Exam 2 (Ch. 14, 16, & 34) PPT Flashcards
The incidence of cancer increases significantly with age, with most cases diagnosed in individuals over 55. However, cancer can develop at any age, and 1.7 million people in the US are diagnosed with invasive cancers annually. What is the most likely explanation for the observation that both the incidence and mortality rates of cancer are declining overall?
A. Improvements in early detection and treatment
B. A decrease in environmental risk factors
C. Increased use of preventative measures and healthier lifestyles
D. All of the above
D. All of the above.
- A. Screening can catch cancers at earlier, at more treatable stages. Advances have also improved survival rates.
- B. Public health campaigns have raised awareness about risks e.i. smoking, excessive sun exposure, and exposure to carcinogens. This has led to changes in behaviors & policies that reduce exposure to risks.
- C. More people are adopting healthier lifestyles, including regular exercise, a balanced diet, and maintaining a healthy weight. Preventative measures like vaccinations and chemoprevention are also contributing to lower cancer rates.
Overall, cancer inicdence is higher in which gender?
Males
More men than women dies from cancer-related death each year.
Men more likely to develop liver cancer
Prostate cancer is the highest incidence
Head & neck cancers are more common in men
Which cancer has the highest death rate in both men & women?
Lung
What are some biologic sex considerations for cancer in women?
- Highest incidence is breast cancer
- Thyroid cancer is more prevalent in women
- Women are less likely to have colon cancer screenings
What are the 2 major dysfunction present in the process of cancer developement?
Defective cell proliferation (growth) & defective cell differentiation
What does metastasis mean?
Abnormal cells invade surrounding tissue & gain access to lymph & blood vessels carrying them to other areas of the body
What does benigin mean?
Cells that are not cancerous
What are the 3 stages of cancer?
- Initiation: Involves a mutation in cell structure
- Promtion: is characterized by the reversible proliferation of altered cells (an increase in the altered cell population further increases the likelihood of more mutations)
- Progression: increased growth rate of the tumor, increased invasiveness and metastasis
Which of the following statements BEST describes the current understanding of cancer development?
A. Cancer arises from a rapid, haphazard event leading to uncontrolled cell growth.
B. Cancer development is typically an orderly, multi-stage process involving genetic changes.
C. Cancer cells develop spontaneously without any changes in normal cellular processes.
D. Cancer is primarily caused by external factors and does not involve genetic alterations.
B. Cancer development is typically an orderly, multi-stage process involving genetic changes.
Which of the following statements BEST describes the role of tumor suppressor genes in cancer development?
A. Tumor suppressor genes promote cell growth and division.
B. Mutations in tumor suppressor genes can lead to uncontrolled cell growth.
C. Inherited mutations in tumor suppressor genes account for the majority of cancers.
D. Tumor suppressor genes are responsible for repairing damaged DNA.
B. Mutations in tumor suppressor genes can lead to uncontrolled cell growth.
Where do most cancers result from?
From damage to genes occurring during one’s lifetime
Not from inherited genes
What are the 3 types of carcinogens?
- Chemical (e.g., benzene, arsenic, formaldehyde, acetone)
- Radiation (e.g. UV rays, X-ray)
- Viral (DNA or RNA viruses) (e.g. HPV, HBV, HIV, Epstein-Barr)
Cell growth, protein synthesis, and preparation for DNA replication.
Describes what phase of the cell cycle?
G1 Phase
DNA replication and synthesis of sister chromatids
Describes what phase of the cell cycle?
S Phase
Post-DNA replication growth and preparation for mitosis
Describes what phase of the cell cycle?
G2 Phase
Cell division and separation of chromosomes
Describes what phase of the cell cycle?
M Phase
Quiescent phase; non-dividing state
Describes what phase of the cell cycle?
G0 Phase
Which of the cell cycle checkpoints is MOST critical in ensuring that damaged DNA is not passed on to daughter cells?
G2 Checkpoint
Where does DNA replication primarily occurs?
The S phase
A client asks the nurse about factors that can initiate cancer development. Which of the following factors should the nurse identify as potential initiators of cellular mutations? (Select all that apply.)
A. High-fiber diet
B. Exposure to radiation
C. Infection with certain viruses
D. Regular exercise
E. Genetic predisposition
B, C, & E
* Radiation (B) and certain viruses (C) can directly damage DNA and initiate mutations. Genetic predisposition (E) refers to inherited mutations that increase cancer susceptibility. A high-fiber diet (A) and regular exercise (D) are generally considered protective against cancer.
What happens to a cell during each stage of cancer?
Initiation: A normal cell experiences DNA damage or mutation.
Promotion: Altered cells are stimulated to proliferate.
Progression: Cancer cells spread to distant sites.
Describe the general characteristic of bengin cells.
Encapsulated: Usually
Differentiated: Normally
Metastasis: Absent
Recurrence: Rare
Vascularity: Slight
Mode of growth: Expansive
Cell characteristics: Fairly normal, like parent cells
Table 16.3, pg. 271
Protective sac (encapsulated)
Slow growing
Locoalized
Non invasive
Describe the general characteristic of malignant cells.
Encapsulated: Rarely
Differentiated: Poorly
Metastasis: Capable
Recurrence: Possible
Vascularity: Moderate to marked
Mode of growth: Infiltrative & expansive
Cell characteristics: Cells abnormal, become more unlike parent cells
Table 16.3, pg. 271
No sac (non-capsulated)
Fast growing
Invasive & infiltrates
Matastasize
What are the main sites of metastasis?
5
- Brain & cerebrospinal fluid
- Lung
- Liver
- Adrenals
- Bone
What is angiogenesis?
The formation of new blood vessels.
* Normal Process: It’s a vital process for growth and healing in the body. For example, it helps in: Embryonic development, Wound healing, & Growth of organs and tissues
- In Cancer: Angiogenesis plays a critical role in cancer growth and spread (metastasis). Tumors need a blood supply to: Bring in nutrients and oxygen, Remove waste products, & Allow cancer cells to travel to other parts of the body
Angio: blood vessels.
Genesis: the creation or origin of something.
What are tumor-associated antigens (TAAs)?
Substances produced by tumor cells that can trigger an immune response
Cancer cells may have altered cell-surface antigens because of malignant transformation. These antigens are termed tumor-associated antigens (TAAs).
We think the immune system responds to TAAs through a process termed immunologic surveillance.
What is immunologic escape?
The process by which cancer cells evade the immune system.
Possible mechanisms:
Suppression of factors that stimulate T cells to react to cancer cells
Weak surface antigens allowing cancer cells to “sneak through” immunologic surveillance
Development of tolerance of the immune system to some tumor antigens
Suppression of the immune response by products secreted by cancer cells
Induction of suppressor T cells by the tumor
Blocking antibodies that Bind TAAs, thus preventing recognition by T cells.
What are the 3 types of nursing cancer preventions?
- Primary
- Secondary
- Tertiary
What is primary cancer prevention?
Reducing risks of disease through health promotion and risk reduction
Vaccines (HBV)
Public Education
What is secondary cancer prevention?
Involves Screening and early detection.
Mammography (age 40-54)
Colon Fecal occult test Both genders 50+ age
What is tertiary cancer prevention?
Improved screening,
diagnosis, and
treatment
Focus on monitoring for preventing recurrence of the primary cancer and screening for development of a secondary cancer
What is personalized medicine?
Cancer
An emerging trend in cancer treatment. It involves using the patient’s genetic information to guide decisions about cancer prevention, diagnosis, and treatment. Many diagnostic studies (tumor markers, genetic markers, molecular receptor status) are useful in determining treatment options.
Recent development of biologic databases
Technologic advances that can identify unique characteristics of individual persons
Computer-driven systems that can mine and analyze datasets
This is an exciting time for oncology as the immediate goal of the precision medicine initiative is to focus on preventing and curing cancers
What are the steps of diagonsis of cancer?
5
- Understand
Nurses need to understand how cancer is diagnosed!! - Determine
Determine presence, extent of tumor - Identify
Identify possible disease metastasis - Evaluate
Evaluate functions of involved and uninvolved body systems and organs - Obtain
Obtain tissue and cells for analysis, including evaluation of tumor stage and grade
How are bone marrow aspirations from the posterior iliac crest preformed?
The skin over the puncture site is cleansed with bactericidal agent, local anesthetic agent, the needle is inserted through the cortex of the bone. The stylet of the needle is then removes, the hub is attached to a 10 mL syringe and 0.2-0.5 mL of fluid marrow is aspirated. The patient will have pain when the periosteum is penetrated and with aspiration, this lasts only a few seconds and can be quite uncomfortable. Pressure is applied over the site with a pressure dressing (complications hemorrhage and infection)
What is the sufix for bengin tumors?
-oma
What is the suffix for malignant epithelial tissue tumors?
-Carcinoma
What is the suffix for malignantc connective tissue tumors?
-Sarcoma
What class are plasma cells in?
Classification of cancer by tissue of origin
Myeloma
What class is Hodgkin & non-Hodgkin in?
