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
How does cancer spread?
locally invasive metastasis
26
Locally invasive cancer
"fingers" of cancer cells invade surrounding tissue
27
Metastasis
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
28
What are the top 4 places for metastasis?
bone lungs liver brain
29
If the primary is the breast, then it tends to go to the
lymph nodes first then the liver lungs or brain
30
Melanoma is very deadly because
by the time it appears the body is completely exposed to the cancer
31
Which cancer is the most painful?
bone
32
Risk factors for cancer (most)
**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
33
What is the most common spot for breast cancer to form?
Lateral upper quadrant next to the armpit
34
If a patient works outside, then they should wear
sunscreen and protect skin due to the risk of occupational exposure
35
What is the hallmark cause of hereditary cancer syndrome?
family hx
36
Hereditary cancer syndrome can occur from what
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
37
If colon cancer runs in your family, when should you do a colonoscopy?
early because very hereditary
38
Viruses are difficult to
evaluate and isolate
39
Virus and generic structure of cells become
incorporated with each other
40
Initial viral infection to the development of cancer is
delayed after many years
41
viruses must act in conjunction with other factors in order to
develop into cancer
42
What virus is most common in causing cancer?
HPV
43
Viruses cause ________ and why is it harmful for cancer pts***
long term inflammation immunosuppressed people
44
HPV can cause what type of cancer
cervical
45
Hepatitis B and C can cause what type of cancer
Liver
46
Epstein-Barr (mono) can cause what type of cancer
Lymphoma
47
Human Herpes Virus 8 can cause what type of cancer
Kaposi's sarcoma
48
HIV can cause what type of cancer
Lymphoma Karposi's sarcoma
49
Helicobacter pylori can cause what type of cancer?
stomach ulcers lymphoma in the stomach lining
50
The vaccination of the HPV
should be encouraged to avoid HPV and warts on genitalia
51
Hormone Replacement Therapy
estrogen progestin
52
How can a hysterectomy cause cancer?
not produce estrogen and progesterone with hormone replacement therapy which causes cancer
53
Can hormone replacement therapy cause cancer?
yes
54
What type of cancers do the risks outweigh the benefits?
Ovarian breast uterine lung brain colon
55
Primary prevention
health promotion and illness prevention - reduction in the incidence of cancer
56
What preventions are done in primary intervention
exercise lifestyle change dietary change stress reduction avoid carcinogens
57
Secondary prevention
screening diagnosis and treatment of illness
58
What type of screening is done in secondary prevention?
self-breast and testicular exams pap smear mammogram colonoscopy
59
What is the goal of secondary prevention?
halt the progress of cancer through early screening and diagnosis
60
Tertiary prevention
disease treatment and rehab - restore health
61
The goal of tertiary prevention
prevent further deterioration
62
Chemoprevention
use of substances to lower risk of cancer
63
What are the different drugs used in chemoprevention?
Selective estrogen receptor modulators - Tamoxifen and raloxifene - selenium
64
Pathophysiology of Tamoxifen
binds estrogen and progesterone to prevent them from feeding the tumor early menopause
65
Tamoxifen and Raloxifene**
reduced risk of breast cancer binds estrogen and progesterone used for up to 5 years
66
What is the 1st chemopreventative drug approved?
Tamoxifen
67
Selenium
reduced risk of prostate cancer
68
What is the goal of screening?
find cancer in the early stages
69
What are the different types of screenings?
physical exam lab tests imaging procedures genetic testing
70
Beginning at what age should men and women get a colorectal screening?
45
71
How often should a fecal occult blood test be done for colorectal screening?
yearly
72
How often should a flexible sigmoidoscopy be done for colorectal screening?
every 5 years
73
How often should a colonoscopy be done for colorectal screening?
every 10 years
74
What cancer is considered very treatable when caught early but very deadly when caught late?
