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189 Cards in this Set

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  • Back
how long aer estrogens taken in prostate ca
indefinitely
Cancer that begins in cells that line certain internal organs and that have glandular (secretory) properties; bone metastasis is common
adenocarcinoma(prostate)
Tx for prostate CA?
surgery first, radiation (brachytherapy ), hormone, orchiectomy
what does p/o care in prostate ca consist of?
care of the perineal wound monitoring for possible urine leaks, hemorrhage, and signs of infection
what does pt often wear p/o prostate CA and why?
Fuller shield or briefs-type underwear to support the dressing on the perineal incision
what is avoided p/o prostate ca?
rectal thermometers, rectal tubes, and suppositories
what type diet p/o prostate ca?
a low-residue diet may be given until wound healing is well advanced
_____is used both for urinary drainage and as a splint for the urethral anastomosis (a surgical connection between 2 structures
catheter
what must RN ensure in r/t catheter p/o prostate ca?
care should be taken that it does not become dislodged or blocked
when is the risk of blockage in prostate ca highest?
1hr after sx
how long is catheter left in place p/o prostate ca? does it require irrigation?
2-3wks. yes
BREAST CANCER- most common malignancy of women, usually occurs after age ____
35
breast ca Risk factors include
family history (15%), long menstrual cycles, early menses, late menopause, nullipara, first pregnancy after age 29
s/s of breast ca?
lump or mass, change in breast size or symmetry, thickening, dimpling of skin, unusual nipple discharge
what 2 genetic markers for breast ca?
prescence of BC-19 and BC-25
what 2 genes for breast ca?
BRCA1 BRCA2, which stands for BReast Cancer gene(some use bc19)
what is done to locate the tumor in breast ca if tumor is non palpable for biopsy?
needle localization
in _____A needle is inserted to appox. site, mammogram is taken to ascertain, and a wire is inserted and left in place to guide surgeon for biopsy
surgical biopsy
The removal surgery will use general anesthesia, takes an hour, and pt should wear a bra 24 hours a day for at least ____weeks after surgery in needle biopsy?
2
____ refers to a measure of how abnormal cells from your tumor appear under the microscope. The more normal it looks, the lower the numbe
tumor grade
Grade ____&____ tumors tend to grow rapidly and spread faster than tumors with a lower grade
3 and 4
describe how far cancer has spread
Cancer staging systems
what does TNM stand for?
Tumor size, Nodal involvement, Metastatic Progress
There are 2 types of breast carcinoma in situ.
what stage?
Ductal carcinoma in situ
Lobular carcinoma in situ
0
in stage ___ the tumor is 2 centimeters or smaller and has not spread outside the breast.
I
larger or has spread to lymph
2
larger and has spread to lymph
3
metastasized to bones, lungs, liver, or brain
4
what is Tx of CA based on?
based on stage of disease
how does tamoxifen work?
suppresses hormone-dependent tumors
Treatment that removes or destroys the function of an organ such as tamoxifen?
additive or ablative therapy
Tx that is not a cure but provides palliative therapy as effectively as does an oopherectomy(removal of ovaries)
additive or ablative therapy
when is additive or ablative therapy such as tamoxifen most effective?
when used to prolong disease-free survival in breast cancer therapies.), and radiation
how often to have BSE?
mammogram?
age 20-40: BSE, clinical exam every 3 yrs.,
age >40: BSE, Clinical and Mammo annually
what meds to stop preop w/breast CA?
HRT
what to watch for after breast removal?
watch for lung puncture and lymphedema
after mastectomy and axillary lymph node dissection what is the most important goal of nursing activities
Restoring arm function on the affected side
how should woman be posit p/o
after mastectomy and axillary lymph node dissection?
semi-Fowler's position with the arm on the affected side elevated on a pillow and abducted(away
when flexing and extending the arm begin after mastectomy and axillary lymph node dissection? what to have her do?
in the recovery room squeezing a ball(give pain med 30 min before starting)
risk factors for cervical CA?
early sexual activity; multiple partners, Hx of STD; high-risk male partners; compromised immunity including HIV infection and Human papillovirus infection; early age at first pregnancy; multiparity, especially for African American, Mexicans, Native Americans; prostitutes
potential risks for cervical CA: heavy use of ____?
Vit ___ and ___deficiency?
derangement of____metabolism?
