objective 10 Flashcards
a term used to describe the total number of people who are living with a
diagnosis of cancer
prevalence
what are the risk factors of cancer?
- Many well-known and common cancer risk factors are preventable.
- In addition to tobacco use, known risk factors include excessive body weight,
lack of physical activity, unhealthy eating habits, alcohol consumption, and
excessive exposure to the sun. - Several of these factors are related to other chronic diseases, such as
diabetes, kidney failure, chronic obstructive lung disease, and cardiovascular
disease
what are healthy cells?
- Blood cells
- Muscle (smooth,
striated, cardiac) cells - Nerve cells
- Bone cells
- Cartilage cells
- Liver cells
- Have specialized function
depending on their location
(differentiated). - Cells grow, replicate, and repair
tissues and organs. - Your immune system and your
genetic material (DNA/RNA)
regulate these processes. - Healthy cells are programmed
“what to do and when to do it.”
healthy cells
- Mutated cells
- Cannot regulate their
replication and pass on the
genetic mutations. - Bear little resemblance to the
normal cells of tissue from
which they arose. - Don’t do their “original job.”
- Cell membranes contain
tumor-specific antigens which
develop overtime as cell
become less differentiated. - Have invasive characteristics to
infiltrate other tissues
cancer cells
The process of cells developing into
mature healthy cells with explicit characteristics and
capabilities to do a certain function. Fetal cells are less
differentiated but become more differentiated as the
cells mature. When a cell develops mutations, it
becomes less “differentiated,” meaning it looks less
and doesn’t function like the cell it once was or was
meant to be
differentitation
process of infiltrating tissue, spreading
from the original development site.
metastasis
growth of new capillaries from the host
tissue to “nourish” the cancer cells
angiogenesis
transformation of a healthy cell into a
cancer cell
carcinogenesis
Abnormal, unrelated cell proliferation
that competes with healthy cells/tissue
for oxygen, nutrients, and space.
Abnormal cell replicate faster than
normal cells, passing on their defective
DNA that do not have regulatory
mechanisms to prevent overgrowth.
cancer
new growths of abnormal tissue
neoplasms
- Noninvasive, does not spread
- Remains localized
- Noncancerous
- May cause minor tissue damage
- Not injurious unless its location causes pressure or obstruction to vital
organs
benign
- Invasive
- Spreads or metastasizes
- When removed, recurrence is more common
- Death if uncontrolled
malignant
what are the 4 classifications of tumors?
carcinomas
leukemias
lymphomas
sarcomas
- Cancer that originates from epithelial tissue
carcinomas
glandular epithelium
adenocarcinoma
Cancer that originates from organs that from blood
leukemias
Cancers that originate from organs that fight infection (lymphoid tissue
lymphomas
Cancers that originate from connective tissue such as muscle and bone
sarcomas
what are carcinogens>
physical agents
chemical agents
diet
viruses
bacteria
genetics
hormones
medical interventions
what are the warning signs of cancer?
- Change in bowel or bladder habits
- A sore that does not heal
- Unusual bleeding or discharge
- Thickening or lump in breast or elsewhere
- Indigestion or difficulty swallowing
- Obvious change in wart or mole
- Nagging cough or hoarseness
determines size of tumor & existence of local invasion and
distant metastasis.
staging
what is the most common classification system?
T: tumor size
N: involvement of lymph nodes
M: presence of metastasis
- Tx primary tumor cannot be assessed
- T0 No evidence of primary tumor
- Tis Carcinoma in situ
- T1, 2, 3 – increasing size and or local extent of the primary tumor
primary tumor
- Nx Regional lymph nodes cannot be assessed
- N0 no regional lymph node metastasis
- N1, 2, 3 increasing involvement of regional lymph nodes
regional lymph nodes
- Mx distant metastasis cannot be assessed
- M0 – no distant metastasis
- M1 distant metastasis
distant metastasis
cancer is in situ, malignant cells are confined to the tissue of
origin, no signs of metastasis
stage 0
higher numbers indicate tumor is of greater size and
or has spread to the lymph nodes and or organs near the primary tumor
stage I, II, III
cancer has spread to other distant parts of the body
stage IV
what are the 2 classifications of tumors?
differentiated
undifferentiated
closely resembles normal tissue and is generally easier to treat
differentiated
does not appear like tissue of origin
undifferentiated
Cells differ slightly from normal cells (mild dysplasia) and
are well differentiated
grade I
Cells are more abnormal (moderate dysplasia) and
moderately differentiated
grade II
Cells are very abnormal (severe dysplasia) and poorly
differentiated.
grade III
Cells are immature and primitive (anaplasia) and
undifferentiated; the cell of origin is difficult to determine
grade IV
- Primary method for diagnosing, staging, treating CA
- Primary treatment; Debulking
- Salvage surgery (i.e. lumpectomy – mastectomy)
- Prophylactic surgery (breast)
- Palliative (paracentesis, thoracentesis)
- May be several treatment modalities to achieve the goal or a cure or control
- Potential effects on clients: postsurgical complications, disfigurement, rehab
surgery
- Antineoplastic agents:
- Interfere with cellular function, reproduction
- Cell cycle - specific drugs: Treat rapidly growing tumors
- Cell cycle - nonspecific drugs: Used for large, slow-growing tumors
- Administration routes & devices
- Oral, IV, IM, intraperitoneally, intrarterially, intrapleurally, topically
- Extravasation prevention; Vesicants
chemotherapy
what are the potential effects of chemo on client?
