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174 Cards in this Set
- Front
- Back
What information does a fishbone diagram contain?
|
HGB
WBC>-----< PLat HCT |
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What information does a metabolic profile diagram contain?
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Na | Cl | BUN /
---------------------------- Glucose K+ | CO2 | Creat \ |
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What is the major focus in cancer prevention in this country?
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early screening, quit smoking, sun exposure, follow screening guidelines
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What cell types are similar in structure?
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Normal and Benign cells
Embryonic and Malignant cells |
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What is the difference between hyperplasia and hypertrophy?
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plasia- increases cells
trophy- cell gets bigger |
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abnormal growth of either benign or malignant cells
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neoplasm
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what are the 4 stages of carcinogenesis?
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initiation, promotion, progression, metastasis
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progress where tumor develops its own blood supply
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angiogenesis
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What are endogenous risk factors for getting cancer?
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age, genetics, hormones, immunologic
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what are external risk factors for getting cancer?
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drugs and chemicals, radiation, tabacco, nutrition (high fat low fiber-colon cancer), secual practices, viruses, psychosocial (stress)
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what is the major cause of death in cancer patients?
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metastasis
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what are the different type of neoplasms?
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carcinoma- epithelial cells
sarcoma- connective tissue melanoma- lower epidermis |
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What are different examples of carcinoma?
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adeno- glandular tissue- broad term
squamous- skin tissue basal cell- skin cancer transitional cell- cell lining in urinary tract |
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what is a solid neoplasm and what is a hematologic neoplasm
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tissue that can be seen- a tumor
no tumor and occurs in the bone marrow |
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75% of all skin cancers, usually facial, crusted, rarely causes death or metastasis.
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Basal Cell Carcinoma
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2nd most common skin cancer
75% chance of cure if detected early |
squamous cell carcinoma
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15% survival with metastasis to skin lung liver bone. Can affect any organ. Can be cured if detected very early. Usually very disfiguring when large portion is cut out.
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Malignant melanoma
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Different ways to determine staging
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clinical, surgical, pathologic (most deffinitive)
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What does TNM mean?
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Tumor Nodule Metastasis
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What are some problems caused by malignant cells?
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obstruction of tubular structures, pressure, hemorrhage, ulceration, infection, hormonal/endocrine changes
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WHat are the screening guidelines for breast, colon, prostate, cervical, and uterine cancer?
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breast- Q3yrs after 40
colon- q10yrs after 50 or q5 if polyps found prostate- Q yr after 50 Cervical- PAP test every few years Uterine- yearly biopsy for high risk patients |
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WHat does CAUTION mean- for the 7 warning signs of cancer
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C- CHanges in bowel/bladder
A- a sore that does not heal U- unusual bleeding or discharge T- thickening/lump in breast or other I- indigestion or difficulty swallowing O- obvious change in wart or mole N- nagging cough or hoarseness |
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What are the top 3 malignancies in men and women?
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Men- prostate, lung, colon/rectum
Women- breast, lung, colon/rectum |
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What are the goals of chemotherapy
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cure,
control- if cure is not possible, controls cancer to increase survival time palliation- temporarily shrinks tumor, comfort measure |
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Chemotherapy in combination with surgery
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adjuvant
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chemo drug type that works in all areas of cell production and work more on older tumors/ drugs that work better on younger tumors
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phase non-specific drugs
phase specific drugs |
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routes of administration for chemo
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PO IV IVP Isolated limb perfusion (confined to a limb), Intracavitary (intraperioneal, intravetricular, intrathecal, intravesical), and IM
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Different types of Intracavitary Administration (intraperioneal, intravetricular, intrathecal, intravesical)
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intraperioneal - ovarian
intravetricular - brain intrathecal - brain intravesical- bladder |
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What medication for chemo must be given IM with z-track technique?
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Leuprone
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How much extravasation will result on it's own?
(if extravasating do not DC cause some chemo has antidotes, but stop infusion) |
1/2 a mL
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Chemo drugs that are S phase , meatopoietic, and cause severe diarrhea, alopecia, stomatitis
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antimetabolites
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hematopoietis is...