Classification of cancer by tissue of origin
Lymphoma
What class is bone marrow cells, WBC’s, RBC’s, & Lymphocytes in?
Classification of cancer by tissue of origin
Leukemia
What does tumor staging determine?
Determines the size of the tumor, the existence of local invasion, lymph node involvement, and distant metastasis
What do each letter in TNM classification system stand for?
T: Primary tumor
N:Regional Lymph Nodes
M: Distant Metastases
What is tumor grading?
pathologic classification of tumor cells: I-IV
The higher the number the more undifferentiated the cell is.
What does Stage 0 indicate?
Clinical tumor staging
Cancer in situ
Group of abnormal cells that have not done anything
What does Stage I indicate?
Clinical tumor staging
Tumor limited to the tissue of origin
localized tumor growth
What does Stage II indicate?
Clinical tumor staging
Limited local spread
What does Stage III indicate?
Clinical tumor staging
Extensive local and regional spread
What does Stage IV indicate?
Clinical tumor staging
Metastasis
What is the most common cancer of the urinary system?
Bladder Cancer
~81,190 new cases of bladder cancer diagnosed annually and ~17, 240 deaths reported every year related to bladder cancer.
At what age do 90% of bladder cancers occur?
Age 55
More common in men than women
What is the most frequent type of bladder cancer?
Transitional cell carcinoma (TCC) is the most common type, with tumors often appearing as papillomatous growths within the bladder.
What are some risk factors of bladder cancer?
- Smoking: Accounts for about half of all cases.
- Occupational Exposures: Dyes used in rubber and other industries.
- Radiation Treatment: Women treated with radiation for cervical cancer.
- Certain Chemotherapy Drugs: Cyclophosphamide, docetaxel, or gemcitabine.
- Chronic Irritation: Long-term use of indwelling catheters, chronic UTIs, and urinary tract stones (especially in the bladder) increase the risk of squamous cell carcinoma specifically.
Prioritization - Nursing Assessment
Scenario: A nurse is caring for a client with bladder cancer. Which of the following assessments should the nurse prioritize? Rank the following in order of priority (most important first).
A. Assess for gross or microscopic hematuria (blood in urine).
B. Inquire about a history of smoking.
C. Monitor for changes in bowel habits.
D. Evaluate the client’s emotional state and coping mechanisms.
- A. Assess for gross or microscopic hematuria (blood in urine). (Most common sign)
- B. Inquire about a history of smoking. (Major risk factor)
- D. Evaluate the client’s emotional state and coping mechanisms. (Important, but lower priority than physical symptoms and risk factors)
- C. Monitor for changes in bowel habits. (Not directly related to bladder cancer)
Match the bladder cancer with the factor that it’s MOST associated with.
Bladder Cancer Type
Transitional Cell Carcinoma (TCC)
Squamous Cell Carcinoma
Adenocarcinoma (rare in bladder)
Factor/Characteristic
a) Chronic irritation of the bladder lining (e.g., from long-term catheter use)
b) Papillomatous growths within the bladder
c) Arises from glandular epithelium; may originate elsewhere and metastasize to the bladder
Transitional Cell Carcinoma (TCC): B
Squamous Cell Carcinoma: A
Adenocarcinoma (rare in bladder): C
What is used to detect bladder cancer?
CT, ultrasounds, & MRI
When cancer is suspected, obtain urine specimens to identify any cancer or atypical cells. (Exfoliated cells from the bladder’s epithelial surface can be detected in voided specimens.)
What is the most common manifestation of bladder cancer?
Microscopic or gross, painless hematuria (chronic or intermittent) is the most common manifestation of bladder cancer
How is the presence of bladder cancer confirmed?
By cystoscopy and biopsy.
What is a biopsy?
The removal of a tissue sample for microscopic examination to confirm a diagnosis of cancer and determine its type and grade. Types include:
* Excisional biopsy: Removal of the entire tumor or suspicious area.
* Needle biopsy: Removal of a small tissue sample using a needle.
* Incisional biopsy: Removal of a portion of the tumor for diagnosis.
What is the difference of wide excision & local excision tumor removal?
Wide excision: Removal of the tumor along with a margin of surrounding normal tissue.
Local excision: Removal of the tumor only, without a wide margin.
What is prophylactic surgery in regards to cancer treatment?
Removal of tissue or organs to prevent cancer development in individuals at high risk.
What is palliative surgery in regards to cancer treatment?
Performed to relieve symptoms and improve quality of life in advanced cancer cases, but not intended to cure the cancer.
What is reconstructive surgery in regards to cancer treatment?
Performed to restore function or appearance after cancer surgery.
Prioritization - Postoperative Nursing Care
A client is recovering from a wide excision of a skin cancer. Which of the following nursing actions should be prioritized in the immediate postoperative period? Rank in order of priority (most important first).
A. Administering pain medication.
B. Educating the client about long-term wound care.
C. Assessing the wound for signs of infection.
D. Encouraging the client to express their feelings about the diagnosis.
- C. Assessing the wound for signs of infection. (Risk of infection is highest immediately post-op)
- A. Administering pain medication. (Pain management is important for comfort and healing)
- B. Educating the client about long-term wound care. (Important, but can be addressed slightly later)
- D. Encouraging the client to express their feelings about the diagnosis. (Psychosocial support is important, but physical needs take priority initially)
cancer
What should the nurse monitor for postaperatice complications?
Infection
Impaired Wound Healing (Factors like malnutrition, obesity, and diabetes can increase risk)
Altered Pulmonary Function
Altered Renal Function
Deep Vein Thrombosis (DVT) (Assess for calf pain, swelling, and redness.)
Prioritization - Postoperative Assessments
A nurse is caring for a patient immediately after abdominal surgery. Which assessments should be prioritized? Rank in order of priority (most important first).
A. Assessing the surgical incision for redness and drainage
B. Auscultating lung sounds
C. Administering pain medication
D. Reviewing preoperative teaching materials with the patient
- A. Assessing the surgical incision for redness and drainage (Risk for infection is highest immediately post-op)
- B. Auscultating lung sounds (Risk for pulmonary complications post-op)
- C. Administering pain medication (Important for comfort, but airway and infection risks take priority)
- D. Reviewing preoperative teaching materials with the patient (Important for long-term recovery, but not the immediate priority)
What are some postop complications?
Infection
Bleeding (Monitor vital signs for signs of shock (low blood pressure, rapid heart rate), and check for internal bleeding (e.g., distended abdomen).)
Thrombophlebitis (Assess for calf pain, swelling, redness, and warmth, which are signs of a blood clot (usually in the leg).)
Wound Dehiscence (If evisceration (organs protruding) occurs, cover with sterile dressings and notify the surgeon immediately.)
Fluid and Electrolyte Imbalances
Organ Dysfunction (For example, after lung surgery, monitor respiratory function. After kidney surgery, monitor renal function.)
Prioritization - Postoperative Nursing Actions
A nurse is caring for a patient immediately after surgery. Which actions should be prioritized? Rank in order of priority (most important first).
A. Administering pain medication.
B. Assessing the surgical incision.
C. Auscultating lung sounds.
D. Reviewing discharge instructions.
- C. Auscultating lung sounds (Airway and breathing are top priorities)
- B. Assessing the surgical incision (Risk for infection and bleeding is highest immediately post-op)
- A. Administering pain medication (Important for comfort, but airway and wound assessment take priority)
- D. Reviewing discharge instructions (Important, but not the immediate priority)
What are some purposes of radtioan therapy?
Curative: To eliminate the cancer and achieve a cure.
Control: To shrink the tumor and/or stop its growth, even if a cure isn’t possible.
Palliative: To relieve symptoms caused by the cancer, such as pain or obstruction, and improve quality of life.
What is external radiation?
Radiation is delivered from a machine outside the body, like a giant X-ray. The patient lies still while the machine aims radiation at the tumor.
What is internal radiation (Brachytherapy)
A radioactive substance is placed directly into or near the tumor. This can be in the form of seeds, wires, or liquids.
What is the nurse’s role in Brachytherapy?
Patient Education: Explain the procedure, its purpose, and what to expect.
Safety Precautions: Implement safety measures to protect themselves, visitors, and other patients from radiation exposure (e.g., time and distance limits, wearing dosimeter badges).
Patient Comfort: Provide comfort and support to the patient during the procedure.
Monitoring for Side Effects: Observe for any side effects related to brachytherapy, such as localized skin reactions or fatigue.
What are some types of radiation reactions?
These are typically localized to the area being treated and can include:
Skin changes (redness, dryness, peeling) (does not necessarily depend on location of radiation)
Fatigue
Hair loss (in the treated area)
Mucositis (inflammation of mucous membranes, if radiation is directed at those areas)
A client is receiving radiation therapy. Match the purpose of the radiation therapy with the appropriate client scenario. (Curative, Control, & Palliative)
1. A client with localized prostate cancer
2. A client with metastatic bone cancer
3. A client with a tumor pressing on the spinal cord
4. A client with newly diagnosed Hodgkin’s lymphoma
- Curative
- Palliatvie
- Control & Palliative
- Curative
Prioritization - Nursing Care for Brachytherapy
A client is undergoing brachytherapy for cervical cancer. Which of the following nursing actions should be prioritized? Rank in order of priority (most important first).
