Cellular Regulation : Nursing Care Flashcards
zimpaired cellular regulation : general info
what is the one thing we do first ?
make the diagnosis : we do this thorugh biopsy
recall that one thing we have to do is make the diagnosis when it comes to impaired cellular regulation, what else?
further testing to help with grading and staging, TNM classification
what is our goal of treatment ? for impaired cellular regulation ?
cure, control, or palliation, minimize tx side effects
what is the methods of treatment when it comes to impaired cellular regulation
surgery, radiation therapy, chemotherapy, hormonal therpahy, targeted theraphy, biologic theraphy, and bone marrow or hematopoietic stem cell transplants
identify if below are methods of treatments when it comes to impaired cellular regulation:
surgery, radiation therapy, chemotherapy, hormonal therapy, targeted therapy, biologic therapy, and bone marrow or hematopoietic stem cell transplants
yes all of the above
methods of tx : are surgery, radiation therapy, chemotherapy, hormonal therapy, targeted therapy, biologic therapy, and bone marrow or hematopoietic stem cell transplants
these support cel recovery with hematopoietic growth factors
recall that surgery could be a use of treatment of cancer, what determines this ?
surgery is dependent on where the cancer is
true or false. people with cancer are not only in one unit, they are scattered everywhere in terms of placements.
true
_____ is one of the things help suppress bone marow to get good cells , we are talking to immunity here and less damage to the body as possible.
gastrin
effects of cancer and cancer treatments :
immunity and clotting what undergoes this
WBC - neutrophil - neutropenia - nadir- absolute neutrophil count” ( ANC )
- anemia
-thrombocytopenia
thinking abt anemia , along with low WBC they typically have low blood cells count why ?
due to the chemo
what are symptoms of anemia ?
this is a low hemoglobin ( therefore they may feel tired, SOB, no energy )
what does nadir mean ?
lowest point of white blood cell count
why is absolute neutrophil count important ?
its important since it shows us how immunocompoms the patient is
true or false. we could get an ANC at 0 which means the pt has 0 immune system.
true
true or false. Cancer treatment could also cause imapired clotting, they do not have platelets, which means they do not stop the body from bleeding.
true
is gi affected during cancer treatments ?
yes : cachexia, functioning of gi tract, and liver is affected as well
why is cachexia occurring ?
the body spends a lot of energy and not able to absorb food and give energy
( people become thin )
functioning of gi tract , how does this affect the body ?
high metabollic rate, no appetite, and ability to change and can be nauseated
( they really have to fight themselves to get nutrients in )
functioning of the liver : how does this impact the body
impacts metabolic functioning ( they cannot give food, and keep fat and get energy )
what undergoes peripheral nerve sensory perception
as an effect of cancer treatment
( rare ) pt may have tumor in spine
( common neurotoxic chemo - reduced sensory perception )
( rare ) pt may tumor in spine ( can u explain this )
change in their peripheral nerve, peripheral system , because of the tracts running in the core
true or false. sensation in their feet, numbers and going downstairs ( more likely to trip )
neuropathic pain ( terrible pain )
true
central motor and sensory function is one of the effects of cancer/cancer treatments what undergoes this
cancer invades bone or brain ( bone fractures, ) hypercalcemia
what happen in central motor and sensory function
much more likely to have a bone fracture , even if they trip ( what there bone from treatment ) much more likely going to break
true or false. patients mobility of the pt ( anything that has to do with central or sensory ) think abt walking and moving.
true
what undergoes resp function
moving and expanding of the lungs will be affected
what undergoes resp funcion
tumor in lung
pleural effusion
compression on vessels, lymph glands
what could tumor in the lung do in terms of resp?
can impair their breathing , very common in cancer ( even if it has nothing to do with the lungs )
What is happening within the pleural effusion
very common in cancer, ( even if it has nothing to do with the lungs ) , if there is a tumour compressing on vessels ( impairs their lungs, their breathing )
true or false. is cancer of the heart common ?
no it’s usually not common
can drugs be somehow cardiac toxic ( hard on the heart ) what can happen ?
can make scar tissue, or make a valve not work as it should
if it’s a severe impact , the pt may impact a heart failure related to the treatment to their cancer.
cardiac function
comfort and quality of life is very important. why is it important for our pt ?
