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2011-10-18 20:56:50
cancer nursing

nursing cancer
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  1. out of the cell cycleNeurons, cardiac muscle cell
    Permanent cells
  2. Dormant/Resting (G0)Liver, kidney
    Stable cells
  3. continuously dividing GIT cells, Skin, endometrium , Blood cells
    Labile cells
  4. Hyperplasia
    more cells (callous)
  5. a cell turns into a different cell. This is the dangerous kind.-leads to cancer
  6. dysplasia, anaplasia
    leads to cancer
  7. Cancer Development 4 STAGES
    • Initiation (mutation in DNA)
    • Promotion (repeated exposure)
    • Progression (benign to metastatic)
    • Metastasis
  8. The degree to which a cell resembles its cell of origin in morphology and function. Cancer cells usually do not achieve same level of differentiation as normal cells- They are autonomous, excessive and disorganized
    cell differentiation
  9. the result of abnormal cell proliferation…abnormal cell differentiation.
  10. Latent period
    May range from 1 to 40 years-For disease to be clinically evident, tumor must reach a critical mass that can be detected
  11. 3 characteristics of Neoplasia
    • Benign
    • malignant
    • borderline
  12. Benign
    • Well-differentiated;
    • specialized
    • Slow growth
    • Encapsulated
    • Non-invasive
    • Does NOT metastasize (does not go into bloodstream)
  13. Malignant
    • Undifferentiated-no specific function
    • Erratic and Uncontrolled Growth
    • Expansive and Invasive
    • Secretes abnormal proteins
  14. most common spread of cancer:
  15. spread of cancer: Blood-borne, commonly to Liver and Lungs
  16. spread of cancer: Seeding of tumors
    direct spread
  17. Second most common cause of death in the United States after heart disease
  18. Biggest risk of cancer:
  19. Age is the single most important factor related to the development of cancer
    >65 yrs
    Hormonal changes
    Altered immune system
    Accumulation of damage
    Age as highest risk factor for cancer
  20. Susceptability differences between men and women
    • Female: breast, lung and colon.
    • Male: prostate, lung and colon.
  21. Cancer rates
    • All races, cancer 541.8 per 100,000 men
    • All races 408.5 per 100,000 women
  22. China (liver)
    UK (lung)
    Japan (stomach)
    Canada (leukemia)
    Australia (skin)
    Brazil (cervical)
    cancer risk by geographic location
  23. Most forms of cancer are _______, and have no basis in heredity. There are, however, a number of recognized genetic risk factors.
  24. ´╗┐´╗┐Epstain Barr virus causes
    Burkitts lymphoma
  25. HPV causes
    cervical cancer
  26. Hepatitis B virus causes
    liver cancer
  27. Human T cell lymphotrophic virus causes
    Adult T cell leukemia
  28. Chemical agents that cause cancer
    • Tobacco smoking is associated with lung cancer and bladder cancer.
    • Exposure to asbestos fibers (mesothelioma)
    • Diet
    • Drugs
    • Radiation
    • Thousands of chemicals have been identified as carcinogens.
  29. Here the goal is to protect healthy people from developing a disease or experiencing an injury in the first place. For example:* education about good nutrition, the importance of regular exercise, and the dangers of tobacco, alcohol and other drugs* education and legislation about proper seatbelt and helmet use* regular exams and screening tests to monitor risk factors for illness* immunization against infectious disease* controlling potential hazards at home and in the workplace
    primary prevention
  30. These interventions happen after an illness or serious risk factors have already been diagnosed. The goal is to halt or slow the progress of disease (if possible) in its earliest stages; in the case of injury, goals include limiting long-term disability and preventing re-injury. For example:* telling people to take daily, low-dose aspirin to prevent a first or second heart attack or stroke* recommending regular exams and screening tests in people with known risk factors for illness* providing suitably modified work for injured workers
    Secondary intervention
  31. This focuses on helping people manage complicated, long-term health problems such as diabetes, heart disease, cancer and chronic musculoskeletal pain. The goals include preventing further physical deterioration and maximizing quality of life. For example:* cardiac or stroke rehabilitation programs* chronic pain management programs* patient support groups
    Tertiary intervention
  32. The four most important risk factors for cancer are:
    • tobacco use,
    • lack of physical activity
    • , exposure to ultraviolet light,
    • and poor nutrition
  33. Avoid or reduce exposure to known or suspected carcinogens
    Cigarette smoke,
    excessive sun exposur
    eEat a balanced diet
    Exercise regularly
    Obtain adequate rest
    lifestyle habits to reduce cancer risk
  34. Utilize the ACS 7 Warning Signals
    • C- Change in bowel/bladder habits
    • A- A sore that does not heal
    • U- Unusual bleeding
    • T- Thickening or lump in the breast
    • I- Indigestion
    • O- Obvious change in warts
    • N- Nagging cough and hoarseness
  35. screening ages for :
    • Breast cancer screening: age 40
    • Colon cancer screening: age 50
    • Uterine/cervical cancer screening:starting at sexual activity, age 20, yearly pap smear
    • Prostate cancer screening:40 years
  36. Diagnostic exams will:
    • Provide the general health status of the pt
    • Type of tumor, location, size, amount of tissue involved, Lymph node involvement ,metastasis
    • Workups vary depending on the type of tumor suspected
    • Lung, breast, prostate, colon
  37. Biopsy method
    • What is a biopsy?
    • How do we get the tissue sample?
    • Fine need aspiration
    • Core needle
    • Endoscopic
    • Incisiona
    • lExcisional
  38. Tumors can be classified by:
    • Anatomic site
    • Ploidy (#chromosomes)
    • Histology (level of differentiation)
    • Grading severityG1-G4 (as number increases the less differentiated the cell and the more advanced or aggressive is the cancer)
    • Extent of disease (TNM-tumor node metastasis)
    • --Staging
  39. Factors that determine treatment modality and goals:
    • Cell type
    • Location and size of tumor
    • Extent of disease
    • Physiologic and psychologic status
    • Expressed needs and desires

