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NCLEX > Oncology > Flashcards

Oncology Flashcards

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1
Q

1 cause of of preventable cancer

A

tobacco

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2
Q

Risk factors for Cancer

A
  • Alcohol + tobacco = Co-carcinogenic
  • Low fiber, ↑red meat, ↑animal fat, Nitrites (processed sandwich meats), alcohol, preservatives and additives
  • Obesity
  • Immunosuppressed
  • Aging (>60)
  • African Americans → Caucasians
  • Heredity
  • exposure to UV-radiation and carcinogens
  • Stress
  • Chronic irritation = uncontrolled growth of abnormal cells
  • Previous medical hx of other types of cancer or chemotherapy
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3
Q

Cancer Primary prevention

A
  • No smoking
  • exercise and good nutrition
  • maintain normal body wt
  • limit/eliminate alcohol
  • Hep B and HPV vaccines
  • avoid exposure to known carcinogens - wear suncreen, avoid prolong sun exposure, avoid 2n-hand smoke
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4
Q 
Cancer Secondary prevention 
FEMALES
• BSE?
• Clinical breast exams?
• Mammogram? Teaching?
• Pap smear?
• Colonoscopy?
• fecal occult blood test?
A

• beginning in 20’s - monthly breast self-exams (BSE)
- day 7 - day 12; or same day every month
• 40 yo - Yearly clinical breast exams; 20 - 39 yo once every 3 yrs
• 40 yo - Mammogram; DO NOT apply lotion/powder/deodorant beforehand
• at 21, start Pap Smear then every 3 yrs
• at 50, Colonoscopy - then every 10 yrs
• at 50, testing stool for fecal occult blood YEARLY

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5
Q 
Cancer Secondary prevention 
MALES
• Clinical Testicular exams?
• TSE?
• digital rectal exam, prostate specific antigen (PSA)?
• colonoscopy?
• fecal occult blood test?
A

• info about breast self-awareness
• Yearly clinical testicular exams
- Monthly testicular self-exams (TSE); testicular cancer common in age group of 15-36 yo
• >50 - digital rectal exam and prostate-specific antigen (PSA)
• at 50, Colonoscopy then every 10 yrs
• at 50, testing stool for fecal occult blood YEARLY

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6
Q

Cancer Tertiary prevention

A
  • support groups

* rehabilitation programs

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7
Q

General S/SX of Cancer?

• What’s C.A.U.T.I.O.N.?

A 
Change in bowel/bladder habits
A sore that does not heal
Unusual bleeding/discharge
Thickening or lump in breast/elsewhere
Indigestion or difficulty swallowing
Obvious change in wart/mole
Nagging cough or hoarseness
  • anemia, leukopenia, thrombocytopenia
  • Unexplained weight loss (CACHEXIA: extreme wasting and malnutrition)
  • Fever
  • FATIGUE - #1 Symptom (doesn’t get better w/ sleep)
  • Pain
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8
Q

Cancer:

Bleeding Precautions

A
  • Use an electric razor
  • Use a soft toothbrush
  • No IMs
  • Quiet play for children
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9
Q

Cancer:

Blood Tests

A
  • Abnormal CBC and diff - Always worry about NEUTROPHIL COUNT (normal: 2500-8000)
  • ↑ AST and ALT
  • tumor biomarkers
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10
Q

Cancer:

Positive Diagnostic Studies

A 
CXR
CT
MRI
PET Scan
Bone marrow biopsy
Tissue biopsy
Imaging studies
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11
Q

Cancer:

Surgery is used for?

A

Prevention - removing benign tumor
Diagnosis - staging, biopsy, lymph node mapping
Treatment

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12
Q

Curative Surgery: Tx for laryngeal cancer?

