Week 3 - Neurological / Cancers Flashcards
Epilepsy- a group of neurologic diseases marked by _____________________
recurring seizures
2 Types of seizures
Focal
Generalized
Generalized seizures- start over wide areas of _____________ of brain
both sides
Focal seizures- begin in _________________ of the brain in a specific region of the cortex
1 hemisphere
2 types of focal seizures
simple
complex
6 types of generalized seizures
tonic-clonic
absense
myoclonic
tonic
atonic
clonic
Psychogenic seizures
Manifests as a tonic-seizure, but it’s not
Cause: ____________
Rhythmic Jerking Movement (can be mistaken as a seizure)
Dx: EEG (electrical brain malfunctions)
Manifests as a tonic-seizure, but it’s not
Cause: Emotional Abuse
Rhythmic Jerking Movement (can be mistaken as a seizure)
Dx: EEG (electrical brain malfunctions)
Seizures - 4 phases
Prodromal
Aural (early ictal)
Ictal
Post ictal
Seizures- risk factors
___________ disturbances
___________ disorders
Metabolic disturbances
extracranial disorders
Seizures- diagnostics
Labs
CT
MRI
EEG
Labs
CT
MRI
EEG
Seizures- nursing management
ABC, O2
Safeguard from _________
_________ to stop seizures
___________________ - Dilantin, Keppra, Cerebyx, Phenobarbital
ABC, O2
Safeguard from injury
Benzos to stop seizures
Anti-convulsants- Dilantin, Keppra, Cerebyx, Phenobarbital
Seizures- complications
SUDEP
NPE
Todd’s paralysis
Status ___________
SUDEP
NPE
Todd’s paralysis
Status Epilepticus
Parkinson’s disease- chronic, progressve neurodegenerative disorder characterized by:
____________
Rigidity, _________ at rest
Gait disturbance
TRAP
Parkinson’s disease- chronic, progressve neurodegenerative disorder characterized by:
Bradykinesia
Rigidity, tremors at rest
Gait disturbance
TRAP
Parkinson’s disease diagnostics
No specific tests
Dx based on ________
No specific tests
Dx based on Hx, S&S
Parkinson’s disease nursing management
__________ with carbidopa (Sinemet)
SE: Dyskinesia
Levodopo with carbidopa (Sinemet)
SE: Dyskinesia
Multiple Sclerosis (MS)- characterized by segmental ___________________________ of brain and spinal cord
demyelination of nerve fibers
Multiple Sclerosis (MS) diagnostics
_____ - demyelinating lesions
MRI
Multiple Sclerosis (MS) nursing management
No cure
Drug therapy to ___________________
-Immunomodulators B-1a and B-1b, Fingolimod (Gilenya)
-Immunosupresants (Dimethyl fumarate/ Tecfidera)
-Corticosteroids (Methylprednisolone/ Solu-Medrol)
No cure
Drug therapy to slow progression
-Immunomodulators B-1a and B-1b, Fingolimod (Gilenya)
-Immunosupresants (Dimethyl fumarate/ Tecfidera)
-Corticosteroids (Methylprednisolone/ Solu-Medrol)
Myasthenia Gravis- chronic, autoimmune disease characterized by profound ___________________________
muscle weakness and fatiguability
Myasthenia Gravis S&S
Painless muscle ____________
Myasthenia ________
Painless muscle weakness
Myasthenia Crisis
Myasthenia Gravis nursing management
Acetylcholinerase inhibitors
Corticosteroids, IV immunoglobulin, Plasmapheresis, immunosuppresives
MV, thymectomy
Acetylcholinerase inhibitors
Corticosteroids, IV immunoglobulin, Plasmapheresis, immunosuppresives
MV, thymectomy
Chronic Seizure (epilepsy): 2 or more seizures and tendency to have recurrent seizures
Cause: __________
Due to _____________________ reacting abnormally, not metabolic disturbances
2 or more seizures and tendency to have recurrent seizures
Cause: Unknown
Due to electrical circuits reacting abnormally, not metabolic disturbances
Seizures: caused by :
(↓ __________or ↓ __________)
metabolic disturbances
(↓ sodium or ↓ glucose)
2 Types of seizures-
Focal Seizures (Localized)
Generalized Seizures (throughout the whole brain)
Seizure phase 1
Prodromal Phase: ___________ a seizure is on the way (foreshadow)
Few hours-days
S/Sx: Changes in ______ , Anxiety, Focus and having lightheadedness
Prodromal Phase: Sensing a seizure is on the way (foreshadow)
Few hours-days
S/Sx: Changes in Mood, Anxiety, Focus and having lightheadedness
Seizure phase 3
Ictal Phase: ______________
Loss of Awareness, ____________
S/Sx: Drooling, Twitching, Loss of Muscle Control, Convulsions, Trouble Breathing w/ Aspiration, turning blue, HR increased in monitor
Ictal Phase: Active Seizing
Loss of Awareness, Blacked out
