Ch. 8, 18, 24, 48, 62 Flashcards
1
Q
screening/warnings signs of cancer (hint: acronym)
A
CAUTION
- changes in bowel or bladder habits (ribboning, painless bleeding)
- a sore that does not heal (anywhere on the body)
- unusual bleeding or discharge (leaking nipples, vaginal bleeding post-menopause, bleeding butt)
- thickening or lump in the breast or elsewhere
- indigestion or difficulty swallowing
- obvious change in a wart or mole (melanoma)
- nagging cough or hoarseness
2
Q
lung cancer: etiology and genetic risk
A
- nonsmokers exposed to secondhand (live in same house) or thirdhand (smoke on clothes, carpet, walls) smoke have risk
- chronic exposure to chemicals and inhalants (factory worker)
- sometimes occurs in adults who never smoked, esp. women
- smokers: 80-90% risk
- no real genetic risk
3
Q
leading cause of death in cancer (type of cancer)
A
lung cancer
- easily metastasis
4
Q
lung cancer: health promotion
A
- not smoking/smoking cessation
- avoiding smoking, pollutants, airway irritants
5
Q
lung cancer: assessment
A
- history: smoker? how long?
- pulmonary: early on: nagging cough, no pain in beginning
- psychosocial
- screening (ACS)
6
Q
lung cancer: interventions
A
- chemotherapy
- radiation
- surgical: take out tumor, chunk of lung, whole lung
7
Q
lung cancer screening
A
- high risk individuals (long smoking history)
-yearly low dose CT scan
-for surveillance because such a high prevalence in smokers
8
Q
lung cancer: surgical management
A
- lobectomy
- pneumonectomy
- segmentectomy
- wedge resection
- wound mangement
- deep breathing, coughing
- promoting mobility
9
Q
lobectomy definition
A
removal of one lobe
- may have chest tube in place
10
Q
pneumonectomy definition
A
removal of the entire lung
11
Q
segmentectomy definition
A
removal of a segment of the lobe
12
Q
wedge resection definition
A
removal of triangle-shaped slice of tissue
13
Q
breast cancer can be
A
invasive or noninvasive
14
Q
the key to effective treatment and survival of breast cancer is
A
early detection
15
Q
most common sites of metastasis for breast cancer
A
- bone
- lungs
- brain
- liver
16
Q
invasive breast cancers include
A
- invasive ductal carcinoma
- inflammatory breast cancer (IBC)
17
Q
invasive ductal carcinoma
A
- originates in mammary ducts and break through wall of ducts into surrounding lymph nodes and tissue
- fibrosis develops around the cancer
- no pain
18
Q
inflammatory breast cancer (IBC)
A
- diffuse erythema (redness on skin)
- pain; rapidly growing breast lump; breast itching
- peau d’orange
19
Q
most common type of breast cancer
A
infiltrating/invasive ductal carcinoma
20
Q
can breast cancer happen in men?
