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Module 3 (MedSurg 1) > Oncology > Flashcards

Oncology Flashcards

1
Q

Cancer is the

A

mutation in the DNA of the cells
- genetics
- carcinogenic environmental
-sedentary lifestyle

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2
Q

What percentage of cancer is hereditary?

A

5-20

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3
Q

What are the good genes for the human body?

A

Proto-oncogene
Tumor suppressor gene

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4
Q

Proto-oncogene does what in the body

A

controls the growth of cells

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5
Q

Oncogene does what in the body?

A

uncontrolled cell growth
- mutated proto-oncogene

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6
Q

The tumor suppressor gene does what in the body?

A

slows down a cellular division
causes cell death

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7
Q

The mutated tumor suppressor gene does what in the human body?

A

uncontrolled cell growth

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8
Q

What are the “bad genes’ involved in cancer?

A

oncogene
mutated tumor suppressor gene

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9
Q

The differentiated cells show the

A

maturity or development of tumor cells

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10
Q

The more it resembles normal tissue the _________ it is to treat.

A

easier

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11
Q

Well-differentiated cells characteristics

A

resemble normal cells; mature
function more like a normal cell
grow at a slower rate
less aggressive
typically benign

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12
Q

Poorly differentiated cells characteristics

A

do not resemble normal cells
immature cells
lack of structure/function
aggressive
typically malignant

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13
Q

Every average person has what genes?

A

Proto-oncogene
Tumor suppressor gene

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14
Q

From the Biopsy, the pathologist determines

A

grade and differentiation

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15
Q

What differentiation is harder to treat?

A

poorly diff.

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16
Q

Benign

A

not cancer
- tumor cells grow only locally and can’t spread by invasion or metastasis

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17
Q

Malignant

A

cancerous
- invade neighboring tissues, enter blood vessels, and metastasize to different sites

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18
Q

Metastasize means

A

spread from the primary location

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19
Q

Characteristics of a Benign tumor

A

well differentiated
expands (encapsulated)
slow growth
NO METASTASIS
localized effects
no destruction unless blood flow impaired

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20
Q

What is the morbidity level of a benign tumor? unless?

A

minimum
unless location interferes with vital organs

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21
Q

Characteristics of malignant tumor

A

poorly differentiated cells
sends out projections to infiltrate and destroy
growth rate variable
YES METASTASIS
generalized effects (anemia, weakness, wt. loss)
extensive destruction
- excretes toxins and uses up blood supply

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22
Q

What is the morbidity of a malignant tumor? unless?

A

high
unless growth and spread can be controlled/halted

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23
Q

What tumor has the potential to metastasize?

A

malignant

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24
Q

If cancer has metastasized to another organ, is the cancer name changed or does it stay the same?
Ex) Starts out as Liver cancer, then spreads to the stomach

A

The name stays the same
still Liver cancer (primary)

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25
Q

How does cancer spread?

A

locally invasive
metastasis

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26
Q

Locally invasive cancer

A

“fingers” of cancer cells invade surrounding tissue

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27
Q

Metastasis

A

malignant cells travel through the blood/lymph system and invade other tissues or organs to form a secondary tumor
- find another similar organ to primary

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28
Q

What are the top 4 places for metastasis?

A

bone
lungs
liver
brain

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29
Q

If the primary is the breast, then it tends to go to the

A

lymph nodes first then the liver lungs or brain

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30
Q

Melanoma is very deadly because

A

by the time it appears
the body is completely exposed to the cancer

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31
Q

Which cancer is the most painful?

A

bone

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32
Q

Risk factors for cancer (most)

A

tobacco and smoking
Diet and obesity
sedentary lifestyle
occupation exposure
family hx
viruses
alcohol
socioeconomic status
pollution
UV radiation
drug and medical procedures
salt, additives, containments

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33
Q

What is the most common spot for breast cancer to form?

A

Lateral upper quadrant next to the armpit

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34
Q

If a patient works outside, then they should wear

A

sunscreen and protect skin due to the risk of occupational exposure

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35
Q

What is the hallmark cause of hereditary cancer syndrome?

A

family hx

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36
Q

Hereditary cancer syndrome can occur from what

A

cancer in 2 + relatives
cancer in family members younger than 50 y/o
the same type of cancer in multiple family members
rare type of cancer in 1 + family members
family with more than 1 type of cancer

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37
Q

If colon cancer runs in your family, when should you do a colonoscopy?

A

early because very hereditary

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38
Q

Viruses are difficult to

A

evaluate and isolate

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39
Q

Virus and generic structure of cells become

A

incorporated with each other

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40
Q

Initial viral infection to the development of cancer is

A

delayed after many years

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41
Q

viruses must act in conjunction with other factors in order to

A

develop into cancer

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42
Q

What virus is most common in causing cancer?

