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Nurs 136- MCA II > Week 3 - Neurological / Cancers > Flashcards

Week 3 - Neurological / Cancers Flashcards

1
Q

Epilepsy- a group of neurologic diseases marked by _____________________

A

recurring seizures

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2
Q

2 Types of seizures

A

Focal

Generalized

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3
Q

Generalized seizures- start over wide areas of _____________ of brain

A

both sides

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3
Q

Focal seizures- begin in _________________ of the brain in a specific region of the cortex

A

1 hemisphere

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4
Q

2 types of focal seizures

A

simple
complex

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5
Q

6 types of generalized seizures

A

tonic-clonic
absense
myoclonic
tonic
atonic
clonic

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6
Q

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)​

A

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)​

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6
Q

Seizures - 4 phases

A

Prodromal
Aural (early ictal)
Ictal
Post ictal

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7
Q

Seizures- risk factors

___________ disturbances
___________ disorders

A

Metabolic disturbances
extracranial disorders

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8
Q

Seizures- diagnostics

Labs
CT
MRI
EEG

A

Labs
CT
MRI
EEG

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9
Q

Seizures- nursing management

ABC, O2
Safeguard from _________
_________ to stop seizures

___________________ - Dilantin, Keppra, Cerebyx, Phenobarbital

A

ABC, O2
Safeguard from injury
Benzos to stop seizures

Anti-convulsants- Dilantin, Keppra, Cerebyx, Phenobarbital

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10
Q

Seizures- complications

SUDEP
NPE
Todd’s paralysis
Status ___________

A

SUDEP
NPE
Todd’s paralysis
Status Epilepticus

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11
Q

Parkinson’s disease- chronic, progressve neurodegenerative disorder characterized by:

____________
Rigidity, _________ at rest
Gait disturbance
TRAP

A

Parkinson’s disease- chronic, progressve neurodegenerative disorder characterized by:

Bradykinesia
Rigidity, tremors at rest
Gait disturbance
TRAP

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12
Q

Parkinson’s disease diagnostics

No specific tests
Dx based on ________

A

No specific tests
Dx based on Hx, S&S

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13
Q

Parkinson’s disease nursing management

__________ with carbidopa (Sinemet)
SE: Dyskinesia

A

Levodopo with carbidopa (Sinemet)
SE: Dyskinesia

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14
Q

Multiple Sclerosis (MS)- characterized by segmental ___________________________ of brain and spinal cord

A

demyelination of nerve fibers

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15
Q

Multiple Sclerosis (MS) diagnostics

_____ - demyelinating lesions

A

MRI

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16
Q

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)

A

No cure
Drug therapy to slow progression
-Immunomodulators B-1a and B-1b, Fingolimod (Gilenya)
-Immunosupresants (Dimethyl fumarate/ Tecfidera)
-Corticosteroids (Methylprednisolone/ Solu-Medrol)

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17
Q

Myasthenia Gravis- chronic, autoimmune disease characterized by profound ___________________________

A

muscle weakness and fatiguability

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18
Q

Myasthenia Gravis S&S

Painless muscle ____________
Myasthenia ________

A

Painless muscle weakness
Myasthenia Crisis

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19
Q

Myasthenia Gravis nursing management

Acetylcholinerase inhibitors
Corticosteroids, IV immunoglobulin, Plasmapheresis, immunosuppresives
MV, thymectomy

A

Acetylcholinerase inhibitors
Corticosteroids, IV immunoglobulin, Plasmapheresis, immunosuppresives
MV, thymectomy

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20
Q

Chronic Seizure (epilepsy): 2 or more seizures and tendency to have recurrent seizures​

Cause: __________​

Due to _____________________ reacting abnormally, not metabolic disturbances​

A

2 or more seizures and tendency to have recurrent seizures​

Cause: Unknown​

Due to electrical circuits reacting abnormally, not metabolic disturbances​

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21
Q

Seizures: caused by :

