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Critical Care (V) > Cancer > Flashcards

Cancer Flashcards

0
Q

Adenocarcinomas

A

Glandular organs

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1
Q

Carcinomas

A

Epithelial tissue

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2
Q

Sarcomas

A

Mesenchymal tissue

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3
Q

Leukemias

A

Blood forming cells

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4
Q

Lymphomas:

A

Lymph tissue

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5
Q

Myelomas:

A

Plasma cells

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6
Q

Risk factors for cancer

A 
Age
Race 
Genetic 
Exposure to chem. toabacco and alcohol
Certain viruses and bacteria
Diet- red meat high fat low fiber
Sun/ radiation
Sexual lifestyle
Poverty, obesity, GERD
Chronic disease.
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7
Q

Viruses

A 
Hep. B/C- liver cancer 
Human T leukemia- lymphoma/ leukemia 
Epstein Barr- lymphoma
HPV- cervical
HIV- lymphoma/ Kaposi's sarcoma
Helicobacter pylori- stomach cancer lymphoma
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8
Q

Tumor Node metastasis (TNM)

Used to stage cancer

A 
Tumor (T)
Tx unable to evaluate primary tumor
T0 no evidence of primary tumor
Tis- tumor in situ
T1,2,3,4 size and extent of tumor
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9
Q

CAUTION: seven warning signs client should watch for

A 
Change in bowel or bladder habits
A sore that doesn't heal
Unusual bleeding or discharge
Thickening or lump in the Brest or elsewhere
Indigestion or difficulty swallowing
Obvious change in warts or moles
Nagging cough or hoarseness
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10
Q

Soft bland foods

A 
Mashed potatoes
Scrambled eggs
Cooked cereal
Milk shakes
Icecream
Frozen yogurt
Bananas
Breakfast mixes
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11
Q

Anemia secondary to bone marrow suppression

A

Monitor: fatigue, pallor, SOB
Manage fatigue with rest periods and energy saving methods
Administer epoetin Alfa and ferrous sulfate.
Monitor Hgb and be prepared to admin. Blood.

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12
Q

Thrombocytopenia secondary to bone marrow suppression:

A

Monitor: petichae, ecchymosis, gums, nosebleeds, occult or frank blood in stool, urine, or vomitus.
Institute bleeding precautions (hold pressure for 10min)
Administer oprelvekin
Be prepared to admin. Platelets <30k

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13
Q

Client education thrombocytopenia

A 
Electric razor
Soft bristle toothbrush
Avoid blowing nose vigorously
Ensure dentures fit
Avoid NSAIDS
Prevent injury when ambulating
Apply cold if injury does occur
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14
Q

Brachytherapy

A
  • Internal radiation placed close to the target tissue (placement in body orifice)
  • Delivered via IV such as radionuclide iodine which is absorbed by the thyroid.
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15
Q

Dosimeter film badge:

A

Records personal amount of radiation exposure.

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16
Q

Dysgeusia secondary to external radiation or teletherapy

A

Distorted sense of taste

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17
Q

Xerostomia secondary to radiation

A

Dry mouth and typically associated with mucositis as well.

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18
Q

Client education for radiation

A
  • Nutrition: avoid spicy, salty, acidic, and hot foods.
  • gently wash skin w/ mild soap and water drying with patting motions.
  • Do not remove tattoo used to guide therapy
  • wear soft clothing and avoid tight
  • Do not expose skin to sun or heat source.
  • inspect skin
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19
Q

Hormone therapy: gonadotropin releasing hormone agonists.

