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Advanced Clinical Nursing Theory > Oncology > Flashcards

Oncology Flashcards

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1
Q

what are the basic tumor types seen in animals?

A

haematopoetic or liquid
solid
round cell

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2
Q

what are the main types of haematopoetic or liquid tumors?

A

lymphoma
leukemia

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3
Q

what are the main types of solid tumors?

A

sarcoma
carcinoma

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4
Q

what tissues do sarcomas affect?

A

skeletal
connective tissue

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5
Q

what tissues do carcinomas affect?

A

organs

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6
Q

what are the main types of round cell tumor?

A

MCT
melanomas

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7
Q

what is a benign tumor?

A

one that will not spread

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8
Q

what is a malignant tumor?

A

one with risk of spread

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9
Q

what is a metastatic tumor?

A

one which grows in a different locations to the primary tumor

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10
Q

what areas of the body are commonly affected by metastasis?

A

those with high blood flow as cancer cells are carried from the primary tumor in the blood stream to other sites

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11
Q

where does leukaemia occur?

A

blood forming tissues

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12
Q

what are the two main types of leukaemia?

A

acute
chronic

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13
Q

what is acute leukaemia?

A

presents with clinical signs directly relating to leukaemia

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14
Q

what is chronic leukaemia?

A

incidental finding when investigating other illness

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15
Q

where does lymphoma occur?

A

cells that make up the immune system

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16
Q

what are the main types of lymphoma?

A

B cell
T cell

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17
Q

how are haematopoetic tumors normally treated?

A

chemo as highly responsive

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18
Q

what are sarcomas classified according to?

A

parent tissue

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19
Q

what are the main sarcoma types seen in animals?

A

osteosarcoma
haemangiosarcoma
soft tissue sarcoma

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20
Q

where are osteosarcomas often found?

A

distal radius
top of femur

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21
Q

what has usually occurred by the time a patient presents with osteosarcoma?

A

metastasis either obvious or sub clinical

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22
Q

what is involved in treatment of osteosarcoma?

A

surgery to remove affected limb
chemotherapy
bisphosphates
radiation therapy

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23
Q

what is the aim of amputation in osteosarcoma patients?

A

palliation as tumors are painful
metastasis has already occurred so unlikely curative

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24
Q

where are haemangiosarcomas located?

A

spleen
heart
blood vessels

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25
Q

how are haemangiosarcomas treated?

A

surgery
chemo

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26
Q

where are haemangiosarcomas commonly found?

A

spleen

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27
Q

what is soft tissue sarcoma a tumor of?

A

connective tissue

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28
Q

what is consistent about soft tissue sarcomas?

A

all behave the same despite their different locations

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29
Q

what is a carcinoma?

A

tumor that is made of tissue that covers any body surface, lines a body cavity or makes up an organ

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30
Q

what are carcinomas that arise from a gland known as?

A

have prefix ‘adeno’

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31
Q

what is a common carcinoma type?

A

squamous cell carcinoma

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32
Q

what animals are squamous cell carcinomas common in?

A

cats

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33
Q

where are squamous cell carcinomas seen often in cats?

A

mouth
nose
ears

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34
Q

where are more aggressive squamous cell carcinomas found?

A

mouth

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35
Q

how are squamous cell carcinomas treated?

A

surgery to remove if superficial / possible
radiation or chemo useful

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36
Q

what is the most common malignant skin tumour in dogs?

A

mast cell tumor

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37
Q

what are mast cells involved with in the body?

A

inflammatory and allergic mechanisms

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38
Q

how may mast cell tumors present?

A

many different ways
may be highly malignant or almost benign

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39
Q

how do mast cell tumors appear within the skin?

A

hard and firm

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40
Q

how do mast cell tumors appear if under the skin layers?

A

mobile and soft - lipoma like

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41
Q

how may mast cell tumors present in cats?

A

splenic
GI

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42
Q

how are mast cell tumors often treated?

A

surgical removal with appropriate margins
radiotherapy
chemotherapy

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43
Q

how does melanoma often appear?

