Neoplasms #1 (1)

Question 1

Benign Tumor

Answer 1

Cells grow only locally and cannot spread by invasion or metastasis

Question 2

Malignant Tumor

Answer 2

Cells invade neighboring tissues, enter blood vessels, and metastasize to different sites

Question 3

Neoplasm

Answer 3

An abnormal growth of tissue, benign or malignant, that serves no physiologic function. AKA tumor

Question 4

Ondanestron (Zofran)

Answer 4

Use: Treatment and prevention of nausea and vomiting. Often used for postoperative nausea and for nausea related to chemotherapy or radiation therapy.

**Action: **Blocks the effects of serotonin at 5-HT3 receptor sites located in vagal nerve terminals and the chemoreceptor trigger zone in the CNS.

Side/Adverse Effects: headache, dizziness, drowsiness, constipation, diarrehea, abdominal pain, dry mouth, extrapyramidal reactions (involuntary movement of eyes, face, limbs)

**Nursing Implications: **

• Administer prior to emetrogenic event when possible (chemo, radiation, anesthesia induction)
• Assess daily bowel activity and stool consistency
• Teach patient to notify health care provider is extrapyramidal symptoms occur
• SAfety precautions for dizziness and drowsiness

Question 5

Fatigue

Answer 5

• Most frequently experienced symptom of cancer and cancer treatment, regardless of the treatment protocol being utilized
• Universal symptom affects 70-100% of cancer patients
• Alters functional and cognitive status, sense of well-being, and relationships
• Receives little attention and priority from the health care team. Consider this nursing diagnosis when you assess you patient

Question 6

Fatigue r/t increased waste production of cell destruction

Answer 6

Definition: An overwhelming, sustained sense of exhaustion and decreased capacity for physical and mental work at the usual level that is not relieved by rest.

Assessment Findings:

• inability to restore energy even after sleep
• lack of energy
• increase in rest requirements
• tired
• inability to maintain usual routines
• increase in physical complaints
• drowsy
• compromised concentration

Outcomes:

• Verbalizes increased energy and improved well-being
• Describes factors that cause or increase fatigue
• Describes factors that conserve energy

Nursing Interventions:

• Provide information about fatiguee
• Assess fatigue using 0-10 scale, ability to perform ADLs, mood and concentration abilities
• Allow patient time to express feelings, concerns about fatigue
• Help patient establish small, easily achievable short-term goals
• Help patient identify essential and nonessential tasks, prioritize as needed and determine what can be delegated. schedule priority activities at times of peak energy
• Teach strategies for energy conservation
• Assist to follow health lifestyle- adequate nutrition and rest, appropriate exercise
• Give patient permission to limit social and role demands
• Manage pain, N/V, other symptoms

Question 7

Chemotherapy

Answer 7

The use of medications or chemical agents to destroy or interfere with the replicaiton of cancer cells. Normal and malignant cells are affected. Systemic treatment: travels through the bloodstream to affect cancer cells.

Question 8

What cells in the body divide rapidly?

Answer 8

hair follicles, mucous membranes, GI mucosa, and bone marrow

Question 9

What cells are the most severly affected by chemotherapy?

Answer 9

Normal cells that rapidly divide. the basis for many of the side effects experienced.

Question 10

What is the goal of chemotherapy?

Answer 10

to destory cancer cells while doing minimal damage to normal cells and to cure the individual. If cure is impossible, control or palliation become the goal.

Question 11

Neoadjuvant

Answer 11

may be given prior to primary treatment to shrink the tumor

Question 12

Chemotherapy use

Answer 12

may be used as a primary treatment, an adjuvant modality (combined with surgery, radiation, biologic-therapy) or a pallative therapy

Question 13

Combination Chemotherapy Protocols

Answer 13

Using two or more chemotherapies together

• Kills more cancer cells (improved tumor response)
• Reduces likelihood that cancer cells will become resistant
• Different mechanisms of action and different toxicities limit the severity of side effects

Question 14

Preparation of chemotherapy

Answer 14

Class II biological safety cabinet or laminar airflow hood for all preparation by pharmacist or trained RN

Question 15

Administration of Chemotherapy

Answer 15

• Double glove with disposable, non-powdered, thick latex gloves (or gloves manufactured as chemo resistant)
• Long sleeve disposable gowns with elastic/knitted cuffs
• Absorbent, plastic backed liner under work surface
• Disposable-puncture proof, shatter proof, leak proof plastic container for waste
• Leur-Lok fittings for syringes, tubings
• Double bag contaminated linen
• keep “spill kit” available (biohazard)