A

HPV

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43
Q

Viruses cause ________ and why is it harmful for cancer pts***

A

long term inflammation
immunosuppressed people

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44
Q

HPV can cause what type of cancer

A

cervical

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45
Q

Hepatitis B and C can cause what type of cancer

A

Liver

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46
Q

Epstein-Barr (mono) can cause what type of cancer

A

Lymphoma

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47
Q

Human Herpes Virus 8 can cause what type of cancer

A

Kaposi’s sarcoma

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48
Q

HIV can cause what type of cancer

A

Lymphoma
Karposi’s sarcoma

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49
Q

Helicobacter pylori can cause what type of cancer?

A

stomach ulcers
lymphoma in the stomach lining

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50
Q

The vaccination of the HPV

A

should be encouraged to avoid HPV and warts on genitalia

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51
Q

Hormone Replacement Therapy

A

estrogen
progestin

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52
Q

How can a hysterectomy cause cancer?

A

not produce estrogen and progesterone with hormone replacement therapy which causes cancer

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53
Q

Can hormone replacement therapy cause cancer?

A

yes

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54
Q

What type of cancers do the risks outweigh the benefits?

A

Ovarian
breast
uterine
lung
brain
colon

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55
Q

Primary prevention

A

health promotion and illness prevention
- reduction in the incidence of cancer

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56
Q

What preventions are done in primary intervention

A

exercise
lifestyle change
dietary change
stress reduction
avoid carcinogens

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57
Q

Secondary prevention

A

screening
diagnosis and treatment of illness

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58
Q

What type of screening is done in secondary prevention?

A

self-breast and testicular exams
pap smear
mammogram
colonoscopy

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59
Q

What is the goal of secondary prevention?

A

halt the progress of cancer through early screening and diagnosis

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60
Q

Tertiary prevention

A

disease treatment and rehab
- restore health

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61
Q

The goal of tertiary prevention

A

prevent further deterioration

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62
Q

Chemoprevention

A

use of substances to lower risk of cancer

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63
Q

What are the different drugs used in chemoprevention?

A

Selective estrogen receptor modulators
- Tamoxifen and raloxifene
- selenium

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64
Q

Pathophysiology of Tamoxifen

A

binds estrogen and progesterone to prevent them from feeding the tumor
early menopause

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65
Q

Tamoxifen and Raloxifene**

A

reduced risk of breast cancer
binds estrogen and progesterone
used for up to 5 years

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66
Q

What is the 1st chemopreventative drug approved?

A

Tamoxifen

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67
Q

Selenium

A

reduced risk of prostate cancer

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68
Q

What is the goal of screening?

A

find cancer in the early stages

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69
Q

What are the different types of screenings?

A

physical exam
lab tests
imaging procedures
genetic testing

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70
Q

Beginning at what age should men and women get a colorectal screening?

A

45

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71
Q

How often should a fecal occult blood test be done for colorectal screening?

A

yearly

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72
Q

How often should a flexible sigmoidoscopy be done for colorectal screening?

A

every 5 years

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73
Q

How often should a colonoscopy be done for colorectal screening?

A

every 10 years

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74
Q

What cancer is considered very treatable when caught early but very deadly when caught late?

A

colon

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75
Q

Monthly Self Breast exams need to start after

A

20 years old

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76
Q

HCP Breast exams need to be done between what years
and every ___ years

A

40-44 and completed every 3 years
(However, Mrs.Duriex recommends one every year after 40)

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77
Q

Pap smear is looking for

A

abnormal cells of the cervix (mostly through sex)

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78
Q

At age 45-54, HCP exams and mammograms need to be done

A

yearly

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79
Q

At age 55, HCP and mammograms need to be done

A

every 2 years

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80
Q

Women at high risk for breast CA need to have what yearly

A

MRI and mammogram

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81
Q

Cervical cancer screening needs to be done when
type of test every

A

age 21 or within 3 yrs of initiating intercourse
- pap test every 2-3 years

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82
Q

If the patient has dysplasia noted, then pap tests are done

A

annually

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83
Q

At the age of 30, a pap test and HPV need to be done

A

5 years
every 3 years with only pap test

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84
Q

Cervical cancer screening is not necessary if all previous tests are negative after what age

A

60

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85
Q

If the petient has had a hysterectomy, should the woman continue a pap test related to vaginal or vulvar cancer?

A

yes

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86
Q

What are the 7 warning signs of cancer? CAUTION

A

Change in bowel or bladder habits
A sore that does not heal
Unusual bleeding or discharge
Thickening or lump in breast/elsewhere
Indigestion or difficulty swallowing
Obvious change in a wart or mole
Nagging cough or hoarseness

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87
Q

Grading

A

pathologist compares the appearance of cancer cells to the normal surrounding cells

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88
Q

Staging

A

Oncologist classifying a malignancy by the extent of spread within the body

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89
Q

What does the pathologist do to cancer?

