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which lab data is of most concern for pt undergoing radiation therapy?
- Platelets < 100,000 = thrombocytopenia
- this places pt at risk for bleeding and infection
intruction for pt with severe stomatitis from chemo?
nystatin swish and swallow, viscous lidocaine
stomatitis- sores and ulcers, inflammation of tissues in the mouth
appropriate intervention for a pt with lung cancer that develops superior vena cava syndrome?
- monitor neuro status
- neuro status can be compromised by increased intracranial pressure and lack of O2
can cause seizures, a brain tumor
what symptoms are common in pts with bladder cancer?
- hematuria without dysuria
- hematuria (blood in urine) without painful urination
care plan for pt with multiple myeloma
- prepare for hemodialysis
- due to increased serum viscosity
- hematologic cancer, cancer of the blood
what are secondary preventions?
- gentic screening
- exams: PAP, mammogram, breast, testicular
cardiopulmonary system can be affected by which chemo drugs?
Daunrubicin and doxorubincin
how much of cancers are caused by the environment?
- BRM: stimulate immune response to eradicate malignant growths
- they have antiviral and antitumor properties
what is DIC?
formation of small blood clots inside the blood vessels throughout the body consume coagulation proteins and platelets, normal coagulation is disrupted and abnormal bleeding occurs from the skin
S/S of DIC?
- easy bruising, prolonged bleeding- gums and GI
- acute DIC: life threatening hemorrhage and infarction
in Hodgkin's disease what type of cell is present in the nodes and is unique to Hodgkins?
Reed-Sternberg cells (gigantic atypical tumor cells)
- malignant proliferation of plasma cells within the bone, lymph nodes, spleen, and liver
- pain in: bones, esp ribs spine and pelvis
- intervention: encourage fluids
S/S of anemia:
fatigue, hypoxia, hypotension, tachycardia, anxiety
S/S of thrombocytopenia?
- petechiae, bruising, beeding gums, hematuria
- tx: platelet transfusion, avoid razors, soft toothbrush, no ASA
- platelets < 100,000
cancer is caused by:
- external (tobacco, chemicals, radiation, infectious orgs)
- internal factors (inherited mutations, hormones, immune conditions)
- both alter genes or disturb genetic control
- can strike at any age
nutrition related to cancer?
- salt-cured, smoked and nitrate cured foods have been linked with cancer
- alcohol increases cancer risk
cancer and genetic predisposition:
- genetics largely control a persons predispostition to develop cancer
- cancer develops ONLY in cells that have mutations, that is, damaged genes
- mutations may be inherited or can be environmental
what constitutes a cancer prevention lifestyle?
- stop smoking (30% of cancer deaths)
- avoid excessive sunlight (melanoma)
- avoid obesity (high fiber, water, decrease fat intake, eat Vit A, C cruciferous veggies and beta carotene)
- limit x ray exposure
- occupational hazards
- Hypertrophy- abnormally large cells
- hyperplasia- increase in the number of cells
- metaplasia- cell not typically found at that tissue
- dysplasia- replacement of mature cell with one thats less mature
- Anaplasia- cellular disorganization
- abnormal growth of new tissue
- begign or malignant
- tending to become worse and cause death
- anaplastic, invasive and metastic
- arise from epithilial tissue
- skin, large intestine, lungs, stomach, prostate, cervix or breast
cancers that arise from connective or muscle tissue
- have the capacity to transform energy and transmit energy from generation to generation
- contact inhibition
- linear reproduction (only 2 daughter cells)
- differentiation: 2 daughter cells will mature and specialize
- G1- RNA and protein synthesis
- S - DNA synthesis occurs
- G2- premitotic, mitotic spindle forms
- Mitosis- cell division
- G0- resting phase, these can be dangerous as they are not atively dividing
- no adhesion: cells break away and migrate
- lack of contact inhibition
- Anarachistic proliferation: divide out of control
- dont specialize
- Situ: in place
- metastasis does not take place immidiatly
- secrete chemicals that destroy the substances that hold the surrounding tissue together
- then they enter the blood and lymph and travel to other parts of the body
- spread of malignant cells from primary tumor to distant sites
histologic confirmation of cancer?
cytology: examination of cells from tissue scrapings
Biopsy of tumor:
- incisional: wedge of tumor at margin
- excisional: removal of entire mass and marins of normal tissue
- needle methods: sample massess that are easily accessible (breasts)
tumor staging and grading:
- staging: extent or spread of disease
- TNM system
- grading: classification of tumor cells
- G1- well differentiated
- G2- moderatley well diff
- G3/G4- poor-very poor diff
- substance secreted by tumors, detectable in blood or urine
- CEA carcinoembryonic antigen (colon cancers, also COPD), PSA (prostate), CA 125 (ovarian), AFP (liver, testicular cancers), human chorionic gonadotrophin (testicular)
- chest x-rays
- Ct scan (brain, lungs, abdomen)
- bone scan
- Positron emission tomography (PET scan shows abnormal tissue areas)
breast cancer treatment
- Monoclonal antibody
- genetic fusing of cancer cells with normal cells can produce disease fighting specific antibodies tailored to seek and destroy targets that are cancer cells
- Pallative- to make pt as comfortable and pain free as possible even though the cancer cannot be treated or has not responded to treatment
- Recontructive- breast (mastectomy), skin
- the use of chemicals that act systemically to treat disease
- affects the most rapidly dividing cells
- can be primary treatment or adjuvant
normal Neutrophil count:
- 2500-6000 cells/mm3
- Neutropenia: ANC < 500
- Neupogen:to increase WBCs in pts with drug induced neutrpenia
- Epoetin (Procrit)- antianemic, used for anemia caused by chemo (increase RBCs)
INCREASE WBCs in pts with drug induced neutropenia
Chemo side effects?
- loss of hair: aloplasia
- GI membranes: N & V: Zofran
- increased risk of infection and bleeding
- stomatitis: Nystatin swish and swallow & Lidocaine so that there isnt pain so that they want to eat. Also Biotene to lubricate.
- renal damage
- potential cardiac toxicities
factors predisposing to infection in cancer pt:
- poor WBC count- neutropenia (give Neupogen)
- poor cellular immunity
- skin and mucosal defects
- prior infection with an org
- RAW food with aerobic gram-negative org (raw fruits, veggies)
effects of cancer: malnurition
- loss of ability to taste SWEETS
- alteration of taste perception marked by sensitivity to Bitterness
Magace: give to increase appetite
Biologic response modifiers:
- naturally occuring treatment methods that can alter the immunologic relationship between the tumor and the cancer pt to provide a therapeutic benefit
- Monoclonal antibodies (Herceptin)
malnutrition: meals and protein need:
- work with dietician
- aversion to meat intensifies as the day goes on so plan a protien filled bfast
- 4-5 small meals a day
- use creams, sauces, to lubricate food
- they interfere with biosynthesis of metabolites or nucleic acids necessary for RNA and DNA synthesis
- cell cycle specific (S phase)
- SE: n&v, diarrhea, bone marrow suppression, proctitis, stomatitis, renal and hepatotoxicity
Tamoxifen: breast cancer med
- prevents natural hormones from feeding tumors, anti-estrogen drug given to post menopausal women who are ER positive.
- most effective when given daily for 2 years
- blocks effects of estrogen
Megace: breast cancer med
- blocks effects of estrogen
- but primarily given to increase appetite in cancer pts.
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