med surg exam 1 Flashcards
What is cellular regulation?
process that controls cellular growth, replication, differentiation, and function to maintain homeostasis
Why do normal cells divide? (orderly and well regulated growth)
to develop normal tissue or to replace lost, damaged or aged normal tissue
What stops rounds of division when dividing results in being completely surrounded or touching other cells ?
contact inhibition
What is neoplasia ?
any new or continued cell growth not needed for normal replacement of dead and damaged tissues
What is hypertrophy?
enlargement of same number of cells (body builders)
what is atrophy ?
shrinkage of cells
What is hyperplasia ?
overproduction of cells (Calluses)
What is metaplasia?
gene and DNA changes (malignant)
What is the feature in which a normal cell has a distinct and recognizable appearance ?
specific morphology
What is a small nuclear to cytoplasmic ratio?
nucleus of a normal cell occupies a little space in the cell
What is tight adherence ?
normal cells make sticky cell adhesion molecules (CAM’s) that bind them to one another
What type of cell does NOT adhere to the nonmigratory rule ?
RBC
What do cyclins do ?
make proteins to promote cells to enter and complete division
What are cyclins controlled by ?
suppressor gene
what occurs that causes apoptosis to happen ?
DNA shortens each time it is divided so when it is all out the cell responds to the cell regulation signal to die
what is the term for a normal number of chromosomes ?
euploidy
what is the term for when chromosomes are not normal ?
aneuploidy
what is a benign tumor cell?
normal cells growing in wrong place at wrong time
what are some examples of a tumor cell?
moles, fibroids, skin tags, endometriosis, nasal polyps
do tumor cells retain the specific morphology of their parent ?
yes
are the specific function of a tumor cell still going to occur ?
yes
do tumor cells have tight adherence ?
yes
do tumor cells migrate ?
no
do tumor cells invade ?
no
do tumor cells tend to have euploidy or aneuploidy ?
euploidy
can tumor cells still have defects that cause them to become CA cells?
yes
what are CA cells ?
cells that abnormal, serve no function, and are harmful to the body
What is anaplasia of a CA cell?
loss of specific appearance to parent cell
what is the nucleus like with a CA cell?
larger and takes up more cytoplasm
do CA cells have a function ?
no- they’re lost partially or completely
what is the adherence like for CA cells ?
loose- so they migrate
does contact inhibition occur for CA cells ?
no
if CA cells don’t respond to checkpoints for control, then what happens to their mitosis schedule ?
they re-enter mitosis continually
what makes the CA cells not respond to apoptic signals ?
enzyme- telomerase
what is carcinogenesis ?
when things like tobacco affect DNA
What is oncogenesis ?
certain genes that are either under suppressed or over expressed
what is a good way to remember oncogenes ?
think “on go” genes that allow the cells to get to mitosis
what does an over expression of oncogenes lead to ?
overgrowth of cells
what does an under suppression of oncogenes lead to ?
the oncogene is always active - so nothing stops it
what is malignant transformation?
when a normal cell becomes a CA cell
What is the first step in carcinogenesis ?
initiation
what occurs during initiation?
genes promote cell division and become oncogenes which produces more cyclins
what type of event is initiation considered to be ?
irreversible event that causes CA
if growth conditions are right, can metastatic CA come from one cell ?
yes
what are carcinogens ?
substances that change the activity of a cells genes so the cell becomes a CA cell
what is the second step of carcinogenesis ?
promotion
what occurs during promotion?
enhanced growth of initiated cell by promoters, it can become a tumor when growth enhanced
what are promoters?
hormones such as insulin and estrogen that make cell division more frequently
What is a latency period ?
time between a cells initiation and the development of an overt tumor
what can shorten a latency period ?
promoters
what is the 3rd step of carcinogenesis ?
progression
what is progression?
continued change of a CA, making it more malignant
what things need to be done in order for a tumor to become a health problem ?