intrauterine exposure to ___?
frequent ____
(diabetes, nulliparity, smoking, BC)
talc
A, C
folic acid
DES
douching
dx for cervical CA
pap
who gets uterine CA?
postmenopausal women aged 50-60
risk for uterine CA?
abnormal uterine bleeding, anovulation, obesity, hypertension, and familial tendency. Increased risk in a history of uterine polyps or endometriosis
can uterine CA be dx by pap?
no
staining of the vagina with iodine, healthy tissue turns brown, malignant tissue can not absorb the stain and is the definitive dx for uterine CA?
Schiller's test
TX for uterine CA?
surgical intervention ranging from hysterectomy to pelvic exenteration, chemotherapy, radiation and hormonal therapy
preop care in hysterectomy?
poss. enema and antiseptic douche. Urge fluids until midnight to aid hydration
post op care hysterectomy?
antiembolitic stockings and early ambulation; cath. if hasn't peed in 8 hr after surgery
who gets nut ca?
primarily adolescent and young men
It is the leading cause of death in US? most common cause? where does it start?
lung CA.
smoking
epithelium of bronchus
lung ca that are more likely to be treated with surgery because they remain localized
Squamous cell carcinomas
which 2 lung CA are associated with lung scarring
oat-cell, adeno
large-cell lung CA?
anaplastic
which lung ca is always assoc. w/smoking?
Non-small cell
which lung Ca usually hs mestatasized by time it is dx & Poorest prognosis and average median survival is 12 to 18 months
Small cell carcinoma
what vit deficiency maybe linked to lung CA?
C
most common s/s of lung CA?
often silent but cough#1 then wheezing, hemoptysis, dyspnea, and chest pain.
how is lung CA dx?
chest x-ray, CT, sputum for cytology, bronchoscopy, needle biopsy of the lungs, tissue biopsy and thoracentesis
Tx for lung CA?
includes pneumonectomy, lobectomy, or wedge resection, radiation and chemotherapy as adjunct (does not respond well to chemo
how to posit pt after lung CA sx? why?
Position on operative side to promote full expansion of unaffected lung and to assist in drainage of secretions from operative site.
p/o pneumectomy care.
Position? why?
operative side to promote full expansion of unaffected lung and to assist in drainage of secretions from operative site
p/o pneumectomy care.
what exercise and why?
Perform arm exercises to minimize complications and prevent degenerative changes in the joints
p/o pneumectomy care.
pt teaching
take frequent rest periods, avoid heavy lifting and prevent infection
p/o pneumectomy care
how much O2
6 l/min
Postop: pneumonectomy care
position until bp stable?
pt kept flat or with head elevated slightly (20 degrees) until BP stable then pt can be in semi-Fowler's position with a pillow under the head and neck
vs p/o pneumonectomy?
VS q15 min until pt recover from anesthesia, then q1 hour until stable, then q2 to 4 hours
what to do if bp persistently low after pneumonectomy
call md
what else should pt do after
pneumonectomy
TCDB(give pain meds before doing)
when can passive arm ex begin after pneumonectomy?
the evening of sx
what type diet for pneumonectomy?
inc vit c and protein
after pneumonectomy the dressing is checked for blood what to do if blood is found in dsg?
call md
ONLY a small amt of ____ is expected after pneumonectomy?
subcutaneous emphysema
what does a progressive amt of subcutaneous emphysema mean after pneumonectomy?
leak of the bronchial stump(call md)
when does bubbling dec in h2o seal chamber of chest tube?
as the need for the chest tube resolves
what does constant bubbling in h2o seal chamber of chest tube mean? what to have @ bedside?
loose connection
hemastat
what to do if chest tube becomes dislodged?
cover the opening immediately with petroleum gauze and apply pressure and call md
what to assess for w/chest tubes at the insertion site? what to do if noted?
subcutaneous emphysema
call md
how should drainage be posit w/chest tube?
place below the level of the chest even during ambulation
how to check for leaks w/chest tube
start @ person and work towards drainage
how often to assess R status w/chest tube?
are kinks and loops ok
@ least q4h
no
what to do to maintain a closed sys w/chest tube?
tape all connections and ensure tube is secured to chest
what should happen w/h2o lvl in chest tube w/each breath?
what 0 movement mean?
fluctuate
not patent or intact
what does periodic air bubbles in chest tube mean? is it ok?
air is being trapped and removed fm chest.
yes
what to do in r/t drainage w/chest tube?
measure q8h
mark lvl on drainage chamber
report red, cloudy, warm or free flowing, more than 70cc/hr
should drainage be emptied on chest tube?

