patho 4 Cancer Moore

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mthompson17
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patho 4 Cancer Moore
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2013-04-14 19:32:43
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Pathophysiology cancer nursing
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patho test 4 cancer
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  1. Cancer?
    disorder of cell proliferation and differentiation
  2. Cancer is the _____ leading cause of death.

    Leading cause of death?
    second

    heart disease
  3. What does neoplasia mean?
    new growth
  4. 3 char. of neoplasia?
    • 1. proliferate to form new tissue
    • 2. often do not differentiate to do the "job" of the tissue where they originate
    • 3. they do not undergo apoptosis to control # of cells
  5. 4 most common cancers in order?
    • 1. lung
    • 2. colon
    • 3. breast
    • 4. prostrate
  6. What is the goal of apoptosis?

    How is this r/t cancer cells?
    to get rid of cells not needed

    cancer cells grow faster than normal cells and are not subject to stim to apoptosis so they have huge numbers of cells growing
  7. What happens to cells once they are fully differentiated?
    they are no longer capable of cell division/mitosis
  8. Anaplasis?
    lack of or loss of cell differentiation

    means without form
  9. Autonomy of cancer cells?
    cancer cells are independent from normal cellular controls - do what they want
  10. What are undifferentiated cells?
    immature stem cells
  11. If a cell does not differentiate properly what will occur?
    a mutation has taken place and can cause a cancer

    type of cancer depends on the mutation that occurred
  12. When is the mutation most risk?
    the less differentiated the cell is when the mutation occurs = the more damage will be done and more diff the cell will be from the parent cell and surrounding tissues

    more mature cell will be better able to deal with the mutation
  13. What does malignancy of cancer cells relate to?
    the more differentiated a cell is when mutation occurs the less malignant it will be
  14. Rapid proliferation occurs in what cells of the body
    hair follicles

    epithelial lining of the GI tract

    bone marrow
  15. Proliferation rate AKA?
    cellular degeneration rate
  16. What cells of the body have no cellular proliferation?
    1. myocardium

    2. neurons

    3. cartilage
  17. Why do cancer pt have hair loss and GI probs?
    b/c the Tx for cancer attack rapid proliferating cells & the cells of hair follicles and GI rapidly proliferate
  18. Benign V/S malignant?
    benign - well-differentiated, slow growing, and doesn't spread - not cancer

    malignant - anaplastic or undifferentiated, rapid growth due to doubling time, metastasis
  19. Anaplastic?
    no form
  20. Benign tumor cells?
    1. look like normal tissue cells and may perform the normal function of the tissue

    2. can secrete hormones - may lead to oversecretion

    3. usually have a capsule around them

    4. usually do not invade neighboring tissues
  21. 2 ways benign tumors can cause problems?
    1. can oversecrete hormones

    2. can damage nearby organs by compressing them - can be life-threatening
  22. Char of benign tumor?

    Malignant?
    defined & clearly delineated

    not
  23. Char. of malignant tumors?
    1. cells don't look like parent cells - not like tissue where they came from - less differentiated

    2. can divide rapidly - tumors can grow rapidly

    3. tumor has no clear boundaries and sends legs out into surr. tissue

    4. do not perform the normal functions of the organ - may secrete hormones ass. with other tissues

    5. can compress and/or destroy the surrounding tissues
  24. A 1 cm malignant tumor contains ______ cancer cells.
    1 billion
  25. Hormone secretion of malignant tumor?
    may secrete hormones from other tissues not closeby
  26. Causes/risk factors of cancer?
    • 1. smoking and drinking
    • 2. genetics
    • 3. sun exposure (UVA/UVB)
    • 4. diet
    • 5. exposure to toxins/chemicals:  agent orange

    multifactorial
  27. What causes cancer to occur?
    a change occurs and multifactors effect it- checkpoints in cell cycle do not catch it and it gets out of control
  28. What is required for cell division?
    duplicating the DNA to daughter cells
  29. Telomeres?

    Why do they shorten over time?
    DNA sequences at the ends of the chromosomes where enzymes that duplicate DNA attach

    ends do not get duplicated - cut off each time
  30. G1 of cell cycle?
    will show if DNA in chrom is damaged by radiation or chem
  31. G2 to M of cell cycle?
    will prevent entry into mitosis if the DNA is not complete/correct - proteins cyclins control cell cycle
  32. If a man has a mutation that causes some of his cells to rebuild their telomeres after q division what will occur?
    this is bad b/c the cell will never die
  33. 2 broad groups of improtant cancer-related genes?
    1. proto-oncogenes

    2. tumor suppressor genes
  34. Proto-oncogenes?

