Nurb test 4: cancer Flashcards
=tumor suppressor genes, mutated but not highly mutated, turns of the cells division , gets turned off when you have a mutated cell dividing uncontrollably turns off turns into an ___
proto-oncogenes
Turn intoOncogene
- permanent change (irreversible)in the cell’s structure=mutated, allows the growth doesn’t regulate, from single exposure
- proto-oncogenes
- oncogenes
Initiation
=tumor growth gene allows the cell to keep dividing, no turning it off
oncogene
- goes to proto-oncogenes to oncogenes increasing and keeps dividing
Prolonged exposure, speeds up cell division
Promotion
- no contact inhibition, keeps growing, goes where ever it wants to go
Grow out of control
Progression
three staged in development of cancer
initiation
promotion
progression
originate from skin, glands, mucous membranes linings of respiratory tract, GI tract, and GU tract.
Carcinoma
originate from connective tissue, muscle, bone, and fat.
Sarcomas
originate from the hematopoietic system or lymph nodes.
Lymphoma and Leukemia’s
- you don’t see any or very few cancer cells, most generally won’t see, rare
Grade X
- best to have, cells resemble parent cell, differentiated= stay in one part and look like regular cell, hasn’t mutated that much Ex: pancreatic cell
Grade I
- less differentiated= can tell it is of that parent cell but not exactly like that parent cell
Moderate differentiated
Grade II
- cells are reverting back to a fetal stage, becoming undifferentiated, means you can’t tell where they are coming from and what their parent cell is
Poorly differentiated
Grade III
- cells are undifferentiated in fetal appearance, can’t tell what the parent cell is
- When doing a biopsy it tells you lower the grade more probability to treat it, where it located from, better chance if lower grade
Grade IV
-insite to=tumor is encapsulated a lining around it, tumor cells are not getting out, can do a lumpectomy remove it/ best to have
Stage 0
- in that area, no movement Ex: breast cancer biopsy is just in that area
Stage I
- still in that area but beginning to branch out a little bit
Stage II
- branched out, going into the lymph system Ex: breast cancer to lymph system
Stage III
- metastasized to other area
Stage IV
tnm
t classification
tumor size
-degree of regional spread to the lymph nodes, involvement 0-4, rate by how many nodes they took out / number of nodes divided by 4 = n / can only take out 16, can range 4-16 nodes
N tnm classification
T rate it 1-4 T1= T2= T3= T4=
T
- 1-3
- 4-6
- 6-9
- more than 10 cm
Based on 8 nodes N0= N1= N2= N3= N4-
N
- no involvement
- 1-2
- 3-4
- 5-6
- greater than 6
M-metastasis-: 0-4 M0= M1= M2= M3= M4=
- no mets
- to one area or 1 organ, most generally it close to the original site Ex: breast to lung
- two different areas close to it
- two -three area, plus distance Ex: prostate mets to lung and to bone
- more than three organs
7 warning signs of cancer
change in bowl habits
- a sore that does not heal= needs to be looked at for melanoma
- uncontrolled bleeding out of any orfice
thickening or a lump in breast or elsewhere
- indigestion or difficulty in swallowing
-obvious change in a wart or a mole
- nagging cough or hoarseness
- Reduce exposure: sun unprotected= never
- Diet
- Exercise
- Rest
- Health Exams: mammograms, digital rectal gland= prostate, pap smear, inspecting skin
- Stress: decreases your immune system
Prevention and Early Detection of Cancer
: very important, see if it runs in the family, cancer in the past, lifestyle= smoking, alcohol, high fat diet, sleeping habits=recovery lack is related to stress, diet, occupation, past medical history, what meds they are on, and exercise.
