cancer

Question 1

differences

Answer 1

arise from primitive tissues (embryonic), result in leukemias, lymphomas, sarcomas, CNS tumors, not from lifestyle factors, respond well to treatment

Question 2

general cm

Answer 2

mass/swell, pale and energy loss, easily bruise, persistant and localized pain/limp, prolonged unexplained fever/illness, HA freq with vomit, eye/vision change, excessive rapid weight loss

Question 3

CNS tumors cm

Answer 3

based on location, size, stage
HA, v, clumsy, unsteady, cranial nerve neuropathy (blurred or double vision), head tilt, seizure, motor abnormality, weak, behavior or personality change, ftt, irritable, VS disturbance

Question 4

CNS tumors tm

Answer 4

based on type
sx, radiotherapy >2yr, chemo, prognosis varies

Question 5

CNS tumors nc

Answer 5

post op: position to decrease pressure where tumor was - midline, off operative site, reduce ICP (decrease stimulation), neck flexion, NPO (gag and swallow), comfort (NPO), eye care (cover or moist, may not be able to close)
promote return to optimal functioning

Question 6

neuroblastoma cm

Answer 6

based on location and stage
often metastasize before diagnosis

Question 7

neuroblastoma tm

Answer 7

based on stage
sx, biopsies, radiation, chemo, transplant (bone or stem cell), prognosis varies

Question 8

lymphoma - hodgkin cm

Answer 8

painless enlargement of lymph, fever, night sweats, reed sternberg cells
complications: liver failure, secondary cancers, delayed puberty

Question 9

lymphoma - hodgkin tm

Answer 9

radiation, long term chemo, hsct, transplant

Question 10

lymphoma - hodgkin nc

Answer 10

significant pain in effected node following alcohol

Question 11

lymphoma - nonhodgkin cm

Answer 11

diffused rather than nodular, poorly differentiated (B and T lymphocytes, uncontrolled growth), dissemination (fast), mediastinal involve and invasion of meninges (CNS)
complication: metastasis, secondary malignancy
pain, lymph swell (deeper - abd), d or c, cough, dyspnea, orthopnea, facial edema or venous engorgement (emergency)

Question 12

lymphoma - nonhodgkin tm

Answer 12

chemo 3/4 stage

Question 13

osteogenic sarcoma cm

Answer 13

long bones (legs) - metaphysis
pain, limp, decreased ROM
complications: metastasis, recurrence within 3 years
can mimick growing pains

Question 14

osteogenic sarcoma tm

Answer 14

surgical resection or amputation, prosthetic, and chemo

Question 14

osteogenic sarcoma nc

Answer 14

preop crucial, support, body image, pain (phantom limb)

Question 15

ewing sarcoma cm

Answer 15

intermittent pain - worses to constant/severe, swell/red
systemic: fever, spinal cord compression, respiratory distress

Question 16

ewing sarcoma tm

Answer 16

radiation, chemo (myeloblative, stem cell, surgical resection, avoid active play or weight bearing with treatment - fractures

Question 17

rhabdomyosarcoma cm

Answer 17

vague s that are often common to childhood (ear ache)
very malignant

Question 18

rhabdomyosarcoma tm

Answer 18

remove, radiation, chemo (long term)

Question 19

wilms tumor (nephroblastoma) cm

Answer 19

abd mass (pain), malaise, anorexia, fever, gross hematuria, htn
long term survival

Question 20

wilms tumor (neproblastoma) tm

Answer 20

nephrectomy and regional lymph nodes, chemo with or without radiation

Question 21

wilms tumor (nephroblastoma) nc

Answer 21

handle and bathe careful (dont palpate), monitor BP and I+O

Question 22

retinoblastoma cm

Answer 22

cats eye reflex (white eye), strabismus, red painful eye with glaucoma, blind (late)
may regress, secondary tumors, spread to brain and other eye, lymph, bone, liver, others

Question 23

retinoblastoma tm

Answer 23

early and uni: irradiation, cryotherapy
bilateral: preserve useful vision in least affected
advanced: enucleation, chemo

Question 24

retinoblastoma nc

Answer 24

post op - enucleation: large pressure dressing, dressing change - saline, abx) family support - screen siblings q1-3 wks first year, protect other eye

