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Nursing 271 > Med Surg: ATI: Cancer Disorders > Flashcards

Med Surg: ATI: Cancer Disorders Flashcards

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1
Q

Leukemia

A

cancers of white blood cells (WBCs) or of cells that develop into white blood cells
-the white blood cells are not functional
-they invade and destroy bone marrow
-can metastasize to liver, spleen, lymph nodes, tests, and brain
>overgrowth of leukemic cells prevents growth of other blood components (platelets, erythrocytes, mature leukocytes)
-lack of mature leukocytes leads to immunosuppression; infection
-lack of platelets leads to increased risk of bleeding

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2
Q

Leukemia: Health promotion

A
  • use protective equipment, such as mask, and ensure proper ventilation while working in environments that contain carcinogens or particles in the air
  • influenza and pneumonia vaccinations are important for all clients who are immunocompromised
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3
Q

Leukemia: Risk Factors

A
  • immunosuppression
  • exposure to chemotherapy agents or medications that suppress bone marrow
  • genetic factors (hereditary)
  • ionizing radiation

> Older adult clients

  • often have diminished immune function and decreased bone marrow function
  • have decreased energy reserves and can tire more easily during treatment; safety is a concern with ambulation
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4
Q

Leukemia: Expected Findings

A
  • bone pain
  • joint swelling
  • enlarged liver and spleen
  • weight loss
  • fever
  • poor wound healing (infected lesions)
  • manifestations of anemia (fatigue, pallor, tachycardia, dyspnea on exertion)
  • evidence of bleeding (ecchymoses, hematuria, bleeding gums)
  • headaches, behavior changes, decrease attention
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5
Q

Leukemia Diagnostic Procedures

A

> CBC

  • WBC can be high, low, or normal
  • Hemoglobin, hematocrit, and platelets decreased

> Coagulation time

  • increased with leukemia
  • monitor for bleeding

> Biopsy of bone marrow (core or fine-needle)
-large quantities of immature leukemic blast cells
Nurse actions during procedure:
-administer pain medications
-apply pressure for 5 to 10 minutes, then pressure dressing
-monitor bleeding and infection for 24 hours

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6
Q

Leukemia Nursing Care

A

> Monitor for infection; assess for physiological indicators of infection (lung crackles, cough, urinary frequency or urgency, oliguria, lesions of skin or mucous membrane)

> Manifestations that stem from the immune response (increased WBC, fever, pus, redness, inflammation) are not likely due to immunosuppression

> Implement neutropenic precautions (for chemotherapy induction and for bone marrow transplant client)

> prevent injury

  • monitor platelets
  • assess for obvious or occult bleeding
  • protect from trauma (avoid injections an venipunctures, apply firm pressure, increase vitamin K intake)
  • use electric shaver, soft bristled-toothbrush, avoid contact sports

> Conserve energy

  • encourage rest, adequate nutrition, and fluid intake
  • ensure client gets adequate sleep
  • assess clients energy resources/capability
  • plan activities as appropriate
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7
Q

Leukemia: Treatment

A
  • Chemotherapy
  • Colony-stimulating Medications: Filgrastim to stimulate production of leukocytes; assess bone pain
  • Hematopoietic bone stem cell transplantation
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8
Q

Complications of Hematopoietic Stem Cell Transplantation

A

Graft-versus-host disease (graft rejection)

-administer immunosuppressants as prescribed

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9
Q

Complications of Leukemia

A

> Pancytopenia: decrease in WBCs, RBCs, and Platelets

  • risk of infection increases as ANC falls; An ANC less than 1,000/mm3 = weak immune system; implement neutropenic precautions
  • maintain hygienic environment
  • monitor for infection (cough, alterations in breath sounds, urine, or feces)
  • report temperature greater than 100 Degrees F
  • administer antimicrobial, antiviral, and antifungal medications as prescribed
  • administer blood products (granulocytes) as needed

> Thrombocytopenia

  • increases risk of bleeding
  • greatest risk is at platelet counts less than 50,000/mm3
  • spontaneous bleeding can occur at less than 20,000/mm3
  • monitor for petechiae, ecchymosis, bleeding of gums, nosebleeds, and occult frank blood in stool, urine, or vomitus
  • institute bleeding precautions (avoid IVs and injections; apply pressure for 10 min after blood is obtained; handle client gently
  • safe environment
  • administer blood products (platelets) if count less than 10,000/mm3

