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nclex review > oncology + hematology > Flashcards

oncology + hematology Flashcards

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1
Q

what is it

cancer

A

malignant neoplastic disorder, cells lose their normal growth-controlling mechanism (growth of cells is uncontrolled)

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2
Q

what is it + routes

metastasis

A

cancer cells move from orginal location to other sites
- local seeding = shed of cancer cells outside local area of tumor
- bloodborne metastasis = tumor cells enter blood (most common cause of spread)
- lymphatic spread = primar sites rich in lymphatics are more susxeptible to early mestatic spread

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3
Q

factors influencing cancer development

A
  • chemical carcinogens: industrial chemcials, medicationsm alcohol, tobacco
  • physical carcinogens: ionizing radiation (x-ray), ultraviolet radiation (sun, tanning bed, germicidal lights), chronic irritation, tissue trauma
  • viral carcinogen: aka oncoviruses (hep B, human paillomavirus)
  • helico bacter pylori - associated with an increased risk of gastric cancer
  • lifestyle: obesity, smoking, diet (preservatives/contaminents/additives/alcohol/nitrates)
  • genetic predisposition
  • advancing age
  • immunosuppression
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4
Q

1 - 4

tumor grades

A
  1. cells differ slightly from normal cells, well differentiated (mild dysplasia)
  2. cell more abnormal, moderately differenctiated
  3. cells are very abnormal, poorly differentiated (anaplasia)
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5
Q

0 to 4

cancer stages

A

stage 0: carcinoma in situ
stage 1: tumor lumuted to tissue of origin, localized growth
stage 2: limited local spread
stage 3: extensive local/regional spread
stage 4: distant metastasis

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6
Q

CAUTION-US

cancer warning signs

A

Changes in bowel/bladder habbits
Any sore that does not heal
Unusual bleeding/dishcarge
Thickening/lump
Indigestion
Obvious change in wart/mole
Nagging cough/hoarseness
Unexplained anemia
Sudden weight loss

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7
Q

diagnostic tests

A
  • biopsy - provides histological proof of malignancy (needle/incision/excisional where lesion removed)
  • bone marrow examination
  • chest radiograph
  • Complete Blood Count
  • Computed Tomography
  • Positron Emission Tomography
  • Cytological studies (papanicolaou test)
  • Endoscopic exam (upper GI, sigmoidoscopy, colonoscopy)
  • evaluation of serum tumor markers (cacinoembryonic antigen, alphafetoprotein)
  • liver function tests
  • Magnetic Resonance Imaging
  • proctoscopic examination
  • radiographic studies (mamography)
  • radioisotope scanning (liver, brain, bone, lung)
  • stool test for occuly blood
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8
Q

causes of pain

A
  • bone destruction
  • pathologic fractures
  • lytic lesions (holes where bone tissue is destroyed)
  • organ obstruction
  • compression of peripheral nerves/spinal cord
  • infiltration
  • tissue distention
  • inflammation
  • necrosis
  • tumor lysis
  • psychological factor (fear/anxiety)
  • surgical/neurpathic pain from treatment
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9
Q
A
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9
Q

pain meds

A
  • mild/moderate: salicylates, acetaminophen/NSAIDS
  • severe: opioids
  • neuropathic: anticonvulsants, antidepressants
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10
Q

surgery types

A
  • prophylactic: attempt to remove tissue/organ at risk
  • curative: all gross + microscopic tissue is removed or destroyed
  • control (cytoreductive/debulking): removing large portion of cells
  • palliative: reduce pain, relieve airway/GI/urinary obstruction, relieve pressure on the brain/spinal cord, prevent hemorrhage, removed infected/ulcerated tumors, drain abscesses
  • reconstructive: restore maximal function + appearance (ex. breast reconstruction)
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11
Q

what it does + common side effects

chemotherapy

A

kills/inhibits reproduction of neoplastic cells, kills normal cells (mostly skin, hair, GI tract lining, spermatocytes, hematopoietic cells)

side effects: fatigue, alopecia, nausea/vomiting, skin changes, myelospression

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12
Q

what it does

radiation

A

destroys cancer cells, with minimal exposure of normal cells to the damaging effects (cells die/unable to divide)

  • external beam radiation aka teletherapy (radiation source external to client - no radiation emitted + no hazard to anyone else)
  • internal radiation aka brachytherapy (source comes in direct + continuous contact with tumor tissues, client emits radiation + is hazardous - capsules, seeds, microspheres)
  • permanent brachytherapy = radioactive elements inserted + remain in patient
  • temporary = radioactive material removed after minutes or days
  • unsealed radiation source: administration via oral/IV route (source enters body fluids + is eliminated via excreta within 48 hours - radioactive + harmful to others)

side effects: fatigue (most common), skin irritation, alopecia, altered taste

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13
Q

what is it

hematopoietic stem cell transplant

A

bone marrow transplantation + peripheral blood stem cell transplantation replace stem cells destroyed by chemo/radiation (needed to prevent infection + hemorrhage)

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14
Q

donor stem cell types

A

allogeneic: stem cell donor is usually sibiling/parent/someone with similar tissue type

synegeneic: cells from identical twin

autologous: person’s own stem cells are harvested during disease remission, stored + frozen

