Cancer general Flashcards
process to control cellular growth, replication, and differentiation
cellular regulation
cells that are abnormal, do not serve a purpose, and are harmful to normal tissue
cancer/malignant cells
3 causes of problems associated with cancer?
- cancer itself
- treatment
- combo
General problems of metastatic cancer
- Reduced blood producing function
- Altered GI function
- Peripheral nerve, motor and sensory deficits
- Decreased respiratory and cardiac function
Goals of cancer management (2)
- Cure or control cancer
* Minimize side effects of treatment(s)
Cancer management is dependent on what things
- Type, location, size and extent of cancer
* Health of person
Different types of treatment for cancer
-Surgery
-Radiation **
-Chemotherapy **
-Immunotherapy
-Small Molecular Inhibitor Targeted Therapy
-Hormone Therapy
(** Where we will focus our time, you will be expected to understand)
3 biggest nursing priorities related to blood with cancer?
- Reduced WBC’s > Impaired Immunity > Risk of Infection
- Reduced RBC’s > Poor Perfusion > Fatigue/ Breathing
- Reduced Platelets > Poor Clotting > Risk of Bleeding
what is mylosuppression?
-Chemotherapy destroys cancer cells AND ALSO
• Kills Healthy Blood Cells
• Suppresses Bone Marrow Function (no replacement)
>Less RBC’s, WBC’s (especially neutrophils), Platelets
low wbc =
neutropenia
ANC < _____ = neutropenia
-ANC is < 1000 cells/mm3
what kind of infections do you get if you are neutropenic?
overgrowth of normal flora (Opportunistic Infections)
interventions for preventing/ treating infections
-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
what is antibiotic stewardship?
giving a person the right antibiotic when they need it and only when they need it as early as possible
general rule for when to implement neutropenic precautions?
For ANC <500 cells/mm3 or < 1000 cells/mm3 w/fever
neutropenic precautions interventions @ hospital (@ home comes later)
- 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
re neutropenia: report what changes to provider?
- Skin
- Mucous membranes
- Cough
- Central Line Site- drainage/ redness
- Fever- systemic
- Drainage
another word for low platelets
Thrombocytopenia
Thrombocytopenia puts you at risk for
BLEEDING
spontaneous vs prolonged bleeding
- Prolonged bleeding=If platelets are < 50,000 platelets/mm3
* Spontaneous bleeding may occur - IV site, GI bleed =If platelets are < 20,000 platelets/mm3
biggest concern with risk of spontaneous bleeding?
spontaneous bleeding in brain –> neuro assessments
platelets <20,000
thrombocytopenia assessment findings
- 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
Thrombocytopenia interventions
-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
bleeding precaution interventions
- 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
another word for overall low RBC =
anemia
anemia and poor nutritional status are often causes of cancer ____ ____
related fatigue
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
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
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
what is cachexia?
a condition that causes the body muscles to waste away –> extreme weight loss
GI changes related to cancer
- Cachexia
- Changes in Taste
- Mucositis & Stomatitis
- Nausea & Vomiting (Chemotherapy)
Mucositis vs Stomatitis
Mucositis & Stomatitis –> damage from chemo
◦ Stomatitis = irritation in entire GI Tract ◦ Mucositis = irritation in mouth only
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
cachexia interventions
- Interventions should be patient-specific
- Protein and CHO rich foods
- Small, frequent meals
- Nutritional supplements
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
Nausea & Vomitting Interventions:
WAITING FOR EMAIL FROM MESSER
when do we most often see motor/sensory deficits w/ cancer?
=Occurs with bone and brain metastasis, compressed nerves
Nursing priorities for motor and sensory deficits
-Restricts mobility • Assess ability • Promote optimization/ Offer assistance • PT/OT -Painful -Risk for injury
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
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
manifestations of poor oxygenation w/ cancer? interventions?
–>Lead to HYPOXIA and POOR TISSUE OXYGENATION
interventions: apply oxygen, HOB, rest periods, tripod position
Alopecia and cancer: concern?
- Protect scalp
* Psychosocial aspect
When lose hair from chemo do you lose it just on your head?
NO! - everywhere
cognitive changes and cancer
- Chemo-brain (chemotherapy)
* Brain tumor/ mets
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
Psychosocial Care- interdisciplinary?
- Support Services
- Case Manager
- Navigator
- Palliative Care
- Caregiver strain
most common type of radiation for cancer?
gamma
Goals of radiation
Cure
Control
Palliate
> Minimize destruction of normal tissue
Localized effects (with exception)
radiation therapy: dose vs exposure
Exposure- amount delivered Dose- amount absorbed by the patient determined by: • Intensity • Duration • Closeness
radiation is given in ______ doses
divided
teletherapy vs brachytherapy
- Teletherapy = External beam
- Brachytherapy=Internal device
• Oral therapy, IV, surgical insertion
• Direct contact with cancer
• Patient emits radiation while as long as device is emitting radiation
Bachytherapy: sealed vs unsealed
Unsealed: Any body fluids are also radioactive
Sealed: Only the patient emits radiation - not excreted into bodily fluids
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
general radiation side effects
- Localized
- Skin changes
- Hair loss
- Altered taste
- Fatigue
- Inflammation
- Tissue Fibrosis/ scarring
- Secondary malignancies
- Cardiovascular Disease
radiation education
- Do not remove markings
- Skin care - do not scrub, use mild soap
- Specific to location and type of radiation
