week 1 - cancer pt.2 Flashcards
Patients with a history of GERD, can develop a change in the esophageal lining, and can develop what condition where PRE-cancerous cells develop?
Barrett’s Esophagus
The primary risk factor of developing pharyngeal or laryngeal (esophageal/ throat) cancer is smoking and chewing tobacco. What are some other risk factors?
-poor oral hygiene
-canned + smoked foods w/ nitrosamine (nitrates)
What are the diagnostic tools used in pharyngeal or laryngeal cancer?
-EGD biopsy
-CAT/ PET scan/ MRI
-endoscopy
What clinical manifestations should be monitored for when diagnosing pharyngeal or laryngeal cancers?
-lump in the neck/ throat
-cough
-change in voice quality
-colds
-can’t swallow
-ear infections
-weight loss
-regurgitation of undigested food
-halitosis + hiccups
what is it called when the esophagus is surgically removed?
esophagectomy
What medication is used in patients with hypothyroidism to supplement the thyroid and improve function?
Synthroid
what is dumping syndrome and how does it relate to throat cancer and an esophagectomy?
-food (sugar) is moving too quickly to your small intestines from your stomach causing blood sugar and fluid shifts
**this is a common complication of throat and stomach surgeries, like am esophagectomy
which kind of feeding tube is usually placed in the RUQ below the xipoid process and ribs?
PEG tube (percutaneous Endoscopic Gastrostomy)
Which kind of feeding tube is a type of PEG tube but this tube is placed through the abd wall and directly into the stomach?
G-Tube (Gastrostomy Tube)
Which kind of feeding tube is placed directly into the Jejunum (small intestine) - this tube is used for meds and feeding when the stomach isn’t accessible?
J-Tune (Jejunostomy Tube)
TPN .vs. PPN
TPN- total nutritional needs, the patient won’t consume food any other way, higher concentration/ denser formula so it’s given in bigger veins like the neck + chest, long term (weeks to months)
PPN- this is supplemental nutrition in conjunction with oral intake or a feeding tube, diluted/ thinner formula so it goes through peripheral veins, temporary use (only up to 2 weeks)
which cancer is the #1 cause of death in the US?
lung cancer
Which cancer is the #2 cause of death in the US?
breast cancer
how often should women over the age of 40 be getting a mammogram?
annually
also important to perform SBE (self breast exams) to look for changes in tissue, areolas and in the lymph nodes
When performing a SBE (preferably one week after menses) what kinds of things should your patient be educated on to look for?
-lumps, dimpling, puckering, bulging
-a nipple that has become inverted or changed position
-redness, soreness, rash, swelling
-discharge from the nipple
-
You can get genetic testing if you have familial history to see if you have the breast cancer genes, what are those genes?
BRCA1, BRCA2 and HER2
which is the MOST COMMON type of breast cancer?
Ductal Carcinoma In Situ (DCIS)
starting in the milk ducts or lobules
Which hormones are looked at to determine the treatment of breast cancer based on their sensitivity to BRCA1, BRCA2 and HER2?
Estrogen Receptor (ER) and Progesterone Receptor (PR)
if the cancer cells are ER or PR positive it can be treated with hormone blocking drugs - if they’re ER or PR negative, hormone blocking drugs won’t work at blocking cancer growth
True or False?
A post op breast patient CAN NOT have a blood pressure taken on the affected side(s).
TRUE
What are the preferred drugs used when breast cancer cells are ER or PR positive post operatively?
Tamoxifen + Raloxifene
(Evista)
What is the surgery called that is a partial removal of breast tissue?
Lumpectomy
After a mastectomy, why is it so important to have the patients arm(s) elevated on pillows post op?
to promote fluid return in the lymph nodes
After a mastectomy, what are 3 other things besides a blood pressure that can not be done on the affected arm?
