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172 Cards in this Set

  • Front
  • Back
A group of more than 200 diseases characterized by uncontrolled and unregulated growth of cells:
-Cancer
At what age are the majority (76%) of cancers cases diagnosed?
-Those over the age of 55; though cancer can occur at any age
Overall since 1992, have cancer incidence rates been:
a) increasing
b) decreasing
c) stable
c) stable
The incidence of this cancer is rising faster than any other malignancy in the U.S., which is a combined result of genetic predisposition and sun exposure:
-Melanoma
Cancer is still the ______ most common cause of death in the U.S.
-second
In people less than 85 years of age, this is the leading cause of death:
-Cancer
Of which ethnicity is both cancer incidence and death rate the highest?
-African Americans (Whites have the second highest)
Differences in survival from cancer are attributed primarily to a combination of several factors, name those:
-Poverty
-Difficult access to poorer quality of health care
-More comorbid conditions
-Differences in tumor biology
This ethnicity is more likely to present with later stage disease than whites.
-African Americans
Male African Americans have a 25% higher incidence rate and 43% higher death rate than whites
-ignore this side
What is the 5-year survival rate?
-65% (an 11% gain over the past 20 years), including those who are disease free, in remission, or undergoing treatment
What is the cancer with the highest death rate among women?
-Lung Cancer
What is the cancer with the highest death rate among men?
-Lung Cancer (rate is higher among men than women)
Cancer with the highest incidence among men is:
-Prostate cancer
Cancer with the highest incidence among women is:
-Breast cancer
-Cellular Growth
-Proliferation
The stem cells of a particular tissue will ultimately differentiate and become mature, functioning cells of that tissue and only that tissue:
-Predetermined
The time from when a cell enters the cell cycle to when the cell divides into two identical cells:
-Generation time of the cell
When is the process of cellular division and proliferation activated?
-In the presence of cellular degeneration or death
-If the body has a physiologic need for more cells (WBC at time of infection)
Normal cells respect the boundaries and territory of the cells surrounding them.
-Contact inhibition
Cells are not in the process of cellular division are in the:
-Resting phase
True or False:
-The rate of normal cellular proliferation differs in each body tissue.
-True:
in some tissue such as bone marrow, hair follicles, and epithelial lining of the GI tract, the proliferation rate is rapid; in other tissues such as the myocardium and cartilage, proliferation does not occur or is slow
True or False:
Cancer cells usually proliferate at the same rate as normal cells of the tissue from which they arise.
-True:
However, cancer cells divide indiscriminately and haphazardly. Sometimes they produce more than to cells at the time of mitosis.
The DNA of the stem cell is substituted or permanently rearranged. When this happens, the stem cell is mutated and one of three things can occur. Name those:
1. the cell can die, either from the damage resulting from the mutation or by initiating apoptosis (programmed cellular suicide)
2. the cell can recognize the damage and repair itself
3. the mutated cell can survive and pass along the damage to its daughter cells
True or False:
The rate of proliferation is more rapid than that of any normal body cell.
False:
In most situations, cancer cells proliferate at the same rate as the normal cells of the tissue from which they originate. The difference is that proliferation of the cancer cells is indiscriminate and continuous. (pyramid effect)
The time required for a tumor mass to double in size is known as its:
-Doubling time
Normally an orderly process that progresses from a state of immaturity to a state of maturity; there is a stable and orderly phasing out of cellular potential:
-Cellular differentiation

-as cells differentiate, the potential to perform all body functions is repressed and the mature cell is capable of performing only specific function
Normal cellular genes that promote growth; affected by mutation; described as the genetic lock that keeps the cell in its mature functioning state; exposure to carcinogens or oncogenic viruses "unlocks" genetic alterations and mutation occurs:
-Protooncogenes
Tumor-inducing genes; interfere with normal cell expression under some conditions, causing the cell to become malignant:
-Oncogenes
Function to regulate growth (suppresses); mutation render them inactive, resulting in a loss of their tumor-suppressing action; increases a person's risk for breast and ovarian cancer:
-Tumor suppressor genes
Tumors in this classification are well differentiated, usually encapsulated, have absent metastasis, rare recurrence, slight vascularity, expansive mode of growth, and cell characteristics are fairly normal; similar to parent cells:
-Benign Neoplasms
Tumors in this classification are poorly differentiated, capable of metastasizing, possible recurrence, moderate to marked vascularity, infiltrative and expansive mode of growth, and cell characteristics are abnormal, become more unlike parent cells:
-Malignant Neoplasms
Cancer cells may display altered cell surface antigens as a result of malignant transformation; immune system is to respond to these:
-Tumor-associated antigens (TAAs)
The response of the immune system to antigens of the malignant cells:
-Immunologic surveillance
This cell continually check cell surface antigens and detect and destroy cells with abnormal or altered antigenic determinants:
-Lymphocytes
These cells are thought to play a dominant role in resisting tumor growth; capable of killing tumor cells; important in the production of cytokines (interleukins and interferon) which stimulate T cells, NK cells, B cells, and macrophages:
-Cytotoxic T cells
These cells are able to directly lyse tumor cells spontaneously without any prior sensitization; stimulated by interferon and interleukins resulting in increased cytotoxic activity:
-Natural Killer Cells
These cells can be activated by interferon to become nonspecifically lytic for tumor cells; also secrete cytokines which stimulates T lymph activation and production; perform phagocytosis; processing of target cells:
-Macrophages
These cells can produce specific antibodies that bind to tumor cells and can kill these cells by complement fixation and lysis; detectable in the serum and saliva of the patient:
-B lymphocytes
The process by which cancer cells evade the immune system:
-Immunologic Escape
A type of tumor antigens found on both the surfaces and the inside of cancer cells, as well as fetal cells:
-Oncofetal antigens
The first phase of cancer development is a mutation in the cell's genetic structure resulting from an inherited mutation or following exposure to a chemical, radiation, or viral agent; has the potential for developing into a clone, group of identical cells, of neoplastic cells; irreversible:
-Initiation Phase
Is an initiated cell a tumor cell? Why or why not?
