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N362: Practice of Nursing III > Week 5: Oncology Part 2 - FOR 362 NOT 363 > Flashcards

Week 5: Oncology Part 2 - FOR 362 NOT 363 Flashcards

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1
Q

What is radiation therapy

A

use of high energy ionizing rays or particles to treat cancer

destroys ability of cancer cells to grow and multiply - cell cycle interruption

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2
Q

Radiation therapy can be ___ or ___

A

external or internal

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3
Q

How often is radiation therapy administered usually

A

usually administered daily for 5 days with a 2 day “holiday” for 2-8 weeks

treatment planning is extensive

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4
Q

Radiation Dosimetry

A

radiation dose being determined by mesurement, calculation or a mix of borth

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5
Q

IMRT

A

intensity modulated radiation therapy - external

delivers high dose radiation to a tumor while sparing vital healthy tissues around the tumor

The beam can mold to the tissues shape and bombard the tumor with small beans of different intesities from all sides

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6
Q

Bracytherapy

A

Internal radiation therapy

Radioactive substances like unsealed or sealed sources deliver large amounts of radiation to a specific area over a short time

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7
Q

Example of Brachytherapy

A

Prostate Seeds

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8
Q

Unsealed Brachytherapy Sources

A

liquid radiation

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9
Q

Sealed Brachytherapy Sources

A

Implants - needles, seeds, wires

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10
Q

Types of Cancer that respond well to Radiation therapy

A

lymphoma

leukemia

squamous cell cancers of oropharynx, glottis, bladder, skin, prostate

breast cancers

adenocarcinomas of the ailmentary tract

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11
Q

Radiation Safety Measures

A

radiation madge

minimize exposure

care - limit time, distance to radiation exposure (6 feet), shielding (lead shield)

monitoring implant placement (sealed sources) every 4-6 hours –> if found, long handled forceps into a lead lined container

no one under 18 or pregnant visiting the radioactive implant pt

mark client room with radiation precautions

body secretions considered contaminated

pt vomitting within the first 4 hours –> everything vomit touches is contaminated

use of disposable gowns, dishes, etc

visitors limited to 1 hour/day and must keep distance from pt

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12
Q

Radiation Safety Measures are important in what time period of sealed source implants

A

24-72 hours

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13
Q

Common effects of radiation therapy can be what?

A

acute, sub acute or late

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14
Q

Common effects of radiation therapy

A

impaired skin integrity

risk for infection r/t skin breakdown - erythema, dry and wet desquamation

activity intolerance and fatigue

altered nutrition less than body requirements r/t anorexia

bone marrow suppression - r/t irradiation of areas with large volumes of production

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15
Q

What are common R Therapy effects in the head and neck

A

Stomatitis/Mucositis

Xerostomia

Tooth decay and caries

osteoradionecrosis

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16
Q

What are common R therapy effects in the brain/scalp

A

alopecia - hair texture - color changes

cerebral edema

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17
Q

What are common R therapy effects in the pelvis

A

diarrhea

cystitis

ED

sexual disorders

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18
Q

What are common R therapy effects in the abdomen

A

N and V

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19
Q

WHat are common R therapy effects in the chest

A

cough

esophagitis

radiation pneumonitis

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20
Q

Nursing assessment wants to look at what for a pt with radiation therapy

A

note skin in field of radiation

monitor labs for neutropenia

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21
Q

Important topics of education for pt.s in radiation therapy

A

equipment, length of treatment

good skin and oral care

safety concerns with implants

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22
Q

Chemotherapy

A

antineoplastic agents used to kill tumor cells by interfering with the cell cycle

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23
Q

Immunotherapy

A

“Biotherapy”

use of agents derived from biologic sources or agents that enhance immune system to kill cancer cells

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24
Q

How does immunotherapy kill cancer cells

A

enhance the immune response, modify actions of the cells, and icnrease vulnerability of the cells

ex: Cytokines, monoclonal antibodies

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25
Q

Targeted Therapy

A

most intesnive/scientific

molecular based therapies that target receptors, proteins, transduction pathways to prevent growth of cancer cells

