Oncology/Palliative Care

Question 1

What is carcinogenesis

Answer 1

3 step process of malignant transformation
1. Initiation: carcinogens cause mutation in cellular DNA and escape protective mechanisms resulting in permanent cellular mutations
2. Promotion: altered cells have repeated exposure to promoting agents (co-carcinogens) which cause proliferation and expansion of cells
3. Progression: altered cells exhibit malignant beh

Question 2

Causes of carcinogenesis

Answer 2

Viruses and bacteria
Physical agents
Chemicals
Genetics
Lifestyle
Hormones

Question 3

Primary prevention of cancer

Answer 3

Reduces risks of dz through health promotion and risk reduction
Ex. immunizations for HPV and HBV vaccines

Question 4

Secondary prevention of cancer

Answer 4

Screening and early detection to identify pre-cancerous lesions and early-stage cancer in asymptomatic pt
Ex. colonoscopy, pap smears

Question 5

Tertiary detection and prevention

Answer 5

Monitoring and prevention of recurrence of primary cancer
Ex. cancer pt are assessed for secondary malignancies such as lymphoma and leukemia

Question 6

Diagnosis of cancer

Answer 6

Physical assessment
Imaging studies (CT, mammogram, MRI, PET)
Lab tests (PSA, FOBT, Tumor marker)
Procedures (pap smear, colonoscopy, bronchoscopy)
Pathologic analysis (biopsy)

Question 7

Staging of cancer

Answer 7

Includes tumor size, local invasion, lymph node involvement, distant metastasis

Question 8

Grading of cancer

Answer 8

The pathologic classification of tumor cells, describes the level of differentiation from the original tissue the cells originated from

Question 9

Goals of treatment of cancer

Answer 9

Cure
Eradication of malignant dz
Control of growth
Palliation (alleviating symptoms)

Question 10

External beam radiation therapy (ERBT)

Answer 10

Most common form of radiation
Rays penetrate the body and target tumor with pinpoint accuracy based on mapping from imaging
Proton therapy-newer target ERBT approach

Question 11

Internal radiation

Answer 11

Localized implantation (brachytherapy)
Systemic radionuclide administration

Question 12

Caring for pt with radioactive implant

Answer 12

Follow specific instructions from radiology department regarding: maximum time to be spent with patient, shielding equipment, special precautions
Pt in private room
Posting signage regarding radiation precautions
Pregnant women are not assigned to care for pt
Prohibiting children
Limiting visitors to 30 minute daily visits
Maintaining 6-feet distance

Question 13

Radiation toxicity

Answer 13

Altered skin integrity: alopecia, radiomastititis
Altered oral mucosa: stomatitis, decreased salivation and xerostomia, change in taste, mucositis
Alteration in bone marrow: anemia, leukopenia, thrombocytopenia
Systemic effects: fatigue, malaise, anorexia
Late effects: occur 6 months to years after treatment
-fibrosis, atrophy, ulceration, necrosis

Question 14

Chemotherapy

Answer 14

Antineoplastic drugs to kill cancer cells- non specific
Treatment of systemic dz rather than localized tumor
Often combined with other types of treatment
Goals: cure, control, or palliative
Chemotherapy drugs are classified based on their MOA and how they affect cell cycle
May be given with chemo protectant medications
Can be given in a variety of settings with various routes of administration
Accurate dosing is a major safety concern

Question 15

Complications of chemotherapy administration

Answer 15

Extravasation: irritant vs vesicant
Hypersensitivity rxn
Chemo toxicities

Question 16

Chemo toxicity

Answer 16

GI tract: nausea and vomiting, stomatitis
Hematopoietic: myelosuppression (depression of bone marrow fxn)
Renal system: many chemo drugs can cause nephrotoxicity, SIADH, renal damage from tumor lysis, hemorrhagic cystititis
Cardiopulmonary: cardiac toxicity, pneumonitis, pulmonary fibrosis
Reproductive: infertility problems, early menopause
Neurologic: encephalopathy, peripheral neuropathy, muscle weakness, loss of balance/coordination, “chemo brain”
Fatigue

