Exam 3 Flashcards
What is the GOAL of CA treatment?
Curative
Control
Palliative
Surgery can be done for all 3 reasons
Factors that determine cancer therapy choice
Tumor histology & staging
Pts physiologic status (comorbidities)
Personal desires
Types of Cancer therapy
Surgery
Chemo
Radiation (external & internal)
Hormone therapy growth factors
Stem cell transplant
Gene therapy
Common side effects of chemotherapy & Radiation
🦴marrow suppression
Fatigue 😴
GI issues
Skin & mucosal issues
Pulmonary concerns 🫁
Cardiovascular effects 🫀
Neuro effects 🧠
Reproductive effects 👶🏼
🦴marrow suppression can cause
Causes neutropenia
- ⬆️🦠
- hemorrhage 🩸
- thrombocytopenia
- anemia
When taking chemo & radiation, what causes fatigue? 😴
Anemia 🩸
Toxic substances
Lack of sleep 😴
Steroids 💊
GI issues due to radiation & chemo
Internal mucosa is sensitive to chemo
Mucocitis 🕳️
N/V/D 🤮💩
Anorexia
Skin and Mucosal issues due to chemo & radiation
Mucocitis 👄🕳️
Loss of taste 👅
Wound care 🩹🤕to cite of ☢️
Alopecia 🧑🦲, 🧢👒,
🧴 sunscreen ☀️
Pulmonary concerns from ☢️& chemo therapy
Irreversible 🫁damage
Cough
Dyspnea
Pneumonitis
Fever 🤒
Night sweats 🌜😥
Pulmonary fibrosis 🍇
Pulmonary edema 🌊
Cardiovascular 🫀effects from chemo & radiation ☢️
Pericardial effusions
Pericarditis ❤️🔥
EKG changes 📈(LV function)
Neuro 🧠effects from chemo & radiation ☢️
Chemo brain ☢️🧠
Slight memory loss 🤔
Reproductive 👶🏻effects from chemo & radiation ☢️
Infertility 🚫🪺🥚
How does immunotherapy work?
- Boosts immune system
Creates environment🌋 bad for CA cells to grow - Attack 🔨CA cells directly
(Cytokines, vaccines, monoclonal antibodies)
How does 🎯targeted therapy work?
🚦Interferes w/CA growth by 🎯specific cell receptors & pathways important in tumor 🪨growth
⬇️damage on nl cells than chemo
🎯therapy is personalized 👩🏽🦳tx based on the biology 🧬 of the tumor
Side effects of Immunotherapy & Targeted 🎯 therapy
Effects are acute & resolve when therapy is over 😅
Capillary leak syndrome (💦shift🔂)
Pulmonary edema 🫁💦
🦴marrow suppression (⬇️than chemo, neutropenic)
Fatigue 😴
Flu like symptoms
What medications 💊 help control chills 🥶 or rigors associated w/ receiving IL-2?
Acetaminophen & IV Demerol 💊
Malnutrition is a complication of CA & treatments. What RN managements should you take?
Calorie counts 🍩
Daily weights ⚖️
⬆️ protein 🍗
💊 for N/V/D 🤮
Flavor foods that are bland 🍓
Infection🦠 is a complication of CA & treatments. What RN managements should you take?
Foley care 💛
Oral hygiene 🪥 😬
Overall hygiene 🛁🧼
Wash hands 🙌🏽
Wear masks 😷
Monitor guests 👀
🚫visits from sick people 🗣️
🚫fresh 💐 or 🍓🍇
Pain😖 is a complication of CA & treatments. What RN managements should you take?
Around the 🕦pain medications
(On time ⏰)
💊for break through pain 😖
You should administer what 💊 when beginning chemotherapy?
Antiemetics 💊🤮
When should you administer APAP when treating with interferons?
Tylenol before treatment &
Every 4 hours ⏰ after treatment
What is Hemophilia? 🩸
🩸Deficient in a coagulation factor:
Hemophilia A- factor 8
(✔️More common)
Hemophilia B- factor 9
What is Von Wilebrand disease? 🩸
Deficiency in the VW factor
(Protein in the clotting cascade)
What disease results in 🩸in mucous membranes and skin?
Von Willebrand Disease
What disease causes 🩸 in the lining of the 👃🏽, intestines, uterus 👛, and vagina?
Von Willibrand Disease
What disease results in 🩸 in the deep⬇️ tissue?
Hemophilia
What disease is caused by a ⬇️deficiency in the Von Willibrand Factor?
Von Willibrand disease
What disease consists of symptoms that are more likely to include 🩸 in joints 💪🏽& within muscles?
Hemophilia 🩸
What disease is caused by the deficiency of factor VIII or IX?
Hemophilia 🩸
What disease is more prominent in men than women?
