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NRSG 200: Med Surg 3 > [Exam 1/Final] Chapter 15 - Management of Patients with Oncologic Disorders > Flashcards

[Exam 1/Final] Chapter 15 - Management of Patients with Oncologic Disorders Flashcards

1
Q

Cancer: What is this?

A

Disease process that begins when abnormal cells is transformed by genetic mutations of cellular DNA

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2
Q

Cancer: What is metastasis?

A

Abnormal cells have invasive characteristics and like to infiltrate other tissues

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3
Q

Cancer: What are malignant cancer cells?

A

Demonstrate uncontrolled growth that does not follow physiologic demand

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4
Q

Malignant Process: What is cell prolifeation?

A

Uncontrolled growth with ability to metastasize and destroy tissue and cause death

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5
Q

Malignant Process: What are teh cell characteristics?

A

Presence of tumor specific antigens that trigger immune response, altered shape, structure, and metabolism

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6
Q

Malignant Process: What are the different types of metastasis?

A

Lymphatic Spread
Hematogenous Spread
Angiogenesis

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7
Q

Malignant Process: What is Lymphatic Spread

A

Lymph runs throughout body. If a cancer cell jumps in this system, will travel throughout whole body

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8
Q

Malignant Process: What is Hematogenous Spread

A

An example would be a blood vessel running through a tumor. If a piece breaks off, it will travel throughout the body

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9
Q

Malignant Process: What is angiogenesis

A

When tumors have growth of its own blood vessels. The tumor is being fed with the blood

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10
Q

Characteristics of Benign and Malignant Neoplasms: How will the characteristics be here?

A

Malignant: Cells are going to lack normal cell characteristics. Lack the proper shape and may not recognize normal cell tissue anymore.

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11
Q

Characteristics of Benign and Malignant Neoplasms: Mode of growth for these?

A

It invades the surrounding tissue for malignant. Benign , it stays within the cell

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12
Q

Characteristics of Benign and Malignant Neoplasms: Rate of growth for these?

A

In malignant, the cells grow much quicker

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13
Q

Characteristics of Benign and Malignant Neoplasms: Metastasis of these?

A

In malignant, the cells will metastasis all over the body. Other is localized

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14
Q

Characteristics of Benign and Malignant Neoplasms: General effects of these?

A

You will see inflammatory system kick in. Weight loss. Systemic changes.

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15
Q

Characteristics of Benign and Malignant Neoplasms: Tissue destruction of these?

A

This has to do with malignant growth of tissue. Destroying tissue.

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16
Q

Characteristics of Benign and Malignant Neoplasms: Ability to cause disease of these?

A

Malignant can cause other tissues to shut down as the cancer grows.

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17
Q

Characteristics of Benign and Malignant Neoplasms: What is the biggest thing to keep in mind with malignant?

A

They just grow grow grow. They ignore suppression signals. And they also contain tumor-specific antigens so they will have tumor marker on them

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18
Q

Carcinogenic Agents and Factors: What viruses and bacteria can cause this?

A

Hep B, HPV, Mono

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19
Q

Carcinogenic Agents and Factors: What physical factors affect this?

A

Sunlight, radiation, chronic irritation like having chronic GERD

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20
Q

Carcinogenic Agents and Factors: What chemical agents affect this?

A

Tobacco and Asbestos , which causes lung cancer

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21
Q

Carcinogenic Agents and Factors: What genetic and familal factors affect this?

A

Cancer will often run in family with breast or ovarian cancer. Thats why they have higher risk of breast cancer in fam. Brocco Tests can be done to test for this

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22
Q

Carcinogenic Agents and Factors: What diet changes this?

A

High alcohol, fat, and nitrates intake

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23
Q

Carcinogenic Agents and Factors: What hormones changes this?

A

Prolonged estrogen therapy.

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24
Q

Carcinogenic Agents and Factors: what is carcinogenesis?

A

This is when you have healthy cells and then you start to expose it to the carcinogens. This is a three step process

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25
Q

Carcinogenic Agents and Factors: What are the steps in carcinogensis?

A

Initiation where you are exposed to the carcinogen
Promotion , repeated exposure
Progression, where you start to have incredibly malignant behaviors so cells start to change.

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26
Q

Normal Immune Response: What is involved here?

A 
Macrophages
T Lymphocytes
Lymphokines
Interferon
B Lymphocytes
NK Cells
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27
Q

Normal Immune Response: Immune system is looking for what?

A

Tumor-associated antigens

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28
Q

Normal Immune Response: What do T Cells do?

A

Kill the canceer cells

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29
Q

Normal Immune Response: What do B cells do?

