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145 Cards in this Set

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NSG ints for alopecia?
Encourage use of wigs, avoid frequent shampooing, combing, or brushing; use soft-bristle hair brush; advise against permanents and hair coloring (increase rate of hair loss
what 2 sys are affected the most by radiation?
gi and hair
a very serious and sometimes life-threatening complication of cancer therapy. It can be defined as a pattern of metabolic abnormalities resulting from spontaneous or treatment-related tumor necrosis or fulminant apoptosis
Tumor lysis syndrome
what E problems in Tumor lysis syndrome?
hyperkalemia, hyperuricemia, and hyperphosphatemia with secondary hypocalcemia
major complication of Tumor lysis syndrome
ARF and coagulopathy
what to keep @ bedside after laryngeal sx in CA?
keep humidified and have suction/airway equip
Nursing priorities immediately following surgery include recovery from general anesthesia, (patent airway, prevention of aspiration, effective breathing pattern) and pain management.
info only
Shorter with a larger diameter used, will help maintain stoma size
until healing occurs
Laryngectomy tube
what to clean Laryngectomy tube with?
NS
what to put on suture line and stoma site w/Laryngectomy tube
Antibiotic ointment
what type dsg for Laryngectomy tube?
Change 4x4 dressing with T cut 4x4
what is in place p/o Laryngectomy tube to remove fluid & air from the surgical site?
Wound drains
when are drains removed in laryngectomy?
when drainage is less than 50cc
Laryngectomy tube may be removed when the stoma is well healed in ______
3-6 weeks
potential complication of radical surgery such as Laryngectomy- acute hemorrhage
Carotid blowout
Resulting puncture through posterior trachea into esophagus heals & is fitted with a voice prosthesis
Tracheo-esophageal puncture (TEP)
T/F Esophageal speech-pt will never speak normally again
T
pt teaching p/o laryngectomy
¥ Loss of smell - use smoke detectors
¥ Changes in taste
¥ Recreation measures-No swimming/ no smoking
¥ Can take shower with stoma covered
sys most affected by radiation?
skin
what type diet for radiation
low residue
Internal radiation consists of the implantation or insertion of radioactive materials directly into the tumor or in close proximity
brachytherapy
which brachytherapy are used for CA of the head and neck and gynecologic malignancies
implant may be temporary with the source placed into a catheter or tube inserted into the tumor area and left in place for several days
Implants such as ______implants, may also be permanent with insertion of radioactive seeds into tumors
prostate
is used in the clinical situation where the tumor dose must be high to eradicate the tumor
Brachytherapy
Caring for the person with an implant requires that the nurse be aware that the pt is radioactive
info only
T/F If a pt has a temporary implant, the pt is radioactive during the time the source is in place
T
T/FIf a pt has a permanent implant, the radioactive exposure to the outside and others is low, and the pt may be discharched with precautions
T
give an example of a pt has a permanent implant, the radioactive exposure to the outside and others is low, and the pt may be discharched with precautions
, the person with a permanent radioactive seed implant for prostate cancer may be told to double flush the toilet and not to allow children to sit of his lap for a specific period of time after the implan
The principles of time, distance and shielding are used when caring for the person with an implant
info
. Nursing care should be organized so that a limited amount of time is spent with the pt with a radiation implant
info
The ______ will indicate how much time at a specific distance can be spent with the pt
radiation safety officer
what determines the amt of time a RN can spend w/a radiation pt
dose delivered by the implant
what is the only type of care is given with radiation implant?
. Only care that must be delivered near the sourse, such as checking placement of the implant, is performed in close proximity
what should be worn when giving care in radiation implant?
