Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Med Surg Block 3 Test 2 > MS Test 2 > Flashcards

MS Test 2 Flashcards

1
Q

Third most common form of cancer 9% of cancer deaths are due to CRC More common in men Highest mortality rates among African American men and women Risk of contracting the disease increases with age Of new cases, 90% in people older than 50 The incidence of CRC in individuals older than 50 is decreasing as a result of increased screening to detect precancerous lesions

A

Colorectal Cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

has an insidious onset, and symptoms do not appear until the disease is advanced. Regular screening is necessary to detect precancerous lesions. Approximately one half of all colon cancers occur in the rectosigmoid area

A

Colorectal Cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

CRC Mortality rates are highest among _____ and _____. About 90% of new CRC cases are detected in people older than 50, and about a third occur in patients with a family history of CRC.

A

African American men and women.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Diet Risk factors for CRC

A

High in red or processed meat

Low in fruits and vegetables

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Lifestyle factors for CRC

A

Obesity

Physical inactivity

Alcohol

Long-term smoking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How can we decrease the risk of CRC?

A

Physical exercise and a diet with large amounts of fruits, vegetables, and grains may decrease the risk.

NSAIDs (e.g., aspirin) in women also may decrease the risk.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Most common type of CRC

A

Adenocarcinoma is the most common type of CRC About 85% arise from adenomatous polyps Tumors spread through the walls of the colon into musculature and into the lymphatic and vascular systems

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Most common sites for metastasis of CRC

A

Most common sites of metastasis

Regional lymph nodes

Liver

Lungs

Bones

Brain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Why is the liver a common site of metastasis from CRC?

A

Because venous blood leaving the colon and rectum flows through the portal vein and the inferior rectal vein,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Clinical manifestations of CRC?

A

Insidious onset .

Symptoms often do not appear until disease is in advanced stages.

Change in bowel habits

Unexplained weight loss

Vague abdominal pain

Symptoms of cancer in the left side of the colon appear earlier

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Symptoms of cancerous lesions (CRC)

A

Rectal bleeding is most common

Alternating constipation and diarrhea

Change in stool caliber

Narrow, ribbon-like

Sensation of incomplete evacuation

Obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Manifestations of CRC

A

Weakness and fatigue

Iron-deficiency anemia

occult bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Complications of CRC

A

Obstruction

Bleeding

Perforation

Peritonitis

Fistula formation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Signs and symptoms of CRC based on location: Transverse Colon

A

Pain

obstruction

change in bowel habits

anemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Signs and symptoms of CRC based on location: Descending Colon

A

Pain

change in Bowel habits

Bright red blood in the stool

obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Signs and symptoms of CRC based on location: Rectum

A

Blood in stool

Change in bowel habits

Rectal Pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Signs and symptoms of CRC based on location: Ascending Colon

A

Pain

mass

change in bowel habits

anemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

At what age should person get a colonoscopy?

A

Beginning at age 50, both men and women at average risk for developing CRC should undergo screening tests to detect both polyps and cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Where do most CRC come from?

A

Most CRC arises from adenomatous polyps. Therefore, early detection and removal of precancerous polyps could prevent most CRC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

CT colonography

A

is also called virtual colonoscopy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How often should diagnostic tests be done for CRC?

A

Regular screening for polyps and cancer Flexible sigmoidoscopy every 5 years Colonoscopy every 10 years Double-contrast barium enema study every 5 years CT colonography every 5 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Annual screening tests for CRC?

A

Annual screening primarily for cancer.

Fecal occult blood test (FOBT)

Fecal immunochemical test (FIT) Test for blood in the stool Must be done frequently to catch the intermittent bleeding common with tumors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Colonoscopy

A

“Gold standard” test.

Entire colon is examined, Biopsy samples can be obtained Polyps can be immediately removed and sent to the laboratory for examination

24
Q

What percent of CRC are found in colonoscopy?

