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197 Cards in this Set
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Neoplasia
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an uncontrolled growth of abnormal cells
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Neoplasm
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any abnormal growth of new tissue
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Malignant Neoplasms
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form irrgularly shaped masses with fingerlike projections, usually multiply quickly, and spread to distant body parts through the bloodstream and lymph system
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Four Main Classifications of Cancer According to Tissue Type
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Lymphomas
Leukemias Sarcomas Carcinomas |
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Lymphomas
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cancers occurring in infection-fighting organs, such as lymphatic tissue
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Leukemias
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cancers occurring in blood-forming organs, such as the spleen and bone marrow
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Sarcomas
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cancers occurring in connective tissue, such as bone
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Carcinomas
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cancers occurring in epithelial tissue, such as the skin
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Environmental Risk Factors
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Industrial chemicals such as asbestos or vinyl chlorides
coal, tar, creosote, arsenic compounds, radium |
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It is estimated that _____ of all cancers are associated with environmental exposures and might be prevented if exposure is avoided.
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80%
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Secondhand Smoke
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in 1993 the EPA declared secondhand smoke a human carcinogen - approx 3000 nonsmoking adults die each year of lung cancer from breathing secondhand smoke
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Lifestyle Factors
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use of tobacco, sun exposure, alcohol consumption, diet
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Alcohol is hypothesized to cause ____ of cancer deaths.
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5%
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Breast Cancer Risk Factors
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family history
high-fat diet obesity after menopause early menarche, late menopause alcohol consumption postmenopausal estrogen and progestin first child after age 30 |
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Cervical Cancer Risk Factors
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multiple sexual partners
having sex at early age exposure to hpv smoking |
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Colorectal Cancer Risk Factors
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family history
low-fiber diet history of rectal polyps |
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Esophageal Cancer Risk Factors
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heavy alcohol consumption
smoking |
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Lung Cancer Risk Factors
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cigarette smoking
asbestos, arsenic, and radon exposure secondhand smoke tuberculosis |
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skin cancer risk factors
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excessive exposure to UV radiation
fair complexion work with coal, tar, pitch, or creosote multiple or atypical nevi (males) |
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stomach cancer risk factors
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family history
diet heavy in smoked, pickled, or salted foods |
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testicular cancer risk factors
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undescended testicles
consumption of hormones by mother during pregnancy |
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prostate cancer risk factors
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increasing age
family history diet high in animal fat |
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Genetic risk factors
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linked to breast, leukemia, colon, stomach, prostate, lung and ovary
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Viral risk factors
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Herpes simplex II and some HPV that are transmitted sexually are known to predispose women to cervical cancer
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Detection: checkups
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A cancer checkup is recommended every 3 years for persons 20-39, and annually for those ages 40 and older.
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diagnostic studies
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blood tests
radiologic studies endoscopy biopsy |
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tumor markers
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substances such as specific proteins, antigens, genes, hormones, or enzymes that are found in the serum and indicate the possible presence of malignancy
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CAUTION
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Change in bladder or bowel habits
A sore that does not heal Unusual bleeding or discharge Thickening or the presence of a lump Indigestion or difficulty swallowing Obvious change in wart or mole Nagging cough |
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Differentiation
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acquisition of characteristics or functions different from those of the original
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Well-differentiated
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Tumor cells that retain many of the identifiable tissue characteristics of the original cell are termed well-differentiated
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Undifferentiated
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Tumor cells having little similarity to the tissue of origin are termed undifferentiated.
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Grading evaluates tumor cells in comparison with ____ _____.
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normal cells
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Grading
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I-IV: the higher the grade the higher the number and the worse the prognosis. A grade I tumor is the most differentiated, and a grade IV tumor is the most undifferentiated.
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Tumors containing poorly differentiated cells are more _________ in growth and may display uncharacteristic behaviors, leading to a poorer _________.
