Cancer (Exam 3) Flashcards
Cancer Patho
defect in cellular proliferation (cancer cells divide in an indiscriminate, unregulated manner and exhibit variations in structure and size)
defect in cellular differentiation (can arise from any cell in the body that can evade the normal regulatory controls of proliferation or growth and cellular differentiation)
Benign Tumors
encapsulated neoplasm that remains localized in the tissue of origin and is typically not harmful
exerts pressure on surrounding organs
will decrease blood supply to normal tissue
Malignant Tumors
nonecapsulated neoplasm that invades surrounding tissue; depends on stage of neoplasm as to whether metastasis occurs
common sites are brain, liver, lungs, adrenals, spinal cord and bone
Malignant Tumors Spread
vascular system via circulation (may penetrate vessel wall and invade adjacent organs)
lymphatic system
implantation (implant in body organ, affinity for certain organs)
seeding (primary tumor sloughs off tumor cells into body cavity)
Cancer Causes
chemical agents
radiation (two forms, UV and ionizing)
viral
genetic
Cancer Prevention
high fiber diets may reduce risk of colon cancer
diet
stress
carcinogens (smoking, tanning beds, sun exposure)
weight and exercise
sleep
alcohol usage
diets high in fat may be factor of breast, colon, prostate cancer
Oropharyngeal Cancer
stomatitis
candida
7 Warning Signs of Cancer
changes in bowel or bladder habits
a sore that doesn’t heal
unusual bleeding or discharge
thinking or lump in breast or elsewhere
indigestion or difficulty swallowing
obvious change in a wart or mole
nagging cough or hoarseness
Skin Cancer Health Promotion
limit sun exposure and avoid tanning beds
sunscreen
wear hat and protective clothing
examine body monthly for possible lesions
keep a body map of skin spots
take pictures of lesions and compare them month to month
Skin Cancer Warning Signs
color change of lesion, especially if it darkens or shows evidence of spreading
size change of lesion, especially rapid growth
shape change of a lesion
redness/hyperpigmentation or swelling around lesion
sensation changes, like itching or tenderness
oozing, crusting, bleeding, etc.
Early Gastric Cancer
chronic dyspepsia
abdominal discomfort initially relived with antacids
feeling of fullness
epigastric, back or retrosternal pain
Advanced Gastric Cancer
n/v
iron deficiency anemia
palpable epigastric mass
enlarged lymph nodes
weakness and fatigue
progressive weight loss
Pancreatic Cancer Risks
smoking
obesity
chronic pancreatitis
cirrhosis
older age over 65
genetic syndromes
Cancer Labs and Diagnostics
xray
tissue biopsy
radiographic studies (mammography, ultrasonography, CT scan, MRI)
radioisotopic scans (bone, liver, lung, brain)
cytology studies (bone marrow aspiration, urine and CSF analysis, cell washings, Pap smear, bronchial washings)
PET scan
tumor/genetic markers
endoscopic exams
CBC, chem profile, LFTs
bone marrow exam (if hematolymphoid malignancy is expected)
molecular receptor status (estrogen/progesterone receptors)
Biopsy
used for definitive diagnosis
needle; tissue samples are obtained by a small gauge aspiration needle or with a large bore needle
incisional; scalpel or dermal punch is used to obtain a tissue sample
excisional; removal of tumor
endoscopic biopsy; direct biopsy through endoscopy of area (GI, GU, respiratory)
Cancer Therapy Goals
prophylaxis; provide treatment when no tumor is detectable but when client is known to be at risk for tumor development, spread or recurrence
cure; client with be disease free with normal life expectancy
control; not cured but controlled by therapy over long periods of time
palliation; to maintain as high a quality of life for pt as possible when cure and control aren’t possible
Cancer Meds General Nursing Implications
observe for ADE
dosage is based on weight and height using body surface are calculation
monitor lab values for evidence of bone marrow suppression; infection from loss of neutrophils, bleeding from loss of thrombocytes, and anemia from loss of erythrocytes
avoid contact with skin when preparing chemo meds that are vesicants
don’t administer a vesicant though a hand/wrist IV site; most administered via a CVAD
general SE of antineoplastic agents are n/v/d, anorexia, alopecia, hyperuricemia, nephrotoxiticy, and bone marrow suppression
monitor renal and hepatic function to evaluate ability of client to break down and excrete chemo agents
Cancer Med Classes
alkylating agents (kill cells by alkylating DNA; dose limiting due to bone marrow suppression)
platinum compounds (similar action to alkylating agents are are cell-cycle nonspecific)
antimetabolites (disrupt critical cellular metabolism; cell-cycle specific, dose limited by bone marrow suppression)
antitumor antibiotics (interfere with DNA synthesis, not used to treat infections; poor GI absorption and given via IV)
mitotic inhibitors (prevent cell division)
hormonal agents (mimic/block action of hormones)
aromatase inhibitors (used to treat estrogen receptor positive breast cancer in post menopausa)
immunostimulants (biological response modifiers that alter host response to cancer cells)
targeted drugs (bind with specific molecules that drive tumor growth)
hematopoietic growth factors (used to support cancer client)
Cancer Therapies
surgery
chemo*
radiation
Chemotherapy
therapeutic ratio is guiding principle; aim is to administer an antineoplastic agent dose large enough to eradicate cancer cells but small enough to limit ADE to safe and tolerable levels
route
catheter
meds (IV)
ADE stomatitis, alopecia, bone marrow suppression, n/v
follow procedures for handling biohazardous materials
Cancer Nursing Care (Psychosocial)
encourage verbalization
assist pt to understand disease process and therapeutic regimen
include family in care
assist pt to cope with bodily changes caused by alopecia
assist pt coping skill and support system; encourage communication and active listening
recognize clients emotional outbursts and anger as part of coping process
encourage measures to maintain pt ego (allow pt to participate in their own care and make decisions, active listening, encourage personal lifestyle choices, discuss body image issues)
Cancer Nursing Care (Nutrition)
appropriate age level diet
total parenteral nutrition to maintain intake
prevent and decrease complications associated with nutrition (antiemetics for treatment of anorexia and n/v and prevention 30 min prior to meals; ondansetron and metoclopramide) (high protein, high cal, nutrient dense foods; track nausea triggers)
maintain healthy, intact skin
Cancer Nursing Care (Elimination)
prevent complications of diarrhea, constipation, UTIs and cystitis
adequate fluid intake (3L a day)
frequently assess for symptoms
avoid bladder caths if possible
check urine for hematuria
encourage frequent voiding
assess for development of vesicovaginal or recto-vaginal fistulas
Cancer Nursing Care (Infection)
prevention of infection
neutropenic precautions
WBC lab values
monitor and prevent bleeding and platelet levels!!
watch LOC, BP, tachy for signs of hemorrhage
