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174 Cards in this Set

  • Front
  • Back
What information does a fishbone diagram contain?
HGB
WBC>-----< PLat
HCT
What information does a metabolic profile diagram contain?
Na | Cl | BUN /
---------------------------- Glucose
K+ | CO2 | Creat \
What is the major focus in cancer prevention in this country?
early screening, quit smoking, sun exposure, follow screening guidelines
What cell types are similar in structure?
Normal and Benign cells

Embryonic and Malignant cells
What is the difference between hyperplasia and hypertrophy?
plasia- increases cells
trophy- cell gets bigger
abnormal growth of either benign or malignant cells
neoplasm
what are the 4 stages of carcinogenesis?
initiation, promotion, progression, metastasis
progress where tumor develops its own blood supply
angiogenesis
What are endogenous risk factors for getting cancer?
age, genetics, hormones, immunologic
what are external risk factors for getting cancer?
drugs and chemicals, radiation, tabacco, nutrition (high fat low fiber-colon cancer), secual practices, viruses, psychosocial (stress)
what is the major cause of death in cancer patients?
metastasis
what are the different type of neoplasms?
carcinoma- epithelial cells
sarcoma- connective tissue
melanoma- lower epidermis
What are different examples of carcinoma?
adeno- glandular tissue- broad term
squamous- skin tissue
basal cell- skin cancer
transitional cell- cell lining in urinary tract
what is a solid neoplasm and what is a hematologic neoplasm
tissue that can be seen- a tumor
no tumor and occurs in the bone marrow
75% of all skin cancers, usually facial, crusted, rarely causes death or metastasis.
Basal Cell Carcinoma
2nd most common skin cancer
75% chance of cure if detected early
squamous cell carcinoma
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.
Malignant melanoma
Different ways to determine staging
clinical, surgical, pathologic (most deffinitive)
What does TNM mean?
Tumor Nodule Metastasis
What are some problems caused by malignant cells?
obstruction of tubular structures, pressure, hemorrhage, ulceration, infection, hormonal/endocrine changes
WHat are the screening guidelines for breast, colon, prostate, cervical, and uterine cancer?
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
WHat does CAUTION mean- for the 7 warning signs of cancer
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
What are the top 3 malignancies in men and women?
Men- prostate, lung, colon/rectum
Women- breast, lung, colon/rectum
What are the goals of chemotherapy
cure,
control- if cure is not possible, controls cancer to increase survival time
palliation- temporarily shrinks tumor, comfort measure
Chemotherapy in combination with surgery
adjuvant
chemo drug type that works in all areas of cell production and work more on older tumors/ drugs that work better on younger tumors
phase non-specific drugs

phase specific drugs
routes of administration for chemo
PO IV IVP Isolated limb perfusion (confined to a limb), Intracavitary (intraperioneal, intravetricular, intrathecal, intravesical), and IM
Different types of Intracavitary Administration (intraperioneal, intravetricular, intrathecal, intravesical)
intraperioneal - ovarian
intravetricular - brain
intrathecal - brain
intravesical- bladder
What medication for chemo must be given IM with z-track technique?
Leuprone
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
Chemo drugs that are S phase , meatopoietic, and cause severe diarrhea, alopecia, stomatitis
antimetabolites
hematopoietis is...
bleeding, infection, anemia
non phase specific chemo drug that causes alopecia, highly emetic, mostly consists of vesicants
antitumor antibiotics
what does the chemo med bleomycin cause?
Pulmonary toxicity
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
Doxorubicin
chemo meds that are highly emetic, some have renal toxicity, prehydration is important, NV diarrhea, non specific phase heatopoietic
Alkylating agents
Specific chemo medication that you must premedicate for with decadron, and benedryl.
Very common medication
taxol (antimiotic)
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
Antimiotics (plant alkaloids)
chemo med class that acts directly on the pituitary function, used for hormonally driven cancers, progestins are given- megace leuprone- estrogen antagonist
hormonal agents
chemo med type used as treatment for fluid retention, diabetes, poor wound healing, HTN. They also lyse lymphoid malignancies
corticosteroids
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
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
Types of radiation therapy
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
Brachytherapy radiation has two types of high doses directly into tumor called
sealed- seeds, needle, wire
unsealed- liquid, systemic IV
Prostate use seeds, thyroid treated with liquid
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
RT might be done before surgery to shrink the tumor or done after to kill cells left behind at site.
