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2229 > Oncology Nursing > Flashcards

Oncology Nursing Flashcards

1
Q

What is cancer?

A

Malignant neoplasms
More than 100 different types of cancers
Refers to diseases where abnormal cells divide without control + are able to invade other tissues

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2
Q

What are cancer cells derived from?

A

They are derived from normal cells that have undergone neoplastic transformation
This is an irreversible process leading to transformation of healthy cell to cancer cell

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3
Q

What are the two characteristics of cancer cells?

A

Uncontrolled proliferation + uncontrolled spread

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4
Q

What is the growth fraction of tumour cells

A

The ratio of the total number of cells to the number of dividing cells
So; the ↑ the growth fraction the more rapidly tumour mass ↑

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5
Q

What is doubling time of tumour cells?

A

The time taken for the tumour to double its volume
Average time for solid tumours being 2-3 months

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6
Q

When are tumours clinically detectable?

A

When they have doubled around 30 times
About 1 Cm in size + 1 gram in weight

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7
Q

What is the Gompertzian Tumour Growth Curve?

A

Describes the decrease in cell doubling time as tumour progression occurs
Useful in describing tumour response to treatments

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8
Q

what is metastasis?

A

Cancer cells invade lymph nodes + blood vessels near a tumour + spread to other parts of the body
Cancer cells have the capacity to intravasate and extravasated, or enter and leave the circulatory + lymphatic systems

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9
Q

Describe the metastatic cascade

A

Tumour initiation → progression of primary tumour → proliferation → cells detach + enter the bloodstream or lymphatic system → successfully evade immune system → invasion / intravasation → extravasation → angiogenesis → colony formation

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10
Q

What is clinical distress related to?

A

Disease status, treatment to.seance, symptom intensity and frequency, lifestyle effects of symptom intensity and frequency, quality of life,

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11
Q

Examples of psychosocial problems in cancer patients and family

A

Adjustment to illness and changes in care, feeling isolated from family, family conflict , decreased quality of life, decisions around advanced care directives, abuse/ neglect, coping difficulties (overwhelmed, irritable and angry, inability to cope with pain, fatigue and nausea), mental health issues, disturbances in body image, sexual problems

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12
Q

Treatments for psychosocial problems

A

Education materials, support and education groups, resource lists, community resources, relationship counselling, grief counselling
Patient counselling, psychotherapy, medication, community responses

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13
Q

Examples of practical problems

A

Transportation issues and parking costs, financial issues, school problems, food/ clothing problems

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14
Q

Treatments for practical problems

A

Education, support groups, counselling for patients and family

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15
Q

Describe supportive care

A

Facilitating a patient or family with the necessary services that they require to meet their physical, social, emotional, informational, psychological, spiritual and practical needs during the journey of a cancer patient

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16
Q

Risk factors that increase the likelihood of heightened emotional distress

A

Being very old or very young, being single, separated, widowed, female, having children younger than 21, past psychiatric treatment, having cognitive impairment

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17
Q

What is involved in screening + triage of a cancer patients + families journey

A

Adequate level of care for level of distress of family + pt
Referral to services required by pt
Education, peer support, counselling

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18
Q

What are the key principles of supportive care?

A

Person centred, system wide + team approach, developing + supporting the workforce to improve their ability to respond to the needs of cancer patients, focus on quality of care by providing evidence based protocols etc, population based planning to identify needs of population

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19
Q

Barriers to the delivery of psychosocial care

A

Do not have access to care (geographically), lack health insurance / coverage that includes mental Health Services, do not ask for help due to stigma, patient-provider miscommunication, inexperience, poor coordination of complex care

20
Q

What are oncogenes?

A

The mutated form of proto-oncogenes, which are the normal growth promoting genes (growth factor, cell survival genes, cell cycle controlling genes)
They become oncogenes when inappropriately activated by mutations in themselves or other genes controlling them
When mutation occurs, the resulting oncogene causes excessive production of growth factors responsible for tumourorigenesis

21
Q

What are some mediators of cell growth?

A

PDGF - platelet derived growth factor = one of the numerous proteins that regulate cell growth and division
EGF- epidermal growth factors = protein with 53 amino acid residues and 3 intramolecular disulphide bonds, plays role in cell growth and proliferation
TGF - transforming growth factor = role in tissue development, cell differentiation, embryonic development
VEGF - vascular endothelial growth factor = signal protein involved in angiogenesis

22
Q

what are some tumour suppressor genes?

A

Function by encoding proteins that block growth promoting proteins, when function is lost uncontrolled growth occurs, so when mutation occurs in tumour suppressor gene, the cell loses its switch off and the cell growth continues with a cease, most common one is in the p53 gene

23
Q

What are the staging systems of cancer diagnosis?

A

TNM
T- tumour = size and extent of primary tumour
N - nodes = number of nearby lymph nodes that contain cancer cells
M - metastasis = spread to other sites

24
Q

Describe breast screen

A

Women aged over 40 (focus 50-69)

25
Q

What is the forefront concept in providing exemplary cancer care?

A

Multidisciplinary care - focuses on continuity of care, development of care pathway and referral networks, and involving the multidisciplinary team at all stages of care

26
Q

What are the benefits of having multidisciplinary meetings?

