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NU 360 > Ch. 8, 18, 24, 48, 62 > Flashcards

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

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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
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3
Q

leading cause of death in cancer (type of cancer)

A

lung cancer
- easily metastasis

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4
Q

lung cancer: health promotion

A
  • not smoking/smoking cessation
  • avoiding smoking, pollutants, airway irritants
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5
Q

lung cancer: assessment

A
  • history: smoker? how long?
  • pulmonary: early on: nagging cough, no pain in beginning
  • psychosocial
  • screening (ACS)
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6
Q

lung cancer: interventions

A
  • chemotherapy
  • radiation
  • surgical: take out tumor, chunk of lung, whole lung
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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
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8
Q

lung cancer: surgical management

A
  • lobectomy
  • pneumonectomy
  • segmentectomy
  • wedge resection
  • wound mangement
  • deep breathing, coughing
  • promoting mobility
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9
Q

lobectomy definition

A

removal of one lobe
- may have chest tube in place

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10
Q

pneumonectomy definition

A

removal of the entire lung

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11
Q

segmentectomy definition

A

removal of a segment of the lobe

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12
Q

wedge resection definition

A

removal of triangle-shaped slice of tissue

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13
Q

breast cancer can be

A

invasive or noninvasive

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14
Q

the key to effective treatment and survival of breast cancer is

A

early detection

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15
Q

most common sites of metastasis for breast cancer

A
  • bone
  • lungs
  • brain
  • liver
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16
Q

invasive breast cancers include

A
  • invasive ductal carcinoma
  • inflammatory breast cancer (IBC)
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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
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18
Q

inflammatory breast cancer (IBC)

A
  • diffuse erythema (redness on skin)
  • pain; rapidly growing breast lump; breast itching
  • peau d’orange
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19
Q

most common type of breast cancer

A

infiltrating/invasive ductal carcinoma

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20
Q

can breast cancer happen in men?

A

yes- men and women

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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
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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
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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)
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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

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25
Q

breast self exams (BSE)

A
  • 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
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26
Q

breast cancer assessment

A
  • history
  • physical exam: have patient sit up right, with hands out
  • psychosocial: body image
  • most cancer found in upper outter quadrant: tail of spence
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27
Q

breast cancer: Nursing considerations

A
  • 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
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28
Q

breast cancer interventions

A
  • surgical
  • nonsurgical
  • breast reconstruction
  • prophylactic mastectomy: removal of breast infected with cancer
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29
Q

breast cancer surgical management

A

lobectomy, mastectomy

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30
Q

colorectal cancer is cancer of the

A

cancer of the colon and rectum (the large intestine)

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31
Q

most colorectal cancers are

A

adenocarcinomas

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32
Q

colorectal cancer: risk factors

A
  • 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)
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33
Q

polyps

A
  • 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
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34
Q

colorectal cancer: health promotion and maintenance

A
  • 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
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35
Q

colorectal cancer comes in forms of

A
  • form polyps
  • malignant tumors
  • adenocarcinomans
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36
Q

adenocarcinomas

A
  • tumors that arise from the glandular epithelial tissue in the colon
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37
Q

complications from colorectal cancer

A
  • bowel obstruction
  • perforation
  • blood vessel invasion
  • pressure on urinary bladder, uterus: urgency/fullness of bladder
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38
Q

colorectal cancer assessment

A
  • history: ribbon stool
  • physical exam:
  • psychosocial
  • screening (ACS)
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39
Q

colorectal cancer screening

A

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)

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40
Q

colorectal cancer diagnostics

A
  • CT
  • sigmoidoscopy
  • colonoscopy
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41
Q

colorectal cancer interventions

A
  • colon resection
  • during colonoscopy: pop the polyps off
  • colostomy bag
  • radiation
  • chemotherapy
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42
Q

ascending colonscopy

A

done for right sided tumors

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43
Q

transverse (double-barrel) colonoscopy

A

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

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44
Q

descending colonoscopy

A

done for left sided tumors

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45
Q

sigmoid colonoscopy

A

done for rectal tumors

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46
Q

impact of cancer on physical function

A
  • 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
Q

cancer management (treatment options in general)

A
  • surgery
  • radiation
  • chemotherapy
  • immunotherapy
  • photodynamic therapy
  • hormonal therapy
48
Q

the oldest form of cancer treatment

A

surgery

49
Q

surgery is used as cancer treatment for:

A
  • 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
Q

radiation therapy (definition)

A

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
Q

radiation: patient teaching

A
  • provide accurate information
  • teach about skin care needs
  • do not remove temporary ink or dye markings
52
Q

brachytherapy aka sealed source radiation

A

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
Q

side effects of radiation therapy

A
  • 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
Q

patient-centered collaborative care for radiation

A
  • 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
Q

cytotoxic systemic therapy

A

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
Q

neoadjuvant chemotherapy

A

used to shrink tumor before surgery or radiation

57
Q

genomic profiling allows for

A

individualized approach to treatment
- your body would react best to this treatment

