AC 2 Exam 4 Flashcards
(188 cards)
1
Q
Is cancer generally painless?
A
Yes; pain starts when it grows and starts pushing/putting pressure on something
2
Q
What are some risk factors for cancer?
A
Genetics, smoking, drinking, dietary factors, chemical agents, sun, radiation, radon, hormonal, etc.
3
Q
What are some characteristics of cancer cells?
A
Altered cell membrane
Nuclei large & irregular
Fragility
Frequent mitosis; need more glucose and oxygen
4
Q
Why is pain control important in cancer patients?
A
Patients won’t/can’t tolerate treatment unless their pain is controlled
5
Q
Primary cancer prevention includes
A
Wearing sunscreen
No smoking/drinking
Clean air
Eat balanced diet
PPE at workplace
6
Q
What medication is used to prevent breast cancer?
A
Tamoxifen
7
Q
When should secondary cancer prevention start?
A
When we suspect cancer
8
Q
Secondary cancer prevention includes
A
Screening and testing
Includes self-examination, mammogram, etc.
9
Q
When should primary cancer prevention start?
A
Should be an everyday practice. All the time.
10
Q
When does tertiary cancer prevention start?
A
When you have cancer
11
Q
Tertiary cancer prevention includes
A
Surgery and cancer treatment
12
Q
Signs and symptoms of cancer include (CAUTION)
A
C - Change in bowel & bladder habits
A - Sore that does not heal
U - Unusual bleeding or discharge
T - Thickening or a lump in breast or else where
I - Indigestion or difficulty swallowing
O - Obvious change in wart or mole
N - Nagging cough or hoarseness
13
Q
Why is ECHO important to obtain before starting chemo?
A
Because chemo can screw up the heart. So baseline needs to be obtained
14
Q
Higher the number on cancer staging
A
More severe the cancer is; cure chance goes down
15
Q
About how many numbers of cancer cells are there for us to start questioning for cancer?
A
About 200
16
Q
What is ploidy?
A
Classifies tumor chromones as normal or abnormal
17
Q
What needs to be done before planning for cancer treatment?
A
Cancer staging
18
Q
What is carcinoma in situ aka stage 0?
A
Body has walled off the cancer cells. Will remove that part and patient will be good and cancer free (but will need screenings and monitoring)
19
Q
What are some nurses’ role during cancer diagnosis?
A
Clarify any misconceptions and fears
Comfort patient during procedures
Assess for the test outcomes
Support family
20
Q
What is an example of prophylactic surgical cancer treatment in relation to breast cancer?
A
Cancer on R. boob but remove both boobs to prevent getting cancer on L. boob
21
Q
What are some nonsurgical cancer treatment/management?
A
Chemo
Radiation
Bone marrow transplantation
Hyperthermia
Biologic response modifiers
22
Q
What’s one big thing to know about radiation treatment?
A
No matter how good and precise the machine is, radiation will still affect nearby organs.
Ex) man with prostate cancer might have urination/bowel issues from radiation
23
Q
What is external radiation for?
A
Treating superficial lesions and deeper structures
24
Q
Why is skin care important with radiation treatment?
A
Can cause redness, burn, nerve damage, etc. ask about sensation changes
25
What are some patient education related to external radiation treatment and skin care?
No lotions, especially alcohol containing ones
No ointments, powders, or soaps
DO NOT wash off skin markings
26
Why do you want to instruct patients to not remove skin markings for radiation treatment?
Because the markings line up with the machine to precisely target cancerous area
27
What do you want to do if a patient's implant that is radioactive falls out?
Don't touch it with bear hands.
Use tongs.
Contact a radiation tech (or specialist) if you don't know what to do
Protect yourself
28
What's brachytherapy?
Internal radiation treatment; high dose to localized area via implants, needles, seeds, beads or catheters
29
Why do patients receiving internal radiation treatment need to be in isolation?
Because they emit radiation. Radiation source is within the patient. Once they receive it, they are potential hazard for a period to others
30
If the half life of an internal radiation treatment is 8 days, how many days does this patient need to be in isolation?
8 days. No close contact with others.
31
What is a potential symptom a thyroid cancer patient could experience as a result of getting external radiation treatment?