A

Total laryngectomy (removal of VOCAL cords, epiglottis, thyroid cartilage)

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13
Q

TOTAL LARYNGECTOMY
• This client will have a permanent what?
• Position post-op?
• NG feedings to protect what? why it’s used?
• Monitor what?
• Watch for ____ artery rupture = MEDICAL EMERGENCY-CALL PROVIDER
• Rupture of the _____ artery = go to OR ASAP!
• Frequent ____ care to decrease bacterial count in mouth
• NPO people tend to get ____
• When the client leaves the hospital, what will be used to cover trach and acts like a filter?
• A _____ environment helps
• All breathing is done thru the ____
• How does a client w/ total laryngectomy talk?
• DONT’s of total laryngectomy

A
  • Permanent tracheostomy or laryngectomy
  • Position - MID FOWLERS
  • NG feedings to protect SUTURE LINE because PERISTALSIS can disrupt it
  • Monitor DRAINS
  • Watch for CAROTID artery rupture = MEDICAL EMERGENCY-CALL PROVIDER
  • Rupture of the INNOMINATE artery = go to OR ASAP!
  • Frequent ORAL care to decrease bacterial count in mouth
  • NPO people tend to get PNEUMONIA
  • BIB will be used to cover trach and acts like a filter?
  • A HUMIDIFIED environment helps
  • All breathing is done thru the STOMA
  • A client w/ total laryngectomy talk with an electrolarynx or the BLOM-SINGER DEVICE
  • NO WHISTLING, NO DRINKING THRU STRAW; SMOKING AND SWIMMING NOT RECOMMENDED
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14
Q

Reconstructive Surgery: Tx for breast cancer?

A

Mastectomy - partial or total (radical)

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15
Q

MASTECTOMY Post-Op Care
• Bleeding–what to check?
• if reconstruction includes using their own tissue, they will also have an ____ surgical site
• what type of drains will they have?

A
  • Check dressings, front and back (pooling of blood can occur)
  • they will also have an ABDOMINAL surgical site (most common site to harvest adipose tissue)
  • Hemovac or Jackson-Pratt drains
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16
Q

MASTECTOMY Nursing Care (if lymph nodes also removed)

• Brush hair, squeeze tennis balls, wall climbing, flex and extend elbow. Why?

A
  • NO CONSTRICTION
  • no BPs
  • no blouses w/ elastic
  • no watch
  • no IV or injections on affected side
  • wear gloves when gardening
  • watch small cuts
  • no nail biting
  • no sunburn

• Promotes NEW (collateral) circulation

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17
Q

Internal Radiation
• Use?
• it’s internal radiation, so it’s ____ the body
• w/ all types, the client emits ____ for a period of time and is a hazard to others
• Unsealed?
• Sealed/Solid? Examples?

A

(BRACHYTHERAPY)
• Used to get the radiation close to the cancer or target tissue
• it’s INSIDE the body
• client emits RADIATION
• Unsealed (client and body fluids emit radiation); IV or PO; Radioactive for 24-48 hrs
• Sealed/Solid (client emits radiation, not body fluids_; temporary or permanent implant placed close to or inside tumor
—Examples: Implantable seeds (prostate ca); vaginal implant (cervical ca)

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18
Q

Precautions w/ Internal Radiation (BRACHYTHERAPY)
• Nursing assignments should be rotated ____, so the nurse is not continuously exposed.
• Nurse should only care for ____ client w/ a radiation implant in a given shift
• Placed in a ____ room? why?
• Wear ____ at all times
• Time limit for visitors? Distance from source? No visitors for ages less than what? No ____ visitors/nurses
• Mark the room w/ instruction for what?
• wear ____ w/ risk of exposure to body fluids
• Prevent dislodgement of the implant by: Keep client on ____, Decrease ____ in diet, Prevent bladder ____
• What do you do if the implant becomes dislodged and you see it?
• Teaching for client?

A

• Nursing assignments rotated DAILY
• Only care for ONE client w/ radiation implant
• PRIVATE room coz client is IMMUNOSUPPRESSED
• wear FILM BADGE at all times
• only 30 MINUTES per day; at least 6 FEET from source; No visitors <16 yo; No PREGNANT visitors/nurses
• Mark the room w/ instruction for SPECIFIC ISOTOPE
• Wear GLOVES w/ risk of exposure to body fluids
• Prevent dislodgement of the implant by: Keep client on BED REST, Decrease FIBER in diet, Prevent bladder DISTENTION
• dislodged implant - Gloves → Use forceps to pick up dislodged implant → Place implant in a lead-lined container → leave in room, call radiation department
• Teaching:
–After radiation, NO SLEEPING in the same bed w/ spouse or children
–NO USE of public transportation
–NO to returning to work immediately
–NO SHARING of utensils or cooking for others
–After us, close lid then flush toilet 2-3 times

