NSG 260 Cancer

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Author:
Frobadiah
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34506
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NSG 260 Cancer
Updated:
2010-09-18 13:54:25
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Cancer WCCC Nursing
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Study Guide for Ms. G's NSG 260 Cancer, Blood, & Tubes test set to notecards (**cancer questions only**)
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  1. List a few statistics that describe the incidence of cancer
    • Number one leading cause of death in people under the age of 85 (US)
    • Over 10 million people have cancer
    • In 1970 the five year survival rate was 50%, in 2005 the five year survival rate was 74%
    • 30% of people now living will have a cancer diagnosis
    • 1500 people die of cancer each day, half are over age 65 and 35% are preventable with early detection.
    • Incidence is increasing, with melanoma rising higher than any other cancer, but the death rate is leveling off.
  2. List the top 3 incidences of cancer by site and cause of death for women
    • Site: Breast, Lung, Colon
    • Death: Lung, Breast, Colon
  3. List the top 3 incidences of cancer by site and cause of death for men
    • Site: Prostate, Lung, Colon
    • Death: Lung, Prostate, Colon
  4. Define: Proto-oncogene
    A normal cell which, when altered by mutation, may become an oncogene and contribute to cancer
  5. Define: Oncogene
    A tumor producing gene
  6. Define: Anti-oncogene
    A tumor suppressing gene
  7. List a few characteristics of cancer
    • Decreased contact inhibition
    • Decreased cohesion
    • Produces proteins, hormones, & other substances to enchance growth
    • Tumor Angiogenic Factor (TAF) formation of blood vessels
    • Not encapsulated
    • Undifferentiated
    • Vascularity
    • Mode of growth
    • Cell characteristics
  8. Define: Initiation
    Stage where a chemical, physical, or biological agent (carcinogen) or an inherited gene alters the DNA in the cell causing a mutation
  9. Give examples: Chemical carcinogens
    • Cigarette smoke
    • Asbestos
    • Nitrites
    • Vinyl chloride
  10. Give examples: Carcinogenic drugs
    • Radioisotopes
    • Immunosuppressives (Azathioprine, Antimetabolites, Alkylating agents, Corticosteriods)
    • Cytoxic agents (Cyclophosamide)
    • Hormones (Diethylstilbesterol, Prenatal estrogen, Postnatal estrogen, Androgenic-anabolic steroids)
  11. Give examples: Physical carcinogens
    Radiation (ionizing, rocks, x-rays, UV light, sun, tanning booths, electromagnetic fields)
  12. Give examples: Biological carcinogens
    • Viruses (hepatitis B, Epstein Barr virus, HPV, herpes virus, HIV)
    • Diet (fats, fiber, Vitamin B deficiency, charcoal grilling, food additives, obesity)
  13. Define: Promotion
    The reversible proliferation of the mutated cell
  14. List: 3 ways that cancer metastasizes
    • Implantation: cancer embeds along the body organ, uses tumor angiogenesis
    • Lymph system: cancer moves to local lymph nodes, but may also "skip" nodes
    • Blood vessels (Hematogenesis): cancer cells enter circulation and use enzymes
  15. List risk factors and ACS screening for: Lung cancer
    • Risk factors: 20 year pack history, asbestos, uranium, COPD
    • ACS screening: none
  16. List risk factors and ACS screening for: Prostate cancer
    • Risk factors: Benign Prostatic Hyperplasia (BPH), African American, age
    • ACS screening: Prostate-Specific Antigen (PSA) and digital exam after age 50, 45 for African Americans with positive family history
  17. List risk factors and ACS screening for: Breast cancer
    • Risk factors: Caucasian, early menarche, late menopause, fibrocystic disease, infertility, first pregnancy after age 30, maternal history of breast cancer, obesity
    • ACS screening: monthly self exams starting at age 20, ages 20-39 Clinical breast Exam (CBE) every 3 years, ages 40 and up mammogram and CBE annually
  18. List risk factors and ACS screening for: Colorectal cancer
    • Risk factors: ulcerative colitis, familial polyposis, high fat/low fiber diet
    • ACS screening: one of the following after age 50 - fecal occult exam & fecal immunochemical test (FIT) yearly, flexible sigmoidoscopy every 5 years, double-contrast barium enema every 5 years, colonoscopy every 10 years
