Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
91 Cards in this Set
- Front
- Back
|
Define neoplasm
|
A new growth of tissue serving no physiologic function
|
|
|
Define neoplasia
|
The process of tumor formation
|
|
|
Carcinoma
|
arises from epithelial tissue
|
|
|
Adenocarcinoma
|
arises from glandular organs
|
|
|
Sarcoma
|
come from mesodermal cells (connective tissue, blood, lymphatics, bone, cartilage)
|
|
|
Lymphoma
|
from blood cells
|
|
|
Multiple myeloma
|
Comes from plasma cells et effects bones
|
|
|
What type of cancer has the highest incidence?
|
Prostate cancer
|
|
|
Primary prevention of cancer:
|
Reduce risk of cancer in healthy people
Ex. Teach avoidance of known carcinogens, dietary et lifestyle changes, etc... |
|
|
Secondary prevention of cancer:
|
Detect and screen to achieve early diagnosis and intervention to halt the cancer process
Ex. Pap smears, breast exams, mammograms, etc... |
|
|
Age as a risk factor:
|
Increased risk for greater than 65 years of age because of hormonal changes, altered immune response, and accumulation of free radicals
*** single most important factor r/t developing cancer |
|
|
Geographics as a risk factor:
|
Ex. Exposure to sunlight et radiation
|
|
|
Genetics as a risk factor:
|
15% of cancers may be attributed to some sort of hereditary component such as breast, colon, lung, ovarian, and prostate
|
|
|
What immune disturbances put a person at risk for developing cancer?
|
Viruses like Epstein barr, genital herpes, HPV, Hep B & C, & CMV all put people at risk for cancer
|
|
|
Tobacco as a risk factor:
(includes smokeless tobacco) |
Strong correlation between lung ca et smoking but also can lead to bladder ca, pancreatic ca, et gastric ca.
Smokeless tobacco causes oral ca |
|
|
Alcohol as a risk factor:
|
Promotes cancer of the liver et esophagus when combined with tobacco.
|
|
|
Diet as a risk factor:
|
High fat, low fiber diets containing **nitrosamines et **nitrosindoles (preservatives found in meats, pickled foods) - promote cancers like breast et colon
|
|
|
***7 warning signs of cancer:
|
1. Changes in bowel habits
2. Sore throat that doesn't heal 3. Unusual bleeding or discharge 4. Thickening or lump in breast or elsewhere 5. Indigestion or difficulty swallowing 6. Obvious changes in warts or moles 7. Nagging cough or hoarseness If any of these s/sx, need to see a doctor immediately |
|
|
Define:
Hyperplasia |
Hyperplasia - increase in the number of normal cells (usually associated with rapid body growth ex. BPH)
|
|
|
Define:
Metaplasia |
Conversion of one type of mature cell into another type of cell not normal for that tissue
|
|
|
Define:
Dysplasia |
Dysplasia - bazaar cell growth resulting in cells that differ in size, shape, appearance, et distribution of cells (usually considered pre-cancerous)
|
|
|
Define:
Anaplasia |
Cells are very disorganized, irregular, et have no structure (almost always malignant)
|
|
|
Staging of cancer:
|
T - Extent/Size of primary tumor (0=no evidence of tumor - 4=huge tumor)
N - Presence/extent of lymph node involvement (0-3) M - Extent of metastasis to other parts of the body (0-3) |
|
|
Grading of cancer:
|
Classification of tumor cells by defining the type of tissue from which the tissue originated
G1-G4 G1=closely resemble the tissue or origin G4=tend to be more aggressive et less responsive |
|
|
Hematology for dx:
|
BRCA 1-2: Breast cancer et ovarian cancer
CA: Cancer antigens (19-9, 27-29, 15-3, 125) CEA: Carcinoembryonic antigen |
|
|
What does a biopsy tell you?
|
The name, grade, et stage of the tumor
|
|
|
What will always be the #1 nursing dx for a pt on radiation?
|
Risk for infection
|
|
|
Client education for radiation:
|
- Wash marked areas of skin w/ plain water only; no soap, powder, deodorant, lotion, perfume, or meds to the sites during treatment
- Avoid rubbing, scratching, or scrubbing treatment site, no application of heat or cold packs, electric razor only - Wear soft, loose-fitting clothing over treatment areas - Protect skin from sun exposure for at least 1 year after treatment completed; use sunblock of at least 15 SPF - Get proper rest, diet, fluid intake for health and repair of normal tissues - If hair loss occurs, protect head |
|
|
Factors that determine the response of cancer cells to chemo:
|
o Rate of tissue from which the tumor arises
o Size of tumor o Age of tumor (the younger the tumor, the greater response to chemo) o Location of the tumor o Presence of resistant tumor cells |
|
|
What is the most frequent cause of morbidity et death in cancer patients?