colon
75
Monthly Self Breast exams need to start after
20 years old
76
HCP Breast exams need to be done between what years and every ___ years
40-44 and completed every 3 years (However, Mrs.Duriex recommends one every year after 40)
77
Pap smear is looking for
abnormal cells of the cervix (mostly through sex)
78
At age 45-54, HCP exams and mammograms need to be done
yearly
79
At age 55, HCP and mammograms need to be done
every 2 years
80
Women at high risk for breast CA need to have what yearly
MRI and mammogram
81
Cervical cancer screening needs to be done when type of test every
age 21 or within 3 yrs of initiating intercourse - pap test every 2-3 years
82
If the patient has dysplasia noted, then pap tests are done
annually
83
At the age of 30, a pap test and HPV need to be done
5 years every 3 years with only pap test
84
Cervical cancer screening is not necessary if all previous tests are negative after what age
60
85
If the petient has had a hysterectomy, should the woman continue a pap test related to vaginal or vulvar cancer?
yes
86
What are the 7 warning signs of cancer? **CAUTION**
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**
87
Grading
pathologist compares the appearance of cancer cells to the normal surrounding cells
88
Staging
Oncologist classifying a malignancy by the extent of spread within the body
89
What does the pathologist do to cancer?
differentiation and grade
90
What does the oncologist do after the pathologist?
oncologist
91
Grading: GX
can not be assessed
92
Grading: G1
low grade well differentiated, slow growing
93
Grading: G2
moderate grade moderately differentiated, growing slightly faster
94
Grading: G3
high grade poorly differentiated, growing faster
95
Grading: G4
high grade undifferentiated, not distinct at all, very aggressive
96
Stage 1 CA
small cancer found in an organ where it originated
97
Stage 2 CA
larger cancer that may/may not have spread to the lymph nodes
98
Stage 3 CA
larger cancer also in the lymph nodes
99
Stage 4 CA
cancer has spread from the original site into other organs
100
PET scan
lights up inflammation in the body
101
TNM system of staging
T = size of primary tumor N = # of lymph nodes involved M = extent of metastasis
102
Staging Tumor Size TX
the tumor can not be measured
103
Staging Tumor Size T0
no primary tumor, can't be found
104
Staging Tumor Size Tis
the tumor is "in situ" (best case) in 1st layer of the organ
105
Staging Tumor Size T1
small or early stage
106
Staging Tumor Size T2
confined to original area
107
Staging Tumor Size T3
has spread to surrounding tissues
108
Staging Tumor Size T4
large, advanced stage cancer
109
TNM classification reflects
depth of tumor infiltration
110
Staging: Number of Nodes NX
Nearby nodes can't be tested/evaluated
111
Staging: Number of Nodes N0
lymph nodes are cancer free
112
Staging: Number of Nodes N1
cancer cells have reached one node
113
Staging: Number of Nodes N2
cancer spread to more than one node
114
Staging: Number of Nodes N3
cancer in lymph nodes extensive/widespread
115
Staging: Extent of Metastasis MX
UNKNOWN if cancer has spread
116
Staging: Extent of Metastasis M0
no distant metastases were found
117
Staging: Extent of Metastasis M1
cancer has spread to one or more distant parts of the body
118
In situ
still in the original layer
119
Localized
still in original organ
120
Regional
spread to nearby lymph nodes or organs
121
Distant
spread to distant body parts
122
Tumor markers
determine the effectiveness of tx
123
Tumor Marker CEA stands for
Carcinoembryonic Antigen
124
CEA tumor marker is related to
pancreas, GI (colon, lung, breast) Normal: 0-2.5 in nonsmokers / less than 5 in smokers
125
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.
d. the cancer is localized to the cervix.
126
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
d. Colorectal screening f. Mammography g. Pap testing h. Sunscreen use
127
Treatment of Cancer
surgery radiation therapy chemotherapy
128
What is the most frequent treatment method for cancer?
surgery
129
Surgery is used in conjunction with
chemotherapy or radiation
130
What is the ideal scenario for cancer when operating in surgery
localized and operative to remove the tumor determine other conjunction treatments
131
What are the reasons for a cancer patient to have surgery
prevent diagnose stage treat
132
If the tumor is benign why would they need surgery?
causes problems to other organs or systems - by becoming too big
133
What are the different types of surgeries?
Diagnostic Primary Prophylactic Palliative Reconstructive
134
A biopsy is what type of surgery?
diagnostic
135
Mastectomy is what type of surgery?
Primary
136
Vasectomy is what type of surgery?
Prophylactic
137
Quality of life improvement is related to what type of surgery?
Pallative
138
Augmentation/plastic surgery is what type of surgery?
reconstructive
139
Tissue Biopsy encompasses these methods?
