Oncology

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NurseFaith
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Oncology
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2014-10-16 10:45:22
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Oncology
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  1. Cancer is a group of over ____ diseases
    200
  2. "cancer" is characterized by:
    uncontrolled and unregulated growth of cells
  3. ____% of cancers are in people over 55 years old
    77%
  4. Overall, the incidence of cancer has been _____
    • Declining
    • (except for Non-Hodgkin's Lymphoma- HIV, and skin cancers)
  5. The Two types of cancer that are not declining:
    Non- Hodgkins Lymphoma (HIV)

    Skin Cancers (from tanning)
  6. Cancer is the ______ most common cause of death
    2nd
  7. The _____ system has a great deal to do with cancer
    • immune 
    • (this is why people with HIV are so susceptible)
  8. Incidence and death rates are disproportionately higher in _____ for cancer
    African Americans
  9. Over ___million Americans have a history of cancer
    11 million
  10. Biology of Cancer
    Poor regulatory controls over proliferation and differentiation

    Loss of Equilibrium (in a perfect world cell death should be = to cell growth)

    Lack of respect for boundaries (between tissues)

    Cells divide indiscriminately and haphazardly

    Mutated cells continue to grow

    The cancer cell has defective differentiation (it does NOT look like host tissue)

    Cancer is graded by pathologist (how much it looks like "parent" cell)

    The higher the grade of the cancer cell, the more unlike the normal cancer (more advanced) it is
  11. Initiation of Cancer
    • Something triggers cells to begin to change
    • (radiation, genetics, chemicals, viruses...we don't really know)
  12. Promotion of Cancer
    Certain factors seem to encourage the growth of abnormal cells (dietary fats - colon cancer, obesity - breast cancer/ovarian cancer, smoking - lung cancer, alcohol - pancreatic/bladder cancer)
  13. Dietary fats seem to encourage ___ cancer
    Colon
  14. Obesity seems to encourage ____ cancer
    breast cancer/ovarian cancer
  15. Smoking seems to encourage ____ cancer
    lung
  16. Alcohol seems to encourage _____ cancer
    Pancreatic and Bladder
  17. Progression of Cancer
    • (not really clear)
    • Increased growth of the tumor, increased invasiveness and metastasis. (Determines Staging)
  18. Classifications of Cancer
    • Carcinomas
    • Sarcomas
    • Leukemia and Lymphoma
  19. Classification of cancer that originate from embryonal ectoderm (skin, glands, mucous membranes, linings of respiratory tract, GI tract, GU tract)
    Carcinomas
  20. Classification of Cancer that originates in embryonal mesoderm (connective tissue, muscle, bone, fat)
    Sarcomas
  21. Classification of Cancer that originates in hematopoietic system
    Leukemia and Lymphoma
  22. Histologic Classifications of Cancer Cells are based on:
    • Grades (1-4)
    • (how much it looks like or doesn't look like the cells it was taken or metastisized from)
  23. Histologic Classification (grade) of cancer cells that differ only slightly from normal cells and are well differentiated
    Grade 1
  24. Histologic Classification (grade) of cancer cells that are more abnormal and moderately differentiated 
    Grade 2
  25. Histologic Classification (grade) of cancer cells that are very abnormal in appearance and are poorly differentiated
    Grade 3
  26. Histologic Classification (grade) of cancer cells that are immature and primitive and undifferentiated (hard to tell origin)
    Grade 4
  27. The Staging of cancer is determined by:
    Extent of the Spread of the Cells
  28. Stage of Cancer where cancer is right in the tissue in one spot "Cancer in Situ"
    Stage 0
  29. Stage of Cancer where cancer is limited to tissue of origin
    Stage 1
  30. Stage of Cancer where there is limited local spread in one region of the body
    Stage 2
  31. Stage of Cancer where there is extensive local and regional spread
    Stage 3
  32. Stage of Cancer where it has spread to distant sites (metastasis)
    Stage 4
  33. Process of Invasion and Metastasis:
    Cancer cells invade surrounding tissues and blood vessels

    Cancer cells are transported by the circulatory system to distant sites

    Cancer cells reinvade and grow and new location

    (cancer spreads through the lymphatic system)
  34. TNM System
    • T= Tumor
    • -is there evidence of tumor? is it in situ? size? location

    • N= Nodes
    • -is there indication of cancer in the lymph nodes? in one region or throughout body?

    • M= Metastasis
    • -is there evidence of distant metastasis? (ie: testicular cancer in lungs)
  35. Types of cancer dx/screenings that are done regularly:
    • Mammograms
    • Prostate stimulating antigen
    • Colonoscopy (men over 50)
  36. AVOID using _____ when pt has cancer, practice the skill of being ____ wherever they are in their journey
    • False Assurance
    • "with"
  37. 7 Warning Signals of Cancer
    Change in Bowel or Bladder habits

    Sore that doesn't heal

    Unusual bleeding or discharge

    Thickening or lump in breast or elsewhere

    Ingestion or difficulty in swallowing

    Obvious change in wart or mole

    Nagging cough or hoarseness
  38. Common signs of Ovarian cancer
    Bloating and indegestion
  39. Dx of cancer can be done by:
    Normal Screenings (PAP, mammograms, PSA, colonoscopy)