A
yes- men and women
21
Q
complications of breast cancer
A
- peau d’orange: skin of the orange; ominous s/ for breast cancer. orange skin, puckering; inverted nipple
- lymphatic nodes
22
Q
breast cancer: etiology and genetic risk
A
- increased age
- family and genetic history: blood relatives only
- early onset menarche, late onset menopause
- postmenopausal obesity (fat tissue makes more estrogen)
- physical inactivity
- use of combination postmenopausal HRT
- mutations in the BRCA1 and BRCA2 gene: genetic testing can infer this
- exposure to hormones
- nulliparous (no kids, think nuns)
- kids late in life
23
Q
breast cancer health promotion
A
- breast self exams/awareness (concentric circles, shower, after period- less tender, swollen, lumpy); if feel something- get clinical exam and mammogram
- clinical breast exams (provider palpation exam)
- mammograms (ultrasound too sometimes)
24
Q
mammogram screenings
A
women
age 40-44: recommended to start screening every year
age 45-54: should get mammograms every year
age 55+: can switch to every other year or can choose to continue yearly, continue screenings as long as in good health and is expected to live 10+ years
- educate women on advantages vs disadvantages of breast screening techniques
25
breast self exams (BSE)
- monthly self-breast exam (BSE) is less emphasized as a screening tool than in the past
- recommended to increase breast self-awareness
- per the american cancer society (2017): all women should be familiar with how their breasts normally look and feel and report any changes to a health care provider right away
26
breast cancer assessment
- history
- physical exam: have patient sit up right, with hands out
- psychosocial: body image
- most cancer found in upper outter quadrant: tail of spence
27
breast cancer: Nursing considerations
- no blood pressure, IVs, injections on side where mastectomy was (DON'T USE AFFECTED SIDE)
- look at surgical site
- elevate affected side
- on drains- monitor drainage (serous or serosanganous, no purulent or increase in drainage)
- pain is expected
- complication of surgical breast cancer intervention: lymphedema (big swelling on affected arm; compression sleeve)
- hand pumps in bed to promote mobility
28
breast cancer interventions
- surgical
- nonsurgical
- breast reconstruction
- prophylactic mastectomy: removal of breast infected with cancer
29
breast cancer surgical management
lobectomy, mastectomy
30
colorectal cancer is cancer of the
cancer of the colon and rectum (the large intestine)
31
most colorectal cancers are
adenocarcinomas
32
colorectal cancer: risk factors
- age > 50 years
- genetic predisposition
- personal/family history of cancer
- diseases that predispose the patient to cancer
- smoking
- obesity
- physical inactivity
- heavy alcohol consumption
- low-fiber diet
- high-fat diet (bacon, processed meats)
33
polyps
- found in the colon
- risk of cancer- can progress to cancer
- sessile: polyp mountain
- pedunculated: polyp stalk
- these can be removed by the doctor and then the patient doesn't have cancer risk anymore
34
colorectal cancer: health promotion and maintenance
- genetic testing for those with family members with CRC
- encourage diagnostic screening
- modify diet: high fiber
- stop smoking and drinking: moderate alc intake
- exercise: increase PA
35
colorectal cancer comes in forms of
- form polyps
- malignant tumors
- adenocarcinomans
36
adenocarcinomas
- tumors that arise from the glandular epithelial tissue in the colon
37
complications from colorectal cancer
- bowel obstruction
- perforation
- blood vessel invasion
- pressure on urinary bladder, uterus: urgency/fullness of bladder
38
colorectal cancer assessment
- history: ribbon stool
- physical exam:
- psychosocial
- screening (ACS)
39
colorectal cancer screening
men and women age 45
- colonoscopy every 10 years
-if polyps found + removed, come back in 5 years
-no polyps, come back in 10 years
- fecal occult blood yearly: guiac (does not mean have cancer, means that you have blood in stool)
40
colorectal cancer diagnostics
- CT
- sigmoidoscopy
- colonoscopy
41
colorectal cancer interventions
- colon resection
- during colonoscopy: pop the polyps off
- colostomy bag
- radiation
- chemotherapy
42
ascending colonscopy
done for right sided tumors
43
transverse (double-barrel) colonoscopy
often used in emergencies as intestinal obstruction for perforation because it can be created quickly. there are 2 stomas. the proximal one, closest to the small intestine, drains feces. the distal stoma drains mucus
44
descending colonoscopy
