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NCLEX > Oncology Part 2 > Flashcards

Oncology Part 2 Flashcards

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1
Q

Another name for INTERNAL radiation

A

Brachytherapy

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2
Q

Internal radiation is used to get the radiation where?

A

Close to the cancer or target tissue INSIDE the body

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3
Q

Does the client emit radiation during internal radiation?

A

YES and they are hazardous to others

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4
Q

Unsealed internal radiation causes the patient to emit radiation how?
How long is it radioactive?
How is it given?

A

Through body fluids
24-48 hours
IV or PO

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5
Q

Sealed/solid internal radiation causes the patient to emit radiation how?
How is it given?

A

Patient emits it! But the body fluids are not radioactive

By a permanent or temporary implant places close or inside the tumor

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6
Q

Assume that all radiation patients what in regards to NCLEX?

A

Are radioactive!!!!! SAFETY!

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7
Q

3 important things to think about when having a internal radiation patient

A
  1. Time - short visits
  2. Distance - as far as possible to get the task done
  3. Shieldling - lead shield if you have to be close
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8
Q

How should nursing assignments be with a patient who is getting internal radiation?

A

Rotate daily!! And a 1 given nurse should only get 1 client with an implant, per shift

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9
Q

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?
A 
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
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10
Q

Internal radiation: What do nurses wear? What are the parameters to follow?

A

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

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11
Q

How to prevent internal radiation implant dislodgment? Diet?

A

Bed rest
Decrease fiber (don’t want to distend the bowel and push it out)
Prevent bladder distention (foley)

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12
Q

What do you do if implant falls out?

A

Gloves, forceps, call radiation person

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13
Q

What 4 things CAN’T a patient do after radiation for several days?

How many toilet flushes?

A

Sleep in bed with someone
Use public transportation
Return to work
Share utensils/cook for others

2-3 flushes

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14
Q

How is radiation given during external radiation?

A

Focused beam of high energy is delivered by a machine OUTSIDE of the body

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15
Q

Is an external radiation patient radioactive?

A

NO

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16
Q

WHERE are most side effects going to occur after external radiation?
What are they?
What are 2 factors that determine severity?

A

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)

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17
Q

What is pancytopenia?

A

ALL blood components are decreased

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18
Q

Can you wash off the markings of external radiation?

Use lotion on them?

A

NO and NO unless ordered

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19
Q

How long should a patient protect themselves from UV radiation after external radiation?

A

1 Year

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20
Q

What 4 things does the oncologist consider when using chemotherapy?

A
  1. What cell cycle phase does the drug attack?
  2. How often the drug is given?
  3. Cell Growth fraction (% cells diving at a given time - the higher the better)
  4. Tumor burden - how much tumor is present?
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21
Q

How does regional chemo work?

A

Regional chemotherapy delivers the drug to a specific site

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22
Q

How often is chemo usually scheduled?

A

Every 3-4 weeks

May need to decrease the dose if the patient can’t tolerate it

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23
Q

What is cell-cycle specific chemo?

A

Chemo where drugs attack during a certain phase of the cell cycle

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24
Q

How do nonspecific chemo drugs work best?

A

Work best when the cell is at a resting phase

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25
Q

What are the 3 most common body systems affected by side effects of chemotherapy? Why?

A
  1. Blood system
  2. GI -N/V
  3. Integumentary - skin & hair

Cells divide more rapidly in these systems

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26
Q

What 5 ways can chemo exposure occur?

What is the NCLEX rule of thumb here?

A 
Skin
Mucous membrane
Inhalation
Accidentally injection
Ingestion

*ALWAYS ASSUME THE WORST - FULL precautions with administration

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27
Q

What do chemo full precautions consist of?

A

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

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28
Q

Chemo excretion PPE

A

Wear 2 pairs of gloves, a gown, and face shield if worried about splashing

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29
Q

How do you dispose of chemo?

What about sharps vs other disposables?

A

YELLOW chemo rigid waste container used for sharps, and IV containers

YELLOW chemo waste bag for gowns, gloves, and disposable

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30
Q

What to do if you spill chemo on yourself? How many times do you clean the space?

A
  1. Wash with soap/water
  2. Get spill kit
  3. Face mask - chemo can be inhaled!
  4. Gown
  5. Two pairs gloves
  6. Goggles
  7. Wipe up spill
  8. Space needs cleaned 3 times
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31
Q

Doxyrubicin risk

A

Cardiotoxicity - need ECG before administration for baseline

32
Q

How are most chemo drugs delivered?
How else can they be given?
Do you need gloves this way?

A

IV via a port

YES - PO, wear gloves

33
Q

What kind of chemo drug will cause tissue necrosis if it infiltrates?
What does this lead to?

A

Vesicant –> extravasation

34
Q

What are S/S of extravasation?

A

Pain, swelling

NO blood return

35
Q

Best way to prevent extravasation

A

Prevention!!!

36
Q

What to do if your patient has extravasation

A

STOP infusion
STAY with patient
COLD packs - To promote vasoconstriction
CALL physician

37
Q

Should you wear gloves when giving oral chemo? Why?

A

YES - can be absorbed through hands

38
Q

How do Biologic Response Modifiers (BRMs) work?

How is this different than chemo?

A

They enhance/use our own immune system to fight and hope to kill the cancer

Chemo acts directly on the cancer to kill it

39
Q

What is a common BRM?

What does it prevent?