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26
Q

Chemotherapy Types/Routes

A

Oral, SQ, IM

Topical

IV (Peripheral, central lines)

Intra arterial

Intra cavity

Intra peritoneal

Intrathecal

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27
Q

CVA (Chemo)

A

Central Venous Access

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28
Q

Extravasation

A

the leakage of blood, lymph, or other fluids like anti cancer drugs from a blood vessel or tube into the tissue around it

It is a complication from a vesicant leading to blistering

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29
Q

What is the fundamental of safe administration of chemotherapy

A

safe handling! !!!

consider any chemo/bio drug to be HAZARDOUS TO YOUR HEALTH - so minimize exposure

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30
Q

Routes for Chemo Administration

A

absorption

injections

inhalation

ingestion

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31
Q

What sort of PPE is used for chemo?

A

Gloves - powder free and tested with chemo agents - double gloving recommended for prep and waste handling

gowns - low permiability fabric with a solid front

respirators - if any aerosol risk

eye or face protection if splash potential

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32
Q

Chemotherapy adminsitration situations requiring PPE

A

introducing or withdrawing needles from vials

transferring drugs form vials to other containers suing needles or syringes

opening ampulse

adminsitering drugs by any route

spiking, priming IV tubing

handling leakages

handling bodily fluids of someone who has received agents in the last 48 hours

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33
Q

Nursing assessment areas for clients receiving chemo/bio agents

A

patient concerns and questions

support systems

coping

nutritional status

CBC and other chemistries

infusion site and CVAD care!!!!!!

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34
Q

Education areas for the nurse to convery for pts receiving chemo or biotherapy

A

side effect onsets and durations

how to manage the side effects at home

recognizing emergency situations

how to manage CVAD

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35
Q

Common SE of Cancer that needs nursing management

A

alopecia

anorexia

diarrhea or constipation

fatigue

myelosuppression

mucositits (other places in addt to oral)

cardiac toxicity

hypersensitivity rxns

lyte disturbances (hypercalc, hypergly, hyper kal, hypernat, hyperuricemia, hypomag, hypocalcemia)

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36
Q

When does alopecia usually start after chemotherapy and radiation therapy and when can regrowth begin

A

beings 2-3 weeks post initiation but can regrown as often as within 8 weeks after last treatment

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37
Q

Nursing Diagnosis for Alopecia

A

alteration in body image r/t alopecia

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38
Q

Nursing interventions for Alopecia

A

mild, protein based shampoos, cream rinse and conditioner

avoid hair dryers, curling irons, bobby pins

wrap or turban to keep head warm

sunscreen scalp if needed

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39
Q

How soon can skin breakdown begin in chemo patients

A

as soon as 2 weeks into radiation therapy, it is dose dependent

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40
Q

Nursing Diagnosis for Skin Breakdown from Radiation therapy

A

Actual or Risk for Impaired Skin Integrity

Risk for infection r/t skin breakdown

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41
Q

Nursing Interventions for Altered Skin Integrity / Skin Breakdown

A

Assess skin integrity

Minimize trauma and protect the skin

If skin with dry breakdown - hydrophilic moisturizing lotion (aquaphor)

If skin weeps - apply non adhesive absorbent dressing

After treatment - protect skin, sunblock

Consult wound ostomy continence nurse

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42
Q

Nursing Diagnosis for Oral Care Issues (Mucositis or Stomatitis)

A

Mucositis or Stomatitis r/t Chemo or Radiation therapy

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43
Q

Nursing Interventions for Oral Care Issues r/t chemo or radiation therapy

A

Inspect mouth daily - check for yeast

Soft bland diet and maintain hydration

Saliva Substitute

Topical Anesthetics (BMX sol’n) and oral care

Antifungals as needed if yeast - ie Nystatin

44
Q

A client has been receiving chemotherapy to treat cancer. Which of following assessment findings suggest that the client has developed mucositis?

