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kol- Med Surg 320 Spring > Cancer general > Flashcards

Cancer general Flashcards

1
Q

process to control cellular growth, replication, and differentiation

A

cellular regulation

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2
Q

cells that are abnormal, do not serve a purpose, and are harmful to normal tissue

A

cancer/malignant cells

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3
Q

3 causes of problems associated with cancer?

A
  1. cancer itself
  2. treatment
  3. combo
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4
Q

General problems of metastatic cancer

A
  • Reduced blood producing function
  • Altered GI function
  • Peripheral nerve, motor and sensory deficits
  • Decreased respiratory and cardiac function
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5
Q

Goals of cancer management (2)

A
  • Cure or control cancer

* Minimize side effects of treatment(s)

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6
Q

Cancer management is dependent on what things

A
  • Type, location, size and extent of cancer

* Health of person

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7
Q

Different types of treatment for cancer

A

-Surgery
-Radiation **
-Chemotherapy **
-Immunotherapy
-Small Molecular Inhibitor Targeted Therapy
-Hormone Therapy
(** Where we will focus our time, you will be expected to understand)

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8
Q

3 biggest nursing priorities related to blood with cancer?

A
  • Reduced WBC’s > Impaired Immunity > Risk of Infection
  • Reduced RBC’s > Poor Perfusion > Fatigue/ Breathing
  • Reduced Platelets > Poor Clotting > Risk of Bleeding
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9
Q

what is mylosuppression?

A

-Chemotherapy destroys cancer cells AND ALSO
• Kills Healthy Blood Cells
• Suppresses Bone Marrow Function (no replacement)
>Less RBC’s, WBC’s (especially neutrophils), Platelets

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10
Q

low wbc =

A

neutropenia

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11
Q

ANC < _____ = neutropenia

A

-ANC is < 1000 cells/mm3

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12
Q

what kind of infections do you get if you are neutropenic?

A

overgrowth of normal flora (Opportunistic Infections)

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13
Q

interventions for preventing/ treating infections

A 
-Infection Prevention
• Hand Washing
• Neutropenic Precautions
-Nurse-Led Protocols
-Obtain Cultures
-Diagnostics
-Antibiotic Administration
-Antibiotic Stewardship: giving a person the right antibiotic when they need it and only when they need it as early as possible 
---> Prevent Sepsis/ Recognize early sepsis
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14
Q

what is antibiotic stewardship?

A

giving a person the right antibiotic when they need it and only when they need it as early as possible

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15
Q

general rule for when to implement neutropenic precautions?

A

For ANC <500 cells/mm3 or < 1000 cells/mm3 w/fever

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16
Q

neutropenic precautions interventions @ hospital (@ home comes later)

A
  • Private Room
  • Wash Hands/ Educate
  • Avoid shared supplies
  • Monitor VS’s, Temperature, WBC’s
  • Inspect Mouth, Skin, Mucous membranes, Line sites
  • Coughing, Deep Breathing
  • Hygiene
  • Activity/ Rest
  • Limit visitors
  • Asepsis
  • No fresh flowers/ plants
  • No raw vegetables, fruits, undercooked meat/ pepper
  • No use of indwelling catheters
  • Remove stagnant water
HOME CARE
• Hand-washing
• Daily baths/ Antimicrobial soap
• Avoid Crowds
• Avoid sharing personal items
• Wash dishes well/ don’t re-use drinking cups
• Monitor temperature
• Diet restrictions 
• Pet litter avoid 
• Use Condoms
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17
Q

re neutropenia: report what changes to provider?

A
  • Skin
  • Mucous membranes
  • Cough
  • Central Line Site- drainage/ redness
  • Fever- systemic
  • Drainage
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18
Q

another word for low platelets

A

Thrombocytopenia

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19
Q

Thrombocytopenia puts you at risk for

A

BLEEDING

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20
Q

spontaneous vs prolonged bleeding

A
  • Prolonged bleeding=If platelets are < 50,000 platelets/mm3

* Spontaneous bleeding may occur - IV site, GI bleed =If platelets are < 20,000 platelets/mm3

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21
Q

biggest concern with risk of spontaneous bleeding?

A

spontaneous bleeding in brain –> neuro assessments

platelets <20,000

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22
Q

thrombocytopenia assessment findings

A
  • Neurological assessments
  • Spontaneous bleeding
  • Petechiae
  • Excessive bruising in lower back/flank
  • Prolonged bleeding- hold central pulling line out is risk –> hold extra pressure or not pull out
  • Blood in urine and stool
  • Tachycardia
  • Hypotension
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23
Q

Thrombocytopenia interventions

A

-Bleeding Precautions
-Neurological Assessments
-Avoid Injuries that may cause bleeding
• Fall precautions
• Insertion of tubes –> minimize!
—->Avoid rectal tubes and medication
-Platelet Administration is below 20,000
-Neumega- promote prdxn of platelets

24
Q

bleeding precaution interventions

A
  • Lift sheet
  • Avoid IM injections/ Venipunctures + signage
  • Apply pressure for 10 minutes for venipunctures/ Hemostasis
  • Use of Ice
  • Assess IV sites
  • Avoid enemas, rectal temps, rectal tubes
  • Abdominal Girth measurement
  • Electric razor
  • Soft-Bristle toothbrush
  • Fall prevention
  • Nose blowing can cause spontaneous bleeding
25
Q

another word for overall low RBC =

A

anemia

26
Q

anemia and poor nutritional status are often causes of cancer ____ ____

A

related fatigue

27
Q

manifestations of Cancer Related Fatigue

A
  • Far worse than ”everyday fatigue”
  • May have a profound affect on ADL’s/ Ability to perform ADL’s
  • May be considered worse than the side effects of Cancer/ cancer treatment (Nausea and vomiting, pain)
  • Lasts for weeks, months, years
28
Q

interventions for cancer related fatigue

A 
• Exercise
• Assess for underlying cause and treat 
• Energy Conservation/ Activity Management
	◦ Set Priorities
	◦ Plan ahead
	◦ Ask for help
	◦ Optimize sleep
• Massage
• Healing touch
29
Q

re- GI changes and cancer: why is GI system so effected by chemo?