S/Sx: Drooling, Twitching, Loss of Muscle Control, Convulsions, Trouble Breathing w/ Aspiration, turning blue, HR increased in monitor
Seizure phase 2
Aural Phase (early ictal): starts ________ _________ a seizure (Warning Sign)
Symptoms are ________ : Aura of Déjà vu, Jamais Vu, Vision Problems, Odd smells/sounds/taste, sometimes dizziness or numb, headache, nausea, panic/intense fear
Aural Phase (early ictal): starts RIGHT before a seizure (Warning Sign)
Symptoms are QUICK: Aura of Déjà vu, Jamais Vu, Vision Problems, Odd smells/sounds/taste, sometimes dizziness or numb, headache, nausea, panic/intense fear
Seizure phase 4
Post-Ictal Phase: _________________
Period of confusion for some pts
Some may feel better quickly, some may need rest (sleeping after is okay)
Watch for ABCs (remove objects and suction aspirations)
Brain Recovery
Period of confusion for some pts
Some may feel better quickly, some may need rest (sleeping after is okay)
Watch for ABCs (remove objects and suction aspirations)
Seizures Risk Factors
____________ Disorders: Traumatic Brain Injury increases ICP, HTN -> Stroke, DM or Hypoglycemia (FATAL)
___________ Disorders: Hypoglycemia, Hyponatremia, ETOH toxicity/withdrawal, Hypoxemia, High Fever
Extracranial Disorders: Traumatic Brain Injury increases ICP, HTN -> Stroke, DM or Hypoglycemia (FATAL)
Metabolic Disorders: Hypoglycemia, Hyponatremia, ETOH toxicity/withdrawal, Hypoxemia, High Fever
Seizures Dx Tests
______ (Na, Glucose, Chem 7, CBC)
____ (Visualize Stroke -> hemorrhage or clot)
_____ (more extensive imaging for clot, lesions or tumor in brain)
_______ (electroencephalogram -> confirm electrical activity in the brain and defects
Labs (Na, Glucose, Chem 7, CBC)
CT (Visualize Stroke -> hemorrhage or clot)
MRI (more extensive imaging for clot, lesions or tumor in brain)
EEG (electroencephalogram -> confirm electrical activity in the brain and defects
Seizures Nursing Management
_____ (turn to side -> prevent aspiration)
____ (if hypoxic)
Keep safe from ___________
Medications
-Benzodiazepines (stop seizures)
-Lorazepam (Ativan), Valium (Diazepam), Versed (Midazolam)
-Anticonvulsants
-Dilantin (start in ER) -> NEVER MIX WITH DEXTROSE
-Keppra (if allergic to Dilantin)
-Cerebyx: rx for cardio and respiratory prob -> place on monitor to assess BP and HR
-Phenobarbital
ABC (turn to side -> prevent aspiration)
O2 (if hypoxic)
Keep safe from injury
Medications
-Benzodiazepines (stop seizures)
-Lorazepam (Ativan), Valium (Diazepam), Versed (Midazolam)
-Anticonvulsants
-Dilantin (start in ER) -> NEVER MIX WITH DEXTROSE
-Keppra (if allergic to Dilantin)
-Cerebyx: rx for cardio and respiratory prob -> place on monitor to assess BP and HR
-Phenobarbital
Seizure Complications
_________ (Sudden Unexpected Death in Epilepsy)
NPE (Neurogenic Pulmonary _______)
Todd’s ___________
Status _______________ (MOST DANGEROUS) -> > ___ min seizure
SUDEP (Sudden Unexpected Death in Epilepsy)
NPE (Neurogenic Pulmonary Edema)
Todd’s Paralysis
Status Epilepticus (MOST DANGEROUS) -> >5 min seizure
Parkinson’s Disease
Low _______________ Levels, pts with PD usually have a Dopamine Deficiency
Dopamine = _________ Functions
No Treatment, just symptoms management
Low Dopamine Levels, pts with PD usually have a Dopamine Deficiency
Dopamine = Motor Functions
No Treatment, just symptoms management
Parkinson’s Disease Nursing Management
____________ w/ Cabidopa (Sinemet) -> Synthetic Dopamine to prevent symp of TRAP
Levadopa w/ Cabidopa (Sinemet) -> Synthetic Dopamine to prevent symp of TRAP
Parkinson’s Disease - Chronic, Progressive _______________ Disorder
Chronic, Progressive Neurodegenerative Disorder
Parkinson’s Disease TRAP
____________ at Rest
_________
____________ /Bradykinesia (No movement or slow movement)
___________ Instability (Unsteady Gait)
Tremor at Rest
Rigidity
Akinesia/Bradykinesia (No movement or slow movement)
Postural Instability (Unsteady Gait)
Parkinson’s Disease Dx Tests
No Specific Tests
Dx based on ______________
No Specific Tests
Dx based on pt Hx and S/Sx
Multiple Sclerosis
Segmental _____________ of Nerve Fibers of Brain and Spinal Cord
Autoimmune Disease: Immune system attacking ____________
Segmental Demyelination of Nerve Fibers of Brain and Spinal Cord
Autoimmune Disease: Immune system attacking Myelin Sheath
Multiple Sclerosis Dx Tests
