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189 Cards in this Set
- Front
- Back
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Define anaplastic
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without shape or differentiation, small and round
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Define aneuploid
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more or less than the normal # of chromosomes
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Define apoptosis
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the finite life-span of normal cells; "programmed cell death"
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Define benign
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new, non-malignant cell growth not needed for normal growth or replacement
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Define carcinogenesis
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the transformation of a normal cell into a cancer cell
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Define doubling time
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the amt of time it takes for a tumor to double in size by mitotic cell divisions
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Define euploid
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the normal chromosome #
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Define fibronectin
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a large, extracellular, transformation-sensitive cell-surface protein present on normal cells that allows normal cells to adhere tightly together
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Define gene expression
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the activation, or "turning on" of a specific gene to the extent that it synthesizes a specific protein that influences the activity of a cell or group of cells
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Define gene suppression
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the deactivation, or "turning off" of a specific gene so that it is silent and does not synthesize a protein
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Define generation time
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the period of time necessary for one cell to enter and complete one round of cell division by mitosis
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Define initiation
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the damage of a normal cells DNA by a carcinogen
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Define latency
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the period of time between when a carcinogenic agent or substance damaged the DNA of a normal cell (initiated it) and when an overt cancer is present
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Define malignant
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cancerous, new growth of cells by invasion that is not needed for normal development or tissue replacement
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Define metastasis
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invasive growth of cancer cells from the original tumor into distant areas
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Define mitosis
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cell division by exact duplication
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Define morphology
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appearance or shape
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Define multipotent
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any undifferentiated cell that has multiple potentials for maturation and differentiation (also called totipotent and pluripotent)
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Define neoplasia
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new cell growth not needed for normal body growth or replacement of dead or missing tissue
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Define oncogene
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a developmental gene (proto-oncogene) expressed at an inaapropriate time, capable of transforming a normal cell into a cancer cell
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Define ploidy
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the chromosome content of a cell
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Define aneuploid ploidy
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the chromosome content of a cell that is greater or lesser than the normal chromosome # for the species
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Define diploid (euploid) ploidy
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the normal chromosome content of a cell for the species (e.g., human cells have 46 chromosomes [23 pairs] per cell)
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Define primary tumor
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a tumor formed in a specific tissue as a result of a carcinogenic agent or event
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Define promotion
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enhancement of cell division in a cell initiated by a carcinogen
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Define proto-oncogene
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a developmental gene expressed during early embryonic development
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Define secondary tumor
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a tumor formed as a result of breaking off from a primary tumor and spreading to distant sites (metastasis)
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Define suppressor gene
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a gene that suppresses the expression of an oncogene
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Define transformation
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the changing of a normal cell into a cancer cell by a carcinogenic agent or event
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What are some examples of altered cellular growth?
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mole or a skin tag
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What human body cells continue to grow by cell division (mitosis) long after maturation is complete?
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Cells of the skin, hair, mucus membranes, bone marrow, and linings of organs such as the lungs, stomach, intestines, bladder, and uterus.
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Do cells of the heart muscle continue to divide after fetal life?
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No. The size of the heart increases as the person grows b/c each cell gets larger, but the # of heart muscle cells doesn't increase.
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Define hypertrophy?
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growth that causes tissue to increase in size by enlarging each cell
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Define hyperplasia?
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growth that causes tissue to increase in size by increasing the # of cells
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Neoplastic cells develop from ______ and can be benign or malignant.
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normal cells
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Cancer cells were once normal cells but changed to no longer ___, ____, or ____ normally.
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look, grow, or function
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normal cells undergo mitosis for one of two reasons?
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to develop normal tissue or to replace lost or damaged normal tissue
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normal cells divide only when body conditions and ____ are just right.
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nutrition
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What is the purpose of apoptosis?
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to ensure each organ has adequate # of cells at their functional peak.
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Every normal cell has at least one special function to contribute to whole-body _______.
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homeostasis
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skin cells make?
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keratin
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liver cells make?
