Cancer Flashcards
Neuropathic pain secondary to chemotherapy. Describes burning sensation in leg.
Question which prescription drug?
- Imipramine
- Carbamazepine
- Gabapentin
- Morphine
Morphine
Imipramine (Antidepressants)
Carbamazepine & Gabapentin (Anticonvulsants)
Provide relief for neuropathic pain
Which brochure will be most useful for addressing questions related to first-line treatment of cancer pain?
- Guide to Analgesic ladder
- Common questions about radiotherapy
- How to make preparation for your cancer surgery
- How nerve blocks can help manage pain.
- Guide to Analgesic ladder
Analgesics are the first-line treatment cancer pain.
If not controlled by Analgesics, other options include: radiation, surgery, nerve blocks
What & when is the nadir period in chemotherapy
7 / 10 days after the start
All blood cell counts will be the lowest
Cancer patient in around-the-clock pain meds may be experiencing end-of-dose pain, according to night nurse during hand off report. What is the most important question to ask?
- How many boluses did you give him last night
- Did patient have > 5/10 pain
- Did you notify HCP & were scripts changed
- Did you try nonpharmaceutical interventions/ adjunct medication
- Did you notify HCP & were scripts changed
End - of - dose pain in a cancer patient means that meds may not be strong enough. HCP needs to review meds
What is Epoetin used for in chemotherapy
Nursing considerations
chemotherapy-associated anemia and a hemoglobin concentration that has declined to a level ≤ 10 g/dL - Epoetin improves hemoglobin & RBC
Patient will be tired due to anemia allow time to rest
Before starting an initial cancer treatment which statement by the patient presents the most worry.
- My symptoms will be cured. I’m so happy I don’t have to worry about this any more.
- I’m grateful for the extended time this will give me with my family
- My pain will be controlled but I will die soon anyways. I would like to take control over my own life & death
- Initially I will have to take time off work but I will be able to return to full time soon
- My pain will be controlled but I will die soon anyways. I would like to take control over my own life & death
This could be a veiled suicide threat.
The other answers show Denial / Acceptance which are normal phases of bad news
Older patient treatment for severe localized pain r/t postherpetic neuralgia secondary to chemotherapy. Nurse most likely to question which.
- Lidocaine patch
- Gabapentinoid
- Capsaicin patch
- Tricyclic antidepressants
Tricyclic antidepressants
Should be avoided in older adults due to SE confusion/ Orthostatic Hypotension.
Lidocaine patch ,Gabapentinoid, & Tricyclic antidepressants are 1st line choices for Postherpetic neuralgia
Capsaicin 2nd line defense
Which SE should be reported to HCP when taking Vincristine (Chemotherapy)
- Paresthesia
- Neausa
- Fatigue
- Anorexia
- Paresthesia
Other SE are to be expected and managed
New hire nurse has limited experience with cancer patients and seems to be constantly under medicating patients. What would the supervisor nurse do first.
- Reassess all patients and admin additional pain meds if necessary
- Write incident report and inform nurse manager
- Assess new hires understanding and beliefs about cancer pain meds
- Ask nurse about past experience in administration of pain meds
- Assess new hires understanding and beliefs about cancer pain meds
When it’s a supervisor question Answr with teaching staff Not assessment of patients
Patient at risk for spinal cord compression due to tumor growth. Which is an early manifestion.
- Last night my back really hurt and I had trouble sleeping
- My leg has been giving out when I try to stand up.
- My bowels are moving like they used to
- When I try to pass urine I have difficulty starting
- Last night my back really hurt and I had trouble sleeping
The others are late symptoms of Spinal Cord Compression
Advice of UAP working with patient who has chemobrain
- Patient can understand you but cannot speak clearly
- Be cautious. They have unpredictable behavior
- Calmly give explanations if patient seems forgetful.
- Report headache immediately to me.
Calmly give explanations if patient seems forgetful.
Chemobrain can last up to years
Breast cancer patient is recieving Trastuzumab (Monoclonal antibody “ MoAB”) Which SE is she most likely to experience?
- Capillary leak syndrome
- Hepatotoxicty
- Flu-like symptoms
- Memory loss
What are Monoclonal Antibodies
- Flu-like symptoms
All choices are SE of MoAB
Capillary leak syndrome may lead to PE
Lab created molecules engineered to serve as substitute antibodies that can restore, enhance, modify or mimic the immune system’s attack on cells that aren’t wanted, such as CANCER CELLS.
Which patients can be put into same room.