Hemophilia 🩸
Nursing management for 🩸 disorders
Neuro checks 🧠
Fall precautions
Skin checks
Bleeding precautions
Soft 🪥
🚫contact sports 🏈
Electric shaver
Fibrin 🩹🤕
Pain inhibits sleep (📞call Dr- possible🩸)
What are labs for hemophilia?
⬆️ PTT due to low clotting factor
Can have normal platelets & PT
Minor 🩸should be treated for?
At least 72 hours ⏱️
Nursing management for joint 💪🏽bleeds
Replacement factors
RICE 🧊🛋️
analgesics - no ASA
Ambulating 💃🏻
Avoid weight bearing 🩼until swelling resolves
Immediate treatment/attention is needed if?
Severe pain 😖or swelling of a muscle or joint that restricts movement or inhibits sleep
Head injury:
Swelling in neck, mouth👄 , abd pain, hematuria, melena🩸, & skin wounds needing suturing 🪡
Immediate treatment/attention is needed if?
Severe pain 😖or swelling of a muscle or joint that restricts movement or inhibits sleep
Head injury:
Swelling in neck, mouth👄 , abd pain, hematuria, melena🩸, & skin wounds needing suturing 🪡
Oral CA facts 👅
Consists of oral cavity, pharynx, and larynx
Common after 35yrs
Average Dx is 65yrs
Risk factors for Oral CA 👅
Tobacco use 🚬💨
Men 🙋♂️
Frequent ETOH use 🥃🍸
Prolonged exposure to ☀️
Occupation to chemicals 🧑🔬💨
Oral HPV
S&S of oral CA 👄
🫦or mouth sores that 🩸easy & don’t heal w/in two weeks
Erythroplgia, Leukoplagia
Crusty areas on 🫦, gums, or inside mouth
Numb/pain on face, neck, or mouth occurring w/out cause
Difficulty chewing, swallowing, speaking, or moving jaw or 👅
Weight loss, 👂🏼pain, chronic bad breath
Types of therapies for Oral CA
Surgical- partial removal of mandible, tongue 👅
Nonsurgical- ☢️ radiation, chemo, palliative
Nutritions- PEG, parental nutrition
Oral👄 CA nursing management
Airway (risk for aspiration🚨), ability to communicate, nutrition, possible trache care, N/V/D
🚫smoking 🚬💨
Oral hygiene 🪥
Pre-op education
Emotional support
Peg tube
Esophageal CA risk factors
Smoking 🚬💨 doubles risk
Age 65-70
Barrett’s esophagus (irritation to mucosal cells from GERD)
Esophageal injury
Excess ETOH use 🍸🥃
Obesity 🤰🏻
Occupational exposure to asbestos or dust 💨
Esophageal CA patho
Tumors appear as ulcers, often advanced
Metastasis to liver & 🫁
Esophageal achalasia
(Delayed emptying of lower esophagus squamous cell)
Early stage- tapering of lower esophagus
Advanced stage- showing dilated, tortuous esophagus
Clinical manifestations of esophageal Cancer
*Progressive dysphagia
(most common early sign🚨)
Occurs w/🥩, soft foods, then liquids
Pain- radiates to neck, jaws,👂🏼, shoulders, sore throat, choking, hoarseness
Weight loss ⚖️🚨
Regurgitation d/t stenosis➡️ aspiration
Possible hemorrhage
Possible fistula in 🫁or trachea
Esophageal CA treatment
Poor prognosis
Surgical therapies
Endoscopic ablation
Chemo
Radiation ☢️
palliative
Targeted therapies 🎯
Nutritional- IVF, J-tube, swallow study
small bland meals, 🪑during feeds,
👀 aspiration 🚨& 🦠, possible chest tube🚨
Esophageal CA assessment
History of GERD, hiatal hernial, Barrett’s esophagus, 🚬& 🍸🥃 use
Progressive dysphagia, pain assessments, pneumonia, dysthymia 📈 d/t surgery in chest
Possible hypocalcemia due to thyroid/neck, ⬆️LFTs
Esophageal CA Education 📚
Oral hygiene 🪥
Managing GERD
Barrett’s Esophagus or HH 🚨
Healthy dietary choices
⬆️protein, ⬆️calorie🚨
G-tube?
