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Sophomore 2 Test 1 > Cancer > Flashcards

Flashcards in Cancer Deck (103):
1

The number one non modifiable risk factor for cancer

Age
- Tends to affect the very young and 65 and older

2

The number one preventable carcinogen

Tobacco
- Use of tobacco both initiates and promotes cancer

3

How does cancer begin (cellular)

Begins when an abnormal cell is transformed by the genetic mutation of the cellular DNA. Cell forms a clone and begins to proliferate - ignores growth regulating signals and changes the surrounding tissue. These abnormal cells infiltrate and gain access to lymph nodes and blood vessels, which travel to other areas of the body.

4

Epidemiology of Cancer

- Tends to affects the very young and 65 and older
- Affects more men than women
- Increased incidence of those who work in industrialized sectors

5

What is a primary tumor?

Original tumor site

6

Parent Tissue

Cells identified from which it came from

7

Metastasis

Primary tumors first extend into the surrounding tissues --> tumor cells secrete enzymes, causing pressure --> cause size increase --> forced cells to invade new territory

- Blood borne metastasis is most common cause of metastasis disease

8

Three interacting factors influence cancer development

1. Exposure to carcinogen
2. Genetic predisposition
3. Immune function

* These account for variation in cancer development from one person to another - even if exposed to the same hazard

9

Viral Causes of Cancer

Difficult to evaluate due to their difficulty to isolate. Thought to incorporate themselves in the genetic structure of the cell

10

Examples of Viral Causes of Cancer

1. Epstein-Barr = primary liver cancer
2. Hepatitis B = primary liver cancer
3. HPV = cervical, vulvar, and other genital carcinomas

11

Examples of Bacterial Causes of Cancer

Helicobacter pylori = gastric malignancy

12

Can alcohol cause cancer?

Increases cancer risk of mouth, pharynx, larynx, esophagus, liver, colorectal, and breast
* No more than two drinks per day for men
* One beverage per day for women

13

Etiology of Cancer: Hormonal Agents

- Breast, prostate, and uterus believed to rely on endogenous hormonal levels for growth
- OCPs and prolonged estrogen therapy associated with hepatocellular, endometrial, and breast cancer
- Menarche of < 12 years, delayed onset of menopause, etc. increase risk of cancer of breast
- Increased number of pregnancies associated with breast endometrial and ovarian

14

Primary Prevention of Cancer

1. Avoidance of known or potential carcinogens
2. Modifying associated factors
3. Removal of "at risk" tissues
4. Chemoprevention
5. Vaccination

15

Chemoprevention

Used for primary prevention of cancer
- Using ASA and Celecoxib to decrease risk of colon cancer
- Vitamin D and Tamoxifen to decrease risk of breast cancer
- Lycopene to reduce risk of prostate cancer

16

Secondary Prevention of Cancer

- Yearly mammogram for women > 40 years of age
- Clinical breast exam for women > 40 years of age every 3 years
- Colonoscopy at age 50 and then every 10 years
- Yearly fecal occult blood for adults of all ages
- Yearly prostate specific antigen (PSA) and digital rectal exam (DRE) for men older than 50

17

Seven Warning Signs of Cancer

C = change in bowel/bladder habits
A = a sore that doesn't heal
U = unusual bleeding or discharge
T = thickening or lump in breast/elsewhere
I = indigestion or difficulty in swallowing
O = obvious change in wart or mole
N = nagging cough or hoarseness

18

Three types of cancer staging

1. Clinical
2. Surgical
3. Pathologic

19

Clinical Staging

Assesses the patient's clinical manifestations and evaluates clinical signs for tumor size and possible spread

20

Surgical Staging

Assesses the patient's clinical manifestations and evaluates clinical signs for tumor size and possible metastatic disease

21

Pathologic Staging

Most Definitive Type in determining tumor size, number sites, and spread by pathologic examination of tissues obtained at surgery

22

Duke's Staging

Stages colon and rectal cancer

23

Clark's Staging

Stages skin cancer

24

Three Forms of Cancer Treatment

1. Surgery
2. Radiation therapy
3. Chemotherapy

25

Prophylactic Surgery

Removal of "at risk" tissue
- removal of mole from a site where there is constant irritation

26

Diagnostic Surgery

Removal of part or all of a suspected lesion
- provides proof of the presence of cancer

27

Curative Surgery

Removal of the entire neoplasm
- Prostatectomy

28

Cytoreductive Surgery

Known as "cancer control"; removing part of the tumor and leaving a known amount of gross tumor
- known as "debulking"; reduces the number of cancer cells and increases the chances that other therapies can be successful

29

Palliative Surgery

Focus is to improve the quality of one's life - not focused on a cure
- Removal of tumor that is causing pain or causing obstruction

30

Second Look Surgery

This is a "rediagnosis" surgery after the patient has went through some type of treatment, such as radiation or chemo
- most common type of surgery used with ovarian cancer

31

Reconstructive or Rehabilitative Surgery

Enhances appearance, function of area, or both
- breast reconstruction after mastectomy

32

Types of Radiation Therapy

1. Teletherapy
2. Brachytherapy

33

Teletherapy

A "distant" type of treatment - radiation source is external to patient
- Because this source is external, the patient is not radioactive and is not a hazardous threat to others

34

Brachytherapy

Is a "close" or "short" therapy - the radiation source comes into direct and continuous contact with the tumor tissues for a specific amount of time
- It produces a high amount of radiation to the tumor with limited amount around surrounding tissue
- Patient emits radiation and is a hazard to others

35

Side Effects of Radiation Therapy

1. Skin changes and hair loss
2. Altered taste sensation
3. Fatigue
4. Tissue fibrosis and scarring

36

Nursing Considerations for Patient on Teletherapy

1. Wash the irritated area gently with either water or a mild soap and water as ordered
2. Use your hand rather than a washcloth to provide gentle care to skin
3. Rinse soap thoroughly and pat skin dry with a clean, soft towel
4. If there are ink and dye marks, be careful not to remove them, as this indicates the exact area where the beam of radiation is to be focused
5. No powders, ointments, lotions, or creams at the radiation site, unless prescribed
6. Wear soft clothing over the radiation site, avoid wearing belts, buckles, straps or any type of clothing that binds or rubs the skin at the site.
7. Avoid exposure of the area to the sun, avoid tense sunrays—plan outdoor activities early in the morning or late in the evening
8. Avoid heat exposure

37

Nursing Considerations for Patient on Brachytherapy

1. Assign private room with a private bathroom
2. Door of patient’s room needs a “Caution: Radioactive Material” sign
3. If portable lead shields are used, place between patient and door
4. Keep patient’s room door closed as much as possible
5. Wear a dosimeter film badge at all times during the patient’s care. While badge offers no protection, it does measure the exposure to radiation. Do not ever share badge—should only be used by who it is assigned to.
6. Wear lead apron while providing care. Apron should always be facing the source of radiation (never turn your back toward the patient)
7. Pregnant nurses should not be assigned to these patients. Pregnant women or those <16yrs of age should not visit.
8. Visiting hours should be limited to 30 minutes per day. Visitors should remain at least 6 feet away from the source.
9. Do not touch the source with bare hands. If source becomes dislodged, use long-handled forceps to retrieve it. Dispose the radioactive source in a lead container that is kept in the room.
10. Save all dressings and bed linens until after the radioactive source is removed. (Other equipment can be removed from the room at any time without special precautions and does not pose a hazard to other people)

38

How is dosage determined for chemotherapy?

Dosage is determined by the patient's total body surface area, previous response to chemo or radiation therapy, and function of major organ systems. When receiving chemo, weight needs to be done prior to administration

39

Extravasation

Antineoplastic chemo agents are additionally classified by their potential to damage soft tissue if they inadvertently leak from a vein (extravasation). If extravasation is suspected, the medication is stopped immediately, and dependent on the drug, an attempt is made to aspirate any remaining drug from the site through the existing needle.

40

Vesicants

These are agents that if deposited into the subcutaneous tissue, cause tissue necrosis and damage to the underlying tendons, nerves, and blood tissues. It may take weeks before damage is apparent. Damage can be so severe that area may require skin graft(s).

41

Chemotherapeutic Agents

1. Alkylating Agents
2. Antimetabolites
3. Antitumor Antibiotics
4. Antimitotics or Antimicrotubules
5. Topoisomerase Inhibitors

42

Alkylating Agents

1. Carboplatin
2. Cisplatin

43

When is Carboplatin used?

Selected areas of use:
1. Head/neck
2. Ovarian
3. Testicular

44

Adverse Effects of Carboplatin

1. Myelosuppression
2. N/V
3. Peripheral neuropathy

45

When is Cisplatin used?

Selected areas of use:
1. Bladder
2. Esophageal
3. Head/neck
4. Lung
5. Ovarian

46

Adverse Effects of Cisplatin

1. N/V
2. Renal toxicity
3. Myelosuppression
4. Neuropathy
5. Ototoxicity

47

Special Considerations for Cisplatin

Causes severe N/V - possibly pre medicate before administering

48

Antimetabolite Drugs

Methotrexate

49

When would methotrexate be used?

