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Unit #4 > Cancer > Flashcards

Cancer Flashcards

1
Q

Teach patient that is receiving chemo to report:

A

Any pimple, sore, rash, or open skin area.

Also report cough, burning on urination, pain around IV site, or drainage from any body area.

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2
Q

Teach UAP even if patient is tired personal hygiene must be performed:

A

At least every 12 hrs.

Mouth care, axillary, and perianal regions must be cleaned.

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3
Q

Infection in neutropenic patients

A

May not develop a high fever or purulent drainage, even when severe infection is present.

P. 420

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4
Q

What spices does a patient need to avoid if neutropenic?

A

Pepper and paprika

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5
Q

Epoetin alfa

A

Prevent or improve anemia, and reduce need for transfusion.

But it can also increase patients risk for HTN, blood clots, stroke, and heart attack.

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6
Q

Priority nursing interventions for pt with neutropenia are protecting them from infection.
Assessment Q8h includes:

A

Total patient assessment.
Skin and mucous membranes,
Lung sounds, mouth assessment, close inspection of IV access,
Should be completed every 8 hrs by RN

P. 419

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7
Q

Patients with thrombocytopenia

Nursing care

A
  • avoid IM injections or venipuncture, if necessary use smallest gauge needle.
  • apply firm pressure to needle stick site for 10 min or until site no longer oozes blood.
  • apply ice to areas of trauma
  • test all urine/stool for presence of occult blood
  • observe IV sites q4h for bleeding
  • do not admin enemas, if suppositories prescribes lubricate liberally and admin with caution.
  • measure abdominal growth daily
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8
Q

Teach patient with thrombocytopenia to:

A
  • notify nursing personnel of bleeding or bruising occurs.
  • use electric razor
  • soft bristled tooth brush or tooth sponge
  • no water pressure gum cleaners
  • make sure dentures fit and do not rub
  • do not blow nose or insert objects into nose
  • wear shoes with firm soles when ambulating
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9
Q

Chemotherapy-induced nausea and vomiting (CINV)

A

Most chemo drugs are emetogenic (vomiting inducing) to some degree.

Treatment includes antiemetic a usually before, during, and after chemo.

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10
Q

Mucositis nursing care

A

Frequent mouth assessment and oral hygiene are key in managing mucositis and stomatitis.

  • soft bristled toothbrush/mouth sponges
  • gentle flossing once daily
  • rinse mouth w/plain water or saline q1h while awake
  • avoid mouthwashes that contain alcohol or other drying agents.
  • clean toothbrush weekly with bleach or hydrogen peroxide, and rinsing with hot water

-swish and spit mixtures for pain relief.

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11
Q

Priority nursing interventions for patient with alopecia

A

Teach patient to prevent injury to scalp, and assist with coping on body image.

Hair regrowth usually begins about 1 month after completion of chemo. The new hair may differ from original hair in color, texture, and thickness.

Teach patient to avoid direct sunlight on scalp by wearing a hat or scarf, and head coverings when wearing items that can rub the head.

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12
Q

Changes in cognitive function due to chemotherapy

A
  • Reduced ability to concentrate.
  • memory loss
  • difficulty learning new info during treatment and for months to years after treatment.
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13
Q

Priority nursing interventions for patient with “chemo brain”

A

Support the patient who reports these side effects.
Listen to their concerns, and tell them that other patients have reported such problems.

Patients should be warned against participating in other activities that could alter cognitive functioning such as:

  • excessive alcohol intake
  • drug use
  • activities that increase risk for head injury
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14
Q

Chemotherapy-induced Peripheral neuropathy

A

(CIPN)
Associated with exposure to certain anti cancer drugs.

Results are widespread, most common problems:

  • loss of sensation in hands/feet
  • orthostatic hypotension
  • erectile dysfunction
  • neuropathic pain
  • loss of taste discrimination
  • severe constipation

CIPN is a long term consequence and may be permanent.

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15
Q

Priority nursing interventions for CIPN

A

Teaching patient to prevent injury.

Chart 24-10
P. 425

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16
Q

Priority nursing interventions for photodynamic therapy

A

Teach the family and patient to prevent complications and coordinating changes in the care environment for protection of patient.

Patient will have general sensitivity to light for up to 12 weeks after photosensitizing drug is injected.
Most intense period of light sensitivity is 48h after injection.

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17
Q

Induction therapy

A

Is intense and consists of combo chemo started at time of diagnosis.
Purpose is to induce remission.
2-3 weeks

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18
Q

Consolidation therapy

A

If leukemia in remission.
Consists of another course of chemo, (4-8 months) can be the same drugs as with induction therapy at different dose,
Or different combo of chemo drugs.

