oncology Flashcards
risk factors
tobacco alcohol + tobacco =cocarcinogenic diet (low fiber, red meat, animal fat, nitrites, alcohol, preservatives and additives) obesity immunosuppressed aging African Americans then whites heredity ultra violet radiation carcinogens stress chronic irritations
primary prevention r/t cancer
no smoking exercise good nutrition normal body weight alcohol limitation vaccines sunscreen
secondary prevention r/t cancer
breast self awareness
monthly breast self exams starting at age 20 on day 7-12 of menstrual cycle
yearly clinical breast exam over 40
age 20-39 clinical breast exam once every three years
mammogram at 40 annually
before mammogram avoid lotion, powder, and deodorant
pap age 21 every 3 years
colonoscopy at 5o every 10 years
fecal occult blood yearly at age 50
secondary prevention r/t cancer for males
yearly clinical testicular exams testicular tumors grow fast so monthly self exams digital rectal exam (PSA) over 50 colonoscopy at 50 and every 10 years fecal occult blood yearly at 50
tertiary prevention r/t cancer
manage long term care
support groups
rehab programs
general s/s
CAUTION change in bowel/bladder a sore that wont heal unusual bleeding/discharge thickening or lump in breast or elsewhere indigestion or difficulty swallowing obvious change in wart or mole nagging cough or hoarseness
invades bone marrow (anemia, leukopenia, thrombocytopenia)
unexplained weight loss (cachexia– extreme wasting and malnutrition)
fever (early sign of blood cancer and lymphoma)
fatigue
pain (bone, testicular, brain)
blood tests r/t cancer
abnormal CBC and diff (neutrophils)
elevated liver enzymes (AST/ALT)
tumor markers (biomarkers)
positive diagnostic studies
chest xray CT scan MRI PET scan bone marrow biopsy tissue biopsy imaging studies
why is surgery used
prevention (benign)
diagnosis
treatment
total laryngectomy
removal of vocal cords, epiglottis, and thyroid cartilage permanent trach or laryngectomy mid fowlers post op NG feedings to protect suture line monitor drains frequent mouth care to decrease bacterial count humidified environment use Blom-Singer device to talk cannot whistle cannot drink through a straw can smoke but not recommended cannot swim
reconstructive surgery
breast cancer common
post op mastectomy
bleeding- check dressings front and back (pooling of blood can occur)
abdominal sites can occur if they are using their own tissue
avoid procedures on arm of affected side if lymph nodes were removed (no constriction, no BPs, no blouses with elastic, no watch, no IV or injections, wear gloves when gardening, watch small cuts, no nail biting, and no sunburn)
brush hair, squeeze tennis ball, wall climbing, flex and extend elbow to promote circulation
internal radiation therapy
brachytherapy
used to get radiation close to tissue/cancer
inside the body
emits radiation for a period of time and is a hazard
sealed: emits radiation, body fluids not radioactive, temporary or permanent implant
unsealed: client and body fluids emit radiation, IV or PO, radioactive for 24-48 hours
precautions with internal radiation
nursing assignments rotated daily only care for one client with radiation in a given shift private room film badge at all times restrict visitors 30 minutes/day for visitors visitors must stay 6ft no visitors less than 16 yo no pregnant visitors/nurses wear gloves private room cannot use same bed, toilet, or utensils as others
how to prevent dislodgment of the implant
bedrest
decrease fiber
prevent bladder distention
what if implant gets dislodged
gloves forceps to pick up the implant place in lead-lined container leave in room call radiation department
external radition
tele therapy eternal beam radiotherapy delivered outside of the body not radioactive SE: erythema, shedding of skin, fatigue, pancytopenia (all blood components are decreased) do not wash off markings don't use lotion on markings protect the skin from sun for 1 year after therapy good skin care
action of chemo
eliminate or reduce cancer cells as they develop
specific chemo drugs– attack a specific phase of cell development
cell cycle non-specific: drugs that work on all or any phase of cell development