A - White cottage cheese - like patches on tongue

B - Yellow Tooth Discoloration

C - Red, open sores on the oral mucosa

D - Rust colored sputum

A

C

45
Q

Xerostomia

A

More specific to Radiation Therapy, especially if near the salivary glands

Saliva changes from thin fluid to thick sticky and acidic unable to cleanse mouth, person at risk for dental caries

46
Q

Nursing Diagnosis for Xerostomia

A

Altered oral mucous membrane (xerostomia) r/t chemo or irradiation

47
Q

Nursing Interventions for Xerostomia

A

excellent mouth care, soft bristle brushes

sauces, gravies, liquids on foods to make them moist

sugarless sour candies

saliva substitutes

no commercial mouthwashes with alcohol

Oral Pilocarpine may stimulate saliva

48
Q

Myelosuppression

A

Decreasing in most cell counts - WBCs, platelets, RBCs

49
Q

Nursing Diagnoses for Myelosuppression

A

Risk for infection r/t immunosuppression, skin breakdown or contamination of supplies

Risk for injury r/t alteration in immune system; clotting factors

50
Q

How to calculate Absolute Neutrophil Count (ANC) to check for neutropenia in cancer patients

A

ANC = % neutrophils (bands + segs) * WBC count

51
Q

What is one way they treat neutropenia and anemia

A

CSF - colony stimulating factors

  1. Filgastrim (Neupogen) - WBC
  2. Pefilgrastim (Neulasta) - WBC
  3. Epogen - RBC
52
Q

Nursing Interventions to minimize infection risks

A

Monitor CBC and granulocyte count

Monitor ANC level - infection risk

Watch for NADIR - lowest white cell count post-therapy

HANDWASHING

Restrict visitors

53
Q

What does EBP suggest is the best ways to prevent infection

A

Hand hygiene using soap and water or antiseptic hand rub for all patients with cancer and their cancer caregivers

Colony stimulating factors for all patients with cancer undergoing chemo with >20% risk of febrile neutropenia

Flu, COVID, and pneumonia vaccines

Do not allow visitors with respiratory infections

Prophylactic antibodies/antivirals for some patients

54
Q

Thrombocytopenia: What sort of injuries can occur with these levels of platelets:

  1. <100,000/mm3
  2. <20,000/mm3
  3. <10,000/mm3
A
  1. injury or surgery may provoke excess bleeding
  2. spontaneous bleeding may occur
  3. often associated w/ serious hemorrhage
55
Q

Nursing Interventions for thrombocytopenia

A

assess bruising, bleeding from CVAD sites, gross blood from other sites

Petechiae

Monitor platelet levels & transfuse under provider order

No IM injections, rectal temps

Use electric razors for shaving, soft toothbrush

56
Q

Nursing diagnosis for Anemia

A

Risk for activity intolerance r/t chemo therapy and irradiation

57
Q

Nursing Interventions for Anemia

A

assess blood counts (H&H)

pace activities, rest activities

Assistive devices

Adequate nutrition

Encourage exercise ==> can actually reduce fatigue

58
Q

Nursing Diagnosis for N/V

A

Altered nutrition less than body requirements r/t N/V

59
Q

Nursing Interventions from N/V

A

assess strategies that have worked for pt.

Monitor lab values r/t nutrition

stimulate appetite and facilitate caloric intake

oral and parenteral anti-emetics that are carefully timed

cold, salty, dry crackers, toast may be tolerated

60
Q

Medications for N/V

A

Benzodiazepines for anticipatory N/V

Mayneed a 5-HT3 receptor antagonist - kytril and zofran

corticosteroids

metoclopramide - Reglan

61
Q

Nursing Interventions for Diarrhea

A

Avoid - high roughage, greasy, spicy foods, milk products, caffeine, alcohol

Encourage - bland diet, increasing fluid intake (weak tea, broth, grape juice)

May need loperamide (immodium) if persistent

62
Q

Nursing Interventions for Constipation

A

Increase fluid intake

Increase high fiber foods (whole grains, bran, fruits and veggies, popcorn)

63
Q

CACS

A

Cancer Related Anorexia Cachexia Syndrome

Biology process that results from a combination of increased energy expenditure and decreased intake

increased nutrient intake cannot always reverse the process !!!