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19
Q

Maintenance therapy

A

May be prescribed for months to years after successful induction and consolidation therapies.

Not used for all types of leukemia.
Purpose is to maintain remission.

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20
Q

Bone marrow transplant

A

Standard treatment for patients with leukemia who are in temporary remission after induction therapy.
Before stem cell transplant, additional chemo is given to “purge” the marrow of leukemic cells.

These treatments are lethal to bone marrow, and without replacement of stem cells patient would die of infection or hemorrhage.

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21
Q

Allogenic bone marrow transplant

A

Transplant of bone marrow from a sibling or matched unrelated donor

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22
Q

Autologous transplant

A

Patients receive their own stem cells that were harvested before high-dose therapy.

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23
Q

Syngeneic transplants

A

Taken from patients identical twin.

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24
Q

Nutrition for neutropenic patients

A
  • single use food products
  • no fresh fruit or raw veggies
  • meat cooked all the way

NO grapefruit!!!!

  • all foods, snacks, or drinks must be packages in individual, single servings.
  • frozen, single-serving meals allowed.
25
Q

Most common form of adult leukemia

A

AML
acute myelogenous leukemia

There are 8 subtypes

26
Q

Most common type of leukemia in children

A

ALL
acute lymphocytic leukemia

The Philadelphia chromosome, usually the hallmark of CML, is present.

27
Q

Chronic Myelogenous Leukemia

A

CML
Occurs most often in people aged over 50. It has the Philadelphia chromosome present.

Has 3 phases:
-chronic phase: mild s/s and respond to tx
-accelerated phase: spleen enlargement, fevers, night sweats, wt. loss
Doesn’t respond to tx, lasts 6-12 mths
-blast phase: transformed into very aggressive acute leukemia. Spreads to other tissues and organs.

28
Q

Chronic lymphocytic leukemia

A

CLL
most common form of chronic leukemia.
Occurs usually in people over 50.
Average survival time ranges from 10 years for patients diagnosed with early stage

29
Q

Bone marrow harvesting

A

Occurs after a suitable donor is identified by tissue typing.

Occurs in OR, where marrow is removed through multiple aspirations from iliac crests.
500-1000mL of marrow aspiration.

This will regrow for donor in a few weeks.

It is then filtered if allogeneic, then immediately transfused to recipient.

30
Q

Peripheral blood stem cell (PBSC) harvesting

A

Requires 3 phases:

  1. Mobilization
  2. Collection by pheresis
  3. Reinfusion
31
Q

Mycophenolate mofetil

CellCept

A

Immunosuppressant

Side effects:
UTI, HTN, peripheral edema, diarrhea, constipation, HA, fever, nausea

32
Q

Tacrolimus

A

Immunosuppressant
Prevents organ transplant rejection.

Side effects:
HA, tremor, insomnia, paresthesia, diarrhea, N/V, constipation, abdominal pain, HTN

33
Q

Beclomethasone dipropionate

A

Anti-inflammatory, immunosuppressant.

Side effects:
inhalation- throat irritation, dry mouth, hoarseness, cough.
Intranasal: nasal burning, dryness

34
Q

Bleeding precautions at home

A

Reinforce safety & bleeding precautions that must be followed until platelet count is >50,000

35
Q

Platelet transfusions

A

When platelet count is

36
Q

Pre transfusion responsibilities

A
  1. Assess lab values
  2. Prescription
  3. Assess VS, UO, skin color, Hx or transfusion reactions.
  4. Obtain venous access
  5. Obtain blood products
  6. With another RN, very name, number, blood compatibility, and note expiration time. (4hrs from time it leaves blood fridge)

Blood specimen for type and cross.
Lab needs at least 45 min to cross match, new type and cross every 72hrs

37
Q

Transfusion

During and after responsibilities

A
  1. Administer using appropriate filter tubing
  2. Dilute with only NS
  3. Remain with patient for first 15-30 of transfusion
  4. Infuse at prescribed rate
  5. Monitor VS

After:

  1. DC and dispose of appropriately
  2. Document
38
Q

Transfusion responsibilities cont.

A

Ask patient to report unusual sensations such as:

  • chills
  • SOB
  • hives
  • itching
39
Q

How fast can blood be administers?

A

1 unit in 2 hrs, depending on cardiac status and hospital policy.

40
Q

Platelet transfusions

A

Can be pooled from as many as 10 donors, and do not have to match blood type.