done for left sided tumors
45
sigmoid colonoscopy
done for rectal tumors
46
impact of cancer on physical function
- immunity and clotting: low WBC, endotoxins to DIC
- GI function: N/V/sores, cant eat/absorb
- peripheral nerve sensory perception: temp or perm (fingers/toes)
- central motor and sensory deficits: off balance
- respiratory and cardiac function: inadequate gas exchange, CO changes
- comfort and quality of life: fear of pain, palliative care
47
cancer management (treatment options in general)
- surgery
- radiation
- chemotherapy
- immunotherapy
- photodynamic therapy
- hormonal therapy
48
the oldest form of cancer treatment
surgery
49
surgery is used as cancer treatment for:
- prophylaxis: taking polyp off before cancerous
- dx: biopsy
- cure: remove tumor
- control: keeping size down
- palliation: to make patient more comfortable
- reconstruction: breast reconstruction
50
radiation therapy (definition)
uses high-energy radiation to kill cancer cells
- goal of having minimal damaging effects on surrounding normal tissue
- usually given in divided doses over a set time
- can be used as standalone or in conjunction with other treatments
- nurse: needs to wear shield for systemic (all of body, including bodily fluids are radioactive); approach from opposite end for brachytherapy (part of body is radioactive)
51
radiation: patient teaching
- provide accurate information
- teach about skin care needs
- do not remove temporary ink or dye markings
52
brachytherapy aka sealed source radiation
internal radiation therapy- aka sealed source
- insert seed to radiate the tumor and then remove seed
- pellet, seed, sealed source- not systemic
- patient is radioactive as long as sealed source is in their body
- approach patient from opposite area (edge of bed)
- limit visitors to 30 min at a time
- no kids
- body fluids not radioactive
53
side effects of radiation therapy
- acute and long-term
- vary according to radiation site
- radiation dermatitis
- altered taste
- fatigue: conserve energy, rest
- bone marrow suppression
- alopecia where beam radiation is given
54
patient-centered collaborative care for radiation
- accurate info to help patient cope
- skin care needs during radiation therapy
- do not remove temporary ink marking
- avoid skin irritation
- follow radiation-oncology department's policy for skin care product use
- nutritional support
- care for xerostomia (dry mouth)
- teach about risk for fractures (for bone exposed to radiation)
- exercise and sleep interventions for fatigue
- mouth sores: magic mouthwash (no alcohol-based mouthwashes)
- nausea: zofran, ice pops, let them eat what they want
55
cytotoxic systemic therapy
aka chemotherapy
- can be used alone, before or after treatment, or in combination
- kills cancer cells and normal cells (cytotoxic means toxic to cells)
- genomic profiling: allows for individualized approach to/specific tx for patient
- places patients at high risk for infection, immunosuppression, complications
56
neoadjuvant chemotherapy
used to shrink tumor before surgery or radiation
57
genomic profiling allows for
individualized approach to treatment
- your body would react best to this treatment
58
chemotherapy treats cancer with
chemical agents
- used to cure and increase survival time
- some selectively for killing cancer cells over normal cells (genomic profiling is used)
- major role in cancer therapy
59
normal cells most affected by chemotherapy
- the skin
- hair
- intestinal tissues
- spermocytes
- blood-forming cells
60
treatment issues with cancer
- Nadir: lowest point of cell count; self-limiting; very high risk of infection- neutropenic precautions
- drug dosage
- drug schedule
- drug administration: extravasation, vesicants
- if patient reports pain, always stop and then can restart if all is okay
61
extravasion
side effect of chemo
- ports or central lines to help prevent it
- red, swollen, painful; eat at skin and kills it (like a chemical burn)
- most important nursing intervention is prevention
-always flush
62
health care provider safety with chemotherapy
- specific protocol for handling chemotherapy drugs, or excreta from patients receiving IV chemotherapy
- PPE: eye protection, masks, double gloves (or "chemo" gloves, gown, glasses)
- certification/training
- no pregnant HCPs
63
side effects of chemo
- alopecia/hair loss
- N/V/anorexia
- mucositis (mouth sores) in the entire GI tract
- skin changes: bruising/petechiae
- anxiety, sleep disturbance
- altered bowel elimination
- decreased mobility
- hematopoietic system changes: worry about falling/bleeding
