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adult 1 med surg > oncology > Flashcards

oncology Flashcards

1
Q

characteristics of normal cells

A
  • intracellular mech that determines proliferation
  • dynamic equilibrium
  • well differentiated
  • contact inhibition
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2
Q

characteristics of malignant cells

A
  • grow uncontrollably
  • no contact inhibition
  • poorly differentiated
  • ADAPT, SPREAD, CHANGE
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3
Q

explain contact inhibition

A

cells stop growing when in contact with each other (not shown in malignant cells)

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4
Q

stages of metastatic process (4)

A
  1. tumor growth
  2. angiogenesis
  3. entry into capillaries + lymph
  4. circulation to other organs
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5
Q

what are carcinogens

A

substances that can contribute to abnormal cell growth and cancer dev

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6
Q

chemical carcinogens

A

benzene, arsenic, pesticides, asbestos

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7
Q

radiation carcinogens

A

xrays, atomic waste, UV radiation

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8
Q

viral carcinogens and what they can develop to

A

EBV –> lymphoma
HIV –> kaposi’s sarcoma
Hep B/C –> hepatocellular cancers
HPV

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9
Q

cancers r/t genetic predisposition

A

breast, colon, uterine cancer,

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10
Q

cancer r/t chronic inflammation

A

esophageal cancer

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11
Q

steps to classify cancer (3) and what they mean

A
  1. tissue of origin - type of growth
  2. grade - degree of malignancy (how abnormal)
  3. stage - extent of disease (how far has it spread?)
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12
Q

types of tissue of origin classifications

A

carcinoma: glandular epithelium
sarcoma: growth in CT, bone, muscle, fat
lymphoma: leukemia, hemapoietic

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13
Q

explain tumor grade?

A

grade: how abnormal; degree of malignancy
- grade I: differs slightly but still well differentiated
- grade IV: can’t tell origin; undifferentiated

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14
Q

explain tumor stage?

A

stage: extent of disease
- stage 0: carcinoma in situ
- stage 4: distant metastasis

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15
Q

TNM tumor staging?

A

t = tumor
n = nodes (lymph)
m = metastasis

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16
Q

dx tests for definitive dx of cancer?

A

cytology and biopsy

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17
Q

t/f: earlier detection and dx allows for better results and more tx options?

A

true

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18
Q

goals of cancer tx (4)

A

cure
control
palliation
rehabilitation

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19
Q

what is targeted tx?

A

target certain genetic parts of cancer cells; target cells helping cancer growth

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20
Q

what is immunotherapy tx?
- what are 2 types?

A

boost the body’s own immune response to help fight cancer
- biologic therapy: interferons
- monoclonal antibodies: herpicept for breast cancer

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21
Q

side effects of targeted and immunotherapy treatments

A

capillary leak syndrome –> pulmonary edema
rashes
flu like symptoms (watch for fever 100.4+)
confusion, insomnia

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22
Q

explain the following types of surgical management:
- prophylactic/preventative
- diagnostic surgery
- surgery for cure (resection)
- surgery for control (debulking)
- surgery for palliation
- reconstructive surgery

A
  • prophylactic/preventative: fam hx of predisposing genes
  • diagnostic surgery: collect specimens for dx
  • surgery for cure (resection): remove tumor
  • surgery for control (debulking): shrinking before radiation exposure
  • surgery for palliation: remove tumor sitting on nerve for comfort
  • reconstructive surgery: restore fx or appearance post tx
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23
Q

explain radiotherapy
- what it is
- good for _____
- MOA:

A
  • what it is: low doses under supervision = target and kill cancer
  • good for targeted tx
  • MOA: ionizing radiation destroy cell reproduction (all rapidly dividing cells) –> O2 free radicals destroy cancer
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24
Q

principles of radiation therapy (3) and explain how to demo each

A

time: rotate shifts, 30min in room for 6hrs then swap
distance: avoid foot of bed
shielding: proper lead aprons/covers

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25
Q

what to do if an implant becomes dislodged?

A

use forceps to pick up and place in lead line box

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26
Q

2 types of radiation therapy?

A

internal (brachytherapy) and external beam radiation

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27
Q

internal beam radiation
- how is the procedure done?
- how long is the seed in place?
- short term or long term?

A

seeds/rods are placed into tissue or cavity to target corresponding tumor

seed in place for 30-60min

can be used for short term or permanent therapy (going back to get another seed)

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28
Q

sealed internal radiation
- what is it
- is the pt radioactive?
- other education?

A

pills/seeds encased in nonradioactive covering

pt is not radioactive

can be left in place for days or reapplied each visit

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29
Q

unsealed internal radiation
- what is it
- is the pt radioactive?
- other education?

