Oncology: 2 Flashcards
What is the number one question clients ask after surgery with cancer?
-successful surgery for cancer is dependent on 3 things:
did they get it all?
- could the cancer be completely removed?
- had the cancer already spread at the time of the surgery?
- was the surgeon able to get adequate margin.
internal radiation (brachytherapy):
is used to get the radiation close to the cancer or target tissue.
- it is inside the body.
- is very close to the target tissue because the radiation is inside the body.
- the patient emits radiation for a period of time and is hazard to others.
brachytherapy is either sealed or unsealed. what does this mean?
unsealed: client and body fluid emit radiation
- this is like a radioisotope that is given IV or PO. radioactive for 24 to 48 hours. ex:hypothyroidism or thyroid cancer
sealed or solid: client emits radiation; body fluid are NOT radioactive
-can be temporary or a permanent implant that is placed close to or inside the tumor.
General radiation precautions for internal radiation. remember ______.
time, distance and shielding
precautions with internal radiation:
- nursing assignments should be rotated DAILY, so that the nurse is not continuously exposed.
- the nurse should only care for ONE client with a radiation implant in a given shift.
- private room
- wear a film badge at all times
- restrict visitors
- limit each visitor to 30 min per day
- visitors must stay at least 6ft from source
- no visitors less than 16 yr old
- no pregnant visitor/nurses
- mark the room with instructions for specific isotope.
- wear gloves with risk of exposure to body fluids.
- prevent dislodgement
how can you help prevent dislodgement of the implant?
keep the client on bedrest.
decrease fiber in the diet
prevent bladder distention
what do you do if the implant becomes dislodged and you see it?
put on gloves
pick it up with forceps or tongs
put in LEAD LINED container
call radiation people
after radiation, can the client sleep in the same bed with their spouse or children?
should they use public transportation?
can they return to work immediately?
can they share utensils or cook for others?
will one flush of the toilet after use be adequate?
No. 6ft from others for 1-11 days NO NO NO NO, close lid and flush 2-3xs
External radiation (teletherapy, external beam radio therapy):
a carefully focused beam of high energy rays is delivered by a machine outside the body.
is external radiation radioactive?
NO
side effect of external radiation are usually limited to ____.
what are they?
s/s are __ and__ related.
exposed tissue
-erythema, shedding of skin, altered taste, fatigue, pancytopenia (all blood components are decreased.)
(pan=everything)
location and dose related
external radiation:
is it okay to wash off the markings?
is it okay to use lotion on the markings?
protect the site from ___ and ___ for ____ after completion of therapy.
NO
NO
sunlight and uv exposure for 1 year after!
Chemotherapy:
the use of chemo is based on several factors.
the oncologist will consider:
- which phase of the cell cycle the drug attacks
- time or how often the drug is given
- growth fraction (% of cells dividing at a given time)
- tumor burden (how many tumors are present)
regional chemo delivers __.
chemo is usually scheduled ___.
chemo to a specific site
every 3 to 4 weeks.
Most common body systems affected by side effects of chemotherapy:
blood and GI system and skin & hair (inegumentary system)
Chemo-
Exposure can occur by drug contact with the ___ or mucous membranes, inhalation, or _____ or ingestion.
skin
accidental injection
full chemo precautions require:
- chemotherapy gown, (isolation gown) -2 pair of chemo gloves (thicker and longer than standard gloves)
- goggles and/or mask if splashing or inhalation can occur.
chemo excretion precautions:
when handling body fluids, wear two pairs of chemo gloves and a chemo gown. add a face shield if worried about splashing.
-be sure to teach excretion safety to family
Disposal chemo precautions:
- yellow rigid chemo waste container. (used for sharps and IV containers)
- yellow chemo waste bag (used for gowns, gloves, and disposable items
what should you do before administering doxorubicin?
baseline EKG
most chemo drugs are given ___.
IV via a port
what is a vesicant?
a type of chemo drug that if it infilterates will cause tissue necrosis.
-stay with the pt receiving a vesicant
signs and symptoms of extravasation:
- the number one thing to remember with extravastin is___.
- what do you do if chemo does extravasate?
- cold packs or warm moist heat?
pain, swelling, and no blood return
prevention
STOP THE INFUSION
cold pack because it will promote vasoconstriction. dont want chemo to spread to more tissue.
chemo drugs can be given orally. should you wear gloves when giving oral chemo?
YES! chemo can absorb through the skin
biologic response modifiers (BRMs):
enhance or use our own immune system to fight and hopefully kill the cancer.
chemo acts directly on the cancer to kill it!
the _____ is a type of BRM because it gives us immunity to the ___ to help prevent____ cancers caused by ____..
HPV vaccine
HP virus
cervical,anal and oral cancers
human papillomavirus
when a peripheral iv infilterates, what should you do?
warm compress
hormone therapy drugs ____ of cancer. (such as prostate, endometrial and certain types of breast cancer)
slow the growth!
why are steroids used for cancer patients?
to increase the effectiveness of chemo.
corticosteroids are hormones too!
bone marrow and stem cell transplant are primarily used as treatments for _____.
hematologic.
occasionally, transplants are necessary when high doses of chemo or radiation have destroyed too many blood cells, and a transplant is needed as a “rescue” treatment.
what are the 2 types of transplants?