cancer pain - management of the pain and the side effects of the meds to treatments ( drowsiness, constipation )
true or false. if we treat cancer , we have to treat side effects that comes with the drugs ) what typically goes away ?
drowsiness typically goes away however constipation doesnt go away
cancer pain
- can be severe , think of pt’s quality of life
what meds do u think they’ll be on in terms of pain?
narcotics ( morphine, hydromorphone/dilaudid, fentanyl )
adjuvants ( additional meds )
doses can be large
what do u consider in cancer pain ?
effectiveness and side effects
regular dosing and PRN for breakthrough
- oral ( po-pll, liquid ) easiet
true or false. we want to be consistent ( q-4 -q6 ) for breakthrough ( alot of infuse tranfusions especially if its palliative pain )
true
continious, infusions, fentanyl transdermal patch are typically seen in cancer pain
yep true
chemo adminsitration
protocol
handling precautions
specific RN training
often combo of drugs given
timing is really important
is true in terms of chemo admin
yes true
what are routes for chemo to go through
IV- peripheral IV, tunneled catheters, PICC, port a cath
what are the complications for chemo?
extravasation injury from infiltration of chemo meds
irritant/vesicant
pros/cons to peripheral IV access compared to venous access device
true or false. when you have a PICC line u do not want to be wet ( the insertion site ) because why ?
true, because it increases the risk of infection
could we take bloodwork from picc line?
yes we can
what is the line that is known to be “ little kid friendly “
port a cath
port a cath has no ____ coming
primarily what they do for kids
line , port a cath
effects of chemo on normal tissue
what is ur body feeling
body responds to the destruction of cells
fatigue, anorexia, taste alteration
effects of chemo on normal tissue
what are some adverse effects
acute, delayed, or chronic, alopecia
what is a cold cap therpahy intially help?
decrease the chance of losing hair ( encourage wearing hats, wigs, scarfs )
true or false. a good example of a chronic side effect of chemo on normal tissue is heart failure : peripheral neuropathy ( there feet is numb and tightly and cannot walk downstairs feeling normal )
true
can these all occur during cancer ?
nausea and vomitting
diarrhea
nutrition
what undergoes eating and food choice?
eating
- food appearance and smell
food choice
-diarrhea-food, fluid intake——– imodium
-nutritious & able to eat/tolerate
what is one antiemetic that is used during cancer treatments?
ondansetron
what is the route given for ondansetron ?
either PO or IV
what is the appearance like typically in cancer
cachexic, muscle mass, moon face
during weight assesment we have to think “ weight “ is it body mass or retained fluid ?” ( calorie counts )
yes
Recall that focusing on muscle mass and see if they maintain there weight is important
small frequent meals ( avoid fatty foods ) since it could bring in more nausea, avoid hot foods, or spicy foods, another thing is DO NOT LAY DOWN after eating.
JUST READ : to avoid hot food
- eat more cold or luke warm food
- hot food carries strong smells and people going through treatments have strong smell ( make them sick )
milkshake, ensure, and thing u can add to add extra protein or calories should be encourage
yes
what is a better position after eating ?
sitting up is better when it starts to digest- clears your stomach dont drink ur fluid with the meal ( fill ur stomach ) try to have nutrients and then drink ur water
is radiation theraphy painful ?
yes it is painful
what is radiation therapy ?
kill cancer cells, want minimal effect on surrounding ( normal ) cells
can radiation therapy be local or systemic ?
yes it can be local or systemic
radiation therapy method of delivery :
external radiation
internal radiation - brachytherpahy ( seeds, ribbons, capsules )
radiosurgery, gamma knife
during an external beam radiation , there is a tattoo, what does that indicate?
permanent tattoo as part of tattoo and done the treatment they turn into a different type of tattoo
radiation effects & treatment acute & long term
site of radiation– organ or body site with cancer
what is skin for radiation effects & treatment : acute & long term
skin– radiation dermatitis; dry, itchy ( pruritis ), may break down
what undergoes radiation effects and treatment
under skin of radiation – organ or body site with cancer
tattoo/ink markings
skin protection- cleaning
—- avoid friction
—-photosensitive & heat sensitive
head and neck – xerostomia ( dry mouth, ) tooth decay- dental care prior to tx
true
what is the systemic effects
fatigue
altered taste
bone marrow suppression
where are beams going through?
