[Exam 1] Chapter 15: Management of Patients With Oncologic Disorders Flashcards
(242 cards)
1
Q
What is Anaplasia?
A
A pattern of growth in which cells lack normal characteristics and differ in shape and organization with respect to their cells of origin
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Q
What is carcinogenesis?
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Three-step cellular process inolving initiation, promotion and progressions.
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Difference between benign and malignant cells?
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B: Resemble normal cells of tissue from where tumors from
M: May bear little resembalance ot the normal cells of the tissue where they rose from
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BEnign tumor general effects?
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Localized phenomenon that does not caused generalized effects, unless affecting vital function
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Malignant tumor general effects?
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Anemia, WEakness, Systemic Inflammation, Weight Loss, and CACS
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Patho of Malignant Process: What occurs during initiation?
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Carcinogens like chemicals, physical factors, cause mutations of DNA.
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Patho of Malignant Process: What occurs during promotion?
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Repeated exposure to co-carcingoens causes proliferation and expansion of initiated cells with increased expression of abnromal genetic information.
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Patho of Malignant Process: What occurs during progression?
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Cells exhibit malignant behavior.Stimulate angiogenesis (growth of new blood vessels) to invade adjacent tissues and metastasize.
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Patho of Malignant Process: Genetic alterations in gene for KRAS associated with?
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pancreatic, lung, and colorectal cancers
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Proliferative Patterns: What are maligant neoplasms?
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They demonstrate uncontrolled cell growth that follows no physiologic demand (neoplasia). These are cancerous cells.
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Proliferative Patterns: What viruses are known to cause cancer?
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HPV, Hep B, and Epstein-Barr Virus.
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Proliferative Patterns - Physical Agents: Physical factors include what
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sunlight, radiation, chronic irritation or inflammation, tobacco carcinogens, industrial chemicals and asbestos
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Proliferative Patterns - Physical Agents: Exposure to radioactive materials at nuclear weapon manufacturing sites has been associated with higher incidence of what
A
leukemia, multiple myeloma, and cancers of the lung, bone, breast, thyroid, and other tissues.
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Proliferative Patterns - Chemical Agents: Smoking is strongle associated with what types of cancers?
A
Cancers of the lung, head and neck, esophagus, stomach, pancreas, cervix, kdiney and bladder.
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Proliferative Patterns - Genetic Factors: Hallmarks of families with a hereditary cancer syndrome include cancer that involves who
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two or more first-degree relatives, onset younger than 50, and same type of cancer with multiple family members.
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Proliferative Patterns - Lifestyle Factors: Dietary susbtances that seem to increase RF cancer includes what
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fats, alcohol, salt-cured or smoked meats, nitrate, and red and processed meats.
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Proliferative Patterns - Hormonal Agents: What can increase the risk of breast cancer
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Period before 12, menopause after 55, null parity (never giving birth) and delayed childbirth after 30.
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Detection/Prevention of Cancer - Primary: How is this done
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Through reducing the risks through health promotion and risk reductions strategies.
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Detection/Prevention of Cancer - Primary: Example of this?
A
Immunization to reduce risk of cancer through prevention of infections associated with cancer.
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Detection/Prevention of Cancer - Secondary Prevention: How is this done
A
Screening and early detection activites that seek to identify precancerous lesions and early-stage cancer in indivduals who lacks S n S of cancer.
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Detection/Prevention of Cancer - Tertiary Prevention: How is this done?
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Focus on monitoring for and preventing recurrence of the primary cancer as well as screening for the development of second malignancies in cancer surviviors.
22
Q
What does MEtastasis mean?
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Abnormal cells that have an invasive characteristics , infiltrate other tissues
23
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What are malignant cancer cells?
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Demonstrate uncontrolled growth that does not follow physiologic demand
24
Q
How do T-Cell Lymphocytes respond to TAAs?
A
Release several cytokines that elicit various immune system actions like proliferation and induction of cancer cell apoptosis.
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Diagnosis of Cancer: Patients with suspected cancer undergo extensive testing why?
1. Determine presence/extent of cancer
2. Identify metastasis
3. Evaluate function of involved/uninvolved body systems
4. Obtain tissue and cells for alaysiss
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Tumor Staging/Grading: What does Staging help determine?
Size of tumor, existence of local invasion, lymph node involvement, and distant metastasis.
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Tumor Staging/Grading: What is GRading?
Its the pathologic classifcation of tumor cells. Seek to define the type of tissue from which tumor originated and degree to which tumor cells retain the functional characteristics.
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Tumor Staging/Grading: Grade I tumors closely resemble what
the tissue or origin in structure and functions.
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Anatomic Stage Group: What is this?
It is assignment to facilitate communication, tx decisions, and estimation of prognosis.
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What is the TNM classification system?
T: Extent of primary tumor
N: Lymph node involvement
M: Extent of metastasis
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Management of Cancer: How is T in TNM graded?
Tx : Tumor cannot be assessed
T0: No evidence of tumor
T1,T2,T3: Tumor increasing in size.
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Management of Cancer: How is N in TNM graded?
Nx: Regional lymph nodes cannot be assessed
N0: No regional lymph nodde metastasis
N1,N2,N3: Increasing involvement of lymph ndoes
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Management of Cancer: How is M in TNM graded?
```
Mx = cannot be assessed
M0 = No distan metastasis
M1 = distant metastasis
```
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Management of Cancer: What type of treatment goals are there?
Complete eradication of maligant disease (cure), prolonged survival, and containment of canceer cell growth (control) or relief of symptoms (palliation)
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Management of Cancer - Surgery: What is Diagnostic surgery?
Definitive method for obtaining tissue to identify characteristics.
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Management of Cancer - Surgery: What can be done to identify the sentinel lymph node or initial lymph node where primary tumor and surrounding tissue drain?
By use of injectable dye and nuclear medicine imaging
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Management of Cancer - Surgery: What is Sentinel Lymph Node Biopsy (SLNB)?