-No; because it has not est the ability to self-replicate and grow
Cancer-causing agents capable of producing cellular alterations:
-Carcinogens
True or False:
Many carcinogens are detoxified by protective enzymes and are harmlessly excreted.
-True
What happens if protective enzymes fail to detoxify carcinogens?
-Carcinogens are able to enter the cell's nucleus and alter DNA. The cell may die or repair itself, but if this does not occur before cell division, the cell will replicate into daughter cells, each with the same genetic alterations.
Name 4 causative factors surrounding the development of cancer:
1. Chemical carcinogens
2. Radiation
3. Viral carcinogens
4. Genetic susceptibility
The second phase of cancer development is characterized by the reversible proliferation of the altered cells; the likelihood of additional mutations is increased; the odds of cancer development are increased with the presence of these agents; is reversible; changing a person's lifestyle to modify these risk factors can reduce the chance of cancer development (prevention is key):
-Promotion Phase
This risk factor is an example of a complete carcinogen capable of initiating and promoting cancer.
-Cigarette Smoking
A period of time, ranging from 1-40 years, elapses between the initial genetic alteration and the actual clinical evidence of cancer is called:
-Latent period
These two factors are associated with the variation in the length of time that elapses before the cancer becomes clinically evident.
1. Mitotic rate of the tissue of the organ
2. Environmental factors
The final phase in the natural history of a cancer; characterized by increased growth rate of the tumor, increased invasiveness, and the spread of the cancer to a distant site (metastasis):
-Progression Phase
Name the most frequent sites of metastasis (5 of them):
1. lungs
2. brain
3. bone
4. liver
5. adrenal glands
The process of the formation of blood vessels within the tumor its; facilitated by factors produced by the cancer cells; own blood supply is critical to its survival and growth:
-Tumor Angiogenesis (a tributes to the rapid growth of metastasis)
A family of enzymes produced by cancer cells that are capable of destroying the basement membrane not only of the tumor itself, but also of lymph and blood vessels, muscles, nerves, and most epithelial boundaries:
-Metalloproteinase enzymes (metastasis process)
Involves several steps beginning with the penetration of blood vessels by primary tumor cells via the release of metalloproteinase enzymes:
-Hematogenous metastasis
The growth and development of a tumor is facilitated by the ability of the tumors cells to:
-Evade cells of the immune system
-To produce a vascular supply within the metastatic site similar to that developed in the primary tumor site
Describe the nurses' role in the prevention of cancer:
-Teaching approaches to minimize anxiety and address the special needs of the learner or group are preferable
-The goal of public education is to motivate learners to change their negative health behavior patterns to achieve and maintain an optimal state of health.
-Nurses have a definite impact in persuading people that a change in lifestyle patterns can have a positive influence on their health.
Describe the nurses' role in the diagnosis of cancer:
-The nurse should be available to actively listen to the patient's concerns and skilled in techniques that will engage the patient and the family members or significant others in discussion about their cancer-related fears.
-Correcting misconceptions
-Nurses should also learn to recognize their own discomfort when faced with discussion about cancer.
-Avoid false reassurance, generalizing, and redirecting the discussion.
