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220 Cards in this Set
- Front
- Back
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Carcinogen
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Something that initiates a change so that cancer begins to occur
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What are some reasons people are getting cancer more
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longevity of people and increased environmental exposure to carcinogens
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What do normal cells do
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divide to repair and replace damaged tissues
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Differentiation
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each normal cell has a specific function; non-migratory; orderly; contact inhibited
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If a tumor doesn't look like that body system....
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then its from somewhere else
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Who is at a high risk for cancer
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african americans
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What is a big risk factor for bladder cancer
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smoking; women; caucasian
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What are some risk factors for cancer
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african american, female, heredity, age, gender, poverty, stress, diet, job, infection, tobacco, alcohol, drugs, obesity, sun
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What are some characteristics of normal cell growth
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assume characteristics of tissue it belongs to, DNA, carries info for protein, Genes control devleopment of traits
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What can a change in a gene cause
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an aberrant cell which can become cancerous
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What normally occurs with mutant cells
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develop and are defective and incapable of surviving and die, or the immune system destroys them
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What occurs if there is a defect in the 2 processes that kill mutant cells
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neoplasia
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normal process that allows cells to specialize
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differentiation
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What occurs with differentiation under adverse conditions
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altered cells are produced and mutate
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What is hyperplasia
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increase in the number of cells; occurs in response to stress
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What is metaplasia
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change in normal differentiation patterns and now form cells not usually found in that location of the body
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What are normal cells but not in normal location
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metaplasia
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When is metaplasia reversible
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when stressor or other conditions reversed
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Dysplasia
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loss of DNA control over differentiation process
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Anaplasia
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regression of cell to undifferentiated cell type; cell division no long under DNA control; not reversible
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Is dysplasia reversible
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yes
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is anaplasia reversible
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no
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What is the only way to see cancer
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a biopsy
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What do benign tumors or neoplasms do?
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resemble tissue of origin, are encapsulated, and don't invade surrounding tissue or organs
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What are malignant tumor cells
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have a change in structure which causes pathological changes form the original tissue; not well defined and invade surrounding tissue
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What are abnormal growths which are due to the migration of tumor cells to a new site via the circulatory or lymphatic system that look like a primary lesion rather than tissue at the new location
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metastatic tumor/growth
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Metastatic tumor/growth
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abnormal growths which are due to the migration of tumor cells to a new site via the circulatory or lymphatic system that look like a primary lesion rather than tissue at the new location
not well defined and invade surrounding tissues |
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What is often confused with thrush
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leukoplakia
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How can metastic growths spread
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circulatory or lymphatic system
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How are tumors described
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anatomical site and tissue origin
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Where do carcinomas and adenomas arise from
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epithelial tissue
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What is carcinoma insitu
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localized tissue
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Gliomas
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arise from glial cells of the CNS
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Leukemias
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arise from blood forming organs
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Melanomas
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arise from pigment cells
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What is intiation-mutation of cells structure
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cell penetrated by a substance that causes damage to DNA, or inherited mutation
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Carcinogenesis
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damages DNA, changes cellular makeup, irreversible, not all go on to be cancerous, may go undetected forever
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Why are not all carcinogenic cells cancerous?
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they undergo apoptosis (cell death)
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What is a substance that stimulates the altered cell to transform into a malignant cell
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promotion
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Examples of carcinogens?
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chemicals, physical, viruses, genetics
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Examples of promotion
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hormones, drugs, chemicals
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The time it takes a mutated cell to develop into a turmo
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latency period
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length of latency period
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1-40 years
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Detectable tumor and metastasis phases
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progression
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What occurs in carcinogenesis
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increase growth rate and spreads
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how many cells in a 1 cm tumor
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1 billion
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What do tumors do with blood
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make own blood supply
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What do tumors do
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colonies and subpopulations
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What are oncogenes
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genes that promote cell proliferation and are capable of triggering cancerous characteristics
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What are virus carcinogens?
