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N498 > Lecture 12 - Oncology > Flashcards

Lecture 12 - Oncology Flashcards

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1
Q

What are 5 ways to use surgery in cancer care?

A

Diagnostic, treatment, prophylactic, palliative and reconstructive

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2
Q

What is the goal of surgery as a primary treatment for cancer?

A

Remove the entire tumor, any involved surrounding tissue including regional lymph nodes if required

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3
Q

What is salvage surgery?

A

Extensive surgical approach to treat local recurrence of cancer after a conservative approach was used

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4
Q

What are some NOC’s of cancer surgery?

A

Participation in health care decisions, anxiety control, knowledge of post-op course and of disease, body image, sexual functioning, bowel elimination and urinary continence

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5
Q

What are some NIC’s of cancer care?

A

Decision making support, anxiety reduction, teaching post-op care, body image enhancement, sexual counselling, constipation management and urinary elimination management

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6
Q

What is radiation in cancer care?

A

Use of ionizing radiation to interrupt cell growth

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7
Q

What 4 purposes does radiation have?

A

Primary treatment, adjuvant treatment, local/symptom control and palliative care

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8
Q

What 4 purposes does radiation have?

A

Primary treatment, adjuvant treatment, local/symptom control and palliative care

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9
Q

What kind of planning must the patient undergo prior to radiation?

A

Go through stimulation training, know what body position they will be in, wear masks that are moulded to that position and to get tattoos to show where exactly the radiation will hit

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10
Q

When are cells most vulnerable to radiation?

A

During DNA synthesis and mitosis (early S, G2 and M phases)

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11
Q

Which tissues are most sensitive to radiation?

A

Tissues that undergo frequent cell division such as bone marrow, lymphatic, GI tract and gonads

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12
Q

What is a radiosensitive tumor?

A

Radiation destroys tissue but normal tissues can still regenerate

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13
Q

What are radiosensitizers?

A

Because tumors that are well oxygenated response well, certain chemotherapy drugs can sensitize more hypoxic tumors to effects of radiation

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14
Q

What is an issue males have with radiation?

A

They can become sterile due to having radiation around the pelvic region so refer them to a sperm bank or sexual counselling

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15
Q

What are some common skin adverse effects to radiation?

A

Erythema to dry skin to moist desquamation

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16
Q

What are some interventions to treat skin adverse effects to radiation?

A

Avoid constrictive clothes, deodorants, oil-based creams, perfumes and avoid heat, cold, sunlight. Keep skin dry and open to air

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17
Q

What are some common bone marrow adverse effects to radiation?

A

Risk of infections, bleeding, fatigue, weakness

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18
Q

What are some interventions to treat bone marrow adverse effects to radiation?

A

Monitor CBC, platelet, education regarding infection control and possibly transfusions

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19
Q

What are some common anorexia-related adverse effects to radiation?

A

Fatigue, nausea, tumor cell break down

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20
Q

What are some interventions to treat anorexia-related adverse effects to radiation?

A

Eat small, frequent and nutritionally dense meals

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21
Q

What are some reasons that may be causing fatigue related to radiation?

A

Tumor cell breakdown, travel to treatment, and length of treatment that goes on for weeks to months

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22
Q

What are some interventions related to fatigue for radiation?

A

Energy conservation, and identify community resources to assist with travel

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23
Q

What is an example of a dose-limiting side effect of radiation?

A

Skin burn

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24
Q

What are brain-specific adverse effects to radiation?