    Examination of abnormal cells via biopsy

    Law work (CBC, liver function, pancreatic enzymes, tumor markers like CA-125 ovarian cancer, PSA, BRCA 1 gene breast cancer)

    Radiology Studies (x-rays, CT, MRI, PET)

    Endoscopic exams (Colonoscopy, Upper GI, Cystoscopy)

    Bone marrow biopsy (if hematopoietic cancer suspected)
  40. Leukemia has WBC >
    100,000 (normal is 5,000-10,000)
  41. FIRST sign of bladder cancer:
    blood in urine (even microscopically)
  42. Goal of Cancer Treatment
    • Cure
    • Control (if it can't be cured, it can be maintained for long periods of time)
    • Palliation (relief and control of sx)
  43. Goal of Surgical Management of Cancer
    To remove tumor while sparing as much normal tissue as possible

    CLEAR MARGINS (re-suctioning until all cancer cells are gone)

    Debulking (removal of as much tumor as possible, even if it all cannot be removed for risk of damaging vital tissue...makes chemo and radiation more effective because it has less cancer to attack)

    Done to assure QOL and preserve body image

    *can be done for cure, control, or palliation
  44. Chemotherapy is used for:
    To provide systemic therapy

    Used for Most Solid Tumors and Hematologic Cancers!!

    Can be done for cure, control or palliation
  45. Chemotherapy works at the ___ level to interfere with cell cycles
    Cellular
  46. Some drugs of chemotherapy are ____, others are ____
    Cell-cycle specific, non-specific
  47. Why is chemotherapy usually given in combo with other chemo drugs
    To maximize effectiveness and attack at different stages of the cell cycle
  48. Chemotherapy is BEST given through ____
    Central Venous Access Device

    *Because many chemo agents are vesicants and will cause local tissue breakdown and necrosis if there is infiltration (extravagation )
  49. Complication of Chemo given through regular IV:
    Extravagation: Local tissue breakdown and necrosis if infiltration occurs


    **STOP CHEMO IMMEDIATELY IF THERE IS ANY PAIN
  50. Intra-arterial chemo can be give ____
    straight to the tumor
  51. Intra-peritoneal chemo is used to treat:
    metastasis on the lining of the peritoneal cavity
  52. Bladder cancer is treated by:
    Intra-bladder chemo (chemo sits directly in bladder for a while to target the specific area)
  53. Dome-shaped disk that is surgically implanted through the cranium (IV chemo cannot permeate the blood-brain barrier)
    Ommaya Reservoir
  54. Chemo works best on cells that are _____
    Rapidly Dividing
  55. ***Complication of chemo due to it acting on rapidly dividing cells
    It cannot tell the difference in a fast-growing cancer cell and fast growing cells of hair follicles, GI lining, or bone marrow
  56. Radiation is a _____ treatment of cancer
    Localized
  57. Process of Radiation Therapy
    The delivery of high energy beams generates free radicals which break chemical bonds in DNA to where cells can't replicate
  58. Cancer cells are more likely to be ______ by cumulative doses of radiation, so it is give over a long period of time
    Permanently Damaged
  59. Each type of tissue in the body has a _______, which is then divided into fractions before radiation begins
    Maximal tolerated dose
  60. Complication/Disadvantage to Radiation:
    Rapidly growing normal cells are also damaged by radiation (hair, GI, blood cells)
  61. Side Effects of Radiation:
    Local reactions to skin

    Redness and irritation can develop 1-24 hours after first dose

    Usually dry, red, itchy, sore skin

    If the rate of cellular sloughin is faster than the ability of new epidermal cells to replace dead cells, wet desquamation occurs with weeping of serous fluid
  62. Things to teach/Interventions for pt undergoing radiation:
    Protect skin from temperature extremes

    No tight clothing, no rubbing, no chemicals or deoderants

    Lubricate with approved lotion only! (aloe vera)
  63. Medications which alter the relationship between host and tumor are considered:
    biologic and targeted therapy
  64. Biologic and Targeted Therapies can inhibit ____ and promote cell death
    • cell proliferation
    • (some inhibit enzymes for cell growth and some prevent new blood vessel development in a tumor)
  65. Advantage to using Biologic and Targeted Therapies for cancer:
    Can kill cancer cells with less damage to normal cells
  66. Types of Biologic and Targeted Therapies:
    Interferon (leukemia, melanoma, kidney, ovarian, multiple myeloma)

    Rituxin (NHL and chronic leukemia)

    Avastin (colorectal, lung cancer, breast)
  67. Biologic and Targeted Therapy used for some Leukemias, melanoma, kidney cancer, ovarian cancer, multiple myeloma
    Interferon
  68. Biologic and Targeted Therapy used for NHL and chronic leukemia
    Rituxin
  69. Biologic and Targeted Therapy used for colorectal, some lung cancers, breast cancer
    Avastin
  70. Allows for safe use of Very High doses of chemo
    Hematopoietic Stem Cell Transplant
  71. When is hematopoietic stem cell transplant done
    when tumors have developed resistance or failed to respond to standard doses of chemo
  72. How can stem cells for a hematopoietic stem cell transplant be collected
    By Bone Marrow from a donor (surgery) 

