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Advanced Clinical Nursing Theory > Oncology > Flashcards

Oncology Flashcards

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
how are haemangiosarcomas treated?
surgery chemo
26
where are haemangiosarcomas commonly found?
spleen
27
what is soft tissue sarcoma a tumor of?
connective tissue
28
what is consistent about soft tissue sarcomas?
all behave the same despite their different locations
29
what is a carcinoma?
tumor that is made of tissue that covers any body surface, lines a body cavity or makes up an organ
30
what are carcinomas that arise from a gland known as?
have prefix 'adeno'
31
what is a common carcinoma type?
squamous cell carcinoma
32
what animals are squamous cell carcinomas common in?
cats
33
where are squamous cell carcinomas seen often in cats?
mouth nose ears
34
where are more aggressive squamous cell carcinomas found?
mouth
35
how are squamous cell carcinomas treated?
surgery to remove if superficial / possible radiation or chemo useful
36
what is the most common malignant skin tumour in dogs?
mast cell tumor
37
what are mast cells involved with in the body?
inflammatory and allergic mechanisms
38
how may mast cell tumors present?
many different ways may be highly malignant or almost benign
39
how do mast cell tumors appear within the skin?
hard and firm
40
how do mast cell tumors appear if under the skin layers?
mobile and soft - lipoma like
41
how may mast cell tumors present in cats?
splenic GI
42
how are mast cell tumors often treated?
surgical removal with appropriate margins radiotherapy chemotherapy
43
how does melanoma often appear?
pigmented black tumor
44
where on the body is melanoma found?
mouth toes skin
45
where are more aggressive melanomas found?
mouth or toes
46
how is melanoma treated?
surgery to improve QOL immunotherapy to slow spread
47
how does immunotherapy for melanoma work?
melanoma vaccine given immune system develops antibodies to melanoma proteins if melanoma recurs the immune system can remove them
48
what is in the melanoma vaccine?
human melanoma proteins
49
how is the melanoma vaccine given?
transdermally
50
do benign tumors always lead to malignant tumors?
no squamous cell carcinoma might
51
what are the most common benign tumors?
lipoma haemangioma adenoma
52
what is haemangioma a tumor of?
blood cells
53
what is paraneoplastic syndrome?
cancer associated alterations to the body structure or function that are not directly related to the tumor or metastasis
54
what are the common PNS seen with lymphoma?
hypercalcaemia anaemia neutropenic leukocytosis thrombocytopenia
55
what effect can successful treatment of a tumor have on PNS?
may lead to disappearance of many PNS
56
what may be signified by return of PNS that had reduced with tumor treatment?
tumor return
57
what may be signified by PNS?
malignancy
58
what can be predicted by the PNS seen?
tumor type as PNS are specific
59
what can be the result of PNS?
greater morbidity than with the tumor itself
60
what is the best curative option for tumors?
surgery
61
what is the purpose of staging and grading of tumors?
gives an idea of available treatment options
62
what varies between tumors?
sensitivity to chemo
63
what cancers have high sensitivity to chemo?
lymphoma some leukaemias
64
what cancers have moderate sensitivity to chemo?
high grade sarcomas MCT fast growing
65
what cancers have low sensitivity to chemo?
slow growing sarcomas carcinomas melanomas
66
what are the main treatment options for low sensitivity tumors?
no chemo, surgery if an option
67
how may location of a tumor affect treatment?
may affect if it is resectable is it resectable with margins?
68
how may owner factors influence tumor treatment?
may not want disfiguring surgery/radical resection may not have finances for treatment
69
how may patient temperament affect treatment?
ability to cope with radical surgery (e.g. OA on other limbs or size) ability to cope with repeated vet visits / treatment /GA
70
how may chemotherapy be used for treatment?
stand alone therapy conjunction with other therapies
71
what may affect if chemotherapy is used?
chemosensitivity of cancer - high, moderate or low
72
how does radiotherapy treat tumors?
radiation induced cellular injury targets fast growing cells
73
what are the issues with radiation treatment?
specific expensive equipment needed
74
what other treatments are available for tumors?
cryotherapy hyperthermic therapy photodynamic therapy immunotherapy
75
what are the surgical treatment options for tumors?
complete resection with margins excisional biopsy incisional biopsy trucut biopsy FNA
76
what is involved in complete tumor resection?
removal of tumor and margins in order to try and cure patients radical and wide surgery
77
what are the margins needed for MCT removal?