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bleeding, infection, anemia
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non phase specific chemo drug that causes alopecia, highly emetic, mostly consists of vesicants
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antitumor antibiotics
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what does the chemo med bleomycin cause?
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Pulmonary toxicity
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What medication can cause cardio toxicity, and you have a lifetime maximum dose you can take. Must get a baseline heart function with a mugascan before starting drug
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Doxorubicin
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chemo meds that are highly emetic, some have renal toxicity, prehydration is important, NV diarrhea, non specific phase heatopoietic
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Alkylating agents
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Specific chemo medication that you must premedicate for with decadron, and benedryl.
Very common medication |
taxol (antimiotic)
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Chemo med class that causes hematopoietic, M phase specific, also cause peripheral neuropathy to the point where dose sometimes is adjusted to prevent irreversible damage
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Antimiotics (plant alkaloids)
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chemo med class that acts directly on the pituitary function, used for hormonally driven cancers, progestins are given- megace leuprone- estrogen antagonist
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hormonal agents
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chemo med type used as treatment for fluid retention, diabetes, poor wound healing, HTN. They also lyse lymphoid malignancies
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corticosteroids
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Process of destroying cancer cells with minimal exposure to normal cells, the only cells affected are the ones in the area of exposure. non phase specific
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radiation therapy- it destroys the atoms within the cells
side effects do not always surface right away and may not show up until mon/yrs later |
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Types of radiation therapy
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electromagnetic- has no mass, xrays, gamma rays
particulate- has mass, slow, penetrates surface teletherapy- external beam, megavoltage gamma and eletron radiation bachytherapy- internal radiation; high doses directly into tumor |
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Brachytherapy radiation has two types of high doses directly into tumor called
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sealed- seeds, needle, wire
unsealed- liquid, systemic IV Prostate use seeds, thyroid treated with liquid |
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How long do prostate seeds last?
Marking placed on body for radiation treatments and should not be removed |
lasts a few months,
no pregnant women or children should sit on a mans lap who has these |
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RT might be done before surgery to shrink the tumor or done after to kill cells left behind at site.
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Gamma knife- sealed brachytherapy that gives radiation right to surgical site.
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WHat precautions are given to the medical staff to reduce exposure to radiation therapy
*nurses wear monthly tested badges* |
limit time, increase distance, shielding provided by hospital (lead wall), disposable serving items, no VS, communicate with staff over the phone
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Cells that rapidly divide are at greater risk of being compromised through RT. THis is called
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radiosensitivity.
Pancytopenia is a common side effect of RT |
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a series of divided radiation doses, given daily until total dose is given. THis allows time for healthy cells to repair
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fractionation
cancer cells will not repair. |
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rest period between two courses of radiation. Also allows body to recover and to get tumor cells in a more suseptible place to take over when restarted
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Split Course
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procedure used to deliver RT after lumpectomy within space after tumor removal. Seed placed in balloon catheter, and portion remains outside body for RT treatments BID x5days
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Mammostie.
May cause local bruising |
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procedure performed by interventional radiologists, treats kidney, liver, lung tumors, thin probe delivers coolant at subfreezing temp
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percutaneous cryoablation
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Alopecia - more common in chemo but can affect RT patients too.
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hairloss- starts 2-3 weeks after first dose, grows back 1-2 months after end of chemo but hair may grow back different.
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most psyhologically traumatic effect of chemotherapy
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alopecia
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anticipitory side effects of opiods (all of which will go away after the body gets use to the dose except for constipation which never goes away)
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constipation, hallucinations, NV, pruritus, resp depression, sedation, urinary retention
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fluid accumulation in abdominal cavity- caused by liver weeping serous fluid
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ascites
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uric acid - built up from lyced cancer cells - can lead to
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hyperuricemia- gout
primarily in big toe as it is cool and farthest from the heart |
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what are ways to diagnose pleural effusion
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chest xray, ct scan, plysical exam
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Treatment of pleural effusion
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treat underlying cause, thoracentesis, pleurodesis, pleurx catheter
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what nursing involvement is there for thoracentesis?
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comfort patient and keep them from falling forward as they stretch over pillows to expand back. Follow up with a chest xray to prevent pneumothorax
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process to treat pleural effusion when it refills often, this allows for repeated effusion treatment without scar tissue to prevent PE in that area
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pleurodesis
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chemo drug type that causes flu like symptoms, hematopoietic, hypersensativity, and it precents cells from entering the initiation and differentiation cycles.