Minimally invasive surigal approach, adopted for regional lymph node staging.
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Management of Cancer - Surgery and Biopsy Types: Biopsy methods incldue what
Excisional, Incisional, and Needle BIopsy
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Management of Cancer - Surgery and Biopsy Types: Why is Excisional Biopsy used?
For small, easily accessible tumors of the skin, upper/lower GI and upper respiraotry tracts. Can remove entire tumor here.
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Management of Cancer - Surgery and Biopsy Types: When is Incisional Biopsy performed?
If the tumor mass is too large to be r emoved. Wedge of tissue form tumor is removed for analyssi.
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Management of Cancer - Surgery and Biopsy Types: How are Excisional and Incisional approaches performed?
Through endoscopy.
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Management of Cancer - Surgery and Biopsy Types: When is Needle Biopsy performed?
To sample suspicious masses that are easily and safely accecssible, like in the breasts, thyroid, lung, liver, and kidney.
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Management of Cancer - Surgery and Biopsy Types: What does Fine-Needle Aspiration biopsy involve?
Aspirating cells rather than intact tissue through a needle that is guided to suspected diseased area.
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Management of Cancer - Surgery As Primary Tx; What is the goal of this?
To remove entire tumor or as much as feasible (debulking)
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Management of Cancer - Surgery As Primary Tx; Two common approaches for this?
Local and wide excisions. Local is in outpatient when mass small. Wide involves removal of primary tumor, lymph nodes, adjacent invovles structure and surounding tissues.
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Management of Cancer - Surgery As Primary Tx; Minimally invasive techniques are becomng popular, why?
Minimization of surgical trauma, decreased blood loss, decrease incidence of wound infection, and decreased surgiical time.
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Management of Cancer - Surgery As Primary Tx; How does Video-Assisted Endoscopic Surgery work?
Endoscope with intense lighting and attached multichip mini-camera is inserted through small incision. Used for thoracic and abdominal.
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Management of Cancer - Surgery As Primary Tx; What is salvage surgery?
Uses an extensive surgical approach to treat the local recurrence of cancer after the use of a less extensive primary approach. Example is Mastectomy.
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Selected TEcniques for Localized Destruction of Tumor Tissue: What is Cryoablation?
Use of liquid nitrogen or a very cold probe to freeze tissue and cause cell destruction
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Selected TEcniques for Localized Destruction of Tumor Tissue: What is Photodynamic Therapy?
IV admin of light-sensitizing agent that is taken up by cancer cells, followed bye xposure to laser light within 24-48 hours.
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Mx of Cancer - Prophylactic Surgery: What does this involve?
Removing non-vital tissues or organs that are at increased risk of developing cancer. Can be because of family hx, or presence of signs and symptoms .
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Mx of Cancer - Prophylactic Surgery: Examples of this?
Colectomy, mastectomy, and oophorectomy.
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Mx of Cancer - Palliative Surgery: Goal of this?
To relieve symptoms when sure not possible, and to make the patient as comfortable as possible.
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Mx of Cancer - Nursing Mx: Postoperative, nurse assess for potential complications such as?
infection, bleeding, thrombophlebitis, wound dehisence, fluid and electrolyte imbalance and organ dysfunction
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Mx of Cancer - Nursing Mx: Postoperative education addresses what?
wound care, pain management, activity, nutrition, and medication information
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Mx of Cancer - Radiation Therapy: Why may this be given prophylactically?
To prevent local recurrence or spread of microscopic cells from primary tumor to distant area
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Mx of Cancer - Radiation Therapy: Why may palliative radiation therapy be used?
To relieve symptoms of locally advanced or metastatic disease.
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Mx of Cancer - Radiation Therapy: What types of ionizing radiation can be used to kill cells?
Electromagnetic radiation (xrays and gamma) and particulate radiation (electrons, beta, protons, neurtons)
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Mx of Cancer - Radiation Therapy: What does ionizing radiation do to cells?
Breaks the strands of DNA helix, leading ot cell death.
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Mx of Cancer - Radiation Therapy: What parts of body are most sensitive to radiation therapy?
Bone marow, lymphatic tissue, epithelium of GI tract, hair follicles, and gonads.
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Mx of Cancer - Radiation Therapy: What is a radiosenstiive tumor?
One that can be destroyed by a dose of radiation that still allows for cell repair and regeneration in the surrounding normal tissue.
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Mx of Cancer - Radiation Dosage: This depends on what?
Sensitivity of the target tissues to radiation, size of tumor, radiation tolerance and critical structures adjancet to tumor target.
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Mx of Cancer - Radiation Dosage: Lethal tumor dose defined as what
dose that will erradicate 95% of the tumor, yet preserve normal tissue.
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Mx of Cancer - Radiation Dosage: How does external-beam radiation therapy (EBRT) work?
Total radiaiton dose is delivred over several weeks in daily doses called fractions. Allows healthy tissue to repair.
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Mx of Cancer - Admin of Radiation: What different ways can this be given
EBRT, Brachytherapy (form of internal radiation), systemic (radioisotopes) and contact or surface molds
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Mx of Cancer - Admin of Radiation, External Radiation: Most commonly used form of radiation therapy?
EBRT
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Mx of Cancer - Admin of Radiation, External Radiation: What are volumetric images?
CT, MRI, PET scans used to provide 3D images of tumor, neighboring tissues at risk for spread, and surrounding normal tissue. Allow oncologist to plan for multiple radiaiton beams at different angles.
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Mx of Cancer - Admin of Radiation, External Radiation: Radiation dose with ERBT?
Is reduced, leading to less toxicity. ALlows ability to control different intensity or energy levels at different angles (intesnsity modulated radiation therapy IMRT)
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Mx of Cancer - Admin of Radiation, External Radiation: How can IMRT be given?