A. Providing patient education about the procedure.
B. Implementing safety precautions for radiation exposure.
C. Managing the patient’s pain.
D. Addressing the patient’s anxiety about the procedure.
- B. Implementing safety precautions for radiation exposure. (Protecting staff and visitors from radiation is paramount)
- A. Providing patient education about the procedure. (Informed consent and patient understanding are crucial)
- C. Managing the patient’s pain. (Comfort is important, but safety and education take precedence)
- D. Addressing the patient’s anxiety about the procedure. (Important, but physical and safety needs are higher priorities)
Scenario: A client is diagnosed with a carcinoma. The nurse is educating the client about the characteristics of carcinomas compared to sarcomas.
Question: Which of the following statements BEST describe(s) characteristics of carcinomas? (Select all that apply.)
A. They originate from connective tissue.
B. They are the most common type of cancer.
C. They include adenocarcinomas and squamous cell carcinomas.
D. They often arise in tissues that line surfaces, such as skin or organ linings.
E. They are less common than sarcomas.
F. They can originate in bone, muscle, or blood vessels.
B, C, and D
What are some specific nursing interventions for cancer pt.?
Skin Care: Teach patients to avoid harsh soaps, perfumes, lotions, or rubbing the treated area. Recommend gentle cleansing and moisturizing as needed.
Nutritional Support: Encourage a balanced diet, manage nausea or vomiting, and provide nutritional supplements if necessary.
Fatigue Management: Help patients manage fatigue by encouraging rest periods, pacing activities, and exploring energy-conserving techniques.
Emotional Support: Provide a safe space for patients to express their feelings and concerns. Offer resources for counseling or support groups.
Patient Education: Educate patients about potential side effects, self-care strategies, and when to notify the healthcare team.
Prioritization - Nursing Assessments for Radiation Therapy
A client is receiving radiation therapy to the chest. Which assessments should the nurse prioritize? Rank in order of priority (most important first).
A. Assessing the skin in the treated area.
B. Evaluating the client’s emotional well-being.
C. Assessing the client’s nutritional intake.
D. Monitoring the client’s complete blood count.
- A. Assessing the skin in the treated area. (Skin reactions are common and require prompt intervention)
- C. Assessing the client’s nutritional intake. (Radiation can affect appetite and nutrition)
- B. Evaluating the client’s emotional well-being. (Important, but physical needs take priority)
- D. Monitoring the client’s complete blood count. (Important, but less immediate than the other assessments)
Trend Question - Monitoring for Radiation Toxicity
A patient is several weeks into radiation therapy. The nurse notices the patient’s red blood cell count is decreasing.
Which of the following BEST explains this trend?
A. This is a normal side effect of radiation therapy.
B. The patient is likely experiencing radiation pneumonitis.
C. The patient may be developing bone marrow suppression.
D. The patient is not adhering to their nutritional plan.
C. The patient may be developing bone marrow suppression.
Rationale: Radiation can affect the bone marrow, leading to decreased production of blood cells, including red blood cells. This is a form of radiation toxicity. The other options are less likely explanations for a decreasing red blood cell count specifically.
Scenario: A client is diagnosed with adenocarcinoma of the lung. The nurse is providing education about the characteristics of adenocarcinomas.
Question: Which of the following statements BEST describe(s) characteristics of adenocarcinomas? (Select all that apply.)
A. They originate from epithelial tissue.
B. They are a subtype of sarcoma.
C. They are the most common type of lung cancer.
D. They often arise in glandular tissues.
E. They are associated with smoking but can also occur in non-smokers.
F. They typically manifest as skin lesions.
A, C, D, and E
Skin Care
What should we tell are patients who are receiving external radiation?
Skin Care:
Avoid creams, lotions, deodorants, perfumes, and talcum powder in the treatment area.
Use lukewarm water to cleanse the area.
Avoid tape on the treated area.
Protect the area from exposure to cold or sunlight.
What should healthcare works in the radiation department wear?
A dosimeter badge to monitor radiation exposure.
A client is undergoing external radiation therapy to the chest. Indicate whether the following actions are appropriate (Yes) or inappropriate (No) for skin care in the treated area.
Applying a fragrance-free lotion
Cleansing the area with lukewarm water
Using tape to secure a dressing over the area
Exposing the treated area to sunlight
Leaving the radiation markings intact
Applying a fragrance-free lotion NO
Cleansing the area with lukewarm water YES
Using tape to secure a dressing over the area NO
Exposing the treated area to sunlight NO
Leaving the radiation markings intact YES
Prioritization - Brachytherapy Safety
A client is receiving brachytherapy. Which nursing actions are the HIGHEST priority? Rank in order of priority (most important first).
A. Educating the client about potential side effects.
B. Limiting visitor time and distance.
C. Ensuring a lead container and long forceps are in the room.
D. Administering anti-emetics for nausea.
- C. Ensuring a lead container and long forceps are in the room. (This is crucial for safety in case of implant dislodgement.)
- B. Limiting visitor time and distance. (Reduces radiation exposure to others.)
- A. Educating the client about potential side effects. (Important, but safety takes precedence.)
- D. Administering anti-emetics for nausea. (Manages symptoms, but not the highest priority in terms of radiation safety.)
A nurse is caring for a client with a sealed radiation implant. Which of the following actions is MOST important for the nurse to take to minimize radiation exposure?
A. Wear a lead apron when in the room.
B. Limit the time spent in the client’s room.
C. Encourage the client to ambulate frequently.
D. Keep the head of the bed elevated at 45 degrees.
B. Limit the time spent in the client’s room.
What type of foods should the nurse emphasize the importance of in cancer patients?
Protein: Essential for tissue repair and immune function. Good sources include lean meats, poultry, fish, eggs, beans, and nuts.
Fruits and Vegetables: Provide vitamins, minerals, and antioxidants. Aim for a variety of colors. (cooked)
Whole Grains: Offer fiber and complex carbohydrates for energy. Choose whole-wheat bread, brown rice, and quinoa.
Healthy Fats: Support cell growth and hormone production. Include sources like avocados, nuts, seeds, and olive oil.
A client undergoing chemotherapy is experiencing nausea and loss of appetite. Indicate whether the following interventions are appropriate (Yes) or inappropriate (No).
Encourage the client to eat three large meals a day
Suggest trying ginger ale or crackers for nausea
Advise the client to avoid spicy or greasy foods
Recommend drinking plenty of fluids between meals
Suggest using a mouthwash with alcohol for sores
Encourage the client to eat three large meals a day NO
Suggest trying ginger ale or crackers for nausea YES
Advise the client to avoid spicy or greasy foods YES
Recommend drinking plenty of fluids between meals YES
Suggest using a mouthwash with alcohol for sores NO
Prioritization - Nutritional Needs
A client is receiving radiation therapy to the head and neck area. Which nutritional needs should the nurse prioritize? Rank in order of priority (most important first).
A. Maintaining adequate hydration
B. Ensuring sufficient protein intake
C. Managing taste changes
D. Addressing potential swallowing difficulties
- A. Maintaining adequate hydration (Hydration is crucial, especially with radiation to this area)
- D. Addressing potential swallowing difficulties (Radiation to the head and neck can impact swallowing)
- B. Ensuring sufficient protein intake (Important for healing and energy, but hydration and swallowing take precedence)
- C. Managing taste changes (Can affect appetite, but not as critical as the other needs)
A nurse is providing discharge instructions to a client who has completed cancer treatment. Which of the following statements by the client indicates a need for further education regarding diet?
A. “I will focus on eating a variety of fruits and vegetables.”
B. “I will make sure to include a good source of protein at each meal.”
C. “I will avoid drinking fluids with my meals to prevent feeling full too quickly.”
D. “I will check with my doctor before taking any vitamin or mineral supplements.”
C. “I will avoid drinking fluids with my meals to prevent feeling full too quickly.”
What are the purposes of chemotherapy?
Curative: To eliminate the cancer and achieve a cure.
Control: To shrink the tumor and/or slow its growth, even if a cure isn’t possible.
Palliative: To relieve symptoms caused by the cancer and improve quality of life.
How is chemotherapy dosage calculated?
Carefully calculated based on factors like body surface area, type of cancer, and the patient’s overall health.
Extravasation: This occurs when chemotherapy leaks out of the vein and into surrounding tissues, causing damage.
Hypersensitivity Reactions: Allergic reactions to chemotherapy drugs can occur, ranging from mild to severe (anaphylaxis).
What are some common side effects of chemotherapy?
Bone marrow suppression: Decreased production of blood cells (red blood cells, white blood cells, platelets), leading to anemia, increased risk of infection, and bleeding problems.
Nausea and vomiting:
Mucositis: Inflammation of mucous membranes, causing mouth sores.
Alopecia: Hair loss.
Fatigue
Other side effects: Can vary depending on the specific drug and the pt.