Esophageal CA nursing management
Possible chest tube🚨, NG tube, central line, feeding tube
Cough & deep breathe (pneumonia)
Esophageal CA nursing management
Possible chest tube, NG tube, central line, feeding tube
Cough & deep breathe (pneumonia)
Post op for Esophageal CA
🦠, dysrhythmias 📈
anastomic leaks
fistula,
🫁edema, respiratory distress,
assess drainage from NG tube, monitor chest tube
cough & deep breathe 🦠💦
incentive spirometer
aspiration precautions 🚨
Acute gastritis symptoms
Sx for several hours➡️a few days
Epigastric tenderness
A/N/V 🤮
Mucosal inflammation➡️hemorrhage
GI bleeding 🩸
Hematemesis 🤮🩸
Dyspepsia ❤️🔥
Chronic gastritis symptoms
Similar to acute
Asymptomatic
Pernicious Anemia (⬇️B12) 💉
Risk factors for gastritis
NSAIDS 💊
Stress 😖📚
Steroids
ETOH 🍸
Spicey foods 🫑🌶️
H pylori 🦠
Viral/bacterial infections 🧫
Steroids
Acute gastritis nursing management
NPO 🚫
IVF
Antiemetics
👀for dehydration
Possible NG tube
👀 for 🩸
Clear liquids➡️ gradual solids
PPIs💊
VS🩺, H&H🩸
Nursing management for chronic gastritis
Combination abx 💊if Hoylori 🦠
Educate 📚on pernicious anemia
Possible B12 💉
Small frequent meals 🥪
Follow up cares
Hematemesis
Bloody emesis 🩸🤮
Fresh, bright red or ☕️grounds
Coming from the stomach 🫄
(Upper GI 🩸)
Melena
Black🖤, tarry stools💩 (has iron)
A slow 🩸from upper GI
Occult bleeding
Small 🩸in gastric secretions, not apparent to 👀
Massive hemorrhage from a UGI 🩸is determined by?
More than 1500ml of 🩸 or
25% of intravascular 🩸volume
Abdominal distention, guarding & peristalsis can be a sign of?
Pancreatitis
During a UGI 🩸, vitals should be taken?
Immediately 👇🏽& q 15-30min
Nursing management/intervention for UGI 🩸
-Identify ⬆️risk
(gastritis, cirrhosis, PUD, Mallory Weiss Tear, Varacies)
-🩸That are likely to reoccur
-NG tube (skin✔️)
-Med✔️ (🚫steroids, NSAIDS)
-Good💊= PPI, H2 receptor blocker (famotadine/Pepcid) take with 🌮
Avoid irritants 🌶️🧂🍔🍹🚬
🚨 Emergency management for an UGI 🩸
Assess for shock 😱
(Tachy, weak pulse, hypotension, 🥶🧊extremities, prolonged cap RF)
Fluids 💦
Insert Foley 💛 q hr assessments
Kidney 🫘perfusion 💛 30ml/hr
VS 🩺
Possible central line 🩸
Oxygen if low H&H
GI assessment (☑️for peritonitis)
Volume replacement
(Crystalloids, PRBC, FFP)
2L 🩸loss= surgery 🔪
Type and cross match 🩸
Telemetry 📈
The pancreas makes?
enzymes to break ⬇️sugar, fat, and starch
The pancreas secretes these enzymes into the GI tract?
Amylase: breaks⬇️ carbohydrates
Protease: breaks⬇️ proteins
Lipase: breaks⬇️ fats
The pancreas secretes these hormones into the 🩸stream
Insulin: to ⬇️ 🩸glucose
Glucagon: to ⬆️ 🩸glucose
Risk factors for acute pancreatitis
Prolonged 🍹🍻consumption 🚨
Gallstones 🪨🚨
Biliary tract disease
🦠 infection
Less common: ⬆️triglycerides
S&S of Acute Pancreatitis
LUQ and pain radiating to back w/sudden onset (worse with 🌮& not relieved with 🤮)
N/V, low🤒🚨, leukocytosis, hypotension🚨, tachy, jaundice 💁♂️, fat necrosis➡️ ➖calcium➡️ tetany
⬇️or absent 💩sounds, paralytic ileus
Crackles 🫁
💚💛🤎discoloration of abd wall
💙echymosis of ribs- Grey Turners
🌀Periumbillical area- Collens sign
Shock 😱, toxemia💃🏻🤰🏻, hypovolemia
Acute pancreatitis complications
Pseudocysts: fluid & exudate
🦠pseudocysts: abscess resulting in necrosis 🖤 to pancreas (🔪drainage to prevent sepsis) If you palpate on abd➡️rupture➡️sepsis
Hypotension from 💦shifting & 🦠
Pleural effusions💦, atelectasis
Tetany 🤌🏽from hypocalcemia
Abd 🤰🏻Compartment syndrome
Pancreatitis Diagnostics 🔬👩🔬
Amylase: ⬆️in early stages and stays ⬆️for 24-72 hours (other disorsers can cause ⬆️)
Serum Lipase: 🚨 lab indicator
Other labs: ⬆️ LFTs, Triglycerides, glucose, bilirubin, & ⬇️Calcium
CT 🚨 best image of pancreas
Amylase lab level
60-120
Lipase lab level
0-160
With Chronic pancreatitis, the pancreas is destroyed 💣due to
Fibrotic 🍇tissue leading to strictures and calcifications
Chronic pancreatitis can be caused by?
