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NCLEX > Oncology > Flashcards

Oncology Flashcards

1
Q

2 types of cancer

A
  1. Solid tumors

2. Hematologic malignancies

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2
Q

Types of solid tumors

A
  1. Sarcomas

2. Carcinomas

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3
Q

Sarcomas

A

Begin in connective tissues

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4
Q

Carcinomas

A

Originate from epithelial tissues

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5
Q

Epithelial tissues

A

Line organs

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6
Q

Which race has the greatest risk for cancer?

A

African Americans, then caucasians

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7
Q

Primary prevention of cancer

A

Prevention with modifying risk factors (lifestyle, vaccines)

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8
Q

Secondary prevention of cancer

A

Screening to detect cancer early (breast exams)

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9
Q

What days of the menstrual cycle are best for doing the breast self exam?

A

7-12, after the period is just about over. Not before, because they will be swollen. If breasts have been removed, tell them to do the same day each month.

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10
Q

Who should get clinical breast exams?

A

Yearly for women over 40, every three years for ages 20-39

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11
Q

Client teaching before mammogram

A

No lotion, powder, deoderant (can be picked up as a Ca deposit which would mean cancer), two views of each breast

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12
Q

When should pap smears be performed?

A

Beginning at age 21 and done every 3 years if there have been no problems

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13
Q

When should colonoscopies be performed?

A

Every 10 years beginning at age 50

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14
Q

When should fecal occult blood be tested?

A

Yearly beginning at age 50, unless previous family history

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15
Q

When should testicular exams be performed?

A

Yearly at the clinic, monthly at home (testicular tumors grow fast)

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16
Q

What age is most at risk for testicular cancer?

A

15-36, so teach self exams early

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17
Q

When should digital rectal exams for prostate specific antigens be checked?

A

Yearly for men over 50

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18
Q

Tertiary prevention of cancer

A

Focuses on management of long term care for pts with complex treatments of cancer. (Support groups, rehab programs)

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19
Q

CAUTION

A 
Change in bowel/bladder habits
A sore that doesn't heal
Unusual bleeding/discharge
Thickening or lump in breast/elsewhere
Indigestion/difficulty swallowing
Obvious change in wart or mole
Nagging cough/hoarseness
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20
Q

Leukopenia

A

Low WBC count, leads to infection

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21
Q

When cancer invades the bone marrow, what can happen?

A

Anemia, leukopenia, thrombocytopenia

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22
Q

Cachexia

A

Extreme wasting and malnutrition

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23
Q

1 symptom of clients complaining of with cancer

A

Extreme fatigue

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24
Q

CBC with diff

A

Tells the # of different WBC in the blood

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25
Q

With cancer, what are you most concerned about with a CBC?

A

Neutrophils
With blood tests, there will also be elevated liver enzymes (AST, ALT, tells if the liver is being damaged) and tumor markers (found at higher than normal levels in the blood, also called bio markers)

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26
Q

How is lung cancer diagnosed?

A

Bronchoscopy

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27
Q

Teaching for bronchoscopy

A

NSP re and NOP until gag reflex returns, watch for respiratory depression, hoarseness, dysphagia, or SQ emphysema (feels like rice krispies sound)

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28
Q

Is it normal or abnormal to have respiratory depression when returning from a bronchoscopy?

A

Abnormal, respiratory depression is different than a decreased respiratory rate

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29
Q

Best time to get a sputum specimen

A

1st thing in the morning

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30
Q

How to get a sputum specimen

A

Sterile specimen, pt should wash mouth out with water to decrease the bacteria count in the mouth, don’t let their mouth touch the cup.
Do this before a bronchoscopy because it’s less invasive.
You can get one from a trach if they have one

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31
Q

Total laryngectomy

A

Removal of vocal cords, epiglottis, thyroid cartilage

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32
Q

Care post op for laryngectomy

A

Mid-Fowlers, they will have permanent trach or laryngectomy.
NG feeds to protect the suture line (peristalsis can disrupt sutures)
Monitor drains to prevent fluid accumulation
Frequent oral care to decrease bacteria in mouth (NPO pts tend to get pneumonia)

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33
Q

What do you watch for post op laryngectomy?

A

Carotid artery rupture (hemorrhage), rupture of the innominate artery (bleeds massively from trach) (Go to OR immediately)

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34
Q

When to hyper oxygenate when suctioning trach

A

Before and after

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35
Q

When do you stop advancing the catheter when suctioning a trach?

