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111 Cards in this Set
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- Back
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thrombolytic therapy (contra)
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contra: active, uncontrolled bleeding (pt is at risk for bleeding during therapy)
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myocardial infarction (nursing action)
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assess cardiac enzymes
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multiple myeloma (tx)
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plasmapheresis (form of hemodialysis, need when pt shows signs of increased serum viscosity), pt must keep well hydrated
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multiple myeloma (contra)
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CA supplements (excess CA may be an issue)
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antineoplastic drugs (se)
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diarrhea (low bulk foods like banana are tx for diarrhea) & pt is at risk for hypokalemia w/ diarrhea
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lobectomy
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pt will have 2 tubes.one in the lower thorax to drain blood & one higher up on the thorax to drain air
nursing priority: promote optimal ventilation including positioning, breathing exercises, & removal of excess secretions b/c respiratory complications are more likely to occur w/ a section of the lung removed. monitor for sob & restlessness which can suggest development of internal bleeding |
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drug combo: antibiotics & chemo (se)
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constipation & leukopenia is common se w/ this drug combo
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thrombocytopenia
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excessive bleeding is an emergency
fatigue is normal. persistent h/a is not an emergency but should be investigated |
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acute leukemia
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s/s: fatigue, anemia, enlarged spleen & enlarged liver
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lymphedema (complication prevention in pts who had modified radical mastectomy
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caused by accumulation of lymph in the tissues & may be a result of obstructedlymph vessels
skin breaks is a primary cause of lymphedema, avoid things like trimming cuticles especially on affected side |
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metastatic osteogenic sarcoma
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generally begins in distal femur, proximal tibia or humerus
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chemotherapy
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purpose is to shrink tumor mass
no spicy foods, at risk for infection, dental floss may irritate gums & contribute to stomatitis or introduce infection, avoid action that may cause irritation or trauma & lead to bleeding. admin antiemetics prior to chemo if experiencing nausea r/t chemo. adequate fluids before, during & after are important to dilute drug levels that stimulate vomiting se: constipation pt w/ severe stomatitis should rinse mouth w/ baking soda in water to promote healing w/o posing any other problems & is soothing (pt should not be using a toothbrush at all & no dentures or alcohol–based mouthwash) increased risk of dehydration. myelosuppression (depressed bone marrow function) is common leading to risk for infection (indicated by elevated temp & bleeding). watch for signs of heart failure which can indicate toxicity males will experience either temp or permanent sterility following chemo |
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colorectal CA
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middle aged adults. hx of ulcerative colitis, diverticulitis & polyps have been implicated in malignant changes
reduce risk: fruits & vegetables (especially cruciferious vegetables) are recommended to decrease risk of colorectal CA. (steaming preserves nutrients & does not introduce carcinogens). foods containing animal fat & red meat should be avoided. grilling or broiling could introduce carcinogens dx: guaiac stool tests, digital rectal exam & sigmoidoscopy. CEA antigen (unreliable, can also be elevated in inflammation & other diseases), CEA titer less than 5ng is norm, > 10 must be investigated tx: sx, radiation & chemo. 3 out of 4 could be saved by early dx |
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brain tumors
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localized intracranial lesion that occupies space in skull. secondary brain tumors develop from metastasized structures outside the brain & occur in 20%–40% of all CA pts. higher w/ age & slightly higher in men
gliomas: common neoplasm. very likely to cause seizures pituitary adenomas: symptoms caused as result of pressure on adjacent structures angiomas: mass of abnormal bold vessels acoustic neuromas: tumor of 8th cranial nerve meningiomas: common benign encapsulated tumor on meninges. slow growing, more often in middle age women |
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colostomy (teaching)
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buttermilk, yogurt, spinach, & parsley can decrease odors from the ostomy pouch.
