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M/S 2 > Exam 4 - Cancer > Flashcards

Exam 4 - Cancer Flashcards

1
Q

cancer is the ___ and ___ growth of cells

A

uncontrolled; unregulated

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2
Q

this results when normal cells mutate into abnormal, deviant cells that multiply and spread

A

cancer

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3
Q

study of cancer is called

A

oncology

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4
Q

3 potential patient goals r/t cancer

A

curative
control
pallative

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5
Q

curative care

A

no microscopic evidence of cancer in the body

remission

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6
Q

control care

A

treatment, retreatment
reduce s/sx
reduce burden of disease
increase quality of ife

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7
Q

palliative care

A

increase quality of life until death

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8
Q

frequent cancer locations in male

A

prostate
lung
colon/rectal

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9
Q

frequent cancer locations in females

A

breast
lung
colon/rectal

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10
Q

proliferation is ___ ___

A

cell growth

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11
Q

differentiation is the cycle of ___ ___

A

cell maturity

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12
Q

specialized cells are for what?

A

a specific area (GI, bone marrow, etc)

this is part of normal proliferation

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13
Q

what is contact inhibition

A

cells do not touch each other

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14
Q

benign growths are ___ where as malignancy will ___

A

encapsulated; spread

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15
Q

___ is a mass of new tissue that grows independently of its surrounding structures; no physiologic purpose

A

neoplasm (tumor)

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16
Q

what are the 2 neoplasm/tumor types

A

benign
malignant

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17
Q

benign neoplasm characteristics

A

localized, solid mass
well defined borders
easily removed
usually do not reoccur
slow growing

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18
Q

malignant neoplasm characteristics

A

grow, double aggressive
irregular shape
can reoccur
travel to form secondary tumor(s) (metastasis)

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19
Q

apoptosis is ___ ___

A

cell death

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20
Q

T or F. cancer cells are able to avoid death

A

true

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21
Q

what are the 2 major defects of cell mutation that result in cancer

A

defective cellular proliferation (growth) and differentiation (maturity)

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22
Q

grading the differentiation (maturity) of cancer

A

histological grading

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23
Q

increase in the number of density of normal cells

A

hyperplasia

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24
Q

adaptation of a cell d/t a stressor in the environment; normal for its type but has developed in an abnormal location; it is a protective manner and is reversible when stressor ceases

A

metaplasia

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25
Q

loss of DNA control over differentiation occurring in response to adverse condition

A

dysplasia

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26
Q

regression of a cell to an immature or undifferentiated cell type; not under DNA control

A

anaplasia

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27
Q

3 steps to cancer development

A

initiation
promotion
progression

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28
Q

initiation stage of cancer development

A

IRREVERSIBLE
mutation in cells genetic structure
avoids apoptosis
exposure to carcinogenic
DNA mutate
change and stays changed

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29
Q

examples of carcinogenics

A

chemical
radiation
viral/infections: HSV, mono, hepatitis, Epstein barre, HIV
genetics
tobacco
inherited mutation
hormones
immune conditions
mutations that occur from metabolism

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30
Q

promotion stage in cancer development

A

REVERSIBLE
can last 1-40 years
depends on level of exposure to carcinogens

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31
Q

progression stage of cancer development

A

NONREVERSIBLE
increased growth
cells not act as malignant cells
being to break off, travel, create own blood supply (mets)
body actively stops trying to kill the cell

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32
Q

how large must a mass be to be detectable

A

1cm = 1 billion cells

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33
Q

common site for mets

A

brain*
lung*
bone*
liver*
lymph nodes

*first sites affected

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34
Q

cancer risk factors

A

infections
genetics/heredity
age (80% occur after 55)
gender
socioeconomics (prevalent in lower)
stress (< 6-8 hours sleep/night)
diet: high fat, low fiber
occupation
tobacco (decrease risk if quit before middle age)
alcohol use
obesity (esp. BMI >30)
sun exposure
recreational drug use (marijuana worse than tobacco)

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35
Q

what are the 4 tumor associated antigens (TAAs)

A

cytotoxic t cells
NK (natural killer) cells
monocyte and macrophages
B lymphocytes

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36
Q

what is the role of TAAs

A

immune cells responsible for seeking and destroying cancer cells in the body

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37
Q

what are TAAs located

A

on the cell surface

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38
Q

CA -125 is produced by ___ cancer cells

A

ovarian

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39
Q

PSA is produced by ___ cancer cells

A

prostate

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40
Q

CEA is produced by ___ cancer

A

GI

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41
Q

AFP is produced by malignant ___ cells

A

liver

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42
Q

first choice testing for Dx cancer

A

MRI

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43
Q

PET scan looks for ___

A

mets

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44
Q

tumor classification is the ___ of the tumor

A

name

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45
Q

tumor classification is by ___ site

A

anatomic site

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46
Q

6 anatomic sites

A

carcinomas
sarcomas
adenocarcinoma
leukemias
lymphomas
multiple myeloma

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47
Q

where do carcinomas arise from?

