week 9 Cancer Flashcards
what assessments are done to diagnose cancer?
health hx, family hx, physical exam, specific dx tests, and ultimately biopsy
two types of non-invasive (in situ) breast ca
ductal carcinoma
lobular carcinoma
is inflammatory breast cancer invasive or in-situ?
invasive
can ductal carcinoma be invasive?
yes- it breaks through the duct walls into surrounding breast tissue
which type of breast ca is rare but highly aggresive and characterized by diffuze erythema, and peau d’orange?
inflammatory breast ca
which of the following is NOT a risk factor for breast ca?
- age >65
- nulliparity or 1st child after 30
-oral contraception
- obesity
-alcohol
- smoking
- high socioeconomic status, jewish heritage
smoking not listed on slide
after what age do you have a mammogram every 2 years?
50
which type of breast surgery will require radiation post-surgery?
lumpectomy
with a sentinal node dissection, how many nodes are usually taken?
1-4
what is a DIEP flap?
when tissue is taken from lower abdomen and moveed up to reconstruct breast
post-op mastectomy: how long will drains be in place?
at least 5 days
what are three main nursing care priorities related to post-op mastectomy:
care for incisions and drains, control pain, restore arm mobility
what are some oral meds given as an adjunct with
mastectomy:
hormones, estrogen receptor blockers, biological and targeted therapy
post-op mastectomy: patients will be taught to care for these at home
drains
post-op mastectomy: what is the progression of drainage color?
red at first, then pink, then apple juice color
post-op mastectomy: criteria for drain removal?
removed after a couple weeks typically (when less than 30ccs in 24 hr period for 2-3 consecutive days)
Post Mastectomy: goals (name 3)
- prevent contractures/muscle shortening
- improve lymph and blood circulation
- gradually increased function over 4-6 weeks
Post Mastectomy: nursing interventinos to restore arm mobility
-analgesics before exercise
- warm water compresses/soaks
-
Post Mastectomy: nursing interventions/teaching to prevent lymphedema
elevate arm, no elastic bandages post op, avoid sun and trauma, no BP or venipuncture, teach when problem becomes emergent
Post Mastectomy: nursing interventions to TREAT lymphedema when it occurs (4 ish categories)
- massage/compression (neumatic or bandages) to move fluid
- diuretics
- isometric exercises
- elevation
what parts of the body does leukemia affect?
bone marrow, lymph system and spleen
what is leukemia?
accumulation of dysfunctional blood cells in bone marrow and lack of production of normal ones
what are the results of leukemia?
thrombocytopenia, decreased WBC, decreased platelets
5 organs/tissues that leukemia cells infiltrate typically
spleen, liver, lymph nodes, bones, meninges
three phases of chemotherapy for leukemia
- induction stage to achieve remission
- consolidation phase
- maintenence phase
what percent of leukemia patients achieve remission with chemo?
70%
describe nursing care priorities during induction stage of leukemia tx
focuses on neutropenia, thrombo-cytopenia, anemia
what types of cells are given to treat pancytopenia in leukemia treatment? how are they aquired?
stem cells. harvested from donor, pt’s own, or identical twin
which cells are most affected by chemotherapy treatments?
bone marrow-stem cells,
epithelial cells in GI
ova or testes
hair follicles
many chemotherapy drugs are _____
vesicants
compare the radioactivity of temporary to permanent radiation implants (internal radiation)
temporary have high radioactivity, permanent emit at a low level and pt can be discharged
what are the three principles of radiation precautions
time, distance, shielding
what labs should a nurse monitor during chemo and radiation treatment (regarding myelosuppression)
HGB, HCT
what can a patient with neutropenia NOT have in the room? (2 things)
flowers and fruit
what is the blood work to monitor if someone is having chemo and radiation to assess their risk for infection?
ANC - absolute neutrophil count
if pt with low ANC is febrile, what happens?
we initiate Abx therapy immediately
what drug can we give to treat neutropenia?
colony stimulating factor (filgrastim-neupogen)
why can we not give ginger to someone with pancytopenia?
because it affects coagulation while they are lacking clotting factors
because of TNF causing nausea/vomiting and diarrhea, we want to assess for _______ (r/t fluid), _______ (r/t ph), and monitor _____ during tx
dehydration, alkalosis, weight
after chemo and radation, how long do we teach pts to avoid sun?
1 year
a patient who is nearing the end of their cancer treatment is planning to spend a day at an outdoor pool. what will we tell them?
avoid direct sun or extreme heat
if pool is chlorinated, don’t go in to prevent desquamation or rash
what should pt be taught about oral hygeine during treatment?
rinse with saline after each meal and before bed, soft toothbrush, small sips of water ++ to replace saliva
loss of sensation to hands and feet
impaired gait and balance
orthostatic hypotension
Neuropathic pain
Erectile dysfunction
Loss of fine motor function (playing an instrument)
Loss of taste discrimination, constipation
what are these a result of?
chemo induced peripheral neuropathy (CIPN)
How do we treat CIPN?
there are no known evidence-based interventions
related to female sexuality, what would I teach a patient undergoing tx?
use lubrication and a vaginal dilator after radiation
describe immunotherapy, monoclonal antibodies, endocrine therapy and targeted therapies
new cancer-treating drugs that can work directly on ca cells or utilize endogenous immunity to attck ca, or slow growth. pts often undergo clinical trials to test these
BIG ONE!
what is SVC syndrome?
obstruction of superior vena cava by tumor, or blood clot in CVAD
what are the signs of SVC (KNOW THIS!)
facial edema, periorbital edema, distention of neck and chest, headache, seizures, eventually obstruced airway and decfeased cardiac output
how do we treat SVC syndrome?
radiation, chmo, surgery if its the tumor. remove the CVAD if that’s the problem
besides SVC syndrom,e, what is an obstructive oncological emergency?
spinal cord compression
if patient has constipation, bakc pain, and loss of reflexes, what might i suspect?
spinal cord compression
what are three metabolic complications/emergencies of cancer?
SIADH, Hypercalcemia, tumor lysis syndrome
what are the four hallmark signs of tumor lysis syndrome?
hyperuricemia
hyperphosphatemia
hyperkalemia
hypocalcemia
patient has Hyperuricemia
Hyperphosphatemia
Hyperkalemia
Hypocalcemia
as a result of rapic destruction of tumor cells. what will i monitor and how will i treat?
monitor urine otput and urinary function labs. hydrate them and treat with allopurinal
if a patient has bone cancer, what is a metabolic complication i am worried about? what is the worst case scenario if this goes untreated? how is this treated?
hypercalcemia,
coma
hydration, diuretic, biophospate infusion like Pamidronate
what oncological emergency can occur when microorganisms enter the bloodstream from wounds, CVADs, etc?
easily leads to sepsis due to myelosuppression. septic shock leads to DIC, which leads to depletion of clotting factors (=bleeding) and clots (=organ damage)