A

pigmented black tumor

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44
Q

where on the body is melanoma found?

A

mouth
toes
skin

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45
Q

where are more aggressive melanomas found?

A

mouth or toes

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46
Q

how is melanoma treated?

A

surgery to improve QOL
immunotherapy to slow spread

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47
Q

how does immunotherapy for melanoma work?

A

melanoma vaccine given
immune system develops antibodies to melanoma proteins
if melanoma recurs the immune system can remove them

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48
Q

what is in the melanoma vaccine?

A

human melanoma proteins

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49
Q

how is the melanoma vaccine given?

A

transdermally

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50
Q

do benign tumors always lead to malignant tumors?

A

no
squamous cell carcinoma might

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51
Q

what are the most common benign tumors?

A

lipoma
haemangioma
adenoma

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52
Q

what is haemangioma a tumor of?

A

blood cells

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53
Q

what is paraneoplastic syndrome?

A

cancer associated alterations to the body structure or function that are not directly related to the tumor or metastasis

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54
Q

what are the common PNS seen with lymphoma?

A

hypercalcaemia
anaemia
neutropenic leukocytosis
thrombocytopenia

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55
Q

what effect can successful treatment of a tumor have on PNS?

A

may lead to disappearance of many PNS

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56
Q

what may be signified by return of PNS that had reduced with tumor treatment?

A

tumor return

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57
Q

what may be signified by PNS?

A

malignancy

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58
Q

what can be predicted by the PNS seen?

A

tumor type as PNS are specific

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59
Q

what can be the result of PNS?

A

greater morbidity than with the tumor itself

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60
Q

what is the best curative option for tumors?

A

surgery

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61
Q

what is the purpose of staging and grading of tumors?

A

gives an idea of available treatment options

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62
Q

what varies between tumors?

A

sensitivity to chemo

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63
Q

what cancers have high sensitivity to chemo?

A

lymphoma
some leukaemias

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64
Q

what cancers have moderate sensitivity to chemo?

A

high grade sarcomas
MCT
fast growing

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65
Q

what cancers have low sensitivity to chemo?

A

slow growing sarcomas
carcinomas
melanomas

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66
Q

what are the main treatment options for low sensitivity tumors?

A

no chemo, surgery if an option

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67
Q

how may location of a tumor affect treatment?

A

may affect if it is resectable
is it resectable with margins?

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68
Q

how may owner factors influence tumor treatment?

A

may not want disfiguring surgery/radical resection
may not have finances for treatment

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69
Q

how may patient temperament affect treatment?

A

ability to cope with radical surgery (e.g. OA on other limbs or size)
ability to cope with repeated vet visits / treatment /GA

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70
Q

how may chemotherapy be used for treatment?

A

stand alone therapy
conjunction with other therapies

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71
Q

what may affect if chemotherapy is used?

A

chemosensitivity of cancer - high, moderate or low

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72
Q

how does radiotherapy treat tumors?

A

radiation induced cellular injury
targets fast growing cells

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73
Q

what are the issues with radiation treatment?

A

specific expensive equipment needed

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74
Q

what other treatments are available for tumors?

A

cryotherapy
hyperthermic therapy
photodynamic therapy
immunotherapy

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75
Q

what are the surgical treatment options for tumors?

A

complete resection with margins
excisional biopsy
incisional biopsy
trucut biopsy
FNA

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76
Q

what is involved in complete tumor resection?

A

removal of tumor and margins in order to try and cure patients
radical and wide surgery

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77
Q

what are the margins needed for MCT removal?

A

2cm normal tissue around
1 tissue plane below

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78
Q

what is involved in an excisional biopsy of a tumor?

A

main mass removed
no excess tissue taken

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79
Q

what may excisional biopsy be used for?

A

diagnosis
treatment as debulking surgery

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80
Q

what are the main surgical diagnostic techniques?

A

incisional biopsy
trucut biopsy
FNA (not rly surg)

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81
Q

what are the main goals of surgery for tumor treatment?