- bone marrow suppression
- avoid pregnancy on chemo
64
bone marrow suppression: patient teaching
- protect patient from infection
teach AP, patient and family how to reduce infection in the home:
- report s/ of infection
- handwashing
- mouth care
- electric razor
- bleeding precautions
- avoid contact sports, activities involving bumping, scratching, scraping
65
neutropenic precautions
- private room
- hand washing
- clean room daily
- wash fruits/vegs
- no fresh flowers/plants
- wear mask
- no sushi, no raw meats, no soft boiled eggs
- don't share equipment
- monitor temperature change by 1 degree
66
immunotherapy
- using the body's own defense system to attack foreign cells (cancer cells)
- immune related adverse events (ir-AE's)
67
colony-stimulating factors as supportive therapy
- used as supportive therapy during chemotherapy by enhancing recovery of bone marrow function after treatment-induced myelosuppression
- helps bone marrow to make more cells
- most common side effect is bone pain (because making more cells)
68
oncologic emergencies
- sepsis and disseminated intravascular coagulation (DIC- making too many clots at once, no more clotting factor- start bleeding anywhere)
- syndrome of inappropriate antidiuretic hormone (SIADH)
- spinal cord compression
- hypercalcemia
- superior vena cava syndrome
- tumor lysis syndrome
69
sepsis and DIC: collaborative management
- prevention
- intravenous antibiotic therapy: set of cultures, then give antibiotics (dont need to get new culture every time giving antibiotic)
- anticoagulants, cryoprecipitated clotting factors: bag of clotting factors
70
SIADH
- water is reabsorbed to excess by the kidney and put into system circulation
- too much "don't pee hormone", hold onto water
- SIADH is most common found with carcinoma of the lung and brain (lung and brain cancers)
- low sodium bc dilutional hyponatremia** (<135)
- edema
- neuro s/sx: confused
71
treatment of SIADH
- diuretics
- sodium replacement
- monitor electrolytes
- monitor neuro signs
72
spinal cord compression
- tumor directly enters the spinal cord or the vertebrae collapse from tumor degradation of the bone
- first s/sx: new onset back pain
- neuro s/sx are LATE (mobility changes)
73
spinal cord compression: s/sx
- pain: new onset back pain
- changes in mobility (later)
74
spinal cord compression: management
- early recognition and treatment
- palliative
- high-dose corticosteroids
- high-dose radiation
- surgery
- external back or neck braces to reduce pressure in the spinal cord: to support bones and protect spinal cord
75
hypercalcemia occurs most often in clients with
bone metastasis
- because the bone breaks down, so we see calcium leak into the blood
76
hypercalcemia s/sx
- fatigue
- loss of appetite
- N/V
- constipation
- polyuria
- severe muscle weakness
- loss of deep tendon reflexes*
- paralytic ileus
- dehydration (think need fluids as an intervention to dilute the calcium content in the body, so if body needs more fluids, then it must not have enough to begin with)
- EKG changes/cardiac priority*
77
hypercalcemia management
- oral hydration/IV hydration
- drug therapy: calcitonin
- dialysis as needed: remove the calcium if cannot get it down
78
superior vena cava syndrome
- superior vena cava is compressed or obstructed by tumor growth
- tumor in chest blocking the chest, pressing on superior vena cava
- tumor went unknown or tumor is very aggressive
- condition can lead to a painful, life-threatening emergency
79
superior vena cava syndrome s/sx
- edema of face
- edema of arms and hands
- dyspnea
- erythema
- epistaxis
- torturous veins on chest
80
superior vena cava syndrome: late stage signs
- hemorrhage
- cyanosis
- change in mental status
- decreased CO
- hypotension
81
superior vena cava syndrome: management
- high-dose radiation therapy: shrink the tumor
- surgery only rarely
- usually manage with palliative care: make patient comfortable
- elevate HOB (bc of upper body edema)
82
tumor lysis syndrome
large numbers of tumor cells are destroyed rapidly
- intracellular contents are released into the bloodstream faster than the body can eliminate them
- lots of cell debris
83
tumor lysis syndrome: management
- prevention: drink lots of water (3500-5000mL/day)
- hydration
- look at electrolytes
- monitor kidney function
- drug therapy
84
patient needs following survivorship
- unique physical and psychosocial needs
- fear of cancer returning
- educate patients on importance of routine follow-ups and adherence to the recommended schedule
85
overview of death, dying, and end-of-life