> Hypoxemia

  • anemia increases risk for hypoxemia
  • plan care to balance rest and activity and use assistive devices
  • monitor RBCs
  • provide diet high in protein and carbohydrates
  • administer colony-stimulating factors such as epoetin alfa (to stimulate RBC production)
  • administer blood products (packed red blood cells)
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10
Q

Lung Cancer

A
  • non-small cell: squamous, adeno, and large cell carcinomas
  • small-cell: fast-growing and is linked to cigarette smoking

> Risk Factors:

  • exposure to cigarette smoke
  • radiation exposure
  • inhaled environment irritants (air pollution, asbestos, coal, other talc dusts)
  • older adult clients have decreased pulmonary reserves due to normal lung changes (decreased lung elasticity and thickened alveoli) contributing to impaired gas exchange
  • structural changes in the skeletal system decrease diaphragmatic expansion, restricting ventilation
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11
Q

Lung Cancer: Assessment

A
  • determine the pack-year history for clients who smoke
  • evaluate use of other tobacco products (cigars, pipes, and chewing tobacco)
  • ask about exposure to second hand smoke
  • monitor for cough that changes in pattern
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12
Q

Lung Cancer: Expected Findings

A
  • fatigue, weight loss, anorexia
  • fever (pneumonitis or bronchitis that occurs with obstruction)
  • persistent cough with or w/o hemoptysis
  • hoarseness
  • altered breathing pattern: dyspnea, prolonged exhalation alternated with shallow breaths (obstruction), rapid shallow breaths (pleuritic chest pain, elevated diaphragm)
  • altered breath sounds (wheezing)
  • diminished or absent breath sounds (obstruction)
  • chest pain or tightness
  • chest wall masses
  • muffed heart sounds
  • pleural friction rub
  • clubbing of fingers
  • increased work of breathing (retractions, use of accessory muscles, stridor, nasal flaring)
  • decreased bone density
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13
Q

Lung Cancer: Diagnostic Procedures

A

> Cytologic Testing
-sputum specimen contains cancer cells

> Thoracoscopy, bronchoscopy, mediastinoscopy
-presence of cancer cells
-can include biopsy or tumor or lymph nodes
Nursing:
-NPO after midnight
-provide throat lozenges or sprays for report of a sore throat once gag reflex returns

> X-ray, CT scan

  • lung lesions
  • presence of tumor

> Thoracentesis with pleural biopsy; MRI, PET scan
-presence of cancer and metastatic disease

> Pulmonary function tests and arterial blood gases
-compromised respiratory status

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14
Q

Lung Cancer: Nursing Care

A

> monitor nutritional status, weight loss, and anorexia
-adequate nutrition; provide needed calories for increased work of breathing and prevention of infection
-encourage fluids for hydration
Maintain patent airway and suction as needed
Fowler’s position to maximize ventilation

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15
Q

Lung Cancer: Medications

A

> Bronchodilators and corticosteroids

-help decrease inflammation and to dry secretions

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16
Q

Lung Cancer: Therapeutic Procedures

A

> Chemotherapy
-primary choice
-cisplatin used
adverse effects: nausea, vomiting, hair loss, mucositis, neutropenia, thrombocytopenia, peripheral neuropathy

> Photodynamic therapy
-performed through bronchoscopy to treat small, accessible tumors

> Radiation
-effective for lung cancer that has not spread beyond the chest wall and is used as an adjuvant therapy

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17
Q

Lung Cancer: Surgical interventions

A
  • goal= remove all tumor cells, including involved lymph nodes
  • pneumonectomy (removal of lung)
  • lobectomy (removal of lobe)
  • wedge resection (peripheral lung tissue)
  • reserved for early stage (I or II) with no metastasis

> Nursing:

  • monitor vital signs, oxygenation (saO2, and ABGs), and evidence for hemorrhage
  • manage chest tube
  • administer oxygen and manage ventilator if appropriate
  • manage pain; teach about PSA pump
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18
Q

Lung Cancer: Palliative procedures

A
  • thoracentesis or pleurodesis to ease breathing
  • laser therapy and photodynamic therapy can be used in treatment and palliative therapy to open airways blocked by tumors
  • pericardiocentesis or pericardial window to improve cardiac function
  • oxygen therapy to correct hypoxemia
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19
Q

