Oncology Flashcards

Question

Preventing dislodgement of implant

Answer 1

How can you help prevent dislodgement of the implant? Keep the client on Bed rest Decreases Fiber in the diet as it distends the bowel Prevent Bladder distention - use an indwelling cath

Answer 2

NO They should also not use public transportation, return to work immediately, share utensils or cook for others. Must flush toilet twice

Answer 3

A carefully focused beam is delivered by machine outside of the body. Client is NOT radioactive. Side effects are usually limited to exposed tissues: Erythema Shedding of skin Altered Taste Fatigue Pancytopenia ( All blood components are decreased) S&S depends on location and dose. Don't wash off or put lotion on markings Protect the site from sunlight and UV exposure for one year after completion of therapy.

Answer 4

``` Common uses: Breast cancer Leukemia Lymphoma Hodgkin Disease Multiple myeloma ``` ``` Contraindications: Hypersensitivity Myelosuppression Pregnancy Liver or kidney disease ``` ``` PO/IV/ 7 days Interactions: Garlic and ginko increase antiplatelet effect. Echinacea decreases effects of immunosuppressive drugs. Ginseng and kava kava alters bleeding times ``` MoA: Directly damages DNA (the genetic material in each cell) to keep the cell from reproducing. These drugs work in all phases of the cell cycle. Advantages: Especially useful for Hodgins’s disease if resistant to other drug combinations. Disadvantages: Severe vesicant that can cause tissue necrosis if it infiltrates into the tissues. Can cause long term damage to thebone marrow ``` Side Effects: Nausea Vomiting Diarrhea Weight loss Hematuria Alopecia Impotence Sterility Ovarian fibrosis Headache Dizziness ``` ``` Adverse Effects: Leukemia Vesicant: Tissue necrosis Hemorrhagic cystitis Cardiotoxicity Hepatotoxicity ``` Interventions: Monitor IV site for extravasation: Cold compresses Assess need for IV hydration. The client should be well hydrated (2L/day) to prevent hemorrhagic cystitis. Observe for s/s of hematuria. Monitor BUN and creatinine Avoid direct skin, eye, and mucus membrane contact with drug Education: Take medication early in the day to prevent accumulation of drug in the bladder. Report signs of infection. Do not visit anyone who has a respiratory infection Emphasize protective precautions. Rationale for chemotherapy. Teach importance of birth control while receiving therapy

Answer 5

``` Common Uses: Breast cancer Ovarian cancer Lung cancer Bladder cancer Leukemi ``` Contraindications: Pregnancy Severe cardiac disease ``` IV/7-10 days Contraindications: Calcium channel blockers increase risk of cardiotoxicity. Green tea may enhance effects. Garlic, St John’s wart may decrease effects of chemo ``` MoA: These drugs are not like the antibiotics used to treat infections. They work by altering the DNA inside cancer cells to keep them from growing and multiplying. anti-tumor antibiotics that interfere with enzymes involved in DNA replication. These drugs work in all phases of the cell cycle. They are widely used for a variety of cancers. Disadvantages: Severe cardiotoxic side effects can occur. Potent vesicant. Cannot exceed lifetime dose of 550mg/m2 ``` Side Effects: Stomatitis Anorexia Nausea/Vomiting Diarrhea Rash Alopecia ``` ``` Adverse Effects: Vesicant Esophagitis Thrombocytopenia Anemia Cardiotoxicity CHF Anaphylaxis ``` ``` Interventions: Give through large bore IV needle. Monitor IV site for extravasation: Apply ice pack. Notify MD. Dexrazoxan IV. Assess cardiac status. ``` ``` Client Education: Signs/symptoms of cardiac dysfunction Drug causes urine to turn pink or red Report signs of infection or bleeding Protective precautions Do not visit anyone with a respiratory infection ```

