Cancer Complications Flashcards
1
Q
What do we need to know about the cancer to provide proper care?
A
- what kind of cancer they have and where it is?
- where has it metastasized?
- what type of treatment are they receiving?
- What type of chemotherapy, when was your last treatment?
2
Q
Cachexia
A
- most common clinical manifestation of cancer.
- dramatically higher risk of mortality associated with cancer if present at diagnosis
- loss of weight, muscle atrophy, fatigue, weakness, and a significant loss of appetite in someone who is not trying to lose weight
- positive risk factor for death
- assess patient for weight loss
3
Q
Control of cancer
- surgery
- chemotherapy
- radiation
- biotherapy
A
- diagnostic, preventative, eliminative, reconstructive, or palliative
- exerts chemical influence on cellular division
- local destruction of cancer cells ; adjuvant (supplements surgery) and palliative
4
Q
Surgery
A
- cure, control (to control the spread of the cancer) palliation (for comfort, cannot reverse underlying condition)
- mastectomy
- colectomy
- thyroidectomy
- the removal of a primary cancerous tumor is the most common operation to try and cure or control cancer. (almost always disrupts the structural integrity of the cancer or BV feeding cancer which can disperse the cancer throughout the body or seed in chest or abdomen. - aim to shrink tumour before removal
5
Q
Chemotherapy
A
- directly and indirectly by interrupting the cell cycle and disrupting the reproduction of cells. Different cycles of chemo are used because cells are at different points of reproduction.
- systemic. prescribed to shrink cancer, prevent cancer from returning, as a therapy on its own, or to kill cancer that has spread to other areas - travels in blood.
- combination used because it disrupts the cell cycle at different points.
6
Q
Radiation and why its used.
A
- local treatment. makes breaks in DNA inside cell. keep cancer from frowning and dividing.
- used to kill or shrink small localized cancers
- to stop cancer from coming back (after surgery)
- to treat symptoms caused by advanced cancer - lesions on the spinal cord or large vessels.
- external beam radiation, internal radiation (radioactive seeds), )systemic (PO meds)
7
Q
Biotherapy: targeted therapy
A
- restores or boosts the body’s own immune system to stop or slow the growth of cancerous cells
- monoclonal antibodies (target only cancer cells)
- cancer vaccines
- growth factors
- given PO, IV, or injection
Side effects: skin rashes, Flu-y
8
Q
most important responsibilities of the nurse
A
- differentiating between toxic effects of treatment and progression of the malignant process. the nurse must also distinguish tolerable adverse effects from acute toxic side effects of chemotherapeutic agents. - request most recent consultation report from the cancer society.
9
Q
Common GI side effects of Chemo
A
- stomatitis, mucositis, esophagitis (inflammation of mouth, throat and esophagus), major sores. patient cant take anything in their mouth. ulceration everywhere. requires careful mouth care because the mouth can have lots of germs.
- N&V, often on meds prior to treatment to fix this.
- Anorexia or loss of taste - TNF, or interleukin 1 from macrophages being destroyed
- Diarrhea - sloughing off of cells in the colon. (risk for electrolyte fluid imbalance from ulceration, inflammation, and diarrhea.
- constipation
- hepatoxicity
10
Q
Bone marrow side effects of Chemo
A
- anemia: drop in red blood cells
- leukopenia: drop in white blood cells
- thrombocytopenia - a drop in platelets.
All of these are related to bone marrow suppression due to chemo
11
Q
Integumentary System: side effects of chemo
A
- alopecia: hair loss (causes body image disturbances)
- skin reactions: hives, extravasation (leaking into the tissue outside the vein - this is why ports are usually put in), hyperpigmentation or radiation burns, wet-down into the dermis, area needs to be covered.
12
Q
Common complications: Infection
A
- GU system, mouth, rectum (inflammation of GI tract), peritoneal cavity, blood (sepsis)
- ulceration/necrosis caused by tumour
- compression of vital organ by tumour
- neutropenia due to disease process OR treatment
13
Q
Febrile Neutropenia
A
- infection can be rapidly fatal to cancer patients so it must be treated ASAP
- SIRS criteria
- start IV immediately (going to need antibiotic immediately) - and fluid.
- Caused by suppression the bone marrow which is related to the life cycle of the blood cells
14
Q
Life cycle of the blood cells
A
- WBC - affected within 1 week because of high turn over.
- platelets - affected within 2-3 weeks.
- RBC - affected in 2-3 months (anemia)
15
Q
neutrophils:
A
WBC that are the first line of defence in the body- arrive at a site of inflammation in 2-6 hr. engulf foreign bacterial or material. Short lifespan.
16
Q
best nursing measure
A
- preventing infection. good mouth care. asking questions immediately when it comes to signs of possible infection.