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bile
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cardiac muscle cells?
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contract
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nerve cells?
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conduct impulses
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red blood cells make?
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hemoglobin to carry O2
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Normal cells make ____ that protrude from the cell surface, allowing cells to bind closely and tightly together.
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proteins (i.e., fibronectin)
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fibronectin is a protien that keeps most normal tissues bound ____ to each other.
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tightly
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Living cells not actively reproducing are in a reproductive resting state termed?
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G0
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During the G0 period, cells actively carry out their ____ but don't _____.
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functions; divide
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Control of whether or not a cell enters the cell cycle to form 2 new cells is dependent on the presence and absence of specific ____.
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proteins (cyclins)
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cyclins promote?
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cell division
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suppressor genes?
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limit cell division
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Define cell phase G1.
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cell is getting ready for division by taking on extra nutrients, making more energy, and growing extra membrane. cytoplasm is also increased
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Define cell phase S.
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cell doubles its DNA content
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Define cell phase G2.
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cell makes important proteins that will be used in actual cell division and in normal physiologic function after cell division is complete
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Define cell phase M.
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actual mitosis (cell splits and makes 2 identical cells)
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generation time ranges from __ to __hrs.
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2-8hrs
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define generation time.
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time it takes one cell to divide into two cells.
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Early embryonic cells?
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have rapid and continuous cell division, don't respond to signals of apoptosis, show anaplastic morphology, have a large nuclear-cytoplasmic ratio, perform no specific functions, adhere loosely together, are able to migrate, aren't contact inhibited, are euploid, and are commitment
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Characteristics of benign tumor cells include?
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have continuous or inappropriate cell growth, show specific morphology, have a small nuclear-cytoplasmic ratio, perform specific differentiated functions, adhere tightly together, are nonmigratory, grow in an orderly manner, and are euploid.
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What are characteristics of cancer cells?
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have rapid or continuous cell division, don't respond to signals for apoptosis, show anaplastic morphology, have a large nuclear-cytoplasmic ratio, lose some or all differentiated functions, adhere loosely together, are able to migrate, grow by invasion, aren't contact inhibited, and are aneuploid.
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What are the steps of malignant transformation?
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initiation, promotion, progression, and metastasis.
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Carcinogens include?
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chemicals, physical agents, or viruses
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Initiation is an irreversible event that can lead to _____ development if it doesn't interfere with the cell's ability to ____.
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cancer; divide
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promotion is the division of a _____ cell, which can cause widespread metastasis.
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cancer
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Define latency period?
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time b/t a cell's initiation and the development of an overt tumor
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Promoters are substances that promote or enhance growth of the initiated ____ cell.
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cancer
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Examples of promoters include?
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hormones, drugs, or a wide variety of chemicals.
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Progression is the period of which a _____ is formed.
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tumor (primary tumor); which has formed its own blood supply and nourishment, through tumor angiogenesis factor (TAF), to survive
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metastasis is when?
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cancer cells break off of the primary tumor and establish secondary tumors in others areas of the body.
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What are the steps of metastasis?
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extenson into surrounding tissues, blood vessel penetration, release of tumor cells, invasion, local seeding, bloodbourne metastasis, and lymphatic spread.
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Grading of a tumor classifies?
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cellular aspects of the cancer
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Staging classifies?
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clinical aspects of the cancer; determines the exact location of the cancer and its degree of metastasis at diagnosis. TNM (tumor, node, and metastasis)
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Define mitotic index?
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the percentage of actively dividing cells within a tumor.
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A tumor with a mitotic index of 10% is ____ and one with a mitotic index of 85% is ______.
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a slow growing tumor; a fast growing tumor
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What are the three interacting factors that influence cancer development?
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exposure to carcinogens, genetic predisposition, and immune function
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What causes the activation of an oncogene, which can lead to cancer development?
