Unit 1 -Cancer + Eyes Flashcards
what is cancer
uncontrolled cell growth (proliferation) it is able to develop anywhere, effects all ages, sexes, ethinic groups, increased risk as you age
Hyperplasia
multiplication of cells due to increased cell division. Cell that normally die do not due to enzyme telomerase
Enzyme Telomerase
an enzyme that helps maintain the length of telomeres which are protective caps at the end of chromosomes. They shorten each time a cell divides and when the become too short the cell stops dividing or dies.
Metaplasia
The cell looks normal. Not the type of cells that are normally found in that tissue or area. A mature cell is replaces with another type of mature cell.
Dysplasia
Abnormal change in cells as they multiply- shape, size, appearance
Carcinoma
Maligant cells, can be insitu/invasive (in original place or not). Type of cancer that originates in epithelial cell, most common.
cancer patho cells
Normal, hyperplasia, mild dysphasia, carnoma in situ, cancer invasive
3 stages of cancer developement
initiation, promotion, progression
Initation of cancer developement
Mutation of the cell DNA during replication or carcinogen exposure, genetic markers.
Promotion of cancer development
Altered cell replication and continues to mutate this is preventable if caught in time
Progression of cancer developemnet
Tumour growth, tumour movement
Non modifiable risk factors
genetics, age, biological sex
Modifiable risk factors
carcinogen, exposure, obesity, smoking, alcohol nitrates, dietary fat
Do genetics have to so with cancer?
in some cases yes, for example women with BRCA1 or BRCA2 gene mutation have up to 85% chanace of developing breast cancer
Role of immune system in cancer
Recognize as foreign and Destry in cancer cells arizr from bodys own cells so see slow immune response as they do not see the threat as foreign
Cytotoxic T cells
slow tumour growth. They recognize and destroy cancer cells.
Natural Killer cells
Lyse cancer cells. Recognize and eliminate cancer cells without requiring prior activation by specific agents.
Macrophages
respond to tumour markers and destroy
B Lymphocytes
create antibodies to fight off inf, diseases this includes cancer
Tumour markers
tumour cells produces an antigen or marker in response to certain cancer cells. Can be found in the blood urine, tumoour tissue. May be utilized as a diagnosistic tool, as a baseline marker, a tool to monitor response to treatment and a sign of reccurence.
Types of tumour markers
AFP, CA125, CA19-9, CEA, HCG, PSA
How do cancer cells escape the immune system
Supress T cells, Escape the immune survalence, immune system decelops a tolerance to bad neighbours, supress teh immune sytem, blovk
Subjective assessment
fatigue, lump or thickened area, weight changes including unintended loss or gain, skin changes such as yellowing, darkening ir redness of the skin, changes in bowel or bladder habits, persistent cough or trouble breathing, diffculty swallowing, hoarseness, persistent indigestions, persistent unexplained muscle or joint pain, persistant unexplained fever or night sweats, unexplained belssing or bruising, family history of cancer
Ways to remember signs of an abnormal assessment
C: Changes in bowel/baldder habits
A: Sore that does not heal
U: Unualsal bleeding or discharge
T: Thicking or lump in breast or other places
I: Indigestion or difficulty swallowing
O:Obvious chnages in warts or moles
N: Nagging cough or persistent hoarseness
U: Unexplained weight loss
P: Pernicous Anemia
Lab tests
Cytology (ex. Pap smear, looking at the shape of cells) Hematology, Chemistry, tumour markers
Diagnostic tests
Scope- gastroscopy, sigmoidoscopy, colonoscopy
CT/MRI
Mammogram
Radio-isotope scans
Genertic markers
Bone marrow biopsy
Biopsy
Lumbar puncture
Biopsy Types
Needle Biopsy, Incisional biopsy, Excisional biopsy, Endoscopic Biopsy
Needle Biopsy
