Adult Client W Oncological Disorder

Front 1

common sites if metastasis

Back 1

breast cancer(bone, lung)
lung cancer(brain)
colorectal cancer(liver)
prostate cancer (bone, spine, legs)
brain tumors (CNS)

Front 2

grading 1-4

Back 2

grading 1- cells differ slightly from norm cell, well differentiated(mild dysplasia)
grade 2- cells more abn. moderately differentiated(moderate dysplasia)
grade 3- cells very abnormal, poorly differentiated (severe dysplasia)
grade 4- cells immature(anaplasia) undifferentiated, origin difficult to determine

Front 3

staging

Back 3

stage 0- cancer in situ
stage 1- tumor limited to tissue of origin, diff to determine
stage 2- limited local spread
stage 3- extensive local regional spread
stage 4- metastasis

Front 4

seven warning signs of cancer "CAUTION"

Back 4

Change on bowel/bladder habits
Any sore that doesnt heal
Unusual bleeding of discharge
Thickening or lump of breast/elsewhere
Indigestion
Obvious change in wart/mole
Nagging cough, hoarseness

Front 5

breast self examination- WHEN?

Back 5

perform 7-10 days after menses
postmenopausal or hysterectomy should select specific day to perform BSE

Front 6

chemotherapy

Back 6

kills/inhibits reproduction of neoplastic cells
systemic effects- affects both healthy and cancerous cells
combination chemotherapy is planned avoid meds w nadirs(immunosuppression)

Front 7

radiation therapy

Back 7

destroys cancer cells w minimal exposure to norm cells. Cells are damaged and die or become unable to divide.

Front 8

types of radiation therapy

Back 8

external beam radiation- doesnt emit radiation,doesnt pose as a threat to anyone

brachytherapy- client emits radiation CAN pose a hazard to other clients

Front 9

two types of brachytherapy

Back 9

unsealed radiation-via oral/IV or body cavities,. not confined to 1 body area, enters body fluids, eliminated via various excreta(radioactive and harmful to others)eliminated within 48hours
sealed radiation- solid implant within tumor target tissues, emits radiation when implant is in place, excreta not radioactive

Front 10

radiation for therapy for cancer- client education

Back 10

1. wash everyday w water alone, mild soap and water
2. use hands rather than washcloth
3. dont remove marking where beam is to be focused
4. dry w patting motions, clean soft towel
5. no powders, ointment,lotions, creams at radiation site unless pres.
6. avoid area to sun exposure, or heat

Front 11

sealed radiation source- client care

Back 11

1. private room/bathroom
2. caution sign outside clients door
3. limit 30min exposure per hcp per 8 hour shift
4. wear dosimeter to measure radiation exposure
5. wear lead shield to reduce exposure
6. visitors for 30 min stay 6ft away
7. save bed linens until source is removed the dispose normally

Front 12

how is bone marrow administered??

Back 12

bone marrow is administered through the clients central line similar to that of a blood transfusion

Front 13

bone marrow transplantation- post transplantation period and complications

Back 13

post transplantations period-
1. client remains w/o natural immunity until donor bone marrow begins to proliferate & engraftment occurs
2. infection and thrombocytopenia major concern until engraftment

Front 14

leukemia- description

Back 14

malignant exacerbation # of leukocytes(immature stage) in bone marrow
acute-sudden onset, short duration
chronic- slow onset, persistant over years
cause- unknown,involve gene cell damage

Front 15

leukemia- s/s

Back 15

aneroxia, fatigue, weakness, dyspnea, exertion, weight loss
bleeding; nosebleeds, gum bleeding, rectal
petechiae, prolonged bleeding, ^temp
normal, elevated, reduced WBC
decreased hmg &hematocrit

Front 16

leukemia- infection

Back 16

common sites- GI, resp tract, skin
protective isolation
everyone wears mask when entering room

Front 17

classification of leukemia

Back 17

acute lymphocytic - mostly lymphoblasts present in bone marrow, age- younger than 15
acute myelogenous- mostly myeloblasts present in bm, age-15-39
chronic myelogenous- mostly granulocytes in bm, age-older than 50
chronic lymphocytic- lymphocytes in bm- 50 years older

