Neoplasia & Care of a Cancer Patient

Question 1

What are the 2 major dysfunctions during cancer development ?

Answer 1

proliferation & differentiation

Question 2

What is cell proliferation ?

Answer 2

the process of cell growth and division
- the growing is continuous
- no off-switch

Question 3

What is cell differentiation ?

Answer 3

normal process where a cell changes from a unspecialized or immature state to a specialized or mature state
- cells take on individual characteristics and become more focused in their function

Question 4

What was the phases of cancer development ?

Answer 4

• initiation: mutation in cells genetic structure
• promotion: reversible proliferation of altered cells
• progression: increased growth rate and spread of cells, invasiveness & metastasis

Question 5

What does benign mean ?

Answer 5

• encapsulated: confined to a specific area
• rarely metastatic
• differentiated
• does not mean it is not having an impact

Question 6

What does metastasis mean ?

Answer 6

where cancer spreads from the original site to another site
- the cancer cells breaks away from the original tumor which travels through the blood or lymph system and form new tumors in other areas

Question 7

What does malignant mean ?

Answer 7

cells are different from the cells around them
- grows rapidly
- ranges from well differentiated to undifferentiated
- can metastasize

Question 8

What are the cancer grade classifications ?

Answer 8

• Grade 1: cells differ slightly from normal cells and are well-differentiated (best prognosis)
• Grade 2: cells are more abnormal and moderately differentiated
• Grade 3: cells are very abnormal and poorly differentiated
• Grade 4: cells are immature and primitive and undifferentiated, and cell of origin is difficult to determine (worse prognosis)

Question 9

What are the cancer staging classifications ?

Answer 9

• O: cancer in situ (found in the place it was first formed & best prognosis)
• 1: tumor limited to tissue of origin; localized tumor growth
• 2: limited local spread
• 3: extensive local and regional spread
• 4: metastasis (worst prognosis)

Question 10

What is the anatomic extent of the disease based on (TNM) ?

Answer 10

• tumor size and invasiveness (T)
• spread to lymph nodes (N)
• metastasis (M)

Question 11

What is the gold standard for diagnosis of cancer ?

Answer 11

biopsy

Question 12

What is some post-op nursing care for a biopsy ?

Answer 12

• risk for bleeding: withhold anticoagulants, watch for staining of dressings, hypotension & tachycardia
• risk for infection
• pain control

Question 13

What is a PET scan ?

Answer 13

positive emission tomography
- uses mildly radioactive liquid (radioactive tracer) to show up areas of your body where cells are more active than normal
- used to help diagnose cancer & found out where and whether the cancer has spread

Question 14

What are the early warning signs of cancer ?

Answer 14

CAUTION
- Change in bowel or bladder
- A lesion that does no heal
- Unusual bleeding or discharge
- Thickening or lump in breast or elsewhere
- Indigestion or difficulty swallowing
- Obvious changes in wart or mole
- Nagging cough or persistent hoarseness

Question 15

What are the overall goals of cancer treatment ?

Answer 15

• cure
• control
• palliation

Question 16

What are the primary factors to determine what cancer therapy is used ?

Answer 16

• cell type
• location and size of tumor
• extent of disease
• physiologic and psychological status
• expressed needs and desires

Question 17

What are some characteristics of chemotherapy ?

Answer 17

use of a chemical as a systemic therapy for cancer
- systemic admin through a central vascular access device (VAD) admin (PICC or port)
- can be given through peripheral IV but it’s a vesicant so close observation is essential to avoid extravasation
- regional admin is a delivery of drug directly to site and allows for higher concentrations can be delivered

Question 18

What are some hazardous precautions for chemotherapy ?

Answer 18

• no pregnant caregivers
• protect self from any contact with chemo or with bodily fluids
  
  • wear gown, eyewear, and mask
  • cover toilet before flushing
  • double glove when handling bodily fluids
• if spill of chemo occurs, there are special clean up kits

Question 19

What are some characteristics of radiation therapy ?

Answer 19

radiation is energy emitted from a source and travels into tissue
- one of the oldest nonsurgical methods of cancer treatment
- 50% of all cancer pt’s will receive radiation therapy at some point

Question 20

What is the different between external beam radiation and internal radiation ?