A

liquid/IV systemic radiation therapy

pt is radioactive for 2-3 days after tx (secretions radioactive)

drink extra fluids to flush, avoid sex, separate bathroom/utensils, don’t sleep or sit right next to each other

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30
Q

external beam radiation
- what is it
- how does the procedure work? (repeated___)

A

outside source of radiation accelerator
- skin area is marked for aim
- repeated doses 5x/wk for few wks
- immobilization device if aiming for head

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31
Q

complications of external beam radiation

A

dry + wet desquamation, fatigue

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32
Q

what is dry + wet desquamation?

A

skin peeling, burning, blistering effect of radiation

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33
Q

education with external beam radiation
- when does full effect take place?

A

pt is not radioactive, expect skin markings
- full effect 10-14 days (where SE are worse)
no tight/rough clothing
no excessive heat or cold
use mild soap, ask Dr before any topical

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34
Q

explain chemotherapy
- good for ____
- MOA:

A

using cytotoxic agents to destroy cancer cells
- good for widespread tx
- MOA: impacts cell repro, affects rapidly dividing cells

35
Q

what are cell cycle specific chemo drugs?

A

–> act on cells undergoing division (1+ areas of replication)
5 fluorouracil (5-FU)
vincristine (Periwinkle)
paclitaxel (Taxol)

36
Q

5 fluorouracil (5-FU)
C:
MOA:
I:
SE:
watch for _____

A

C: antimetabolite, cell cycle specific
MOA: stop DNA synthesis, inhib RNA
I: GI cancers
SE: bleeding, infection, myelosuppression, stomatitis, alopecia, hyperpigmentation, rash
watch for Nadir

37
Q

what is nadir?

A

lowest point of PLT and WBCs when taking a chemo drug

38
Q

vincristine (Periwinkle)
C:
MOA:
I:
SE:

A

C: plant alkaloid, cell cycle specific
MOA: prevent mitosis
I: leukemia, lymphoma, neuroblastoma
SE: neurotoxicity, strong vesicant

39
Q

paclitaxel (Taxol)
C:
I:
SE:

A

C: taxanes, cell cycle specific
I: hormonal cancer: ovarian, breast
SE: myelosuppression, alopecia, hypersensitivity, n/v

40
Q

what are non cell cycle specific drugs?

A

act on dividing and resting cells, more toxic
cyclophosphamide (Cytoxan)
carmustine
doxarubicin (Adriamycin)

41
Q

cyclophosphamide (Cytoxan)
C:
MOA:
SE:
when to hold?

A

C: alkylating agent, non cell cycle specific
MOA: given based on PLT count
SE: severe myelosuppression, hemorrhagic cystitis, SIADH, cardiomyopathy, sterility, alopecia, anorexia, n/v
hold when PLT count too low

42
Q

carmustine
C:

A

C: nitrosourea, non cell cycle specific

43
Q

doxarubicin (Adriamycin)
C:
I:
SE:
how is it admin?

A

C: antibiotic, non cell cycle specific
I: larger tumors not actively dividing
SE: myelosuppression, mucositis, cardiotoxicity, vesicant, alopecia
admin as single bolus inj

44
Q

what are estrogen hormone agonists and antagonists

A

estrogen can make some tumors grow faster
Tamoxifen
fulvestrant (Faslodex)
Aromatase inhibitors

45
Q

Tamoxifen
C:
I:

A

C: anti-estrogen, selective estrogen receptor modulator
I: 1st line tx for breast cancer in post menopausal women

46
Q

fulvestrant (Faslodex)
C:
I:

A

C: selective estrogen receptor degrader
I: advanced breast cancer in post menopausal women

47
Q

aromatase inhibitors
C:
MOA:

A

C: anti-estrogen
MOA: block aromatase: enzyme in tissue that makes estrogen

48
Q

side effects of all estrogen hormone agonists/antagonists

A

infertility risk, hot flashes, acne, blood clots, weight gain

49
Q

what are different hormone therapies for prostate cancer?

A

luteinizing hormone releasing hormone agonists
androgen receptor blockers
androgen synthesis inhibitors

50
Q

luteinizing hormone releasing hormone agonists
MOA:
SE:

A

goserelin (Zoladex), leuprolide = got these from book
MOA: block androgen release in prostate
SE: gynecomastia

51
Q

Prednisone and Decadron
C:
I:

A

C: adrenocorticoids
I: dec inflammation, improve appetitie, inc sense of wellbeing

52
Q

why should a patient on Taxol have ice packs on their hands

A

keep nail beds from separating during Taxol therapy

53
Q

phase I clinical trial

A

checking for safety, kinetics, interactions

54
Q

phase II clinical trial

A

refine dose range, kinetics, effectiveness

55
Q

phase III clinical trial

A

testing on larger scale for efficacy

56
Q

phase IV clinical trial

A

post marketing surveillance after FDA approval

57
Q

questions a non-chemo certified nurse should ask

A

when was the pts’s last tx
rxn to chemo drugs, interactions
how to handle body secretions
gloving, handling, disposal
need for IV fluids?