  19. List risk factors and ACS screening for: Uterine or Cervical cancer
    • Risk factors: early intercourse with multiple partners, poor hygiene, STDs, cervical dysplasia
    • ACS screening: screen annually 3 years after starting intercourse (no later than age 21), at age 30 with 3 negative exams are rescreened & HPV screened every 2-3 years, after age 70 with 3 negative exams may stop screening. Women with a total hysterectomy can stop having cervical screenings unless surgery was treatment for cervical cancer
  20. Acronym: CAUTION
    • C: change in bowel/bladder habits
    • A: a sore that does not heal
    • U: unusual bleeding or discharge
    • T: thickening or lump in breast or elsewhere
    • I: indigestion or difficulty swallowing
    • O: obvious change in wart or mole
    • N: nagging cough or hoarseness
  21. List: 3 different types of biopsies
    • Needle: aspiration (bone marrow, prostate, breast, liver, kidney)
    • Incisional: portion of the lesion to make diagnosis (dermal punch)
    • Excisional: remove entire tumor
  22. Define: Debulking or Cytoreductive cancer surgery
    Removal of a portion of the tumor
  23. Define: Supportive cancer surgery
    Provision of supportive care, such as feeding tubes
  24. Define: Palliative cancer surgery
    Removal of cancer to reduce symptoms
  25. List: Surgical cure criteria
    • Slow growing
    • Clean margins
    • Prevent seeding
    • No local spread
  26. Histology: Grade I Tumor
    Well differentiated (mild dysplasia)
  27. Histology: Grade II Tumor
    Moderately differentiated (moderate dysplasia)
  28. Histology: Grade III Tumor
    Poorly differentiated (severe dysplasia)
  29. Histology: Grade IV Tumor
    Anaplastic
  30. Define: TNM staging
    • Tumor, Nodes, Metastasis
    • 0-4 scale used to identify the course and extent of a cancer diagnosis
  31. List: 3 side effects common to all radiation patients
    • Fatigue
    • Anorexia/taste changes
    • Skin reactions ("baby skin" rule)
  32. What localized side effects would you anticipate for a patient receiving teletherapy for: Lung or Breast cancer
    • Cough
    • Dyspnea
    • Pneumonitis
  33. What localized side effects would you anticipate for a patient receiving teletherapy for: Brain cancer
    • Increased ICP
    • Peripheral neuropathy
    • Fatigue
  34. What localized side effects would you anticipate for a patient receiving teletherapy for: Pelvic or Colon cancer
    • Constipation
    • Hepatotoxicity
    • N/V/A/D
    • Inflammation of the mucosa
  35. What localized side effects would you anticipate for a patient receiving teletherapy for: Prostate cancer
    • Reproductive dysfunction
    • Hemorrhagic cystitis (dysuria, hematuria, hemorrhage)
  36. Nursing care for: a patient receiving brachytherapy/intracavity radiation
    • Private room (lead lined, radiation hazard marking)
    • Bedrest
    • Elimination: foley catheter
    • Diet: low residue
  37. How do you handle the accidental dislodgement of an intracavity device?
    • Using tongs, place the device in a lead lined container. Do not handle directly!
    • Notify safety officer
  38. Are the body fluids of a patient receiving intracavity radiation radioactive?
    No. The radiation is contained within the device. The body fluids, while affected by the radiation, do not themselves become radioactive.
  39. Nursing care for: a patient receiving unsealed radiation
    • Private room (lead lined, radiation hazard marking for 96 hours)
    • Elimination: flush 3x
    • Diet: use of disposable utensils
    • Hospital clothes and linens
  40. List: 3 ways to protect yourself from radiation exposure
    • Time: shortest time possible (ALARA)
    • Distance: inverse square rule
    • Shielding
  41. Define: Inverse square law
    • The further you get away from the source of radiation the less exposure you suffer.
    • (I1/I2) = (D22/ D12)
  42. Define: Cell cycle specific chemotherapy
    Has effect on cells in the process of cellular replication and proliferation
  43. Define: Cell cycle nonspecific chemotherapy
    Has effect on cells in the process of cellular replication, proliferation, and rest
  44. Which normal cells are most affected by chemotherapy?
    Cells with a high rate of proliferation (i.e. lining of the mouth and GI tract) - kills them