Shave Punch Incision Excisional Fine needle Core needle
140
Shave Biopsy
top layers of the skin are shaved off with a small surgical blade bandaid
141
Punch Biopsy
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
Incisional Biopsy
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
Fine Needle Biopsy
23-30g needle aspirate and suction fluid out of the site **superficial tumor** **least painful**
144
Core Needle Biopsy
12g needle liver, kidney and retract specimens **most painful**
145
Surgery as a primary treatment includes these 3 curing methods
Debulking Radical Excisions Salvage Surgery
146
Primary/Curative Surgery Debulking
remove as much of the tumor as possible
147
Radical means
take everything including muscle, sub Q, and skin
148
Primary/Curative Surgery Radical Excisions
can be disfiguring and alter functioning takes muscle, sub Q and skin is all taken
149
Primary/Curative Surgery Salvage Surgery
extensive surgery to site at **which previous therapies have failed**
150
Radical Mastectomy
removal of the breast and associated lymph nodes near the armpit
151
Radical Neck Dissection
removal of jaw bone, tongue, lymph nodes, neck glands
152
Primary Treatment Surgery Electrosurgery to skin
electrical current to destroy tumor cells
153
Primary Treatment Surgery Cryosurgery to skin
liquid nitrogen to freeze tissue
154
Primary Treatment Surgery Chemosurgery to skin
chemical applied to tissue
155
Primary Treatment Surgery Laser surgery to skin
precise high-dose radiation therapy
156
Prophylactic Surgery
removal of non-vital tissues/organs that may develop cancer
157
Prophylactic Surgery considerations
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
Palliative Surgery
pain relief not intended to treat or cure goal **high quality of life** "to alleviate without curing"
159
Reconstructive surgery
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
Care of surgical pt
incision care prevent infection manage pain educate on drains, s/s of infection, and dietary intake to promote healing
161
Does the nurse take off the surgical dressing first?
no, the surgeon does
162
S/S of infection
redness, swelling, warmth
163
What food is eaten to promote healing?
Vitamin C Protein
164
The radiation and Chemotherapy goal is to
eliminate cancerous cells
165
Radiation/Chemotherapy affects
**rapidly proliferating cells (skin, GI, and hair)** - a wide range of symptoms - death can result - benefits outweigh the risks (mostly)
166
Is it the nurse's job to encourage a patient to pursue chemotherapy?
no, patient's choice if they want to pursue
167
Radiation Therapy does what to the body
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
Lethal Tumor Dose
the amount required to eradicate 95% of the tumor and simultaneously salvage or **spare normal tissue**
169
Total radiation dosage is delivered over
weeks to allow healthy tissue to recover
170
Repeated radiation doses allow
the periphery of the tumor to reoxygenate and become more susceptible to radiation
171
Factors affecting dosage
radiosensitivity of tumor normal tissue tolerance the volume of tissue to be irradiated
172
The radiosensitivity of the tumor is dependent on
presence of oxygen
173
Normal tissue tolerance is the point which
normal tissues are **irreparably damaged**
174
The volume of tissue to irradiated determines the
total prescribed dose to be separated into several smaller doses
175
Treatments are usually given daily, ___ days per week for an average of ____ - ______ treatments
5; 25-30
176
Benefits of Radiation Therapy
used before surgery to shrink tumors intra-operative given before, during, or after chemo palliative (shrink tumors, reduce pressure, pain, and other symptoms)
177
Radiation Toxicity
localized to the area of treatment maybe higher if in conjunction with chemo
178
Generalized effects of Radiation Toxicity
**Fatigue** N/V Anemia Thrombocytopenia
179
A hypoxic cell is ________ times harder to treat as it shrinks
2-3
180
How does a pt with Radiation Toxicity get anemia?
bone marrow suppression and decrease in RBCs
181
How does a pt with Radiation Toxicity get thrombocytopenia?
low platelet levels w/ low blood flow
182
External Radiation Therapy aka
Teletherapy
183
Internal Radiation Therapy aka
Brachytherapy
184
If a Cancer pt is getting radiation treatment, what assessments and education do we need to tell them?