A

HPV vaccine - cervical, anal, oral cancers

40
Q

1 risk for cervical cancer

A

HPV

41
Q

What kind of immunity does the HPV vaccine give us?

A

Active immunity because the body is having to actively make the antibodies

42
Q

How does hormone therapy work?

Example?

A

It slows cancer growth

Ex: Tamoxifen

43
Q

What is an example of a hormone used in cancer hormone therapy?
How does it work?

A

Corticosteroids - steroids can be used to increase the effectiveness of chemotherapy

44
Q

Risk of taking steroids?

A

Decreased immunity, especially when taken for cancer

45
Q

What are the primary treatments for hematologic cancers?

Why else might they be used?

A

Bone marrow and stem cell transplant

May be used as a rescue treatment with C/R destroy too many cells

46
Q

What is the difference between bone marrow transplant and stem cell transplant?

A

Bone marrow: Stem cells are collected from bone marrow

Stem cell: Stem cells are collected from the blood stream

BOTH refer to stem cells!

47
Q

Who can donate stem cells?

A

The patient themselves, a maternal/match donor, or identical twin

48
Q

How are stem cells given?

How do they work?

A

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

49
Q

What are the 2 major complications of stem cell transplant?

A

GVHD

Infection - Most immunosuppressed patients we can get!!!

50
Q

What is graft vs host disease (GVHD)?

How do we treat it?

A

The graft rejects or attacks the host (patient)

Give anti-rejection drugs and steroids

51
Q

What are the main signs of GVHD?

A

Abdominal pain, cramps, N/V, diarrhea
Jaundice
Dark urine
Skin rash/itching/redness

52
Q

2 most detrimental side effects to the patient from cancer or its treatment

A

Body image - alopecia, scarring, amputation, breast removal, weight gain/puffiness from steroids

Fatigue

53
Q

What is the #1 cause of cancer related deaths?

A

INFECTION - Need to treat ASAP

54
Q

General ways to prevent infection in cancer patients

A

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)

55
Q

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?

A

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

56
Q

What is the best way to assess neutropenia?

What is normal?

A

Absolute Neutrophil Count (ANC) - how many WBCs are neutrophils

Normal: 2200-7700 cells/mm3

57
Q

What is Nadir?

What does it lead to if untreated?

A

The lowest point of neutrophils

Sepsis, Septic Shock, Death
TREAT RIGHT AWAY

58
Q

What are the risk factors for neutropenia?

A 
Old and young age
Malnourished
B12 and Folic acid deficiency
Impaired tissue integrity
Presence of other disease/cancer/cancer treatment
59
Q

6 important components of neutropenic precautions

Vitals?
Room?
Hand washing?
Invasive precautions?
What drug is not good?
A

Prophylactic antibiotics

  1. VS q4 minimum
  2. Private room, door closed w/ sign
  3. Antimicrobial soap - not just regular soap
  4. No invasive procedures (IM meds, rectal exam/meds)
  5. Limit Acetaminophen - Can cover S/S fever or infection
60
Q

Can a neutropenic patient have an indwelling catheter and NG tube?

A

NO!!! These are invasive!

61
Q

What is the second leading cause of death in cancer patients?
What is this due to?

A

DVT (VTE)

Bed rest, surgery, using a central line, tumors that compress vessels or invade them, certain chemo drugs

62
Q

Biggest risk of having DVT

A

A PE!

63
Q

What are the risk factors for thrombocytopenia?

A

Advanced metastatic disease/ Hematologic malignancies

Bleeding disorders (Hemophilia, liver disease, Idiopathic thrombocytopenia purpura)

Bacterial infections
Anti-coagulants

Result of cancer treatments

64
Q

What is the biggest risk of having low platelets?

A

BLEEDING!

65
Q

What are important things to include in an assessment of a thrombocytopenia patient?

A

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

66
Q

How to treat low platelets?

How does this work?

A

Platelet transfusion - these control or prevent bleeding

67
Q

When are RBC transfusions given in cancer patients?

A

When patients have symptomatic anemia

68
Q

At what level of Hbg/hct do we need to give RBCs?

What is normal?

A

Below 8 hgb (normal 11-17)

Below 24% Hct (normal 35-50)

69
Q

What is an important factor to check when giving RBC or platelets to cancer patients?

What to we do to prevent this?

A

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

70
Q

Never infuse ____ platelets!!
Why?
How should they be administered?

A

NEVER INFUSE COLD PLATELETS! They spleen will reject them

They need to be room temperature

71
Q

How they will reduce the risk of transfusion related reactions when giving blood?

A

Irradiate the blood

72
Q

What is the most feared SE of chemo and often radiation?

A

N/V

73
Q

Medications to treat nausea

A

Ondansetron (Tron agents block serotonin effects) - give before each treatment

Netupitant/palonosetron (1 dose to prevent acute or delayed N/V)

74
Q

Nonpharmacologic treatments for nausea

A

Ginger
Aromatherapy - ginger, lavender, lemon, basil, weed
Behavioral therapies -Relaxation/distraction
Acupuncture

75
Q

Treating pain regarding cancer

A

Treat WITHOUT regards for dependance

76
Q

Gold standard for pain management

A

Opioids - There is no ceiling with these patients and it is client dependent

77
Q

What is pain most often due to in cancer patients?

A

Tumor involvement

Treatment - mucositis or peripheral neuropathy

NCLEX (23 decks)

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