A

Cerebral edema - watch for ICP and seizures

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25
What are head and neck-specific adverse effects to radiation?
Stomatitis, xerostomia, change/ loss of taste
26
What are chest area- specific adverse effects to radiation?
Esophagitis, radiation, pneumonitis, and pulmonary fibrosis
27
What are abdomen/pelvic area-specific adverse effects to radiation?
Fertility, sexuality, cystitis, diarrhea and nausea
28
What are abdomen/pelvic area-specific adverse effects to radiation?
Fertility, sexuality, cystitis, diarrhea and nausea
29
What are antineoplastics?
Primary mode of action involves interfering with supply & utilization of building blocks of nucleic acids. It also interferes with intact DNA and RNA molecules needed for cell growth and replication
30
What are antineoplastics?
Primary mode of action involves interfering with supply & utilization of building blocks of nucleic acids. It also interferes with intact DNA and RNA molecules needed for cell growth and replication
31
What are the 3 main goals of chemotherapy?
Cure, control, palliation
32
What are 5 different routes for administering chemotherapy?
PO, IV, intrathecal, intraperitoneal and intracavity
33
What does narrow therapeutic index mean for chemotherapy?
There is a fine balance between therapeutic effect of antineoplastic drugs and its toxicities
34
What are short term adverse effects of chemotherapy?
Decreased WBC, RBC, PLT, alopecia, N/V, mucositis, diarrhea, dehydration, fluid overload, fatigue, flu-like symptoms, constipation, allergic/ anaphylactic reactions, irritation of skin, progressing to tissue damage extravasation
35
What are long term adverse effects of chemotherapy
Neuropathy, pulmonary fibrosis, renal dysfunction, cardiac dysfunction, sexual dysfunction, cognitive changes, hypocalcemia, rash, nail changes, hyperpigmentation, sun sensitivity, secondary malignancy, thyroid problems
36
What is "chemo brain"?
Patients may have memory issues related to chemotherapy taking months to clear out of the brain
37
What is modified radical mastectomy?
Entire breast is removed and the lining over the pectoralis major muscle. Pectoralis minor may not be removed and axillary lymph node dissection is part of the surgery
38
What is total mastectomy?
All breast tissue is removed as well as the areolar and nipple. Does not include ALND
39
What is total mastectomy?
All breast tissue is removed as well as the areolar and nipple. Does not include ALND
40
What is breast conserving surgery?
Removing tumor with clear margins and to achieve cosmetic result
41
What are the 3 types of breast conserving surgery?
Lumpectomy, wide excision and quadrantecomy
42
What is lumpectomy?
Tumor is removed, major portion of breast tissue is left can up to 3cm margin removed
43
What is wide excision?
Partial mastectomy
44
What is quadrantecomy?
Partial mastectomy, full quadrant of breast removed including tumour, overlying skin, lining over muscle
45
What is quadrantecomy?
Partial mastectomy, full quadrant of breast removed including tumour, overlying skin, lining over muscle
46
What are the 5 things to consider for breast conserving surgery?
Tumor size, prior radiation to chest, access to radiation centre, breast size and patient preference
47
What is a contraindication of breast conserving surgery?
If the patient has experienced cancer before and treated with radiation
48
What is the most important predictor for disease recurrence and survival?
Presence of axillary node metastasis?
49
What is the most important predictor for disease recurrence and survival?
Presence of axillary node metastasis?
50
What is the goal of SLNB?
Sentinel lymph node biopsy - to determine if the patient, undergoing surgical procedure, requires axillary lymph node dissection procedure
51
What are some nursing diagnoses related to post- breast cancer surgery?
Anxiety, risk for infection, delayed wound healing, immobility, pain, disturbed sensory perception, self-care deficit, deficient knowledge of drain management and arm exercises to regain ROM
52
What is lymphedema?
Lymph fluid in tissues of the arm that pool and swell from upper arm to fingers
53
What are 2 education pieces to teach for post-breast cancer surgery to prevent lymphedema?
Once discharged, patients should report any new swelling on the arm on side4 of surgery that lasts more than 24 hours and to avoid carrying shoulder bags on the affected side
54
What are 2 education pieces to teach for post-breast cancer surgery to prevent lymphedema?
Once discharged, patients should report any new swelling on the arm on side4 of surgery that lasts more than 24 hours and to avoid carrying shoulder bags on the affected side
55
What position should the affected side be in post-breast surgery with ANLD?
Slightly elevated with pillow in immediate post-op period
56
What are 3 education pieces to teach for post-breast cancer with ANLD?
1) Teach them to empty the drain that goes home with them and to observe for any changes, noting expected decrease in drainage 2) Keep incision sites clean. Shower, soap and water post-op D-2. No deodorants or antiperspirant 3) Provide information on normal sensory sensations patient may experience post-op
57
What sort of exercises should the patient perform post-breast surgery?
ROM exercises for 20 min 3x/day for 4-6 weeks, start D-2. Make fists and relax, shoulder shrugs, elbow bend and extend, wing rotations
58
How much should patients post-breast surgery avoid lifting?
Avoid moving or lifting more than 10 lbs until ROM improves and wound has healed
59
How much should patients post-breast surgery avoid lifting?
Avoid moving or lifting more than 10 lbs until ROM improves and wound has healed
60
How much should patients post-breast surgery avoid lifting?
Avoid moving or lifting more than 10 lbs until ROM improves and wound has healed
61
What is an important piece of the standard treatment for breast cancer?
Pre-medication - control allergic reactions/ anaphylactic reactions and to control N/V
62
What are 4 things to consider as pre-treatment for chemotherapy?
1) Cardiac and respiratory function 2) CBC with differential and platelets 3) BUN, creatinine, bilirubin and AST 4) Consider the emetogenic potential of each chemotherapy drug
63
How can you prevent N/V before it happens?
Aprepitant pre-chemo on D-1, ondansetron D-1 and dexamethasone D-1
