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Exam 3 Flashcards

1
Q

What is the GOAL of CA treatment?

A

Curative
Control
Palliative

Surgery can be done for all 3 reasons

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2
Q

Factors that determine cancer therapy choice

A

Tumor histology & staging

Pts physiologic status (comorbidities)

Personal desires

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3
Q

Types of Cancer therapy

A

Surgery
Chemo
Radiation (external & internal)
Hormone therapy growth factors
Stem cell transplant
Gene therapy

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4
Q

Common side effects of chemotherapy & Radiation

A

🦴marrow suppression
Fatigue 😴
GI issues
Skin & mucosal issues
Pulmonary concerns 🫁
Cardiovascular effects 🫀
Neuro effects 🧠
Reproductive effects 👶🏼

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5
Q

🦴marrow suppression can cause

A

Causes neutropenia
- ⬆️🦠
- hemorrhage 🩸
- thrombocytopenia
- anemia

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6
Q

When taking chemo & radiation, what causes fatigue? 😴

A

Anemia 🩸
Toxic substances
Lack of sleep 😴
Steroids 💊

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7
Q

GI issues due to radiation & chemo

A

Internal mucosa is sensitive to chemo
Mucocitis 🕳️
N/V/D 🤮💩
Anorexia

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8
Q

Skin and Mucosal issues due to chemo & radiation

A

Mucocitis 👄🕳️
Loss of taste 👅
Wound care 🩹🤕to cite of ☢️
Alopecia 🧑‍🦲, 🧢👒,
🧴 sunscreen ☀️

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9
Q

Pulmonary concerns from ☢️& chemo therapy

A

Irreversible 🫁damage
Cough
Dyspnea
Pneumonitis
Fever 🤒
Night sweats 🌜😥
Pulmonary fibrosis 🍇
Pulmonary edema 🌊

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10
Q

Cardiovascular 🫀effects from chemo & radiation ☢️

A

Pericardial effusions
Pericarditis ❤️‍🔥
EKG changes 📈(LV function)

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11
Q

Neuro 🧠effects from chemo & radiation ☢️

A

Chemo brain ☢️🧠
Slight memory loss 🤔

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12
Q

Reproductive 👶🏻effects from chemo & radiation ☢️

A

Infertility 🚫🪺🥚

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13
Q

How does immunotherapy work?

A
  1. Boosts immune system
    Creates environment🌋 bad for CA cells to grow
  2. Attack 🔨CA cells directly

(Cytokines, vaccines, monoclonal antibodies)

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14
Q

How does 🎯targeted therapy work?

A

🚦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

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15
Q

Side effects of Immunotherapy & Targeted 🎯 therapy

A

Effects are acute & resolve when therapy is over 😅

Capillary leak syndrome (💦shift🔂)
Pulmonary edema 🫁💦
🦴marrow suppression (⬇️than chemo, neutropenic)
Fatigue 😴
Flu like symptoms

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16
Q

What medications 💊 help control chills 🥶 or rigors associated w/ receiving IL-2?

A

Acetaminophen & IV Demerol 💊

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17
Q

Malnutrition is a complication of CA & treatments. What RN managements should you take?

A

Calorie counts 🍩
Daily weights ⚖️
⬆️ protein 🍗
💊 for N/V/D 🤮
Flavor foods that are bland 🍓

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18
Q

Infection🦠 is a complication of CA & treatments. What RN managements should you take?

A

Foley care 💛
Oral hygiene 🪥 😬
Overall hygiene 🛁🧼
Wash hands 🙌🏽
Wear masks 😷
Monitor guests 👀
🚫visits from sick people 🗣️
🚫fresh 💐 or 🍓🍇

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19
Q

Pain😖 is a complication of CA & treatments. What RN managements should you take?

A

Around the 🕦pain medications
(On time ⏰)

💊for break through pain 😖

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20
Q

You should administer what 💊 when beginning chemotherapy?

A

Antiemetics 💊🤮

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21
Q

When should you administer APAP when treating with interferons?