As standard daily fractions or hyperfractionated twice-daily fractions, which shortens duration of pts treatment schedule.
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Mx of Cancer - Admin of Radiation, External Radiation: How deos Image-guided radiation therapy work?
Uses continuous monitoring of the tumor with ultrasound, x-ray, or CT scan to spare the healthy surrounding tissue and reduce side effects.
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Mx of Cancer - Admin of Radiation, External Radiation: What is Stereotactic Body Radiotherapy (Another type of ERBT)
It uses higher doses of radiation to penetrate very deeply into the body to control deep-seated tumors that cannot be treated by other approaches such as surgery.
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Mx of Cancer - Admin of Radiation, External Radiation: How is Stereeotactic Body Radiotherapy performed?
With higher tx frction doses over a short spain of time (1-5 tx days).
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Mx of Cancer - Admin of Radiation, External Radiation: How does Proton Therapy work?
utilizes high linear energy transfer (LET) in the form of charged protons. Capable of delivering high-energy dose to a deep-seated tumor, with decreased doses of radiation to tissues in front of tumor.
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Mx of Cancer - Admin of Radiation, Internal Radiation: What doe sthis include?
Localized implantation or systemic radionuclide administration.
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Mx of Cancer - Admin of Radiation, Internal Radiation and Brachytherapy: What is this?
Placement of radioactive sources within or immediately next to cancer site in order to provide highly targeted, intense dose of radiation beyond a dose usually provided by EBRT
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Mx of Cancer - Admin of Radiation, Internal Radiation and Brachytherapy: Primary advantage of high-dose radiation brachytherapy?
Treatment time is shorted, there is reduced exposure to personnel, and procedure can be perofrmed on an outpatient basis over several days.
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Mx of Cancer - Admin of Radiation, Internal Radiation and Systemic Radiotherapy: How does this work?
Involves use of IV administration of a therapeutic radioactive isotope targeted to a specific tumor. THis includes cancers of the thyroid.
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Mx of Cancer - Toxicity: When can this occur?
Acute or early toxicites most often begin within 2 wweeks of treatment.
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Mx of Cancer - Toxicity: What body systems are most likely affected by this?
Skin, epithelial lining of GI tract, and bone marrow
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Mx of Cancer - Toxicity: Alterations in oral mucosa secondary to radiation therapy in head and neck region include what
stomatitis (inflammation of oral tisue)), decreases alivation, xerostomia (Dryness of mouth) and change in taste.
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Mx of Cancer - Toxicity: What systemic side effects are experienced by patients receiving radiation therapy?
Fatigue, malaise, anorexia. Subside within 6 months of cessation of treatment.
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Mx of Cancer - Toxicity: Late effects (6 months ot years afters treatmetn ) of radiation therapy include what?
Permanent damage to tissues, loss of elasticity, and changes to decreased vascular supply. Includes fibrosis, atrophy, ulceration, and necrosis.
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Mx of Cancer - Toxicity: What does nurse assess with someone receiving EBRT?
Patients skin regularly throughout course of treatment.
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Mx of Cancer - Protecting Caregivers: What precautions must be done for someone recieving internal radiation?
Contact with care team in guided by principles of time, distance, and shielding to minimize exposure of personnel to raiation.
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Mx of Cancer - Protecting Caregivers: What precuations may be taken for someone recieving internal radiation?
Private room, have staff where dosimeter badges, no pregnant staff, and limiting visits to 30 mins.
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Chemotherapy: What is this
use of antineoplastic drugs that attempt to destroy cancer cells by interfering with cellular functions, including replication and DNA repair. USed to treatment systemic disease rather than localized lesions.
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Cell Kill and Cell Cycle: What is the goal of treatment when it comes to killing cells?
Eradication of enough of the tumor so that the remaining maligant cells can be destroyed by the bodys immune system
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Cell Kill and Cell Cycle: What are the four distinct phases of cell cycl?
G1: RNA and PRotein Synthesis
S Phase: DNA Synthesis
G2: Premiotic phase, DNA synthesisi complete
Mitosis: Duplicated chromosomes separate, division occurs
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Cell Kill and Cell Cycle, Clasification of Chemotherapeutic Agents: What are cell cycle-specific agents?
Agents that exert their maximal effect during specific phases of the cell cycle. Destroy cells that are actively reproducing, the S phase.
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Cell Kill and Cell Cycle, Clasification of Chemotherapeutic Agents: What stage do plant alkaloids alter?
M Phase, where they half mitotic spindle formation
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Cell Kill and Cell Cycle, Clasification of Chemotherapeutic Agents: What are cell cycle-nonspecific agents?
Chemotherapeutic agents that act independently of the cell cycle phases. HAve prologned effect on cells, leading to cell damage/death
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Cell Kill and Cell Cycle, Admin of Chemotherapeutic Agents, Dosage: Dosage is based on what
patients total BSA, weight, previous exposure, and response to chemotherapy or radiation therapy.
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Cell Kill and Cell Cycle, Admin of Chemotherapeutic Agents, Extravasation: Why can this happen?
When tissue can be damaged if chemotherapy agents inadvertently leak from a vein into surrounding tissue (extravasation).
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Cell Kill and Cell Cycle, Admin of Chemotherapeutic Agents, Extravasation: What are Vesicants?
Agents that is deposited into SQ or surrounding tissues, cause inflammation, tissue damage, and possibly necrosis of tendons, muscles, nerves, and blood vessels.
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Cell Kill and Cell Cycle, Admin of Chemotherapeutic Agents, Extravasation: Vesicant chemotherapy should never be given where
in the peripheral veins involving the hands or wrist. Permitted for short duration only.
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Cell Kill and Cell Cycle, Admin of Chemotherapeutic Agents, Extravasation: What should be used for frequent or prolonged administration of antineoplastic vesicants?