A

ectoderm
endoderm

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48
Q

where do sarcomas arise from?

A

mesoderm

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49
Q

where do adenocarcinomas arise from?

A

grandular tissue

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50
Q

where does leukemias arise from?

A

blood-forming cells

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51
Q

where does lymphoma arise from?

A

lymph tissue

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52
Q

where does multiple myeloma arise from?

A

plasma cells, effects the bones

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53
Q

grading grades the ___ of the tumor

A

aggressiveness

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54
Q

How many tumor grades are there?

A

4

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55
Q

grade 1

A

cells slight different

mild dysplasia; LEAST malignant

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56
Q

grade 2

A

more abnormal

moderate dysplasia

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57
Q

grade 3

A

clearly abnormal

severe dysplasia

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58
Q

grade 4

A

anaplastic (immature) and undifferentiated

cell origin is difficult to determine

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59
Q

staging is the ___ within the body

A

spread

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60
Q

what is TNM of staging

A

T umor size, depth, surface spread
N odes involvement (present or absent)
M ets (present or absent)

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61
Q

staging ranges from __ to __

A

0-4

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62
Q

stage 0

A

carcinoma in-situ

early form

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63
Q

stage 1

A

localized

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64
Q

stage 2

A

early locally advanced

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65
Q

stage 3

A

late locally advanced

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66
Q

stage 4

A

mets

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67
Q

different tumor classifications

A

T0
T-IS
T1, T2, T3, T4

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68
Q

T0

A

no evidence of primary tumor

69
Q

T-IS

A

tumor in-situ

70
Q

T1, T2, T3, T4

A

progressive degrees of tumor size and involvement

71
Q

different node classifications

A

N0
N1A, N2A
N1B, N2B, N3B
NX

72
Q

N0

A

no abnormal regional nodes

73
Q

N1A, N2A

A

regional nodes, no mets

74
Q

N1B, N2B, N3B

A

regional lymph nodes
mets suspected

75
Q

NX

A

regional nodes can not be assessed clinically

76
Q

different mets classifications

A

M0
M1, M2, M3

77
Q

M0

A

no evidence of distant mets

78
Q

M1, M2, M3

A

mets involvement, including distant nodes

79
Q

these are protein molecules detectable in serum or other bodily fluid

biochemical indicator of the presence of malignancy

A

tumor markers

80
Q

4 examples of tumor markers

A

antigens
hormones
proteins
enzymes

81
Q

2 types of radiation therapy

A

teletherapy (external)
brachytherapy/intracavity (internal)

82
Q

when is radiation therapy most effective

A

when cells are rapidly growing

83
Q

brachytherapy/internal radiation ALARA principle

A

As Low As Reasonably Acceptable

r/t time, distance, shielding

84
Q

Brachytherapy visitor restrictions

A

no pregnancy women
no person under 18 y/o
limit visitation time (30 minutes/day)
keep distance (6 feet)

85
Q

long term effects of radiation

A

PNA
pericardium damage
blood vessel damage
infertility
lymphoma

86
Q

radiation education

A

evaluate skin daily
gentle soap (non-alcohol based)
only clean site with your hand
avoid sun exposure
no cosmetics
wear loose clothing
taste distortion (red meat may taste metallic)
mucositis
anorexia
do not wash markings off

87
Q

do chemo drugs only kill bad cells?

A

No, they kill bad AND healthy cells

88
Q

2 major chemotherapy categories

A

cell cycle phase - specific
cell cycle phase - nonspecific

89
Q

what is nadir

A

when WBC are at their lowest

< 1000

90
Q

T or F. Monitor uric acid levels with chemotherapy

A

True

91
Q

Chemotherapeutic agent drug classes (5)

A

alkylating agents
antimetabolites
antitumor abx
miotic inhibitors
hormone and hormone antagonist

92
Q

common S/E among chemotherapeutic agents

A

bone marrow depression
N/V/D
electrolyte issues

93
Q

Alkylating agents can cause ___ impairment

A

renal

94
Q

what kind of diet should those on alkylating agents eat?

A

low purine d/t increase in uric acid

95
Q

examples of alkylating agents

A

Cytoxan (admin on empty stomach)
Cisplatin (1-2 L IVF before, after; ototoxicity)
Mustargen

96
Q

Can chemo drugs be administered in peripheral lines?