A

Clinician benefits through positive outcomes because of improved communication, education + cooperation, patient benefits as they know their treatment providers are working as a team

27
Q

Chemotherapy side effects

A

Fatigue, nausea, vomiting, pain or soreness, sores in throat or mouth, changes to skin (itch, red, dry, acne), diarrhoea, constipation, weight gain / loss, hair loss, change to libido, change to concentration + memory, emotional changes, blood cell disorders ( result in anaemia, dizziness, SOB, ↑ risk infection, effects on nervous system ( tingling, burning)

28
Q

Side effects of radiotherapy

A

Skin problems (dryness, itch, peeling, blistering), fatigue
Other potential side effects depend on where radiation is given:
Head / neck → dental problems
Chest → stiffness
Stomach + belly → nausea, vomit, diarrhoea
Pelvis → diarrhoea, urination problems, reproductive problems

29
Q

What is the order of cancer treatment?

A

Neo-adjuvant treatment → all treatments that are administered before primary cancer treatment ( eg radiotherapy/chemo before surgery)
Adjuvant treatment → therapy administered after primary treatment ( eg chemo administered after radiation)

30
Q

What is the goal of multimodal treatment approach to cancer treatment?

A

Increase effectiveness of treatment whilst minimising the adverse effect of primary treatment

31
Q

What is chemotherapy?

A

Targets rapidly dividing cells, works by interfering with the process of DNA replication or by damaging DNA so the cell must undergo apoptosis
It cannot distinguish between normal + malignant cells

32
Q

What is the cell kill hypothesis?

A

States that a chemo concentration given for a defined period of time kills a constant fraction of cells in the population, independent of the number of cells
Therefore repeated doses must be administered to reduce size of tumour
This fractional killing is due to the cell-cycle specificity of chemo

33
Q

Classifications of chemo according to cell cycle activity

A

Cell cycle specific → agents act on cells in a specific phase, most effective against rapidly growing cancer
Cell cycle non-specific → agents act on cells no matter what phase of cell cycle they are in, because they are in effect in resting phase (G0) they are effective against slow growing tumours + rapidly dividing tumours

34
Q

Why is chemo given in cycles?

A

Gives normal cells time to recover between doses

35
Q

What occurs due to bone marrow suppression?

A

Anaemia ( low RBC count) → less oxygen carried around body, pt becomes fatigued, SOB, tachycardia + anaemic
Lencapenia ( low white blood cell count) → WBC fight infection so pt can become immunocompromised
Thrombocytopenia (low platelet count) → function of platelets to maintain homeostasis, pt at risk of bruising + bleeding

36
Q

What is radiation therapy?

A

Uses ionising radiation to destroy or deactivate cancer cells, while attempting to preserve the integrity of normal tissue
Ionising radiation kills by damaging the nucleus of cells which in turn damages DNA synthesis → causes cells to lose their ability to reproduce

37
Q

Side effects of radiotherapy

A

Depend on area being treated, volume of tissue, fractionation + total dose, type of radiation, health + age of individual
Risk of fatigue + skin reactions

38
Q

What is internal radiotherapy ?

A

Gives radiation from inside the body, delivers high dose of radiation with fewer side effects than external radiotherapy

39
Q

What is external radiotherapy?

A

A beam of radiation is pointed at a specific part of the body and radiation is applied to that part of the body/from the outside, does not make a person radioactive

40
Q

What are the 5 ontological emergencies that patients are at risk of developing

A

Neutropenia sepsis
Spinal cord compression
Tumour lysis syndrome
Superior vena cava obstruction
Hyperglycaemia

41
Q

What is superior vena cava obstruction / syndrome

A

Causes: bronchogenic carcinoma, small cell lung cancer, squamous cell lung cancer, lymphoma
Symptoms: facial oedema, periorbital oedema, distension of veins in head + neck + chest, headache
Risk increased by CVC insit, previous radiotherapy to mediastinum

42
Q

What is spinal cord compression?

A

Usually caused by malignant tumour in epidural space
Usually associated with breast, lung, GI, renal tumours + melanoma
Symptoms: intense, localised back pain, vertebral tenderness, motor weakness / dysfunction, paraesthesia, autonomic dlysfunctor

43
Q

What is tumour lysis syndrome?

A

Large tumours that are rapidly growing, their intercellular contents(K DNA etc) released due to cellular breakdown which leads to hyperuricemia, hype-phosphatemia, hypercalcemia + hyperkalemia
Symptoms → weakness, muscle cramps, diarrhoea, nausea + vomiting
Prophylaxis → aggressive hydration , strict FBC to maintain renal function, allopurinol administration ( reduce uric acid crystallisation), blood + urine monitoring
If TLS + allopurinol replaced with rasburicase

44
Q

What is hypercalaemia?

A

Caused by metastatic bone disease, multiple myeloma or parathyroid hormone like substance secreted by cancer cells
Symptoms → apathy, fatigue, muscle weakness, ECG changes, polyuria + nocturia , anorexia, nausea + vomit
Treat → hydration + bisphosphonates

45
Q

What is neutropenic sepsis?

A

Most common oncological emergency + leading cause of acute deterioration
Neutrophils → type of granular WBC, vulnerable to cytotoxic agents
With out enough neutrophils pt are susceptible to infection + severity of sepsis
Every hour the pt remains untreated = higher mortality rate

46
Q

How to respond to an oncological emergency

A

Nurse in single room
Recognise deterioration → pt assessment
React / respond → early intervention, MET call, antibiotics, fluid resus, investigation (blood, CXR MSU)
Review → frequent monitoring

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