Right atrial silastic catheters, implanted venous access devices, or peripheraly insesrted central catheters (PICCs)
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Cell Kill and Cell Cycle, Hypersensitivity Reactions: What can this include?
Rash, urticaria, fever, hypotension, cardiac instability, dyspnea, wheezing, throat tightness and syncope.
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Cell Kill and Cell Cycle, Hypersensitivity Reactions (HSRs): Immedite HSRs appear when?
Within 1 hour of infusion. Delayed can appear many hours afterwards.
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Cell Kill and Cell Cycle, Hypersensitivity Reactions (HSRs):What type of reaction is the most common?
Immunoglobulin E (IgE)-mediated reaction.
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Cell Kill and Cell Cycle, Hypersensitivity Reactions (HSRs): What should be done when signs of this occur?
Medication should be discontinued immediately and demergency procedures initiated.
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Cell Kill and Cell Cycle, Toxicity and GI System: Most common side effect from chemotheapy?
N/V, which may opersist for 24-48 hours, and may be delayed for 1 week afterwards.
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Cell Kill and Cell Cycle, Toxicity and GI System: When does acute chemotherapy induced nausea/vomiting (CINV) occur
First 24 hours after chemotherapy, with a maximal inesisity after 5-6 horus
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Cell Kill and Cell Cycle, Toxicity and GI System: When does delayed CINV occur?
24 hours posttreatment and may last as many as 7 days with maximal intensityy 48-72 hours after drug admin.
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Cell Kill and Cell Cycle, Toxicity and GI System: What mechanism is responsible for this N/V?
Activation of multiple receptors found in vomiting center of medulla, chemoreceptor trigger zone, GI tract, pharynx, and cerebral cortex. 5-HT or Serotonin) and dopamine recpeotrs are involved.
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Cell Kill and Cell Cycle, Toxicity and GI System: What is helpful to treat CINV?
Corticosteroids, phenothiazines, sedatives, and histamines are helpful when using in combination with serotonin blockers to provide antiemetic protection
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Cell Kill and Cell Cycle, Toxicity and GI System: Nonpharmacologic approaches to treat CINV?
Relaxation techniques, imagery, acupressure or acupuncture. Small, frequent meals may also help
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Cell Kill and Cell Cycle, Toxicity and GI System: Why does stomatitis occur?
Because of rapid turnover of epithelium that lines the oral cavity. Entire GI tract susceptible to mucositis (inflammation of the mouth, throat, and GI tract)
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Cell Kill and Cell Cycle, Toxicity and Hematopoietic System: What are some side effects that can occur here?
Myelosuppression (Depression of boen function, resulting in decreased WBCs (leukopenia), granulocytes (neutropenia), RBCs, and platelets (thormbocytopenia).
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Cell Kill and Cell Cycle, Toxicity and Hematopoietic System: Myelosupression is lowest when?
7-14 days after chemotherapy has been given. Neutrophil count <1,500
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Cell Kill and Cell Cycle, Toxicity and Hematopoietic System: What can be given after chemotherapy to stimulate the bone marow to produce WBCs, especially neutrophils
Colony-stimulating factors and granulocyte macrophage colony stimulating factor
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Cell Kill and Cell Cycle, Toxicity and Hematopoietic System: why is Erythropoietin (EPO) helpful?
Stimulates RBC production, thus decreasing the symptoms of treatment-induced chronic anemia and reducing need for blood transfunsions.
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Cell Kill and Cell Cycle, Toxicity and Renal System: Why can kidneys become damaged?
Water secretion can be impaired, leading to SIADH, decreased renal perfusion, precipitate end production.
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Cell Kill and Cell Cycle, Toxicity and Renal System: Rapid tumor cell lysis after chemotherapy results in what
increased urinary excretion of uric acid, which can cause renal damage.
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Cell Kill and Cell Cycle, Toxicity and Renal System: What electrolyte imabalances can occur?
hyperkalemia, hyperphosphatemia, and hypocalcemia and obstructive nephropathy.
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Cell Kill and Cell Cycle, Toxicity and Renal System: What lab values must be monitored?
BUN, serum creatinine, creatinine clearance and serum electrolytes.
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Cell Kill and Cell Cycle, Toxicity and Renal System: What is Hemorrhagic cystitis?
Bladder toxicity that can result from cyclophosphamide and ifosfamdide therapy.
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Cell Kill and Cell Cycle, Toxicity and Renal System: Protection of bladder focuses on what
aggressive IV hydration, frequent voiding and diuresis.
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Cell Kill and Cell Cycle, Toxicity and Cardiopulmonary System: Patients at risk for development is this include
those >70 , those with history of preexisting cardiac disease, hypertension, tobaccos use, renal dysfunction and longer survival time.
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Cell Kill and Cell Cycle, Toxicity and Cardiopulmonary System: THose with known cardiac disease are treated with what type of dose,
lower dose or agents not known to be associated with cardiac toxicity.
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Cell Kill and Cell Cycle, Toxicity and Cardiopulmonary System: Bleomycin, Carmustine, Busulfan, Mitomycin, and Paclitaxel have what toxic effects on the lungs?
Alveolar damage, bronchospasm, pneumonitis, and pulmonary fibrosis.
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Cell Kill and Cell Cycle, Toxicity and Cardiopulmonary System: what may occur with capillary leak syndrome?
Subtle onset of dyspnea and cough may progress rapidly to acute respiratory distress and respiratory failure.
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Cell Kill and Cell Cycle, Toxicity and Reproductive System: What problems may men and women develop?
W: Ovulation or early menopause
M: Temporary or permanent azoosperma (absence of spermatozoa)
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Cell Kill and Cell Cycle, Toxicity and Neurologic System: What can repeated doses of taxanes and plant alkaloids cause?
Cumulative peripheral nervous system damage with sensory alterations in hands and feet. Includes tingling, pricking, or numbness of extremities, burning, or freezing pain. Can lead to loss of deep tendon reflexes.
