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NCLEX > Oncology > Flashcards

Oncology Flashcards

(69 cards)

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1
Q

primary prevention

A

ways to prevent the actual occurrence of cancer
-no smoking
-exercise and good nutrition
-maintain normal body weight
-limit or eliminate alcohol intake
-vaccines for preventable viral exposures (Hep B & HPV)
-avoid exposure to known carcinogens

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2
Q

secondary prevention

A

when screenings are used to pick-up on cancer early, when there is a greater chance for cure or control

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3
Q

secondary prevention for female

A

-monthly breast self exams starting at 20
day 7-12 after period
-yearly clinical breast exams for women >40 y.o.
-yearly clinical breast exams for women 20-39 need one every three years
-Annual mammogram at age 40 (no lotion. no powder, no deodorant)
-Pap smears at age 21 and every 3 years
-colonoscopy at age 50 then every 10 years
-occult stool testing yearly at age 50

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4
Q

secondary prevention for male

A

-yearly breast and testicular exams
-digital rectal exams, PSA over age 50
-colonoscopy at age 50 and then every 10 years
-fecal occult blood testing annually over the age of 50

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5
Q

tertiary prevention

A

focuses on the management of long-term care for clients with complex treatments for cancer
-support groups and rehab programs

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6
Q

general signs and symptoms of Cancer

A

-Change in bowel/bladder habits
-A sore that does not heal
-Unusual bleeding/discharge
-Thickening or lump in breast or elsewhere
-Indigestion or difficulty swallowing
-Obvious change in wart or mole
-Nagging cough or hoarseness

-anemia, leukopenia, thrombocytopenia
-unexplained weight loss
-fever
-fatigue
-pain

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7
Q

bleeding precautions

A
  1. Use an electric razor
  2. Use a soft toothbrush
  3. No IMs
  4. Quiet play for children
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8
Q

blood tests for cancer diagnosis

A

-abnormal CBC & diff (neutrophil count)
-elevated AST & ALT
-tumor markers (biomarkers)

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9
Q

total laryngectomy

A

-removal of vocal cords, epiglottitis, and thyroid cartilage
-client will have a permanent tracheostomy or laryngectomy
-Position pt in Mid-Fowlers (30-45 degrees)
-NG feedings to protect the suture line
-monitor drains
-watch for carotid artery rupture
-rupture of the innominate artery
-frequent oral care to decrease bacterial count in the mouth
-humidified environment helps
-breathing done through a stoma

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10
Q

post op care following a mastectomy

A

-bleeding –> check dressings, front and back
-abdominal incision site possible
-hemovac or jackson-pratt drain

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11
Q

nursing care if any lymph nodes removed with mastectomy

A

avoid procedures on arm of the affected side
-no constriction, no BPs, no blouses with elastic, no watch, no IV or injections on the affected side
-wear gloves when gardening, watch small cuts, no nail biting, and no sunburn
-brush hair, squeeze tennis balls, wall climbing, flex and extend elbow to promote new collateral circulation

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12
Q

internal radiation therapy

A

brachytherapy is used to get radiation close to the cancer or target tissue
-it is inside the body
-client will emit radiation for a period of time and is a hazard to others

unsealed
-client & body fluids emit radiation
-isotope given PO or IV
-Radioactive for 24-48 hours

sealed
-client emits radiation, body fluids are not radioactive
-can be temporary or a permanent implant that is placed close to or inside the tumor
ex: prostate cancer-implantable seeds, cervical cancer- vaginal implant

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13
Q

precautions for internal radiation

A

-rotate nursing assignments daily
-nurses should only care for one client with a radiation implant in a shift
-patient should be in a private room
-wear a film badge at all times
-restrict visitors
-limit each visitor to 30 minutes per day
-visitors must stay at least 6 feet from the source
-no visitors less than 16 years old
-no pregnant visitors/nurses
-mark the room with instructions for specific isotope
-wear gloves
-keep client on bedrest, decrease fiber in pt’s diet, prevent bladder distention
-pt should not sleep with spouse or children, should not return to work immediately, should not share utensils or cook for others
-need to flush the toilet 2-3x after use

