Med Surg: ATI: Cancer Disorders Flashcards
(46 cards)
Leukemia
cancers of white blood cells (WBCs) or of cells that develop into white blood cells
-the white blood cells are not functional
-they invade and destroy bone marrow
-can metastasize to liver, spleen, lymph nodes, tests, and brain
>overgrowth of leukemic cells prevents growth of other blood components (platelets, erythrocytes, mature leukocytes)
-lack of mature leukocytes leads to immunosuppression; infection
-lack of platelets leads to increased risk of bleeding
Leukemia: Health promotion
- use protective equipment, such as mask, and ensure proper ventilation while working in environments that contain carcinogens or particles in the air
- influenza and pneumonia vaccinations are important for all clients who are immunocompromised
Leukemia: Risk Factors
- immunosuppression
- exposure to chemotherapy agents or medications that suppress bone marrow
- genetic factors (hereditary)
- ionizing radiation
> Older adult clients
- often have diminished immune function and decreased bone marrow function
- have decreased energy reserves and can tire more easily during treatment; safety is a concern with ambulation
Leukemia: Expected Findings
- bone pain
- joint swelling
- enlarged liver and spleen
- weight loss
- fever
- poor wound healing (infected lesions)
- manifestations of anemia (fatigue, pallor, tachycardia, dyspnea on exertion)
- evidence of bleeding (ecchymoses, hematuria, bleeding gums)
- headaches, behavior changes, decrease attention
Leukemia Diagnostic Procedures
> CBC
- WBC can be high, low, or normal
- Hemoglobin, hematocrit, and platelets decreased
> Coagulation time
- increased with leukemia
- monitor for bleeding
> Biopsy of bone marrow (core or fine-needle)
-large quantities of immature leukemic blast cells
Nurse actions during procedure:
-administer pain medications
-apply pressure for 5 to 10 minutes, then pressure dressing
-monitor bleeding and infection for 24 hours
Leukemia Nursing Care
> Monitor for infection; assess for physiological indicators of infection (lung crackles, cough, urinary frequency or urgency, oliguria, lesions of skin or mucous membrane)
> Manifestations that stem from the immune response (increased WBC, fever, pus, redness, inflammation) are not likely due to immunosuppression
> Implement neutropenic precautions (for chemotherapy induction and for bone marrow transplant client)
> prevent injury
- monitor platelets
- assess for obvious or occult bleeding
- protect from trauma (avoid injections an venipunctures, apply firm pressure, increase vitamin K intake)
- use electric shaver, soft bristled-toothbrush, avoid contact sports
> Conserve energy
- encourage rest, adequate nutrition, and fluid intake
- ensure client gets adequate sleep
- assess clients energy resources/capability
- plan activities as appropriate
Leukemia: Treatment
- Chemotherapy
- Colony-stimulating Medications: Filgrastim to stimulate production of leukocytes; assess bone pain
- Hematopoietic bone stem cell transplantation
Complications of Hematopoietic Stem Cell Transplantation
Graft-versus-host disease (graft rejection)
-administer immunosuppressants as prescribed
Complications of Leukemia
> Pancytopenia: decrease in WBCs, RBCs, and Platelets
- risk of infection increases as ANC falls; An ANC less than 1,000/mm3 = weak immune system; implement neutropenic precautions
- maintain hygienic environment
- monitor for infection (cough, alterations in breath sounds, urine, or feces)
- report temperature greater than 100 Degrees F
- administer antimicrobial, antiviral, and antifungal medications as prescribed
- administer blood products (granulocytes) as needed
> Thrombocytopenia
- increases risk of bleeding
- greatest risk is at platelet counts less than 50,000/mm3
- spontaneous bleeding can occur at less than 20,000/mm3
- monitor for petechiae, ecchymosis, bleeding of gums, nosebleeds, and occult frank blood in stool, urine, or vomitus
- institute bleeding precautions (avoid IVs and injections; apply pressure for 10 min after blood is obtained; handle client gently
- safe environment
- administer blood products (platelets) if count less than 10,000/mm3
> Hypoxemia
- anemia increases risk for hypoxemia
- plan care to balance rest and activity and use assistive devices
- monitor RBCs
- provide diet high in protein and carbohydrates
- administer colony-stimulating factors such as epoetin alfa (to stimulate RBC production)
- administer blood products (packed red blood cells)
Lung Cancer
- non-small cell: squamous, adeno, and large cell carcinomas
- small-cell: fast-growing and is linked to cigarette smoking
> Risk Factors:
- exposure to cigarette smoke
- radiation exposure
- inhaled environment irritants (air pollution, asbestos, coal, other talc dusts)
- older adult clients have decreased pulmonary reserves due to normal lung changes (decreased lung elasticity and thickened alveoli) contributing to impaired gas exchange
- structural changes in the skeletal system decrease diaphragmatic expansion, restricting ventilation
Lung Cancer: Assessment
- determine the pack-year history for clients who smoke
- evaluate use of other tobacco products (cigars, pipes, and chewing tobacco)
- ask about exposure to second hand smoke
- monitor for cough that changes in pattern
Lung Cancer: Expected Findings
- fatigue, weight loss, anorexia
- fever (pneumonitis or bronchitis that occurs with obstruction)
- persistent cough with or w/o hemoptysis
- hoarseness
- altered breathing pattern: dyspnea, prolonged exhalation alternated with shallow breaths (obstruction), rapid shallow breaths (pleuritic chest pain, elevated diaphragm)
- altered breath sounds (wheezing)
- diminished or absent breath sounds (obstruction)
- chest pain or tightness
