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269 Cards in this Set

  • Front
  • Back
Define Setting Priorities.
The process of establishing a preferential order for client problem identification or nursing stratagies.
In Nursing, what is Intervention Clustering often referred to as?
What are the three grouping types of interventions in Nursing
What is the underlying structure used when setting nursing priorities?
Maslows hierarchy of needs.
What are considered High Ranking Interventions, and what is an example?
Life Threatening situations.

These would be the A, B, C's of Airway, Breathing, and Circulation.
What is a Medium Intervention Group?
These items are of a Health threatening nature.

An example an acute exacerbation of an illness, or the decreased ability to cope, these items may not immediately threaten, yet they can cause delay of development or cause destructive physical/ emotional changes.
What is a Low Priority Intervention?
Supporting normal levels of Growth and Development. An example might be ADL.
Define Hematopoiesis.
The process of blood cell formation.
What are the original line of blood cells called?
Pluripotent stem cell (PPSC)
What are the two lines that PPSC originate into first?
-Lymphoid line
-Myeloid line
Where are the ymphoid line blood cells grown?
In the lymphatics
Where are the Myeloid line grown?
In the bone marrow
What are the three primary problems we will study with regard to Oncology?
What are the four parts of the blood that we will study this quarter?
Red Blood Cells
White Blood Cells
The highest priority of need is based on:

A. Maslow’s hierarchy of needs
B. Basic ADL’s
C. Developmental delays
D. Life threatening events
D. Life Threatening Event
What are standard Hemoglobin Levels for Males?
What are standard Hemoglobin Levels for Females?
What are standard Hematocrit Levels for Males?
What are standard Hematocrit Levels for Females?
What is a generalized range for Leukocytes?
What is the two largest areas of Blood Cell Production in the body?
The Pelvis at 16.23% followed by the Femur at 8.53%
Name the three classes of WBC.
What two types of blood cells are Agranulocytes?
Lymphocytes and Monocytes
They live for weeks.
What are the three types of Granulocytes
What are the two types of Neutrophilis?
Banded which are inmature
Segmented which are mature.
Do RBC's have a nucleus?
What is the lifespan of a Neutrophil?
About 24 hours.
What is the role of the Monocyte/Macrophage?
To Envelope Bacteria.
Name the three Granulocytes
What is Neuogen?
Filgrastim. It helps build WBC when a client is Neutropenic?
What is the difference in Neutorphil count between a healthy person, and one who is neutropenic from Chemotherapy?
Healthy 5000-10000 Neutrophils
Neutropenia 1500 Neutrophils
What is an ANC?
Absolute Neutorphil Count.
What is the ANC Calculation?
((Total Seg %) +(Total Band%)) * Total White Count = ANC
What is a "Shift to the Left"?
A higher percentage of Bands in Acute Bacterial Infection
What is the main function of RBC?
Carry oxygen to the body tissues and organs, while removing waste.
What is the average life or an RBC?
120 Days
What is the name of the drug that stimulates RBC?
Epoetin Alpha (EPO)
What is the ratio of plasma to cells?
55% Plasma
45% Cells
What si the lifespan of a sickled RBC?
20 days.
What is the priority nursing Dx for a client with Sickle Cell?
Pain Management.
What is multiple myeloma?
Cancer of the plasma cells.
What is the usual age of Dx for acute leukemia?
50+ with a median age of 67
What is the usual age of Dx for chronic leukemia?
11 Years
What is Induction Therapy?
Intensive Course of chemo therapy designed to induce complete remission.
aWhat is Consolidation Therapy?
Modified course of intensive chemo to get rid of any remaining disease. Usually a higher dose of one or more agents are used.
What type of Lymphoma is most likely curable?
Hodgkins Lymphoma.
What is GCSF?
granulocyte colony-stimulating factor aka Neupogen
What is the lifespan of a platelet?
9-10 days
What percentage of platelets are normally stored in the spleen?
30-40% before they release into circulation. As many as 80% can be sequestered in the spleen during spenomegly.
What is low platelet counts called, and what problems present?
Thrombocytopenia can lead to bleeding risks.
What is the name for too many plaetlets and what problems present?
Thrombocytosis, is an elevated count, but dysfunctional cells.
What drugs are most likely to cause platelet dysfunction?
What is the name of the drug that stimulates platlet production?