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14
Q

external radiation (teletherapy, external beam radiotherapy)

A

a carefully focused bean of high energy rays is delivered by a machine outside of the body

-client is not radioactive
-side effects are limited to exposed tissues: erythema, shedding of skin, fatigue, pancytopenia (decreased WBC, RBC, platelets)
-S&S are location and dose related
-patient needs to protect the site from sun light & UV exposure for 1 year after completion of therapy

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15
Q

Action of chemotherapy

A

-eliminate or reduce the number of cancer cells by destroying the cells as they are developing
-drugs attack a specific phase of cell development (cell-specific drugs)
-drugs that work at all or any phase of cell development are cell cycle non-specific
-drugs work best when cells are actively growing

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16
Q

precautions for chemo

A

-gown: coated to prevent contamination
-two pairs of gloves, thicker & longer than standard gloves, one pair under the gown & one pair over
-goggles and/or mask if splashing or inhalation can occur

**chemo is excreted for 3-7 days after administration

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17
Q

disposal of chemo

A

-yellow rigid chemo waste containers- sharps & IV equipment
-yellow chemo waste bag- gowns, gloves, and disposable items
wash hands with soap & water after removing gloves

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18
Q

managing chemo spills

A
  1. wash hands thoroughly with soap and water
  2. get spill kit from wall in client’s room
  3. put on respirator mask
  4. put on chemo gown
  5. put on 2 sets of gloves
  6. put on goggles
  7. use absorbent pads to wipe up spill

-floor needs to be cleaned 3x with detergent & water

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19
Q

extravasation

A

-chemo drugs given through central line
-vesicants can infiltrate and cause tissue necrosis

signs & symptoms
-pain
-swelling, and no blood return

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20
Q

treatment for extravasation

A

-stop infusion
-send for extravasation kit
-stay with the client
-know protocols prior to administration

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21
Q

GI system side effects of Cancer/treatment

A
  • Nausea/vomiting: most common side effect 24-48 hours after tx. Routine antiemetic given 1st week of chemo
    ondansetron or netupitant/palonosetron
    non-pharm tx: ginger, aromatherapy (peppermint, lavender, lemon), acupuncture, acupressure, distraction, relaxation techniques

-Stomatitis: oral cavity is susceptible to irritation

-Diarrhea: worry about nutrition & F&E imbalances

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22
Q

ondansetron

A

-block the effects of serotonin

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23
Q

integumentary side effects of cancer/tx

A

-alopecia
-huge sense of loss
-encourage pt to look at their incision

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24
Q

hematopoietic system (bone marrow) side effects of cancer/tx

A

-bone marrow suppression causes decrease RBCs, WBCs, & platelets. At risk for anemia, thrombocytopenia & infection

