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NCLEX-RN (5) Adult Health > Oncology > Flashcards

Flashcards in Oncology Deck (77)
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1

What are the 3 main treatments for cancer?

  1. Chemotherapy
  2. Radiation
  3. Surgery

2

Why are tubes commonly seen with cancer clients?

Many cancer clients have had surgery to remove a tumor and will typically have some type of tube temporarily (and sometimes permanently):

  • colostomy
  • tracheostomy
  • nephrostomy
  • chest tubes

Review tubes.

 

3
Define:

Metastasis

Metastasis is when the cancer has moved from its original source to a different part of the body or system.

4
Define:

Benign neoplasm

A benign neoplasm is a non-cancerous tumor.

5

How are many cancers diagnosed?

Cancers are diagnosed by using a scope and biopsying the area.

The client may also have a CT scan or MRI to look for a tumor. There are also some blood tests. 

6
Risk factors:

Cancer

Risk factors for cancer focus on problems that cause gene mutation:

  • smoking and excessive alcohol
  • chemicals in the environment
  • sun exposure and chronic skin irritation
  • obesity and poor diet
  • increased age
  • immunosuppressed
  • radiation
  • viral infections

7

How many stages of cancer are there?

There are 5 stages of cancer:

  • 0, I, II, III, IV, V

The higher the number, the more severe the cancer.

8

What are the warning signs of cancer?

  • change in bowel or urinary habits (especially bleeding)
  • sores that don't heal
  • unusual bleeding or discharge
  • lumps (in breasts)
  • a change in a mole
  • nagging cough or hoarseness

9

What are some common anti-neoplastic medications (chemo meds)?

3 common antineoplastic meds:

  • rituximab
  • methotrexate
  • anastrozole

10

Why are all chemotherapy meds considered "high alert meds"?

All chemo meds are high-alert meds because they have adverse effects of bleeding and infection.

LPNs cannot give chemotherapy.

11

What causes the many side effects of chemo meds?

Chemo meds kill cancer cells, but they also affect all tissue cells that are rapidly dividing.

This puts the client at a high risk of infection and bleeding.

 

12
Define:

Neutropenia

Neutropenia is a low neutrophil count that indicates there is a high risk of infection.

13

What are the signs and symptoms of infection?

  • increased temperature >100 F (38C) (or 1 degree over baseline)
  • increased pain, swelling, and redness
  • green/yellow/foul-smelling discharge
  • pneumonia/flu/cold symptoms

14
Define:

Thrombocytopenia

Thrombocytopenia is a low platelet count that indicates there is a high risk of bleeding.

15

What are the signs and symptoms of bleeding?

  • decreased platelets < 150,000 (< 20,000 is critical)
  • petechiae: red dots on skin
  • ecchymosis: bruising
  • blood from any orifice (urine, stool, nose, gums)
  • large drops in hemoglobin and hematocrit

16

What are the interventions for the adverse effect of chemotherapy: neutropenia?

Neutropenic precautions:

  • private room
  • no fresh fruits or flowers in room
  • freshwater for drinking
  • avoid ill people
  • meticulous hand hygiene and wear gloves
  • no live vaccines
  • avoid invasive procedures
  • fruits and vegetables need to be washed and cooked before eating
  • assess for signs and symptoms of infection

17

What are the interventions for the adverse effect of chemotherapy: thrombocytopenia?

Bleeding precautions:

  • prevent falls
  • no straining (give stool softeners)
  • no nail clippers (use a file)
  • no straight edge razors (use electric)
  • avoid shots
  • soft toothbrush

18

What 2 medications increase the risk of bleeding and should be avoided with a client on bleeding precautions?

NSAIDs and aspirin

19

How long should pressure be applied for clients on bleeding precautions?

5 - 10 minutes

20

What is tumor lysis syndrome?

Tumor lysis syndrome is when cells get damaged from chemotherapy and uric acid is released in the bloodstream.