Question 17

Safely administering chemotherapy

Answer 17

Nurses are at risk when administering chemotherapy and safety is a top priority
Follow policy and procedures regarding PPE, handling, disposal, and management of spills/exposures
Emergency spill kit should be readily available where chemotherapy is administered

Question 18

Hematopoietic stem cell transplant

Answer 18

Most commonly treats hematologic malignancies (myeloma, leukemia, lymphoma)
Stem cells are collected from pt or donor, the cells are processed and re-infused into the pt
Different types of stem cell transplants
Post stem cell transplant complications vary based on type

Question 19

Immunotherapy

Answer 19

Mediations or biochemical mediators that stimulate or suppress components of the immune system to kill cancer
Significant advances in treatment options which have increased survival for pts
Monitor for immune mediated complications/side effects

Question 20

Targeted therapies

Answer 20

Use agents to kill or prevent the spread of cancer cells by targeting a specific part of the cell
Have less side effects on healthy cells than chemotherapy
A “personalized” approach to treatment of pt’s cancer

Question 21

Nursing management: stomatitis

Answer 21

Most common in pts receiving combination therapy and head and neck cancer diagnosis
Leads to dysphagia, decreased PO intake, infection
Assessment: oral cavity, dehydration, malnutrition
Treatment: oral hygiene, mouth rinses (biotin, salt/baking soda rinse), magic mouth wash, cryotherapy during infusions
Cancer treatments may be put on hold to allow for healing

Question 22

Nursing management: skin integrity

Answer 22

Assess for skin and educate pt to notify provider of any new rashes, pruritis, lesions
Radiation dermatitis: keep skin clean, alleviate pain, prevent infection and promote a moist wound healing environment
Educate to avoid sun exposure and use of wearing sunscreen
Avoidance of long hot showers/baths

Question 23

Nursing management: alopecia

Answer 23

Education: timeline of hair loss, type of hair loss (thinning/total/permanent), hair regrowth
Psychosocial: body image, self esteem, loss of control, depression
Cold cap therapy
Community resources/financial assistance

Question 24

Nursing management: nutrition

Answer 24

Treat underlying cause (ex. nausea/vomiting/diarrhea)
Speech therapy/nutritional consult
Appetite stimulants: megestral acetate or corticosteroids
Enteral & parenteral nutrition
Encourage small, high calories/high protein snacks/meals

Question 25

Nursing management: pain

Answer 25

Cancer pain may be acute or chronic
Influenced physical, psychosocial, cultural/spiritual factors
May be direct or indirectly related to diagnosis
Pain often indicates progression of dz
Assess pain, use OLDCART
Pain regimen varies by pt and dz process- changes throughout diagnosis and treatment plan
Use pharmacologic and non-pharmacologic measures to alleviate pain

Question 26

Nursing management: fatigue

Answer 26

Fatigue can interfere with ADLs for months to years after diagnosis/treatment
Acute fatigue vs cancer-related fatigue
Fatigue is very subjective
Management: encourage exercise and periods of rest, treat underlying cause

Question 27

Potential complications: infection

Answer 27

Monitor for s/s of infection closely
Monitor CBC with differential
Nadir visits
Prophylactic antibiotics/antivital medications
Notify provider if temp greater than 100.4
Diagnostics: blood cultures, chest x-ray, UA/UC
Will be started on broad spectrum ABX until cultures result
Pt are at high risk for sepsis/septic shock
Implement neutropenic precautions

Question 28

Potential complication: coagulation

Answer 28

Risk for bleeding: throbocytopenia, monitor CBC, assess pt for s/s of bleeding
Risk for clotting: related to pre-existing condition or cancer related, treatment, hospitalization, surgery, debilitation, peripheral/central catheter placement, assess for s/s of DVT, PE, superficial venous thrombosis

Question 29

Oncologic emergencies

Answer 29

Super vena cava syndrome
Spinal cord compression
Hypercalcemia
Tumor lysis syndrome