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Adult Nursing II Exam 3 > Oncology & End-Of-Life > Flashcards

Oncology & End-Of-Life Flashcards

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1
Q

What are the different ways cancer can metastasize?

KNOW THIS!!!…per Hayley

A

Lymphatic
Hematogenous (blood)
Angiogenesis

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2
Q

What is angiogenesis?

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A

Growth of new vessels

  • Advanced cancers secrete angiogenic factors to facilitate feeding of the tumor
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3
Q

What percentage of breast cancers are HER2 positive?

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A

30%

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4
Q

What medicaiton is given to treat HER2+ breast cancers?

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A

Herceptin

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5
Q

List common carcinogenic agents & factors that increase an individual’s risk of developing cancer.

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A
  • Genetics
  • Diet
  • Hormones
  • Smoking
  • Chronic Inflammation (individuals who are immunosuppressed like in Crohns)
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6
Q

What are tumor markers?

A

Proteins made at higher amounts in cancerous cells than in normal (benign) cells

  • antigens expressed on cell surface or relased from normal cells in response ot tumors
  • Helpful for surveillance & diagnosis of cancer
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7
Q

Tumor Classifications & Nomenclature (explain each of the following):

  • Benign Tumors
  • Malignant Tumors
  • Lipoma
  • Leiomyoma
  • Carcinoma
  • Adenocarcinoma
  • Sarcoma
  • Lymphoma
  • Leukemia
A
  • Benign Tumors: non-cancerous
  • Malignant Tumors: cancerous tumors
  • Lipoma: fat
  • Leiomyoma: smooth muscle
  • Carcinoma: epithelial tumors (malignant)
  • Adenocarcinoma: ducts or glands
  • Sarcomas: malignant connective tissue tumors
  • Lymphomas: lymphatic tissue tumors
  • Leukemias: cancer in blood-forming cells
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8
Q

Hwo should the nurse reply whena parent questions why a computed tomographic (CT) can of the head was not ordered for their 5-year-old child after a minor fall?

a.) Physicians are cautious about ordering CT scans on children younger than 10 years of age
b.) CT scans are seldom conclusive when used to diagnose head injuries in young children
c.) The child’s symptoms will determine whether a CT scan is necessary and whether it is worth the espense
d.) Research suggests that repeated CT scans can increase the risk of developing brain cancer

A

d.) Research suggests that repeated CT scans can incrase the risk of brain cancer

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9
Q

Forms of Primary Prevention for Cancer

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A
  • Avoid known carcinogens (tobacco)
  • Lifestyle & Dietary changes
  • Physical activity
  • Weight control (obesity is linked to uterus, prostate, breast, gallbladder, & colon cancer)
  • Alcohol limitations
  • Sun avoidance
  • Vaccinations (HPV)
  • Public & patient education
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10
Q

Forms of Secondary Prevention for Cancer

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A
  • Identification of patients at high risk for cancer
  • Cancer screening (mammography, breast self exam, self-testicular exam, colonoscopy, pap smear, etc.)
  • Public & patient education
  • Measuring tumor markers
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11
Q

Explain the TNM Classification

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A

TUMOR (T):
* Tx = cannot be adequately assessed
* T0 = no evidence of primary tumor
* Tis = carcinoma in situ
* T1 - T4 = progressive increase in tumor size

NODES (N):
* N0 = no evidence of regional node metastasis
* N1 - N3 = increasing involvement of regional lymph nodes

METASTASIS (M):
* M0 = no distant metastasis
* M1 = distant metastasis

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12
Q

What are the tumor (T) stages for TNM classification?

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A
  • Tx = cannot be adequately assessed
  • T0 = no evidence of primary tumor
  • Tis = carcinoma in situ
  • T1 - T4 = progressive increase in tumor size
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13
Q

What are the node (N) stages for TNM classification?

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A
  • N0 = no evidence of regional node metastasis
  • N1 - N3 = increasing involvement of regional lymph nodes
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14
Q

What are the metastasis (M) stages for TNM classification?