Dysphagia
32
Healthcare workers wearing a radiation badge or monitoring device are to
Measure how much radiation they get so they are protected.
If they reach a certain amount they will be sent home and have rest period
33
Why is cluster care important when caring for a patient receiving radiation?
To minimize exposure to protect yourself
34
What kind of cells does chemo destroy?
Any rapidly growing cells. Doesn't matter if it is cancerous or not
35
Can chemo kill you?
Yes. It kills rapidly growing cells. Your organs are full of rapidly growing cells
36
Can all nurses give chemo?
No. You have to be certified
37
Why is combination therapy commonly used when treating cancer?
Because all chemo drugs are different; it can be cell cycle specific, phase specific, or nonspecific.
That means different chemo kills cells at different stages.
Killing cells at different stages will be more effective
38
Why is chemo drug so dangerous and requires precise calculation?
Because there is a relatively small difference between a therapeutic dose and a toxic dose
39
What are some types of chemo?
Antimetabolites
Antitumor antibiotics
Nitrosureas
Alkylating agents (mustard gas type)
Plant alkaloids
Hormonal agents
40
How is chemo drug prepared?
Wearing PPE and under the hood
41
Port is used during IV chemotherapy. Patient has cancer on R. arm. Where would the port be placed?
Opposite side of where the cancer is; so L. side
Usually, but not always on opposite side
42
Why are GI related symptoms common in chemo side effects?
Because your GI tract cells are fast growing cells. Chemo targets those cells
43
What are some S/E of chemo?
GI - N/V/D, stomatitis, anorexia, mucostitis
Infection and hemorrhage
Kidney damage from dead cells (esp. from tumor lysis syndrome)
Cardiac toxicity, signs of CHF
Reduces lung function
Sterility or chromosomal abnormality in offspring
peripheral neuropathy, loss of DTR, paralytic ileus, hearing loss
44
What recommendation can you make to patients who want to have kids but are about to receive chemo?
Freeze egg/sperm
45
Why are infection and hemorrhage side effects of chemo?
Due to bone marrow suppression
46
Why is anorexia a problem when receiving chemo?
Patients need to eat to heal. If they don't eat, it will take longer for them to recover
47
Fresh flowers, fruits, or vegetables are not allowed for chemo patients because
They are prone to infection. All those can cause infection
48
Why do you need to monitor kidney function closely when receiving chemo?
All the dead cells from chemo will be filtered through the kidney -> kidney damage
All the drugs they are getting are also filtered through the kidneys -> more damage
49
Chemo can make pee very acidic which if left untreated, can damage kidneys. What can be given to the patient to help with this?
Good hydration and allopurinol to alkalize urine
50
Why is aseptic technique important when caring for a patient receiving chemo?
Because of bone marrow suppression, their neutrophil count is low -> susceptible to infection.
51
What's chemo brain?
Thinking and memory problems after cancer treatment. They will get over it but it may take a while
52
Patient education on alopecia (how to manage)
Keep scalp moist, use mild shampoos
Look Good-Feel Better program can be helpful
53
What are some things that patients with stomatitis or oral mucositis can use to rinse their mouth?
Magic mouthwash
Plain water
Salt water
54
What kind of mouth wash is not recommended for stomatitis/oral mucositis?
Commercial mouth rinses with alcohol
Lemon-glycerin swabs
These are too strong
55
What's Nadir?
The lowest point that the blood counts fall to after chemo
56
What's the most important thing staff and family need to do when caring for neutropenic patients?
Strict handwashing
57
What kind of diet is recommended for neutropenic patients?
Low microbial diet
58
Can you check rectal temperatures and give rectal suppositories, enemas, or examinations to patients with thrombocytopenia?
No. Risk of bleeding. Nothing up the ass.
59
Why would you give stool softeners to thrombocytopenia patients?
To avoid straining; increased risk of bleeding
60
No IM injections on thrombocytopenia patients. Why?
Risk of bleeding
61
What is Superior Vena Cava Syndrome (SVCS)?
Compression or invasion of SVC by tumor and/or enlarged lymph nodes
62
What are some symptoms of superior vena cava syndrome?
