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NURS 3512 - Class 7-12 > Week 11 - Chemo and Radiation > Flashcards

Week 11 - Chemo and Radiation Flashcards

1
Q

what is the ultimate goal of chemo

A
  • to reduce the number of cancer cells
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2
Q

what is combination therapy

A
  • a multidrug regimen that kills cancer cells more effective while allowing normal cells to repair and proliferate
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3
Q

which cells are most effected by chemo (5)

A
  • bone marrow stem cells
  • epithelial cells of the GI tract
  • ova
  • testes
  • hair follicles and skin cells
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4
Q

why does chemo affect normal tissue

A
  • chemo agents cannot selectively distinguish between normal cells (esp. those that proliferate rapidly) & cancer cells
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5
Q

what are nursing considerations for chemo r/t admin (4)

A
  • may pose hazards to HCP when handled
  • drugs may be absorbed via inhalation or skin contact
  • also risk in handling body fluids and excreta of pts receiving chemo
  • HCP must read the guidelines and protocols for safe handling of chemo drugs
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6
Q

what are the most common routes for admin of chemo (2)

A
  • oral

- IV

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7
Q

what risks are associated w IV admin of chemo (3)

A
  • exravasation
  • irritation or damage to the vessels
  • infection
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8
Q

what is extravasation

A
  • infiltration of drugs into tissues surrounding the infusion site = local tissue damage
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9
Q

why is extravasation a risk w chemo

A
  • chemo is a vesiciant = causes severe local tissue breakdown and necrosis when infiltrated into the skin
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10
Q

what are signs of extravasation (6)

A
  • pain **
  • swelling
  • redness
  • presence of vesicles on skin
  • ulceration
  • necrosis
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11
Q

what is a way to minimize the risks associated w chemo admin

A
  • may be administered thru a CVAD
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12
Q

what are imp nursing considerations when giving IV vesicants (3)

A
  • assess IV site for pain, swelling, redness
  • use caution during admin
  • use CVAD whenever possible
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13
Q

if extravasation leads to ulceration & necrosis, what is often required?

A
  • skin grafts for closure
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14
Q

what is radiation

A
  • the emission and distribution of energy thru a space or a material medium
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15
Q

what is the overall goal of radiation theraoy

A
  • destroy cancer cells
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16
Q

hoe does radiation kill cancer cells

A
  • thru the energy produced by radiation
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17
Q

what impact does radiation have on normal cells

A
  • normal cells within the radiation field are affected
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18
Q

what are 2 types of radiation

A
  • internal

- external

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19
Q

what is external radiation

A
  • most common form of radiation treatment delivery

- pt is exposed to radiation w a megavoltage treatment machine they lie under

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20
Q

what is internal radiation

A
  • radioactive materials are implanted or inserted directly into the tumour or close to the tumour
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21
Q

what is another name for internal radiation therapy

A
  • brachytherapy
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22
Q

internal radiation can be either… what are imp nursing considerations for both of these

A
  • temporary = highly radioactive while in place

- permanent = low radioactive exposure to the outside or others , canbe discharged w precautions

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23
Q

when is brachytherapy clinically appropriate

A
  • when the radiation dose necessary to eradicate the tumor exceeds the dose tolerance of nearby tissues
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24
Q

what are precautions to take w brachytherapy (5)

A
  • use the principles of time, distance, and shielding
  • radioactive pt in private room
  • organize nursing care so time spent in direct contact w pt is at a mininum
  • where a radiation badge
  • pregnant women and children should not enter the room
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25
Q

what is involved in radiation treatment planning

A
  • simulation
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26
Q

describe simulation r/t radiation planning

A
  • pt lies on table in the treatment position
  • identify under fluroscopy what part of the body needs radiation
  • image is taken to verify the field, and marks are placed on the skin to ensure the field can be reproduced on a daily basis (these marks cannot be washed off)
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27
Q

amt of radiation treatments depends on..