Gamma knife- sealed brachytherapy that gives radiation right to surgical site.
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
Cells that rapidly divide are at greater risk of being compromised through RT. THis is called
radiosensitivity.
Pancytopenia is a common side effect of RT
a series of divided radiation doses, given daily until total dose is given. THis allows time for healthy cells to repair
fractionation
cancer cells will not repair.
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
Split Course
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
Mammostie.
May cause local bruising
procedure performed by interventional radiologists, treats kidney, liver, lung tumors, thin probe delivers coolant at subfreezing temp
percutaneous cryoablation
Alopecia - more common in chemo but can affect RT patients too.
hairloss- starts 2-3 weeks after first dose, grows back 1-2 months after end of chemo but hair may grow back different.
most psyhologically traumatic effect of chemotherapy
alopecia
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)
constipation, hallucinations, NV, pruritus, resp depression, sedation, urinary retention
fluid accumulation in abdominal cavity- caused by liver weeping serous fluid
ascites
uric acid - built up from lyced cancer cells - can lead to
hyperuricemia- gout
primarily in big toe as it is cool and farthest from the heart
what are ways to diagnose pleural effusion
chest xray, ct scan, plysical exam
Treatment of pleural effusion
treat underlying cause, thoracentesis, pleurodesis, pleurx catheter
what nursing involvement is there for thoracentesis?
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
process to treat pleural effusion when it refills often, this allows for repeated effusion treatment without scar tissue to prevent PE in that area
pleurodesis
chemo drug type that causes flu like symptoms, hematopoietic, hypersensativity, and it precents cells from entering the initiation and differentiation cycles.
monoclonal antibodies
chemo drug type that is S phase specific, causes Dia. NV, alopecia, bone marrow suppression
topoisomerase inhibitors
s phase specific chemo drug that is used for sickle cell and head and neck cancer
hydroxyurea
chemo drug that use to cause major birth defects but is effective in treating multiple mylenoma
thalidomide
this drug that is used as a rescue drug for high doses of methetrexate
leucovorin
renal toxicity reducer drug and aids in xerostomia from RT of head and neck
Amifostine (Ethyol)
drug that protects the heart and cardiac complications from Adriamycin
Dexrazoxane (Zinecard)
drug that is given with Ifosfamide to prevent hemorrhage which would occur without it
Mesna (Mesnex)
drug that protects from skeletal complications from multiple myeloma and other malignancies
Pamidronate (Aredia)
What areas of the drugs must be checked when using combination therapy?
Nadir, SIde effects, and Phases of activity against the cell (S, G, M)
What are some side effects of RT?
skin reactions , late toxicites (due to blood vessels and connective tissue in the area), leukemia/lyphoma, bone marrow suppression (flat bones), EXTREME FATIGUE
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
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
Sentinel node
WHere should a blood pressure be taken for a masectomy patient?
Take BP on the uneffected side or on the leg if both sides are affected
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
BRMs- biological response modifiers
BRMs types (2) they can cause severe inflammatory reactions, huge fluid shifts, seen in ICU and can be life threatening
Interleukins (ILs)
Interferons (INFs)
how are colony stimulating factors administered- (neupogen, epogen, procrit, neumega)
SQ- push drug in slow so it burns less
Obstruction of the vena cava from a tumor (lung lymphoma), painful and life threatening , late stage manifestation of the disease
superior vena cava syndrome (SVCS)
what are some early and late manifestations of superior vena cava syndrome?
Early- tight shirt collar, facial edema, edema in neck, arms, hands, dyspnea, epistaxis, erythema in upper body
Late- hemorrhage, cyanosis, MS changes, hypotension
How is SVCS diagnoses and how is it treated?