Single donor platelet does reduce exposure to antigens, and help prevent formation of platelet antibodies.

41
Q

Platelet administrations

A

Have to be infused immediately when received. over 15-30 min.

Special transfusion set with shorter tubing and smaller filter is used.

42
Q

Fresh frozen plasma (FFP)

A

Dressing preserves the clotting factors, and then can be used for patients with clotting disorders.

Infuse FFP immediately after thawing.
ABO compatibility is require for transfusion of plasma products.

Infuse as rapidly as pt can tolerate usually over 30-60 min. Through regular Y-set or straight filtered tubing.

43
Q

Acute transfusion reactions.

A

-febrile, hemolytic, allergic, or bacterial reactions; circulatory overload; or GVHD.

44
Q

Febrile transfusion reaction

A

Chills, tachycardia, fever, hypotension, tachypnea

45
Q

Hemolytic transfusion reaction

A 
May be mild with fever and chills. 
Or life-threatening with Disseminated intravascular coagulation (DIC) and circulatory collapse. 
-apprehension
-headache
-chest pain
-low back pain
-tachycardia-tachypnea
-hypotension
-hemoglobinuria

-a sense of impending doom

46
Q

Allergic transfusion reaction

A

Urticaria, Itching, bronchospasm, or anaphylaxis:

Patient with history of allergies or allergic reaction can be given washed RBCs in which WBCs, plasma, and immunoglobulin have been removed

47
Q

Bacterial transfusion reAction

A

Tachycardia, hypotension, fever, chills, shock.

48
Q

Circulatory overload

A

Can occur when blood product is infused too quickly.

  • HTN
  • bounding pulse
  • distended jugular veins
  • dyspnea
  • restlessness
  • confusion

Older adults are at higher risk

49
Q

Transfusion associated

graft-versus-host disease

A

Is rare but life-threatening problem that can occur in immunocompromised, immunocompetent patients.

50
Q

Leukemia medications

A
  • Imatinab mesylate (gleevac)
  • gentamicin
  • ceftazidime
  • acyclovir
  • fluconazole
  • vancomycin
51
Q

Imatinib

A

Nausea, diarrhea, vomiting, HA, fluid retention, rash, musculoskeletal pain, muscle cramps, arthralgia

52
Q

Common symptoms of leukemia

A
  • weight loss, fever, frequent infections.
  • easy SOB
  • weakness
  • pain or tenderness in bone/joints
  • fatigue, anorexia
  • swelling in lymph nodes
  • enlargement of liver/spleen
  • night sweats, easy bruising/bleeding, purplish patches or spots
53
Q

Lab tests in leukemia

A

Increased WBC counts. Especially blast cells.

Lowered RBC

Insufficient platelets

H/H: decreased

54
Q

Bone marrow biopsy

A

Larger needle used to bore a hole.
Then smaller needle is used to aspirate bone marrow.
Usually at the back of the hipbone.

55
Q

Absolute neutrophil count

A

If falls below 1000 ^ risk for infection.

ANC below 500 is life threatening.

56
Q

Measures to prevent infection in neutropenic patients

A

-Monitor blood count daily.
-monitor temp Q4h
-prohibit sick visitors
-no fresh flowers
-change water in all containers daily
(Stagnant water can breed bacteria)
-eliminate fresh salads, and unpeeled fruits/veggies in diet.
-provide HEPA filter mask for out of the room
- ensure total body hygiene and pericare after BMs
-oral hygiene after meals and q4h during daytime.
-avoid lemon glycerine swabs, mouthwash, and hydrogen peroxide.
- avoid plastic cannula IVs if ANC

57
Q

Protective environment following stem cell transplant

A
  1. Private room (reverse air flow)
  2. Door kept closed
  3. Supplies kept in room
  4. Children under 12 not allowed, over 12 need proof of immunizations
  5. No one with cold, cough, sore throat
  6. Visitors who have received “live vaccine” not allowed on HSCT unit
  7. ALL visitors must wear mask, sanitize hands, and wear gloves in room
  8. Pt is not to pick up anything off floor
  9. Pt must wear shoes/slippers when out of bed
58
Q

Graft-versus-host disease

GVHD

A

Graft cells attack host cells.

Tissue damaged is usually skin, GI tract, and liver.

Presence of some GHVD indicates successful engraftment.

59
Q

“Chemo brain”

A

Pts report changes in cognitive function, most commonly reduced ability to concentrate, memory loss, and difficulty learning new info.

Unit #4 (3 decks)

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