Question 25

testicular

Answer 25

not common, usually malignant self examine! tm: orchiectomy - chemo/radiation

Question 26

leukemia complications

Answer 26

anemia, infection, bleeding (decrease platelets), spleen, liver and lymph - infiltration to enlarge

Question 27

leukemia cm

Answer 27

stem cells produce immature wbc, fill bone marrow and lead to decreased rbc and platelets causing anemia, thrombocytopenia, and neutropenia fever, pallor, bleed, lethargy, malaise, anorexia, large joint and bone pain bone marrow failure: petechiae, frank bleeding, joint/bone pain, fatigue CNS involvement: HA, persistant n/v, irritable, dizzy, seizure, behavior change, 6th cranial nerve palsy (eye tract)

Question 28

leukemia tm

Answer 28

diagnose with bone marrow biopsy treat s, combo chemo, cranial irradiation

Question 29

leukemia nc

Answer 29

educate, treatment schedule, manage SE, prevent complications, coping skills, QOL, g+d maintain

Question 30

chemo - remission induction

Answer 30

rapid, 3-4 weeks, oral steroids and IV chemo, kill active, sickest

Question 31

chemo - consolidation

Answer 31

strengthen, remission, CNS prophylaxis, intrathecal and IV

Question 32

chemo - intensification

Answer 32

destroy remaining

Question 33

chemo - maintenance

Answer 33

prevent relapse, treat spread

Question 34

chemo causes

Answer 34

kills normal and cancerous short term: immunosuppression, infection, myelosuppression, n/v, oral mucositis, alopecia long term: microdontia and missing teeth, hearing and vision changes, hematopoietic, immunologic or gonadal dysfunction, various alterations of systems, 2nd cancer

Question 35

chemo - bone marrow suppression

Answer 35

admin blood safely, nc for anemia, nc for thrombocytopenia, colony stimulating factors, nc for neutropenia

Question 36

chemo - alopecia

Answer 36

most adjust well, hat, scarves, wigs, will grow back (different color/texture)

Question 37

chemo - n/v

Answer 37

antiemetics before chemo and q3-4 hours until drugs clear, avoid strong smells, small and freq, cool, chemo early in day

Question 38

chemo - stomatitis

Answer 38

multiple ulcers prevent: oral mucosa and teeth clean, antifungal and bacterial mouthwash, avoid acidic treat: rinse with NS, magic mouth wash, avoid local anesthetics (cant swallow)

Question 39

chemo - fear and anxiety

Answer 39

inform, plan of care with family, assess coping, optomistic, no false hope, resources, diversional activities

Question 40

oncologic emergencies

Answer 40

hemorrhagic cystitis tumor lysis syndrom septic shock (monitor for circulatory failure) hyperCa from large bone destruction (hydrate and P supplement)

Question 41

hemorrhagic cystitis

Answer 41

bladder pain and blood in urine increase fluid intake, void frequently, mesna to protect bladder

Question 42

tumor lysis syndrome

Answer 42

tumors release high uric acid, k, P into blood leading to metabolic acidosis, renal failure, death rf: large tumor/lots, sensitive to chemo, increased proliferation rate, high wbc at diagnosis

Question 43

tumor lysis syndrome - cm

Answer 43

flank pain, lethargy, n/v, oliguria, pruritus, arrythmias, impaired renal, tetany, neuro change

Question 44

tumor lysis syndrome - tm and nc

Answer 44

fluid before therapy (3-4x maintenance), i+o, daily weight, urine specific gravity <1.01, e and meds to decrease conversion of metabolic by products to uric acid, urine pH (7-7.5), monitor for tetany and mental change, collect labs

Question 45

SE of radiation therapy

Answer 45

short: fatigue, n/v, oral mucositis, myelosupression, skin integrity at site long: growth alter, hormone dysfunction, hearing and vision, learning problem, heart dysfunction, pulmonary fibrosis; hepatic, sexual, or renal dysfunction; osteoporosis, development of secondary sex characteristics

Question 46

cancer - pain management

Answer 46

oral or IV, dose with weight, titrated for SE, pain scale appropriate

Question 47

cancer - nutrition

Answer 47

normal w+h, pref (shake/pudding), antiemetics, weigh daily or weekly and h, high cal meals when appetite high, vit and min supplements, TPN and IV lipids

Question 48

cancer - health promo

Answer 48

dental: floss, dentist, soft vaccine: 2 weeks before or during = inactivated, 3 months after = good