through our skin , ( think abt their skin ) they can develop radiation dermatitis
what can radiation dermatitis lead to ?
lead to an open wound because radiation has broken down into those skin cells
if they have a tattoo or ink marking ( do not wash ) why do we want not wash it ?
we need it for treatment
when it comes to cleaning, be careful !
don’t exfoliate and scented things ( do not use them ) !it got dyes –> so be careful!
how do we avoid friction ?
lose fitting clothing is good, no tight belts, breast cancer have problems ( wearing a bra ( friction of the material ) have to find alternative
head and neck cancer - use radiation is their mouth ( they have tooth decay from it )
true
skin should be moisturized ( external beam radiation )
yes this is true
true or false. avoid alcohol-based cleaners/creams, avoid retinol creams
true
true or false. avoid exposure to sun and heat.
true
radiation therapy : sealed implant “
safety -
reduce exposure to ionizing radiation
– intensity, duration, closeness
radiation therapy “sealed implant”
if they have implant in them
they are radioactive, with the hope of consistently killing the cancer
is it true or false. implant cannot be shut off anytime–> we have to be aware of following policies from xray exposure and any visitors
true
true or false. if a pt has brachytherapy ( internal radiation therapy ) consider safety of others and the RN
true
if a pt has brachytherapy ( internal radiation therapy ) consider safety of others and the RN
radioactive isotopes
pt room, signage
visitor restriction
RN- dosimeter film badge
dosimeter is what ?
how much radiation the person is exposed to ( just for protection )
urinated or stool is not radioactive
- we have to think abt it?
yes we have to think abt it
dosimeter film badge leads to what ?
lead apron and lead container
if they have implant in them they are what ?
radioactive, with the hope of consistently killing the cancer
myelosuppression & neutropenia WBC - fight infection
overgrowth of pts own normal flora ( microbiome )
cross-contamination/prevent transmission of organisms fr others
what is the general care * hand washing
- hospital room/environment
-equipment
true
what undergoes Ng assessment
head to toe
VS- temp
bloodwork
protocols - surveillance or situational : culture/CXR/swab atbx
true or false. visitors and care for self when discharge home undergoes myelosuppression & neutropenia.
true
true or false. clean atleast once a day, thermometer, stethoscope ( have their own equipment in their room ) prevents cross contamination
true
abnormally low white blood cell count
not fighting infection
when they do get it overgrowth of their own normal flora
is this true or false : - careful of cross contamination ( if they are myelosuppresion or nuetropnia ( o or 2.5 ) special unit
- the pt on our unit has no immune system - if we do do this ( no visitors who has been sick. chicken pox, measles, or ask abt immunizations ) to make sure that everybody is protective from any skinless
true
this would be recommended?( daily blood work , usually wbc, anc ( neutrophil ) hemoglobin and platelets )
yes
thrombocytopenia is what ?
platelets - clotting
prevent injury / prevent bleeding-safety
personal care
-shaving
-oral care
eating mouth
would be seen within thrombocytopenia
what undergoes it
eating/mouth
-stomatitis/mucositis
its important to what when thrombocytopenia
assess own body
blowing nose
activities
rectal
- prevent constipation
is this true : for flossing - gentle ( very gently as soon as u cut their skin or gums ( they bleed alot )
eating or mouth care - from the chemo and radiation ( make sure we are gently and doing a lot of rinsing )
tap water or salt water ( make sure they know how to asses their own body )
- anything swollen
true
blowling their nose ( dont close nostril and blow hard, intra thoracic pressure, bleed through nose or any aneurysm they do not know abt - it could lead to bleeding )
yes
any activities - cutting knives will be something to avoid
true
rectal- any hemmoroid can be severe ( no enemas )
yes
acute complications of cancer it’s tx
rn role is what ?
assess patient ( recent hx, h2toe assessment, lab work, dx test result , and listen to patient/family )
acute complications of cancer and it’s tx
what undergoes assesment
share your findings and thoughts , early dx, immediate; can be fatal
acute complications of cancer & it’s tx include
- Sepsis/septicemia
- DIC disseminated intravascular coagulation
- SIADH Syndrome of antidiuretic hormone
- SCC Spinal cord compression
are these typically seen as acute complications
hypercalcemia
superior vena cava syndrome
tumor lysis syndrome
would this occur during acute complication of cancer & treatment
impaired immunity
overwhelming infection –organisms in body
low grade fever 38.0 may be only sign
Hi mortality rate
Yes
what protocol/printed orders
culture, cxr, swabs
start antibiotics
if they get a fever or high temperature
- it could kill them
-septic shock ( high mortality rate, happens fast and body is unable to mount any response )
yes this is true
if the ogranisms comes back and its not covered by the drug
- doctor will change it ( not a bacteria they found, maybe it was a fungal infection )
—> change orders and start flagel etc.