    OR

    Stem cells can be removed from blood through a separator machine
  73. Retrieval of bone marrow or stem cells
    Harvesting
  74. Goal of Hematopoeitic Stem Cell Transplant
    CURE...or long, long remission
  75. "Conditioning regimen" for hematopoeitic stem cell transplant begins....
    10 days before the transplant
  76. Action of Hematopoeitic Stem Cell Transplant
    Infusing new healthy cells "rescues" the damaged bone marrow through the engraftment and subsequent normal proliferation of healthy cells
  77. Types of Transplants:
    • Allogenic- given by donor (risk of rejection)
    • Synegeneic- identical twin (no rejection)
    • Autologous- pt's own stem cells (if no suitable donor can be found)
  78. Type of transplant where cells are given by a donor (often family member or match through National Marrow Donor Program)....risk of rejection
    Allogenic
  79. Type of transplant where cells come from identical twin (no rejection occurs)
    Synegeneic
  80. Type of transplant where the pt gets his own cells back (only done if there is no suitable donor to be found)
    Autologous
  81. Nursing Care for Bone Marrow Transplantation:
    Blood counts are taken down to 0

    • Keep Environment sterile
    • --Sepsis is BIGGEST risk
    • --Pt is critically ill
    • --Bleeding is large risk

    Watch for Graft vs Host Disease! (occurs when T-Lymphocytes from donated marrow recognize the recipient as foreign and begin to attack skin, liver, GI)
  82. Risks of Bone Marrow Transplant
    Biggest risk is SEPSIS

    Bleeding

    Graft vs Host Disease
  83. When T-lymphocytes from donated marrow recognize the recipient as foreign and begin to attack liver, skin and GI system
    Graft vs Host disease
  84. Studies estimate that at least _____% of people with cancer use some type of complementary intervention to radiation and chemotherapy
    50%
  85. MYTH: proposition for massage therapy
    Massage therapy reduces cancer patient's pain and anxiety
  86. Verdict for MYTH of massage therapy:
    Massage is perfectly fine for pt who enjoys it...it is worthwhile if the pt feels better and if they feel like it improves QOL
  87. MYTH: Proposition of Acupuncture on cancer pt
    Acupunture reduces nausea, vomiting and pain from cancer
  88. Verdict for MYTH of acupuncture:
    Although the evidence conflicts, it appears that accupunture does reduce pain and n/v ...with low risk interventions like acupuncture, some experts believe that the importance of a perceived benefit may trump clinical benefit
  89. MYTH: Proposition of Physical Activity and the cancer pt
    Engaging in physical activity such as walking, running, or recreational sports can improve cancer survival
  90. Verdict for the MYTH of physical activity and the cancer pt
    CONFIRMED! The evidence showing that regular moderate-vigorous exercise improves survival for men and women diagnosed with range of cancers is compelling
  91. MYTH: proposition of sugar intake and the cancer pt
    Cutting sugar out of one's diet will stop a tumor from growing
  92. Verdict for the MYTH of sugar intake and the cancer pt
    Unconfirmed for a potential anticancer effect from eliminating sugar, but it's important to minimize excess sugar intake as a part of maintaining a generally health diet
  93. MYTH: proposition for antioxidants and the cancer pt
    Consuming antioxidant supplements may protect against cancer and prevent tumor growth
  94. Verdict for the MYTH about antioxidants and cancer pts
    Busted for supplements, though it is plausible that antioxidants from food may be beneficial, supplemental vit E actually INCREASES  the risk of PROSTATE CANCER!!!! Supplemental A, C, E and beta-carotene actually increases overall mortality in esophageal, gastric, colorectal, pancreatic and liver cancers
  95. MYTH: proposition for Reiki (transferring universal energy)
    Reiki can diminish cancer pain and stress
  96. Verdict of the MYTH of Reiki and the cancer pt
    Busted, but harmless if it increases an individual's sense of well-being
  97. MYTH: proposition of meditation and the cancer pt
    Medication "mindfulness" diminishes anxiety, stress, and depression in cancer patient
  98. Verdict of the MYTH of meditation:
    Confirmed for diminishing anxiety, stress and depression in people with cancer
  99. Complication of chemo when it kills normal healthy RBC
    • Anemia and Fatigue
    • (fatigue can also be due to pain meds, pain, lack of sleep)

    Heart works harder when there are too few RBC

    Feel weak, tired, heart pounding, SOB, dizzy
  100. Interventions for Anemia and Fatigue complications due to chemo:
    •Rest, limit activities (do just what is necessary)

    •Accept help from family and friends

    •Well-balanced diet with plenty of calories and proteins

    •Stand up slowly

    • •EPOGEN (ProCrit) to stimulate bone
    • marrow to produce more RBCs

    •Blood transfusions only if symptoms of anemia are severe
  101. Complication from chemo resulting in fat and muscle depletion, inadequate nutrition
    Anorexia and Malnutrition

    • Nausea
    • Mouth/Throat pain
    • Metallic Taste (from medications and cancer cells dying)
  102. Interventions r/t cancer patient suffering from anorexia and malnutrition
    •Teach importance of eating

    •Nutrient Density!