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19
Q 
External Radiation
• use?
• client radioactive or not?
• Side Effects?
• s/sx are \_\_\_\_ and \_\_\_\_ related
• Teaching for client?
A

Teletherapy/External Beam Radiotherapy
• A carefully focused beam of high energy rays is delivered by a machine OUTSIDE of the body
• client is NOT RADIOACTIVE
• SE: erythema, shedding of skin, FATIGUE, Pancytopenia
• s/sx are LOCATION and DOSE related
• Teaching:
–NO WASHING OFF markings
–NO USING LOTION on markings
–Protect site from sunlight and UV exposure for 1 YEAR
–Good skin care; NO LOTION/POWDER/OINTMENT w/o PHP order

20
Q

Action of Chemotherapy
• goal?
• Specific chemo drugs? Non-specific chemo drugs?
• work best when?

A

• Goal - ELIMINATE/REDUCE number of cancer cells by destroying cells as they’re developing
• Specific - attack a specific phase of cell development
Non-Specific - work at all/any phase of cell development
• Work best when cells are ACTIVELY GROWING
*most active growth is when tumor first begins to develop

21
Q

Precautions for administration of Chemotherapy
• Routes?
• Be careful, why?
• make sure you are ____ it correctly
• Exposure can occur by drug contact with the what?

A
  • Routes: oral, topical, IM, IV, intracavity (directly into body cavity)
  • Be careful because of Exposure to drugs that are CARCINOGENIC, MUTAGENIC, TERATOGENIC
  • make sure you are HANDLING it correctly
  • Exposure can occur by drug contact with the SKIN or MUCOUS MEMBRANES, INHALATION, INGESTION, ACCIDENTAL INJECTION
22
Q

Chemotherapy Full precautions require
• gown? coated why? what to do if contaminated?
• gloves? placement?
• goggles/mask?

A
  • Chemotherapy gown; coated to prevent contamination; change immediately if contaminated
  • 2 PAIRS chemotherapy gloves (thicker, longer); one pair under gown, one pair over the gown cuff
  • Goggles and/or mask if there’s splashing/inhalation
23
Q

Chemo drugs can be given orally. Wear ____ with administration

A

Chemotherapy gloves

24
Q

Chemotherapy: Excretion precautions
• what to wear when handling body fluids?
• chemotherapy is excreted when?

A
  • 2 pairs of chemo gloves and chemo gown

* 3 - 7 days after administration

25
Q

Disposal of Chemotherapy

A
  • Yellow rigid chemo waste container (sharps, IV equipment)
  • Yellow chemo waste bag (gowns, gloves, disposable items)
  • wash hand w/ soap and water after removing gloves
26
Q

Chemotherapy: Managing Spills

A
  • hHandle as a HAZARDOUS CHEMICAL SPILL
  • Obtain Spill Kit and use ALL protective equipment for clean up

–wash hands w/ soap and water → get SPILL KIT → Post “Caution Chemo spill” sign outside the room door → resp mask → chemo gown → 2 chemo gloves → goggles →ise absorbent pads to wipe up spill

27
Q

EXTRAVASATION
• Patho?
• S/SX
• Treatment?

A

Complication w/ Chemotherapy Administration
• Chemo drugs are given in a central IV line; Peripheral line only if IV push or infusion <1 hr; VESICANT (chemo drug that if it infiltrates = NECROSIS)

• s/sx: Pain, Swelling, No blood return

• Tx
#1 thing to remember - PREVENTION!
STOP INFUSION and send for extravasation kit → stay w/ client and watch the site

28
Q

Transplants
• use for?
• Stem cells from blood or bone marrow can come from where?
• Stem cells are given into ____ much like a blood transfusion → over time, settle in the bone marrow = produce ____ ____ cells

A
  • Treatment for HEMATOLOGIC cancers
  • Stems cells come from the client, a matched donor, or identical sibling/twin
  • Stem cells are given into VEIN → over time, settle in the bone marrow = produce HEALTHY BLOOD cells
29
Q

Stem Cell Transplant

A

stems cells are transplanted from bloodstream

30
Q

Bone Marrow Transplant

A

stem cells are transplanted from bone marrow

31
Q

Transplant: Early signs of rejection

A 
abdominal pain
jaundice
pruritus
diarrhea
dark, tea colored urine (RBC breakdown)
32
Q