A

curative
debulking and additional treatment
palliative for comfort

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82
Q

what preventative oncology surgery is seen?

A

removal of retained testicles

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83
Q

what oncologic emergency surgeries are there?

A

bleeding management (splenic mass)
pathological fracture
infection
bowel perforation
bowel obstruction

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84
Q

what is the purpose of tumor staging?

A

to find out how much tumor is present in the body at the time of staging
get an over view of patients health

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85
Q

what may be picked up during tumor staging that can inform treatment?

A

concurrent conditions
PNS

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86
Q

what is the information gathered during staging used for?

A

formulation of treatment decisions

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87
Q

what system is used to stage tumors?

A

TNM

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88
Q

what does the T of TNM stand for?

A

tumor size (primary)

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89
Q

what does the N of TNM stand for?

A

level of lymph node involvement

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90
Q

what does the M of TNM stand for?

A

presence of metastasis

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91
Q

when is staging performed?

A

before start of treatment
assessment of response to treatment
before recommencing treatment after relapse

92
Q

what are the tests involved in tumor staging?

A

physical exam
history
urinalysis
bloods
chest xray
abdominal ultrasound
imaging

93
Q

what blood tests will be used for tumor staging?

A

CBC
biochem
specific and relevant to patient (e.g. t4?)

94
Q

what views of the chest are needed to check for metastasis?

A

3 inflated views

95
Q

what mets can be seen on chest x-ray?

A

over 4/5mm

96
Q

what is involved in abdominal US for tumor staging?

A

check common metastasis sites
FNA of liver, spleen and LN

97
Q

what specialised imaging may be used during tumor staging?

A

echo
CT
MRI

98
Q

what is echo used for during tumor staging?

A

check for any signs of CHF or cardiac issue before doxorubicin given

99
Q

what is CT used for during tumor staging?

A

checking tumor invasion and spread
more sensitive to lung mets
surgical planning

100
Q

what is MRI used for during tumor staging?

A

neuro based tumors
tumors in soft tissue obscured by bone

101
Q

when is tumor grading done?

A

during histology after biopsy or tumor resection

102
Q

what information is used to grade tumors?

A

appearance under microscope
mitotic index
organisation of cells
evidence of invasion of blood vessels

103
Q

what are the tumor grades?

A

low
intermediate
high

104
Q

what is the value of tumor grading?

A

useful for prognosis

105
Q

what is mitotic index?

A

number of currently dividing cells seen across 10 high power fields

106
Q

what does a high mitotic index indicate?

A

high level of malignancy

107
Q

when may a cancer patient present in hospital?

A

initial investigation
staging
illness (e.g. after chemo)
palliative care at end of life

108
Q

what nursing model should be used to support inpatients?

A

ability model

109
Q

what are the areas of the Ability model/

A

eat
drink
urinate
defecate
breathe normally
maintain temp
groom and clean itself
mobilise adequately
sleep and rest
expression of normal behaviour

110
Q

who designed the ability model?

A

Orpet and Jeffries

111
Q

what is involved in patient assessment when designing the care plan?

A

information gained about patients normal routine
owner questionnaire
face to face discussion
team members

112
Q

when is the assessment phase of the ability model revisited?

A

regularly e.g. ward rounds, handover, checks such as pain scoring

113
Q

what is involved in the planning stage of the ability model?

A

setting SMART goals
identify actual and potential problems
identification of nursing interventions
prioritisation of interventions

114
Q

what are SMART goals?

A

Specific
Measurable
Acchievable
Realistic
Timely

115
Q

what is crucial when patients are receiveing nursing interventions?

A

document clearly - how much, what it is, how often

116
Q

what are the interventions involved in medical models?

A

physiological issues
medications needed

117
Q

what are the interventions involved in nursing models?

A

medical interventions
eating
drinking
urination needs
defecating
psychological
environmental
sociocultural

118
Q

what are some of the potential psychological, environmental and sociocultural nursing interventions?

A

nervous patients
bitch on heat being accommodated
enrichment
patient as an individual

119
Q

what is the purpose of evaluation of nursing care plans and interventions?