Prioritization - Managing Chemotherapy Side Effects
A client is receiving chemotherapy and is experiencing nausea, vomiting, and mucositis. Which nursing actions are the HIGHEST priority? Rank in order of priority (most important first).
A. Administering antiemetics as prescribed.
B. Assessing the client’s oral mucosa.
C. Encouraging the client to eat small, frequent meals.
D. Providing emotional support and reassurance.
- A. Administering antiemetics as prescribed. (Controlling nausea and vomiting is crucial for patient comfort and preventing complications.)
- B. Assessing the client’s oral mucosa. (Mucositis can lead to serious complications if not managed.)
- C. Encouraging the client to eat small, frequent meals. (Helps manage nausea and maintain nutrition.)
- D. Providing emotional support and reassurance. (Important, but physical needs take precedence.)
A nurse is administering chemotherapy intravenously. The client reports pain at the insertion site, and the nurse notices swelling and redness. What is the nurse’s FIRST action?
A. Slow down the infusion rate.
B. Apply a warm compress to the area.
C. Stop the infusion immediately.
D. Administer an antihistamine.
C. Stop the infusion immediately.
What are some common chemotherapy toxicities?
Gastrointestinal:
Manifestations: Nausea, vomiting, diarrhea, constipation, mucositis (inflammation of the mucous membranes), anorexia (loss of appetite), and weight loss.
Hematopoietic (Bone Marrow Suppression):
Manifestations: Anemia (low red blood cells), neutropenia (low white blood cells), and thrombocytopenia (low platelets).
Renal:
Manifestations: Decreased kidney function, electrolyte imbalances, and potential kidney damage.
Cardiopulmonary:
Manifestations: Can vary depending on the specific drug. Some drugs can damage the heart (cardiotoxicity) or lungs (pulmonary toxicity).
Reproductive:
Manifestations: Infertility (both male and female) and potential harm to a developing fetus if pregnant.
Neurologic:
Manifestations: Peripheral neuropathy (numbness, tingling, pain in hands and feet), cognitive changes (“chemo brain”), and seizures (less common).
Cognitive
Manifestations: Difficulty with memory, concentration, and multitasking.
Fatigue:
Manifestations: Persistent and overwhelming tiredness that is not relieved by rest.
What labs should the nurse mointor when Managing in chemotherapy?
CBC (Complete Blood Count):
BUN (Blood Urea Nitrogen) and Creatinine
Bone Marrow Suppression: Chemotherapy can damage bone marrow, leading to decreased production of blood cells:
Thrombocytopenia (Low Platelets): Increases risk of bleeding.
Neutropenia (Low White Blood Cells): Increases risk of infection.
Anemia (Low Red Blood Cells): Causes fatigue and shortness of breath.
How can the nurse modify the risks of infection & bleeding that come with chemotherapy?
Infection: Implement neutropenic precautions (hand hygiene, avoiding crowds, etc.) to minimize infection risk.
Bleeding: Monitor for signs of bleeding (bruising, nosebleeds, gum bleeding) and take precautions to prevent falls or injuries.
A nurse is providing discharge instructions to a client who has received chemotherapy. Which statement by the client indicates a need for further education?
A. “I will call the doctor if I have a fever over 100.4°F (38°C).”
B. “I will avoid crowded places to reduce my risk of infection.”
C. “I will use a soft toothbrush and avoid flossing.”
D. “I will take aspirin for my headache.”
D. “I will take aspirin for my headache.”
Goals of curative chemotherapy? What types of cancer are most responsive?(6)
Goal: To completely eradicate the cancer and achieve long-term remission or a cure.
Cancers Often Responsive:
* Burkitt’s lymphoma
* Wilms’ tumor
* Neuroblastoma
* Acute lymphocytic leukemia (ALL)
* Hodgkin’s lymphoma
* Testicular cancer
Goals of controlive chemotherapy? What cancers is control often the focus of? (4)
Goal: To stop cancer growth and/or spread, prolonging life and improving quality of life, even if a complete cure is not achievable.
Cancers Where Control is Often the Focus:
* Breast cancer
* Non-Hodgkin’s lymphoma
* Small cell lung cancer
* Ovarian cancer
Goals of palliation chemotherapy? What are the main focuses? (4)
Goal: To alleviate symptoms and improve quality of life in cases where the cancer is advanced and not curable.
Focus:
* Relieve pain
* Relieve obstruction
* Improve the sense of well-being
A client undergoing chemotherapy for ovarian cancer experiences severe nausea and vomiting. The healthcare provider prescribes an antiemetic medication. Which of the following potential outcomes of chemotherapy align with the overall goal of “palliation” in this client’s situation? Select all that apply.
A. Eradication of all cancer cells
B. Shrinking of the tumor
C. Relief of nausea and vomiting
D. Improvement in the client’s sense of well-being
E. Prolongation of life by several years
C. Relief of nausea and vomiting
D. Improvement in the client’s sense of well-being
A patient is receiving chemotherapy for Burkitt’s lymphoma. What is the expected outcome of this treatment?
Cure of the cancer
A patient with advanced lung cancer is receiving chemotherapy. The primary goal of the treatment in this scenario is most likely:
A. To eradicate the cancer completely.
B. To slow the growth of the cancer and alleviate symptoms.
C. To prevent the cancer from recurring in the future.
D. To boost the patient’s immune system to fight the cancer.
B. To slow the growth of the cancer and alleviate symptoms.
Bone Marrow Suppression
Match the therapy with the type of effect.
System Effect & Localized Effect
Radiation & Chemotherapy
Bone marrow suppression, also known as myelosuppression, is a common and significant side effect of chemotherapy (and sometimes radiation). It occurs because these treatments target rapidly dividing cells, including those in the bone marrow responsible for producing blood cells.
Systemic Effect: Chemotherapy’s impact on bone marrow is systemic, affecting blood cell production throughout the body.
Localized Effect: Radiation’s impact is more localized, affecting bone marrow within the treatment field.
What are some serious consequences to bone marrow suppression?
Bone marrow suppression can lead to life-threatening complications, including hemorrhage (bleeding) and overwhelming infection due to a weakened immune system. Profound fatigue also results from anemia.
What mointoring is crucial with bone marrow suppression?
CBC Monitoring: Regular monitoring of the Complete Blood Count (CBC) is crucial, paying close attention to:
Neutrophils (a type of white blood cell): Low neutrophils (neutropenia) significantly increase the risk of infection.
Platelets: Low platelets (thrombocytopenia) increase the risk of bleeding.
Red Blood Cells (RBCs): Low RBCs (anemia) cause fatigue and reduce oxygen-carrying capacity.
Timing of Lowest Counts (Nadir): Blood cell counts often reach their lowest point (nadir) 7-10 days after starting chemotherapy. This is important to anticipate and plan care.
What are some types of nursing interventions that should be set in place for pts with bone marrow suppression? (4)
List some methods for each type.
Infection Prevention: Implement neutropenic precautions (strict hand hygiene, avoid crowds and sick individuals, meticulous personal hygiene).
Bleeding Precautions: Monitor for signs of bleeding (bruising, petechiae, nosebleeds, gum bleeding, blood in stool or urine), avoid invasive procedures if possible, and handle patients gently.
Fatigue Management: Encourage rest, prioritize activities, assist with daily tasks, and address underlying anemia if present.
Patient Education: Teach patients about the signs and symptoms of infection, bleeding, and anemia, and when to report them to the healthcare provider.
Prioritization - Nursing Care for Myelosuppression
A client receiving chemotherapy has a WBC count of 2,500 cells/mm3 (normal range: 4,500-11,000 cells/mm3), a platelet count of 90,000 cells/mm3 (normal range: 150,000-400,000 cells/mm3), and a hemoglobin level of 9 g/dL (normal range: 12-16 g/dL). Which nursing actions should be prioritized? Rank in order of priority (most important first).
A. Encouraging rest periods and assisting with activities.
B. Monitoring for signs of bleeding.
C. Administering blood transfusions as ordered.
D. Implementing neutropenic precautions.
D. Implementing neutropenic precautions. (Risk for infection due to low WBC count is the highest priority.)
B. Monitoring for signs of bleeding. (Risk for bleeding due to low platelet count is the next highest priority.)
A. Encouraging rest periods and assisting with activities. (Important for managing fatigue due to anemia, but infection and bleeding risks are more immediate.)
C. Administering blood transfusions as ordered. (May be necessary to treat severe anemia, but not an immediate action unless the anemia is symptomatic or life-
What is neutropenia?
Neutropenia, a low count of neutrophils (a type of white blood cell), is a serious risk factor for life-threatening infection and sepsis. This is especially critical in patients undergoing cancer treatment, as their bone marrow may be suppressed.
Definition: A condition in which the Absolute Neutrophil Count (ANC) is less than 1000 cells/μL.
Severe Neutropenia: ANC less than 500 cells/μL.
Risk: High risk for infection and death from sepsis.
What are 2 of the high risk for neutropenia?