A

Tylenol before treatment &
Every 4 hours ⏰ after treatment

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22
Q

What is Hemophilia? 🩸

A

🩸Deficient in a coagulation factor:

Hemophilia A- factor 8
(✔️More common)

Hemophilia B- factor 9

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23
Q

What is Von Wilebrand disease? 🩸

A

Deficiency in the VW factor

(Protein in the clotting cascade)

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24
Q

What disease results in 🩸in mucous membranes and skin?

A

Von Willebrand Disease

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25
What disease causes 🩸 in the lining of the 👃🏽, intestines, uterus 👛, and vagina?
Von Willibrand Disease
26
What disease results in 🩸 in the deep⬇️ tissue?
Hemophilia
27
What disease is caused by a ⬇️deficiency in the Von Willibrand Factor?
Von Willibrand disease
28
What disease consists of symptoms that are more likely to include 🩸 in joints 💪🏽& within muscles?
Hemophilia 🩸
29
What disease is caused by the deficiency of factor VIII or IX?
Hemophilia 🩸
30
What disease is more prominent in men than women?
Hemophilia 🩸
31
Nursing management for 🩸 disorders
Neuro checks 🧠 Fall precautions Skin checks Bleeding precautions Soft 🪥 🚫contact sports 🏈 Electric shaver Fibrin 🩹🤕 Pain inhibits sleep (📞call Dr- possible🩸)
32
What are labs for hemophilia?
⬆️ PTT due to low clotting factor Can have normal platelets & PT
33
Minor 🩸should be treated for?
At least 72 hours ⏱️
34
Nursing management for joint 💪🏽bleeds
Replacement factors RICE 🧊🛋️ analgesics - no ASA Ambulating 💃🏻 Avoid weight bearing 🩼until swelling resolves
35
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 🪡
36
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 🪡
37
Oral CA facts 👅
Consists of oral cavity, pharynx, and larynx Common after 35yrs Average Dx is 65yrs
38
Risk factors for Oral CA 👅
Tobacco use 🚬💨 Men 🙋‍♂️ Frequent ETOH use 🥃🍸 Prolonged exposure to ☀️ Occupation to chemicals 🧑‍🔬💨 Oral HPV
39
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
40
Types of therapies for Oral CA
Surgical- partial removal of mandible, tongue 👅 Nonsurgical- ☢️ radiation, chemo, palliative Nutritions- PEG, parental nutrition
41
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
42
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 💨
43
Esophageal CA patho
Tumors appear as ulcers, often advanced Metastasis to liver & 🫁
44
Esophageal achalasia (Delayed emptying of lower esophagus squamous cell)
Early stage- tapering of lower esophagus Advanced stage- showing dilated, tortuous esophagus
45
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
46
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🚨
47
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
48
Esophageal CA Education 📚
Oral hygiene 🪥 Managing GERD Barrett’s Esophagus or HH 🚨 Healthy dietary choices ⬆️protein, ⬆️calorie🚨 G-tube?
49
Esophageal CA nursing management
Possible chest tube🚨, NG tube, central line, feeding tube Cough & deep breathe (pneumonia)
50
Esophageal CA nursing management
Possible chest tube, NG tube, central line, feeding tube Cough & deep breathe (pneumonia)
51
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 🚨
52
Acute gastritis symptoms
Sx for several hours➡️a few days Epigastric tenderness A/N/V 🤮 Mucosal inflammation➡️hemorrhage GI bleeding 🩸 Hematemesis 🤮🩸 Dyspepsia ❤️‍🔥
53
Chronic gastritis symptoms
Similar to acute Asymptomatic Pernicious Anemia (⬇️B12) 💉
54
Risk factors for gastritis
NSAIDS 💊 Stress 😖📚 Steroids ETOH 🍸 Spicey foods 🫑🌶️ H pylori 🦠 Viral/bacterial infections 🧫 Steroids
55
Acute gastritis nursing management