A

No, central lines only

97
Q

What are the 5 steps to complete if a pts IV infiltrates

A

turn off pump
D/C IVF from cannula
aspirate remaining contents in cannula
administer antidote (kept at bedside)
call MD

98
Q

antimetabolites are used to treat ___, ___, and ___ ___

A

leukemia
lymphomas
solid tumors

99
Q

antimetabolites contraindications

A

major sx previous month
previous use of alkylating agents
hx of high-dose pelvic radiation
pre-existing bone marrow impairment
women in childbearing years
hepatic, renal impairement

100
Q

what to monitor for with antimetabolites

A

renal, cerebral function
photo sensitivity

101
Q

examples of antimetabolites

A

methotrexate
5-FU
Mercaptopurine

102
Q

5-FU can lead to which kind of toxicity

A

cardiotoxicity (resembles MI, angina, cardiogenic shock)

103
Q

how are antitumor antibiotics administered

A

slow IVP

DO NOT USE in AC, dorsum of hand or wrist

104
Q

antitumor antibiotic examples

A

doxorubicin (Adriamycin)
bleomycin (Blenoxane)
mithramycin (Plicamycin)

105
Q

doxorubicin (Adriamycin) considerations

A

monitor for cardiotoxicity
nadir 10-14 days after administration
radiation recall is common

106
Q

Mitotic inhibitors/plant extracts inhibit ___ causing ___ ___

A

mitosis; cell death

107
Q

mitotic inhibitors/plant extract examples

A

etoposide (N/V, hypotension, bone marrow depression)
taxol (angioedema)
vincristine (motor weakness, paraesthesia)

108
Q

hormone and hormone antagonist can be used for which 2 reasons

A

stimulate appetite
reduce inflammation

109
Q

what to monitor with hormones and hormone antagonsts

A

hyperglycemia
impaired healing
HTN
osteoporosis
hirsutism

meds are prednisone based; think prednisone s/sx

110
Q

hormones and hormone antagonist examples

A

estrogens (diethylstillbestrol)
antiestrogens (Tamoxifen)
—hot flashes, hemorrhage
progestin (megestrol; leuprolide)
androgen (testosterone)

111
Q

general S/E of chemotherapeutic agents

A

bone marrow suppression (immunosuppression, thrombocytopenia, anemia)
anorexia
N/V/D
stomatitis
xerostomia
alopecia
fatigue
organ toxicity
impaired reproductive ability or altered fetal development

112
Q

nurse PPE for handling chemo IV meds

A

gloves
mask
gown

113
Q

which technique is used to access CVADs

A

sterile

114
Q

nursing considerations for chemotherapy pts

A

monitor CBC with diff, plts, BUN, LFT
VS
neutropenic precautions

115
Q

immunosuppression education

A

avoid crowds, infected people and small children
hand hygiene
avoid undercooked meat, raw fruits + veggies
report s/sx of infection ASAP to HCP
avoid yard work
no live virus vaccines

116
Q

nursing considerations for thrombocytopenia pts

A

monitor stools, urine for bleeding
electric razor
avoid ASA, ASA containing products
avoid IM injections
avoid contact sports
avoid dental work unless absolutely necessary
soft toothbrush; don’t floss
avoid alcohol based mouthwashes

117
Q

thrombocytopenia education

A

apply ice to injured area, seek medical attention
inform HCP of chemo, radiation treatments
assess for ecchymosis, petechiae, trauma
no skid sole; closed toe shoes
avoid tripping hazards
be alert to spontaneous bleeds if plt < 20000

118
Q

what do immunotherapy/biotherapy/target therapy drugs do

A

enhance the person immune responses
changes relationship with cancer, how it reacts

119
Q

immunotherapy/biotherapy/target therapy S/E

A

flu like symptoms
HA
rash
N/V

120
Q

purpose of colony stimulating factors

A

reduce risk of thrombocytopenia

rapidly reproduces WBC, RBC, plt

121
Q

when is it acceptable to use erythropoiesis-stimulating agents (ESAs)

A

treating anemia specifically caused by chemotherapy

122
Q

what are the 2 types of bone marrow/stem cell transplant

A

autologous (own bone marrow)
allogenic (donor bone marrow)

123
Q

how is bone marrow/stem cell transplant infused

A

central line

124
Q

bone marrow/stem cell transplant are most commonly used for which cancer?

A

leukemia

125
Q

bone marrow/stem cell transplant puts pt at high risk for ___ and ___

A

infection; death

126
Q

where is bone marrow/stem cells harvested from

A

iliac crest (most common)
umbilical cord
blood

127
Q

a pt receiving a bone marrow/stem cell transplant will be on which kind of precautions and isolation?

A

P: neutropenic
I: reverse

128
Q

when will levels begin to increase after a bone marrow/stem cell transplant?

A

2-4 weeks

129
Q

explain graft vs. host complication r/t bone marrow/stem cell transplant

A

donated cells attack the host

130
Q

what is the desired effect/graft vs. tumor r/t bone marrow/stem cell transplant

A

donated cells attack the tumor

131
Q

when is a dietary referral needed?