true
swabs — where can you do it in the site?
rectum , nose, and mouth
DIC is often called by
sepsis
DIC what is the description?
abnormal clotting & then bleeding- address cause and correct coag abnormalities
what type of skin can we see under DIC
petechiae, purpura
SIADH what type of sodium do we have ?
low sodium, diluted blood
what is it like in siadh?
abnormal anti diuretic hormone soaked inside
siadh patients hold on to what ?
holding on to a bunch of water therefore diluting that blood
what is our interventions in a siadh patient ?
restrict fluid intake- in terms of treatment, get sodium levels higher - giving 3 percent normal saline
if a pt has siadh - weight is going up ( because of fluid, not because of eating food )
the person may feel things because of low sodium, -= weakness nausea and vomiting
true
if left untreated 0 seizures and coma ( try to get sodium back up. ) and can restrict fluid
true
excessive ADH secretion
hyponatremia w low serum osmolality
hypervolemic is often transcient due to nautretic mechanisms
SIADH: causes
CNS disorders
tumors
drugs
surgery
infections
genetics
what is the treatment for SIADH?
adh antagonist
what is the sign and symptoms of SIADH
N & V, obtundation. H.A , seizure, resp arrest, coma
excess water retention can cause brain swelling and neuron dysfunction
spinal cord compression typically cause what pain?
back pain
neurologic changes- affect spinal cord nerves
-muscle strength
‘heaviness’
sensation
gait
gi/gu issues
deep tendon reflexes
this often happens if a pt has a tumor
- cancer that has a cancer in the spinal cord - _____and ___________- rare
parapelegic and intraplagic
just read ! weaker and muscle strength - proceed heaviness and weight usually in the limbs - sensation will decrease
- often times ( they have gait issues —> limping or dragging )
person can also have gi/gu symptoms depending on the location due to spinal cord ( constipation, incontinent of stoll or urine ) they do not have sensation to go to the bathroom
true
two thins to fix : if possible is surgery ( surgery on the spinal cord is risky ) to resect or remove this tumour,
radiation is the other thing ( to try to shrink the tumor )
yes
what is hypercalcemia ? why is this happening ( and what type of cancer is this more common in )?
most likely happen if the person has cancer if its involving bone
- we start to see there calcium levels go high
and the big thing it could do is fail ur kidneys
true or false. hypercalcemia are type of cancer that involves the bone and others
true
what is important when it comes to hypercalcemia
hydration and mobility ( because immbolity and dehydration could occur –> exacerbate )
true or false. potential renal failure could occur when a pt has hypercalcemia
yes this si true
what is the treatment for hypercalcemia
hydration diuretic biphosphonate
why would hydration and giving diuretic to a hypercalcemia be beneficial to them ?
to keep them hydrated, and giving diuretic after could help them flush the system
what does biphosphonate do ?
medication where it kinda slows down osteoclast
what is superior vena cava syndrome
this is when the tumor is in a position where it grows compresses on the superior vena cava
superior vena cava syndrome how does this cause complication ?
obstructs the vena cava- this is seen in the chest xray , often with lung cancer or hodgkins or non hodgkins
what is the treatment for superior vena cava ?
treatments is radiation ( to try an shrink that obstruction tumor )
could also undergo chemo
true or false. cvc could occur gradual or quickly.
true
what is tumor lysis syndrome ?
this is a metabollic complication- can cause fatal biochemical changes
what is our treatment goals when it comes to tumor lysis syndrome
prevent kidney failure
prevent severe electrolyte imbalance
what are we looking at, when a pt has tumor lysis syndrome
look at their ins and outs and have a good look at their resp system
ausculate ( any crackles, sob, are they needing more oxy, edema)
is this true or false. to prevent kidney damage to a pt who has tumor lysis syndrome, give iv fluid , give alluporinol and treat gout- this helps uric acid levels
true
what is tumor lysis syndrome triggered by usually?