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aggressive, prognosis
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Treatment Modalities
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surgery
radiation chemotherapy biotherapy/immunotherapy hormone therapy targeted therapy photodynamic therapy bone marrow transplantation |
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Acid Phosphatase
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prostate ca
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Alkaline Phosphatase
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liver ca
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Bence Jones Protein
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multiple myeloma
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CA-15-3
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breast ca
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CA-19-9
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pancreatic carcinoma
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CA-125
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ovarian ca
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CEA
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colorectal cancer
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PSA
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prostate ca
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calcitonin
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thyroid ca
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Radiotherapy (radiation therapy)
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uses high-energy ionizing radiation to kill cancer - goal is to eradicate malignant cells without causing harm to healthy tissues
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adenoma
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glandular tissue
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angioma
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blood vessels
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chondroma
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connective tissues
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lipoma
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fatty tissues
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myoma
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muscle tissue
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nevus
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skin
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osteoma
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bone
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benign
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well-differentiated, encapsulated, grow slowly, do not metastasis, no recurrence after removal, favorable prognosis unless interferes with vital organ functions, removed surgically, may become malignant
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malignant
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irregular shaped masses with finger-like projections that infiltrate and destroy surrounding tissues, large irregular nucleus, undifferentiated, multiply quickly, rate of growth variable r/t level of differentiation
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cell proliferation
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generally undetectable until has doubled 30 times and contains 1 billion cells, about 1 cm in size.
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Liver Cancer Risk Factors
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alcohol consumption
hepatitis infections |
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Pancreatic CA Risk Factors
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sudden onset IDDM
Hx of pancreatitis alcohol consumption |
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Early Detection: Breast
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monthly breast exam
yearly exam by clinician > 40 baseline mammogram at 35 yearly mammogram > 40 |
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Early Detection: Lung
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emphasis on no smoking or quitting
yearly cxr |
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Early Detection: Colorectal
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annual rectal exam > 40
Sigmoidoscopy/BE > 50 3-5 yr annual stool guaic > 50 |
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Early Detection: Cervical
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Pap smear annually for all women over 20, or sexually active
Pap smear if acquires any other sexually transmitted dz |
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Early Detection: Oral
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dental exams every 6-12 mo
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Early Detection: Skin
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skin mapping
monthly skin assessments |
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Staging
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determines the extent of spread of CA
TNM system is currently used for solid tumors this system aids in tx planning, give prognosis info, assist in tx evals, and to facilitate the exchange of info between tx centers |
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Staging: T
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Anatomical size of tumor
T0 - no evidence of primary tumor TIS - tumor is in situ/carcinoma in situ TI, T2, T3, T4 - progressive increase in tumor size and involvement TX - tumor cannot be assessed |
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Staging: N
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extent of lymph node involvement
N0 - regional lymph nodes show no abnormaltiy N1, N2, N3 - increasing degrees of lymph node involvement of regional nodes NX - regional lymph nodes can not be assessed |
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Staging: M
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Presence or absence of metastasis
M0 - no evidence of distant metastasis M1 - distant metastasis present |
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Stage 1
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T1, N0, M0 - clinical exam reveals a mass limited to the organ of origin. Lesion is operable and resectable with only local involvement, no nodal or vascular spread, best chance of survival 70-90%
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Stage 2
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T2, N1, M0 - clinical exam reveals local spread to surrounding tissue and first station lymph nodes. Lesion is operable and resectable but because of greater local extent, there is uncertainty as to t completeness of removal. Specimen shows evidence of microinvasion into the capsule and lymphatics.
Good chance of survival: 50% = or -5% |
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Stage 3
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T3, N2, M0 - clinical exam reveals extensive primary tumor with fixation to a deeper structure, bone invasion, and lymph nodes. Lesion is operable but not resectable and gross disease will be left behind.
