Oncology Flashcards
primary prevention
ways to prevent the actual occurrence of cancer
-no smoking
-exercise and good nutrition
-maintain normal body weight
-limit or eliminate alcohol intake
-vaccines for preventable viral exposures (Hep B & HPV)
-avoid exposure to known carcinogens
secondary prevention
when screenings are used to pick-up on cancer early, when there is a greater chance for cure or control
secondary prevention for female
-monthly breast self exams starting at 20
day 7-12 after period
-yearly clinical breast exams for women >40 y.o.
-yearly clinical breast exams for women 20-39 need one every three years
-Annual mammogram at age 40 (no lotion. no powder, no deodorant)
-Pap smears at age 21 and every 3 years
-colonoscopy at age 50 then every 10 years
-occult stool testing yearly at age 50
secondary prevention for male
-yearly breast and testicular exams
-digital rectal exams, PSA over age 50
-colonoscopy at age 50 and then every 10 years
-fecal occult blood testing annually over the age of 50
tertiary prevention
focuses on the management of long-term care for clients with complex treatments for cancer
-support groups and rehab programs
general signs and symptoms of Cancer
-Change in bowel/bladder habits
-A sore that does not heal
-Unusual bleeding/discharge
-Thickening or lump in breast or elsewhere
-Indigestion or difficulty swallowing
-Obvious change in wart or mole
-Nagging cough or hoarseness
-anemia, leukopenia, thrombocytopenia
-unexplained weight loss
-fever
-fatigue
-pain
bleeding precautions
- Use an electric razor
- Use a soft toothbrush
- No IMs
- Quiet play for children
blood tests for cancer diagnosis
-abnormal CBC & diff (neutrophil count)
-elevated AST & ALT
-tumor markers (biomarkers)
total laryngectomy
-removal of vocal cords, epiglottitis, and thyroid cartilage
-client will have a permanent tracheostomy or laryngectomy
-Position pt in Mid-Fowlers (30-45 degrees)
-NG feedings to protect the suture line
-monitor drains
-watch for carotid artery rupture
-rupture of the innominate artery
-frequent oral care to decrease bacterial count in the mouth
-humidified environment helps
-breathing done through a stoma
post op care following a mastectomy
-bleeding –> check dressings, front and back
-abdominal incision site possible
-hemovac or jackson-pratt drain
nursing care if any lymph nodes removed with mastectomy
avoid procedures on arm of the affected side
-no constriction, no BPs, no blouses with elastic, no watch, no IV or injections on the affected side
-wear gloves when gardening, watch small cuts, no nail biting, and no sunburn
-brush hair, squeeze tennis balls, wall climbing, flex and extend elbow to promote new collateral circulation
internal radiation therapy
brachytherapy is used to get radiation close to the cancer or target tissue
-it is inside the body
-client will emit radiation for a period of time and is a hazard to others
unsealed
-client & body fluids emit radiation
-isotope given PO or IV
-Radioactive for 24-48 hours
sealed
-client emits radiation, body fluids are not radioactive
-can be temporary or a permanent implant that is placed close to or inside the tumor
ex: prostate cancer-implantable seeds, cervical cancer- vaginal implant
precautions for internal radiation
-rotate nursing assignments daily
-nurses should only care for one client with a radiation implant in a shift
-patient should be in a private room
-wear a film badge at all times
-restrict visitors
-limit each visitor to 30 minutes per day
-visitors must stay at least 6 feet from the source
-no visitors less than 16 years old
-no pregnant visitors/nurses
-mark the room with instructions for specific isotope
-wear gloves
-keep client on bedrest, decrease fiber in pt’s diet, prevent bladder distention
-pt should not sleep with spouse or children, should not return to work immediately, should not share utensils or cook for others
-need to flush the toilet 2-3x after use
external radiation (teletherapy, external beam radiotherapy)
a carefully focused bean of high energy rays is delivered by a machine outside of the body
-client is not radioactive
-side effects are limited to exposed tissues: erythema, shedding of skin, fatigue, pancytopenia (decreased WBC, RBC, platelets)
-S&S are location and dose related
-patient needs to protect the site from sun light & UV exposure for 1 year after completion of therapy
