small and freq, cool, chemo early in day
chemo - stomatitis
multiple ulcers
prevent: oral mucosa and teeth clean, antifungal and bacterial mouthwash, avoid acidic
treat: rinse with NS, magic mouth wash, avoid local anesthetics (cant swallow)
chemo - fear and anxiety
inform, plan of care with family, assess coping, optomistic, no false hope, resources, diversional activities
oncologic emergencies
hemorrhagic cystitis
tumor lysis syndrom
septic shock (monitor for circulatory failure)
hyperCa from large bone destruction (hydrate and P supplement)
hemorrhagic cystitis
bladder pain and blood in urine
increase fluid intake, void frequently, mesna to protect bladder
tumor lysis syndrome
tumors release high uric acid, k, P into blood leading to metabolic acidosis, renal failure, death
rf: large tumor/lots, sensitive to chemo, increased proliferation rate, high wbc at diagnosis
tumor lysis syndrome - cm
flank pain, lethargy, n/v, oliguria, pruritus, arrythmias, impaired renal, tetany, neuro change
tumor lysis syndrome - tm and nc
fluid before therapy (3-4x maintenance), i+o, daily weight, urine specific gravity <1.01, e and meds to decrease conversion of metabolic by products to uric acid, urine pH (7-7.5), monitor for tetany and mental change, collect labs
SE of radiation therapy
short: fatigue, n/v, oral mucositis, myelosupression, skin integrity at site
long: growth alter, hormone dysfunction, hearing and vision, learning problem, heart dysfunction, pulmonary fibrosis; hepatic, sexual, or renal dysfunction; osteoporosis, development of secondary sex characteristics
cancer - pain management
oral or IV, dose with weight, titrated for SE, pain scale appropriate
cancer - nutrition
normal w+h, pref (shake/pudding), antiemetics, weigh daily or weekly and h, high cal meals when appetite high, vit and min supplements, TPN and IV lipids
cancer - health promo
dental: floss, dentist, soft
vaccine: 2 weeks before or during = inactivated, 3 months after = good
