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kol- Med Surg 320 Spring > Cancer general > Flashcards

Cancer general Flashcards

1
Q

process to control cellular growth, replication, and differentiation

A

cellular regulation

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2
Q

cells that are abnormal, do not serve a purpose, and are harmful to normal tissue

A

cancer/malignant cells

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3
Q

3 causes of problems associated with cancer?

A
  1. cancer itself
  2. treatment
  3. combo
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4
Q

General problems of metastatic cancer

A
  • Reduced blood producing function
  • Altered GI function
  • Peripheral nerve, motor and sensory deficits
  • Decreased respiratory and cardiac function
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5
Q

Goals of cancer management (2)

A
  • Cure or control cancer

* Minimize side effects of treatment(s)

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6
Q

Cancer management is dependent on what things

A
  • Type, location, size and extent of cancer

* Health of person

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7
Q

Different types of treatment for cancer

A

-Surgery
-Radiation **
-Chemotherapy **
-Immunotherapy
-Small Molecular Inhibitor Targeted Therapy
-Hormone Therapy
(** Where we will focus our time, you will be expected to understand)

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8
Q

3 biggest nursing priorities related to blood with cancer?

A
  • Reduced WBC’s > Impaired Immunity > Risk of Infection
  • Reduced RBC’s > Poor Perfusion > Fatigue/ Breathing
  • Reduced Platelets > Poor Clotting > Risk of Bleeding
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9
Q

what is mylosuppression?

A

-Chemotherapy destroys cancer cells AND ALSO
• Kills Healthy Blood Cells
• Suppresses Bone Marrow Function (no replacement)
>Less RBC’s, WBC’s (especially neutrophils), Platelets

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10
Q

low wbc =

A

neutropenia

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11
Q

ANC < _____ = neutropenia

A

-ANC is < 1000 cells/mm3

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12
Q

what kind of infections do you get if you are neutropenic?

A

overgrowth of normal flora (Opportunistic Infections)

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13
Q

interventions for preventing/ treating infections

A 
-Infection Prevention
• Hand Washing
• Neutropenic Precautions
-Nurse-Led Protocols
-Obtain Cultures
-Diagnostics
-Antibiotic Administration
-Antibiotic Stewardship: giving a person the right antibiotic when they need it and only when they need it as early as possible 
---> Prevent Sepsis/ Recognize early sepsis
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14
Q

what is antibiotic stewardship?

A

giving a person the right antibiotic when they need it and only when they need it as early as possible

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15
Q

general rule for when to implement neutropenic precautions?

A

For ANC <500 cells/mm3 or < 1000 cells/mm3 w/fever

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16
Q

neutropenic precautions interventions @ hospital (@ home comes later)

A
  • Private Room
  • Wash Hands/ Educate
  • Avoid shared supplies
  • Monitor VS’s, Temperature, WBC’s
  • Inspect Mouth, Skin, Mucous membranes, Line sites
  • Coughing, Deep Breathing
  • Hygiene
  • Activity/ Rest
  • Limit visitors
  • Asepsis
  • No fresh flowers/ plants
  • No raw vegetables, fruits, undercooked meat/ pepper
  • No use of indwelling catheters
  • Remove stagnant water
HOME CARE
• Hand-washing
• Daily baths/ Antimicrobial soap
• Avoid Crowds
• Avoid sharing personal items
• Wash dishes well/ don’t re-use drinking cups
• Monitor temperature
• Diet restrictions 
• Pet litter avoid 
• Use Condoms
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17
Q

re neutropenia: report what changes to provider?

A
  • Skin
  • Mucous membranes
  • Cough
  • Central Line Site- drainage/ redness
  • Fever- systemic
  • Drainage
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18
Q

another word for low platelets

A

Thrombocytopenia

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19
Q

Thrombocytopenia puts you at risk for

A

BLEEDING

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20
Q

spontaneous vs prolonged bleeding

A
  • Prolonged bleeding=If platelets are < 50,000 platelets/mm3

* Spontaneous bleeding may occur - IV site, GI bleed =If platelets are < 20,000 platelets/mm3

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21
Q

biggest concern with risk of spontaneous bleeding?

A

spontaneous bleeding in brain –> neuro assessments

platelets <20,000

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22
Q

thrombocytopenia assessment findings

A
  • Neurological assessments
  • Spontaneous bleeding
  • Petechiae
  • Excessive bruising in lower back/flank
  • Prolonged bleeding- hold central pulling line out is risk –> hold extra pressure or not pull out
  • Blood in urine and stool
  • Tachycardia
  • Hypotension
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23
Q

Thrombocytopenia interventions

A

-Bleeding Precautions
-Neurological Assessments
-Avoid Injuries that may cause bleeding
• Fall precautions
• Insertion of tubes –> minimize!
—->Avoid rectal tubes and medication
-Platelet Administration is below 20,000
-Neumega- promote prdxn of platelets

