Care of Patients with Cancer Flashcards
1
Q
cancer w/ highest incidence among women
A
breast cancer
2
Q
cancer w/ highest incidence among men
A
prostate cancer
3
Q
process of cancer development
A
- initiation
- promotion
- progression
4
Q
stage of cancer development where there is a mutation of a cell’s genetic structure
A
initiation
5
Q
what causes mutation of cell’s genetic structure
A
- inherited mutation (5-10%)
- exposure to carcinogens (chemical, radiation, viral)
6
Q
T/F: activities of promoting factors for cancer are reversible
A
True
7
Q
What are most cancer-related deaths in the US related to
A
- tobacco use
- unhealthy diet
- physical inactivity
- obesity
8
Q
latent period (time between mutation in cell and actual signs of cancer)
A
1-40 years
9
Q
stage of cancer where there is growth and invasion of tissues and tumor angiogenesis
A
progression
10
Q
routes for metastasis
A
blood and lymphatics
11
Q
most common sites of metastasis
A
- brain
- bone
- liver
- lung
- adrenal glands
12
Q
antigens found on tumor cell surfaces, in tumor cells, and in fetal cells
A
oncofetal antigens (tumor markers)
13
Q
carcinoembryonic antigen (CEA) indicates what
A
- colon, lung, pancreas, or breast cancer
- also seen in cirrhosis, ulcerative colitis, and heavy smokers
14
Q
alpha fetoprotein (AFP) indicates what
A
hepatic or germ cell cancers (testicular and ovarian)
15
Q
CA-125 indicates what
A
ovarian cancer
16
Q
CA-19-9 indicates what
A
pancreatic and gallbladder
17
Q
CA 15-3, CA 27-29, and HER-2 indicate what
A
breast cancer
18
Q
prostate-specific antigen (PSA) indicates what
A
prostate cancer
19
Q
characteristics of benign tumors
A
- well differentiated and encapsulated
- no metastasis
- rare recurrence
- expansive growth
- similar to parent cells
- slight vascularity
20
Q
characteristics of malignant tumors
A
- poorly differentiated and non-encapsulated
- can metastasize
- possible recurrence
- infiltrative and expansive growth
- different from parent cells
- moderate to marked vascularity
21
Q
purpose of cancer staging
A
helps determine patient’s prognosis and best treatment
22
Q
TNM cancer staging
A
- tumor size and invasiveness
- Nodes (spread to lymph nodes)
- Metastasis
23
Q
5 stages of cancer
A
- 0: cancer in situ
- 1: tumor limited to tissue of origin; localized tumor growth
- 2: limited local spread
- 3: extensive local spread and regional spread
- 4: metastasis
24
Q
prevention of cancer
A
- avoid or reduce exposure to known carcinogens (smoking, alcohol, excessive sun exposure)
- eat a balanced diet
- exercise regularly
- maintain healthy weight
- adequate rest
- reduce stressors and improve coping skills
- use sunscreen
25
7 warning signs of cancer
CAUTION
- changes in bowel or bladder
- a sore that doesn't heal
- unusual bleeding or discharge from any orifice
- thickening or a lump (breast or elsewhere)
- indigestion or difficulty swallowing
- obvious changes in wart of mole
- nagging cough or hoarseness
26
diagnostic tests for cancer
- radiologic studies
- colonoscopy or sigmoidoscopy
- laboratory tests
- biopsy
27
What is the definitive test for cancer
biopsy
28
treatment goals for cancer
- cure
- control
- palliation
29
treatment of cancer is determined by what factors
- type of tumor and stage
- pt's physical health
- pt's psychological health
- pt's personal choice of tx
- ethical decisions
30
reasons for surgical therapy for cancer
- diagnosis (biopsy)
- prevention (removal of nonvital organs to prevent cancer)
- cure/control (removal of localized cancer tissue; primary site or metastasis)
- palliation of symptoms (relief of pain, obstruction, or hemorrhage)
- supportive care (insertion of therapeutic devices)
- rehabilitation (reconstructive sx)
31
preparation and administration of chemotherapy
- potential occupational hazard
- caution w/ body fluids for 48 hours (double gloved and special signs)
- double flush the toilet and cover toilet to prevent spraying
- only properly trained personnel can administer chemo
32
How might chemo be absorbed by the nurse
- skin
| - inhalation during preparation, transportation, and administration
33
methods of chemo administration
- oral
- IM
- IV (most common)
- intracavitary (pleural or peritoneal)
- intrathecal
- intraarterial
- intravesical (bladder)
- continuous infusion
- subcutaneous
- topical
34
best venous access device to prevent extravasation during chemotherapy
central line
35
what does chemo cause as an irritant
sclerosis of vein (monitor signs of phlebitis)
36
what does chemo cause as a vesicant
- severe local tissue destruction and necrosis w/ infiltration
- if infiltrated -> stop IV immediately
37
what to assess for w/ central line