cucumbers cause formation of gas & associated odors from the ostomy pouch |
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CA pts experiencing anorexia
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instruct pt to rinse mouth to redue unpleasant taste sensation & stimulate appetite
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sigmoid colostomy, large intestines
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solid feces, teach ways to minimize odor w/ drainage, regularity may be achieved through irrigation or allowing natural evacuation
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colostomy, small intestines
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drainage contains significant digestive enzymes
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external radiation therapy
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skin irritation can be a problem, rinsing w/ weak saltwater is a good precaution against infection, pt is at risk for bruising & bleeding
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metastasis
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ca cells traveling in the bloodstream is one of the primary mechanisms of metastasis
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interleukin–2
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stimulate production of T–lymphocytes as part of CA tx
it is a therapy w/ biologic response markers (BRMs) that is based on restoration of body's natural defenses (immune response) herbal preps not recommended for those on BRMs |
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monoclonal anitobdies
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a specific type of biologic response modifier (BRM) that protects the normal cells
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bone marrow transplant
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replaces damaged cells
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malignant melanoma
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genetic factors are most associated w/ malignant melanoma
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actinic keratosis
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some actinic keratosis lesions do eventually transform into squamous cell carcinoma. does not have a genetic component
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platelet count (norm)
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150,000–450,000/mm3
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reddness at entry site of central venous catheter
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may indicate beginning of an infection
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cervical ca TXed w/ applicator containing radioactive elements
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provide low–residue diet to limit bowel movements which decreases risk of dislodgment. pt on internal radiation will be put on total bed rest w/ a urinary cath
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prednisone
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wt gain is a temporary se, should be given early in the day, mod salt restriction is good, K intake should be increased for a child taking prednisone
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distance, time, shielding
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key principle to protect again radiation exposure
the greater the distance from radiation source, the less exposure to ionizing rays the less time spent providing care, the less radiation exposure source of radiation determines if lead shield is necessary to provide care |
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CA of the bladder
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more common in men. occur after 50
hematuria w/o dysuria is most common symptoms/s: intermittent hematuria, clots in urine, pain after voiding, bladder irritability, nocturia, dribbling & urinary fx dx: cystoscopy & biopsy tx: cystoscope resection if tumor is well localized, radical cystectomy & urethrectomy w/ permanent ill conduit (male impotence & permanent sterility) |
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steroid hormones
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pt should decrease intake of NA b/c fluid retention is often a problem
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vincristine (oncovin)
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chemo drug
neuropathy (numbness & decreased reflexes), & alopecia are expected se |
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se of CA
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hypercalcemia, constipation, & fluid retention
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alkylating agents
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busulfan, carboplatin, cisplatin, cyclophosphamide, etc.
chemo drug that prevents DNA replication.react w/ DNA to inhibit cell division/growth se: n&v, hemorrhagic cystitis & renal toxicity |
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pt w/ lung ca who develops superior vena cava syndrome
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monitor neurological status which can be compromised by increased intracranial pressure & lack of o2 as a result of superior vena cava syndrome
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super vena cava syndrome (nursing care)
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monitor for dysphagia which is a clinical manifestation of edema associated. position pt based on facilitating breathing to improve comfort & decrease anxiety
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stage IV adenocarcinoma
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indicates tumor has metastasized, gas exchange b/c impaired as cancerous tissues increase
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tumor lysis syndrome
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arises when contents of cells destroyed by chemo or radiation are released into the body causing electrolyte imbalances.
increasing fluids assists kidneys in flushing the material |
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cachexia
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pt needs best nutritional content possible. small, frequent meals often work best to maintain wt
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lost chord club
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support group of those who have had laryngectomies (removal of larynx including vocal chords)
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abdominal–perineal resection for rectal CA
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sidelying position in bed is resting position that is least likely to be uncomfortable or irritating while surgical wound is healing
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wilm's tumor
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palpation of abd may cause CA cells to migrate into nearby or even distant sites
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radical prostatectomy
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impotence is expected
a penile prosthesis can enable pt to achieve erection |
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multiple myeloma
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dx test: serum electrophoresis reveals excessive bence jones proteins
hypercalcemia is a common complication b/c breakdown of bone releases calcium into bloodstream. maintaining hydration is important to help prevent hypercalcemia |
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nitrites & nitrates (cause risk of...)