Health history
dx
: whole exam not just the one for the complaint
Physical examination dx
where it originated from, undifferentiated or poorly,
Cancer Factors that determine the treatment modality is:
Cell type of cancer:
Cancer Factors that determine the treatment modality is:
- Cell type of cancer:
- location of the cancer
- size of the cancer
- extent of the disease
Ex: aorta=constriction
Size of the cancer or tumor
Location of the cancer:
how many areas has it metastasized to Ex: bone, liver, or brain how many areas seen / several areas in liver will be palliative
Extent of the disease:
-Treatment following primary treatment Ex: remove tumor now chemo
Adjuvant
-Treatment prior to surgery Ex: cancer tumor of lung is huge and wrapped around nerve and muscle in clavicle will use radiation to shrink then will go into to remove
Neoadjuvant
try to remove the tumor and surrounding tissues until you come to clean margins= cant visualize any cancer in that tissue Ex: 5 cm remove 7 cm bc clean margins
Surgery:
directed at one area within the body, now for micromets= 1 or 2 cells may have gone through the lymph nodes, 3 rounds of chemo also Ex: breast stage 2 best option
Radiation therapy:
- specific area within the body Ex: breast hormone treatment
- Biologic therapy
decreasing the size of the tumor, remove much of the tumor as they can without hurting the normal structures, then can do radiation to help shrink more, can never remove whole thing Ex: tumor engulfed around pancreas, can’t remove tumor, and need pancrease
Debulking:
cancer surgical therapy
: Make lead block before pt gets there and then shine light from the simulator will light up the area, area bigger than the tumor, make dots where they need to line up to get the exact area, usually within 2-3 weeks after surgery= enough time for body to recoup but not enough time for cells to start reproducing initial treatment can take up to two- three hours
Go in everyday Monday through Friday 36-42 treatments , go home every night / will have burns
Simulation
cancer radiation therapy
weight, eating, sleeping, feeling, examine skin for burns and blisters= certain lotion (Carie), can’t use any type bc metals in it
After 1st week will be so tired, over long bone wbc counts and hemoglobin will be down
Nurses always need to do assessment:
cancer radiation therapy
mild doesn’t penetrate through the skin
Alpha:
cancer radiation emission
strong, normal type used
Beta:
cancer radiation emission
: more forceful, strong, may not have to do 36 treatments , more burns with
Gamma
cancer radiation emission
will have, want to lay in bed all day long, could be depression= doesn’t mean have to be on meds/ tell them to eat good meals 6 snacks= skin break down, and walking program=release endorphins, blood circulating, feel good about self
Cancer Radiation Therapy- Nursing Management
1. Fatigue:
6 small meals a day= if bad skin break down, just don’t feel like eating, metal taste in mouth after 5th treatment ,
- don’t use silverware use plastic wear, - Oral care: good mouth care don’t use Listerine or strong mouth wash can breakdown membrane= baking soda and warm water/ suck on a lemon drop before eat will stimulate taste buds so they can taste there food - Eat favorite food
Anorexia:
nursing management cancer radiation
may have n/v bc stress, fatigue, and where it is/ use Zofran if nausea not if vomiting / drink enough fluids, eat small meals
Gastrointestinal:
cancer radiation nursing care
: due to radiation over long bones, where cells are made at, nurse monitor labs wbc too low will have to stop so they can come back up bc immune system problem, eating correctly
Bone Marrow Suppression
large lengthy burn, reddened, blisters= seeping, very painful= won’t wear bra or no clothing, not sleeping eating, afraid to bath
This bad doc will stop it for 1 week then will have a visit for starting again if skin still not healed then will have one more week off, then will resume
Cancer Radiation Therapy- Nursing Management Burns
1. Skin reactions:
skin is clean, apply caldril to help with burn, do not use solercaine will cause more burning, can use aloe vera cream= cooling effect, can dress it if seeping can get infected teach how to= can’t will look at every day and come in and have me do it (older people)
Eating correctly to promote skin repair
Nursing care:
cancer radiation therapy
problem swallowing, sore on tongue from it =
_____= lidocaine, flageyl= fungal, and antibiotic in it
Swish and spit if oral/ swish and swallow= goes down esophagus
Numbs pain= lidocaine, gets rid of bacteria- helps heal
Good oral care and Mouth wash baking soda and water
Eat small meals
Oral, Oropharynx, and Esophageal Reactions:
cancer radiation therapy
nursing care
mary’s magic potion
- can have resp issues, most generally not to much, sob inhaler, may take 2-3 days off if bad reaction
Pulmonary
cancer radiation therapy nursing care
- young age men may encourage to do sperm banking to have baby later, depends on how long radiation is might be able to produce sperm/ will have to wait 5 years to have kids , would encourage doing sperm bank instead
- female- can have eggs harvested to artificial simination, waste down, chest can shield down not 100 percent.