A

show that nursing interventions are working
show goals are being accheived

120
Q

what must take place in order to evaluate nursing care plans and interventions?

A

assessment of the patient to pick up on any other issues as well as those that are resolving

121
Q

what may change around evaluation of nursing care plans and interventions?

A

depending on the intervention some assessments may be done sooner than others (e.g. pain more rapidly assessed than feeding/grooming)

122
Q

what will happen after evaluation of nursing care plans and interventions?

A

plan adjusted accordingly

123
Q

what are some specific nursing considerations for onco patients?

A

enrichment as may be hospitalised for a long time
anorexia - may need to TTE and look for cause
may have impaired immune function - reverse barrier nurse
care with waste and chemo drugs
care with chemo administration

124
Q

where are chemo drugs excreted?

A

may be in all body fluids particularly urine, faeces and vomit

125
Q

how long are chemo drugs excreted for?

A

3-5 days

126
Q

what is required to keep caregivers of chemo patients safe?

A

barrier nursing

127
Q

what are the stages of mitosis?

A

prophase
metaphase
anaphase
telophase
cytokensis

128
Q

what are the number of mitotic cycles controlled by?

A

cell nucleus

129
Q

what do cells spend most of their time in?

A

interphase

130
Q

what occurs during interphase?

A

cell matures
makes DNA copies

131
Q

what occurs during prophase?

A

preparation for cells to split
chromosomes form

132
Q

what happens during metaphase?

A

chromosomes line up down the centre of the cell

133
Q

what happens during anaphase?

A

chromosomes split

134
Q

what happens during telophase?

A

chromosomes stretch out

135
Q

what happens during cytokinesis?

A

cell splits into two new cells

136
Q

what is apoptosis?

A

cell death

137
Q

what triggers apoptosis?

A

shortening of telomeres
cell only replicates a certain number of times

138
Q

how does the body suppress cancer formation?

A

cell cycle is regulated
cells respond to growth and environmental signals
tumor suppressor genes exist
cell is repaired or goes into apoptosis if cell malfunctions

139
Q

how does cancer arise?

A

accumulation of genetic mutations that eliminate normal cell constraints

140
Q

what effect has increased longevity had on cancer?

A

allows more time for mutations to accumulate and develop into cancer

141
Q

what are the main environmental causes of cancer?

A

chemical carcinogens
physical agents
hormonal
cancer causing viruses
inherited (not recognised in animals)

142
Q

what are the main chemical carcinogens?

A

tobacco smoke
pesticides
herbicides and insecticides
cyclophosphomide

143
Q

what are the main physical agents that can cause cancer?

A

sunlight
trauma/chronic inflammation
magnetic fields
radiation
surgery
implanted devices
asbestos

144
Q

what are the hormonal influences on cancer?

A

neutering may be protective against some (e.g. mammary cancer) but may increase risk of others (e.g. lymphoma)

145
Q

what are examples of cancer causing viruses?

A

papilloma virus
retroviruses (FeLV)

146
Q

what are the main DNA mutations that cause deviation from the normal cell cycle?

A

sustaining proliferative signalling
evasion of growth suppression
resist apoptosis
enable replicative immortality
induce angiogenesis
activation of invasion and metastasis

147
Q

what is the minimum number of mutations required to cause cancer?

A

5-6

148
Q

how is replicative immortality of cells enabled?

A

telomeraze produced by cells which prevents shortening of telomeres
this prevents signalling for normal apoptosis so cells survive

149
Q

define tumour

A

neoplasm either benign or malignant

150
Q

define neoplasia

A

formation of new abnormal growth that is not responsive to normal physiologic control mechanisms
benign or malignant

151
Q

define cancer

A

metastatic neoplasm

152
Q

define benign tumor

A

can be space occupying and cause tissue distortion but no metastasis

153
Q

what is the impact of malignant tumors on the surrounding tissue?

A

locally invasive

154
Q

what cells does chemotherapy work on?