  45. Why are chemotherapy drugs used in combination?
    • Drug effectiveness
    • Synergistic effect
    • Cycle specific + nonspecific drugs
    • Different side effects
  46. What is Megace used for?
    Appetite stimulant
  47. Extravasation Protocol
    • Stop the drug infusion
    • Leave the needle in place
    • Administer the antidote
    • Remove needle
    • Use hot/cold packs
    • Assess site
  48. Safety precautions when handling/administering chemotherapy (nurse focused)
    • Only give chemo if you've been trained
    • Chemo is stored separately from other meds
    • Gown, gloves, goggles, and respirator mask
    • Disposal of syringes, tubing, gauze, etc. in HAZARD container
    • Glove when handling excreta
    • Avoid giving chemo when pregnant, trying to get pregnant, or breast feeding
    • Periodic health screening
  49. Define: Biological Response Modifiers (BRM)
    • Natural substances normally produced in small amounts by the immune system
    • Boost the body's response to fight tumors and foreign substances
    • Fights indirectly by stimulating the immune system
  50. Biological Response Modifier: Interferon
    • Function: Inhibits DNA protein synthesis and causes tumor antigen expression on tumors
    • S/E: flu like symptoms (give Tylenol before/during administration)
  51. Biological Response Modifier: Interleukin 2
    • Function: Activates NK cells, lymphokine activated killing cells, and tumor infiltrating lymphocytes
    • S/E: neurological, fever, chills, renal/liver dysfunction
  52. Biological Response Modifier: Monoclonal Antibodies
    • Function: Binds to tumor antigens and tries to destroy them, may be able to bind chemo or dyes to antibodies that will seek cancer cells
    • S/E: fever, chills, vomiting (need premedicated with Tylenol, Benadryl, Merperdine)
  53. Biological Response Modifier: Tumor Necrosis Factor
    • Function: Damages the capillaries of the tumor, activates the immune system
    • S/E: capillary leak syndrome
  54. Biological Response Modifier: Neupogen, G-CSF/Neulasta
    • Function: Causes the proliferation and differentiation of granulocytes
    • S/E: bone pain, fever, chills, rash, myalgias
  55. Biological Response Modifier: Leukine, GM-CSF/Prokine
    • Function: Causes the proliferation and differentiation of granulocytes and macrophages
    • S/E: bone pain, fever, chills, rash, myalgias, fluid retention
  56. Biological Response Modifier: Procrit, Aranesp
    • Function: Causes the proliferation and differentiation of erythrocytes
    • S/E: hypertension, fever, N/V/D, SOB, tingling sensation
  57. Biological Response Modifier: Neumega, Multi-CSF/Oprelvekin
    • Function: Causes the proliferation and differentiation of platelets, granulocytes, and monocytes
    • S/E: bone pain
  58. Describe: Pain ladder
    • Step 1: Non-opioid + adjuvant (ASA, paracetamol, NSAIDs)
    • Step 2: Opioid for mild to moderate pain + non-opiod + adjuvant (codeine)
    • Step 3: Opiod for moderate to severe pain + non-opioid + adjuvant (morphine, oxycodone, fentanyl)
  59. Nursing care for: cancer patient with diagnoses of nutrition and goals of nutrition
    • Assessment: nutritional status
    • Interventions: avoid judgmental statements, administer antiemetics, teach to eat slowly, bland/lukewarm/high calorie/high protein/small/frequent feedings, stimulate salivation, remove unpleasant sights/smells, relaxation techniques, avoid gas producing foods, teach to increase protein rich foods
    • Note: High protein foods - double strength milke (1 cup = 14g), yogurt (10g), eggs (6g), cottage cheese (1/2 cup = 15g), beef (3oz = 21g), tuna (6oz = 44.5g)
  60. Nursing care for: cancer patient with diagnoses of altered mucous membranes
    • Assessment: oral mucousa daily for ulcers, candida, herpes, xerostomia (dry-mouth), stomatitis, and fit of dentures
    • Interventions: use toothettes, mouthwashes of baking soda/saline q2h, topical anesthetics or oncology mouthwash, avoid irritating foods, apply artificial saliva/petroleum jelly to lips
  61. Nursing care for: cancer patient with diagnoses of body image disturbance
    • Assessment: body image, alopecia, post surgical, weight loss
    • Interventions: provide support, select wig (chemo - hair grows back but may be different), use gentle products on hair, makeup tips, educate about special clothing and prosthetics
