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Nursing > Cancer Care > Flashcards

Cancer Care Flashcards

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1
Q

Malignant Cancer Cells

A
  • Have abnormal regulation of growth
  • Continue to grow even at the expense of their host
  • Grow by invasion
  • Travel via lymph nodes and blood
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2
Q

Benign Cancer Cells

A
  • Grow by expansion

- Slow or may halt

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3
Q

What is are the differences b/t Malignant and Cancer cells?

A
  • Rate of growth
  • Ability to metastasize/spread
  • Destruction of tissue
  • Ability to cause death
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4
Q

Metastasis

A

The capacity of a tumor to invade and spread from their original site to other organs in the body

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5
Q

What are the 2 most common mechanisms of metastasis?

A

lymphatic channels or blood vessels

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6
Q

What are the most common sites of metastasis?

A

bones, lungs, liver, and CNS

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7
Q

Angiogenesis

A

process by which a new blood supply is formed, creating an interface b/t the tumor and the vascular surface of the host

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8
Q

Lymphatic Spread

A

Tumor emboli enter the lymph channels by way of the interstitial fluid, which communicates w/ lymphatic circulation
-penetrate by infiltration

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9
Q

What happens after the tumor emboli enter lymphatic circulation?

A

They lodge in lymph nodes or pass b/t the lymphatic and venous circulation

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10
Q

Hematogenous Spread

A

Dissemination of malignant cells via the blood stream

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11
Q

What happens when malignant cells travel through the blood stream?

A

They attach to endothelium and attract fibrin and platelets to seal themselves from the immune system
-then enzymes are secreted that destroy surrounding body tissues allowing implantation

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12
Q

What viruses and bacteria are linked to cancer?

A
  • Hep C = hepatocellular carcinoma
  • Helicobacter pylori = gastric ulcers
  • HPV = genital region, upper respiratory tract, or skin
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13
Q

Chemical agents and Cancer

A
  • 1/3 cancer deaths are from tobacco use
  • 4% daily alcohol consumption
  • 30-40% oral cancers and 20-50% esophageal cancers are from daily alcohol consumption
  • Chemicals in workplace = carcinogens/co-carcinogens
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14
Q

What are the most important modifiable determinants of cancer risk?

A

Obesity, diet, and levels of physical activity

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15
Q

What dietary substances appear to increase the risk of cancers?

A

fats, alcohol, salt-cured/smoked meats, and nitrate containing foods

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16
Q

Primary Prevention of Cancers

A

Focus on preventing or delating the onset of cancer

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17
Q

Secondary Prevention

A

Focuses on EARLY detection w/ the goal of identifying cancer in early stages before symptoms develop

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18
Q

Tertiary Prevention

A

Management of the disease and the prevention of progression to later stages

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19
Q

What is the process to diagnose cancer?

A
  • Determine presence of tumor and its extent
  • Identify possible spread
  • Evaluate function of involved/uninvolved body system/organs
  • Obtain tissues and cells for analysis
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20
Q

TNM System

A

T = extent of primary tumor
N = Lymph node involvement
M = metastasis
-Determines the size of the tumor and extent of the disease

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21
Q

Tumor Grading

A

Classifying tumor cells

-tumor assigned numeric value from I-IV

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22
Q

What does a grade 1 tumor mean?

A

Well differentiated, closely resemble the tissue of origin in structure and function

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23
Q

What does a grade 4 tumor mean?

A

Poorly differentiated as they do NOT clearly resemble the tissue of origin in structure or function

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24
Q

What are the 3 Management Goals?

A
  • Cure- completely eradicate
  • Control-prolong survival/prevent progression
  • Palliation-relief of symptoms
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25
Q

What is the most important factor in determining eligibility for treatments?

A

Performance Status

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26
Q

Surgery

A

May be the primary method of treatment or it may be prophylactic, palliative, reconstructive, or diagnostic

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27
Q

Diagnostic Surgery

A

BIOPSY must be performed to obtain a tissue sample for analysis of cells suspected to be malignant

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28
Q

What are the 2 goals of surgery?

A
  • Remove the entire tumor

- Remove as much as possible and any involved surrounding tissue

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29
Q

What are the 2 types of surgical approaches?