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HIV, Hep. B, HPV
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What are drug carcinogens
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chemo drugs, estrogen, ?steroids
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What are some chemical carcinogens
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hydrocarbons, benzopyrene (cig smoke), arsenic (pesticides), carbon tet, nitrates in foods (hotdog,bacon, smoked meat)
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what are physical agents that cause cancer
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sun exposure, radon
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CAUTION acronym
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Change in bowel habits
A sore mouth Unusual bleeding or discharge Thickening or lump Indigestion or difficulty swallowing Obvious changes in mole or wart Nagging cough or hoarseness |
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What are some ways to prevent cancer
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do no smoke, limit alcohol, eat high fiber diet, avoid fatty foods, wear sunblock, limit sun exposure, self breast exam after age 20, testicular exam after age 15, yearly screening tests, pop, mammography, color, prostate
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What are some factors that influence cancer development
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environmental, carcinogens: chemical, physical, sun, tanning, irritation, tobacco, viral, dietary, age, genetics, immune function
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What are some parts to early detection of cancer?
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mammogram, pap smear, stools for occult blood, sigmoid/colonoscopy, breast self exam, testicular self exam, skin inspection
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What is tumor angiogenesis?
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growth of new blood vessels from pre-existing vessels
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Vasculogenesis
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spontaneous blood vessel formation
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intussusception
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new blood vessel formation by splitting of existing ones
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What occurs with angiogenesis?
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induce capillary growth into the tumor, which some researchers suspect supply require nutrients- allowing for tumor expansion
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What is avastin
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approved for colorectal cancer with chemotherapy that targets angiogenesis
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What is metastasis
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cancer spreads from its original location, extending into surrounding tissue, penetrating blood vessels, and penetrating lymphatic tissues
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Oncology
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study of solid tumors associated with organs
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study of blood forming tissues
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hematology
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grading of cancer
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how much the cancer cell resembles the original cell
1-4= well to poorly differentiated |
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Stage of cancer of metastasis
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4
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Staging of cancer
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location and extend of malignant disease
0 (in situ)- 4 (mets) |
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What are some ways to prevent lung cancer?
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avoid tobacco, occupational exposure, appears years after exposure
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What are signs and symptoms of lung cancer?
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cough, hoarseness, dyspnea, hemoptysis, chest pain, decreased breath sounds
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What are some surgeries for lung cancer?
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thoracotomy, pneumonectomy, lobectomy
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How do you position a person after lung surgery?
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bad side down
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What are some ways to prevent colorectal cancer
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diet high in fiber (broccoli, cauliflower), including cruciferous vegetables, and eat leass animal fat
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What do you do for early detection of colorectal cancer?
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get a digital rectal exam after age 40 and a yearly fecal occult blood test after age 50 and a colonoscopy every 10 years
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Where do primary brain tumors arise from
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brain tissue
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Secondary brain tumors arise from
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metastasis
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What happens with benign brain cancer
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without tx, continue to grow and take up space in a confined area and put pressure neural and vascular and compromise brain tissue and you get necrosis of brain
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What do you usually give with brain cancer
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big dose of steroids to decrease swelling
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What are signs and symptoms of brain cancer
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headache worstening upon awakening**, vomiting without nausea, behavioral changes, seizures, visual changes, papiledema, aphasia, hemiplegia
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What might you give with brain cancer for the signs and symtpoms
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anticonvulsant like Dilantin, and reduce secretions (robinul)
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What are some ways to diagnose cancer
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history and physical, blood tests, CBC, CMP, biopsy, imaging
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What is the definitive diagnostic test for cancer
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biopsy
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What are substances produced by turmos that can be detected in blood
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tumor markers
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What do tumor markers do
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help with diagnosis of cancer and help identify and monitor
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What should never be done with a blood test for PSA
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digital rectal exam
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What are you looking for with tumor markers
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increases
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What is the tumor marker for testicular cancer or small cells in the lung
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AFP
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What is the tumor marker for ovarian cancer
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CA 125
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What is the tumor marker for the colon
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CEA
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What may increase tumor marker CEA aside from actual cancer
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smoking
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What is tumor marker of prostate
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PSA
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tumor marker for pancreatic, colon, and ovarian cancer
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CA 19-9
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What is tumor markers for breast
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CA 15-3 and CA 27,29
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What are genetic markers or genomes that show if you're susceptible to ovarian and breast cancer?
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BRCA1, BRCA2
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What tumor markers may be elevated if you smoke
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AFP and CEA
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What may you monitor for effectiveness of cancer tx?
