Exam 1: Cancer development and care/ End of life care Flashcards
Staging of cancer: T
T- Primary Tumor Tx- Primary tumor cannot be assessed To- No evidence of primary tumor Tis- Carcinoma in situ T1, T2, T3, T4- Increasing size and/or/local extent of the primary tumor
Staging of cancer: N
N- Regional lymph nodes
Nx- regional lymph nodes cannot be assessed
No- No regional lymph node metastasis
N1, N2, N3- Increasing involvement of regional lymph nodes
Staging of cancer: M
M- Distant Metastasis
Mx- Presence of distant metastasis cannot be assessed
Mo- no distant metastasis
M1- Distant metastasis
Tumor lysis syndrome: what is it, symptoms
- Large number of tumor cells are rapidly killed by chemotherapy or radiation
- lymphoma, leukemia, multiple metastatic conditions
symptoms
- Major change in electrolytes and uric acid- potassium, phosphate, and uric acid are released into circulation
- chvostek’s sign, trousseau’s sign- hypocalcemia
- hyperactive Deep Tendon Reflex
- Prolonged QT intervals
- Death from renal failure or cardiac arrest
more fluids
Superior Vena Cava syndrome
- superior vena cava compressed or obstructed by tumor growth
- can lead to painful, life-threatening emergency
symptoms
- may begin suddenly or gradually and may worsen when bending over or lying down
Cancer Patient education
C.A.U.T.I.O.N
- Changes in bowel or bladder habits
- A sore that does not heal
- Unusual bleeding or discharge
- Thickening or lump in breast or elsewhere
- Indigestion or difficulty swallowing
- Obvious change in wart or mole
- Nagging cough or hoarseness
Cancer treatment: Surgery
Oldest form of cancer treatment
- Prophylaxis
- Diagnosis
- Cure
- Control, cytoreductive
- Palliation
- Second-look surgery
- Reconstruction or rehabilitation
Radiation therapy safety and education
- Teach accurate objective facts to help patient cope
- Do not remove markings
- Administer skin care
- Use lotions to protect skin according to department policy
- Avoid direct skin exposure to sunlight
- Care for xerostomia (dry mouth)
- Bone exposed to radiation more vulnerable to fracture
- Safety for others
Cancer treatment: Chemotherapy
- Treatment of cancer with chemical agents
- Major role in cancer therapy
- Cures and increases survival time
- Some selectivity
- Normal cells most affected—skin, hair, intestinal tissues, spermatocytes, blood-forming cells
Chemotherapy drugs: Antimetabolites
- pretends to be other cell and tricks the cancer cell
- 5-fluorouracil (Adrucil)
Chemotherapy drugs: Antitumor antibodies
- interrupts the DNA synthesis
- doxorubicin (Adriamycin)
Chemotherapy drugs: Antimitotic agents
- slows cell division
- paclitaxel (Toxol)
Chemotherapy drugs: Alkylating agents
- inhibit cell division
- cyclophosphamide (Cytoxan)
Chemotherapy drugs: Topoisomerase inhibitors
- prevent cell division
- Topotecan
Chemotherapy drugs: Miscellaneous chemotherapeutic agents
- Hydroxyurea (Droxia)
Chemotherapy patient education
- Avoid food sources containing bacteria
Fresh fruit, vegetables; undercooked meat, fish or eggs; paprika, raw nuts, yogurt - Avoid yard work, gardening
- Wash toothbrush daily in dishwasher or bleach solution
- Avoid crowds
- Avoid fluids sitting at room temperature> 1 hour
- Wash glasses and cups after each use
Oncologic Emergencies
- Sepsis, disseminated intravascular coagulation
Collaborative management:
- Prevention (best measure)
- IV antibiotic therapy
- Anticoagulants, cryoprecipitated clotting factors
Thrombocytopenia treatment
- Platelet transfusion
- romiplostim (Nplate)
- eltrombopag (Promacta, Revolade)
- fostamatrinib (Tavalisse)
Palliative
Philosophy of care, organized/structured system delivering care for individuals with life-threatening illness
DNR Orders
- By law, health care providers must initiate CPR for a person who is not breathing or pulseless unless DNR exists
- Can be written in advance (portable DNR)
Weakness Management
- Aspiration precautions
- Mouth care, moisture for lips
- Altered routes of medication administration if needed—choose least invasive route with most effective treatment
Pain Management
- Pain is symptom dying patients fear most
- Schedule pain medications to prevent recurrence of pain
- Consider alternative administration route of pain medication as needed
Complementary & Alternative Therapies
- Massage
- Music therapy
- Therapeutic touch
Reiki therapy - Aromaterapy
- Dyspnea Management (Pharmacologic)
- Treat primary cause, relieve psychological distress that accompanies symptoms
- Opioids
- Anticholinergics
- Bronchodilators
- Sedatives
- Corticosteroids
- Oxygen therapy
- Diuretics
- Antibiotics
Nausea & Vomiting Management
- Antiemetic agents
Prochlorperazine (Compazine)
Dexamethasone (Decadron, Deronil)
Metoclopramide (Reglan, Maxeran) - Remove any source of odors
- Comfortable room temperature
Restlessness & Agitation Management
- Assess for pain, urinary retention, constipation, other reversible cause
- Treat underlying cause
- Pharmacologic agents
haloperidol [Haldol, Peridol] - Complementary and alternative therapies
music, aromatherapy-
Seizure management
- Pharmacologic therapy
Benzodiazepines
Barbiturates (phenobarbital)