Front 18

lymphoma(Hodgkin's Disease)-description

Back 18

malignancy of lymph nodes that originate in single lymph node or single chain
metastasis occurs
3. usually involves lymph nodes, tonsils, spleen, bone marrow
4. characterized by presence of Reed-Sternberg cells in nodes
5. causes- viral infections, prev. exposure to alkylating chemical agents

Front 19

lymphoma(Hodgkin's disease)- s/s

Back 19

night sweats, positive biopsy of lymph nodes, cervical nodes most often affected.
positive computer tomography scan of the liver and spleen

Front 20

stages of lymphoma (hodgkin's disease)

Back 20

stage 1- single lymph node region or extralymphatic organ or site
stage 2- two or more lymph nodes regions on same side of diaphragm or localized involvement of an extralymphatic organ
stage 3- lymph node regions on both sides of diaphragm
stage 4- diffuse/disseminated involvement of 1 or more extralymphatic organs w/or w/o associated lymph node involvement

Front 21

multiple myeloma- description

Back 21

malignant proliferation of plasma cells and tumors within the bone
2. excessive # of abn. plasma cells invade the bone marrow, develop into tumors, ultimately destroy the bone
3. abn. cells produce abn. antibody(myeloma protein, bence jones protein)found in bld, urine.
4. < levels of immunoglobulin and antibodies ^ levels of uric acid and calcium, can lead to RF
cause-unknown

Front 22

multiple myeloma- s/s

Back 22

bone skeletal pain, esp in pelvis, spine, ribs
recurrent infections
osteoporosis
^calcium uric acid (RF)
spinal cord compression and paraplegia

Front 23

multiple myeloma-interventions

Back 23

encourage at least 2L of water per day (offset hypercalcemia, hyperuricemia, proteinuria)
2. encourage ambulation- prevent renal problems, slow done bone resorption

Front 24

types of testicular cancer

Back 24

germinal tumors (seminomas, nonseminomas)
nongerminal tumors(interstitial cells tumor, androblastoma)

Front 25

cervical cancer- interventions

Back 25

laser therapy, cyrotherapy,
conization(cone shaped area of cervix is removed, long term f/u)
hysterectomy

Front 26

tx for cervical cancer

Back 26

nonsurgical- (chemotherapy, cryosurgery, external radiation, internal radiation implants, laser therapy)
surgical(conization, hysterectomy, pelvic exenteration)

Front 27

types of pelvic exenteration

Back 27

anterior(removal of uterus, ovaries, fallopian tubes, vagina, bladder, urethra, pelvic lymph nodes)
posterior(removal of uterus, ovaries, fallopian tubes, descending colon, rectum, anal canal
total (combination of anterior and posterior)

Front 28

breast cancer- s/s

Back 28

mass felt in the upper outer quadrant or beneath the nipple.
2. nipple retraction, elevation
3. asymmetry w affected breast being higher
4. skin edema, peau d"orange skin

Front 29

breast cancer- post operative interventions

Back 29

position in semi fowlers, turn to unaffected side, affected arms elevated above level of heart
2. place sign above bed stating "No IV, no injections, no BP readings, no venipunctures in the affected arm"
3.Arm is protected for life

Front 30

surgical breast procedures

Back 30

lumpectomy(tumor is excised and removed, lymph node dissection may also be performed)
simple mastectomy(breast tissue and nipple removed, lymph nodes are intact)
modified rectal mastectomy(breast tissue, nipple, lymph nodes are removed, muscles are left intact)

Front 31

pancreatic cancer- description

Back 31

most are highly malignant, rapidly growing adenocarcinomas that originate from epithelium of the ductal system
2. symptoms doesnt occur until tumor is large, prognosis is poor

Front 32

pancreatic cancer- s/s

Back 32

jaundice, unexplained weight loss, clay colored stools, glucose intolerance

Front 33

surgical interventions for gastric cancer

Back 33

subtotal gastrectomy
billroth 1(gastroduodenostomy, partial gastrectomy, remaining segment is anastomosed to the duodenum)
billroth 2(gastrojejunostomy, partial gastrectomy, remaining segment is anastomosed to the jejunum)
total gastrectomy- called esophagojejunostomy, removal of stomach, attachment of esophagus to jejunum or duodenum

