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77 Cards in this Set
- Front
- Back
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what are the types of treatments for cancer?
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surgery
Radiation Chemotherapy Biotherapy Bone marrow transplant Combined |
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how is surgery used for diagnosing cancer
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obtaining specimen by needle biopsy or cytologic specimen
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why is biopsy done
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for identification of diagnosis and staging of the cancer
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when is excisional biopsy done
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when the tumor is small
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when is incisional biopsy done
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when tumor is large and may take only small portion for diagnosis
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how is surgery used as a treatment of cancer
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removing localized tumors/masses/lymph nodes
usually combined with other tx-chemo radiation |
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what does palliative surgery do?
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it improves quality of life
not curative used to reduce pain, pressure, obstruction prevent hemorrhage and infection |
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why is reconstructive surgery done
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for optimal function and quality of life
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what is preventive surgery
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mastectomy for women high risk for development of breast ca
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Radiation therapy types
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primary - only treatment
adjuvant - radiation with other treatments palliative - to reduce pain with obstruction |
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what does radiation do to cancer cells?
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it uses high energy ionizing radiation to
- destroy the cells ability to reproduce and repair DNA - induces apoptosis - normal cells are also injured |
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what are the two types of radiation?
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Internal - sealed or unsealed
external beam radiation |
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Where is the effect of external radiation therapy seen
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maximum effect occurs at tumor depth not at skin surface
skin sparing |
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what cancer types does sealed source radiation therapy treat
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intracavity used to treat
uterine cervical breast prostate (implanted directly into tumor temp/permanent) |
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how do sealed radiation work in the body
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- does not circulate in the body
- does not contaminate blood, sweat, vomit or urine |
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what are the safety precautions that needs to be followed when using sealed source radiation
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- do not touch radioisotopes with bare hands
- limit exposure - handle radiation source with forceps |
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brachytherapy
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Brachytherapy (from the Greek word βραχυς brachys, meaning "short-distance"), also known as internal radiotherapy, sealed source radiotherapy, curietherapy or endocurietherapy, is a form of radiotherapy where a radiation source is placed inside or next to the area requiring treatment. Brachytherapy is commonly used as an effective treatment for cervical,[1] prostate,[2] breast,[3] and skin cancer[4] and can also be used to treat tumours in many other body sites.
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what is an internal unsealed source radiation therapy
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- used in systemic therapy
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how is unsealed source rad therapy employed
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via IV/oral/instilled directly
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what are the some types of cancer treated with unsealed rad therapy
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Thyroid cancer, bone cancer
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when using unsealed sources of radiation is our body fluids contaminated
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yes - because radioisotopes circulate through the body, so secretions and body fluids are contaminated
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what are the safety issues that should be employed during the treatment with unsealed rad therapy
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- private rooms
- cover room surfaces - disposable dishes - flush toilet several times after use - limit visitors and staff contact - pregnant women should not care for these patients - gloves |
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what is the time limit for nurses with radiation exposure
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30 minutes/8 hour shift
plan time and organize supplies >distance <exposure |
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what do you use to shield/protect body from radiation
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lead shields
Film badges rotate care among staff pregnant nurses do not care for the patients |
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how do you dispose radioactive isotopes
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tongs
specific containers |
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when does clinical manifestations develop in radiation treatment
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10 to 14 days after treatment
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how to minimize side effects of radiation therapy
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protect skin from sun for 1 year
soft clothing |
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what are the SE of radiation
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skin reaction - mild redness of 2nd degree burn
infertility alopecia xerostomia (Dry mouth)- sores, yeast, thrush N/V dysphagia bone marrow suppression - pancytopenia |
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when is chemo therapy used
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- for systemic intervention
- used when disease is wide spread - used when risk of undetectable disease is high - used when tumor can't be resected and is resistant to radiation therapy - used along with other treatments |
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How does chemo work
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- disrupts reproduction of cells
- does not kill all cells in one exposure, takes multiple cycles |
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how do a nurse manage a chemo
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- skilled
- oncology certified or chemo class - thorough assessment - review lab especially CBC - verify orders and 2 nurses to check to verify - plan for antiemitic, hydration, diuresis, electrolyte supplementation - observe for side effects (do not occur during or immediately after admin) - educate pt. family |
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What are the routes of admin of Chemo
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-IV
-Regional ( topical, intra-arterial,intaracavity) - Intrathecal |
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How do you admin IV chemo
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- prefer to use large veins for piv sites, avoid hands wrist and AC
- assess IV site prior durning and after admin for phelbitis and extravasation - central line preferred, PICC, ports - catheter care to prevent blood stream infection |
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What is topical chemo
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flurouracil for squamous cell carcinoma
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what is intra-arterial chemo
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high risk, but gives maximum exposure
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what is intra-cavity chemo
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instills med into area such as bladder, abdomen or pleural space
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what is intrathecal chemo
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- crosses blood brain barrier, med instilled in reservoir allowing med into CSF
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What are the signs of hypersensititvity reaction to chemo
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Dyspnea
Chest tightness or pain pruitius , urticaria tachycardia, hypotension flushed appearance cyanosis |
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what do you do when one of the hypersensitivity reaction to chemo occurs
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- stop drug immediately
- maintain airway - maintain IV access with 0.9% NS - notify MD - VS q 2 minutes - administer epinephrine, benadryl, steroids per orders |
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What do you do when there is a chemo extravasation (pain, erythema, swelling, and lack of blood return)
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- stop med immediately
- attempt to aspirate any residual med - do not apply direct pressure - apply warm/cold compress as indicated - notify MD - observe site - document before and after IV site |
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What is Biotherapy?
