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45 Cards in this Set
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- Back
Cancer incidence and Trends
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Mortality rates exceeded by heart disease
1994 Prostate Cancer more prominent than lung and colon 50% increase since 1980 Breast cancer is second, lung 3rd Colorectal 4th. 5 year survival rate for all cancer 58%. Cancer is many diseases 25% of all deaths attributable to cancer |
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Cell Cycle-not just cancer cells
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Phases of cell growth
G1 first growth phase Prepares for synthesis of DNA S DNA synthesis G2 second growth phase Prepares for division M-Mitosis (division) Cells mature or undergo replication G0 resting phase-cells do not multiply |
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Known Carcinogens-things that are known to be cancer causing
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Viruses Herpes 2 virus
HPV virus-genital warts. Drugs and Hormones Chemotherapeutic drugs Recreational drugs Estrogen and DES Chemical agents Physical Agents Solar Radiation Ionizing radiation |
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Differentiation- Define
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Differentiation- A normal process occurring over many cell cycles that allows cells to specialize in certain tasks
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Unproductive cellular alterations that can happen 4 types
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Hyperplasia: overgrowth of tissue. Increase in # or density of normal cells.
men with enlarged prostates-Benign prostatic hypertrophy-BPH Dysplasia-Loss of DNA control, over- differentiation. Abnormal degree of variation in size, shape, appearance, and disturbance in usual arrangement. Cervix.-hysterectomy. Metaplasia-Change in normal pattern of differentiation into cell types that are not normally found in the location of the body-ex. Smoker lungs Dysplasia is more serious Anaplasia-regression of a cell to an immature or regression of a cell type. Lack of cell differentiation, altered in appearance, size, shape, look different from the cells that they originated from. Malignant cells can be identified by changes occurring among groups of cells and within individual cells. These changes are known as "anaplasia." Anaplasia is a feature of malignancy; it is not found in normal tissues or in benign neoplasms. |
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Risk factors for developing cancer-Noncontrollable
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Hereditary Inherited-genetic defects
Age-66% of all cancers occur in people over age 65. Gender Poverty Inadequate access to health care, especially preventative screening and counseling |
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Controllable risk factors for developing cancer
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Stress-unmanaged keeps epinephrine, cortisone at high levels. Type C cancer personality: Not very good at coping.
Depression Diet-preserved high fat low fiber foods.-not good. Occupation-asbestos Infection Tobacco Use Alcohol Use Use of recreational drugs Obesity Sun exposure |
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What promotes cancer
interaction of lots of different things. |
Promoters: viruses, unhealthy lifestyle, smoking, poor diet, physical agents, chemical agents
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What are some environmental factors that can cause cancer
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Stress
Chronic disease Depressed immune system |
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Benign neoplasms-explain
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Local
Cohesive Well defined borders Pushes other tissues out of the way Slow growth Encapsulated Easily removed Does not recur |
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Malignant Neoplasms
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Invasive-invade tissues, organs, blood
Noncohesive Doesn’t stop at border Invades and destroys surrounding tissues Rapid growth Metastasizes Not easy to remove Can recur |
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Characteristics of Malignant neoplasms
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Loss of regulation of the rate of mitosis
Loss of specialization and differentiation Loss of contact inhibition Progressive acquisition of a cancerous phenotype Irreversibility Altered cell structure Simplified metabolic activities Transplantability Ability to promote their own survival |
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Various cancers and sites of metastases
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Bronchogenic: Spinal cord, brain, liver, bone
Breast: Regional lymph nodes, vertebrae, brain, liver Colon: Liver, lung, brain, ovary Prostate: Bladder, bone (esp. vertebrae), liver Malignant melanoma Lung, liver, spleen, regional lymph nodes |
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Lab and diagnostic tests for cancer
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Diagnosis: Location, microscopic, blood tests
Grading: differentiated and growth rate Grade 1=Most differentiated, least malignant Grade 4=Least differentiated, and most aggressively malignant Staging: Amount of spread Tumor: T0-T4 Nodes: NO-N12 Metastasis MO-M3 Cytologic Exam Exfoliation Aspiration Needle aspiration Tumor Markers -Oncofetal antigens AFP (Anti-fecal Protein) CEA (Carcino embryonic antigen) -Hormones HCG (human Chorionic genotrofin?) PTH (Parathyroid Growth Hormone) -Tissue specific proteins PSA (Prostatic specific antigen) Oncologic Imaging X-ray imaging Computed Tomography Magnetic resonance imaging Ultrasonography Direct visualization -Sigmoidoscopy -Cystoscopy -Endoscopy -Bronchoscopy Exploratory surgery with biopsy |
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Cancer therapy basis
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Overall aggressiveness of the cancer