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associated w/ increased risk of CA
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ileal conduit
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appliance most typically last 3–7 days w/ leakage, should be changed before it leaks. to modify opening in skin barrier, open to a max of 1.6mm or 1/8inch larger than stoma
skin barrier between pts skin & appliance protects against infection & excoriation around stoma. tape is used around skin barrier but never directly on pouch |
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colostomy sx
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return of norm fecal output may take several days following sx. in 3–6 days colostomy will begin to function
dark red or black coloring of stoma may indicate infection edema at stoma site & small amount of drainage from stoma is norm postSX finding |
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claudication
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leg pain resulting from obstruction of blood vessels
intermittent claudication: pain in legs, edema & hair loss ABI <1.0 indicates possible claudication of peripheral arteries. used to assess degree of stenosis of peripheral arteries |
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causes person to be more susceptible to CA
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pts w/ genetic abnormalities are several times more susceptible
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radiation therapy (diet)
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high protein, high carb & low residue
it affects gi tract, diet should be highly nutritious but not irritating |
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distant metastasis of a neuroblastoma
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indicated by periorbital edema & exophthalmus
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neutropenia
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low absolute neutrophil count
greatest risk is infection |
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colostomy
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wash area w/ mild soap & PAT dry to prevent skin breakdown
pouch opening should be trimmed 0.3cm (1/8 inch) larger than stoma drainage bag should be emptied when 1/3 – 1/4 full. drainage pouch may not be needed if pt is able to learn an irrigation routine for emptying colon |
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unilateral modified radical mastectomy
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elevation of arm on affected side relieves pain after mastectomy
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risk for infection (entry sites)
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oral cavity, IV sites & perineum
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combo chemo
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uses drugs that target diff phases of cell cycle or have diff chemical action to increase the # of cells destroyed
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internal radiation therapy (visitors)
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no pregnant women! visitors must remain 6 feet from source of radiation
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lung CA
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most puts have advanced stage before they b/c symptomatic
tumor marker commonly present is carcinoembryonic antigen (CEA) |
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cuffed endotracheal tube
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inflated cuff prevents aspiration of gastric contents
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excess tidal volume
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causes too much CO2 to be blown off causing respiratory alkalosis
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color of mucous membranes
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great indicator of pt's oxygenation status
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process for antibiotic therapy for serious infection
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culture infected site
while waiting, admin antibiotic known to tx common organisms susceptibility testing done when causative organism is IDed admin narrow spectrum antibiotic |
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sigh mechanism
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delivers a RXed # of sighs per hour to mimic normal respirations to prevent atelectasis
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4 major types of CA
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carcinoma: from epithelial tissue
sarcoma: from connective tissue lymphoma: from lymphoid tissue leukemia: blood–forming cells in bone marrow |
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gardasil vaccine
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HPV prevention
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sealed radiation source implant
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pt emits radiation but body fluids are not radioactive
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hodgkin's lymphoma
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more prevalent in men in early 20's and after age 50
coughing, dysphagia, dyspnea, enlargement fo cervical lymph node, fatigue, generalized pruritis, night sweats, pain in cervical lymph nodes when drinking, unexplained fever & wt loss confirmed by biopsy w/ presence of reed–sternberg cells stage 1: single node or single site stage 2: more than 1 node, localized to single organ on same side of diaphragm stage 3: involves lymph nodes on both sides of diaphragm stage 4: diffuse involvement w/ disease disseminated in organs & tissues prognosis is good if detected early tx: stage 1 or 2 high does radiation above diaphragm. stage 3 & 4 chemo & radiation below diaphragm and possibly sx to remove spleen |
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platiniol (cisplatin)
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chemo med. can cause renal damage, admin bolus of fluid before & after to ensure meds is flushed through renal system
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bone CA & calcium
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hypercalcemia is common in those w/ bone CA
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TPN
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when bag is empty & waiting for another admin D10W to prevent complications from sudden lack of glucose
place pt in L lateral decubitus position to displace air emboli away from R ventricle |
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doxorubicin (adriamycin)
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antineoplastic/antibiotic. can cause cardiotoxicity shown through changes in ECG & congestive heart failure.