_____ -> Demyelinating Lesions
MRI -> Demyelinating Lesions
Myasthenia Gravis - Chronic autoimmune disease characterized by profound ______________________________
muscle weakness and fatigability
Multiple Sclerosis Treatment
No Cure for MS
Drug Therapy to Slow Progression -> Suppress and Control ______________
Immunomodulators
Immunosuppressants
Corticosteriods
No Cure for MS
Drug Therapy to Slow Progression -> Suppress and Control Immune System
Immunomodulators
Immunosuppressants
Corticosteriods
Myasthenia Gravis Clinical Manifestations
___________ Muscle Weakness
Myasthenia Crisis -> SEVERE and ________________
Muscles that control ___________ become weak -> Respiratory Failure -> Mechanical Ventilation
Painless Muscle Weakness
Myasthenia Crisis -> SEVERE and LIFE THREATENING
Muscles that control breathing become weak -> Respiratory Failure -> Mechanical Ventilation
Myasthenia Gravis Nursing Management
___________________ Inhibitors
Watch out for Cholinergic Crisis
Corticosteroids, IV immunoglobulin, Plasmapheresis and Immunosuppressive Agents
Mechanical Ventilation, Thymectomy
Acetylcholinesterase Inhibitors
Watch out for Cholinergic Crisis
Corticosteroids, IV immunoglobulin, Plasmapheresis and Immunosuppressive Agents
Mechanical Ventilation, Thymectomy
Myasthenia Gravis vs Cholinergic Crisis
Myasthenic Crisis: Pt is being _______________ or they have worsening MG
Cholinergic Crisis: Pt is being _____________ with Cholinergic Agents
Best way to distinguish is look at pt history and _____________
Myasthenic Crisis: Pt is being under-medicated or they have worsening MG
Cholinergic Crisis: Pt is being overmedicated with Cholinergic Agents
Best way to distinguish is look at pt history and medications
Cancer: group of disease characterized by uncontrolled and unregulated _____________
cell growth
Initiation: a _________ in the cell’s genetic structure.
A mutation is any ________ in the usual DNA
Initiation: a mutation in the cell’s genetic structure.
A mutation is any change in the usual DNA
Promotion: reversible ___________ of altered cells
Activity promoters is reversible (cancer prevention)
Promotion: reversible proliferation of altered cells
Activity promoters is reversible (cancer prevention)
Progression: last stage where there is an increase in growth rate of _______, increased invasiveness and metastasis
Progression: last stage where there is an increase in growth rate of tumor, increased invasiveness and metastasis
Immunologic surveillance: helps prevent cancer cells from growing into _______
The immune system uses _____________ surveillance to respond to TAAs.
Immunologic surveillance: helps prevent cancer cells from growing into tumors
The immune system uses immunologic surveillance to respond to TAAs.
How are tumors classified?
_______________ : looks at WHERE the first cancer first developed
-myeloma: bone marrow
_____________ (grading) : looks at the CELLS
___________ of disease (staging): looks at the SIZE and SPREAD throughout the body
Anatomic site: looks at WHERE the first cancer first developed
-myeloma: bone marrow
Histology (grading) : looks at the CELLS
Extent of disease (staging): looks at the SIZE and SPREAD throughout the body
TNM classification: most common, uses 3 subcategories to determine the anatomic extent
T: ________ size and invasiveness
N: ______ involvement: presence or absence of regional spread to lymph nodes
M: _____________ distance
TNM classification: most common, uses 3 subcategories to determine the anatomic extent
T: tumor size and invasiveness
N: node involvement: presence or absence of regional spread to lymph nodes
M: metastasis distance
Prevention: we want to TEACH patients and the public about cancer prevention and early detection
- Limit ________ use.
- Get regular ______________ (e.g., 30 min or more of moderate physical activity 5 times weekly).
- Maintain a normal ________ .
- Have regular physical examinations.
- Obtain regular colorectal screenings.
- Avoid cigarette smoking and other tobacco use.
- Get regular mammography screening and Pap tests.
- Be familiar with your own family history and risk factors for cancer.
- Obtain adequate _______ of at least 6–8 hours per night.
- Use sunscreen with a sun protection factor of 15 or higher. Avoid tanning beds.