A

differentiation and grade

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90
Q

What does the oncologist do after the pathologist?

A

oncologist

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91
Q

Grading: GX

A

can not be assessed

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92
Q

Grading: G1

A

low grade
well differentiated, slow growing

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93
Q

Grading: G2

A

moderate grade
moderately differentiated, growing slightly faster

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94
Q

Grading: G3

A

high grade
poorly differentiated, growing faster

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95
Q

Grading: G4

A

high grade
undifferentiated, not distinct at all, very aggressive

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96
Q

Stage 1 CA

A

small cancer found in an organ where it originated

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97
Q

Stage 2 CA

A

larger cancer that may/may not have spread to the lymph nodes

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98
Q

Stage 3 CA

A

larger cancer also in the lymph nodes

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99
Q

Stage 4 CA

A

cancer has spread from the original site into other organs

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100
Q

PET scan

A

lights up inflammation in the body

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101
Q

TNM system of staging

A

T = size of primary tumor
N = # of lymph nodes involved
M = extent of metastasis

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102
Q

Staging Tumor Size
TX

A

the tumor can not be measured

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103
Q

Staging Tumor Size
T0

A

no primary tumor, can’t be found

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104
Q

Staging Tumor Size
Tis

A

the tumor is “in situ” (best case)
in 1st layer of the organ

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105
Q

Staging Tumor Size
T1

A

small or early stage

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106
Q

Staging Tumor Size
T2

A

confined to original area

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107
Q

Staging Tumor Size
T3

A

has spread to surrounding tissues

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108
Q

Staging Tumor Size
T4

A

large, advanced stage cancer

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109
Q

TNM classification reflects

A

depth of tumor infiltration

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110
Q

Staging: Number of Nodes
NX

A

Nearby nodes can’t be tested/evaluated

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111
Q

Staging: Number of Nodes
N0

A

lymph nodes are cancer free

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112
Q

Staging: Number of Nodes
N1

A

cancer cells have reached one node

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113
Q

Staging: Number of Nodes
N2

A

cancer spread to more than one node

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114
Q

Staging: Number of Nodes
N3

A

cancer in lymph nodes extensive/widespread

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115
Q

Staging: Extent of Metastasis
MX

A

UNKNOWN if cancer has spread

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116
Q

Staging: Extent of Metastasis
M0

A

no distant metastases were found

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117
Q

Staging: Extent of Metastasis
M1

A

cancer has spread to one or more distant parts of the body

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118
Q

In situ

A

still in the original layer

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119
Q

Localized

A

still in original organ

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120
Q

Regional

A

spread to nearby lymph nodes or organs

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121
Q

Distant

A

spread to distant body parts

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122
Q

Tumor markers

A

determine the effectiveness of tx

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123
Q

Tumor Marker CEA stands for

A

Carcinoembryonic Antigen

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124
Q

CEA tumor marker is related to

A

pancreas, GI (colon, lung, breast)
Normal: 0-2.5 in nonsmokers / less than 5 in smokers

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125
Q

When reviewing the chart for a patient with cervical cancer, the nurse notes that the cancer is staged as Tis, N0, M0. The nurse will teach the patient that
a. the cancer cells are well-differentiated.
b. it is difficult to determine the original site of cervical cancer.
c. further testing is needed to determine the spread of the cancer.
d. the cancer is localized to the cervix.

A

d. the cancer is localized to the cervix.

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126
Q

A 61-year-old woman who is 5 feet, 3 inches tall and weighs 125 pounds (57 kg) tells the nurse that she has a glass of wine two or three times a week. The patient works for the post office and has a 5-mile mail-delivery route. This is her first contact with the healthcare system in 20 years. Which of these topics will the nurse plan to include in patient teaching about cancer? (Select all that apply.)
a. Alcohol use
b. Physical activity
c. Body weight
d. Colorectal screening
e. Tobacco use
f. Mammography
g. Pap testing
h. Sunscreen use

A

d. Colorectal screening
f. Mammography
g. Pap testing
h. Sunscreen use

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127
Q

Treatment of Cancer

A

surgery
radiation therapy
chemotherapy

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128
Q

What is the most frequent treatment method for cancer?

A

surgery

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129
Q

Surgery is used in conjunction with

A

chemotherapy or radiation

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130
Q

What is the ideal scenario for cancer when operating in surgery

A

localized and operative to remove the tumor
determine other conjunction treatments

131
Q

What are the reasons for a cancer patient to have surgery

A

prevent
diagnose
stage
treat

132
Q

If the tumor is benign why would they need surgery?

A

causes problems to other organs or systems
- by becoming too big

133
Q

What are the different types of surgeries?

A

Diagnostic
Primary
Prophylactic
Palliative
Reconstructive

134
Q

A biopsy is what type of surgery?

A

diagnostic

135
Q

Mastectomy is what type of surgery?

A

Primary

136
Q

Vasectomy is what type of surgery?