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A
  • M0 = no distant metastasis
  • M1 = distant metastasis present
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15
Q

What is a mediport?

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A

implanted vascular device

  • Used for infusion of chemotherapy
  • Usually placed in subclavian or external jugular vein

If meeting resistance when accessing port a small amount of tpa can be administered to break up any clots

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16
Q

What should be done if there is resistance when trying to access an implanted vascular device like a Mediport?

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A

administer a small amount of tpa to break up any clots (need a provider’s order)

17
Q

What are the 2 types of radiaiton & what is the difference in the two types?

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A

Ionizing Radiation: external radiation

Brachytherapy: seeds implanted inside the tumor

18
Q

Side Effects of Radiation

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A
  • Fertility issues
  • Skin lesions
  • Diarrhea
  • Erythema
19
Q

Nursing Care of Patients Undergoing Radiation

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A

Skin Care: avoid use of strong sopas, cosmetics, & perfumes

Oral Care: floss every 24 hours unless painful or platelet count is less than 40,000

Protect care providers

20
Q

PPE When Administering Chemotherapy

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A
  • Double Layer of powder-free gloves specifically disgnated for chemotherapy
  • Long sleeve disposable gown made of polyethylene-coated polypropylene or other laminate materials
21
Q

Adverse Effects of Chemotherapy

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A
  • Toxicity
  • GI Effects: N/V, diarrhea, mucositis (mouth or gut is sore or inflammed), stomatitis (inflammation & redness of oral mucosa)
  • Hematopoietic Effects: myelosuppression (stop ro slow the growth of blood forming cells in the bone marrow)
  • Renal Damage: direct effects during excretion & accumulation fo end products after cell lysis
  • Cardiopulmonary: potential cardiac toxicities
  • Reproductive System: potential sterility, potential reproductive cell abnormalities
  • Neurologic Effects: peripheral neuropathy, loss of deep tendon reflex, paralytic ileus
22
Q

What is absolute neutrophil count (ANC)?

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A

looking at the neutrophil count to determine…

  • **if the patient’s immune system is functioning well **
  • patient’s risk of acute infection
23
Q

What is NADIR?

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A

Lowest absolute neutrophil count – when patient is at highest risk for infection

  • taken 7-10 days after chemotherapy
24
Q

Most common side effects of chemotherapy

A
  • Nausea & Vomiting (give antiemetic like zofran)
  • Alopecia (2-3 weeks after onset of treatment)
    Taste Changes (everything tastes like metal; changes in sense of smell)
  • Cachexia
25
Q

The family member of a patient with terminal metastatic cancer who is experiencing cachexia-related weight loss asks the nurse why the patient is losing weight despite taking in a large amount of calories per day. What is the nurse’s best response?

a.) “When patients are at this stage of metastatic cancer the food being eaten is not being digested”
b.) “This weight loss is related to the cancer itself & occurs despite an intake of adequate calories”
c.) “We likely need ot increase the calories more; you are welcome to bring food from home”
d.) “You will need to discuss the plan of care with your family member as I am not at liberty to discuss it with you”
e.) “We can consult with the doctor & dietitian about tube feeding to prevent more weight loss”

A

b.) “This weight loss is related to the cancer itself & occurs despite an intake of adequate calories”

26
Q

What is a key biologic response modifier category to know?

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A

Neupogen = bone marrow stimulant

  • Given when WBC count is low to help WBC growth occur
27
Q

What signs & symptoms can occur in Tumor Lysis Syndrome?

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A
  • Hyperkalemia (elevated potassium)
  • Hyperphosphatemia (elevated phosphate)
  • Hyperuremia (elevated uric acid)
  • Hypocalcemia (low calcium)

Can all start after initial chemo treatment

28
Q

Nursing interventions for tumor lysis syndrome

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A

Hydration

Monitor Fluid & Electrolyte Imbalances
* Potassium & phosphorus restrictions
* Sodium bicarbonate administration (for hyperuremia)
* Allopurinol administration (decrease uric acid production)

29
Q

What is superior vena cava syndrome?