Client will need increased fluids to flush out kidneys and allopurinol to decrease uric acid.

21

What are the interventions for the side effect of chemotherapy: nausea/vomiting?

  • give antiemetics before eating
  • provide bland foods

22

What are the interventions for the side effect of chemotherapy: diarrhea?

  • replace fluids
  • monitor fluid and electrolyte balance
  • give antidiarrheals
  • avoid foods that are irritating to stomach (spicy, caffeine and fiber)

23

What are the interventions for the side effect of chemotherapy: stomatitis/mucositis?

  • provide oral hygiene
  • avoid alcohol mouth wash
  • give nystatin to prevent oral candidiasis
  • mild foods
  • diet high in protein and calories

24

What are the interventions for the side effect of chemotherapy: constipation?

  • fluids
  • fiber
  • walking

25

What are the interventions for the side effect of chemotherapy: alopecia (hair loss)?

  • get fitted for wig before chemo starts
  • headwraps
  • be gentle on hair

 

26

What are the interventions for the side effect of chemotherapy: infertility?

  • use a sperm bank
  • use contraceptives

 

27

What is radiation therapy?

Radiation therapy is a type of cancer treatment that uses beams of intense energy to kill cancer cells.

28

What is the difference between external radiation and internal radiation?

  1. External radiation is when a beam is directed toward a client.
    • the client is not radioactive
  2. Internal radiation is when radiation is inserted into the client for a certain amount of time.
    • the client is radioactive

29

What are the 2 types of internal radiation?

  1. Sealed radiation
  2. Unsealed radiation

30

What is unsealed radiation?

Unsealed radiation is internal radiation that is given by IV, oral or placed in a body cavity.

Anything that is excreted is radioactive for 24 hours.

31

What is sealed radiation?

Sealed radiation is internal radiation that is implanted into the client's body.

Client is radioactive, but excretions are NOT radioactive. The client is no longer considered radioactive once the implant is removed.

32

What are the general side effects of radiation (regardless of where the radiation is directed at)?

Skin irritation and fatigue

Radiation can damage skin cells.

33

Because external radiation is directed at the skin, what is the teaching for skincare?

Teaching about skincare during radiation therapy is focused on being gentle to the skin:

  • wash area gently with mild soap or just water 
  • don't wash off markings for radiation
  • pat area dry (no rubbing)
  • avoid sun and heat
  • no lotions or creams
  • no belts or constrictive clothing over site

34

What type of hospital room does a client get who has internal radiation?

For internal radiation, client gets a private room and private bathroom because of radioactivity.

35

How do nurses reduce their exposure to radioactive clients?

Avoid too much radioactive exposure by:

  • clumping nursing care (doing more things at once)
  • rotate staff
  • 30 minutes maximum for direct client care in a shift
  • wear a dosimeter badge
  • wear lead shields

36

Who should NOT be around a client with internal radiation?

Do not allow these people around clients with internal radiation:

  • pregnant nurses or pregnant visitors
  • children < 16 years old

37

How far away should visitors stand from a client with internal radiation?

Visitors should stay at least 6 feet away from a client with internal radiation.

38

Where should dirty bed linens be placed for a client with internal radiation?

Keep dirty bed linens in the room until client is ready to leave.

39

Does there have to be dedicated equipment in the room for a client with internal radiation?

No. The equipment can leave and enter the room without any risk to other clients.

40

What is the intervention if the radiation implant falls out of the client?

Use long-handled forceps and place the implant in a lead container.

Notify the HCP.

41

What is a bone marrow transplant?

A bone marrow transplant is the replacement of stem cells that were destroyed by chemotherapy or radiation.

These stem cells will grow to make RBCs, WBCs, and platelets.

42

Which types of cancers typically get a bone marrow transplant?

Clients will get a bone marrow transplant who had a blood cancer such as:

  • leukemia
  • lymphoma
  • multiple myeloma.

43

What is the priority assessment after a bone marrow transplant?