- chest wall masses
- muffed heart sounds
- pleural friction rub
- clubbing of fingers
- increased work of breathing (retractions, use of accessory muscles, stridor, nasal flaring)
- decreased bone density
Lung Cancer: Diagnostic Procedures
> Cytologic Testing
-sputum specimen contains cancer cells
> Thoracoscopy, bronchoscopy, mediastinoscopy
-presence of cancer cells
-can include biopsy or tumor or lymph nodes
Nursing:
-NPO after midnight
-provide throat lozenges or sprays for report of a sore throat once gag reflex returns
> X-ray, CT scan
- lung lesions
- presence of tumor
> Thoracentesis with pleural biopsy; MRI, PET scan
-presence of cancer and metastatic disease
> Pulmonary function tests and arterial blood gases
-compromised respiratory status
Lung Cancer: Nursing Care
> monitor nutritional status, weight loss, and anorexia
-adequate nutrition; provide needed calories for increased work of breathing and prevention of infection
-encourage fluids for hydration
Maintain patent airway and suction as needed
Fowler’s position to maximize ventilation
Lung Cancer: Medications
> Bronchodilators and corticosteroids
-help decrease inflammation and to dry secretions
Lung Cancer: Therapeutic Procedures
> Chemotherapy
-primary choice
-cisplatin used
adverse effects: nausea, vomiting, hair loss, mucositis, neutropenia, thrombocytopenia, peripheral neuropathy
> Photodynamic therapy
-performed through bronchoscopy to treat small, accessible tumors
> Radiation
-effective for lung cancer that has not spread beyond the chest wall and is used as an adjuvant therapy
Lung Cancer: Surgical interventions
- goal= remove all tumor cells, including involved lymph nodes
- pneumonectomy (removal of lung)
- lobectomy (removal of lobe)
- wedge resection (peripheral lung tissue)
- reserved for early stage (I or II) with no metastasis
> Nursing:
- monitor vital signs, oxygenation (saO2, and ABGs), and evidence for hemorrhage
- manage chest tube
- administer oxygen and manage ventilator if appropriate
- manage pain; teach about PSA pump
Lung Cancer: Palliative procedures
- thoracentesis or pleurodesis to ease breathing
- laser therapy and photodynamic therapy can be used in treatment and palliative therapy to open airways blocked by tumors
- pericardiocentesis or pericardial window to improve cardiac function
- oxygen therapy to correct hypoxemia
Colorectal Cancer
cancer of the rectum or colon
- can begin as a poly that is benign and if left untreated can grow and risk of malignancy increases
- can metastasize (through blood or lymph) to liver (most common), lungs, brain, or bone
Colorectal Cancer: Health promotion
- diet rich in calcium (calcium binds to free fatty acids and bile salts in the lower GI tract)
- diet low in fat and simple carbohydrates but high in fiber
- age-specific screening
- genetic testing for familial adenomatous polyposis
- healthy lifestyle
- no smoking/ alcohol
Colorectal Cancer: Risk Factors
- adenomatous colon polyps
- African American descent
- inflammatory bowel disease (ulcerative colitis, Crohn’s)
- high-fat, low-fiber diet
- long-term smoking
- physical inactivity
- heavy alcohol consumption
- infection exposure to helicobacter pylori, streptococcus bovis, HPV
- personal or family hx
Colorectal Cancer: Expected findings
> changes in stool consistency or shape (with or without noticeable blood)
Blood in stool
-left-sided tumors likely to produce frank bleeding and change in bowel pattern, consistency
-right-sided tumors cause stools to be darker due to ulceration of the colon and intermittent bleeding
cramps and/or gas
palpable mass
weight loss and fatigue
vomiting
abdominal fullness, distention or pain
-abnormal bowel sounds indicative of obstruction (high-pitched tinkling bowel sounds)
rectal pain
sensations of bowel fullness after defecation
Diagnostic Procedures
- virtual colonoscopy can be performed using CT scans or MRI; noninvasive, no sedation
- fecal testing recommended every year if guaiac-based fecal occult blood testing or fecal immunochemical testing is used, or every 3 years if the stool DNA test is used
- screening guidelines for individuals with polyps of family hx
> Guaiac-based fecal occult blood testing (FOBT)
-findings:2 positive stools within 3 days
Nursing:
-do not use stool from digital rectal examination to avoid false-positive results
-negative results do not completely r/o CRC
Client Education:
-avoid red meat, anti-inflammatory medications, and vitamin C for 48 hours prior to testing
> Biopsy
-definitive diagnosis
> Endoscopy: colonoscopy, sigmoidoscopy
-visualization of polyps or lesions
> Double contrast barium enema
-uses the two contrasts of air and barium
-expected findings: visualization and location of tumor
Nursing:
-administer stimulant laxative following procedure as prescribed (facilitates evacuation of barium, which can harden in the intestine)
> CBC
-decreased hemoglobin and hematocrit
> Carcinoembryonic antigen (CEA)
- expected: positive (denotes malignancy; not specific to CRC)
- positive may = many types of cancer
> CT/MRI
-visualization and location of tumor/ metastasis
Colorectal Cancer: Therapeutic Procedures
> Chemotherapy
-prescribed for clients who have stage III and IV or stage I
> Targeted medication therapy
- Monoclonal antibodies:
- angiogenesis inhibitors (inhibit growth of new blood vessels to tumors): bevacizumab
- tyrosine kinase inhibitors (decrease cell proliferation and increase cell death): cetuximab and panitumumab
> Adjuvant therapy
-given to decrease the chance of metastasis for stage II and distant metastasis for stage III
> Radiation
- minimize localized manifestations around the tumor
- used a palliative measure to control pain, hemorrhage, bowel obstruction, or metastatic disease