Potential for spreading of the cancer Potential hazards of therapy itself Established success rate of therapy |
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Antineoplastic Drugs
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Interfere with the cell cycle of both Ca and normal cells
Cells most at risk: Those in rapid proliferation Blood forming cells Bone marrow Hair follicles GI tract Side effects: Blood disorders N/V Hair loss Not all Ca cells destroyed Cycle specific drugs Act at certain phases of cell division Nonspecific drugs |
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Chemotherapeutic agents types
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Alkylating agents
-Poison mustard used in WW1 Antimetabolites Mitotic Inhibitors -derived from plants Antibiotics -Derived from microorganisms Hormones Radioactive Misc. |
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Alkylating agents
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Act by interfering with the structure of DNA
Defective DNA unable to reproduce Cycle nonspecific Affect all rapidly proliferating cells Cause irreversible infertility Cyclophosphamide (Cytoxan) |
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Antimetabolites
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Cycle specific agents
Act only on dividing cells during S phase Most effective on rapid growing cancers. Methotrexate (MTX) |
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Mitotic Inhibitors-Plant alkaloids
(Think Vinca) |
Most interfere with cell division or mitosis
Others act in G2 or S phase Vincristine Sulfate (Oncovin) VP-16 |
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Cytotoxic Antibiotics
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Derived from various species of streptomyces
Not used to treat infection Not selectively toxic to bacterial cells Binds to almost everything they contact and kills cells by damaging cell membrane Cycle nonspecific Toxicity: damage to cardiac muscle. Doxorubicin (Adriamycin)Big Red |
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Hormones and Hormone Antagonists
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Selectively suppresses the growth of certain tissues of the body without cytotoxic action
Sex hormones: Estrogens, Androgens, and Progestins Corticosteriods Main hormone used in cancer therapy Phase specific (G1) Tx of malignant lymphomas to suppress lymphocyte production Tamoxifen (Nolvadex) steroids (prednisone) |
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Radioactive Drugs
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Concentrate in a specific tissue and emit radiation within a short time
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Combination therapy
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Single agent is rarely as effective in treatment of Ca as combination therapy
Rationale for selection: Exhibit different toxicities Different Mechanisms of action ie different phases of cell cycle Individually active against specific cancer More pronounced beneficial effect when used together than alone Smaller doses can be utilized of each agent |
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If extravasation occurs, if tissue damage or necrosis occurs
Ex. if a vesicant drug infiltrates |
Follow procedure of institution
This may include: Antidote Steroids Sodium Bicarbonate Cold compress in 6-12 hours Warm compress may be preferred |
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Define vesicant, irritant, and extravasation
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Vesicant drugs are very toxic, so tissue damage can occur
Irritant: Cause discomfort at IV site-potassium Extravasation- |
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Monitor lab studies
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Depression of bone marrow
WBC < 4,000 Platelet count < 200,000 Uric acid > 35 mg/100ml Glucose: FBS > 120 2 hr PP>120 Report to physician Fluid and electrolyte balance: Force Fluids-to prevent deposits of urates in the kidneys Maintain urine output of at least 2 Liters/day Offer 3000 ml if not contraindicated: cardiac, renal impairment, older patients, and children Zyloprim may be given to inhibit formation of uric acid |
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Other treatments for cancer
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Surgery: diagnosis and staging in 90%
Primary treatment of more than 60% Radiation therapy Kill the tumor Reduce its size Decrease pain Relieve obstruction Types: Teletherapy external Brachytherapy direct Immunotherapy Biologic response modifiers (BRM) Photodynamic therapy Photofrin Laser treatment 3 days later Bone Marrow Transplantation Surgery: diagnosis and staging in 90% Primary treatment of more than 60% Radiation therapy Kill the tumor Reduce its size Decrease pain Relieve obstruction Types: Teletherapy external Brachytherapy direct Immunotherapy Biologic response modifiers (BRM) Photodynamic therapy Photofrin Laser treatment 3 days later Bone Marrow Transplantation |
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Nursing implications for external radiation tx
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External
Adverse effects: skin changes, blanching, erythema, hemorrhage, ulceration, n/v, diarrhea Assess lung sounds for rales Record other medications Monitor WBC and platelets Teaching: Plain H2O, no soap, etc. Do not rub, scratch, or scrub Apply neither heat or cold Wear loose, soft clothing Protect skin from sun exposure during and 1 year after SPF 15 Plenty of rest and eat a balanced diet |
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Nursing implications for internal radiation treatment
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Internal: an implant is placed into the affected tissue
Patient must be in a Private room Limit visits to 10-30 min. at least 6ft away Monitor S.E. -burning sensations, excessive perspiration, chills and fever, N/V, diarrhea Assess for fistulas or necrosis Teaching: Stay in bed and rest quietly while in place Avoid close contact with others until discontinued Dispose of excretory materials in special containers or in a toilet not used by others Eat a balanced diet Carry out ADLs as able. |