  62. Nursing care for: cancer patient with diagnoses of risk for infection
    • Assessment: signs of infection
    • Interventions: maintain personal hygeine, monitor for signs of infection, avoid crowds, avoid dental work when WBCs are low, no immunizations w/o doctor approval
    • Note: Neutropenic precautions - private room, handwashing, screen visitors, no fresh fruit/vegetables/flowers/plants, no stagnant water, Neupogen/Neulasta, report fever of 100.4 to doctor
  63. Nursing care for: cancer patient with diagnoses of risk for injury/bleeding
    • Assessment: overt or covert bleeding (GI bleeding), platelet counts
    • Interventions: avoid IM/SC injections (hold pressure for 5 minutes, use small bore needles), BPs infrequently, provide safe environment, use soft toothettes, no flossing, no toothpicks, avoid straining on stool, rectal, or vaginal trauma (gentle lubricated secual intercourse), use electric razors, avoid tight clothing, avoid ASA NSAIDS, avoid anticoagulants, use of Neumega
  64. Nursing care for: cancer patient with diagnoses of fatigue
    • Assessment: fatigue level, keep log, usually begins during first week (over 70% of patients on chemo are anemic)
    • Interventions: sleep and naps, mild exercise, use of Procrit and Aranesp (lasts 3x longer than Procrit)
  65. Normal value for: RBCs
    • Men: 4.7 - 6.1 million
    • Women: 4.2 - 5.4 million
  66. Normal value for: WBCs
    5,000 - 10,000
  67. Normal value for: Platelets
    150,000 - 350,000 (below 20,000: spontaneous bleeding)
  68. Normal value for: Hgb
    • Men: 14-18
    • Women: 12-16
  69. Normal value for: Hct
    • Men: 42-52
    • Women: 36-48
  70. Tumor Marker: CEA
    • Carcinoembryonic antigen
    • Disappears during last 3 months of fetal life
    • Elevated with GI cancer, also with breast, liver, and lung cancer
  71. Tumor Marker: AFP
    • Alpha Fetoprotein
    • Produced by fetal liver
    • Elevated with liver cancer, also with Hodgkin's lymphoma and renal cancer
  72. Tumor Marker: CA 125
    Elevated with ovarian cancer
  73. Tumor Marker: CA 19-9
    Elevated with biliary and pancreatic cancer, also lung cancer and cystic fibrosis
  74. Tumor Marker: CA 15-3
    Elevated with metastatic breast cancer
  75. Tumor Marker: PSA
    • Prostatic Specific Antigen
    • Elevated with prostate cancer
  76. Oncological crisis: Infection
    • Symptoms: fever, blood work
    • Treatment: antibiotics, antipyretics
  77. Oncological crisis: Paraneoplastic disease
    • Symptoms: SAIDH, insulin, hypercalcemia, ACTH
    • Treatment: manage symptoms, treat tumor
  78. Oncological crisis: Tumor syndrome lysis
    • Symptoms: hyperuricemia, hyperphosphatemia, hyperkalemia, hypocalcemia
    • Treatment:hydration to increase urine production and treat electrolyte imbalances
  79. Oncological crisis: Hypercalcemia
    • Symptoms: bone problems, A/N/V, renal stones (hematuria, flank pain)
    • Treatment: calcitonin, mithramycin, monitor cardiac status
  80. Oncological crisis: Super vena cava syndrome
    • Symptoms: facial edema, cough, distension of neck and chest veins
    • Treatment: palliative radiation
  81. Oncological crisis: Disseminated intravascular coagulation (DIC)
    • Symptoms: bleeding from 3 separate sites (clotting/bleeding at the same time), increased PTT & PT, decreased platelet count
    • Treatment: heparin, platelets, fresh frozen plasma (FFP)
  82. Oncological crisis: Spinal cord compression
    • Symptoms: intense back pain, motor weakness, dysfunction, parathesia
    • Treatment: palliative radiation
  83. What is the role of the immune system in cancer development?
    Surveillance - altered cells are made but usually destroyed by the immune system
  84. What is the purpose of a bone marrow transplant? Nursing implications?
    • Purpose: to replenish healthy marrow after high dose chemo or radiation is given to destroy cancer cells
    • Nursing implications: reverse isolation precautions, sterile drinking water, mouth care q2h, takes 2-4 weeks for marrow to start working
  85. What is the purpose of a peripheral stem cell transplant? Nursing implications?
    • Purpose: to replenish healthy undifferentiated cells back into the body after high dose chemo or radiation is given to destroy cancer cells
    • Nursing implications: reverse isolation precautions, sterile drinking water, mouth care q2h

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