Oprelvekin which is a man made interleukin-11.
How many genes to humans have?
What is PKU?
A genetic disorder in which the body lacks the enzyme necessary to metabolize phenylalanine to tyrosine. Left untreated, the disorder can cause brain damage and progressive mental retardation as a result of the accumulation of phenylalanine and its breakdown products.
What is FISH Analysis?
Fluorescence In Situ Hybridization. A low cost, repid response, prenatal test used to test.
The technique of in situ hybridization is used to locate the chromosomal location of a specific DNA (or RNA) probe. The theory is the same as for Southern hybridization, except that the DNA to which the probe will hybridize is the actual chromosome. The probe is labeled with a flourescent probe. It is then added to a chromosomal preparation from the species of interest. After a sufficient time for annealing to occur, the chromosomes are viewed using a floruescent microscope. The probe will hybridize to the chromosome carrying the sequence of interest. If the species has been characterized cytogenetically, the marker can be assigned to the appropriate chromosome. Because this technique uses a flourescent probe it is called flourescence in situ hybridization or FISH. It has also be called chromosome painting.
What is hematology?
The blood system.
What are the two components of the blood system?
Fluid Content (Plasma)
Cellular Content
What is the name of the cell from which all other cells form?
PPSC Pluri-Potent Stem Cell.
What are the major problems of Cancer Therapy?
What is the main function of Bone Marrow.
To act as a spongy, fatty tissue to house stem cells.
What is a Unipotent stem cell?
A cell committed to a single, differentiated structure and a single mode of functioning.
What is a Pluripotent Stem Cell?
Concerning an embryonic cell that can form different kinds of cells. 2. Having a number of different actions.
What are two common plamsa expanders?
Albumin and Dextran.
What is the physiological change that stimulates RBC Production?
What are some of the reasons that Cancer is so feared?
- deformity: fear of large bulky tumors
- death: #2 leading cause of death
- contagion: fear of how it spreads
Differentiate between Incidence, Prevelance, and Mortality.
Incidence - the number of newly diagnosed cases yearly
Prevalence - the total number of clients with the disease in a year
Mortality - the yearly death rates due to a disease
What is Carcinogrnesis?
What is Cancer?
Wild overgrowth of cells. Cancer isn’t a different cell, it is a regular cell that won’t stop reproducing.
What is initiation?
basic change in the cellular components, can be inheritant or due to a cellular exposure
Name three Internal Cancer Initiators.
What is an oncogene?
A gene that everyone has, but might be off until turned on by a promoter, which might trigger a cancer.
Name three External Cancer Initiators.
Viral (AIDS Related CA)
Name some Cancer Promoters.
Hi Fat Diet
Occupatinal Hazards
What is Primary Prevention.
Preventative measures such as vaccines, and Education that prevent the disease from happening.
What is Secondary Prevention?
We prevent disease from getting a ‘foot hold’ in the body. The focus is to find disease early when tumors have small volume and are growing relatively fast – this is Screening for disease
Name three criteria for successful screening tests.
- Be able to use with large numbers of people
- Accurate (low number false + or - result)
- Acceptable (comfort, $, risk, convenient)
- Detect disease in an early stage
What is the Caution Acrynym?
C-hange in bowel/ bladder
A-sore that doesn’t heal
U-nusual bleed/discharge
O-bvious change wart/mole
N-agging cough/hoarseness
What are the five items used to classify a Tumor?
- Histology
- Biologic behavior
- Anatomic site
- Differentiation
- Staging
What is Histology?
Refers to the tissue of origin of the cancer cell
What is the histology of Carcinoma?
Epithelial Tissues (Organ Linings)
What is the histology of Sarcoma?
Connective Tissue (Bone/Muscle)
What is the histology of Glial or Cytomas?
Nerve Tissue
What is the Histology of Leukemia/Lymphoma?
Non solid tumors of the blood or lymph fluids.
What are the five Biologic Behaviors of a tumor?
-rate of growth
-mode of growth
What is the term for a Non Cancerous Tumor?
What is the term for a Malignant Tumor?
Describe Prognosis of a tumor.
Describe the growth rates of tumors.
Describe the Structure of tumors.
Describe the destructive capability of tumors.
Describe the Recurrance of Turmos.
Describe the spread of tumors.
What is the primary cancer site?