Obstructing pancreatitis: obstructing gall🪨, tumors, trauma🥊,
pseudocysyt, disease & inflamm.
Non obstructing: Chronic 🍷🥃🍹🍻
Chronic pancreatitis S&S
Abd pain:
Heavy, gnawing, cramping, 🚫relief with 🌮 or antacids
Pancreatic insufficiency:
Weight⬇️, constipation, steatorrhea, grey 💩
Pseudocysts, duodenal and bile duct obstruction, ascities, CA, effusion
Diet for chronic pancreatitis
Small frequent meals
No carbonated beverages 🥤🍻
🚫🍷🚬
⬆️carbs 🍞🍜🥛
Risk factors for Pancreatic CA
⬆️ fat diet 🐖
Chronic 🍷🥃🍸
Chronic pancreatitis
DM 💉
Age 👵🏽👴🏼& 🚬
Black Americans 👩🏾
Manifestations of pancreatic CA
Abdominal pain 😖
Jaundice 🧔♂️
Rapid weight ⬇️
Anorexia
🤮
Parental Nutrition for pancreatic CA is?
A mix of proteins, carbohydrates, fats, electrolytes, vitamins, dextrose, and amino acids
Parental Nutrition facts ✅
TPN/ PPN
Refrigerate until 30min before IV
2 RN✅
1.2 micron filter for PN w/lipids
0.22 micron filter for PN w/out lipids
Y Tubing
Change tubing, filter, clave, bag q 24hrs due to 🦠 from 🍬
Glucose ✅ q4-6 hrs
🦠risk d/t central line 🩸
When D/C:
Risk for hypoglycemia
If 🛑suddenly and waiting another bag, provide ⬆️dextrose solution 💦
Refreshing syndrome- sudden feeding with anorexia
-Hypophosphatemia
-Hypocalcemia (Depressed 🫁)
Cholelithiasis
Stones 🪨in the gallbladder
Cholecystitis
Inflammation of the gallbladder wall
Associated with gall🪨
Gall🪨 are more common in
Female 💃🏻
Fat 🤰🏻
Fertile
Over Fourty 🥳
Oral contraceptive use
Pain from cholelithiasis or cholecystitis can happen
3-6 hours after a ⬆️ fat meal or when the patient lies down 🛌
S&S of gallbladder disease?
RUQ pain
R-Shoulder pain 😖
Fever 🤒 & 🥶
Billiary colic (pain comes & goes)
Complications from gallbladder disease
Rupture of gallbladder➡️peritonitis ➡️sepsis➡️ ☠️💀🏴☠️
Jaundice 🧔♂️ (skin assess)
Biliary cirrhosis
Ascities 🫄(pain assess)
Necrotic tissue 🖤
Fistula 🕳️
Subphrenic abscess
Pancreatitis
Urine is dark (bilirubin)
Clay colored 💩
(Neuro ✅for hepatic encephalopathy)
Conservative therapy for gallbladder disease
IV 💦
NG tube or NPO
Antiemetics
Analgesics
Antibiotics 🦠
ERCP (scope of biliary🌲)
Shock wave lithotripsy- pee out 🚽💛
Surgical therapy for gallbladder disease
Laparoscopic cholecystectomy
(🕳️= ⬆️risk of 🩸)
Incisional 🔪🧵🪡
Cirrhosis can be caused by?
ETOH use 🍷🍺🥃
Hep C 💉
Malnutrition 🦴
Genetic
Frequent use of APAP (Acute)
Complications of cirrhosis
Portal HTN 🚨
⬇️liver fx➡️ 💦shift➡️ portal HTN➡️ protein shifts out of vascular into 🫄=ascities (Give Albumin)
⬆️Ammonia➡️ 🧠decline= give lactose (Titer💩)
Hypernatremic 🧂
Gynicomastia 🤦🏽♂️👙
Jaundice 🧔♂️
Flank pain
Varicies 🩸
Palmar Erythema (cut nails)
Urinary retention 🚽
During a parasethesis, the fluid should be
Straw colored fluid
During cirrhosis liver function labs🧑🔬…
Normal LFTs at first then….
⬆️LFTs
Cares for Cirrhosis
⬆️calorie, ⬇️protein, ⬇️🧂 diet
2g sodium 🚫
F&E … tube feeds
🩸Assessments
Beta Blocker to ⬇️ portal HTN= varicies
Vasopressin to ⬇️🩸
Lactulose for Amonia
Dietetics for Anemia
Analgesics—- 🚫narcotics
Hydroxyzine- palmar erythema
HOB 💺for ascities
I&Os- urine output- bladder scans
Daily weights
🧠status
Asteristix- 👋🏼&🦶🏼shaking
