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98 Cards in this Set
- Front
- Back
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What is cancer ?
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Uncontrolled cell growth w/o physiologic demand.
-genetic mutation of cell DNA -Ignores growth regulation -proliferates abnormally |
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Metastasis
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When the Mutant cells become invasive
-Enter surronding tissue -tavel through lymph and blood vessels |
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Cellular Process Carcinogenesis (Initiation)
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Carcinogen alters structure of the DNA or changes apoptosis
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Cellular Process Carcinogenesis (Promotion)
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Repeated exposure to carcinogen promotes wxpression of mutation w/o regulation
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Cellular Process Carcinogenesis (progession)
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Mutant cell have increased +metastsized
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Tumor suppressor Genes
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-regulate cell growth
-supress growth of tummors -mutantions become inactivated =suprression/ decreased tumor growth |
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BenignTumor
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-Well differentiated
-normally encapsulated -simular to partent cell -rarly occur |
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Malignant Tumor
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-undifferentiated
-invassive -unlike parent cell -frequent recurrence -rarely encapsuled -vasularity -tumor specif antigens |
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Common sites of Metastasis
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-Brain
-Lungs -Liver -Bones VASCULAR !! |
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Four major Types of Cancer
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Carcinoma
sarcoma lymphoma leukemia |
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Carcinoma
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arising from epitheal tissue
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sarcoma
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connective tissue
muscle bone |
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lymphoma
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lymphoid tissue
ex:burkitts lymphoma |
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leukemia
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cancer of blood forming cells in bone marrow
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Warning signs for cancer?
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-bowel /bladder changes
-sore that doesnt heal -unusual bleeding /discharge -thinking/lumps -intergestion/diff swallowing -change in wart /mole -nagging cough/hoarsness |
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A
B SKIN CANCER C Pneumonic D |
Asymmetical
Borders irregular Colors Diameter (larger than 5cm) |
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DX CANCER
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ALWAYS MADE W/ BIOPSY!
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Dignostic plan for cancer
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-complete health hx
-id risk factors -physical exam -dx studies |
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Types of Biopsy
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Fine Needle Aspiration
Large core excisional incisional |
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Managment of care (cancer)
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-Cure: complete eradication
-Control:containment of cancer growth /prolonged survival -Palliation:relief of symptoms |
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Nursing role
Perioperative care |
consider post op risk
-dvt -infection -impaired wound healing -altered pulmonary &renal fun support fam & dishcharge planning |
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cure & control
surgical therapy |
spare normal tissue &remove all or as much as possible affected tissue
= smaller tumor size or completleing gone :) |
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debulking or cytoreduction =?
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when tumor cannot be completly removed :(
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supportive & palliative care
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purpose is to preserve quality of life & supportive care
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examples of palliative care
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-feeding tubes
head and neck ca patients -colostomy rectal assess or obstruction -suprapubic cystosmy prostate ca -reconstructive procedures -laminectomy spinal cord compression relief |
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chemo
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chemicals used to reduce the # of maligment cells in primary metastatic tumors
problem: doesnt kill specific cells |
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chemo combination
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combined w/ radiation and or surg
to -reduce tumor - destroy cells |
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chemo responds well to..
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rapid mitotic rate of tissue
ex leukemia =high proliferative rate -small tumors -younger tumors -location of tumor (blood brain barrier :( ) -presence of resistant tumor cells (mutations in the tumor can lead to resistance) |
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role of chemo
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-CURE
burkitts lymphoma willams tumor testicular -CONTROL breast cancer ovarian ca small lung ca non hogkins lymphoma -PALLIATION relieve pain |
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what kind of cell are more susceptable to chemo?