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proto-oncogenes are turned on or overexpressed and are now called oncogenes which can cause the cell to change from normal cells to cancer cells; cyclins are then developed allowing uncontrolled cell division (due to exposure of normal cel to carcinogen, which then causes DNA mutation, which then leads to suppressor gene damage that prevents it from controlling the expression of proto-oncogenes)
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Normal cells that have the ability to divide are at _____ risk for cancer development than are normal cells that are not capable of cell division.
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greater
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Tobacco use both _____ and ______ cancer.
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initiates; promotes
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The risk for cancer development from tobacco use depends on a person's?
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immune function, amt of tobacco exposure, and tobacco tar content
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chemical and physical carcinogens cause cancer by?
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DNA damage
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What are some physical carcinogens?
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radiation: ionizing: radon, uranium, and radium, x-rays, cosmic radiation (most rocks and soil contain various amts of uranium and radium), ultraviolet (UV): tanning beds and germicidal lights
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How do viral carcinogens cause cancer?
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when viruses infect the body cells, they break the DNA chain and insert their own genetic material into the human DNA chain. Breaking the DNA, along with viral gene insertion, mutates the normal cell's DNA and can either activate an oncogene or damage suppressor genes.
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Viruses that cause cancer are called?
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oncoviruses
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What are some dietary factors that are related to cancer development?
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low fiber intake, high intake of red meat, and high animal fat intake
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What are some personal factors that are related to cancer development?
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immune function (immunosuppressed greater risk=elderly, HIV, organ transplant), age, and genetic risk.
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What are the 7 warning signs of cancer?
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CAUTION; C=changes in bowel or bladder habits; A= a sore that doesn't heal; U= unusual bleeding or discharge; T= thickening or lump in the breast or elsewhere; I= ingestion or difficulty swallowing; O= obvious change in a wart or mole; N= nagging cough or hoarseness
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What is primary prevention of cancer?
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the use of strategies to prevent the actual occurrence of cancer. most effective when there is a known cause for cancer type.
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What is secondary prevention of cancer?
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the use of screening strategies to detect cancer early, at a time when cure or control is more likely.
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What does primary prevention consists of?
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avoidance of known or potential carcinogens (i.e., using skin protection during sun exposure, avoiding tobacco, and eliminating environmental asbestos), modification of associated factors (i.e., alcohol consumption, high fat low fiber diet -can cause colon, breast, and ovarian cancer; multiple sexual partners- can cause cervical cancer); removal of at risk tissues (i.e., moles, colon polyps, breasts); and chemoprevention.
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What is chemoprevention?
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A strategy that uses drugs, chemicals, natural nutrients, or other substances to disrupt one or more steps important to cancer development.
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What are some aspects of secondary prevention?
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screening programs (i.e., yearly mammography >40 yo, yearly clinical breast exam >40yo, colonoscopy at age 50 and then every 10yrs, yearly fecal occult blood in adults of all ages, yearly PSA and DRE for men over age 50); gene therapy for cancer prevention (i.e., BRCA-1 gene-increases r/f both breast and ovarian cancer, BRCA-2 gene-increases r/f breast cancer, APC gene-increases r/f colon cancer)
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What are some known environmental carcinogens?
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alcoholic beverages, anabolic steroids, arsenic, asbestos, benzene, chemotherapy drugs: alkylating agents, anthracycline antibiotics, antimetabolites; cyclosporine, diesel exhaust, formaldehyde, hair dyes, ionizing radiation, mineral oils, pesticides, polycyclic hydrocarbons, polychlorinated biphenyls, sunlight, and tobacco
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What are some malignancies associated with tobacco use?
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lung, pharyngeal, esophagus, cervical, bladder, stomach, oral cavity, laryngeal, pancreatic, kidney, liver, and myeloid leukemia
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What are some dietary habits that helps to reduce cancer risks?
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Avoid excessive intake of animal fat; avoid nitrites (prepared lunch meats, sausage, bacon); minimize your intake of red meats; keep your alcohol consumption to no more than one or two drinks per day; eat more bran; eat more cruciferous vegetables, such as broccoli, cauliflower, brussel sprouts, and cabbage; eat foods high in vitamin A (such as apricots, carrots, and leafy green and yellow vegetables) and vitamin C (such as fresh fruits and vegetables, especially citrus fruits)
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What are some inherited cancers?
