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190 Cards in this Set

  • Front
  • Back
what is cancer characterized by?
uncontrolled and unregulated growth of cells
what cancers are seen more today?
skin cancer and nonhodgkins lymphoma
5yr survival rate is now 65% for those who are..
disease free
in remission
under tx
what is the fastest rising malignancy in the united states?
melanoma
cancer is most likely to be seen in what type of patients?
black men
what is the second most common death in the united states?
cancer

(heart disease is #1)
what is a nonmodifiable risk factor?
factor that you can do nothing about to change
what are examples of non-modifiable risk factors?
genetic predisposition
age
race
gender
transcultural considerations
weakened immune system
some people are genetically predisposed to develop certain types of cancer.. give examples.
breast
lung
ovarian
prostate
how can an increase in free radicals put you at risk to developing cancer?
^free radicals result from the bodys metabolic and oxidative process that accumulate and cause damage and mutation of cells
according to selye, continued stress leads to what?
to state of exhaustion and weakens the immune system
what are some examples of modifiable risk factors?
stress
diet
occupation
infection
smoking
obesity
sun exposure
recreational drugs &alcohol
hormomes
how can obesity put you at risk for cancer?
increase in hormonally driven cancers

sex hormones are synthesized from fat cells
what is diethylstilbesterol (DES)?
a hormonal drug given to pregnant woment in the late 40s early 50s which ended up increasing the risk of cervical, endometrial, and breast cancer in the women and their daughters
about half of cancer related deaths in the united states are related to what?
tobacco use
unhealthy diet
physical inactivity
obesity
what is the acronym for 7 warning signs of cancer?
CAUTION
what are the 7 warning signs of cancer according to the american cancer society?

hint CAUTION
C=changes in bowel/bladder habits
A=a sore that doesnt heal
U=unusual bleeding/discharge
T=thickening or lump
I=indigestion or dysphagia
O=obvious change in wart/mole
N=nagging cough or hoarseness
what is primary prevention?

give example(s).
true prevention
avoiding exposure to known causes of cancer
like not smoking or wearing sunscreen
what is secondary prevention?

give example(s).
screening for early detection and tx

pap, mammo
there is no screening (or secondary prevention) for what cancer???
lung CA
what is mitosis

what is important characteristic of new cells?
process of cellular division where all new cells develop from parent cells

and remain the same size, shape, and have same DNA as parent cell
when will cell proliferation increase?
if additional cells are needed?

-WBCs increase w/infection
mitosis review!!!

what are the phases?
G1= 1st growth; synthesis of RNA and protein
S= more growth; synthesis of DNA and doubling DNA content, nucleus becomes larger
G2=final growth; RNA and protein synthesis fro cell division
M=mitosis; division of cell
how are normal cells "like soldiers"??
-all look alike
-performs specific jobs
-adhere tightly together
-grow in orderly, well regulated manner

-they also have limited cell divison to develop normal tissues/replace damaged
-are nonmigratory
-have contact inhibition
-small nuclear-to-cytoplasmic ratio
how are cancer cells different from normal cells?
-abnormal growth pattern
-serve no useful function
-indiscriminant and continuous cell divison
-are not contact inhibited= invade and destroy surrounding tissues
-down look like parent cell
-adhere loosely together
-migrate
how can cancer cells affect nutrition?
can divert nutrition from host to meet own needs
what is metastasis?
cancer cells metastasize

they form secondary tumors
cancer cells develop into what?
malignant neoplasms (tumors)
cancer cells will produce ectopic hormone.

whats that??
hormone needed for growth
cancer cells will have
tumor angiogenesis.