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25
general infection prevention precautions
-provide a private room, limit visitors -keep client's own supplies in room -change dressings & IV tubing daily -cough & deep breathe -no gardening or cleaning up after pets -avoid crowds; wear a mask out in public -good handwashing -wash hands after touching pet -drink only fresh water -avoid uncooked meat, seafood, or eggs -brush teeth with soft toothbrush 4x/day -no alcohol-based mouthwash -report to hospital for temp >100.4
26
neutropenic precautions
-abx as prescribed -Vital signs q4 hours -private room with door closed & sign -antimicrobial soap for handwashing -no invasive procedures (IM, rectal exams/meds) -avoid indwelling catheters or NG tubes if possible -limit use of acetaminophen
27
pain tx & side effects for cancer
-opioids are "gold standard" -do not worry about risk for dependence -monitor for constipation
28
neutropenia
-a decrease in the number of neutrophils (mature WBCs) in the blood -calculate the absolute neutrophil count -normal ANC= 2,500-8,000 cells/mm tx of neutropenia: abx, neutropenic precautions
29
DVTs & cancer
second leading cause of death in cancer patients -prolonged bed rest -surgery -use of a central line -external compression of vessels by the tumor -invasion of vessels by the tumor -certain chemo drugs
30
risk factors for thrombocytopenia
-advanced metastatic disease -hematological malignancies -bleeding disorders -bacterial infections -anticoagulant meds -cancer treatment
31
risk factors of cervical cancer
-HPV -repeated STDs -multiple partners -smoking & 2nd hand smoke exposure -nutritional deficiences: folate, beta-carotene, Vitamin C -prolonged hormonal therapy -family hx -immunosuppression -sex @ a young age & multiple pregnancies
32
signs and symptoms of cervical cancer
-asymptomatic in pre-invasive cancer -invasive cancer symptoms: painless vaginal bleeding -watery, blood-tinged vaginal discharge -pelvic pain -leg pain along sciatic nerve -flank/back pain -excellent cure rate if caught early
33
diagnosis of cervical cancer
pap smear
34
treatment of cervical cancer
-electrosurgical excision -laser -cryosurgery -radiation and chemo for late stages -conization- remove part of the cervix -hysterectomy
35
risk factors of endometrial cancer
-greater than 50 y.o. -taking estrogen therapy without progesterone -positive family hx -late menopause -no pregnancy (null parity)
36
signs and symptoms of endometrial cancer
-post-menopausal bleeding -watery/bloody discharge, low back/abdominal pain, pelvic pain
37
diagnosis of endometrial cancer
-CA-125 (blood test) to R/O ovarian involvement -dilatation & curettage and endometrial biopsy
38
treatment of endometrial cancer
-total abdominal hysterectomy (uterus & cervix only) major complication: hemorrhage -Bilateral oophorectomy (ovaries) -Bilateral salpingectomy (tubes) -radical hysterectomy remove all of the pelvic organs client may have colostomy or ileal conduit -monitor for hemorrhage (24 hrs after) because of pelvic congestion of blood -radiation (intra-cavitary) -chemo -estrogen inhibitors
39
patient education after hysterectomy
-monitor for infection d/t urinary catheter -prevent abdominal distention--> void!! -avoid high-fowler's because it will make more blood go to the pelvis -check dressing -early ambulation -avoid sex & driving -avoid girdles & douches -avoid exercise that will increase pelvic congestion -hemorrhage can occur 10-14 days post op -whitish discharge is normal -do not take baths, only showers
40
Risk factors of breast cancer
-3 fold risk if a first degree relative (mother, sister, daughter) had pre-menopausal breast cancer -high dose radiation to thorax prior to age 20 -period onset prior to age 12 -menopause after age 50 -no pregnancy -first birth after 30 y.o.
41
signs and symptoms of breast cancer
-change in breast appearance (orange peel, dimpling, retraction, discharge from breast) or lump -tail of spence: upper quadrant, where 48% of tumors occur
42
treatment of breast cancer
-surgery -chemo drugs -hormonal therapy estrogen receptor blocking agents estrogen synthesis inhibitors -radiation
43
risk factors for lung cancer
-leading cause of cancer death worldwide -smoking!! -once smoking has been stopped for 15 years, the incidence is that of a non-smoker
44
signs & symptoms of lung cancer
-hemoptysis, dyspnea, hoarseness, cough, change in endurance, chest pain, pleuritic pain on inspiration, displaced trachea -may metastasize to bone
45
diagnosis of lung cancer
-bronchoscopy -chest x-ray -CT -MRI
46
treatment of lung cancer