NPO 🚫 IVF Antiemetics 👀for dehydration Possible NG tube 👀 for 🩸 Clear liquids➡️ gradual solids PPIs💊 VS🩺, H&H🩸
56
Nursing management for chronic gastritis
Combination abx 💊if Hoylori 🦠 Educate 📚on pernicious anemia Possible B12 💉 Small frequent meals 🥪 Follow up cares
57
Hematemesis
Bloody emesis 🩸🤮 Fresh, bright red or ☕️grounds Coming from the stomach 🫄 (Upper GI 🩸)
58
Melena
Black🖤, tarry stools💩 (has iron) A slow 🩸from upper GI
59
Occult bleeding
Small 🩸in gastric secretions, not apparent to 👀
60
Massive hemorrhage from a UGI 🩸is determined by?
More than 1500ml of 🩸 or 25% of intravascular 🩸volume
61
Abdominal distention, guarding & peristalsis can be a sign of?
Pancreatitis
62
During a UGI 🩸, vitals should be taken?
Immediately 👇🏽& q 15-30min
63
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 🌶️🧂🍔🍹🚬
64
🚨 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 📈
65
The pancreas makes?
enzymes to break ⬇️sugar, fat, and starch
66
The pancreas secretes these enzymes into the GI tract?
Amylase: breaks⬇️ carbohydrates Protease: breaks⬇️ proteins Lipase: breaks⬇️ fats
67
The pancreas secretes these hormones into the 🩸stream
Insulin: to ⬇️ 🩸glucose Glucagon: to ⬆️ 🩸glucose
68
Risk factors for acute pancreatitis
Prolonged 🍹🍻consumption 🚨 Gallstones 🪨🚨 Biliary tract disease 🦠 infection Less common: ⬆️triglycerides
69
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
70
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
71
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
72
Amylase lab level
60-120
73
Lipase lab level
0-160
74
With Chronic pancreatitis, the pancreas is destroyed 💣due to
Fibrotic 🍇tissue leading to strictures and calcifications
75
Chronic pancreatitis can be caused by?
Obstructing pancreatitis: obstructing gall🪨, tumors, trauma🥊, pseudocysyt, disease & inflamm. Non obstructing: Chronic 🍷🥃🍹🍻
76
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
77
Diet for chronic pancreatitis
Small frequent meals No carbonated beverages 🥤🍻 🚫🍷🚬 ⬆️carbs 🍞🍜🥛
78
Risk factors for Pancreatic CA
⬆️ fat diet 🐖 Chronic 🍷🥃🍸 Chronic pancreatitis DM 💉 Age 👵🏽👴🏼& 🚬 Black Americans 👩🏾
79
Manifestations of pancreatic CA
Abdominal pain 😖 Jaundice 🧔‍♂️ Rapid weight ⬇️ Anorexia 🤮
80
Parental Nutrition for pancreatic CA is?
A mix of proteins, carbohydrates, fats, electrolytes, vitamins, dextrose, and amino acids
81
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 🫁)
82
Cholelithiasis
Stones 🪨in the gallbladder
83
Cholecystitis
Inflammation of the gallbladder wall Associated with gall🪨
84
Gall🪨 are more common in
Female 💃🏻 Fat 🤰🏻 Fertile Over Fourty 🥳 Oral contraceptive use
85
Pain from cholelithiasis or cholecystitis can happen
3-6 hours after a ⬆️ fat meal or when the patient lies down 🛌
86
S&S of gallbladder disease?
RUQ pain R-Shoulder pain 😖 Fever 🤒 & 🥶 Billiary colic (pain comes & goes)
87
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)
88
Conservative therapy for gallbladder disease
IV 💦 NG tube or NPO Antiemetics Analgesics Antibiotics 🦠 ERCP (scope of biliary🌲) Shock wave lithotripsy- pee out 🚽💛
89
Surgical therapy for gallbladder disease
Laparoscopic cholecystectomy (🕳️= ⬆️risk of 🩸) Incisional 🔪🧵🪡
90
Cirrhosis can be caused by?
ETOH use 🍷🍺🥃 Hep C 💉 Malnutrition 🦴 Genetic Frequent use of APAP (Acute)
91
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 🚽
92
During a parasenthesis, the fluid should be
Straw colored fluid
93
During cirrhosis liver function labs🧑‍🔬…
Normal LFTs at first then…. ⬆️LFTs
94
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

Med Surg2 (5 decks)

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