Lung and Colorectal Cancer Flashcards
(119 cards)
1
Q
Cachexia
A
extreme body wasting and malnutrition; develops from an imbalance of food intake and energy use
2
Q
Weight maintenance
A
diet high in protein and carbs
3
Q
Purpose of cancer management
A
to prolong survival time or improve quality of life
4
Q
Cancer therapy includes
A
radiation, surgery, chemotherapy, hormonal manipulation, photodynamic therapy, immunotherapy, and targeted therapy
5
Q
Prophylactic surgery
A
removes “at-risk” tissue; performed when a pt has an existing premalignant condition or a family history that predisposes the person to development of a specific cancer
6
Q
Diagnostic surgery (biopsy)
A
removal of all or part of a suspected lesion for examination and testing; proof of presence
7
Q
Curative surgery
A
removal of all cancer tissue
8
Q
Cancer control/cytoreductive surgery
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removes part of but not the entire tumor; aka “debulking” surgery; decreases the number of cancer cells
9
Q
Palliative surgery
A
focuses on improving the quality of life during the survival time; does not focus on cure
10
Q
Second-look surgery
A
“rediagnosis” after treatment; assess disease status in pts who have been treated
11
Q
Reconstructive/Rehabilitative surgery
A
increases function, enhances appearance, or both
12
Q
Pt centered collaborative care
A
Assess coping; support pt; encourage to express concerns; assist in helping accept changes in appearance or function; encourage pt to look at, touch surgical site, and participate in dressing changes; provide info regarding support groups; refer to mental health as needed
13
Q
Radiation therapy
A
destroys cancer cells; minimal damaging effects on the surrounding normal cells; most is ionizing radiation; cells damaged either die outright or become unable to divide
14
Q
Exposure
A
amount of radiation delivered to a tissue
15
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Radiation dose
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amount of radiation absorbed by the tissue
16
Q
Rate of death with radiation therapy
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a few cells die immediately; more die within the next 24 hrs as they attempt to divide
17
Q
Radiation therapy administration
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given as a series of divided doses; small doses given on a daily basis for a set time period
18
Q
Teletherapy
A
radiation delivered from a source outside of the pt; the pt is not radioactive and is not hazardous to others
19
Q
Intensity modulated radiation therapy (IMRT)
A
type of teletherapy; breaks up the single beam into thousands of smaller beams that allow better focus on the tumor
20
Q
Stereotactic body radiotherapy (SBRT)
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type of teletherapy; uses 3-dimensional tumor imaging to identify the exact tumor location; delivered in one to five separate treatment sessions
21
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Teletherapy notes
A
location is determined for therapy accuracy; pt must always be in the same position for each therapy session
22
Q
Brachytherapy
A
“short” or “close” therapy; direct, continuous contact with tumor tissues for a specific time period; high does of radiation in tumor tissues; limited dose in surrounding normal tissues; uses radioactive isotopes; radiation source is inside pt; pt emits radiation for period of time and is hazard to others
23
Q
Brachytherapy - unsealed isotopes
A
enter body fluids and are eliminated in waste products
24
Q
Brachytherapy - sealed radiation
A
implanted within or near the tumor; deliver “low-dose rates”; pt is hospitalized for several days; also delivers “high-dose rate”; pt has therapy several days a week for 1 or so hrs; pt is only radioactive when implant is in place
25
Radiation side effects
skin changes, hair loss, altered taste sensations, fatigue
26
Care of pt with sealed radiation
private room/bath; "Caution: radioactive" sign on door; portable lead shields should be placed between the pt and the door; keep pts door closed; limit visitors to 30-minutes and remain 6 ft from pt; never touch source with bare hands; keep all dirty linens bagged in room until radioactive source is removed
27
Side effects of radiation therapy
skin changes, hair loss, altered taste sensations, fatigue
28
Skin protection during radiation therapy
wash with mild soap and water; use hand to wash; rinse soap thoroughly from skin; do not remove ink or dye markings that identify radiation beam focus; pat skin dry; only use skin care prescribed by radiation dept; wear soft clothing over radiation site; avoid sun; avoid heat
29
Chemotherapy