58
Q

what is better for chemotherapy: PICC/central lines or peripheral IVs and why?

A

PICC/central lines are better = less risk of extravasation of toxic chemo drug

59
Q

explain extravasation

A

drug infused leaks into vein –> blistering and necrosis of tissue from toxic chemo drug

60
Q

explain myelosuppression

A

SE of chemo
bone marrow activity decrease = dec Hgb, WBCs, PLTs

61
Q

explain Nadir

A

SE of chemo
lowest level of PLT and WBCs (7-14days past tx)

62
Q

what does it mean to be neutropenic and what lab is monitored?
- neutropenic protocol

A

low neutrophil count
ANC - absolute neutrophil count < 1000 = neutropenic

protocol: positive pressure room, restrict outside items/visitors, full PPE, monitor temp

63
Q

what to do if chemo pt has a fever

A

fever = 100.4+ ONCOLOGICAL EMERGENCY
admin filgrastim (Neupogen) : bone marrow stimulant to make WBCs, prevent infection in chemo pt

64
Q

what is thrombocytopenia and what lab is monitored?
- thrombocytic protocol

A

low platelet count
PLTs < 20,000 = thrombocytopenia

protocol: fall precautions, monitor for bleeding, avoid straight razors, no rectal/IM

65
Q

some pt education for neutropenia/thrombocytopenia

A

avoid crowds, sick ppl, pox immunizations, contact sports, injuries, razors

protect skin from breakdown

check for bleeding s/s and PICC line for redness

care with blowing nose

66
Q

when should a chemo pt call the MD?

A

dizziness, chills, loose stools, fever, abd pain

67
Q

what is cancer cachexia (wasting syndrome)
- tx?

A

anorexia and/or unintended weight loss and appetite loss
- treat the cancer, muscle growth should return; encourage high cal and high protein foods
- admin Megace: appetite stimulant

68
Q

cancer cachexia/anorexia recommendations

A

small, freq meals (high cal, high protein)
eat with company
loose fitting clothing
ice cubes/mints/tart candy = stim saliva
talk with dietician/dentist

69
Q

mucositis
- what is it
- C/M
- what to avoid
- protocol

A

chemo complication; cold/canker sore

C/M: redness, white lesions, dry mouth, low grade fever, difficulty swallowing

avoid listerine/alcohol based mouthwash = burn the mouth

protocol: mouth care before/after meals, topical mouth rinses, artificial saliva, non carbonated fluids, soft foods

70
Q

diarrhea
- C/M:
- protocol

A

C/M: electrolytie imb (K+), get stool sample

protocol: BRAT diet

71
Q

what is the BRAT diet

A

bananas, rice, applesauce, toast

72
Q

radiation recall
–> admin??

A

skin reaction; severe sunburn after chemo/radiation
–> admin steroids

73
Q

hand foot syndrome

A

skin reaction; redness + tingling in palms + soles of feet, moist desquamation, blistering

74
Q

when does alopecia start / when does new hair growth start

A

starts: 2-3 weeks after 1st dose
new growth: 4-6 weeks after last dose

75
Q

pulmonary effects of tx
- radiation
- chemo

A

radiation: cough, dyspnea, pneumonitis, fibrosis
chemotherapy: pulmonary edema, pneumonitis, fibrosis

76
Q

cardiovascular effects of tx
- radiation
- chemo

A

radiation: pericardial effusion, pericarditis
chemo: EKG changes, HF, ventricular dysfxn

77
Q

how to help reduce fatigue

A

prioritization of activities, activity mgmt, relaxation, massage, sleep quality

78
Q

metabolic oncological emergencies (3)

A

hypercalcemia: breakdown of bone (twitches and confusion)

SIADH: retain fluid, hyponatremia

Tumor Lysis Syndrome: hyperkalemia, high uric acid, hyperphosphatemia, hypocalcemia

79
Q

tx of tumor lysis syndrome

A

kayexalate, insulin, allopurinol, sodium bicarb

80
Q

obstructive oncological emergencies (4)

A

superior vena cava syndrome

sepsis (dec BP, inc HR, fever, lactic acid)

3rd space syndrome: lung/abd cancer pleural effusion

spinal cord compression: tumor on spine “can’t feel or move feet”

81
Q

infiltrative oncological emergencies (2)

A

cardiac tamponade
coronary artery rupture

82
Q

disseminated intravascular coagulation

A

abnormal clotting, something consuming all of the clotting factors = excessive bleeding

83
Q

palliative vs hospice care

A

palliative: relief from symptoms, done during dx, tx, and follow up, paid by self or insurance, in hospital

hospice: for terminal illness w/in prognosis of < 6months , no curative tx, paid insurance, Medicare or Medicaid, wherever pt wants

adult 1 med surg (5 decks)

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