A

noted weight loss of 5%

132
Q

what is the primary cause of death r/t chemotherapy

A

infection

133
Q

s/sx of poor nutrition

A

withdrawn/fatigued
over/under weight
pasty/dry/scaly skin
bruising
brittle hair
red/spongy gums
dark red/swollen tongue
stooped posture
easily distracted

134
Q

metabolic oncologic emergencies

A

SIADH
hyperkalemia
tumor lysis syndrome
septic shock
DIC

135
Q

does SIADH cause:

fluid retention/hyponatremia OR fluid deficit/hypernatremia

A

fluid RETENTION
HYPOnatremia

136
Q

SIADH treatment

A

treat the cancer
fluid restriction
salt tables, lasix
3% NS (hypertonic solution)
monitor closely

137
Q

hypercalcemia is r/t ___ ___

A

bone mets

often a complications of breast cancer

138
Q

hypercalcemia treatment

A

treat cancer
hydrate: 3-4L daily
diuretics
biophosphonates (-ronate)
stool softeners

139
Q

what is tumor lysis syndrome

A

when cells are killed, they burst releasing all the intracellular contents into the bloodstream

aka tissue distruction

140
Q

tumor lysis syndrome shows the chemo/radiation is ___

A

working!

141
Q

rapid tumor lysis syndrome can lead to ___ failure

A

renal

142
Q

tumor lysis syndrome s/sx

A

elevated phosphate, K, uric acid
low calcium
renal failure
24-48 hr after treatment (lasts 5-7 days)
weakness, muscle cramps
N/V/D

143
Q

tumor lysis syndrome treatment

A

prevent renal failure
prevent severe F/E imbalances
prophylactic meds with chemo
catch early
HYDRATION + Allopurinol
K treated with insulin + glucose

144
Q

DIC s/sx

A

low plt
prolonged PT, PTT
elevated d-dimer
pallor
petechia, purapura, bleeding

145
Q

DIC nursing priorities

A

support airway
O2
circulation

146
Q

DIC treatment

A

O2
volume replacement
blood products: plt, FFP

147
Q

DIC is associated with which 2 cancers

A

lung cancer, lymphoma

148
Q

what is superior vena cava syndrome

A

compression of the vena cava by a tumor, enlarged lymph node, obstructed circulation

149
Q

s/sx of superior vena cava syndrome

A

excess fluid in the chest, neck, face

150
Q

superior vena cava syndrome treatment

A

immediate radiation to reduce the size of the obstruction

151
Q

s/sx of spinal cord compression

A

intense, localized, persistent back pain
motor weakness + dysfunction
change in bowel, bladder habits
paresthesia

152
Q

where is a tumor located r/t spinal cord compression

A

epidural space

153
Q

diagnostic test for Dx spinal cord compression

A

MRI

154
Q

spinal cord compression treatment

A

pain meds
corticosteroids
radiation/chemo
laminectomy

155
Q

anorexia-cachexia syndrome

A

cancer diverts nutrition to itself while causing changes that decrease appetite

SEVERE muscle wasting; nausea, pain, elevated glucose

156
Q

sunscreen should be at least SPF ___

A

15

157
Q

good dietary habits for cancer prevention

A

low fat, high veggie
limit sugar, red meat, nitrates, and processed food

158
Q

CAUTIONUF r/t warning signs of cancer

A

C hange in bowel/bladder
A sore that doesn’t heal
U nsual bleeding, discharge
T hickening, lump
I ndigestion, difficulty swallowing
O bvious change in wart/mole
N agging cough, hoarseness
U nexplained weight gain, loss
F eeling tired, weak

159
Q

PAP smear recommendations for:

21-29
30-65
65+

A

21-29: q3 years
30-65: q5 years + HPV
65+: no testing if have been normal, cont x20 years if abnormal

160
Q

mammograms for women 45-54

A

annually + monthly SBE

161
Q

when should men and women have a FOB

A

q3 years starting at 50 y/o

162
Q

when should men and women begin colonoscopies

A

50; q5-10 years

163
Q

When should African American men with a hx of prostate cancer begin getting exams

A

45 y/o

164
Q

when should men begin getting prostate exams

A

70 y/o

165
Q

what are Kubler-Ross’ 5 stages of grieving

A

denial
anger
bargaining
depression
acceptance

166
Q

active listening techniques

A

maintain eye contact
lean foward
sit eye level

167
Q

living will vs. POA

A

LW: pt has their preferences outlined
POA: pt appoints someone to make medical decisions on their behalf

168
Q

expected physiologic changes r/t impending death

A

weakness, fatigue
social isolation
increased sleepiness > unresponsiveness
increase HR, RR, low BP > irregular pulse, respirations, BP
impaired secretion removal
decreased UOP
incontinence > oliguria, anuria
skin is warm or cool > pallor, mottling
pain

M/S 2 (10 decks)

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