why add h2o to sys?
what minimum lvl of h2o?
no

prevent tension on pleural space
2cm
chest tubes chould NOT restrict activity
info
chest tube placement for hemo?

pneumo?
4-5


2-3
what to do if inc bubbling w/chest tube?
check for leak
removal of a small piece of peripheral lung tissue
lung resection
does a thoracentesis require pt to be npo or under GA?
no. local anesthetic
how to posit pt for thoracentesis?
leaning forward with arms and head leaning over
how to posit pt after thoracentesis?
on the unaffected side for 1hr
who gets bladder CA?
men older than 50
what jobs have inc risk of bladder CA?
cable workers, petroleum workers, hairdressers, weavers, aniline dye workers, rubber workers, spray painters, and leather finishers
s/s of bladder CA?
intermittent, painless hematuria, clots in the urine, pain after voiding, bladder irritability, nocturia, dribbling and urinary frequency
how is bladder CA dx?
cystoscopy and biopsy
#1 s/s of bladder CA?
painless hematuria
drug commonly used to bladder CA?(mr. vt)mr vermont
valrubicin (Valstar), thiotepa (Thioplex), mitomycin, and doxorubicin (Rubex
sx if the tumor is well localized in bladder CA?
Cystoscope resection
what is major SE of radical cystectomy and urethrectomy with permanent ileal conduit
impotence and sterility
drains urine, 6" ileum removed, one end out thru abd wall, ureters reconnected, and the open end of the ileum is brought to the skin surface on the abdomen to form the stoma
ileal conduit
is an appliance required all the time for ileal conduit? why?
#1 nsg priority?
yes. cont urine drainage
good skin care
diseased part of the large bowel is removed and the two healthy ends of the bowel are sewn back together (resected
colon resection
what may be in place to allow bowel to heal after a colon resectoin
colostomy
preop colon resection?
abt if ordered, low residue diet, then clear liquid then npo and bowel is cleansed
what to monitor p/o colon resection to determine if pt can eat?
bowel sounds
what meds to avoid p/o colon sx? what to use instead?
laxatives.
stool softners
when to get up after colon sx? how long to avoid strenuous ex and work?
asap.
4-6wk
most common cause of pancreas CA?
alcoholism
s/s of pancreas CA?
weight loss, anorexia, weakness, nausea, jaundice and a palpable abdominal mass
new onset DM
Dx for pancreas CA?
liver function studies, x-rays, scans, biopsy and elevated fasting blood suga
surgical removal of the head of the pancreas, the common bile duct, the distal part of the stomach, and duodenum done in pancreas CA?
whipple procedure
how to posit p/o whipple
semifowlers
what should rn expect to be in place after whipple
NG to low suction
downside to whipple procedure?
Long, extensive surgery with risks associated with long anesthesia time and long exposure of the internal viscera
childhood tumor of the kidney with a good prognosis if treated
WILMS' TUMOR-(also called nephroblastoma
s/s of wilm's tumor?
palpable firm, non-tender, smooth mass in the abdomen, hypertension, vomiting
risk factor for wilms tumor?
family hx
the presence of ____ in urine to r/o wilm's tumor?
catecholamines
rarely is wilm's diagnosed after there has been bleeding into the tumor, resulting in sudden swelling of the abdomen and a low red blood cell count (anemia
(info)
what is avoided in wilm's tumor? why?
palpating the abd, b/c it could cause rupture and seeding, dissemination of the tumor
pt teaching p/o wilm's tumor.
alert to fluid volume deficit, teach pt that children who have only one kidney should not play rough contact sports, refer to Candlelighters (child cancer group
malignant proliferation of blast cells (pre-WBC); they crowd out normal white blood cells, red blood cells, and platelets
LEUKEMIA
acute lymphoblastic leukemia) , common in young children, reasonably good prognosis
ALL
acute myeloblastic leukemia) common in all ages
AML
chronic myelogenous leukemia) uncommon before age 20.
CML
s/s of CML
high fever, abnormal bleeding (thrombocytopenia), chills, pallor, recurrent infection, prolonged weakness
how is luekemia Dx-
bone marrow aspirate with a large component of immature WBC
tx for leukemia?
bone marrow transplant and chemo
malignant tumor of bone more common in males, most frequently children and adolescents
Ewing's sarcoma
the fourth most common primary malignant neoplasm of bone, occurring most frequently in male pt under the age 30
Ewings
s/s of ewings sarcoma
rapid growth within the medullary cavity of long bones (a diffuse endothelioma ), especially the femur, humerus, pelvis, tibia, and ribs
most frequent site is the lungs of mestatssis in ewing
lungs
a malignant tumor that develops from bone marrow, usually in long bones or the pelvis
ewings
4 most common s/s of ewings
pain, swelling, fever, and leukocytosis
describe the tumor in ewings

