MS2 - Quiz 9

Question 0

Radiation - Teaching

Answer 0

• Gently cleanse skin in treatment field using a mild soap, tepid water, soft cloth, and gentle patting motion. Rinse thoroughly and pat dry.
• Apply nonmedicated, nonperfumed, moisturizing lotion or cream. OTC hydrocortisone cream 1% may reduce itching.
• Rinse area with saline solution, expose area to air as much as possible. Observe daily for signs of infection.
• Avoid tight-fitting clothing such as bras and belts over treatment field
• Avoid wearing harsh fabrics, such as wool or corduroy
• Gentle detergents
• Avoid direct exposure to sun, wear protective clothing and sunscreen in sun
• Avoid swimming in saltwater or chlorinated pools during time of treatment
• Avoid use of potential irritants, avoid tape, dressings, adhesive bandages

Question 1

Neutropenia - Teaching

Answer 1

• Wash your hands frequently and make sure those around you wash their hands frequently, particularly if they help with your care. Antibacterial gel can also be used.
• Notify HCP if: fever is 100.4 or greater; chills or feeling hot; redness, swelling, discharge, or new pain on or in our body; changes in urination or bowel movements; cough, sore throat, mouth sores, or blisters
• Avoid crowds and people with colds, flu, or infections. If you are in a public area, wear a mask and use hand sanitizing gel frequently.
• Avoid uncooked meats, seafood, or eggs and unwashed fruits and vegetables.
• Bathe or shower daily. A moisturizer may be used to prevent skin from drying and cracking.
• Brush your teeth with a soft toothbrush four times daily. You may floss once daily if it does not cause excessive pain or bleeding. Avoid alcohol-based mouthwashes.
• Do not perform gardening or clean up after pets. Feeding and petting dog or cat are fine, but wash hands well after handling.

Question 2

Chemo administration - Nursing Care/Assessment

Answer 2

x

Question 3

Platelet levels and precautions to take when levels are low

Answer 3

Platelets 150,000-400,000 (Thrombocytopenia = too low)

• Notify HCP about manifestations of bleeding (black tarry bloody bowel; black/bloody vomit, sputum, urine; bruising or small red or purple spots on skin; bleeding from mouth or anywhere in body; headache or changes in how well you can see; difficulty talking, sudden weakness of arm or leg, confusion)
• Walking should be done with sturdy shoes or slippers. Get up if weak or at risk for falling.
• Do not blow nose forcefully. Nosebleed - keep head up, apply firm pressure to nostrils and bridge of nose. If bleeding continues, place ce bag over bridge of nose and nape of your neck. Call HCP if nosebleed lasts > 10 mins.
• Do not bend down with your head lower than waist.
• Prevent constipation - drink plenty of fluids, do not strain with bowel movement, do not use suppository, enema, or rectal thermometer without HCP approval.
• Shave only with electric razor
• Do not pluck eyebrows or other body hair
• Do not get tattoos or other body piercings
• Avoid using meds that prolong bleeding, such as aspirin
• Use soft-bristled toothbrush, flossing usually safe if done with thin tape floss, do not use alcohol based mouthwashes
• Menstruation - should keep track of # of pads used per day, do not use tampons
• Notify HCP before having invasive procedures done, such as dental cleaning, manicure, pedicure

Question 4

Complications of cancer - how to assess them

Answer 4

Nutrition

• Weigh patient at least twice a week to monitor weight loss - notify HCP as soon as 5% loss is noted
• Monitor albumin and prealbumin levels
• 10 lb weight loss - difficult to maintain nutrition status
• Dysgeusia (altered taste sensation) may contribute to pt not eating

Infection

• Temperature (100.4 or greater - contact HCP)
• S/S fever
• CBC

Oncologic Emergencies

• Superior vena cava syndrome - facial edema; periorbital edema; distention of veins of head, neck, and chest; headache; seizures
• Spinal cord compression - back pain that is intense, localized, persistent and accompanied by vertebral tenderness and aggravated by Valsalva maneuver, motor weakness and dysfunction; sensory paresthesia and loss; autonomic dysfunction; change in bowel or bladder function
• Third space syndrome - Hypovolemia (incl. hypotension, tachycardia, low central venous pressure, and decreased urine output)

Question 5

Goal of palliative surgery for the cancer patient

Answer 5

• Relief of pain
• Obstruction
• Hemorrhage

Examples:

1. Debulking of tumor to relieve pain or pressure
2. Colostomy for relief of bowel obstruction
3. Laminectomy for the relief of spinal cord compression

Question 6

Types of routes for chemo. adminstration

Answer 6

Oral
Intramuscular 
Intravenous - most common
Intracavity (pleural, peritoneal)
Intrathecal
Intraarterial
Perfusion
Continuous infusion
Subcutaneous
Topical

Question 7

Comfort drugs for patients on chemo.

Answer 7

• NSAIDs
• Opioids - moderate to severe pain
• Adjuvant pain medications

Should be used and selected based on the character and/or cause of the pain
Analgesics (e.g., morphine, fentanyl) should be given around the clock with addtl doses avail as needed for breakthrough pain

Question 8

What can healthcare providers do to protect themselves from the chemo drugs during administration?

Answer 8

x

Question 9

Complications of Cancer - Metabolic emergencies and Infiltrative emergencies - symptoms - what to assess for?

Answer 9

Metabolic emergencies

• SIADH - weight gain without edema, weakness, anorexia, nausea, vomiting, personality changes, seizures, oliguria, decrease in reflexes, coma
• Hypercalcemia - apathy, depression, fatigue, muscle weakness, ECG changes, polyuria, nocturia, anorexia, nausea, vomiting. Calcium >12 mg/dL often produce symptoms
• Tumor lysis syndrome - hyperuricemia, hyperphosphatemia, hyperkalemia, hypocalcemia. Weakness, muscle cramps, diarrhea, nausea, vomiting.

Infiltrative Emergencies

• Cardiac tamponade - heavy feeling over the chest, shortness of breath, tachycardia, cough, dysphagia, hiccups, hoarseness, nausea, vomiting, excessive perspiration, decreased level of consciousness, distant or muted heart sounds, extreme anxiety
• Carotid artery rupture - bleeding - can manifest as minor oozing to spurting of blood in the case of a “blowout” of the artery