A

Only 50% of CRCs are detected by sigmoidoscopy

25
Q

How often should people have a colonoscopy?

A

every 10 years beginning at age 50, except for African Americans, who should have the first colonoscopy at age 45.

Those who have a first-degree relative who developed colorectal cancer before the age of 60, or who have two first-degree relatives with CRC, should have a colonoscopy every 5 years beginning at age 40, or 10 years earlier than the youngest age at which a relative developed cancer.

26
Q

What other lab studies must be done after diagnosis of CRC?

A

Colonoscopy and tissue biopsies confirm diagnosis

Additional laboratory studies must be done

CBC to check for anemia

Coagulation studies

Liver function tests

27
Q

What is Carcinoembryonic antigen (CEA)? (Diagnostic test)

A

Complex glycoprotein Sometimes produced by colorectal cancer cells. May be used to monitor for disease recurrence after surgery or chemotherapy NOT a good screening tool because of a large number of false positives

28
Q

How is a CRC tumor staged?

A

Prognosis and treatment correlate with pathologic staging of the disease TNM system (to stage)

Prognosis worsens with Greater size and depth of tumor Lymph node involvement.

29
Q

Surgical goals for CRC?

A

Complete resection of tumor.

Thorough exploration of abdomen.

Removal of all lymph nodes that drain the area

Restoration of bowel continuity

Prevention of surgical complications

30
Q

How do we know surgical therapy was successful for CRC?

A

Successful when Resected margin of the polyp is free of cancer.

Cancer is well differentiated

No lymphatic or blood vessel involvement is apparent

31
Q

Surgical therapy for CRC

A

Polypectomy during colonoscopy is used to resect colorectal cancer in situ

Some polyps can be removed during colonoscopy, whereas others necessitate surgery.

32
Q

How do we determine the site of the colon resection?

A

The site of the colon and rectal cancer dictates the site of the resection (e.g., right hemicolectomy, left hemicolectomy

33
Q

How do we treat stage 1 CRC tumors?

A

Surgical removal of stage I cancer includes removal of the tumor and at least 5 cm of intestine on either side of the tumor plus removal of nearby lymph nodes. Laparoscopic surgery is sometimes used for stage I tumors, especially those in the left colon.

34
Q

How do we treat low risk Stage 2 CRC tumors?

A

Low-risk stage II tumors are treated with wide resection and reanastomosis, but chemotherapy is used in addition to surgery for high-risk stage II tumors.

35
Q

How do we treat stage 3 CRC tumors?

A

Stage III tumors are treated with surgery and chemotherapy.

36
Q

How do we treat stage 4 CRC tumors?

A

Stage IV tumors Indicates cancer has spread to distant sites

Surgery is palliative

Chemotherapy is directed at controlling the spread of the cancer

Radiation may be used to provide pain relief

37
Q

Why would we perform a temporary colonoscopy?

A

Perforation

Peritonitis

Hemodynamic instability

Later, the ends of the colon can be surgically reconnected.

38
Q

3 surgical options in rectal cancer?

A

Local excision

Low anterior resection (LAR) to preserve sphincter function

Abdominal-perineal resection (APR) with a permanent colostomy

39
Q

Abdominal-perineal resection (APR) with a permanent colostomy

A

In APR, both the tumor and the entire rectum are removed, and the patient has a permanent colostomy.

The perineal wound may be closed around a drain or left open with packing to allow healing by granulation. Complications that can occur are delayed wound healing, hemorrhage, persistent perineal sinus tracts, infections, and urinary tract and sexual dysfunctions.

40
Q

Low anterior resection (LAR) to preserve sphincter function

A

The LAR is used more frequently because of the potential for more normal control over defecation. When the tumor is not resectable or if metastasis is present, palliative surgery is done to control hemorrhage or relieve a malignant bowel obstruction. An LAR may be indicated for tumors of the rectosigmoid and the middle to upper rectum. If the tumor is far enough from the anal sphincters, the sphincters may be left intact. The use of end-to-end anastomosis staplers has allowed lower (<5 cm from anus) and more secure anastomoses.