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monoclonal antibodies
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chemo drug type that is S phase specific, causes Dia. NV, alopecia, bone marrow suppression
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topoisomerase inhibitors
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s phase specific chemo drug that is used for sickle cell and head and neck cancer
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hydroxyurea
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chemo drug that use to cause major birth defects but is effective in treating multiple mylenoma
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thalidomide
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this drug that is used as a rescue drug for high doses of methetrexate
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leucovorin
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renal toxicity reducer drug and aids in xerostomia from RT of head and neck
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Amifostine (Ethyol)
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drug that protects the heart and cardiac complications from Adriamycin
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Dexrazoxane (Zinecard)
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drug that is given with Ifosfamide to prevent hemorrhage which would occur without it
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Mesna (Mesnex)
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drug that protects from skeletal complications from multiple myeloma and other malignancies
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Pamidronate (Aredia)
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What areas of the drugs must be checked when using combination therapy?
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Nadir, SIde effects, and Phases of activity against the cell (S, G, M)
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What are some side effects of RT?
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skin reactions , late toxicites (due to blood vessels and connective tissue in the area), leukemia/lyphoma, bone marrow suppression (flat bones), EXTREME FATIGUE
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What type of skin reactions occur with RT?
Cleanse daily with mild soap. NO lotion, no shaving, sun,, heat, ice |
skin can become dry, flakey, temporary hair loss, skin sloughs off, moist and drainy
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the primary node that cancer is draining into so if it is clean of cancer in tests than all other nodes should be clean as well
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Sentinel node
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WHere should a blood pressure be taken for a masectomy patient?
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Take BP on the uneffected side or on the leg if both sides are affected
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Drugs that stimulate immune system to recognize cancer cells and destroy them. THere are major issues with administration of drug like bone pain, fatigue, fever
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BRMs- biological response modifiers
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BRMs types (2) they can cause severe inflammatory reactions, huge fluid shifts, seen in ICU and can be life threatening
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Interleukins (ILs)
Interferons (INFs) |
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how are colony stimulating factors administered- (neupogen, epogen, procrit, neumega)
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SQ- push drug in slow so it burns less
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Obstruction of the vena cava from a tumor (lung lymphoma), painful and life threatening , late stage manifestation of the disease
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superior vena cava syndrome (SVCS)
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what are some early and late manifestations of superior vena cava syndrome?
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Early- tight shirt collar, facial edema, edema in neck, arms, hands, dyspnea, epistaxis, erythema in upper body
Late- hemorrhage, cyanosis, MS changes, hypotension |
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How is SVCS diagnoses and how is it treated?
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Dx- CT scan, MRI, XRay
Treatment- radiation, stents |
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complication where tumor pushes on the spinal cord, degrades bone and vertebrae collapse, pinches spinal cord
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Spinal Cord Compression (SCC)
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What are the signs and symptoms of Spinal Cord Compression (SCC)?
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pain is the 1st sign, also loss of sensation is a common early sign, numbness, tingling, muscle weakness, paralysis (permanent)
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what are the ways to diagnose and treat SCC (spinal cord compression)
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Dx- MRI, Xrays, Bone Scan
Treat- corticosteroids (buys time), RT (does not stabilize spine), Surgery (remove tumor to relieve compression) external brace |
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complication of chemo where there is a release of K, pruines (liver converts to uric acid), and phosphorus
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tumor lysis syndrome (the patient is at greatest risk of this after the 1st treatment- most tumor cells are killed then)
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degradation of bone, parathyroid horomone release, decreased mobility, and dehydration can all lead to...
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hypercalcemia
(need to try to keep pt weight bearing to prevent) |
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tumors tend to produce abnormal clotting factors which can lead to
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thrombus/embolus
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what are the signs and symptoms of pleural effusion
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cough, dyspnea, chest pain, fever, diminished lung sounds
usually locared in lower lung area, can have up to 300mL before S&S develop |
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what is the normal protein
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6.0-8.0
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what is the normal prealbumin
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12-42
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what is the normal albumin
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3.5-5.0
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what is the normal Hemoglobin
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11.7-15.1
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what is the normal Hematocrit
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34.5-43.7
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what coordinates the reaction of vomiting in the body resulting from chemo treatment? 80% chemo causes NV 50% radiation
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chemoreceptor trigger zone (CTZ) in brain
vomiting center (VC) medulla 5HT3 secretions stimulates receptors in brain |
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what are the 3 types of CINV reactions?