**Breathing *Nutrition Skin Pain
185
Brachytherapy procedure includes??????
needles inside the tissue to **spare the dying tissue**
186
Nursing Considerations for Brachytherapy
monitor the number of needles and don't move needle could puncture the bladder if moved
187
Brachytherapy Side effects
sealed/unsealed *implants fatigue anorexia immunosuppression other similar to external
188
If the pt has a sealed implant, then the body
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
If the patient has an unsealed implant then the body
will give off radiation body secretions may be contaminated Isolation
190
What type of isolation will occur with a radiation implant?
Nurses and pts have less than 60 mins in the room per shift
191
Education for Temporary Brachytherapy
**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
What is the key to flushing out radiation?
hydratation
193
In brachytherapy, If the needle comes out and is laying on the bed, what does the nurse do?*****
pick up chemotherapy gloves and long-handed forceps and place them in a lead-lined container
194
Side Effects of Radiation
**fatigue** skin changes alopecia immunosuppression radiation pneumonia ulceration of oral mucous membranes GI: N/V/D symptoms increase as treatment progresses
195
Patient Education for Radiation Therapy (6)
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
If the patient has radiation therapy wash the affected area with
tepid water and a soft washcloth
197
T/F: You should wash off the teletherapy radiation marks everyday after treatment.
False, never wash off the markings
198
What type of tape is used for radiation therapy patients?
paper (apply outside the treatment area **no adhesive tape**
199
Patients with radiation treatment need to protect their
skin with sunscreen (for up to a year after radiation stops) if hair loss occurs, cover their head
200
Radiation therapy patients should eat
5-6 small meals/day = fat/fiber/lactose
201
If a patient has diarrhea, they should be on what type of diet?
BRAT
202
Radiation therapy pts need
proper rest diet fluid intake for health and repairing normal tissues
203
Nursing Considerations for Brachytherapy
needle could puncture the bladder if moved
204
Chemotherapy (aka Poison)
use of anticancer drugs to eliminate cancer cells (combo) - affects the entire body's normal cells - numerous side effects - death may occur
205
Antineoplastic
meds used to treat cancer (systemic poison)
206
What is the number 1 cause of death during chemotherapy?
sepsis bc they have no WBCs to fight due to bone marrow suppression
207
CHemotherapy goal
kill cancerous cells while preserving other, more healthy cells - not always possible - high % of pts die from treatment, not cancer
208
T/F: Chemotherapy has multiple cycles, administration, and body surface areas unique to every person.
True
209
Administration of Chemotherapy excreted in body fluids up to
48 hours after treatment
210
Administration of Chemotherapy usually requires
specialized ports
211
Administration of Chemotherapy **Monitor**
lab values closely (WBCs, RBCs, H&H, Platelets) =**liver enzymes especially** = Steroid should check glucose
212
Administration of Chemotherapy is given by 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
Extravasation
causative leakage of meds into the tissue around it causing death of tissue
214
What is a crucial step in Pt teaching guidelines for chemotherapy?
**Hand washing is crucial**
215
Chemotherapy will delay
healing
216
For 48-72 hrs following chemo the pts need to (7)
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
Handling cytotoxic drugs
no safe exposure limit (PPE and 48 hrs of chemo) routes of exposure (inhalation, absorption, indigestion) follow agency guidelines for proper disposal
218
What PPE is needed to handle chemo drugs?
gloves gowns chemo hazard containers
219
Cytotoxic Drugs RISK OF EXPOSURE
Handling body fluids of pt within 48 hours of chemo Always PPE Accidental spills
220
Immunotherapy
boosts the immune system creates an environment that is not conductive for CA cells to grow attacks CA cells directly
221
Is immunotherapy toxic like chemotherapy?
no, it is less toxic then chemotherapy
222
Targeted Therapy
interferes with cancer growth targets specific receptors important in tumor development
223
Side effects of Immunotherapy and targeted therapy
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
Side effects of chemo
**N/V** from rapidly proliferated cells alopecia stomatitis* pain enteritis diarrhea anemia fatigue
225
Side effects related to labs of Chemo
myelosuppression pancytopenia** leukopenia neutropenia thrombocytopenia granulocytopenia
226
pancytopenia
decrease in all cells (red, white, platelets)
227
In a cancer patient, what assessment is needed frequently to prevent or catch stomatitis
Mouth assessment bc of rapidly proliferating cells
228
Fatigue in cancer patients is mainly caused by
stress and mental devastation debilitating prolonged health and quality of life (see a therapist)
229
Fatigue from cancer therapy is unrelated to _________ and unrelieved by __________
activity and unrelieved by rest
230
With fatigue what levels should be monitored?