Colorectal Cancer

A

cancer of the rectum or colon

  • can begin as a poly that is benign and if left untreated can grow and risk of malignancy increases
  • can metastasize (through blood or lymph) to liver (most common), lungs, brain, or bone
20
Q

Colorectal Cancer: Health promotion

A
  • diet rich in calcium (calcium binds to free fatty acids and bile salts in the lower GI tract)
  • diet low in fat and simple carbohydrates but high in fiber
  • age-specific screening
  • genetic testing for familial adenomatous polyposis
  • healthy lifestyle
  • no smoking/ alcohol
21
Q

Colorectal Cancer: Risk Factors

A
  • adenomatous colon polyps
  • African American descent
  • inflammatory bowel disease (ulcerative colitis, Crohn’s)
  • high-fat, low-fiber diet
  • long-term smoking
  • physical inactivity
  • heavy alcohol consumption
  • infection exposure to helicobacter pylori, streptococcus bovis, HPV
  • personal or family hx
22
Q

Colorectal Cancer: Expected findings

A

> changes in stool consistency or shape (with or without noticeable blood)
Blood in stool
-left-sided tumors likely to produce frank bleeding and change in bowel pattern, consistency
-right-sided tumors cause stools to be darker due to ulceration of the colon and intermittent bleeding
cramps and/or gas
palpable mass
weight loss and fatigue
vomiting
abdominal fullness, distention or pain
-abnormal bowel sounds indicative of obstruction (high-pitched tinkling bowel sounds)
rectal pain
sensations of bowel fullness after defecation

23
Q

Diagnostic Procedures

A
  • virtual colonoscopy can be performed using CT scans or MRI; noninvasive, no sedation
  • fecal testing recommended every year if guaiac-based fecal occult blood testing or fecal immunochemical testing is used, or every 3 years if the stool DNA test is used
  • screening guidelines for individuals with polyps of family hx

> Guaiac-based fecal occult blood testing (FOBT)
-findings:2 positive stools within 3 days
Nursing:
-do not use stool from digital rectal examination to avoid false-positive results
-negative results do not completely r/o CRC
Client Education:
-avoid red meat, anti-inflammatory medications, and vitamin C for 48 hours prior to testing

> Biopsy
-definitive diagnosis

> Endoscopy: colonoscopy, sigmoidoscopy
-visualization of polyps or lesions

> Double contrast barium enema
-uses the two contrasts of air and barium
-expected findings: visualization and location of tumor
Nursing:
-administer stimulant laxative following procedure as prescribed (facilitates evacuation of barium, which can harden in the intestine)

> CBC
-decreased hemoglobin and hematocrit

> Carcinoembryonic antigen (CEA)

  • expected: positive (denotes malignancy; not specific to CRC)
  • positive may = many types of cancer

> CT/MRI
-visualization and location of tumor/ metastasis

24
Q

Colorectal Cancer: Therapeutic Procedures

A

> Chemotherapy
-prescribed for clients who have stage III and IV or stage I

> Targeted medication therapy

  • Monoclonal antibodies:
  • angiogenesis inhibitors (inhibit growth of new blood vessels to tumors): bevacizumab
  • tyrosine kinase inhibitors (decrease cell proliferation and increase cell death): cetuximab and panitumumab

> Adjuvant therapy
-given to decrease the chance of metastasis for stage II and distant metastasis for stage III

> Radiation

  • minimize localized manifestations around the tumor
  • used a palliative measure to control pain, hemorrhage, bowel obstruction, or metastatic disease
25
Q

Colorectal Cancer: Surgical Intervention

A

following tumor excision, the colon might be reconnected (end-to-end anastomosis), a colostomy created (temporary or permanent), or a coloanal reservoir, or j-pouch, created temporarily

> Colon resection (colectomy): removal of portion of the colon to excise tumor
Colectomy: removal of colon with temporary or permanent colostomy or ileostomy
Abdominal-perineal (AP) resection: the tumor, sigmoid colon, rectum, and anal sphincter are removed, and the client has a permanent sigmoidostomy

26
Q

Colorectal Cancer: Preoperative Education

A
  • preoperative diet (clear liquids several days prior to surgery)
  • complete bowel prep with cathartics
  • understand administration of antibiotics (neomycin, metronidazole) to eradicate intestinal flora
27
Q