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Nursing Implications for Immunotherapy
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Monitor for side effects
Monitor enzymes Evaluate response Assess coping behaviors Manage fatigue and depression Encourage self care. Close supervision Teaching: Increase fluid intake, Take analgesics and antipyretic meds Maintain bed rest until symptoms abate SC injection or IV pump management. |
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Pain management in the cancer patient
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Type:
Direct tumor involvement Associated with treatment Unrelated to Ca or Tx Give medication on a regular schedule No limit to amount client can receive. MS is the drug of choice Pharmacologic: Careful initial and ongoing assessment Evaluate functional goals Nonnarcotic drugs (ASA or ibuprofen) with adjuvants (corticosteroids or antidepressants). Progress to stronger drugs (Percodan or Darvon to dilaudid) Try combinations and escalate dosages. |
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Bone marrow transplantation
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To stimulate non functioning marrow or replace marrow
BMT given as an IV infusion of bone marrow cells from donor to patient Commonly used in leukemias Being expanded to include treatment of solid tumors, such as breast tumors. |
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Other important Nursing Measures
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Carefully monitor I&O
Rapid weight changes Skin turgor Vital sign changes Lung sounds Laboratory values Mood changes |
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Anorexia, Nausea and Vomiting
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Provide Foods that the patient enjoys, but in small amounts
Food high in protein and vit. C to encourage cellular growth and repair Vitamin and Mineral supplements Give antiemetics: (pre better than post) Ondansetron (Zofran) Granisetron (Kytril) Dronabinon (Marinol) Metocloramide (Reglan) Limit excess physical activity, liquids only before drug tx, relaxation techniques, hypnosis, guided imagery. |
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Stomatitis
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Daily assessment of integrity of oral mucous membranes
Routine mouth care q 2-4 hours, q2hr if develops Thoroughly rinse mouth after meals Avoid commercial mouth washes, use 1 tsp baking soda in 500 ml of H20 Soft bristle toothbrush or toothette Use bland, high caloric liquids Local anasthetics such as lidocaine 30 min. before meals, children 1 hr before meals |
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Xerostomia (Dry mouth)
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Drink fluids
Rinse mouth with baking soda solution Artificial saliva Lubricate lips with water soluble gel |
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Protection Against infection
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Lowest point (nadir) of bone suppression is 9-10 days where cancer patients are most prone to infection
Common sites: Lower respiratory tract Perineal area Pharynx GU tract Skin Usual s/s of infection are absent Most common indication of infection is fever, although patient taking steroids may not develop this sign Prevention: Improving host Reducing exposure Suppressing organisms. |
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Aseptic technique
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Isolation from infectious persons
Life support island with life-threatening leucopenia Visitors are limited Hand washing Wearing masks No uncooked foods No cut flowers Patients own flora often responsible for infection: Ensure good hygiene care Special perineal care, cleansing of axillae, perineum and groin, with providone-iodine or using antifungal powder. |
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Safety needs-cancer patient
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Handle pt gently
Avoid ASA and alcohol (interfere with action of platelets) Prevent fx due to osteoporosis if large doses of corticosteroids Pad bed rails Maintain pressure on injection sites for 3-5 minutes Know antidotes for various anticancer agents. |
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Alopecia
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Alopecia-hair loss
Apply tourniquet around forehead during IV therapy Keep in place 10-15 minutes after treatment complete Hypothermia to scalp with chilled air, ice cap, 10 min. before, during, and 30 min after treatment Do not use if indications that drug should reach the scalp (leukemia, etc.) Use wig or bandanna to camouflage hair loss. |
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Oncologic Emergencies
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Pericardial effusion and Neoplastic Cardiac tamponade
Superior vena cava syndrome Sepsis and septic shock Spinal cord compression SIADH Obstructive Uropathy Hypercalcemia Hyperuricemia |
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Nursing Diagnoses
cancer patients |
Anxiety
Body image disturbance Anticipatory grieving Risk for infection Risk for injury Altered Nutrition: less than body requirements Impaired tissue integrity Pain |
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Safe handling of cytotoxic drugs.
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Wear while giving or mixing
Surgical Mask Protective goggles or glasses Gloves Long-sleeved protective gown Wash hands Check tubing to ensure all connections are tight Label with special hazard label Bleed infusion into gauze is plastic bag All contaminated materials are disposed of in hazard container and wash hands thoroughly Manage spills -Spill kit -Disposable respirator mask and shoe covers suggested Post procedure. |
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Functional health care pattern: what does cancer fit under?
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Nutrition Metabolic alterations-Fits in the cancer prospective.
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