week 15 Flashcards
Staging and Grading Cancer
Cancer can be found at its primary site or it can
metastasize to other sites.
▪ Always named for the primary site
Carcinoma
- Within an organ
- Skin, mouth, lungs, breast,
prostate, colon and rectum,
pancreas, ovaries, liver,
kidneys
Sarcoma
- Within connective tissues
Rare form of cancer - Bones, muscles, tendons,
cartilage, nerves, fat, blood
vessels
Lymphoma
- Within lymphatic tissue
- Lymph nodes, spleen,
thymus gland, bone marrow
Leukemia
- Within blood-forming tissue
Does not form a tumor - Granulocytes, monocytes,
lymphocytes
Stage 0 or carcinoma in situ
- pre-malignant or pre-cancer. - Abnormal cells
are found only in the first layer of cells in the place where the changes first started.
-The cells do not invade
the deeper tissues. These cells may become cancer over time, - Most kinds of cancer do not use this stage
Stage I
Cancer is only in the cells where it first started and the area is small. This is considered early stage and most curable.
Stage II
- Cancer is in the organ where it first started. It may be a bit larger than stage I and/or may have spread to nearby lymph nodes
Stage III
Cancer in the organ where it first started. It may be larger than stage II and may have spread to nearby lymph nodes and/or other nearby tissues, organs, or structures
Stage IV
- Cancer has spread to organs in other parts of the body (metastasized)
- still the same type of cancer as where it first started
Recurrent
-Recurrent cancer has come back (recurred) after it has been treated.
-It may come back in the
same area or in a different part of the body
-Common Cancer Staging Method
T
Refers to the size and the extent of primary tumor
N
The number of nearby lymph nodes that have cancer; indicates the absence or
presence of lymph node involvement.
M
Absence or presence of metastases
Number system
Either an X or number is assigned to each T, M, or N. A client’s stage might be T3N1M0,
and this system gives the client more information about the cancer.
Number system
X: Cannot be measured
0: Not present
1, 2, 3, or 4: Higher numbers indicate more significant effects
Cancer Grading
The tumor grade is a system used to classify cancer cells in terms of how abnormal they look under a microscope and how quickly the tumor is likely to spread and grow.
Grade I and II tumors
- resemble normal cells.
- They tend to grow and multiply slowly,
- least aggressive type of tumor.
- ▪I
▪Well differentiated (low grade)
▪II
▪Moderately differentiated (intermediate grade)
Grade III and IV tumors
- have cells that do not look like normal cells of the same type. - - They tend to grow rapidly and spread faster than in tumors with a lower grade (I or II)
▪III
▪Poorly differentiated (high grade)
▪IV
▪Undifferentiated (high grade)
Surgery
▪ Not all tumors can be removed.
▪ In cases where only a portion of the tumor can be removed surgically, radiation and/or chemotherapy may be used before or after surgery
Radiation
When the goal of radiation is to shrink the tumor, the associated
symptoms are expected to be alleviated as well
Chemotherapy
▪ Because chemotherapy is a systemic treatment, and not specifically directed toward cancer cells, it kills healthy cells as well.
▪ A client with cancer must be strong enough, even before chemotherapy is administered, to be able to tolerate the side effects of drugs
RADIATION
(RADIOTHERAPY) SIDE
EFFECTS
Immunosuppression
Fatigue
Skin irritation/burns
Soft tissue fibrosis
Delayed wound healing
Edema
Hair loss
CHEMOTHERAPY SIDE
EFFECTS
Nausea
Vomiting
Hair loss
Neuropathies
Mouth sores
Low blood cell counts
Loss of appetite
Preventive interventions
To lessen the effect of expected disabilities, emphasize client education, improve the
client’s physical functioning and general health status, and assist with the early
identification of adjustment issues
Restorative interventions
To return clients to previous levels of physical, psychological, social, and vocational
functioning
Supportive interventions
To teach clients to make accommodations for their disabilities and to minimize debilitating changes caused by ongoing disease
Palliative interventions
To focus on minimizing or eliminating complications, providing comfort and support, pain control, prevention of contractures and pressure sores, prevention of unnecessary deterioration from inactivity, and psychological support for the client and family members
Pre-rehabilitation
▪ Rehabilitation that starts at the time of initial diagnosis, before any cancer treatment begins.
▪ Starts early with the goals of decreasing the morbidity
▪ Includes physical and psychological assessments
OT Interventions
▪ADL Retraining
▪Transfer Training
▪Energy Conservation and Body Mechanics Training
▪Cardiovascular and Strengthening Exercise
▪Pain Management
▪Maintenance of occupational participation
▪Education
Cancer-related fatigue (CRF)
▪Exhaustion
▪ An effect of the cancer itself as well as that of the cancer treatments and is the most common complaint of clients with cancer.
Chemotherapy-related cognitive dysfunction
More commonly known as “chemo brain” or “chemo fog” is a possible side effect of certain chemotherapy drugs that
impairs cognitive function and may present during or after
treatment
▪ Forgetfulness
▪Difficulty concentrating
▪Difficulty multitasking
▪Feeling disorganized
▪Difficulty with learning new skills
▪Emotional lability
PAM Indications for Clients With Cancer
▪Heat therapy has the physiological effects of decreasing pain and causing vasodilation
▪ Cryotherapy has the physiological effects of vasoconstriction (decreased blood flow), decreasing inflammation, decreasing pain, .