Colorectal Cancer: Postoperative Nursing Actions

A
  • assess stoma (should be reddish pink, moist, small amount of blood); report ischemia, necrosis, or frank bleeding
  • manage pain; teach PCS pump
  • maintain nasogastric suction (decompression)
  • progress the diet slowly after suctioning is d/c and monitor client’s response (bowel sounds present, no nausea, or vomiting)
  • discuss possible incontinence and sexual dysfunction with the client
  • provide ostomy teaching
28
Q

Breast Cancer

A
  • can present as a hard painless mass
  • gynecomastia can be present in men
  • can be noninvasive (in situ) or invasive

> Ductal Carcinoma in situ (DCIS)

  • cancer cells are located in the duct and have not invaded surrounding tissue
  • DCIS cells lack the biologic capacity to metastasize

> Lobular Carcinoma in situ (LCIS)

  • abnormal cell growth occurs in the milk-producing glands
  • can increase risk of developing a separate breast cancer at a later time
  • managed with observation
  • when other risk factors exist, prophylactic treatment (tamoxifen, raloxifene, or mastectomy) can be considered
29
Q

Breast Cancer: Health promotion

A
  • consume five servings of fruits and vegetables daily
  • screening mammography
  • healthy weight
  • physical exercise
  • minimize alcohol intake
  • breast feeding for a year or more decreases breast cancer risk
  • avoid hormone replacement therapy
  • avoid environmental estrogens
30
Q

Breast Cancer: Risk Factors

A 
>High genetic risk
-inherited mutations of BRCA1 and BRCA2
>history of previous breast cancer
-dense breast tissue
-biopsy confirmed atypical hyperplasia
-first degree relative
-early menarche
-late menopause
-nulliparity or first pregnancy after 30
-Males: testicular disorders
-use of oral contraceptives
-high-fat diet
-low-fiber diet
-excessive alcohol intake
-cigarette smoking
-exposure to low-level radiation
-hormone replacement therapy
-obesity
31
Q

Breast Cancer: Expected Findings

A

-breast change (appearance, texture, presence of lumps)
-breast pain or soreness
>Physical:
-skin changes
-dimpling
-breast tumors (usually small, irregularly shaped, firm, nontender, and nonmobile)
-increased vascularity, erythema
-nipple discharge
-nipple retraction or ulceration
-enlarged lymph nodes
-male clients report a mass around the areola that is hard and painless, nipple inversion, ulceration or swelling of the chest; lymphedema and gynecomastia may be present

32
Q

Breast Cancer: Diagnostic Procedures

A

> Breast self-examination (BSE), clinical breast exam
-findings: palpable tumor or lesions
education: have regular CBE every 3 years age 20 to 39; yearly over age 40)

> Biopsy
-definitive; sentinel lymph node biopsy can be performed during surgery

> Genetic Testing
-gene mutation of BCRA1 and BCRA2

> Mammography
-visualization of lesion

> MRI, ultrasound CT scan, X-ray, PET scan

33
Q

Breast Cancer: Hormone therapy

A

most effective in cancer cells with estrogen and progesterone receptors

> Ovarian ablation: luteinizing releasing hormone (LH-RH) leuprolide or goserelin

  • inhibits estrogen synthesis
  • used in premenopausal clients to stop or prevent the growth of breast tumors

> SERMs (Selective Serotonin receptor modulators): toremifene (Tamoxifen and raloxifene)

  • used for high-risk for breast cancer or who have advanced breast cancer
  • suppress the growth of remaining cancer cells postmastectomy or lumpectomy
  • tamoxifen may increase risk of DVT and pulmonary emoblism
34
Q

Breast Cancer: Chemotherapy/ Radiation

A

can augment or replace a mastectomy
-usually given combination of medications (cyclophosphamide, doxorubicin, and fluorouracil)

> radiation therapy usually reserved for clients who had a lumpectomy or breast-conserving procedure

  • whole or partial breast radiation
  • skin care priority due to radiation damage and generalized fatigue
  • brachytherapy with radioactive seeds
35
Q

Clients who have metastatic cancer can receive what?

