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202B > pt with cancer modalities > Flashcards

pt with cancer modalities Flashcards

1
Q

what are the 4 major types of tx for cancer

A
  • surgical removal (debulking) of a tumor
  • chemo
  • radiation
  • biological therapy
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2
Q

what is the goal of sx for cancer

A
  • remove the cancer

- spare as much normal tissue as possible

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3
Q

what types of sx are done with cancer

A
  • biopsies- definitive diagnosis
  • rehabilitation/reconstructive
  • supportive care- catheters feeding tubes
  • preventional - removal of nonvital organs
  • liative- Palliative- reduce the sxs without curing
  • exploritory laparotomy - “surgical staging”
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4
Q

what is surgical staging

A

when the pt has pain or other problems and the md cannot figure out what is causing it. an exploratory laparotomy may be done to get a visual of what is going on

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5
Q

what does chemo therapy offer

A

cure
control
palliative care

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6
Q

what is chemo used to treat

A
  • liquid tumors- such as leukemia, lymph cancers.

- solid tumors

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7
Q

what is the goal of chemo

A

to destroy majority of cancer cells and micrometastasis leaving remainder to be destroyed with normal immune processes

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8
Q

how does chemo work

A

damages the DNA and interferes with cell division

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9
Q

what is the mitotic index

A

the actual # of cells in the M phase (the phase when the cell divides into 2 daughter cells)

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10
Q

when is chemo most effective

A

when the greatest number of cells are dividing

when the mitotic index is high

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11
Q

what are the 2 major categories of chemo

A

cell cycle non specific
and
cell cycle specific

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12
Q

what is the cell cycle non specific

A

cyotoxic in ANY phase of cell growth

effective with large slow growing tumors

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13
Q

what is the cell cycle speicific

A

destroys cells that are actively dividing.

effective with rapidly growing tumors

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14
Q

what are we going for when combining cell cycle specific and non specific

A

to get a synergistic effect
to be more effective than a single agent

hoping to get rid of as many cancer cells as possible in the shortest amount of time

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15
Q

what does chemo success depend on

A

-general health of the pt.
(comorbidities, bad habits, overweight, etc. )

types and stage of breast cancer
growth rate of cancer
development of drug resistance

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16
Q

what is methotrexate

A

a cell cycle specific med.
an antimetabolite
works in the S phase(inhibits DNA synthesis)

used for sarcoidosis

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17
Q

what is cytoxin

A

a cell cycle non specific
an alkylating agent (most beneficial in the resting phase)

it is used to prevent rejection of organs.

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18
Q

what is the nurses role in chemotherapy

A
  • educating the patient and reinforcing the info the dr has given to the pt
  • what to expect
  • educate about chemo meds
  • IV access- watch for extravation
  • know the potential toxicity to the pt and the RN
  • teach the pt to know the signs of reaction to chemo and to alert if they experience those sxs
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19
Q

what do we want to do prior to administering chemo

A

give anti nausea meds
analgesics for discomfort
IV hydration to prevent kidneys becoming damaged

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20
Q

how are chemo agents absorbed

A
  • inhalation and skin contact.
  • body fluids also carry risk
  • cover toilet when flushing
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21
Q

what do you need to do when drawing up chemo meds

A

be under a laminar hood

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22
Q

how do you handle a chemo spill

A

hazardous waste spill protocol

-special kits and specific personnel to clean up

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23
Q

how do you dispose chemo products

A
  • sealed special chemo bags
  • discard into chemo receptacles
  • wear the gloves in the chemo kit- usually are thicker - or you can double glove.
  • wash hands after disposal.
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24
Q

what does hormonal manipulation and what is the med

A

Tamoxifen

it blocks the hormones that regulate tumor growth

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25
Q

how does anti tumor abx work and what is the med

A

Bleomycin

it interferes with DNA of a tumor
good for squamous cell ca

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26
Q

how do corticosteroids work in cancer

A

disrupt cell membranes of tumors

dexamethasone
good for leukemia

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27
Q

what is the most distressing side effect of chemo

A

fatigue

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28
Q

what can exercise do when pts are on chemo

A

it can decrease fatigue and improve coping skills

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29
Q

what are the toxic effects of chemo

A

hair follicles
GI cells
Bone marrow cells

heart
liver
kidneys
lungs

neuropathy
hearing loss

all are effected

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30
Q

what is Nadir

A

the point in which bone marrow cells reach their lowest level after admin of chemo (about 7-10 days)