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breast, prostate, ovarian
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What are some familial clustering cancers?
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breast and melanoma
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What are some general disease-related consequences of untreated cancers?
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Impaired immune and hematopoietic (blood-producing) function (occurs with any cancer that invades the bone marrow b/c reduces production of healthy WBC, decreases the # of RBC -anemia, and platelets-thrombocytopenia; altered GI tract structure and function (Cachexia [extreme body wasting and malnutrition] develops from an imbalance between food intake and energy use; motor and sensory deficits (when cancers invade bone or the brain, or compress the nerves); and decreased respiratory function (if lung tissue is involved, lung capacity is decreased).
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Therapies for cancer include?
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surgery, radiation, chemotherapy, hormonal manipulation, immunotherapy, gene therapy, and targeted therapy.
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Cancer surgeries may be used for what purposes?
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prophylaxis, diagnosis, cure, control, palliation, determination of therapy effectiveness, and reconstruction.
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When are prophylactic surgeries performed?
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When a pt has either an existing "premalignant" condition or a known family hx that strongly predisposes the person to the development of cancer (the at risk organ or tissue is removed to prevent cancer development) (i.e., prophylactic surgery for a premalignant condition is removing a benign mole from a location where continuous irritation or exposure to sunlight occurs)
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What does diagnostic (biopsy) surgery provide proof of?
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cancer
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What are the types of curative surgeries for cancer?
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local excision, wide local excision (radical), wide excision, extended radical excision
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How is local excision performed?
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removal of all identified tumor along with a small margin of normal tissues
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How is wide local excision (radical) performed?
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removal of identifiable tumor plus immediate tissue or adjacent tissue
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How is a wide excision performed?
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removal of tumor, surrounding tissue, adjacent structures, and usual lymph channels draining the area.
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How is an extended radical excision performed?
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removal of tumor, lymphatics, adjacent organs, and all tissues in the region.
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What is the purpose of a local excision?
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to remove small, localized tumors.
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What is the purpose of a wide local excision (radical)?
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to remove small tumors with only local tissue invasion.
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What is the purpose of a wide excision?
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to remove small to moderate sized tumors with known local invasion.
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What is the purpose of an extended radical excision?
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to remove a tumor infiltrate in a wide area but with no known distant metastasis.
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What is the purpose of cytoreductive surgery (Control)?
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debulks by removing part of the tumor and leaving a known amt of gross tumor. This decreases the # of cancer cells and increases the chances that other therapies can be successful.
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What is the purpose of palliative surgery?
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to improve quality of life during the survival time. Tumor tissue that is causing pain, obstruction, or difficulty swallowing is removed.
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What is the purpose of a "second look"?
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Considered a "rediagnosis" after tx. The purpose is to assess the disease status in pts who have been tx and have no s/s of remaining tumor. The results of this surgery are used to determine whether a specific therapy should be continued or discontinued.
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What is the purpose of reconstructive or rehabilitative surgery?
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Increase function, enhance appearance, or both. Examples include breast reconstruction after a mastectomy, replacement of the esophagus after radiation damage, bowel reconstruction, revision of scars, release of contractures, and placement of penile implants.
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What are some s/e of surgical therapy?
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Cancer surgery involves the loss of a specific body part or its function. Some cancer surgeries result in major scarring or disfigurement. Pts may be anxious abt the chance of surviving the cancer and may be grieving abt a loss of body image or a change in lifestyle.
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What is the nursing care of pts undergoing surgical therapy for cancer?
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Consider the pts ability (and the ability of the family and significant others) to cope with the uncertainty of cancer and its tx and with the changes in body image and role.
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What is the purpose of radiation therapy?
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To destroy cancer cells with minimal exposure of the normal cells to the damaging actions of radiation.
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Where are the effects of radiation seen?