A

Produce antibodies

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30
Q

Normal Immune Response: What do NK cells do?

A

Attack any cells that are not supposed to be in the body

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31
Q

Primary and Secondary Prevention: What is primary prevention?

A

Concerned with reducing cancer risk in healthy people.

Avoid carcinogens, vaccines, wear sunscreen, diet.

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32
Q

Primary and Secondary Prevention: what is secondary prevention?

A

Involves detection, screening to achieve early diagnosis and intervention

Look at self-breast exam, testicular self-exam. Early detection the better.

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33
Q

Primary and Secondary Prevention: Big emphasis on what type?

A

Primary and secondary prevention. Mammograms are now included with insurance.

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34
Q

Primary and Secondary Prevention: What is tertiary prevention?

A

Preventing reoccurence and preventing developing of secondary cancers.

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35
Q

Diagnosis of Cancer: What is the first thing that needs to be done?

A

Determine presence, extent of tumor

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36
Q

Diagnosis of Cancer: After presence determined, what is done?

A

Identify possible spread (metastasis) of disease or invasion of other body tissues.

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37
Q

Diagnosis of Cancer: What is usually done when thinking of treatment?

A

Evaluate function of involved body system and obtain tissue and cells for analysis for evaluation of tumor stage.

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38
Q

Diagnosis of Cancer: What can be used to help diagnose?

A

CT , MRI, PET Scan, Draw Tumor Markers.

Keep in mind how patient is reacting to diagnosis of cancer.

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39
Q

Tumor Staging and Grading: What is staging?

A

Determines size of tumor, existence of metastasis

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40
Q

Tumor Staging and Grading: What is used for staging?

A

TNM.

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41
Q

Tumor Staging and Grading: What does TNM stand for?

A

T: Extent of primary tumor
N: Lymph node involvement
M: Extent of metastasis

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42
Q

Tumor Staging and Grading: What is grading?

A

Classification of tumor cells. Is the tissue well-differentiated, does it look like liver tissue is supposed to?

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43
Q

Tumor Staging and Grading: What is the grading system?

A

1-4 system. 1 resembles normal tissue while 4 does not resemble it at all.

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44
Q

Cancer Mx: This is aimed at what?

A

Cure
Control
Palliation

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45
Q

Cancer Mx: What is cure?

A

Complete eradication of the disease

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46
Q

Cancer Mx: What is control?

A

We can contain the cancer and prolong life .

47
Q

Surgical Tx: What are the different types of treatment?

A 
Dignostic Surgery
Biopsy
Tumor REmoval
Prophylactic Surgery
Palliative Surgery
REconstructive Surgery
48
Q

Surgical Tx: What would be included in diagnostic?

A

Biopsies will be done to determine the type of cancer.

49
Q

Surgical Tx: What types of biopsies are included?

A

Excisional (whole tumor is removed, when easily accessible)
Needle (They just sample tissues of suspicious masses. Breast, thyroid)
Incisional (There is a very large mass and cannot remove it. Take wedge of tissue out)

50
Q

Surgical Tx: Problem with removing tumor?

A

You can shed some of the cancer cells and cause it to go throughout the whole body

51
Q

Surgical Tx: Tumor removal includes what?

A

Wide Excision or local excision

52
Q

Surgical Tx: What is prophylactic surgery?

A

Used with mastectomy or oophorectomy. This is when you have a genetic predisposition for cancer.

53
Q

Surgical Tx: When do you see reconstructive surgery?

A

Usually with cancers of the head and neck. Will be reconstructed to give a better appearance.

54
Q

Surgical Tx: What is palliative surgery?

A

This promotes comfort. Mass removed that’s causing obstruction or numbness in other parts of the body.

55
Q

Radiation Therapy: This is done why?

A

For curative, control, or palliative

56
Q

Radiation Therapy: WHat may be seen during a curative radiation?

A

You may see radiation given for thyroid or cervical or ehad and neck cancers

57
Q

Radiation Therapy: Control is done why?

A

To control size and prevent spread

58
Q

Radiation Therapy: What are different types?

A

External Radiation

Internal Radiation

59
Q

Radiation Therapy: What is external radiation?

A

That will be EBRT. This is delivered over weeks given daily. Calculated dose

60
Q

Radiation Therapy: What is internal radiation?

A

THis is brachytherapy. Seeds are planted in prostrate or if they have uterine cancer, may use catheter to give radiation. This can be a high-dose or a low-dose radiation.

61
Q

Radiation Therapy: What does radiation do to the cells?

A

It burns the cells , and this depends on the location of the radiation.