work best on cells actively growing
precautions for administration of chemo
oral
IM
topical
IV
intracavaity
look up drug info before administering
chemo gown-coated to prevent contamination-change immediately if contaminated
two pairs of chemo drugs (one under gown and one over the gown cuff)
wear goggles/mask if worried about splashing
excreted for 3-7 days after administration
disposal of chemo
yellow rigid chemo waste container for sharps and IV
yellow waste bag for gown, gloves, and disposable items
wash with soap and water after removing gloves
manage chemo spills
hazard chemical spill
obtain spill kit and use all PPE for clean up
major complication of chemo
extravasation
patho of extravasation
given IV via central line
peripheral only if drug is push or infuses in less than an hour
a vesicant is a drug that if it infiltrates it will cause tissue necrosis
s/s of extravasation
pain
swelling
no blood return
treatment for extravasation
*** prevention
stop infusion and send for extravasation kit
stay with client
transplants
used for hematologic cancers
stem cell transplant
when stem cells are transplanted from the blood stream
given into a vein and settle in the bone marrow and produce healthy blood cells
bone marrow transplant
stem cells transplanted from bone marrow
GI r/t cancer
N/V antiemetic meds (Ondansetron) given routinely first week of chemo
stomatitis (oral cavity very susceptible to irritation)
diarrhea (nutrition and fluid and electrolyte imbalance)
Ondansetron
blocks effects of serotonin (serotonin receptor antagonist)
all end in “ton”
Netupitant/Palonosetron
oral combination antiemetic that prevents acute and delayed N/V
only 1 dose
one pill
one hour before chemo
non pharm for N/V
ginger
aromatherapy
complimentary/alternative therapies (Acupuncture, acupressure, distraction, and relaxation)
integumentary system r/t cancer
alopecia (hair loss)
huge sense of loss with mastectomy, amputation, or a scar that is a result of surgery
want them to look at the incision
hematopoietic system (bone marrow) r/t cancer
causes decreased RBC, WBC, and platelets
at risk for anemia, infection, and bleeding
general precautions to prevent infection
private room limit visitors own supplies change dressing and IV tubing daily no gardening or cleaning of pets cough and deep breath avoid crowds hand wash drink only fresh water avoid uncooked meat, seafood or eggs brush teeth with soft toothbrush 4x/day no alcohol based mouthwash report high temo
neutropenic precautions
****also infection precautions antibiotics VS q 4hrs private room w/ door closed antimicrobial soap not regular soap no invasive procedures (IM, rectal exam) avoid catheters and NG tubes limit tylenol
fatigue r/t treatment
provide periods of rest
naps
limit visitation
pain r/t treatment
without worry of dependence
can be from mucositis or peripheral neuropathy
use opioids
client dependent– no ceiling on the dose
other therapies for pain management
acupressure accupuncture cannabis distraction hydrotherapy massage
neutropenia
decreased neutrophils (mature WBCs) in the blood calculate using ANC (absolute neutrophil count)
treatment: antibiotics and neutropenic precautions
ANC normal
2500-8000 cells/mm
DVTs
second leading cause of death in cancer clients
why? bedrest surgery central line external compression invasion of vessels chemo drugs
afraid of PE
thrombocytopenia
decrease in circulating platelets in the blood
platelets are responsible for clotting
must have platelets to clot the blood to prevent bleeding
risk factors for thrombocytopenia
advanced metastatic disease
hematological malignancies
bleeding disorders (hemophilia, liver disease, ITP)
bacterial infections
anticoagulant meds (aspirin, clopidogrel, heparin, warfarin)
result of cancer treatments
thrombocytopenia assessment
hx VS pulse ox change in LOC, headache, pupil changes conjunctival hemorrhages petechiae, ecchymosis, purpura oozing of blood bleeding from rectum, ears, nose, or mouth
treatment for thrombocytopenia
give platelets
RBC transfusion
symptomatic anemia
dont want hgb/hct below 8 and 24%
platelet transfusion
control/prevent bleeding with thrombocytopenia