- part of normal life
- nurses have a great impact on an adult's experience with death
86
nurses' impact/role on end-of-life experience
- preventing death without dignity
- promoting a peaceful, meaningful death
- helping patient remain free from distress
- minimizing suffering for patients and families
- observe patients' and families' wishes
- observe clinical practice standards
87
hospice care
model for quality, compassionate care for people facing life-limiting illness or injury
- often provided to patients with terminal cancer, dementia, end-stage COPD, cardiac disease, neurologic disease
- 6 month prognosis
- no IV hydration
- oral care, moisten mucous membranes, emollient on lips
- high doses of pain medication (morphine always)
- biggest focus is pain management
88
palliative care
philosophy of care for people with life-threatening disease
- goal is to improve quality of life for patient and family
- focus on quality of life
- used at any time in illness timeline
89
end-of-life physical assessment
- symptoms of distress: resp distress, hemorrhage, pain
- weakness
- sleeping more
- anorexia
- changes in organ system function
- LOC
- changes in vital signs
90
end-of-life teaching points
- teaching family interventions that relieve discomfort and stress
91
end-of-life patient problems
potential for sx of distress that would prevent a peaceful death
92
end-of-life: nursing actions/interventions
- needs and preferences acknowledged and met
- control/management of symptoms of distress
- meaningful interactions with family and other loved ones
- peaceful death
93
end-of-life: managing pain
- pain is the symptom that dying patients fear the most
- opioid and non-opioid analgesics
94
the symptom that dying patients fear the most
pain
95
pain management: medical marijuana (cannabis)
- cannabinoid-based medicines (CBMs)
- be aware of state-specific laws
- have to be certified to give it
- reported to address fatigue, anorexia, sleep problems, anxiety, nausea, vomiting
- recommended only for refractory cancer pain as adjunct to other prescribed analgesics
96
pain management: complementary and integrative health (non pharmacological therapy)
- massage
- music therapy
- therapeutic touch
- guided imagery
- aromatherapy and essential oils
97
managing weakness in end of life: interventions used
- may be advised to stay in bed to avoid falls, injuries
- foley catheter may be used as a comfort measure
- put aspiration precautions in place
- provide mouth care; apply emollient to lips
98
nursing management at end of life
- spiritual needs
- distress
- psychosocial needs
- postmortem care
99
s/sx of pain
- distress
- SOB/dyspnea
- N/V
- agitation and delirium
- seizures
100
active euthanasia
- not supported by most health professional organizations in the US
- the patient actually does it
101
physician-assisted death (PAD)
- legalized in some European countries
- legally approved in some stated within the US
102
withdrawing or withholding life-sustaining treatment
- withdrawal of the intervention does not directly cause the patient's death
103
voluntary stopping of eating and drinking (VSED)
patient voluntarily stops eating and drinking to allow death?
104
mastectomy
- removal of entire breast tissue that has cancer in it
- can be single (1 breast) or double (both breasts)
105
breast cancer prevalence
1 in 8 women in the US will develop breast cancer at some point in their life
106
a "good" lump
non-tender, mobile, discrete (can feel edges)
107
where is most colorectal cancer found?
in the sigmoid colon
108
colon cancer complication: bowel perforation
- breaks through wall of colon into the abdomen
- s/sx: pain, rigid abdomen, increase WBC
109
DIC s/sx
signs of body bleeding
- petechiae
- bruising
110
photodynamic therapy
inject patient with something that highlights cancer cells
111
hormonal therapy
- ie. estrogen blockers for breast cancer
- for hormone-driven cancers
112
beam radiation
- least amount of precautions
- aim radiation to smallest amount possible
- when beam is on, radiation is in the room
- beam is off, no more radiation, patient is not radioactive
- radiation burn: redness, burn
- skin care!
- reinforce teaching
- gentle cleansing of skin: use hands not loofa
- no sun exposure
- expect hair loss where the beam is (temporary)
- knocks down blood cell production; pancytopenia
- aplastic anemia
- bone marrow suppression
113
systemic radiation
- most radioactive
- take radioactive isotope, pill/IV
- unsealed source- whole body/systemic
- double flush toilet
- poop and pee is radioactive
- need to be isolated
