care continuum (19%) Flashcards
aim to prevent disease before it occurs
e.g. smoking cessation, diet modification, exercise promotion, early detection through cancer screening, vaccines
primary prevention
detecting & treating cancer early, when likely curable
secondary prevention
describes how well a test can detect a specific disease or condition in people who actually have the disease or condition
e.g. erythrocyte sedimentation rate (ESR) - very sensitive to inflammation but does not delineate exactly where the inflammation is occuring
sensitivity
how accurate a test will be in testing for one particular item
e.g. ESR is very specific for inflammationn
specificity
- the chance a test will have a false reading
- can be false positive (positive result when it should actually be negative)
- can be false negative (negative result when it should actually be positive)
predictive value
testing that is done to a large group of people
e.g. state-mandated testing performed on newborns after delivery
mass screening
screening & early detection
testing that is done for a specific disease on patients who are at risk for developing that disease
e.g. genetic testing for presence of a tumor marker when there is family hx of genetic disease (such as cystic fibrosis)
selective/prescriptive screening
checks for the presence of a specific disease
single screening
looks for at least two abnormalities at one time
e.g. screening for elevated cholesterol and testing a PSA at the same time
multiple screening
looking at a person over a period of time for the development of any conditions
e.g. assessing children for appropriate development w/each well-child visit
multiphasic screening
- refers to the amount of new cases that are diagnosed in a given time period, typically a year
- reported as the number of cases per 100,000 individuals
incidence rate
- the total number of cases that were active during any part of a given time period, typically a year
- this statistic can include those who are currently fighting the disease, those in remission, or those who have been cured
prevalence rate
- refers to the number of people who have died from a particular disease during a given time period, typically a year
- reported as the number of deaths per 100,000 individuals
mortality/death rate
- refers to the mortality among only those diagnosed w/a particular disease
- gives information on how deadly a certain type of cancer may be
- reported as a percentage
case fatality rate
- refers to the likelihood of living at least a given length of time, usually 5-10 years after having been diagnosed w/a particular disease
- reported as a percentage
survival rate
- refers to the likelihood of being diagnosed w/a particular disease in a given time period
- this time period can be stated as a set length of time, prior to given age, or at any point in an individual’s entire lifetime
- can be expressed as a percentage or as numerical odds (e.g. 12 out of 100,000)
absolute risk
refers to the likelihood of being diagnosed w/a particular disease among those subject to an identified risk factor for the disease
e.g. __________________ of a person who smokes cigarettes developing lung cancer is much higher than the ____________________ of a person who does not smoke
relative risk
- refers to difference in likelihood of being diagnosed w/a particular disease b/w those exposed to a risk factor & those not exposed
- essentially expresses how much of a person’s risk for a disease is d/t a particular risk factor
e.g. how much more likely is someone to develop lung cancer given that they smoke?
attributable risk
- the chance of a person developing the disease throughout their lifetime
- does not take into account specific risk factors that may be present in different individuals
cumulative risk
surivivorship
- considered the cancer patient
- called this from the moment of diagnosis
- a cancer ____________ is considered a ____________ their whole life, even if they have a recurrence
survivor
- caregivers and family members are called this
- the patient does not have to die from cancer for there to be this
secondary survivor
initial stage of the disease when a person is first diagnosed w/cancer
nrsg interventions: education (which continues throughout all stages) - on disease process, txs available, community resources available for support, importance of compliance w/tx plan
acute stage
occurs after selected treatments are completed and includes the stage at which long-term therapy may occur
nrsg interventions: educating importance of continuing screening procedures to monitor for cancer recurrence
extended stage
- patient is considered cancer free
- frequently monitored by a patient being cancer free for 5-years
nrsg interventions: education, expecially importance of continued compliance w/screening for cancer recurrence
permanent stage
- pts/families may be resistive to info and unable to accept that a person is denying/impaired
- may act stunned, immobile, or detached
- may be unable to respond appropriately or remember what’s said, often repeatedly asking the same questions
first stage of Kubler Ross’s stage of grief
denial
- may be directed inward or outward
- women, especially, blame themselves, lead to severe depression or guilt
- men, commonly, may express overt hostility
second stage of Kubler Ross’s stage of grief
anger
- involves if-then thinking (often directed at a deity)
- pt/family may change doctors, trying to change the outcome
third stage of Kubler Ross’s stage of grief
bargaining
- pt and family may feel no one understands what they are going through and is overwhelmed w/sadness
- may be tearful or crying and may withdraw and asked to be left alone
fourth stage of Kubler Ross’s stage of grief
depression