Cells and tissue fragement bone marrow (The needle into the spine)
Incisional biopsy
Punch of tissue (skin lesion, tissue sample) Skin cancer
Excisional Biopsy
REmoval of an entire tumour/ Mass
Endoscopic
GI, GU, Lungs
Cancer Stage 0
cancer in situe
-Remove/monitor it
Cancer stage 1
Tumor limited to the tissue of organ, localized tumour
Cancer stage 2
Limited to local spread, with an orgin and does not exceed it
Stage 3 cancer
extensive local and regional spread
Stage 4 cancer
Metastasis, they spread
Nurses role in time of diagnosis
communicate, support, listen, relationship developement, answer question, explain
Do not do during time of diagnosis
“everything will be okay” , be impatient, rush through assessments
Metastasis
establishment of microenviornement spread throughout the body
What is TMN
T: extent of the tumour (size, number, location)
N: Extent of spread to the lymph nodes
M: Presence of metastasis
3 treatments
Cure, control, palpitation
Surgery and cancer
Remove tumour and surrounding tissue, cure localized cancer, ineffective if metastasis, follow up with radiation
(Common in skin and thyroid)
Radiation
radiation releases free radicals free radials damage DNA and stop ability, uses high enefery radiation to shrink the tumour and kill cancer cells
Chemotherapy
Reformation of new blood vessels.
Targets bone marrow, hair follicles, endothelial cells (any reproducing)
Ways to administer Chemotherapy
PO, IV< IM, Inter cavity, intrathecal, intra arterial, intra peritoneal, intra vesicular, SC
3 Principles of Cancer chemotherapy
Cytotoxic (Kills the cell)
Cytostatic (Inhibit tumour growth)
Induce cell differentiation
Complications from chemo
Fatigue, bone marrow suprression, WBC inf (neutropenia), GI cells stomatitis, Integrated cells, alopecia, RBC anemia, hepatoxicity, Nadir (lowest point a pateints RBC can go)
How does chemo cause this damage?
A number of blood cells that divide rapidly can be damaged along with cancer cells during chemo.
WBC help protect the body from inf, low levels indicates neutropenia and is more likely to get infection.
RBC carry oxygen throughout the body. Low levels is known as anemia. This leads to fatigue and more serious complications
PLatelets are the structure that stops bleeding, low levels is called thrombocytopenia, can cause bruising and bleeding.
Hair follicles are effected casuing alopecia
Cells lining the stomach can be affected by chemo and can cause vomiting and diarreah
Lab chemistry
NA, K, Uream Creatinine
Immunotherapy
Cytokines, monoclonal antibodies, vaccine, gene therapy
Targeted therapy
Monoclonal antibodies, small molecules inhbitors, differentiang agents
when cancer is the invading agent the cancer cells are able to learn to
mimic the immune system and adapt to it, using immune mechanism to protect protect themselves
Cells in microenvironment
Dendritic, T cells, T regulatory cell, macrophages, natural killer cells, stomal cells
Objective nursing assessment
CNS, CVS, GI, Nutrition, GU, Inf, Endocrine, PAIN, Psychosocial
Interventions to do in cancer
Diagnose, treat, prevent spread, support, med: treat symptoms, cancer, complications
Referalls to use
omcology, socail work, PT, OT, Nutrition, Clinical psychology, Pallitive, Pain clinic, support groups, pharmacy
How to evaluate if treatment is working
Bloodwork, biopsy, ultrasound, follow up
Screening for breast cancer
mammogram, Takes images to detect any growth of tumours
Subjective assessment gor breast cancer
routine screening, health history, symptoms
Objective assessment breast cancer
General axillary and superclavicular lymphadenothy (lymph nodes), Integ change, Resp change, Jaundice, Ascites, hepatomegaly, reproductive
Male breast cancer
Usually found in the nipple area, hard nontender mass, more involvnment with lympnodes, e
Breast cancer medication
Estrogen receptor blockers, aromatase inhibitor, estrogen receptor modulator, biological targeted therapy