The site of origin of the cancer cell.
What is the metastatic site?
The area traveled to. New tumor started from an original cell.
How does metastatic disease travel?
Direct Contact
Lymphatic Drainage
Blood Travel
What is differentiation?
Also called Grading. How closley the cell looks like the original tissue.
What is a G-1 Grade?
Well differentiated: can easily identify the original tissue
Waht is a G-2 Grade?
Moderate: can moderately tell tissue type
What is a G-3 Grade?
Poorly: hardly resembles original tissue
What is the term for a Non Cancerous Tumor?
What is the term for a Malignant Tumor?
Describe Prognosis of a tumor.
Describe the growth rates of tumors.
Describe the Structure of tumors.
What is a G-4 Tumor?
Anaplastic: can’t tell where tissue came from in the body
What is the TNM of Staging a Tumor?
N=Nodal Involvment
M=Metastatic Invasion
What is Stage 1 Tumors Characteristics?
Size = T1
Nodal = N0
Mets = M0
What is a Stage 2 Tumors Characteristics?
Size = T2
Nodal = N1
Mets = M0
What is a Stage 3 Tumors Characteristics?
Size = T3
Nodal = N2
Mets = M0
What is a Stage 4 Tumors Characteristics?
Size = T4
Nodal = N3
Mets = M+
Define the Treatment Goal of Curing.
To Make Cancer Free
Define the Treatment Goal of Control.
to increase survival by inhibiting the spread of tumor, attempt to reduce
What isthe Treatment Goal of Palliation?
to provide comfort, when cure is not likely, may include reduction of tumor burden for symptom control
When discussing treatment goals with the patient and family unit, what is important to remember?
Everyone involved needs to understand and agree on the goal, or the outcome is anything but successful!
How does patients physical status affect treatment.
The general rule is the client will have a better outcome if they are in good physical condition before treatment
How does patients emotional status affect treatment.
The will to fight determines the extent of treatment options the person is willing to try, Quality of Life (QOL) should always be paramount.
When is Surgery and or Radiation an option?
When Local.
When tumor is found at primary site & no evidence of travel
When is Chemotherapy and or Immunotherapy an option?
When Systemic.
When likelihood of cancerous cellular travel is evident
What is Cell Cycle Theory?
G1: RNA & protein synthesis
S: DNA synthesized
G2: RNA & protein synthesis
M: Cell division
Go: cell in resting phase, differentiates to work, or dies
What is Static Growth of Tissue?
It is Static. It never proliferates. (Nerve Cells)
What is Expanding Growth of Tissue?
It is expanding. Grows in response to physiologic need. (Liver Tissue)
What is Renewing Growth Rate?
Constant Growth (GI Lining, Bone Marrow, Skin)
Why dont we Grow to Death?
Feedback Inhibition
What is Feedback Inhibition?
When a group of cells has grown enough to meet the physiologic need, the cells will signal each other to return to a resting phase, this feedback inhibits cell growth
The problem with cancer cells – they don’t signal to stop growing, and they keeping making more cancer cells.
How do chemotherapy drugs work in the body?
By acting on the cell when it is attempting to replicate
What are the three specific actions that Chemo Therapy takes?
Interferes with DNA
Inhibits DNA/RNA Synthesis
Destroys Proteins.
Differentiate between the two Classifications of Chemotherapy.
CCS Cell Cycle Specific.
NCCS Non Cell Cycle Specific.
What are Cell Cycle Specific (CCS)?
Drugs that act on a specific phase of cell replication
What are Non-cell Cycle Specific (NCCS)?
Drugs that attack cell during any phase of cell life
What are Antimetabolites?
CCS Chemotherapy that works in the S Phase
What are Vinca Alkaloids?
CCS Chemotherapy that works in the M Phase.
What are Alkylating Agents?
NCCS Chemotherapy
What are Nitrosureas?
NCCS Chemotherapy
What are Antibiotics?
NCCS Chemotherapy
What is the general attack plan for cancer cells.
Eradicate the tumor. Tumor cells can become desensitized, so the first treatment should be the strongest.
What are the Nursing Concepts during Chemotherapy?
Safety to Client and Nurse
Drug Administration
Side Effect Management.
What are some routes that a Nurse might accidentilly be exposed to a chemotherapy agent?
How is Chemotherapy usually dose calculated?