A

When you meet resistance or when the client coughs

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36
Q

When do you suction a trach?

A

On the way out, intermittent, no longer than 10 seconds

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37
Q

What to watch for while suctioning a trach

A

Arrhythmias, vagal nerve stimulation (HR drops, not hypoxic bc with hypoxia HR goes up, this is how you will know it’s the vagus nerve)

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38
Q

What to do if you suspect vagal nerve stimulation while suctioning a trach?

A

Stop suctioning, hyperoxygenate

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39
Q

When the trach client leave the hospital, what covers the trach?

A

A bib will act like a filter since they aren’t using their nose as a filter, don’t use plastic or anything with fibers

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40
Q

Laryngectomy tube

A

Smaller around than a trach, not as long, for long term use, they go home on them

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41
Q

How do pts breathe with a total laryngectomy?

A

Through the stoma

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42
Q

How do pts with a total laryngectomy talk?

A

Use an electrolarynx, blom-singer device is commonly used

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43
Q

What can the client do with a total laryngectomy?

A

Not whistle
Not drink through a straw
Can smoke, not recommended
Can’t swim

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44
Q

Cancer staging

A

Classifies the size of tumor (T),
If lymph nodes are involved (N)
Presence of metastasis (M)

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45
Q

Trick for situating clients

A

Highest position that isn’t high fowlers

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46
Q

Cancer grading

A

Compares the cancer cells with the parent cell they evolved from. The less they look like the parent tissues, the more aggressive. 1-4 grade scale. 4 being the worst

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47
Q

Goals of treatment for cancer

A

Cure
Control
Palliation

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48
Q

Adjuvant therapy

A

When two therapies are used together

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49
Q

Neoadjuvant therapy

A

Time specific therapy, one before the next

Chemo or radiation may be used before removal surgery to shrink the size of a tumor

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50
Q

Mastectomy

A

Removal of breast tissue, can be partial or total (radical)

Hemovac or Jackson-Pratt drains

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51
Q

Reconstruction of breasts

A

Can be done with mastectomy or at a later time.

They will have an abdominal surgical site (most common site for adipose tissue harvesting)

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52
Q

What to check for after mastectomy

A

Bleeding, check front and back dressings for pooling of blood (pooling could be inside tissues)

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53
Q

How to care for and educate a patient if lymph nodes were removed with a mastectomy

A
  • Avoid procedures on arm affected forever
  • No constriction, BPs, elastic shirts, watches, IV, injections on affected side
  • Wear gloves when gardening, watch small cuts, no nail biting, no sunburn
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54
Q

Post op mastectomy

A

Brush hair, squeeze tennis balls, wall climbing, flex and extend elbow to promote new/collateral circulation

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55
Q

Palliative care

A

Sx to improve client’s quality of life when there is no cure

Can remove parts of tumor to make you more comfortable even though it will not cure you

56
Q

Internal radiation is also called what?

A

Brachytherapy

57
Q

Internal radiation

A

Used to get the radiation close to the cancer. It is inside your body, so you will emit radiation for a period of time and be a hazard to others

58
Q

Adequate margins

A

Amount of regular tissue removed around tumor. Clear margins means there can still be micro metastasis

59
Q

Unsealed brachytherapy

A

Client and body fluids emit radiation
Radioisotope is given IV or PO
Radioactive for 24-48 hours

60
Q

Sealed or solid brachytherapy

A

Client emits radiation, not through body fluids

Can be temp or permanent implant that is placed close to or inside the tumor

61
Q

What to generally remember for internal radiation precautions

A

Time, distance, shielding

62
Q

Nursing assignments with internal radiation

A

Rotated daily, wear film badge, only one radiation implant in a given shift, no pregnant nurses, mark room with instructions for specific isotope, wear gloves with risk of exposure to body fluids

63
Q

Precautions for internal radiation

A

Private room

Restrict visitors-30 min per day, 6 feet from source, none under 16, no pregnant

64
Q

How can you help prevent dislodgment of an internal radiation implant?

A

Keep client on bedrest
Decrease fiber in the diet (fiber distends bowel)
Prevent bladder distention (use foley)

65
Q

What do you do if a brachytherapy implant becomes dislodged and you see it?

A

Wear gloves, pick it up with tongs, put it in a lead-lined container

66
Q

After brachytherapy, can the client sleep in the same bed with their spouse or children?