(↓ __________or ↓ __________)​

A

metabolic disturbances​

(↓ sodium or ↓ glucose)​

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22
Q

2 Types​ of seizures-

A

Focal Seizures (Localized)​

Generalized Seizures (throughout the whole brain) ​

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23
Q

Seizure phase 1

Prodromal Phase: ___________ a seizure is on the way (foreshadow) ​

Few hours-days ​

S/Sx: Changes in ______ , Anxiety, Focus and having lightheadedness​

A

Prodromal Phase: Sensing a seizure is on the way (foreshadow) ​

Few hours-days ​

S/Sx: Changes in Mood, Anxiety, Focus and having lightheadedness​

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24
Q

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​

A

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​

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25
Q

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​

A

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​

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26
Q

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) ​

A

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) ​

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27
Q

Seizures Risk Factors​

____________ Disorders: Traumatic Brain Injury increases ICP, HTN -> Stroke, DM or Hypoglycemia (FATAL)​

___________ Disorders: Hypoglycemia, Hyponatremia, ETOH toxicity/withdrawal, Hypoxemia, High Fever​

A

Extracranial Disorders: Traumatic Brain Injury increases ICP, HTN -> Stroke, DM or Hypoglycemia (FATAL)​

Metabolic Disorders: Hypoglycemia, Hyponatremia, ETOH toxicity/withdrawal, Hypoxemia, High Fever​

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28
Q

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

A

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

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29
Q

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​

A

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​

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30
Q

Seizure Complications​

_________ (Sudden Unexpected Death in Epilepsy) ​

NPE (Neurogenic Pulmonary _______)​

Todd’s ___________​

Status _______________ (MOST DANGEROUS) -> > ___ min seizure​

A

SUDEP (Sudden Unexpected Death in Epilepsy) ​

NPE (Neurogenic Pulmonary Edema)​

Todd’s Paralysis​

Status Epilepticus (MOST DANGEROUS) -> >5 min seizure​

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31
Q

Parkinson’s Disease​

Low _______________ Levels, pts with PD usually have a Dopamine Deficiency​

Dopamine = _________ Functions​

No Treatment, just symptoms management

A

Low Dopamine Levels, pts with PD usually have a Dopamine Deficiency​

Dopamine = Motor Functions​

No Treatment, just symptoms management

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32
Q

Parkinson’s Disease​ Nursing Management​

____________ w/ Cabidopa (Sinemet) -> Synthetic Dopamine to prevent symp of TRAP​

A

Levadopa w/ Cabidopa (Sinemet) -> Synthetic Dopamine to prevent symp of TRAP​

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32
Q

Parkinson’s Disease - Chronic, Progressive _______________ Disorder​

A

Chronic, Progressive Neurodegenerative Disorder​

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33
Q

Parkinson’s Disease​ TRAP​

____________ at Rest​

_________

____________ /Bradykinesia (No movement or slow movement)​

___________ Instability (Unsteady Gait)​

A

Tremor at Rest​

Rigidity​

Akinesia/Bradykinesia (No movement or slow movement)​

Postural Instability (Unsteady Gait)​

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34
Q

Parkinson’s Disease​ Dx Tests​

No Specific Tests​

Dx based on ______________

​

​

A

No Specific Tests​

Dx based on pt Hx and S/Sx​

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35
Q

Multiple Sclerosis​

Segmental _____________ of Nerve Fibers of Brain and Spinal Cord​

Autoimmune Disease: Immune system attacking ____________

A

Segmental Demyelination of Nerve Fibers of Brain and Spinal Cord​

Autoimmune Disease: Immune system attacking Myelin Sheath​

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36
Q

Multiple Sclerosis​ Dx Tests​

_____ -> Demyelinating Lesions

A

MRI -> Demyelinating Lesions

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37
Q

Myasthenia Gravis​ - Chronic autoimmune disease characterized by profound ______________________________

A

muscle weakness and fatigability​

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37
Q

Multiple Sclerosis​ Treatment​

No Cure for MS​

Drug Therapy to Slow Progression -> Suppress and Control ______________

Immunomodulators​

Immunosuppressants​

Corticosteriods​

A

No Cure for MS​

Drug Therapy to Slow Progression -> Suppress and Control Immune System​

Immunomodulators​

Immunosuppressants​

Corticosteriods​

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38
Q

Myasthenia Gravis​ Clinical Manifestations​

___________ Muscle Weakness​

Myasthenia Crisis -> SEVERE and ________________

Muscles that control ___________ become weak -> Respiratory Failure -> Mechanical Ventilation​

A

Painless Muscle Weakness​

Myasthenia Crisis -> SEVERE and LIFE THREATENING​

Muscles that control breathing become weak -> Respiratory Failure -> Mechanical Ventilation​

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39
Q

Myasthenia Gravis​ Nursing Management​

___________________ Inhibitors ​

Watch out for Cholinergic Crisis​

Corticosteroids, IV immunoglobulin, Plasmapheresis and Immunosuppressive Agents​

Mechanical Ventilation, Thymectomy​

A

Acetylcholinesterase Inhibitors ​

Watch out for Cholinergic Crisis​

Corticosteroids, IV immunoglobulin, Plasmapheresis and Immunosuppressive Agents​

Mechanical Ventilation, Thymectomy​

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39
Q

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 _____________​

A

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​

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40
Q

Cancer: group of disease characterized by uncontrolled and unregulated _____________
​
​