What are some fast growing cells that are at risk during Chemotherapy?
Mucous Membranes
Bone Marrow/Blood Cells
Reproductive Tissues
What is XRT?
Radiation Therapy.
What is the overall goal of XRT?
Cell Death
What types of cells does XRT affect?
Both cancerous and normal cells.
In XRT, differentiate between a partial and complete break of the Double Helix.
Partial Break, the cell dies during replication attempt.
Complete Break, the cell dies immediately.
What is Immunotherapy?
The use of natural and synthetic substances to stimulate or suppress the immune response, to treat deficits, or to interfere with the growth of malignant neoplasms. Treatment will allow body’s own defense mechanisms to recognize and mobilize to attack cancerous cells.
What are the granulocytes?
Neutrophiles, Esonophiles, Basophiles
What are the agranulocytes?
Lymphocytes, Monocytes
What is the progression of a leukocyte?
It is formed in the bone marrow, then goes to whereever in the body it is needed to fight infection
Which two WBC adhear to the inside of the blood vessesl waiting to be released when needed into the circulation?
Neutrophiles, Monocytes
Who responds to infection first?
Monocytes which become macrophages when they swell to five times their normal size.
When does the Neutrophile count begin to show after invasion from an infectin?
Four to Eight Hours
How long do neutrophiles live?
Long enough to digest 25 bacteria what which time they commit suicide.
How long does a macrophoage work?
For months or years keeping things clean and tidy by consuming the dead neutrophiles.
Other than infection, what are some possible causes for increased neutrophiles?
Strenous Exercise, Stress, Surgery or drugs such as steroids.
How long does a mature neutrophile live?
About seven hours.
How much reserve of neurtophiles does the body have?
About six days.
What does the term Shift to the left mean?
It indicates that the bodies reserves are low in neutrophiles, and it is releaseing nearly complete cells called bands.
When is an infection considered severe?
When the bands reach 8% of the total.
What is a shift to the right mean?
There is still an increase in the needed neutrophiles, but they are not fighting infection, but cleaning up dammaged cells from things like, burns, surgery, electrical shock, MI and maginant disease or hemorrage.
When is the lowest point in neurtophiles after a chemo tx?
Usually 7-15 days.
What is the term for this low point of nueroophiles.
What would you suspect if you saw a high Eosinophil count?
Allergies or paracytic disease like trichina.
What is the total normal percetage of Eosinophiles.
How many genes are in the human genome?
What are the major fears of Cancer?
Bulky Tumors, Disfiguring Tumores, Number 2 Cause of Death, How is it spread?
How do we determine the tx of cancer?
Need a goal of Tx//What is the pt status//What options are available.
Does chemo kill cells in the circulation blood?
No, it depresses the bone marrows ability to replicate cells.
What is mylosuppression?
Les cells in circulating blood.
What is the lowest point of WBC after a chemo therpy called?
What is one o the most prevelent indisious symptom of cancer and cancer treatment?
How is fatigue rated?
On a 10/10 scale like pain. It is subjective and should be based on the clinets report.
What is of the first signs of thrombocytopenia?
List the platelet risk counts.
50-100K Mild Risk//20-50K Moderate Risk//<20K Severe Risk//<10K Spontaneous Bleeding.
What are the nursing intervetions with bleeding?
What are some symptoms of an Intercranial bleed during thrombobytopenia?
H/A, Blurred Visino, Personality Changes and LOC Changes.
What is the most frequent cause of morbitidy in a cancer patient?
Define the term Incidence rate for Cancer.
The number of new cases occuring in a specified population during a year.
Black 335
Define prevelence of cancer.
The total number of people alive today whose cancer has been dx in the current year, and previous years.
Black 3335
Differentiate between how healthy vs cancerous cells look.
Cancer cells have variable sizes and shapes. May have large or multiple nuclei.
Black 341
If a cell is more mature in appearance and more like normal cells from which they have arrisen, what would they be termed?
Well Differentiated, or Low Grade.
Black 341
What is a low or normal PSA for a man?
0 - 2 ng/ml
How do cancer cells growth differ from healthy cells?
Cancer cells loose the contact inhibitin of normal cells, can establish metastasis, avoid normal regulation hormones, and avoid being recognized by the immune system as being altered.
Black 342
What is contact inhibition?