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acute - within 1st 24 hrs and most severe 5-6 h post chemo
delayed- after 24h most severe 48-72 anticipatory- triggered by association (smells tastes, objects) |
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early signs of hypercalcemia
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fatigue, loss of appetite, NV, constipation, polyuria(can't concentrate urine)
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late signs of hypercalcemia
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sever muscle weakness, loss of DTRs, paralytic ileus, dehydration, coma, ECG changes
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what are the normal calcium levels?
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8.9-10.3
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what medication is the treatment of hypercalcemia
dialysis (if kidneys are damaged too much) |
NSS, prednisone inhibits bone reabsorption; lasix-blocks Ca reabsorption, bisphosphonates (SE bone pain, hypocalcemia)
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what types of bisphosphonates are there?
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calcitonin (miacalcin), Gallium nitrate, etidronate (Didronel), Pamidronate (Aredia), Zoledronic acid (Zometa)
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What are the restrictions in using Calcitonin (Miacalcin)?
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DO NOT shake vial,
store upright, unopened refridgerated; opened room temp; it is hard on the nasal mucosa, it can cause ulcerations and need to alternate nostrils |
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systemic infection where pathogens are circulating in the blood stream
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septicemia (Sepsis)
spreads from every part of the body (UTI, IV site, tooth) |
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signs and symptoms of septicemia
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fever/chills, hypotension, pain, headache. NV, diarrhea, prostration (extreme exhaustion)
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How are platlets and H&H are effected with anemia?
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they are unaffected until late in septic shock. Then they are low. anemia and thrombocytopenia
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how does c-reactive protein work?
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activates when bound to healthy cells in the blood vessels (endothelial cells); when you have septic shock, c-reactive is low; early indicator & declines before other manifestations
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When testing blood for septicemia, how are the blood cultures drawn?
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2 blood cultures are drawn, one centrally and one peripherally
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septic shock phase- hyperdynamic phase, endotoxins trigger inflammation, increase of HR RR BP coagulation of tiny capillaries, tiny clots form in all organs, leads to hypoxia
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Warm-Shock or High- output
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The process of coagulation of tiny capillaries (hypoxia, ischemia)
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Disseminated Intravascular Coagulation (DIC)
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septic shock stage- all clotting factors are used up so hemorrhaging occurs. Lowers BP HR, hypovolemic, leads to eschemia. Depends on where it occursm that organ shuts down first
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Cold-shock or low-output
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what are the treatments for septicemia/shock
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IV antibiotics, hydration, O2, anticoagulants (early to prevent clots), clotting factors (later on to help with hemorrhage), Xigris (activated protein C)
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wasting syndrome
80% of cancer patients |
anorexia, cachexia
|
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unintentional weight loss of greater than 10% body weight in the past 6 months and serum albumin levels of less than 3.5
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malnutrition
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what is the diagnosis and treatment for anorexia/cachexia
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Dx:weekly weights, TP, prealbumin, albumin, H&H
trtmnt: underlying cause, nutritional supplements TPN |
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What is the most common CINV?
(may add ativan to these) |
Acute- highly emetic- antiemetic plus a steroid and emend, medium- antiemetic,and steroid, low- steroid or nothing
|
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How is RINV treated?