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A

occurs when superior vena cava is compressed or obstructed by tumor growth

  • Usually in lung cancer

Commonly associated with lung cancer & lymphoma

30
Q

Signs & Symptoms of Superior Vena Cava Syndrome

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A
  • Swelling in the face, trunk, & extremities
  • Orthopnea
  • JVD
  • Dizziness or light-headedness
  • Dyspnea
  • Cough
  • Headache

MAIN SX = JVD & FACIAL or UPPER EXTREMITY EDEMA

31
Q

What is Tumor Lysis Syndrome / when does it occur?

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A

Occurs when large quantities of tumor cells are rapidly destroyed & intracellular components (like potassium & uric acid) are released into the body faster than they can be eliminated

32
Q

Treatment of Superior Vena Cava Syndrome

A
  • Stent is placed in SVC to open it & allow proper blood flow
  • Steroids for inflammation
  • Diuretics to decrease fluid
33
Q

What are common nursing diagnoses in patients with cancer?

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A
  • Impaired oral mucosa
  • Impaired tissue integrity
34
Q

List different complications / oncologic emergencies

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A
  • Spinal cord compression (numbness, tingling, etc.)
  • Superior Vena Cava Syndrome
  • Hypercalcemia
  • Tumor lysis syndrome
  • INFECTION
  • Paraneoplastic syndromes (mistakenly attack normal cells)
  • Bone pain
  • Muscle weakness
  • Abnormal heart rhythms
  • GI issues
35
Q

Legislative Issues (End of Life Care)

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A

DNR Orders
Advanced Directives
* Living will
* Guardianship
* Durable power of attorney
* Assisted Suicide

36
Q

A family is asking why their father with end stage COPD is being referred to hospice care. The best response from the nurse would be…

a.) Hospice care provides complete pain control
b.) Hospice assists the family & patient to prepare for death
c.) Hospice will follow the patient’s choice for “DNR” status
d.) Hospice is provided in the home & will allow the family to be involved in the decisions for care

A

b.) Hospice assists the family & patient to prepare for death

37
Q

Signs & Symptoms of Approaching Death

A
  • Refusal of food & fluids
  • Shortness of breath
  • Decreased urinary output
  • Weakness & increased sleep
  • Confusion & restlessness
  • Impaired vision & hearing
  • Secretions in the throat
  • Cheyne-Stokes breathing
  • Incontinence
  • Decreased temeprature control
38
Q

A patient was admitted to the critical care unit several weeks ago with an acute myocardial infarction (MI) & subsequently underwent coronary artery bypass grafting (CABG) surgery. Sinc ea cardiac arrest 5 days ago, the patient has been unresponsive. The electroencephalogram (EEG) shows no meaningful brain activity. After a family conference, the physician orders a DNR & palliative care is begun. What does this mean?

a.) The patient will continue to receive the same aggressive treatment short of resuscitation if he has another cardiac arrest
b.) All treatment will be stopped & the patient will be allowed to die
c.) All attempts will be made to keep the patient comfortable without prolonging his life
d.) The patient will be immediately transferred to hospice

A

c.) All attempts will be made to keep the patient comfortable without prolonging his life

39
Q

A nurse is participating in primary prevention effors directed at cancer. In which activities is this nurse most likley to engage? (Select all that apply)

a.) Demonstrating breast self exam methods to women
b.) Instructing people on the use of chemoprevention
c.) Providing vaccinations against certain cancers
d.) Screening teenage girls for cervical cancer
e.) Teaching teens the dangers of tanning boths

A

b.) Instructing people on the use of chemoprevention

c.) Providing vaccinations against certain cancers

e.) Teaching teens the dangers of tanning boths

Adult Nursing II Exam 3 (7 decks)

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