-Explanations should be included as much info as needed by the pt and the family; should be given in clear, understandable terms and reinforced as necessary (i.e. written material)
-Realize pt may need repeated explanations regarding diagnostic workup
This procedure is the only definitive means of diagnosing cancer and, as such, is essential in planning a treatment regimen for the patient; will determine whether the tissue is benign or malignant, the anatomic tissue from which the tumor arises, and the degree of cellular differentiation of the cancer cells present in the tumor:
-Biopsy
This procedure is used to obtain cells and tissue fragments through a large-bore needle that is guided into the tissue in question; cytologic analysis is then performed to determine the presence of tumor:
-Needle or aspiration biopsy
This procedure is performed with a scalpel or dermal punch, is a common technique used for obtaining a tissue sample for making a diagnosis of cancer:
-Incisional biopsy
This procedure involves the removal of the entire tumor; used for small tumors (<2 cm), skin lesions, intestinal polyps, and breast masses; can be considered therapeutic as well as diagnostic:
-Excisional biopsy
What does CAUTION stand for?
-C hange in bowel or bladder habits
-A sore that does not heal
-U nusual bleeding or discharge
-T hickening or a lump in breast/elsewhere
-I ndigestion or difficulty in swallowing
-O bvious change in a wart or mole
-N agging cough or hoarseness
In the lymphatic system, tumor cells may be "trapped" in the first lymph node confronted or they may bypass regional lymph nodes and travel to more distant lymph nodes, a phenomenon known as:
-Skip metastasis
Tumor classification systems are intended to provide a standardized way to:
1.) communicate the status of the cancer to all members of the health care team
2.) assist in determining the most effective treatment plan
3.) evaluate the treatment plan
4.) serve as a factor in determining the prognosis
5.) compare like groups for statistical purposes
In the _______ _______ of tumors, the tumor is identified by the tissue of origin, the anatomic site, and the behavior of the tumor.
-Anatomic classification
Originates from embryonal ectoderm (skin and glands) and endoderm (mucous membrane linings of the respiratory tract, GI tract, and GU tract)
-Carcinomas
Originate from embryonal mesoderm (connective tissue, muscle, bone, and fat)
-Sarcomas
Benign tumors have the ending:
-"oma"
Malignant tumors have the ending:
-"carcinoma" or "-sarcoma"
In this classification of tumors, the appearance of cells and the degree of differentiation are evaluated pathologically:
-histologic grading
True or False:
Tumors that are poorly differentiated (undifferentiated) have a worse prognosis than those that are closer in appearance to the normal tissue of origin.
-True
What is the appropriate grade for: cells differ slightly from normal cells (mild dysplasia) and are well differentiated.
-Grade I
What is the appropriate grade for: cells are more abnormal (moderate dysplasia) and moderately differentiated.
-Grade II
What is the appropriate grade for: cells are very abnormal (severe dysplasia) and poorly differentiated.
-Grade III
What is the appropriate grade for: cells are immature and primitive (anaplasia) and undifferentiated; cell of origin is difficult to determine.
-Grade IV
Classifying the extent and spread of disease; based on a description of the extent of the disease rather than on cell appearance:
-Staging
This staging classification system determines the anatomic extent of the malignant disease process by stages:
-Clinical Staging
Stage 0: cancer in situ
Stage I: tumor limited to the tissue of origin; localized tumor growth
Stage II: limited local spread
Stage III: extensive local and regional spread
Stage IV: metastasis
-Clinical Staging
This classification system is used to determine the anatomic extent of the disease involvement according to 3 parameters: tumor size and invasiveness (T), presence or absence of regional spread to the lymph nodes (N), and metastasis to distant organ sites (M):
-The TNM classification system
What does rTNM stand for?