2cm normal tissue around 1 tissue plane below
78
what is involved in an excisional biopsy of a tumor?
main mass removed no excess tissue taken
79
what may excisional biopsy be used for?
diagnosis treatment as debulking surgery
80
what are the main surgical diagnostic techniques?
incisional biopsy trucut biopsy FNA (not rly surg)
81
what are the main goals of surgery for tumor treatment?
curative debulking and additional treatment palliative for comfort
82
what preventative oncology surgery is seen?
removal of retained testicles
83
what oncologic emergency surgeries are there?
bleeding management (splenic mass) pathological fracture infection bowel perforation bowel obstruction
84
what is the purpose of tumor staging?
to find out how much tumor is present in the body at the time of staging get an over view of patients health
85
what may be picked up during tumor staging that can inform treatment?
concurrent conditions PNS
86
what is the information gathered during staging used for?
formulation of treatment decisions
87
what system is used to stage tumors?
TNM
88
what does the T of TNM stand for?
tumor size (primary)
89
what does the N of TNM stand for?
level of lymph node involvement
90
what does the M of TNM stand for?
presence of metastasis
91
when is staging performed?
before start of treatment assessment of response to treatment before recommencing treatment after relapse
92
what are the tests involved in tumor staging?
physical exam history urinalysis bloods chest xray abdominal ultrasound imaging
93
what blood tests will be used for tumor staging?
CBC biochem specific and relevant to patient (e.g. t4?)
94
what views of the chest are needed to check for metastasis?
3 inflated views
95
what mets can be seen on chest x-ray?
over 4/5mm
96
what is involved in abdominal US for tumor staging?
check common metastasis sites FNA of liver, spleen and LN
97
what specialised imaging may be used during tumor staging?
echo CT MRI
98
what is echo used for during tumor staging?
check for any signs of CHF or cardiac issue before doxorubicin given
99
what is CT used for during tumor staging?
checking tumor invasion and spread more sensitive to lung mets surgical planning
100
what is MRI used for during tumor staging?
neuro based tumors tumors in soft tissue obscured by bone
101
when is tumor grading done?
during histology after biopsy or tumor resection
102
what information is used to grade tumors?
appearance under microscope mitotic index organisation of cells evidence of invasion of blood vessels
103
what are the tumor grades?
low intermediate high
104
what is the value of tumor grading?
useful for prognosis
105
what is mitotic index?
number of currently dividing cells seen across 10 high power fields
106
what does a high mitotic index indicate?
high level of malignancy
107
when may a cancer patient present in hospital?
initial investigation staging illness (e.g. after chemo) palliative care at end of life
108
what nursing model should be used to support inpatients?
ability model
109
what are the areas of the Ability model/
eat drink urinate defecate breathe normally maintain temp groom and clean itself mobilise adequately sleep and rest expression of normal behaviour
110
who designed the ability model?
Orpet and Jeffries
111
what is involved in patient assessment when designing the care plan?
information gained about patients normal routine owner questionnaire face to face discussion team members
112
when is the assessment phase of the ability model revisited?
regularly e.g. ward rounds, handover, checks such as pain scoring
113
what is involved in the planning stage of the ability model?
setting SMART goals identify actual and potential problems identification of nursing interventions prioritisation of interventions
114
what are SMART goals?
Specific Measurable Acchievable Realistic Timely
115
what is crucial when patients are receiveing nursing interventions?
document clearly - how much, what it is, how often
116
what are the interventions involved in medical models?
physiological issues medications needed
117
what are the interventions involved in nursing models?
medical interventions eating drinking urination needs defecating psychological environmental sociocultural
118
what are some of the potential psychological, environmental and sociocultural nursing interventions?
nervous patients bitch on heat being accommodated enrichment patient as an individual
119
what is the purpose of evaluation of nursing care plans and interventions?
show that nursing interventions are working show goals are being accheived
120
what must take place in order to evaluate nursing care plans and interventions?
assessment of the patient to pick up on any other issues as well as those that are resolving
121
what may change around evaluation of nursing care plans and interventions?
depending on the intervention some assessments may be done sooner than others (e.g. pain more rapidly assessed than feeding/grooming)
122
what will happen after evaluation of nursing care plans and interventions?
plan adjusted accordingly
123
what are some specific nursing considerations for onco patients?
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
where are chemo drugs excreted?
may be in all body fluids particularly urine, faeces and vomit
125
how long are chemo drugs excreted for?