    What occurs with over activity of this gene?
    genes that normally code for parts of cell growth activiation

    causes cancer
  35. When does cancer develop?
    when proto-oncogenes are inapp. stim. or tumor-suppressor genes are lost or inactive
  36. Oncogene?
    overactive or mutant form of proto-oncogene
  37. Tumor-Suppressor genes?
    genes that normally inhibit cell proliferation
  38. What do mutant oncogenes do?
    will interrupt normal intracellular communication pathways that normally regulate the growth activiation of cells
  39. When do cancers arise in relation to tumor suppressor genes?
    when TSG are lost or inhibited
  40. 4 categories of proto-oncogene cell proliferation?
    • 1. growth factor
    • 2. growth factor receptor
    • 3. cytoplasmic signaling
    • 4. transcription factors
  41. What usually is the cause of changes in proto-oncogenes an tumor suppressor genes?
    mutation due to risk factors
  42. What types of things can cause mutations that convert proto-oncogenes to oncogenes?
    1. retroviral invasion into the host

    2. mutagenic event

    3. regulatory sequence mutation of DNA

    4. error in chromosome replication
  43. What are retroviruses?
    RNA virus that replicates in a host cell & incorporates its DNA into the host
  44. 3 EX of retroviruses and the cancer that they can cause?
    1. HIV - kaposi sarcoma

    2. Epstein-Barr virus - Burkitt lymphoma

    3. human T-lymphocyte - leukemia
  45. Kaposit sarcoma?
    form of lung cancer
  46. Epstein-Barr?
    mono
  47. Main cause of cancer?
    some event leads to inapp. or inaccurate genetic info being passed on
  48. Normal function of tumor suppressor genes?
    inhibit cell division
  49. What occurs when tumor suppressor genes are not functioning normally?
    cell division is not inhibited and cells will divide continuously
  50. EX of tumor suppressor genes?
    • 1. Rb gene
    • 2. P53 gene
    • 3. BRCA 1 & BRCA 2
  51. What is the Rb gene?
    codes for the master break of the cell cycle - blocks cell division by binding transcription factors needed for division
  52. P53 gene?
    quality control gene - transcription factor that binds to genes and fixes errors
  53. Common tumor suppressor gene that is ass. with cancers?
    p53
  54. BRCA 1 & 2 genes are ass. with what cancer?
    breast cancer

    ppl with BRCA 1 & 2 are more predisposed to breast cancer
  55. How do chemo and radiation work?
    they induce cell death by mediating P53 to catch probs

    cause enough damage to the cell to trigger P53 mediated apoptosis
  56. Oncogenesis?

    Patho?
    change from proto-oncogenes to oncogenes

    Initiation -normal cell -> carcinogen (virus, sun, toxin, etc) -> DNA damage and cell mutation

    Promotion - activation of oncogenes by a promoter agent

    Progression - malignant tumor has formed
  57. 3 stages of cancer development?
    1. initiation

    2. promotion

    3. progression
  58. What occurs during the initiation stage of cancer?
    gene mutation
  59. Etiologic agents or carcinogens that can cause initiation stage?
    • 1. tabacco
    • 2. radiation
    • 3. certain viruses
    • 4. asbestos
    • 5. chemicals
    • 6. chemotherapeutic and immunosppressive agents
    • 7. alcohol
  60. What occurs during promotion stage of cancer?
    mutant cell is induced to replicate and divide
  61. What occurs during the progression stage of cancer?
    mutant cell receives properties that allow it to be malignant
  62. Cancers r/t tobacco?
    • 1. pancreas
    • 2. bladder
    • 3. kidney
    • 4. mouth
    • 5. esophagus
    • 6. cervical
    • 7. lung
  63. Radiation can cause ____ or ____.
    certain kinds can cause cancer and can also be used to Tx it
  64. Tobacco is a _____ carcinogen which means?
    complete - affects initiation and promotion
  65. Leading cause of cancer death in men and women with survival rate of only ____%?
    lung cancer