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31
Q

what cell is the most abundantly loss

A

WBCs because they are being suppressed but also are being used up to fight infection

32
Q

what should you do to manage nausea with chemo

A

keep pt well hydrated
encourage small frequent meals
avoid noxious stimuli
premeditate prior to tx with anti emetics

33
Q

what happens to the immune system while on chemo

A

infection- leukopenia d/t myelosupression

34
Q

when is someone on neutropenic precautions

A

if the WBC is <2000

35
Q

what stimulates WBC production

A

neupogen

36
Q

what is mucositis

A

a toxic inflammatory condition

involves the mucus membranes of GI tract

37
Q

what is stomatitis

A

a form of mucositis

it causes painful sores in the mouth

38
Q

how to you mangage mucositis

A

treat diarrhea or constipation with anti diarrhea’s or stool softness / high fiber diet

provide oral care-

39
Q

what is tumor lysis syndrome

A

cellular contents of tumor cells released during chemo

can cause electrolyte imbalance-
ex: hyperkalemia/hyperphosphatemia

40
Q

how do you treat tumor lysis syndrome

A

hydration

allopurinol - to decrease uric acid concentrations and to protect kidney function

41
Q

what are methods of administration for chemo drugs

A

Oral and IV routes-most common

long term central line may be used for IV access

42
Q

what is extravastion

A

infiltration of chemo

can result in permanent damage to nerves, tendons, muscle and skin

43
Q

how do you treat extravasation

A

STOP the infusion

  • do NOT d/c the iv catheter- there may be an antidote that can be put in that catheter
  • if extravasation occurs- aspirate the remaining drug
  • instill specific antedote
  • apply warm or cold compress as indictated by agent used
44
Q

why is chemo on a certain schedule

A

to allow the body to rest between drug administrations

allow normal body cells to proliferate and repair damaged tissues

45
Q

what is the chemo dose based on

A

the pts body surface area
previous response to chemo
and major organ function

46
Q

how long does chemo tx last

A

about 3 months or longer

47
Q

what is palliative radiation therapy used for

A

to relieve pain and symptoms

48
Q

what does radiation do

A

destroys highly mitotic cells

it damages their DNA resulting in cell death

49
Q

what is external Beam RT

A

the pt is exposed to a certain amount of radiation for a certain amount of time over a certain duration

(pt not radioactive)

50
Q

what is brachytherapy

A

a radioisotope is placed into or near the tumor or in systemic circulation

it emits a certain amount of radiation towards the tumor

(pt and excretions are radioactive)

51
Q

what is a sealed source of brachytherpay

A

an implant, seeds, ribbons inserted into the pt

pt is radioactive

52
Q

what is an unsealed source of brachytherapy

A

given systemically IV PO or into body cavitity

the pts excretions are radioactive

53
Q

what are the radiation safety standards

A

keep distance from radiation source
minimize time of exposure
<30 min per 8 hr shift
shielding- lead aprons

54
Q

what is the distance recommendation for pts with radiation

A

6 ft away from the pt

depending on the source of radiation

55
Q

what are adverse effects of radiation

A

skin reactions-dequamation (sunburn type area where getting radiation) can be either dry or moist

fatigue- daily exercise program can help the fatigue

56
Q

why is a pt “tattooed” with radiation

A

done prior to radiation therapy to align the radiation beam in specific patterns to get the cancer source