    •5-6 small meals/day

    •Use plastic utensils (helps prevent metal taste)

    •Do something active

    •Milkshakes or smoothies, juice or soup even if no solids
  103. Chemo destroys platelets, putting pt at risk for
    BLEEDING

    *thrombocytopenic precautions
  104. Interventions r/t cancer pt suffering from Bleeding
    •Brush teeth with baby toothbrush (hot water on bristles)

    •Blow nose very gently

    •Be careful using scissors or knives

    •Use electric razors only

    •Apply pressure for 5 minutes on any cut or stick

    •Loose, comfortable shoes

    •NO dental floss or toothpicks

    •NO tampons, rectal temps, enemas, suppositories

    •Notify if unexplained bruising
  105. Drug that stimulates bone marrow to produce platelets
    NUMEGA
  106. Pain meds, chemo meds, decreased activity, foods low in fiber, not enough liquids...all can lead to
    Constipation
  107. Things to teach patients/interventions for constipation
    Drink at least 8 cups of liquid/day

    Warm liquids may stimulate peristalsis

    Be as active as possible

    High fiber foods (whole grains and cereals, dried beans, peas, raw veggies, fresh and dried fruits, nuts, seeds)

    May need stool softeners or laxatives

    Observe for distention, bowel sounds, firmness

    Keep close track of bowel movements
  108. Chemo destroys healthy cells which line the large and small bowel...leading to:
    Diarrhea
  109. Teaching/Interventions related to Diarrhea
    • 5-6 small meals/day
    • Foods high in salts and potassium to  replace what is lost

    8-12 cups of fluid while diarrhea is present

    LOW fiber foods (bananas, white rice, white toast, plain yogurt, chicken, cooked cereals, cottage cheese, eggs, noodles, canned fruits)

    Meds like Immodium may be needed
  110. When hair on head, face, arms, legs, underarms, pubic areas fall out....
    Alopecia
  111. Hair loss usually begins about ____ weeks after chemo begins
    2-3
  112. Anticipatory guidance for pt dealing with Alopecia
    The best time to get a wig is right before chemo begins (insurance will pay, or there are wig banks)

    Many people cut/shave their own hair to have control

    Protect tender scalp = hat, turban, sunscreen

    May feel colder than normal with no hair

    Sleep on satin pillow case- less friction than cotton

    Experiment with hats, scarves, extra make-up
  113. ____ occurs when chemo kills normal WBCs and the body cannot fight infection
    Neutropenia
  114. Observe chemo pt closely for ___ (temp, redness, discharge, cloudy urine, sinus pain, etc)
    Infection
  115. Teaching/Interventions about Infection for the Cancer Pt
    Strict Handwashing

    Use sanitizing wipes to clean surfaces you touch (phone, TV remote, ATM, elevator buttons)

    Be gentle when wiping after bowel movement (baby wipes)

    Stay away from people who are sick with colds, flu

    Stay away from children with drippy noses or who have had "live" vaccines (polio, chicken pox)

    Stay away from crowds

    Be careful not to cut/nick yourself (shaving or washing dishes)

    Check temp ever day  and notify if over 100.5

    • DO NOT TAKE TYLENOL, IBUPROPHEN, or ASPIRIN WITHOUT TALKING TO HEALTH CARE PROVIDER (ie: liver pt with tylenol, low plt count patient with aspirin)
    • Watch for infection around port

    Good mouth care with soft tooth brush

    Skin Care (esp feet)...gently pat skin dry

    Clean cuts right away

    Be careful of animal waste products (liter box, fish tanks, bird cages)

    No flu shot or other vaccines without MD

    Keep hot foods hot, cold foods cold

    NO fresh, unwashed foods (SALADS!)

    Beware of undercooked fish, seafood, meat, chicken or eggs

    Watch expiration dates on food or drinks

    No standing water!!! (pseudomonas)

    No plants (flowers have cirratia???)
  116. Drug that stimulates bone marrow to produce WBC
    Neupogen
  117. Mouth and Throat Changes for chemo pt
    Mouth Sores, Increased sensitivity to hot/cold, infections of gums or teeth or tongue, changes in taste and smell (dry mouth)
  118. Anticipatory guidance for throat/mouth changes of chemo pt
    See Dentist BEFORE starting chemo and get all necessary dental work done 

    Check mouth and tongue every day looking for sores

    Keep mouth moist (water, ice, sugar-free candy or gum)

    Alcohol-free mouth wash or warm water, baking soda, and salt (BIOtene)

    Choose foods that moist, soft, easy to chew and swallow

    Soften foods with gravy, sauces, broth yogurt

    Avoid Citrus

    Avoid foods that may scrape mouth (chips)
  119. When should you give a chemo pt an antiemetic drug
    1 hour before each chemo and for a few days after
  120. Anticipatory guidance for pt that is experiencing Nausea and Vomiting
    Bland foods and drinks (crackers, toast, gelatin)

    Plan when it's best to eat/drink (5-6 small meals)

    Do not drink a lot during meals

    Do not lie down after eating

    Cold foods are better tolerated (no odor)