this is triggered by chemo- too effective too quickly
this usually happens within 24 - 48 hrs
how long can it persist for ( tumor lysis syndrome ) after chemo
can persists 5 to 7 days ( potassium has been depleted as well )
release of potassium and extracellular fluid causes what ?
causes fluid ( high potassium and uric acid ) increase lower production of uric acid
what are the two types of breast cancer treatment ?
surgery
- breast conservingpumpectomy and partial mastectomy
- simple mastectomy
-modified radical mastectomy
surgeon - clear margins “lymph nodes”
true or false. : the cancer remains
invasive is the most common - thats where it spreads ( depends on where the cancer is )
one of them is surgery and they often have chemo - might also have radiation and oral meds
- this is a lot but everybody treatment looks different
true
what is this describing :have been spread
metasisize
what happens in terms of surgery ( cancer )
cut out and removes the cancer ( one of them is breast conserving )
lung balectomy ( cut out that part )
partial mastectomy - part of that cancer and a bit more of the breast
is this true or false: and would this be a good outcome or bad
?
surgery has been done, they took out the cancer and they look out all around ( found no cancer ) clear margins
well no facking shat bruh
aside from surgery what are other options in terms of treatment for breast cancer
chemo
radiation( primary or brachytheraphy )
oral medications
reconstructive
what undergoes oral medications
hormonal therapy , estrogen receptor blockers, biological and targeted therapy
what is a lymph node dissection ?
if dye can travel like that ( so can cancer ) lymph ode being removed form the body is a huge deal
what is a lymph edema ?
swelling ( this is life long ) we want t avoid this , less lymph nodes -loss of chance of lymphedema
what does alnd stand for ? and what is it
remove 12-20 nodes
auxillary lymph node dissection
what is slnd
sentinal lymph node dissection
only nodes that drain from tumom are removed and sent for pathology ( 1-4ish)
true or false. more nodes are removed if cancer cells are found in sentinel nodes
- results in lower rates of lymphedema
true
define if this is true description amonst slnd
asentinal lymph node dissection
- lymph node closest to the tumor ( look closest to the tumor if there is cancer 2 cm away, and 10 cm away, its very likely will go tot he 2cm one )
—> this is what there getting to ( look at that, which nodes drains closely to the tumor area ) - we want to stop any transmission
- they will be in the OR when they do this
( take that sentinal ymph node, and send to the lab ) - look quickly
( inject dye closest to the tumor, look to see where does that travel ? )
yes this is true
what is this describing : this is a surgery cut and remove ( fat skin from the wall of abdomen )
Reconstructive breast surgery
reconstructive breast surgery
define its description
fat, skin and blood vessels cut from the wall of the lower abdomen and moved up to reconstruct the breast. no muscle is cut or removed.
true or false. during reconstructive breast surgery, blood vessels of the flap are carefully reattached to blood vessels in the chest wall
yes this is true and we have to assess the perfusion
why is it important to assess perfusion after reconstructive breast surgery
they have to reattach blood vessels
- make sure it is still attach and perfusion is going through ( or else this flap will die and not be able to survive )
postop mastectomy nursing care
surgical site - incisions and drains
what undergoes this
incision, flap, drain and tubing
is this okay to do ? discharge home with drains in place- teach family to empty drain
- color and amount
yes this is okay to do postop mastectomy
what we must the pt do that we have to initiate ?
follow up appt- dr assessment of incision, remove the drain
what is usually the pain postop mastectomy
usually mild, post op 4 to 5 ( no need for pain killer )
what is usual sleeping postion of post op mastectomy pt
usually by their side , learning forward ( works )
what is the a big risk of someone who got mastectomy postop
big risk of lymphedema ( lymph nodes ) this is not go away ( life long )
what is highly enoucourage postop mastectomy
postop exercises adn moblity
post op mastectomy just read: kept in the person, for about 5 days post op or if the drains have been less than 50 mls per 3 days
- nothing more to drain
teach them abt that
just read as well : we want the insicision dry and drain ( no big shower, keep it dry )
- keep the flap dry and drian tubing ( stays in ) and doesnt come out
these people has to be taught how to empty these drains ( going to go home ) for 24 hours or so
- go home and will have drains for a couple of days ( empty drain twice a day , how much it is and the colour )
- if its ever frank blood ( pure — reed ) this is an emergency
YUH
Post mastectomy : restore arm mobility, prevent lymphedema : in this section we talked about goals. What is our goals in terms of this ?