SE of Cancer and/or Cancer Tx

GI System

A

1) Nausea/Vomiting (N/V)
• last 24-48 after tx
• routine antiemetic meds given 1st week of chemo
TREATMENT:
Antiemetic drugs
1. ondansetron (Zofran)
-serotonin receptor antagonists (-tron): onsansetron, granisetron, dolasetron
2.Netupitant/palonosetron (Akynzeo)
-oral combination antiemetic; prevents acute and delayed N/V from chemo – 1 dose 1 pill 1 hr before chemo
3. Non-pharmacologic tx
-Ginger
-Aromatherapy
-acupuncture, acupressure, distraction and relaxation techniques (music therapy, peppermint essential oil diffuser)

2) Stomatitis
oral cavity susceptible to irritation

3) Diarrhea
worry nutrition and FE imbalances

33
Q

SE of Cancer and/or Cancer Tx

Integumentary System

A

• alopecia (hair loss)
• sense of loss w/ mastectomy, amputation, surgery scar
—have them look at the incision

34
Q

SE of Cancer and/or Cancer Tx
Hematopoietic System (Bone Marrow)
• what’s #1 cause of cancer-related deaths?

A
  • ↓ RBCs, ↓ WBCs, ↓ Platelets – client at risk for anemia, infection, and bleeding
  • INFECTION is #1 cause of cancer-related deaths
35
Q 
General Precautions to Prevent Infection
• what type of room? limit what?
• keep what in the room? what items not to share?
• what needs to be changed daily?
• how to prevent pneumonia?
• gardening and cleaning?
• being in public?
• what to do frequently?
• what to do after touching a pet?
• drink what?
• avoid what in diet?
• brush teeth with? how often?
• mouthwash?
• report to hospital if?
A
  • Private room; Limit visitors and nurses in the room
  • Keep client’s own supplies; Don’t share toiletries
  • Change dressings and IV tubing daily
  • Cough and deep breathe to prevent pneumonia
  • NO gardening or cleaning up after pets
  • Avoid crowds; Wear mask when out in public
  • Good handwashing frequently using antibacterial gel
  • Wash hands after touching a pet
  • Drink FRESH WATER
  • Avoid uncooked meat, seafood, eggs (No sushi); Avoid fresh/raw fruits/vegetables
  • Brush teeth w/ SOFT toothbrush 4 TIMES daily
  • NO alcohol-based mouthwash
  • report to hospital for temp >100.4 (38 C)
36
Q 
Neutropenic Precautions (+general precautions)
• what's prescribed?
• VS every how many hours?
• what type of room?
• what soap to use for handwashing?
• what procedures to avoid?
• what to avoid if at all possible
• limit use of what med?
A
  • Antibiotics as prescribed
  • VS q4h (temp check q2h)
  • Private room w/ door closed and posted sign
  • Antimicrobial soap for handwashing (not regular soap_
  • No invasive procedures (IM injections, rectal exams/meds)
  • Avoid indwelling catheters and NG tubes
  • limit use of acetaminophen (Tylenol)
37
Q

SE of Cancer and/or Cancer Tx
FATIGUE
• treatment?

A
  • every onc client has some fatigue, some d/t tx

* provide period rest, naps, limit visitation time; teach clients to do these at home

38
Q

SE of Cancer and/or Cancer Tx
PAIN
• Treat pain without worry about risk for ____
• Causes of pain?
• “Gold standard” treatment for pain? imp info to remember?

A

• Treat pain without worry about risk for DEPENDENCE
• causes of pain - direct tumor involvement, result of tx (mucositis, peripheral neuropathy)
• OPIOIDS is gold standard tx
–NO ceiling on dose for a cancer client; Limit dose coz of SE, not dose/time; Call PHP if increased dose needed

39
Q

Complementary/Alternative therapies for Pain Management

A
  • Acupressure
  • Acupuncture
  • Cannabis (Marijuana)
  • Distraction therapies (music, peppermint essential oil diffuser)
  • Hydrotherapy
  • Massage
40
Q

NEUTROPENIA
• what is it?
• normal ANC?
• treatment?

A
  • ↓ neutrophils (mature WBCs) in blood
  • 2500 - 8000 cells/mm
  • Tx: Antibiotics; Implement Neutropenic Precautions
41
Q

DVT’s
• Why is cancer a big risk factor for development of a DVT?
• What are we most afraid of w/ DVT?