whats that??
process by which malignant cells create their own blood supply
what is the latent period?
may range from 1-40yrs
-length associated with mitotic rate of tissue of origin and developmental factors
what are the most common sites of metastasis?
lungs
brain
bone
liver
adrenal glands
define differentiation.
cells perform specific tasks
and can change in adverse conditions to adapt to new environment
define hyperplasia,
when the number of cells are increased in an organ and there is no alteration in DNA,

results from stress, increased metabolic demand or hormonal changes

ex pregnancy
what is metaplasia?
when dividing cells differentiate into cell types not usually found in that part of the body

no DNA changes and may be caused by stressor as protective mechanism

ex columnar epith to squamousal epith in smokers
what is dysplasia?
when there is a difference in size,shape, and appearance of normal cells with DNA changes

may be d/t irritant, inflamm

ex smoking
define anaplastic.
no cellular differentiation
without shape or definition
no DNA function

high risk for malignant cells (not reversible)
define carcinogenisis.
transformation of normal cells into cancerous cells
tumor inducing genes that are normally repressed, when they are exposed to carcinogens they are activated and proliferation is increased

i am describing what type of gene?
oncogenes
this developmental gene keep cells in mature functioning state and are responsible for rapid proliferation of cells that occurs after fertilization in early embryonic stages

i am describing what gene?
proto-oncogenes
which gene has cell balls or morolas that are just cells with no differentiation?
proto-oncogenes
what happens when the cell balls of the proto-oncogenes are damaged?
when morola or cell ball is damaged by carcinogens they begin to rapidly proliferate cancerous cells
this theory of carcinogenisis is when the body cant recognize defective cells
immune response failure
explain tumor invasion.
when tumore pressure can cause necrosis of tissue and then tumor moves into empty space it created
-disruption of basement membrane
-tumor angiogeneisis factor (TAF) to establish blood supply
-causes cells to change from original initiated cells to have fewer normal characteristics

what process am i describing?
tumor invasion
cells of tissue of origin identifies what?
the primary tumor
tumor cells from original area travel to another area to form secondary tumor

i am describing what?
metastasis
when tumors metastasize the new tumor does not resemble the tissue at the new site but rather..
cells from the primary site of tumor development
how do tumors metastasize?
spread by blood/lympathic system, surrounding tissues by local seeding (spread to adjacent organs), iatrogenic (when spread by medical interventions ie surgery)
certain cancers metastasize to common sites. if i have..
breast->
lung->
colorectoral->
prostate->
brain->
melanoma->

where would these cancers move to??
breast-> bone, lung
lung->brain
colorectoral->liver,lung,brain
prostate->bone,bladder
brain->CNS
melanoma->systemic: lung,liver, spleen
what is a carcinoma?
epithelial cancerous tumor
what is adenocarcinoma?
glandular cancer
whats are sarcomas?
connective tissue cancer
what are fibrosarcomas?
fibrous connective tissue cancer
what is osteosarcoma?
bone cancer
what are two major classifications of cancer?
-solid: breast, lung, prostate
-hematologic [blood cell forming tissues]: leukemia
the histologic grading of cancer cells is based on 4 levels. explain.
G1= lowest grade closest to cells of origin (dysplasia) the least different
G2= moderate dysplasia
G3= severe dysplasia
G4= anaplasia- most different with high level of malignancy
cancer staging determines the exact location and degree of metastasis. done in 3 ways. explain.
1. clincial staging (s&s, diagnostics, biopsy)
2. surgical staging (tumor size, site)
3. pathological staging (pathology)
tell me about the TNM classification system.
T= tumor size/depth in cm; IS (insitu=tumor that is localized in small area)
N= node- ^# for ^nodes (presence of lymph node involvement)
M= metastasis- as #^, ^amt of metasstsis
(0-none;1,2,3,4-distant)
[hematologic alterations of cancer]

effects of.. chemo
pancytopenia
what is the latent period?
may range from 1-40yrs
-length associated with mitotic rate of tissue of origin and developmental factors
what are the most common sites of metastasis?
lungs
brain
bone
liver
adrenal glands
define differentiation.
cells perform specific tasks
and can change in adverse conditions to adapt to new environment
define hyperplasia,
when the number of cells are increased in an organ and there is no alteration in DNA,

results from stress, increased metabolic demand or hormonal changes

ex pregnancy
what is metaplasia?
when dividing cells differentiate into cell types not usually found in that part of the body

no DNA changes and may be caused by stressor as protective mechanism

ex columnar epith to squamousal epith in smokers
what is dysplasia?
when there is a difference in size,shape, and appearance of normal cells with DNA changes

may be d/t irritant, inflamm

ex smoking
define anaplastic.
no cellular differentiation
without shape or definition
no DNA function