|
Immunosuppression
|
|
|
When does a chemo pt need to contact their physician immediately?
|
-fever >100.5
OR -cough w/ SOB |
|
|
What's Nadir?
|
The lowest WBC count
Occurs between 7-10 days after initiation of chemotherapy |
|
|
At what platelet count are precautions started?
|
<50,000
<20,00=very high risk |
|
|
What is the onset of anemia w/ chemo?
|
3-4 months after initiation of tx
|
|
|
Teaching oral care for chemo pt:
|
-Oral care needs to be done before et after each meal et at bedtime
-Can use a saline solution of 1tsp of salt in 1L of water |
|
|
How much water does a chemo pt need to drink per day to be adequately hydrated?
|
2-3L
|
|
|
What labs need to be monitored for nutritional status?
|
-H&H
-Albumin -Pre-albumin |
|
|
Head care for a pt with alopecia:
|
Hair should be washed 2-3 times a week w/ mild shampoo, pat dry, no blow-dryer or hair dye
|
|
|
Viscous agents that cause necrosis:
What do u need to do? |
-Nitrogen mustard
-Adriamyacin -Vincristine -Cold compresses et assess respiratory |
|
|
Prevention of extravasation:
|
***Observe for blood return
|
|
|
Who else is exposed to the chemo?
|
Nurse/family
-all need to know OSHA guidelines for handling et disposing |
|
|
What is usually the reason for limiting the dose of a chemotherapeutic agent?
|
Increased risk of infection et bleeding
|
|
|
How is the renal system effected by chemo?
|
The kidneys can be overloaded by filtering all the trash from the lysis of the tumor.
Can lead to acute renal failure |
|
|
Teaching to prevent knowledge deficit when it comes to the reproductive system et chemo:
|
Teach that they need to bank their sperm et eggs in advance then use BC for 2 yrs after they finish chemo
|
|
|
What's the most common type of bone marrow transplant?
|
Allogenic - infused with bone marrow harvested from a donor/healthy individual
|
|
|
Disadvantage of Allogenic BMT
|
-The donor cells will make new immune cells that attack the recipients body.
***Known as graft vs host disease |
|
|
Required pre-tx for BMT:
|
ablative or nonablative radiation/chemo
|
|
|
Why are BMT's pre-tx w/ chemo/radiation?
|
-make room in the bone marrow for transplanted cells
-suppress the pts immune system -lessen the chance of graft rejection -destroy all of the cancer cells anywhere in the pts body |
|
|
Nursing care for BMT:
|
Watch for graft vs host disease:
-can appear as a rash on the skin -often starts on palms of hands et soles of feet then can spread to other parts of the body |
|
|
If a tumor is expanding et pressing on the spinal cord, what is used to shrink it?
|
Steroids et radioactive therapy
|
|
|
Early s/sx of spinal cord compression:
|
****Back pain that is intense, localized, et persistent that is aggravated by the valsalva maneuver
|
|
|
What is superior vena cava syndrome?
|
Compression or obstruction of the superior vena cava - death may occur if compression is not relieved
|
|
|
Early s/sx of superior vena cava syndrome:
|
-periorbital edema
-facial edema -jugular vein distention ****Earliest symptoms progress to edema of the neck, arms, hands, with difficulty swallowing et SOB |
|
|
What is disseminated intravascular coagulopathy?
|
A severe disorder of coagulation (severe clotting)
***The effected person is often acutely ill et has wide-spread hemorrhaging ***Common bleeding sites: mouth, nose, venous puncture sites |
|
|
S/sx of cardiac tamponade:
Tx: |
***Cough, dysphasia, hiccups, hoarseness
pericardiocentesis or pericardial window |
|
|
What electrolyte imbalance is of concern with cancer pts?
|
Hypercalcemia
>12 produces symptoms s/sx -fatigue -weakness -confusion -constipation -polyuria -polydipsia -dehydration -decreased LOC |
|
|
Nursing intervention for hypercalcemia:
|
Encourage ambulation because immobility can cause an exacerbation
|
|
|
What's tumor lysis syndrome?
|
A syndrome associated with radiation/chemo when there is a rapid destruction of chemo therapy
Release of intracellular contents of dead tumor cells leads to electrolyte imbalances |
|
|
4 cardinal electrolyte imbalances (w/ tumor lysis syndrome):
|
-Increased K
-Decreased Ca -Increased uric acid levels -Increased phosphate levels |
|
|
Cardiac changes from the electrolyte imbalances:
|
Shortened QT complexes et widened QRS - can lead to cardiac arrest
|
|
|
What is the single greatest barrier to effective pain control?