Environmental lung cancer risk factors
smoking, coal dust, air pollution, Radon gas, asbestos, ionizing radiation
Is lung cancer genetic
yes, some people are genetically predisposed
after the age of 55-74 what screening is done for cancer
Straight to treatment adter 75 years of age
subjective data for lung cancer
smoking, Asbestos exposure, occupational hazard, personal or family history of lung cancer, outdoor exposure to air pollution, exposure to radiation, immunocomprimised
objective assessment for lung cancer
integ, resp, cv, neuro, msk
non small lung cancers
account for most lung cancers
Apenocarcinoma (periphery of lung, from goblet cell)
Squamous cell carcinoma (centreally located from columnar epithelial cells that become squamous epithelial cells)
-Unucual shape and squished in
Small cells lung cancer
not as common, centerally located, from small immature neuroendocrine cells
Therapy for lung cancer
surgical, radiation, chemo, biotherapy, meds, o2
Screening for prostate cancer
Starting at age 50
-PSA (prostate specific antigen blood test)(the finger, should feel like a tip of the nose), Digital rectal exam (done after PSA)
Subjective data assessment for prostate cancer
-Trouble urinating, age, sexual dysfunction, health history, symptoms
objective assessment for PRostatea cancer
general, urinary, MSK, PSA
treatement for Prostate cancer
conservative therapy (meds to treat the symptoms), Surgical therapy, radiation therapy, Androgen synthesis inhibitor and androgen receptor blocker
TURP
Transurethral resection fo the prostate (it blasts the prostate and sucks it out)
Subjective assessment
age 50 and older, ETOH (Over 4 drinks a week), IBS, smoking, polyps, Fx hx, Obesity, increased consumption of red meat.
screening for Colorectal cancer
Stool based FIT or gFOBT, Visual structural exams
Subjective data to collect for colorectal exam
health hx, weakness, fatigue, anorexia, weight loss, N and V, change in bowel habits, abd and lwo back pain
Age relation to cancer
increased changes with age
what is cataracts
Anythign that disrupts the crystalline lens fibre homeostasis eventually results in cataracts. Often age related, there is a crystalized lens that goes over the eyes.
What med can cause cataracts
cortocosteroids
what can cause cataracts
age, drugs, systematic illness such as diabetes, atopy, myotonic dystrophy, trauma, latrogen radiation, rential surgery
Symptoms of cataracts
Increasing difficulty with vision at night, sensitivty to light and glare, cloudy film over vision, seeing halo arounf light, frequent changes in eyeglassess or less, increasing nearsightedness, fading yellowing of colour, double vision in a single eye
Clinical presentation of cataracts
opacity within the lens, cortex, nuclear, sub scapular, dilation drops can help to see clearer
Risk factor for catarcts
increasing age, diabetes, excessive exposure to siunlight, smoking, obesity, previous injury or inflammation, previous eye surgery, prolonged use of corticosteroids, excessive alcohol
diagnostic test for cataracts
glare test, visual acuity drops significantly, clinical exam, biometry: Corneal curvature and a-scan ultrasound
Treatment for cataracts
perscription glasses, extra light for detailed near task, magnifying glasses, limit tasks that are need fine vision, avoid driving in the dark
possible complications for catarcts surgery
Infection 1:14000, posterior capsule rupture/dropeed nucleus1:1500 , rentinal detachement 1:500 , persistent swelling elevated 1:100 intracolular pressure 1:30-50
what is the most common cause of blindness in canada
age related macular degeneration
what is Dry atriphic AMD presentation
most common type 905, macular cell atrophy, slow adn progressive, painless, developement of drusen (yellow extracellular deposits)
Wet presentation (neovascular AMD, exudate AMD)
