Exam 4 Flashcards
(114 cards)
1
Q
Define neoplastic cells
A
Unpredictable cell growth, uninhibited reproduction can migrate through blood and lymph, serves no useful purpose, invades, erodes and spread, can grow anywhere, accelerated metabolism
2
Q
What is neoplasm
A
Abnormal growth and tissue with no useful purpose. Can cause harm to host
3
Q
What is benign mean
A
Does not spread or invade. Harmless
4
Q
What is malignant
A
Tumor has spread
5
Q
What is metastasis
A
Spreading from original site to another organ
6
Q
What is angiogenesis
A
Tumor can make own blood supply
7
Q
What is initiation stage
A
Cells are introduced to a carcinogen
8
Q
What are some viral carcinogen
A
Epstein Barr
AIDS
9
Q
What is the promotion stage
A
Proliferation of altered cells
10
Q
What are some promoting factors for promotion stage
A
Inc vascularity
Diet
Obesity
Smoking
Alcohol
11
Q
What is progression stage
A
Increased growth of tumor
Increased invasion (metastasis)
Increased vascularization (angiogenesis)
12
Q
What does CAUTION UP mean
A
Chance in bowel or bladder
A lesion that does not heal
Unusual bleeding or discharge
Thickening or lump
Indigestion or difficulty swallowing
Obvious changes in wart or mole
Naggin cough or persistent hoarseness
Unexplained weight loss
Pernicious anemia
13
Q
Where does blood cancer originate
A
In bone marrow/ blood system
Ex. Leukemia, lymphoma, multiple myeloma
14
Q
Where are solid tumors originate
A
A single site of origin
Ex. Lung, colorectal, pancreatic, breast
15
Q
What is leukemia
A
Uncontrolled proliferation of non function WBC
Group of cancers taht affect the blood and blood-forming tissues in the marrow, lymph system and spleen.
Abnormal growth of hematopoietic cells
No regulation==accmulation of dysfunctional cells
16
Q
What is Chronic Myelogenous leukemia
A
Slow growing (many asymptomatic)
Affects proliferation of eosinophils, basophils, neutrophils
Controlled with treatment of symptoms(sometime treatment is worse)
Bleeding, tired, enlarged spleen, bone pain, petechiae
17
Q
What is Chronic lymphocytic leukemia
A
Affects B cells and T cells
Inactive B cells infiltrate Bone marrow, spleen, and liver
Early stages-often need no treatment (little S/S)
Anemia, night sweats, frequent illness
Complications may develop w progression
Often diagnosed incidentally
18
Q
What diagnostics do you do for leukemias
A
CBC,CMP, Cancer markers
Bone marrow biopsy
PET/CT scan
MRI spleen
19
Q
What are medication treatments for leukemias
A
Chemo with corticosteroids
Radiation
Stem cell transplant
20
Q
What is complication of leukemia that in an oncology emergency
A
Tumor lysis syndrome
Breakage of a large tumor that results in metabolic and electrolyte abnormalities
Hyperkalemia, hyperuricemia, hyperphosphatemia, hypocalcemia
Monitor heart and brain
Nausea, vomiting, diarrhea, confusion, seizure, muscle cramps
21
Q
What are lymphomas
A
Arise from WBC, typically form solid tumors in lymphatic tissue (nodes, thymus, spleen)
Originate from bone marrow and lymph
22
Q
What are the two types of lymphomas
A
Hodgkin’s and non-hodgkins
23
Q
What is the difference between hodgkins and non hodgkins
A
Hodgkin’s lymphoma—associated with Epstein Barr(mono), mostly adolescents, can happen anytime, persistent fever, night sweats, chemo, radiation
Non-hodgkins (Barketts) swollen lymph nodes, cough, SOB, facial swelling. Grows quickly
24
Q
In hodgkins or non hodgkins an opportunistic cancer
A
Non hodgkins
25
T/F Hodgkin’s lymphoma spreads widely
F
Hodgkins starts in a single lymph node and usually has a good prognosis
non-hodgkins can spread more widely and has a fair prognosis
26
Where does multiple myeloma infiltrate
Neoplastic plasma cells infiltrate bone marrow to cause bone destruction and increase risk of pathologic fractures
27
What are some risk factors to cause multiple myeloma
Neoplastic plasma cells infiltrate bone marrow to cause bone destruction and increase risk of pathologic fractures and cause skeletal pain (pelvis, spine, ribs) triggered by movement
28
How do you diagnose multiple myeloma
Bence Jones protein
-24 hour urine collection
Made by plasma cells excreted in urine
Serum creatinine will be high
CBC, cmp
Meylosuppression, hypercalcemia
MRI, CT, X-ray
Bone marrow biopsy
29
What are some symptoms of mutiple myeloma
Increase thirst and urination
Confusion or decreased alertness
Kidney damage
Numbness, tingling, or pain in hands and feet
Bone and pain fractures
Frequent infections
Constipation
Fatigue and weakness
Bone pain and fractures
30
What are medications to give for multiple myeloma
Corticosteroids
IV furosemide
Allopurinol
Chemotherapy
Pain management
Ambulation and hydrate (hypercalcemia)
31
What are the 2 types of lung cancer
Non-small cell-less aggressive 88% of cases
Small cell: very aggressive (moves to other organs)
32
Allopurinol is used to treat multiple myeloma. Why?
