Unit 21 Altered Cell Treatment Flashcards
What is the most common type of breast cancer?
Adenocarcinoma, from hormones
What are risk factors for breast cancer?
- Genetics
- Female gender
- Age
- Multiparty
- Nulliparty
- First child after age 30
- Early menarche and late menopause
- Obesity, increased dietary fat
- Alcoholism
- Exogenous hormones
What are 80% of the 5-10% inherited breast cancers caused by?
What would you do for these PT’s?
Mutation in the BRCA 1 or BRCA 2 genes
Preventive surgery and chemo prevention w/ tomaxicin
What is the clinical presentation of Breast Cancer?
- Lump in breast (non-tender, fixed, hard, irregular borders)
- Peau de orange (orange peal)
- Nipple discharge of any kind
- Pain due to metastasis
- Redness
- Ulceration
- Edema
- Dilated veins
What are many of the diagnostics markers used for?
Seeing which medication works best
What is the definitive dx for breast cancer?
Tissue diagnosis (biopsy)
What are diagnostic tests for breast cancer?
> Physical exam
> Imaging:
-mammography, MRI, ultrasound
> Evaluation for metastasis disease:
-CT scan, bone scan
> Markers:
- Human epidermal growth factor receptor (HER2)
- Estrogen receptor (ER)
- Progesterone receptor (PR)
- Carcinoembryonic antigen (CEA)
What are the ways of performing breast biopsy?
- Fine needle aspiration (least invasive)
- Ultrasound guided needle aspiration
- Stereotactic core biopsy (laying down on table one)
- MRI guided needle aspiration
Surgical method:
-Lumpectomy (removal of lump)
What are the kinds of Mastectomy?
Lumpectomy: lump removed, shows same effect as traditional removal with radiation
Simple: whole breast
Modified Radical: breast and nodes
Radical: breast, nodes, and muscles
What is the Sentinel Lymph Node?
First lymph node from the tumor (cancer)
What is the prevention for the axillary node dissection complication, Lymphedema?
- Avoid BP, injections, and blood draws in affected extremity
- Use sunscreen > 15 spf
- Wear gloves for gardening
- Use cooking mitt for removing objects from oven
- Avoid cutting cuticles
- Use electric razor for shaving armpit
- Avoid lifting objects > 5 to 10 lbs
- Soap and water w/ointment if break in skin occurs
If redness, swelling, or fever occurs, call surgeon or nurse
What is the management of already developed Lymphedema?
Compression sleeves and garments
Exercises
Avoid constricting clothing
Keep skin lubricated and clean
Surgical correction
What are nonsurgical breast cancer treatments?
Radiation therapy
Chemotherapy
Hormone therapy
Targeted therapy
Describe Radiation therapy and it’s treatment from breast cancer.
For curative, control, or palliative purposes
- Given before, sequentially with chemotherapy, or after chemotherapy
- External radiation called Teletherapy, outside the body
- Internal radiation called Brachytherapy, implants inside body
- About 6 weeks
What are acute and chronic radiation side effects?
Acute:
- Toxicity - localized to where beam is pointed, increased chances if chemo at same time
- Desquamation (skin peeling)
- Nausea (if abdomen treated)
- Effects on GI system
- Effects on bone marrow (anemia, decreased platelets)
- System effects (fatigue, anorexia)
Chronic:
- Infertility
- Secondary Cancers
- Memory loss
- Fibrosis
- Renal damage
What is the care of the PT with radioactive implants?
PT instructions and
Care providers instructions
PT instructions:
- Bedrest
- Private room and bath
- No lotions, perfumes, razors
- Use plain water or very milf soap, no washclothes
- No constrictive clothing
- Keep markings
- Avoid sun exposure and ice packs
Care provider instructions:
- Use long-handled forceps to place in lead container
- No pregnant personnel
- Limit time under 30 minutes
- Keep distance from PT minimum 6 ft
- Dispose of urine and feces properly (flush twice)
- Wear dosimeter badge
- Signage for PT room
What are nursing considerations for Wet Desquamation?
Do not disrupt any blisters that have formed
Avoid frequent washing of area
Report any blistering
Use prescribed creams or ointments
If area weeps, apply nonadhesive absorbent dressing
If area is w/o drainage apply moisture hydrocolloid dressings/gels
Consult MD if eschar forms
What is Chemotherapy?
What can it be used for?
Agents used to destroy tumor cells by interfering with cellular function and replication
Curative, control, palliative
Define the following terms: Alopecia Emetic potential Myelosuppression Nadir Extravasion
Alopecia - bald/hair loss
Emetic potential - emesis/vomiting (most chemo drugs)
Myelosuppression - bone marrow activity decreased, low WBCs, RBC’s, Hgb.
Nadir - 10-28 days into chemotherapy, absolute bone marrow depression
Extravasation - infiltration into skin (emergency)
What are chemotherapy Rx’s (antineoplastics) used in breast cancer?
cyclophosphamide
doxorubicin
tamoxifen
trastuzumab
methotrexate
How are chemo medications classified?
What cells are they mostly effective against?
Most effective agains rapidly dividing cells
Classified by cell cycle-specific or non specific and by their action
What is the PPE for handling chemo, administering materials, and body fluid?
Double chemotherapy-tested gloves
Gowns
Protective eyewear
What is the nursing protocol for Extravasation from Vesicant Chemotherapy?