Poor chance of survival: 20% = or - 5% |
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Stage 4
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T4, N3, M1 - evidence of distant metastasis beyond the site of origin. Lesion may be inoperable, is non-resectable. Little or no chance of survival. < 5%
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Internal radiation
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isotopes may be introduced into the body by sealed or unsealed sources. 3 factors that will decrease their degree of exposure:
time, distance, shielding |
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factors affecting response to chemo
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Stage
Site Sensitivity of tumor activity of drug schedule of tx prior tx performance status concurrent organ dysfunction severe side effects poor nutritional status |
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Chemo response
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disappearance of s/s in 4 weeks
partial - 50% reduction in 1 mo, no increase in size or lesions stable - < 50% reduction in size, no progressive lesions progressive - > 50% increase in size |
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Antimetabolites
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interfere with the s phase of dns synthesis, interferes with metabolism of certain chemicals essential for well being of the cell, most effective in cells that are reproduced quickly
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ex 5Fu, methotrexate
SE: bone marrow depression, stomatitis |
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Alkylating Agents
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disrupts cell nucleus, damages already formed DNA, interferes with division, action not limited to synthesis or reproducing stage of cells so action is effective in treating slow growing tumors as well as rapid growing tumors
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ex cytoxan, mustargen, cisplatin
SE: bone marrow depression, N/V, diarrhea, alopecia |
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Antibiotic Agents
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inhibit DNA synthesis, too toxic for treating bacterial infections but proved to be more damaging to cancer cells than to normal tissue
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Ex bleomycin, adriamycin, dactinomycin
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Alkaloid Agents
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alkaloids - interfere with mitotic spindle formation - lose ability to divide
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ex vincristine, vinblastine, VP16
SE: neurtoxicity |
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Hormones
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certain hormonal environments favor growth of tumors, so hormones are given which antagonize the hormone that stimulates growth - deprive the cell to decrease growth fraction and block receptor proteins
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ex estrogens for prostate ca, androgens for breast ca (prednisone??)
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Biological response modifiers - Biotherapy
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biologic response modifiers which stimulate body's natural immune system
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ex interferon, monoclonal antibodies, interleukin-2, tumor necrosis factor, bacillus calmette-guerin (BCG), and colony stimulating factor
SE: fever, malaise, myalgia, HA, anaphylaxis |
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Nursing Care for Chemo
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observe and report symptoms of toxicity, protective isolation r/t lowered resistance, specialized mouth care, skin care, hi cal, hi protein, hi fluid diet, change position, I&O, monitor for extravasation
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extravasation
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s/s - pain, swelling, redness, vesicles, absent or sluggish blood return, diffuse hardening
tx - d/c med and follow protocol |
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Biotherapy
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BRM - agents that stimulate the body's natural immune system to control or destroy malignant cells
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Bone Marrow Transplant
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used for ca that respond to high doses of chemo or radiation therapy
tx: aspirating and storing a fraction of bone marrow, exposing client to high dose radiation or high dose drug therapy, reinfusion of bone marrow after tx length of stay: 35-40 days |
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Bone Marrow may be:
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autologous - self
syngeneic - identical twin allogenic - histocompatible donor, preferably a sibling |
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Bone Marrow Transplant complications
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infection
bleeding GI effects renal insufficiency veno-occlusive dz - deposits of fibrin obstruct venules of liver graft v host dz - new bone marrow cells recognize environment as foreign and try to destroy host |
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Symptom management of bone marrow dysfunction
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tx kills bone marrow cells
decreased WBC increases risk for infection tx: reverse isolation if neutrophils <500 Handwashing (antimicrobial soap) VS q4h decreased platelets tx: assess skin dly, stool and urine electric razor only, soft toothbrush, no ASA products, assess puncture sites and apply pressure x5 min |
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Nadir Period
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lowest point after immunosuppression caused by chemo - 7-10 days post
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Cachexia
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protein wasting secondary to malnutrition
tx - assess weight loss > 10%, serum alb < 3.4g/dl megace to increase appetite nutrient supplements QID and nutrient dense foods multivitamins TPN |
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Anorexia
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tx: small frequent meals of hi cal, highly seasoned
eat when feeling best N/V - 3-4 hr after chemo lasts 72 hrs tx: antiemetics before chemo zoftan/anzemet small frequent meals complex CHO liquids 30-60 min ac cool, bland foods oral care avoid strong odors plastic eating utensils |
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Mucosal Inflammation - Stomatitis
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7-14 days after chemo, lasts 2-3 weeks
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Stomatitis N.I.
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assess for early s/s of edema, ulceration, erythema, increased salivation
oral care QID avoid rough, chewy foods popsicles avoid mouthwashes, use NS |
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Dysphagia N.I.