A

Prophylactic

137
Q

Quality of life improvement is related to what type of surgery?

A

Pallative

138
Q

Augmentation/plastic surgery is what type of surgery?

A

reconstructive

139
Q

Tissue Biopsy encompasses these methods?

A

Shave
Punch
Incision
Excisional
Fine needle
Core needle

140
Q

Shave Biopsy

A

top layers of the skin are shaved off with a small surgical blade
bandaid

141
Q

Punch Biopsy

A

a small round piece of tissue about the size of a pencil eraser is removed using a sharp, hollow, circular instrument
down into the dermal cells
closed with sutures

142
Q

Incisional Biopsy

A

a cut is made through the skin to remove a sample of abnormal tissue or part of a lump or suspicious area is too big

143
Q

Fine Needle Biopsy

A

23-30g needle
aspirate and suction fluid out of the site
superficial tumor
least painful

144
Q

Core Needle Biopsy

A

12g needle
liver, kidney and retract specimens
most painful

145
Q

Surgery as a primary treatment includes these 3 curing methods

A

Debulking
Radical Excisions
Salvage Surgery

146
Q

Primary/Curative Surgery
Debulking

A

remove as much of the tumor as possible

147
Q

Radical means

A

take everything including muscle, sub Q, and skin

148
Q

Primary/Curative Surgery
Radical Excisions

A

can be disfiguring and alter functioning
takes muscle, sub Q and skin is all taken

149
Q

Primary/Curative Surgery
Salvage Surgery

A

extensive surgery to site at which previous therapies have failed

150
Q

Radical Mastectomy

A

removal of the breast and associated lymph nodes near the armpit

151
Q

Radical Neck Dissection

A

removal of jaw bone, tongue, lymph nodes, neck glands

152
Q

Primary Treatment Surgery
Electrosurgery to skin

A

electrical current to destroy tumor cells

153
Q

Primary Treatment Surgery
Cryosurgery to skin

A

liquid nitrogen to freeze tissue

154
Q

Primary Treatment Surgery
Chemosurgery to skin

A

chemical applied to tissue

155
Q

Primary Treatment Surgery
Laser surgery to skin

A

precise high-dose radiation therapy

156
Q

Prophylactic Surgery

A

removal of non-vital tissues/organs that may develop cancer

157
Q

Prophylactic Surgery considerations

A

family hx and genetic predisposition
presence/absence of symptoms
risks vs benefits
ability to detect cancers early
patient’s acceptance of post-op outcomes

158
Q

Palliative Surgery

A

pain relief
not intended to treat or cure
goal high quality of life
“to alleviate without curing”

159
Q

Reconstructive surgery

A

trying to repair injury or loss of function from curative or radical surgeries
- spacer until healed and tx is done then do plastic surgery (6 months to a year)

160
Q

Care of surgical pt

A

incision care
prevent infection
manage pain
educate on drains, s/s of infection, and dietary intake to promote healing

161
Q

Does the nurse take off the surgical dressing first?

A

no, the surgeon does

162
Q

S/S of infection

A

redness, swelling, warmth

163
Q

What food is eaten to promote healing?

A

Vitamin C
Protein

164
Q

The radiation and Chemotherapy goal is to

A

eliminate cancerous cells

165
Q

Radiation/Chemotherapy affects

A

rapidly proliferating cells (skin, GI, and hair)
- a wide range of symptoms
- death can result
- benefits outweigh the risks (mostly)

166
Q

Is it the nurse’s job to encourage a patient to pursue chemotherapy?

A

no, patient’s choice if they want to pursue

167
Q

Radiation Therapy does what to the body

A

energy to kill/shrink tumors
energy to eliminate CA cells
damages cell’s DNA
Healthy cells can be damaged
tx of choice for localized CA if inoperable

168
Q

Lethal Tumor Dose

A

the amount required to eradicate 95% of the tumor and simultaneously salvage or spare normal tissue

169
Q

Total radiation dosage is delivered over

A

weeks to allow healthy tissue to recover

170
Q

Repeated radiation doses allow

A

the periphery of the tumor to reoxygenate and become more susceptible to radiation

171
Q

Factors affecting dosage

A

radiosensitivity of tumor
normal tissue tolerance
the volume of tissue to be irradiated

172
Q

The radiosensitivity of the tumor is dependent on

A

presence of oxygen

173
Q

Normal tissue tolerance is the point which

A

normal tissues are irreparably damaged

174
Q

The volume of tissue to irradiated determines the

A

total prescribed dose to be separated into several smaller doses

175
Q

Treatments are usually given daily, ___ days per week for an average of ____ - ______ treatments

A

5;
25-30

176
Q

Benefits of Radiation Therapy

A

used before surgery to shrink tumors
intra-operative
given before, during, or after chemo
palliative (shrink tumors, reduce pressure, pain, and other symptoms)

177
Q

Radiation Toxicity

A

localized to the area of treatment
maybe higher if in conjunction with chemo

178
Q

Generalized effects of Radiation Toxicity

A

Fatigue
N/V
Anemia
Thrombocytopenia

179
Q

A hypoxic cell is ________ times harder to treat as it shrinks

A

2-3

180
Q

How does a pt with Radiation Toxicity get anemia?