- Eliminate, reduce, or change the perception of stressors and enhance the ability to effectively cope with stress
- Eat a balanced diet that includes vegetables and fresh fruits, whole grains, and fiber. Reduce dietary fat and preservatives. Limit smoked and salt-cured meats with high nitrite concentrations.
- Limit alcohol use.
- Get regular physical activity (e.g., 30 min or more of moderate physical activity 5 times weekly).
- Maintain a normal weight.
- Have regular physical examinations.
- Obtain regular colorectal screenings.
- Avoid cigarette smoking and other tobacco use.
- Get regular mammography screening and Pap tests.
- Be familiar with your own family history and risk factors for cancer.
- Obtain adequate rest of at least 6–8 hours per night.
- Use sunscreen with a sun protection factor of 15 or higher. Avoid tanning beds.
- Eliminate, reduce, or change the perception of stressors and enhance the ability to effectively cope with stress
- Eat a balanced diet that includes vegetables and fresh fruits, whole grains, and fiber. Reduce dietary fat and preservatives. Limit smoked and salt-cured meats with high nitrite concentrations.
_______________: can offer a cure for some cancers, control for long period, & be used for palliative relief of symptoms when cure or control is no longer possible
Chemotherapy: can offer a cure for some cancers, control for long period, & be used for palliative relief of symptoms when cure or control is no longer possible
Chemotherapy Function: disrupt cellular __________________
replication & proliferation
Two Broad Categories of Chemo:
Cell cycle phase-specific: chemo only disrupting the cell during _____________ of the cell cycle
Cell cycle phase- nonspecific: agents are not dependent on the cell being in a particular phase. Have effect on the cells during ____________ of the cell cycle.
Cell cycle phase-specific: chemo only disrupting the cell during specific phases of the cell cycle
Cell cycle phase- nonspecific: agents are not dependent on the cell being in a particular phase. Have effect on the cells during all stages of the cell cycle.
Different Methods of Administration: [Chemo]
Standard Peripheral IV
Non-tunneled Central Catheter
Tunneled Central Catheter- less risk of infection
PICC Line
**Port- implanted under the skin, Huber
Standard Peripheral IV
Non-tunneled Central Catheter
Tunneled Central Catheter- less risk of infection
PICC Line
**Port- implanted under the skin, Huber
______________ : most common side effect of chemo and radiation
Myelosuppression
The male client is sitting in the chair and his entire body is rigid with his arms and legs contracting and relaxing. The client is not aware of what is going on and is making guttural sounds. Which action should the nurse implement first?
Push aside any furniture
Place the client on his side
Assess the client’s vital signs
Ease the client to the floor
D. Ease the Client to the floor
The client should not remain in the chair during a seizure. He should be brought safely to the floor so that he will have room to move the extremities. Pushing aside furniture and placing the client on their side can take place after easing the client onto the floor.
Myelosuppression
Stem cells are constantly regenerating in our bone marrow
Stem cells are responsible for creating ___________
Stem cells are constantly regenerating in our bone marrow
Stem cells are responsible for creating blood cells!
The nurse enters the room as the client is beginning to have a tonic-clonic seizure. What action should the nurse implement first?
Note the first thing the client does in the seizure
Assess the size of the client’s pupils
Determine if the client is incontinent of urine or stool
Provide the client with privacy during the seizure
Note the first thing the client does in the seizure
Noticing the first thing the client does during a seizure provides information and clues as to the location of the seizure in the brain. It is important to document whether the beginning of the seizure was observed
The client who just had a 3 minute seizure has no apparent injuries and is oriented to name, place and, time but is very lethargic and just wants to sleep. Which intervention should the nurse implement?
Perform a complete neurological assessment
Awaken the client every 30 minutes
Turn the client to the side and allow the client to sleep
Interview the client to find out what caused the seizure
C. Turn the client to the side and allow the client to sleep
During the Postictal phase, the client is very tired and should be allowed to rest quietly; Placing the client on the side will help prevent aspiration and maintain a patent airway
Previous administrations of chemotherapy agents to a cancer patient have resulted in diarrhea. Which dietary modification should the nurse recommend?
A. A bland, low-fiber diet
B. A high-protein, high-calorie diet
C. A diet high in fresh fruits and vegetables
D. A diet emphasizing whole and organic foods
A. bland, low-fiber diet
Patients experiencing diarrhea secondary to chemotherapy and/or radiation therapy often benefit from a diet low in seasonings and roughage before the treatment. Foods should be easy to digest and low in fat. Fresh fruits and vegetables are high in fiber and should be minimized during treatment. Whole and organic foods do not prevent diarrhea.