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Cell Kill and Cell Cycle, Toxicity and Neurologic System: Patients receiving oxaliplatin must be instructed to do what
avoid drinking fluids or going outside iwth hands or feets exposed to cold temperatre.
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Cell Kill and Cell Cycle, Toxicity and Neurologic System: What may Cisplatin cause?
Peripheral neuropathies and hearing loss due to damage of acoustic nerve
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Cell Kill and Cell Cycle, Toxicity and Cognitive Impairment: WHat is chemo brain?
A decline in information-handling processes of attention and concentration, executive function, information processing, speed, language, and visual-spatial skill.
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Nursing Management, Assessing Fluid/Electrolyte Status: What puts someone at risk for this?
Anorexia, N/V, Altered Taste, Mucositis, Diarrhea.
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Nursing Management, Administering Chemotherapy: Nurses provide patient and family education that emphasizes what two key points?
Imporance of adhering to prescribed self-administered premeds and recognizing signs and symptoms to the nurse once infusion has started.
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Nursing Management, Administering Chemotherapy: Peripheral admin is limited to what?
1 hour and use only a soft, plastic catheter placed in forearm area.
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Nursing Management, Administering Chemotherapy: Indications of extravasation during admin includes what?
Absence of blood return from IV catheter, resistance to flow of IV fluid, and burning pain, swelling, or redness at site. `
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Nursing Management, Mxing Cognitive Changes: Examples of nonpharmacologic approaches that nurses recommend include
exercise, natural restorative environmental inerveion, and cognitive training programs.
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Nursing Management, Protecting Caregivers: What side effects can occur to nurses due to this contact?
SKin and eye irritation, N/V, nasal mucosal ulcerations, infertility, low-birth weight babies, congenital anomalies, spontaneous abortions and mutagenic susbtances in urine
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Nursing Management, Types of Hematopoietic Stem Cell Transplantion (HSCT): Whatis Allogenic HSCT?
From a donor other than the patient
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Nursing Management, Types of Hematopoietic Stem Cell Transplantion (HSCT): What us Autologous HSCT
From the patient
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Nursing Management, Types of Hematopoietic Stem Cell Transplantion (HSCT): What is Syngeneic HSCT
From an identical twin
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Nursing Management, Types of Hematopoietic Stem Cell Transplantion (HSCT): What is Myeloablative HSCT
Consists of giving patients high-dose chemotherapy and occasionally total-body irradiation
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Nursing Management, Types of Hematopoietic Stem Cell Transplantion (HSCT): What is Nonmyeloablative HSCT?
Mini-Transplants, does not completely destroy bone marrow cells.
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Nursing Management, Types of Hematopoietic Stem Cell Transplantion (HSCT): AlloHSCTs used primarily why
for diseases of boen marrow and are depending of availability of donors.
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Nursing Management, Types of Hematopoietic Stem Cell Transplantion (HSCT): What type of chemotherapy will AlloHSCT use?
Myeloablative (high-dose)or nonmyeloablative (mini-transplant) chemotherapy
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Nursing Management, Types of Hematopoietic Stem Cell Transplantion (HSCT): How does ablative AlloHSCT occur
Recipient receives high doses of chemotherapy and possibly total-body irradiation to completely eradicate (ablate the bone marrow and any maligant cells and prevent rejection of donor stem cells). Then collected HSCs are infused in IVs to bone marrow. Produce in 2-4 weeks (RBCs, WBCs).
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Nursing Management, Types of Hematopoietic Stem Cell Transplantion (HSCT): How does nonablative AlloHSCT work?
Chemotherapy doses lower and aimed at destroying maligant cells (w/o eradicating bone marrrow) and suppressing recipients immune system.
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Nursing Management, Types of Hematopoietic Stem Cell Transplantion (HSCT): Acute side-effects of high dose therapy include?
Alopecia, hemorrhagic systitis, N/V, encephalopahy, pulmonary edema, AKI, fluid and electrolyte imbalances.
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Nursing Management, Types of Hematopoietic Stem Cell Transplantion (HSCT): Chronic side effects of high dose therapy includes?
sterility, pulmonary, cardiac, renal, neurologic, and hepatic dysfunction, and avascular bone nacrosis.
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Nursing Management, Types of Hematopoietic Stem Cell Transplantion (HSCT): 30 days after conditioning regimen, AlloHSCT patients are at risk for developing hepatic sinusoidal obstructive syndrome (HSOS), causing?
inflammation, which embolizes RBCs resulting in destruction, fibrosis, and occlusion of the sinusoids.
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Nursing Management, Types of Hematopoietic Stem Cell Transplantion (HSCT): Signs of HSOS include?
weight gain, hepatomegaly, increased bilirubin, and ascites.
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Nursing Management, Types of Hematopoietic Stem Cell Transplantion (HSCT): What is Graft-Versus-Host Disease (GVHD)
Occurs when donor lymphocytes initiate an immune response against the recipients tissues (skin, GI, liver) during beginning of engraftment.
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Nursing Management, Types of Hematopoietic Stem Cell Transplantion (HSCT): How to prevent GVHD?
Immunosuppressant drugs like cyclosporine , methotrexate, tacrolimus, and mycophenolate mofetil may be given.
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Nursing Management, Types of Hematopoietic Stem Cell Transplantion (HSCT): Acute signs of GVHD?
Diffuse rash progressing to blistering and desquamation , mucosal inflammation of eyes and entire GI tract, and diarrhea.
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Nursing Management, Types of Hematopoietic Stem Cell Transplantion (HSCT): Who may benefit from Autologous HSCT?
Patients with disease of the bone marrow who do not have a suitable donor for AlloHSCT or for patients who have healthy bone marrow but require bone-marow ablative doses of chemotherapy. Includes lymphomas.
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Nursing Management, Types of Hematopoietic Stem Cell Transplantion (HSCT): What happens to stem cells in Autologous HSCT?