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tumor markers
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What are some types of tx for cancer
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surgery (cure, control, palliation), radiation, chemotherapy, biotherapy, combination
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What is cure treatment
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disease free; survival rate of 5 years or more
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What is control treatment
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maintain the disease from progressing and provide the client with quality of life
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What is palliative tx
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prevent the client from having horrible symptoms
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What is purpose of cancer surgery
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to remove or debulk as much of tumor as possible and to assist in diagnosis and staging, prophylaxis, second look, reconstructive
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What is an example of prophylaxis
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removing breasts if at high risk for breast cancer
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What are some nursing diagnosis for cancer surgery
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alteration in comfort or pain r/t incision, risk for infection r/t incision, decreased mobility, drains, body image, knowledge deficit
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purpose of radiation therapy
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to destroy cancer cells with minimal exposure to normal cells
cells are kicked out of the natural orbit making them unable to divide, and therefore die, and cancer cells are less capable to repair |
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What does the total dose of radiation therapy depend on?
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size, location of tumor, surrounding normal tissue, and radiosensitivity of tumor
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What is brachytherapy
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an internal continuous radiation
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What occurs in brachytherapy?
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direct exposure with radioactive isotopes or seeds
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What do you do with unsealed radiation
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it is excreted from the body
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What do you do with sealed radiation
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it stays or is physically removed
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What are examples of unsealed radiation
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IV or PO such as I-131 for thyroid cancer (ingested or injected)
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What is an example of sealed radiation
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prostate seeds, cervical seeds
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What is radiation that is placed in the body cavity
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sealed radiation
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How do you put in a sealed radioactive device
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put the apparatus in during surgery, then you afterload it once patient is in room
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What may be some good nursing diagnoses related to radiation?
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fear, anxiety, isolation
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What is important to remember with radiation therapy
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SAFETY
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What is important to remember with clients with brachytherapy radiation
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educate family and client on inverse square law (intensity of radiation source decreased with distance/time/ and shielding), put in private room, limit visitors and time of visitation, sometimes body substances are radioactive, prevent dislodgement
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What are some general rules for visitors on brachytherapy?
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limited or none; no one under 16 and cannot stay over 30 minutes
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In sealed radiation, what is radioactive
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only the source
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What is radioactive if unsealed
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all body substances
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What do you always need when dealing with a radioactive source
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lead lined gloves, lead lined container, long handled forcepts
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When do you want to hit a tumor?
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when multiplying at highest rate/efficiency
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What do you give when doing bronchial
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give codeine to reduce cough so theres no gag reflex or aspiration
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What do you do for a patient when they have radiation?
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low residue diet/ Lomotil (so they dont have to get up), Foley catheter, HOB 30 degrees, give patient remote and call light, make sure source is not in the bed
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What do you never go in a radioactive patients room without
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A SHIELD!
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What are some things you should do for a patient with brachytherapy radiation?
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support client due to isolation, monitors vitals, assess nutrition, no pregnant nurses, all equipment and linens stay in room, emergency equipment, shield, nurse must wear a dosimeter film badge
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What is the total amt of time spent in a brachytherapy patients room
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30 minutes total in 8 hours
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What are some nursing diagnosis for brachytherapy?
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impaired skin integrity, diarrhea/incontinence, impaired mobility, potential for ineffective coping r/t isolation
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What must happen with stuff in patients room
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everything left in room with patient is discharged, sometimes use Geiger to test, every radioactive item MUST be accounted for, everything sealed is removed except for prostate seeds
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What is external beam therapy
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teletherapy
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Is pt with teletherapy radioactive?
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no
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What occurs with teletherapy
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it is a fractioned or divided dose, patient goes to radiation oncology, must be cooperative, repeats several times a week for several weeks, area is marked and DO NOT WASH OFF
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What must a pt be before getting teletherapy
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cooperative
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What must you remember with teletherapy
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DO NOT WASH OFF THE MARK
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What are some nursing diagnoses for teletherapy
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skin impairment, potential for nutritional deficit, potential for mucositis (inflammation of oral mucosa), skin dryness, nausea, risk for body image changes
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What are some parts to nursing care for teletherapy radiation?
