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70 Cards in this Set

  • Front
  • Back
3 phases of cancer
initiation
promotion
progression
Describe initiation phase of cancer development
mutation of cell's genetic structure resulting from an inherited mutation or following exposure to chemical, radiation or viral agent. also linked to diet, hormones.
Describe promotion phase of cancer development
characterized by reversible proliferation of altered cells. has laten period that can last 1-40 years
Describe progression phase of cancer development
increased growth rate of tumor
invasiveness & metastasis
Describe the role of the immune system to cancer.
Provides defense, homeostasis & SURVEILLANCE
•Cancer cells look very much like normal cells but usually have antigens on them
Describe risk factors for lung cancer.
20yr pack history, asbestos, uranium, COPD
Describe risk factors for breast cancer.
Caucasian, early menarche or late menopause, fibrocystic disease, infertility, 1st pregnancy after age 30, maternal hx of breast ca, obesity
Describe risk factors for prostate cancer.
African American, elderly
Describe risk factors for colorectal cancer.
ulcerative colitis, family hx of polyps, high-fat, low fiber diet
Describe risk factors for cervical cancer.
early intercourse, multiple partners, STI’s or cervical dysplasia (abnormal pap)
7 warning signs of cancer:
C – change in bowel, bladder – stringy stool, passing around tumor
A – a lesion or sore not healing
U – unusual bleeding or discharge
T – thickening or lump in breast or elsewhere
I – indigestion or difficulty swallowing
O – obvious changes in wart or mole
N – nagging cough or persistent hoarseness
What is the purpose of the CEA tumor marker?
detects breast, liver, lung, GI cancers
What is the purpose of the AFP tumor marker?
incr in liver, renal, Hodgkin’s lymphoma ca
What is the purpose of the CA-125 tumor marker?
ovarian ca
What is the purpose of the CA 19-9 tumor marker?
cystic fibrosis, lung, billiary, pancreatic cancer
What is the purpose of the CA 15-3 tumor marker?
metastatic breast cancer
What is the purpose of the PSA tumor marker?
prostate specific antigen, night frequency w/urination, trouble starting or stopping, blood in urine, back pain while urinating. Typical normal result is 0-4, but w/hx of BPH 4-8 before ca suspected.
What are normal values for RBCs
female 4.2 – 5.4, male 4.7 – 6.1
What are normal values for WBCs
4,000 – 10,000
What are normal values for Hemoglobin
female 12-16, male 14-17.4
What are the normal values for hematocrit?
38-48%, male 42-52%
Describe how various types of cancers are staged
• Stage 0 – in situ; tumor is in place of origin, hasn’t moved anywhere
Stage 1 – tumor is in tissue of origin
Stage 2 – local spread has occurred
Stage 3 – local & regional spread
Stage 4 – metastasis
Describe how various types of cancers are classified according to TNM
i.Primary Tumor (T)
1.T0 – no evidence of primary tumor
2.Tis – carcinoma in situ (place of origin)
3.T1-4 – ascending degrees of incr in tumor size & involvement
4.Tx – tumor cannot be measured or found
ii.Regional Lymph Nodes (N)
1.N0 – no evidence of disease in lymph nodes
2.N1-4 – ascending degrees of nodal development
3.Nx – regional lymph nodes unable to be assessed clinically
iii.Distance Metastases (M)
1.M0 – no evidence of distant metastases
2.M1-4 ascending degree of metastatic involvement of the host, including distant nodes
3.Mx – cannot be determined
i.Most common radiation treatment
ii.Prep skin first, marks for as long as tx occurs – do not wash off or rub off, immobilized
iii.Other areas shielded
iv. No radiation safety risk for others
External radiation – aka teletherapy
i.Implantation or insertion of radioactive materials into or close to tumor – seed, wire, tube – can be temporary or permanent
ii.Minimal exposure to healthy tissue
iii.Used in combination w/teletherapy
iv.Patient should understand need for time & distance restrictions on healthcare workers
v.Permanent – body acts as shield
vi.Temporary – uterine – pt in lead private room, usually on bed rest because it can dislodge