    15
  66. What increases risk of cancer r/t tobacco and alcohol?
    if use tobacco and alcohol together
  67. Risk factors for promotion of cancer?
    • 1. increased dietary fat
    • 2. obesity
    • 3. cigarette smoking
    • 4. alcohol consumption
    • 5. prolonged severe stress
    • 6. hormones- estrogen and testosterone
    • 7. infection
  68. What occurs during the progression stage of cancer?
    mutant cells begin to exhibit malignant behavior
  69. 5 characteristics of a malignant tumor?
    1. anaplastic with abnormal cell size and shape and/or undifferentiated

    2. doubling time

    3. infiltrates and spreads distantly through blood stream and lymphatic system (metastasis)

    4. tumor necrosis
  70. Key concept about promotion?
    it is reversible
  71. 2 characteristics of malignant cells?
    1. produce telomerase

    2. insufficient P53

    3. tumor necrosis
  72. Telomerase produced by malignant cells?
    enzyme that allows malignant cells to survive and thrive - telomeres are not shortened and the cell does not die
  73. Effect of insufficient P53 in malignant cells?
    prevents apoptosis of cells b/c P53 is what will recognize that the cell is abnormal
  74. How does metastasis occur?
    malignant cells produce special enzymes and receptors to help them escape the original tissue and go through endothelial tissue of vessels -> bloodstream or lymph -> metastasize & enter new tissues
  75. Primary means of metastasis?
    through the bloodstream or lymphatic system
  76. Anaplastic?
    no form
  77. What are tumor markers?

    3 purposes?
    substances found in body fluids or tissue that can help Dx tissue type effected

    • 1. ID tissue type
    • 2. det Tx
    • 3. eval pt progress
  78. Purpose of grading and staging of metastasis?
    help guide selection of Tx according to behavior of malignant tumor
  79. TNM staging system?
    T - size of the original tumor & whether it has invaded nearby tissue

    N - nearby lymph nodes that are involved

    M - metastasis to distant tissues
  80. 4 types of tumor markers?
    • 1. antigen
    • 2. hormones
    • 3. isoenzyme
    • 4. immunoglobulins
  81. 5 types of antigen markers and cancer they are ass. with?
    memorize????
    • 1. carcinoembryonic origin (CEA):  lots of areas
    • 2. CA 125:  ovaries
    • 3. CA 15-3:  breast
    • 4. CA 27-29
    • 5. prostate-specific antigen (PSA) for prostate cancer
  82. If a man has s/s of BPH what may be checked?
    PSA checked - if elevated could be s/s of prostate cancer
  83. Angiogenesis?

    Why is it imp in cancer?
    formation of new blood vessels

    tumor cannot grow to more than 2cm without angiogenesis b/c need nutrients and O2
  84. What is tumor grading?

    What does it determine?
    histologic characterization of tumor cells

    determines degree of anaplasia (nondifferentiated) & form of the tumor

    will get a score
  85. When does angiogenesis usually occur?
    late stages of cancer
  86. Staging of a tumor?
    describes the location and pattern of spread of the tumor
  87. Naming tumors?
    benign tumors -oma

    • malignant tumors:
    • carcinoma - epithelial tissue
    • sarcoma - mesenchymal tissue
  88. Malignant tumors?
    cancer tumors
  89. Epithelial tissue?
    forms linings of the body
  90. Mesenchymal tissue?
    conn. tissues
  91. Neuroma?

    Neuroblastoma
    nerve cell benign

    nerve cell malignant
  92. 7 wrning signs of cancer in adults?
    • CAUTION:
    • C - change in bowel or bladder
    • A - a sore that does not heal
    • U - unusual bleeding or discharge:  vomiting blood, bleeding after menapause
    • T - thickening or lump:  SBE, mammogram
    • I - indigestion/difficulty swallowing: 
    • O - obvious change in mole or wart
    • N- nagging cough or hoarsness
  93. Warning signs of cancer in children?
    • CHILDREN:
    • C - continued, unexplained weight loss
    • H - HA with vomiting in the am
    • I - increased swelling or persistent pain in bones or joints
    • L - lump or mass in abd, neck, or elsewhere
    • D - dev of whitish appearance of pupils
    • R - recurrent fevers not caused by infections
    • E - excessive bleeding or bruising
    • N- noticeable paleness or prolonged tiredness
  94. Cancer risk factor in diabetics?
    if they have a sore that doesn't heal they will be less likely to report it
  95. Concern if pt says they constantly have a lump in their throat?
    may be esophageal or other cancer
  96. 5 manifestations of cancer?
    • 1. metastasis
    • 2. pain
    • 3. fatigue
    • 4. cachexia
    • 5. altered carbohydrate metabolism = diabetes-like syndrome
    • 6. anemia
    • 7. leukopenia/neutropenia
    • 8. thrombocytopenia
    • 9.infection
  97. How will nagging cough or hoarseness be evaluated?
    will rule out other causes before cancer is considered
  98. 4 effects of cancer on the body?
    • 1. pain
    • 2. cachexia - wasting/atrophy of body tissues
    • 3. myelosuppression
    • 4. alopecia & mucositis
  99. What causes pain in cancer?