A

cell growth ​

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41
Q

Initiation: a _________ in the cell’s genetic structure. ​

A mutation is any ________ in the usual DNA​

A

Initiation: a mutation in the cell’s genetic structure. ​

A mutation is any change in the usual DNA​

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42
Q

Promotion: reversible ___________ of altered cells ​

Activity promoters is reversible (cancer prevention) ​

A

Promotion: reversible proliferation of altered cells ​

Activity promoters is reversible (cancer prevention) ​

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43
Q

Progression: last stage where there is an increase in growth rate of _______, increased invasiveness and metastasis ​

A

Progression: last stage where there is an increase in growth rate of tumor, increased invasiveness and metastasis ​

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44
Q

Immunologic surveillance: helps prevent cancer cells from growing into _______​​

The immune system uses _____________ surveillance to respond to TAAs.

A

Immunologic surveillance: helps prevent cancer cells from growing into tumors ​​

The immune system uses immunologic surveillance to respond to TAAs.

45
Q

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 ​

A

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 ​

46
Q

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

A

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

47
Q

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.
A
  • 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.
48
Q

_______________: 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 ​

A

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 ​

49
Q

Chemotherapy Function: disrupt cellular __________________

A

replication & proliferation​

50
Q

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.​

A

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.​

51
Q

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​

​

A

Standard Peripheral IV ​​

Non-tunneled Central Catheter ​​

Tunneled Central Catheter- less risk of infection ​​

PICC Line ​​

**Port- implanted under the skin, Huber​

52
Q

______________ : most common side effect of chemo and radiation ​

A

Myelosuppression

53
Q

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

A

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.​
53
Q

Myelosuppression

Stem cells are constantly regenerating in our bone marrow​

Stem cells are responsible for creating ___________

A

Stem cells are constantly regenerating in our bone marrow​

Stem cells are responsible for creating blood cells!

54
Q

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​

A

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 ​

55
Q

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​

A

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​

56
Q

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

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.​

57
Q

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 ​

A

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.​

58
Q

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 ​

A

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 ​

59
Q

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​

A

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.​

60
Q

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​

A

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.​

61
Q

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​

A

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.​

62
Q

What is the Pyramid Effect?

Experimental __________________ of cancer cells, likened to an inverted pyramid

A

growth pattern

63
Q

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.

A

rapid tumor growth

64
Q

Promotion stage - altered cells __________ , but this growth can be reversed

A

multiply

65
Q

What is promotion in cancer development?

Altered cells begin to proliferate and accumulate increasing the likelihood of additional ________________

A

genetic mutations

66
Q

Stage 2 cancer

-has grown more deeply into nearby tissues
Stage II: Limited _________ _________

A

local spread

67
Q

What defines Stage IV in cancer classification?

-cancer has spread to _________ parts of body
*Stage IV: _____________

A

-cancer has spread to distant parts of body
*Stage IV: Metastasis

68
Q

Explain the TNM Classification System.

A

*tumor size and invasiveness (T)
presence or absence of regional spread to the lymph nodes (N)
metastasis to distant organ sites (M).

69
Q

What are the characteristics of a Grade IV tumor?

*Grade IV: Cells are __________, primitive (anaplasia), and ______________.
Cell _________ is hard to determine (high grade).

A

*Grade IV: Cells are immature, primitive (anaplasia), and undifferentiated.
Cell origin is hard to determine (high grade).

70
Q

How is a Grade II tumor defined?

*Grade II: Cells are more ____________ (moderate dysplasia) and moderately ______________ (intermediate grade).

A

*Grade II: Cells are more abnormal (moderate dysplasia) and moderately differentiated (intermediate grade).

71
Q

What are the seven warning signs of cancer? [CAUTION]

A

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

72
Q

What is an excisional biopsy?

*surgical removal of ________________________________________________
It is:

A

*surgical removal of the entire lesion, lymph node, nodule, or mass; therapeutic as well as diagnostic.

73
Q

What is fine-needle aspiration (FNA)?

*Diagnostic; done with a small-gauge aspiration needle that provides _________________________________

A

cells from the mass for cytologic examination

74
Q

What is the common route for chemotherapy administration?

