Cancer Care Flashcards
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
2
Q
Benign Cancer Cells
A
- Grow by expansion
- Slow or may halt
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
4
Q
Metastasis
A
The capacity of a tumor to invade and spread from their original site to other organs in the body
5
Q
What are the 2 most common mechanisms of metastasis?
A
lymphatic channels or blood vessels
6
Q
What are the most common sites of metastasis?
A
bones, lungs, liver, and CNS
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
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
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
10
Q
Hematogenous Spread
A
Dissemination of malignant cells via the blood stream
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
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
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
14
Q
What are the most important modifiable determinants of cancer risk?
A
Obesity, diet, and levels of physical activity
15
Q
What dietary substances appear to increase the risk of cancers?
A
fats, alcohol, salt-cured/smoked meats, and nitrate containing foods
16
Q
Primary Prevention of Cancers
A
Focus on preventing or delating the onset of cancer
17
Q
Secondary Prevention
A
Focuses on EARLY detection w/ the goal of identifying cancer in early stages before symptoms develop
18
Q
Tertiary Prevention
A
Management of the disease and the prevention of progression to later stages
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
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
21
Q
Tumor Grading
A
Classifying tumor cells
-tumor assigned numeric value from I-IV
22
Q
What does a grade 1 tumor mean?
A
Well differentiated, closely resemble the tissue of origin in structure and function
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
24
Q
What are the 3 Management Goals?
A
- Cure- completely eradicate
- Control-prolong survival/prevent progression
- Palliation-relief of symptoms
25
What is the most important factor in determining eligibility for treatments?
Performance Status
26
Surgery
May be the primary method of treatment or it may be prophylactic, palliative, reconstructive, or diagnostic
27
Diagnostic Surgery
BIOPSY must be performed to obtain a tissue sample for analysis of cells suspected to be malignant
28
What are the 2 goals of surgery?
- Remove the entire tumor
| - Remove as much as possible and any involved surrounding tissue
29
What are the 2 types of surgical approaches?
Local excision or Wide/radical excision
30
Local Excision
removal of the mass and a small margin of normal tissue that is easily accessible
31
Wide/Radical Excision
removal of the primary tumor, lymph nodes, involved structures, and surrounding tissues that may be high risk for tumor spread
32
Prophylactic Surgery
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
33
Palliative Surgery
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
Internal Radiation Risks
- 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
What is the goal of Internal Radiation
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
External Radiation
Dependent on the depth of the tumor
| -95% develop radiation dermatitis
37
What should a patient do for Radiation Dermatitis?
- 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
Chemotherapy
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
What is chemo used primarily to treat?
Systemic disease rather than localized lesions that are amendable to surgery or radiation
40
Chemo may be combined w/ what?
Surgery, radiation therapy, or both to reduce tumor size to destroy remaining tumor cells postop or to treat hematological malignancies
41
What do most people with cancer actually die from?
Most people do NOT die from their tumor, but they die from infection or bleeding
42
What happens every time a tumor is exposed to a chemotherapeutic agent?
A percentage of tumor cells are DESTROYED (20-99%)
43
Goal of Chemotherapy
Eradicate enough of the tumor so that the remaining tumor cells can be destroyed by the body's immune system
44
What cells are the most sensitive to chemo?
Cells that are rapidly dividing within a tumor
45
How is the route of chemo chosen?
Depends on the type of agent, the required dose, and type, location, and extent of tumor being treated
46
What is the dosage of chemo based on?
Based primarily on the patient total body surface area, previous response to chemo or radiation therapy, function of major organ systems, and PS
47
Chemo must be verified by how many nurses?
2
48
Extravasation: Infusion Related Event
Vesicants deposited into the sub q tissue causing tissue ulceration and necrosis as well as damage to underlying tendons, nerves, and blood vessels
49
When should a central venous access be inserted for chemo?
If frequent antineoplastic vesicants is anticipated in a patient w/ poor veins, or if vesicant agent requires administration over more than 1 hour
50
What patients are at high risk for extravasation?
- those w/ small veins
- lymphedema
- obesity
- impaired level of consciousness
51
What can the nurse do to decrease the risk of extravasation?
- 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
What should the nurse monitor for w/ extravasation?
- 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
What should the nurse do when extravasation occurs?
- STOP medication immediately
- Aspirate ant residual drug from IV line
- Administer antidote if indicated
54
Chemotherapy induced nausea and vomiting
Common and feared side effect and may persist for 24-48 hours after administration
-may be prescribed antiemetics
55
Anticipatory Nausea and Vomiting
may be experienced after the first cycle and is caused by classical conditioning: triggered by odors, sights, thoughts
56
Myelosuppression
depression of the bone marrow function, resulting in decreased production of blood cells
-Decreases WBS, RBC, and platelets
57
What happens when there is a decrease in RBC, WBC, and platelets?
Increased risk of infection and bleeding
58
Leukopenia
decreased number of white blood cells
59
Anemia
Decreased number of red blood cells
60
Thrombocytopenia
Low platelet count
61
When would a patient be considered for a blood transfusion?
Hemoglobin level < 8
62
Chemo Side Effects on Reproductive System
Results in abnormal ovulation, early menopause, or sterility
63
Fatigue
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
Normal WBC Count
4,500-10,500 cells/mm3
65
NADIR
lowest point WBC count will drop after medication
66
What are CRITICAL Values of WBC?
< 500
| > 30,000
67
Nursing Interventions for Infection
- 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
Stomatitis
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
When would a patient develop stomatitis?
5-14 days after the patient receives chemo
70
Nursing Interventions for Stomatitis
- 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
Alopecia
temporary or permanent thinning or complete loss of hair
72
When does hair loss typically occur?
2-3 weeks after initiation of treatment; regrowth may take 6 months
73
Nursing Interventions for Alopecia
- 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
Nutrition for Cancer Patients
- high calorie/high protein snacks and supplements
- cold foods
- Small, frequent meals
- Add extra calories to foods patients want to eat
- Appetite stimulants
75
Superior Vena Cava Syndrome
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
Spinal Cord Compression
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
Hypercalcemia
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
Pericardial Effusion
Accumulation of fluid in the pericardial space compressing the heart and thereby impedes expansion of the ventricles limiting cardiac filling
79
Disseminated Intravascular Coagulation (DIC)
Complex disorder of coagulation and fibrinolysis (destruction of clots) resulting in thrombosis and bleeding
80
Syndrome of Inappropriate Secretion of Antidiuretic Hormone (SIADH)
result of the failure in the negative feedback mechanism that normally regulates the release of antidiuretic hormone
81
Tumor Lysis Syndrome (TLS)
Rapid release of intracellular contents as a result of radiation, or chemo induced cell destruction of large or rapidly growing cancers