Selected areas of use:
1. Breast
2. Head/neck
3. Leukemia
4. Lymphoma
5. Osteosarcoma

50

Side Effects of Methotrexate

1. Mucositis
2. Diarrhea
3. N/V
4. Myelosuppression

51

Special Considerations for Methotrexate

High doses (>150-12,000mg/m2) require rescue with leucovorin and serum monitoring. May deplete metabolites (e.g. folic acid); may need B12 or folic acid supplement

52

Antitumor Antibiotics

1. Bleomycin

53

When would Bleomycin be used?

Selected areas of use:
1. Lymphoma
2. Testicular

54

Adverse Effects of Bleomycin

1. Pulmonary fibrosis
2. Pneumonitis
3. Dermal reactions (hyperpigmentation, rash, hyperkeratosis)

55

Special Considerations for Bleomycin

Special Considerations: causes pulmonary fibrosis—may start out as interstitial Pneumonitis and progress to pulmonary fibrosis. Usually in doses >450U—doses should not exceed 400U

56

Antimitotics/Antimicrotubules

1. Vincristine

57

When would Vincristine be used?

1. Leukemia
2. Lung
3. Lymphoma
4. Myeloma
5. Sarcoma

58

Adverse Effects of Vincristine

1. Peripheral neuropathy
2. Bone pain
3. Jaw pain

59

Special Considerations of Vincristine

Do not give intrathecally; results in death; administer steroid, H1-receptor antagonist (diphenhydramine)& H2-receptor antagonist (ranitidine, famotidine) to prevent anaphylaxis and hypersensitivity

60

Topoisomerase Inhibitors

1. Irinotecan

61

When would Irinotecan be used?

1. Colorectal
2. Lung

62

Adverse Effects of Irinotecan

1. Diarrhea
2. Myelosuppression
3. N/V

63

Special Considerations for Irinotecan

May cause acute cholinergic symptoms (sweating, flushing, diarrhea)
- treated with Atropine

64

Nursing Interventions for Stomatits/Mucositis

1. Mouth care
2. Soft tooth brush
3. Triple mix mouthwash
4. NO lemon glycerin swabs
5. Alcohol-free mouthwash
6. Avoid irritating foods

65

Nursing Interventions for Nausea/Vomiting/Anorexia

1. Adjust diet
2. Avoid strong odors
3. Frequent mouth care
4. Schedule antiemetics (ondansetron)
5. Encourage rest after meals in chair or HOB elevated

66

Foods to help with Diarrhea

1. Yogurt
2. Rice
3. Noodles
4. Cream of wheat
5. Skinned chicken or turkey
6. Lean beef
7. Fish
8. White bread

67

Meds for Diarrhea

1. Atropine
2. Diphenoxylate

68

Meds for Constipation

1. Docusate sodium
2. Polyethylene glycol
3. Magnesium citrate

69

Foods for Constipation

1. High fiber foods
2. Fruits
3. Whole grains

70

Nursing Interventions for Alopecia

1. Teach to prevent head injury to the scalp & cope with body image
2. Head covering to prevent sunburn
3. May need assistance in choosing a type of headcovering
4. Purchase wig prior to therapy and have stylist to mimic usual style
5. “Look Good, Feel Good Program” from ACS to offer ways to improve appearance

71

Nursing Interventions for Myelosuppression

1. Protect from infection
2. Assess at least q8h and PRN
3. Aseptic technique with any invasive procedure
4. Teach family reduction of risks in the home
5. Report any changes in skin, mucous membranes, or other health condition
6. Notify HCP of cough, dysuria, pain at venous access site, or any type of drainage.
7. Good hand washing technique
8. Does not have typical signs of infections—any elevation in temperature should be considered a sign of infection and should be reported to the health care provider immediately.
9. Teach at no time is the patient a hazard to other people—however, other people can be an infection hazard to the patient.

72

Nursing Interventions for Thrombocytopenia

1. Avoid IM injections and venipunctures
2. Avoid frequent flossing, soft bristled tooth brush, do not use water pick, be sure dentures fit properly and do not rub,
3. Use electric shaver instead of razor
4. No nose blowing, do not insert any objects in the nose
5. Avoid any trauma to rectal tissues—no enemas, no rectal temps
6. Measure the abdominal girth daily

73

Patients at Risk for Anaphylaxis

1. Lymphomas that are being treated with Bleomycin
2. Acure lymphoblastic leukemia (ALL) treated with L-asparaginase
3. Crainospinal tumors treated with tenoposide