1- tumor needs own blood supply so it makes EDGF, 2- mutations form to make it more malignant
what mutations need to occur to make a tumor a health problem ?
driver mutation and passenger mutation
what is a driver mutation?
provide cell with advantages that allow cell to live and divide no matter conditions
what is a passenger mutation?
these are used as CA identifiers for therapies
what is a primary tumor ?
original group of CA cells or tumor caused by carcinogenesis
what are secondary tumors ?
when primary tumor breaks off and makes own colony
how do tumors extend into surrounding tissues/ blood vessels ?
they secrete enzymes
what is a common cause of CA spread?
bloodborne metastasis
when a tumor invades surrounding tissues, what develops ?
secondary tumor
where do solid tumors come from ?
specific tissues (breast CA and lung CA)
where do hematologic CA’s come from?
blood- cell forming tissues (leukemias and lymphomas)
what does Ploidy classify?
number and structure of tumor chromosomes
what does staging classify?
clinical aspects of CA
why is grading needed ?
b/c some CAs are more malignant than others
what does grading compare ?
appearance and activity of CA cell to parent cell
what is the purpose of grading ?
evaluating the pt with CA for prognosis and right therapy
the degree of aneuploidy also increases with what?
malignancy
what chromosome abnormality is present in leukemia cells ?
philadelphia chromosome abnormality
what does staging determine?
the exact location and whether metastasis has occured
what does clinical staging assess?
pts sx and evaluates tumor size and possible spread
what type of staging is the most definitive ?
pathological staging
how does pathological staging occur ?
looks at tissues obtained at surgery
what system is used to describe the anatomical extent of cancers ?
tumor node metastasis (TNM)
what type of tumor does the TNM system have specific prognostic types for?
solid tumors
how is tumor growth assessed ?
doubling time
what is doubling time ?
amount of time it takes for tumor to double in size
What is the mitotic index?
% of actively dividing cells in a tumor
how fast does a tumor with a mitotic index of 10% grow compared to 85%?
10%= slow, 85%=fast
how small is the smallest detectable tumor ?
1 cm (containing 1B cells)
what 3 factors influence CA development ?
carcinogens, genetics, and immunity
what is the main mechanism of carcinogenesis ?
proto-oncogene to activation to oncogene status (comes from overexpression)
what type of factor makes up the most % of CA pts ?
environmental (by 80%)
how does chemical carcinogenesis occur ?
exposure to chemicals, drugs, and products used in every day life
what % of CA is r/t tobacco?
30%
what does physical carcinogenesis come from?
physical agents or events that damages DNA
what are the 2 main things that cause physical carcinogenesis ?
radiation and chronic irritation
how does viral carcinogenesis occur ?
when viruses affect body cells and break DNA strands
what are viruses that cause CA?
oncoviruses
what diet factors can increase risk of CA?
low fiber and high red meat and animal fat
what does Tx mean ?
tumor cant be assessed
what does T0 mean ?
no evidence of primary tumor
what does Tis mean?
carcinoma in situ
what does it mean if we see a tumor that was classified as T1 go to T3?
its increasing in size and local extent of primary tumor
what does Nx mean ?
lymph nodes cant be assessed
what does N0 mean ?
no regional lymph node metastasis
what does it mean when we see a lymph node classified as N1 go to N3?
there is increasing involvement in nodes around
what does Mx mean ?
presence of distant metastasis cant be assessed
what does M0 mean ?
no distant metastasis
What does M1 mean ?
distant metastasis
if the grading of a malignant tumor (G) goes from G1 to G4 then what has happened to the cell?
we cant really see what parent cell they came from anymore
what about G0- what happened?
we cant determine the grade of the tumor
what does cell mediated immunity (NK and T cells) provide ?
immune surveillance
what is the most important risk factor for CA?
aging
what is primary CA prevention?
prevent actual occurence of CA, things we can modify and changewh
what are some examples of primary prevention?
stop smoking, vaccinations, using sunscreen, avoid asbestos)
what is secondary CA prevention?
use of screening strategies to detect CA early, at a time when cure or control is more likely
what are some examples of secondary CA prevention?
genetic screening, cervical screening, self breast exams, FOBT, digital rectal exam (DRE), mammograms, and colonoscopies
what is chemoprevention?
strategy that uses drugs, chemicals, natural nutrients to disturb one or more steps in CA development
what type of prevention is chemoprevention?
primary
what is superior vena cava syndrome (SVC) ?
it is an oncologic emergency that occurs when a tumor is compresses this vessel
what does prophylactic surgery do ?
removes potentially CA tissues as a means of preventing CA development (removing opposite breast in a pt with breast CA gene)
what does diagnostic surgery dO?