Question 16

Safety Tips Chemotherapy

Answer 16

• Do not eat or drink in areas where antineoplastic agents are prepared or administered
• Become familiar with and be able to recognize sources of exposure to antineoplastic agents
• Wash hands before using and after removing personal protective clothing
• Handle wastes related to antineoplastic agents separately from other hospital trash. Treat them as hazardous waste. Utilize appropriate chemowaste disposal bags and chemowaste sharps container
• Clean up spills immediately using appropriate precautions
• Learn what written policies your unit has for the safe handling of antineoplastic agents

Question 17

Chemotherapy Teaching Plan

Answer 17

1. Action, side effects of chemotherapy
2. Self-care measures for anticipated side-effects (hair loss, GI symptoms)
3. Notify staff is IV chemotherapy becomes dislodged or IV site painful
4. Double flush toilet X 48 hours

Question 18

Baseline Assessments Prior to chemotherapy

Answer 18

Lab Values (H/H, WBC, platelet, absolute neutrophil count): Rules out possibility of anemia, leukopenia, and thrombocytopenia. May need to hold chemo if present.

Ordered doses appropriate for calculated body surface area (ht/wt): Prevents chemotherapy underdosing or over-dosing

Side-Effects Experiences: Determines if it is safe to administer next dose (manageable symptom of toxicity). Focuses teaching.

Vital Signs: Allows comparison to baseline. Determines if safe to administer next dose (if sick not going to administer).

Question 19

Nursing Interventions During IV Chemotherapy Administration

Answer 19

• Assess patent IV
• Assess and manage side-effects
• Teaching as indicated (determined by side-effects of chemotherapy)

Question 20

Radiation Therapy

Answer 20

Use of high energy x-rays or particles to destroy tumor cells. Local treatment (treats only a specific area of the body).

Question 21

What does radiation therapy do?

Answer 21

Alters the cell’s ability to divide due to DNA damage. Cancer cells often cannot repair the radiation damage and cell death occurs. Normal tissue cells are often able to recover from the injury is therapeutic doses are maintained.

Question 22

Which cells are most severly affected by radiation therapy?

Answer 22

normal cells that divide rapidly

Question 23

Radiation therapy goal

Answer 23

To destroy cancer cells while sparing normal tissue and to cure the individual. .If cure is impossible, control or palliation becomes the goal.

Question 24

Radiation Therapy Use

Answer 24

Primary treatment, an adjuvant modality, or a pallative therapy

Question 25

External Beam Radiotherapy (teletherapy)

Answer 25

• Treatment iven by an external beam machine
• May use x-rays gamma rays, electrons, protons, or neutrons
• Radiation treatment given by external beam machine

Question 26

Internal Sealed Radiotherapy (brachytherapy)

Answer 26

• Therapeutic use of radionuclide that is sealed within metal container
• Radioactive particles penetrate the container to treat the disease
• placed directly into or adjacent to tumors
• temporary or permanent
• high dose rate or low dose rate (left in)
• temporary sealed radioactive sources removed after the prescribed dose is reached in the calculated number of hours
• HDR allows localized doses of radiation to be delivered to the tumor quickly to reduce side-effects and allow therapy on an outpatient basis

Question 27

Internal Unsealed Radiotherapy

Answer 27

• Treatment with unsealed radioactive source that is ingested, injected, or instilled
• radiation is metabolized and absorbed by the body then concentrated in a specific target organ
• also called radiopharmaceutical therapy

Question 28

Three types of radiation therapy

Answer 28

1. External Beam Radiotherapy
2. Internal Sealed Radiotherapy
3. Internal Unsealed Radiotherapy

Question 29

Time (radiation)

Answer 29

The amount of exposure is directly proportional to the amount of time spent near the souce. Less time spent near source, less radiation received. The amount of time at a specific distance that can be spent with a patient is determined by the radiation safety officer.

Question 30

How will a nurse minimize time around radiation?

Answer 30

1. organize care
2. teach self-care measures
3. rotate assigned staff
4. communicate via intercom/phone

Question 31

Distance (radiation)

Answer 31

The amount of radiation exposure one receives is inversely related to the distance one is from the source. Small differences in distances are critical.

Question 32

How will a nurse maximize distance from radiation therapy?

Answer 32

1. Stand as far from the source as possible when delivering care (ex. stand at head of bed for patient with gynecologic radiation implant)
2. Teach patient self-care measures

Question 33

Shielding (radiation)

Answer 33

The amount of radiation exposure received from a specified radioactive source can be decreased by the use of an absorbing material (shield)

Question 34

How will the nurse shield from radiation?

Answer 34

1. Keep shielding between source and personnel
2. Select the correct material for shielding based on type of radition source (ex. lead for high energy gamma sources)