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education on skin care (do not remove mark), wash with mild soap (dove, ivory), pat dry, assess skin for redness, dryness, cracking, no creams, lotions, powders, ointments (unless approved by MD), wear soft loose fitting clothes, avoid heat exposure and sunlight
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What are some dietary instructions for a patient on teletherapy
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small frequent meals to increase calories, avoid hot/cold extremes, avoid spicy, no alcohol based mouthwash!, nutrition supplements
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What is very important for patients in teletherapy
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very careful and frequent mouthcare
LOOK INSIDE THE MOUTH! check for mucositis and thrush |
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What are some general side effects of radiation?
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localized skin reactions, hematopoietic, GI, epithelial, gonadal, neutropenia, low WBC, thrombocytopenia, low Hgb
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What are some important parts to patient placement for teletherapy
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no side rails, need to be alert and oriented and cooperative, must be in exact same position every time!, avoid missing a dose!
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What is the purpose of chemotherapy
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to provide the greatest number of cancer cell death with minimal side effects to the client
systematic tx that interrupts dna synthesis and kills cells in replication |
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What is the point of combination chemotherapy?
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several different drugs to provide greatest cell death
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What is chemo dosing based on
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mg/kg of body weight or BSA
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What is scheduling used for in chemo
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to maximize cell kill with minimal damage to normal cells
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Nadir
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the point in time after chemotherapy where the effects of chemotherapy are at their strongest and the side effects are at their maximum providing the lowest level of bone marrow activity and circulating WBC
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When is the best time to give meds to reduce chemo side effects
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at Nadir
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When are you most likely to see chemo s/e such as low WBC and low bone marrow activity
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during Nadir (strongest point)
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What may you want to give at the Nadir
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drugs that stimulate (RBC, WBC, etc) to reduce s/e of chemo
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How can you give chemo
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in any method, but mostly IV
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What are vesicant agents
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chemo drugs that cause tissue damage if they leak from a vein site; they are EXTREMETLY irritating
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What do you do if a vesicant agent leaks?
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STOP INFUSION! RESTART IV, INITIATE EXTRAVASATION PROTOCOL
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What are irritant agents
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chemo drugs that cause a flare reaction over the IV site
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what do you do for irritant agents
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slow infusion, ice pack
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What must you do in chemo
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nurse must receive education, wear gloves for protection, dispose of all chemo related equipment in chemo-biohazard container, shield for face and mucous membranes, splatter proof gown
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What must be done before giving a patient chemo
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patient MUST BE IDENTIFIED
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What are some things to remember with chemotherapy
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special gown, double flush toilet, cover toilet when flushing, if vomit, call housekeeping and DO NOT use paper towel, because chemo is systemic
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Where does a HICKMAN sit?
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on top of R atrium in the superior vena cava
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What is HICKMAN
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external access with internal insertion
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Where are venous access devices placed
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under skin
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Where is a portacath placed?
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SubQ completely under the skin
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What is the benefit of a portacath
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less risk of infection, cancer and emergency IV meds
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Where does intraperitoneal chemo go?
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in abdominal wall for ovarian cancer
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What must you avoid with antimetbolites chemo?
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whatever is toxic to the liver
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What are some things to remember with antimetabolites
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avoid what is toxic to liver, usually causes GI side effects
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What antimetabolite might you give for colon and breast cancer
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5FU or 5 fluorouracil
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what is methotrexate for
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colon and breast cancer
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What is the antidote for methotrexate?
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leucovorin
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What does leucovorin do?
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stops drugs from destroying future metabolic pathways
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What is fludarabine given for
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cml
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What is gemcitibine given for
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pancreatic
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What do antitumor antibiotics do?
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cause damage to RNA and DNA synthesis and have vesicant properties
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What is an example of an antitumor antibiotic?
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bleomycin, doxorubicin
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What must you test with bleomycin?
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PULMONARY FUNCTION!, must test function, chest xray, watch for pulmonary complaints (SOB, tachypnea)
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What might you give doxorubicin for?
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breast, myeloma, nhl, aml
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What can doxorubicin do?
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turn urine red and cause myelosuppression, cardiac s/e
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What do alkylating agents do?
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interfere with dna synthesis
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What is an alkylating agent for the breast
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cyclophosphamide
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What might you give cisplatin for
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lung, head, neck
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What might you give carboplatin for
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breast, lung
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What may alkalyting agents cause?