Progressive SOB
Cough
Facial swelling
Edema of neck, arms, hands, thorax
Tightness
Difficulty swallowing
Engorged & distended jugular
63
How is superior vena cava syndrome managed?
Radiation to shrink tumor and relieve symptoms
Chemo
Oxygen therapy
Anticoagulants
Diuretics
64
Why would anticoagulants be used when treating superior vena cava syndrome?
Bc superior vena cava is narrowed; blood clots can form. it's no good
65
Why would diuretics be used to treat SVCS?
Obstruction of superior vena cava can cause fluid build up in upper body which leads to swelling. We need to get rid of extra fluids
66
Why do you want to watch fluid balance when managing SVCS?
To reduce upper body edema
67
What is tumor lysis syndrome?
Cells burst in large numbers due to cytotoxic therapies. when the cells burst, it release all the cell products into the bloodstream, causing electrolyte imbalance.
68
What electrolytes need to be monitored for tumor lysis syndrome?
Potassium (high)
Phosphorus (high)
Uric acid (high)
Calcium (low; secondary to high phosphorus)
69
Tumor lysis syndrome patients are at risk for
Renal failure (cell debris gets filtered)
Alterations in cardiac function (due to hyperkalemia)
70
What medication is given to tumor lysis syndrome patients?
Allopurinol (uric acid)
71
What patient education is needed for tumor lysis syndrome patients?
Adequate hydration to help with electrolyte balance and kidney stones from uric acid
Take allopurinol 2-4 days prior to chemo
72
Urine output for tumor lysis syndrome patients should be at least
150mL/hr
73
Why is Rheumatoid arthritis systemic?
Because it's an autoimmune disease; It's called rheumatic disease.
74
What is arthritis?
Inflammation of one or more joints; either inflammatory or non-inflammatory
75
Why is long term steroid use in osteoarthritis not recommended?
It's only a temporary fix, can lead to hyperglycemia, increased risk of infection, and fractures
And cushing's like symptoms
76
What are some other names for osteoarthritis?
Degenerative joint disease
Wear and tear
77
Do OA symptoms develop slowly or quickly?
Slowly; it's "degenerative" joint disease. wear and tear over time
78
What are some symptoms of OA?
Pain and tenderness with activity, improves with rest
Stiffness/loss of flexibility (morning stiffness) < 30 min
Crepitus
Bone spurs
Enlarged joints
Joint effusions when knees are inflamed
79
Is OA a bilateral or unilateral disease?
Typically unilateral; however, nodes can appear bilaterally
80
What are some treatments for OA?
Acetaminophen as primary choice of pain management
Lidocaine topical cream
Joint injections (steroids)
Rest/exercise
Heat/cold alternating
Weight control
81
Pre-op care for joint surgery
Assess for mobility issues, need for assistive or adaptive equipment
Discontinue bleeding risk meds at least 1 weeks before (NSAIDs, anticoagulants, hormone replacement therapy, oral contraceptives, etc.)
82
Post-op care for total hip arthroplasty
Abduction pillow
Prevent hip dislocation, blood clots, infection, and anemia
No standing/sitting for prolonged time
No internal rotation
No bending greater than 90 degrees
Pain management
Move slowly
83
Why is pain management important for post joint surgery?
PT is required to help gain mobility back. Without controlled pain, patient will not participate.
84
What are some complications after a total joint surgery?
Dislocation (esp. with hip)
Infection
Venous thromboembolism (blood clot or fat embolism)
Hypotension
Bleeding
85
What are some patient educations following a post total hip replacement?
Don't cross legs
Don't twist body when standing
Don't overexert
Inspect incision site daily for infection
Don't sit/stand for prolonged time
Perform post-op exercise as instructed
86
What's a continuous passive motion machine (CPM)?
To keep operated knee elevated and in neutral position
87
What are some early signs of RA?
Joint: inflammation
Systemic: low-grade fever, weakness, fatigue, paresthesia
88
What are some late signs of RA?
Joint: deformities, moderate-severe pain, morning stiffness
Systemic: Anemia, weight loss, subcutaneous nodules, peripheral neuropathy, Sjogren's syndrome, Felty's syndrome, Caplan's syndrome
89
What is Sjogren's syndrome?
Dry eyes, mouth, vagina
Late signs of RA
90
What is Felty's syndrome?