Cells know when to stop. ie Cells growing on the bottom of a Petri dish stop when they reach the sides. Cancer cells will continue to divide while they pile up on each other.
Black 342
Do cancer cells divide faster than normal cells?
No, the problem comes in that they do not stop replicating. They spend little time in G0
Black 342
What is the smallest mass that is detecatble clinically?
1g or 1cc

Black 342
What is doubling time?
The length of time needed for a malignant tumor cell population to double in size.

It might take 10 years for a tumor to reach 1cm, but only another year for it to be 8cm.
Black 342
Can a normal Breast Tissue Cell travel to the Liver?
No, Normal cells are adherent to other normal cells from which they have arisen.
Black 342
What is Angiogenesis and what is its role in metastatic cancer disease?
It is the vascularization of a tumor with blood vessels. It allows for a tumor to metastasize.
Black 343
How large can a tumor grow /s angiogenesis?
Not larger than 0.5mm because it cant get nutrients.
Black 343
What are the two pathways to cell death?
Necrosis, which is cell death from injury. They swell, release their cellular contents, which causes inflammation and phagocytosis.
Apoptosis, which is cellular suicide. It is preprogramed, does not cause inflamation, but does cause the dead cells to be phagocytoized.
Black 345
Is cancer only caused by excessive cell growth?
No, it is also caused by lack of normal cell death (Apoptosis).
Black 345
About how many genes on the human chromosome?
Black 347
How many different clinically differentiated diseases make up cancer?
100 or More
Black 347
Are all neoplasms cancerous?
No, a growth can be begign or Malignant.
Black 347
What is a Fibroma?
It is benign tumor which may grow anywhere in the body, but frequenly make their home in the uterus.
Black 349
What is a Lipoma?
A common benign neoplasm that arises in adipose tissue.
Black 349
What is a Leiomyoma?
A Benign tumor of the smooth muscle origin.
Black 349
What is a malignant neoplasm that arises from epithelial tissue called?
Black 349
What is a Carcinoma in Situ?
A malignant neoplasm, of epithelial origin, which remains confined to the site or origin.
Black 349
What is a Malignant Fibrosarcoma?
Similair to a Fibroma, but malignant. They are usually well defined, respond well to surgery, and rarely metastasize.
Black 349
What is a bronchogenic carcinoma?
This type of tumor accounts for 90% of all lung cancers.
Black 349
What is primary prevention in Cancer care?
Interventions before pathalogic changes have begun.
Black 352
What is secondary prevetion in cancer care?
Early detection, before they get a foot hold on the client.
Black 352
What are three main approaches to cancer prevention?
-Host Modification.
Black 353
Define Regualtion as it relates to cancer prevention.
Uses in the USA include prohibiting sale of tobacco and alcohol to minors, limiting smoking in public spaces, regulation carcinoginic exposure like asbestos and carcinogens in food.
Black 353
What is the most commonly dx cancer in American Women?
Breast CA
Black 353
What are risk factors for Breat CA?
Early manarche, late menopause, nulliparous or >30 at first birth.
More than 77% of women dx with Brest CA are greater than what age?
Greater than 50 yo.
Black 353
When should annual clinical mamography begin for women?
Between 40 and 50.
Black 353
At what age should women begin BSE?
Black 353
Do women who use BSE decreased mortality?
Not necessarily, but they generally present with smaller tumors.
Black 353
What is the ratio of American who continue to smoke will ultimately die of lung cancer?
Black 353
What is the leading cause of Cancer Deaths among Americans?
Lung CA.
Black 353
What is the major cause of Lung CA, and what % can be attributed to it?
More than 80% are attributed to smoking.
Black 353
Other than smoking, what are some risk factors for Lung CA?
Tubericle scar, asbestos, exposure to radiation, air pollution.
Black 353
Because radiographs usually detect Lung tumors too late, what is being investigated as a diagnostic tool for high risk lung CA candidates?
Black 353
What is the ratio of American who continue to smoke will ultimately die of lung cancer?
Black 353
What is the leading cause of Cancer Deaths among Americans?
Lung CA.
Black 353
What is the major cause of Lung CA, and what % can be attributed to it?
More than 80% are attributed to smoking.
Black 353
Other than smoking, what are some risk factors for Lung CA?
Tubericle scar, asbestos, exposure to radiation, air pollution.