- Infection Risk: Neutropenia significantly impairs the immune system, making individuals highly susceptible to bacterial, fungal, and even viral infections. What might be a minor infection in someone with a healthy immune system can quickly become life-threatening in a neutropenic patient.
- Sepsis Risk: Sepsis, a severe and potentially fatal reaction to infection, is a major concern in neutropenic patients.
What is crucial to monitor in neutropenic patients?
Temperature Monitoring: Routine temperature monitoring is essential. A fever in a neutropenic patient is considered a medical emergency and requires immediate intervention.
Pt. should report any temp change immediately.
What are some infection prevention measures that should be taken with neutropenic patients?
4
- Hand Hygiene: Strict and frequent hand hygiene by healthcare providers, patients, and visitors is paramount.
- Reverse Isolation: This may include measures like limiting visitors, prohibiting fresh fruits, vegetables, and flowers (which can harbor bacteria or mold), and ensuring a clean environment.
- WBC Growth Factors: Medications like Filgrastim (Neupogen) may be used to stimulate the bone marrow to produce more neutrophils.
- Avoidance of Crowds and Sick Individuals: Patients should be educated to avoid crowds and contact with people who have colds, flu, or other infections.
What are some nursing interventions for neutropenia?
Early Detection: Promptly recognize signs and symptoms of infection (fever, chills, redness, swelling, drainage, cough, sore throat).
Immediate Reporting: Report any temperature elevation immediately to the healthcare provider.
Infection Prevention: Implement all prescribed infection control measures diligently.
Patient Education: Educate patients and their families/visitors about the risks of infection, preventive measures, and the importance of prompt reporting of any signs of illness.
A client with neutropenia is at high risk for infection. Indicate whether the following nursing actions are appropriate (Yes) or inappropriate (No).
1. Encourage frequent hand washing by the client
2. Allow fresh flowers in the room
Monitor temperature every 4 hours
3. Administer Filgrastim (Neupogen) as ordered
4. Encourage the client to eat raw fruits & veggies
- Encourage frequent hand washing by the client YES
- Allow fresh flowers in the room NO
Monitor temperature every 4 hours YES - Administer Filgrastim (Neupogen) as ordered YES
- Encourage the client to eat raw fruits & veggies NO
Prioritization - Managing Neutropenia
A client with neutropenia has a temperature of 100.8°F (38.2°C). Which nursing actions are the HIGHEST priority? Rank in order of priority (most important first).
A. Administering antibiotics as prescribed.
B. Notifying the healthcare provider immediately.
C. Implementing neutropenic precautions.
D. Obtaining cultures (blood, urine, sputum) as ordered.
- B. Notifying the healthcare provider immediately. (A fever in a neutropenic patient is a medical emergency.)
- A. Administering antibiotics as prescribed. (Prompt treatment is crucial once the provider is notified.)
- D. Obtaining cultures (blood, urine, sputum) as ordered. (To identify the source of the infection.)
- C. Implementing neutropenic precautions. (These should already be in place, but if not, they are important to initiate.)
A nurse is providing discharge instructions to a client with neutropenia. Which statement by the client indicates a need for further teaching?
A. “I will avoid fresh fruits and vegetables.”
B. “I will take my temperature daily.”
C. “I will avoid contact with people who have colds or the flu.”
D. “I will take my temperature once a week.”
D. “I will take my temperature once a week.”
What is thrombocytopenia?
Thrombocytopenia, a low platelet count, is a common side effect of cancer treatment, particularly chemotherapy. Platelets are essential for blood clotting, so a deficiency can lead to serious bleeding problems.
Definition: Platelet counts below 100,000/μL.
Spontaneous Hemorrhage Risk: Possible once counts fall below 10,000/μL.
Spontaneous Bleeding/Hemorrhage: Severe thrombocytopenia can result in spontaneous bleeding, such as nosebleeds, gum bleeding, or internal bleeding. Major hemorrhage is a life-threatening complication.
What is the platelet counts indicate bleeding risk and a need for platelet transfusion?
Bleeding Risk Threshold: The risk of bleeding generally increases significantly when the platelet count falls below 50,000/μL.
Platelet Transfusions: Platelet transfusions may be necessary to prevent or treat bleeding, particularly when the platelet count falls below 20,000/μL or if the patient is actively bleeding.
What are some nursing interventions for thrombocytopenia?
Monitor Platelet Count
Assess for Bleeding: Frequently assess for any signs of bleeding, including petechiae (small red spots), bruising, nosebleeds, gum bleeding, hematuria (blood in urine), melena (blood in stool), or heavy menstrual bleeding.
Implement Bleeding Precautions:
Use a soft-bristled toothbrush, Avoid IM injections, rectal temperatures, and enemas, Handle patients gently, Minimize blood draws., & Instruct patients to avoid activities that could cause injury.
Patient Education: Educate patients and families about the signs and symptoms of bleeding, when to report them to the healthcare provider, and safety measures to prevent bleeding.
Invasive Procedures: Invasive procedures, like injections or biopsies, should be avoided whenever possible to minimize the risk of bleeding.
Activities to Avoid: Patients should be taught to avoid activities that could increase their risk of injury or bleeding, including contact sports, vigorous exercise, and straining during bowel movements.
Prioritization - Managing Thrombocytopenia
A client receiving chemotherapy has a platelet count of 40,000/μL. Which nursing actions are the HIGHEST priority? Rank in order of priority (most important first).
A. Assessing for signs of active bleeding.
B. Instructing the client to avoid activities that could cause injury.
C. Administering a platelet transfusion as ordered.
D. Educating the client about the signs and symptoms of bleeding.
- A. Assessing for signs of active bleeding. (Active bleeding requires immediate intervention.)
- C. Administering a platelet transfusion as ordered. (May be necessary if the platelet count is very low or if the patient is actively bleeding.)
- B. Instructing the client to avoid activities that could cause injury. (Important for preventing bleeding, but assessment and treatment of active bleeding take priority.)
- D. Educating the client about the signs and symptoms of bleeding. (Important for ongoing self-care, but immediate assessment and interventions are higher priorities.)
A nurse is caring for a client with a platelet count of 15,000/μL. Which of the following actions should the nurse anticipate?
A. Administering a unit of packed red blood cells.
B. Preparing the client for a platelet transfusion.
C. Implementing neutropenic precautions.
D. Monitoring for signs of infection.
B. Preparing the client for a platelet transfusion.
What is Hematopoietic Stem Cell Transplantation (HSCT)?
HSCT is a procedure that replaces damaged or destroyed blood-forming stem cells with healthy ones. These stem cells can come from the bone marrow, peripheral blood, or umbilical cord blood.
Uses of HSCT:
Malignant Diseases: Leukemia, Lymphoma, &Multiple myeloma
Non-Malignant Diseases:
Aplastic anemia, Thalassemia, & Sickle cell anemia
Risks: HSCT has significant risks, including infection, bleeding, anemia, graft-versus-host disease (in allogeneic transplants), and even death.
**Nursing Care: **Nurses play a crucial role in patient education, managing side effects, preventing complications, and providing emotional support throughout the HSCT process.
Hematopoietic Stem Cell Transplantation (HSCT)
What is Allogeneic?
Stem cells are donated from another person (a donor). The donor is usually a close relative (like a sibling) but can also be an unrelated person.
Matching: For allogeneic transplants, the donor’s tissue type needs to be closely matched to the recipient’s to reduce the risk of complications like graft-versus-host disease (GVHD).
Hematopoietic Stem Cell Transplantation (HSCT)
What is Autologous?
Stem cells are collected from the patient’s own body before treatment (like chemotherapy or radiation) and then transplanted back.
Hematopoietic Stem Cell Transplantation (HSCT)
What is syngeneic?
Stem cells are donated from an identical twin
Hematopoietic Stem Cell Transplantation (HSCT)
What is Myeloablative?
High doses of chemotherapy and/or radiation are given before transplant to kill cancer cells and bone marrow. This allows the new stem cells to engraft but has significant risks.
Hematopoietic Stem Cell Transplantation (HSCT)
What is Nonmyeloblative?
Lower doses of chemotherapy and/or radiation are given. This approach may be better tolerated but may be associated with a higher risk of relapse in some cancers.
Prioritization - Post-HSCT Complications
A client is 10 days post-allogeneic HSCT. Which of the following potential complications should the nurse prioritize in their assessment? Rank in order of priority (most important first).
A. Providing emotional support and addressing anxiety.Monitoring for signs and symptoms of infection.
B. Monitoring for signs and symptoms of infection.
C. Managing pain and fatigue.
D. Assessing for skin changes suggestive of graft-versus-host disease (GVHD).
B. Monitoring for signs and symptoms of infection. (Infection is a major and potentially life-threatening complication in the immediate post-transplant period due to immunosuppression.)
D. Assessing for skin changes suggestive of graft-versus-host disease (GVHD). (GVHD is a significant risk in allogeneic transplants and often presents with skin manifestations.)
C. Managing pain and fatigue. (Important for comfort and quality of life, but infection and GVHD take priority.)
A. Providing emotional support and addressing anxiety. (Essential for overall well-being, but physical complications are the priority.)