    Nursing consideration?
    effects pain receptors - will have diff need for pain meds than others

    need more pain meds
  100. Cause of cachexia in cancer?
    most severe form of malnutrition/anorexia of cancer r/t toxin release by cancer cells

    this is r/t to the cancer not the Tx's
  101. Myelosuppression?

    What causes it in cancer?
    bone marrow suppression that causes decrease in blood cells - RBC, WBC, & platelets

    disease process or secondary to treatment
  102. What causes alopecia and mucositis in cancer?

    What is mucositis?
    chemo and/or radiation

    inflammation/ulceration of MM of digestive tract
  103. Anemia s/s?
    H&H low
  104. Leukopenia?
    decreased WBC
  105. Neutropenia?
    low neutrophils
  106. Thrombocytopenia?
    low platelets
  107. If person has cancer and H&H, WBC, and platelets are low what are the risks?
    risk for bleeding and infection
  108. 5 S/S of cancer cachexia syndrome?
    • 1. weight loss
    • 2. muscle wasting
    • 3. weakness
    • 4. anorexia
    • 5. anemia
  109. Cachexia nursing consideration?
    poor quality of life
  110. Altered carb met. in cancer?
    causes a syndrome similar to diabetes where insulin resistance causes hyperglycemia
  111. Cancer pt at risk for ___ & ____.

    Nursing interventions?
    • risk for bleeding and infections
    • 1. soft toothbrushes
    • 2. not using razors to shave
    • 3. hand washing
    • 4. reverse isolation- protect the pt from what others have
  112. Changes in organ function in cancer?
    can cause organ failure or overproduction of normal organ secretions

    benign usually cause increased secretions and malignant will usually decrease secretions r/t interruption of function
  113. 5 local effects of tumor growth?
    • 1. bleeding
    • 2. compression of BV, lymph vessels, hollow organs, or nerves
  114. What happens if BV are compressed?
    ischemia and clots
  115. What happens if lymph vessels are compressed?
    lymph nodes enlarge and edema
  116. What happens if nerves are compressed?
    pain & movement may be affected
  117. Paraneoplastic syndrome?

    Cause?
    cause unknown

    manifestations in sites other than where tumor is - cancer cells produce hormones or hormone-like proteins that affect body in diff ways and areas
  118. What will occur if a tumor secretes PTH -related hormone?
    hypercalcemia
  119. 5 EX of paraneoplastic syndrome?
    1. PTH - hormone secreted = hypercalcemia

    2. ACTH released = cushing syndrome

    3. ADH = hyponatremia and water overload

    4. cancer cells may produce proteins that affect clotting

    5. may cause neurologic disorders
  120. Pt with paraneoplastic syndrome may be predisposed to ___ and ___.
    clotting and bleeding
  121. What may be the earliest indicator of a cancer prob?
    paraneoplastic syndrome s/s
  122. What is usually the first s/s of cancer?

    What will occur with Tx?
    fatigue

    further fatigue
  123. Dx measures for cancer?
    • depends on type of cancer suspected
    • 1. pap smear
    • 2. biopsy - gold standard
    • 3. tumor markers
    • 4. staging and grading
  124. 3 goals of cancer treatment?
    1. curative

    2. control

    3. palliative
  125. Reed sternberg cell?
    cell found in Hodgkins lymphoma that can be Dx of this cancer
  126. 9 Cancer Tx?
    • 1. surgery
    • 2. radiation
    • 3. chemo
    • 4. immunotherapy
    • 5. interferon
    • 6. interleukins
    • 7. monoclonal antibodies
    • 8. gene and molecular therapy
    • 9. stem cell transplantation
  127. 6 SE of cancer Tx?
    • 1. N/V, abd pain
    • 2. alopecia
    • 3. anemia
    • 4. leukopenia/neutropenia
    • 5. thrombocytopenia
    • 6. infection
  128. 3 things surgery used for in cancer?
    • 1. Dx
    • 2. staging
    • 3. palliative
    • 4. curative
  129. Relationship of radiation, chemo, and surgery?
    may use radiation to decrease tumor size so can operate, may be used in conjunction
  130. Radiation and chemo local or systemic?
    radiation - local