ewings is also called
soft gray mass

endothelial myeloma
what do xrays initially x-ray show in ewings
periostaeal bone destruction
tx for ewings
involves radiation therapy and wide surgical resection of the tumor or
amputation(#1)
chemo for ewings
(OICA)
Oh I Cee A ewing
cyclophosphamide (Cytoxan), vincristine (Oncovin), ifosfamide (Ifex), and doxorubicin (Adriamycin)
most common manifestation of ewing
tall for age
NSg interventions for ewing's are r/t what things?
teaching about phantom pain, psychological support for alteration in body image, proper body alignment and positioning.
____is a malignant tumor of the hyaline cartilage
Chondromasarcoma
most common sites for chodrosarcoma(2)?
spreads to?
ribs and pelvis

lungs
#1 tx for Chondromasarcoma
amputation
abnormal cellular growth that originates in the lymph glands and lymphatic tissue
LYMPHOMAS- (ex: HodgkinÕs Disease
s/s of lymphoma?
swelling of the lymph glands (unilateral), tonsils, adenoids, and nodes in the cervical area; progressive anemia
the presence of what cells helps dx lymphoma
Reed Steinberg
Chemo to tx lymphoma
BACOP
bleomycin, adriamycin, cytoxan, vincristin (Oncovin), and prednisone
#1 s/s of laryngeal ca?
difficulty swallowing
NSG intervention preop in laryngeal CA?
explain poss. loss of voice and methods of communication
ways to communicate after laryngealectomy?
writing, electric pharynx, esophageal speech, TEP transesoph. puncture
what will be in place p/o laryngealectomy
trach
what type air and feedings w/laryngealectomy
use humidified air; start with nasogastric feeding and then thick fluids like jello and custard
what foods to avoid p/o laryngeal CA because they inc salavation?
sweets
metastasis will cause hip pain
metastasis will cause slurred speech
metastasis will cause nausea
breast
lung
colon
fate influences health practices" or "belief that bad actions cause disease
hispanic
what race has a higher incidence of stomach cancer
japan
alters metabolism and leads to catabolism of lean body mass and fat
cachexia
what type diet to use w/radiation?
low residue(low fiber)
a vegetable of the mustard family: especially mustard greens; various cabbages; broccoli; cauliflower; brussels sprouts
antioxidants
cruciferous vegetables
cruciferous vegetables are high in what vit?
ACE, carotene
Countries in which people eat a lot of salt-cured, smoked, and nitrite-cured foods have a high prevalence of cancer of the stomach and esophagus.
nitrates(inc risk of CA)
____virus is frequently associated with several cancers
eppstein-barr
HIV, Autoimmune diseases, and immunosuppression are all associated with CA
info only
Clinical CBE

Self SBE exams
q3y

monthly @ 20 y.o
colonscopy when to get
every 10 years for men and women
Flexible sigmoidoscopy
q5y
PSA and digital rectal examination (DRE
annually at age 50
pap screenings
Begin 3 years after first sex or at age 21, which ever is sooner, annually. At age 30, if all have been normal, start every 3 year schedule. At age 70 or after hysterectomy and there are no signs of CA, stop the screening.
what test is used after a cancer treatment to check results
CEA (carcinoembryonic antigen)
what must Rn remember in r/t CEA?
Developing fetus will cause a false-positive, and many cancers do not produce this protein and give a false negative
what might UA show in CA
Bence Jones protein, melanin
what CEA level may mean CA?
normal HCG
normal psa
>10
5-25
0-4
what happens to platelets in CA?
decrease
a tumor that arises from the sympathetic nervous system. Most common form of extra-cranial solid tumor of childhood. Tumor formed of embryonic ganglion cells, primarily in the pediatric population
Neuroblastoma
describes the situation where the number of neutrophils in the blood is too low
Neutropenia
neutrophils fight what type infection
bacterial
Massive amts of _____ can aggravate, but normal amts are good for CA.
carrots
not enough platelets
Thrombocytopenia
increase in new cells that results from a stimulus, reversible once the stimulus is removed. Normal growth
Hyperplasia
conversion of a cell from highly specialized to less specialized
Metaplasia
lower degree of cell differentiation (ie. less like tissue of origin)
Anaplasia
or Malignant growth of new cells that doesnÕt remove when the stimulus is removed
Neoplasia
bizarre cell growth that causes cells to be different in shape, size or arrangement than cells from the same type of tissue. May be reversible
Dysplasia
High dose chemotherapy or radiotherapy aimed at destroying any residual cancer cells but which at the same time destroys the patient's own bone marrow and therefore requires stem cell rescue.
Ablative therapy
infection of the mouth characterized by ulcers and inflammation
Stomatitis
what sol'ns to use for stomatitis?
use mouth wash or normal saline, mild peroxide solution, sodium bicarbonate, stimulate saliva with gum, candies, buttermilk, yogurt
what meds to coat lesions in
stomatitis?
Mycostatin; MOM or Kaopectate