Hepatosplenomegaly, leukopenia
Late signs of RA
91
What is Caplan's syndrome?
Rheumatoid nodules in the lungs
Late signs of RA
92
What labs can help diagnose RA?
ANA (antinuclear antibody)
RF (rheumatoid factor)
ESR & CRP - inflammation markers
93
What are some medications used to treat RA?
NSAIDs - pain relief and reduce inflammation
Steroids - reduce inflammation and slow joint damage. it will mask symptoms
DMARDs - slow the progression of RA
Biologic DMARDs - like Humira, Remicade, etc.
94
What's a common DMARDs used to treat RA?
Methotrexate; which is a chemo med.
Closely monitor labs for liver damage, bone marrow suppression, and lung infections
95
Are DMARDs type of immunosuppressant?
Yes. That's why we need to monitor for bone marrow suppression and liver damage
96
What are some non-pharm management for RA?
Fish oil
Plan oils
Tai chi
The oils can interfere with medications, so check with provider beforehand. And make sure they are good quality
97
Does OA cause joint swelling?
Little or no swelling is expected
98
Morning stiffness lasts longer in which arthritis?
RA; longer than 1 hour while OA is less than 30 minutes
98
Which arthritis has symptoms of painful, swollen, and stiff joints?
RA
98
What are the signs of hip fracture?
Leg turned out, one leg shorter than the other
Inability to move immediately after a fall
Severe pain in hip or groin
98
What type of anticoagulant is used to prevent DVT in joint replacement patients?
Low molecular weight heparin
99
What are some complications of fractures?
Compartment syndrome
Hypovolemic shock
Fat embolism
100
What should you do when you suspect a hip fracture while waiting for help?
Don't sit them up; no bending greater than 90 degrees.
Just make them comfortable as possible without moving them too much
101
What can you do to prevent osteoporosis?
Weight-bearing exercises
102
What is primary osteoporosis caused by?
Menopause and decreased testosterone.
Testosterone builds bone while estrogen helps maintain bone health
103
Why are astronauts at risk for osteoporosis?
They are in a gravity-free zone; no weight bearing is happening
104
How is phosphorus and calcium related?
When one goes up, other goes down. It's like sodium-potassium pump
105
What's the best tool to diagnose osteoporosis?
Dual X-ray absorptiometry (DEXA scan)
106
What's a T-score when diagnosing bone mineral density using DEXA scan?
Represents the number of standard deviations above or below the average BMD (bone mineral density)
107
What are the T-score ranges for Osteopenia and Osteoporosis?
Osteopenia -1 to -2.4
Osteoporosis < -2.5
Lower the number, less density
108
What are some medications used to treat osteoporosis?
Calcium and vitamin D
Biphosphonates
Estrogen agonist/antagonists
Monoclonal antibodies - when others don't work
109
Why do you need to take calcium and vitamin D together?
Vitamin D helps absorb calcium
110
What osteoporosis medication slows bone breakdown but long-term use can lead to osteonecrosis and long-bone fracture?
Biphosphonates
111
What's the difference between T-score and Z-score?
T-score compares BMD with young, healthy people of same sex as patient
Z-score compares BMD with same sex and age as patient.
112
What medication is used to treat acute gout?
Colchicine - anti-inflammatory
Corticosteroids
NSAIDs
113
What medication is used to treat chronic gout?
Allopurinol - blocks uric acid production
Febuxostat - blocks xanthine into uric acid
Probenecid - increases secretion of renal dysfunction
114
What are the dietary restrictions gout patients will have?
Low purine;
Less organ/red meats, shellfish, oily fish with bones, alcohol
115
What medication needs to be avoided when receiving treatments for gout?
Aspirin; deactivates treatment meds
116
What medication blocks xanthine from turning into uric acid?
Febuxostat
For chronic gout
117
Why is drinking lots of water important in gout patients?
To reduce renal insufficiency
And to push uric crystals out
118
What medication is used to treat refractory (unmanageable) gout?
Pegloticase IV, Q2 weeks
Converts uric acid to allantoin
May cause anaphylaxis
119
What important thing is affected in all anemias?
Oxygen carrying capacity
120
Anemia is caused by
Blood loss
Inadequate production
Increased destruction
Vitamin Deficiency
121
Anemia classification according to MCV
Macrocytic anemia (MCV >100)
Normocytic anemia (80
122
What class of anemia is caused by deficiency of vitamin B12, folic acid, or intrinsic factor?
Macrocytic anemia
123
Acute blood loss, chronic disease, bone marrow failure, and hemolysis are classified as
Normocytic anemia
124
Hem synthesis defect (ex. iron deficiency), Gloin synthesis, sideroblastic are classified as
Microcytic anemia
125
What causes iron deficiency anemia?
Acute blood loss
Chronic blood loss
Inadequate nutritional intake
126
What are the symptoms of iron deficiency anemia?
Gradual onset
Early symptoms: fatigue, weakness, SOB, pale
Severe: brittle, concave fingernails, soreness and redness of tongue, corner of mouth dry and cracked
127
When finding the source/cause of bleeding, what organ/system should be considered first?
GI (occult blood, GI workup)
128
What class of anemia is iron deficiency anemia?
Microcytic
129
How is iron related to anemia?
Hemoglobin needs iron to function
130
Gastritis, neuromuscular changes, irritability, headache, paraesthesia, vasomotor disturbances can occur as
Iron deficiency anemia progresses
131
Do you have to know the cause before treating anemia?
Yes. Never treat before knowing the cause; you need to fix the underlying cause
132
What medication is used to treat iron deficiency anemia?
Ferrous Sulfate 325mg for 6-12 months after bleeding stops
133
What are some important patient education on taking ferrous sulfate?
Take on empty stomach unless not tolerable
Take vitamin C with it
Stool will be dark green to black
134
What foods are rich in iron?
Liver, red meat, dark leafy greens, beans, seafood, fortified cereal
135
What class of anemia does hemolytic anemia belong to?
Normocytic anemia
136
Inflammation, infection, tissue injury, low FE, and low bone marrow production are all causes of
Anemia of chronic disease
137
What are some chronic illnesses that can lead to anemia?
Malnutrition
Chronic infection/inflammation
Cancer
Renal insufficiency
Chronic liver disease
138
What is hemolytic anemia?
Hemolysis or premature destruction of RBC; may be related to autoimmune antibodies
139
What 2 things are needed for RBC production?
Folic acid and vitamin C
140
Trauma, heart valves, burns, toxic chemicals, sickle cell anemia, aspirin, ibuprofen acetaminophen, and penicillin can cause which type of anemia?
Hemolytic
141
What supplement should you take when you have hemolytic anemia?
Folic acid
142
What food can inhibit iron absorption?
Coffee, tea, milk, cereals, dietary fiber, carbonated beverages, dietary supplements with calcium, magnesium, zinc, copper
Antacids, H2 blockers, PPIs
143
What class of anemia does pernicious (B12) and folate deficiency fall under?
Macrocytic anemia
144
What causes pernicious anemia?
Lack of intrinsic factor in the stomach due to h. pylori, heavy drinking, smoking, gastrectomy, etc
145
What kind of neurologic deficits can occur with pernicious anemia?
Peripheral neuropathy
146
What treatment is given to pernicious anemia?
B12 injections monthly
Lifetime treatment since it is incurable
147
What are some symptoms of pernicious anemia?
Slow development (20-30 yrs)
Beefy red tongue
Difficulty walking
Abdominal pain
Infections
Gi/Cardiac/Kidney illness
Mood swings
148
What is vitamin B12 used for?
Help produce RBCs, DNA, and develop CNS
149
What foods are high in vitamin B12?
Organ meats, dairy, seafood
150
What causes folate deficiency anemia?
Malabsorption syndromes, poor nutrition (not enough veggies), alcoholism, malignancies
151
Scales and fissures in mouth, stomatitis, painful ulceration of the buccal mucosa and tongue, dysphagia, flatulence, and watery diarrhea are symptoms for
Folate deficiency anemia
152
What is the treatment for folate deficiency anemia?
Oral folic acid
Parenteral folic acid
153
Lots of folic acid supplementation can cause
Masking of B12 deficiency
Turn urine dark yellow
154
Acute Myeloid Leukemia is characterized by
Immature myeloblasts (mature form - WBC) in the bone marrow; insufficient blood cells
155
What is the prognosis of AML in patients younger than or equal to 65?