    chemo - systemic
  131. ______ is primary Tx for most hematologic cancers and some solid tumors
    chemo
  132. Disadvantage of chemo?
    does not distinguish b/t cancer cells and normal body cells esp. MM & hair follicles
  133. S/S that most pt report r/t chemo?
    fatigue is primary s/s

    will also have nausea
  134. What lab needs to be monitored for pt undergoing radiation or chemo?
    must monitor WBC - if get too low cannot do the Tx
  135. Hormone therapy in cancer?
    use hormones necessary for the cancer to grow to kill it
  136. What V/S being abnormal would be most concerning in cancer pt?
    fever - infection risk
  137. Stem cell transplantation - where do the stem cells come from?
    harvest from bone marrow or peripheral blood

    bone marrow is richer source

    may have stem cell donars
  138. How is N/V Tx in cancer?
    zofran/ondansetron is primary
  139. Nursing considerations about alopecia?
    • teaching and therapeutic comm are imp
    • 1. teach about SE and provide emotional and physical issues

    2. wig info

    3. therapeutic teaching is imp

    4. when might expect to lose their hair

    5 can be rapid and occur in clumps

    6. can grow back and may look diff than when they lost it:  diff color or texture
  140. Nursing consideration about risk for infection regarding teaching?
    teach pt risk and to report fever even if low-grade and taking temp is important

    any temp increase in cancer is bad
  141. 3 different sources of stem cells and where do they come from?
    • 1. autologous - from pt
    • 2. allogenic - tissue matched person
    • 3. syngeneic - identical twin
  142. 6 common solid tumors of childhood?
    • 1. brain and NS tumors
    • 2. neuroblastoma
    • 3. Wilms' tumor
    • 4. retinoblastoma
    • 5. osteosarcoma
    • 6. Ewing's sarcoma
  143. 3 tendencies of heritable forms of cancer?
    • 1. an earlier age of onset
    • 2. higher frequency of multifocal lesions
    • 3. bilateral involvement of paired organs or multiple primary tumors
  144. Dx of childhood cancers?
    often overlooked

    • 1. prolonged/recurrent fever not ass. with infection
    • 2. unexplained weight loss
    • 3. growing masses
  145. Wilm's tumor?
    nephroblastoma - cancer of kidneys that usually occurs in children
  146. Retinoblastoma?
    cancer that dev in the cells of the retina
  147. Osteosarcoma?
    aggressive malignant neoplasm that starts in the bone
  148. Ewing's sarcoma?
    rare bone cancer
  149. Risk of cancer in siblings?
    double that of normal population
  150. Leukemia?
    malignant neoplasm of blood-forming tissues of the bone marrow, spleen, and lymph system that causes abnormal proliferation and accumulation of immature WBC
  151. Patho of leukemia?
    abnormal or immature WBC form and do not function properly -> massive proliferation of abnormal immature cells -> fewer normal WBCs are produced -> normal bone marrow becomes diffusely replaced with abnormal or immature WBC -> interferes with bone marrow ability to produce cells -> bone marrow does not function
  152. How is leukemia categorized?
    by type of WBC affected and the course and duration of the disease
  153. 2 char of acute lymphocytic/lymphoblastic leukemia?  (ALL)?
    • 1. immature lymphocytes proliferate in the marrow
    • 2. rapid onset & progression with short clinical course
  154. Age of onset of ALL?
    acute lymphocytic/lymphoblastic leukemia

    most common in children b/t 2 -10 but can occur in middle age or older
  155. What occurs in Acute myologenous/myelocytic leukemia (AML)?

    Myeloid/myeloblast?
    immature granulocytes proliferate and accumulate in marrow

    granulocyte precursor/stem cell
  156. Myelodysplastic syndrome?

    AKA?

    Nursing consideration?
    bone marrow is damaged and makes dysfunctional or immature blood cells

    AKA pre-leukemia

    can progress to acute myelogenous/myelocytic leukemia (AML)
  157. Diff b/t myelodysplastic syndrome and aplastic anemia?
    mayelodysplastic syndrome bone marrow makes dysfunctional or immature blood cells

    in aplastic anemia blood cells are not made
  158. 3 char of acute leukemia?
    • 1. rapid onse
    • 2. rapid progression with short clinical course
    • 3. left untreated death will result in days to months
  159. Incidence of AML increases with ____?
    age over 50
  160. What occurs in chronic lympocytic leukemia (CLL)?
    abnormal incompetnet lymphocytes proliferate and accumulate
  161. CLL is more common in ____ & _____.

    Onset?
    more common in men and ppl b/t age 50-70

    more gradual onset with age 50-70
  162. Chronic myelogenous leukemia (CML)?
    abnormal stem cells lead to an uncontrolled proliferation of granulocyte cells resulting in a marked increase in circulating blast cells
  163. When does CML primarily occur?

    Incidence slightly higher in _____.

    Onset?
    ages 30-50

    men

    gradual onset
  164. Philadelphia chromosome?
    chromasomal abnormality ass. with CML

    presence is highly Dx of CML
  165. Chronic leukemia characteristics?
    • 1. insidious onset
    • 2. more prolonged clinical course
    • 3. asymptomatic early in disease
    • 4. life expectancy may be more than 5 years
  166. 16 S/S of acute and chronic leukemia?
    • 1. anemia
    • 2. leukopenia
    • 3. thrombocytopenia
    • 4. dyspnea
    • 5. fatigue/malaise
    • 6. decreased activity tolerance
    • 7. anorexia and weight loss
    • 8. bone or joint pain
    • 9. HA
    • 10. visual disturbances
    • 11. fever
    • 12. lymphadenopathy - enlarge lymph nodes
    • 13. hyperuricemia - high uric acid
    • 14. splenomegaly
    • 15. increased WBC
    • 16. hepatomegaly
  167. 8 nursing assessments for leukemia pt?
    • 1. pain
    • 2. nutrition
    • 3. signs of bleeding
    • 4. signs of infection
    • 5. vital signs
    • 6. oral mucosa
    • 7. neutropenia
    • 8. H&H/CBC/PLT count
  168. Only definitive Dx test for leukemia?
    bone marrow biopsy
  169. Meds for leukemia?
    • 1. pain
    • 2. antiemetics
    • 3. chemo - induction therapy
  170. Inductin therapy?
    initial treatment - usually chemo with leukemia
  171. Bone marrow transplant in leukemia?
    can be curative

    chemo to destory abnormally deviding blast cells of pt -> marrow removed from hip/long bones of donar is injected into pt blood stream -> will migrate to bone marrow and start to produce healthy cells
  172. SE of bone marrow transplant?
    • 1. flu-like s/s:  fever, chills, body aches
    • 2. chest pain
    • 3. N/V & diarrhea

    s/s may last a few weeks
  173. Complications/ risks of bone marrow transplantation?
    • 1. destroys WBC - risk for infection
    • 2. transplant rejection
  174. Tx of risk for infection in bone marrow transplant pt?
    prophylactic ABX
  175. Where are bone marrow biopsy taken from? 

    Pre nursing consideration?

    Post nursing consideration?
    posterior iliac crest, anterior iliac crest, or sternum

    assess coagulation before procedure

    after procedure apply firm pressure for 5 minutes
  176. 3 ways to protect bone marrow transplant/biopsy pt from infection?
    • 1. vital sign assessments
    • 2. neutropenic precautions
    • 3. monitor Nadir - lowest blood count of WBC
  177. Nadir and chemo?
    chemo will cause nadir point then will climb back up
  178. Nursing management of leukemia?
    • 1. meds
    • 2. bone marrow transplant
    • 3. bone marrow biopsy
    • 4. protect from infection
    • 5. prevent bleeding
    • 6. prevent fatigue
    • 7. maintain hydration & nutrition
    • 8. stomatitis
    • 9. discuss concerns and fears
    • 9. alopecia
  179. Lymphoma?
    group of malignant neoplasms that affect the lymphatic system
  180. 2 types of lymphoma?
    • 1. Hodgkin's disease
    • 2. Non-Hodkin's Lymphoma
  181. Hodgkins's disease and nonhodgkin's lymphoma?
    hodgkins- char by the presence of Reed-Sternberg cell

    nonhodgkins - include all lymphomas except hodgkin
  182. Reed-sternberg cell?
    giant cells from B lymphocytes that are ass. with/Dx of Hodgkin's lymphoma
  183. Cause of lymphomas?
    unknown
  184. Patho of Hodgkin's lymphoma?
    Reed-Sternberg cells replace normal cells in 1 lymph node -> spreads to adjacent structures through lymph system-> infiltrates other tissues
  185. Age of Hodgkin's disease occurrence?