Shielding and film badge
_____will indicated any radiation exposure
film badge
what is done to verify placement of the implant?
xray
A person who stands 2 m away from source of radiation receives only ___as much exposure as when standing only 1 m away
1/4
At 4 m only ____of the exposure will be received
1/16
T/FIncreasing the distance from the radiation source decreases the exposure
T
____ and ____should be worn by anyone who attends pt during x-ray treatment or during examination by fluoroscopy
Lead-lined gloves and lead apron
_____chemotherapy is where chemotherapy is given into the fluid around the spinal cord during a lumbar puncture
Intrathecal
body's defenses are senstitized and "biologic response modifiers" are activated
Immunotherapy
ex of Immunotherapy
.: BCG and C. parvum bacille, monoclonal antibodies, interferon, interleukin-2, and colony-stimulating factors (the cytokines)
______stimulates the production of neutrophils (a type of white blood cell). G-CSF is a cytokine.
Granulocyte colony-stimulating factor
for mild to moderate pain; If chemotherapy is being administered and can also slow clotting?
nsaids
meds for moderate to severe pain?
morphine, Actiq, Duragesic, Dilaudid, oxycodone (OxyContin, Percocet, and Tylox) and codeine
(a flare-up of pain characterized by rapid onset, severe intensity and short duration
Breakthrough Pain
what med for Breakthrough Pain
Immediate-release oral morphine
what 3 antidepressants are prescribed to treat pain
Elavil, Pamelor, Norpramine

PEN
what anticonvulsants to control burning and tingling pain, painful symptoms of nerve damage
Tegretol and Neurontin
what meds to lessen swelling, which often causes pain.
Corticosteroids
what route should be avoided w/pain meds?
IM
Med is inside the spinal column but outside the dura mater
epidural
when should antiemetics be started w/chemo?
a few days before Tx starts
antiemetics for chemo(4)?
Zofran, Kytril, Compazine, and Emend
which foods to avoid w/chemo? why? how to eat in chemo?
high fat.
stay in stomach longer
small frequent meals
meds tha reduces swelling/ inflammation
corticosteriods(prednisone)
nsg care when prednisone
give w/food and monitor I
major SE of corticosteriods?
immunosuppression and they may mask signs of infection
what do corticosteriods cause the retention of? which may cause?
retention of sodium (salt) and fluid, weight gain, high blood pressure loss of potassium, headache and muscle weakness
what are some other se of prednisone?
puffiness of the face (moon face), growth of facial hair, thinning and easy bruising of the skin, impaired wound healing, glaucoma, cataracts, ulcers in the stomach and duodenum, worsening of diabetes, irregular menses, osteoporosis that results in fractures of bones.
what med interacts with the estrogen receptor and antagonizes estrogen's action inhibition of advanced hormone-dependent breast cancer and the reduction in the incidence of contralateral new primary breast cancers when given to women with early stage disease
Tamoxifen
2 major concerns w/tamoxifen?
thromboembolism and endometrial cancer
interferes with the growth of cancer cells and slows their growth and spread in the body
Taxol
what CA is Taxol used to Tx?
breast, ovary and lung cancers, and AIDS-related Kaposi's sarcoma
taxol is extracted from the bark of the ____
Pacific yew
The choice of which antineoplastic to use depends on what
what the cell type of the tumor is, and on its site of growth
does chemo effect normal or CA cells more? why
CA. b/c they grow faster
what cells are often affected by chemo?
bone marrow, hair, gi
se of chemo?
CHF, immunosuppression (Thrombocytopenia
what to give chemo pt to protect from infection and own self?
BSI
____ is an inflammation of the oral mucous membranes, freq associated with chemo
Stomatitis
react with DNA to inhibit cell division/growth
Alkylating agents
major SE of Alkylating agents
renal toxicity.
ex of Alkylating agents
Busulfan, carboplatin, cisplatin, cyclophosphamide, ifosfamide, melphalan, nitrogen mustard and thiotepa
cross blood-brain barrier to react with DNA to inhibit cell division/growth
Nitrosoureas
ex of BCNU (carmustine), CCNU (lomustine), methyl CCNU (semustine), and streptozocin
BCNU (carmustine), CCNU (lomustine), methyl CCNU (semustine), and streptozocin
Side Effects of Nitrosoureas?
myelosuppression (a reduction in the ability of the bone marrow to produce blood cells), especially thrombocytopenia (low platelets).
compete with metabolites during nucleic acid production which prevents cell growth
Antimetabolites
ex of Antimetabolites
5-fluorouracil, 5-azactadine, 6-mercaptopurine, 6- thioguanine cytarabine.
Side Effects of antimetabolites
renal toxicity, hepatotoxicity, proctitis, mucositis, ulcerations and stomatitis
interfere with DNA-dependent RNA synthesis and bind with DNA to block cell growth
Antitumor antibiotics
ex of Antitumor antibiotics
Andriamycin (doxorubicin)bleomycin, dactinomycin, daunorubicin, mithramycin, mitomycin, mitoxantrone
se of Andriamycin (doxorubicin)
alopecia, hepatic dysfunction, red urine, and cardiomyopathy
se of the other antitumor abt
cardiac toxicity
change the chemical environment by binding to hormone receptor sites which prohibits the growth of tumors susceptible to hormones
Hormonal agents
ex of hormonal agents?
Tamoxifen, androgens, anti-estrogens, estrogens, progesterone and steroids
______chemotherapy such as Tamoxifen is what is considered additive or ablative therapy. It is not a cure but provides palliative therapy as effectively as does an oopherectomy(removal of ovaries). It is most effective when used to prolong disease free survival in breast cancer therapies.
Endocrine antineoplastic
when are endocrine antineoplastics most effective?
when used to prolong disease free survival in breast cancer therapies
major immunosuppressants for chemo?
mycophenolate mofetil (cellcept), azaprine (Imuran), or cyclophosphamide (cytoxan); corticosteroids (prednisone); cyclosporine (neural), tacrolimus (prograf) or sirolimus (rapamycin); antilymphocyte globulin
____is used in most transplant centers in the USA
Cyclosporine
what type chemo is methotrexate?
immunosuppressant
Give ____ 24-48 hours after methotrexate to prevent reversal of bone marrow and GI toxicity.
Ca+
se that may show up when using immunosuppressants for CA?
infections Kaposi's sarcoma is more common in immune suppressed persons
corticosteriods mask _____
infection
what type diet for chemo?
small, frequent, high nutrient/high protein foods, eat prior to chemo/rad tx. Food consistency should be tolerated and swallowed well, encourage supplemental feeding and reduce lactose in the diet.
what should the diet of CA empasize?
high kcal and protein
(milk, cream, cheese, and cooked eggs)
Other suggestions might include increasing your use of sauces and gravies, or changing your cooking methods to include more butter, margarine, or oil. Sometimes, nutrition recommendations for cancer patients suggest that you eat less of certain high-fiber foods because these foods can aggravate problems such as diarrhea or a sore mouth.
FYI
the major concerns with the IV administration of chemotherapeutic agents is infiltration of drugs into tissue surrounding the infusion site
Extravasion
drugs that when infiltrated into the skin cause sevel local breakdown and necrosis
vesicants
Specific measures to ensure adequate dilution, patency, and early detection of injury are important during chemotherapy
info
what fluids are used for chemo and what size needle?
of normal saline solution or 5% dextrose in water or saline solution with a small-lumen short needle or catheter
what to ensure in r/t venipuncture w/chemo IV?
ensure that revent venipunctures have not been performed proximal to the IV site
what to avoid when selecting arms for IV chemo?
avoid using an arm that has poor lymphatic drainage or that has previously received radiation therapy
what type vein for chemo?
select a vein that is large enough to promote infusion without irritating the intima of the vein
when a vesicant is administered, avoid the veins in the_____(3)
hand, wrist, and antecubital space
what to have pt report in r/t IV chemo and sensation?
instruct the pt to immediately report any changes in sensation, especially burning or stinging pain;
what to check for before starting chemo?
check for a blood return
if more than one agent is given how should they be given?
give the vesicant agents first, when the vein is at its optimum integrity
Slowly push those drugs that are given by the push or bolus method
info
how should IVP or bolus med be given?