prevent contractures and muscle shortening, improve lymph and blood circulation ( prevent lymphedema )
what is the estimated time to gradual increase of function for post mastectomy in order to restore arm mobility, and prevent lymphedema ?
gradual increase of function over 4-6 weeks
what is the nursing interventions - affected arm
analgesics before exercise
warm water relaxes muscles
elevate arm post op
for nursing interventions in order to prevent lymphedema : what other things should we implement?
no elastic bandages post op
avoid the sun and trauma
no bp or venipuncture
true or false. it is important to teach pts to when to seek medical attention.
yes no shat
what are some postmastectomy exercises?
hand wall climbing
rope turning
side bends
shoulder blade squeeze
how many stages does lymphedema have ?
stage 1 to stage 4
what is stage 1 lymphedema ? and what abt stage 4 ?
1) least signifiant
4) is most significant, very edmatous
what do we want to prevent during post mastectomy other than lymphedema ?
prevent frozen shoulder ( its tights not able to move, muscles get short )
compression garment on lymphedema i not the same as wrapping a tenser
well no shat bruh
what is leukemia?
malignant disease that affects bone marow, lymph system, spleen
leukemia : the cancer cells/dysfunctional accumulate in where?
bone marow
true or false. in leukemia there is no room for good cells.
true
IF U HEAR BLAST - this what ?
bad cells
immature white blood cells are good or bad
bad
what are the subtypes of leukemia ?
AML , ALL, CML CLL
acute, chronic, myelogenous, lymphocytic
what does this mean : AML , ALL, CML CLL
acute lymphoblastic leukemia (ALL) acute myeloid leukemia (AML) chronic lymphocytic leukemia (CLL) chronic myeloid leukemia (CML)
what does leukemia results in :
thrombocytopenia, leukocytopenia, anemia- often hospitlization
define if these are result from leukemia?
Frequent bloodwork, blood product transfusion
* Potential: splenomegaly, hepatomegaly, lymphadenopathy, bone pain, meningeal irritation)
yes
bone marrow aspirate and biopsy determine what
determine subtype of leukemia and treatment protocol
how does bone marow aspirate and biopsy ?
take some blood and look at white blood cells
- bone marrow aspirate ( done in the ileic crest and get some bone marrow and send to the lab )
how is bone marrow aspirate and biopsy done?
done with mild sedative and mild cream
for kids
- continously sedared (
leukemia :treatment specific protocol
may admit to hospital = aggressive radiation
what undergoes aggressive chemo and radiaition in terms of sepcific protocl in leukemia
Induction Stage: Goal is remission (70% pts achieve remission)
* destroy leukemic cells in tissues, blood & bone marrow. Can cause critical complications (transfer to MICU at HSC or PICU at Childrens)
* Unit with air filtration (double doors)
* *Ng care focuses on:
* managing neutropenia, thrombocytopenia, anemia
* prevent/tx infection (follow protocols – surveillance swabs, culture, CXR, antibx)
* support systems (may need TPN, O2, IV fluid, protect kidney function) – assess for infection
define if these are true
true
what is consolidation phase during leukemia treatment
mor chemo kill any remaining leukemic cells
what is a maintenance phase during leukemia treatment with specific protocl
treatment with lower doses every 3-4 weeks for prolonged time
temp every 4 hours
suveillance swab
if they do get an infection - swabbing them right away
in terms of someone who has leukemia and getting specific protocl
yes this is true
leukemia : treatment what is a possibel treatment ?
bone marrow transplant where stem cells are transfused
true or false. chemo and radiation in high doses prior is possible in leukemia treatment
yes this is true
leukemia : treatment
infuse stem cells & wait for body to respond and develop immune system. Pt is what ?
pancytopenic
what is recommended for leukemia patients who are under treatment
strict reverse isolation
define if these are true amongs leukemia : when in treatments
- Standing orders if pt has temp
- Give blood products until pts body can make own
yes this is true
what do we have to do before there marrows starts to works and transplants happens q
reverse isolation and keep them alive no shat