A
  • Prolonged bed rest; Surgery; Use of central line; External compression of vessels by tumor; Invasion of cells by tumor; Certain chemo drugs
  • Worry about development of a PE (Pulmonary embolus)
42
Q 
THROMBOCYTOPENIA
• what is it? Platelets responsible for what?
• risk factors?
• assessment?
• treatment?
A

• ↓ of circulating platelets in blood; Platelets responsible for clotting (must have platelets to clot the blood to prevent bleeding)

RISK FACTORS
• advanced metastatic disease
• hematological malignancies
• bleeding disorders (Hemophilia, liver disease, ITP)
• bacterial infections
• Anticoagulant meds - aspirin, clopidogrel (Plavix), Heparin, warfarin (Coumadin)
• result of cancer tx

ASSESSMENT
• History
• VS
• O2 sats
• Change in LOC (headache, pupil changes)
• conjunctival hemorrhages
• petechiae, ecchymosis, purpura
• oozing from puncture/surgical sites 
• bleeding from rectum, ears, nose, or mouth

TREATMENT
• Give platelets

43
Q

Blood products
• RBC transfusions
• Platelet transfusions
• Why are blood products irradiated?

A
  • RBC for clients w/ symptomatic anemia–don’t want H/H to drop below 8 g/dL and 24% (need RBCs)
  • PLT - control or prevent bleeding in thrombocytopenia
  • Reduces risk of transfusion-related reactions
44
Q 
Blood Product Infusion Process
POINTS TO REMEMBER
• administered by who?
• what IV solution to use
• what NOT to infuse via blood IV tubing
• all blood products require what?
• blood will be given via \_\_\_\_
• what needs to be done before administering the blood?
  • each client must have _____ in the lab prior to obtaining a blood product; it’s only good for how many hours?
  • Verification - where? with who? what to verify?
  • Check blood product, why?
  • What do you need prior to administering blood or blood products?
  • STEPS of infusion
  • do NOT infuse blood quickly in what clients?
  • infusion should be started within ____ minutes of receiving blood from blood bank
  • all blood from each unit must be completed within a ____ hour time frame
A
  • administered by RN
  • Only use NS
  • do NOT infuse meds via blood IV tubing
  • need a filter
  • given via pump
  • baseline VS and transfusion records, 2 IVs
  • each client must have TYPE and SCREEN and CROSSMATCH in the lab prior to obtaining a blood product; it’s only good for 72 HOURS
  • 1) in the blood blank and on the floor;

2) w/ a designated person in blood bank and w/ another RN at the bedside on the floor;
3) client’s name, DOB, blood bank #, unit #, exp date of unit of blood/blood product, blood type and group, PHP’s prescription

  • check for any signs of abnormalities
  • PHP’s prescription and client’s signed consent form (PHP’s responsibility to explain need and possible SE)

STEPS of infusion
• 2 IVs ready → baseline VS → get blood from blood bank → Started within 30 mins of receiving blood from blood bank → Begin infusion SLOWLY → obser client for first 15 mins → no reaction, ↑infusion rate (must be completed within 4 HOURS) → dispose blood tubing and blood/blood product bag → flush lines w/ 0.9 NS after transfusion → Document

  • do NOT infuse blood quickly in – elderly, has heart or kidney condition, or very young
  • infusion should be started within 30 MINUTES of receiving blood from blood bank
  • completed within 4 HOURS
45
Q

Blood Product Infusion Process

SIGNS OF TRANSFUSION REACTION

A
  • chest pain
  • hives or skin rash
  • hypotension/hypertension
  • fever
  • chills
  • anxiety
  • wheezing
  • headache or muscle pain w/ fever
  • flushing
  • back pain
  • dizziness
  • itching
  • urticaria
  • tachycardia
  • tachypnea
  • dyspnea
  • N/V
46
Q

Blood Product Infusion Process

If an adverse reaction occurs you should:

A
  • STOP INFUSION
  • remove blood and blood tubing set
  • may have to return blood and tubing to blood bank
  • start NS w/ new primed tubing at keep vein open (KVO) rate
  • check and document VS–stay w/ client
  • notify PHP and monitor for anaphylaxis
  • notify lab/blood bank of reaction

NCLEX (24 decks)

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