64
What are some interventions to address alopecia with chemotherapy?
Discuss potential hair loss, be aware which drugs cause alopecia, encourage patient tocut hair, stop coloring, stop using heat appliances, plan for wig, be able to describe hair loss, teach scalp care
65
How would you describe to a patient about hair loss with chemotherapy?
Often 2-3 weeks after first chemotherapy, hair loss will include facial hair, eyebrows, eyelashes and body hair. Hair will grow back after treatment but it may be a different color or texture
66
How would you teach a patient about scalp care with alopecia?
Use mild shampoos, non-perfumed lotion for scalp itchiness and use sun protection
67
What is Herceptin used for with breast cancer?
For adjuvant and metastatic breast cancers where tumor overexpress HER2 proteins
68
What should you monitor for with administering Herceptin?
Fever, chills during infusion along with N/V, pain, rigor, headache, dizziness and rash
69
What should you monitor for when administering Herceptin?
Fever, chills during infusion along with N/V, pain, rigor, headache, dizziness and rash
70
What is a complication of using Herceptin that you should monitor for?
Cardiotoxicity accompanied with dyspnea, increased cough, peripheral edema. Get a baseline MUGA
71
What is the indication for hormone therapy with breast cancer?
For patients with hormone receptor- positive tumors
72
2/3 of breast cancer tumors are dependent on x for growth. What is x?
Estrogen
73
What would you prescribe for a patient who is estrogen receptor positive?
SERM's
74
What are some side effects of tamoxifen?
Hot flashes, fluid retention, nausea, tumor flare, irregular menstruation, vaginal bleeding and discharge, vaginal dryness, risk of TE, increase risk of endometrial cancer
75
What is watchful waiting with prostate cancer?
For men with limited life expectancy related to comorbidities or small, low-grade cancer, do regular PSA testing and biopsies to ensure cancer has not become more aggressive
76
What is the standard treatment option for localized prostate cancer?
Radiation and/or surgery
77
When would you use ADT?
Androgen deprivation therapy - recurrent prostate cancer that's previously been treated locally that responds well to systemic hormone therapy
78
What is radical prostatectomy?
Standard surgical procedure that is nerve-sparing and decreases incidence of ED
79
What is retropubic prostatectomy?
Low abdominal incision with decreased incidence of incontinence
80
What is perineal prostatectomy?
Used less often, high risk of post-op ED, incontinence and infection
81
What are 4 ways urinary function is altered related to prostatectomy?
1) Urinary catheter - in place up to 7 days post op 2) Significant urinary control to return in 12 weeks 3) Mild stress incontinence leading to dribbling - wear pads 4) 1-2% have long-term challenges with urinary continence
82
What are 4 ways urinary function is altered related to prostatectomy?
1) Urinary catheter - in place up to 7 days post op 2) Significant urinary control to return in 12 weeks 3) Mild stress incontinence leading to dribbling - wear pads 4) 1-2% have long-term challenges with urinary continence
83
What are some complications of external beam radiation with prostate cancer?
Cystitis leading to bladder spasms, urethral stricture, altered urinary pattern, diarrhea
84
What is brachytherapy for prostate cancer?
Implanting radioactive seeds that slowly release radiation into the perineal area into prostate gland guided by CT and transrectal US
85
What are 3 education pieces to teach the patient undergoing brachytherapy for prostate cancer?
1) Radiation safety for 2-3 months 2) Urinary side effets 3) Hematuria in first 72 hours
86
What should you teach the patient regarding sexual dysfunction related to local therapy for prostate cancer?
Counselling with the patient and partner to discuss the changes in sexual function you can expect, discuss preserving or regaining function. Provide information about timelines for sexual recovery and consider Cialis and Viagra
87
What is the goal of hormone therapy for prostate cancer?
Stop growth of androgen- dependent cancer cells and induce cell death
88
What are side effects of LHRH agonists?
Lutenizing hormone-releasing agonists - decreased libido, hot flashes, impotence, change in male characteristics, breast swelling, weight gain, muscle loss, osteoporosis, anemia, fatigue, increased risk of heart disease and diabetes, tumor flare and blood clots
89
What are side effects of LHRH agonists?
Lutenizing hormone-releasing agonists - decreased libido, hot flashes, impotence, change in male characteristics, breast swelling, weight gain, muscle loss, osteoporosis, anemia, fatigue, increased risk of heart disease and diabetes, tumor flare and blood clots
90
Describe small cell lung cancer
Rapid growth, metastasizes early and extensively
91
Describe the role of external beam radiation for lung cancer
Used for control as a neoadjuvant treatment to surgery
92
Why is radiation an important part of palliative care for lung cancer patients?
They experience symptoms of dyspnea, bronchus obstruction,chest pain, hemoptysis, bone and liver pain
93
What is pneumonectomy?
Entire lung is removed. No chest tube is required, space fills with fluid & prevents mediastinal shift
94
What is lobectomy?
More common; vessels and bronchus are divided, lobe removed. Requires chest tubes to help re-expand rest of the lung
95
What are 5 things to include in post-op care for thoracic surgery related to lung cancer?
1) Reduction in lung capacity takes a period of adaptation 2) Risk of pulmonary edema - restrict to low IV fluid rate 3) Avoid operative side 4) Teach how to splint chest when coughing 5) Exercises to prevent atelectasis
96
What are side effects of radiation for lung cancer?
Because of the radiation field that involves the trachea, esophagus and heart there are side effects such as sore throat, esophagitis, radiation and pneumonitis
97
How do you treat radiation pneumonitis?
Steroids
98
What are 5 nursing diagnoses related to lung cancer?
1) Ineffective breathing pattern related to pain​ 2) Impaired gas exchange related to tumor growth​ 3) Pain related to disease progression​ 4) Powerlessness related to inability to control symptoms​ 5) Knowledge deficit related to disease & treatment

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