A
  • tumour size, type, and location
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28
Q

what complications/adverse effects can chemo & radiation lead to (9)

A
  • impact hematological system
  • GI effects
  • pain
  • fatigue
  • skin reactions
  • alopecia
  • oral, oropharyngeal, and esophageal reactions
  • pulmonary effects
  • ## reproductive effects
29
Q

what impact does chemo & radiation have on the hematological system

A

= myelosuppression = bone marrow suppression

30
Q

what does bone marrow suppression lead to (3)

A
  • anemia
  • leukopenia (neutropenia)
  • thrombocytopenia
31
Q

in which order does chemo & radiation impact BMS

A
  • WBCs first
  • then plts
  • then RBCs
32
Q

what is included in nursing care for anemia (4)

A
  • monitor hcg, hct, CBC
  • encourage intake of foods that promote RBC production (see anemia deck)
  • give colony stimulating factors (erythropoeitin)
  • pt may require blood transfusions
33
Q

what is the risk associated w neutropenia (2)

A
  • risk of infection which can lead to sepsis and death

- classic signs of inflammation (and therefore infection) may not occur

34
Q

what is included in nursing care for neutropenia r/t chemo & radiation (5)

A
  • monitor the absolute neutrophil count
  • monitor for S&S of infection
  • if pt is febrile, assume its caused by infection and abx therapy is initiated immediately (within 1 hr)
  • give colony stimulating factor (neupogen)
  • pt may require reverse isolation (private room, glove, gown, mask)
35
Q

what is included in pt teaching r/t neutropenia (4)

A
  • avoid large crowds
  • good hygeine
  • no fresh fruit/flowers in the room
  • pt needs to wear mask if leaves room
36
Q

what is the risk associated w thrombocytopenia

A
  • risk of bleeding and hemorrhage
37
Q

what is included in nursing care for a pt with thrombocytopenia (6)

A
  • admin of blood products
  • admin of plts
  • assess for signs of bleeding (petechia, bruising, etc.)
  • assess for S&S of internal bleeding (blood in urine, melena, decreased LOC)
  • minimize venipuncture and injections
  • monitor plts, hct, hgb
38
Q

what is included in pt teaching for thrombocytopenia (4)

A
  • use an electric shavor, not a razor
  • use a soft bristled toothbrush
  • avoid drugs, foods, and herb that affect coagulation (aspirin, ginger)
  • avoid injury (non-contact sports, wear gloves w household chores, etc.)
39
Q

how common is fatigue in cancer pts

A
  • effects 80-100%
40
Q

what is the cause of cancer treatment induced fatigue

A
  • unclear

- thought to be accumulation of metabolites as cells breakdown

41
Q

what are nursing interventions for fatigue (4)

A
  • maintain good nutrition and hydration
  • alternate periods of rest and mild activity (ex. walking)
  • encourage client to seek assistance and support from family and friends
  • manage pain and anxiety to help reduce fatigue
42
Q

what is including in nursing interventions for pain r/t chemo and radiation

A
  • give opioids around the clock w extra for breakthrough pain
43
Q

what impact does cancer treatment have on the GI system (5)

A
  • anorexia
  • NV
  • DC
  • hepatotoxicity
  • decreased secretion of mucus, HCl acid, epsin
44
Q

how does cancer treatment lead to anorexia and NV (4)

A
  • TNF and IL-1 suppress appetite from cancer
  • cellular breakdown stimulates the nausea center
  • drug stimulate the nausea center
  • destruction of GI lining (bc is v sensitive to chemo & radiation)
45
Q

what is included in nursing care for anorexia, and NV (6)

A
  • monitor pt’s weight during treatment
  • encourage small, frequent meals
  • anti-emetics prior to treatment
  • assess for dehydration and alkalosis
  • give high protein, high cal foods that are easy to swallow (ex. ensure, milkshakes)
  • beware of anticipatory vomitting
46
Q

what nursing interventions are used for diarrhea r/t cancer treatment (5)

A
  • low residue diet
  • meticulous skin care
  • sitz baths
  • antidiarrheals
  • record #, consistency, and character of stools per day
47
Q

what is anticipatory NV

A
  • conditioned response that results in the experience of NV when the pt encounters cues associated w the treatment
    ex. upon walking thru the doors of the cancer center
48
Q

what impact does cancer treatment have on the skin (3)

A

destruction of skin cells from chemo and radiation =

  • erythema
  • wet desquamation
  • dry desquamation
49
Q

what is included in nursing care for skin reactions to cancer treatment (6)

A
  • use gentle soap (ex. dove)
  • use mild detergents
  • avoid tight clothes and harsh fabrics
  • avoid sun and extreme temps (no heating pads, ice packs, and hot water bottles in treatment field)
  • avoid chlorine
  • prevent infection
50
Q

what is included in nursing care for dry skin reactions (2)

A
  • lubricate w non-medicated, non-perfumed lotion

- remove lotion before radiation and reapply after

51
Q

what is included in nursing care for wet skin reactions

A
  • keep clean & protected
52
Q

what are nursing interventions for alopecia r/t cancer treatment (5)

A
  • provide options for hair loss (ex. scarves, head coverings, wigs)
  • cut hair short
  • provide emotional support
  • avoid excessive brushing of hair & shampooing
  • avoid use of hair drier and other electric appliances to har
53
Q

what impact does chemo have on alopecia? radiation?