41
Q

What is a J pouch?

A

created by folding the distal colon back on itself and suturing it to form a pouch, which will replace the rectum as a reservoir for stool.

42
Q

Why do we use chemo for CRC?

A

to shrink a tumor before surgery

An adjuvant treatment following colon resection

For stage III and high-risk stage II tumors

Palliative treatment for nonresectable colorectal cancer

43
Q

What therapy is there besides chemo for CRC?

A

Biologic and targeted therapy is also used.

44
Q

Drug alert for capecitabine (Xeloda):

A

Instruct patient not to get immunizations without physician’s approval.

Report temperature > 100.5º F/38º C immediately.

45
Q

What chemo drugs are used for CRC?

A

5-Fluorouracil (5-FU) plus folinic acid.

Leucovorin is used alone or in combination with oxaliplatin (Eloxatin)

Eloxatin is preferred if patients can tolerate the side effects

Oral fluoropyrimidines (capecitabine [Xeloda]) have been found equally effective

46
Q

Angiogenesis inhibitors

A

inhibits the blood supply to tumors,

bevacizumab (Avastin) and

ziv-aflibercept (Zaltrap)

Regorafenib (Stivarga) is a multikinase inhibitor that blocks several enzymes that promote cancer growth.

Cetuximab (Erbitux) and panitumumab (Vectibix) block the epidermal growth factor receptor. They are used in the treatment of metastatic CRC.

47
Q

Radiation therapy for CRC?

A

May be used postoperatively

As an adjuvant to surgery and chemotherapy

As palliative therapy for metastasis

To reduce tumor size

To provide symptomatic relief

48
Q

Nursing implementation for CRC screening

A

Encourage all persons older than 50 to have regular CRC screening

Help identify those at high risk

Participate in early cancer screening to help decrease mortality rates

Realize that fear and lack of information create barriers to prevention activities

49
Q

What should nurse teach about colonoscopy?

A

Colonoscopy detects polyps only when the bowel has been adequately prepared.

Provide teaching about bowel cleansing for outpatient procedures

Correctly administer cleansing preparations to inpatients

50
Q

What is the bowel prep procedure for colonoscopy?

A

clear liquid diet for 24 to 48 hours before procedure

4 L of oral polyethylene glycol (PEG) solution the evening before the procedure. Drinking 2 L the evening before and 2 L the morning of the procedure provides better cleansing, especially for endoscopy scheduled for the afternoon. Because many people find the PEG lavage solution difficult to drink and experience nausea and bloating, manufacturers have modified the PEG solutions to improve taste and palatability.

Magnesium citrate solution

bisacodyl tablets are sometimes given before the PEG lavage to remove the bulk of stool so that only 2 L of PEG is needed. Encourage patients to continue drinking and to drink all of the solution. Stools will be clear or clear yellow liquid when the colon is clean.Make sure drink is cold to make it more palatable.

51
Q

Nursing care for pt with colon resection

A

Provide care, information, and emotional support.

Provide information about prognosis future screening

Provide support in dealing with diagnosis Inform about the extent of the surgical procedure

52
Q

mental care for pt with permanent ostomy?

A

Patients who have an APR will have a permanent ostomy and consequently will need intense emotional support.

53
Q

Care for pt with permanent ostomy?

A

Consult a wound, ostomy, and continence nurse specialist

Select the ostomy site

Provide follow-up care and teaching

54
Q

Postoperative care for CRC

A

Sterile dressing changes

care of drains

patient and caregiver teaching about the stoma

55
Q

Care of pt with APR extensive surgery?

A

Patients with more extensive surgery (e.g., APR) may have an open wound and drains (e.g., Jackson-Pratt, Hemovac), as well as a permanent stoma.

56
Q

Care of pt with reanastomosis of bowel:

A

general postoperative care.

Med Surg Block 3 Test 2 (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions