Nc4.2

Front 1

NSG ints for alopecia?

Back 1

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

Front 2

what 2 sys are affected the most by radiation?

Back 2

gi and hair

Front 3

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

Back 3

Tumor lysis syndrome

Front 4

what E problems in Tumor lysis syndrome?

Back 4

hyperkalemia, hyperuricemia, and hyperphosphatemia with secondary hypocalcemia

Front 5

major complication of Tumor lysis syndrome

Back 5

ARF and coagulopathy

Front 6

what to keep @ bedside after laryngeal sx in CA?

Back 6

keep humidified and have suction/airway equip

Front 7

Nursing priorities immediately following surgery include recovery from general anesthesia, (patent airway, prevention of aspiration, effective breathing pattern) and pain management.

Back 7

info only

Front 8

Shorter with a larger diameter used, will help maintain stoma size
until healing occurs

Back 8

Laryngectomy tube

Front 9

what to clean Laryngectomy tube with?

Back 9

NS

Front 10

what to put on suture line and stoma site w/Laryngectomy tube

Back 10

Antibiotic ointment

Front 11

what type dsg for Laryngectomy tube?

Back 11

Change 4x4 dressing with T cut 4x4

Front 12

what is in place p/o Laryngectomy tube to remove fluid & air from the surgical site?

Back 12

Wound drains

Front 13

when are drains removed in laryngectomy?

Back 13

when drainage is less than 50cc

Front 14

Laryngectomy tube may be removed when the stoma is well healed in ______

Back 14

3-6 weeks

Front 15

potential complication of radical surgery such as Laryngectomy- acute hemorrhage

Back 15

Carotid blowout

Front 16

Resulting puncture through posterior trachea into esophagus heals & is fitted with a voice prosthesis

Back 16

Tracheo-esophageal puncture (TEP)

Front 17

T/F Esophageal speech-pt will never speak normally again

Back 17

T

Front 18

pt teaching p/o laryngectomy

Back 18

¥ Loss of smell - use smoke detectors
¥ Changes in taste
¥ Recreation measures-No swimming/ no smoking
¥ Can take shower with stoma covered

Front 19

sys most affected by radiation?

Back 19

skin

Front 20

what type diet for radiation

Back 20

low residue

Front 21

Internal radiation consists of the implantation or insertion of radioactive materials directly into the tumor or in close proximity

Back 21

brachytherapy

Front 22

which brachytherapy are used for CA of the head and neck and gynecologic malignancies

Back 22

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

Front 23

Implants such as ______implants, may also be permanent with insertion of radioactive seeds into tumors

Back 23

prostate

Front 24

is used in the clinical situation where the tumor dose must be high to eradicate the tumor

Back 24

Brachytherapy

Front 25

Caring for the person with an implant requires that the nurse be aware that the pt is radioactive

Back 25

info only

Front 26

T/F If a pt has a temporary implant, the pt is radioactive during the time the source is in place

Back 26

T

Front 27

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

Back 27

T

Front 28

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

Back 28

, 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

Front 29

The principles of time, distance and shielding are used when caring for the person with an implant

Back 29

info

Front 30

. Nursing care should be organized so that a limited amount of time is spent with the pt with a radiation implant

Back 30

info

Front 31

The ______ will indicate how much time at a specific distance can be spent with the pt

Back 31

radiation safety officer

Front 32

what determines the amt of time a RN can spend w/a radiation pt

Back 32

dose delivered by the implant

Front 33

what is the only type of care is given with radiation implant?

Back 33

. Only care that must be delivered near the sourse, such as checking placement of the implant, is performed in close proximity

Front 34

what should be worn when giving care in radiation implant?

Back 34

Shielding and film badge

Front 35

_____will indicated any radiation exposure

Back 35

film badge

Front 36

what is done to verify placement of the implant?

Back 36

xray

Front 37

A person who stands 2 m away from source of radiation receives only ___as much exposure as when standing only 1 m away

Back 37

1/4

Front 38

At 4 m only ____of the exposure will be received

Back 38

1/16

Front 39

T/FIncreasing the distance from the radiation source decreases the exposure

Back 39

T

Front 40

____ and ____should be worn by anyone who attends pt during x-ray treatment or during examination by fluoroscopy

Back 40

Lead-lined gloves and lead apron

Front 41

_____chemotherapy is where chemotherapy is given into the fluid around the spinal cord during a lumbar puncture

Back 41

Intrathecal

Front 42

body's defenses are senstitized and "biologic response modifiers" are activated

Back 42

Immunotherapy

Front 43

ex of Immunotherapy

Back 43

.: BCG and C. parvum bacille, monoclonal antibodies, interferon, interleukin-2, and colony-stimulating factors (the cytokines)

Front 44

______stimulates the production of neutrophils (a type of white blood cell). G-CSF is a cytokine.

Back 44

Granulocyte colony-stimulating factor

Front 45

for mild to moderate pain; If chemotherapy is being administered and can also slow clotting?

Back 45

nsaids

Front 46

meds for moderate to severe pain?

Back 46

morphine, Actiq, Duragesic, Dilaudid, oxycodone (OxyContin, Percocet, and Tylox) and codeine

Front 47

(a flare-up of pain characterized by rapid onset, severe intensity and short duration

Back 47

Breakthrough Pain

Front 48

what med for Breakthrough Pain

Back 48

Immediate-release oral morphine

Front 49

what 3 antidepressants are prescribed to treat pain

Back 49

Elavil, Pamelor, Norpramine

PEN

Front 50

what anticonvulsants to control burning and tingling pain, painful symptoms of nerve damage

Back 50

Tegretol and Neurontin

Front 51

what meds to lessen swelling, which often causes pain.

Back 51

Corticosteroids

Front 52

what route should be avoided w/pain meds?

Back 52

IM

Front 53

Med is inside the spinal column but outside the dura mater

Back 53

epidural

Front 54

when should antiemetics be started w/chemo?

Back 54

a few days before Tx starts

Front 55

antiemetics for chemo(4)?

Back 55

Zofran, Kytril, Compazine, and Emend

Front 56

which foods to avoid w/chemo? why? how to eat in chemo?

Back 56

high fat.
stay in stomach longer
small frequent meals

Front 57

meds tha reduces swelling/ inflammation

Back 57

corticosteriods(prednisone)

Front 58

nsg care when prednisone

Back 58

give w/food and monitor I

Front 59

major SE of corticosteriods?

Back 59

immunosuppression and they may mask signs of infection

Front 60

what do corticosteriods cause the retention of? which may cause?

Back 60

retention of sodium (salt) and fluid, weight gain, high blood pressure loss of potassium, headache and muscle weakness

Front 61

what are some other se of prednisone?

Back 61

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.

Front 62

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

Back 62

Tamoxifen

Front 63

2 major concerns w/tamoxifen?

Back 63

thromboembolism and endometrial cancer

Front 64

interferes with the growth of cancer cells and slows their growth and spread in the body

Back 64

Taxol

Front 65

what CA is Taxol used to Tx?

Back 65

breast, ovary and lung cancers, and AIDS-related Kaposi's sarcoma

Front 66

taxol is extracted from the bark of the ____

Back 66

Pacific yew

Front 67

The choice of which antineoplastic to use depends on what

Back 67

what the cell type of the tumor is, and on its site of growth

Front 68

does chemo effect normal or CA cells more? why

Back 68

CA. b/c they grow faster

Front 69

what cells are often affected by chemo?

Back 69

bone marrow, hair, gi

Front 70

se of chemo?

Back 70

CHF, immunosuppression (Thrombocytopenia

Front 71

what to give chemo pt to protect from infection and own self?

Back 71

BSI

Front 72

____ is an inflammation of the oral mucous membranes, freq associated with chemo

Back 72

Stomatitis

Front 73

react with DNA to inhibit cell division/growth

Back 73

Alkylating agents

Front 74

major SE of Alkylating agents

Back 74

renal toxicity.

Front 75

ex of Alkylating agents

Back 75

Busulfan, carboplatin, cisplatin, cyclophosphamide, ifosfamide, melphalan, nitrogen mustard and thiotepa

Front 76

cross blood-brain barrier to react with DNA to inhibit cell division/growth

Back 76

Nitrosoureas

Front 77

ex of BCNU (carmustine), CCNU (lomustine), methyl CCNU (semustine), and streptozocin

Back 77

BCNU (carmustine), CCNU (lomustine), methyl CCNU (semustine), and streptozocin

Front 78

Side Effects of Nitrosoureas?

Back 78

myelosuppression (a reduction in the ability of the bone marrow to produce blood cells), especially thrombocytopenia (low platelets).

Front 79

compete with metabolites during nucleic acid production which prevents cell growth

Back 79

Antimetabolites

Front 80

ex of Antimetabolites

Back 80

5-fluorouracil, 5-azactadine, 6-mercaptopurine, 6- thioguanine cytarabine.

Front 81

Side Effects of antimetabolites

Back 81

renal toxicity, hepatotoxicity, proctitis, mucositis, ulcerations and stomatitis

Front 82

interfere with DNA-dependent RNA synthesis and bind with DNA to block cell growth

Back 82

Antitumor antibiotics

Front 83

ex of Antitumor antibiotics

Back 83

Andriamycin (doxorubicin)bleomycin, dactinomycin, daunorubicin, mithramycin, mitomycin, mitoxantrone

Front 84

se of Andriamycin (doxorubicin)

Back 84

alopecia, hepatic dysfunction, red urine, and cardiomyopathy

Front 85

se of the other antitumor abt

Back 85

cardiac toxicity

Front 86

change the chemical environment by binding to hormone receptor sites which prohibits the growth of tumors susceptible to hormones

Back 86

Hormonal agents

Front 87

ex of hormonal agents?

Back 87

Tamoxifen, androgens, anti-estrogens, estrogens, progesterone and steroids

Front 88

______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.

Back 88

Endocrine antineoplastic

Front 89

when are endocrine antineoplastics most effective?

Back 89

when used to prolong disease free survival in breast cancer therapies

Front 90

major immunosuppressants for chemo?

Back 90

mycophenolate mofetil (cellcept), azaprine (Imuran), or cyclophosphamide (cytoxan); corticosteroids (prednisone); cyclosporine (neural), tacrolimus (prograf) or sirolimus (rapamycin); antilymphocyte globulin

Front 91

____is used in most transplant centers in the USA

Back 91

Cyclosporine

Front 92

what type chemo is methotrexate?

Back 92

immunosuppressant

Front 93

Give ____ 24-48 hours after methotrexate to prevent reversal of bone marrow and GI toxicity.

Back 93

Ca+

Front 94

se that may show up when using immunosuppressants for CA?

Back 94

infections Kaposi's sarcoma is more common in immune suppressed persons

Front 95

corticosteriods mask _____

Back 95

infection

Front 96

what type diet for chemo?

Back 96

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.

Front 97

what should the diet of CA empasize?

Back 97

high kcal and protein
(milk, cream, cheese, and cooked eggs)

Front 98

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.

Back 98

FYI

Front 99

the major concerns with the IV administration of chemotherapeutic agents is infiltration of drugs into tissue surrounding the infusion site

Back 99

Extravasion

Front 100

drugs that when infiltrated into the skin cause sevel local breakdown and necrosis

Back 100

vesicants

Front 101

Specific measures to ensure adequate dilution, patency, and early detection of injury are important during chemotherapy

Back 101

info

Front 102

what fluids are used for chemo and what size needle?

Back 102

of normal saline solution or 5% dextrose in water or saline solution with a small-lumen short needle or catheter

Front 103

what to ensure in r/t venipuncture w/chemo IV?

Back 103

ensure that revent venipunctures have not been performed proximal to the IV site

Front 104

what to avoid when selecting arms for IV chemo?

Back 104

avoid using an arm that has poor lymphatic drainage or that has previously received radiation therapy

Front 105

what type vein for chemo?

Back 105

select a vein that is large enough to promote infusion without irritating the intima of the vein

Front 106

when a vesicant is administered, avoid the veins in the_____(3)

Back 106

hand, wrist, and antecubital space

Front 107

what to have pt report in r/t IV chemo and sensation?

Back 107

instruct the pt to immediately report any changes in sensation, especially burning or stinging pain;

Front 108

what to check for before starting chemo?

Back 108

check for a blood return

Front 109

if more than one agent is given how should they be given?

Back 109

give the vesicant agents first, when the vein is at its optimum integrity

Front 110

Slowly push those drugs that are given by the push or bolus method

Back 110

info

Front 111

how should IVP or bolus med be given?

Back 111

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

Front 112

Repeat until the medication has been given and allow the IV infusion to flush the vein for several minutes when giving chemo by iv

Back 112

info

Front 113

what to avoid in rt vesicant infusions

Back 113

continuous peripheral IV infusions of vesicant agents

Front 114

what must be done if pt receives a vesicant in a peripheral IV?

Back 114

the pt receiving the vesicant agent must be monitored directly for local tissue responses at all times

Front 115

what to do if pt complains of a burning or stinging pain or if an infiltration is suspected

Back 115

Stop the infusion immediately

Front 116

after stopping infusion for c/o tingling or burning what should be done by Rn?

Back 116

check for blood return and, if present, continue to administer drug

Front 117

what to do if pt c/o buring or tingling w/a vesicatn?

Back 117

stop the infusion and begin appropriate extravasion procedures

Front 118

what type tape to secure needle placement and allow direct observation of area w/chemo

Back 118

transparent tape

Front 119

if extravasion occurs what to do first?

Back 119

Stop the IV infusion immediately

Front 120

if extravasion occurs what to do 2nd

Back 120

call md or use the standing written orders for treatment related to specific vesicant agent

Front 121

what to do 3rd w/extravasion

Back 121

; remove the IV infusion tubing and aspirate any remaining drug with a new syringe

Front 122

what to do 4thw/extravasion

Back 122

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

Front 123

what type cream to apply if ordered w/extravasion

Back 123

topical corticosteroid

Front 124

how to posit site w/extravasion and do you apply heat or cold?

Back 124

elevate the site and use cold compresses for 24-48 hours.

Front 125

what type chemo is cold compresses contraindicated w/extravasion? what to use instead?

Back 125

plant alkaloids
heat

Front 126

what is the cardinal s/s of extravascation?
other s/s?

Back 126

PAIN
swelling, redness, and the presence of vesicles on the skin are other symptoms

Front 127

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

Back 127

. Restoring arm function on the affected side after mastectomy and axillary lymph node is the most important goals of nursing activities

Front 128

how should arms be positioned if an axillary lymph node dissection has occurred or if a woman has had a modified radical mastectomy

Back 128

semi-Fowler's position with the arm on the affected side elevated on a pillow

Front 129

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?

Back 129

Flexing and extending the fingers should begin in the recovery room with progressive increases in activity encouraged.

Front 130

what to do prior to exercises w/breast CA to decrease pain

Back 130

give pain med

Front 131

Platelets: normal

Back 131

150,000-400,000

Front 132

platelet Lifespan?. what level is serious? life threatening?

Back 132

7-10 days
<20k
<10k

Front 133

a decrease in the # of platelets in the circulating blood, major concern is bleedin

Back 133

Thrombocytopenia

Front 134

In a patient with leukemia, hemorrhage is most likely due to ______?

Back 134

low platelet count

Front 135

normal Absolute neutrophil count

Back 135

1.5-8

Front 136

A shortage of all types of blood cells, including red and white blood cells as well as platelets

Back 136

Pancytopenia

Front 137

Common clinical manifestations of pancytopenia in a pt. undergoing chemotherapy are ___ and ___?

Back 137

hemorrhage and infection.

Front 138

Lab values in tumor lysis include increased _____, ____, _____ and decreased _____?

Back 138

potassium, increased phosphate and increased uric acid, with decreased calcium

Front 139

hypoxia and activity intolerance with decreased ?
risk for infection with low?
risk for bleeding with low ?

Back 139

RBC
WBC
platelet

Front 140

risk for prostate Ca with elevated?
risk for breast Cancer with prescence of?

Back 140

PSA

BC-19 and BC-25

Front 141

Seven Warning Signs of Cancer (American Cancer Society
CAUTION

Back 141

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

Front 142

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

Back 142

PATENT DUCTUS ARTERIOSUS

Front 143

when does the ductus arterious close?

Back 143

10-15 hrs and may take up to 7-10 days after birth

Front 144

s/s of a PDA?

Back 144

mild cyanosis, machinelike heart murmur, respiratory distress, tachycardia, tachypnea

Front 145

High pulmonary pres. in PDA can lead to ___ or ___?

Back 145

CHF or pneumonia.