    Allow fizz to leave carbonated drinks

    Small bites of popsicles or fruit ices

    Suck on sugar-free mints or tart candies (not if mouth is sore)

    Deep Breathing, cold cloth on head/neck

    zofran, compazine, decadron > for nausea
  121. Drugs given for chemo pt experiencing N/V....give 1L of fluids prior!
    Zofran, Compazine, Decadron
  122. Nervous System Changes for chemo patient
    Tingling, burning, weakness, numbness, feeling cold, pain when walking, soreness, achy muscles, being clumsy and losing balance, shaking/rambling, "chemo confusion"
  123. Teaching regarding nervous system changes
    Avoid falls (walk slowly, handrails, no-slip bath mats, rubber soled shoes)

    Extra rest

    Antidepressants may help
  124. Moderate to severe pain occurs in _____% of people who are receiving active cancer treatment
    50%
  125. ____% of people have pain with advanced cancer
    80-90%
  126. What is the number 1 fear of people when they hear the diagnosis of "cancer"
    Pain
  127. Single greatest barrier to effective pain management
    Inadequate pain assessment
  128. __ and ___ are NOT reliable indicators of pain, especially chronic pain
    Vital Signs, Patient Behaviors
  129. How often should pain meds be given to cancer patient
    on a regular schedule (not PRN)

    Do not skip doses because the pt "looks" okay
  130. There is no ____ that cannot be controlled
    Pain
  131. Long acting PO pain reliever that can be given continuously over 12 hours
    Oxycodone
  132. For immediate breakthrough pain, the pt will be instructed to take:
    Percocet
  133. Sexual Changes that occur with chemo pt
    Changes in hormone levels

    Decrease blood supply to penis

    Vaginal dryness/early menopause

    Fatigue decreases interest in sex

    Physical changes make men/women feel unattractive

    Stress importance of NOT GETTING pregnant
  134. Interventions/Teachings for sexual changes that occur in chemo pts
    Vaginal creams, Water based lubricants, Encourage open communication, Explore new ways to show love, Encourage counseling with psychologist, social worker, marriage counselor, sex therapist
  135. Group of malignant disorders affecting the WBCs...Impacts blood, blood forming tissues of bone marrow/lymph system and spleen
    Leukemia
  136. Leukemia is ___ if not treated very aggresively
    Fatal
  137. What immature, prematurely formed WBCs are called
    "Blasts"
  138. Bone marrow becomes full of ___ in leukemia, so they cannot fight infection
    "blasts"
  139. How is leukemia diagnosed
    WBC and bone marrow exam (WBC will be over 100,000)
  140. How is leukemia treated
    "Induction Chemotherapy"
  141. Very high dose for 6 weeks or more, continuously...requires hospitalization
    Induction Chemotherapy
  142. What is done every 3-4 weeks once remission is reached in Leukemia
    Consolidation Chemo and possibly bone marrow transplantation
  143. Proliferation of abnormal, giant, multi-nucleated cells called Reed-Sternberg Cells
    Hodgkin's Lymphoma
  144. Hodgkin's Lymphoma occur in ____ of people...shows with swelling of cervical lymph nodes or in axilla or groin
    2/3
  145. Exposure to _____ or _____ may be a cause of Hodgkin's Lymphoma
    Epstein-Barr Virus or HIV
  146. Hodgkin's Lymphoma has a ____ onset
    Quiet

    • Little weight loss
    • Low grade temp
    • Fatigue
    • Weakness
    • Chills
    • Night Sweats
  147. How is Hodgkin's Lymphoma Diagnosed:
    lymph node biopsy, bone marrow exam, CT
  148. Treatment to Hodgkin's Lymphoma
    • Chemo ALWAYS
    • Radiation if confirmed to small area
  149. Hodgkin's Lymphoma has a ____% survival rate at 5 years
    90%
  150. Non-Hodgkin's Lymphoma usually has ____ cytes involved
    B or T lymphocytes
  151. Incidence of NHL has increased by 2-3% each year due to aging population and incidence of ____
    HIV
  152. What is the major cause of death for Hodgkin's and Non-Hodgkin's Lymphoma?
    Infection
  153. Poliferation of plasma cells in bone marrow...they grow out of control and squeeze RBCs and Plts...malignant plasma cells grow and push calcium out of bones and diffuse osteoporosis
    Multiple Myeloma
  154. First Symtom of Multiple Myeloma
    • Skeletal Pain
    • (pelvis, spine, ribs)
  155. Complication of Multiple Myeloma
    Vertebral destruction leads to collapse of vertebrae, spinal cord compression

    Pathological Fractures

    Hypercalcemia (causes neurologic, renal, GI probs)
  156. S/S of hypercalcemia
    Changes in LOC, Constipation, Elevated BUN