A
  • chemo = temporary, but affects all body hair

- radiation = may be temp or permanent based on dose, but only impacts hair in treatment field

54
Q

what oral, oropharyngeal, and esophageal impact does cancer treatment have (8)

A

destruction of mucosal lining of GI tract d/t chemo & radiation :
- decreased salivary flow = xerostomia (dry mouth)
- progressive taste loss (d/t loss of salivia)
- difficulty swallowing
- thick salivia less able to perform the function of cleansing teeth and moistening food
- oral stomatitis
- mucositis
- esophagitis
= compromised nutritional status

55
Q

what are nursing interventions for the oral, oropharyngeal, and esophageal reactions to cancer treatment (9)

A
  • meticulous oral assessment (examine teeth & gums daily)
  • oral care before & after each meal and before bed time –> rinse w saline solution
  • brush teeth w soft toothbrush
  • drink small amts of water freq / saliva substitue
  • avoid hot temp, alcohol, spicy foods, and tobacco
  • assess ability to swallow, saliva, mucous membranes regularly
  • eat soft, non-irritating, high-cal, high-protein foods
  • monitor weight
  • make foods visually pleasing d/t taste loss
56
Q

what can be used to alleviate oral stomatitis, mucositis, and esophagitis r/t cancer treatment (4)

A
  • antacids
  • benadryl
  • lidocaine cocktail
  • anasthetic gel to oral lesions
57
Q

what pulmonary effects can chemo cause (3)

A
  • pulmonary edema
  • interstitial fibrosis
  • pneumonitis
58
Q

what pulmonary effects can radiation cause (2)

A
  • pneumoitis

- damaged lung tissue

59
Q

the pulmonary effects of cancer therapies may be…

A
  • irreversible and progressive
60
Q

what are signs of pneumonitis and fibrosis (4)

A
  • dry, hacking cough
  • fever
  • exertional dyspnea
  • night sweats
61
Q

what is included in nursing care for the pulm effects of cancer treatment (5)

A
  • bronchodilators
  • expectoants
  • O2
  • rest
  • cough suppressants for night
62
Q

what reproductive effects does radiation have (4)

A
  • erectile dysfunction
  • loss of vaginal lubrication
  • narrowing of vagina
  • damage to the ability to produce healthy eggs and sperm
63
Q

the effects of chemo & radiation on the reproductive system depend on?

A
  • the dose and type of chemo used
64
Q

what is included in nursing care for the reproductive impacts of cancer treatment (4)

A
  • pre-treatment harvesting of sperm or ova can be considered
  • teach use of vaginal lubricant and vaginal dilator post-radiation
  • potential infertility can be distressing –> counselling should be considered
  • shield the ovaries whenever possible w radiation (unlike the testes, they have no avenue for repair)
65
Q

what impact might cancer treatment have on the cardio system (3)

A
  • pericarditis
  • myocarditis
  • cardiotoxicity
66
Q

what is included in nursing care for CVS effects of cancer treatment (3)

A
  • monitor for S&S of these disorders
  • monitor ECG and cardiac ejection fraction
  • may have to modify drug therapy
67
Q

a nursing diagnosis r/t radiotherapy is fatigue. what nursing interventions are done for this (7)

A
  • explain that it may cause fatigue
  • assess severity of fatigue
  • identify factors that contribute to fatigue
  • promote factors that reduce fatigue
  • consider pharmacological treatments in consultation w the oncologist
  • assist pt & fam in strategies to help conserve energy
  • ensure pharmacological therapies are taken as prescribed
68
Q

a nursing diagnosis r/t neutropenia is risk for infection. what nursing interventions are done for this (9)

A
  • maintain isolation techniques as appropriate
  • screen all visitors for communicable disease
  • remove fresh flowers & plants from pt areas
  • follow neutropenic precautions
  • monitor for S&S of infection and sepsis
  • monitor lab values
  • promote hand hygeine, oral care, skin hygeine, pulm hygiene
  • teach pt & caregiver about S&S of infection
  • instruct pt to take antibiotics as prescribed

NURS 3512 - Class 7-12 (49 decks)

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