~35%
156
Prognosis of AML in patients older than 65?
4%
157
What are the symptoms of Acute Myeloid Leukemia?
Neutropenia (fever & infection)
Anemia (fatigue & weakness)
Thrombocytopenia (bleeding)
Painful, enlarged liver or spleen
Gum hyperplasia
Bone pain (bone marrow affected)
158
What diagnostics are used to diagnose Acute Myeloid Leukemia?
CBC (low RBC and platelets, leukocytes may be normal, low, or high)
Bone marrow aspiration
159
What is the treatment goal for Acute Myeloid Leukemia?
Try to induce remission
160
What medication is used to treat AML (aggressive form)?
Cytarabine
161
What medication is used in elderly AML patients who cannot tolerate usual treatment?
Hydroxyurea
But lower cure rate. QOL will be increased
162
What surgical/procedural treatment can be done in AML patients?
Bone marrow transplant
163
Which leukemia has longer life expectancy? Acute or chronic?
Depends on stage, but chronic
164
Which leukemia is characterized by malignant transformation of B cells?
Chronic Lymphocytic Leukemia (CLL)
165
What are the "B symptoms?"
Fevers, night sweats, unintentional weight loss, infections
166
When is treatment started for Chronic Lymphocytic Leukemia?
Not until symptoms appear/severe.
This is a disease of older person (>72) so we want to consider risk vs. benefit
167
What is Chronic Myelogenous Leukemia?
Overproduction of abnormal myeloid/blast
168
What is a good diagnostic marker for Chronic Myelogenous Leukemia?
Philadelphia chromosome
169
What are some symptoms of Chronic Myelogenous Leukemia?
May be asymptomatic
Fatigue, weakness, anorexia, splenomegaly
SOB/confusion with very high leukocyte counts
Fever and adenopathy in blast stage
170
What are the treatments for Chronic Myelogenous Leukemia?
Chemo to suppress in early stages
Bone marrow transplants (successful if early in disease, under 50, and in good health)
Can potentially be cured with BMT
171
What are some nursing cares for leukemia patients?
Manage mucositis
Know s/s of leukemia, what to assess for, and treatment outcome
Control pain and discomfort
Risk of dehydration
Assist with self-care
Anxiety/grief/hospice/home health
172
What's Hodgkin's Lymphoma?
Presence of Reed-Sternberg cell (malignant lymph cell)
Development of systemic symptoms
173
What's the first sign of Hodgkin's Lymphoma?
One or more enlarged, painless lymph nodes
174
What are some symptoms of Hodgkin's Lymphoma?
Organ symptoms from compression by tumor
"B" symptoms
Increased inflammation markers, WBC
Impaired cellular immunity
175
Why can Hodgkin's Lymphoma go undiagnosed for several years?
Because it is painless unless the tumor is pressing on other organs
176
What treatment is given during early Hodgkin's Lymphoma?
Radiotherapy - cure rate of 80%
177
What treatment is given at the late stage of Hodgkin's Lymphoma?
Combination Chemo
Radiation
80% can be put in remission
178
Prognosis for older adult is poorer in which lymphoma?
Non-Hodgkin's
179
What are the symptoms of Non-Hodgkin's Lymphoma?
"B" complex symptoms
Non-tender peripheral lymphadenopathy
May have moderately enlarged liver and spleen
180
What's one big thing about Multiple Myeloma?
Bone pain
181
What's the survival rate of Multiple Myeloma?
5 years for newly diagnosed patients 33% (poor prognosis)
182
What are the symptoms of Multiple Myeloma?
Pathological fractures
Back pain/ribs
Bone pain
Renal failure due to bone breakdown
183
Multiple Myeloma and lab findings (CRAB)
C - elevated calcium
R - renal insufficiency
A - anemia
B - bone lesion
184
What treatment are given to Multiple Myeloma?
Chemo, radiation, plasmapheresis (when blood viscosity is high)
6-8 months of aggressive treatment
185
What are the nursing interventions for Multiple Myeloma?
Pain control
Assist with ADLs
Nutrition
Symptom control