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myelosuppression and organ toxicity
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What may alkylating agents do?
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vesicant properties, hydrate well
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What are the only chemo agents that cross the BBB
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nitrosureas
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What is an example of a nitrosurea?
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BCNU- brain
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What can BCNU, or a nitrosurea cause
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GI side effects, neurotoxicity
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What does an antimitotic chemo agent do?
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interferes with spindle development and sometimes has vesicant/irritant properties
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What is an antimitotic in teh lung and NHL
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vincristine
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What is an antimitotic for breast, lung
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vinorelbine
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What is an antimitotic for ovarian, breast, lung
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paclitaxel
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What is an antimitotic for ovarian, lung
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docetaxel, hycamptin
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What may antimitotic chemo agents cause
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myelosuppression, anaphylaxis, neuropathies
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What are some topoisomerase inhibitors
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irinotecan, topotecan, atoposide
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What may topoisomerase inhibitors cause
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GI side effects, myelosuppresion
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When are topoisomerase inhibitors used
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after failure of initial tx
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What are some male specific hormone chemo agents
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eulexin, lupron, zoladex
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What are some reasons hormones are used for chemo
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prostate, testicular cancer, breast cancer post menopause
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What may female hormone chemo agents cause
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secondary sex characteristics like facial hair and a low voice
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What is a female hormone chemo agent for breast
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tamoxifen
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What are some hair side effects of chemo
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alopecia (balding), skin changes (hair loss is temporary, but grows back differently), wear sun block
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What are some things to teach chemo pts in response to skin/hair
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hair loss temporary, grows back differently, wear sunblock, suggest wig, scarf, or turban
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What are some other GI s/e of chemo
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GI changes, disturbance, mouth sores, N/V, esophagitis, gastritis, colitis, diarrhea
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What are some things to teach a chemo pt about GI
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avoid fresh fruits and veggies, take antinausea meds as ordered (Zofram), push fluids (to encourage removal of chemo agent), monitor nutrition (take cover off food before giving to pt.), stomatitis (ulcers on buccal mucosa), avoid spicy and citrus foods, provide good and frequent mouthcare but no alcohol based mouthwash
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What is the drug of choice for candidiasis stomatitis?
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Nistatin
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What may occur to epithelial lining with chemo?
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disturbance, mucositis, vaginitis
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What do you need to remember with chemo in regards to epithelial?
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assess mouth daily, do oral hygiene, soft bristle toothbrush, salt/soda mouthwash, lubriate lips, no lemon glycerin swabs, use vaginal lubricants, moisturize skin, humidify air
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What are some bone marrow s/e to chemo?
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bone marrow suppresion, leukopenia, neutropenia, thrombocytopenia, anemia
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What is leukopenia
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low wbc
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neutropenia
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low neutrophils; monitor these!
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ANC
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automated neutrophil count, gives TRUE wbc cound
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Anemia
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low rbc
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What do you educate pts with chemo for blood/bone marrow
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s/e that will occur at home, that it takes 7-14 days to peak and w/e will occur then
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When does chemo peak
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7-14 days
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When do chemo s/e peak
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7-14 days (Nadir)
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What are some other s/e of chemo
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sterility, impotence, gonadal changes
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What should you encourage reproductively for patients on chemo
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birth control, may need to sperm/ova bank, wear condom
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What is important in infection control for chemo
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wash hands, avoid crowds, daily hygiene, avoid animal waste, avoid fresh fruist and veggies and uncooked foods, monitor temp, notify physician if have CHILLS of temp over 100, fever, shakes, nosebleeds, tarry stools, ecchymosis, avoid all over the counter products like aspirin, ibuprofen
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What are some other things to remember with pts with chemo
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take antinausea meds, push fluids, monitor nutritional status, pace activities, use BC, use vaginal lubricants
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What are some hematologic s/e of chemo
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compromised host precautions
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When is chemo held
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if WBC below 3000
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What should you monitor for hematologic with chemo
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SSX of infection like fever, tachy, lymphadenopathy, night sweats, skin infection, poor healing
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When is patient w/ chemo critically ill
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WBC low and temp above or of 101, put in isolation and culture everything
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What does neupogen do?
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stimulate bone marrow to increase wbc
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