Reproductive
cancer radiation therapy
nursing care
: not done well, don’t know if they are going to live, is it worth it, can’t hardly get out of bed or eat / ask how they are doing every day, talk to them, family involvement, support group, walking therapy
Coping
cancer radiation therapy
nursing care
Advantages-in control
disadvantages- are they compliant, do they really take it
Potential complications:
Nursing Implications- making sure they are compliant
Oral
cancer method of administration
=directly infuse medication into the brain, liver, sometimes spine=rare cancer
-goes directly to the arterial vessel supplying the tumor
Advantages- a lot of chemo doesn’t cross brain barrier, can treat cancer in brain with, greater cell kill
Disadvantages- distant metastases chemo won’t get into it, will have to get other chemo for mets, requires surgical implantation, can become occluded or hepatic artery injury
Nursing Implications-prevent infection, S&S of bleeding, monitor ptt and pt labs
Intra-arterial
cancer method of administation
: bleeding, embolism, pain, arterial injury, catheter migration or dislodgement, and occlusion
Potential complications
intraarterial
- more related to cerebral spinal fluid, continuous drip
-lumbar puncture into the subarachnoid space
-needs to be given by a nurse or physician that is trained in it
Disadvantages- incomplete distribution of drug in the CNS= most time a Ommaya reservoir is inserted
Nursing Implications- monitor for signs of infection
Intrathercal/Intraventricular
cancer method of administration
Potential complications: headache, nauseas, vomiting, fever, increased intracranial pressure, and nuchal rigidity
intrathercal intraventricular
cancer method of administratoin
- put a tenckhoff catheter is surgically or percutaneous placed in the belly around umbilical area 3-4 in away, there till chemo is over or an extra 5 weeks after chemo is over,
- used for ovarian cancer=starts to spread, gives off seeds into abd area start growing on tissues on abd wall
- colon: tumors growing not till stage 3 or 4, goes out as regional spread tumors everywhere
- instill 2 liters of chemo therapy agent into belly, clamp catheter
- always pain meds a head of time
Intraperitoneal
cancer method of administration
Potential complications: abd pain, catheter occlusion dislodgement and migration, distention, ileus, intestinal perforation, and infection
Intraperitoneal
cancer method of administration
painful, short term treatment with chemotherapy
disadvantage Intraperitoneal
cancer method of administration
-into pleural cavity, used to scare tissue or work with lung cancer, sometimes can be radioactive= works a little bit better: no isolation
Disadvantages-requires thorotomy tube, med can only be delivered by a physician
Intrapleural
cancer method of administration
chemo make sure it is not a vesicate
-give slowly and diluted by pharmacist in special room under hood
Advantages- fast acting
Disadvantages-venous access difficulty
IV-
cancer method of administration
=very volatile to vein and rupture easy and eat the skin causes phlebitis and sclerosis and limiting future peripheral venous access* do not give IV
vesicate
infiltration of the drug into tissues surrounding the infusion site causing local tissue damage
extravasation
S&S= selling, redness, and presence of vesicle on the skin, after few days skin may begin to ulcerate and necrosis
extravasation=
Tx: pt may need surgical intervention from debridement to skin grafting
Nursing Implications: watch for device or catheter infection, monitor for extravasation
-if extravasation occurs immediately turn of the infusion to minimize further damage
IV cancer method of treatment
- can be single or double lumen, clamps on it so valve doesn’t close, always open, surgically inserted, clamped=there is nothing go through it, open draw to make sure there is a blood return: should have because in superior vena cava