Dx- CT scan, MRI, XRay
Treatment- radiation, stents
complication where tumor pushes on the spinal cord, degrades bone and vertebrae collapse, pinches spinal cord
Spinal Cord Compression (SCC)
What are the signs and symptoms of Spinal Cord Compression (SCC)?
pain is the 1st sign, also loss of sensation is a common early sign, numbness, tingling, muscle weakness, paralysis (permanent)
what are the ways to diagnose and treat SCC (spinal cord compression)
Dx- MRI, Xrays, Bone Scan
Treat- corticosteroids (buys time), RT (does not stabilize spine), Surgery (remove tumor to relieve compression)
external brace
complication of chemo where there is a release of K, pruines (liver converts to uric acid), and phosphorus
tumor lysis syndrome (the patient is at greatest risk of this after the 1st treatment- most tumor cells are killed then)
degradation of bone, parathyroid horomone release, decreased mobility, and dehydration can all lead to...
hypercalcemia
(need to try to keep pt weight bearing to prevent)
tumors tend to produce abnormal clotting factors which can lead to
thrombus/embolus
what are the signs and symptoms of pleural effusion
cough, dyspnea, chest pain, fever, diminished lung sounds
usually locared in lower lung area, can have up to 300mL before S&S develop
what is the normal protein
6.0-8.0
what is the normal prealbumin
12-42
what is the normal albumin
3.5-5.0
what is the normal Hemoglobin
11.7-15.1
what is the normal Hematocrit
34.5-43.7
what coordinates the reaction of vomiting in the body resulting from chemo treatment? 80% chemo causes NV 50% radiation
chemoreceptor trigger zone (CTZ) in brain
vomiting center (VC) medulla
5HT3 secretions stimulates receptors in brain
what are the 3 types of CINV reactions?
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)
early signs of hypercalcemia
fatigue, loss of appetite, NV, constipation, polyuria(can't concentrate urine)
late signs of hypercalcemia
sever muscle weakness, loss of DTRs, paralytic ileus, dehydration, coma, ECG changes
what are the normal calcium levels?
8.9-10.3
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)
what types of bisphosphonates are there?
calcitonin (miacalcin), Gallium nitrate, etidronate (Didronel), Pamidronate (Aredia), Zoledronic acid (Zometa)
What are the restrictions in using Calcitonin (Miacalcin)?
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
systemic infection where pathogens are circulating in the blood stream
septicemia (Sepsis)

spreads from every part of the body (UTI, IV site, tooth)
signs and symptoms of septicemia
fever/chills, hypotension, pain, headache. NV, diarrhea, prostration (extreme exhaustion)
How are platlets and H&H are effected with anemia?
they are unaffected until late in septic shock. Then they are low. anemia and thrombocytopenia
how does c-reactive protein work?
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
When testing blood for septicemia, how are the blood cultures drawn?
2 blood cultures are drawn, one centrally and one peripherally
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
Warm-Shock or High- output
The process of coagulation of tiny capillaries (hypoxia, ischemia)
Disseminated Intravascular Coagulation (DIC)
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
Cold-shock or low-output
what are the treatments for septicemia/shock
IV antibiotics, hydration, O2, anticoagulants (early to prevent clots), clotting factors (later on to help with hemorrhage), Xigris (activated protein C)
wasting syndrome
80% of cancer patients
anorexia, cachexia
unintentional weight loss of greater than 10% body weight in the past 6 months and serum albumin levels of less than 3.5
malnutrition
what is the diagnosis and treatment for anorexia/cachexia
Dx:weekly weights, TP, prealbumin, albumin, H&H
trtmnt: underlying cause, nutritional supplements TPN
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
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
most patients that have stomatitis also have this
bone marrow depression
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
what are treatment for stomatitis
salt water gargles, oral hygeine, magic swizzle, bland diet, medication
what is in magic swizzle?
lydicain gel (pain), liquid benedryl (inflammation), mylanta (coats)
cytoprotective medicine given before chemoe to help prevent stomatitis
palifermin (kepivance)
ascites is very rich in this
protein which leads to hypoalbuminemia which is low serum albumin level because protein is in cavity and not in veins
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.
draw CBC between chemo if results too low, may impact the amount dr gives in next chemo
dose limiting
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
overwhelming number of bands indicate overwhelming infection
left shift
what does WBC differential test for
neutrophils-main focus for cancer (segs and bands)
lymphocytes and monocytes- infections, eosinophils and basophils- allergic reactions
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)
How is ANC calculated?
Total WBC x % of segs and bands
normal >2500, mild >1000, moderate >500, severe <500
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
what is the maneuver where you tap the facial nerve and if it twitches it's posative. Tests for hypocalcemia
chvostek
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
what are S&S of leukemia?
lacelike "rash" bruising on body, bleeding, pallor, fatigue, weight loss, dyspnea, headache, bone pain and joint swelling
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