Allopurinol is used to decrease the uric acid levels created by other cancer medications
33
What are some risk factors for color rectal cancer
Obstruction, perforations, fistulas
34
How do we prevent infection in colorectal cancer treatment
Low residue diet
Bowel cleanse
Antibiotics
35
Betweeen exocrine and endocrine pancreatic cancer, which one is more common
Exocrine
36
T/F pancreatic cancer has a poor prognosis
Exocrine True
Poor prognosis 5-12 months
8% five year survival rate
37
What are symptoms of pancreatic cancer
Abdominal pain
Indigestion
Anorexia
Weight loss
Jaundice
Biliary tube obstruction
38
What are treatments of pancreatic cancer
Surgical resection
Extensive post op care
—epidural, chest tube, JP drains, NG tube, cardiac monitoring, IVF, TPN
LOS 7-10 days at minimum
Pancreatic enzymes, antacids, pain control, small frequent meals
Usually take out pancreas and spleen
—lose spleen can inc risk of infection
39
T/F is most common cancer in women
False
2nd most common cancer among women
40
What is the difference between noninvasive and invasive
Noninvasive—has not spread out of breast tissue
Invasive—spread to nearby tissues
41
What are manifestations of breast cancer
Lump or thickening of breast-nontender
Nipple retraction and or discharge
Peau d’orange skin (peels orange flakes)
Q
42
When do you start getting a mammogram
Starts at 40 years
Women’s biggest risk factor is age
Birth control more than 15 years
43
What is the survival rate of ovarian cancer
5-10 year survival less then 50%
44
What are the 3 different types of ovarian cancer
Epithelial (most common)—grow from cells on surface over ovaries
Germ cell—develops from eggs
Stoma cells—develop from cells in ovaries that produce hormones
45
What are factors that can prevent
Completing at least one pregnancy
Breastfeeding
Long term use of oral contraceptives
Avoiding high fat diet
First pregnancy curs at younger age
Not using fertility drugs
46
What are manifestations of ovarian cancer
Clerking during menopause
Abdominal discomfort
Low back pain
Weight change (ascities)
Nausea/vomiting
Constipation
Urination changes
Palpable ovaries
47
What are diagnostics of ovarian cancer
Pelvic exam
Tumor markers
CA-125 is increased in 80% of cases
Tissue biopsy
48
What are treatments of ovarian cancer
Surgery (take everything)
Chemo and radiation
Hormone therapy
Palliative care
49
T/F prostrate cancer is androgen-dependent cancer
T
It is slow growing and adroitness dependent cancer
50
What are risk factors of prostate cancer
Males >50 years old
Family history
Frequent STIs
Obese
51
What are manifestations of prostate cancer
Early stage: no symptoms
Lower urinary tract dysuria, hesitancy, frequency
Hematuria, retention, nocturia, sacral pain
Blood is sperm, painful ejaculation
Pain in low back/hips
52
What are diagnostics of prostate cancer
PSA screenings: not always accurate
Digital rectal exam: no always definitive
Biopsy
MRI
53
What do you start and stop PSA screenings
Starts of 55
And screenings stop after 70
54
What are treatments of prostate cancer
Conservative
Surgery
Radiation
Hormone therapy
55
What are considerations or side effects from treatments with prostate cancer
Incontinence becomes issue
Ejectile dysfunction
Infertility may be expected
56
What are screenings we do for cervical cancer
HPV screenings every 5 yeas
Pap test (25-65)
Vaccinations
57
What does ABCDE stand for for skin cancer
Asymmetry, border, color, diameter, evolving
58
What does extravasation and vesicants for high risk chemotherapy
Extravasatoin-drugs infiltrate to tissues causing damage
Vesicants—severe tissue damage
59
What is the chemotherapy safety
Certification required to administer
Administer cannot be pregnant
Specific PPE
Wearing gloves when handling
Linens to be discarded in special bad
60
What are the chemo challenges for bone marrow, GI tract, and skin and hair
Bone marrow: suppression
GI: n/V/P mucositis
Skin/hair: Alopecia
Short term: risk for acute toxicity and hypersensitivity reactions
Long term: risk for damage to organs later in life
61
What does simulation mean in radiation therapy
Marking
Higher energy; deeper tumor
62
What is the goal of radiation
Destroy the tumor because cancer cells are more vulnerable to radiation due to rapid growth