A

bone marrow suppression and decrease in RBCs

181
Q

How does a pt with Radiation Toxicity get thrombocytopenia?

A

low platelet levels w/ low blood flow

182
Q

External Radiation Therapy aka

A

Teletherapy

183
Q

Internal Radiation Therapy aka

A

Brachytherapy

184
Q

If a Cancer pt is getting radiation treatment, what assessments and education do we need to tell them?

A

**Breathing
*Nutrition
Skin
Pain

185
Q

Brachytherapy procedure includes??????

A

needles inside the tissue to spare the dying tissue

186
Q

Nursing Considerations for Brachytherapy

A

monitor the number of needles and don’t move
needle could puncture the bladder if moved

187
Q

Brachytherapy Side effects

A

sealed/unsealed *implants
fatigue
anorexia
immunosuppression
other similar to external

188
Q

If the pt has a sealed implant, then the body

A

does not give off radiation BUT pregnant women and small children should still avoid exposure to pt
- limit time to 60 mins a shift as a nurse and visitors

189
Q

If the patient has an unsealed implant then the body

A

will give off radiation
body secretions may be contaminated
Isolation

190
Q

What type of isolation will occur with a radiation implant?

A

Nurses and pts have less than 60 mins in the room per shift

191
Q

Education for Temporary Brachytherapy

A

avoid close contact with others until tx is completed
no contact with pregnant women
bed rest to prevent dislodging radioactive source
maintain balanced diet, consider small, frequent meals
maintain fluid intake to ensure adequate hydration: 2-3 L/day

192
Q

What is the key to flushing out radiation?

A

hydratation

193
Q

In brachytherapy, If the needle comes out and is laying on the bed, what does the nurse do?*****

A

pick up chemotherapy gloves and long-handed forceps and place them in a lead-lined container

194
Q

Side Effects of Radiation

A

fatigue
skin changes
alopecia
immunosuppression
radiation pneumonia
ulceration of oral mucous membranes
GI: N/V/D
symptoms increase as treatment progresses

195
Q

Patient Education for Radiation Therapy (6)

A

wash the treated area with tepid water and a soft washcloth
use an electric razor only
DO NOT remove treatment markings on skin
no heat or cold packs
no products (lotion/deodorant) to the sites during tx
avoid wearing tight, starched, or stiff clothing over treatment area

196
Q

If the patient has radiation therapy wash the affected area with

A

tepid water and a soft washcloth

197
Q

T/F: You should wash off the teletherapy radiation marks everyday after treatment.

A

False, never wash off the markings

198
Q

What type of tape is used for radiation therapy patients?

A

paper (apply outside the treatment area
no adhesive tape

199
Q

Patients with radiation treatment need to protect their

A

skin with sunscreen (for up to a year after radiation stops)
if hair loss occurs, cover their head

200
Q

Radiation therapy patients should eat

A

5-6 small meals/day
= fat/fiber/lactose

201
Q

If a patient has diarrhea, they should be on what type of diet?

A

BRAT

202
Q

Radiation therapy pts need

A

proper rest
diet
fluid intake for health and repairing normal tissues

203
Q

Nursing Considerations for Brachytherapy

A

needle could puncture the bladder if moved

204
Q

Chemotherapy (aka Poison)

A

use of anticancer drugs to eliminate cancer cells (combo)
- affects the entire body’s normal cells
- numerous side effects
- death may occur

205
Q

Antineoplastic

A

meds used to treat cancer (systemic poison)

206
Q

What is the number 1 cause of death during chemotherapy?

A

sepsis
bc they have no WBCs to fight due to bone marrow suppression

207
Q

CHemotherapy goal

A

kill cancerous cells while preserving other, more healthy cells
- not always possible
- high % of pts die from treatment, not cancer

208
Q

T/F: Chemotherapy has multiple cycles, administration, and body surface areas unique to every person.

A

True

209
Q

Administration of Chemotherapy
excreted in body fluids up to

A

48 hours after treatment

210
Q

Administration of Chemotherapy
usually requires

A

specialized ports

211
Q

Administration of Chemotherapy
Monitor

A

lab values closely (WBCs, RBCs, H&H, Platelets)
=liver enzymes especially
= Steroid should check glucose

212
Q

Administration of Chemotherapy
is given by a

A

chemo-certified RN only (2) to check drugs, pt, and orders
patency of port
set the pump together to ensure the rate is correct

213
Q

Extravasation

A

causative leakage of meds into the tissue around it
causing death of tissue

214
Q

What is a crucial step in Pt teaching guidelines for chemotherapy?