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In the tissues in the path of the radiation beam.
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What is the mechanism of action of radiation?
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When cells are exposed to ionizing radiation, atoms within the cells are "kicked out" of orbit, resulting in a tremendous release of intracellular energy. Cells damaged by radiation either die outright or become unable to divide. Cells in the cell cycle have more damage when exposed to radiation than do nondividing cells.
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What are the 3 types of rays produced by gamma radiation?
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gamma, beta, and alpha
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The amt of radiation delived to a tissue is called the ____?
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exposure
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The amt of radiation absorbed by the recipient tissue is called the ____?
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dose
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The dose is always less then the _____.
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exposure
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What are the 3 factors that determine the absorbed dose?
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intensity of exposure, duration of exposure, and closeness of the radiation source to the cells.
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What is the inverse square law?
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The intensity of the radiation decreases with the distance from the radiation source. For example, the radiation dose received at a distance of 2' from the radiation source is only 1/4 of the dose received at a distance of 1' from the radiation source; the dose of radiation received at 3' is only 1/9 of the dose received at 1'.
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Why is radiation given in a series of divided doses?
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because of the varying responses of all cancer cells within a given tumor. A few cells die immediately, and more die within the next 24hrs as they attempt to divide, Some cells become sterile as a result of this single tx. Still other cells repair the radiation-induced damage and recover.
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What is fractionation?
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small doses of radiation are given on a daily basis for a set period of time to allow greater destruction of cancer cells while reducing the damage to normal tissues.
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Standard radiotherapy is usually fractionated between ___ and ___/dy, multiplied by as many days as needed to achieve the total prescribed dose.
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180; 280
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The total dose of radiation depends on the _____ and _____ of the tumor and on the radiation sensitivity of the tumor and surrounding normal tissue.
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size; location
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A ____-rad dose delivered to the liver would destroy the liver as well as the tumor.
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6000
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What are the 2 types of radiation delivery used for cancer therapy?
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teletherapy and brachytherapy
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What is the purpose of teletherapy (beam radiation)?
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radiation source is external to the pt. The pt isn't radioactive and poses no hazard to anyone. the exact location of the tumor is determined for greater accuracy of radiation therapy. The pt must always be in exactly the sameposition for all txs. Ensure that the pt can get into and maintain this position. Position fixing devices and markings, either on the pts body or on the devices, ensure the proper position each day of tx.
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What is the purpose of brachytherapy ("short" or "close" therapy)?
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radiation source comes into direct continuous contact with the tumor tissues for a specific period of time; provides a high dose of radiation in tumor tissues and a limited dose in surrounding normal tissues; use radioactive isotopes either in solid form or within body fluids;
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How are isotopes delivered to the tumor tissues?
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Isotopes that can be suspended in a fluid are unsealed and given via the oral or IV routes or as an instillation into body cavities, such as the peritoneal cavity and the spinal fluid space; solid or sealed radiation sources are implanted within or very near the tumor. these radiation sources can be temporary or permanent. Most of the implants emit continuous, low energy radiation to tumor tissues. Some devices (e.g., seeds or needles)can be placed into the tissue and stay in place by themselves. Other sources must be held in place with special applicators
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What should the nurse know when providing care for a pt who is recieveing brachytherapy treatment?
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With all types of brachytherapy the radiation source is within the pt therefore the pt emits radiation for a period of time and is a hazard to others. Unsealed isotopes (soluble isotopes)enter body fluids and eventually are eliminated in waste products, which are radioactive and can be harmful to other people. With solid implants the pt emits radiation while the implant is in place, but the excreta are not radioactive.
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What is the best practice for care of the pt with sealed implants of radioactive sources?