(Do not need: may take dronabinal, megestrolacetate, steroids)

64
Q

What are some s/s of CACS

A

Wasting

weight loss

weakness

fatigue

impaired immune fxn

65
Q

Nursing Diagnosis for Esophagitis/Pharyngitis

A

Impaired Swallowing r/t side effects of rad. therapy or chemo

66
Q

Nursing Interventions for Esophagitis/Pharyngitis

A

assess for difficult or painful swallowing

eat a soft, bland or pureed diet

scheduled medications to promote comfort - BMX 15 min before meals, systemic pain medication

67
Q

Nursing Diagnosis for Pain

A

Chronic pain r/t rad therapy and chemotherapy

68
Q

Nursing Interventions for Pain

A

Pharmacological intervention

adjuvant co analgesics

non pharmacological interventions

education

collaborate w/ interdisciplinary team including palliative providers

69
Q

Reproductive/Sterility Issues r/t Chemo and Irradiation

A

ED after pelvic radiation

vaginal stenosis - dyspareunia

ovarian failure - try to shield from rad therapy

testicles - avoid radiation to area

impaired sexual enjoyment - assess feelings

70
Q

Ways Females can overcome repro/sterility issues

A

cryopreservation of embryos - may delay chemotherapy by 2-6 weeks

oocyte cryopreservation - regarded as experimental, pregnancy rate low

cryopreservation of ovarian tissue

71
Q

Ways Males can overcome repro/sterility issues

A

cryopreservation of sperm

ethical issues r/t this area

72
Q

BMT v HSCT (Bone marrow v Hematopoietic Stem Cell Transplantation)

A

Intense chemo followed by infusion of stem cells

Used in hematologic malignancies (i.e. malignant myeloma, acute leukemia, and non-Hodgkins Lymphoma)

Harvesting bone marrow tissues v. peripheral blood stem cell collection (apheresis)

> Allogenic HCST (AlloHSCT) from donor
Autologous (AuHSCT) from patient

73
Q

Nursing Management for BMT & HSCT Pre-Transplant

A

Support pt. through extensive work up and evaluation

74
Q

Nursing Management for BMT & HSCT During-Transplant

A

Preparing patient for transplant - high dose chemo destroys immune system and toxic effects of chemo/RT

Watch for GVHD (graft v host disease)

High risk for infection, sepsis, bleeding

Monitor s/s of acute toxicity

75
Q

Nursing Management for BMT & HSCT Post Transplant

A

recipient and the donor

recipients - infection risks

donors - mood alterations, guilty feelings if doesnt work

76
Q

GVHD

A

Graft v Host Disease

Complication of allogeneic transplants - immune mediated rxn to the newly grafted stem cells

77
Q

Nursing Care and Management of GVHD

A

Prevention!

Immunosuppressant drugs (cyclosporine, methotrexate, steroids)

Assess skin - acute GVHD includes a diffuse rash that can be SIMILAR top 2nd degree burn

78
Q

Structural Oncology Emergencies

A

Cardiac Tamponade

Increased ICP

Spinal Cord Compression

Superior Vena Cava Syndrome

79
Q

Metabolic Oncology Emergencies

A

DIC

Hypercalcemia

Anaphylaxis/Hypersensitivity Syndrome

Sepsis

Malignant Pleural Effusion

Syndrome of inappropriate antidiuretic hormone

tumor lysis syndrome

80
Q

Spinal Cord Compression

A

primary tumors within the cord or vertebral metastases compress neural tissue and its blood supplies, resulting in compromised neurologic fxn

