Oncology Part 2 Flashcards
Another name for INTERNAL radiation
Brachytherapy
Internal radiation is used to get the radiation where?
Close to the cancer or target tissue INSIDE the body
Does the client emit radiation during internal radiation?
YES and they are hazardous to others
Unsealed internal radiation causes the patient to emit radiation how?
How long is it radioactive?
How is it given?
Through body fluids
24-48 hours
IV or PO
Sealed/solid internal radiation causes the patient to emit radiation how?
How is it given?
Patient emits it! But the body fluids are not radioactive
By a permanent or temporary implant places close or inside the tumor
Assume that all radiation patients what in regards to NCLEX?
Are radioactive!!!!! SAFETY!
3 important things to think about when having a internal radiation patient
- Time - short visits
- Distance - as far as possible to get the task done
- Shieldling - lead shield if you have to be close
How should nursing assignments be with a patient who is getting internal radiation?
Rotate daily!! And a 1 given nurse should only get 1 client with an implant, per shift
Safety precautions for visitors of patients on internal radiation
Room? How long should visitors stay? How far away should they be form the patient? How old? Pregnant?
Private room Restrict visitors Limit each visitor to 30 min/day Must stay 6 feet away from source No visitors under 16 No pregnant people
Internal radiation: What do nurses wear? What are the parameters to follow?
A film badge
Don’t share this! Nurse needs to keep track of how much you’ve been exposed because it needs to be discarded after a certain amount of exposure
Always wear gloves when there is a risk of contact with body fluids
How to prevent internal radiation implant dislodgment? Diet?
Bed rest
Decrease fiber (don’t want to distend the bowel and push it out)
Prevent bladder distention (foley)
What do you do if implant falls out?
Gloves, forceps, call radiation person
What 4 things CAN’T a patient do after radiation for several days?
How many toilet flushes?
Sleep in bed with someone
Use public transportation
Return to work
Share utensils/cook for others
2-3 flushes
How is radiation given during external radiation?
Focused beam of high energy is delivered by a machine OUTSIDE of the body
Is an external radiation patient radioactive?
NO
WHERE are most side effects going to occur after external radiation?
What are they?
What are 2 factors that determine severity?
Usually limited to exposed areas - these areas are radiated multiple times within a few days
Erythema - inflammation Shedding of the skin Altered taste FATIGUE #1 Pancytopenia
Severity r/t location and dose (such as more hair loss with higher radiation to the head)
What is pancytopenia?
ALL blood components are decreased
Can you wash off the markings of external radiation?
Use lotion on them?
NO and NO unless ordered
How long should a patient protect themselves from UV radiation after external radiation?
1 Year
What 4 things does the oncologist consider when using chemotherapy?
- What cell cycle phase does the drug attack?
- How often the drug is given?
- Cell Growth fraction (% cells diving at a given time - the higher the better)
- Tumor burden - how much tumor is present?
How does regional chemo work?
Regional chemotherapy delivers the drug to a specific site
How often is chemo usually scheduled?
Every 3-4 weeks
May need to decrease the dose if the patient can’t tolerate it
What is cell-cycle specific chemo?
Chemo where drugs attack during a certain phase of the cell cycle
How do nonspecific chemo drugs work best?
Work best when the cell is at a resting phase
What are the 3 most common body systems affected by side effects of chemotherapy? Why?
- Blood system
- GI -N/V
- Integumentary - skin & hair
Cells divide more rapidly in these systems
What 5 ways can chemo exposure occur?
What is the NCLEX rule of thumb here?
Skin Mucous membrane Inhalation Accidentally injection Ingestion
*ALWAYS ASSUME THE WORST - FULL precautions with administration
What do chemo full precautions consist of?
Chemo/isolation gown
2 pairs of chemo gloves (thicker and longer, one pair under and one pair over the gown cuff)
Goggles or mask if splashing can occur
Chemo excretion PPE
Wear 2 pairs of gloves, a gown, and face shield if worried about splashing
How do you dispose of chemo?
What about sharps vs other disposables?
YELLOW chemo rigid waste container used for sharps, and IV containers
YELLOW chemo waste bag for gowns, gloves, and disposable
What to do if you spill chemo on yourself? How many times do you clean the space?
- Wash with soap/water
- Get spill kit
- Face mask - chemo can be inhaled!
- Gown
- Two pairs gloves
- Goggles
- Wipe up spill
- Space needs cleaned 3 times
Doxyrubicin risk
Cardiotoxicity - need ECG before administration for baseline
How are most chemo drugs delivered?
How else can they be given?
Do you need gloves this way?
IV via a port
YES - PO, wear gloves
What kind of chemo drug will cause tissue necrosis if it infiltrates?
What does this lead to?
Vesicant –> extravasation
What are S/S of extravasation?
Pain, swelling
NO blood return
Best way to prevent extravasation
Prevention!!!
What to do if your patient has extravasation
STOP infusion
STAY with patient
COLD packs - To promote vasoconstriction
CALL physician
Should you wear gloves when giving oral chemo? Why?
YES - can be absorbed through hands
How do Biologic Response Modifiers (BRMs) work?
How is this different than chemo?
They enhance/use our own immune system to fight and hope to kill the cancer
Chemo acts directly on the cancer to kill it
What is a common BRM?
What does it prevent?
HPV vaccine - cervical, anal, oral cancers
1 risk for cervical cancer
HPV
What kind of immunity does the HPV vaccine give us?
Active immunity because the body is having to actively make the antibodies
How does hormone therapy work?
Example?