58
Q

chemotherapy treats cancer with

A

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
Q

normal cells most affected by chemotherapy

A
  • the skin
  • hair
  • intestinal tissues
  • spermocytes
  • blood-forming cells
60
Q

treatment issues with cancer

A
  • 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
Q

extravasion

A

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
Q

health care provider safety with chemotherapy

A
  • 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
Q

side effects of chemo

A
  • 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
Q

bone marrow suppression: patient teaching

A
  • 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
Q

neutropenic precautions

A
  • 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
Q

immunotherapy

A
  • using the body’s own defense system to attack foreign cells (cancer cells)
  • immune related adverse events (ir-AE’s)
67
Q

colony-stimulating factors as supportive therapy

A
  • 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
Q

oncologic emergencies

A
  • 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
Q

sepsis and DIC: collaborative management

A
  • 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
Q

SIADH

A
  • 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
Q

treatment of SIADH

A
  • diuretics
  • sodium replacement
  • monitor electrolytes
  • monitor neuro signs
72
Q

spinal cord compression

A
  • 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
Q

spinal cord compression: s/sx

A
  • pain: new onset back pain
  • changes in mobility (later)
74
Q

spinal cord compression: management

A
  • 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
Q

hypercalcemia occurs most often in clients with

A

bone metastasis
- because the bone breaks down, so we see calcium leak into the blood

76
Q

hypercalcemia s/sx

A
  • 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
Q

hypercalcemia management

A
  • oral hydration/IV hydration
  • drug therapy: calcitonin
  • dialysis as needed: remove the calcium if cannot get it down
78
Q

superior vena cava syndrome

A
  • 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
Q

superior vena cava syndrome s/sx

A
  • edema of face
  • edema of arms and hands
  • dyspnea
  • erythema
  • epistaxis
  • torturous veins on chest
80
Q

superior vena cava syndrome: late stage signs

A
  • hemorrhage
  • cyanosis
  • change in mental status
  • decreased CO
  • hypotension
81
Q

superior vena cava syndrome: management

A
  • 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
Q

tumor lysis syndrome

A

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
Q

tumor lysis syndrome: management

A
  • prevention: drink lots of water (3500-5000mL/day)
  • hydration
  • look at electrolytes
  • monitor kidney function
  • drug therapy
84
Q

patient needs following survivorship

A
  • unique physical and psychosocial needs
  • fear of cancer returning
  • educate patients on importance of routine follow-ups and adherence to the recommended schedule
85
Q

overview of death, dying, and end-of-life

A
  • part of normal life
  • nurses have a great impact on an adult’s experience with death
86
Q

nurses’ impact/role on end-of-life experience

A
  • 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
Q

hospice care

A

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
Q

palliative care

A

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
Q

end-of-life physical assessment

A
  • symptoms of distress: resp distress, hemorrhage, pain
  • weakness
  • sleeping more
  • anorexia
  • changes in organ system function
  • LOC
  • changes in vital signs
90
Q

end-of-life teaching points

A
  • teaching family interventions that relieve discomfort and stress
91
Q

end-of-life patient problems

A

potential for sx of distress that would prevent a peaceful death

92
Q

end-of-life: nursing actions/interventions

A
  • needs and preferences acknowledged and met
  • control/management of symptoms of distress
  • meaningful interactions with family and other loved ones
  • peaceful death
93
Q

end-of-life: managing pain

A
  • pain is the symptom that dying patients fear the most
  • opioid and non-opioid analgesics
94
Q

the symptom that dying patients fear the most

A

pain

95
Q

pain management: medical marijuana (cannabis)

A
  • 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
Q

pain management: complementary and integrative health (non pharmacological therapy)

A
  • massage
  • music therapy
  • therapeutic touch
  • guided imagery
  • aromatherapy and essential oils
97
Q

managing weakness in end of life: interventions used

A
  • 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
Q

nursing management at end of life

A
  • spiritual needs
  • distress
  • psychosocial needs
  • postmortem care
99
Q

s/sx of pain

A
  • distress
  • SOB/dyspnea
  • N/V
  • agitation and delirium
  • seizures
100
Q

active euthanasia

A
  • not supported by most health professional organizations in the US
  • the patient actually does it
101
Q

physician-assisted death (PAD)

A
  • legalized in some European countries
  • legally approved in some stated within the US
102
Q

withdrawing or withholding life-sustaining treatment

A
  • withdrawal of the intervention does not directly cause the patient’s death
103
Q

voluntary stopping of eating and drinking (VSED)

A

patient voluntarily stops eating and drinking to allow death?

104
Q

mastectomy

A
  • removal of entire breast tissue that has cancer in it
  • can be single (1 breast) or double (both breasts)
105
Q

breast cancer prevalence

A

1 in 8 women in the US will develop breast cancer at some point in their life

106
Q

a “good” lump

A

non-tender, mobile, discrete (can feel edges)

107
Q

where is most colorectal cancer found?

A

in the sigmoid colon

108
Q

colon cancer complication: bowel perforation

A
  • breaks through wall of colon into the abdomen
  • s/sx: pain, rigid abdomen, increase WBC
109
Q

DIC s/sx

A

signs of body bleeding
- petechiae
- bruising

110
Q

photodynamic therapy

A

inject patient with something that highlights cancer cells

111
Q

hormonal therapy

A
  • ie. estrogen blockers for breast cancer
  • for hormone-driven cancers
112
Q

beam radiation

A
  • 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
Q

systemic radiation

A
  • most radioactive
  • take radioactive isotope, pill/IV
  • unsealed source- whole body/systemic
  • double flush toilet
  • poop and pee is radioactive
  • need to be isolated

NU 360 (12 decks)

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