Answer 20

External Radiation:
- comes from a outside source
Internal Radiation (Brachytherapy):
- radiation is placed into the patient
- ALARA: (as low as reasonable achievable) wear a badge to track the total radiation for the HCP
- patient is the source of radiation only when the device is in them
- limit the time in the room to small amounts (cluster care)

Question 21

What are some late effects of chemotherapy and radiation ?

Answer 21

• increased risk for leukemia’s and other secondary malignancies due to bone marrow suppression
  
  • Ex.) multiple myeloma, Non-Hodgkin’s lymphoma, cancers of the organs and of the bones
• fibro sarcomas have been reported several years after radiation therapy
• smoking may significantly increase the risk of secondary malignancies
• secondary malignancies are usually resistant to therapy

Question 22

What are some examples of oncological emergencies ?

Answer 22

• spinal cord compression
• metabolic emergencies: septic shock, hypercalcemia, disseminated intravascular coagulation (watch clotting factors, won’t have high WBC count), syndrome of inappropriate antidiuretic hormone secretion (hyponatremia and water retention)
• tumor lysis syndrome

Question 23

What is spinal cord compression ?

Answer 23

a tumor in the epidural space of the spinal cord which can lead to paralysis or vertebrae degrade due to cancer
- S&S:
- intense, localized, persistent back pain
- motor weakness
- sensory paresthesia and loss
- change in bladder and bowel function

Question 24

What is tumor lysis syndrome ?

Answer 24

triggered by chemo’s rapid destruction of large number of tumor cells
- often triggered by first doses of chemo
- when cells die, it leads to an increase in uric acid, increase in serum phosphate, and decrease in calcium
- this can lead to renal failure and changes in cardiac function that can be fatal
- Tx: IV hydration (to dilute concentration) & allopurinol (to control uric acid levels)

Question 25

How may perfusion be affected by cancer tx ?

Answer 25

- monitor for inflammation due to radiation - some chemo drugs are cardiotoxic - may need echo prior to chemo, monitor EKG and for any clinical manifestations - can develop pericarditis and myocarditis

Question 26

How may cognitive/neurological elements be affected by cancer ?

Answer 26

- increased intracranial pressure - may be controlled with steroids - peripheral neuropathy - monitor for manifestation of paresthesia, areflexia - may need chemo interruption or reduced dose until symptoms get better - chemo brain - use daily planner - get sleep and rest - exercise brain

Question 27

How may fluids and electrolytes be affected by chemo ?

Answer 27

- monitor renal function (BUN and creatinine) for renal toxicity - keep accurate I/O's - monitor for tumor lysis syndrome - monitor for uric acid levels: tx with allopurinol - encourage increased fluid intake

Question 28

How is infection risk affected by cancer tx ?

Answer 28

- infection is the primary cause of death - RN's role is infection prevention - treatments can cause leukopenia, neutropenia, and depression of bone marrow - the body cannot fight off infections - usual sites of infection: lungs, urinary tract, mouth/rectum, peritoneal cavity and blood

Question 29

What are neutropenic precautions ?

Answer 29

- strict handwashing when entering room and before pt care - private room with door closed - wipe down high touch surfaces - no lab coats, jackets, stethoscopes - no fresh fruits, vegetables, or flowers in the room - no sick visitors or staff - gown, masks, goggles not required

Question 30

What is the goal of neutropenic precautions and when they are initiated ?

Answer 30

to prevent infections in immunocompromised patients by protecting them from the "outside world" - initiated when ANC <1,000

Question 31

How causes thrombocytopenia in cancer pt's ?

Answer 31

bone marrow suppression leads to thrombocytopenia (decreased platelets) - because the platelets are made in the bone marrow - essentially what happens is the cancer infiltrates the bone marrow and crowds out the healthy bone marrow - low platelets= risk for bleeding - spontaneous bleeding can occur when platelet count is less than or equal to 20,000 - may require platelet transfusions

Question 32

What are some thrombocytopenic precautions ?