A 
cells in GI tract are rapidly replicating, most chemo targets rapidly replicating cells 
May also be from
• Cancer
• Chemotherapy
• Radiation
30
Q

what is cachexia?

A

a condition that causes the body muscles to waste away –> extreme weight loss

31
Q

GI changes related to cancer

A
  • Cachexia
  • Changes in Taste
  • Mucositis & Stomatitis
  • Nausea & Vomiting (Chemotherapy)
32
Q

Mucositis vs Stomatitis

A

Mucositis & Stomatitis –> damage from chemo

◦ Stomatitis = irritation in entire GI Tract
◦ Mucositis = irritation in mouth only
33
Q

4 types of nausea related to chemo/cancer

A
  • Acute- happens as soon as someone is treated w/ chemotherapy
  • Anticipatory- conditioned–> think about chemo and have n/v
  • Delayed- n/v 1-5 days after receiving chemo
  • Breakthrough-protocols and meds not controlling n/v
34
Q

cachexia interventions

A
  • Interventions should be patient-specific
  • Protein and CHO rich foods
  • Small, frequent meals
  • Nutritional supplements
35
Q

Mucositis & Stomatitis Interventions:

A 
-Cold (ice or ice-pops)
• Oral cryotherapy
Mouth rinses/Medicated mouthwashes
• Sodium bicarbonate 	       	
• Lidocaine			                        
• Magic mouthwash --> compound of 3 agents 
-Use non-irritating mouth cleansers/ no floss
-Soft bristle toothbrush
-Mucosal Protectants
-Assess, assess, assess
-Hygiene
36
Q

Nausea & Vomitting Interventions:

A

WAITING FOR EMAIL FROM MESSER

37
Q

when do we most often see motor/sensory deficits w/ cancer?

A

=Occurs with bone and brain metastasis, compressed nerves

38
Q

Nursing priorities for motor and sensory deficits

A 
-Restricts mobility
• Assess ability
• Promote optimization/ Offer assistance
• PT/OT
-Painful
-Risk for injury
39
Q

Peripheral neuropathy assessment/intervention/priorities

A 
-Peripheral neuropathy
• Loss of sensation in lower extremities
• May be painful
• Loss of balance
• Injury to feet (unaware of injury)
-Prevent injuries
-Fall risk
-Assess sensation in feet
-Assess for wounds

3 ways we have balance in our body : seeing, hearing, feeling

40
Q

Reduced oxygenation- causes w/ cancer?

A

–>Tumors in airway
• Decreased lung capacity with lung tissue involvement
• Tumors may press on vessels in the chest and block blood flow
• Tumors may thicken alveolar/ damage pulmonary blood vessels

41
Q

manifestations of poor oxygenation w/ cancer? interventions?

A

–>Lead to HYPOXIA and POOR TISSUE OXYGENATION

interventions: apply oxygen, HOB, rest periods, tripod position

42
Q

Alopecia and cancer: concern?

A
  • Protect scalp

* Psychosocial aspect

43
Q

When lose hair from chemo do you lose it just on your head?

A

NO! - everywhere

44
Q

cognitive changes and cancer

A
  • Chemo-brain (chemotherapy)

* Brain tumor/ mets

45
Q

Cancer: Psychosocial Implications

A
  • Anxiety and depression
  • Fear of Recurrence
  • Sleep Disturbances
  • Physical Changes
  • Reduced function
  • Sexual Dysfunction/ Fertility issues
  • Work/ Inability to participate in normal roles
  • Spiritual issues
46
Q

Psychosocial Care- interdisciplinary?

A
  • Support Services
  • Case Manager
  • Navigator
  • Palliative Care
  • Caregiver strain
47
Q

most common type of radiation for cancer?

A

gamma

48
Q

Goals of radiation

A

Cure
Control
Palliate

> Minimize destruction of normal tissue
Localized effects (with exception)

49
Q

radiation therapy: dose vs exposure

A 
Exposure- amount delivered
Dose- amount absorbed by the patient 
determined by: 
• Intensity
• Duration
• Closeness
50
Q

radiation is given in ______ doses

A

divided

51
Q

teletherapy vs brachytherapy

A
  1. Teletherapy = External beam
  2. Brachytherapy=Internal device
    • Oral therapy, IV, surgical insertion
    • Direct contact with cancer
    • Patient emits radiation while as long as device is emitting radiation
52
Q

Bachytherapy: sealed vs unsealed

A

Unsealed: Any body fluids are also radioactive
Sealed: Only the patient emits radiation - not excreted into bodily fluids

53
Q

Precautions for patients with brachytherapy

A
  • Private room
  • Sign on door
  • Keep door closed
  • Wear lead apron
  • Restrict time in room
  • Keep visitors 6 feet away/ limit time <30 minute
  • Do not assign pregnant caregivers
  • Handling of bed linens and dressings in room until patient has left room
54
Q

general radiation side effects

A
  • Localized
  • Skin changes
  • Hair loss
  • Altered taste
  • Fatigue
  • Inflammation
  • Tissue Fibrosis/ scarring
  • Secondary malignancies
  • Cardiovascular Disease
55
Q

radiation education

A
  • Do not remove markings
  • Skin care - do not scrub, use mild soap
  • Specific to location and type of radiation

kol- Med Surg 320 Spring (43 decks)

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