Action of chemotherapy
-eliminate or reduce the number of cancer cells by destroying the cells as they are developing
-drugs attack a specific phase of cell development (cell-specific drugs)
-drugs that work at all or any phase of cell development are cell cycle non-specific
-drugs work best when cells are actively growing
precautions for chemo
-gown: coated to prevent contamination
-two pairs of gloves, thicker & longer than standard gloves, one pair under the gown & one pair over
-goggles and/or mask if splashing or inhalation can occur
**chemo is excreted for 3-7 days after administration
disposal of chemo
-yellow rigid chemo waste containers- sharps & IV equipment
-yellow chemo waste bag- gowns, gloves, and disposable items
wash hands with soap & water after removing gloves
managing chemo spills
- wash hands thoroughly with soap and water
- get spill kit from wall in client’s room
- put on respirator mask
- put on chemo gown
- put on 2 sets of gloves
- put on goggles
- use absorbent pads to wipe up spill
-floor needs to be cleaned 3x with detergent & water
extravasation
-chemo drugs given through central line
-vesicants can infiltrate and cause tissue necrosis
signs & symptoms
-pain
-swelling, and no blood return
treatment for extravasation
-stop infusion
-send for extravasation kit
-stay with the client
-know protocols prior to administration
GI system side effects of Cancer/treatment
- Nausea/vomiting: most common side effect 24-48 hours after tx. Routine antiemetic given 1st week of chemo
ondansetron or netupitant/palonosetron
non-pharm tx: ginger, aromatherapy (peppermint, lavender, lemon), acupuncture, acupressure, distraction, relaxation techniques
-Stomatitis: oral cavity is susceptible to irritation
-Diarrhea: worry about nutrition & F&E imbalances
ondansetron
-block the effects of serotonin
integumentary side effects of cancer/tx
-alopecia
-huge sense of loss
-encourage pt to look at their incision
hematopoietic system (bone marrow) side effects of cancer/tx
-bone marrow suppression causes decrease RBCs, WBCs, & platelets. At risk for anemia, thrombocytopenia & infection
general infection prevention precautions
-provide a private room, limit visitors
-keep client’s own supplies in room
-change dressings & IV tubing daily
-cough & deep breathe
-no gardening or cleaning up after pets
-avoid crowds; wear a mask out in public
-good handwashing
-wash hands after touching pet
-drink only fresh water
-avoid uncooked meat, seafood, or eggs
-brush teeth with soft toothbrush 4x/day
-no alcohol-based mouthwash
-report to hospital for temp >100.4
neutropenic precautions
-abx as prescribed
-Vital signs q4 hours
-private room with door closed & sign
-antimicrobial soap for handwashing
-no invasive procedures (IM, rectal exams/meds)
-avoid indwelling catheters or NG tubes if possible
-limit use of acetaminophen
pain tx & side effects for cancer
-opioids are “gold standard”
-do not worry about risk for dependence
-monitor for constipation
neutropenia
-a decrease in the number of neutrophils (mature WBCs) in the blood
-calculate the absolute neutrophil count
-normal ANC= 2,500-8,000 cells/mm
tx of neutropenia: abx, neutropenic precautions
DVTs & cancer
second leading cause of death in cancer patients
-prolonged bed rest
-surgery
-use of a central line
-external compression of vessels by the tumor
-invasion of vessels by the tumor
-certain chemo drugs
risk factors for thrombocytopenia
-advanced metastatic disease
-hematological malignancies
-bleeding disorders
-bacterial infections
-anticoagulant meds
-cancer treatment
risk factors of cervical cancer
-HPV
-repeated STDs
-multiple partners
-smoking & 2nd hand smoke exposure
-nutritional deficiences: folate, beta-carotene, Vitamin C
-prolonged hormonal therapy
-family hx
-immunosuppression
-sex @ a young age & multiple pregnancies
signs and symptoms of cervical cancer
-asymptomatic in pre-invasive cancer
-invasive cancer symptoms:
painless vaginal bleeding
-watery, blood-tinged vaginal discharge
-pelvic pain
-leg pain along sciatic nerve
-flank/back pain
-excellent cure rate if caught early
diagnosis of cervical cancer
pap smear
treatment of cervical cancer
-electrosurgical excision
-laser
-cryosurgery
-radiation and chemo for late stages
-conization- remove part of the cervix
-hysterectomy
risk factors of endometrial cancer
-greater than 50 y.o.