- Infiltration noticed, infusion stopped and disconnect tubing
- Identify agent
- Leave cannula in place and try to aspirate drug
- Neutralize as ordered, if antidote available use
- Notify healthcare provider
What are the two mechanisms of anti-neoplastic drugs?
- affect cell survival
2. boost the immune system in its efforts to combat the abnormal cells
What are the effects of anti-neoplastics Rx’s on the cell cycle non-specific and the cell cycle specific?
Cell Cycle Non-Specific:
- Cytotoxic in ANY phase of the cell cycle
- Both proliferating and non-proliferating cells killed
- Dose dependent
Cell Cycle Specific:
- Cytotoxic during a specific phase of the cell cycle
- Only proliferating (rapidly producing) cells killed
- Schedule dependent
Describe the Alkylating Agent, cycophosphamid.
How are they administered?
What are the adverse effects?
Nursing considerations?
-Broad spectrum
Administration: IV, IM Pleural, PO
Adverse effects: Hemorrhagic cystitis (bleeding bladder), alopecia, N/V, loss of fertility, pancytopenia
Nursing considerations:
- Dose limiting toxicity
- Education: contraception, drink H20 and empty bladder, keep head warm
Describe the anti-neoplastic antibiotic, doxorubicin.
How is it given?
What are the adverse effects?
Nursing considerations?
- Specific to certain tumors
- Derived from bacteria
Must be given IV
Adverse effects:
- cardiopulmonary toxicity
- usual N/V, loss of fertility, pancytopenia
- red urine
Nursing considerations:
- Need baseline cardiac tests (EKG, ECHO)
- Dose limiting, there is a lifetime maximum dose.
Describe the miotic inhibitor, vincristine.
How is it given?
What are the adverse effects?
Nursing Considerations?
- Used for leukemia, lymphoma, neuroblastoma, thyroid cancer, brain tumors.
- Kills cells as the process of mitosis begins
Administered IV
Adverse effects: Low blood count, renal/hepatotoxicity, N/V, alopecia, neuropathy
Nursing consideration:
-Vesicant necrosis and cellulitis if extravasation occurs
Describe the antimetabolities medication, methotrexate.
How can healthy cells be recused with this Rx?
How is it administered?
Adverse effects?
Nursing considerations?
- Rapidly dividing cancer cells can’t use this essentially nutrient imposter to live.
- Works on multiple cancers
Rescue healthy cells w/ leucovorin
Administration: IV, IM, Intrathecal, PO
Adverse effects:
- Mouth sores
- N/V
- Alopecia
- Bone marrow suppression
Nursing considerations:
- No folic acid
- Increase fluid intake
- Avoid pregnancy
Describe the hormone modulator, leuprolide.
How is it administered?
What are the adverse effects?
What are the nursing considerations?
- Used in cancers that are sensitive to hormone-dependent tumors
- For prostate and breast cancer
Administration: SC, IM
Adverse effects:
- Hot flashes
- Ankle edema
- Gynecomastia
- Depression
Nursing considerations:
-Category X drug, avoid pregnancy
Describe the hormonal agent, tamoxifen.
How is it administered?
What are the adverse effects?
-For metastatic, ductal carcinoma insitu, ovarian, and to preventive cancer
Administration:
-PO
Adverse effects:
- Blood clots
- Hot flashes
- Vaginal discharge
- Edema
- Weight loss
Describe the monoclonal antibody Rx, bevacizumab.
What is the administration?
Adverse effects?
Nursing considerations?
- Enhances PT’s own ability to fight cancer cell invasion
- Specific drug for specific cancers
Administation:
- IV
- Avastin second line Rx
- Antibodies attach to specific receptors
Adverse effects:
- Pulmonary edema
- Flu-like symptoms
Nursing considerations:
-Watch bleeding
Describe the medication, trastuzumab.
What are the side effects?
-Use as monotherapy for treatment of metastatic breast cancer that has relapsed following prior chemotherapy
-For tumors that overexpress the HER2
(Human Epidermal growth factor 2)
Side effects:
- Cardiotoxicity
- CHF with or without symptoms
What are the following agents used to treat/what do they do. allopurinol Interferon Interleukins ondansetron metaclopramide
allopurinol - treat high uric acid levels
Interferon - makes cancer cells more vulnerable to killing by T cells
Interleukins - stimulates the immune system
ondansetron - prevent N/V
metoclopramide - antiemetic, used in GERD
What is erythropoietin, filgrastim, and sagramostim?
What class of Rx’s are they?
erythropoietin - stimulates the production of red blood cells
filgrastim - Increases WBC’s
sargramostim - Increases bone marrow
Colony Stimulating Factor
What are adverse effects of chemotherapy?
Toxicity N/V Diarrhea Stomatitis Myelosuppression Renal damage Potential sterility Neurologic effects
What are nursing interventions for Alopecia?
Discuss potential hair loss and regrowth
Explore impacts on self image
Prevent or minimize hair loss
Cut long hair before treatment
Wear sunscreen and hat outside
What are nursing interventions for Impaired Oral Muscosa?
Avoid ETOH, tobacco, and spicy food
Normal saline mouth rise q2h
Soft toothbrush
Myocostatin
What are nursing interventions for fatigue?
Rest periods
Promote sleep
Adequate protein intake
OK to exercise
Blood transfusions for anemia
At what tumor diameter should the nurse evaluate and report of cancer is present?
1 cm