A

Hand washing is crucial

215
Q

Chemotherapy will delay

A

healing

216
Q

For 48-72 hrs following chemo the pts need to (7)

A

flush toilet twice
rinse toilets with bleach daily
caregiver should wear gloves if in contact with
- any body fluids
- contaminated laundry
avoid sex
- use 2 forms of birth control

217
Q

Handling cytotoxic drugs

A

no safe exposure limit (PPE and 48 hrs of chemo)
routes of exposure (inhalation, absorption, indigestion)
follow agency guidelines for proper disposal

218
Q

What PPE is needed to handle chemo drugs?

A

gloves
gowns
chemo hazard containers

219
Q

Cytotoxic Drugs RISK OF EXPOSURE

A

Handling body fluids of pt within 48 hours of chemo
Always PPE
Accidental spills

220
Q

Immunotherapy

A

boosts the immune system
creates an environment that is not conductive for CA cells to grow
attacks CA cells directly

221
Q

Is immunotherapy toxic like chemotherapy?

A

no, it is less toxic then chemotherapy

222
Q

Targeted Therapy

A

interferes with cancer growth
targets specific receptors important in tumor development

223
Q

Side effects of Immunotherapy and targeted therapy

A

flu-like symptoms (HA, fever, chills, fatigue, extreme weakness, anorexia, and nausea)
tachycardia
orthostatic hypotension
neurologic deficits - confusion, memory loss, insomnia
bone marrow depression

224
Q

Side effects of chemo

A

N/V from rapidly proliferated cells
alopecia
stomatitis*
pain
enteritis
diarrhea
anemia
fatigue

225
Q

Side effects related to labs of Chemo

A

myelosuppression
pancytopenia**
leukopenia
neutropenia
thrombocytopenia
granulocytopenia

226
Q

pancytopenia

A

decrease in all cells (red, white, platelets)

227
Q

In a cancer patient, what assessment is needed frequently to prevent or catch stomatitis

A

Mouth assessment
bc of rapidly proliferating cells

228
Q

Fatigue in cancer patients is mainly caused by

A

stress and mental devastation
debilitating
prolonged
health and quality of life (see a therapist)

229
Q

Fatigue from cancer therapy is unrelated to _________ and unrelieved by __________

A

activity and unrelieved by rest

230
Q

With fatigue what levels should be monitored?

A

thyroid

231
Q

Emetogenic

A

nausea causing drugs

232
Q

Nausea and Vomiting is directly ralated to what in cancer patients?

A

type of chemo administered

233
Q

What is the key to helping pts on chemo with N/V?

A

prevention give antiemetic before s/s and treatment from pt occur

234
Q

Acute N/V

A

occurs within 24 hours

235
Q

Delayed N/V

A

occurs within 2-5 days

236
Q

Anticipatory N/V

A

occurs before chemo
like a trigger of a sound/smell/taste

237
Q

Ondansetron is a

A

antiemetic (5-HT₃ antagonist ↓ risk of CINV)

238
Q

Ondansetron combined with a steroid (dexamethasone/Emend)

A

increase appetite
limited side effects with short-term use
use around the clock for 24-72 hours following treatment

239
Q

With N/V, monitor for

A

dehydration (I&O)

240
Q

Anorexia-Cachexia Syndrome

A

loss of skeletal muscle and fat
not starvation
unexplained rapid wt loss
altered smell and taste
halt cancer treatment
corticosteroids are effective
end result of cancer

241
Q

Catabolic state

A

body tissue and muscle proteins used to support cancer cell growth

242
Q

What kills more cancer pts than cancer itself?

A

Immunosuppression
- no fighting ability with cold
-stem cells

243
Q

Immunosuppression does what to the body

A

decreased ability to fight infection
risk for infection increases when
- low WBCs and neutrophils
risk for anemia increases when
- low RBCs and H&H
risk for bleeding increases when
- decrease platelets

244
Q

Immunosuppressed pts (Stem cell units) are given what meds

A

prophylactic
antifungals
antivirals

245
Q

What labs need to constantly be checked with immunosuppressed pts?

A

WBCs
platelets

246
Q

risk for infection increases when

A
  • low WBCs and neutrophils
247
Q

risk for anemia increases when

A
  • low RBCs and H&H
248
Q

risk for bleeding increases when

A
  • decrease platelets
249
Q

NADIR

A

the lowest point of blood cell count will get
each cell occurs at a different time
immune system compromised

250
Q

NADIR WBCs and platelets

A

7 - 14 days

251
Q

NADIR RBCs

A

several weeks

252
Q

Treatments are designed around what

A

NADIR

253
Q

Absolute Neutrophil count shows what if low

A

increased risk of infection
less than 100 = extremely high risk (stem cell)

254
Q

What is the 1st sign of a patient going septic?

