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NCLEX > Oncology > Flashcards

Oncology Flashcards

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1
Q

primary prevention

A

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

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2
Q

secondary prevention

A

when screenings are used to pick-up on cancer early, when there is a greater chance for cure or control

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3
Q

secondary prevention for female

A

-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

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4
Q

secondary prevention for male

A

-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

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5
Q

tertiary prevention

A

focuses on the management of long-term care for clients with complex treatments for cancer
-support groups and rehab programs

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6
Q

general signs and symptoms of Cancer

A

-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

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7
Q

bleeding precautions

A
  1. Use an electric razor
  2. Use a soft toothbrush
  3. No IMs
  4. Quiet play for children
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8
Q

blood tests for cancer diagnosis

A

-abnormal CBC & diff (neutrophil count)
-elevated AST & ALT
-tumor markers (biomarkers)

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9
Q

total laryngectomy

A

-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

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10
Q

post op care following a mastectomy

A

-bleeding –> check dressings, front and back
-abdominal incision site possible
-hemovac or jackson-pratt drain

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11
Q

nursing care if any lymph nodes removed with mastectomy

A

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

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12
Q

internal radiation therapy

A

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

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13
Q

precautions for internal radiation

A

-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

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14
Q

external radiation (teletherapy, external beam radiotherapy)

A

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

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15
Q

Action of chemotherapy

A

-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

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16
Q

precautions for chemo

A

-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

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17
Q

disposal of chemo

A

-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

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18
Q

managing chemo spills

A
  1. wash hands thoroughly with soap and water
  2. get spill kit from wall in client’s room
  3. put on respirator mask
  4. put on chemo gown
  5. put on 2 sets of gloves
  6. put on goggles
  7. use absorbent pads to wipe up spill

-floor needs to be cleaned 3x with detergent & water

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19
Q

extravasation

A

-chemo drugs given through central line
-vesicants can infiltrate and cause tissue necrosis

signs & symptoms
-pain
-swelling, and no blood return

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20
Q

treatment for extravasation

A

-stop infusion
-send for extravasation kit
-stay with the client
-know protocols prior to administration

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21
Q

GI system side effects of Cancer/treatment

A
  • 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

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22
Q

ondansetron

A

-block the effects of serotonin

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23
Q

integumentary side effects of cancer/tx

A

-alopecia
-huge sense of loss
-encourage pt to look at their incision

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24
Q

hematopoietic system (bone marrow) side effects of cancer/tx

A

-bone marrow suppression causes decrease RBCs, WBCs, & platelets. At risk for anemia, thrombocytopenia & infection

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25
Q

general infection prevention precautions

A

-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

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26
Q

neutropenic precautions

A

-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

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27
Q

pain tx & side effects for cancer

A

-opioids are “gold standard”
-do not worry about risk for dependence
-monitor for constipation

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28
Q

neutropenia

A

-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

29
Q

DVTs & cancer

A

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

30
Q

risk factors for thrombocytopenia

A

-advanced metastatic disease
-hematological malignancies
-bleeding disorders
-bacterial infections
-anticoagulant meds
-cancer treatment

31
Q

risk factors of cervical cancer

A

-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

32
Q

signs and symptoms of cervical cancer

A

-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

33
Q

diagnosis of cervical cancer

A

pap smear

34
Q

treatment of cervical cancer

A

-electrosurgical excision
-laser
-cryosurgery
-radiation and chemo for late stages
-conization- remove part of the cervix
-hysterectomy

35
Q

risk factors of endometrial cancer

A

-greater than 50 y.o.
-taking estrogen therapy without progesterone
-positive family hx
-late menopause
-no pregnancy (null parity)

36
Q

signs and symptoms of endometrial cancer

A

-post-menopausal bleeding
-watery/bloody discharge, low back/abdominal pain, pelvic pain

37
Q

diagnosis of endometrial cancer

A

-CA-125 (blood test) to R/O ovarian involvement
-dilatation & curettage and endometrial biopsy

38
Q

treatment of endometrial cancer

A

-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

39
Q

patient education after hysterectomy

A

-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

40
Q

Risk factors of breast cancer

A

-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.

41
Q

signs and symptoms of breast cancer

A

-change in breast appearance (orange peel, dimpling, retraction, discharge from breast) or lump
-tail of spence: upper quadrant, where 48% of tumors occur

42
Q

treatment of breast cancer

A

-surgery
-chemo drugs
-hormonal therapy
estrogen receptor blocking agents
estrogen synthesis inhibitors
-radiation

43
Q

risk factors for lung cancer

A

-leading cause of cancer death worldwide
-smoking!!
-once smoking has been stopped for 15 years, the incidence is that of a non-smoker

44
Q

signs & symptoms of lung cancer

A

-hemoptysis, dyspnea, hoarseness, cough, change in endurance, chest pain, pleuritic pain on inspiration, displaced trachea
-may metastasize to bone

45
Q

diagnosis of lung cancer

A

-bronchoscopy
-chest x-ray
-CT
-MRI

46
Q

treatment of lung cancer

A

-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

47
Q

risk factors of laryngeal cancer

A

-smoking (any form of tobacco use)
-alcohol
-voice abuse
-chronic laryngitis
-industrial chemicals

48
Q

S&S of laryngeal cancer

A

-hoarseness
-lump in neck
-sore throat
-cough
-problems breathing
-earache
-weight loss
-no early signs

49
Q

diagnosis of laryngeal cancer

A

-laryngeal exam
-MRI

50
Q

treatment of laryngeal cancer

A
  1. surgery: total laryngectomy, humidified environment, breathing done through a stoma
  2. radiation
  3. chemo
  4. speech rehab
    -begins preop
51
Q

risk factors for colorectal cancer

A

-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

52
Q

diagnosis of colorectal cancer

A

fecal occult blood testing begins at age 45

colonoscopy is the definitive test

53
Q

signs and symptoms of colorectal cancer

A

-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

54
Q

treatment of colorectal cancer

A

-surgery, radiation, chemo
-possible colostomy or abdominoperineal resection (colon, anus, rectum)–> cannot take rectal temp

55
Q

do not take rectal temp if

A

thrombocytopenic, abdominoperineal resection, or immunosuppressed

56
Q

risk factors for bladder cancer

A

smoking

57
Q

S&S of bladder cancer

A

-painless, intermittent gross/microscopic hematuria

58
Q

diagnosis of bladder cancer

A

cystoscopy

59
Q

treatment of bladder cancer

A

-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

60
Q

S&S of prostate cancer

A

-hesitancy, frequency, frequent infections, nocturia, urgency, dribbling
-may be asymptomatic
-painless hematuria (most common)

61
Q

diagnosis of prostate cancer

A

-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

62
Q

treatment of prostate cancer

A

-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)

63
Q

radical prostatectomy

A

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

64
Q

prostatectomy (TURP)

A

-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)

65
Q

risk factors of stomach cancer

A

-H-pylori
-pernicious anemia
-achlorhydria
-pickled foods, salted meats/fish, nitrates/increased salt
-tobacco & alcohol
-billroth II (partial gastrectomy with an anastomosis

66
Q

S&S of stomach cancer

A

-heartburn & abdominal discomfort
-loss of appetite, weight loss
-blood stools, coffee-ground vomitus
-jaundice
-epigastric & back pain
-feeling of fullness
-anemia
-obstruction

67
Q

diagnosis of stomach cancer

A

Upper GI, CT, EGD

68
Q

tx of stomach cancer

A

-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

69
Q

schilling’s test

A

measures the urinary excretion of Vitamin B-12 for dx of pernicious anemia

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