|
Inadequate pain assessment
The nurse needs to determine whether the pain is persistent or breakthrough pain |
|
|
Nursing responsibilities in cancer care:
|
Always maintain hope (not always for cure but for quality of life, decrease pain, peaceful death)
|
|
|
Nurses role with cancer survivors:
|
-encouraging support groups
-promoting health behaviors -encouraging regular f/u exams -teach to look for late effects of tx |
|
|
Side effects of BMT
|
***Low blood pressure
|
|
|
Risk factors for breast cancer:
|
_ Genetics:BRCA-1 or BRCA-2 (also at risk for ovarian cancer)
_ Family History (1st degree relative) _ Early menses (before 12)/late menopause (after 55) _ Preg. after 30y/o; never pregnant _ Weight gain/obesity after menopause (adipose tissue holds estrogen) |
|
|
What's Ductal Carcinoma in Situ (DCIS)?
|
_A proliferation of malignant cells inside the milk ducts that are encapsulated.
Not invasive yet |
|
|
Examples of infiltrating ductal carcinoma:
|
Paget's et Inflammatory breast ca
|
|
|
Paget's:
What is it? S/sx? |
persistent lesions of nipple/areola w/ or w/o palpable mass
s/sx: itching, burning, bloody nipple discharge w/ superficial erosion et ulceration |
|
|
Inflammatory breast ca:
What is it? S/sx? |
most malignant form of breast ca; aggressive/fast-growing
s/sx: skin looks red, feels warm, has thickened appearance that is often described as resembling an orange peel “peau d’ orange”. Caused by ca cells blocking lymph channels |
|
|
What's Infiltrating Lobular carcinoma?
|
-2nd most common type
-NOT a solid mass |
|
|
Questions to ask re: breast assessment:
|
• How long have you noticed the problem?
• How often do you do self-breast exams? • When/if you had a mammogram? • When you started your menstrual cycle • Is your cycle regular? • Do you use hormone replacement? |
|
|
Tx for breast ca:
(other than chemo/rad) |
_ Radical Mastectomy – removal of breast/axillary lymph nodes but preserves pectoral muscle
_ Breast conservation therapy (BCT) – removes entire tumor along with margin of normal tissue |
|
|
How often do they need to f/u after tx?
|
f/u every 6 months x2 years then annually
|
|
|
Risk factors for cervical cancer:
|
_ Sexual activity before age 17
_ Multiple sex partners _ Sex with uncircumcised men |
|
|
Early symptoms for cervical cancer:
|
NONE
Early cervical cancer has no symptoms |
|
|
Prevention of cervical cancer:
|
HPV vaccine: females age 9-26 (3 shots over 6 months)
|
|
|
Who is testicular cancer most common in?
|
Caucasian men b/w 15-40
|
|
|
Clinical manifestations of testicular cancer:
What brings a person into the doctor? |
_ Gradual with a mass or a lump on the testicle (firm, non-tender)
Usually acute pain |
|
|
How often should a testicular self exam be done?
|
1xmonth
|
|
|
When should a person begin testicular self exams?
|
Adolescence
|
|
|
When is it best to preform a testicular self exam?
|
After a warm shower/bath
|
|
|
What's the leading cause of skin cancer?
|
Sun exposure
|
|
|
Basal cell:
|
-Most common, least deadly
-Doesn’t spread beyond skin, if left untreated can lead to massive tissue destruction |
|
|
Squamous cell:
|
o Very aggressive
o Potential to metastasize o Wider, more infiltrated, more inflammation than basal cell o Upper ext. face, lower lip, forehead o 75% of deaths from squamous cell |
|
|
What the most accurate/tissue sparing tx for skin cancer?
|
surgery - removes layer by layer
|
|
|
What's the most lethal form of skin cancer?
|
Malignant melanoma
|
|
|
4 forms of melanoma:
|
1. Superficial
2. Lentigo 3. Nodular – more aggressive/invades rapidly 4. Acral |
|
|
Tx for melanoma:
|
Never should be cauterized; must be incisional
Usually surgery or biopsy but if spread to lymph nodes, chemo required |
|
|
Prognosis w/ melanoma:
|
Melanoma on hand, foot, scalp=better prognosis
If on torso, increased chance of metastasis to bone, liver, lungs, CNS (more common in men et elderly)=poorer prognosis If staged at 0=100% survival Stage 4=palliative |
|
|
Assessment of moles:
|
ABCD of Moles
A = Asymmetry B = Irregular Border C = Variegated Color D = Diameter |
|
|
What is ANC et how do you calculate it?
|
Absolute neutrophil count
Total WBC count x (%segmented neutrophils + bands)/100 ANC<1000cells/mm3 = severe risk - NADIR |