-no blood return need have raise their arm or cough and try again, doesn’t work may need to get a clot buster=tpa little for 20 minutes and it flushes
-flush with normal saline then chemo then normal saline with a little bit of heparin clamp before you take the syringe off, lasts a year
-1 white= one chemo
-1 red=one blood draw, no more pain on the patient
-dressing change= pt wear a mask to avoid exposure to bacteria/ sterile central line dressing change every 7 days
Monitor: signs of infection, assess the site, make sure that they are clamped=not problem
Hickman
central vascular access device
- no more than a year, looks like a Hickman but no clamp because the lumen is controlled by blood pressure, the lumen is closed when not instilling, don’t use heparin on it
- problem with clotting
Groshong central vascular access
going into the superior vena cava, inserted by trained nurses, tunneled up arm, cover sit well, has antimicrobial stuff on circle, always clamped if not in use
-xrayed tip has a radioactive sensor to tell if right
-short term
-also flush with heparin
Monitor- infection
dressing change= pt wear a mask to avoid exposure to bacteria/ sterile central line dressing change every 7 days
PICCs-
central vascular access
Choose over picc: don’t have lines hanging, easier for the patient can put lidocaine in to stop from the pain from when needle is inserted
port-a- cath
central ventricular access
surgically implanted into the superior vena cava, single and double port, always a titanium surrounding the silicone pad that you inject into under the skin= find port by feeling around area will be able to feel exactly where it is, pull taunt then stick needle into the center of the skin and feel it go all the way through to the back of the port=hard stop, surgically inserted, infection is less likely, infection if
-most have because can last several years
-inserted into the breast needle, large breast the port can flip over=call surgeon get chest x-ray
-some people are very thin and are able to see the outline of the port, say in chart which side they put it in
-open lumen finished flush and put in heparin then take needle out
-only use hoover needle=looks like a hook, non-poring needle=protect the silicone pad so it doesn’t cause a coring which could cause them to bleed, goes back together when taken out
sterile dressing, maintain sterile field, change every 7 days
Get blood draw from port, no arms
Needle in: check for signs of infection
Port-A-Caths:
central ventricular access
-Meet with oncologist will review the biopsy=staging, nodes removed and involved t and n, grade, and where the original site is=different chemo for different sites
-then look at weight and height= obtain body surface area
The dose of each drug is carefully calculated using body weight and height or body surface area.
Combination of cell cycle phase-specific =specific phase of cycle and cell cycle-nonspecific are generally used together for better cell kill
Combination drug use sees a wider range of side effects
NADIR count may vary with combination drugs-
Treatment Plan
lowest level of blood cell counts due to bone marrow depression 7-28 days / chemo doesn’t differentiate between normal cells and bad
NADIR
= important to know how to do, watch how much chemo getting
Calculate dose/m2 x BSA
Body Surface area
more than 100 significant you call the doctor
Height in cm x weight in kg) Divide the sum by 3600
Now get the square root of this sum
This is your final number
1”=2.54cm / 1kg=2.2lb
: destroys bone marrow every cancer patient will have, easily dev infection
Can cause death= wbc and neutrophils low
Neutropenia
cancer side effects
are lungs, GU, mouth, rectum, peritoneal cavity, and blood (septicemia)
Usual sites of infection
neutropenia
- contact doctor with temperature greater than 100.5F.
