Oncology Flashcards
1 cause of of preventable cancer
tobacco
Risk factors for Cancer
- 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
Cancer Primary prevention
- 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
Cancer Secondary prevention FEMALES • BSE? • Clinical breast exams? • Mammogram? Teaching? • Pap smear? • Colonoscopy? • fecal occult blood test?
• 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
Cancer Secondary prevention MALES • Clinical Testicular exams? • TSE? • digital rectal exam, prostate specific antigen (PSA)? • colonoscopy? • fecal occult blood test?
• 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
Cancer Tertiary prevention
- support groups
* rehabilitation programs
General S/SX of Cancer?
• What’s C.A.U.T.I.O.N.?
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
Cancer:
Bleeding Precautions
- Use an electric razor
- Use a soft toothbrush
- No IMs
- Quiet play for children
Cancer:
Blood Tests
- Abnormal CBC and diff - Always worry about NEUTROPHIL COUNT (normal: 2500-8000)
- ↑ AST and ALT
- tumor biomarkers
Cancer:
Positive Diagnostic Studies
CXR CT MRI PET Scan Bone marrow biopsy Tissue biopsy Imaging studies
Cancer:
Surgery is used for?
Prevention - removing benign tumor
Diagnosis - staging, biopsy, lymph node mapping
Treatment
Curative Surgery: Tx for laryngeal cancer?
Total laryngectomy (removal of VOCAL cords, epiglottis, thyroid cartilage)
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
- 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
Reconstructive Surgery: Tx for breast cancer?
Mastectomy - partial or total (radical)
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?
- 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
MASTECTOMY Nursing Care (if lymph nodes also removed)
• Brush hair, squeeze tennis balls, wall climbing, flex and extend elbow. Why?
- 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
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?
(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)
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?
• 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
External Radiation • use? • client radioactive or not? • Side Effects? • s/sx are \_\_\_\_ and \_\_\_\_ related • Teaching for client?
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
Action of Chemotherapy
• goal?
• Specific chemo drugs? Non-specific chemo drugs?
• work best when?
• 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
Precautions for administration of Chemotherapy
• Routes?
• Be careful, why?
• make sure you are ____ it correctly
• Exposure can occur by drug contact with the what?
- 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
Chemotherapy Full precautions require
• gown? coated why? what to do if contaminated?
• gloves? placement?
• goggles/mask?
- 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
Chemo drugs can be given orally. Wear ____ with administration
Chemotherapy gloves
Chemotherapy: Excretion precautions
• what to wear when handling body fluids?
• chemotherapy is excreted when?
- 2 pairs of chemo gloves and chemo gown
* 3 - 7 days after administration
Disposal of Chemotherapy
- 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
Chemotherapy: Managing Spills
- 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
EXTRAVASATION
• Patho?
• S/SX
• Treatment?
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
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
- 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
Stem Cell Transplant
stems cells are transplanted from bloodstream
Bone Marrow Transplant
stem cells are transplanted from bone marrow
Transplant: Early signs of rejection
abdominal pain jaundice pruritus diarrhea dark, tea colored urine (RBC breakdown)
SE of Cancer and/or Cancer Tx
GI System
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
SE of Cancer and/or Cancer Tx
Integumentary System
• alopecia (hair loss)
• sense of loss w/ mastectomy, amputation, surgery scar
—have them look at the incision
SE of Cancer and/or Cancer Tx
Hematopoietic System (Bone Marrow)
• what’s #1 cause of cancer-related deaths?
- ↓ RBCs, ↓ WBCs, ↓ Platelets – client at risk for anemia, infection, and bleeding
- INFECTION is #1 cause of cancer-related deaths
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?
- 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)
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?
- 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)
SE of Cancer and/or Cancer Tx
FATIGUE
• treatment?
- every onc client has some fatigue, some d/t tx
* provide period rest, naps, limit visitation time; teach clients to do these at home
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?
• 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
Complementary/Alternative therapies for Pain Management
- Acupressure
- Acupuncture
- Cannabis (Marijuana)
- Distraction therapies (music, peppermint essential oil diffuser)
- Hydrotherapy
- Massage
NEUTROPENIA
• what is it?
• normal ANC?
• treatment?
- ↓ neutrophils (mature WBCs) in blood
- 2500 - 8000 cells/mm
- Tx: Antibiotics; Implement Neutropenic Precautions
DVT’s
• Why is cancer a big risk factor for development of a DVT?
• What are we most afraid of w/ DVT?
- 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)
THROMBOCYTOPENIA • what is it? Platelets responsible for what? • risk factors? • assessment? • treatment?
• ↓ 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
Blood products
• RBC transfusions
• Platelet transfusions
• Why are blood products irradiated?
- 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
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
- 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
Blood Product Infusion Process
SIGNS OF TRANSFUSION REACTION
- 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
Blood Product Infusion Process
If an adverse reaction occurs you should:
- 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