62
Q

Radiation Therapy: What will cause there to be an increased side effect to this?

A

If this has been paired up with chemotherapy

63
Q

Radiation Therapy: Common SE seen?

A

Dermatitis (Dry Mouth, Inflammation of Skin, Wet Desquamation which is red and oozing skin)

Stomatitis (Inflammation of oral tissue, seen with head and neck cancers)

Xerostomia (Dry mouth)

Mucositis (Inflammation of the GI tract)

64
Q

Nursing Care of Pt Undergoing Radiation Therapy: This will depend on what?

A

If they have low dose or high-dose radiation.

65
Q

Nursing Care of Pt Undergoing Radiation Therapy: Restrictions and precautions for low dose will be what?

A

If catheter implanted, they would require private room for 72 hours, don’t want catheter to be dislodeged so log roll them.

Low Residual Diet

Low Diarrheal diet.

You don’t want any straining that could dislodge cather

66
Q

Nursing Care of Pt Undergoing Radiation Therapy: Restriction and precautions for high dose radiation?

A

Radiation exposure to others is minimal if they have seen implants. Its quick

67
Q

Nursing Care of Pt Undergoing Radiation Therapy: This is about protecting staff as well, which includes what?

A

Distancing, Shielding, Giving Patients Private rooms. If around them, will need to wear Dosa meters which will tell you if you’ve had too much radiation

68
Q

Chemotherapy: What is this?

A

Agents used to destroy tumor cells by interfering with cellular function, replication

69
Q

Chemotherapy: How does this trea the body?

A

Treats the body systemically, not locally

70
Q

Chemotherapy: How does it kill the cells?

A

By killing the cell during a specific cell cycle.

71
Q

Chemotherapy: What is the max amount of chemo someone can take?

A

Too much can destroy the heart because it has caused cardiomyopathy. Max amount varies per patient.

72
Q

Chemotherapy Toxicity: What GI side effects occur?

A

N/V, Anorexia, Stomatitis, Mucositis.

73
Q

Chemotherapy Toxicity: How to help with GI side effects?

A

N/V: Teach to eat and drink when not nauseated. Can give antiemetics. Small frequent meal with high protein/high calorie.

74
Q

Chemotherapy Toxicity: What to know for weight?

A

You want to monitor weight. You want to maintain weight and make sure that they are not losing.

75
Q

Chemotherapy Toxicity: How to help with stomatitis?

A

Tell them to use hard candy. Don’t use tobacco or alcohol.

76
Q

Chemotherapy Toxicity: What Hematopoietic changes occur?

A

Anemia, Leukpneia, Thrombocytopenia. Chemo destroys healthy cells. RBCs destroyed. Monitor for infection, avoid large groups. Electric razor, soft bristle toothbrush.

77
Q

Chemotherapy Toxicity: What changes occur with kidney?

A

Make sure they still have adequte renal output and montor labs. Urine may decrease.

78
Q

Chemotherapy Toxicity: What should we do for reproductive?

A

May need to harvest eggs or sperm

79
Q

Chemotherapy Toxicity: What neurologic changes may occur?

A

Chemo-brain. They may have a permanent brain fog and they also may have fatigue from all of the other changes occuring in the body

80
Q

Nursing Mx in Chemotherapay: What do we want to assess?

A

Fluid and Electrolytes - Tells us about nutrition and to make sure electrolytes are within normal range

Cogntive Status - Are they having chemo brain?

81
Q

Nursing Mx in Chemotherapay: What could be taught to them

A

Modifying risks for infection abd bleeding

82
Q

Nursing Mx in Chemotherapay: We need to be familar with what?

A

Agency policies. We want to wear proper equipment and PPE to protect ourselves

83
Q

Nursing Mx in Chemotherapay: What to give before chemotherapy is administerd?

A

Give them an antiemetic to help with the N/V

84
Q

Chemotherapy Administration: Often given through what?

A

Port placed through chest or larger vessel or a PICC line.

If given through peripheral IV, extravasation can occur. Make sure to monitor IV sites

85
Q

Chemotherapy Administration: What are hypersensitivity reactions?

A

Life-threatening. Occur within 15-30 minutes of initiation of IV chemo.

We want to discontinue immediately . Give an antihistamine or tylenolol before next treatment to prevent fever. Steroids to help with inflammatory response.

86
Q

Hematopoietic Stem Cell Transplantation (HSCT): Used when?

A

Used for hematological cancers that effect marrow or solid tumors treated with chemotherapy dosage that ablates bone marrow

87
Q

Hematopoietic Stem Cell Transplantation (HSCT): What are the types of HSCT?