74

Treatment of Anaphylaxis

1. Stop drug
2. Maintain IV with NS
3. Maintain patent airway
4. Administer O2
5. Administer Epinephrine SC or IM in early stages, IV if unconscious or hypotensive

75

S/Sx of Hypercalcemia

1. Anorexia
2. N/V
3. Constipation
4. Renal insufficiency
5. EKG changes
6. Muscle fatigue
7. Bone pain
8. Weakness

76

Hypercalcemia Treatment

1. Includes vigorous IV hydration (5-8L) of NS per day
2. Diuretics
3. Glucocorticoids
4. Calcitonin
5. Diphosphonate
6. Mithramycin
7. Dialysis (if life threatening)

77

SIADH

- Water is reabsorbed by the kidney and put into systemic circulation
- Causes hyponatremia and fluid retention
- Cancer is the most common cause

78

Nursing Care of SIADH

- Fluid restriction (only allowed 1L/day)
- Increase sodium intake and drug therapy.
- Demeclocycline –PO antibiotic that works in resistance of ADH

79

Superior Vena Cava Syndrome

SVC is compressed or obstructed by tumor growth or formation of clots in the vessel.
* Life threatening EMERGENCY

80

S/Sx of Superior Vena Cava Syndrome

1. Edema of the face, especially around the eyes
2. Tightness of the shirt or blouse collar (Stoke's sign)

81

S/Sx of Worsening Superior Vena Cava Syndrome

1. Edema in the arms and hands
2. Dyspnea
3. Erythema of the upper body
4. Epistaxis

82

Late S/Sx of Superior Vena Cava Syndrome

1. Hemorrhage
2. Cyanosis
3. Mental status change
4. Decrease cardiac output
5. Hypotension
6. Death (if compression is not relieved)

83

Treatment for Superior Vena Cava Syndorme

1. High dose radiation therapy (temporary relief)
2. Surgery (rarely done)
3. Metal stent in the vena cava (relieve swelling)

84

Tumor Lysis Syndrome

- Large numbers of tumor cells are destroyed rapidly.
- TLS is a positive sign that cancer treatment is effective. If untreated, can lead to death

85

S/Sx of Tumor Lysis Syndrome

1. Hyperkalemia
2. Cardiac arrhythmias
3. Hyperuricemia
4. Acute renal failure

86

Nursing Care for TLS

1. Hydration!
2. Alkaline Fluids (Sodium Bicarb) to prevent uric acid preciptation
3. Antiemetics
4. Diuretics (Furosemide)
5. Allopurinol, rasburicase (to decrease uric acid levels)
6. Polystyrene Sulfonate (po or enema)
7. IV glucose and insulin
8. Dialysis

87

Nursing Care for Pain

1. Assist with rest and sleep.
2. Benzodiazepines, and/or antidepressants may improve the effect of analgesics. It is best to give meds on a schedule.
3. IV bolus of a narcotic may be used
4. PCA pump
5. Oral sustained release analgesic
6. Pain Patches
7. PO routes must be a higher dose to equal IM or IV dose. It is considered a 1:3 ratio for the equivalence of IV/PO dosage.

88

Morphine

Multiple routes of administration. Available in immediate and controlled release

89

Morphine Dosages

Parental = 10
PO = 30

90

Codeine

IM has unpredictable absorption and tons of side effects, used PO for mild to moderate pain; usually compounded with nonopioid (like tylenol #3)

91

Codeine Dosages

Parental = 130
PO = 200

92

Hydromorphone

Useful alternative to morphine. Has shorter duration than morphine. Available in high-potency formulation useful for SC infusion

93

Hydromorphone Dosages

Parental = 1.5
PO = 7.5

94

Levorphanol

Longer acting than morphine

95

Levorphanol

Parental = 2
PO = 4

96

Meperidine

No longer preferred as first-line therapy for management d/t by-product is normederidine, which has side effects of irritability, crabbiness, and seziures. Also not recommended in elderly patients with impaired renal function. continuous IV infusion is not recommended

97

Meperidine Dosages

Parental = 75
PO = 300

98

Methadone

Longer acting morphine when given repeatedly. Long half-life—can lead to delayed toxicity from accumulation within 3-5 days. Start PO dosing on PRN schedule

99

Methadone Dosages

Parental = 10
PO = 20

100

Oxycodone

Used for moderate pain when combined with a nonopioid (Percocet, Tylox); can be used like PO morphine for severe pain

101

Oxycodone Dosages

Parental = N/A
PO = 20

102

Oxymorphone

Used for moderate to severe pain; No PO form

103

Oxymorphone Dosages

Parental = 1
Rectal = 10