Black 353
Because radiographs usually detect Lung tumors too late, what is being investigated as a diagnostic tool for high risk lung CA candidates?
Black 353
What is the third highest incidence type of cancer?
Black 354
Who gets more colon CA Men or Women?
Black 354
Name some risk factors for Colon CA.
ETOH, Smoking, Sedintary lifestyle. Also high fat, low fiber diet.
Black 354
Starting when, and how often should fecal occult blood tests be given to prevent colon CA?
q3-5 years starting at age 50.
Black 354
What is the greatest risk factor for Prostate CA?
Black 354
What race of men have the highest incidence of Prostate CA?
Black 354
At what age should low risk men begin getting DRE and PSA tests?
Age 50.
At what age should High risk men begin getting DRE and PSA tests?
Age 40.
How often does ACS recommend that men get DRE and PSA once they begin?
With Annual physical.
What are cervical cancers closely linked to?
Sexual activity.
What are two viruses that can be linked to Cervical Cancer?
What sex. is at greater risk for Head/Neck CA?
What is the only definitive evidence of cancer?
Examination of the malignant cells via microscope.
What is another term for degree of malignancy?
What is another term for the extent of a malignancy?
What is the exten of spread of a malignancy called?
What are the three components of staging?
T=Tumoer Size
N=Nodal Involvment
How is the Tumor Marker AFP used?
It identifies Lung, Testi, Pancreatic, colon
How is the Tumor Marker CA-125 used?
Ovarian and Panc
How is the Tumor Marker CA-15-3 used?
What stage would a carcinoma in situ be staged at?
Stage 0
If a client has distant metastasis and a very poor prognosis, what stage would be assigned to this cancer?
Stage IV
Is the term "Cure" universally accepted by most HCP?
No, the term Control is more widely accepted.
Why is a thorough understanding of disease, and well thought out treatment plan so important with diagnosis?
Early agressive treatment intervetions usually offer the best hope of cure.
How are treatment modalities chosen?
Based on the type of tumor, extent of disease, client co-morbid conditions like cardiac disease.
Are most clients treated with only one treatment modailityissues. ?
No, they used combined modality or multimodal therapies.
Give an example of multi-modal therapy.
An ovarian tumor might be treated surgically to debult, then treated with chemotherapy.
What percentage of clients recieve XRT during some point in their disease?
More than 60%.
How can XRT be used as a treatment?
As Primary, Adjuvant, or Pallative care care
What are three delivery methods for XRT?
External Beam
Radiation Source Placed Close to Surface of Body
Radiation Source Placed
How long is Sealed Source Radiation left in a body cavity?
24-72 Hours.
If clients have unsealed-source radiation, what cautions must be taken for saftey?
clients Urine, sweat, blood, and vomit will have a radioactive isotope. Client should flush toilet several times.
What psych-soc precautions are necessary for a client who will be having radiation implants?
The social isolation. No visitors, nurse will spend limited time in room. Bring reading, or handiwork.
What is a goal of RT?
Destroy the cancer while keeping the dosages within safe normal tissue tolerance to avoid harming normal tissues.
When are three times that Chemo is appropriate?
Disease is widespread
Risk of undetectable disease is high
The tumor cannot be resected, and is resistent to RT.
What is Neoadjuvant chemotherapy?
Preoperative Chemo to reduce bulk and lower stage of the tumor.
What is a Ommaya Reservoir?
A reservoir placed between the scalp and skull to deliver chemotherapy to the brain.
When does the Nadir traditionally occur for chemotherapuetic agents?
7-14 Days after drug administration.
What is the First and most numerous type of cell to arrive at an area of disease or tissue injury?
What is the level of ANC at which a client usually is considered neutropenic?
When does thrombocytopenia have a high risk of hemorrhage?
When platelets are below 10K.
At what number is chemo usually held until platelets have recovered to?
How long after the recovery of the WBC does platlet recovery take?
2-6 Weeks.
About how many clients of chemo get anemia?
In addition to EPO what should the client receive to promote erythropesis?
B12, Folate, Iron
What is Stomatitis?
Inflamation and ulceration of the mucosal lining of the mouth.
How soon after the first chemo treatment will alopecia begin?
2-3 weeks.
When is hair usually begin to grow after chemo and xrt?
Chemo 4-6 weeks.
XRT 8-9 weeks.