vii.Can’t have people sitting on lap, can’t sleep with partner
Internal radiation – aka brachytherapy
Identify the side effects of radiation therapy
Fatigue, skin reactions, alopecia, anemia, neutropenia, thrombocytopenia, anorexia, N/V, consitpation, diarrhea, stomatitis
nsg mgmt for fatigue
encourage periods of rest, pace activities according to energy level
nsg mgmt for skin reactions & alopecia
i.Dry skin should be lubricated w/nonirritating lotion or solution that contains no metal, alcohol, perfume or additives
ii.Wet reaction must be kept clean & protected from further damage
iii.Prevent infection
iv.Facilitate wound healing
v.Protect irritated skin temperature extremes
vi.Avoid constricting garments, harsh chemicals, & deodorants, no wool, corduroy
vii.Help patient to deal w/hair loss
nsg mgmt for anemia
monitor H&H, administer iron supplements and erythropoietin as ordered, encourage foods that promote RBC production (liver, eggs, dried fruits, legumes, dark green leafy veggies, whole-grain and enriched bread & cereals), , observe for signs of bleeding
nsg mgmt for neutropenia
i.Assess for signs of infection
ii.Interventions: good personal hygiene
iii.Avoid crowds
iv.Avoid dental work when counts low
v.No immunizations unless MD approves
vi.Neutropenic precautions if WBCs less than 2000 – reverse isolation, no fruits/veg
vii.Assess Nadirs – lowest WBC they have 7-15 days after chemo typically, expected, no resistance to anything, avoid visitors, crowds
nsg mgmt for thrombocytopenia
i.Assess for overt or covert bleeding
ii.Avoid IM/SC injections - bleeding
iii.Check BP infrequently
iv.Safe environment
v.Soft toothettes, no flossing, no toothpicks
vi.Avoid straining – stool softeners, don’t do high fiber diet – too much bulk
vii.Gentle lubricated sexual intercourse
viii.Use electric razors
ix.Avoid tight clothing, ASA, NSAIDs, anticoagulants
x.May require Neumega, Procrit
nsg mgmt for anorexia
monitor weight, small, frequent meals of high protein high calorie foods, serve foods they like in pleasant environment
nsg mgmt for n/v
– teach to eat/drink when not nauseated, administer antiemetics PRN
nsg mgmt for diarrhea
administer antidiarrheals as needed, encourage low-fiber low-residue diet, encourage fluid intake
nsg mgmt for constipation
take stool softeners as needed, eat high-fiber foods, incr fluid intake
nsg mgmt for stomatitis
i.Assess oral mucosa daily for ulcers, candida, herpes, xerostomia (dry mouth)
ii.Teach pts to examine oral cavity daily & maintain oral care routine
iii.Use toothettes
iv.Oncology mouthwash
v.Dental work should be performed before initiation
vi.Pain relief
vii.Salivart – oral moisturizer, suck on hard candy
viii.Discourage tobacco & alcohol use
nsg mgmt for pulmonary effects (pneumonia) r/t cancer tx
Treatment symptoms
1.Bronchodilators
2.Expectorants/cough suppressants
3.Bed rest
4.Oxygen
nsg mgmt for reproductive effects r/t cancer tx
i.Inform pt on expected sexual side effects
ii.Use appropriate shielding
iii.Encourage discussions of issues related to sexuality
iv.Refer pt to counseling if needed
nsg mgmt for ineffective coping r/t cancer tx
i.Assist in planning
ii.Teach symptom mgmt to maintain quality of life
iii.Tell pt what to expect to decrease anxiety
iv.Encourage discussion of fears
v.Inform pt of provided supportive care
External radiation precautions to protect individuals & others
shield areas not receiving external radiation
no radiation safety risk for other from external radiation
Internal radiation precautions to protect individuals & others
i.Organize care to limit amount of time spent in direct contact w/patient
ii.Make sure patient understands time & distance precautions
iii.Pt body acts as a shield w/permanent internal radiation
iv.Pt will need to be in a lead lined room for temporary internal radiation
v.Can’t have people sitting on lap,, no exposure to children, may not be able to sleep with partner
vi.Double-triple flushing commode, double bag trash
vii.Nurse must wear film badge and lead apron while in room
Safety precautions for handling chemotherapeutic agents
•Chemo bags are in yellow bags, all trash thrown into yellow bio-hazard bags.