Collected from the patient and preserved for reinfusion. After chemo, stem cells are reintroduced.
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Nursing Management, Types of Hematopoietic Stem Cell Transplantion (HSCT): Disadvantage of Autologous HSCT?
Risk that tumor cells may remain in bone marrow despite high-dose chemotherapy.
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Types of Hematopoietic Stem Cell Transplantion (HSCT), Implementing Care B4 Tx: What kind of assessments occur?
Nutritional, extensive physical exams, organ function tests, and blood work including past infections.
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Types of Hematopoietic Stem Cell Transplantion (HSCT), Care During Tx: Nursing Mx during infusion consists of what?
Monitoring patients vital signs and blood oxygen, signs like fevers, chills, SOB< chest pain and cutaneous reactions.
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Types of Hematopoietic Stem Cell Transplantion (HSCT), Care During Tx: What type of reaction will someone have to cryoprotectant dimethysulfoxide (DMSO) to preserve harvested stem cells
N/V, chills, dyspnea, cardiac dysrhythmias, and hypotnesion progressing to cardiac and respiratory arrest.
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Types of Hematopoietic Stem Cell Transplantion (HSCT), Care During Tx: Engraftment Syndrome may occur during neutrophil recovery phahse. Features include
noninfectious feveer associated with skin rash, weight gain, diarrhea, and pulmonary infiltrate
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Types of Hematopoietic Stem Cell Transplantion (HSCT), Care During Tx: During first 30 days, can have reactivation of viruses including
herpes simplex, EBV, cytomegalovirus, and varicella zoster.
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Types of Hematopoietic Stem Cell Transplantion (HSCT), Care During Tx: WHat are some signs that HSOS is occuring?
Fluid retention, jaundice, abdominal pain, ascites, tender and enlarged liver and encephalopathy.
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Types of HSCT, Care After Tx: Late effects include what?
Infections, restrictive pulmonary abnormalities and recurrent pneumonias. Sterility may also occur.
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Types of HSCT, Care After Tx: Donors may experience what after donation?
Mood alterations, decreased self-esteem and guilt from feelings of failure if transplantation fails.
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Nurse Mx, Hyperthermia: Why is this done?
To raise the temperature greater than 106.7 to destroy cancerous tumors. Effective when combined with other therapies.
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Nurse Mx, Hyperthermia: Why is this thought to be useful?
Because hypoxic tumor cells and cells in the S phase are more sensitive to heat than radiation.
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Nurse Mx, Hyperthermia: How can the heat be produced?
Radio waves, ultrasound, microwaves, magnetic waves, hot-water baths, or even hot-wax immersions.
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Nurse Mx, Hyperthermia: Side effects of this?
burns, fatigue, hypotension, peripheral neuropathies, thrombophlebitis, N/V, diarrhea, and electrolyte imbalances.
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Nurse Mx, Targeted Therapies: What do these therapies target?
Target receptors, proteins, signal transduction pathways, and other processes to prevent the continued growth of cancer cells.
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Targeted Therapies and Biologic Response Modifiers: What is this?
Includes the use of naturally occuring or recombinant agents or treatment methods that can alter the immunologic relationship betweent he tumor and the patient with cancer to provide a therapeutic effect. . Goal is to stop maligant growth
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Targeted Therapies and Nonspecific Biologic Response Modifiers: What do these do?
When injected into patient, agents serve as antigens that stimulate an immune response. Stimulated immune response should then eradicate malignant cells.
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Targeted Therapies and Biologic Response Modifiers - Monoclonal Anitbodies: How does this work?
Enables investigators to grow and produce targeted antibodies for specific malignant cells. Normal cells spared. Identifies key antigen proteins on surface.
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Targeted Therapies and Biologic Response Modifiers - Monoclonal Anitbodies: What happens when this MoAB attaches ot the cell?
The important signal transdunction pathway for communication b/w malignant cells is blocked. Inability to reproduce
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Targeted Therapies and Biologic Response Modifiers - Monoclonal Anitbodies: How are these created?
Tumor cells injected into mice. B-Cells in spleen of mouse produce antibodies. Then grow in culture medium. Known as hybridoma. Desired antibodies then harvested.
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Targeted Therapies and Biologic Response Modifiers - Monoclonal Anitbodies: Difference between Chimeric MoAbs or Human MoAbs?
Chimeric MoAbs: Combo of mouse and human components
Human MoAbs: All-Human Components
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argeted Therapies and Biologic Response Modifiers - Monoclonal Anitbodies: How is this used for someone with breast cancer?
Its tagged with a stain that binds with protein of interest. Here, identifies progesterone and estrogen on receptor of breast cell.
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argeted Therapies and Biologic Response Modifiers - Monoclonal Anitbodies: Used to assist with diagnosis of what?
Ovarian, colorectal, breast, and prostate cancers along with some types of leukemia and lymphoma.
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Targeted Therapies and Biologic Response Modifiers - Cytokines: What do cytokines do?
Produced primarily by cells of immune system to enhance or suppress the production and functioning of immune system, and used to treat cancer.
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Targeted Therapies and Biologic Response Modifiers - Cytokines, Interferons: What are these used for?
Limited basis for treatment of some solid and hematologic cancers. Significant toxicities, so they have been restricted
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Targeted Therapies and Biologic Response Modifiers - Cytokines, Interleukins: How are they produced?
By subsets of T-Cell Lymphocytes, NK Cells, and Dendritic Cells.
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Targeted Therapies and Biologic Response Modifiers - Cytokines, Interleukins: What treatment is thsi used for
REnal cell cancer and metastatic melanoma in adults. Very toxic though, so its limited.
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Targeted Therapies and Biologic Response Modifiers - Cancer Vaccine: How do Autologous Vaccines work?
Use Pt's own cancer cells. Taken by biopsy, killed, and prepared for injection back in patient
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Targeted Therapies and Biologic Response Modifiers - Cancer Vaccine: How do allogeneic vaccines work?