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assign the pt to a private room with a private bath; place a caution: radioactive material sign on the door of the pt room; wear a dosimeter film badge at all times while caring for pts with radioactive implants. The badge measures an individuals exposure to radiation and should be used by only one individual; pregnant nurses shouldn't care for these pts-dont allow pregnant women or children younger than 16yo to visit; limit each visitor to 1/2 hr each day. Be sure visitors are at least 6 feet from the source; never touch the radioactive source with bear hands. In the rare instance that it is dislodged, use long handled forceps to retrieve it. Deposit the radioactive source in the lead container kept in the pts room; save all dressings and bed linings untill after the radioactive source is removed. After the source is removed dispose of dressings and linens in the usual manner. Other equipment can be removed from the room at any time.
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What are some side effects of radiation therapy?
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skin changes and hair loss; altered taste sensation and fatigue-increased energy demands needed to replace damaged cells; adversion to the taste of red meats;radiation can cause tissue fibrosis and scarring that may not show-up till years later.
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What is the nursing care provided for pts undergoing radiation therapy?
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explain the purpose and side effects of therapy; skin care; instruct pt not to remove markings when cleaning the skin until the entire coarse of therapy is completed; dont use lotions or ointments in areas of skin in the path of radiation beam unless Rx; avoid direct skin exposure to the sun during tx and for 1 year after tx is completed; assess for difficulty in swallowing with pts recieveing radation to upper chest and throat; assess salivary glands for damage and dry mouth (xerostomia) in pts who have recieved head and neck; assess for bone damage b/c is less dense and breaks more easily; teach abt s/s that might be expected from the location and dose of radiation recieved.
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What education should the nurse provide for the pt recieving radiation therapy?
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wash the irradiated area gently each day with water alone or with a mild soap and water; use your hand rather than a washcloth to be more gentle; rinse soap thoroughly from your skin; take care not to remove the marking that indicate exactly where the beam of radiation is to be focused; dry the irradiated area with patting motions rather than rubbing motions. use a clean soft towel or cloth; use no powders, ointments, lotions, or creams on your skin at the radiation site unless they are prescribed by your radiologists; wear soft clothing over the skin at the radiation site; avoid wearing belts, buckles, straps, or any type of clothing that binds or rubs the skin at the radiation site; avoid exposure of the irradiated area to the sun; avoid heat exposure.
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What is chemotherapy?
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chemical agents used to treat cancer. Effecta are systemic, providing the opportunity to kill metastatic cancer cells that may have escaped local tx.
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What is the use of chemotherapy?
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cure and increase survival time.
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What is the term used to describe chemotherapy that is used with surgery or radiation?
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adjuvant therapy
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Chemotherapy has some selectivity for killing cancer cells over normal cells.
T or F |
T
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The killing effect that chemotherapy has on cancer cells is related to the ability of chemotherapy to damage ____ and interfere with _____ ______.
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DNA; cell division
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Tumors that are most sensitive to chemotherapy are those that have?
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rapid growth
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Chemotherapy druga usually are given _____ and exert their cell-damaging effects (cytotoxic) on _____ cells as well as cancer cells.
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systemically; healthy
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What are some normal cells that are most effected by chemotherapy?
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ones that divide rapidly including skin, hair, intestinal tissues; spermatocytes, and blood forming cells.
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How are chemotherapy drugs classified?
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by he specific types of action they exert in the cancer cell.
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What is antimetabolite chemotherapy tx used for?
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closely resembles normal metabolites needed for vital cell processes and are counterfeit metabolites that fool cancer cells into using the antimetabolites in cellular reactions. Because antimetabolites cannot function as proper metabolites their presence impairs cell division.
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What is anti-tumor antibiotic chemotheraoy tx used for?
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damage the cells DNA and interrupt DNA or RNA synthesis.
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What are alkylating agent chemotherapy tx used for?
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cross-lonk DNA making the 2 DNA strands bind tightly together. This tight binding prevents proper DNA and RNA synthesis inhibiting cell division.
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What are antimitotic agent chemotherapy tx used for?
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usually made from plant sources; interfere with the formation of microtubules so cells cannot complete mitosis during cell division, as a result the cancer cell doesn't divide at all or only divides once resulting 2 daughter cells that cannot continue to divide.
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What are topoisomerase inhibitor chemotherapy tx used for?