    • Above will determine goals:
    • Cure
    • Control
    • Palliation
  40. Treatment options
    • Surgery
    • Radiation Therapy
    • Chemotherapy
    • Biotherapy(Immunotherapy)
    • Bone marrow transplant
    • All of these modalities can be used to “cure” the patient or, with the exception of biotherapy and bone marrow transplant, can be used for palliation.
  41. Surgery

    --Alone- It is limited by tumor accessibility, patient’s medical condition, tumor’s extent
    --In combination with other modalities-RT and/or chemo
    --Cure or palliative goals
  42. Emerging field – only used for 30 years

    Chemotherapeutic drugs are administered orally, injected, intraarterially (infusion pump), intracavitary, intraperitoneal, intrathecal (space containing CSF)

    Can be used alone or in combination with surgery and RT

    Combinations of drugs are usually used vs. single agents

    Combination of drugs kill cells in different phases of the cell cycleLimited by amount of normal cell death

    What do therapists have to be careful of with patients on chemo?
  43. growth that causes tissue to increase in size by increasing the number of cells:
  44. any new or continued cell growth not needed for normal development or replacement of dead and damaged tissues is called ___
  45. Programmed cell death is _____
  46. Withouth specific shape or differentiation
  47. carcinogenesis/oncogenesis are other names for ___
    cancer development
  48. steps in carcinogenesis:
    • Initiation
    • promotion
    • progression
    • metastasis
  49. 30% of all cancers is caused by
    tobacco smoking
  50. primary/secondary prevention?
    -avoidance of known carcinogens
    -modifying risk factors
    -removal of "at risk" tissues
  51. Yearly mammogram for women older than ___
  52. Yearly breast exams for women older than ___
  53. Colonoscopy at age ____ yrs and then every ___ years
    • 50
    • 10
  54. Yearly prostate exam for men over ____
  55. Extreme body wasting and malnutrition
  56. A diet high in ___ and ___ is recommended for cancer pts.
    protein and carbs
  57. Early cancer may not have ____ _____
    early symptoms
  58. Biggest complication of chemo:
  59. ________ Therapy
    -most often used
    -each drug effective against the cancer
    -minimally overlapping toxicities
    -synergystic effect
    -decreased possibility of drug resistance
    -increased percent of cells killed at one time
    Combination Therapy
  60. removal of all cancer tissue is called _____ surgery.
  61. ______ surgery is focused on improving quality of life, not cure.
  62. ___ therapy

    -May pose an occupational hazard

    -Drugs may be absorbed through Skin and Inhalation during preparation, transportation, and administration

    -Only properly trained personnel should handle drugs
  63. ____therapy

    -Drugs may be irritants or vesicants

    -Damage intima of vein, but not tissue damageSevere local tissue breakdown and necrosis
  64. predictable; usually resolution is rapid

    Requires little to no change in treatment

    Expect nausea and vomitting, hair loss, problems with GI tract, toxic effects monitored to determine if therapy is effective.
    Expected effects of chemotherapy
  65. Serious and even life-threatening

    Treatment change required

    discontinue drugdose reduction
    Toxic effects of Chemotherapy
  66. Occurs during and immediately after drug administration


    Allergic reactions


    Extravasation (flare reaction)Give corticosteroids- the inflammatory response is basically an “allergic” response
    Acute toxicity from chemo
  67. Mucositis


    Bone marrow suppression

    Delayed nausea and vomiting

    Skin rashes
    Delayed effects of chemo
  68. Bone marrow suppression-common side effect