-taking estrogen therapy without progesterone
-positive family hx
-late menopause
-no pregnancy (null parity)
signs and symptoms of endometrial cancer
-post-menopausal bleeding
-watery/bloody discharge, low back/abdominal pain, pelvic pain
diagnosis of endometrial cancer
-CA-125 (blood test) to R/O ovarian involvement
-dilatation & curettage and endometrial biopsy
treatment of endometrial cancer
-total abdominal hysterectomy (uterus & cervix only)
major complication: hemorrhage
-Bilateral oophorectomy (ovaries)
-Bilateral salpingectomy (tubes)
-radical hysterectomy
remove all of the pelvic organs
client may have colostomy or ileal conduit
-monitor for hemorrhage (24 hrs after) because of pelvic congestion of blood
-radiation (intra-cavitary)
-chemo
-estrogen inhibitors
patient education after hysterectomy
-monitor for infection d/t urinary catheter
-prevent abdominal distention–> void!!
-avoid high-fowler’s because it will make more blood go to the pelvis
-check dressing
-early ambulation
-avoid sex & driving
-avoid girdles & douches
-avoid exercise that will increase pelvic congestion
-hemorrhage can occur 10-14 days post op
-whitish discharge is normal
-do not take baths, only showers
Risk factors of breast cancer
-3 fold risk if a first degree relative (mother, sister, daughter) had pre-menopausal breast cancer
-high dose radiation to thorax prior to age 20
-period onset prior to age 12
-menopause after age 50
-no pregnancy
-first birth after 30 y.o.
signs and symptoms of breast cancer
-change in breast appearance (orange peel, dimpling, retraction, discharge from breast) or lump
-tail of spence: upper quadrant, where 48% of tumors occur
treatment of breast cancer
-surgery
-chemo drugs
-hormonal therapy
estrogen receptor blocking agents
estrogen synthesis inhibitors
-radiation
risk factors for lung cancer
-leading cause of cancer death worldwide
-smoking!!
-once smoking has been stopped for 15 years, the incidence is that of a non-smoker
signs & symptoms of lung cancer
-hemoptysis, dyspnea, hoarseness, cough, change in endurance, chest pain, pleuritic pain on inspiration, displaced trachea
-may metastasize to bone
diagnosis of lung cancer
-bronchoscopy
-chest x-ray
-CT
-MRI
treatment of lung cancer
-surgery (stage 1 & 2)
-lobectomy: part of the lung, chest tubes & surgical side up
-pneumonectomy: entire lung removed, position on affected side (surgical side down, good lung up), no chest tubes, avoid severe lateral positioning
risk factors of laryngeal cancer
-smoking (any form of tobacco use)
-alcohol
-voice abuse
-chronic laryngitis
-industrial chemicals
S&S of laryngeal cancer
-hoarseness
-lump in neck
-sore throat
-cough
-problems breathing
-earache
-weight loss
-no early signs
diagnosis of laryngeal cancer
-laryngeal exam
-MRI
treatment of laryngeal cancer
- surgery: total laryngectomy, humidified environment, breathing done through a stoma
- radiation
- chemo
- speech rehab
-begins preop
risk factors for colorectal cancer
-may start as a polyp
-2/3 occur in the rectosigmoid region
-may metastasize to the liver–> bleeding precautions
-bowel obstruction, perforation, fistula to bladder/vagina
-inflammatory bowel disease, genetics
-dietary factors (refined carbs, low fiber, high fat, red meat, fried & boiled foods)
-first degree relative increased risk by 3x
-older then 50
diagnosis of colorectal cancer
fecal occult blood testing begins at age 45