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15
Q

what it is + classifications

leukemia

A

group of hematological malignancies involving abnormal overproduction of leukocytes in bone marrow

classifiaction:
- acute lymphocytic leukemia: mostly lymphoblasts, age of onset younger than 15 years
- acute myelogenous leukemia: mostly myeloblasts, onset 15-39 years
- chronic myelogenous leukemia: mostly granulocytes in bone marrow, onset in 4th decade
- chronic lymphocytic leukemia: mostly lympocytes, onset after 50 years

16
Q

symptoms

leukemia

A
  • anorexia, fatigue, weakness, weight loss
  • anemia (decreased hemoglobin/hematocrit) - palpitactions, tachycardia, orthostatic hypotension, pallor + dyspnea
  • decreased platelet count - overt bleeding (nose/gums/rectal/hematuria), eccymoses + petechiae, prolonged bleeding
  • elevated temp
  • enlarged lymph nodes, spleen, liver
  • headache
  • bone pain/join swelling
  • positive bone marrow biopsy
17
Q

what is it

hodgkin’s lymphoma

A

abnormal proliferation of lymphocytes + malignancy of lymph nodes (usually involves lymph nodes, tonsils, spleen, bone marrow)

18
Q

multile myeloma

A

malignant proliferation of plasma cells in bone (invade bone marrow + destroy bone)
- decreased production of immiunoglobulin + antibodies, increased uric acid + calcium (can lead to kidneyy failure)

19
Q

cervical cancer treatments

A
  • laser therapy: vaporizes tissues
  • cyrosurgery: freezing tissues
  • conization: cone-shaped area of cervix is removed
  • hysterectomy
  • pelvic exenteration: removal of all pelvic contents (bowel, vagina, bladder) can be anterior/posterior/total, ileal conduit/colostomy may be needed
20
Q

risk factors

breast cancer

A
  • greater than 65 year
  • family history
  • early menarche, late menopause
  • previous breast/uterus/ovary cancer
  • nulliparity (no children)
  • late first birth
  • oral contraceptie use
  • hormone replacement therapy
  • obersity
21
Q
A
21
Q

risk factors

endometrial/uterine cancer

A
  • estrogen replacement therapy
  • birth control pills
  • IUD
  • nulliparity
  • polycystic ovary disease/endometrial hyperplasia
  • increased age
  • early menarche/late menopause
  • family history
  • obestiy
  • hypertension
  • diabetes mellitus
22
Q

risk factors

lung cancer

A
  • exposure to cigarette smoke
  • exposure to environmental/occupational pollutants
23
Q

what is it

contiuous bladder irrigation

A

three way irrigation is used to decrease bleeding + prevent clots (3 lumens, for balloon inflation + instillation + outflow)

interventions:
- urine must be kept pink, run rapidly if bright red/clots
- if obstructed turn off CBI + irrigate with normal saline

24
Q

oncological emergencies

A
  • sepsis - cancer at increases risk for infection + disseminated intravascular coagulation (can progress to hemorrhage)
  • syndrome of inappropriate ADH - tumors can secrete substances that mimic ADH (serum sodium levels decrease)
  • spinal cord compression - tumor enters spinal cord, vertebral column can collapse
  • hypercalcemia - from bone releasing calcium into bloodstream with metastasis
  • superior vena cava syndrome - vena cava is compressed by tumor
  • tumor lysis syndrome - large quantities of tumor cells are destroyed rapidly, potassium + uric acid are released faster than the body can eliminate them (can lead to acute kidney injury)
  • anemia - blood lacks healthy RBCs/hemoglobin (blood loss/faulty RBC production/RBC destruction)
  • iron-deficiency anemia: iron stores are depleted for hemoglobin manufacturing
  • vit b12 deficiency anemia: macrocytic anemia (RBCs too big), lack of intrinsic factor (secreted by gastric mucosa) needed for vit b12 absorption in intestines
  • folate-deficiency anemia: macrocytic anemia, RBCs too big + oval
  • aplastic anemia: deficiency of circulating erythrocytes
  • pancytopenia - deficiency of RBCs, leukocytes, thrombocytes
25
Q

antineoplastic meds (chemo)

A

kill/inhibit neoplastic cell reproduction, can be cell cycle phase specific meds (only affects cells during specific phase of reproduction cycle) or cell cycle phase nonspecific (works whenever)

26
Q

alkylating meds

A

break DNA helix (interfere with DNA replication)

nonspecific cell cycle phase

27
Q

antitumor antibiotic meds

A

interfere with DNA + RNA synthesis

nonspecific

28
Q

antimetabolite meds

A

halt synthesis of cell protein = no cell division

cycle specific - S phase

29
Q

mitotic inhibitor meds

A

no mitosis = dead cell

cell cycle phase specific - M phase

30
Q

topoisomerase inhibitor meds

A

block enzyme needed for DNA synthesis + cell division

cycle specific - G2 + S phase

31
Q
A
31
Q

hormonal meds + enzymes

A

suppress immune system + block normal hormones for hormone sensitive tumors, change hormonal balance + slow growth of certain tumors

32
Q

immunomodulator meds

A

stimulate immune system to recognize cancer cells + destroy them

33
Q

targeted therapy meds

A

monoclonal antibodies + small molecular inhibitors that target a cellular element of the cancer cell or antisense meds that work at gene level

nclex review (12 decks)

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