thyroid
231
Emetogenic
nausea causing drugs
232
Nausea and Vomiting is directly ralated to what in cancer patients?
type of chemo administered
233
What is the key to helping pts on chemo with N/V?
prevention give antiemetic before s/s and treatment from pt occur
234
Acute N/V
occurs within 24 hours
235
Delayed N/V
occurs within 2-5 days
236
Anticipatory N/V
occurs before chemo like a trigger of a sound/smell/taste
237
Ondansetron is a
antiemetic (5-HT₃ antagonist ↓ risk of CINV)
238
Ondansetron combined with a steroid (dexamethasone/Emend)
increase appetite limited side effects with short-term use use around the clock for 24-72 hours following treatment
239
With N/V, monitor for
dehydration (I&O)
240
Anorexia-Cachexia Syndrome
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
Catabolic state
body tissue and muscle proteins used to support cancer cell growth
242
What kills more cancer pts than cancer itself?
Immunosuppression - no fighting ability with cold -stem cells
243
Immunosuppression does what to the body
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
Immunosuppressed pts (Stem cell units) are given what meds
prophylactic antifungals antivirals
245
What labs need to constantly be checked with immunosuppressed pts?
WBCs platelets
246
risk for infection increases when
- low WBCs and neutrophils
247
risk for anemia increases when
- low RBCs and H&H
248
risk for bleeding increases when
- decrease platelets
249
NADIR
the **lowest** point of blood cell count will get each cell occurs at a different time immune system compromised
250
NADIR WBCs and platelets
7 - 14 days
251
NADIR RBCs
several weeks
252
Treatments are designed around what
NADIR
253
Absolute Neutrophil count shows what if low
increased risk of infection less than 100 = extremely high risk (stem cell)
254
What is the 1st sign of a patient going septic?
respirations increase
255
S/S of Sepsis
high respirations fever 100.5 + fatigue, body aches chills, sweating hypotension tachycardia lab values (WBCs high) notify MD
256
Before giving an antibiotic, get
blood cultures
257
If a pt is going septic , what should you do?
notify MD obtain chest x-ray blood and urine cultures ?if requested, then antibiotics?
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Neutropenia
abnormally low absolute neutrophil count (can't fight against) most cancer pts
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What are the symptoms of neutropenia?
none until infection occurs
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Monitor with neutropenia with
CBC with differential
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What are the causes of neutropenia
decreased production of WBC increased destruction of WBCs
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Neutropenic Precautions
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
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Thrombocytopenia
decrease in platelets
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Platelets (150,000 - 400,000) promote
coagulation, vascular integrity, vasoconstriction, adhesion - produced in bone marrow (7-9 days)
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Critical Values of Thrombocytopenia
less than 50,000 or more than 1 million
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Transfusion of platelets below
10,000
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Pt education on Thrombocytopenia
**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
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Pain in a cancer pt should be assessed
at every encounter (pain scale with scheduled and prn)
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Pain relief measures, not analgesics
distraction imagery relaxation touch therapy
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Chemo-Brain
"mental fog" caused by chemotherapy, radiation, and some types of immunotherapy
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If a pt is having chemo-brain, what nursing interventions should you encourage pts to
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)
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If chemo-brain persists, what drugs can be used?
Alzheimer drugs
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Ascites is a ______ sign of cancer itself, not side effect of treatment
late
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Ascites
pathological accumulation of fluid within the abdominal cavity - serum albumin/protein
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Symptoms of Ascites
abdominal distension fullness early satiety difficulty breathing decreased mobility edema
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Management of Ascites
**low salt diet** - reduces water retention and edema) diuretic therapy paracentesis (palliative) possible pleurx to enable pt to drain at home perioneovenous shunts
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T/F: Ascites is a late sign and usually a poor prognosis. What is the key to ascites
True, comfort is the key
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Risk Factors of Breast Cancer
Gender Increasing age (40+) Early menarche/late menopause Family history High-fat diet Obesity
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Can males get breast cancer?