-surgery (stage 1 & 2) -lobectomy: part of the lung, chest tubes & surgical side up -pneumonectomy: entire lung removed, position on affected side (surgical side down, good lung up), no chest tubes, avoid severe lateral positioning
47
risk factors of laryngeal cancer
-smoking (any form of tobacco use) -alcohol -voice abuse -chronic laryngitis -industrial chemicals
48
S&S of laryngeal cancer
-hoarseness -lump in neck -sore throat -cough -problems breathing -earache -weight loss -no early signs
49
diagnosis of laryngeal cancer
-laryngeal exam -MRI
50
treatment of laryngeal cancer
1. surgery: total laryngectomy, humidified environment, breathing done through a stoma 2. radiation 3. chemo 4. speech rehab -begins preop
51
risk factors for colorectal cancer
-may start as a polyp -2/3 occur in the rectosigmoid region -may metastasize to the liver--> bleeding precautions -bowel obstruction, perforation, fistula to bladder/vagina -inflammatory bowel disease, genetics -dietary factors (refined carbs, low fiber, high fat, red meat, fried & boiled foods) -first degree relative increased risk by 3x -older then 50
52
diagnosis of colorectal cancer
fecal occult blood testing begins at age 45 colonoscopy is the definitive test
53
signs and symptoms of colorectal cancer
-change in bowel habits, constipation, diarrhea, or narrowing of the stool -blood in the stool, cramping, abdominal pain, weakness, fatigue, anemia, abdominal fullness, unexplained weight loss -obstruction-visible peristaltic waves with high pitched tinkling bowel sounds
54
treatment of colorectal cancer
-surgery, radiation, chemo -possible colostomy or abdominoperineal resection (colon, anus, rectum)--> cannot take rectal temp
55
do not take rectal temp if
thrombocytopenic, abdominoperineal resection, or immunosuppressed
56
risk factors for bladder cancer
smoking
57
S&S of bladder cancer
-painless, intermittent gross/microscopic hematuria
58
diagnosis of bladder cancer
cystoscopy
59
treatment of bladder cancer
-surgery (remove all of part of the bladder)--> urinary diversion (urostomy) -ileal conduit- piece of the iluem is turned into the bladder, ureters are placed in one end; the other is brought to the abdominal surface as a stoma -may be impotent -hourly outputs -increase fluids (2,000-3,000 mL/day) to flush conduit -mucus in the urine is normal -change appliance in the AM
60
S&S of prostate cancer
-hesitancy, frequency, frequent infections, nocturia, urgency, dribbling -may be asymptomatic -painless hematuria (most common)
61
diagnosis of prostate cancer
-digital rectal exam: if prostate is hard/nodular usually means prostate cancer -lab work increase PSA, >4 ng/mL 2 or more first degree relatives with prostate cancer, start screening at 45 y.o. alkaline phosphatase (increased indicates bone metastasis), may metastasize to the spine, sacrum, or pelvis -biopsy for confirmation
62
treatment of prostate cancer
-watchful waiting: in early stages (for asymptomatic, older adults with another illness) -surgery 1. radical prostatectomy 2. prostatectomy (TURP-transurethral resection of the prostate) -radiation -chemo -hormone therapy (may decrease testosterone)
63
radical prostatectomy
done when the cancer is localized to the prostate -take out the prostate=cancer free -may have erectile dysfunction -may have incontinence -client is sterile -if no lymph node involvement, no increase in acid phosphatase, and no metastasis, surgeon will try to preserve pudendal nerve
64
prostatectomy (TURP)
-usually for BPH to help urine flow, not a cure for cancer -bleeding is most common complication -continuous bladder irrigation-maintains patency and flushes out clots: 3 way catheter, no kinks, subtract irrigation from output -keep up with amount of irrigant instilled give belladonna & opium suppository or oxybutynin for bladder spasms -avoid sitting, driving and strenuous exercise -avoid straining (take Docusate)
65
risk factors of stomach cancer
-H-pylori -pernicious anemia -achlorhydria -pickled foods, salted meats/fish, nitrates/increased salt -tobacco & alcohol -billroth II (partial gastrectomy with an anastomosis
66
S&S of stomach cancer
-heartburn & abdominal discomfort -loss of appetite, weight loss -blood stools, coffee-ground vomitus -jaundice -epigastric & back pain -feeling of fullness -anemia -obstruction
67
diagnosis of stomach cancer
Upper GI, CT, EGD
68
tx of stomach cancer
-surgery: gastrectomy fowler's position, decreases stress on suture line -NG tube -two major complications: dumping syndrome and Vitamin B-12 deficient anemia (pernicious) -chemo -radiation
69
schilling's test
measures the urinary excretion of Vitamin B-12 for dx of pernicious anemia

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