Answer 6

``` Common Uses: Palliative treatment of advanced breast cancer positive lymph nodes in postmenopausal women ``` Contraindications: Pregnancy Breastfeeding Hypersensitivity PO Interactions: Increased risk of bleeding with anticoagulants MoA: This male hormone (androgen) promotes regression of tumors by competing with estradiol at estrogen receptor sites. Decreases DNA synthesis. Reduces risk of breast cancer in postmenopausal women Advantages: Prevents tumor recurrence in both pre-menopausal and postmenopausal women ``` Side Effects: Masculine secondary sexual characteristics. Hot flashes Irregular menses Fatigue Headaches Impotence Decreased interest in sexual activity ``` ``` Adverse Effects: Increases risk of developing uterine cancer. Stroke Pulmonary embolism Thrombocytopenia ``` Interventions: Monitor CBC, platelet count weekly. Monitor for allergic reactions. Education: Avoid use of St. John’s wart, dong qui, black cohosh. Use nonhormonal contraception during and for 2 months after discontinuing treatment. Notify prescriber of signs of stroke. Increase fluids to 2 liters/day unless contraindicated. Protect from sun.

Answer 7

Leukemias Breast cancer Ovarian cancer Intestinal tract cancer Contraindications: Pregnancy and Severe Infection ``` IV/IM/1 - 9 days Interactions: Cimetidine increases effect of F-FU Methotrexate: ASA, phenytoin increase toxicity of the drug. ``` MoA: Interfere with DNA and RNA growth by substituting for the normal building blocks of RNA and DNA. These agents damage cells during the S phase, when the cell’s chromosomes are being copied. Methotrexate acts as a substitute for folic acid, which is needed for the synthesis of proteins and DNA. Disadvantages: Clients receiving methotrexate must receive leucovorin calcium to “rescue” normal cells from the adverse effects of the drug. ``` Side Effects: Bone marrow suppression Stomatitis Nausea/Vomiting Anorexia Alopecia Rash Photosensitivity Erythema Hematic and renal dysfunction ``` ``` Adverse Effects: Bone marrow suppression Thrombocytopenia Hemorrhage Renal failure Extravasation ``` Intervention: Monitor IV site for extravasation: Apply ice pack. Notify MD. Avoid direct skin contact with medication. Administer antiemetic 30-60 minutes before therapy I&O Monitor blood counts. Encourage mouth rinses every 2 hours with normal saline Client Education: Report signs of infection Examine mouth daily/ report signs of stomatitis Do not visit anyone with a respiratory infection Use sunscreen when outdoors Maintain protective precautions Good oral care with soft toothbrush Encourage small, frequent meals. Encourage cool, bland foods.

Answer 8

Common uses: Advanced Breast cancer Prostate cancer Contraindications: Pregnancy Breastfeeding ``` IM/SubQ/1-2 weeks Interactions: Increased antineoplastic action with megestrol. Black cohosh may interfere with treatment. ``` MoA: Suppress the secretion of follicle-stimulating hormone and luteinizing hormone from the pituitary gland. Initially an increase in testosterone levels is seen. However, with continued use the pituitary gland becomes insensitive to this stimulation, leading to a reduction in the production of androgens and estrogens.. ``` Side Effects: Memory impairment Depression Peripheral edema Alopecia Anorexia Diarrhea Hot flashes Impotence Nausea/vomiting ``` ``` Adverse Effects: Seizures MI PE Dysrhythmias GI bleeding ``` Interventions: Assess for increased bone pain. Monitor for allergic reaction. Education: Notify prescriber if menstruation continues – menstruation should stop. Bone pain should disappear after 1 week. Monitor weight. Report weight gain of > 2 lbs (0.9 kg)/day. How to administer SubQ/IM medication.

Answer 9

``` Common Uses: Breast cancer Lung cancer Myelomas Lymphomas Leukemias ``` IV Interactions: Increased bleeding risks with NSAIDS and Anticoagulants MoA: Mitotic inhibitors are often plant alkaloids and other compounds derived from natural products. They work by stopping mitosis in the M phase of the cell cycle but can damage cells in all phases by keeping enzymes from making proteins needed for cell reproduction. Disadvantages: These medications can cause nerve damage ``` Side Effects: Peripheral neuropathy Bradycardia Hypotension Nausea/Vomiting Diarrhea Mucositis/stomatitis Alopecia Arthralgia ``` ``` Adverse Effect: SVT Neutropenia Leukopenia Thrombocytopenia Anemia Tissue necrosis Pulmonary edema ``` ``` Interventions: ECG monitoring. Monitor for hypotension Assess for paresthesias. Premedicate with antiemetics. VS during first Monitor IV site for extravasation: Apply ice pack. ``` ``` Education: Report signs of infection: fever, sore throat, flulike symptoms. Report signs of anemia: fatigue, headache, faintness, SOB, irritability. Report bleeding. Bleeding precautions. Avoid vaccinations. ```