Answer 32

- no aspirin or anticoagulants - no NSAIDS (ibuprofen) - try to avoid/minimize needle sticks and use smallest needle (22 G) - no tampons or vaginal suppositories - no rectal temps or rectal suppositories - cleanse oral cavity after meals and snacks with soft swabs to prevent any tears - use electric razor

Question 33

When do we implement thrombocytopenic precautions ?

Answer 33

- using anticoagulants - liver disease present - platelets less then 150,000 - hemophilia present - using thrombolytic meds

Question 34

What are some S&S we observe for those on thrombocytopenic precautions ?

Answer 34

- hematuria (blood in urine) melena (dark, tarry stool which digested blood) - nosebleeds - gingival bleeding - bruising

Question 35

What are some digestion complications in cancer pt's ?

Answer 35

- stomatitis - mucositis - esophagitis - nausea and vomiting - anorexia - hepatotoxicity

Question 36

What are some assessments findings for digestion in cancer patients ?

Answer 36

- signs of dehydration - metabolic alkalosis - I/O's - weight at least twice weekly or more frequently if rapid weight loss

Question 37

What are some nursing considerations for digestion for a cancer patient ?

Answer 37

- keep oral mucosa clean - use mouth swabs after meals/snacks - avoid mouthwashes like listerine, use sterile saline instead - for pain, alert and oriented adults can have Viscous Lidocaine to numb mouth - avoid children (may accidentally swallow= numb gag reflex= aspiration risk) - avoid spicy foods, rough textured foods, and high temp foods - use nutritional supplements whenever possible (instead of milk in milkshake use nutritional supplement) - encourage eating (if they want, let them eat) - if nauseous, give them antiemetic (Zofran) 30 mins prior to eating - if have a lot/thick secretions: can suction with a soft tip yank Auer - use bottled or filtered water - TPN is the last resort - causes increased risk for infection (due to increase glucose) and risk for electrolyte imbalances

Question 38

What is some nutritional changes in cancer pt's ?

Answer 38

Malnutrition: - fat and muscle depletion are big concerns - nutritional counseling when 5% weight loss noted Altered taste sensation - physiologic basis of altered taste is unknown - teach pt to avoid foods that are disliked, experiment with different seasonings to mask alterations

Question 39

What is some tissue integrity changes in cancer pt's ?

Answer 39

- Alopecia: hair loss that often happens with chemo - assess pt's feelings and coping before we project our own feelings on them - skin reactions can develop 1-24 hrs after treatment - Goal: protect the skin to prevent infections and facilitate wound healing - give them soft wipes and barrier creams to prevent skin breakdown

Question 40

What are some chemo related skin changes ?

Answer 40

- hyperpigmentation - telangiectasia (blood vessels appearing on skin) - photosensitivity - acne erythema - thinning skin

Question 41

What are some tissue integrity nursing considerations for radiation therapy ?

Answer 41

- never put any lotions or gels before radiation - if dry desquamation: after radiation can use a water-based lubricant like Aquaphor - avoid tight, restrictive or harsh clothing - avoid any type of strong or scented soaps, use a very mild baby shampoo unscented - PAT DRY if wet desquamation - no heating pads

Question 42

Why is important to remember about pain for a cancer patient ?

Answer 42

always investigate new pain as a potential site of metastasis

Question 43

What are some considerations about reproduction and sexuality for cancer patients ?

Answer 43

- encourage discussion of issues related to sexuality before beginning treatment - can discuss ova and sperm banking even in young ages - can refer to counseling if needed - inform patient of expected sexual SE (low libido) - use appropriate shielding (especially during chemo should avoid kissing/sex)

Question 44

What are some S&S of hypercalcemia ?

Answer 44

Serum Ca >12 - muscle weakness - ECG changes (shortened QT interval)

Question 45

What are the different reasons for surgery ?

Answer 45

- biopsy: diagnosis, staging, determining treatment plan - prevention: surgical intervention used to eliminate or reduce the risk of cancer development - cure control: objective is to remove all or as much as possible of a tumor - support & palliative care: when cure is no longer possible the focus shifts to supportive care

Question 46

What is the role of the immune system in cancer ?

Answer 46

- immune response is to reject or destroy cancer cells - may be inadequate as cancer cells arise from normal human cells - some cancer cells have changes on their surface antigens