- inspect site for redness, edema, warmth, drainage, and tenderness
- check for patency (flush w/ normal saline)
38
What technique is used for central line dressing changes and cleansing
sterile technique
39
How to care for central lines
- place transparent occlusive dressing
- don't submerge in water
- educate on signs of infection and when to change dressing
40
3 types of central lines for chemo
- PICC line
- implanted port
- tunneled catheter
41
acute toxicity of chemotherapy (normal tissues)
- occurs during and immediately after administration
- N/V
- allergic reactions (anaphylaxis)
- dysrhythmias
- extravasation
42
delayed effects of chemo on normal tissues
- mucositis (irritation in mouth)
- alopecia
- bone marrow suppression (risk for infection, anemia, and bleeding)
- delayed N/V
- skin rashes
- altered bowel function (diarrhea/constipation)
- cumulative neurotoxicity (chemo brain: foggy and memory problems; peripheral neuropathy)
43
chronic toxicity of chemo (normal tissues)
- hemorrhagic cystitis
- heart (rapid heart failure and pericardial effusion)
- kidney (nephrotoxicity)
- liver (hepatotoxicity)
- lungs (pneumonitis and fibrosis)
- infertility (men and women)
44
2 types of radiation therapy
- external (teletherapy)
| - internal (brachytherapy)
45
characteristics of external radiation therapy
- typically delivered once a day for 5 days a week for 2-8 weeks
- used to treat defined area of body
- effects on all tissues that radiation goes through
46
T/F: radiation markings should be removed when bathing
False; marking should never be removed
47
characteristics of internal radiation
- implanted or inserted into patient
- radiation seeds or brachycatheter
- minimizes exposure to healthy tissue
- patient is emitting radioactivity
48
nursing safety when caring for patient receiving internal radiation
- limit time near pt (cluster care)
- distance from source
- shielding used
- wear film badge to monitor exposure
49
symptoms of chemotherapy and radiation therapy
- bone marrow suppression (infection, bleeding, anemia)
- fatigue
- stomatitis, mucositis, esophagitis
- N/V
- taste alterations
- anorexia
- diarrhea or constipation
- neurologic changes (chemo brain and peripheral neuropathy)
- integumentary (hair loss, desquamation)
50
how to care for dry desquamation (looks like sunburn)
- goal: facilitate healing and prevent infection
- apply ointment (no perfumes or alcohol) -> aquafor or aloe
-
51
how to care for wet desquamation (tissue is destroyed faster than it's replaced; painful)
- keep area clean
- vaseline gauze
- avoid the sun
- avoid tight soft clothing
- don't put hot or cold on the skin
- don't soak skin
- avoid using tape or adhesives on skin
52
radiation causes increased risk for what
- leukemia
- angiosarcoma
- skin cancer
53
other late effects of radiation
- strictures/fistulas
- radiation necrosis
- arthralgia
- renal insufficiency
- osteoporosis
54
other treatment for cancer
- biologic and targeted therapies
- hematopoietic growth factors
- erythropoietin
55
alter biologic response to tumor cells
biologic therapies
56
target and bind cell receptors important to tumor growth
targeted therapies
57
types of hematopoietic growth factors
colony-stimulating factors: filgrastim (Neupogen) -> stimulates bone marrow production or establish bone marrow function
58
how is epoetin alpha (Epogen) administered
subcutaneous injections
59
types of hematopoietic stem cell transplantations (HSCT)
- allogenic: comes from another person (graft vs host disease)
- syngeneic: comes from identical twin
- autologous: comes from the patient (if allogenic is not available)
60
sources of cells for stem cell transplant
- bone marrow transplant (BMT)
- peripheral stem cell transplantation (PSCT) - doesn't get as many cells
- umbilical cord - may not have enough cells for adult transplant
61
process for stem cell transplant
- pt has total body irradiation (destroy bone marrow and cancer cells)
- stem cells infused
62
care for patient after bone marrow irradiation
- protective isolation
- double airlock door
- no fresh fruits or flowers
63
complications of stem cell transplant
- bacterial, viral, and fungal infections
| - graft vs host disease
64
explain graft vs host disease
- T lymphocytes from donor stem cells recognize recipient as foreign
- attacks organs such as skin, liver, and GI tract
65
coping w/ cancer
- American cancer society (look good, feel better program)
- support groups
- care giver support groups
66
how to care for patient w/ mouth sores from chemo/radiation
- provide high-protein and high-calorie, soft foods every 2 hours
- avoid acidic foods/fluid (ex. orange juice)