A

Local excision or Wide/radical excision

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30
Q

Local Excision

A

removal of the mass and a small margin of normal tissue that is easily accessible

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31
Q

Wide/Radical Excision

A

removal of the primary tumor, lymph nodes, involved structures, and surrounding tissues that may be high risk for tumor spread

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32
Q

Prophylactic Surgery

A

Removing nonvital tissues or organs that are likely to develop cancer

  • offered selectively b/c long term physiological/psychological effects are not known
  • Colectomy, mastectomy, oophorectomy
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33
Q

Palliative Surgery

A

Cure is NOT possible, the goals are to make the patient as comfortable as possible and improve their quality of life
-relieves complications: obstructions, hemorrhage, pain

34
Q

Internal Radiation Risks

A
  • Time = as the amount of time w/ the patient increases, the nurses exposure to radiation increases
  • Shielding = use of a lead shield to buffer the exposure to radiation
  • Distance = the closure you are, the greater the radiation exposure
35
Q

What is the goal of Internal Radiation

A

Deliver safe, efficient care that meets the patients’ needs in the shortest amount of time -NO more than 30 minutes in 8 hour shift

36
Q

External Radiation

A

Dependent on the depth of the tumor

-95% develop radiation dermatitis

37
Q

What should a patient do for Radiation Dermatitis?

A
  • Avoid creams/powders on treated area
  • NO scrubbing
  • Avoid constrictive clothing
  • Avoid extreme temps
  • Avoid itching
  • Gently cleanse w/ lukewarm water and a mild non-deodorant soap
38
Q

Chemotherapy

A

Antineoplastic agents are used in an attempt to destroy tumor cells by interfering w/ cellular functions, including replication
-repeated therapy needed over prolonged period to achieve regression

39
Q

What is chemo used primarily to treat?

A

Systemic disease rather than localized lesions that are amendable to surgery or radiation

40
Q

Chemo may be combined w/ what?

A

Surgery, radiation therapy, or both to reduce tumor size to destroy remaining tumor cells postop or to treat hematological malignancies

41
Q

What do most people with cancer actually die from?

A

Most people do NOT die from their tumor, but they die from infection or bleeding

42
Q

What happens every time a tumor is exposed to a chemotherapeutic agent?

A

A percentage of tumor cells are DESTROYED (20-99%)

43
Q

Goal of Chemotherapy

A

Eradicate enough of the tumor so that the remaining tumor cells can be destroyed by the body’s immune system

44
Q

What cells are the most sensitive to chemo?

A

Cells that are rapidly dividing within a tumor

45
Q

How is the route of chemo chosen?

A

Depends on the type of agent, the required dose, and type, location, and extent of tumor being treated

46
Q

What is the dosage of chemo based on?

A

Based primarily on the patient total body surface area, previous response to chemo or radiation therapy, function of major organ systems, and PS

47
Q

Chemo must be verified by how many nurses?

A

2

48
Q

Extravasation: Infusion Related Event

A

Vesicants deposited into the sub q tissue causing tissue ulceration and necrosis as well as damage to underlying tendons, nerves, and blood vessels

49
Q

When should a central venous access be inserted for chemo?

A

If frequent antineoplastic vesicants is anticipated in a patient w/ poor veins, or if vesicant agent requires administration over more than 1 hour

50
Q

What patients are at high risk for extravasation?

A
  • those w/ small veins
  • lymphedema
  • obesity
  • impaired level of consciousness
51
Q

What can the nurse do to decrease the risk of extravasation?

A
  • Avoid veins in the hands, wrist, and antecubital area
  • Avoid small/fragile veins
  • Use smallest cannula in largest vein
  • Clear dressing
  • Avoid butterfly needle
52
Q

What should the nurse monitor for w/ extravasation?

A
  • Absence of blood return from IV catheter
  • Resistance to flow of IV fluid
  • Leaking around insertion site
  • Swelling, burning, pain, redness, blistering at IV site or in the upper arm, back, chest, or jaw
53
Q

What should the nurse do when extravasation occurs?