The nurse is reviewing a client who will be having chemotherapy and radiation for his tumor. Which of these will the nurse need to implement for this client
A. ensure client gets a private room and private bathroom
B. make sure the client and staff understand there should be no visitors
C. limit time with client by clustering care 30 mins per shift
D. educate nursing aides that the client is not to receive any skin irritating products
D. educate nursing aides that the client is not to receive any skin irritating products
This answer is correct because radiation treatment irritates the skin. It makes the skin red, dry, itchy, and sensitive. Anything that causes skin irritation can tear or worsen the skin, increasing risk for infection. No deodorants, lotions, make up, creams, powders, tape, or shaving the affected area is recommended. The area should be cleaned with hands, no cloths.
While caring for a client receiving brachytherapy for endometrial cancer, the student nurse understands that there are three important factors to consider. Select all that apply
Time spent with the client
Recording the amount of exposure
Shielding against radiation
Distance to the client
Providing education to the client
Time spent with the client
Shielding against radiation
Distance to the client
Radiation safety: Nurses should minimize exposure by limiting time spent near the patient, maintaining a safe distance and using shield
Which of the following diagnostic tests are commonly used to diagnose Acute Lymphocytic Leukemia (ALL)?
A. Chest X-ray and Spirometry
B. Complete Blood Count (CBC) and Bone Marrow Biopsy
C. Electrocardiogram (ECG) and MRI
D. Liver Function Test and Ultrasound
B. Complete Blood Count (CBC) and Bone Marrow Biopsy
A CBC can reveal abnormal levels of white blood cells, red blood cells, and platelets, which is often the first sign of ALL.A bone marrow biopsy is used to confirm the diagnosis by detecting abnormal lymphoblasts in the marrow.
What are the genetic risk factors associated with mutations in the BRCA1 gene?
A. Increased risk of autoimmune diseases
B. Increased risk of cardiovascular diseases
C. Increased risk of breast and ovarian cancers
D. Increased risk of Alzheimer’s disease
C. Increased risk of breast and ovarian cancers
Mutations in the BRCA1 gene are primarily associated with a significantly increased risk of breast and ovarian cancers. These mutations may also raise the risk of other cancers, such as prostate and pancreatic, but breast and ovarian cancers are the most strongly linked to BRCA1 mutations.
Reed-Sternberg cells are typically associated with which of the following conditions?
A. Non-Hodgkin lymphoma
B. Acute lymphocytic leukemia
C. Multiple myeloma
D. Hodgkin lymphoma
D. Hodgkin lymphoma
Reed-Sternberg cells are abnormal, large cells that are characteristic of Hodgkin lymphoma (type of blood cancer). Their presence is a key feature in diagnosing this type of blood cancer.
What is the Pyramid Effect?
Experimental __________________ of cancer cells, likened to an inverted pyramid
growth pattern
Pyramid Effect
Cancer cells grow at the same speed as normal cells, but ignore signals that control growth and death, leading to uncontrolled, continuous growth. Sometimes, they produce more than two cells during division, causing _____________________ in a pyramid-like pattern. The time it takes for a tumor to double in size is called its doubling time.
rapid tumor growth
Promotion stage - altered cells __________ , but this growth can be reversed
multiply
What is promotion in cancer development?
Altered cells begin to proliferate and accumulate increasing the likelihood of additional ________________
genetic mutations
Stage 2 cancer
-has grown more deeply into nearby tissues
Stage II: Limited _________ _________
local spread
What defines Stage IV in cancer classification?
-cancer has spread to _________ parts of body
*Stage IV: _____________
-cancer has spread to distant parts of body
*Stage IV: Metastasis
Explain the TNM Classification System.
*tumor size and invasiveness (T)
presence or absence of regional spread to the lymph nodes (N)
metastasis to distant organ sites (M).
What are the characteristics of a Grade IV tumor?
*Grade IV: Cells are __________, primitive (anaplasia), and ______________.
Cell _________ is hard to determine (high grade).
*Grade IV: Cells are immature, primitive (anaplasia), and undifferentiated.
Cell origin is hard to determine (high grade).
How is a Grade II tumor defined?
*Grade II: Cells are more ____________ (moderate dysplasia) and moderately ______________ (intermediate grade).
*Grade II: Cells are more abnormal (moderate dysplasia) and moderately differentiated (intermediate grade).
What are the seven warning signs of cancer? [CAUTION]
Change in bowel or bladder habits
A sore that does not heal
Unusual bleeding or discharge from any body orifice
Thickening or a lump in the breast or elsewhere
Indigestion or difficulty in swallowing
Obvious change in a wart or mole
Nagging cough or hoarseness
What is an excisional biopsy?
*surgical removal of ________________________________________________
It is:
*surgical removal of the entire lesion, lymph node, nodule, or mass; therapeutic as well as diagnostic.
What is fine-needle aspiration (FNA)?
*Diagnostic; done with a small-gauge aspiration needle that provides _________________________________
cells from the mass for cytologic examination
What is the common route for chemotherapy administration?