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Biotherapy is used to manipulate the immune response
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what are the types of Biotherapy?
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- Hematopoietic growth factor
2 bioologic response modifiers Interferon Interleukin |
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what is hematopoietic growth factor?
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-stimulates bone marrow recovery after chemo
-ex -erythropoietin stimulates RBC production WATCH CBC |
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what is interferon?
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proteins with antiviral, immunomodulatory and anti-proliferative activity
ex - to treat kaposi sarcome SE - fever chills, hypotension, fatigue - pre medicate with tylenol/benadryl |
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what is interleukin?
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it is derived from T cell, enhances function of natural killer cells
ex- treat renal cell carcinoma, melanoma toxic response: increased cap permeability, hypotension, wt gain, ascities, pulmonary edema |
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What is Bone Marrow translplant?
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- used to treat leukemia or to counter effects of chemo
- damaged bone marrow replaced by healthy bone marrow - bone marrow contains stem cells which can develop RBC, WBC's and platelets |
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what is autologous bone marrow donor
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clients own bone marrow
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what is allogenic bone marrow donor
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matching donor
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what is syngenic bone marrow donor
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identical twin donor
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what are the Treatment response and SE of cancer treatments
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Myelosuppreession
GI effects Integumentary effects Reproduction effects Psychosocial aspects |
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what is myelo suppression?
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- neutropenia
- thrombocytopenia - anemia |
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what is pancytopenia
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if involves all three neutropenia, thrombocytopenia and anemia
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what is NADIR
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time after chemo when WBC and platelets are lowest - usually occurs 7-14 days after chemo
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what would be the major patient care concerns during Nadir
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INFECTION
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what is Neutropenia?
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lack of neutrophils
<1000/mm3 (risk for infection, high mortality rate for sepsis from neutropenia) normal is >2500/mm3 |
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what is the red flag when neutrophil count is low?
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FEVER - prompt treatment, antibiotic therapy, cultures, CXR, monitor vs
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what are the interventions for a neutropenic client?
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hand hygiene
oral care 4-6 times day adequate fluid intake avoid raw uncooked food lot bacteria diet avoid crowds no cleaning bird/litter no fresh fruits adequate rest |
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what is thrombocytopenia?
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decreased number of platelets
<20,000 - high risk for hemorrhage - chemo withheld until Plt >100000/mm3 - may take 2-6 weeks to recover - may need platelets transfused |
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what are the nursing interventions for thrombocytopenia
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- avoid injury
- soft tooth brush - electric razor - stool softener - avoid rectal temp - avoid ASA, NSAIDS - Avoid IM, SQ injection - notify MD if petechiae, tarry stools, blood in urine or vomit, changes in LOC |
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What is Anemia
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lack of RBD
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what are the causes of Anemia
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- blood loss
- RBC destruction - liver spleen diseases - drug toxicity |
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what are the symptoms of anemia
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- fatigue
- HA - Pallor - Dizziness - Dyspnea |
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what can be used to treat anemia?
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(may need transfusions of PRBC)
- erythropoietin - balance exercise and rest |
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what are the GI effects of cancer treatment
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N/V
anorexia stomatitis diarrhea/constipation |
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N/V during cancer treatment
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- chemo or radiation involving chest, abdomen or back
- 60% chemo N/V - pre-medicate with zofran, kytril, anzemet |
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what are the non-pharmacological interventions for n/v
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relaxation
guided imagery avoid foul odors eat small frequent meals ice chips ginger ale |
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what causes anorexia (weight loss 5% or more in one month)
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- alterations in taste
- dry mouth - n/v -stomatitis -pain -Diarrhea, constipation |
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what are some of the interventions for anorexia
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consult dietician
high protein, high cal diet nutritional supplement |
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what is stomatitis
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inflammation and ulceration of the oral mucosa, or ulcers throughout the GI tract
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what are s/s of stomatitis
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painful, decreased fluid/food intake, infections(Candida)
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what are the interventions for stomatitis
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- thorough and gentle oral exam and cleaning
- moisturizers - topical anesthetics and analgesics - avoid extremely hot.cold/spices/fruit juices - eat soft foods, nutritional supplement |
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what are the interventions for diarrhea -increase in frequency or water content
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- low residue or liquid diet
- monitor for fluid and electrolyte imbalance - perineal hygiene - anti diarrheal meds |
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what are the interventions for constipation - dry or infrequent stools
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- increase fiber and fluid
- stool softeners - laxatives |
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what are some integumentary effects of cancer treatment
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alopecia - 2 to 3 weeks after 1st chemo/rad
-may/may not grow - may grow different - body image changes/support |
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what are the skin reactions that occur with cancer treatments
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- hyperpignmentation - darkening of skin, nail beds, mouth, gum (temp can last 10-12 months after therapy)
- photosensitivity - temp - disappears after treatment stops - radiation pt. receiving radiation before chemo may have redness, blisters, skin shedding and permanent darkening after skin heals |
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what are some effects of cancer treatment on the reproductive system
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- self image
- sexual functioning and fertility - genetic effects of chemo may not be known - dont avoid this issue - sperm banks, harvesting eggs if possible before treatment |
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what are the psychosocial aspects of cancer care
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support groups for pt and family
promote positive self concept long term support |