A
  • Androgenic hormones are used to suppress estrogen dependent cancer
  • estrogen in hormones are used to suppress testosterone dependent cancer.
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20
Q

Hormone therapy: Nursing actions

A
  • Monitor cardiac, blood pressure, pulmonary edema
  • male clients: decreased libido, erectile dysfunction and feminizing effects(gynecomastia, hot flashes, bone loss)
  • client should increase Calcium & Vit D
  • female: (chest/ facial hair, amenorrhea, decreased breast tissue)
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21
Q

Immunotherapy:

Biological Response modifiers BRM

A 
Antibodies
Cytokines:
2 primary cytokines:
•interleukins- coordinate inflammatory and immune response (lymphocytes)
•interferons- have an anti-tumor effect.
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22
Q

BRM Nursing Actions

A

Interleukins: monitor for influenza-like symptoms and edema.
Interferons: Altered LOC lethargy
Peripheral neuropathy
Orthostatic hypotension
– skin rashes are common (avoid sun & swimming)

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23
Q

Photodynamic therapy

A 
Injection of photo sensitizing agent absorbed by all cells. After 1-3 days only remains in cancer cells. Exposed to specific wavelengths via endoscope.
Destroyed or reduced. 
Used: 
non small cell lung cancer
Esophageal cancer
Small rumors close to body surface
Avoid: sun for 6 weeks
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24
Q

Skin cancer type:

Squamous cell

A

Rough scaly lesion with central ulceration and crusting

•localized; may metastasize.

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25
Q 
Skin cancer type:
Basal cell (basal epidermis or nearby dermal cells)
A

Small waxy nodules w/ superficial blood vessels, well defined borders.
•erythema and ulceration
•invade local structures (nerve bone cartilage lymphatic and vascular tissue) rarely metastasize but high rate of recurrence.

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26
Q 
Skin cancer type:
Malignant melanoma (melanocytes)
A

New moles or change in existing mole
(Can occur in intestines or any other body structure with pigment cells)
•cracks ulcerations bleeding are possible
•teach client ABCDE system to evaluate moles.

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27
Q

Health promotion (skin cancer)

A 
Limit exposure 10-3pm
Apply sunscreen near reflective surfaces
Sunblock should be at least 15 SPF UVA UVB applied 30 min before and reapply every 2 hours. 
Wear protective clothing
Avoid indoor tanning.
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28
Q

Risk factors for skin cancer

A 
Immunosuppressive therapy
Exposure over long periods
Chronic inflammation burns or scars
Fair complexion
Several large or many small moles
Hx of melanoma
Higher elevation and closer to the equator
Age over 50
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29
Q

ABCDE of suspicious lesions

A
  • Asymmetry- one side does not match other
  • Borders-ragged mother irregular or blurred.
  • Color- lack of uniformity in pigment
  • Diameter- width > 6mm(pencil eraser)
  • Evolving- change in appearance or condition(shape size color height texture bleeding or itching.
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30
Q

Therapeutic procedure for skin cancer

Cryosurgery

A

Freeze and destroy isolated lesions
Applying liquid nitrogen -200 C
-skin will be edematous and require cleansing w/ peroxide along with topical anti microbial.

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31
Q

Therapeutic procedure skin cancer:

Topical Chemotherapy

A

5-fluorouracil cream for Tx: of actinic keratoses or widespread superficial basal cell carcinoma.

32
Q

Therapeutic procedure skin cancer:

Interferon

A

Post op Tx: of stage 3 or greater melanoma

Provide relief from adverse effects and promote nutrition/fluids.

33
Q

Leukemia:

A

Cancer of WBC, they are not functional and spread to bone marrow, liver, spleen, lymph nodes, testes and brain.
Categ. As acute or chronic along with type of WBC affected.

34
Q

Leukemia risks

A

Prevents growth of other blood components(platelets, erythrocytes, mature leukocytes)
•leads to immunosuppression leading cause of death is infection
•increased risk of bleeding

35
Q

ALL Acute lymphocytic leukemia

A

5 year survival rare for children 85%

< 50% adults

36
Q

AML Acute myelogenous leukemia

A

Most common among adults

Prognosis poor

37
Q

Chronic lymphocytic leukemia CLL

A

Most cases people over 60 and progresses slowly

38
Q

CML chronic myelogenous leukemia

A

Most cases young adults less than 2 year survival rate from time of diagnosis.

39
Q

Lymphomas- cancers of lymphocytes and lymph nodes. Can metastasize to almost any organ.

