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Nursing 4 Exam 4 > Unit 20 Altered Cell Overview/Pain control > Flashcards

Unit 20 Altered Cell Overview/Pain control Flashcards

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1
Q

Defnine Malignancy.

A

Abnormal regulation of growth

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2
Q

Describe the Proliferative Patterns, Benign and Malignant.

A

Benign:

  • Well differentiated
  • Encapsulated (stays where it is)
  • Slow growth
  • No metastasis
  • Local effects
  • No tissue destruction

Malignant:

  • Undifferentiated “dysfunctional”
  • Infiltrates
  • Rapid growth
  • Metastasis
  • Systemic effects (anemia, cachexia, infections)
  • Tissue Destruction
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3
Q

What is the most common cancers for men and women?

A

Men:

  • Prostate
  • Lung

Women:

  • Breast
  • Lung
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4
Q

What are characteristics of a cancer cell?

A

Undifferentiated (Dysfunctional):
-polymorphic and pleomorphic

Autonomous self sufficiency of growth signals:

  • Resists apoptosis (resistant to “death”)
  • Multiplies indefinitely (immortal)

Angiogenesis (grows on it’s own)

Metastasis (spreads):
-invades local tissue and instant tissue

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5
Q

What is Carcinogenesis? What is the process?

A

Process by which cancer arises.

Initiation:
-gene mutation from carcinogens (smoking, etc)

Promotion:
-repeated exposure (cell multiplication)

Progression:

  • cancer developed at this point
  • increase in malignancy, angiogenesis
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6
Q

What are the mechanisms of metastasis?

A 
Lymphatic spread (most common)
-travels next to circulatory system

Hematogenous spread
-tumor piece breaks off and travels/grows in capillaries

Angiogenesis
-own blood supply to jump to next organ , new blood vessels form from pre-existing ones

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7
Q

What is the Cell Cycle?

A

G0 = doing what it should be doing

G1 = Growth

S = DNA replicates (good time to kill a cancer cell)

G2 = prepare to divide / repairs

Mitosis = Mother cell becomes 2 daughter cells

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8
Q

What is proto oncogenes?

What are tumor suppressor genes?

A

ON switch for cellular growth

OFF switch for cellular growth
in cancer they do not shut off

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9
Q

What are examples of the following carcinogens:

  • Viruses, bacteria
  • Physical agents
  • Chemical agents
  • Genetic susceptibility
  • Dietary factors
  • Hormonal agents
  • Immune system failure
A

Viruses, bacteria: HPV, HIV, HEP B

Physical agents: Sunlight, radiation, tobacco

Chemical agents: Nitrogen mustard

Genetic susceptibility: BRCA (breast cancer), down syndrome at risk for leukemia

Dietary factors: alcohol, etc

Hormonal agents: estrogen

Immune system failure: HIV

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10
Q

What is the primary prevention of cancer?

A

> To ensure it never develops:
-Education

  • Vaccination
  • Avoidance of known carcinogens
  • Modifications of associated factors

> Removal of at risk tissue

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11
Q

What is secondary prevention for cancer?

A

Screening for early detection and Rx

Examples:

  • Self exams
  • Clinical exams
  • Blood, urine, and stool tests, etc.
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12
Q

What is the new protocol for mammograms within the age ranges?
What is the new protocol for clinical self breast exams?

A

40-44 optional
45-54 anual
55+ once every two years

New protocol is to not do them (which is bologna sandwich)

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13
Q

Describe the testicular self-exam.

A

After a shower:

  • Gently locate right testicle
  • Roll between your thumb and fingers
  • Repeat on left side

Contact MD if lump is found

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14
Q

What is the screening guidelines for early detection of prostate cancer by the ACS?

A

Age 50 men who at average risk and are expected to live at least 10 years or more:
- Have conversation

Age 45 for men at high risk:

  • First degree relative dx’d with prostate cancer at early age (< 65)
  • do testing

Age 40 for men at even higher risk:

  • > one first degree relative who had prostate cancer at an early age,
  • do testing
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15
Q

What are the screening guidelines for men and women for Colorectal Cancer?

A

Beginning at age 50, should follow one of the following examination schedules:
>Tests that find polyps and cancer
-Flexible sigmoidoscopy every 5 years
-Double-contrast barium enema every 5 years
-CT colonography every 5 years
-Colonoscopy every 10 years

> Tests that find mainly cancer

  • Guaiac fecal occult blood test every year
  • Fecal immunochemical test every year
  • Stool DNA test every 3 years
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16
Q

What is the lung cancer screening protocol?

Who would be excluded?

A

Low dose CT scan for High Risk PT’s who:

  • Are age 55-74 y.o, with no signs of symptoms of lung cancer
  • Active or former smoker with a 30 pack hx
  • Active smoker: should also be vigorously urged to enter smoking cessation program
  • Former smoker: must have quit within the past 15 years

General excluded ppl:

  • Life limiting co-morbid conditions.
  • Metallic implants or devices in chest or back
  • Requirement for home O2 supplementation
17
Q

What are early cancer warning signs?