Answer 10

``` Common Uses: Leukemia Lung cancer Ovarian cancer GI cancer ``` ``` Contraindications: Pregnancy Breastfeeding Bone marrow depression ``` ``` PO/IV Interactions: Increased bleeding risk with NSAIDS, anticoagulants, platelet inhibitors ``` MoA: These drugs interfere with enzymes called topoisomerases, which help separate the strands of DNA so they can be copied during the S phase. (Enzymes are proteins that cause chemical reactions in living cells.) ``` Side Effects: Alopecia Constipation Diarrhea Nausea Vomiting Damage peripheral nerve fibers Motor instability ``` ``` Adverse Effects: Leukopenia Hypersensitivity Neurotoxicity Loss of DTRs Bone marrow suppression ``` Interventions: Monitor IV site for extravasation: Apply ice pack. Notify MD. Assess liver and renal function studies. Increase fluid intake to 2-3 L/day unless contraindicated. Education: Rinse mouth 3-4 times/day with water; Brush teeth with soft toothbrush for stomatitis. Teach that total alopecia may occur. Hair grows back but is different in color and texture. Avoid foods with citric acid or hot and rough texture if stomatitis is present. Avoid vaccines, toxoids. Report signs of anemia: fatigue, headache, faintness, SOB, irritability.

Answer 11

Common uses: Advanced bladder cancer Metastatic testicular cancer Metastatic ovarian cancer ``` Contraindications: Pregnancy Breastfeeding Preexisting hearing impairment Bone marrow suppression ``` ``` IV Interactions: ASA, NSAIDS, Alcohol increase bleeding risk. Bumetanide, furosemide increase ototoxicity risk. Loop diuretics increase nephrotoxicity risk. ``` MoA: Alkylates DNA, RNA; Inhibits enzymes that allow for the synthesis of amino acids in proteins; activity not cell-cycle-phase specific. Advantages: Less likely to cause leukemia later than alkylating agents. Disadvantages: Extravasation can occur damaging tissue ``` Side EffectS: Tinnitus Blurred vision Altered color perception N/V Diarrhea Weight loss Impotence Amenorrhea Alopecia ``` ``` Adverse Effects: Extravasation Bone marrow depression Renal toxicity Bleeding Ototoxicity Seizures ``` Nursing interventions: Monitor IV site for extravasation: Sodium Thiosulfate. Cold compresses. Monitor CBC, platelet count weekly. Hold drug for WBC < 4000 or platelet <100,000. Monitor BUN, creatinine. Monitor for signs of anaphylaxis. Monitor temperature q4h Monitor for bleeding. Increase fluid intake to 2-3 L/d to prevent calculi and promote elimination of medication Education: Report s/s of infection. Report s/s of anemia. Report bleeding, bruising, petechiae Bleeding precautions. Report decreased urine output/flank pain. Do not receive vaccinations during treatment

Answer 12

``` Common uses: Breast cancer Endometrial carcinoma Renal cancer Stimulate appetite ``` PO MoA: Act by shrinking the cancer tissues - brings about cell death Advantages: Megace stimulates appetite by unknown action. ``` Side Effects: Mood swings Insomnia Depression Indigestion Diarrhea Weight gain Flatus Nausea/vomiting ``` Adverse Effects: Fluid retention Thrombotic disorders Nursing interventions: Assess PSA levels in men with prostate cancer. Monitor for thrombophlebitis. Education: Report vaginal bleeding Teach signs of fluid retention. Monitor glucose if diabetic.