high risk for malignant cells (not reversible)
define carcinogenisis.
transformation of normal cells into cancerous cells
tumor inducing genes that are normally repressed, when they are exposed to carcinogens they are activated and proliferation is increased

i am describing what type of gene?
oncogenes
this developmental gene keep cells in mature functioning state and are responsible for rapid proliferation of cells that occurs after fertilization in early embryonic stages

i am describing what gene?
proto-oncogenes
which gene has cell balls or morolas that are just cells with no differentiation?
proto-oncogenes
what happens when the cell balls of the proto-oncogenes are damaged?
when morola or cell ball is damaged by carcinogens they begin to rapidly proliferate cancerous cells
this theory of carcinogenisis is when the body cant recognize defective cells
immune response failure
explain tumor invasion.
when tumore pressure can cause necrosis of tissue and then tumor moves into empty space it created
-disruption of basement membrane
-tumor angiogeneisis factor (TAF) to establish blood supply
-causes cells to change from original initiated cells to have fewer normal characteristics

what process am i describing?
tumor invasion
[hematologic alterations of cancer]

effects of leukemia and lyphomas
tumor cells invade bone marrow and can decrease immune function by producing excessive WBCs
what is thrombocytopenia?
decreased platelets
what is leukopenia?
decreased WBCs
what is pancytopenia?
decrease in all cells
WBC, RBC, platelet
tumor erosian of BV can cause..
hemorrhage
renal cancer can produce increased amts of?
erythropoetin

-cause increased RBCs (polycythemia) and clot formation
what is a scaphoid abdomen?
sunken in abd
what is cachexia syndrome?
when the pt is emaciated/ malnourished d/t anorexia caused by pain, infection, depression, chemo, radiation
what is the normal body response to invader that requires a tremendous amount of energy?
physical stress
the following is d/t what?

over a prolonged period of time pt becomes fatigued, has wt loss, altered blood chemistries
physical stress
what is psychological stress
wide range of emtions, could be body image concerns or sexual dysfunction
which test can you do to find the exact location of the lesion using a contrast medium?
angiography
radioisotope scans are also known as..?
bone scans
how can biopsies be obtained?
needle or syringe
what is the difference between incisional and excisional biopsies?
incisional- taking wedge of tissue from larger mass

excisional-remove entire lesion without healthy tissue
alphafetal protein (AFP) and carcinogenic embryonic antigen (CEA) are used for what?
tumor markers used to monitor the progression of cancer after it has be dx'd and tx'd
an increase in these hormones suggest what?

HCG,ADH,PTH
hormone secreting cancer's
what is palliative care?
comfort and relief of symptoms (pain)
what is the goal of tx of cancer?
appropriate therapy for cure with minimal function and structural impairment
tx is determined by three things.?
specific type of cancer
extent of disease
overall health of pt
what therapy damages DNA and interferes with various phases of cell cycle?
chemotherapy
chemo drugs are classified by what?
(the specific period in the life of the cell where they are most likely to interrupt cell processess)

structure & action
chemo drugs are categorized into what two major categories?

*typically given in combination
cell cycle phase [nonspecific] act throughout cell cyle
&
cell cycle phase [specific]
prednisone is a corticosteriod which does what?
interferes with G1 phase
what do hormone antagonists do?
compete for homes at receptor sites to prevent hormone binding and slow tumor growth in hormonally driven cancer
what do breast cancer patients get?

what do prostates cancer patients get?
breast cancer-antiestrogen
tamoxofen=nolvadex
anastrozole=arimidex

prostate cancer-antiandrogen
bicalutamide=casodex
flutamide=eulexin
nilutamide=nilandron
leuprolide=lupron
what therapy enhances immune system effectiveness by use of meds to aid in defense by recognizing and destroying cancer cells?
cytotoxic therapy-cytokines
interleukins do what?
enhance immune sytem effectiveness
??? can slow tumor cell division an stimulate natural killer cells
interferons
systemic complications, inflam reactions, symptoms similiar to flu are SE of ??
interferon
what is the palliative Rx for interferon?
tylenol
fluids
rest
what is colony stimulating factors?
the bodys biological response to chemo, stimulate faster recovery of bone marrow function
what is the function of:
neupogen
neulasta
WBC production
neupogen= filgrastim
neulasta=pegfligrastim
what is the function of:
epogen, procrit
aranesp
RBC production
epogen, procrit=epoetin alpha
aranesp=darbepoetin
what is the function of:
neumega
platelet production
neumegan=oprelvekin
what are some special considerations of chemo for men and women?
potential infertility