colonoscopy is the definitive test
signs and symptoms of colorectal cancer
-change in bowel habits, constipation, diarrhea, or narrowing of the stool
-blood in the stool, cramping, abdominal pain, weakness, fatigue, anemia, abdominal fullness, unexplained weight loss
-obstruction-visible peristaltic waves with high pitched tinkling bowel sounds
treatment of colorectal cancer
-surgery, radiation, chemo
-possible colostomy or abdominoperineal resection (colon, anus, rectum)–> cannot take rectal temp
do not take rectal temp if
thrombocytopenic, abdominoperineal resection, or immunosuppressed
risk factors for bladder cancer
smoking
S&S of bladder cancer
-painless, intermittent gross/microscopic hematuria
diagnosis of bladder cancer
cystoscopy
treatment of bladder cancer
-surgery (remove all of part of the bladder)–> urinary diversion (urostomy)
-ileal conduit- piece of the iluem is turned into the bladder, ureters are placed in one end; the other is brought to the abdominal surface as a stoma
-may be impotent
-hourly outputs
-increase fluids (2,000-3,000 mL/day) to flush conduit
-mucus in the urine is normal
-change appliance in the AM
S&S of prostate cancer
-hesitancy, frequency, frequent infections, nocturia, urgency, dribbling
-may be asymptomatic
-painless hematuria (most common)
diagnosis of prostate cancer
-digital rectal exam: if prostate is hard/nodular usually means prostate cancer
-lab work
increase PSA, >4 ng/mL
2 or more first degree relatives with prostate cancer, start screening at 45 y.o.
alkaline phosphatase (increased indicates bone metastasis), may metastasize to the spine, sacrum, or pelvis
-biopsy for confirmation
treatment of prostate cancer
-watchful waiting: in early stages (for asymptomatic, older adults with another illness)
-surgery
1. radical prostatectomy
2. prostatectomy (TURP-transurethral resection of the prostate)
-radiation
-chemo
-hormone therapy (may decrease testosterone)
radical prostatectomy
done when the cancer is localized to the prostate
-take out the prostate=cancer free
-may have erectile dysfunction
-may have incontinence
-client is sterile
-if no lymph node involvement, no increase in acid phosphatase, and no metastasis, surgeon will try to preserve pudendal nerve
prostatectomy (TURP)
-usually for BPH to help urine flow, not a cure for cancer
-bleeding is most common complication
-continuous bladder irrigation-maintains patency and flushes out clots: 3 way catheter, no kinks, subtract irrigation from output
-keep up with amount of irrigant instilled
give belladonna & opium suppository or oxybutynin for bladder spasms
-avoid sitting, driving and strenuous exercise
-avoid straining (take Docusate)
risk factors of stomach cancer
-H-pylori
-pernicious anemia
-achlorhydria
-pickled foods, salted meats/fish, nitrates/increased salt
-tobacco & alcohol
-billroth II (partial gastrectomy with an anastomosis
S&S of stomach cancer
-heartburn & abdominal discomfort
-loss of appetite, weight loss
-blood stools, coffee-ground vomitus
-jaundice
-epigastric & back pain
-feeling of fullness
-anemia
-obstruction
diagnosis of stomach cancer
Upper GI, CT, EGD
tx of stomach cancer
-surgery: gastrectomy
fowler’s position, decreases stress on suture line
-NG tube
-two major complications: dumping syndrome and Vitamin B-12 deficient anemia (pernicious)
-chemo
-radiation
schilling’s test
measures the urinary excretion of Vitamin B-12 for dx of pernicious anemia