    Who does occur more in?
    peaks in 2 age groups:  15 to 35 and 55-75

    occurs more often in men
  186. Non-Hodgkin's lymphoma patho?
    cells that make up lymphoid tissue become a bnormal and eventually crowd out normal cells

    originates outside lymph nodes and disseminates rapidly
  187. What cells are present in Hodgkin's lymphoma but not non-Hodgkin's?
    Reed sternberg cells
  188. Incidence of non-hodgkin's lymphoma?
    incidence increases b/t 50-70

    more often in men
  189. 4 risk factors/etiologic factors for non-hodgkin's lymphoma?
    • 1. viral infections - Epstein Barr
    • 2. env factors
    • 3. exposure to chem/radiation
    • 4. H. pylori
  190. Tx of non-hodgkin's lymphoma?
    will have AGGRESSIVE TX
  191. 3 char of lymphoma?

    9 manifestations with advanced disease?
    • 1. insidious onset
    • 2. painless unilateral or bilateral lymph node enlargement
    • 3. enlarged lymph nodes - cervical first then  to axillary to inguinal

    • 1. weight loss
    • 2. night sweats
    • 3. malaise
    • 4. chills
    • 5. pruritis
    • 6. anorexia
    • 7. non-productive cough
    • 8. dyspnea
    • 9. renal failure
  192. Nursing assessments of lymphoma?
    • 1. lymph nodes
    • 2. pain
    • 3. nutrition
    • 4. weight
    • 5. activity level
    • 6. respiratory status
    • 7. kidney function
    • 8. Dx tests
  193. Dx tests to monitor in lymphoma?
    • 1. CBC
    • 2. BUN/creatinine
    • 3. lymph node biopsises
  194. 2 systems that can be affected by lymphoma?
    kidneys and lungs
  195. 8 nursing considerations for lymphoma?
    • 1. meds
    • 2. raidation
    • 3. post-procedure lymphangiogram
    • 4. protect from infection
    • 5. maintain normal body temp
    • 6. pain
    • 7. adequate nutrition
    • 8. aggressive treatment
  196. Multiple myeloma?
    plasma cell neoplasms
  197. Plasma cells?
    WBC that are normally in lymph nodes and act as antigen presenting/immune response cells
  198. Incidence of multiple myeloma?
    mostly men 50-69

    more prominent in Aa
  199. Cause of mult myeloma?
    unknown
  200. Patho of multiple myeloma?
    malignant plasma cells arise form 1 clone of B cells & proliferate withing the hematopoietic tissue -> infiltrate bone to produce osteolytic lesions -> bone destruction leads to hypercalcemia and pathologic fractures -> proliferation of plasma cells crowds marrow space -> plasma cells synth and secrete abnormal small number of immunoglobulins & large # of proteins -> marked increase in IgG or IgA & increased blood viscosity r/t proteins ->
  201. Bence jones protein?
    proteins that are a part of regular antibodies & will spill into the urine with mult myeloma
  202. 11 manifestations of mult myeloma?
    • 1. gradual insidious onset
    • 2. pain
    • 3. infection
    • 4. cord compression
    • 5. osteoporosis
    • 6. renal stones
    • 7. hypercalcemia
    • 8. GI distress
    • 9. altered musculoskeletal status
    • 10. F&E imbalance
    • 11. altered cardiopulmonary function
  203. 6 nursing assessments for mult myeloma?
    • 1. pain
    • 2. fractures
    • 3. pneumonia
    • 4. kidney probs
    • 5. MS problems
    • 6. CV probs
  204. Dx tests for mult myeloma?
    • 1. electrolytes
    • 2. CXR
    • 3. labs
    • 4. CT
    • 5. UA for bence jones proteins
  205. Meds for mult myeloma?
    • 1. antimicrobials
    • 2. chemo
    • 3. management of hypercalcemia
  206. Tx of mult myeloma?
    palliative only - no cure

    meds and radiation
  207. Nursing considerations for mult myeloma?
    adequate hydration & ROM
  208. Supportive care for mult myeloma?
    • 1. manage pain
    • 2. blood products
    • 3. when occurs:  rest joint, apply ice, admin hemophilia factors

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