-"Restaging" classification is differentiated from stage at diagnosis as the clinical significance may be quite different
This surgical intervention can be used to eliminate or reduce the risk of cancer development in patients who have underlying conditions that increase their risk of developing cancer:
-Surgical prevention
The objective for this surgical intervention is to remove all or as much resectable tumor as possible while sparing normal tissue:
-Surgical cure and control
The focus of this surgical intervention shifts to preservation of quality of life at the highest possible level for the longest possible period of time; provide supportive care that maximizes bodily function or facilitates cancer treatment:
-Surgical supportive and palliative care
Increasingly greater emphasis is being placed on this surgical intervention in cancer care to increase the quality of life; if the quality of life is to be maintained, pts must be able to accept and cope with their altered body image and functional ability on a daily basis:
-Surgical rehabilitative care
-The use of chemicals as a systemic therapy for cancer:
-Chemotherapy
This cancer intervention has evolved to become a therapeutic option that can offer cure for certain cancers, control other cancers for long periods of time, and in some instances offer palliative relief of symptoms when cure or control no longer is possible:
-Chemotherapy
The goal of this cancer intervention is to eliminate or reduce the number of malignant cells present in the primary tumor and metastatic tumor site(s):
-Chemotherapy
Describe the 5 factors that determine the response of cancer cells to chemotherapy:
1.) Mitotic rate of the tissue from which the tumor arises (the more rapid the mitotic rate, the greater the potential for response)
2.) Size of the tumor
3.) Age of the tumor
4.) Location of the tumor
5.) Presence of resistant tumor cells (mutation and biochemical inability of some cancer cells to convert the drug to its active form)
This category of chemo drugs have their effect on the cells during all phases of the cell cycle, including those in the process of cellular replication and proliferation and those in the resting phase:
-Cell cycle phase-nonspecific chemotherapeutic drugs
-Both categories are often administrated in combination with one another to maximize effectiveness by using agents that function by differing mechanisms and throughout the cell cycle
This category of chemo drugs exert their most significant effects during specific phases of the cell cycle:
-Cell cycle phase-specific chemotherapeutic drugs
-both categories are often admin in combination with one another to maximize effectiveness by using agents that function by differing mechanisms and throughout the cell cycle
This type of chemo drug will damage the intima of the vein, casing phlebitis and sclerosis and limiting future peripheral venous access, but will not cause tissue damage if infiltrated:
-Irritants
This type of chemo drug will if inadvertently infiltrated into the skin, may cause severe local tissue breakdown and necrosis:
-Vesicants
These are placed in large blod vessels and permit frequent, continuous, or intermittent admin of chemo, biologic and targeted therapy, and other products, thus avoiding multiple venipunctures for vascular access; indicated in instances of limited vascular access, intensive chemo, repetitive or continuous infusions of vesicant agents, and projected long-term need for vascular access:
-CVADs (central vascular access devices)
Describe some advantages and disadvantages of CVADs:
-Advantages: reduced need for venipuncture, decreased risk of extravasation injury, and facilitation of supportive therapies
-Disadvantages: risk of systemic infection
Name the 3 major types of vascular access devices used in oncology patients:
1.) tunneled catheters
2.) PICCs
3.) implanted infusion ports
This type of regional delivery method delivers drug to the tumor via the arterial vessel supplying the tumor; surgical placement of a catheter that is subsequently connected to an external infusion pump or an implanted infusion pump for infusion of the chemo agent; generally results in reduced systemic toxicity:
-Intraarterial Chemotherapy
This type of regional delivery method delivers drug to the peritoneal cavity for treatment of peritoneal metastases from primary colorectal and ovarian and malignant ascites; chemo is generally infused into the peritoneum in 1-2L of fluid and allowed to "dwell" in the peritoneum for a period of 1-4 hours, the fluid is then drained from the peritoneum:
-Intraperitoneal Chemotherapy
This regional delivery method involves a lumbar puncture and injection of chemo into the subarachnoid space; has resulted in incomplete distribution of the drug in the CNS, particularly to the cisternal and ventricular areas therefore an Ommaya reservoir is often inserted:
-Intrathecal or Intraventricular Chemotherapy
A Silastic, dome-shaped disk with an extension catheter that is surgically implanted through the cranium into a lateral ventricle:
-An Ommaya reservoir (used Intrathecal or Intraventricular Chemo)
Chemotherapy-induced _____ _____ are the result of the destruction of normal cells, especially those that are rapidly proliferating such as those in the bone marrow, the lining to the GI system, and the integumentary system (skin, hair, nails):
- side effects
This adverse effects classification for chemo occurs during and immediately after drug admin and includes anaphylactic and hypersensitivity reactions, extravasation or a flare reaction, anticipatory nausea and vomiting, and cardiac dysrhythmias:
-Acute toxicity
This adverse effect classification for chemo are numerous and include delayed nausea and vomiting, mucositis, alopecia, skin rashes, bone marrow suppression, altered bowel function (diarrhea and constipation), and a variety of cumulative neurotoxicities depending on the affected component of the nervous system:
-Delayed effect
This adverse effect classification of chemo involves damage to organs such as the heart, liver, kidneys, and lungs:
-Chronic toxicities
Describe the qualities of a treatment plan for cancer and how drug regimens are selected:
-Choosing agents with different mechanisms of action and varying toxicity profiles avoids tumor cell resistance and minimizes the occurrence and severity of side effects
-Drug regimens are selected based on evidence supporting their use in specific cancers, and are sometimes customized to meet the needs of an individual pt
-Chemo is most effective when tumor burden is low, therapy is not interrupted, and the pt receives the intended dose
The emission and distribution of energy through space or a material medium; local energy in ionizing radiation and resultant generation of free radicals act to break the chemical bonds in DNA:
-Radiation
This type of damage caused by radiation causes sufficient chromosomal disruption that the cell is unable to replicate, or may also impair protein synthesis functions necessary for survival:
-Lethal damage
This type of damage caused by radiation has a potential for repair in between radiation doses, or potential for accumulated damage to occur with repetitive doses, which ultimately leads to cell death; cancer cells are less capable of repairing sublethal DNA damage than healthy cells:
-Sublethal damage
This beam expends energy quickly upon impact with matter therefore penetrating only a short distance; example such as electrons; clinically used in treating superficial skin lesions:
-Low-energy beams
This beam has greater depth of penetration, not attaining full intensity until they reach a certain depth; suitable for delivering optimal doses to internal targets while sparing the skin; example such as photons:
-High-energy beams
How is the radiation dose determined?