A
  • STOP medication immediately
  • Aspirate ant residual drug from IV line
  • Administer antidote if indicated
54
Q

Chemotherapy induced nausea and vomiting

A

Common and feared side effect and may persist for 24-48 hours after administration
-may be prescribed antiemetics

55
Q

Anticipatory Nausea and Vomiting

A

may be experienced after the first cycle and is caused by classical conditioning: triggered by odors, sights, thoughts

56
Q

Myelosuppression

A

depression of the bone marrow function, resulting in decreased production of blood cells
-Decreases WBS, RBC, and platelets

57
Q

What happens when there is a decrease in RBC, WBC, and platelets?

A

Increased risk of infection and bleeding

58
Q

Leukopenia

A

decreased number of white blood cells

59
Q

Anemia

A

Decreased number of red blood cells

60
Q

Thrombocytopenia

A

Low platelet count

61
Q

When would a patient be considered for a blood transfusion?

A

Hemoglobin level < 8

62
Q

Chemo Side Effects on Reproductive System

A

Results in abnormal ovulation, early menopause, or sterility

63
Q

Fatigue

A

Feeling of weariness, weakness, lack of energy, lack of motivation

  • exacerbated by the stress of coping w/ cancer
  • Encourage alternating periods of rest and activity
  • Maintain as normal a life as possible
64
Q

Normal WBC Count

A

4,500-10,500 cells/mm3

65
Q

NADIR

A

lowest point WBC count will drop after medication

66
Q

What are CRITICAL Values of WBC?

A

< 500

> 30,000

67
Q

Nursing Interventions for Infection

A
  • Report temp > 101 F
  • Administer antibiotics after cultures
  • Strict sepsis w/ IV lines, catheters, etc..
  • Hand Hygiene
  • Coughing/Deep breathing
  • Minimize contact w/ other ill people
68
Q

Stomatitis

A

inflammatory response of the oral tissues that is characterized by mild redness and edema or if severe by painful ulcerations, bleeding, and secondary infection

69
Q

When would a patient develop stomatitis?

A

5-14 days after the patient receives chemo

70
Q

Nursing Interventions for Stomatitis

A
  • Use soft bristled tooth brushes and nonabrasive toothpaste
  • Oral rinses after meals and at bedtime
  • Avoid any alcohol
  • Avoid food difficult to chew or hot/spicy
  • Lubricate lips
  • Topical anti-inflammatory/anesthetic agents
71
Q

Alopecia

A

temporary or permanent thinning or complete loss of hair

72
Q

When does hair loss typically occur?

A

2-3 weeks after initiation of treatment; regrowth may take 6 months

73
Q

Nursing Interventions for Alopecia

A
  • Scalp hypothermia
  • Advice to use shampoos w/o detergents
  • Avoid hair coloring, bleaching, perms, hot rollers, excessive, aggressive hair brushing
  • Encourage wig selection prior to hair loss to match color and texture
  • Supportive programs
74
Q

Nutrition for Cancer Patients

A
  • high calorie/high protein snacks and supplements
  • cold foods
  • Small, frequent meals
  • Add extra calories to foods patients want to eat
  • Appetite stimulants
75
Q

Superior Vena Cava Syndrome

A

Compression or invasion of the superior vena cava by tumor, enlarged lymph, or intraluminal thrombus that obstructs circulation of the head, neck, arms, and thorax

76
Q

Spinal Cord Compression

A

Occurs when a malignant disease or a pathologically collapsed vertebrae compresses or displaces the thecal sac that contains the spinal cord causing neurologic impairment

77
Q

Hypercalcemia

A

Potentially life threatening metabolic abnormality resulting when the calcium released from the bones exceeds the amount that the kidneys have the ability to excrete or the bones can reabsorb

78
Q

Pericardial Effusion

A

Accumulation of fluid in the pericardial space compressing the heart and thereby impedes expansion of the ventricles limiting cardiac filling

79
Q

Disseminated Intravascular Coagulation (DIC)

A

Complex disorder of coagulation and fibrinolysis (destruction of clots) resulting in thrombosis and bleeding

80
Q

Syndrome of Inappropriate Secretion of Antidiuretic Hormone (SIADH)

A

result of the failure in the negative feedback mechanism that normally regulates the release of antidiuretic hormone

81
Q

Tumor Lysis Syndrome (TLS)

A

Rapid release of intracellular contents as a result of radiation, or chemo induced cell destruction of large or rapidly growing cancers

Nursing (21 decks)

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