    Altered bowel function

    Cumulative neurotoxicities-damage to nerve cells, neuropathy, monitor for progression
    Delayed effects of chemo
  69. Nursing management of pt. under chemo involves:
    knowing difference between tolerable side effects and toxic side effects
  70. Report serious reactions of chemo because some toxicities are ___
  71. Can be used alone or in combination with other modalities – 50% of all cancer patients receive RT

    Cure and palliationCan preserve organ function - larynx, prostate-less impotence and incontinence than surgery

    Better Cosmesis-skin cancers

    Limited by critical structures

    Patient must be able to endure treatment
    Radiation Therapy
  72. Local treatment modality

    One of the oldest nonsurgical methods of cancer treatment

    Up to 60% of all cancer patients will receive radiation therapy
    radiation therapy
  73. Cellular damage may be lethal or sublethal

    Normal tissues are usually able to recover

    Cancer cells are more likely to be permanently damaged
    Radiation therapy
  74. Total doses divided into fractions

    Typically delivered once a day for 5 days a week for 2 to 8 weeks

    Number and strength of doses is determined by mitotic rate of target tissue with rapidly growing tumors being more sensitive
    Radiation therapy
  75. Most common radiation treatment
    teletherapy/external radiation
  76. Patient exposed to radiation from a megavolt machine

    Cobalt 60 machine—gamma rays

    Cyclotron—neutrons or protons

    Linear accelerator—ionizing radiation
    Radiation therapy
  77. Implantation or insertion of radioactive materials into or close to tumor

    Minimal exposure to healthy tissue

    Used in combination with teletherapy
    Brachytherapy/internal radiation
  78. Patient is emitting radioactivity

    Limit amount of time near patients being treated

    Organize care

    Shielding should be used

    Wear film badge to monitor exposure
  79. common side effects of radiation and chemo
    • Bone marrow suppression
    • Fatigue
    • GI disturbances
  80. Integumentary and mucosal reactions

    Pulmonary effects

    Reproductive effects
    common side effects of radiation and chemo
  81. Purpose of this therapy is to destroy cancel cells with minimal exposure of the normal cells to the damaging actions of radiation
    Radiation therapyt
  82. Most radiation therapy for cancer is
    ionizing radiation
  83. In this therapy, the patient emits radiation for a period of time and is a hazard to others.
  84. side effects of: ___
    altered taste sensation
    aversion to taste of red meat
    Radiation therapy
  85. skin care need is a priority nursing intervention for pts. receiving
    radiation therapy
  86. dry mouth is also called
  87. when can you start seeing adverse effects of chemo?
    in 2-3 weeks
  88. theray that uses the body’s own immune systemB and T cells and natural killer cell lymphocytes:
  89. In Biotherapy: Produce protein molecules or antibodies that attack and destroy foreign substances such as cancer
    B cells
  90. in Biotherapy: Mature into killer cells once they make contact with the antigen on a foreign substance
    T cells
  91. Scavenge and kill tumor cells
    NK cells
  92. Able to kill tumor cells without damaging normal cells:
    Targeted therapy
  93. Tyrosine kinase inhibitors
    Monoclonal antibodies
    Vascular endothelial growth factor receptor inhibitors
    Proteasome inhibitors
    types of Targeted therapy
  94. -Interferon inhibits DNA and protein synthesis
    -Cytokines (enhance the immune system) with antiviral, antiproliferative, and immunodulatory properties
    Biologic and targeted therapies
  95. Spontaneously attack and kill foreign substances
    NK cells
  96. Produced to react to a specific antigen

    Cytotoxic agent can be attached-more cell kill action
    Monoclonal antibodies
  97. Naturally occurring proteins that can kill cancer cells

    Can help identify the antigen of cancer cells
  98. Stimulate more T cell production (killer cells)

    help regulate inflammationa and immune protection
    Interleukin 2
  99. Spinal cord compression

    Superior vena cava syndrome


    Cardiac Tamponade
    Oncology emergencies
  100. damage that occurs either when a tumor directly enters the spinal cord or when the vertebrae collapse from tumor degradation of the bone.

    if paralysis occurs: it is usually permanent

    -make sure to assess neurologic changes. back pain, muscle weakness, numbness, tingling, unsteady gait
    spinal cord compression
  101. compression/obstruction by the tumor growth or by formation of clots in the vessel

    early signs occur when a patient wakes up after a nights sleep and include edema of the face, esp. around the eyes, and tightness of shirt or collar
    superior vena cava syndrome
  102. Cardiac tamponade is compression of the heart that occurs when blood or fluid builds up in the space between the myocardium (heart muscle) and
    the pericardium (outer covering sac of the heart).

    Anxiety, restlessness, Chest pain, Radiating to the neck, shoulder, back, or abdomen, Sharp, stabbing Worsened by deep breathing or coughing
    Cardiac tamponade
  103. an estimation of life expectancy based on all information about the tumor and from tumor trials
  104. Prognosis is only an
  105. If a patient is disease free for 5 years , he/she is considered cured.
    5 year survival rule
  106. 1. Do not talk too much. Use silence to stimulate the patient to talk.
    2. Pain is a model for the assessment of other symptoms
    .3. Believe the patient
    .4. Routinely assess severity by using a validated tool
    .5. Most people also grieve in anticipation of loss.
  107. name this drug:
    side effect are seizures, bradycardia, shock, cardiac arrest, respiratory depression

    common: constipation
    notify doctor if respiration >12/min
    do not bcc
    physical dependency may result from long term use
  108. Name this drug:
    an antiemetic

    side effects: headache, dizziness, diarrhea, constipation
    adverse: bronchospasm

    headache requiring analgesic is common
    Zofran/ Ondasteron
  109. Name this drug:
    used to treat nausea and vomiting caused by chemotherapy in people who have already taken other medications to treat this type of nausea and
    vomiting without good results

    weaknes,ssudden warm feeling,stomach pain,nausea,vomiting,memory loss,anxiety confusion,dizziness,unsteady walking
  110. _____ therapy works by changing the level of hormones in the body, or by blocking the hormones so they can't help cancer cells to grow. (Some
    cancers need hormones to help them grow and multiply.)

    side effects: nausea, vomiting, dvt, PE, bleeding, stroke
    Hormone therapy
  111. biggest risk factor for colon cancer is:
  112. radiation therapy is now done on a:
    daily basis
  113. what are the most common metastatic sites of cancer cells?
    Liver is one of the most metastatic sites.The others are the lymph nodes, lung, bone, and brain.
  114. A client receives a sealed radiation implant to treat cervical cancer. When caring for this client, the nurse should have the pt:
    maintain the client on complete bed rest with bathroom privileges only to prevent dislodgement of the implant.
  115. What personal protective equipment (PPE) does the nurse wear when administering chemotherapy to the client?
    double gloving
  116. Used to treat nausea and vomiting caused by chemotherapy in people who have already taken other medications to treat this type of nausea and vomiting without good results.
  117. It is usually taken 1 to 3 hours before chemotherapy and then every 2 to 4 hours after chemotherapy, for a total of 4 to 6 doses a day. Swallow the capsule, do not BCC.
  118. side effects of Marinol/Dronabinol
    • weakness
    • sudden warm feeling
    • stomach pain
    • nausea
    • vomiting
    • memory loss
    • anxiety
    • confusion
    • dizziness
  119. major side effect of Zofran/Ondasteron
  120. In this type of therapy, the pt. DOES NOT lose his/her scalp hair:
    Radiation Therapy
  121. therapy given as a series of divided doses because of varying responses of all cancer cells within a given tumor:
    radiation therapy
  122. type of radiation therapy: distant treatment where patient is not radioactive and is not a hazard to others.
  123. close therapy where radiation source comes into direct, continuous contact with the tumor tissues for a specific period of time.
  124. in _______, when the isotopes are unsealed they enter body fluids and eventually are elmininated in waste products, which are radioactive and should not be directly touched by other people
  125. in _____, once the isotope is eliminated (as waste product), neither the patient nor the body wastes are radioactive. Most of this isotope is elmininated within 48 hrs.
  126. altered taste sensation and fatigue are common complains of pts. receiving ____
    external beam radiation
  127. true or false:
    wash the irradiated area each day with either water or a mild soap and water as prescribed by your radiologist.
  128. true or false:
    It is ok to wash and remove ink or dye markings that indicate exactly where to focuse radiation beams.
    False. Do not remove these markings!
  129. Chemotherapy used along with surgery or radiation is termed ____.
    adjuvant therapy
  130. Therapy that usually lasts for 3-4 weeks and are given through IV.
  131. a major complication of IV infusion during chemo is ____ , or the movement of the IV needle so that the drug leaks into the surrounding tissues.
  132. The most impt. nursing intervention for extravasation is:
  133. common distressing side effects of ____ include the ff:
    sleep disturbance
    altered bowel movement
  134. This critical problem is the major dose limiting side effect of cancer chemo and a common cause of death for pts. during treatment:
    Infection placing an extreme risk for sepsis. (also related to bone marrow suppresion)
  135. major side effect of Neumega/Oprelvekin used to treat thrombocytopenia:
    fuid retention, increases risk for CHF and pulmonary edema
  136. Therapy done by decreasing the amount of hormones to hormone-sensitive tumors which can help slow the cancer growth rate:
    hormone manipulation therapy
  137. side effects of hormonal manipulations:
    • women develop male characteristics.
    • men develop femal characteristics (gynecomastia; dev't. of breasts among men)