    (neuro, renal, GI probs)
  157. ____ occur as normal bone marrow is replaced with malignant plasma cells in Multiple Myeloma
    Anemia, Thrombocytopenia, Neutropenia
  158. How is multiple myeloma diagnosed:
    • Bone marrow biopsy
    • X rays (bone erosion, thinning, or fractures)
  159. How are high calcium levels treated in Multiple Myeloma
    Hydration (want 1-2 liters of urine/day)...diuretics may be given
  160. What is given to protect the kidneys from uric acid (which is released from dead cells) in Multiple Myeloma
    Allopurinol
  161. Head and neck cancers are usually ____ at the time of dx
    Advanced
  162. ____% of people over 50 with prolonged tobacco and alcohol use are dx with Head and Neck Cancers
    90%
  163. May appear as a unilateral sore throat or even ear pain
    Throat Cancer
  164. Painless growth in mouth, or ulcer that doesn't heal...pain is late sx
    Oral Cancer
  165. Laryngeal cancer often presents as ______
    Hoarseness "lump in my throat"
  166. How is Head and Neck cancer dx
    Visualization 

    CT to see local and regional spread

    Biopsy to confirm
  167. Why is metastasis very common for head and neck cancers
    Head and neck is rich in blood supply and lymph nodes
  168. How is head and neck cancer treated
    Radiation to the exact area...if it has spread, use Chemo

    Surgery to remove cancer (laryngeal cancer surgery always requires at least a temporary tracheostomy)
  169. Laryngeal cancer surgery always requires a ____
    temporary or permanent tracheostomy
  170. What frequently accompanies total laryngectomy
    Radial Neck Dissection
  171. Priorty after pt has surgery on Head/Neck cancer
    • AIRWAY!!!!! (tracheostomy)
    • Suction as needed-- very bright blood the first 24-48 hours
  172. Teaching/Interventions r/t Head and Neck cancer pts after surgery
    Unable to eat/drink for a while after surgery

    Speech therapy to help swallowing

    Tube feedings until swallowing is easier

    Hydration with IV

    Elevate HOB to prevent aspiration

    Jackson-Pratt Tube will be in place so blood from deep muscles can escape

    Saliva may be decreased or absent...INCREASE fluid intake, sugarless gum/candy and always have water bottle

    Artificial larynx for communication
  173. Prior to surgery of Head/Neck cancer pt, establish:
    How to communicate with pt once they have a trach

    Inform everyone on unit that pt will not be able to talk at first and to GO into room

    Put pt in room near nursing station
  174. Leading cause of cancer death (28%) with very low survival rates
    Lung Cancer
  175. Most important risk factor (90% men, 80% women)
    Smoking
  176. Earliest signs (though they show up late) of Lung cancer
    Chronic Cough, Blood in Sputum, Pneumonitis
  177. Later symptoms of lung cancer
    Anorexia, Fatigue, Weight Loss

    Difficulty breathing if tumor is large or encroaches on bronchi

    Hoarseness
  178. How is Lung Cancer Dx
    Routine chest x-ray

    CT scan- tumor enlargement

    PET scan- "hot spots"
  179. Treatment of lung cancer
    Surgical resection if stage 1 or 2 (only 30-50% survival rate at 5 years)

    Radiation

    Chemo or Biologic Therapy (avastatin)
  180. Nursing Dx related to Lung Cancer
    Ineffective airway clearance

    Ineffective Breathing patterns

    Anxiety

    Acute Pain

    Imbalanced Nutrition
  181. 4th most common cancer...can spread into bile ducts and gallbladder
    Liver Cancer
  182. Hep C is responsible for ____% of Liver Cancer
    50-60
  183. Hep B is responsible for ___% of liver cancer
    20%
  184. Cancer cells from other parts of the body are often carried to the ___ via portal circulation
    Liver
  185. Presentation of Liver Cancer:
    Cirrhosis, Hepatomegaly, Splenomegaly, Jaundice, Weight loss, peripheral edema, Ascites, RUQ pain, anorexia
  186. How is liver cancer Dx
    • Ultrasound
    • CT
    • MRI
    • Biopsy
  187. Position a pt that has just had biopsy of the liver on:
    RIGHT SIDE!
  188. Treatment of liver cancer:
    Surgical resection (15%)

    Liver Transplant (only if metastasis hasn't occurred)

    Radiofrequency ablation (thin needle inserted into core of tumor and electrical energy destroys cells)

    Cryoablation (liquid nitrogen)

    Chemo (slows progress)

    Chemoembolization-- cath is placed in artery going to tumor site
  189. Death most often occurs ___after dx of liver cancer due to hepatic encephalopathy or massive GI bleeed
    4-7 months
  190. Pancreatic Cancer:
    •4th leading cause of death. Risk increases with age, smoking

    •Adenocarcinomas, arising from epithelial cells of ductal system

    •Common bile duct gets obstructed and jaundice occurs (usually the first symptom)

    •Majority of times the cancer has metastasized by the time of diagnosis, and death between 5-12 months later

    •Five year survival rate is just 5%

    •Jaundice, anorexia, rapid weight loss, pruritis, unrelenting pain

    Diagnosed by ultrasound and CT
  191. Pancreaticoduodenectomy (Whipple Procedure)
    •Resection of proximal pancreas, adjoining duodenum, distal stomach, and distal common bile duct.