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activly dividing cells (fast acting ca)
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providing chem
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occupational hazard from exposure ( chemo itself along with body fluids from reciveing patients )
-inhalation -skin contact -chemo guidlines need special training/cert |
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chemo is a ________
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Vesicants
- highly reactive chemicals that combine with proteins, DNA, and other cellular components to result in cellular changes immediately after exposure. |
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Methods of Admin for chemo
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-oral
-IM -IV -intracavity -intravescial -intrathecal -intraarterial (directly into vessel) |
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complications/side effects of
CHEMO |
-toxixity
- damage to underlying nerves,tendons,blood vessels |
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EXTRAVSIATION
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when the chemo causes nectosis and damage to underlying tendons, blood vessels and nerves. can happen when done SQ
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signs of EXTRAVSIATION
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-absence of blood return from intravenus catheter
-resistence to flow of intravenous fluid -swelling pain,redness at the site |
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Gastrointestinal side effects of chemo
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Nausea & vominting
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3 types of Nausea and vomiting
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-anticapatory (thinking bout it/ right before)
-acute (during treatment ) -delayed (after treatment) |
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interventions for nausea & vomiting
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sertonin blockers,dopaminergic blockers,steriods , histamins
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Stomatits,Mucositis and Esophagitis
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Side effects from CHEMo
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Interventions for
Stomatitis mucositis esophagitis |
-keep mouth,lipd moist
-soft tooth brush , non alcholitic mouth washes -magic mouth washes , antiacids topicals aviod : spicy foods,alcohol,hot/cold food |
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Hematoppietic
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side effect of chemo
myelosuppression -depression of bone marrow function =decreased wbc , rbcs & platelets TEACH PT -risk for infection &bleeding Interventions = magic mouth wash malox =coating lidicane = numbing |
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Neutropenia
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side effect of chemo
neutrophills <1000 -NI 2500-5000 white blood cell depression caused by the chemo Neutropenic precuations &diet |
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Neutropenic precuations &diet
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LOOK UP
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Renal complications from CHEMO
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damage due to excretion & accumulation of of uric acid from cell lysis
intracellular contents can be released into blood stream. =eletrolyte imbalnce MONITOR!!! |
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Cardiopulmonary side effects of chemo
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Cardiac & pulmonary toxicity
Monitor ejection fraction/ hrt failure &pulmonary fibrosis |
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Reproductive side effects of Chemo
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-Early menopause
-permanent sterility -Temp or long term testicular low sperm count TEACH PT and Partners |
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Neurological side effects of chemo
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-Peripheral neruopathy
-loss of deep tendon reflex -paralyic illus -hearing loss (can be reversable or goes away after chemo is complete ) |
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Nursing Role for CHEMO PT
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-assess fluid electrolyte status
-modify risk for infection Aseptic technique follow labs teach fam and friends -Carfully admin chemo drug |
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Aseptic Technique
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sterile conditions
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Raditation
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Ionization of atomic particles
Generations of Free Radicals Break chemcal bonds of DNA Cell either dies or renders unable to duplicate = cell death ultimatley |
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Low vs High energy radiation
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Low - penetrates short distances
High -greater depth pentration max does |
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Rapidly proliferating vs slowly proliferating cells
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rapidly: short courses GI/Bone morrow
Slowly: need longer courses cartilage,bone,kidneys |
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Radiation Simulation
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used to ID exact tumor &location size and boundries
-ct MRI,PET, xray, immobiliization devices & tatoos |
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Internal Radiation
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aka Brachytherapy
-implanted into tumor or surronding tissue. -isotopes decay over time -theses pt are emitting radioactivity while device is in place ! good for head ,neck,GYN & prostate |
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Internal radiation precuations / nursing role
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-limit time w pt
-maximize distance -shield self w lead apron during pt contact -limit visitors to 30 min per day 6 feet away -no pregos nurses or visitors |
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Avoid dilodgement while internal radiation
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-Bed rest
-Low residue diet -Foley catherter |
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Side effects of radiation
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- fatigue
-weight loss -tissure fribosis & scaring -dry skin /burning of the skin -w/ EXTERNAL = avoid sun exposure, up to 12 months |
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Long term risks of radiation & chemo
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-increased risk for leukemias and other secondary malifancies
-multipy myeloma -non hodgkins lymphoma - & CA of the bladder ,uterus,scapula etc. |
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Bone marrow Transplant
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-for hempagical cancers
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types of bone marrow transplants
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Allogenic : unrelated donor
Autologous: self Syndergenic : identical twin Stem cells |
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Bone marrow transplant Patient
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Private room
no sick visitors no invasive procedures no fresh flowers or plants only cooked meals bleeding precautions NO TEMP TOLERATED |