63
What is external beam and internal bean radiation therapy
External -most common
-pt is not radioactive
Includes the internal target and external surrounding tissue
No prep required
Internal
-brachytherapy
Head/neck/GYN cancers
Radioactive seeds are implanted close to tumor
—-private room, limited activity
(No pregnant females are to enter room)
64
What are radiation therapy challenges for withhead and neck, GI, and prostate
Head and neck: dry mouth (xerostomia, loss of state, difficulty swallowing,
GI: diarrhea, sore
Prostate: bladder irrigation
Symptoms resolve when treatment stops
65
What is stem cells transplant
Process that eradicated diseased tumor cells and bone marrow so that grafting and transplantation of healthy cells can occur (delayed complications)
Transplanted healthy cells rescue the damaged bone marrow
66
What are the challenges for stem cells transplants
Can be fatal
Hospitalization for > 30 days expected
Takes 2-4 weeks for transplanted cells to start making new cells
High risk for simple infection
Bleeding
67
T/F high level radiation breaks down bone marrow implant and stem e
T
68
What are the nursing cares for mucositis
Assess daily
Strict oral care before and after each meal
Topical analgesics
Avoid alcohol and tobacco
Avoid alcohol mouthwashes
Discourage spicy food
Keep mouth moisturized
Small frequent fluids
Saliva substitutes
Floride supplements
Dentis/ 6months
69
What are nursing cares for GI tract upset in cancer patients
Manage mucositis and GI
Initiate TPN or supplemental nutrition early
Monitor nutritional labs (proteins, albumin, ABS lymphocytes)
Promote foods they life small and frequent
Protect skin from breakdown
Daily weights
70
What are some skin reactions to cancer treatments
Dry peeling scale like skin (dry desquamation)
Wet desquamation—deep red painful ulcerations
71
What are some nursing scares for skin reactions for cancer patients
Prevent infection
Monitor healing
No heating/ice therapy
Avoid constructing clothes
No harsh chemicals, lotions, or deodorants
Corticosteroids
**dont rub,
72
In order how are the bone marrow blood cells repressed
White blood cells
Neutrophils
Red blood cells
Platelets
73
What is neutropenia
Low WBC count
5000-1000
<200 is critical
Risk for threatening infections
74
What are nursing cares for neutropenia
Vital signs
Strict hand hygiene
Daily cbc and cmp
Monitor S.S
Avoid large crowds
Private room
Negative airflow
No fresh flowers
No fresh fruit or vegetables
Avoid foley, NG, and rectal temps
75
What do you administer for neutropenia
\administer figrastim
Subq injection
Stimulates bone marrrow to increase production of cells
Side effects: bone pain
76
What is thrombocytopenia
Low platelet count
150,000-450,000
<20,000=high risk of bleeding and brain hemorrhage
<10,000 spontaneous GI bleeding can occur
77
What are nursing cares for thrombocytopenia
Monitor for bleeding (nose, Hematuria, bloody stool, petechiae
Prevent falls (bed alarms, non-skid socks )
AVOID: ASA products, constipation, rectal temps, invasive procedures
EDUCATE: soft tooth brush, no flossing, use electric shaver, administer platelet transfusion as indicated, administer filgrastim
78
What is anemia
Low RBC/Hgb
HGB< 10
RBC< 1million
Severe <6
Fatigue is most common but causes problems if untreated
79
What are nursing cares for anemia
Conserve energy
Encourage balanced nutrition and hydration
Administer o2
Asses skin integrity and hypoxia
Administer RBC and erythropoietin
80
What is the normal range for albumin
3.5-5.5
81
What is the normal range of prealbumin
15-50
82
Why is albumin important
Transports meds and as albumin decreases, it causes increase pressure in vessels and cause 3rd spacing
83
What is the normal range for total serum protein
6.4 to 8.2
84
What is the value of absolute lymphocyte count that means malnutrition
<1000=malnutrition
85
What are some external nutrition complications
Aspiration : keep head of bed elevated
Diarrhea: assess bowels
Abdominal distention/pain: check residual volumes
Constipation: assess bowels
Dehydration
86
When do we use parentera L nutrition (peripheral or central line)
When patients are unable to digest or absorb enternal nutrition
High levels of physiological stress
87
What are some complications of paraenteral nutrition