-Based on tumor volume, type of tumor, and treatment setting
-Maximal tolerated dose is calculated
-Dose is divided into daily "fractions" and admin Monday thru Friday for a period of 2-8 weeks
High daily doses of radiation may be given with fewer fractions:
-Hypofractionated
Lower daily doses of radiation may be given over a longer period of time:
-Hyperfractionated
Doses may be delivered twice daily:
-Accelerated fractionation
What does "rads" stand for?
-Radiation Absorbed Doses
-the unit for radiation dose
A centigray is equivalent to:
- 1 rad and 100 centigray equals 1 gray
Which tissue is more sensitive to radiation?
a.) rapidly proliferating tissue
b.) slowly proliferating tissue
a.) rapid proliferating tissue
-rapidly dividing cells in the GI tract, oral mucosa, and bone marrow will die quickly and exhibit early acute responses to radiation
-tissues with slowly proliferating cells, such as cartilage, bone, and kidneys, manifest later responses to radiation
This form of radiation therapy is used as an independent treatment modality with curative intent:
-Definitive or primary therapy
This form of radiation therapy is used with or without chemo preoperatively to minimize tumor burden and improve the likelihood of complete surgical resection:
-Neoadjuvant therapy
This form of radiation therapy is admin following surgery or chemo to improve local control of disease and reduce risk of local disease recurrence:
-Adjuvant therapy
This form of radiation therapy is admin to high risk areas to prevent future cancer development:
-Prophylaxis
This form of radiation therapy is used to limit tumor growth to extend the symptom-free period as much as possible:
-Disease control
This form of radiation therapy is given to prevent or relieve distressing symptoms such as pain or shortness of breath, and for preservation of neurologic function:
-Palliation
-External beam radiation; the most common form of radiation treatment delivery; the beam has to pass through external tissues to reach the internal source:
-Teletherapy
-Mean "close" or internal radiation treatment; consists of the implantation or insertion of radioactive materials directly into the tumor (interstitial) or in close proximity adjacent to the tumor (intracavity or intraluminal); allows for direct dose delivery to the target with minimal exposure to surrounding healthy tissues:
-Brachytherapy
Describe the symptoms and nursing actions for a patient experiencing bone marrow suppression:
-Myelosuppression is one of the most common effects of chemo and can occur with radiation; symptoms resulting are infection, hemorrhage, and overwhelming fatigue
-Major difference in manifestations between radiation and chemo is that with radiation (local therapy) only bone marrow within the treatment field will be affect, whereas chemo (a systemic therapy) affects bone marrow function throughout the body
-Nurses should monitor CBC, especially neutrophils, platelets, and RBC counts
-Every measure should be taken to prevent infections for those with neutropenia; WBC growth factors are given to increase levels
-Thrombocytopenia: platelets levels <50,000; platelet infusions given when <20,000
-Anemia: generally has a later onset; low Hgb level (<11) receive RBC growth factors until level is between 11 and 13
What is nadir and when does it occur?