3-5 days
126
what is required to keep caregivers of chemo patients safe?
barrier nursing
127
what are the stages of mitosis?
prophase metaphase anaphase telophase cytokensis
128
what are the number of mitotic cycles controlled by?
cell nucleus
129
what do cells spend most of their time in?
interphase
130
what occurs during interphase?
cell matures makes DNA copies
131
what occurs during prophase?
preparation for cells to split chromosomes form
132
what happens during metaphase?
chromosomes line up down the centre of the cell
133
what happens during anaphase?
chromosomes split
134
what happens during telophase?
chromosomes stretch out
135
what happens during cytokinesis?
cell splits into two new cells
136
what is apoptosis?
cell death
137
what triggers apoptosis?
shortening of telomeres cell only replicates a certain number of times
138
how does the body suppress cancer formation?
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
how does cancer arise?
accumulation of genetic mutations that eliminate normal cell constraints
140
what effect has increased longevity had on cancer?
allows more time for mutations to accumulate and develop into cancer
141
what are the main environmental causes of cancer?
chemical carcinogens physical agents hormonal cancer causing viruses inherited (not recognised in animals)
142
what are the main chemical carcinogens?
tobacco smoke pesticides herbicides and insecticides cyclophosphomide
143
what are the main physical agents that can cause cancer?
sunlight trauma/chronic inflammation magnetic fields radiation surgery implanted devices asbestos
144
what are the hormonal influences on cancer?
neutering may be protective against some (e.g. mammary cancer) but may increase risk of others (e.g. lymphoma)
145
what are examples of cancer causing viruses?
papilloma virus retroviruses (FeLV)
146
what are the main DNA mutations that cause deviation from the normal cell cycle?
sustaining proliferative signalling evasion of growth suppression resist apoptosis enable replicative immortality induce angiogenesis activation of invasion and metastasis
147
what is the minimum number of mutations required to cause cancer?
5-6
148
how is replicative immortality of cells enabled?
telomeraze produced by cells which prevents shortening of telomeres this prevents signalling for normal apoptosis so cells survive
149
define tumour
neoplasm either benign or malignant
150
define neoplasia
formation of new abnormal growth that is not responsive to normal physiologic control mechanisms benign or malignant
151
define cancer
metastatic neoplasm
152
define benign tumor
can be space occupying and cause tissue distortion but no metastasis
153
what is the impact of malignant tumors on the surrounding tissue?
locally invasive
154
what cells does chemotherapy work on?
rapidly dividing cells at various stages in DNA replication and cell division cell signalling
155
what are the main ways chemo is used?
primary induction primary neoadjuvant adjuvant consolidation maintainance rescue or salvage palliative
156
what is primary induction chemotherapy?
initial chemotherapy a person receives before undergoing additional cancer treatment
157
what is primary neoadjuvant chemotherapy?
chemo before surgery used to shrink tumor size to allow resection
158
what is adjuvant chemotherapy?
used after surgery to mop up any remaining cells
159
what is consolidation chemotherapy?
used after initial treatment (of whatever type) to target additional cells and reduce likelihood of relapse
160
what is maintenance chemotherapy?
ongoing treatment of cancer with medication after the cancer has responded to the first recommended treatment
161
what is rescue / salvage chemotherapy?
change to different protocol due to failure to respond to other chemo type
162
what is palliative chemotherapy?
aimed at reducing disease signs and pain to improve quality of life
163
what type of chemo treatment plan is best?
multimodal
164
what are the benefits of multimodal chemo schedules?
broad range of interaction between drugs and tumor cells slows development of tumor drug resistance
165
what is the aim when choosing chemo doses?
maximal cell kill within range of tolerable host toxicity
166
what drugs should be used for chemo?
only those with known single use efficacy against tumor type non-overlapping toxicity
167
what is crucial when choosing chemo timings?
doses should be given at consistent intervals
168
why is it important that chemo drugs do not have overlapping toxicities?
so treatment can continue without having to wait for symptoms to reduce
169
what are the main types of chemotherapy agent?
alkylating agents antitumor antibiotics antimetabolites antimicrotubule agents corticosteroids platinum L-asparginase targeted agents
170
how do alkylating agents work in chemo?
binds alkyl groups to cellular macromolecules cross linking DNA
171
what are the main types of alkylating agents?
chyclophosophomide chlorambucil lomustine
172
how do antitumor antibiotics work in chemo?
multimodal action of cellular toxicity
173
what are some examples of antitumor antibiotics?
doxorubicin mitoxantrone
174
how do antimetabolites work in chemo?