- stem cell transplant
- bone marrow transplant
- stem cells from the blood or the bone marrow can come from the client, a matched donor, or from an identical sibling or twin.
- stem cells are given into a vein, much like a blood transfusion, and over time they settle in the bone marrow and produce healthy blood cells.
what are the signs of transplant rejection?
- abdominal pain or cramps, nausea, vomiting, diarrhea.
- jaundice or other liver problems
- dark (tea colored) urine
- skin rash, itching, and redness on areas of the skin
what are the complications of transplant?
infection
graft vs host disease (GVHD) [the graft rejects or attack the host]
GVHD is treated with _______.
anti-rejection drugs and steroids.
major side effects of cancer and/or treatment:
- body image
- fatigue (provide adaquate rest)
- infection (#1 cause of cancer related deaths)
- neutropenia
- DVT (VTE)
- thrombocytopenia
- N/V
- Pain
general way to prevent infection:
- private room
- wash hands
- have their own supplies in their room
- limit people in the room (visitors and nurses)
- change dressings and IV tubing daily
- cough and deep breath
- no fresh flowers or potted plants
- avoid crowds
- do not share toiletries
- bathe warm moist areas usually twice daily (groin and under the arms)
- wash hand after touching a pet
- avoid raw fruits and veggies
- drink only fresh water (sit out more than 15mins, its OLD)
Nursing considerations:
- watch for a slight increase in the temp. it may mean___.
- tell your oncology client to come to the hospital or clinic for an oral temp. of ____ or greater.
- monitor ____.
sepsis
100.4
absolute neutrophil count
normal absolute neutrophil count (ANC)
2200 to 7700 cells/mm3
define neutropenia.
what is the best way to assess neutropenia?
a decrease in the number of neutrophils (mature WBCs) in the blood.
the best way to assess neutropenia is by calculating an absolute neutrophil count. (ANC)
The ANC tells you exactly how many of your WBCs are neutrophils and indicates how well your client can handle an infection.
define nadir
the lowest point
-neutrophils are the first- line defense inside the body to protect us from infections
neutropenia + infection——
sepsis, septic shock and death
what are the risk factors for neutropenia?
- age (the very old and the very young are at most risk.)
- advanced metastatic disease
- malnourishment
- b12 and folic acid deficiencies contribute to neutropenia
- impaired tissue integrity
- presence of other disease
- hematoglogic malignancies (leukemia,lymphoma, and myeloma)
- results of cancer treatment
treatment of neutropenia:
antibiotics
implement neutropenia precautions
neutropenic precautions:
also include all the general way to prevent infection
- vital signs every 4 hours minimum
- private room with door closed and posted sign
- antimicrobial soap for handwashing, not reg soap.
- no invasive procedures (no IM,rectal exam, or rectal meds, foley cath and ng tubes)
- limit use of tylenol
second leading cause of deaths in cancer clients:
DVT (VTE)
why is malignancy a big risk factor for development of DVT?
- prolonged bedrest
- surgery
- use of a central line
- external compression of vessels by the tumor
- invasion of vessels by the tumor
- certain chemo drugs
what are we most afraid of with a DVT?
development of a pulmonary embolis
define thrombocytopenia
a decrease in the number of circulating platelets in the blood.
platelets are responsible for clotting.
risk factors for thrombocytopenia
- advanced metastatic disease
- hemtological malignancies
- bleeding disorders such as hemophilia,liver disease, ITP (idiopathic thrombocytopenia purpura)
- bacterial infections
- anticoagulants medicines (ASA,plavix, heparin, warfarin)
- result of cancer treatment
thrombocytopenia assessment (bleeding assessment):
- history
- vital signs
- pulse ox
- changes in LOC, HA, pupil changes (any neuro changes)
- conjunctival hemorrhages (eyes are bloodshot)
- petechiae, ecchymosis (bruising), purpura (red purple bruising)
- oozing from puncture sites or surgical site
- bleeding from the rectum, ears, nose or mouth
treatment for thrombocytopenia:
-give them some platelets
Red blood cell transfusions:
for clients with systematic anemia
-do not want the hgb/hct to drop below 8 g/dl and 24%. (needs RBCs)
Platelet transfusions:
never infuse when___.
to control or prevent bleeding associated with thrombocytopenia.
-never infuse cold platelets,make sure they are room temp.
what kind of RBCs and platelets do you want?
cytomegalovirus (CMV) negative/CMV safe
test the rbcs and platelets to make sure they are negative for CMV.
leukoreduction=
CMV safe.
chemo has a classification based on its ___ risk.
emedic
prevention of N/V as a side effect.
- give antiemetic meds before each treatment
- behavioral therapies
- acupuncture/acupressure
ondansetron (zofran):
works by blocking the effects of serotonin, so its a serotonin receptor antagonist.
serotonin receptor antagonist all end in “tron”
netupitant/palonosetron (akynzeo):
oral combination antiemetic
-prevents acute and delayed N/V caused from chemo. ONLY ONE DOSE
non-pharmacologic treatment for N/V:
- ginger
- aromatherapy
- acupuncture/acupressure
- distraction
- relaxation technique
____ are considered the “gold standard” for cancer pain.
opioids
There is no ceiling on the dose of an opioid for a cancer client; it is client dependent.