•Special handling w/gloves.
•Nurses pregnant/trying to get pregnant should not handle chemo drugs.
•Extravasation goes out of vein, tissue damage. Leave IV in and give antidote. Stop admin immediately. Then notify MD and administer antidote. Cold packs can provide relief or hot packs depending on pain.
Describe the effects biological response modifiers (BRM) have on cancer.
Consists of agents that modify the relationship between the host and the tumor by altering the biologic response of the host to the tumor cells in one of 3 ways:
i.They have direct antitumor effects
ii.They restore, augment, or modulate host immune system mechanisms
iii.They have other biologic effects, such as interfering w/the cancer cells’ ability to metastasize or differentiate.
Describe the effects targeet therapy have on cancer.
•Targeted therapy interferes w/cancer growth by targeting specific cellular receptors & pathways that are important in tumor growth.
•They attack tumor cells but spare normal cells
Describe the effects interferons have on cancer.
Interferons interfere w/tumor cell production and inhibit DNA protein synthesis in the tumor cell & cause tumor antigen expression on tumors
Describe the effects interleukins have on cancer.
Interleukins stimulate immune system and rebuild natural killer cells
Describe the effects monoclonal antibodies have on cancer.
•Monoclonal antibodies are capable of binding to specific target cells to ultimately destroy them – in last 15 yrs chemo agents have been mixed w/monoclonal antibodies to get them directly to cancer cell
Identify the toxic effects & common SE of immunotherapy
SE are dose dependent and include:
i.Flu-like symptoms
ii.Anorexia/weight loss
iii.Fatigue
iv.Nausea/vomiting – if they get motion sickness more likely to get nauseous
v.Changes in cognitive function
vi.Also cardiotoxicity – arrhythmias, heart failure, renal failure, liver failure, “take patients w/in an inch of their lives”
vii.Monoclonal Antibodies may cause infusion related symptoms such as fever, chills, urticaria, and rarely anaphylaxis
Nsg mgmt for immunotherapy
i.Treat symptoms, don’t stop chemo
ii.Administration of acetaminophen before treatment and every 4 hrs after treatment
iii.IV meperidine to control severe chills
iv.Monitor vital signs & temp
v.Plan rest periods for the patient
vi.Assist w ADLs
vii.Monitor for adequate oral intake
viii.Diphenhyramine
ix.Increase in fluids
3 categories of hematopoietic stem cell transplants (HSCT)
i.Allogeneic - donor
ii.Syngeneic – twin donor
iii.Autologous – pt own bone marrow
3 sources of cells for transplant include:
i.Bone marrow
ii.Peripheral blood
iii.Umbilical cord blood
Describe the procedure for bone marrow transplant
•Harvesting of bone marrow is done under general anesthesia, marrow is aspirated from sternum and iliac crest, donor may have pain at site, marrow is replaced after a few weeks naturally, marrow is purged & frozen – person donating bone marrow has more problems than pt
•Takes 2-4 weeks for marrow to begin working looks like they are getting blood – hangs in bag)
Nsg mgmt for pain in cancer
i.Rate pain using a patient reporting scale including location, intensity, quality, aggravating/alleviating factors, relief measures
ii.Use the pain ladder, stepping up when pain is not controlled
iii.Administer pain meds around the clock especially the “contin” meds to maintain a pain free state. Also treat breakthrough pain w/short acting narcotic or NSAID.