    •Anastamosis of the pancreatic duct, common bile duct, and stomach to the jejunum

    •Very difficult surgery and requires ICU stay for monitoring of fluid status and bleeding

    •Biggest danger is pancreatic enzymes eating into suture material

    •Radiation not usually helpful except maybe to relieve pain

    •Chemo not very effective

    •Nursing diagnoses:  Pain and alteration in nutrition
  192. Colorectal Cancer
    •3rd most common cancer, 2nd leading cause of death

    •No symptoms until disease is advanced

    • •85% arise from polyps which could be seen on colonoscopy.  Polyp can invade and
    • penetrate the muscular wall of the colon; tumor cells then have access to regional lymph nodes and vascular system

    •90% in people over age 50.  Colonoscopy should be done at age 50 and every 10 years after

    •Stool check for occult blood should be done every year

    •Surgical resection of the colon will be done; may require colostomy

    Chemo if metastasis, biologic therapy with Avastin
  193. BLADDER CANCER
    •Usually begins as a papillomatous growth within the bladder

    •Risk factor is smoking.  More common in men 60-70

    •Microscopic or gross, painless hematuria is most common clinical finding

    •Urinalysis can determine cancer cells.  CT and ultrasound

    •Staging is determined by the depth of invasion of the bladder wall

    •80% are superficial (inside lining of the bladder only)

    • •Treat with BCG (weakened strain of mycobacterium bovis)…it activates the
    • immune system to kill the cancer.  Instill via foley, let it dwell.  Done every other week for 3-6 months

    •If bladder wall is invaded, partial or total cystectomy with urinary diversion (see page 1155 of your book)
  194. Prostate Cancer
    •One in every 5 men will develop prostate cancer in their lifetime.  75% of cases are in men over 65.  Often slow-growing

    • •Prostate cancer is androgen-dependent.  Can spread by direct extension, through
    • pelvic lymph system or through blood

    •Bone is most common site of metastasis

    •Asymptomatic in early stage, or perhaps BPH symptoms

    •PSA is recommended along with digital rectal exam every year in men 50 and older

    •Radical prostatectomy, external radiation, or internal radiation (seeds or high dose brachytherapy)

    •Side effects of surgery or radiation:  impotence and incontinence

    •Hormone deprivation therapy may be done to block the effects of testosterone on the cancer

    •Osteoporosis, loss of muscle mass, erectile dysfunction, hot flashes, gynocomastia are side effects

    •Chemo is given only to men with hormone-refractory prostate cancer in late stages

    • Nursing diagnoses: 
    • Decisional conflict related to numerous alternative treatment options,
    • sexual dysfunction, anxiety related to possible sexual and urinary dysfunction
    • and incontinence
  195. Testicular Cancer
    •Most common cancer in men 15-34.  Usually the right testicle

    •Painless lump in the testicle with sometimes scrotal swelling and feeling of heaviness.  Non-tender, firm

    •Diagnosed with ultrasound of testicle.  Blood may show increased levels of AFP. 

    •Testicular self-exam every month starting at puberty!

    •Orchiectomy with regional lymph node removal.  Chemo and radiation if metastasis

    •Fertility is an issue…cryopreservation of sperm should be discussed
  196. Cervical Cancer
    •Due to repeated injury to the cervix over years.  Strong relationship between HPV and cervical cancer

    •Peak incidence is in women in their early 30’s

    •Thin, watery discharge is often the first sign, then spotting

    •PAP tests should be done within the first 3 years of the first sexual intercourse, but no later than 21

    •Colposcopy (exam of the cervix with binocular microscope along with a biopsy)

    •Cone biopsy (cores out the cervix; maintains fertility)

    •Cryotherapy (freezing the bad tissue)

    • •Loop Electrosurgery Excision Procedure (LEEP) removes superficial cervical
    • tissue and allows more comprehensive exam of the cells

    •Vaccine against HPV (Gardasil and Cervarix) for 18-26 year olds

    •If invasive, hysterectomy
  197. Endometrial Cancer
    • •Most common gyn malignancy.  Low
    • mortality because it’s usually diagnosed early.

    •Survival rate is 95%

    •Major risk factor is unopposed estrogen (without progesterone).  Also increasing age, nulliparity, late menopause, obesity

    • •Arises from lining of endometrium.  Hyperplasia occurs when estrogen is not
    • counteracted by progesterone

    •If invasion of the myometrium occurs, regional lymph nodes can become involved.  Usual sites of metastasis are lung, bone, liver, brain

    •First sign is uterine bleeding.  Diagnosed by endometria biopsy

    •Hysterectomy may result in total cure
  198. Ovarian Cancer
    •5th leading cause of cancer death in women.  Usually advanced at time of diagnosis.  Most often 55-65 when diagnosed

    •Metastasizes by shedding malignant cells which may implant on the uterus, bladder, bowel, and omentum.  Also metastasizes by lymphatic spread

    •Symptoms are vague in early stages…accumulation of fluid (ascites) causes abdominal distention. Also pelvic pain, bloating, urinary frequency, difficulty eating or feeling full quickly.  Diagnosis may be delayed as GI causes are ruled out

    • •Bimanual pelvic exams should be done to identify presence of an ovarian mass. 
    • Post-menopause, ovaries should not be palpable

    •Diagnosed by abdominal or transvaginal ultrasound.