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artificial saliva
soft or pureed diet |
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Pain
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usually advanced stage r/t metastatic bone disease, venous or lymphatic obstruction or nerve compression
affects ADLs, sleep, relationships tx: noninvasive: TENS, relaxation techniques, guided imagery transdermal patches PCA nonopioids first, then opioids given round the clock or PRN |
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Fatigue
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R/T tx and anemia, pain, lack of rest
tx: frequent rest periods |
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Pathological fx
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major problem of ca with mets to bone
normal activities can cause painful breaks |
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ascities
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abd ca
tx: paracentesis |
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Hypercalcemia
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found in bone mets
serum calcium > 10.5 mg/dl s/s: N/V, constipation, weakness, dehydration, renal failure, coma rx: IV NS, Lasix |
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Spinal Cord Compression
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increase risk with lung, breast, prostate ca
s/s: back pain increased by lying down, cough tx: decrease tumor size by radiation, surgery, steroids |
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Superior Vena Cava Syndrome
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sx r/t superior vena cava obstruction
dyspnea, swelling of face/neck, edema of the upper extremities, chest pain, cough tx: decrease tumor size by radiation, surgery diuretics, O2 |
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Cardiac Tamponade
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increased pericardial fluid cases decreased cardiac output
s/s: tachy, JVD, ankle/sacral edema, pleural effusion, ascites, lethargy tx: pericardiocentesis |
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Psychosocial Alterations
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each client responds differently to dx, depending on coping mechanisms and support system
CA affects client's family as well issues include loss of control, changes in body image, and financial burdens Touch often most comforting intervention |
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HM - Leukemia
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neoplastic proliferation of white blood cells originating in hematopoietic stem cells
increased number of immature, abnormal WBCs; decreased number of RBCs, Hgb, Platelets |
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HM - Lymphoma
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Neoplasms of lymphoid tissue
Hodgkin's accounts for 40% |
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Treatment goals for leukemia and lymphoma
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slow growth of malignant cells
maintain normal RBC, Hgb, platelets manage symptoms |
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Leukemia
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unregulated proliferation of white cells in bone marrow replacing normal marrow elements
proliferates in liver, spleen, lymph nodes invasion in: meninges, GI tract, kidney skin classified according to cell line involved (lymphocytic or myelocytic) and maturity of malignant cells (acute - immature or chronic - differentiated) etiology unknown |
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Acute Myelogenous Leukemia
AML |
affects the hematopoietic stem cells that differentiate into myeloid cells (monocytes, granulocytes, erythrocytes, platelets)
usually occurs in adolescence and > 55 yrs prognosis: with chemo complete remission in 50-75% |
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S/S AML
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evolve from insufficient production of normal blood cells
vulnerability to infection weakness, fatigue, tachy, dyspnea secondary to anemia thrombocytopenia purpura, petechiae, bleeding from mm pain from enlarged liver or spleen lymphadenopathy HA or vomiting secondary to meningeal leukemia bone pain secondary to expansion of marrow |
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DX AML
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CBC
Bone Marrow Bx LP xray, ct, mri |
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TX AML
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bone marrow transplant
chemo peripheral blood stem cell transplant |
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Chronic Leukemia
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occurs in adults with a gradual increase in WBC over months to years
increased number of abnormal B lymphocytes, WBC >20,000 possible genetic link: Philadelphia chromosome tx: chemo, high protein, CHO, vitamin, bland, nonirritating diet |
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Hodgkin's Disease
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rare lymphoma usually arising as painless swelling in lymph nodes
s/s: painless, enlarged nodes in neck groin or above clavicles, weight loss, fatigue, pruritus, recurrent high fever, night sweats, anemia, thrombocytopenia, and susceptibility to infection tx: radiation, chemo, surgery, diet changes |
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Non-Hodgkin's Lymphoma
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enlarged, painless nodes in neck, axillary, abdominal, and inguinal areas, fever, night sweats, excessive tiredness, indigestion, abdominal pain, loss of appetite, and bone pain
tx: chemo, radiation, and bone marrow or peripheral blood stem cell transplant |
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Myeloma
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plasma cells become malignant, crowd out normal cell production, destroy normal bone tissue, and cause pain
s/s: bone pain, swollen and tender joints, low-grade fever, and general malaise not curable tx: symptomatic |
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Anemias
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abnormality in the number and characteristics of RBCs, insufficient number of RBCs to meet tissue demand for oxygen
RBCs normally survive 2-3 months and are destroyed in the liver, spleen, bone marrow |
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Impaired production of RBCs
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Bone marrow injury