A

rapidly dividing cells at various stages in DNA replication and cell division
cell signalling

155
Q

what are the main ways chemo is used?

A

primary induction
primary neoadjuvant
adjuvant
consolidation
maintainance
rescue or salvage
palliative

156
Q

what is primary induction chemotherapy?

A

initial chemotherapy a person receives before undergoing additional cancer treatment

157
Q

what is primary neoadjuvant chemotherapy?

A

chemo before surgery used to shrink tumor size to allow resection

158
Q

what is adjuvant chemotherapy?

A

used after surgery to mop up any remaining cells

159
Q

what is consolidation chemotherapy?

A

used after initial treatment (of whatever type) to target additional cells and reduce likelihood of relapse

160
Q

what is maintenance chemotherapy?

A

ongoing treatment of cancer with medication after the cancer has responded to the first recommended treatment

161
Q

what is rescue / salvage chemotherapy?

A

change to different protocol due to failure to respond to other chemo type

162
Q

what is palliative chemotherapy?

A

aimed at reducing disease signs and pain to improve quality of life

163
Q

what type of chemo treatment plan is best?

A

multimodal

164
Q

what are the benefits of multimodal chemo schedules?

A

broad range of interaction between drugs and tumor cells
slows development of tumor drug resistance

165
Q

what is the aim when choosing chemo doses?

A

maximal cell kill within range of tolerable host toxicity

166
Q

what drugs should be used for chemo?

A

only those with known single use efficacy against tumor type
non-overlapping toxicity

167
Q

what is crucial when choosing chemo timings?

A

doses should be given at consistent intervals

168
Q

why is it important that chemo drugs do not have overlapping toxicities?

A

so treatment can continue without having to wait for symptoms to reduce

169
Q

what are the main types of chemotherapy agent?

A

alkylating agents
antitumor antibiotics
antimetabolites
antimicrotubule agents
corticosteroids
platinum
L-asparginase
targeted agents

170
Q

how do alkylating agents work in chemo?

A

binds alkyl groups to cellular macromolecules cross linking DNA

171
Q

what are the main types of alkylating agents?

A

chyclophosophomide
chlorambucil
lomustine

172
Q

how do antitumor antibiotics work in chemo?

A

multimodal action of cellular toxicity

173
Q

what are some examples of antitumor antibiotics?

A

doxorubicin
mitoxantrone

174
Q

how do antimetabolites work in chemo?

A

inhibit use of cellular metabolites in cellular growth and division

175
Q

how do antimicrotubule agents work in chemo?

A

interfere with cellular function and replicaition

176
Q

what are the main types of antimicrotubule drugs?

A

vincristine
vinblastine

177
Q

how do corticosteriods work in chemo?

A

induction of apoptosis in haematologic cancers

178
Q

how does platinum work in chemo?

A

binds DNA

179
Q

what are examples of platinum chemo agents?

A

cisplatin
carboplatin

180
Q

how does L-Asparginase work in chemo?

A

induction of apoptosis in tumor cells

181
Q

how do targeted agents work in chemo?

A

block receptors on the cell surface

182
Q

what are some examples of targeted chemo agents?

A

palladia
masivet

183
Q

what is lymphoma?

A

diverse group of neoplasms with common origin from lymphocytes

184
Q

what tissues can be affected by lymphoma?

A

almost any in the body
particularly lymphoid tissues (nodes, spleen, BM)

185
Q

what is one of the most common tumors in dogs?

A

lymphoma

186
Q

what is the most common type of lymphoma?

A

multicentric

187
Q

what presentation of lymphoma is commonly seen in cats?

A

intestinal

188
Q

what is the treatment for lymphoma?

A

chemo cycles until remission

189
Q

what is average life expectancy if undergoing lymphoma treatment?

A

up to 2 years

190
Q

what protocol is used to treat lymphoma?

A

CHOP

191
Q

what are the components of the CHOP protocol?

A

Cyclophosphomide
Hydroxydaunorubicin (Doxorubicin)
Oncovin (vincristine)
Prednisolone

192
Q

what drug may be given instead of doxorubicin?