___________
[concerns - venous access problems, device- or catheter-related infection, and extravasation]
IV route
What is brachytherapy?
-insertion of ____________ materials directly into or near tumor
radioactive
brachytherapy
Radiation — “close” or internal radiation treatment.
~implantation/insertion of radioactive materials directly into the tumor (interstitial) or near the tumor (intracavitary or intraluminal); allows for ______________________ to the target with minimal exposure to surrounding healthy tissues.
direct delivery of radiation
chemotherapy drug - Vesicants - if infiltrated into the skin, may cause severe __________________________
local tissue breakdown and necrosis
How does chemotherapy affect WBC counts?
bone marrow suppression > reduction of WBC causes neutropenia
Chemotherapy ______ white blood cell (WBC) counts by damaging the bone marrow, where WBCs are produced.
lowers
Stomatitis is inflammation of the ___________________
[Chemotherapy or radiation treatment destroy epithelial cells located in field (e.g., head and neck, stomach, esophagus). Rapid cell destruction causes inflammation and ulceration.]
mouth and lips.
What is the nursing management for stomatitis?
- Assess oral _________ daily
- Use nutrition supplements (e.g., Ensure, Boost) if intake is decreasing.
- Eating, swallowing, and talking may be difficult > ____________.
- Avoid irritating spicy or acidic foods or too hot or too cold food
- Choose moist, bland, and softer foods.
- Keep oral cavity clean &moist by frequent oral rinses w/ saline / salt & soda solution.
- Use artificial saliva to manage dryness (radiation).
- Discourage use of irritants, such as tobacco and alcohol.
- Apply topical __________ (e.g., viscous lidocaine, oxethazaine).
- Assess oral mucosa daily
- Use nutrition supplements (e.g., Ensure, Boost) if intake is decreasing.
- Eating, swallowing, and talking may be difficult > analgesics.
- Avoid irritating spicy or acidic foods or too hot or too cold food
- Choose moist, bland, and softer foods.
- Keep oral cavity clean &moist by frequent oral rinses w/ saline / salt & soda solution.
- Use artificial saliva to manage dryness (radiation).
- Discourage use of irritants, such as tobacco and alcohol.
- Apply topical anesthetics (e.g., viscous lidocaine, oxethazaine).
What is the preferred drug for managing nausea and vomiting in chemotherapy?
-____________ (5-HT3) receptor antagonists (ondansetron, palonosetron [Aloxi])
-neurokinin-1 receptor antagonists (NK1RA) (e.g., aprepitant [Emend], rolapitant [Varubi])
-Dexamethasone given with other antiemetics helps manage acute and delayed CINV.
Serotonin
Philadelphia chromosome & leukemia
*Philadelphia chromosome originates from the translocation between the BCR gene on chromosome 22 and the ABL gene on chromosome 9. [The protein that is encoded by the newly created BCR-ABL gene on the Philadelphia chromosome interferes with normal cell cycle events, such as the regulation of ________________.]
cell proliferation
Philadelphia chromosome & leukemia
Philadelphia chromosome is present in about 98% or more of patients with __________________________
~ important indicator of residual disease or relapse after treatment
~ also found in ALL and occasionally in AML.
CML; diagnostic hallmark of CML
What is acute myelogenous leukemia (AML)?
AML = 1 / 3 of all leukemias; 80% of the acute leukemias in adults.
~uncontrolled ____________ of myeloblasts, the precursors of granulocytes.
~___________ of the bone marrow.
AML = 1 / 3 of all leukemias; 80% of the acute leukemias in adults.
~uncontrolled proliferation of myeloblasts, the precursors of granulocytes.
~hyperplasia of the bone marrow.
What is acute myelogenous leukemia (AML)?
~manifestations R/T replacement of normal hematopoietic cells in the marrow by leukemic myeloblasts + infiltration of other organs and tissue
~onset is often _____________________ - serious infections and abnormal bleeding
abrupt and dramatic
acute lymphocytic leukemia (ALL) - diagnostics
↓ _____________
↓, normal, or ↑ _____ count.
↑ ______.
Hypercellular bone marrow with lymphoblasts which may be in CSF
Presence of Philadelphia chromosome (up to 25% of patients).
↓ RBC, Hgb, Hct, platelet count.
↓, normal, or ↑ WBC count.
↑ LDH.
Hypercellular bone marrow with lymphoblasts which may be in CSF
Presence of Philadelphia chromosome (up to 25% of patients).
drug therapy for acute lymphocytic leukemia (ALL).
-asparaginase, cyclophosphamide, cytarabine, daunorubicin, methotrexate, prednisone, vincristine
-asparaginase, cyclophosphamide, cytarabine, daunorubicin, methotrexate, prednisone, vincristine
What is chronic lymphocytic leukemia?