vit b12 deficiency folic acid deficiency iron deficiency |
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RBCs destroyed faster than produced
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infection
abnormal RBC (sickle-cell) chemicals |
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Loss of blood (anemias)
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trauma
ulcers |
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Aplastic Anemia
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failure of bone marrow to produce RBCs in adequate numbers
causes: meds, leukemia |
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Aplastic Anemia DX
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bone marrow aspiration
history CBC showing leukopenia, thrombocytopenia, anemia |
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Aplastic Anemia assessment
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fatigue, weight loss, dyspnea on exertion, lowered resistance, bleeding tendency, pallor, anorexia, HA, fever, bleeding from MM
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Aplastic Anemia tx
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remove cause
blood transfusion bone marrow transplant protective isolation |
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Iron Deficiency Anemia
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failure to ingest or absorb dietary iron resulting in defective formation of RBCs
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Iron Def. Anemia dx
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decrease in erythrocyte count, Hgb, Hct
decrease in iron stores Microcytic, hypochromic RBCs serum iron |
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Iron Def. Anemia assessment
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fatigue, anorexia
pallor dyspnea on exertion tachy stomatitis dry skin numbness and tingling |
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Iron Def. Anemia tx
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determine cause
oral Fe, give through straw if liquid parenteral Fe, give Z-Track method increase iron containing foods cook with iron skillet |
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Pernicious Anemia
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inadequate production of RBCs and Hgb related to lack of intrinsic factor
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Pernicious Anemia Dx
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gastric analysis - no HCl acid
Schilling - radioactive B12 given orally, 24 hour urine begun, B12 IM to saturate liver so radoactive B12 will be excreted in urine decreased RBC Bilirubin increased r/t hemolysis of defective RBCs |
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Pernicious Anemia assessment
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tiredness, glossitis, stomatitis, diarrhea, indigestion, bloating, weakness, dyspnea, faintness, pallor, numbness and tingling, apathy, dullness, irritability, jaundice
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Pernicious Anemia tx
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vit B12 IM
increase iron, protein, vitamin diet bedrest until RBC normal turn, skin care |
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Folic Acid Def.
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seen in decrease on intake of raw fruits and vegies
dx: anemia present, decreased serum folate level |
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Folate Def. assessment
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severe fatigue
sore tongue dyspnea anorexia, nausea HA weakness |
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Folate Def. tx
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folic acid 1 mg daily
vit c diet high in iron, protein, vitamins |
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Sickle Cell Anemia
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hereditary form of hemolytic anemia. seen in blacks, Mediterranean, arab countries
inherited from each parent, autosomal recessive trait |
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sickle cell dx
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sickledex
hemoglobin electrophoresis |
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sickle cell assessment
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stress trigger crisis
rbcs become sickle shaped and do not flow smoothly causing blockages of blood vessels leading to ischemia and infarction affects spleen, kidney, heart, lungs, brain, joints, and bones abnormal pain muscular and joint pain prone to stasis ulcers juandice tachy dyspnea cardiomegaly arrhythmias |
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sickle cell tx
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avoid infections, stressful situations
bedrest during crisis analgesics, warm compresses, blankets increase fluids, I&O oxygen steroids skin care transfusions in severe, complicated anemia |
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Malaria
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protozoa damages erythrocytes and causes anemia
transmission by mosquito Dx: blood test |
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Malaria assessment
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fever at regular intervals
chills HA N/V Anemia spleen enlargement |
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Malaria tx
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antimalarial meds
antipyretics analgesics prevention (nets) |
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Polycythemia Vera
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abnormal increase in production of rbc, wbc, plateles of unknown cause
increases the viscosity and volume of blood leading to thrombi |
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Polycythemia dx/assessment
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dx: increased wbc and rbc
insidious onset, prolonged course HA, fatigue, HTN, pedal edema, dizziness, dyspnea, numbness and tingling, visual disturbances, rubor to cyanosis, pruritus |
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polycythemia tx
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phlebotomy of 500mL
antineoplastic - leukeran to decrease bone marrow activity low dose ASA hydroxyurea reduced H&H and plt counts zyloprim to decrease uric acid production interferon alfa high calorie, high protein, low sodium, iron containing foods avoided ambulate increase fluids I&O |
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polycythemia complications