treatment of cancer with chemical agents; used to cure and to increase survival time; tumors with rapid growth are more sensitive to chemotherapy
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Alkylating agents
prevents DNA and RNA synthesis to inhibit cell division
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Antimetabolites
resemble normal metabolites and are "counterfeit" metabolites that fool cancer cells into using the antimetabolites in cellular reactions; impairs cell division
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Antimitotic agents
interfere with the formation and actions of microtubules; cells cannot complete mitosis during cell division; cell either does not divide at al or divides only once; results in two daughter cells that cannot continue to divide
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Antitumor antibiotics
damage the cells DNA and interrupt DNA or RNA synthesis
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Topoisomerase inhibitors
disrupt an enzyme needed for DNA synthesis and cell division; prevents proper DNA maintenance; causes DNA breakage and cell death
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Combination chemotherapy
giving more than one specific anticancer drug in a times manner; more effective in killing cancer cells; side effects and damage caused to normal tissues increases with combination therapy
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Chemotherapy dosage
calculated according to type of cancer and pts size; based on mg per squared meter of total body surface area; given on regular basis; timed to maximize cancer cell kill and minimize damage to normal cells; usually scheduled every 3-4 wks
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Intrathecal route
delivers drugs into the spinal canal
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intraventricular route
delivers drugs into the ventricles of the brain
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Intraperitoneal route
delivers drugs into the abdominal cavity
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Intravesicular route
delivers drugs into the bladder
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Intravenous route
most preferred route; nurse should have completed a chemotherapy course
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Priority for IV chemotherapy
prevention of extravasation; close monitoring
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Chemotherapy cautions for health care workers
use extreme caution when handling, preparing, giving, or disposing of chemo; wear PPE including eye protection, masks, double gloves, gown
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Chemo side effect: Bone marrow suppression
neutropenia, anemia, thrombocytopenia
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Neutropenia
reduced neutrophils; increase risk of infection; most infections are result of pt's own normal flora
46
Care of pt with neutropenia
private room; handwashing; pt room/bathroom cleaned daily; no common supplies; limit number of health care personnel entering room; monitor VS every 4 hrs; inspect mouth, skin, and mm every 8 hrs; inspect open areas every 4 hrs; change wound drsg daily; obtain specimens for culture of suspicious areas; cough/deep breathe; appropriate activity level; change IV tubing daily; frequently used equipment in room; limit visitors to healthy adults; strict aseptic technique; monitor WBC/absolute neutrophil count daily; avoid foley catheter; no fresh flowers, raw fruits and vegetables, undercooked meat, eggs, and fish, pepper, paprika
47
Teach pt to report
temp >100; persistent cough; pus or foul-smelling drainage; boil or abscess; cloudy or foul smelling urine that causes burning
48
Anemia
reduced RBCs; may require transfusion therapy; erythropoiesis-stimulating agents (ESAs) can prevent or improve anemia assoc with chemotherapy
49
Erythropoiesis-stimulating agents (ESAs)
increase production of many blood cell types; increases risk for htn, blood clots, strokes, and heart attacks; dosing is based on individual pt hgb levels; examples: darbepoetin alfa, epoetin alfa
50
Thrombocytopenia
reduced platelets; provide safe hospital environment; growth factor therapy to increase platelet production
51
Growth factor therapy
causes fluid retention and increases the risk for heart failure and pulmonary edema, other side effects: conjunctival bleeding, hypotension, tachycardia; teach to weigh daily and report sudden weight gain or dyspnea; provide safe hospital environment; avoid injury and excessive bleeding
52
Care of pt with thrombocytopenia