24
Q

bleeding precaution interventions

A
  • Lift sheet
  • Avoid IM injections/ Venipunctures + signage
  • Apply pressure for 10 minutes for venipunctures/ Hemostasis
  • Use of Ice
  • Assess IV sites
  • Avoid enemas, rectal temps, rectal tubes
  • Abdominal Girth measurement
  • Electric razor
  • Soft-Bristle toothbrush
  • Fall prevention
  • Nose blowing can cause spontaneous bleeding
25
another word for overall low RBC =
anemia
26
anemia and poor nutritional status are often causes of cancer ____ ____
related fatigue
27
manifestations of Cancer Related Fatigue
* Far worse than ”everyday fatigue” * May have a profound affect on ADL’s/ Ability to perform ADL’s * May be considered worse than the side effects of Cancer/ cancer treatment (Nausea and vomiting, pain) * Lasts for weeks, months, years
28
interventions for cancer related fatigue
``` • Exercise • Assess for underlying cause and treat • Energy Conservation/ Activity Management ◦ Set Priorities ◦ Plan ahead ◦ Ask for help ◦ Optimize sleep • Massage • Healing touch ```
29
re- GI changes and cancer: why is GI system so effected by chemo?
``` cells in GI tract are rapidly replicating, most chemo targets rapidly replicating cells May also be from • Cancer • Chemotherapy • Radiation ```
30
what is cachexia?
a condition that causes the body muscles to waste away --> extreme weight loss
31
GI changes related to cancer
- Cachexia - Changes in Taste - Mucositis & Stomatitis - Nausea & Vomiting (Chemotherapy)
32
Mucositis vs Stomatitis
Mucositis & Stomatitis --> damage from chemo ◦ Stomatitis = irritation in entire GI Tract ◦ Mucositis = irritation in mouth only
33
4 types of nausea related to chemo/cancer
* Acute- happens as soon as someone is treated w/ chemotherapy * Anticipatory- conditioned--> think about chemo and have n/v * Delayed- n/v 1-5 days after receiving chemo * Breakthrough-protocols and meds not controlling n/v
34
cachexia interventions
- Interventions should be patient-specific - Protein and CHO rich foods - Small, frequent meals - Nutritional supplements
35
Mucositis & Stomatitis Interventions:
``` -Cold (ice or ice-pops) • Oral cryotherapy Mouth rinses/Medicated mouthwashes • Sodium bicarbonate • Lidocaine • Magic mouthwash --> compound of 3 agents -Use non-irritating mouth cleansers/ no floss -Soft bristle toothbrush -Mucosal Protectants -Assess, assess, assess -Hygiene ```
36
Nausea & Vomitting Interventions:
WAITING FOR EMAIL FROM MESSER
37
when do we most often see motor/sensory deficits w/ cancer?
=Occurs with bone and brain metastasis, compressed nerves
38
Nursing priorities for motor and sensory deficits
``` -Restricts mobility • Assess ability • Promote optimization/ Offer assistance • PT/OT -Painful -Risk for injury ```
39
Peripheral neuropathy assessment/intervention/priorities
``` -Peripheral neuropathy • Loss of sensation in lower extremities • May be painful • Loss of balance • Injury to feet (unaware of injury) -Prevent injuries -Fall risk -Assess sensation in feet -Assess for wounds ``` 3 ways we have balance in our body : seeing, hearing, feeling
40
Reduced oxygenation- causes w/ cancer?
-->Tumors in airway • Decreased lung capacity with lung tissue involvement • Tumors may press on vessels in the chest and block blood flow • Tumors may thicken alveolar/ damage pulmonary blood vessels
41
manifestations of poor oxygenation w/ cancer? interventions?
-->Lead to HYPOXIA and POOR TISSUE OXYGENATION interventions: apply oxygen, HOB, rest periods, tripod position
42
Alopecia and cancer: concern?
* Protect scalp | * Psychosocial aspect
43
When lose hair from chemo do you lose it just on your head?
NO! - everywhere
44
cognitive changes and cancer
* Chemo-brain (chemotherapy) | * Brain tumor/ mets
45
Cancer: Psychosocial Implications
* Anxiety and depression * Fear of Recurrence * Sleep Disturbances * Physical Changes * Reduced function * Sexual Dysfunction/ Fertility issues * Work/ Inability to participate in normal roles * Spiritual issues
46
Psychosocial Care- interdisciplinary?
* Support Services * Case Manager * Navigator * Palliative Care * Caregiver strain
47
most common type of radiation for cancer?
gamma
48
Goals of radiation
Cure Control Palliate >Minimize destruction of normal tissue >Localized effects (with exception)
49
radiation therapy: dose vs exposure
``` Exposure- amount delivered Dose- amount absorbed by the patient determined by: • Intensity • Duration • Closeness ```
50
radiation is given in ______ doses
divided
51
teletherapy vs brachytherapy
1. Teletherapy = External beam 2. Brachytherapy=Internal device • Oral therapy, IV, surgical insertion • Direct contact with cancer • Patient emits radiation while as long as device is emitting radiation
52
Bachytherapy: sealed vs unsealed
Unsealed: Any body fluids are also radioactive Sealed: Only the patient emits radiation - not excreted into bodily fluids
53
Precautions for patients with brachytherapy
* Private room * Sign on door * Keep door closed * Wear lead apron * Restrict time in room * Keep visitors 6 feet away/ limit time <30 minute * Do not assign pregnant caregivers * Handling of bed linens and dressings in room until patient has left room
54
general radiation side effects
* Localized * Skin changes * Hair loss * Altered taste * Fatigue * Inflammation * Tissue Fibrosis/ scarring * Secondary malignancies * Cardiovascular Disease
55
radiation education
* Do not remove markings * Skin care - do not scrub, use mild soap * Specific to location and type of radiation

kol- Med Surg 320 Spring (43 decks)

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