Made from cancer cell lines from other people who had a specific type of cancers. Grown in lab -> killed -> prepared for injection
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Targeted Therapies and Biologic Response Modifiers - Cancer Vaccine: What do prophylactic vaccines do?
Prevent disease. Approved for prevention of HPV.
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Targeted Therapies and Biologic Response Modifiers - Cancer Vaccine: What do therapeutic vaccines do?
Kill existing cancer cells and inhibit further cancer development.
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Targeted Therapies and Biologic Response Modifiers - Gene Therapy: What is this?
Approaches that correct genetic defects, manipulate genes to induce tumor cell destruction or assist the bodies immune defense in the hope of preventing or combating disease.
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Targeted Therapies and Biologic Response Modifiers - Gene Therapy: What is a vector
Vehicle or carrier to transport a gene into the target cell. Must know which vector would be most effective for tx.
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Targeted Therapies and Biologic Response Modifiers - Gene Therapy: What is Tumor-Directed Therapy?
Intro of a therpeutic gene (suicide gene) into tumor cells in an attempt to destroy them. Difficult to identify the gene that would cause most tumor destruction however.
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Targeted Therapies and Biologic Response Modifiers - Gene Therapy: How does Active Immunotherapy work
Admin of genes that will invoke the antitumor responses of the immune system
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Targeted Therapies and Biologic Response Modifiers - Gene Therapy: How does Adoptive Immunotherapy work?/
Admin of genetically altered lymphocytes that are programmed to cause tumor destruction
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Targeted Therapies - Monitoring Therapeutic/Adverse Effects: Some side effects of IFB?
Fever, myalgia, N/V
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Maintaining Tissue Integrity - Stomatitis: What is Mucositis?
A common side effect of radiation and some types of chemotherapy, and is the inflammatory process involving mucous membranes of oral cavity and GI tract.
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Maintaining Tissue Integrity - Stomatitis: What is Stomatitis?
Form of mucositis, is an inflammatory process of the mouth, including the mucosa and tissues surrounding the tooth. Includes change in sensation, redness, edema, or ulcerations.
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Maintaining Tissue Integrity - Stomatitis: When does this commonly develop
5-14 days after patients recieve certain chemotherapeutic agents.
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Maintaining Tissue Integrity - Stomatitis: This may lead to what side effects?
Oral pain that can significantly affect swallowing, nutritional intake, speech, quality of life, coping abilities, and willingness to adhere to treatment regimen
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Maintaining Tissue Integrity - Stomatitis: How can you monitor for this?
Understand patients practices for oral hygiene and perform oral cavity assessment at each visit.
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Maintaining Tissue Integrity - Stomatitis: Risk factors for this?
poor oral hygiene, general debilitation, existing dental disease, prior irradiation to the neck, and impaired slivary gland function, and myelosuppression.
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Maintaining Tissue Integrity - Stomatitis: Best way to minimize the risk fo oral complications associated with cancer therapies?
Maintenance of good oral hygiene including brushing, flossing, rinsing, dental care.
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Maintaining Tissue Integrity - Stomatitis: What medication may be given to prevent this
Palifermin (Kepivance), IV admin synthetic form for those preparing for HSCT. Promotes epithelial cell repair.
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Maintaining Tissue Integrity - Radiation-Associaed Impairment of Skin Integrity: Patients may develop radiation dermatitis associated with what
pain, irritation, pruritus, burning, skin, sloughing without drainage.
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Maintaining Tissue Integrity - Radiation-Associaed Impairment of Skin Integrity: Nursing care for patient with radition dermatitis incldues what
maintenance of skin integrity, cleansing, promotion of comfort, pain reduction, and promotion of moist-wound healing environment.
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Maintaining Tissue Integrity - Radiation-Associaed Impairment of Skin Integrity: How to prevent this?
Use moisutrizer, avoid sun exposure and avoid tape or bandages.
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Maintaining Tissue Integrity - Alopecia: When does this usually begin?
Around 2-3 weeks after initiation of chemotherapy, and regrows 8 weeks after last treatment
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Maintaining Tissue Integrity - Alopecia: Onset of gradually progressing alopecia and body hair loss associated with targeted therapies occurs how often
1-3 months after start of reatment and may be patchy. Reversible after end of therapy
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Maintaining Tissue Integrity - Alopecia: Cryotherapy has been used to help prevent this, but must be avoided with who?
Patients with hematologic malignancies.
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Maintaining Tissue Integrity - Malignant Skin Lesions: Locally invasive or metastatic cancer to skin may result in what SE
redness, discolored nodules, or progression to wounds involving edema, exudate, and tissue necrosis.
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Maintaining Tissue Integrity - Malignant Skin Lesions: Nurses assess malignant skin lesions for whaht?
Size, appearance, condition of surrounding tissue, odor, bleeding, drainage, and associated pain or other symptoms.
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Maintaining Tissue Integrity - Malignant Skin Lesions: Potential for serious complications include
hemorrhage, vessel compression/obstruction, airway obstruction
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Promoting Nutrition - Nutritional Impairment: What are some common nutritional problems?
Anorexia, malabsorption and cancer-related anorexia-cachexia syndrome
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Promoting Nutrition - Nutritional Impairment: nutritional cocnerns include what
decreased protein/caloric intake, metabolic or mechanical effets of cancer, systemic disease and SE of tx
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Promoting Nutrition - Nutritional Impairment, Anorexia: What are some alterations to taste they may have
increased salty, sour, and metallic taste sensations and altered response to sweet/bitter
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Promoting Nutrition - Nutritional Impairment, Anorexia: Taste alterations may result from what
mineral deficiencies (zinc), increase in circulating amino acids and cellular metabolities and admin of chemotherapeutic agents.
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Promoting Nutrition - Nutritional Impairment, Anorexia: Why may patient have early feelings of fullness?