Front 34

intestinal tumors- s/s

Back 34

abn. stools- ascending colon tumor(diarrhea), descending colon tumor(constipation, some diarrhea, flat, ribbon like stool)
guarding, abd. distention
late sign(abd.mass, cachexia)

Front 35

intestinal tumors- interventions

Back 35

signs of intestinal perforation(low blood pressure, rapid weak pulse, distended abd. ^temp)
2. signs of intestinal obstruction(vomiting(fecal matter), pain, constipation, abd. distention)
3. early sign(hyperactive peristaltic activity, obstruction progresses hypoactive)

Front 36

colostomy or ileostomy- post operative

Back 36

ascending colon(expect liquid stool)
transverse colon colostomy(loose to semiformed stools)
descending colon colostomy(close to normal stool)
ileostomy(drainage will be dark greento yellow as pt begins to eat, stool is liquid, dont give suppositories, risk for dehydration and electrolyte imbalance)

Front 37

colostomy irrigation

Back 37

lukewarm water 500-1000ml infused water and stool collect in bag.
1. pt is ambulatory, pos. sitting on toilet
2. pt is bedrest turn to side
3. hang bottom of bag shoulder level of pt or little higher
4. carefully insert tube w/o force
5. clamp tube if cramping, release as cramping subsides
6. perform same time each day(1 hour after a meal)

Front 38

lung cancer- post operative

Back 38

monitor chest tube drainage system, will drain air and/or blood that accumulates in pleural space.

Front 39

cancer of the prostate- s/s

Back 39

1.hard pea sized nodule palpated on rectal exam.
2. late signs(weight loss, urinary obstr. , pain radiating from lumbosacral area down the leg)
diagnosis- made through biopsy of prostate

Front 40

cancer of the prostate-transurethral resection of the prostate(TURP)

Back 40

insertion of scope on urethra excise prostatic tissue
1. bleeding common after turp (MON for BLEEDING)
2. continuous bladder irrigation will be prec. to keep urine pink color
2. bladder spasms are common after surgery
3. dribbling and incontinence may occur post op
4. sterility may/ may not occur

Front 41

cancer of the prostate- suprapubic prostatectomy

Back 41

removal of prostate by abd. incision w bladder incision
1. abd. draining may drain copious amounts of urine, needs frequent changing
2. severe hemorrhage is possible NI mon for blood loss
3. bladder spasm are common
4. longer healing time then TURP
5. sterility occurs
6. CBI to keep urine pink (AP)

Front 42

cancer of the prostate- retropubic prostatectomy

Back 42

removal of prostate gland by lower abdominal incision w/o opening bladder
1. less bleeding
2. minimal drainage
3. CBI used
4. sterility occurs

Front 43

cancer of the prostate- perineal prostatectomy

Back 43

prostate gland is removed through incision made between the scrotum and anus
1. minimal bleeding
2. mon. closely for infection
3. uninary incontinence is common
4. sterility occurs

Front 44

cancer of the prostate- post op interventions

Back 44

1. mon urine for hemorrhage and clots
2. increase fluids to 2400-3000 ml day unless CI
3. mon for arterial bleeding (bright red urine w numerous clots)if occurs increase the continuous bladder irrigation, not. dr.
4. mon for venous bleedings (burgundy colored urine output)not physician, may apply traction on catheter.
5. norm light pink urine, amber in 3days
6. cont. urge to void is norm
7. pt avoid attempts to void around the catheter, cause bladder spasm

Front 45

post op: suprapubic prostectomy

Back 45

1.(AP)clamp suprapubic catheter after foley cath is removed, client attempt to void, after pt voided, check amountof residual urine in bladder by unclamping the suprapubic catheter and measuring the output.
2. removal of catheter when residual urine is consistently 75ml or less

Front 46

post op: retropubic prostatectomy

Back 46

1. bc bladder isnt entered, no urinary drainage
2. check urinary and purulent drainage, if occurs not. physician
3.

Front 47

post op: perineal prostatectomy

Back 47

1. incision may or may not drain
2. avoid rectal thermometers, rectal tubes, enemas

Front 48

urinary stoma care

Back 48

change in morning,
use non karaya gum products(urine erodes karaya)