handle pt gently; use lift sheet when moving and positioning pt in bed; avoid IM injections and venipunctures; when unavoidable, use smallest needle possible and apply firm pressure for 10 minutes; apply ice to trauma; test all urine and stool for occult blood; observe IV sites every 4 hrs for bleeding; notify nursing for trauma, bleeding, or bruising; avoid rectal trauma; measure abd girth daily; electric shaver rather than razor; soft bristled toothbrush; no water pressure gum cleaners; good fitting dentures; do not blow nose; wear firm soled shoes; keep pathways clear
53
Chemo side effect: Nausea/vomiting
most chemo drugs induce n/v; can be well controlled with antiemetic therapy
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Interventions for n/v
antiemetics to be given before during, and after chemo; music, progressive muscle relaxation, guided imagery, acupressure, distraction, drinking concord grape juice before meals
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Chemo side effect: mucositis
sores in mucous membranes; often develop in the entire GI tract; mouth sores are painful and interfere with eating
56
Interventions for mucositis
good and frequent oral hygiene; avoid traumatization of the oral mucousa; soft-bristled toothbrush; gentle flossing once daily; rinse mouth with plain water or saline hourly; avoid mouthwashes containing alcohol; clean toothbrushes weekly by running through dishwasher or rinsing in concentrated soln of liquid bleach or hydrogen peroxide; "swish and spit" mouthwash containing local anesthetic and anti-inflammatory agents
57
Chemo side effect: Alopecia
hair loss; temporary; regrowth usually begins about 1 month following completion of chemo
58
Management for alopecia
prevent injury to the scalp; assist pt in coping with body image change; ice cap during and for a few hrs after chemo; avoid direct sunlight; use sunscreen; wear head covering; purchase wig before chemo
59
Chemo side effect: change in cognition
reduced ability to concentrate, memory loss, difficulty learning new information; drugs do not cross blood-brain barrier; drugs induce inflammation and general biochemical changes that could reduce cognitive function temporarily; termed "chemo brain"
60
Management for change in cognition
support pt; listen to pts concerns; ensure pt that others have reported this side effect; warn pts against participating in other behaviors that could alter cognition
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Chemo side effect: Peripheral neuropathy
loss of sensory or motor function of peripheral nerves associated with exposure to certain anticancer drugs; often rapid onset; long term consequence and may be permanent
62
Management for peripheral neuropathy
teach to prevent injury; erectile dysfunction may be helped with devices or drug therapy; assess pts ability to cope with these changes; coordinate with occupational therapist to help pt adjust
63
Pt teaching for peripheral neuropathy
protect feet and other body areas where sensation is reduced; wear well fitting shoes; long break-in period for new shoes; avoid pointed toe shoes; avoid heels higher than 2"; inspect feet daily; avoid temp extremes; test water with thermometer when washing dishes or bathing; use potholders while cooking; use gloves when washing dishes or gardening; allow foods to cool from steaming; eat foods high in fiber; drink 2-3 L water daily; get up from lying or sitting position slowly; if dizzy, sit down until dizziness fades; look at feet and floor where you are walking; avoid using area rugs; use handrails when going up and down stairs
64
Photodynamic therapy
selective destruction of cancer cells through a chemical reaction triggered by laser light; can be used to destroy some cancers, reduce the size of tumors, and allow more complete tumor removal by surgery, and to shrink tumors in airways or esophagus to relieve obstruction
65
Nursing care priorities for photodynamic therapy
prevent complications and coordinating changes in the care environment for protection of the pt; pt has sensitivity to light for up to 12 weeks following drug injection; most intense period is 48 hrs after injection; skin and eyes remain sensitive for 30-90 days; pt should be homebound for 1-3 mos; lighting is kept to minimum; consult pharmacy for drug interactions
66
Pt and family teaching for before photodynamic therapy
bring protective clothing and sunglasses when pt comes in for injection; have someone to drive pt home; avoid leaving home during daylight for 1-3 mos; cover all windows with light-blocking shades or heavy drapes; replace high-wattage bulbs with lower-wattage ones
67
Pt and family teaching following photodynamic therapy