inhibit use of cellular metabolites in cellular growth and division
175
how do antimicrotubule agents work in chemo?
interfere with cellular function and replicaition
176
what are the main types of antimicrotubule drugs?
vincristine vinblastine
177
how do corticosteriods work in chemo?
induction of apoptosis in haematologic cancers
178
how does platinum work in chemo?
binds DNA
179
what are examples of platinum chemo agents?
cisplatin carboplatin
180
how does L-Asparginase work in chemo?
induction of apoptosis in tumor cells
181
how do targeted agents work in chemo?
block receptors on the cell surface
182
what are some examples of targeted chemo agents?
palladia masivet
183
what is lymphoma?
diverse group of neoplasms with common origin from lymphocytes
184
what tissues can be affected by lymphoma?
almost any in the body particularly lymphoid tissues (nodes, spleen, BM)
185
what is one of the most common tumors in dogs?
lymphoma
186
what is the most common type of lymphoma?
multicentric
187
what presentation of lymphoma is commonly seen in cats?
intestinal
188
what is the treatment for lymphoma?
chemo cycles until remission
189
what is average life expectancy if undergoing lymphoma treatment?
up to 2 years
190
what protocol is used to treat lymphoma?
CHOP
191
what are the components of the CHOP protocol?
Cyclophosphomide Hydroxydaunorubicin (Doxorubicin) Oncovin (vincristine) Prednisolone
192
what drug may be given instead of doxorubicin?
epirubicin
193
what is the benefit of epirubicin over doxorubicin?
reduced risk of cardiotoxicity but increased risk of GI toxicity
194
what part of the CHOP protocol is not always given?
preds may only be given if the patient is systemically unwell
195
what type of protocol is CHOP?
discontinuous
196
what is a discontinuous protocol?
has a set time limit and will end
197
what is seen as a side effect of chemo?
toxicity
198
why are toxicities seen as a side effect of chemo?
chemo drugs target all cells that are dividing not just cancer cells
199
why are toxicities seen in certain areas of the body?
due to the presence of rapidly dividing cells
200
what are the main areas of the body affected by chemo toxicity?
bone marrow GI
201
what are the main areas to consider when nursing chemo patients?
feeding toileting barrier nursing (or reverse)
202
what may you need to consider for a chemo patient pre diagnosis?
PNS nausea reduced energy inappetance
203
what may you need to consider for a chemo patient who is unwell during treatment?
reverse barrier if neutropenic chemo drug excretion
204
what may you need to consider for a chemo patient during end of life care?
palliation comfort
205
how are chemo clinics usually performed?
patients admitted for treatment only and then home
206
how can chemo be administered?
bolus injection infusion tablet
207
what is essential about chemo IVC placement?
clean stick to avoid extraversation
208
how should chemo drugs be drawn up?
PPE worn in a fume cabinet to reduce risks if spills or any spray use connectors on bottles and syringes
209
describe the process of chemo administration
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
how can you increase confidence in discussing chemo with owners?
increase knowledge and understanding experience understanding of owners needs (emotional/physical)
211
can all patients be helped?
yes even with financial / time / disease constraints supportive care curative treatment palliative care hospice care euthanasia
212
how may owners be kept involved with the treatment of their pet?
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
what may be experienced by staff/client when dealing with chemo patients?
compassion fatigue reduction in empathy burnout
214
how can clients/staff be supported to alleviate compassion fatigue?
change chemo nurses admit patient for respite owner groups
215
when is neutropenia nadir seen?
2-5 days post treatment
216
how long does a CHOP cycle last?
16 weeks
217
what advice should be given to owners about managing waste from their pet receiving chemo?
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
for how long after treatment do owners need to manage waste from their pet receiving chemo?
4-5 days
219
where is chemo waste excreted?
urine and or faeces
220
what should happen if drugs extravasate?
leave IVC in place aspirate inject hylauronidase around the area apply heat compression
221
what are the grade 1 vesicants?
vincristine epirubicin
222
what specific toxicity is seen with vincristine?
mild myelosuppression peripheral neurotoxicity GI effects (ileus)
223
what specific toxicity is seen with cyclophosphomide?
neutropenia GI toxicity sterile haemorrhagic cystitis
224
what specific toxicity is seen with chlorambucil?
myelosupression
225
what specific toxicity is seen with epirubicin?
anaphylaxis myelosuppression GI toxicity cardiotoxicity
226
what toxicity is seen with doxorubicin?
cardio can lead to CHF

Advanced Clinical Nursing Theory (36 decks)

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