yes
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The younger the breast cancer diagnosis
the more aggressive it is (UNDER 40)
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Symptoms of Breast CA
**Painless breast mass Painful breast mass** Nipple discharge Local edema Nipple retraction Nipple crusting
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Primary prevention for Breast CA
Wellness Smoking Cessation Daily exercise Healthy diet Low in saturated fat High in Fiber
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Secondary Prevention for Breast CA
Mammogram Beginning yearly after 40yrs of age Breast Self Exam (BSE) every month >20 years of age Perform after menstruation Same time every month
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Tertiary Prevention for Breast CA
Symptom control - **Lymphedema (SWELLING OF THE LYMPH NODES)** Rehabilitation - Reconstruction
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What are you looking for when you do a self-breast examination every month?
if anything has changed since last time (lump)
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Assessment of Breast CA
= 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
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Late signs of Breast CA
pain ulceration cachexia
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Ultrasound is used to do what with dx breast CA
Consistency of breast masses (cyst or dense mass?) determine blood flow to that area
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Aspiration Biopsy
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
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Incisional Biopsy
removes only part of the abnormal area
291
Excisional Biopsy
removes the entire tumor or abnormal area
292
50% of breast cancer occurs in what quadrant
lateral upper
293
The diagnostic tests (BRCA1-2, HER-2, Estrogen and Progesterone receptors) show what
types of breast cancer (known as the triple)
294
Triple negative means
good
295
Triple positive means
bad
296
Easier to treat what type of cancer
Hormones
297
surgical Tx for Breast CA
Lumpectomy Simple Mastectomy Radical or Modified Radical Mastectomy
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NONsurgical Tx for Breast CA
Chemotherapy Radiation (Teletherapy anf Brachytherapy via radium implants, pellets, and seeds) Hormonal manipulation - Tamoxifen
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Simple Mastectomy means
removal of just breast tissue
300
Modified Radical Mastectomy means
removal of all cancerous and leave a few lymph nodes
301
Radical Mastectomy means
breast and lymph node removal
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Brachytherapy preserves
skin tissue
303
Nurse Pre-Operative Care
**Emotional support** - look good feel good room General preop teaching Specific training
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Lymphedema of the arm Complications
Lifelong potential complication Prevention - Elevation, ROM, ADLs, protect Treatment - Intermittent compression sleeve, manual massage, elevation, diuretics Importance of follow up
305
Functions of the skin
Protection Body temperature regulation Psychosocial Sensation Vitamin D production Immunological Absorption Elimination
306
What is the most important thing for helping the skin?
Sunscreen
307
Skin Assessment Tools
Perfect time when giving them a bath Eyes Hands Ears History taking and data gathering **Braden Scale** Nutritional assessment tools
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Key Steps for Skin Assessments
Health history* Inspection and palpation Examination (head to toe, light, Braden scale, variables) Documentation
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Skin CA is a _____ person disease
young
310
Document exactly what is
observed or palpated - appearance, texture, temp, turgor, color, moisture, sensation, vascularity, lesions/rashes
311
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.”
Yes both are
312
Which skin cancer is the most deadly and has several different dark colors?
melanoma
313
Which cancer is more common in farmers, takes years to grow, and becomes deadly?
Basal cell carcinoma
314
Which skin cancer looks scaly?
Squamous cell carcinoma
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Risk factors of Skin CA
**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
What meds can cause you to be more sensitive to the sunlight?
antibiotics corticosteroids
317
What meds can cause you to be more sensitive to the sunlight?
antibiotics corticosteroids
318
How do you recognize skin cancer?
ABCDE assessment - change, hard/lumpy, oozes/bleeds/does not heal/itchy/tender/painful
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ABCDE assessment
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
Dx and Staging of Breast Cancer
Biopsy labs/imaging sentinel node biopsy staging (size, deep of layers, metastasis)
321
Treatment depends on
Type and stage Size and location of tumor General health and medical history
322
Treatment types of Skin CA
Excision Surgery Chemotherapy Radiation Biologic Therapy (IMMUNOTHERAPY)
323
Prevention and Education of Skin CA
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
What port is used for cancer patients and can only be accessed with what?
Port a Cath Huber needle