A

Hodgkin’s lymphoma- young adults (viral infection, exposure to chem.)
Non Hodgkin’s -most common >50
Gene damage, viral infections, autoimmune disease, exposure

40
Q

Thyroid cancer:

Papillary carcinoma

A

Grows slowly and is most common form.

41
Q

Thyroid cancer: Follicular carcinoma

A

Affects blood vessels, bone, lung tissues.

42
Q

Thyroid cancer:

Medullary cancer

A

Often the result of an endocrine disorder that causes multiple tumors.

43
Q

Thyroid cancer: Anaplastic carcinoma:

A

Replicates quickly invading area around tumor usually metastasizes before diagnosis.

44
Q

Health promotion secondary to thyroid cancer

A

Wear thyroid guard to protect neck during upper body X-Ray

Avoid smoking

45
Q

Risk factors thyroid cancer

A

Female gender
Diet low in iodine
Radiation
Older adult

46
Q

Hyperplasia

A

Increase in # or density of normal cells in response to stress, increased metabolic demands, elevated levels of hormones.
Ex: myocardial cells, uterine cells
Reversible

47
Q

Metaplasia:

A

Differentiation into cell types not normally found in that location.
Normal cell not in normal areas- protective response to adverse conditions. (Inflammation)
Reversible

48
Q

Dysplasia

A

Loss of DNA control over differentiation
Abnormal variation in size shape and appearance along with arrangement
Ex: cervix in response to HPV.

49
Q

Anaplasia:

A

Regression of cell to an immature or undifferentiated cell type. No longer under DNA control.
In response to overwhelming destructive conditions inside the cell. Associated with malignancies.
Not reversible.

50
Q

Diagnostics for cancer

A 
Biopsy
Bone marrow aspiration
CT CAT
MRI
PET
X-Ray
Scans 
ultrasound 
CBC
Tumor markers
Urinalysis
Lumbar puncture
Serum chem panel
Red blood indices
51
Q

Benign tumor characteristics

A 
Localized growth
Well-defined borders
Encapsulated
Contact inhibition
Grow slowly
Stable in size
Easily removed
Typically Don't recur
52
Q

Characteristics of malignant cells

A

•Loss of regulation
•Loss of specialization
•Loss of contact inhibition
•Progressive acquisition of a cancerous phenotype- new gen. More deviant
•Irreversibility
•Altered cell structure
•Simplified metabolic activities- increased synthesis of substances needed for cell division
•Transplantability
•Promote own survival- create a CT framework and own blood supply(angiogenesis)
Divert nutrition via diffusion (<1mm) or from blood supply thereafter.

53
Q

Metastasis:

  1. Intravasation
  2. Survival while in blood
  3. Extravasation
A

Invasion of cancer cells through basal membrane into blood or lymphatic vessel.

54
Q

Tumor suppressor genes

A

Normally suppress oncogenes (promote cell proliferation)

Become inactive through deletion or mutation.

55
Q

Anorexia- cachexia syndrome

A

Wasted appearance due to rapid weight loss, emancipation, malnutrition, and loss of energy.
Neoplastic cells divert nutrition to their own use and glucose metabolism is altered causing increased serum glucose that suppresses appetite. Tumor also secreted substances that alter smell and taste and cause early satiety. Catabolism of body’s tissue and muscle proteins. Normally state of starvation reduces metabolic rate, but not in cancer because of malignant cells.
GI cancer decreases absorption

56
Q

What is only diagnostic that reveals type of cell and structural difference from Parent tissue?

A

Microscopic histologic examination
Biopsy (PAP smear)
Sputum

57
Q

Focused interview

A
  • Hx of disease S/S led to seeking care
  • other diseases
  • current physical or psych. Problems
  • understanding
  • expectations
  • functional limitations
  • effect on lifestyle
  • reliable support system
  • coping strategies
58
Q

Nursing diagnosis for cancer

A 
Anxiety
Disturbed body image
Anticipatory grieving 
Risk for infection
Risk for injury
Imbalanced nutrition< than require.
Impaired tissue integrity
59
Q

Goals:

A

Client will maintain weight within normal range based on height and body type
Client will remain hydrated evidenced by skin turgor and mucous membranes.
Client and family will vocalize feeling and seek support from others
Client with list potential side effects of chosen therapies and strategies for minimizing symptoms.