iv.Do not equate opioid tolerance & physical dependence w/addiction. Cancer patients will develop tolerance & physical dependence but not psychological dependence (addiction).
v.all cancer patients deserve pain control regardless of their past history w/addiction.
vi.dose the patient using the amount of opiod that controls pain with the fewest side effects. Morphine is drug of choice.
vii.If patient builds up a tolerance to opioids he may require high doses of medication w/o suffering untoward effects seen w/acute pain management (overdose & respiratory depression).
viii.never use Meperidine for chronic pain management. It produces a toxic metabolite causing muscle twitching & renal damage.
ix.Avoid opiate agonist/antagonist medications on patient receiving long-term opioid therapy. They may cause withdrawal symptoms due to the opiod antagonist action. (Stadol, talwin, nubain)
x.Use simplest doses & least invasive pain modalities first. Oral, rectal, if vomiting, transdermal, IV, IM, SQ, intraspinal.
xi.Placebos should never be used in management of cancer pain.
xii.use other pharmacological alternatives for pain mgmt also. Relaxation, guided imagery, biofeedback, TENS, heat/cold therapy, massage, exercise, etc.
xiii. “The person dying of cancer should not be allowed to live out life with unrelieved pain because of the fear of side effects, rather appropriate aggressive palliative support should be given.”
Describe importance of early detection & prevention of cancer.
•Elimination of predisposing risk factors reduces the incidence of cancer and increases the survival of patients who have cancer
•Seven warning signs of cancer (see above)
•Lifestyle habits –
i.avoid exposure to known carcinogens – smoking, sun, tanning beds, charcoal grilled food, hot dogs, limit nitrites & asbestos
•Eat a balanced diet including low fat high fiber, soy & legumes (rich in vit B,A,C), cruciferous stop cancer growth (broccoli, cabbage, brussel sprouts, bok choy, kale)
i.Impede cancer growth – dark beer, green tea, calcium, constipation
•Exercise regularly
•Obtain adequate rest
•Regular health exams
•Change perceptions of stressors
•Learn to cope w/stress
•Enjoy consistent periods of relaxation & leisure
•Practice self-examination
•Seek medical care if cancer is suspected
35. Describe health promotion & disease prevention activities – teaching protocol related to rehabilitative goals.
• Early detection – ACS guidelines
i.CEA - carcinoembryonic antigen found in GI ca & others – test for this
ii.High risk (20yr pack history, asbestos, uranium, COPD – lung cancer but no screening available
iii.High risk breast ca – Caucasian, early menarche or late menopause fibrocystic disease infertility 1st pregnancy after age 30, maternal hx of breast ca, obesity – mammogram age 40 1xyr or 2, SBE, 1 professional exam Q3 yr
iv.Ca risk incr w/age – inability to fight as body gets old
v.Prostate ca – African American, elderly. Rectal exam age 50 & PSA (prostate specific antigen) blood test
vi.Colorectal ca – ulcerative colitis, fam hx polyps, high fat, low fiber diet. Colonoscopy age 50 repeat every 5 or 10 yrs depending on results & fam hx
vii.Cervical ca – pap smears once sexually active, high risk if intercourse early, multiple partners, STI’s or cervical dysplasia (abnormal pap)
•Teaching plan
i.Diet see above
ii.Medication
1.Hormone therapy
2.Previous anticancer therapies
Describe S/S of common oncological crises - superior vena cava syndrome
tumor obstructs superior vena cava
•May manifest as facial edema, cough, distension of neck & chest veins, periorbital edema
•Treatment is palliative radiation, chemo
Describe S/S of common oncological crises - paraneoplastic disease (aka metabolic syndrome)
•Hypercalcemia – because tumor is secreting hormone to cause or due to bone CA, tx w/ tumor removal or calcitonin (acts like diuretic on blood)
•SIADH – ADH tells us to stop peeing, this signals to stop peeing but body isn’t overloaded, fluid management
•Insulin – cancer cells more sensitive to insulin – hypoglycemia may develop
•ACTH – secreted by pituitary, tells adrenal cortex to secrete glucocorticoids to relieve stress, androgens to release testostone. Tumors can release ACTH to control adrenals. Tx tumor or remove it to handle the problem.