Stay away from crowds during NADIR period because risk for infection is greater during this time Go out to eat but before 4 after 8/ go grocery store at night when not busy - no fresh flowers, fresh fruit or vegetables that can’t be peeled out of skin Ex: apple yes someone else peel
Avoid sick people and kids
Patients education
neutropenia
is a must know. - make sure immune system is strong enough for chemo, will take a dive when on chemo. *If it is below 500 than you must hold the chemotherapy and call the doctor. Can give growth stimulating hormone to develop wbc
The Absolute Neutrophil Count (ANC)
neutropenia
Normal ANC
Safe ANC- give chemo
Neutropenic
Severe Neutropenia-
greater than 2500
greater than 1000
500-1000
below 500
Patient needs to remain from crowds, isolate self at home with someone who is well and home care/ most will admit for precaution for 3-4 days
- Protect against people with colds or flu - Place in protective isolation if in hospital= taken by ambulance
Management of less than 500
neutropenia
Calculation of ANC
Segmented Neutrophils (also known as neutrophils or polys), Bands, WBC
*all on CBC
(Neutrophils + Bands) x WBC = sum x 10=anc
A. Pre-meds: always to prevent side effects of chemo, nausea and vomiting allergic reaction
- = prevent nausea/ vomiting
- longer half life, last longer after chemo to prevent N/V
- allergic reaction, sleep through treatment, high dose, someone else drive
- longer half life, N/V, inflammation
Nursing Management Zofran Aloxie Benadryl Decadron
Breast Cancer survival increased with use of __________
- after chemo is over and with _______
-chemo pt, made from trees in California , filter med before sent in vials/ pharmacy given by cva filter because still micro wood fibers=use filter to give to pt bc wood fibers
Disadvantage-causes neuropathy in hand and feet which is permanent from the micro wood fibers
Biotherapeutic Strategies
Trastuzumab A. Herceptin
Paclitaxel Taxol
Lymphoma survival rates improved with addition of
Biotherapeutic Strategies
Rituximab (Rituxan)
- loss of appetite related to chemo or radiation, most common, because Nausea and nothing tastes good, metal taste from treatment, tired and don’t feel like eating
- use lemon drops, fav food, 6 times a day small meals high protein and calorie, plastic wear
- monitor weight
Cancer Side effects Nursing Management
1. Anorexia
- chemo works on chemo receptor trigger zone in brain.
- give premeds antiemetic’s, Zofran at home if ___/ start to ____won’t work after they start
- drink enough fluids when not ____
- really bad do soft food
Cancer Side effects Nursing Management
Nausea/Vomiting
- 90% of pts with chemo or radiation develop
- make sure they drink enough fluid 3 liters a day
- soft fluid, low fiber low residue
- last longer than 24 hours call doctor give Immodle
Cancer Side effects Nursing Management
Diarrhea
-some chemo agents cause metallic taste
Cancer Side effects Nursing Management
Altered Taste Sensation
- common side effect of chemo and radiation (occurs in 30-40%)
- sores in the mouth=Mary’s magic potion, or mouth was with baking soda and water
- assess mouth daily, nutritional sup, analgesics for pain
- diet=avoid irritating spicy foods, keep mouth clean
Cancer Side effects Nursing Management
Mucositis/Stomatitis
- destruction of hair follicles, protect scalp from sun and cold
- going to happen no matter what
- prepare for it= cut real short before they go into treatment
- get scarves, get wig, turban
- hair grow back will be different than when started
- avoid excessive shampooing or brushing
Cancer Side effects Nursing Management
Alopecia
-due to chemo or tumor progression
-increase fiber and fluids
-not eating increase fluid and mild laxative
Miralax great= easy on colon, stool softener
Cancer Side effects Nursing Management
Constipation
= tell me what you are doing at home to help work through it, drink water, activities in morning, rest, walk a little bit, try to walk after dinner also/ it’s okay going to be tired *empower patient
Cancer Side effects Nursing Management
fatigue, N/V
- usually associated with treatment, which is most distressing to patients
- Can cause depression
- Find out when most energy to plan activities
- Walking plan= helps with depression too
- Get rest don’t be afraid to ask for help
Cancer Side effects Nursing Management
Fatigue
- very important because it is a rapidly growing cell
-can get dry skin
Cut could bleed longer and longer to heal
Keep it clean and from infection
Good hygiene= Keri Lotion: NO FRAGRENCES
Cancer Side effects Nursing Management