CLL = most common leukemia in adults in the US
~Production and accumulation of functionally _________ but long-lived, small, mature-appearing _________; B cells usually involved.
~The lymphocytes __________the bone marrow, spleen, and liver.
~Lymph node ____________ (lymphadenopathy) is present throughout body.
~Production and accumulation of functionally inactive but long-lived, small, mature-appearing lymphocytes; B cells usually involved.
~The lymphocytes infiltrate the bone marrow, spleen, and liver.
~Lymph node enlargement (lymphadenopathy) is present throughout body.
chronic lymphocytic leukemia dx
Mild ________ and thrombocytopenia .
Total WBC count >100,000/μL.
↑ in peripheral lymphocytes and lymphocytes in bone marrow.
May have autoimmune hemolytic anemia, idiopathic thrombocytopenic purpura, hypogammaglobulinemia.
Mild anemia and thrombocytopenia .
Total WBC count >100,000/μL.
↑ in peripheral lymphocytes and lymphocytes in bone marrow.
May have autoimmune hemolytic anemia, idiopathic thrombocytopenic purpura, hypogammaglobulinemia.
______ = most common leukemia in adults in the US
CLL
What is the role of bleomycin in treating Stage IA Hodgkin’s lymphoma?
-kill cancer cells, it is an antitumor, antibiotic that works by inducing ____________________
breaks in DNA strands
Which lymph nodes are commonly affected in Hodgkin’s lymphoma?
cervical, axillary, or inguinal lymph nodes
What are the clinical manifestations of Hodgkin’s lymphoma?
~___________ onset
~_____________ of cervical, axillary, or inguinal lymph nodes; movable and nontender
~may have weight loss, fatigue, weakness, fever, chills, tachycardia, or night sweats.
~small amounts of alcohol > rapid onset of ______at the site of disease.
~Generalized itching without skin lesions may develop; Cough, dyspnea, stridor, and dysphagia may occur
~advanced: hepatomegaly and splenomegaly; Anemia results from increased destruction and decreased production of RBCs.
~may lead to superior ________________ syndrome; Jaundice; Spinal cord; Bone pain
~gradual onset
~enlargement of cervical, axillary, or inguinal lymph nodes; movable and nontender
~may have weight loss, fatigue, weakness, fever, chills, tachycardia, or night sweats.
~small amounts of alcohol > rapid onset of pain at the site of disease.
~Generalized itching without skin lesions may develop; Cough, dyspnea, stridor, and dysphagia may occur
~advanced: hepatomegaly and splenomegaly; Anemia results from increased destruction and decreased production of RBCs.
~may lead to superior vena cava syndrome; Jaundice; Spinal cord; Bone pain
What is the first-line treatment for Hodgkin’s lymphoma ________
advanced disease _____________
-ABVD - adriamycin, bleomycin, vinblastine, dacarbazine [4-6 cycles]
-BEA COPP - bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone [8 cycles]
What is the first-line treatment for Hodgkin’s lymphoma (ABVD)
advanced disease (BEACOPP)?
-ABVD - adriamycin, bleomycin, vinblastine, dacarbazine [4-6 cycles]
-BEA COPP - bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone [8 cycles]
What are Reed-Sternberg cells? [Hodgkin’s Lymphoma]
-multinucleated cells: large __________ _____________ or WBC that may contain more than 1 nucleus
-multinucleated cells: large abnormal lymphocytes or WBC that may contain more than 1 nucleus
What diagnostic tests are used for Hodgkin’s lymphoma?
__________ blood analysis
_____________ biopsy
________________ examination
radiologic studies
Peripheral blood analysis
lymph node biopsy
bone marrow examination
radiologic studies
What are the genetic risk factors associated with the BRCA1 gene?
-__________ jewish; family history of ovarian/breast cancer
-known history of BRCA1 gene mutation
-Ashkenazi jewish; family history of ovarian/breast cancer
-known history of BRCA1 gene mutation
What is ductal carcinoma in situ? [in same place]
~ Noninvasive cancer stays within the _________________; do not grow into normal tissues within or beyond the breast.
~_____________; may progress to invasive breast cancer if untreated.
~Treatment - breast-conserving treatment (lumpectomy), radiation therapy, total mastectomy, and/or hormone therapy (e.g., tamoxifen)
~ Noninvasive cancer stays within the milk ducts or lobules; do not grow into normal tissues within or beyond the breast.
~unilateral; may progress to invasive breast cancer if untreated.