A

Think CAUTION:

C hanging bowel/bladder habits

A sore throat that doesn’t go away

U nusual bleeding

T hickening or lump

I ndigestion or difficulty swallowing

O bvious change in wart or mole

N agging cough or harseness

18
Q

What are tumor makers for?

Give some examples.

A

Point to, but do not dx cancer

Examples:

  • PSA (prostate specific antigen)
  • AFP (alfa fetal protein) -think, why would adult secrete this?
  • CEA (carcinoembryonic antigen)
  • CA 125 (cancer antigen 125)
  • b-HCG (beta- Human chrionic gonadotropin)
  • Bence Jones proteins in urine
19
Q

What are diagnostic tests that dx cancer?

A

Bone marrow biopsy

Endoscopic biopsy

Needle biopsy

Surgical biopsy

20
Q

What confirms Cancers?

A

Biopsy

21
Q

How is Cancer graded?

A

Grade 1: closely resembles normal tissue

Grade 2: Tissue still has well-formed glands, but they are larger and further apart

Grade 3: Glands are recognizable, but they are beginning to invade other tissues

Grade 4: Only a few recognizable glands, neoplastic clumps seen

Grade 5: No recognizable gland cells

22
Q

How is Cancer staged?

A

T = primary tumor

N = Nodes

M = Metastasis

23
Q

Describe the staging of cancer, Primary Tumor (T).

A

Tx- primary tumor cannot be assessed

T0- no evidence of primary tumor

Tis- carcinoma in situ (removed even though not metastasized

T1 to T4 - Increasing size and local extent of primary tumor

24
Q

Describe the staging of cancer, Regional Lymph Nodes (N).

A

Nx -regional lymph node cannot be assessed

N0 - no regional lymph node metastasis

N1 to N3 - increasing involvement of regional lymph nodes

25
Q

Describe the staging of cancer, Distant Metastasis (M).

A

Mx - Metastasis cannot be assessed

M0 - No distant metastasis

M1 - presence of distant metastasis

26
Q

What does metastasis essentially mean?

A

Cancer spread to “distant” organs

27
Q

What are radiology diagnostic tests used for cancer?

A

PET scan - ionized solution into vein, shows cancer

CT scan

Bone scan

Ultrasound

Xrays

28
Q

What is the leading cause of cancer related death in men and women in the US?

What are the risk factors?

A

Lung cancer

  • Tobacco smoke
  • Secondhand smoke
  • Smog
  • Radon
  • Genetics
29
Q

What is the pathophysiology of Lung Cancer?

A

> 90% arise from the epithelium of bronchus

8 to 10 years to reach 1 cm (that’s why we CT)

Liver, brain, bone are most common sites of metastasis

30
Q

What are the types of lung cancer?

A

> Small Cell or Oat Cell carcinoma
(rapid growing, worst one)

> Non-small Cell carcinoma

  • squamous cell
  • large cell
  • adenocarcinoma
31
Q

Post Bronchoscopy what should the nurse check for?

A

Return of gag reflex

32
Q

What do the following tumor markers test for?
EGFR gene
ALK gene

A

EGFR - Non-small cell lung cancer

ALK - Non-small cell lung cancer

33
Q 
What are the ways to manage the potential side effects of opioids such as:
Sedation
Constipation
N and V
Itching 
Respiratory depression
A

Sedation: rest, put on fall risk

Constipation: ducosate sodium, increase fiber and fluids

N and V: take w/ food, oldonasterone

Itching: anti-histamine, calamine lotion

Respiratory depression: O2, stimulate breathing, naxolone

34
Q

What do you not want to supplement oxycodone with and why?

A

Acetaminophen

4,000 mg a day limit. of acetaminophen

35
Q

What is adjuvant medication refer to?

A

Enhances effectiveness of opioid analgesics

36
Q

What are common side effects of the following adjuvant medications:
antidepressants
anticonvulsants
corticosteroids

A

antidepressants:

  • nausea
  • constipation
  • insomnia
  • increase weight gain
  • decreased libido

anticonvulsants:

  • dizziness
  • drowiness
  • rash
  • bone marrow suppression

corticosteroids:

  • immunosuppression
  • Increased weight gain
  • muscle weakness
  • ecchymosis
  • osteoporosis
37
Q

What are causes of malnutrition in cancer PT’s?

A

The medications

Depressed moods

Changes in taste

GI disturbances

N and V

Diarrhea

Early satiated (fullness)

38
Q

What is cancer cachexia?

A

Wasting syndrome characterized by weight loss, anorexia, asthenia (weakness), and anemia.

PT’s have weight loss that cannot be reversed with normal nutritional support

39
Q

What are ways to improve nutrition in cancer PT’s?

A

Small amounts frequently

High calorie foods

Lean meats

Increased fruits and vegetables

Increased fluids

Multivitamins

Avoid smells that make PT sick

Nursing 4 Exam 4 (6 decks)

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