-NO IV.s
-NO injections
-NO venipunctures
Tissue Flap Procedures are one of the ways to reconstruct the breasts after a mastectomy. This is where you take tissue from other body areas to reconstruct the breast. What are the 3 common areas to take tissue from?
TRAM flap - Abdomen
Latissimus Dorsi flap - back
DIEP flap - this is also from the abdomen, but muscle is preserved
Tissue expanders are ________ implants placed under the skin + chest muscle after a mastectomy. They are gradually filled with ______ over several weeks to stretch the skin and create space for permanent implants.
temporary; saline
What are the 2 main types of lung cancer?
-Small cell lung cancer (SCLC)
-Non small cell lung cancer (NSCLC)
which type of lung cancer is
-more invasive
-spreads more rapidly
-metastasizes more quickly?
Small cell lung cancer (SCLC)
What are some risk factors for lung cancer?
-smoking/ second hand smoke
-radon
-asbestos
-arsenic
-uranium
-chromium
-nickel
-soot
-tar
-diesel
-air pollution
-HIV
-infection
-radiation
If there is cancer in the visceral pleura, this means cancer is where in the lungs?
in the lining that covers the lungs
If there is cancer in the parietal pleura, this means cancer is where?
somewhere in the lining that covers the entire thoracic cavity
What is the space called that’s in between visceral pleura and the parietal pleura?
the pleural space
What kinds of signs and symptoms will you see with lung cancer?
-bloody sputum
-coughing that doesn’t go away
-SOB
-chest pressure
-decreased appetite + swallowing
What is the complication called when there is air in the pleural space?
pneumothorax
What is the complication called when there is blood in the pleural space?
hemothorax
What is the complication called when there is air collecting in the pleural space and it can’t escape, compressing the heart, lungs and major blood vessels?
tension pneumothorax
What is the complication called when the visceral + pleural lining is inflamed, resulting in the 2 rubbing together causing a really sharp chest pain?
pleurisy or pleuritis
Pleural effusion is when their is ______ accumulation in the pleural space.
fluid
_______ is when a needle is put into the thoracic cavity to drain fluid.
Thoracentesis
What is the difference between PLEURODESIS and PLEUROCENTESIS?
pleurodesis - Talc is put into the pleural space to cause inflammation and scarring to adhere the chest wall to the lungs to prevent fluid from re-accumulating
pleurocentesis- a temporary procedure where a needle is used to remove fluid from the pleural space
What is the incision called when it’s into the thoracic area?
thoracotomy
A lobectomy is the _______ of a lobe of the lung.
removal
Make sure to encourage the use of incentive spirometry post op to prevent what?
pneumonia
Why is it important to monitor for tracheal deviation after a lobectomy? What is causing that complication?
when there is a lobe of the lung removed there is nothing their filling that space - the way air is moving, it can cause the trachea to shift to the affected side - towards the empty space to “fill it”
how do you verify the placement of a chest tube?
x-ray
What should be included in your assessment of a patient with a chest tube?
-air leaks
-kinks in the tubing
-ABC’s + lung expansion
-output
When assessing chest tube output, should their be a gradual increase or decrease in amount hourly?
there should be a gradual decrease in output hourly
can you raise a chest tube above the patients heart?
no.
what is it called when there is a collection of purulent fluid or pus?
empyema
what are 3 side effects/ complications of repeated thoracentesis?
-pain
-depleted protein + electrolytes
-pneumothorax
What are the 2 ways a pleurodesis procedure can be performed?
thoracoscopically or through a chest tube
when performing a pleurodesis via chest tube, after the agent is inserted, you need to clamp the chest tube, how long does the chest tube need to be clamped for?
60-90 minutes
during a pleurodesis, after the chest tube is clamped, the patient needs to be put into many different positions to achieve what?
even distribution of the agent, make sure it’s in contact with all the pleural space
After a chest tube pleurodesis is completed, why is the chest tube drainage continued for several days following?
to prevent fluid from reaccumulating and and promote the adhesion of the visceral and parietal pleura