removal of all or part of a suspected lesion for examination and testing to confirm or rule out CA dx
what does curative surgery do?
removes all CA tissues
what is curative surgery most effective on?
small localized tumors or non-invasive skin CA
what does debulking surgery do?
removes part of the tumor if removal of entire mass is not possible
what does palliative surgery do?
providing sx relief and improving quality of life (NOT CURATIVE)
what does restorative or reconstructive surgery do?
increases function, enhances appearance or both
an organ loss reduces _____
function
why do we want to teach the pt about exercises after surgery ?
to get them to regain as much function as possible
what type of tx is radiation considered to be when the effects are seen in tissues within radiation path?
local
when is radiation considered systemic ?
when IV radioactive substance travels throughout the body to target CA cells
what is an example of a short term effect of radiation?
redness and desquamation
what is an example off long term effect of radiation ?
pulmonary fibrosis (from rad to the chest)
what is exposure ?
the amount of radiation delivered to a tissue
what is radiation dose?
amount of rad absorbed by the tissue
why is the rad dose always less than the exposure ?
because some energy is lost as it travels to its destination
what 3 factors determine the absorbed dose ?
intensity, duration, and closeness
what is the unit that is used to describe absorbed radiation rays ?
grays
what determines the total dose of radiation used?
the tumor size, location, and sensitivity of tumor and tissues nearby
what is fractionation?
when rad therapy is given as series of divided doses over a set time
what does fractionation allow for ?
great destruction of CA cells while reducing the damage to normal tissues (intensity of dose increases with distance of rad source)
What is cachexia ?
extreme body wasting and malnutrition that may occur during tx with advanced CA
how does a tumor obstruction affect the absorption of nutrient ?
they reduce it
how does CA tx affect sensory perception?
neurotoxic chemical agents injure peripheral nerves and lead to peripheral neuropathy
how does CA cause motor and sensory deficits ?
when CA invades the bone, brain, or compresses nerves
when CA invades the bone, what can it cause ?
pain, fractures, spinal cord compression (SCC), or hypercalcemia (from bone breaking down) which reduces mobility
what 2 ways can radiation be delivered ?
external (external beam) or internal (brachytherapy)
what is the external beam?
radiation delivered from a source outside of the patient
is the pt with external radiation radioactive? why or why not ?
no because the source is external
what does intensity modulated radiation therapy (IMRT) do for external radiation?
reduces amount of normal tissue exposed to radiation by breaking up single beam into thousand smaller ones allowing for diff intensity levels
what does stereotactic body radiation therapy do for external radiation?
it is a 3 dimensional tumor imaging to identify the tumor location, which allows precise delivery of high doses and spares more surrounding tissue
what is radio surgery ?
tx that uses ionizing radiation as surgical instrument instead of cutting blade
what are some examples of radiosurgery?
gamma knife and the cyberknife which are used for tx of brain tumors by carefully aiming radiation
what is the “tattoo” pts are marked with before a procedure ?
the skin is marked at the exact tumor location
what is brachytherapy also known as ?
ionizing internal radiation
what is the radiation source like with brachytherapy ?
it comes into direct continuous contact with tumor for a specific time period (seeds, ribbons, capsules)
how does radiation work with brachytherapy ?
it provides higher dose of rad in the tumor over a specific period of time, while limiting dose to normal tissues
how does brachytherapy use the radioactive isotopes ?
either solid or within body fluids, like external catheter in tumor bed or ingestion of radioactive source
what is different about pts on brachytherapy compared to the external beam ?
these pts emit radioactive material while source is intact
are the solid sources for brachytherapy temporary or permanent ?
they can be both
what type of radiation do traditional implants deliver ?
low dose rate radiation (LDR)
How does high dose rate (HDR) radiation occur ?
pt comes into rad therapy couple times a week and a stronger implant is planed near catheter near CA bed for short duration
what is radiation dermatitis ?