A

respirations increase

255
Q

S/S of Sepsis

A

high respirations
fever 100.5 +
fatigue, body aches
chills, sweating
hypotension
tachycardia
lab values (WBCs high)
notify MD

256
Q

Before giving an antibiotic, get

A

blood cultures

257
Q

If a pt is going septic , what should you do?

A

notify MD
obtain chest x-ray
blood and urine cultures
?if requested, then antibiotics?

258
Q

Neutropenia

A

abnormally low absolute neutrophil count (can’t fight against)
most cancer pts

259
Q

What are the symptoms of neutropenia?

A

none until infection occurs

260
Q

Monitor with neutropenia with

A

CBC with differential

261
Q

What are the causes of neutropenia

A

decreased production of WBC
increased destruction of WBCs

262
Q

Neutropenic Precautions

A

wash hands frequently
low bacteria diet (no fresh fruits or veggies)
no fresh flowers, plants, pets
avoid crowds
no visitors with infections
no live vaccinations

263
Q

Thrombocytopenia

A

decrease in platelets

264
Q

Platelets (150,000 - 400,000) promote

A

coagulation, vascular integrity, vasoconstriction, adhesion
- produced in bone marrow (7-9 days)

265
Q

Critical Values of Thrombocytopenia

A

less than 50,000 or more than 1 million

266
Q

Transfusion of platelets below

A

10,000

267
Q

Pt education on Thrombocytopenia

A

Monitor platelet count
Monitor stools/urine for bleeding
Use electric razor only
Apply ice to the affected area if trauma occurs
Avoid dental work or other invasive procedures
Avoid aspirin and aspirin-containing products
bleeding safety precautions
- soft toothbrush and no flossing
Assess skin for ecchymosis, petechiae and trauma at least every shift**
Avoid IM injections and limit venipunctures**
No aspirin

268
Q

Pain in a cancer pt should be assessed

A

at every encounter (pain scale with scheduled and prn)

269
Q

Pain relief measures, not analgesics

A

distraction
imagery
relaxation
touch therapy

270
Q

Chemo-Brain

A

“mental fog” caused by chemotherapy, radiation, and some types of immunotherapy

271
Q

If a pt is having chemo-brain, what nursing interventions should you encourage pts to

A

Use a calendar or day-planner
Write down everything
Exercise the brain with crossword puzzles or other word or number games, jigsaw puzzles, play cards
Get physical exercise as tolerated
Ask for support (friends, family, support groups)

272
Q

If chemo-brain persists, what drugs can be used?

A

Alzheimer drugs

273
Q

Ascites is a ______ sign of cancer itself, not side effect of treatment

A

late

274
Q

Ascites

A

pathological accumulation of fluid within the abdominal cavity
- serum albumin/protein

275
Q

Symptoms of Ascites

A

abdominal distension
fullness
early satiety
difficulty breathing
decreased mobility
edema

276
Q

Management of Ascites

A

low salt diet - reduces water retention and edema)
diuretic therapy
paracentesis (palliative)
possible pleurx to enable pt to drain at home
perioneovenous shunts

277
Q

T/F: Ascites is a late sign and usually a poor prognosis.
What is the key to ascites

A

True, comfort is the key

278
Q

Risk Factors of Breast Cancer

A

Gender
Increasing age (40+)
Early menarche/late menopause
Family history
High-fat diet
Obesity

279
Q

Can males get breast cancer?

A

yes

280
Q

The younger the breast cancer diagnosis

A

the more aggressive it is (UNDER 40)

281
Q

Symptoms of Breast CA

A

Painless breast mass
Painful breast mass
Nipple discharge
Local edema
Nipple retraction
Nipple crusting

282
Q

Primary prevention for Breast CA

A

Wellness
Smoking Cessation
Daily exercise
Healthy diet
Low in saturated fat
High in Fiber

283
Q

Secondary Prevention for Breast CA

A

Mammogram
Beginning yearly after 40yrs of age
Breast Self Exam (BSE) every month
>20 years of age
Perform after menstruation
Same time every month

284
Q

Tertiary Prevention for Breast CA

A

Symptom control
- Lymphedema (SWELLING OF THE LYMPH NODES)
Rehabilitation
- Reconstruction

285
Q

What are you looking for when you do a self-breast examination every month?