60
Q

Cancer screening guidelines

Colorectal cancer

A

Fecal occult blood test annually beginning at age 50
Flexible sigmoidoscopy at age 50 Q5Y
Colonoscopy- Q10Y
Double contrast barium enema- Q5Y

61
Q

Cancer screening guidelines

Breast cancer

A

Monthly self breast exam at age 20 in shower just after period.
Clinical breast exam Q3Y 20-40, annually >40
Mammogram annually age 40

62
Q

Cancer screening guidelines

Cervical and uterine

A

PAP Q3Y beg. W/ vag. Intercourse or age 21
After age 30 may perform less freq.
PAP may be stopped at age 70
PAP smear may be stopped following hysterectomy.

63
Q

Cancer screening guidelines

Prostate cancer

A

PSA and digital rectal exam Beg. Age 50 and for younger men at high risk.

64
Q

Health counseling and cancer checkup-

A

Exam for cancer of thyroid, testicles, ovaries, Lymph node, oral region, and skin Q3Y over age 20 and annually over age 40.

65
Q

When to call nurse or physician

When to call 911

A 
Oral temp >101.5
Severe headache
Significant increase in pain at usual site or pain at new site not relieved by meds
Difficulty breathing
New bleeding
Confusion,irritability, restlessness.
W/D decreased activity level crying
Deep sadness or desire to end life
Changes in body function
Changes in eating patterns
Appearance of edema
911: difficulty breathing cyanosis unconscious or convulsion
Unmanageable behavior
66
Q

Normal range lab values

A 
Protein: 6-8 g/dL 
Albumin: 3.5-5 g/dL 
Hgb: 13.5-18 g/dL
Hct: 40-54%
BUN: 5-25 mg/dL
Creat: 0.5-1.5 mg/dL
67
Q

Radical mastectomy

A

Removal of entire affected breast underlying chest muscles and lymph nodes under the arms.

68
Q

Simple mastectomy:

A

Removal of the complete breast only

69
Q

Segmental mastectomy

A

Removal of the tumor and surrounding margin of breast tissue.

70
Q

Modified radical mastectomy:

A

Removal of breast tissue and lymph nodes under the arm leaving chest muscle intact.

71
Q

Sentinel node biopsy:

A

Radioactive substance or dye is injected into region of tumor the dye is carried to the first (sentinel) lymph node to receive lymph from the tumor and most likely to contain cancer cells.

72
Q

Lumpectomy

A

Excision of primary tumor adjacent breast tissue followed by radiation therapy.

73
Q

Breast cancer diagnosis

A 
Anxiety 
Decisional conflict
Grief
Risk for infection
Risk for injury
Disturbed body image over loss of breast.
74
Q

Breast assess:

A 
Family HX 
personal Hx
Breast changes 
Nipple discharge 
Use of hormone replacement therapy
Menstrual Hx
Pregnancies
Alcohol
Physical activity
Diet
75
Q

Small cell carcinoma (oat cell)

20-25% of all lung cancers

A

Central lesion with hilar mass
SIADH, Cushing syndrome, thrombophlebitis.
>40% of clients have distant metastasis at time of presentation.

76
Q

Adenocarcinoma

20-40% of all lung cancers

A

Peripheral mass involving bronchi w/ few local symptoms. Hypertrophic pulmonary osteoarthropathy
Early metastasis to central nervous system, skeletal and adrenal gland.

77
Q

Squamous cell carcinoma

30-32% of all lung cancers

A

Central lesion located in large bronchi
S/S: cough, dyspnea, atelectasis, wheezing. Hypercelcemia.
(Local invasion)

78
Q

Large cell carcinoma:

10-15% of all lung cancers

A

Peripheral lesion larger than associated adenocarcinoma and tends to cavitate; gynecomastia, thrombophlebitis.
Early metastasis

Critical Care (V) (5 decks)

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