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Biologic Respionse Modifers
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natually occuring or recombinant agents that alter the immunologic relationships between cancer cells n caner pt .. activate the immune system
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target therapy
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target specific cellular receptors/pathways to interfer w tumor growth
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Gene therapy
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replace missing /unhealthy genes w healthy ones
done by : transfer of exogenous genes into cllls of patients |
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Complications on CA
Nurtrition |
Malnutrition -comtributes to progession
-assess lytes and lab values -ability to chew / swallow |
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Leading cause of death in CA patients
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INFECTION
always monitor lab Teach |
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Bleeding Risk CA
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bloody stools
dental care mental status changes |
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Oncologic Emergency
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Obstructive
Metabolic Infiltrative |
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Obstructive Emergency
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superier vena cava syndrome (compression of vena cava
facial edema perioblical edema headache seizures |
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Spinal cord compression
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Oncologic Emergency
Tumor in epidural space of spinal cord S/S : intense back pain motor weakness sensory paresthesia n loss change in bladder or bowel functions |
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3rd space syndrome
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shifting of fluid from vascular to interstital space
tachy hypotension Fluid replacement &plasma protein. |
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Metabolic Oncolgic Emergency
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hypercalemia
actue hypercalemia treat w hydration biphosphates diuretics |
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Tumor Lysis syndrome
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Oncolgic Emergency
rapid breakdown of cells causes hypocalemia can cause renal failure ,coma and death |
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four signs of tumor lysis syndrome
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hyperkalemia
hypoxcalemia hyperphsophattemia |
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SAIDH
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syndrome of inappropriate Antidiuretic Hormone Syndrome
abnormal production of antidiertic hormone =water retention &hyponatermia by cancer cells weight gain w/o edema weakness/weight loss Fluid restriction |
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Infiltrative
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oncologic EM
Cardiac Tamponade (fluid accumulation on the pericadal sac or constriction of pericardium by tumor Percarditits s/s heavy chest,sob , tachy., hoarsness, |
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Treatment for Cardiac Tamponade
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Vasopressor
IV hydration o2 |
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Carotid Artery Rupture
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due to invasion of the arterial wall by tumor ,suregy /radiation
most often head/neck CA Treatment = surg |
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Prostate CA
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most common invasion CA for men
slowest -growing CA late onset painful ejactulation weight loss hip pain |
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Prostate CA DX
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DRE Q yr starting @40
PSA Q yr starting @ 50 Dx Biopsy |
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Prostate CA Treatment
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radical prostatectomy
removal of entire prostate gland &seminal vesical & part of bladder neck trouble ejectulating Radiation & chemo |
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Post op postate CA patient
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watch for bright red viscous bleeding w clots : Arterial Bleeding
Treat pain Avoid rectal truma stool softners , low residue diet, nothing in the butt monitor I & 0 |
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Testicular CA
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most common in males 15-34 Curable !!!!
teach self exam normally effect 1 testicle |
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s/s of testicular CA
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lump/enlargment of teste
feeling of heavness dull ach in groin or abdom testes pain |
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Breast CA
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Mass detectable in early stages
-teach importance of screenigns and self breast exams!!! |
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later stage sx of breast ca
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breast pain
dimpling of breast nipple retraction peau d' orange |
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DX of breast ca
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biopsy only way
w/bone scan n MRI |
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Breast Ca Treatment
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surgery, radiation,or chemo
lumpectomy /mastectomy post op radiation/chemo |
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nursing care of post op breast CA pt
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treat pain
evevate extremity on pillow monitor for infection never let arm be dependent no bp on that side monitor for lymphedema (when arm gets extremly swollen) |
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Hodgkins Lymphoma
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peaks in early 20's and after 50
long term serival common |
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s/s od hodgkins lymphoma
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fever, fatiuge , night sweats, coughing, sob ,weight loss
REED -STERNBERG CELLS noted in BIOPSY |
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treatment of hodgkin's lymphoma
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radiation in early stages
chemo w radiation if extensive |
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Non-Hodgkin's lymphoma
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diff from hodgkins
no REED -STERNBERG CELLS can spread to all lymph nodes older 60+ patients more favorable survival |
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non-hodgkins lymphoma
treatment |
chemo
radiation sometimes used |
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Leukemia
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unregulated WBC profliferation in bone marrow
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s/s of leukemia
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frequent infections /cold
decreased platlet functions weight loss headach bone pain &swelling |
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dx of leukemia
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Labs
decreased H/H high WBC Abnormal clotting times BONE MARROW ASPIRATION & BIOPSY DEFINITIVE DX |