A

if anything has changed since last time (lump)

286
Q

Assessment of Breast CA

A

= Any chnage in size, contour, or texture*
Mass felt during BSE
Mammogram
A non-moveable mass –typically painless
Usually, only one breast is involved
Skin dimpling, puckering
Nipple discharge, retraction
Peau d’orange = orange dimpling of the skin

287
Q

Late signs of Breast CA

A

pain
ulceration
cachexia

288
Q

Ultrasound is used to do what with dx breast CA

A

Consistency of breast masses
(cyst or dense mass?)
determine blood flow to that area

289
Q

Aspiration Biopsy

A

fine needle aspiration (FNA), a small amount of breast tissue or fluid is removed from a suspicious area with a thin, hollow needle and checked for cancer cells

290
Q

Incisional Biopsy

A

removes only part of the abnormal area

291
Q

Excisional Biopsy

A

removes the entire tumor or abnormal area

292
Q

50% of breast cancer occurs in what quadrant

A

lateral upper

293
Q

The diagnostic tests (BRCA1-2, HER-2, Estrogen and Progesterone receptors) show what

A

types of breast cancer (known as the triple)

294
Q

Triple negative means

A

good

295
Q

Triple positive means

A

bad

296
Q

Easier to treat what type of cancer

A

Hormones

297
Q

surgical Tx for Breast CA

A

Lumpectomy
Simple Mastectomy
Radical or Modified Radical Mastectomy

298
Q

NONsurgical Tx for Breast CA

A

Chemotherapy
Radiation (Teletherapy anf Brachytherapy via radium implants, pellets, and seeds)
Hormonal manipulation - Tamoxifen

299
Q

Simple Mastectomy means

A

removal of just breast tissue

300
Q

Modified Radical Mastectomy means

A

removal of all cancerous and leave a few lymph nodes

301
Q

Radical Mastectomy means

A

breast and lymph node removal

302
Q

Brachytherapy preserves

A

skin tissue

303
Q

Nurse Pre-Operative Care

A

Emotional support - look good feel good room
General preop teaching
Specific training

304
Q

Lymphedema of the arm Complications

A

Lifelong potential complication
Prevention
- Elevation, ROM, ADLs, protect
Treatment
- Intermittent compression sleeve, manual massage, elevation, diuretics
Importance of follow up

305
Q

Functions of the skin

A

Protection
Body temperature regulation
Psychosocial
Sensation
Vitamin D production
Immunological
Absorption
Elimination

306
Q

What is the most important thing for helping the skin?

A

Sunscreen

307
Q

Skin Assessment Tools

A

Perfect time when giving them a bath
Eyes
Hands
Ears
History taking and data gathering
Braden Scale
Nutritional assessment tools

308
Q

Key Steps for Skin Assessments

A

Health history*
Inspection and palpation
Examination (head to toe, light, Braden scale, variables)
Documentation

309
Q

Skin CA is a _____ person disease

A

young

310
Q

Document exactly what is

A

observed or palpated
- appearance, texture, temp, turgor, color, moisture, sensation, vascularity, lesions/rashes

311
Q

Are these documentations correct and accurate skin assessments?
“Skin is pink, warm, dry, and elastic; no petechiae, lesions or excoriation; multiple moles of small size and regular border and surface.”

“Red, macular rash generalized over trunk and thighs; semi-confluent lesions measure 1 to 2 cm; abrupt onset.”

A

Yes both are

312
Q

Which skin cancer is the most deadly and has several different dark colors?

A

melanoma

313
Q

Which cancer is more common in farmers, takes years to grow, and becomes deadly?

A

Basal cell carcinoma

314
Q

Which skin cancer looks scaly?

A

Squamous cell carcinoma

315
Q

Risk factors of Skin CA

A

Sunlight and UV radiation
Severe and/or blistering sunburns
Tanning (direct sunlight or tanning booths)
Family history
Fair (pale) skin that burns easily
Medical conditions or medications

316
Q

What meds can cause you to be more sensitive to the sunlight?

A

antibiotics
corticosteroids

317
Q

What meds can cause you to be more sensitive to the sunlight?

A

antibiotics
corticosteroids

318
Q

How do you recognize skin cancer?

A

ABCDE assessment
- change, hard/lumpy, oozes/bleeds/does not heal/itchy/tender/painful

319
Q

ABCDE assessment

A

A – Look for asymmetry in a mole
B – Assess for an irregular border
C – Is the color a mixture of different colors or has it changed recently?
D – Is the diameter >6mm
E – Has there been an evolution in the mole size, shape, color?

320
Q

Dx and Staging of Breast Cancer

A

Biopsy
labs/imaging
sentinel node biopsy
staging (size, deep of layers, metastasis)

321
Q

Treatment depends on

A

Type and stage
Size and location of tumor
General health and medical history

322
Q

Treatment types of Skin CA

A

Excision
Surgery
Chemotherapy
Radiation
Biologic Therapy (IMMUNOTHERAPY)

323
Q

Prevention and Education of Skin CA

A

Limit sun exposure
Stay away from sunlamps and tanning booths
Avoid outdoor activities during the hottest part of the day
Wear long sleeves and long pants
Wear a hat with a wide brim
Use sunscreen (SPF 30)
Regularly check your skin for changes in moles

324
Q

What port is used for cancer patients and can only be accessed with what?

A

Port a Cath
Huber needle

Module 3 (MedSurg 1) (12 decks)

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