~Treatment - breast-conserving treatment (lumpectomy), radiation therapy, total mastectomy, and/or hormone therapy (e.g., tamoxifen)
Risk factors for breast cancer
Over age 55
Female
family history
preg after 30
alcohol use
benign breast disease
genetic factors
Chemicals
Taller
Smoking
Obesity
early menarche before 12
late menopause after 55
race/ethnicity
physical inactivity
Over age 55
Female
family history
preg after 30
alcohol use
benign breast disease
genetic factors
Chemicals
Taller
Smoking
Obesity
early menarche before 12
late menopause after 55
race/ethnicity
physical inactivity
Tonic-clonic:
Loss of consciousness
Falling to ground
Convulsion
Can start in 1 hemisphere and spread to other
1- 3 (up to 5) minutes long
Stiffening
Rhythmical jerking
May look dusky or blue
“Status epilepticus”
After seizure, person may be confused, sleepy, depressed, irritable.
Don’t know what’s going on after they wake up.
Loss of consciousness
Falling to ground
Convulsion
Can start in 1 hemisphere and spread to other
1- 3 (up to 5) minutes long
Stiffening
Rhythmical jerking
May look dusky or blue
“Status epilepticus”
After seizure, person may be confused, sleepy, depressed, irritable.
Don’t know what’s going on after they wake up.
Psychogenic seizures (PNES):
____________ Looks like a seizure but isn’t. Caused by psychological factors like emotional abuse or traumatic event.
EEG monitoring needed to diagnose.
Look at pt’s history. Any physical or emotional abuse?
non epileptic.
Absence: AKA Petite
-__________ or stare in to space for a few seconds-eyes don’t blink, jerky lip movements
-Common in kids
-Don’t cause any long term problems
-Last only a few seconds & often goes unnoticed
-Can happen up to 100/day when untreated
Blank out
Myoclonic
-Brief ________________ of muscle or muscle group
-Sudden, excessive, twitch of body -> may be forceful enough that they fall to ground.
-Occur in clusters
jerking spasm
Tonic:
-Sudden _________________ arm, leg, body muscles
-20 seconds or less
-Can happen while they’re sleeping. If they’re standing, they may fall.
stiffness or tension i
Atonic: “______”
-Causes sudden loss of muscle strength or movement
-Great risk of head injury
-Wear a helmet!
-Lasts <15 seconds. Person remains conscious. Returns to normal activity almost immediately.
Drop
Clonic:
-Rare
-Occur in all ages
___________________. Motor symptoms affect whole body including arms and legs followed by limb jerking– may or may not be symmetrical.
Rhythmical jerking
Simple focal seizure:
Person is ____________________ that they are having a seizure.
Sudden, unexplainable feelings of joy, anger, sadness, nausea.
Hear, smell, taste, see, feel things that are not real.
Complex focal seizure:
Person is ______________________ that they are having a seizure.
Repetitive movement like lip smacking.
Simple focal seizure:
Person is conscious & aware that they are having a seizure.
Sudden, unexplainable feelings of joy, anger, sadness, nausea.
Hear, smell, taste, see, feel things that are not real.
Complex focal seizure:
Person is unconscious & unaware that they are having a seizure.
Repetitive movement like lip smacking.
A patient’s laboratory report reveals that the cells from the tumor biopsy are grade II. Which interpretation would the nurse make about the tumor cells?
Abnormal and moderately differentiated
Very abnormal and poorly differentiated
Immature, primitive, and undifferentiated
Differing slightly from normal cells, well differentiated
Abnormal and moderately differentiated
The biopsy report of a patient states that the patient has stage I cervical cancer. In which way would the nurse explain this stage to the patient?
The tumor has a limited local growth.
The tumor has metastasized to other parts.
The tumor is limited to the tissue of origin.
The tumor has extensive local and regional spread.
The tumor is limited to the tissue of origin.
Which statement explains the primary protective role of the immune system related to malignant cells?
Immune cells bind with free antigen released by malignant cells.
Immune cells produce blocking factors that immobilize cancer cells.
The immune system produces antibodies that attack the cancer cells.
The immune system provides surveillance for tumor-associated antigens (TAAs).
The immune system provides surveillance for tumor-associated antigens (TAAs).
Which extracranial condition would the nurse associate with a patient’s seizures?
Migraine
Meningitis
Brain tumor
Hypertension
Hypertension
Hypertension is an extracranial condition associated with seizures. Migraines, brain tumors, and meningitis are all intracranial conditions that can be associated with seizures.
Drop attacks are a characteristic of which type of seizure?
Tonic seizure
Clonic seizure
Atonic seizure
Myoclonic seizure
Atonic seizure
Which goal of a cancer treatment plan focuses on cancers that cannot be eradicated but are responsive to anticancer therapies?
Cure
Biopsy
Control
Palliation
Control
Which disease process includes Lhermitte sign as a clinical manifestation?
Multiple sclerosis
Myasthenia gravis
Lou Gehrig disease
Huntington disease
Multiple sclerosis
Which medication would be prescribed for a patient who has peripheral neuropathy after taking chemotherapy?
Furosemide
Gabapentin
Metoclopramide
Morphine sulfate
Gabapentin