-Nadir is the lowest blood cell counts and it typical for pts to experience between 7-10 days post-therapy
Describe symptoms and nursing actions for a patient experiencing fatigue:
-A nearly universal symptoms affecting 70-100% of pts with cancer
-Reported by pts as being the most distressful
-Fatigue associated with radiation therapy generally begins during the third to fourth week of treatment, persists after treatment ends, and then gradually subsides
-Weight loss, depression, nausea, and other symptoms can exacerbate fatigue
-Nurse can help pts recognize fatigue is a common side effect of therapy and not an indication of worsening
-Educate pt that ignoring fatigue can worsen symptoms; maintain good nutritional status and hydration; walking programs have been found to increase energy level (unknown why)
Describe symptoms and nursing actions for a patient experiencing nausea and vomiting:
-Common symptoms of chemo and in some radiation therapy
-May occur within 1 hr following chemo, 3-4 following radiation, and may persist up to 24 hr following
-May experience anticipatory n & v
-Delayed n & v can develop 24 hr and up to a week following treatment
-Nurse must assessed for signs and symptoms of dehydration and metabolic alkalosis; record I & O
-N & V can be successfully managed with antiemetic regimens, dietary modification, and other nonpharmacologic interventions
Describe symptoms and nursing actions for a patient experiencing diarrhea:
-A reaction of the bowel mucosa to radiation and to certain antineoplastic agents
-With radiation, treating pts with a full bladder may be done to move the small bowel out of the treatment field
-Best managed with antidiarrheals, antimotility agents, and antispasmodics
-Diet low in fiber and residue should be recommended
-Avoid fried or highly seasoned foods
-Lukewarm sitz baths, rectal area must be kept clean and dry to maintain skin integrity
-Number, volume, consistency, and character of stools per day should be noted
Describe symptoms and nursing actions for patient experiencing stomatitis:
-Irritation, inflammation, and/or ulceration of the mucosa; a common complication
-A complex problem involving not only the epithelial lining but also other mucosal components, including the endothelial, extracellular matrix, and connective tissues
-Xerostomia: dry mouth; dryness or thick saliva compromises the protective salivary function of assisting with cleansing teeth, moistening food and swallowing
-Taste loss; nutritional status may be compromised
-Oral assessment; oral care should be performed at least before and after each meal and at bedtime, rinsing of saline solution
-Feedings of soft, nonirritating high-protein and high-calorie foods should be offered as well as nutritional supplements
-Pts should be weighed to monitor for weight loss
Describe symptoms and nursing actions for a patient experiencing anorexia:
-Need to be monitored carefully during treatment to ensure that weight loss does not become excessive; measured at least twice a week
-Small, frequent meals of high-protein, high-calorie foods are better tolerated than large meals
-Nutritional supplements and parenteral nutrition may be ordered
Describe symptoms and nursing actions for a patient experiencing skin reactions:
-With radiation, skin effects are local, occurring only in the treatment field
-With chemo, skin effects are systemic effecting hair, skin, and nails
-Erythema is an acute response followed by dry desquamation
-If the rate of cellular sloughing is faster than the ability of the new epidermal cells to replace dead cells, a wet desquamation occurs with exposure of the dermis and weeping of serous fluid
-Prevention of infection and facilitation of wound healing
-Avoid heating pads, ice packs, hot water bottles, constricting garments, rubbing, harsh chemicals, and deodorants
-Dry skin should be lubricated
-For wet desquamation, keep tissues clean with normal saline compresses and protect from further damage with moisture vapor-permeable dressings or Vaseline gauze
-Mild erythema, hyperpigmentation, ulceration, blistering, and pain
-Alopecia associated with radiation is local, whereas chemo affects hair throughout the body
Describe symptoms and nursing actions for a patient experiencing pulmonary effects including pneumonitis and pulmonary edema:
-Pneumonitis can be an acute inflammatory reaction related to radiation; often asymptomatic, although an increase in cough, fever, and night sweats may occur; treatment with bronchodilators, expectorants, bed rest, O2, with corticosteroids
-Pulmonary edema (noncardiogenic) related to capillary leak syndrome or fluid retention, hypersensitivity pneumonitis, interstitial fibrosis, and pneumonitis produced by an inflammatory reaction or destruction of alveolar-capillary endothelium
Describe symptoms and nursing actions for a patient experiencing cardiovascular effects:
-Radiation to the thorax can damage the pericardium, myocardium, valves, and coronary blood vessels; with pericardial effusion or pericarditis the key problems
-May cause ECG adnormalities and late effects are left ventricular dysfunction and HF
Describe symptoms and nursing actions for a patient experiencing reproductive effects:
-Symptoms vary according to the radiation treatment field and dosage and the particular chemo agent and dose as well as host factors
-Can cause temporary or permanent gonadal failure
-Protection of testes and ovaries with shields
-Potential infertility can be a significant consequence for the individual, and counseling may be indicated
-Pretreatment harvesting sperm or ova may be considered
-The nurse needs to encourage discussion of issues related to sexuality, offer specific suggestions, and make referrals for ongoing counseling when indicated
Describe nursing actions for a patient coping with therapy:
-Anxiety about various aspects of treatment admin, dependency on others, ability to pay, potential side effects, and poor outcomes
-Providing info and support can help to minimize the negative impact of anticancer therapy on quality of life
-Pt teaching, symptom management, and interventions
-Arranging for pts to meet with individuals who have successfully completed therapy can offer hopefulness and confidence
-Make regular supportive telephone contacts, emotional support with available resources such as the American Cancer Society, churches, and other community resources