A

epirubicin

193
Q

what is the benefit of epirubicin over doxorubicin?

A

reduced risk of cardiotoxicity
but increased risk of GI toxicity

194
Q

what part of the CHOP protocol is not always given?

A

preds may only be given if the patient is systemically unwell

195
Q

what type of protocol is CHOP?

A

discontinuous

196
Q

what is a discontinuous protocol?

A

has a set time limit and will end

197
Q

what is seen as a side effect of chemo?

A

toxicity

198
Q

why are toxicities seen as a side effect of chemo?

A

chemo drugs target all cells that are dividing not just cancer cells

199
Q

why are toxicities seen in certain areas of the body?

A

due to the presence of rapidly dividing cells

200
Q

what are the main areas of the body affected by chemo toxicity?

A

bone marrow
GI

201
Q

what are the main areas to consider when nursing chemo patients?

A

feeding
toileting
barrier nursing (or reverse)

202
Q

what may you need to consider for a chemo patient pre diagnosis?

A

PNS
nausea
reduced energy
inappetance

203
Q

what may you need to consider for a chemo patient who is unwell during treatment?

A

reverse barrier if neutropenic
chemo drug excretion

204
Q

what may you need to consider for a chemo patient during end of life care?

A

palliation
comfort

205
Q

how are chemo clinics usually performed?

A

patients admitted for treatment only and then home

206
Q

how can chemo be administered?

A

bolus injection
infusion
tablet

207
Q

what is essential about chemo IVC placement?

A

clean stick to avoid extraversation

208
Q

how should chemo drugs be drawn up?

A

PPE worn
in a fume cabinet to reduce risks if spills or any spray
use connectors on bottles and syringes

209
Q

describe the process of chemo administration

A

check IVC placement with saline
draw back to check presence of blood
connect syringe
administer over correct time
check IVC placement with saline every 1-2 mins

210
Q

how can you increase confidence in discussing chemo with owners?

A

increase knowledge and understanding
experience
understanding of owners needs (emotional/physical)

211
Q

can all patients be helped?

A

yes even with financial / time / disease constraints
supportive care
curative treatment
palliative care
hospice care
euthanasia

212
Q

how may owners be kept involved with the treatment of their pet?

A

chemo leaflets to read through at home
chemo passport filled in at each appointment to keep owner up to date
give owners things they can do to support their pet a home

213
Q

what may be experienced by staff/client when dealing with chemo patients?

A

compassion fatigue
reduction in empathy
burnout

214
Q

how can clients/staff be supported to alleviate compassion fatigue?

A

change chemo nurses
admit patient for respite
owner groups

215
Q

when is neutropenia nadir seen?

A

2-5 days post treatment

216
Q

how long does a CHOP cycle last?

A

16 weeks

217
Q

what advice should be given to owners about managing waste from their pet receiving chemo?

A

wear gloves to handle waste
double bag then dispose of in normal waste
encourage urination away from common areas or walkways
urination in the garden shoul be washed away to help dilute it

218
Q

for how long after treatment do owners need to manage waste from their pet receiving chemo?

A

4-5 days

219
Q

where is chemo waste excreted?

A

urine and or faeces

220
Q

what should happen if drugs extravasate?

A

leave IVC in place
aspirate
inject hylauronidase around the area
apply heat compression

221
Q

what are the grade 1 vesicants?

A

vincristine
epirubicin

222
Q

what specific toxicity is seen with vincristine?

A

mild myelosuppression
peripheral neurotoxicity
GI effects (ileus)

223
Q

what specific toxicity is seen with cyclophosphomide?

A

neutropenia
GI toxicity
sterile haemorrhagic cystitis

224
Q

what specific toxicity is seen with chlorambucil?

A

myelosupression

225
Q

what specific toxicity is seen with epirubicin?

A

anaphylaxis
myelosuppression
GI toxicity
cardiotoxicity

226
Q

what toxicity is seen with doxorubicin?

A

cardio
can lead to CHF

Advanced Clinical Nursing Theory (36 decks)

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