Visual disortion, such as straight lines seeming bent, sudden, painless, center at vision loss in one or both eyes, a well defined blurry spot in vision, general haziness in overal vision
Does macular degeneration effect peripheral vision
NO, so it often does in cause complete blindness
What is happening in wet exadative
Abupt onset of worsening symptoms, new blood vessel growth in chorids that bleed through rentinal pigment epithelium, vessels leak, scar tissue forms, untreated leads to blindness
Treatment for dry macular degeneration
smokinf cessation, sun protection, antiosidant suppliment, ARED 2 formula
Treatment for wet degeneration
intravitreal anti-vegf ing, Avastin, Lucentis, eylea
-Lazer treatment for older people
Treatment for wet and dry degeneration
Low vision rehabilitation:
Hand’/stand magnifiers, Microspcope, CCTV, Eccentric viewing lighting
Nursing management for Macular degeneration
MI (smoking cessation), Advocate continuing supplement during med reviews. FOr wet frequency is really important, assisting with low vision aids
Treatment frequency for wet AMD
Every 4 weeks x3 then treat and extend
What is glaucoma effecting
the optic nerve
Patho of glaucoma
Decreased ocular perfusion pressure, High IOP, Low BP or both
-Ocular nerve atrophy
-peripheral vision loss
-High IOP occurs
What is the optic nerve
a bundle of more than 1 million nerve fibers that carry visual messages. You have one connecting the back of each eye (your retina) to your brain. Damage to an optic nerve can cause vision loss
Normal intraocular pressure
10-21 mmHg
Primary glaucoma vs secondary glaucoma
Primary open angle glaucoma: Most prevalent, angle open but fluid too slow
Primary closure glaucoma: the drainage angle is blocked, causing a sudden or grdual rise in IOP
Secondary open angle glaucoma: Exfoliation syndrome, pigmeent dispersion symndrome, storage weber syndrome
Angle closure: ICE syndrome, choriodal effusion, tamoxifen
Risk factors for glaucoma
age, family history, sleep apnea, diabetes, steroids and other med, hyperthyroidism, hypertension, reynauds, migraine, topical steriods
Tests
Measuring intraocular pressure, testing for optic nerve damage, checking for areas of vision loss, measuring corneal thickness, inspecting the drainage angle
Symptoms of chronic glaucoma
difficulty with orientation adn mobility (bumping into things), pathchy blindness in periphery, tunnel vision
Acute angle glaucoma
Severe (11/10) headache and eye pain, N and V, Blurred vision, Halos around lights, eye redness
Treatment for glaucoma
-NEED treatment or they will go blind
-Drops, surgery
Decrease aqeuous production treatment
Beta-blocker, alpha-adrenergic, carbonic anhydrase, inhibitor
Surgery: lazer cycloabalation
Increase water aqueous outflow
Drops: prostaglandin Analogues, Nitric oxide, Muscarinic agonist, Rho Kinase
Surgery: Selective laser trabeculoplasty, microinicisional drainage device, Trabeculectomy
Prostglandin eye drops
increase the outflow of the fluid within the eye and reduce pressure. Can cause mild redening, stinging, and changes in pigment aswell as blurred vision
Beta Blocker eye drops
these reduce the production of fluid in your eye, thereby lowering the pressure in your eye, possible side effects include difficulty breathing, slwoed heart rate, lower blood pressure, impotence and fatigue
Alpha adrenergic agonist eye drops
reduce the production of aqueos hummer. side effects include irregular heart rate, high bp, fatigue, red, itchy, swollen eyes
Miotic or collinergic agents
These increase the outflow of fluid from your eye. An example is pilocarpine. Side effects include smaller pupils, possible blurred vision or dim vision and brow ache. Rarely used for medical therapy
when does acute angle glaucoma become an emergency
when pressure goes over 70, vision can be lost within hours
what to do for someone in an acute glaucoma crisis
decrease aqeous production (timolol, bromonidine) admin IV mannitol, no PGA