Skin care
Obstructive Emergencies
Tumor obstruction of an organ or blood vessel such as:
- superior vena cava syndrome
- spinal cord compression syndrome
- third space syndrome-
- intestinal obstruction
– facial edema, periorbital edema, distention of veins in head neck and chest, headache and seizures
obstructive emergencies
superior vena cava syndrome
–intense back pain that is localized and persistent, vertebral tenderness and aggravated by Valsalva maneuver, motor weakness, sensory paresthesia
obstructive emergencies
spinal cord compression syndrome
b/c cell death or lysis Sx: apathy, depression, fatigue, muscle weakness
Metabolic emergencies
3. Hypercalcemia:
: low ca, high potassium, phosphatemia, hyperurcemia
metabolic emergencies
Tumor lysis syndrome
high wbc, fatigue, fever increased HR and Resp rate
metabolic emergency Septic shock
Metabolic Emergencies
- ectopic hormones
- sundrome of inappropriate antidiuretic hormone
- Hypercalcemia:
- Tumor lysis syndrome
- Septic shock
- Disseminated intravascular coagulation:
shift fluid to interstitial space Sx: hypotension, tachycardia, loss central venous pressure, and decreased urine output
third space syndrome-
obstructive emergency
caused from septicemia no control of bleeding, control with medication
Disseminated intravascular coagulation:
metabolic emergency
: wt gain without edema, weakness, anorexia, N/V, personality changes, seizures, oliguria, decreased reflexes
Syndrome of inappropriate antidiuretic hormone
metabolic emergency
directly from the tumor or treatment
Released from neoplasm ( ban growth) or cells outside the usual source
Production of ectopic hormones
metabolic emergency
-Lethal, more quality time but will not survive it
Risk factors: high fatty diets, lack of exercise, family history, high cholesterol, poor diet
Pancreatic Cancer
Provide symptomatic and supportive nursing care.
Pain management: end stage extremely painful
Psychological support
Maintain nutrition: a lot of time will have G tube in because they don’t feel like eating
Nursing Management:
pancreatic cancer
Risk factors: family history both maternal and paternal, diet, smoking, lack of exercise
Diagnostic Studies: mammogram if see spot will do ultrasound no MRI
. Breast Cancer
Signs and Symptoms: lump, discharge from nipple, change in appearance
breast cancer
A. if contained
not contained ____= reconstruction surgery
New thing family history double ____ reduce anxiety and prevention
B. depending on amount of involvement
C. if in lymph system
Breast cancer
surgery a. lumpectomy b. masectomy
radiation
chemo
Occurs in the kidney only in children
Asymptomatic abdominal mass on side and back usually found by a parent or during a well child check or bath
Dx: CT Scan or MRI along with CBC, electrolytes, kidney function test, and liver function test
Wilm’s Tumor
A. first to shrink the tumor
B. =remove kidney or just tumor with clean margins and part of kidney
Ng tube 1 or 2 ivs, in pain
Care for patient and family bc freak out
-good I and O= too much in will have third spacing/ too much out- dehydration
After surgery will get more chemo again
treatment wilms tumor
Chemo
surgery
Education on chemotherapy, side effects, and emotional care
Pre-operative teaching
After surgery-GI assessment, fluid replacement, NG care, and wound care
Assessment of coping skills for family and patient
Nursing management:
wilms tumor
Early stages is asymptomatic
Dx: Screening tools are PSA and digital rectal exam every year will fine
Early stages of are curable
Prostate Cancer
Symptoms: dysuria, dribbling, frequency, urgency, hematuria, and lumbosacral pain with radiation as disease processes= more advanced
prostate cancer
-*pt must be turned every 30 minutes for 3 hours= to get meds in all areas, leave in extra hour then drain fluid off the belly luck to get back 700 ml rest is absorbed in belly good because chemo is working
Nursing Implications- reassure it is okay, call get an order of Ativan to help with anxiety, signs of infection
Nursing care intraperitoneal
Early detection through PSA and DRE starting at age 50
Pre-op teaching and Post-op care
Education on chemotherapy and side effects
Self-care after surgery and during therapy
Men concerned because it makes them impudent now medication can be taken care of
Nursing Management
prostate cancer
B. Patient teaching: do every time keep doing, ask if they are doing it Decrease infection with hand washing Omit fresh vegs. and fruits with low WBC When to call the doctor Avoid exposure to illness
Nursing management chemo