Not severe but lasts longer because you get trtmnt every day |
high- (whole body RT) antiemetic, and steroid; medium (1 side of body) antiemetic, low (isolated area) nothing needed
|
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most patients that have stomatitis also have this
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bone marrow depression
|
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inflammation of oral mucous membranes. redness and burning to painful ulcerations
100% in pts preparing for stem cell transplant, and RT in head |
stomatitis and mucositis
|
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what are treatment for stomatitis
|
salt water gargles, oral hygeine, magic swizzle, bland diet, medication
|
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what is in magic swizzle?
|
lydicain gel (pain), liquid benedryl (inflammation), mylanta (coats)
|
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cytoprotective medicine given before chemoe to help prevent stomatitis
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palifermin (kepivance)
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ascites is very rich in this
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protein which leads to hypoalbuminemia which is low serum albumin level because protein is in cavity and not in veins
|
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What are S&S of ascites?
treatment is palliative as fluid always returns |
abd distention, tight glistening skin, protruding ubilicus, shortness of breath, constipation anorexia, frequency.
|
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draw CBC between chemo if results too low, may impact the amount dr gives in next chemo
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dose limiting
|
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what are the rates for -
leukopenia anemia platlets |
leuko- WBC <5 5-10
Anemia- HBG- 12-16/14-18 HCT- 37-47/42-52 female/male Platelets- 150k-400k |
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overwhelming number of bands indicate overwhelming infection
|
left shift
|
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what does WBC differential test for
|
neutrophils-main focus for cancer (segs and bands)
lymphocytes and monocytes- infections, eosinophils and basophils- allergic reactions |
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most serious complication of bone marrow supression, leading cause of death in cancer patients. Severity and length depends on drug/dose
|
neutropenia (temporary and show no pus , swelling, or redness)
|
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How is ANC calculated?
|
Total WBC x % of segs and bands
normal >2500, mild >1000, moderate >500, severe <500 |
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What is the normal RBCs?
|
4.7-6.1 / 4.2-5.4
anemia- hbg <14 m <12 f hct <42 m <37 f |
|
what is given as palliation for lung cancer
|
o2 therapy, RT to shrink tumor, laser therapy, thoracentesis, pleurodesis-prevents reoccurence, Roxanol- helps for pain and for breathing issues
|
|
what are medical treatments for lung cancer
|
chemo- for SCLC, adjuvant
radiation- often used in combo with chemo or survery surgical- main trtmnt of stage 1&2 nsclc |
|
what guage catheter is ideal for blood transfusions
|
20 guage
|
|
what level of platelets run the risk of excessive bleeding
(10 day lifespan. xfered platlets 2-3 days) |
<50 or spontaneous bleeding <20- treat with transfusion or neumega. Pooled blood use limited or develop antibodies
|
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what is the maneuver where you tap the facial nerve and if it twitches it's posative. Tests for hypocalcemia
|
chvostek
|
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How is leukemia classified
it can be acute or chronic (if not treated, pt will die of infection or hemorrhage) |
classified into 1 of 4 types based on cell type and rate of progression
|
|
what is a common chemical known to cause leukemia?
|
benzine
|
|
any diseases that cause bone marrow changes are called
|
mylodisplastic syndromes
|
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what are S&S of leukemia?
|
lacelike "rash" bruising on body, bleeding, pallor, fatigue, weight loss, dyspnea, headache, bone pain and joint swelling
|
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How is Leukemia diagnosed?
|
CBC will show extremely high WBC count and low H&H and Plat
bone marrow biopsy |
|
what is the most common leukemia type in children? (under 15 yo)
|
Acute Lymphocytic Leukemia (ALL)
highly treatable in children, poor prognosis in adults. Cancer of B cells |
|
Leukemia type that is very agressive with a rapid progression; poor prognosis and occurs in 15-39 yo
|
Acute Myelogenous Leukemia (AML)
The best prognosis is with a bone marrow transplant |
|
What are the 3 steps of drug therapy for AML/ALL?
|
Induction- intense combo chemo, goal to acheive rapid and complete remission
consolidation- lasts months, lower chemo dose to cure, maintenance- lasts for years, keep cancer gone. |
|
For bone marrow transplant, you kill all bone marrow in body. Then how do you administer stem cells ?
|
IVP given over 30 minutes
these patients get stomastitis |
|
What are the different sources for a transplant?
|
autologous (self donation), syngeneic (identical twin), allogeneic (sibling, HLA matched relative), Peripheral blood stem cells
|
|
Rare type of leukemia occurs in adults >50 yo
poor prognosis |
chronic lymphocytic leukemia (CLL)
|
|
A common chronic leukemia that occurs in adults >50 and is possibly genetic
|
Chronic Myelogenous Leukemia (CML)
|
|
Two types of lymphoma
|
Hodgkins- has reed-sternberg cell
Non Hodgkins- no reed-sternberg cell |
|
What type of cancer has been linked to the epstein barr virus?