81
Q

Who is at risk spinal cord compression

A

breast lung prostate renal melanoma and myeloma often metastasize to bone

lymphoma, seminoma, neuroblastoma often metastasize to spinal cord

persons with primary cancers of the spinal cord

82
Q

Early S/S of Spinal Cord Compression

A

BACK PAIN is a first symptom - may be local, radicular or both

Back pain worse when in supine, with coughing , straining, flexion of neck

motor weakness or dysfunction, sensory loss

83
Q

Local Back Pain d/t Spinal Cord Compression

A

constant, dull aching, progressive pain

84
Q

Radicular Back Pain d/t Spinal Cord Compression

A

constant, initiated with movement, radiates along a dermatome

85
Q

Late S/S of spinal cord compression

A

Loss of sensation for deep pressure, vibrations, position

urine or fecal incontinence or retention

impotence

paralysis

muscle atrophy

86
Q

What is necessary once spinal cord compression is recognized

A

emergent treatment

87
Q

Diagnosis methods Spinal Cord Compression

A

Spinal X rays

bone scan

MRI - preferred

CT scan

Myelogram

88
Q

Treatment of Spinal Cord Compression

A

Radiation therapy

Surgery

Pharmacological

89
Q

Radiation Therapy for Spinal Cord Compression

A

most common treatment for epidural metastasis and cord compression

often used alone and period of several weeks

90
Q

Surgery for Spinal Cord Compression

A

only if radiation didnt work

used to decompress the area

91
Q

Pharmacological Treatment for Spinal Cord Compression

A

steroids to reduce edema and pain, can also treat the tumor

chemo - adjuvant treatment to certain types of CA

analgesic - opioids with anticonvulsants and antidepressants

92
Q

Nursing Interventions for Spinal Cord Compression

A

decrease severity of symptoms and control pain

perform ongoing neurological assessments

monitor bowel and bladder patterns

maintain muscle tone by assisting ROM exercises

prevent complications r/t immobility

93
Q

Superior Vena Cava Syndrome (SVC Syndrome)

A

Compression or invasion of SVC by a tumor, enlarged nodes or thrombus that obstructs circulation

94
Q

What is SVC Syndrome

A

associated with lung cancer (small cell), lymphoma or metastasis

95
Q

How fast is SVC Syndrome onset

A

gradual or sudden

96
Q

What is causing the symptoms/signs of SVC Syndrome

A

usually a result of impaired drainage despite collateral circulation attempts

97
Q

S/S of SVC Syndrome

A

progressive dyspnea and cough

facial swelling!!!!

edema in neck, arms, hands

jugular, arm, and temporal vein distention

prominent venous patterns on chest wall

increased ICP - visual disturbances, headache, mental status

engorged neck

trouble breathing w/ chemo

98
Q

Methods of Diagnosis of SVC Syndrome

A

clinical findings

CXR

thoracic CT

MRI

99
Q

Treatment for SVC Syndrome

A

RT to shrink tumor size

chemo for sensitive cancers or when Rad therapy has reached max tolerance

anticoagulants if thrombosed

O2, corticosteroids, diuretics for symptom management

bypass stents more likely than surgery unless emergent

100
Q

Nursing Care of SVC Syndrome

A

Assess for the risk - type of cancer

watch for S/S - particularly FACIAL SWELLING

I&O

cardiac and resp support

manage the complications of RT and chemo

101
Q

Tumor Lysis Syndrome

A

a potentially life threatening metabolic imbalance that occurs w/ the rapid release of intracellular potassium, phosphorus, and nucleic acid into th9e blood as a result of rapid tumor cell death

102
Q

Tumor Lysis Syndrome is a Syndrome of what things?

A

Hyperkalemia

Hyperphosphatemia

Hyperuricemia - nucleic acid to uric acid conversion

Hypocalcemia - increased phosphorus bindings to calcium to form calcium phosphate salts

103
Q

Tumor Lysis Syndrome can cause…

A

cardiac arrhythmias

renal failure

multisystem organ dysfunction

104
Q

Treatment for Tumor Lysis Syndrome

A

IV hydration pre and post treatment of chemotherapy

Sodium bicarb to decrease solubility of uric acid, prevents potential kidney injury

decrease uric acid production - allopurinol

forced diuresis - loop diuretics, mannitol

excretion of phosphate through antacids

kayexalate for hyperkalemia

potential for dialysis

105
Q

Nursing Management/Interventions for Tumor Lysis Syndrome

A

safety - recognize clients at risk, seizure precautions for problematic calcium

maintain fluid intake

restrict K and phosphorus in diet

assess for the dysrhythmias, renal failure

strict I & O

N362: Practice of Nursing III (15 decks)

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