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gout
CHF HTN peptic ulcer Hemorrhage Infarctions |
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Agranulocytosis
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reduced number of granulocytes
s/s: HA, fever, chills, fatigue, mm ulcerations, and low wbcs treat to remove cause of bone marrow suppression or prevention of infection, transfusions, neupogen, and antibiotics |
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DIC
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syndrome of alternation clotting and hemorrhaging due to primary disease process or condition
suspect with predisposing illness and onset of purpura, bleeding, and renal impairment s/s: oozing from venipuncture, mm, and wound tx: resolve cause, blood products, medications |
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Hemophilia
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inherited bleeding disorder
lack of clotting factors s/s: hemarthrosis, pain, swelling, redness, and fever complication: intracranial hemorrhage tx: replacement of missing clotting factors |
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thrombocytopenia
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decrease in number of platelets in blood
s/s: petechiae, ecchymoses, and bleeding from mm tx: transfusion of platelets, apheresis, splenectomy, medications, and diet changes. |
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Peds
Dehydration |
when dehydration occurs extracellular volume decreases causing decreased tissue perfusion and impaired renal function and may result in acid-base imbalances and electrolyte alteration
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Mild fluid loss
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loss of less than 3-5% of body weight
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moderate fluid loss
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loss between 6-9% of body weight
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severe dehydration
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loss is more than 10% of body weight
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Isotonic fluid loss
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equal amounts H2O and Na
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Hypotonic fluid loss
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more electrolytes than H2O are lost
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Hypertonic fluid loss
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more H2O than electrolytes
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S/S dehydration mild-moderate
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lack of tears, dry mm, decreased skin turgor, pale or mottled color, decreased urinary output
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S/S dehydration severe
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tachycardia, decreased BP, sunken eyes, depressed anterior fontanel
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dehydration tx
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replace and restore normal fluid and lyte balance, correct acid-base imbalance, meet nutritional needs
oral rehydration and/or IV fluids monitor for change in color, increased pulse, decrease in urine output, decreased or low BP (perfusion difficulties) teach parents s/s offer 1-3 tsp of fluids every 10-15 min weight diapers, keep I&O |
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Idiopathic Thrombocytopenic Purpura
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Hemorrhagic disorder resulting from increased plt destruction by the immune system characterized by decrease in number of plts
Usually occurs after viral illness such as rubella or chicken pox antibodies seem to be responsible for plt destruction in several patients |
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ITP s/s
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occurs in children 2-8 yo
commonly follows URI or childhood communicable disease easy bruising, petechiae, ecchymosis bleeding from mm |
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ITP management
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restrict activity
admin of corticosteroids for high risk admin RBCs for blood loss admin of gamma globulin (increases plt count) splenectomy r/t being primary site for plt destruction pt and family instruction |
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Hemophilia
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group of bleeding disorders when one of the factors for blood clotting is deficient
A - classic - deficiency of factor VIII B - Christmas disease - deficiency of factor IX - x linked genetic defect |
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Hemophilia s/s
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prolonged bleeding from anywhere in the body
prolonged bleeding from trauma excessive bruising |
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Hemophilia management
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replace missing blood factor
prevent chronic crippling effects of joint bleeding with corticosteroids or APAP, cold compresses to joints genetic counseling, teaching |
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Pediatric CA - most common
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brain, optic nerve, usually gliomas, often fast-growing and inoperable, kidney, adrenal glands, bones, CNS structures
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Pediatric CA - not common
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Hodgkin's, lymphosarcoma, sarcoma (osteogenic sarcoma)
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pediatric ca tx
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surgery, chemo, radiation, bone marrow transplant
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S/E r/t chemo - peds
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myelosuppression - transient decrease in blood cell production
anemia, neutropenia, immunosuppression |
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ped nadir period
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10-14 days
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S/E r/t chemo 2 - peds
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stomatitis
N/V/D weight loss elevated liver enzymes hemorrhagic cystitis alopecia, vesicants cause irritation may extravasate oligomenorrhea, possible sterility |
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Cancer cells are most sensitive to chemo when _______ _______.