Answer 13

Common uses: Breast cancer prophylaxis in postmenopausal women Contraindications: Pregnancy and breastfeeding PO Interaction: Decrease action of anticoagulants MoA: Act like antiestrogens to slow tumor growth, but have fewer side effects than tamoxifen. ``` Side Effects: Insomnia Depression Hot flashes Peripheral edema N/V Diarrhea Dyspepsia Vaginitis Weight gain Hypocalcemia ``` ``` Adverse Effects: Stroke Thromboembolism Pulmonary embolism Osteoporosis ``` Interventions: Bone density test at baseline and throughout treatment. Client education: Take calcium supplements, Vitamin D if intake is inadequate. Increase exercise with weights. Report fever, acute migraine, emotional distress.

Answer 14

Risk Factors: The number one risk factor is Human Papilloma Virus. Repeated STDs Multiple sexual partners Smoking and exposure to second hand smoke Dietary factors such as certain nutritional deficiencies: folate, beta-carotene and vitamin C. Prolonged hormonal therapy Family history. Immunosuppression Sex at a young age and multiple pregnancies Signs and Symptoms: Often asymptomatic in pre-invasive cancer Invasive cancer classic symptoms: painless vaginal bleeding Other general S/S: watery, blood-tinged vaginal discharge, pelvic pain (and it may occur with intercourse), leg pain along sciatic nerve, and flank/back pain Excellent cure rate if detected early Diagnosis: Pap Smear ``` Treatment: Electrosurgical excision Laser Cryosurgery Radiation and chemo for late stages Conization - remove part of the cervix Hysterectomy ```