contraindicated in pregnancy
miscarriage
birth defects
which method of drug administration is preferred for rapid action?
intravenous (IV)
this route of administration is also called "infusaport"
venous access device (VAD)
a vesicant drug is a _______ drug.
irritating
what is extravasation?
a complication of chemotherapy drug when drug leaks into surrounding tissues causing damage to skin, nerves, tendons, and muscle
!could result in amputation
what do you do in the event of extravasation?
antidote depending on drug
elevate extremity
warm/cold compress depends on drug
stop IV
attempt to aspirate med/blood
what are OSHA guidelines for hypersensitivity to chemo? s/s of anaphylatic reaction?
monitor closely 1st 15-30min

rash, SOB, wheezing

stop drug immediately, call MD, call code if condition warrants
what are some ways to prevent reaction pre-med?
prevent allergic reaction
benedryl IV
decadron IV

prevent n/v
antacid IV (zantac)
antiemetic (zofran)
nephrotoxic drugs require what and when?
adequate hydration a & p
what are some s/e of chemo?
alopecia (hair loss)
xerostomia (dry mouth)
n/v
mucositis (sores in MM of GI tract)
stomatitis (sores in mouth)
what is the difference between anticipatory, acute, and delayed N/V? what is the tx?
anticipatory- when you know from past experience that you will be nausea so you develop nausea before tx
acute-during administration
delayed-up to 5-7days p

tx:
antiemetics: zofran, anzemet, compazine, reglan, marinol, emend(aprepitant 3doses)
how can you manage mucositis and stomatitis?
soft toothbrush q8hrs
rinse with plain water/saline
no commercial mouthwashes
no spicy, hot, cold foods
high protein diet
^vit C for healing

"magic mouthwash"
what is magic mouthwash?
combo of anti-inflam, analgesic, anesthetic drugs, antifungal
SWISH & SWALLOW

tx for mucositis/stomatitis
what is nadir?
time when bone marrow activity is at its lowest that means decrease in number of WBC, RBC, & platelet
what is the most life threatening effect of chemotherapy?
nadir
how do you care for a patient with leukopenia?

how do you advise these patients when at home?
private room
no flowers/plants
limit #of caregivers
monitor V/S& WBC
avoid invasive procedures
aseptic technique

Home:
limit vistors
avoid crowds
report temps over 100
avoid pets, kitty litter
low bacteria diet
avoid salads /uncooked foods
what is thrombocytopenia?
platelet count of less than 20,000

may have spontaneous bleeding
how can you avoid bleeding for patients with thrombocytopenia?
avoid IMs, venipuncture
no aspirin products
electric razor
prevent trauma, wear shoes
no contact sports
soft toothbrush
no flossing/dental work
caution blowing nose
what causes an increase in cardiac and respiratory workload?
hypoxia
____ has a major role in dx, staging, and tx of cancer

90% of cancers are dx by it
60% of cancers are tx c it
surgery
what is prophylaxis?
removal of tissue "at risk" for cancer
what does debulking at primary or metastatic site mean?
surgery to reduce the size of the lesion but cannot cure it; only reduce number of cancer cells
this type of surgery is rehabilitative to increase function
reconstructive

also cosmetic appearance
Nurses can help cancer survivorship by what/how??
educate healthcare workers about needs of cancer survivors, teach survivors to look for late effects
promote: good nutrition, regular exercise, appropriate health screening
what are the neurological s/e of dying?
decrease in all senses, hearing is last sense gone, loss of gag reflex, pain
patients dying who are in respiratory distress normally have what type of respirations?
cheyne stokes
increased rate
noisy respirations
show s/s of hypoxia
how do you position a patient in respiratory distress when dying?
if they are:

conscious-fowlers
unconscious-sidelying
how is the GI & GU system affected when dying?
GI:decreased peristalsis
nausea, distention
loss of sphincter control