- Neutrophils count 1000/mm³
- Underwent debulking of tumor to relieve pressure
- Underwent bone marrow transplant
- Laminectomy for spinal cord compression
- Brachytherapy for prostate cancer
- Terminal, receiving end-of-life care
- Approaching nadir associated with chemotherapy
- Underwent debulking of tumor to relieve pressure
- Laminectomy for spinal cord compression
Brachytherapy = radiation, patient will emit radiation No Room Mate
Nadir = Low Blood Cells (White,Res,Thrombocytopenia)
Lung cancer & develops SIADH Which treatment does the nurse anticipate first.
1. Fluid bolus
2. Fluid restrictions
3. Urinalysis
4. Sodium-restricted diet
Fluid restrictions
Hyponatremia is concern in SIADH.
Sodium restricted deit would be Contradicted
Remember Story of woman with SIADH who drink out of toilet and the teacher gave her broth.
The brother prevented Hyponatremia
End-of-life care is being preformed. Patient is Mottled & cool, dyspnea develops & appears frightened & anxious. What do you do first?
- Admin as needed dose of morphine elixir
- Deliver 20 rescue breaths with bag-valve mask
- Call rapid response team
- Offer emotional support & comfort
- Admin as needed dose of morphine elixir
Morphine will reduce anxiety with air hunger & would offer physical relief.
Emotional relief is important too but comes afterwards
Nurse A switches assignment with Nurse B because they ‘don’t like to work with prostate cancer patients”
What action should the nurse take first?
- Insist they switch back & talk to them both at the end of shift
- Allow it.
- Ask Nurse A To state her posistion regarding prostate cancer patients and seek alternatives to future issues
- Explain that all patients deserve kindness despite a nurses personal feelings
- Ask Nurse A To state her posistion regarding prostate cancer patients and seek alternatives to future issues
ID the reason. After plan can be made to assist the nurse ( referral to counseling or in service training)
Avoid being too Draconian (excessively harsh/ nazi like)
Nurses often switch patients but the charge nurse should be made aware of this
Which assessment suggest patient is having incident pain?
- Frequently reports pain 30 minutos before next dose
- Demonstrates protectiveness of right arm when moving or standing
- Reports buring or tingling in left leg
- Appears silent, withdrawn when familia leaves
- Demonstrates protectiveness of right arm when moving or standing
Incident pain is associated with an event such as walking, change posistions, or coughing
Pain 30 minutos before next dose is Breakout Pain
Burning & Tingling are Neuropathic pain
Biphosphonate medications are used in cancer patients how?
Relieve bone pain & reduce risk of fractures.
Also lowers calcium levels
Bone cancer aka osteosarcoma, or osteogenic sarcoma
Most critical and needs to be addressed first
- Small cell lung cancer tracheal deviation after pulmonary resection
- Bladder cancer decreased urine after intravesical chemotherapy
- Non-hodgkin lymphoma cardiac Dysrhthmias after chemotherapy
- Severe ab pain after bowel resection for colon cancer
Small cell lung cancer tracheal deviation after pulmonary resection
Tracheal deviation could mean tension pneumothorax - serious
Superior vena cava syndrome - compression/ obstruction that leads to congestion of blood.
Caused by thrombis or Tumor blockage.
Life threatening
Early manifestations include ….
Early manifestations: edema of face / periorbital, tightness around neck gown. Cough, dyspnea, orthopnea.
Stridor in late cases
Dark urine & flank pain
N/V
Muscle cramps & Heart palpations
Client with Aggressive non-Hodgkin lymphoma who is being treated with chemotherapy.
What is the likely problem?
Nursing interventions…
Tumor lysis syndrome
Maintaining renal flow with hydration and diuretics.
Hyperuricemia is treated with allopurinol and sodium bicarbonate.
Electrolyte imbalances are addressed.
The patient is monitored for complications – namely cardiac dysrhythmias, renal failure and seizure.
8AM
Patient alert & conversant. Weak able to sit up. Glasgow Coma Scale 15.
VS
Temp 98
HR 110
RR 30
Pulse Ox 92
Labs
BS 70
K 3.5
NA 136
Ammonia 80
11AM
Lethargic and confused. Follows simple commands with encouragement
Put the following in order of operation
- Assess vital signs
- Assess responsiveness & LOC
- Obtain BS
- Assess previous electrolyte levels & Ammonia value.
- Notify HCP
- Apply Pulse Ox meter
- Attach to Cardiac monitor
- Examine for signs of trauma
- Repeat Glasgow coma scale
- Assess responsiveness & LOC
- Apply Pulse Ox meter
- Assess vital signs
- Obtain BS
- Attach to Cardiac monitor
- Repeat Glasgow coma scale
- Examine for signs of trauma
- Assess previous electrolyte levels & Ammonia value.
- Notify HCP