photosensitizing effects last from 1-3 mos; continue to wear protective clothing; drink plenty of water; do not take any newly prescribed or OTC drugs without contacting the physician who performed the PDT; re-expose to sunlight slowly; continue to wear dark sunglasses; follow up with ophthalmologist to check whether retina has damage
68
Biological Response Modifiers (BRMs)
modify the pts biologic responses to tumor cells; work by stimulating the immune system to recognize cancer cells and take actions to eliminate or destroy them; interleukins and interferons are common types of BRMs
69
Interleukins (ILs)
BRM that helps regulate inflammation and immune protection; recognize and destroy abnormal body cells
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Interferons (INFs)
slows tumor cell division; stimulates growth and activation of NK cells; induces cancer cells to resume a more normal appearance and function; inhibits the expression of oncogenes
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BRM therapy side effects
generalized and often severe inflammatory reactions; edema; peripheral neuropathy; decreased sensory perception; visual disturbances; decreased hearing; unsteady balance and gait; orthostatic hypotension; skin dryness, itching, and peeling
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Pt teaching during BRM therapy
reactions are temporary; apply moisturizers; use mild soap to clean skin; protect involved areas from sun; avoid swimming; avoid topical steroid creams on affected areas
73
Lung cancer
treatment often aimed toward symptom relief; most arise from the bronchial epithelium (bronchogenic carcinomas); classified by their histologic cell type (small cell lung cancer, epidermoid cancer, adenocarcinoma, large cell cancer); metastasis occurs by direct extension, through the blood, and by invading lymph glands and vessels; paraneoplastic syndromes caused by hormones secreted by tumor cells complicate certain lung cancers
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Lung cancer staging
Based on TNM system: T, primary tumor; N, regional lymph nodes; M, distant metastasis
75
Primary prevention for lung cancer
reducing tobacco smoking; safety precautions for workers in industrial settings
76
Lung cancer warning signs
hoarseness, change in resp pattern, persistent cough, blood-streaked sputum, rust-colored or purulent sputum, frank hemoptysis, chest pain or tightness, shoulder, arm, or chest wall pain, recurring pleural effusion, pneumonia, or bronchitis, dyspnea, fever associated with one or two other signs, wheezing, weight loss, clubbing of fingers
77
Lung cancer clinical manifestations: pulmonary
labored or painful breathing, tenderness or mass felt when palpating chest, fremitus, displaced trachea, dull or flat lung sounds, wheezing, decreased or absent breath sounds, friction rub
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Lung cancer clinical manifestations: nonpulmonary
muffled heart sounds, dysrhythmias, cyanosis, finger clubbing, increased bone density, bone pain, pathologic fractures, fatigue, weight loss, anorexia, dysphagia, n/v, confusion, personality changes, bowel and bladder tone decrease
79
Lung cancer clinical manifestations: psychosocial
fear, anxiety, guilt, shame; convey acceptance, interact with pt in nonjudgmental way; encourage pt to express feelings
80
Diagnostic assessment of lung cancer
Cytologic testing, thoracentesis, x-ray, CT, fiberoptic bronchoscopy, needle biopsy, thoracoscopy, mediastinoscopy, direct surgical biopsy, MRI, radionuclide scans, pulmonary function tests, arterial blood gas, PET scan
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Non-surgical management of lung cancer
chemotherapy, targeted therapy, radiation therapy, photodynamic therapy
82
Surgical management of lung cancer
removal of the tumor only, removal of a lobe, or removal of the entire lung; done in hope of cure
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Lobectomy
removal of a lung lobe
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Pneumonetomy
removal of an entire lung with severing of the bronchus
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Preoperative care for lung cancer surgery
relieve anxiety and promote pts participation in care; encourage pt to express fears and concerns; reinforce surgeon's explanation of the surgical procedure; provide education related to what to expect following surgery; teach about probably location of surgical incision or thorascopy openings, shoulder exercises, and chest tube and drainage system
86
Wedge resection
removal of the peripheral portion of small, localized areas of disease
87
Postoperative care for lung cancer surgery