17
Q
Normal Values
A
WBC: 4.0-10.0
Neutrophils: 2.0-7.5
Neutropenia: < 0.1
18
Q
Pharmacologic Treatment: neutropenia
A
- granulocytes colony-stimulating factors
- antibiotics
- G-CSF is given as injection under the skin given daily during treatment. Trend the white cell count up. Can cause bone pain, itchy skin, or fever
- Hold chemotherapy until WBC count has increased to normal amounts
19
Q
Malnutrition
A
- protein and calorie malnutrition common
- clinical manifestations: depletion of fat and muscle
- early on in cancer treatments malnutrition is most commonly associated with the treatment
- wasting of muscle and weight loss
20
Q
Superior Vena Cava Syndrome (Oncologic Emergencies: obstructive)
A
- due to: obstruction of vena cava by a tumour (common only by lung CA, Hodgkin’s and non-Hodgkin’s lymphoma)
21
Q
Clinical manifestations of superior vena cava syndrome and diagnosis and Tx
A
- facial edema
- periorbital edema
- distended neck and chest veins
- headache
- seizures
- this is due to fluid building up in the head
- diagnosis: CXR
- treatment: urgent radiation therapy
- if nothing can be done, the patient needs very comprehensive and intentional palliative care
22
Q
Malignant Spinal Cord Compression (MSCC)
A
- Due to: tumour compressing the spinal cord (primary or metastatic tumours)
23
Q
MSCC - Clinical Manifestations
A
- Back pain (localized and persistent) - ask questions about the pain, if it just onset now, and if they have not been doing anything that could have caused this back pain we need to be considering the possibility of metastasis
- vertebral tenderness
- motor weakness and dysfunction
- sensory paresthesias and loss
- changes in bowel/bladder function
24
Q
Treatment MSCC
A
- emergent glucocorticoids (dexamethasone) - IV depending on the type of cancer 4-8 mg BID or QID IV total of 16 mg a day. effective within 24 hr. reduce the swelling and inflammation
- urgent radiation therapy - slower to act. but sustains the response
- sometimes neurosurgery is indicated
- get imaging to determine the presence of a tumour.
- nerve cells do not reproduce, when the spinal cord is compressed, reduce the pressure immediately so the patient does not end up with long term damage.
25
Q
Intestinal Obstruction: Oncologic emergencies
A
- due to: complete or partial obstruction due to swelling of the intestine or solid tumour invasion
26
Q
Clinical manifestations: intestinal obstruction
A
- nausea/vomiting
- abdominal pain
- abdominal distension
- do a GI assessment
27
Q
Treatment: intestinal obstruction
A
- NG tube decompression
- Surgical removal of obstruction
28
Q
SIADH: Metabolic emergency
A
- due to: abnormal or sustained production of ADH (antidiuretic hormone) - occurs most often in small cell lung cancer
- excess of ADH increases the permeability of the distal tubule and collecting duct and reabsorption of water, body hangs onto the water which causes us to retain fluid. ECF is expanding.
29
Q
Clinical manifestations: SIADH
A
- fluid retention
- serum hypo-osmolality
- dilution hyponatremia because there’s so much water
- early: muscle cramps, weakness
- late: vomiting, abdominal cramping, seizures, come
- decreased urine output
30
Q
Treatment SIADH
A
- treat cause! the tumour. fluid restriction of 800-1000ml/day (sometimes duiretics, if it is emergent give them hypertonic solution, but not usually)
31
Q
Hypercalcemia
A
a condition in which the blood calcium level is too high
- most common oncologic metabolic emergency
- has poor prognosis, 80% of patients with hypercalcemia will die within a year.
- cancer-related hypercalcemia is the leading cause of hypercalcemia in hospitalized patients
- due to: increased breakdown of bone tissues (osteoclast activity) due to malignancy (multiple myeloma) or bony metastasis (from lung, breast cancer)
- seen in pelvis or the spine
32
Q
Clinical manifestations of hypercalcemia
A
- apathy/depression/fatigue
- muscle weakness
- ECG changes
- anorexia, nausea, vomiting
- polyuria/nocturia
severe hypercalcemia: severe muscle weakness, decreased deep tendon reflexes, kidney stones, irregular heartbeat, even heart attach, monitor with EKG
33
Q
Normal calcium levels
A
around 2.65
- corrected calcium = measured calcium (mmol/L) + (40-albumin) x 0.02)
34
Q
Ionized calcium
A
ionized calcium is the calcium you are concerned about because it is the active form of calcium
- standard lab test will give the total calcium unless specified that the ionized calcium is the one that is wanted.
35
Q
Treatment: Hypercalcemia
A
- mobility decreases incidence in at-risk clients
- HYDRATION!!! (N/S 1-2 L IV bolus, then maintenance infusion until increased urine output is established)
- calcitonin: to inhibit bone resorption (quick-onset)
- loop diuretic (ie. lasix) ONLY in patients with fluid overload
- Biphosphates: inhibit calcium release from the bone: late onset but mainstay of treatment
- Glucocorticoids: depends on the cause
36
Q
Tumor Lysis Syndrome
A
- follows the destruction of a large number of neoplastic/cancer cells due to chemo or radiation allowing for vast number of intracellular electrolytes to enter the blood stream. often causes changes in potassium, phosphorous, and uric acid levels
- most commonly seen in patients with highly aggressive hematologic cancers because they are rapidly growing so as you target them they will also be rapidly dying.
- usually occurs when effective chemotherapy has begun.
37
Q
Hyperkalemia
A
can cause serious and occasionally fatal arrhythmia
38
Q
Hyperphosphatemia
A
can cause secondary hypocalcemia leading to neuromuscular irritability (tetany), dysrhythmias, and seizure and can also precipitate as calcium phosphate crystals in various organs
39
Q
Hyperuricemia
A
due to catabolism of nucleic acids and can induce acute kidney injury. spike in uric acid secretion.
40
Q
Clinical manifestations of TLS
A
- reduced urine output
- uremia
- fluid overload
- cardiac dysrhythmias
41
Q
Interventions TLS
A
- alopurinol prophylactically if they are at risk
- hydration, electrolyte balance
- IV hydration to flush the calcium phosphate crystals out of the kidneys
42
Q
What is allopurinol
A
- reduces production of uric acid in body
- people on moderate or high risk of TLS will be put on the medication prophylacitcally