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bone marrow aspiration
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usually done by physician w/ specimens obtained from sternum or iliac crest
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xerostomia
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dryness of mouth from variety of causes
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CA w/ familial tendencies
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breast, colon, lung, ovarian & prostate
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CA (risk factors)
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hormonal risks: birth control or hormone replacement therapy, early menarche, late menopause, 1st pregnancy after 30 yrs
non hormonal risks: family fx, lack of regular exercise, postmenopausal obesity, increased use of alcohol, working night shift, older than 65, no full –term pregnancies, never breastfed, higher socioeconomic status, jewish heritage & 2 or more 1st degree relatives w/ breast CA at early age |
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myelosuppression
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bone marrow depression r/t chemo. w/in 7–10 days after tx, pt is extremely susceptible to infection
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bse
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breast self–exam
perform monthly bse from age 20–39 & women older than 40 should have annual breast exam by healthcare provider & annual mammogram |
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7 warning signs of CA
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change in bowel or bladder habits (unintentional wt loss), sore that does not heal, unusual bleeding or discharge, thickening or lump, indigestion or difficulty in swallowing, obvious change in wart or mole & nagging cough or hoarseness
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CA & angeogenesis
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new vessels supply tumor w/ nutrients & o2
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breast CA
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commonly metastasizes to lung, liver, bone (pt may suffer pathological fractures), kidneys, brain & adrenal glands
s/s: lump or mass, change in breast size or symmetry, thickening, dimpling of skin, unusual nipple discharge tx: depending on stage of disease. lumpectomy, modified radical mastectomy, radical mastectomy, chemo or radiation, hormone ablation (good for younger b/c they have more estrogen to feed it) post–sx: bse should include examination of chest wall where breast was removed |
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metastasis
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implies worsened prognosis & increase mortality
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external radiation therapy
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tx is given 5 days a week for 5 mins each for several weeks
exact markings are critical to limit damage to healthy tissues during tx |
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bone marrow transplant prep for leukemia
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pt will receive total body irradiation to ensure tx to all areas
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brachytherapy/internal radiation therapy
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utilizes sealed radioactive sources through internal implant. this direct therapy allows relatively high does of radiation to be admin over short period of time directed at tumor and surrounding tissues receive minimal radiation
limit amount of time in contact w/ pt. assess skin for signs of reaction (redness, erythema & desquamation especially in skin folds like axilla & groin |
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leukopenia
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decrease of wbc in blood. pt is at risk for infection. WASH HAND!!
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bone marrow harvesting
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occurs in OR under general anesthesia
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consequences of graft rejection follow bone marrow transplant
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pt will die w/o another transplant
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early signs of leukemia
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pallor, joint pain & fever
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thrombocytopenia
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deficiency of platelets in blood causing bleeding into tissues, bruising & slow blood clotting following injury
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stomatitis
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pt is likely to have burning in mouth, pain w/ swallowing & open lesions on the lips
tx: magic mouth wash, avoid citrus foods, nystatin, carafate, lidocaine, sometimes yeast will grow from tx |
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WBC
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4,000–9000mm3
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renal cell carcinoma
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nurse must monitor for capillary leak syndrome r/t to interleukin therapy for CA. manifested by generalized edema, decreased urine output & hypotension
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filgrastim (neupogen)
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stimulates production of WBCs & decreases risk of infection. pt will experience skeletal pain so admin analgesics prn
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interferon
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may cause fatal or life–theatening neuropsychiatric disorder. pt must be monitored for depression & if present d/c drug
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erythropoietin (procrit)
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helps reduce anemia–associated symptoms of chemo by stimulating RBC production
erythropoietin: hormone produced by kidney necessary for erythropoiesis & glycoprotein produced by kidney that stimulates RBC production |
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cetuximab (erbitux)
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monoclonal antibody that can be useful in tx of non–hodgkin's lymphoma, metastatic breast CA, leukemia & metastatic colorectal CA
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naloxon (narcan)
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opioid antagonist
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pantazocine (talwin)
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opioid agonist–antagonist
decreases opioid abuse & alleviates mod pain |
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methadone
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RXed to assist in detox & mntr those w/ drug addiction
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morphine sulfate
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common se: constipation & pruritus
ae: respiratory depression |
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nalbuphine (nubain)
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may cause hypotension w/ position changes
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respiratory depression
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morphine sulfate
respiratory rate may decrease, causing hypoventilation allowing build up of CO2 which causes cerebral vasodilation & increasing intracranial pressure |
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opioid agents
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morphine, hydromorphone (dilaudid), hydrocodone, codeine, oxycodone, etc.
respiratory depression, urinary retention |
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NSAIDs
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most common SE: nausea & gastric irritation. take w/ meals
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CA pts (mortality rate)
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Native AM have lowest mortality rate
African Am have highest mortality rate |
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autologous bone marrow transplant
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use of pets own bone marrow from disease– free tissue & frozen
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allogenic bone marrow transplant
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harvested from healthy donor (histocompatible donor)
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angiogensis
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ability for cells to grow new capillaries to supply nutritional needs
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antitumor antibioitics
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adriamycin, bleomycin, dactinomycin, daunorubicin, mithromycin, mitomycin, mitoxantrone
interferes w/ DNA dependent RNA synthesis & bind with DNA to block cell growth se: cardiac toxicity |
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casal cell epithelioma
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common in blond, fair skinned, caucasian males after 40 years old. prolonged sun exposure is largest risk factor. lesions usually in face (small, smooth, pink, translucent papillose that progress to firm raised bordered lesions w depressed centers)
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