closed-chest drainage to drain air and blood that accumulate in pleural space; chest tube allows re-expansion of the lung and prevents air and fluid from returning to the chest; nursing care priorities are to ensure the integrity of the system, promote comfort, ensure chest tube patency, and prevent complications
88
Chest tube review
tube from pt is connected to the 1st chamber (drainage collection chamber); second chamber (water seal) prevents air from moving back up the tubing system and into the chest; third chamber is suction regulator; chamber 1 does not initially have fluid in it; measure fluid hourly during the first 24 hrs; chamber 2 should always have 2 cm of water in it, water will bubble with expiration until all air has been evacuated from pleural space; tidaling should occur with inhalation/exhalation
89
Notify physician or rapid response team for
tracheal deviation, sudden onset or increased intensity of dyspnea, O2 sat less than 90%, drainage greater than 70 mL/hr, visible eyelets on chest tube, chest tube falls out of pts chest (first cover area with dry sterile gauze), chest tube disconnects from drainage system (first put end of tube in container of sterile water and keep below the level of pts chest), drainage in tube stops in first 24 hrs
90
Surgical pain management
administer prescribed drugs for pain and assess the pts response to them; monitor VS before and after opioid analgesics; plan care activities around time of analgesia
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Surgical respiratory management
maintain patent airway, ensure adequate ventilation, prevent complications; assess resp status every 2 hrs; warm and humidify oxygen; assist pt up to semi-Fowler's position or up in chair asap; IS hourly; cough by splinting
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Lung cancer palliative therapy
drug therapy (bronchodilators, corticosteroids, mucolytics, abx therapy), radiation therapy, thoracentesis, dyspnea management, pain management, hospice care
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Thoracentesis
fluid removal by suction after placement of a large needle or catheter into the intrapleural space; temporarily relieves hypoxia
94
Colorectal cancer
cancer of the colon or rectum; most are adenocarcinomas (tumors that arise from the glandular epithelial tissue); increased proliferation of the colonic mucosa forms polyps that can transform into malignant tumors; can metastasize by direct extension or by spreading through blood or lymph; liver is most common site of metastasis
95
Risk factors for CRC
older than 50 yrs; genetic predisposition; personal or family history of caner; Crohn's; ulcerative colitis; long term smoking; increased body fat; physical inactivity; heavy alcohol consumption; high-fat diet
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CRC health promotion
diagnostic screening at 50 yrs; regular fecal occult blood testing and colonoscopy every 10 yrs or double-contrast barium enema every 5 yrs; modify diet as needed to decrease fat, refined carbs, low-fiber foods; encourage baked and broiled foods
97
CRC clinical manifestations
rectal bleeding, anemia, change in stool consistency or shape; gas pains, cramping, incomplete evacuation; hematochezia, straining with BM, narrowing of stool; dull pain, mahogany-colored stool; mass in lower right quad, anemia; visible peristaltic waves, tinkling sound
98
CRC psychosocial assessment
fear, anxiety, life has been disrupted, searching for ways to deal with diagnosis, concern about family, concerns about pain, possible disfigurement, possible death, anxiety concerning implications for immediate family members
99
CRC lab assessment
Hgb/Hct decreased; elevated LFTs; occult blood in stool; teach to avoid ASA, vit C, and red meat for 48 hrs before giving stool specimen; discontinue anti-inflammatory drugs for a designated period before test; 2-3 separate stool samples should be tested on 3 consecutive days; carcinoembryonic antigen (CEA) is elevated but not specifically associated with CRC
100
CRC imaging assessment
double-contrast barium enema, colonoscopy, CT, MRI, sigmoidoscopy, colonoscopy (definitive test for diagnosis)
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CRC nonsurgical management
radiation therapy, drug therapy
102
CRC surgical management
colon resection, colectomy, abdominoperineal resection
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Colon resection
removal of the tumor and regional lymph nodes
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Colectomy
colon removal
105
Abdominoperineal resection
performed when rectal tumors are present
106
CRC preoperative care