Answer 15

``` Risk Factors: Greater than 50 years of age Taking estrogen therapy without progesterone Positive Family history Late menopause NO pregnancy ``` S/S Major symptoms: Post menopausal bleeding Other: watery/bloody vaginal discharge, low back/abd pain, pelvic pain Diagnosis: CA-125 (blood test) to ovarian involvement. Most definitive is D&C and endometrial biopsy Treatment: Radiation, Chemotherapy, Estrogen inhibitors ``` Hysterectomy TAH = uterus and cervix only Bilateral oophrectomy (ovaries) Bilateral salpingectomy (tubes) ``` Radical/abdominal hysterectomy - may remove all of the pelvic organs. Client may have colostomy or ileal conduit. 24 hour risk for hemorrhage because of pelvic congestion of blood. Major complication with vaginal hysterectomy - think infection! will probably have an indwelling cath, if not, make sure in the next 8 hours she voids. Prevent abdominal distention after surgery because don't want tension on suture line, it can lead to dehiscence and evisceration. Avoid high fowler's because it makes more blood go to the pelvis May have abdominal and perineal dressing to check, As this client is at risk for pneumonia, thrombophlebitis and constipation, what is one thing you can do to prevent all these complications - Early ambulation Avoid sex and driving, girdles and douches, any excercise that increase pelvic congestion should be avoided, Client can hemorrhage 10 - 14 days, Whitish vaginal discharge is normal, shower is best.

Answer 16

Risk: one has a 3 fold risk increase of developing breast cancer if a first degree relative 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 preg First birth after 30 years of age S&S Change in the appearance of the breast ( orange peel appearance, dimpling, retraction and discharge from the breast or lump) Tail of Spence is where 48% of breast tumors occur: located in upper outer quadrant ``` Treatment: Surgery Chemo Hormonal therapy: Estrogen receptor blocking agents and synthesis inhibitors Radiation ```

Answer 17

Smoking S/S Hemoptysis, dyspnea (may be confused with TB, but TB has night sweats), hoarseness, cough, change in endurance, chest pain, pleuritic pain on inspiration, displaced trachea May metastasize to bone ``` Diagnosis: Bronchoscopy Chest XRAY CT MRI ``` Treatment: Surgery: The main treatment for stage I and II lung cancer Lobectomy: only take out part of the lung Chest tubes and surgical side up Pneumonectomy: the entire lung is removed Position on affected side (surgical side down, good lung up). No chest tubes, Why? There is not lung! Avoid severe lateral positioning = mediastinal shift

Answer 18

Smoking, alcohol, voice abuse, chronic laryngitis, industrial chemicals Signs and Symptoms Hoarseness, lump in neck, sore throat, cough, problems breathing, earache, weight loss, no early signs, Laryngeal exam, MRI Treatment: Surgery: Total laryngectomy Humidified environment *Remember, with a total laryngectomy ALL breathing is done through the stoma. Radiation Chemotherapy Speech Rehabilitation When should client teaching begin? Preoperatively at admission Be a good client advocate: Refer to International Association of Laryngectomees. *See if there are local groups such as the Lost Cord Group

Answer 19

Risks: May start as a polyp 2/3s of colorectal cancer occurs in the rectosigmoid region Most frequent site of metastasis: the Liver *Take bleeding precautions Other problems to watch for: bowel obstruction, perforation, fistula to bladder/vagina Additional risk factors: inflammatory bowel diseases, genetic, dietary factors (refined carbs, low fiber, high fat, red meat, fried and broiled foods) if you have a first degree relative with CRC your risk just increased 3X the norm 95% of those who get CRC are greater than 50 years old Diagnosis: Fecal occult blood testing should begin at age: 50 The definitive test for colorectal cancer is a colonoscopy. S&S Change in bowel habits, constipation, diarrhea, or narrowing of stool Other S/S: blood in the stool, cramping abdominal pain, weakness, fatigue, anemia, abdominal fullness, unexplained weight loss May become obstructed (visible peristaltic waves with high pitched tinkling bowel sounds) Treatment: Surgery, radiation, and chemo May have a colostomy post op or may require an abdominoperineal resection Abdominoperineal resection-removal of the colon, anus, rectum *Can you take a rectal temp on this client? No, there is no rectum! *Don’t take rectal temp if thrombocytopenic, abdominoperineal resection, or immunosuppressed*

Answer 20

Smoking Painless, intermittent gross/microscopic hematuria Cystoscopy Treatment: Surgery (remove all or part of bladder) - urinary diversion (urostomy) Ileal conduit (a piece of the ileum is turned into the bladder; ureters are placed in one end; the other end is brought to the abdominal surface as a stoma) May be impotent Hourly outputs Increase fluids (2,000-3,000 ml of fluid per day). * Fluids help flush out conduit Is mucus in the urine normal? Yes The intestines always make mucus (the bladder is made from a part of intestine). Change appliance in the morning (This is when output will be at its lowest). It is OK to place a little piece of 4X4 inside the stoma during skin care to absorb urine....... Just don’t forget to remove it!

Answer 21

This client comes to the physician with S/S of benign prostatic hyperplasia (BPH): hesitancy, frequency, frequent infections (because the bladder is not completely emptied), nocturia, urgency, dribbling. Many clients are asymptomatic. Most common sign is painless hematuria Digital rectal exam is done and if the prostate is hard/nodular; usually means prostate cancer. ``` Labwork PSA increased ( only produced by prostate). normally lass than 4 ng/ml ``` ALP and acid phosphatase is increased, means bone metastasis Biopsy must be done to confirm cancer prior to surgery

Answer 22