GU:incontinence, dec output
how is the integumentary system affected when dying?
loss of circulation to skin, cyanosis, mottling of extremities, cold& clammy skin

be careful of shearing when moving pt
what cardiac changes would occur in a patient who is dying?
slowing and weakened pulse, arrhythmias, weakness and fatigue
define grief?
grief is the emotional response of the individual to loss
what is the difference between anticipatory and dysfunctional grieving?
anticipatory: grieving prior to loss

dysfunctional: an exaggerated response to actual/potential loss; can be chronic, or delayed and is UNHEALTHY
what is the most famous theory on grief ??

hint: elisabeth kubler ross
5 stages of grieving

1 denial
2 anger
3 bargaining
4 depression
5 acceptance
which stages of grief "soften the blow" of death?
shock and denial

people are numb and in disbelief and are confused
[SIMPLY A STATEMENT NOT A Q?]

time will not heal grief
grief is a chance for personal growth
define mourning.
the process following a loss in which grief is eventually altered and or resolved
what is the state of thought, feeling, or activity following loss

hint: in our society the usual time is one year
bereavement
nursing dx regarding loss, death, dying.
impaired adjustment
ineffective /comprised coping
anticipatory grieving
hopelessness
altered nutrition
situational low self esteem
sleep pattern disturbance
spiritual distress
your job is to teach the family what

(death/dying)
about the grief process and what to expect, encourage them to express grief with support people, and to return to normal activities on a schedule
how can you assist your patient with loss/grieving in each stage
1 denial- be supportive; do not reinforce
2 anger- is normal; dont take it personally; allow patient to verbalize
3 bargaining- may express guilt
4 depression- its normal and okay to cry; stay with pt; caring/compassion
5acceptance :)
nurses responsibility is to ensure patients are treated
with dignity, honor, and respect, autonomy

and they're needs are met, are comfortable,
what is hospice care?
care for patients with life expectancy <6months

palliative care w/holistic approach:
physical, spiritual, emotional

in home or hospice facility
what % of cancer pts will recieve radiation therapy?
60
what is the purpose of radiation therapy?
to destroy malignant cells; decrease size of tumor and relieve pain c minimal exposure/damage to normal cells
what is ionizing radiation?
cells are damaged or killed when atoms inside the cell are "kicked out" of orbit, lethal to DNA of rapidly growing CA cells, overtime can also injure rapidly growing normal cells
WHAT ARE THE 2 TYPES OF RADIATION THERAPY?
EXTERNAL(TELETHERAPY)
INTERNAL(BRADYTHERAPY)
TELL ME ABOUT EXTERNAL RADIATION.
-MOST COMMON
-PT EXPOSED TO RADIATION FROM MEGAVOLT MACHINE
-PT MUST BE IN EXACT POSITION
-MARKINGS AND POSITION FIXING DEVICES USED
-TX USUALLY 5DAY/WK, 2-7 WKS
WHAT IS INTERNAL RADIATION?
IMPLANTATIONOR INSERTION OF RADIOACTIVE MATERIALS INTO OR CLOSE TO TUMOR; IMPLANT CAN BE LEFT IN PLACE FOR DAYS OR PERMANENTLY
what are some pros to internal radiation?
-allows for high dose radiation that will only effect the tumor
-minimal exposure to healthy tissue
why should caregivers use caution with radiation pts?
during therapy pts are radioactive & hazarduos to caregivers; they should use caution with time, distance and shielding
what caution measures would you use in caring for a radioactive pt?
-provide private room
-use caution with bodyfluids, linen
-if implant dislodges use long forcepts and appropriate container
-limit visitors to 6ft for 10-30 min
-limit nursing staff contact
-no pregnant ppl
what are local s/e of radiation? systemic?
local- hair loss; skin=erythema, sloughing
systemic= altered taste, fatigue
what would you do in care for a pt undergoing radiation therapy?
-mild or no soap
-DO NOT REMOVE MARKINGS
-no powder
-unscented lotions, creams or aloe-must be remover before tx
-wear soft clothing
-aviod irritatig clothes
-avoid heat or sun exposure
-use electric razor
what could pain be from?
tumor, bone metastasis, nerve involvement, ischemia, s/e of surgery, chemo & radiation
pain managemant...
-provide adequate pain control so pt can fxn as they wish and die pain free
-give meds on regular schedule
~long acting PO and transdermal
-fentanyl lollipops
-end stages= continuous IV infusion
nursing implications:
-coping-assist in planning
-transportation, nutrition, emotional support- teach s/s management, offer community resources
-tell pt what to expect to decrease anxiety
-encourage discussion of fears
-reassure pt situation is temporaly
-inform pt of provided supportive care
high fever, dehydration, peripheral edema, tachypnea, hot flushed skin, anxiety, restlessness