- represents form of resolution and often occurs outside of the medical environment after months
- pts are able to accept death/dying/incapacity
- families are able to resume their normal activities and lose constant preoccupation w/their loved ones
- able to think of the person w/o severe pain
final stage of Kubler Ross’s stage of grief
acceptance
immunohistochemistry (IHC)
- a technique in which tissue antigens on frozen tissue sections are identified
- antigens are detected by the use of specific antibodies coupled to either fluorescent compounds or pigmented entities, allowing the pathologist to view these interactions on a fluoroscope or through a microscope
- also various methods of amplifying the interactions, or enzymatically exposing masked antigens to aid in their visualization
needle aspiration biopsy
- the removal of tissue fragments through the use of a needle
- this approach is usually highly specific & predictive if positive, but sample size is typically too small to perform histological analysis
flow cytometry
- method of analyzing populations of cells in suspension for various properties
cells (i.e. tumor sample cells) are aspirated into the fluidic system of a machine (called a flow cytometer) - cells are mixed w/a fluid that places them in suspension & a unidirectional or laminar flow is created
- as each cell flows past a laser sensor, photons emitted are picked up & intensified by photomultiplier tubes
- data is electronically converted into either histograms or dot plots that compare characteristics of the cells in the population
incisional biopsy
- surgical removal of only a small portion of the tumor
- this approach provides more information but requires meticulous technique to avoid sampling mistakes & the induction of tumor spread
excisional biopsy
- complete excision of a suspected tumor area
- used for relatively small tumors or when other methods are inconclusive
needle core biopsy
using a special needle to excise & retrieve a section of tissue large enough for histological analysis
PCR molecular diagnostic technique
- amplifies the amount of DNA, which is usually then used in other methodologies, such as sequencing
- an enzyme called reverse transcriptase is used to generate DNA copies called cDNA from an RNA template w/short nucleotide chains or oligonucleotides as primers
- number of cDNA copies is then usually amplified through a process called nesting
southern blotting molecular diagnostic technique
- uses enzymatic digestion of a pt sample, electrophorectic separation of the products, then probing or blotting w/suitable molecular probes
- latter methodology is labor intensive & slow
tumor marker assays
- quantify levels of certain molecules found in serum, other body fluids, cells, & tissues that have an association w/the presence of malignancy
- most of the available assays are either radioimmunoassays (RIAs) or enzyme-linked immunosorbent assays (ELISAs), which respectively use radioisotopes or enzymes linked to various substances (often specific antibodies) as detection vehicles
- value of these immunoassays depends upon their specificity (i.e. their ability to accurately detect malignancy vs. normal tissue or benign growths) & sensitivity (the capacity for early detection during screening or preliminary Dx)
health disparities
describes the concept of a disease or class of diseases having a measurably different impact on different subsets of a population, usually applied to distinct ethnic groups
how does smoking impact the development of lung cancer?
- approx. 90% of all people who develop lung cancer are smokers
- there are known risks for lung cancer w/second-hand exposure to smoke, but no exact figures are known for incidence of cancer in this population
- it is known when smokers quit smoking, some repair occurs within lung tissue
- this does not immediately decrease the risk of developing lung cancer, but the risk will begin to decrease at least 5 years after quitting smoking
what does the CDC recommend to prevent cancer from human papillomavirus (HPV)?
- approx. 26,000 cases of cancer diagnosed each year are directly attributable to HPV
- CDC recommends an HPV vaccine for females 13-26 years of age & for males 13-21 years of age
Americans with Disabilities Act (ADA) & Federal Rehabilitation Act
federal laws that prohibit employers from discriminating against their employees based on a disease or disability
Genetic Information Nondiscrimination Act (GINA)
- provides protection from discrimination of employees based on the results of a genetic test or a family hx of a disease
- the ________________ law covers the same employers that are covered under the ADA law (those w/at least 15 employees)
Family & Medical Leave Act (FMLA)
requires employers of at least 50 or more employees to provide up to 12 wks of unpaid leave during any 12-month period to attend to their own serious health conditions or that of an immediate family member
rehabilitation
aim of ________________ is the cure of the patient, or as near to that as possible, w/the reinsertion of the patient back into his or her original environment w/the same job, duties, & interpersonal relationships the patient had before the cancer Dx
adaptation
- ____________ of the patient is a consequence of tx, w/all limitations acknowledged & overcome to the fullest extent possible w/o compromiosing the patient’s quality of life that was present before
- goal is to reenter life as before or as near to previous life as possible
- there are many organizations that can give support & comfort, & ease the transition back into normal life
reintegration
- describes the process of assisting the patient to return to work through a program w/their employers to understand each other’s needs & how to work together to reach the goal or re-employment