Treatment: Watchful waiting: in early stages (for asymptomatic, older adults with another illness) Surgery: Radical Prostatectomy (done when the cancer is localized to the prostate) Take out the prostate and the client is cancer free (if there is no metastasis). May have erectile dysfunction due to pudendal nerve dam age. May have incontinence (Kegel exercises) Client is sterile. If there is no lymph node involvement, no increase in acid phosphatase, and no metastasis, the surgeon will try to preserve the pudendal nerve. Prostatectomy (TURP- transurethral resection of the prostate) Usually reserved for BPH to help urine flow, NOT a cure for prostate CA No incision (go through the urethra) Most common complication? Bleeding With other procedures you have to explain the risk of impotency/infertility, because with other procedures they have an incision. Is it normal to see bleeding after this surgery? Yes Continuous bladder irrigation – maintains patency, flushes out clots. 3-way catheter No kinks Subtract irrigant from output. Keep up with amount of irrigant instilled What drug do you give for bladder spasms? belladonna and opium suppository (B&O suppository®), oxybutynin (Ditropan®) When the catheter is removed what do you watch for? Urinary retention Temporary incontinence is expected (perineal exercises-Kegel) Avoid sitting, driving, strenuous exercise; do not lift too much…Why? Can cause them to bleed Docusate (Colace®); avoid straining. Why? Straining will cause them to bleed. Increase fluids: to flush out the kidneys. The TURP is used for symptomatic relief of symptoms… to allow the urine to flow out… This is not a cure for prostate cancer. Radiation Chemotherapy Hormone therapy May decrease testosterone levels through bilateral orchiectomy

Answer 23

Risk factors: H-Pylori-associated with stomach cancer Pernicious anemia and Achlorhydria - There is an increased instance of stomach cancer with people who have pernicious anemia and achlorhydria. Related to: pickled foods, salted meats/fish, nitrates, increased salt Billroth II (partial gastrectomy with an anastomosis) Tobacco and Alcohol Signs/Symptoms: Most common: Heartburn and abdominal discomfort Other S/S: loss of appetite, weight loss, bloody stools, coffee-ground vomitus, jaundice (liver metastasis), epigastric and back pain, feeling of fullness, anemia, stool (+) for occult blood, achlorhydria (no HCL in the stomach), obstruction Signs/Symptoms of an obstruction: abdominal distention, nausea/vomiting, pain.) Treatment for obstruction: NPO, NG tube to suction for abdominal decompression Diagnosis: Upper GI, CT, EGD Treatment: Gastrectomy Fowlers position, decreases stress on the suture line Will have NG tube for decompression 2 Major complications: Dumping syndrome andB12 pernicious anemia No stomach - no intrinsic factor - can’t absorb oral B-12 - can’t make good RBCs - client is anemic

Answer 24

The use of chemo is based on several facts The oncologists will consider Which pahse of the cell cycle the drug attacks Time or how often the drug is given Growth faction ( % of cells dividing at a given time) Tumor burder Regional chemo delivers chemo to a specific site Usually sced every 3 to 4 weeks Most common body systems affected by side effects: Blood, GI and Skin + Hair

Answer 25

Exposure can occur by drug contact with the skin or mucous membranes inhalation or accidental injection or ingestion Full precautions require: Chemo gown, 2 pairs of chemo gloves, googles/mask Excretion precautions: Need to be taught to famiy. When handling body fluids wear two pairs of chemo gloves and a chemo gown. add a face shield.

Answer 26

Yellow rigid chemo waste container used for sharps and IV containers Yellow chemo waste bag used for gowns gloves and disposable items

Answer 27

Handle as a hazardous chemical spill | Obtain spill kit and use all protective equipment for clean up

Answer 28

Most given via IV port A vesicant in infiltrated, will cause tissue necrosis S/s of extravasation: Pain, swelling and no blood return Stay with client receiving vesicant. The most important this is PREVENTION. Stop the infusion if it happens, apply cold packs. If drug is oral, wear gloves

Answer 29

Bone marrow ans stem cells are used as treatments for hematologic cancer. Occasionally, transplants are necessary when high does of chemo or radidation have destroyed too many blood cells and a transplant is needed as a rescue treatment

Answer 30

Stem cell + Bone Marrow It can come from the client, a matched donor or frmo an identical sibling or twin They are given into the vein and over time, settle in the bone arrow and produce healthy blood cells

Answer 31

Infection (Immunosuppressed) Graft vs HOst Disease The graft rejects or attacks the host. Treated with anti-rejection drugs and steroids. ``` Signs of rejection Abd pain or cramps, N/V, diarrhea Jaundice or other liver problems Dark, tea colored urine SKin rash, itching, redness on areas of the skin ```

Answer 32

Body Image - Alopecia, Scar, Weight gain and puffiness from steroid therapy or weight loss. Fatigue - Plan client care (adequate rest periods) Infection - private room, wash hands, have their own supplies, limit visitors, change IV tubing and dressings daily, cough and deep breath, no fresh flowers or potted plants, avoid crowds, Do not share toiletries, bathe warm moist areas usually twice daily, wash hands after touching pet, avoid raw fruits and veggies, only fresh water

Answer 33

Watch for a slight increase in temp. It may mean sepsis. Since they are immunosuppressed, the temp spikes will not be big and they won't have the typical s/s of infection Come to hospital for 38 temp Monitor absolute neutrophil count

Answer 34

A decreased number of neutrophils in the blood. | Absolute neutrophil count is the best way to assess. Indicates how well the client can handle the infection.

Answer 35

The lowest point. Neutros are first line defense inside the body to protect us from infections. Don't wait for cultures - physicians need to treat best guess. Neutropenia + infection = sepsis, septic shock and DEATH

Answer 36