A

Allogenic
Autologous
Syngeneic

88
Q

Hematopoietic Stem Cell Transplantation (HSCT): What is allogenic HSCT?

A

A donor has given their stem cells.

89
Q

Hematopoietic Stem Cell Transplantation (HSCT): What is autologous HSCT?

A

This is the patient. They give their own stem cells. Go through aphresis , they get clean, go through chemo to destroy remaining leukemia and then retransplant their own stem cells

90
Q

Hematopoietic Stem Cell Transplantation (HSCT): What is syngeneic HSCT?

A

This only occurs if they have an identifcal twin to get stem cells transplanted.

91
Q

Hematopoietic Stem Cell Transplantation (HSCT): How does this work?

A

Will use peripheral blood stem collection and take stem cells out for transplantation.

92
Q

Hematopoietic Stem Cell Transplantation (HSCT): Graft-versus host disease may occur which is what

A

immune system recognized donor cells as malignant cells and destoys them

93
Q

Nursing Mx in HSCT: Wht is done in pretransplantation care?

A

Before engraftment, are at high risk for infection. Monitor for signs of infection because they can become septic and increased rf bleeding

94
Q

Nursing Mx in HSCT: What care is done posttransplant?

A

Caring for recipients and donors.

95
Q

Cancer Mx - Monitoring and Mxing Potential Complications: What does this include?

A

Infection, Septic Shock, Bleeding/Hemorrhage

96
Q

Cancer Mx - Monitoring and Mxing Potential Complications: What factors contribute to infection?

A

Impaired Skin, Chemo, IV Catheters, IV Lines, Invasive Procedures. Be aware of contributing factors for infection

97
Q

Cancer Mx - Monitoring and Mxing Potential Complications: If patients get an infection, they can go into what?

A

Septic Shock

98
Q

Septic Shock: What is this?

A

Ssepticemia, septic shock life-threatening complications that must be prevented or detected, treated promptly

99
Q

Septic Shock: Who is at greatest risk for this

A

Patients who are neutropenic and who have hematologic malignancies

100
Q

Septic Shock: Signs of this?

A

AMS, temperature changes, cool and clammy skin, decreased urine output, hypotension, tachycardia, dysrhythmias, electrolyte i mabalnces and abnormal ABGs.

101
Q

Bleeding and Hemorrhage: Thrombocytopenia is characterized by what?

A

Platelet count of less than 100,000.

102
Q

Bleeding and Hemorrhage: Plans of nursing care here include what?

A

Assessment parameters, intervetions for patients AT RISK OF BLEEDING

103
Q

Oncologic Emergencies: What is included?

A 
Superior Vena Cava Syndrome
Spinal Cord Compression
Pericaridal Effusion/Cardiac Tamponade
Disseminated Intravacular Coagulation (DIC)
SIADH
Tumor Lysis Syndrome
Hypercalcemia
104
Q

Oncologic Emergencies: What is super vena cava syndrome?

A

Compression or invasion of superior vena cava. Associated with lung cancer. Looks like right sided heart failure with SOB, facial swelling, JVD. Need to treat cause if its a tumor.

105
Q

Oncologic Emergencies: What is spinal cord compression?

A

Tumor metastasized to the spine. That is compressing on spinal cord. May see decreased blood flow to lower extremity, decreases sensation to extremities and bowel/bladder dysfunction.

106
Q

Oncologic Emergencies: How to fix spinal cord compression?

A

May need a laminectomy or may need radiation to shrink it

107
Q

Oncologic Emergencies: Why does pericardial effusion occur?

A

Fluid is building up around the heart and the heart can’t squeeze as efectiely

108
Q

Oncologic Emergencies: What is DIC?

A

Might develop a clotting disorder.

109
Q

Oncologic Emergencies: Why does SIADH occur

A

Kidneys are affected by cancer and radiation

110
Q

Oncologic Emergencies: What is tumor lysis syndrome?

A

REfers to rapid destruction of cells. When they get destroyed, it leads to electrolyte imbalances.

111
Q

Oncologic Emergencies: Why does hypercalcemia occur?

A

Might see this from cellular destruction. Monitor for weakness, N/V, decreased LOC, decreased reflexes. Only way to treat is to give them fluids

112
Q

Hospice: What is this?

A

Comprehensive, multidisciplinary approach to care of patients, with terminal illness for their famileis

113
Q

Hospice: This focuses on what?

A

Quality of life, palliation of symptoms, psychosocial, spiritiual care.

NRSG 200: Med Surg 3 (46 decks)

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