    •There is a tumor marker (CA-125) which is positive in 80% of women with ovarian cancer.  This test is useful in monitoring the course of the disease

    •Treatment:  total abdominal hysterectomy with bilateral salpingo-oophorectomy and debulking

    • •IV chemo and/or intraperitoneal chemo and radioisotopes if metastasis to peritoneal
    • cavity
  199. Breast Cancer
    •The most common malignancy in women (except skin cancer)

    •Second only to lung cancer as leading cause of death

    •Can also occur in men (2,000 cases every year)

    •Currently 2.5 million women in the US have survived breast cancer

    •5 year survival rate in women with localized breast cancer and no node involvement is 98%!

    • •Risk factors: 
    • family history, estrogen obesity, sendentery life style, increasing age, hormone replacement with just estrogen

    •Mutations in the BRCA1 gene may cause as many as 10-40%

    • •Most arise from the epithelial lining of the milk ducts.  May be “in situ” (just inside the
    • duct) or invasive (grown through the duct and into tissue)

    • •Lump or abnormality on mammogram.  Most often the cancer is in the upper outer
    • quadrant of the breast.  If palpable,
    • usually hard and may be irregularly shaped, poorly delineated, non-mobile and
    • non-tender

    •Diagnosed with mammogram, ultrasound or CT or MRI of the breast to see lymph nodes and possible metastases

    •Lymph node involvement is the most important prognostic factor

    •Biopsy determines the grade of the cancer and also if cells are hormone sensitive or not

    •Survival rates are about the same for modified radical mastectomy or lumpectomy with radiation

    •In surgery, the sentinel lymph node is removed and pathologist looks at it while the patient is in the OR.  If cancer cells are present, then 12-20 axillary nodes are removed

    • •Lymphedema (accumulation of
    • lymph fluid in soft tissue) can occur as a result of the excision of lymph
    • nodes.  When axillary nodes cannot return
    • lymph fluid to the central circulation, fluid accumulates in the arm, causing
    • obstructive pressure on the veins and venous return (swelling, heaviness, pain,
    • impaired motor function, numbness in fingers and hand)

    •Lumpectomy…removal of the entire tumor along with a margin of normal surrounding tissue. Radiation to the entire breast with a boost to the tumor bed

    •Modified radical mastectomy---removal of the breast and axillary nodes but preserves the pectoralis major muscle.  Done if the tumor is too large to excise with good margins

    •Women have the option of breast reconstruction immediately following mastectomy, or it can be delayed until post-op recovery is complete

    •Lifetime follow-up with mammograms, monthly BSE

    •Radiation can be given traditionally or high dose brachytherapy (see Mammo-site, page 1318)

    • •Chemo is sometimes given before surgery to decrease the size of the primary tumor and possibly allow less extensive surgery.  Combo chemo and bone marrow transplant
    • possible

    • •Hormone therapy…if cancer cells are estrogen receptor positive, meds like Tamoxifen (Nolvadex) can block the
    • source of estrogen, thus promoting tumor regression

    •Biologic and targeted therapy:  HERCEPTIN is a monoclonal antibody.  It attaches to antigens in breast cancer cells and is taken into the cells and eventually kills them.  AVASTIN (angiogenesis inhibitor)
  200. Nursing Care after Breast Surgery
    •Pain management (most pain is from lymph node removal)

    •Jackson-Pratt tubes are left in place

    •Restoring the affected arm to full function is an important goal (to prevent contractures and muscle shortening as well as lymphatic stagnation)

    •After surgery, gently flex the arm on a pillow to provide elevation

    •Begin wiggling fingers, moving wrist and elbow slightly even in PACU

    •Progressive increases in arm activity and exercises (but medication must be given 30 minutes before!)

    •Goal is full ROM within 4-6 weeks
  201. Prevention of Lymphedema
    •Never leave the arm dependent (prop even when sleeping)

    •No BP or venipuncture or injections in the affected arm

    •Instruct to protect arm from even minor injury

    •“Decongestive therapy” with massage may be done if lymphedema is severe

    •Jobst stocking-type sleeve may be worn for compression
  202. Oncology Emergencies
    •Chemotherapy infiltration/extravasation

    •Superior vena cava syndrome

    •Hypercalcemia

    •Tumor lysis syndrome

    •Inappropriate ADH Secretion Syndrome

    •Spinal cord compression

    •Septic shock

    •Cardiac tamponade

    •Pleural effusion


    •***See pages 294-295 in textbook
  203. When administering large volumes of crystalloid solutions, the nurse must monitor:
    The lungs for adventetious sounds and signs of interstitial edema (ACS)
  204. ____ medications are given in all forms of "shock" to improve a pts hemodynamic stability when fluid therapy alone cannot maintain adequate MAP
    • Vasoactive
    • ***Should never be stopped abruptly
    • ***V/S monitored every 15 min
  205. Pts in shock may require ____ calories a day
    • 3000
    • (enteral nutrition is preferred)
  206. What are some meds prescribed to pts in shock that are developing stress ulcers and GI compromised blood supply
    • Antacids
    • H2 Blockers (Pepcid and Zantac)
    • PPI (Prevacid and Nexium)

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