these are s/s of ??
pts present with s/s of sepsis
low BP, respiratory distress, cold & clammy skin, decreased output, and mental status change

these are s/s of??
classic symptoms of shock
what is most serious bacteria?
gram negitive
what are the tx for patient with sepsis?
broad spectrum antibiotics & hemodynamic support
DIC (disseminated intravascular coagulation) causes what?
extensive bleeding & clots block BVs
this *LIFE THREATENING* problem is from the release of thrombin or thromboplastin from cancer cells and sepsis
disseminated intravascular coagulation (DIC)
what is the tx for DIC?
early phase-heprin IV
later phase-clotting factors

poor prognosis- Pt to ICU
SIADH is most often seen with what?
small cell lung cancer

some tumors produce ADH and excessive amt of water are absorbed

FLUID VOLUME OVERLOAD
this is tx for ??

eliminate underlying cause
restrict fluids
monitor serum and urine Na levels, osmolality & BUN
demeclocycline (whats this??)
SIADH
syndrome of inappropriate antidiuretic hormone

demeclocycline is the antagonist to ADH
what is the cause of spinal cord compression?

why is it important to recognize condition early?
expanding tumors grow into spinal cord

catch before permanent paralysis occurs
whats the s/s of spinal cord compression? whats the tx?
Sx:
back pain, numbness, tingling, muscle weakness, loss of perineal sensation, bowel/bladder dysfunction

tx:
high does radiation, IV steroids, occastionally surgery
this occurs most often in late stages of bone metastasis..
hypercalcemia
what is the relationship of cancer and hypercalcemia?
tumors may secrete parathyroid hormone causing calcium to leave the bone and enter the blood

this causes dangerously high levels of serum calcium
symptoms of hypercalcemia depend on the calcium level.. give some examples.
fatigue, N/V, muscle weakness, decrease in deep tendon reflex (DTR), cardiac arrhythmias, seizures, coma, death
whats the tx for hypercalcemia?
hypercalcemia is *life threatening*

oral hydration
drugs to lower serum level
calcitonin, fosamax
dialysis
how serious is superior vena cava syndrome? and what exactly is it?
*life threatening* when blood flow is blocked by a tumor in the venous system of the head, neck and upper trunk
early morning facial and periorbital edema, upper body edema, SOB, cyanosis, mental changes, decreased CO, low BP,

S/S of ?
superior vena cava syndrome
tx for superior vena cava syndrome..
high dose radiation
corticosteriods
heparin
pain meds
o2 support
possible tracheostomy
if this goes untreated it can cause acute renal failure..
its when a large number of tumor cells are destroyed and potassium and purines are secreted into the blood stream..
tumor lysis syndrome/ hyperuricemia
tumor lysis syndrome is a sign of what?
effective cancer therapy
hyperuricemia is a result of what?
breakdown of cancer cells
this is tx for..?

prevent through hydration (3000cc/day)
allopurinol (zyloprim) to increase excretion of purines
monitor uric acid levels
tumor lysis syndrome/
hyperuricemia
when dealing with cancer in the gerontologic stages.. what are some important considerations for these patients??
clinincal manifestions may be mistaken for age related changes, more vunerable to complications of cancer and cancer therapy, functional status should be considered when selecting a tx plan
be aware of what late and long term effects of cancer?
secondary cancer
cognitive changes
cardiovascular & sexual dysfunction