Treatment includes mgmt of symptoms & treatment of tumor
Describe S/S of common oncological crises - disseminated intravascular coagulation (DIC)
•May manifest as bleeding from 3 separate sites w/bleeding & clotting at the same time, elevated PTT & PT, decreased platelets (urine, mouth, nose, any area)
•Treatment includes heparin to control clotting & fresh frozen plasma (FFP)
Describe S/S of common oncological crises - spinal cord compression
•May manifest as intense back pain, motor weakness, dysfunction, paresthesia
•Treatment includes palliative radiation, corticosteroids
2 types of chemo drugs
cell cycle phase
nonspecific &
specific
what do nonspecific cell cycle phase drugs do?
attack at any stage of replication or at rest
examples of nonspecific cell cycle phase drugs
oAlkylating agents (cisplatin, cytoxan, nitrogen mustard)
oNitrosoureas
oPlatinum drugs
oAntitumor antibiotics (adriamycin, bleomycin)
oCorticosteroids
oHormone therapy (progestins, tamoxifen) – control estrogen release Megace will increase appetite and tumor regression (adjuvant therapy) – doesn’t kill cells just slows them down.
examples of specific cell cycle phase chemo drugs
oAntimetabolites (fludara, methotrexate, 5Fu, Taxol)
oMitotic inhibitors
oTopoisomerase inhibitors
examples of biologic therapy drugs
•Tyrosine kinase inhibitors (gleevec)
•Monocolonal antibodies (rituxan, herceptin)
example of adjuvant therapy for cancer
•Erythropoietin (Epogen, Procrit)
oCSF responsible for stimulating erythroid precursor cells to produce mature RBCs produced in the kidneys
•Interleukin-11 (Neumega)
oPlatelet growth factor
oIndicated for prevention of severe thrombocytopenia and reduction of need for platelet transfusions
oAdverse effects include edema, dyspnea, tachycardia, nausea & mouth sores
oNeupagen stimulate granulocytes & macrophages
fast-acting narcotics for pain mgmt
oMSO4, MSIR (roxanol)
oCodeine
oOxycodone (Roxicodone, Percolone)
oOxycodone+acetaminophen added (Percocet, Roxicet, Tylox)
oOxycodone+aspirin added (Percodan)
oHydrocodone biturate + acetaminophen (Vicodin)
oHydromorphone (Dilaudid)
examples of long-acting narcotics for pain mgmt
oMScontin, Oxycontin
oTransdermal fentanyl (Duragesic)-100x more potent than Morphine (patch must be wasted by 2 RNs)
common s/e of narcotics
sedation, constipation, urinary retention, respiratory depression, pruritis, orthostatic hypertension
Other meds for cancer pain
•Nonopioids work in peripheral tissues (NSAIDs)
•Adjuvants are not conventional pain meds but augment the actions of opioids
•Tricyclic antidepressants (Elavil, Pamelor, Tofranil) – nerve pain
•Anticonvulsants (Tegretol, Dilantin, Neurotin) – nerve pain
•Steroids – pain
•CNS stimulants – Ritalin
•Antihistamines – Vistaril
•Biphosphonates – Aredia (cancer bone pain)
antiemetic drugs
•Ondansetron (Zofran) – blocks vomiting
•Trimethobenzamide (tigan) – suppresses medulla vomiting response – IM injection is painful
•Metoclopramide (reglan) – shortens gastric emptying & transit time
•Lorazepam (ativan) – has antiemetic properties
•Dexamethason (Decadron) – antiemetic, especially for cisplatin