Due to decrease in digestive enzymes, abnormalities in metabolism of glucose and prolonged stimulation of gastric volume receptors.
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Promoting Nutrition - Nutritional Impairment, Malabsorption: Inability of GI tract to absorb nutrients may result in what problems?
Increase GI irritation, peptic ulcer disease, and fistula formation
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Nutritional Impairment, Cancer-Related Anorexia-Cachexia Syndrome (CACS): What is this?
Combination of increased energy expenditure and decreased intake. Anorexia, unintentional weight loss and increased metabolic demand occur while cytokines are released leading to inflammation
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Nutritional Impairment, Cancer-Related Anorexia-Cachexia Syndrome (CACS): Patients with this complain of what
loss of appetite, early satiety and fatigue.
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Nutritional Impairment, Cancer-Related Anorexia-Cachexia Syndrome (CACS): Signs of this appear to result in what?
decreased quality of life, psychological distress, and anxiety.
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Nutritional Impairment, General Nursing Considerations: What is assessed by the nurse for this?
Current weight, weight loss, diet and med history, patterns of anorexia, nausea/v, diarrhea and situations of foods that aggravate and relieve symtpoms
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Nutritional Impairment, General Nursing Considerations: What may be done to help someoen with head and neck cancers eat?
May have a PEG tube placed for enteral nutrition prior to start of treatment.
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Nutritional Impairment, General Nursing Considerations: What can Prokinetic agents like metoclopramide help with?
Used to increase gastric emptying in patietns with early satiety.
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Nutritional Impairment, General Nursing Considerations: What can be done with malabsorption is a problem?
Enzyme and vitamin replacement may be instituted.
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Nutritional Impairment, General Nursing Considerations: How can parenteral nutrition be given?
Long-term venous access devices like a right artrial catheter, implanted venous port, or PICC
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Relieving Pain: The WHO advocates for what to treat cancer pain?
Three-Step approach. Analgesics are given based on patients reported level of pain.
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Decreased Fatigue: Is soldem alone, and patients often experience this with what
pain, dyspnea, anemia, sleep disturbances or depression.
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Decreased Fatigue: Difference between acute fatigue and cancer-related fatigue?
Acue: Occurs after energy demanding experience
Cancer: distressing, persistent subjective sense of physical , emotional, or cognitive tiredness.
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Improving Body Image / Self-Esteem: What does the nurse identify here?
Potential threats to body image and patients ability to cope with the many bodily changes experienced with the disease.
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Addressing Sexuality: Patients at greatest risk for sexual dysfunction involve who
those with tumors that involve the sexual or pelvic organs and those with treatments that affects hormones mediating sexual function
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Assisting in Grieving Process: During this time, nurse must continue to assess patient and family for what
positive or maladaptive coping behaviors, interpersonal communication, and evidence of need for additional psychosocial support.
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Monitoring/Managing Potential Complications - Infection: Most common sites of infection?
Pharynx, skin, perianal area, urinary and respraotry tract
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Monitoring/Managing Potential Complications - Infection: What may be the only sign of infection due to decreased WBCs?
A fever
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Monitoring/Managing Potential Complications - Infection: What is the bodies initial WBC defense?
Neutrophils. Act be engulfing and destroying infective organisms through phagocytosis
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Monitoring/Managing Potential Complications - Infection: What is Leukopenia?
A decrease in circulating WBCs.
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Monitoring/Managing Potential Complications - Infection: What is Granulocytopenia?
Decrease in neutrophils
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Monitoring/Managing Potential Complications - Infection: What does a differential WBC count identify
Relative number of WBCs and permits tabulation of polymorphonuclear neutrophils and segmented neutrophils
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Monitoring/Managing Potential Complications - Infection: What happens as absolute neutrophil count (ANC) continues to decrease?
Risk of infection increases.
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Monitoring/Managing Potential Complications - Infection: ANC less than 500 shows what?
Severe risk of infection
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Monitoring/Managing Potential Complications - Infection: What is nadir?
Is the lowest ANC following chemotherapy, targeted therapy or radiation therapy that suppresses bone marrow function
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Monitoring/Managing Potential Complications - Infection: What are the most frequently isolated cuases of infection?
Gram-positive bacteria and gram-negative organisms.
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Monitoring/Managing Potential Complications - Infection: What happens if a neutropenic patient has a fever?
Broad-spectrum antibiotics are prescribed before the infecting organism is identified.
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Septic Shock: What is thrombocytopenia?
Decrease in the circulating platelet count, and is most coommon cause of bleeding in patients with cancer and is defined as < 100,000
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Septic Shock: What happens if platelet count is < 10,000
The risk for spontaneous bleeding is increased
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Septic Shock - Bleeding/Thrombocytopenia: What causes thrombocytopenia to occur
From bone marrow depression after certain types of chemotherapy and radiation therapy with tumor infiltration of bone marrow.
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Septic Shock - Bleeding/Thrombocytopenia: What is an early sign of thrombocytopenia?
Petechiae and ecchymosis, which show early signs of decreasing platelet counts.
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Septic Shock - Bleeding/Thrombocytopenia: What types of VTE can be problems for patients
DVT, PE, SVT, and Thrombosis in abdominal or thoracic venous tributaries.
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Septic Shock - Bleeding/Thrombocytopenia: Factors associated with risk for VTEs in cancer patients include
pre-existing underlying or cancer coagulopathies, medications including chemo, hospitalization, surgical procedures, increased age, and debilitation
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Cancer Survivorship: What is this?
The period from cancer diagnosis through the remaining years of life and focuses on the health and life of a person beyond diagnostic and treatment phases.
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Cancer Survivorship: What does a survivorship care plan include?
Summary of cancer diagnosis and treatment and recommendations for follow-up care, including apapraoches to treat symptoms, rehabilitative needs, and monitoring for late effects and surveillance.