A

a vascular endothelial growth factor inhibitor (bevacizumab) to reduce blood flow to the growing tumor

36
Q

Breast Cancer: Surgical Interventions

A
  • Lumpectomy (breast-conserving)
  • Partial mastectomy (wide excision)
  • Total mastectomy
  • Modified radical mastectomy (lymph nodes and muscle removed)
  • reconstructive surgery
37
Q

Breast Cancer: Surgical Interventions Nursing Actions

A
  • sit with head of bed elevated 30 degrees when awake and support their arm on a pillow; lying on unaffected side can relieve pain
  • client wear a sling while ambulating (to support arm)
  • avoid administering injections, taking blood pressure, or obtaining blood from the client’s affected arm; place a sign above patients bed regarding these precautions
  • emphasize importance of well fitted breast prothesis for a client who had a mastectomy
  • emotional support
  • monitor surgical drains
  • perform early arm and hand exercises (squeezing rubber ball, elbow flexion and extension, hand-wall climbing)
  • report numbness, pain, heaviness, or impaired motor function to affected arm
  • do not wear constrictive clothing
38
Q

Prostate Cancer

A

-slow-growing cancer in response to androgen (testosterone)

39
Q

Prostate Cancer: Health promotion

A
  • diet low in animal fat and include omega 3 fatty acids (fish), fruits and vegetables
  • regular exercise
  • discuss PSA screening
40
Q

Prostate Cancer: Risk Factors

A
  • hx of vasectomy
  • age greater than 65
  • family hx
  • high-fat, complex carbohydrate, or low fiber diet
  • hereditary prostate cancer
  • rapid growth of prostate
  • exposure to environmental toxins such as arsenic
41
Q

Prostate Cancer: Expected Findings

A
  • urinary manifestations: hesitancy, weak stream, urgency, frequency, nocturia
  • recurrent bladder infections
  • urinary retention
  • blood in urine and semen (late manifestation)
  • painful ejaculation
  • pain, particularly bone (pelvis, spine, hips, ribs)
  • unexplained weight loss
  • loss of sexual desire or function
  • penile discharge or scrotal pain/swelling
  • residual urine after voiding a small amount of urine
  • swollen lymph nodes, especially in groin
42
Q

Prostate Cancer: Diagnostic Procedures

A

> Digital Rectal Exam (DRE)

  • expected: hard prostate with palpable irregularities
  • discuss prostate screening after age 50

> Biopsy:

  • expected: presence of cancer
  • Gleason score or 7 or higher: moderately differentiated
  • Gleason score of 8 to 10: poorly differentiated
  • PSA, age, race, and family hx used to determine if biopsy is needed

> Genetic Testing
-expected: hereditary prostate cancer 1 (HPC1), BRTCA1, or BRCA 2 positive

> Prostate Specific Antigen (PSA)

  • Findings: elevation (greater than 4 ng/mL)
  • have the PSA assessed prior to Digital rectal exam

> Transrectal ultrasonography (TRUS)
-visualization of lesions
Education: extra fluids, no strenuous exercise, manifestations to report
-enema will be administered prior to procedure

> Urinalysis
-hematuria, bacteriuria

> Bone scan, MRI, CT, x-ray
-determines metastasis

43
Q

Prostate Cancer: Medications

A

Sipuleucel-T

  • a vaccine against cancer
  • destroys existing cells and prevents future cancer development
44
Q

Prostate Cancer: Hormone Therapy

A

Leuprolide, Goserelin, Triptorelin: luteinizing hormone -releasing- hormone (LH-RH) agonist
-used in advanced prostate cancer to produce chemical castration
>education:
-hot flashes are an adverse effect
-impotence and decreased libido
-monitor for osteoporosis which can occur due to testosterone suppression

45
Q

Prostate Cancer: Chemotherapy

A

used on clients whose caner has spread or who have had minimal improvement with other therapies
-have routine blood tests performed to monitor for neutropenia, leukopenia, thrombocytopenia, and anemia

46
Q

Prostate Cancer: Surgical

A

-PSA levels should reduce within a few days postoperatively

> Radical Prostatectomy: treatment of choice

  • not likely beneficial id spread to lymph nodes, bones or other organs
  • removal of prostate gland, along with seminal vesicles, the cuff at the bladder neck, and regional lymph nodes
  • perineal nerves are seldom disrupted, so client should not experience sexual dysfunction
  • dry climax can occur; removal of tissue at bladder neck allows seminal fluid to travel upward rather than down the urethral tract, results in retrograde ejaculation

> Nursing:

  • provide catheter care and administer bladder antispasmodics
  • monitor suprapubic catheter output; usually removed when output is less than 75 mL

Nursing 271 (208 decks)

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