MOST COMMON SE of CA tx, is changes to the skin that can range from redness and rash to skin desquamation
what can radiation damage to normal tissues start ?
they can lead to inflammation processes that leas to tissue fibrosis and scarring
what do we tell pts to avoid the day of tx?
deodorants and lotions
what are the most sensitive normal tissues to radiation?
bone marrow, skin, mucous membranes, hair follicles, and germ cells (ovum and sperm)
how often are we going to wash radiation area ?
wash once a day with either water and mild soap as prescribed (no scrubbing)
what are we going to use to wash radiation area ?
hand not washcloth
what clothing do we want the pts to avoid ?
tight clothing (belts, buckles, straps)
when are sun rays most intense ?
from 10AM to 4PM
what is the function of cytotoxic systemic therapy ?
to kill CA cells (unlike surgery or radiation)
what is neoadjuvant therapy?
when chemo is used to shrink tumor cell before surgery or radiation
what type of tumors are more sensitive to chemo?
tumors with rapid growth
What is adjuvant chemotherapy ?
kill remaining CA cells after surgery or radiation
What is Nadir?
the time when bone marrow and WBC levels are low after therapy
What is the function of alkylating agents ?
stops cell division by preventing DNA and RNA synthesis
What is the function of anti metabolic agents ?
impair cell division, blocks metabolic actions
What is the function of anti-mitotic agents ?
they dont let cell complete mitosis
what is the function of anti tumor antibodies ?
blocks dna or rna synthesis
What is the function of topoisomerase inhibitors ?
disrupt topoisomerase which is essential for DNA synthesis which leads to cell death
What is dose dense chemo?
giving chemo rounds closer together that is supplemented with bone marrow growth factor
what is the intrathecal route?
delivers drugs to CSF
what is the intraperitoneal route ?
drugs go into ABD cavity (mostly used for ovarian CA)
what is the intravesicular route ?
drugs instilled directly into the bladder
what do intra-arterial infusions do ?
deliver high doses locally
how long does the nurse need to wear approved PPE when taking care of a pt on chemo?
within 48 hours of their last treatment
when a pt appears to have extravasation occur to their arm, what can we do to help the area BESIDES stop the infusion?
we may be able to inject the antidote directly into the site of extravasation
if a PO CA drug was missed, when does the pt take the next dose ?
they take it at the scheduled time - NOT when they remember suddenly
where do most infections come from when a pt has neutropenia ?
their own overgrowth of natural gut flora
what is odd about the s/s of neutropenia ?
the pt normally does not have a fever
how often should the pt with neutropenia have hygienic care?
PO, perineal, and axillary care needs to happen every 12 hrs
when does the acute type of chemo induced n/v (CINV) occur ?`
within first 24 hrs after chemo
when does the delayed type of chemo induced n/v (CINV) occur ?`
after the first 24 hrs
when does the breakthrough type of chemo induced n/v (CINV) occur ?`
intermittently
what does emetogenic mean ?
vomit inducing
when does Dacarbazine trigger n/v?
as soon as drug is started
what type of CINV does cisplatin induce ?
delayed n/v
what drug therapy works the best for CINV?
serotonin agonist drugs (5-HT3)
what is a SE that the pt on ondansetron (serotonin agonist) needs to be aware of ?
prolongs QT interval
what do we need to watch for when a pt is on granisetron transdermal patches ?
HA
what do we need to watch for when a pt is on palonosetron?
assess bowel habits, ensure stool softeners or laxatives are ordered
what do we need to watch for when a pt is on aprepitant (neuronkin 1 receptor agonist)?
have INR checked and be aware in interferes with warfarin
what do we need to watch for when a pt is on Esoaprepitant (neuronkin 1 receptor agonist)?
interferes with birth control
what do we need to be aware of when a pt is on dexamethasone ?
it can cause NA retention and HTN, can affect sleep, and need to monitor blood sugar
what is mucositis ?
inflammatory process that affects mucous membranes of the oral mucosa and GI tract that begins after chemotherapy
what can be used for the prevention of oral cryotherapy?
ice water or ice chips before therapy starts, during, or after rapid infusions
what is the function of biologic response modifiers ?
they use bodys own defense system to attack foreign cells, it prevents tumors from hiding from immune system
what do interleukins do ?
help immune system recognize and destroy CA cells
What do interferons do?
slow down tumor cell division, stimulate growth and activation of NK cells
What is the function of monoclonal antibodies ?
improves immune function while blocking cell receptors on cell surface, preventing cell division
how long does it normally take for hypersensitivity reactions (HSR’s) or infusion reactions to occur ?
during the procedure- anywhere from 30 min to 2 hours
what can decrease the incidence of infusion reactions ?
premedication with acetaminophen and diphenhydramine