Which of the following BEST describes a myeloablative conditioning regimen before HSCT?
A. It uses lower doses of chemotherapy and/or radiation.
B. It is associated with a lower risk of graft-versus-host disease.
C. It aims to completely destroy the patient’s bone marrow.
D. It is typically used for autologous HSCT.
C. It aims to completely destroy the patient’s bone marrow.
Prioritization - Pre-HSCT Evaluation
A client is being evaluated for HSCT. Which assessments/diagnostic tests should the nurse prioritize in this evaluation process? Rank in order of priority (most important first).
A. Assessing the client’s emotional and psychological status.
B. Tissue typing and crossmatching for potential donors.
C. Obtaining a detailed medical history, including past infections and treatments.
D. Evaluating the client’s understanding of the HSCT procedure and potential risks.
- B. Tissue typing and crossmatching for potential donors. (Essential for allogeneic HSCT, which is a common type.)
- C. Obtaining a detailed medical history, including past infections and treatments. (Identifies potential risks and complications.)
- A. Assessing the client’s emotional and psychological status. (Important for support and coping, but physical factors take precedence.)
- D. Evaluating the client’s understanding of the HSCT procedure and potential risks. (Important for informed consent, but physical assessments are the priority.)
What is the steps to autologous hematopoietic stem cell transplantation (HSCT)? (6)
- Harvest Stem Cells or Bone Marrow
- Treat Stem Cells or Bone Marrow
- Chemotherapy
- Patient’s Remaining Bone Marrow and Cancer Cells are Destroyed.
- IV Injection of Purified Stem Cells
- Stem Cells “Home” to Bone Marrow and Produce New Blood Cells
What is Graft-versus-Host Disease (GVHD)?
GVHD is a serious complication that can occur after an allogeneic hematopoietic stem cell transplant (HSCT), where a patient receives stem cells from a donor.
Immune Response: GVHD happens when the donor’s T lymphocytes (a type of white blood cell) recognize the recipient’s tissues as foreign and attack them.
Target Organs: The most commonly affected organs are the skin, gastrointestinal tract, and liver.
What are some symptoms of GVHD?
Skin: Rash, itching, redness, blistering
Gastrointestinal: Nausea, vomiting, diarrhea, abdominal pain
Liver: Jaundice, elevated liver enzymes
What are the treatment and prevention methods for GVHD?
Prevention: Immunosuppressant drugs, such as cyclosporine, are given to prevent GVHD.
Treatment: Treatment for GVHD often involves corticosteroids and other immunosuppressive medications.
What are some nursing considerations for GVHD?
Assessment: Monitor patients closely for signs and symptoms of GVHD, especially skin changes, gastrointestinal symptoms, and liver function abnormalities.
Patient Education: Educate patients about the risk of GVHD, signs and symptoms to watch for, and the importance of reporting any changes promptly.
Medication Management: Administer immunosuppressant medications as prescribed and monitor for side effects.
Supportive Care: Provide supportive care to manage symptoms, such as skin care for rashes, antiemetics for nausea, and nutritional support for diarrhea.
Prioritization - Managing Acute GVHD
Scenario: A client post-allogeneic HSCT develops a skin rash, diarrhea, and elevated liver enzymes within the first 100 days. Which nursing actions are the HIGHEST priority? Rank in order of priority (most important first).
A. Administering immunosuppressive medications as prescribed.
B. Monitoring the client’s skin for changes and providing skin care.
C. Assessing the frequency and severity of diarrhea and managing fluid balance.
D. Educating the client about the signs and symptoms of GVHD.
- A. Administering immunosuppressive medications as prescribed. (Essential to suppress the immune response causing GVHD.)
- C. Assessing the frequency and severity of diarrhea and managing fluid balance. (Diarrhea can lead to dehydration and electrolyte imbalances.)
- B. Monitoring the client’s skin for changes and providing skin care. (Important for comfort and preventing infection, but immunosuppression and diarrhea take priority.)
- D. Educating the client about the signs and symptoms of GVHD. (Important for long-term management, but immediate interventions are the priority.)
Which medication is MOST commonly used to prevent GVHD after allogeneic HSCT?
A. Cyclosporine
B. Filgrastim
C. Ondansetron
D. Loperamide
A. Cyclosporine
What is some nursing management in HSCT for the 1st step of Implementing Pre-Transplantation Care?
Assessment: Thorough physical and psychosocial assessment of the recipient.
Education: Educate the recipient and family about the HSCT process, risks, benefits, and expected outcomes.
Preparation: Prepare the recipient for the conditioning regimen (chemotherapy and/or radiation), which may include administering medications, ensuring hydration, and managing side effects.
Donor Evaluation (Allogeneic): In allogeneic transplants, assess the donor’s eligibility and ensure informed consent.
What is some nursing management in HSCT for the 2nd step of Providing Care During Treatment?
Monitoring: Closely monitor the recipient for complications related to the conditioning regimen, such as infection, bleeding, mucositis, nausea/vomiting, and fatigue.
Supportive Care: Provide supportive care to manage side effects and complications, including administering medications, providing nutritional support, and managing pain.
Protecting Recipient: Implement measures to prevent infection and bleeding, especially during periods of low blood cell counts (neutropenia and thrombocytopenia).
Emotional Support: Provide emotional and psychosocial support to both the recipient and family throughout the transplant process.
What is some nursing management in HSCT for the 3rd step of Providing Post-Transplantation Care?
Monitoring for Engraftment: Monitor for signs of engraftment (when the transplanted stem cells start producing blood cells).
Managing Complications: Manage post-transplant complications, such as infection, graft-versus-host disease (GVHD), and organ toxicity.
Patient Education: Educate the recipient about long-term follow-up care, potential late effects, and strategies for maintaining health and well-being.
Donor Follow-up (Allogeneic): In allogeneic transplants, ensure appropriate follow-up care for the donor.
Caring for Recipients vs. Caring for Donors:
Recipients: Focus is on managing complications, supporting recovery, and achieving long-term health.
Donors: Focus is on ensuring their safety during the donation process and monitoring their health post-donation.
Prioritization - Post-Transplant Assessments
A client is 7 days post-allogeneic HSCT. Which assessments should the nurse prioritize? Rank in order of priority (most important first).
A. Assessing for signs and symptoms of infection.
B. Monitoring for signs of engraftment (rising blood cell counts).
C. Evaluating the client’s emotional state and coping mechanisms.
D. Assessing for signs and symptoms of graft-versus-host disease (GVHD).
- A. Assessing for signs and symptoms of infection. (Risk of infection is highest in the immediate post-transplant period.)
- B. Monitoring for signs of engraftment (rising blood cell counts). (Engraftment is crucial for recovery and indicates the transplant’s success.)
- D. Assessing for signs and symptoms of graft-versus-host disease (GVHD). (GVHD is a significant risk in allogeneic transplants.)
- C. Evaluating the client’s emotional state and coping mechanisms. (Important, but physical needs take priority.)
A nurse is providing discharge instructions to a client who has undergone HSCT. Which statement by the client indicates a need for further education?
A. “I will need to continue to follow neutropenic precautions at home.”
B. “I should expect to feel fatigued for several weeks or months after the transplant.”
C. “I will avoid contact with anyone who has a cold or infection.”
D. “I can resume all my normal activities as soon as I get home.”
D. “I can resume all my normal activities as soon as I get home.”
Notes on Nursing Care: Maintaining Tissue Integrity in Cancer Patients
What is stomatitis?
Inflammation of the oral mucosa, often a side effect of chemotherapy and radiation therapy.
Nursing Interventions:
* Regular oral assessments
* Gentle oral hygiene (soft toothbrush, non-alcoholic mouthwash)
* Pain management (topical anesthetics, systemic analgesics)
* Dietary modifications (avoid spicy, acidic, or hot foods)
* Patient education on oral care
Notes on Nursing Care: Maintaining Tissue Integrity in Cancer Patients
What is alopecia?
Hair loss, often a side effect of chemotherapy.
Nursing Interventions:
* Emotional support and counseling
* Education about the temporary nature of hair loss
* Suggestions for coping (wigs, scarves)
* Scalp care to prevent irritation
A client is experiencing stomatitis due to chemotherapy. Indicate whether the following interventions are appropriate (Yes) or inappropriate (No).
- Encourage the use of an alcohol-based mouthwash
- Offer soft, bland foods
- Apply a topical anesthetic to oral lesions
- Suggest the client brush their teeth vigorously
- Recommend the client drink hot liquids
- Encourage the use of an alcohol-based mouthwash NO
- Offer soft, bland foods YES
- Apply a topical anesthetic to oral lesions YES
- Suggest the client brush their teeth vigorously NO
- Recommend the client drink hot liquids NO
Prioritization - Skin Care for Radiation Therapy
A client is undergoing radiation therapy to the chest. Which nursing actions are the HIGHEST priority regarding skin care in the treatment area? Rank in order of priority (most important first).