▪Ultrasound is indicated for pain, inflammation, and tissue healing.
▪TENS is indicated for pain.
▪Neuromuscular electrical stimulation (NMES) is indicated to facilitate muscle contractions, decrease spasticity and spasms, increase strength, and enhance local circulation
Contraindications
- malignancies are listed as a contraindication because of the unknown effects of changes in blood flow and movement of cells and their impact on the cancer
- no research currently supports the contraindication reversal,
Palliative and Hospice Care
- primary goal of palliative care is to alleviate suffering and improve the QoL for clients with advanced illnesses.
▪Offers support and coping strategies to clients and their families
HIV Overview
- HIV targets the CD4 T lymphocytes, also known as CD4 cells or T cells.
▪CD4 cells have a key role within the immune system in that they trigger the immune response
to fight infection and disease
▪In the attack process, the virus continues to replicate itself
The three stages of HIV infection are (1) acute HIV infection, (2) clinical latency, and (3) AIDS.
▪Because of the advances in medical treatment options, not all individuals infected with HIV
will develop AIDS.
▪ It can take 10 to 15 years for an HIV-infected person to develop AIDS; antiretroviral drugs can slow down the process even further.
▪if left untreated, an individual infected with HIV becomes vulnerable to other infections, called opportunistic infections
Is not an autoimmune disease, despite its effect on the immune system
▪In an autoimmune disease, the body attacks its own system.
▪In HIV cases, the trigger is an external force
Causes and Risk Factors
HIV is primarily contracted through exposure to specific
body fluids from another individual who is infected
with HIV.
stage 1
fever, fatigue, swollen lymph nodes, diarrhea, weight
loss, cough, and/or shortness of breath. This typically lasts
from 1 to 3 weeks
second stage
clinical latency, an individual may be asymptomatic for up to 10 years (or longer) after contracting HIV infection.
Centers for Disease Control and Prevention (CDC) reports that
14% of individuals in the United States with HIV infection are
unaware that they are infected
Antiretroviral therapy (ART)
▪ Drug regimen that controls or reduces HIV
progression and symptoms
▪ May help reduce spreading the disease
Pre-exposure prophylaxis (PrEP)
▪ Drug regimen that helps the sexual partner reduce
chances of contracting the disease
Polytrauma
“two or more injuries to physical regions or organ systems, one of which may be life threatening, resulting in physical, cognitive, psychological, or
psychosocial impairments and functional disability.”
▪ Happens in a blink of the eye and can alter the course of
one’s life
Activity
describe what the injured person was doing when a potentially life-threatening injury occurred
External Cause of Injury
▪ Mechanism of injury (MOI)
-Precipitating cause or the cause that started the chain of events that led to the injury
▪ Manner or intent of injury
- Assigned by trained hospital staff on the basis of information obtained from the client’s medical record.
▪ Unintentional injuries
- “Not deliberately inflicted, including any such injury described as an ‘accident,’ regardless of whether inflicted by oneself or by another person.”
▪ Assault injuries
-Nonfatal injuries that result as “acts of violence where physical force by one or more persons is used with the intent of
causing harm, injury, or death to another person.”
▪ Legal intervention injuries
- Injuries sustained as a result of police or law enforcement intervention in the course of official duties.
▪ Self-harm injuries
- Result from deliberate or self-directed violence.
Vehicle collision
During a collision, parts of the vehicle, such as the bumper, hood, and frame, come in contact with an external
site, which commonly include trees, other vehicles, guardrails, and so on
Body collision
The body collides with safety devices, including seat belts and air bags, or the steering wheel, dashboard, or windshield
Internal organ collision
Generally include the brain, aorta, lungs, heart, and abdominal organs.
Secondary impacts
Include flying objects and other passengers
Polytrauma Diagnoses
At least two or more injuries, of which at least one is life threatening
▪ Fractures, sprains dislocations
▪ Intracranial injuries
▪ Internal Injuries
▪ Superficial injuries
▪ Nerve Injuries
▪ Unspecified injuries and systemic injuries
Comorbidities and Complications
▪ Neurological system
▪ Musculoskeletal system
▪ Cardiopulmonary system
▪ Endocrine, integumentary, and gastrointestinal
systems
Premorbid status
▪Older age
▪ Obesity
▪Tobacco abuse
▪Chronic obstructive pulmonary disease (COPD)
▪Alcohol abuse
▪Dementia
Nontraumatic Critical Illness
Some individuals experience critical illness in a different form, where there is
no isolated traumatic event or mechanism of injury.
▪ May then develop into sepsis, or systemic inflammatory response syndrome
(SIRS)
▪Inflammatory state affecting the whole body, resulting in increased heart rate (HR) and
respiratory rate (RR), increased white blood cell count, and fever.
Critical illness polyneuropathy
Acute disorder primarily affecting motor and sensory axons, causing severe limb and respiratory muscle weakness.
Critical illness myopathy
Similar definition; however, it is an acute disorder of the muscle, with flaccid presentation and symmetrical weakness.
COMORBIDITIES AND COMPLICATIONS:
The Musculoskeletal System
▪Abnormal tone
▪Heterotopic ossification
▪Compartment syndrome
▪Amputations
▪Fat embolism syndrome
▪Deep vein thrombosis (DVT)
▪Pulmonary embolism (PE)
-ARDS (Acute Respiratory Distress Syndrome)
-Endocrine complications
-Gastrointestinal complications