Metabolic problems: altered renal function, liver dysfunction, hyperglycemia, refeeding syndrome
Centeral line problems: catheter-acquired infection, pneumothorax, occlusion/thrombosis
88
What is refeeding syndrome
Shift in fluids and electrolytes that may occur in malnurished pts that receive artificial feedings
89
What are some signs of refeeding syndrome
Hypophosphate—most common (hallmark)
Hypomagnesia
Hypokalemia
Thiamine deficiency
Water retention
90
What are parenteral nutrition nursing cares
Vital signs Q4
Daily weights
Blood glucose monitoring Q4-6hrs
Pump/line maintenance
Monitor insertion site
Monitor electrolytes, BUN, CBC, CMP
Change tubing Q24 hours
91
What do we do if we need to turn off TPN
Most wean slowly, never abruptly
92
What two leukemias are common in children
Acute lymphoid leukemia
Acute myeloid leukemia
93
What is the most common childhood leukemia
Acute lymphoblastic leukemia (ALL)
94
What are symptoms in children with ALL
Fatigue, fever, anemia, pallor, anorexia, bone pain, bruising, petechiae, swollen lymph nodes, frequent infections
95
What are diagnostics of ALL
CBC, bone marrow biopsy, lumbar puncture
96
What are treatments for ALL
Chemo and Stem cells transplant
97
T/F AML acute myelogenous leukemia can affect all three types of blood cells
True
98
What are symptoms of AML
Fever (w or wo infection, anemia, bone pain, petechiae, nosebleeds, painless lumps
TREATED WITH AGGRESSIVE CHEMO
99
What is the 2nd most common cancer in children
Glialomas
Glial tumors
Vomiting, lethargy, irritability
100
Where does neuroblastomas start
Tumor originating from neural crest cells
Very aggressive, spreads fast
Manifests during toddler years
“What a blast to be a toddler”
101
What are neuroblastoma manifestations
Symptoms of neuroblastomas are very different depending on size, location, and spread of tumor
-abdominal mass/swollen abdomen
-swelling around eyes
-changing in peeing (squeezing kidney/bladder)
-dizziness, lightheadedness
-fatigue
-increase in BP
102
What is wilm’s tumor
Nephroblastoma
90% of kidney tumors
Diagnoses between ages 2-3
Metastasis is rare
103
What are wilm’s tumor manifestations
Unilateral painless mass
Typically seen during bath
Fatigue, malaise, weight loss, UTIs
Hematuria and hypertension are rare (1/3)
104
What are diagnostics of wilm’s tumor
BUN, creatinine, urinalysis, ultrasound of abdomen, CT
Treatment: surgery removal asap
Chemo radiation for advanced
105
What it retinoblastoma
Develops during fetal life or early childhood
Rare
60 % unilateral
Two types: exophylic (below retina), endophylic (toward cavity)
106
What are manifestations of retinoblastoma
White glow in pupil (cats eye)
Stabismus
Red painful eyes
Blindness (late)
Chemo, or surgery of is growing too quickly
107
What is osteosarcoma
Tumor in bone that occurs in metaphysical of long bones
Younger teens
Happens at the end of growth plate
108
What are manifestations and treatment of osteosarcoma
Pain and swelling during activity
Tenderness and warmth at palpitation at site
Diagnose: imaging and biopsy
treatment: chemo and radiation, surgical resection. Amputation
109
What is earrings sarcoma differ from osteosarcoma
Occurs in shaft of lone bones and trunk bones
Common between ages 10-20 years
Most common in caucasians
Pelvis, chest wall, long bones of leg
110
What are manifestations, diagnostics, and treatment of ewings sarcoma
Pain and swelling around tumor
Fever and weight loss
Constant bone pain
diagnostics-imaging and biopsy
Treatment: chemo immediately to shrink tumor, amputation , pain management, emotional support
111
What is rhabdomyosarcoma
Cancer of skeletal muscle
Most common in pediatric soft tissue
Head and neck muscles, eyes, nasal sinuses, throat, spine
Most common in head and neck
112
What are manifestations of rhabdomyosarcoma
Ptosis
Proptosis (buldging)
Vision impairment
Sinus obstruction
Pain of site or pain due to compression of tumor
CT imaging and biopsy
Chemo and radiation
113
What are considerations of treating pediatric cancers
Impaired cognitive development
Delay of onset puberty
Underdevelopment lack of growth
Infertility
Impaired dentition
Other chronic problems: neuropathy, diabetes insipidus, hearing loss, reduced lung elasticity, teeth
114