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enzyme needed for DNA synthesis and cell division. It nicks and straightens the DNA helix allowing the DNA to be copied and then reattaches the DNA together. They prevent these processes causing DNA breakage and cell death.
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What are the actions ofsome miscellaneous chemotherapuetic agents?
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inhibition of important enzyme systems; competition for important substance in metabolic pathways.
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Successful cancer chemotherapy involves giving more than one specific anticancer drug in a timed manner.
T or F What is this technique called? |
T; combination therapy
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With combination therapy damage to normal tissue increases.
T or F |
T
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In combination therapy the selection of drugs is based on?
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known tumor sensitivity to the drugs and the degree of s/e expected (i.e., suppression of bone marrow activity and imune function).
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Define nadir?
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the time when bone marrow activity and WBC counts are at their lowest levels after chemotherapy.
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When does the nadir occur?
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different times for different drugs (i.e., the expected nadir for cytarabine is 5-7 days and for mitomycine C is abt 4wks).
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To reduce immunosuppression, combination chemotherapy avoids using drugs with nadirs that occur?
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at or near the same time
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How are drug dosages of most chemotherapy agents calculated?
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according to the type of cancer and the pts size. milograms per sq meter of total body surface area (TBSA), which uses the pts ht and wt and is calculated as follows: ht (cm) X wt(kg)/ 10,000 = answer cm2
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How is chemotherapy drugs scheduled?
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given on a regular basis and are timed to maximize cancer cell kill ands minimize damage to normal cells. The schedule may vary somewhat to accomodate a pts response to therapy, but is usually scheduled q 3-4wks for specified # of times, on average 6-12 xs.
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What types of cancer is oral chemotherapuetic drugs prescribed for?
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hodgkin's lymphoma, leukemia (maintanence phase), small cell lung cancer.
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What types of cancer is IV chemotherapuetic drugs prescribed for?
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most solid tumors, leukemias, and lymphomas
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What types of cancer is intra-arterial chemotherapuetic drugs prescribed for?
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hepatic tumors (primary and metastatic), head and neck cancers
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What types of cancer is isolated limb perfusion chemotherapuetic drugs prescribed for?
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cancers confined to a limb: osteogenic sarcoma; Ewing's sarcoma; Rhabdomyosarcoma; regioanl melanoma
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What types of cancer is intracavitary: intraperitoneal, intraventricular, intrathecal, intravesical chemotherapuetic drugs prescribed for?
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intraperitoneal= ovarian cancer; intraventricular=brain tumors; intrathecal= brain tumors, prophylaxis for acute lymphocytic leukemia; intravesical= bladder tumors.
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What is a major complication of IV infusion of chemotherapuetic drugs?
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extravasation
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Define extravasation?
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the movement of the IV needle so the drug leaks into the surrounding tissues.
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What are the s/s of extravasation with vesicant drugs?
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pain, infection, and tissue loss
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Define vesicant?
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chemicals that cause tissue damage on direct contact.
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Small extravasations resolve without extensive tx if less than ___ of a vesicant drug has leaked into the tissue.
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0.5ml
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If a larger amt of a vesicant is leaked into the tissue what occurs?
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intensive tissue damage occurs and surgical intervention may be necessary.
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What are some tx for extravasation.
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cold compress, warm compress, antidotes may be injected into the site of extravasation. Consult with oncologist and pharmacist to determine the specific antidote needed for extravasated drug.
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Most chemotherapy drugs are absorbed through the ?
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skin and mucus membranes
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Use extreme caution and wear ____ whenever preparing, giving, or disposing of chemotherapy drugs.
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protective clothing
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What is the best practice for documenting extravasation?