Give in small increments (0.5 to 1.0 ml). Pause 30 to 60 seconds after each increment, and allow the IV infusion to flush the vein; check blood return, and again gently push 0.5 to 1.0 ml of the medication
Repeat until the medication has been given and allow the IV infusion to flush the vein for several minutes when giving chemo by iv
info
what to avoid in rt vesicant infusions
continuous peripheral IV infusions of vesicant agents
what must be done if pt receives a vesicant in a peripheral IV?
the pt receiving the vesicant agent must be monitored directly for local tissue responses at all times
what to do if pt complains of a burning or stinging pain or if an infiltration is suspected
Stop the infusion immediately
after stopping infusion for c/o tingling or burning what should be done by Rn?
check for blood return and, if present, continue to administer drug
what to do if pt c/o buring or tingling w/a vesicatn?
stop the infusion and begin appropriate extravasion procedures
what type tape to secure needle placement and allow direct observation of area w/chemo
transparent tape
if extravasion occurs what to do first?
Stop the IV infusion immediately
if extravasion occurs what to do 2nd
call md or use the standing written orders for treatment related to specific vesicant agent
what to do 3rd w/extravasion
; remove the IV infusion tubing and aspirate any remaining drug with a new syringe
what to do 4thw/extravasion
inject the prescribed antidote (if one is available) in the infusion needle or in a Òpin cushion fashion in the skin surrounding the needle site
what type cream to apply if ordered w/extravasion
topical corticosteroid
how to posit site w/extravasion and do you apply heat or cold?
elevate the site and use cold compresses for 24-48 hours.
what type chemo is cold compresses contraindicated w/extravasion? what to use instead?
plant alkaloids
heat
what is the cardinal s/s of extravascation?
other s/s?
PAIN
swelling, redness, and the presence of vesicles on the skin are other symptoms
What are the most important goals if an axillary lymph node dissection has occurred or if a woman has had a modified radical mastectomy, specific interventions will be needed
. Restoring arm function on the affected side after mastectomy and axillary lymph node is the most important goals of nursing activities
how should arms be positioned if an axillary lymph node dissection has occurred or if a woman has had a modified radical mastectomy
semi-Fowler's position with the arm on the affected side elevated on a pillow
after axillary lymph node dissection has occurred or if a woman has had a modified radical mastectomy, lumpectomy or total mastectomy when should exercises begin and what should pt do?
Flexing and extending the fingers should begin in the recovery room with progressive increases in activity encouraged.
what to do prior to exercises w/breast CA to decrease pain
give pain med
Platelets: normal
150,000-400,000
platelet Lifespan?. what level is serious? life threatening?
7-10 days
<20k
<10k
a decrease in the # of platelets in the circulating blood, major concern is bleedin
Thrombocytopenia
In a patient with leukemia, hemorrhage is most likely due to ______?
low platelet count
normal Absolute neutrophil count
1.5-8
A shortage of all types of blood cells, including red and white blood cells as well as platelets
Pancytopenia
Common clinical manifestations of pancytopenia in a pt. undergoing chemotherapy are ___ and ___?
hemorrhage and infection.
Lab values in tumor lysis include increased _____, ____, _____ and decreased _____?
potassium, increased phosphate and increased uric acid, with decreased calcium
hypoxia and activity intolerance with decreased ?
risk for infection with low?
risk for bleeding with low ?
RBC
WBC
platelet
risk for prostate Ca with elevated?
risk for breast Cancer with prescence of?
PSA

BC-19 and BC-25
Seven Warning Signs of Cancer (American Cancer Society
CAUTION
Changes in bladder or bowel habits
A sore that does not heal
Unusual discharge or bleeding
Thickening or lump in the breast or elsewhere
Indigestion or difficulty swallowing
Obvious change in a mole or wart
Nagging cough or hoarseness
a defect resulting from the failure of the ductus (located between the aorta and the pulmonary artery) to close it is patent and shouldn't be--, causing shunting of blood to the pulmonary artery
PATENT DUCTUS ARTERIOSUS
when does the ductus arterious close?
10-15 hrs and may take up to 7-10 days after birth
s/s of a PDA?
mild cyanosis, machinelike heart murmur, respiratory distress, tachycardia, tachypnea
High pulmonary pres. in PDA can lead to ___ or ___?
CHF or pneumonia.