A. Instructing the client to avoid using any lotions or creams on the treated skin.
B. Assessing the skin for signs of redness, blistering, or breakdown.
C. Educating the client about the potential for long-term skin changes.
D. Encouraging the client to wear loose-fitting, cotton clothing.
- B. Assessing the skin for signs of redness, blistering, or breakdown. (Early detection of skin reactions is crucial for prompt intervention.)
- A. Instructing the client to avoid using any lotions or creams on the treated skin. (This is important to prevent skin irritation during radiation therapy.)
- D. Encouraging the client to wear loose-fitting, cotton clothing. (This helps minimize friction and irritation.)
- C. Educating the client about the potential for long-term skin changes. (Important for the client to know, but immediate skin care needs take precedence.)
A client undergoing chemotherapy is experiencing alopecia. Which nursing action is MOST appropriate?
A. Reassure the client that hair loss is permanent.
B. Encourage the client to avoid talking about their hair loss.
C. Suggest the client wear a wig or head covering if desired.
D. Instruct the client to wash their hair daily with a gentle shampoo.
C. Suggest the client wear a wig or head covering if desired.
Instructions: A client with cancer is experiencing anorexia and malabsorption. Indicate whether the following interventions are appropriate (Yes) or inappropriate (No).
- Encourage large, infrequent meals
- Offer small, frequent meals
- Provide high-calorie, high-protein foods
- Restrict fluids to minimize feelings of fullness
- Collaborate with a registered dietitian
- Encourage large, infrequent meals NO
- Offer small, frequent meals YES
- Provide high-calorie, high-protein foods YES
- Restrict fluids to minimize feelings of fullness NO
- Collaborate with a registered dietitian YES
Prioritization - Managing Cancer-Related Fatigue
A client with cancer is experiencing significant fatigue. Which nursing actions should be prioritized? Rank in order of priority (most important first).
A. Encouraging rest periods and energy conservation techniques.
B. Assessing for contributing factors such as anemia or pain.
C. Discussing the impact of fatigue on the client’s quality of life.
D. Recommending a vigorous exercise program to combat fatigue.
- B. Assessing for contributing factors such as anemia or pain. (Addressing underlying causes is crucial.)
- A. Encouraging rest periods and energy conservation techniques. (Helps manage fatigue.)
- C. Discussing the impact of fatigue on the client’s quality of life. (Important for emotional support and planning care.)
- D. Recommending a vigorous exercise program to combat fatigue. (Exercise can be beneficial, but it should be moderate and tailored to the individual’s energy levels.)
A client with cancer is experiencing mucositis and has difficulty eating. Which dietary modification is MOST appropriate?
A. Serving hot, spicy foods.
B. Offering foods high in citric acid (e.g., orange juice).
C. Providing soft, bland foods at room temperature.
D. Encouraging the use of a straw for all beverages.
C. Providing soft, bland foods at room temperature.
Palliative Care
Focus?
Timing?
Life Expectancy?
Covered by?
Treatment?
Focus: Provides relief from the symptoms and stress of a serious illness. The goal is to improve quality of life for both the patient and the family.
Timing: Can be provided at any stage of a serious illness, alongside curative treatment.
Life Expectancy: Not tied to a specific life expectancy.
Covered by: Traditional medical insurance or Medicare.
Treatment: Can involve more aggressive treatment of symptoms without compromising quality of life.
Hospice Care
Focus?
Timing?
Life Expectancy?
Covered by?
Treatment?
Focus: Provides comfort care for patients with a terminal illness when a cure is no longer possible.
Timing: Elegible when a physician certifies that life expectancy is 6 months or less if the illness runs its normal course.
Life Expectancy: Requires a limited life expectancy of 6 months or less.
Covered by: Medicare, Medicaid, and most private insurers.
Treatment: Focuses on managing pain and other symptoms to allow the patient to die with dignity.
Timely Referral: Patients should be referred to hospice in a timely fashion to maximize the benefits of care.
Comprehensive Approach: Hospice care involves a multidisciplinary team (doctors, nurses, social workers, chaplains, aides, volunteers).
Focus Areas:
Quality of life
Palliation of symptoms
Psychosocial and spiritual care for the patient and family.
What are some shared aspects of palliative & hospice care?
Quality of Life: Both emphasize improving quality of life.
Emotional, Physical, and Spiritual Support: Both provide holistic support for patients and families.
What is hematology?
The study of blood and blood-forming tissues.
Includes bone marrow, blood, spleen, and lymph system.
What are the 2 types of bone marrow?
Yellow (adipose) - inactive in blood cell production.
Red (hematopoietic) - actively produces blood cells.
Red blood cells (RBCs), white blood cells (WBCs), and platelets develop from a common hematopoietic stem cell in the bone marrow.
The bone marrow uses a negative feedback system to regulate blood cell production based on the body’s needs.
Prioritization - Blood Cell Production
The body needs more red blood cells due to chronic blood loss. Which action should the bone marrow prioritize? Rank in order of priority (most important first).
A. Increasing platelet production.
B. Increasing red blood cell production.
C. Increasing white blood cell production.
- B. Increasing red blood cell production. (The body has a specific need for more RBCs.)
- C. Increasing white blood cell production. (Important for immune function, but not the immediate priority.)
- A. Increasing platelet production. (Also important, but not the immediate priority.)
What is hemostasis?
Hemostasis:
The arrest of bleeding.
A complex process involving multiple factors and steps.
Hemostasis involves both platelet and coagulation factors.
The process is tightly regulated to ensure clot formation only when needed and to prevent excessive clotting.
- Vascular Injury and Subendothelial Exposure: Damage to a blood vessel leads to a brief vasoconstrictive response (narrowing of the vessel) to reduce blood flow. The underlying tissue (subendothelium) is exposed.
- Adhesion: Platelets adhere to the exposed subendothelium.
This process is aided by adhesive glycoproteins like collagen and von Willebrand factor (vWF). - Activation:Platelets are activated, changing shape and becoming sticky.
They release factors that promote further platelet activation and aggregation. - Aggregation: Activated platelets clump together, forming a platelet plug.
This process is reinforced by the formation of fibrin strands, creating a visible fibrin clot. - Platelet Plug Formation: The initial platelet plug is stabilized by the fibrin clot, forming the final blood clot.
- Clot Retraction and Dissolution: The clot retracts, pulling the edges of the damaged vessel together.
The clot is eventually dissolved (fibrinolysis) to restore blood flow and prevent blockage.
Counter-mechanisms, such as anticoagulants and antithrombin activity, help keep blood in its fluid state and prevent excessive clotting.
A patient experiences a minor injury with some bleeding. Which step of hemostasis occurs first?
A. Platelet aggregation.
B. Vasoconstriction.
C. Fibrin clot formation.
B. Vasoconstriction.
Prioritization - Subjective Data for Thrombocytopenia
A client is being evaluated for possible thrombocytopenia (low platelet count). Which subjective data should the nurse prioritize collecting? Rank in order of priority (most important first).
A. Reports of easy bruising or prolonged bleeding.
B. History of recent infections or fever.
C. Description of fatigue or weakness.
D. Information about current medications or supplements.
- A. Reports of easy bruising or prolonged bleeding. (Directly related to thrombocytopenia.)
- D. Information about current medications or supplements. (Some can affect platelet function.)
- B. History of recent infections or fever. (Infections can sometimes cause thrombocytopenia.)
- C. Description of fatigue or weakness. (Can be present in thrombocytopenia but less specific than bleeding-related symptoms.)
A client who is a Jehovah’s Witness is scheduled for surgery. Which action by the nurse is MOST appropriate regarding the client’s religious beliefs and potential blood transfusions?
A. Assume the client will accept blood transfusion in a life-threatening situation.
B. Respect the client’s refusal of blood products and explore alternative treatment options.
C. Attempt to persuade the client to accept blood transfusion, as it is a life-saving procedure.
D. Inform the surgical team that the client’s religious beliefs should be disregarded in case of emergency.
B. Respect the client’s refusal of blood products and explore alternative treatment options.
What do each part of the complete blood count measure?
Hemoglobin
Hematocrit
Total RBC Count
RBC Morphology
Reticulocyte Count
WBC Count
Platelet Count
Hemoglobin (Hb): Measures the amount of hemoglobin in red blood cells (RBCs), which carries oxygen. Low levels indicate anemia.
Hematocrit (Hct): Measures the percentage of RBCs in the blood. Low levels also indicate anemia.
Total RBC Count (Erythrocyte Count): Measures the number of RBCs in a given volume of blood.
RBC Morphology: Examines the size, shape, and appearance of RBCs, which can provide clues to specific conditions.
Reticulocyte Count: Measures the number of young, immature RBCs (reticulocytes). Useful for assessing bone marrow’s response to anemia.
WBC Count: Measures the total number of white blood cells (WBCs) in the blood. Increased levels can indicate infection; decreased levels can indicate immune suppression.
WBC Differential: Measures the percentage of each type of WBC (neutrophils, lymphocytes, monocytes, eosinophils, basophils). Useful for diagnosing infections, allergies, and other conditions.