Consists of agents the modify the relationship between the host and the tumor by altering the biologic response of the tumor cells:
-Biologic therapy
1.) They have direct antitumor effects
2.) They restore, augment, or modulate host immune system mechanisms
3.) They have other biologic effects, such as interfering with the cancer cells' ability to metastasize or differentiate
-The 3 ways biologic agents may affect host-tumor responses
Interferes with cancer growth by targeting specific cellular receptors and pathways that are important in tumor growth; they are able to kill cancer cells without damaging normal cells; function by being directed at specific binding sites, thus inhibiting the internalization of receptor-antibody complexes and signaling pathways; may also stimulate an immunologic response:
-Targeted therapy
Describe nursing actions for a patient receiving biologic and targeted therapy:
-Nursing interventions for flu-like symptoms include the admin of acetaminophen before treatment and 4 hr afterward
-IV meperidine (Demerol) has been used to control the severe chills associated with some biologic agents
-Monitoring VS and temp, planning for periods of rest for the patient, assisting with ADLs, and monitoring for adequate oral intake
Describe nursing actions for patients with or at risk for malnutrition (a complication of cancer):
-Characterized by muscle and fat depletion
-Suggest and encourage intake of foods high in protein and calories
-Nurse should suggest the need for a nutritional supplement to the HCP as soon as a 5% weight loss is noted or if the pt has the potential for protein and calorie malnutrition
-Alb and prealbumin levels should be monitored
-It may need to necessary to use enteral or parenteral nutrition
Describe nursing actions for patients who have an altered taste sensation (a complication of cancer):
-Instruct to avoid foods that are disliked
-Encourage to experiment with spices and other seasoning agents in an attempt to mask the taste alterations
Describe the nursing actions for patient at risk for infection (a complication of cancer):
-Infection is the primary cause of death in the pt with cancer
-Occurs as a result of the ulceration and necrosis caused by the tumor, compression of vital organs by the tumor, and neutropenia caused by the disease process or the treatment of cancer
-Assessment most often includes signs and symptoms of fever, determination of etiology, and CBC
Results from obstruction of the superior vena cava by a tumor or thrombosis; symptoms include facial edema, periorbital edema, distention of veins of the head, neck, and chest, headache, seizures; most common causes are lung cancer, non-Hodgkin's lymphoma, and metastatic breast cancer; considered a serious medical problem; treatment is radiation to the site of obstruction:
-Superior Vena Cava Syndrome
A neurologic emergency caused by the presence of a malignant tumore in the epidural space of the spinal cord; most commonly caused by tumors of the breast, lung, prostate, GI, renal and melanoma; symptoms include back pain that is intense, localized, and persistent, accompanied by vertebral tenderness, motor weakness and dysfunction, sensory paresthesia and loss, and autonomic dysfunction; radiation therapy in conjunction with prompt initiation of corticosteroids:
-Spinal Cord Compression
Involves a shifting of fluid from the vascular space to the interstitial space that primarily occurs secondary to extensive surgical procedures, biologic therapy, or septic shock; may exhibit signs of hypovolemia; treatment includes fluid, electrolyte, and plasma protein replacement; monitor for signs of hypervolemia after treatment is started:
-Third Spacing Syndrome
Are primarily caused by tumor obstruction of an organ or blood vessel:
-Obstructive Emergencies
Are caused by the production of ectopic hormones directly from the tumor or are secondary to metabolic alterations caused by the presence of the tumor or cancer treatment:
-Metabolic Emergencies
Results from abnormal or sustained production of ADH with resultant H2O retention and hyponatremia; occurs most frequently in carcinoma of the lung; cancer cells in these tumors are actually able to manufacture, store, and release ADH; symptoms include weight gain, weakness, anorexia, N & V, personality changes, seizures, and coma; treatment includes treating underlying malignancy and measures to correct the Na-H2O imbalance:
-Syndrome of Inappropriate ADH (SIADH)
This cancer complication can occur in the presence of cancer that involves metastatic disease of the bone or multiple myeloma, or when a parathyroid hormone-like substance is secreted by cancer cells in the absence of bony metastasis; symptoms include apathy, depression, fatigue, muscle weakness, ECG changes, polyuria and nocturia, anorexia, nausea and vomiting:
-Hypercalcemia
A metabolic complication characterized by rapid release of intracellular components in response to chemo; often associated with tumors that have high growth rates and are sensitive to the effects of chemo; massive cellular destruction releases a host of intracellular components into the bloodstream, including K, PO4, DNA, and RNA; lead quickly to acute renal failure; 4 hallmark signs hyperuricemia, hyperphosphatemia, hyperkalemia, and hypocalcemia; usually occurs within the first 24-48 hours after initiation of chemo and may persist for approx 5-7 days:
-Tumor Lysis Syndrome
This type of emergency occurs when tumors infiltrate major organs or secondary to cancer therapy:
-Infiltrative Emergencies
This cancer complication results from fluid accumulation in the pericardial sac, constriction of the pericardium by tumor, or pericarditis secondary to radiation therapy to the chest; symptoms include heavy feeling over chest, shortness of breath, tachycardia, cough, distant or muted heart sounds; surgically remove fluid from around the hear; nursing actions include O2 therapy, IV hydration, and vasopressor therapy:
-Cardiac Tamponade
This cancer complication occurs most frequently in patients with cancer of the head and neck secondary to invasion of the arterial wall by tumor or to erosion following surgery or radiation therapy; ranges from minor oozing to spurting of blood in case of a "blowout"; pressure should be applies and IV fluid and blood products admin:
-Carotid Artery Rupture
How many cancer survivors are in the United States?