|
Hodgkins lymphoma
|
|
Which lymphoma spreads in a predictable manner? (up the chain)
|
hodgkins lymphoma
|
|
What are the S&S of hodgkins?
|
large painless swelling of area usually in the neck, fever, night sweats
|
|
how is hodgkins treated in what stages?
|
I and II RT in specific region,
III IV radiation, 4 chemo drugs ABVD |
|
how many sub types of non-hodgkins are there?
|
12
|
|
What are the two grades of lymphoma?
|
low grade- slow progress, longer survival rate, cures are rare
high grade- agressive tumors, change for long term cure is better |
|
What cancer is 2x more common in african americans
|
multiple myeloma - also causes renal failure
|
|
what cancer type turns bone into swiss cheese look?
|
multiple myeloma - caused by excess cytokine production which increases cancer cell growth rate and destroys bones
|
|
what are the early signs of multiple myeloma>?
|
fatigue, weakness, weight loss, easy bruising, bone pain
|
|
what are the progressed stages of multiple myeloma?
|
bone fractures, HTN (from kidney damage), increased infections (neutropenia), hypercalcemia (bone degredation), fluid imbalances
|
|
what are known causes of cervical cancer?
|
HPV and smoking
abnormal pap leads to colposcopy |
|
what are S&S of cervical cancer?
|
abnormal bleeding, vaginal discharge- watery blood-tinged or dark and foul smelling as disease progresses
|
|
What are late symptoms of cervical cancer as it metastisises?
|
leg pain/swelling, hydronephritis, weight loss, pelvic pain, hematuria, rectal bleeding, chest pain/cough
|
|
what is the prefered treatment for early cervical cancer?
|
LEEP- loop electrosurgical excision procedure (can check for margins in lab)
|
|
What are the surgery options for stage 1 and 2 breast cancer?
|
lumpectomy followed by chemo therapy, or a modified radical mastectomy - no chemo needed- removes breast, fatty tissue, and axillary lymph nodes
|
|
What are the 90% of all breast cancer?
|
< 1cm, no lymph node involvement, live long lift without treatment
|
|
cervical cancer surgery types
|
conization- preserves fertility
hysterectomy- simple (uterus and cervix) radical (u, cer, and lymph nodes and upper vagina) pelvic exenteration- if tumor only spreads in pelvis removes uu, cer, vag, rectm,blad, urethra, all supprt tissue |
|
What is the 4 injection vaccine to protect against HPV 16 18 (cancer) 6 and 11 (warts)
|
Gardisil
|
|
what is the largest risk of ovarian cancer?
|
family history (also large estrogen exposure and breast cancer mutations BRCA 1 & 2)
|
|
What type of cancer requires a "second look" surgery a year after the first one?
|
ovarian cancer
|
|
Is a breast lump painful or painless?
|
painless.
may also see thickening, swelling; tenderness, ulceration, dimpling, peau d'orange |
|
Cancer that is slow, predictable metastasis (always goes into bone of pelvis)
|
prostate cancer- most common invasive cancer in men
|
|
what are S&S of prostate cancer?
|
difficulty starting stream, bladder infections, retention, gross hematuria, bone pain
|
|
Treatment for prostate cancer?
|
"watchful waiting" - sometimes up to 10 yrs from dx to trtmnt
surgery, RT, CT, horomone therapy (horomone driven cancer) |
|
what is the term used for strange symptoms caused by lung cancer?
|
paraneoplastic syndromes
|
|
What are the major types of lung cancer?
|
SCLC(small cell) caused by smoking, fast growing, strange symptoms/
NSCLC (nonsmall cell) devided into 3 types- epidermoid, adenocarcinoma, large cell |
|
What are some paraneoplastic syndromes caused by SCLC?
|
cushings, hypercalcemia, hypoglycemia
|
|
what are some S&S of lung cancer?
|
pleural effusion, hoarseness, blood in sputum, clubbin fingers, wheezing, weight loss, lethargy, confusion
|