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dividing rapidly
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cell-cycle specific antineoplastics
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drug is toxic when the cell is in a specific phase of growth
malignancies most susceptible to chemo are those that proliferate rapidly |
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cell-cycle nonspecific antineoplastics
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drugs are active throughout the cell cycle
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chemo is most effective when tumor is _____ and cell replication is ______.
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small, rapid
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larger tumors and antineoplastics
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as tumor enlarges, more cells go into resting phase - these cells respond better to phase-non-specific chemo agents
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what is the best therapeutic tx?
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Combination Therapy -
surgery, radiation, chemo, and immunotherapy |
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choice of drug depends on (3)
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type of tumor cells
their rate of growth size of tumor |
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what special directions for preparing to administer cisplatin?
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wear disposable plastic gloves
prevent spilling *no aluminum* |
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Oral antineoplastics must be taken _____
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on an empty stomach
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tx r/t chemo spill
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do not enter room w/o PPE on
ask caregivers to leave room and have pt cover mouth and close eyes locate chemo spill kit |
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Infiltration/Extravasation
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TURN OFF INFUSION
apply ice immediately obtain injectable medicine per protocol |
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chemo cannot be given (2)
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through small peripheral vein
by gravity - must be on a pump |
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alkylating agents
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cell-cycle nonspecific capable of combining with cellular components at any phase
usually development of resistance to one causes cross-resistance Cisplatin Nitrogen Mustard used for sarcomas, lymphomas, leukemias |
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antimetabolites
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cell-cycle specific
5fu used for leukemia, osteogenic sarcoma, squamous cell ca, breast ca, and genital area cas |
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Natural Products
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cell-cycle specific
Vinca Alkaloids vincristine and vinblastine are natural derivatives of periwinkle plant used for leukemias, hodgkins dz, lymphomas, sarcomas |
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antibiotics
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cell-cycle specific
adriamycin used for sarcomas, hodkins, lymphomas, tumors of head and testicles |
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steroids
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corticosteroids beneficial in tx of lymphomas and acute leukemia b/c of ability to suppress lymphocytes
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hormones
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estrogens for male ca (prostate) causes regresssion in primary tumor and metastases
androgens for metastatic breast ca |
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interferons
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act as a biological response modifier - affects cell proliferation and other cell functions and immune system response, antiviral action
leukemia & lymphomas resistant to standard tx |
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Taxol (paclitaxel)
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comes from bark of western yew, structurally different from antineoplastics, used for metastatic breast or ovarian ca that is refractory to conventional chemo
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radioactive isotopes
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radioactive material injected into affected site (ie thyroid) IV or PO. Putting seeds in prostate.
special precautions are taken to prevent worker exposure |
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alopecia
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about 2nd week - 10-21 days after tx cycle is complete
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neutropenia
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report fever of 100.4 or higher
cough, sore throat, chills, freq urination WBC less than 2000 tx: Neupogen education: no fresh foods no free standing water in containers (denture cups) humidifiers avoid pets, immunizations teach strict aseptic technique |
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thrombocytopenia
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plts below 100,000
s/s: bruising, hematuria, epistaxis, coffee ground emesis, excessive or prolonged menstrual flow avoid injections electric razors, avoid nail trimmers, dental floss, firm toothbrushes no ASA products report: bleeding gums, easy bruising, increased menstrual bleeding, tarry stools, coffee ground emesis |
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anemia
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fatigue, dizziness, shortness of breath and palpitations
may need transfusion tx: epogen, erthropoietin, procrit |
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transfusion rxn
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fever, chills, back pain
temp increases .5 -1 degree STOP BLOOD |
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stomatitis
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may occur 5-7 days after admin and continue up to 10 days after tx
report white patches on tongue, throat, or gums oral care q4h w NS viscous lidocaine or MUR assess gag reflex |
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