57
Q

what is the pt to do after radiation

A
  • keep area of radiation dry
  • do not wash treatment area until told by md
  • wear loose fitting clothing
  • shave with electric razor
  • protect from direct sunlight, chemicals and extreme temps
58
Q

what is the late effects of radiation and chemo

A

secondary malignancies- usually more resistant to therapy,

may occur months or year after therapy

59
Q

what is biologic response modifiers

A

a tx in adjacent to chemo/radiation
colony stimulating factors, interferons, interleukins, and monoclonal antibodies

used to boost the immune system
has anti tumor effects

  • restores, modifies, stimulates, augments natural immune defenses
  • can be used alone or in combo with other therapy
60
Q

what are the hematopoietic drugs and what do they do

A

neupogen- restore WBCs
epogen- Restore RBCs
Neumega- restore platelets

61
Q

what are interferons do and how are they given

A

they are an anti-viral and anti-tumor properties

they prevent cancer cells from dividing and replicating

given IM or Sub Q

62
Q

what do interleukins do

A

they are cytokines released from activated lymphocytes

it activates the immune system:

  • has an anti tumor action- recognizes cancer cells and destroys them
  • proliferation and activation of NK cells
  • Proliferation of T cells
  • Increased production of B cells
63
Q

what do monoclonal antibodies do

A

enhances the effects of the immune response on tumor cells

angiogenesis inhibitor- inhibits blood supply to the tumor

64
Q

what are side effects of interferons, monoclonal antibodies, and interleukins

A

Flu- like syndrome
fatigue

autoimmune sxs (inflammation of organs)
capillary leak syndrome
orthostatic hypotension
tachy
neurologic effects(confusion, memory loss, sleep disorders)
65
Q

what are side effects of chemo

A 
FATIGUE
GI- 
mucositis
N&amp;V
anorexia
diarrhea
constipation
hepatotoxicity

Hematologic-all d/t bone marrow suppression
anemia
leukopenia
thrombocytopenia

integumentary-
alopecia- all over body
hyperpigmentation
photosensitivity

sore throat
extravasation
fear/anxiety
depression
fluid and electrolyte imbalance
possible sterility
allergies
pain
renal damage (from nephrotoxic agents)
66
Q

what are nursing managements for low hgb and hematocrit

A

Epogen for RBC production
neumega for platelet production after chemo is done

bood transfusions may be indicated for a symptomatic anemic patient

67
Q

what are long term effects of chemo

A 
cataracts
arthralgias
endocrine alterations
renal insufficiency
hepatitis
osteoporosis
neurocognitive dysfunction

secondary malignancies

68
Q

what diet should a person on chemo therapy have

A

high protein, high carb
small and frequent meals
decrease noxious stimuli

keep hydrated

69
Q

what complications are related to chemo

A

myelosuppression
toxic damage to organs
toxic damage to neurologic system- neuropathies and hearing loss

70
Q

what med is an example of an interferon

A

Roferon

71
Q

How do you prevent nephrotoxicity in someone receiving chemotherapy

A

hydrate prior during and after therapy

72
Q

what are some adjuvant therapies with chemo

A
  • hormonal manipulation: blocks hormones that facilitate tumor growth (tamoxifen)
  • antitumor abx– interferes with DNA of tumor (bleomycin)
  • Corticosteroids– disrupt cell membranes of tumor (dexamethasone)
73
Q

what are the colony stimulating factor drugs

A

-hematopoetic drugs

neupogen- to restore WBC
epogen- restore RBCs
nuem ego- restore platelets

74
Q

what are the types of radiation therapy

A

external beam RT(most common)
Brachytherapy/ internal RT
-sealed source
unsealed source

75
Q

what are adverse effects of radiation

A
  • fatigue
  • skin reactions (dry desquamation/wet desquamation)
  • possibility of dental caries if radiation in the head area

202B (10 decks)

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