A

No, stay 6 feet away for 1-11 days

67
Q

Should clients use public transportation after brachytherapy?

A

No, should stay 6 feet away for 2-3 days

68
Q

Can clients with brachytherapy share utensils or cook for others or return to work immediately?

A

No

69
Q

How to flush toilet with brachytherapy client

A

Close lid, flush 2-3 times

70
Q

External radiation is also called what?

A

Teletherapy, external beam radio therapy

71
Q

How does external radiation delivered?

A

Pt lays on x-ray table, a carefully focused beam of high energy rays is delivered by a machine outside of the body

72
Q

Is the client radioactive with external radiation?

A

No

73
Q

Side effects of teletherapy

A

-Usually limited to exposed tissues, location and dose related
Erythema, shedding of skin, altered taste, fatigue, pancytopenia

74
Q

Pancytopenia

A

All blood components are decreased

75
Q

Number one complaint of radiation

A

Fatigue

76
Q

What should you think of first with tele therapy?

A

Skin problems

77
Q

Is it okay to wash off or use lotion on tele therapy markings?

A

No

78
Q

Common side effects of brain external radiation

A

Lose hair, have sores in mouth

79
Q

How to care for the tele therapy site

A

Protect from sunlight and UV exposure for 1 year after completion of therapy, skin is still very sensitive, no lotions without doc order

80
Q

When is chemo usually scheduled?

A

Every 3-4 weeks, it can knock them down for a week after. They should eat well when they can before they come again.

81
Q

Can a regular RN have a chemo pt?

A

Must take a course to administer, but can still monitor pts on it if you haven’t

82
Q

Growth fraction

A

% of cells dividing at a given time, can be a good thing when giving chemo, can kill more cells

83
Q

Tumor burden

A

How much tumor is present

84
Q

Body systems affected by chemo

A

Blood, GI, Skin/Hair (these are the areas where cells are dividing the most rapidly)

85
Q

Cell cycle non specific chemo drugs

A

Work best when cells are in resting phase, don’t care which phase the cell is in, they just destroy it

86
Q

Can you combine specific and non specific cell cycle chemo drugs?

A

Yes, kills more cells

87
Q

Full chemo precautions

A

Chemo (isolation) gown
2 pairs of chemo gloves (thicker, longer)
Goggles/mask if splashing or inhalation can occur

88
Q

Excretion precautions

A

2-7 days after chemo is administered, when handling body fluids: wear two pairs of chemo gloves and a chemo gown. Add face shield if worried about splashing
*Teach client’s family excretion safety as well

89
Q

Disposal of chemo drugs

A

Yellow rigid chemo wast container for sharps, yellow chemo bag for gowns, gloves, disposable items

90
Q

Sequence for cleaning chemo spill

A
  1. Wash hands w/ soap and water
  2. Get spill kit from client’s room
  3. Facemask
  4. Gown
  5. Gloves (1 under gown, 1 over)
  6. Goggles
  7. Use absorbent pads to wipe up spill
91
Q

How to manage chemo spill

A

Handle as hazardous chemical spill, obtain spill kit and use all protective equipment for clean up

92
Q

How are most chemo drugs given?

A

IV via a port

93
Q

Vesicant

A

Type of chemo drug that if it infiltrates will cause tissue necrosis, stay with client during administration
-Any time you’re giving a chemo drug, look it up and see if it’s a vesicant

94
Q

Dosarubasin chemo drug considerations

A

EKG as baseline, its cardiotoxic

95
Q

S/S of extravasation

A

Pain, swelling, no blood return

96
Q

What do you do if chemo extravasates?

A

Stop infusion, cold packs to vasoconstrict (warm would make the vesicant spread), call doc

97
Q

How to administer PO chemo drugs

A

Wear gloves

98
Q

Biologic Response Modifiers

A

Enhance your own immune system to fight and hopefully kill the cancer

99
Q

HPV vaccine is what type of vaccine?

A

BRM because it gives ACTIVE immunity (body has to actively make the antibodies) to the virus to help prevent cervical, anal, and oral cancers

100
Q

1 risk factor to cervical cancer

A

HPV infection

101
Q

Hormone therapy cancer drugs

A

Slow the growth of cancer by blocking the body’s ability to make the hormone or interferes with the ability to use the hormone
Corticosteroids are hormones, steroids are used to increase the effectiveness of chemo (worry about decreased immunity)

102
Q

Treatments of hematologic cancers

A

Bone marrow and stem cell transplants

103
Q

When are bone marrow and stem cell transplants done?