``` Age Advanced Metastatic disease Malnourishment B12 and folic acid deficiencies Impaired tissue integrity Presence of other disease( Diabetes, COPD, HF, HIV/AIDS) Hematologic malignancies Leukemias, lymphomas and myelomas Result of cancer treatments ```

Answer 37

Antibiotics ( Prophylactic) Implement Neutropenic Precautions Include all the general ways to prevent infection plus Vital signs every 4 hours Private room with door closed and posted sign Antimicrobial soap for handwashing, not just regular soap No invasive procedures ( NO IM, rectal exam or meds), NG tube or indwelling cath. Limit use of tylenol

Answer 38

Second leading cause of death in cancer clients Prolonged bed rest, Surgerym use of central line, External compression of vessels by tumor, certain chemo drugs We are worried about PE

Answer 39

Decrease in the number of circulating platelets in the blood - they are responsible for clotting. ``` Advanced metastatic disease Hematological Malignancies Bleeding disorders such as hemophilia, liver disease, idiopathic thrombocytopenia purpura Bacterial Infections Anticoagulant meds Result of cancer treatment ```

Answer 40

History Vital signs, SPO2, change in LOC, reports headache and pupil changes, conjunctival hemorrhages, Petechiae, Ecchymosis and purpura, Oozing from puncture site or surgical sites, Bleeding from the rectum, ear, nose or mouth GIVE THEM PLATELETS

Answer 41

RBC transfusions For clients with symptomatic anemia. Don't want Hgb/Hct to drop 8 g/dl and 24%. Platelet Transfusions TO control or prevent bleeding associated with thrombocytopenia (Don't infuse cold platelets because the spleen will reject them ) You want cytomegalovirus negative RBC and Platelets. CMV is a common herpes virus that resembles mononucleosis, usually dormant. To make blood safe, they undergo leukoreduction.

Answer 42

Most common side effect of chemo and radiation. Prevention: Antiemetic before treatment Behavioural therapies Acupuncture/acupressire ``` Ondasetron Netupitant/paLPNOSTREON Oral combination antiemetic Ginger Aroma therapy - peppermint Acupuncture/Acupressure Distraction Relaxation Techniques ```

Answer 43

Treat without regard of risk of opioid dependence Happens due to direct tumor involvement, but can also be the result of the treatment such as with mucositis or peripheral neuropathy OPioids are considered the gold standard NO CEILING DOSE

Answer 44

TNF inhibitor drugs (eg, etanercept [Enbrel], infliximab [Remicade], adalimumab [Humira]) block the action of TNF, a mediator that triggers a cell-mediated inflammatory response in the body. These drugs reduce the manifestations of rheumatoid arthritis (RA) and slow the progression of joint damage by inhibiting the inflammatory response. The medication causes immunosuppression and increased susceptibility for infection and malignancies. Clients should have a baseline TST before initiating therapy and yearly skin tests thereafter. Those with latent tuberculosis (TB) must be treated with antitubercular agents before initiating treatment with these drugs. Otherwise, TB reactivation would occur Major adverse effects of biologic disease-modifying TNF inhibitor drugs (eg, etanercept, infliximab, adalimumab) include severe infections and bone marrow suppression. TB reactivation is a major concern. Therefore, all clients must receive a TST to rule out latent TB.

Oncology Flashcards

(68 cards)