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document the date and time when suspected or identified; document the date and time when the infusion was started; record the time when the infusion was stopped; document the exact contents of the infusion fluid and the volume of fluid infused; document the estimated amt of fluid extravasated; document the needle type and size; diagram the exact insertion site; indicate on the diagram the location and # of venipuncture attempts; record the time b/t the extravasation and the last full blood return; identify all agents admistered in the previous 24hrs through this site (list agent administerd, dosage and volume, and order of administration); take and record the pts VS; take a photograph of the site; document the administration of neutralizing or antidote agents; document the application of compresses; document other nursing interventions; record the pts responses to nursing interventions; document the physician notification (including the time); document the written and oral instructions given to the pt abt follow-up care; document any consultation requests; sign the documentation.
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What are the s/e of chemotherapy?
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alopecia, n/v, open sores on mucus membranes, and many skin changes, anxiety, sleep disturbance, altered bowel elimination, and decreased mobility.
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What types of therapy are used to reduce the s/e of chemotherapy?
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drug therapy, massage, guided imagery, reiki, aromatherapy,and other forms of complimentary therapy
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What is the nursing care of pts undergoing chemotherapy?
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managing the distressing symptoms occurring with therapy.
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What are some interventions for pts undergoing chemotherapy treatment?
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reassure pt that hair loss is temporary; inform pt that new hair may differ from original hair in color, texture, and thickness; assist pt with selecting a head cover that suites their income and lifestyle (wigs, caps, scarves, and turbons); ACS have wigs they lend out; tx n/v with antiemetics 91 or more drugs may be used); assist the pt with n/v to achieve comfort through nonpharmacologic means along with antiemetic; assess the pt for complications resulting from excessive vomiting such as dehydration and electrolyte imbalances; assess mouth for stomatitis and mucositis; assess for infection; monitor CBC
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Hair regrowth usually begins in abt ___ after completion of chemotherapy.
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1 month
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Most drugs induce n/v when the drug is given and for ___ days afterwards.
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1-2
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Cisplatin can iduce delayed n/v that can conitnue as long as ___ days after recieving it.
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5-7
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Define mucositis?
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sores in the mucus membranes
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Define stomatitis?
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sores in the mouth
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What is the best practice for mouth care of pts with mucositis?
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examine the pts mouth 9including the roof, under the tongue, and b/t the teeth and cheek) q 4hr; document the location, size, and character of fissures, blisters, sores, or drainage; get an order to obtain specimens of sores or drainage for culture; brush the teeth and tongue with a soft-bristled brush or sponges q 8hr; rinse the mouth with a solution of 1/2 peroxide and 1/2 NS q 12hr; avoid the use of glycerin-based mouthwashes; administer antimicrobial medications as prescribed; administer topical nalgesic medications as prescribed or as needed; help the conscious pt to "swish and spit" room-temp tap water or NS as needed; apply pertroleum jeely to the pts lips after each episode of mouth care and as needed; assist the pt in using "artificial saliva" as needed, if prescribed; assist the pt in menu choices to avoid spicy or hard food; offer complete mouth care before and after every meal.
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How should the nurse educate the pt on infection prevention?
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avoid crowds and other large gatherings of people who might be ill; don't share personal toilet articles, such as toothbrushes, toothpaste, washcloths, or deoderant sticks, with others; if possible, bathe daily; wash the armpits, groin, genitals, and anal area at least twice a day with an antimicrobial soap; clean your toothbrush daily by either running it through the dishwasher or rinsing it in liquid laundry bleach; wash your hands thoroughly with an antimicrobial soap before you eat or drink, after touching a pet, after shaking hands with anyone, as soon as you come home from any outing, and after using the toilet; eat a low-bacteria diet, and avoid salads, raw fruit and vegetables, undercooked meat, pepper, and paprika; wash dishes b/t use with hot, sudsy water, or use a dishwasher; dont drink water that has been standing for longer than 15min; dont reuse cups and glasses without washing; dont change pet liter boxes; take your temp at least once a day; report any of the following s/s of infection to your physician right away: temp >100, persistent cough (with or without sputum), pus or foul smelling drainage from any open skin area or normal body opening, presence of a boil or abscess, urine that is cloudy or foul smelling or that causes burning on urination; take all prescribed meds; dont dig in the garden or work with houseplants.
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