A

When high doses of chemo or radiation have destroyed too many blood cells

104
Q

How to transfer stem cells

A

Given into a vein, like a blood transfusion, over time they settle in the bone marrow and produce healthy blood cells

105
Q

Signs of stem cell rejection

A

Abdominal pain, cramps, n/v, diarrhea
Jaundice, other liver problems
Dark (tea colored) urine
Skin rash, itching, redness on areas of skin

106
Q

Major complication of stem cell transplants

A

Infection, this pt is receiving so much chemo they have a very bad immune system

107
Q

How to treat GVHD

A

Anti-Rejection drugs and steroids

108
Q

1 cause of cancer related deaths

A

Infection

109
Q

How to bathe cancer pt

A

Bathe warm moist areas twice daily (groin, under arms)

110
Q

IV tubing and dressing changes with cancer pt

A

Change daily

111
Q

What do you worry about with a slight increase in temp in the cancer pt?

A

Sepsis. Tell them to come to hospital or clinic for oral temp of 100.4 or greater

112
Q

Mature WBC

A

Neutrophil, first line of defense inside body to protect from infections

113
Q

Normal absolute neutrophil count

A

2200-7700

114
Q

Nadir

A

Lowest point

115
Q

Neutropenia + infection = ?

A

Septic shock and death

116
Q

Risk factors for neutropenia

A 
Very old, very young
Advanced metastatic dz
Malnourishment
B12/Folic acid deficit
Impaired tissue integrity
Other dz
Blood dz (leukemia, lymphomas, myelomas)
Result of caner tx
117
Q

When is fresh water old?

A

When it has been sitting out for 15 minutes or more

118
Q

Tx for neutropenia

A

Antibiotics, neutropenic precautions

119
Q

Neutropenic precautions

A

Vitals Q4h
Private room, closed door, posted sign
Antimicrobial soap, not regular soap
No invasive procedures (sticks, rectal med/temp/exam)
Foley, NG tube (avoid when you can)
Limit use of acetaminophen, toxic to liver

120
Q

Second leading cause of death in cancer clients and why

A

DVT
Prolonged bed rest, sx, central lines, external compression of vessels by tumor, invasion of vessels by tumor, certain chemo drugs

121
Q

What are you most worried about with a DVT?

A

PE

122
Q

Anticoagulant meds

A

Decrease circulating platelets

Aspirin, clopidogrel, heparin, warfarin

123
Q

Tx for thrombocytopenia

A

Give platelets

124
Q

How to treat symptomatic anemia

A

RBC transfusion

125
Q

What do you not want the hbg/hct to drop below with anemia?

A

8 and 24%, they’ll need RBC transfusion

126
Q

Cytomegalovirus (CMV)

A

Really common herpes virus, bad for immunosuppressed, they’re already sick enough without getting CMV too
Test RBCs and platelets to make sure they’re negative for CMV before transfusions
*Worry about with pregnant women and passing to fetus

127
Q

Leukoreduction

A

Removes CMV, 50% of donated blood has CMV in it

128
Q

How to reduce the risk of transfusion related reactions

A

Leukoreduction and irradiation since immunosuppressed are more at risk for infusion reactions

129
Q

Why do you give room temp platelets and not cold platelets?

A

Spleen will reject them and not absorb well

130
Q

Most feared side effect of chemo and radiation

A

N/V

131
Q

Ondansetron

A

Blocks effects of serotonin, antiemetic, doesn’t cause drowsiness, pill is just as effective as IV form

132
Q

Netupitant/palonosetron

A

Oral combo antiemetic, prevents acute and delayed N/V caused by chemo. Only ONE dose, a pill one hour before the round of chemo

133
Q

Non-Pharmacologic tx for N/V

A

Ginger (ginger ale)
Aromatherapy (peppermint, lavender, lemon, basil)
Acupuncture/Acupressure (bands on cruises)
Distraction
Relaxation

134
Q

Pain with cancer

A

Usually related to direct tumor involvement, but can be the result of tx, such as with mucositis or peripheral neuropathy

135
Q

How to treat cancer related pain

A

Treat without regard to risk of dependence
Opioids are the “gold standard” for cancer pain
NO ceiling on dose of an opioid for a cancer client, it is client dependent
Hydrotherapy
Massage

136
Q

Cannabis

A

Medical marijuana

NCLEX (14 decks)

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