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NURS 3512 acute & chronic > Week 9 cellular regulation, breast cancer, leukemia > Flashcards

Week 9 cellular regulation, breast cancer, leukemia Flashcards

1
Q

What diagnostic is the most definitive for Cancer?

A

biopsy

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2
Q

What is cancer treatment based on and why?

A

biopsy results
because it tells us what kind of cancer cells and how to best treat them

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3
Q

What are the 5 components of assessment that help us determine cancer?

A
  1. Healthy history
  2. Family history
  3. physical exam
  4. Specific diagnostic tests
  5. Biopsy
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4
Q

What factors for cancer diagnoses are included in health history?

A

smoking
alcohol
sun exposure
stress
lifestyle

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5
Q

What factors for cancer diagnoses are included in family history?

A

Family history of genetic cancers:
breast cancer
bowel cancer

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6
Q

What factors for cancer diagnoses are included in physical exam?

A

difficulty breathing
lump in the breast
hoarse voice
etc.

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7
Q

What specific diagnostic tests can be used for cancer diagnoses?

A

chest xray
CT
blood work
carioembronic antigens

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8
Q

When we want to cure/control cancer, what interventions are used?

A

Surgery
Chemo
radiation
combo of these

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9
Q

If curative isn’t an option, why are chemo and radiation sometimes used?

A

Palliative approach- to reduce pain and extend quality of life

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10
Q

What are the 2 broad categories of breast cancer?

A
  1. non-invasive
  2. invasive
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11
Q

What are the two components of non-invasive (in situ) breast cancer and what does each one mean?

A

Ductal Carcinoma in Situ (DCIS) - Early- form. Ca cells have invaded the duct but not the surrounding tissue

Lobular Carcinoma in Situ (LCIS)
Cells that look like cancer are contained in the milk producing glands (lobules).

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12
Q

What are the two types of invasive breast cancer and what does each one mean?

A

Invasive Ductal Carcinoma
Ca cells break through the duct walls into surrounding breast tissue.

Inflammatory Breast Ca (rare but highly aggressive)
Diffuse erythema, edema (peau d’orange- puckering like an orange peel)
Rapidly growing, painful, itchy

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13
Q

Which type of breast cancer is rare but highly aggressive?

A

Invasive - inflammatory breast cancer

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14
Q

What are the breast cancer risk factors?

A
  1. age >65
  2. genetic factors/family history
  3. Nulliparity (been preggers but not given birth d/t fetus death) -or first born after 30
  4. Early period, late menopause
  5. Physical inactivity/obesity
  6. Recent OCP or HRT or previous radiation
  7. Alcohol consumption
  8. High socioeconomic status
  9. Jewish heritage
  10. birth control pills/hormone replacement
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15
Q

What are the 6 components of breast cancer check/diagnoses?

A
  1. mammography
  2. Clinical breast exam
  3. BSE (self breast exam)
  4. MRI
  5. Ultrasound
  6. biopsy (to clarify findings)
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16
Q

How often should someone with breasts after age 50 get a mammography?

A

q 2 yrs

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17
Q

What is the primary treatment for breast cancer?

A

sugery

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18
Q

What are secondary treatment for breast cancer?

A

Drugs
radiation
chemo

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19
Q

What are 6 things people with breasts should watch for to proactively check for breast cancer?

A
  1. Lump
  2. Pulled in nipple
  3. Dimpling
  4. Dripping
  5. Redness/rash
  6. Skin changes
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20
Q

What are the two best ways to check for breast cancer?

A

mammography
clinical breast exam

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21
Q

What are the 3 goals of surgical treatment for breast cancer?

A
  1. Maximize the treatment
  2. Minimize the risk of it coming back
  3. Good cosmetic outcome
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22
Q

What are the 3 types of surgery for breast cancer?

A
  1. Breast Conserving: Lumpectomy
  2. Simple masectomy
  3. modified radical masectomy
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23
Q

What is breast conserving: lumpectomy surgery?

A

Remove entire tumor along with a margin of normal surrounding tissue – (insitu)
Will require post surgery radiation to entire breast plus boost to tumor bed
May cut away some lymph nodes, breast and nipple preserved

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24
Q

What is simple masectomy?

A

Entire breast is removed and some lymph nodes

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25
Q

What is modified radical masectomy ?

A

Removes entire breast, lymph nodes and if necessary, some of chest wall

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26
Q

What is the old lymph node dissection called?

A

ALND (Auxilary Node Dissection)
12-20 nodes removed

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27
Q

What is the new lymph node dissection called?

A

SLND (Sentinal Node Dissection)

28
Q

What are the 2 differences between ALND and SLND?

A
  1. (SLND) Only nodes that drain from tumor are removed and sent for pathology (1-4ish) . More nodes are removed if cancer cells are found in sentinel nodes.
  2. (SLND) Results in lower rates
    of lymphedema
29
Q

What are post-surgery options for masectomy?

A
  1. implants
  2. Autologous: DIEP flap
30
Q

When caring for someone post Autologous: DIEP flap what are 2 important things to monitor?

A
  1. Check for viability of new breast tissue (from abdomen)
  2. ensure good circulation since all the blood vessels were anastomised
31
Q

What are the main priorities Post mascetomy surgery?

A
  1. Care for incisions and drains
  2. Control pain – distressing and decreases healing
  3. Restore arm mobility (Prevent Lymphedema)
  4. Psychological Care
  5. Adjuvant therapy
32
Q

Why do we need to care for incisions and drains post masectomy?

A

infection
bleeding
drainage

33
Q

Why is fluid unwanted post masectomy?

A

It impedes healing

34
Q

How long will a post surgery mastectomy patient have drains in for ?

A

5 days

35
Q

Why is it important to control pain post masectomy?