Platelet Count: Measures the number of platelets in the blood. Low levels increase the risk of bleeding.
What do the following clotting studies measure?
Activated Clotting Time (ACT)
Activated Partial Thromboplastin Time (aPTT)
Antithrombin
Bleeding Time
D-Dimer
Activated Clotting Time (ACT): Measures the time it takes for blood to clot under specific conditions. Used to monitor heparin therapy.
Activated Partial Thromboplastin Time (aPTT): Measures the time it takes for blood to clot via the intrinsic pathway. Used to monitor heparin therapy and detect clotting disorders.
Antithrombin: Measures the level of antithrombin, a natural anticoagulant. Deficiency increases the risk of clotting.
Bleeding Time: Measures the time it takes for bleeding to stop after a small puncture wound. Assesses platelet function.
D-Dimer: Measures the level of cross-linked fibrin, a product of clot breakdown. Elevated levels can indicate clotting disorders like DIC or DVT.
What do the following clotting studies measure?
Fibrinogen (Factor I)
International Normalized Ratio (INR)
Plasminogen
Prothrombin Time (PT)
Thrombin Time
Fibrinogen (Factor I): Measures the level of fibrinogen, a protein essential for clot formation. Low levels can increase the risk of bleeding.
International Normalized Ratio (INR): A standardized ratio calculated from the prothrombin time (PT). Used to monitor warfarin therapy.
Plasminogen: Measures the level of plasminogen, a protein that is converted to plasmin, which breaks down clots.
Prothrombin Time (PT): Measures the time it takes for blood to clot via the extrinsic pathway. Used to monitor warfarin therapy and assess liver function.
Thrombin Time: Measures the time it takes for fibrinogen to be converted to fibrin. Used to detect heparin and other clotting abnormalities.
A client’s hemoglobin level is 10 g/dL (normal range: 12-16 g/dL). Which condition is MOST likely indicated by this result?
A. Polycythemia (excess RBCs)
B. Anemia (low RBCs or hemoglobin)
C. Infection (elevated WBCs)
D. Thrombocytopenia (low platelets)
B. Anemia (low RBCs or hemoglobin)
What is pancytopenia?
A condition where the entire CBC is suppressed, resulting in a marked decrease in all three blood cell types:
* Red blood cells (RBCs)
* White blood cells (WBCs)
* Platelets
WBC Count > 10,000/μL:
Associated with infection, tissue injury or death, and certain cancers (leukemia, lymphoma).
Extremely High WBC Counts (e.g., > 25,000/μL):
Occur with certain types of leukemia.
WBC Count < 5,000/μL (Leukopenia):
Associated with bone marrow depression, severe or chronic illness, and other types of leukemia.
What is thrombocytosis?
Too many platelets
What is a more precise measure of infection risk than the total WBC count, as it specifically looks at neutrophils?
The absolute neutrophil count (ANC)
Prioritization - Managing Neutropenia
Scenario: A client has an ANC of 400 cells/μL. Which nursing actions should be prioritized? Rank in order of priority (most important first).
A. Implementing neutropenic precautions.
B. Monitoring for signs of infection.
C. Administering antibiotics as ordered.
D. Educating the client about infection prevention.
- A. Implementing neutropenic precautions. (Protecting the client from potential sources of infection is paramount.)
- B. Monitoring for signs of infection. (Early detection of infection is crucial in neutropenic patients.)
- C. Administering antibiotics as ordered. (Prompt treatment is necessary if infection develops.)
- D. Educating the client about infection prevention. (Important for self-care, but immediate interventions take precedence.)
At what platelet count does the risk of spontaneous hemorrhage significantly increase?
A. Below 100,000/μL
B. Below 50,000/μL
C. Below 20,000/μL
D. Below 10,000/μL
D. Below 10,000/μL
What is Leukemia?
A type of cancer that affects the blood-forming tissues, hindering the body’s ability to fight infection. Here’s what we know about its causes and development:
* No Single Cause: Leukemia doesn’t have one specific cause. It’s believed to develop from a combination of factors.
* Genetic and Environmental Influences: Both genetic predispositions and environmental exposures can increase the risk of developing leukemia.
* Oncogenes: Abnormal genes, called oncogenes, can contribute to the development of leukemia and other cancers. These genes normally regulate cell growth and division but can become disrupted.
Pathophysiology
leukemia involves the uncontrolled proliferation of abnormal blood cells, usually white blood cells (WBCs). These abnormal cells don’t function properly and crowd out healthy blood cells, leading to various complications like anemia, increased risk of infection, and bleeding problems.
What are some risk factors of leukemia?
Chemical Agents: Exposure to certain chemicals like benzene.
Chemotherapy Drugs: Ironically, some chemotherapy drugs used to treat other cancers can increase the risk of secondary leukemia.
Viruses: Certain viruses, such as the Epstein-Barr virus (EBV) and human T-cell leukemia virus (HTLV-1).
Radiation: Exposure to high levels of radiation.
Immunologic Factors: Weakened immune systems may increase the risk.
Which statement BEST describes the current understanding of leukemia development?
A. It is caused by a single, identifiable factor.
B. It is primarily an inherited genetic disorder.
C. It likely involves a combination of genetic and environmental influences.
D. It is solely caused by exposure to high levels of radiation.
C. It likely involves a combination of genetic and environmental influences.
Types of Leukemia
What is Acute Myeloid Leukemia (AML)?
Rapidly progressing cancer of myeloid cells.
Myeloid cells are a type of blood cell that normally develops into red blood cells, platelets, or some types of white blood cells.
Myeloid vs. Lymphoid: This refers to the type of immature blood cell (myeloblast or lymphoblast) that becomes cancerous.
Types of Leukemia
What is Acute Lymphocytic Leukemia (ALL)?
Rapidly progressing cancer of lymphoid cells.
Lymphoid cells are a type of white blood cell that normally develops into lymphocytes.
Myeloid vs. Lymphoid: This refers to the type of immature blood cell (myeloblast or lymphoblast) that becomes cancerous.
Types of Leukemia
What is Chronic Myelogenous Leukemia (CML)?
Slowly progressing cancer of myeloid cells.
Myeloid vs. Lymphoid: This refers to the type of immature blood cell (myeloblast or lymphoblast) that becomes cancerous.
Types of Leukemia
What is Chronic Lymphocytic Leukemia (CLL)?
Slowly progressing cancer of lymphoid cells.
Myeloid vs. Lymphoid: This refers to the type of immature blood cell (myeloblast or lymphoblast) that becomes cancerous.
Prioritization - Leukemia Types
A client is diagnosed with leukemia. Which information is MOST critical for the nurse to know to understand the expected disease progression and treatment plan? Rank in order of priority (most important first).
A. The client’s age and overall health.
B. The specific type of leukemia (AML, ALL, CML, CLL).
C. The client’s emotional and psychological state.
D. The client’s access to social support and resources.
- B. The specific type of leukemia (AML, ALL, CML, CLL). (This determines the disease course and treatment approach.)
- A. The client’s age and overall health. (These factors influence treatment options and prognosis.)
- C. The client’s emotional and psychological state. (Important for support but less critical than disease-specific information.)
- D. The client’s access to social support and resources. (Important for long-term care but less immediate than disease and patient factors.)
A client is diagnosed with a rapidly progressing cancer that affects lymphoid cells. Which type of leukemia is this MOST likely to be?
A. Acute Myeloid Leukemia (AML)
B. Acute Lymphocytic Leukemia (ALL)
C. Chronic Myelogenous Leukemia (CML)
D. Chronic Lymphocytic Leukemia (CLL)
B. Acute Lymphocytic Leukemia (ALL)
What are some acute/immediate blood transfusion reactions?
Allergic: Hives, itching, flushing, anaphylaxis (rare).
Febrile, Non-Hemolytic: Fever, chills, headache.
Hemolytic: Fever, chills, back pain, nausea, vomiting, dark urine, shock, DIC (Disseminated Intravascular Coagulation).
Transfusion-Related Acute Lung Injury (TRALI): Respiratory distress, hypoxia, pulmonary edema.
What are some delayed blood transfusion reactions?
Delayed Hemolytic Reactions: Anemia, jaundice.
Infections: Hepatitis B, Hepatitis C, HIV, other bacterial or parasitic infections (risk is low due to screening).
Graft-versus-Host Disease (GVHD): Fever, rash, diarrhea, liver dysfunction (occurs in immunocompromised individuals).
What are the 10 nursing steps of action for suspect blood transfusion reaction?
- Stop the transfusion immediately.
- Stay with the patient and monitor closely.
- Maintain a patent IV line with normal saline solution.
- Notify the blood bank and healthcare provider promptly.
- Recheck identifying tags and numbers on the blood bag and patient’s wristband to ensure correct match.
- Monitor vital signs and urine output.
- Treat symptoms as ordered by the healthcare provider.
- Save the blood bag and tubing and send them back to the blood bank for investigation.
- Collect required blood and urine specimens as ordered to evaluate the reaction.
- Document the reaction thoroughly in the patient’s medical record.