reinforce physician's explanation; tell pt colostomy is a possibility; certified wound, ostomy, continence nurse will recommend optimal placement of the ostomy and give pt teaching; reinforce teaching about abdominal surgery; review routines for turning and deep breathing; discuss method of pain management; pt may do "bowel prep"; may have dose of IV abx prior to incision; NG tube may be placed; peripheral IV or central venous catheter is placed for fluid and electrolyte replacement; case manager or social worker visit
107
CRC operative
if anastomosis is not feasible, colostomy is created; loop stoma is made by bringing a loop of the colon to the skin surface, severing and everting the anterior wall, and suturing it to the abdominal wall; end stoma is constructed with a colostomy is intended to be permanent; end stoma is contructed by severing the end of the proximal portion of the bowel and bringing it out through the abdominal wall
108
CRC postoperative care: open colon resection
NGT; IV PCA 24-36 hrs postop; after NGT removal diet is slowly progressed as tol
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CRC postoperative care: laparoscopic surgery
progress from liquids to solids more quickly; less pain; able to ambulate sooner; shorter hospital stay
110
Stoma assessment
reddish pink, moist, should protrude about 3/4" from the abdominal wall; may be slightly edematous and small amount of bleeding is common initially; report signs of ischemia and necrosis, unusual bleeding, and mucocutaneous separation
111
Colostomy management
should begin functioning in 2-4 days; may begin with excessive gas collection; empty when 1/3-1/2 full of stool; ascending colon is liquid, transverse colon is pasty, descending colon is more solid
112
Colostomy wound management
serosanguineous drainage from perineal wound may be observed for 1-2 mos; complete healing may take 6-8 mos; may experience phantom rectum sensations; assess for signs of infection, abscess, or other complications
113
Perineal wound care
place absorbent dressing over the wound; instruct pt that he/she may use a feminine napkin for a dressing and wear jockey type shorts rather than boxers
114
Perineal wound comfort measures
soak the wound in sitz bath for 10-20 min 3-4 times daily; admin pain med as prescribed; instruct pt about permissible activities; pt should use side-lying position in bed; avoid sitting for long periods; use foam pads or a soft pillow to sit on; avoid air rings or rubber donut devices
115
Perineal wound prevention of complications
maintain fluid and electrolyte balance by monitoring input/output and output from the wound; observe incision integrity; monitor wound drains; watch for erythema, edema, bleeding, drainage, unusual odor, and excessive or constant pain
116
CRC surgical pt coping
observe and identify pts current methods of coping, effective sources of support used in past, present perceptions of the health problem, signs of anticipatory grief; encourage to verbalize feelings, look at and touch the stoma, participate in colostomy care; assist pt with identifying nature and reaction to loss, verbalize feelings and fears; establish trusting, ongoing relationship and provide support through grief; encourage pt to implement cultural, religious, and social customs associated with loss and identify sources of community support
117
Colostomy home management
ostomy products should be kept in area neither hot nor cold; consume regular diet on discharge; avoid lifting heavy objects and straining on defecation; avoid driving for 4-6 wks if open surgical approach; usual activities in 1-2 wks for laparoscopy; opening of appliance should be large enough not only to cover the peristomal skin, but also to avoid stomal trauma; stoma will shrink within 6-8 wks after surgery; measure at least once weekly and if the pt gains or loses weight; trace the pattern of the stomal area on the wafer portion and cut an opening about 1/8-1/16" larger than the stomal pattern; skin prep is to clean around the stoma with mild soap and water; avoid moisturizing soaps; report any fever or sudden onset of pain or swelling around stoma
118
Preventing colostomy odor
certain foods and habits can cause flatus or contribute to odor; charcoal filters, pouch deodorizers, or breath mint in pouch can help eliminate odors; crackers, toast, yogurt can help prevent gas; buttermilk, cranberry juice, parsley, or yogurt can help prevent odor
119
Health care resources for colostomy
make referrals to community-based case managers or social workers; United Ostomy Association of America; American Cancer Society; hospice, nursing home, or other long-term care setting may be appropriate; info about ostomy supplies needed and where they can be purchased