___________

[concerns - venous access problems, device- or catheter-related infection, and extravasation]

A

IV route

75
Q

What is brachytherapy?

-insertion of ____________ materials directly into or near tumor

A

radioactive

76
Q

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.

A

direct delivery of radiation

77
Q

chemotherapy drug - Vesicants - if infiltrated into the skin, may cause severe __________________________

A

local tissue breakdown and necrosis

78
Q

How does chemotherapy affect WBC counts?

A

bone marrow suppression > reduction of WBC causes neutropenia

79
Q

Chemotherapy ______ white blood cell (WBC) counts by damaging the bone marrow, where WBCs are produced.

A

lowers

80
Q

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.]

A

mouth and lips.

81
Q

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).
A
  • 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).
82
Q

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.

A

Serotonin

83
Q

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 ________________.]

A

cell proliferation

84
Q

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.

A

CML; diagnostic hallmark of CML

85
Q

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.

A

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.

86
Q

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

A

abrupt and dramatic

87
Q

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).

A

↓ 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).

88
Q

drug therapy for acute lymphocytic leukemia (ALL).

-asparaginase, cyclophosphamide, cytarabine, daunorubicin, methotrexate, prednisone, vincristine

A

-asparaginase, cyclophosphamide, cytarabine, daunorubicin, methotrexate, prednisone, vincristine

89
Q

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.

A

~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.

90
Q

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.

A

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.

90
Q

______ = most common leukemia in adults in the US

A

CLL

91
Q

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 ____________________

A

breaks in DNA strands

92
Q

Which lymph nodes are commonly affected in Hodgkin’s lymphoma?

A

cervical, axillary, or inguinal lymph nodes

93
Q

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

A

~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

94
Q

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]

A

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]

95
Q

What are Reed-Sternberg cells? [Hodgkin’s Lymphoma]

-multinucleated cells: large __________ _____________ or WBC that may contain more than 1 nucleus

A

-multinucleated cells: large abnormal lymphocytes or WBC that may contain more than 1 nucleus

96
Q

What diagnostic tests are used for Hodgkin’s lymphoma?

__________ blood analysis
_____________ biopsy
________________ examination
radiologic studies

A

Peripheral blood analysis
lymph node biopsy
bone marrow examination
radiologic studies

97
Q

What are the genetic risk factors associated with the BRCA1 gene?

-__________ jewish; family history of ovarian/breast cancer
-known history of BRCA1 gene mutation

A

-Ashkenazi jewish; family history of ovarian/breast cancer
-known history of BRCA1 gene mutation

98
Q

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)

A

~ 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)

99
Q

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

A

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

100
Q

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.

A

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.

101
Q

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?

A

non epileptic.

102
Q

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

A

Blank out

103
Q

Myoclonic

-Brief ________________ of muscle or muscle group
-Sudden, excessive, twitch of body -> may be forceful enough that they fall to ground.
-Occur in clusters

A

jerking spasm

104
Q

Tonic:
-Sudden _________________ arm, leg, body muscles
-20 seconds or less
-Can happen while they’re sleeping. If they’re standing, they may fall.

A

stiffness or tension i

105
Q

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.

A

Drop

106
Q

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.

A

Rhythmical jerking

107
Q

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.

A

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.

108
Q

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

A

Abnormal and moderately differentiated

109
Q

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.

A

The tumor is limited to the tissue of origin.

110
Q

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).

A

The immune system provides surveillance for tumor-associated antigens (TAAs).

111
Q

Which extracranial condition would the nurse associate with a patient’s seizures?

Migraine

Meningitis

Brain tumor

Hypertension

A

Hypertension

Hypertension is an extracranial condition associated with seizures. Migraines, brain tumors, and meningitis are all intracranial conditions that can be associated with seizures.

112
Q

Drop attacks are a characteristic of which type of seizure?

Tonic seizure

Clonic seizure

Atonic seizure

Myoclonic seizure

A

Atonic seizure

113
Q

Which goal of a cancer treatment plan focuses on cancers that cannot be eradicated but are responsive to anticancer therapies?

Cure

Biopsy

Control

Palliation

A

Control

114
Q

Which disease process includes Lhermitte sign as a clinical manifestation?

Multiple sclerosis

Myasthenia gravis

Lou Gehrig disease

Huntington disease

A

Multiple sclerosis

115
Q

Which medication would be prescribed for a patient who has peripheral neuropathy after taking chemotherapy?

Furosemide

Gabapentin

Metoclopramide

Morphine sulfate

A

Gabapentin

Nurs 136- MCA II (12 decks)

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