It slows cancer growth
Ex: Tamoxifen
What is an example of a hormone used in cancer hormone therapy?
How does it work?
Corticosteroids - steroids can be used to increase the effectiveness of chemotherapy
Risk of taking steroids?
Decreased immunity, especially when taken for cancer
What are the primary treatments for hematologic cancers?
Why else might they be used?
Bone marrow and stem cell transplant
May be used as a rescue treatment with C/R destroy too many cells
What is the difference between bone marrow transplant and stem cell transplant?
Bone marrow: Stem cells are collected from bone marrow
Stem cell: Stem cells are collected from the blood stream
BOTH refer to stem cells!
Who can donate stem cells?
The patient themselves, a maternal/match donor, or identical twin
How are stem cells given?
How do they work?
Stem cells are given into a vein (like a blood transfusion) and over time they settle in the bone marrow and produce healthy blood cells
What are the 2 major complications of stem cell transplant?
GVHD
Infection - Most immunosuppressed patients we can get!!!
What is graft vs host disease (GVHD)?
How do we treat it?
The graft rejects or attacks the host (patient)
Give anti-rejection drugs and steroids
What are the main signs of GVHD?
Abdominal pain, cramps, N/V, diarrhea
Jaundice
Dark urine
Skin rash/itching/redness
2 most detrimental side effects to the patient from cancer or its treatment
Body image - alopecia, scarring, amputation, breast removal, weight gain/puffiness from steroids
Fatigue
What is the #1 cause of cancer related deaths?
INFECTION - Need to treat ASAP
General ways to prevent infection in cancer patients
Private room, had washing, own supplies (tools, cups, etc), limit visitors/nurses, coughing and deep breathing, no fresh flowers/plants, avoid crowds, avoid raw fruits/veggies, only drink fresh water - old water if sitting out for more than 15 mins
Change dressings and IV tubing daily, don’t share toiletries, bathe moist areas twice a day (groin and underarms)
What could a slight increase and temperature indicate in this patient?
When should you tell your clients to come into the hospital?
Key thing to consider with this?
Sepsis!!
Come in for a temp greater than 100.4
*Look for lower increases too because immunosuppressed patients don’t usually have a spike in temp
What is the best way to assess neutropenia?
What is normal?
Absolute Neutrophil Count (ANC) - how many WBCs are neutrophils
Normal: 2200-7700 cells/mm3
What is Nadir?
What does it lead to if untreated?
The lowest point of neutrophils
Sepsis, Septic Shock, Death
TREAT RIGHT AWAY
What are the risk factors for neutropenia?
Old and young age Malnourished B12 and Folic acid deficiency Impaired tissue integrity Presence of other disease/cancer/cancer treatment
6 important components of neutropenic precautions
Vitals? Room? Hand washing? Invasive precautions? What drug is not good?
Prophylactic antibiotics
- VS q4 minimum
- Private room, door closed w/ sign
- Antimicrobial soap - not just regular soap
- No invasive procedures (IM meds, rectal exam/meds)
- Limit Acetaminophen - Can cover S/S fever or infection
Can a neutropenic patient have an indwelling catheter and NG tube?
NO!!! These are invasive!
What is the second leading cause of death in cancer patients?
What is this due to?
DVT (VTE)
Bed rest, surgery, using a central line, tumors that compress vessels or invade them, certain chemo drugs
Biggest risk of having DVT
A PE!
What are the risk factors for thrombocytopenia?
Advanced metastatic disease/ Hematologic malignancies
Bleeding disorders (Hemophilia, liver disease, Idiopathic thrombocytopenia purpura)
Bacterial infections
Anti-coagulants
Result of cancer treatments
What is the biggest risk of having low platelets?
BLEEDING!
What are important things to include in an assessment of a thrombocytopenia patient?
Hx, VS, pulse ox
Change in LOC - HA, pupils (indicate head bleed)
Conjunctival hemorrhages (bloodshot)
Petechiae, ecchymosis, purpura
Oozing from puncture of surgical sites
Bleeding form rectum, ears, nose, or mouth
How to treat low platelets?
How does this work?
Platelet transfusion - these control or prevent bleeding
When are RBC transfusions given in cancer patients?
When patients have symptomatic anemia
At what level of Hbg/hct do we need to give RBCs?
What is normal?
Below 8 hgb (normal 11-17)
Below 24% Hct (normal 35-50)
What is an important factor to check when giving RBC or platelets to cancer patients?
What to we do to prevent this?
They need to be cytomegalovirus (CMV) NEGATIVE - this is a type of herpes virus that we worry about with transmission to a fetus
About 50% of donated blood has this!
We test the blood and do a leukoreduction to make it safe
Never infuse ____ platelets!!
Why?
How should they be administered?
NEVER INFUSE COLD PLATELETS! They spleen will reject them
They need to be room temperature
How they will reduce the risk of transfusion related reactions when giving blood?
Irradiate the blood
What is the most feared SE of chemo and often radiation?
N/V
Medications to treat nausea
Ondansetron (Tron agents block serotonin effects) - give before each treatment
Netupitant/palonosetron (1 dose to prevent acute or delayed N/V)
Nonpharmacologic treatments for nausea
Ginger
Aromatherapy - ginger, lavender, lemon, basil, weed
Behavioral therapies -Relaxation/distraction
Acupuncture
Treating pain regarding cancer
Treat WITHOUT regards for dependance
Gold standard for pain management
Opioids - There is no ceiling with these patients and it is client dependent
What is pain most often due to in cancer patients?
Tumor involvement
Treatment - mucositis or peripheral neuropathy