A

distressing to patient
decreases healing

36
Q

When is a drain removed?

A

when less than 30ccs in 24 hour period for consecutive 2-3 days

37
Q

What is the progression of drainage colour?

A

Red- at first
Pink- later on
apple juice colour - even later
then clear

38
Q

What components are we watching for in the drainage post mastectomy?

A

accumulation of :
blood
lymph

39
Q

What are the 2 major goals post mastectomy?

A
  1. Restore arm mobility
  2. Prevent Lymphedema
40
Q

What does arm mobility prevent post mastectomy?

A

contractures
muscle shortening

41
Q

How long should it take to gain arm mobility post mastectomy?

A

4-6 weeks (gradual)

42
Q

What 3 interventions do nurses use to help prevent lymphedema?

A

1.Analgesics before exercise
2.Warm water relaxes muscles
3.Elevate arm post-op

43
Q

What 2 things should nurses avoid doing post mastectomy?

A

No elastic bandages/compression post-op
No BP or venipuncture on that arm

44
Q

What 2 things should nurses teach patients post mastectomy ?

A

Avoid sun and trauma
when to seek medical attention like pain getting worse

45
Q

What is lymphedema?

A

Accumulation of lymphatic fluid in soft tissue b/c Axillary lymph cannot return fluid to central circulation d/t removal of nodes or damage from radiation
-fluid accumulates in the affected arm and Causes obstruction/pressure

46
Q

What are 6 strategies to manage lymphedema?

A

1.Massage therapy to mobilize the fluid
2.Compression bandages- can be preventative too
3.Pneumatic compression sleeve (pumps & releases air)
4.Diuretics
5.Isometric (stable like holding arms up) exercises
6.Elevation

47
Q

What are some ways we can support the psychosocial care of a patient post mastectomy?

A

-Safe environment to talk
-normalize their feelings
-connect with cancer care/support groups (reach to recover program)
-spiritual care
-social worker to connect this person to resources
-help patient and family communicate with each other

48
Q

What is Leukemia?

A

Group of malignant diseases affecting bone marrow, lymph system, and spleen
4 Main Types (AML, ALL, CML, CLL)

49
Q

What ages do we see Acute Lymphoblastic leukemia (ALL) in typcially?

A

Kids ages 2-4
adults over 50

50
Q

What stage of life do we see Chronic myelogenous leukemia typically in?

A

Adults

51
Q

What happens to cells in Leukemia?

A

Results in thrombocytopenia decreased WBC, Decreased platelets

because the misshapen, incorrect cells crowd out the good RBC, WBC and platelets

52
Q

What do Leukemic cells infiltrate and what is the result?

A

infiltrate organs

splenomegaly
hepatomegaly
lymphadenopathy
bone pain
meningeal irritation

53
Q

Leukemia causes abnormal blood counts. What symptoms will we see in these patients as a result?

A
  1. Systemic
    -weight loss
    -Fever
    -*frequent infections
  2. Lung issues
    - SOB
  3. Muscular issues
    -weakness d/t lack of O2
  4. Bones/Joints pain
  5. Psychological effects
    - Fatigue
    - Loss of appetite
  6. Lymph node issues
    - swelling
  7. Spleen/liver enlargement
  8. Skin issues
    - night sweats
    - *bleeding/bruising
    - *ecchymosis
    - *purple patches/spots
54
Q

What are the 3 phases of chemotherapy treatment?

A
  1. Induction Stage
  2. Consolidation stage
  3. Maintenance stage
55
Q

What is the goal of the induction chemo stage?

A

Remission
70% patients reach remission

56
Q

What does chemo do to leukemic cells ?

A

destroys them in the tissues, blood and bone marrow

57
Q

What 3 things do nurses monitor with someone in the induction stage of leukemia chemo treatment?

A

pancytopenia:
1.neutropenia
2.thrombocytopenia
3.anemia

58
Q

How does the nurse monitor pancytopenia in leukemia patients undergoing chemo treatment in the induction stage?

A

Neutropenia
-infection
thrombocytopenia
-bleeding
anemia
-fatigue

59
Q

What test diagnoses type of Leukemia?

A

Bone marrow biopsy

60
Q

What is the goal of the consolidation phase of leukemia chemo treatment?

A

To eliminate remaining leukemic cells that may not be evident.
-1-2 more courses of chemo given to consolidate (got it all)

61
Q

What is the goal of the Maintenance phase of leukemia chemo treatment?

A

Maintenance Phase
Treatment with lower doses every 3-4 weeks for prolonged time.

62
Q

What are the 3 most imporant things nurses need to prevent in someone going through leukemia chemo/radiation treatment?

A
  1. avoid infections!
  2. avoid sepsis!
  3. avoid bleeding issues!
63
Q

When does a leukemia patient need Marrow & stem cell transplant?

A

Right after they receive very high dose chemo/radiation in the induction stage
-given via IV

64
Q

What are the 3 ways that marrow & stem cells are harvested?

A

1.Allogenic (must be a match)
-Obtaining stem cells from a donor
2. Autologous
-Patient’s stem cells are removed, treated to remove CA and stored until ready for use.
3. Syngeneic
-Obtaining marrow from an identical twin & storing until it’s time

65
Q

What is the purpose of the marrow & stem cell transplant?

A

helps patient make healthy RBC, WBC and platelets

66
Q

When is a patient considered pancytopenic?

A

When they are waiting for the new cells to grow post marrow & Stem cell transplant (7-21 days)

67
Q

What two things must we do for patients in the pancytopenic stage regarding contact precautions and blood products/meds?

A
  1. strict reverse isolation
  2. give RBCs and platelets
  3. maybe need antibiotics if have infection

NURS 3512 acute & chronic (29 decks)

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