-10 million survivors and the number is expected to rise
Trends in the incidence and death rates of cancer include the fact that:
a.) lung cancer is the most common type of cancer in men.
b.) a higher percentage of women than men have lung cancer.
c.) breast cancer is the leading cause of cancer deaths in women.
d.) African Americans have a higher death rate from cancer than whites.
d.)
Cancer is the name for a large group of diseases, all of which are characterized by:
a.) increasing differentiation of cells.
b.) productions of toxins that alter cells.
c.) rapid, explosive proliferation of cells.
d.) cell growth that escapes normal control.
d.)
A characteristic of the stage of progression in the development of cancer is:
a.) oncogenic viral transformation of target cells
b.) a reversible steady growth facilitated by carcinogens.
c.) a period of latency before clinical detection of cancer.
d.) proliferation of cancer cells in spite of host control mechanisms.
d.)
The primary protective role of the immune system related to malignant cells is:
a.) surveillance for cells with tumor-associated antigens
b.) binding with free antigen released by malignant cells.
c.) production of blocking factors that immobilize cancer cells.
d.) responding to a new set of antigenic determinants on cancer cells.
a.)
The primary difference between benign and malignant neoplasms is the:
a.) rate of cell proliferation
b.) site of malignant tumor
c.) requirements for cellular nutrients
d.) characteristic of tissue invasiveness
d.)
Important nursing roles related to prevention and detection of cancer include:
a.) instructing people to eat low-fiber, refined carb diets
b.) instructing persons on ways to increase capacity to cope with stress
c.) teaching people to have annual screening tests for all detectable cancer sites
d.) using people's natural fear of cancer to motivate changes in unhealthy lifestyles
b.)
The goals of cancer treatment are based on the principle that:
a.) surgery is the single most effective treatment for cancer.
b.) initial treatment is always directed toward cure of the cancer.
c.) a combination of treatment modalities is effective for controling many cancers.
d.) although cancer cure is rare, quality of life can be increased with treatment modalities.
c.)
The most effective methods of admin a chemo agent that is a vesicant is to:
a.) give it orally.
b.) give it intraarterially
c.) use an Ommaya reservoir
d.) use a central venous access device
d.)
The nurse explains to a patient undergoing brachytherapy of the cervix that she:
a.) must undergo simulation to locate the treatment area
b.) requires the use of radioactive precautions during nursing care
c.) may experience desquamation of the skin on the abdomen and upper legs
d.) requires shielding of the ovaries during treatment to prevent ovarian damage
b.)
Stomatitis, a common side effect of chemo agents, occurs because the:
a.) site of the malignancy is near the oral cavity
b.) general health of the pt with cancer is poor.
c.) chemo drugs have an external, local, and irritating effect.
d.) rapidly dividing cells of the mucous membranes of the mouth are being destroyed.
d.)
The nurse teaches the patient receiving IL-2 about the drug based on the knowledge that this agent is admin primarily for the purpose of:
a.) stimulating the immune system
b.) inhibiting DNA and protein synthesis in tumor cells
c.) decreasing the antigenic expression of antigens on tumor cell surfaces.
d.) preventing bone marrow suppression associated with chemo admin
a.)
The nurse counsels the pt receiving radiation therapy or chemo that:
a.) effective birth control methods should be used for the rest of the pt's life
b.) if N &V occur during treatment, the treatment plan will be modified
c.) following successful treatment, a return to the person's previous functional level can be expected
d.) the cycle of fatigue-depression-fatigue that may occur during treatment can be reduced by restricting activity.
c.)
An appropriate nursing intervention to promote nutrition in the pt with cancer is:
a.) providing bland, pureed food because the person's taste sensation is altered
b.) providing increased protein for normal cell recovery and immune system function
c.) encouraging the pt to eat a high-calorie, high-protein snack every few hours to prevent weight loss.
d.) alerting the physician that nutritional supplements may be needed wen the pt have a 10-lb weight loss
a.)
SIADH that occurs in certain types of cancer is primarily due to:
a.) autoimmune reaction
b.) gram-negative septicemia
c.) invasiveness of cancer cells
d.) ectopic hormonal production
d.)
A pt has recently been diagnosed with early stages of breast cancer. Which of the following is most appropriate for the nurse to focus on?
a.) maintaining hope
b.) preparing a will and advance directives
c.) discussing replacement child care for pt's children
d.) discussing the pt's past experiences with her grandmother's cancer
a.)