- Hypersensitivity (type1): 5% chance
- Extravasation: leak into tissues directly (tissue necrosis)
- Nausea (first and most common); Stomatitis: mucosal lining of mouth
- Mucositis: inflammation GI lining
- Bone marrow suppression (7-14 days post)
- Sterility
- Alopecia (temporary or permanent)
- Renal damage; Heart Failure
- Peripheral neuropathy, muscle weakness, imbalance
High-energy ionizing radiation
* Cause tissue disruption by alteration of the DNA molecule leading to cell
death or formation of free radical and irreversible DNA damage cell
death
* Cells that undergo frequent cell division are more sensitive to radiation
radiation therapy
High-energy x-rays aimed at specific locations
external radiation therapy
Short-distance therapy; Uses less radiation; Used alone or in combination
internal radiation therapy
what are the cumulative SE of radiation?
- Skin reactions: erythema to dry desquamation(flaking), moist
desquamation (dermis exposed, skin oozing), ulceration - Oral: Stomatitis, xerostomia, change and loss of taste, dysphagia
- Anorexia, nausea, vomiting, diarrhea (if colon in irradiated field)
- Leukopenia (low wbc) and thrombocytopenia (low platelets)( if bone
marrow in irradiated field)
what are the LT SE of radiation>
Fibrosis (thickening os scarring) : small intestine, lungs, & bladder,
Cataracts, Sterility, Blood cell formation disturbances, & New cancers
what are the common nursing interventions for chemo and radiation?
BITES
- Can be acute or chronic
- Due to cancer process, treatments
- Advanced cancer pain is often irreversible and not quickly resolved
but it is controllable - Pharmacological and non-pharmacological approaches
- Important to control pain for quality of life and to be aware of
physical, psychosocial, cultural and spiritual influences
pain management
- Most significant and frequent symptom for those receiving
cancer therapy and the stress of coping - Table 18-14
- Maintaining good nutrition and adequate hydration, alternating
periods of rest and activity, relying on family members for
assistance with responsibilities, and managing pain and anxiety
may help reduce fatigue.
fatigue
- Skin is vulnerable to the effects of radiation and chemotherapy.
- Erythema may develop 1 to 24 hours after a single treatment.
Erythema is an acute response followed by dry desquamation (Figure
18.15). If the rate of cellular sloughing is faster than the ability of the
new epidermal cells to replace dead cells, a wet desquamation occurs,
with exposure of the dermis and oozing of serum (Figure 18.16). - Skin reactions are particularly evident in areas subjected to pressure,
such as behind the ear and in gluteal folds, the perineum, the breast,
the collar line, and bony prominences.
impaired skin integrity
- Anorexia, malabsorption, cachexia (weakening/wasting of body)
- Patients with anorexia need to be monitored carefully during
treatment to ensure that weight loss does not become excessive. - Body weight should be measured at least twice weekly. Small,
frequent meals of high-protein, high-calorie foods are better
tolerated than large meals - Nutritional supplements may be required.
- Can have physical and psychosocial consequences
- Advanced stages may need nutritional support via enteral rout
nutrition
an cause death in a patient whose immune system is
suppressed as a result of cancer treatment.
* Infection occurs as a result of the ulceration and necrosis caused by the
tumour, compression of vital organs by the tumour, and neutropenia
caused by the disease process or the treatment of cancer.
* A critical aspect of nursing care is teaching about infection risk associated with
neutropenia. A patient with a body temperature of 38°C (100.5°F) or higher
should be seen at the hospital or cancer centre as soon as possible.
* Assessment most often includes signs and symptoms of fever,
determination of possible cause, and complete blood cell count.
* The classical manifestations of infection are often not present in a
patient with neutropenia and a depressed immune system.
infection
what are the psychosocial manifestations of approaching death?
- Altered decision making
- Anxiety about unfinished business
- Decreased socialization
- Fear of loneliness
- Fear of meaninglessness of one’s life
- Fear of pain
- Helplessness
- Life review
- Peacefulness
- Restlessness
- Saying goodbyes
- Unusual communication
- Vision-like experiences
- Withdrawal