Assess for bleeding and infection

44

What type of pain meds are given to clients with cancer pain?

Opioids - morphine is the most common.

45

What are the 3 main types of blood cancers?

Blood cancers are:

  1. leukemia
  2. lymphoma
  3. multiple myeloma

46
Describe:

Leukemia

Leukemia is a blood cancer that starts in the bone marrow and travels through the bloodstream. The mutated cells crowd out healthy blood cells.

  • It causes decreased counts of WBCs, RBCs, and platelets, causing bleeding and infection.

47
Describe:

Lymphoma

Lymphoma is a blood cancer of WBCs (lymphocytes) that mutate, grow out of control and collect in the lymph nodes.

  • there is painless swelling of enlarged lymph nodes

48

What is the difference between Hodgkin's lymphoma and Non-Hodgkin's lymphoma?

Hodgkin's lymphoma originates in a single lymph node or a chain of nodes.

  • average age of onset is 15 - 25 years old or > 60 years old

Non-Hodgkin's lymphoma originates from other cells or organs and goes to the lymph nodes.

  • average age of onset is 60
  • most clients have this type

49
Describe:

Multiple myeloma

Multiple myeloma is a blood cancer that develops in the bone marrow and affects plasma cells (a type of WBC). These mutated cells accumulate in the bone marrow and weaken the bone.

There is a high risk of fractures: prevent falls and injuries.

 

50

What is the average age of onset for testicular cancer?

15 - 40 years old

51

What are the characteristic signs and symptoms of testicular cancer?

Signs and symptoms of testicular cancer:

  • may feel pulling sensation on testicles
  • painless swelling
  • able to feel a mass

52

What is an orchiectomy?

Orchiectomy is a surgery to remove the testicles.

53

At what age should yearly mammograms begin?

45 years old

54

What are the characteristic signs and symptoms of breast cancer?

Signs and symptoms of breast cancer:

  • a mass or lump that doesn't move
  • abnormal discharge from nipples
  • dimpling of the skin

55

What is a mastectomy?

A mastectomy is a surgery to remove a breast.

56

What are the post-operative interventions on the side where the mastectomy was done?

  1. nothing invasive is to be done on affected side
    • no needle sticks, no blood pressures
  2. elevated the affected arm to prevent edema
    • may need a pressure sleeve
  3. Monitor JP drain

57

What are the complications after a mastectomy?

Infection and lymphedema

58

How much weight can a client carry on the affected side of the mastectomy?

Avoid carrying anything more than a few pounds (1 kg) for at least 6 weeks.

No heavy purses or bags.

59

What is to be avoided on the side of the mastectomy because of the risk of infection?

  • avoid cuts, bruises, and burns
  • wear gloves with gardening and cooking
  • Teach client to avoid injuries as much as possible

60

What type of clothing is worn after a mastectomy?

Wear loose clothing to prevent constriction.

61

What are the risk factors for colon cancer?

Risk for colon cancer:

  • diet high in red meat and low in fiber
  • chronic inflammation

62

What is the priority assessment for a client with esophageal or mouth cancer?

Esophageal or mouth cancer: assess for breathing, swallowing, and aspiration

63

What are the priority interventions for a client with esophageal or mouth cancer?

Priority interventions for esophageal or mouth cancer are due to pain in the mouth and throat:

  • give pain meds
  • assess nutritional status

64

What is the priority assessment for a client after surgery to remove a gastric or intestinal tumor?

Access for bloody stools, hemorrhage, peritonitis, and intestinal blockages.

65

What is a common tube after an intestinal or colon surgery to remove a tumor?

ileostomy or colostomy

66

What is a common tube or procedure after the removal of a lung tumor?

chest tubes or a thoracentesis

67

How can cervical cancer be prevented?

Prevent cervical cancer by getting the human papillomavirus (HPV) vaccine.

68

What is a cystectomy?

A cystectomy is a surgery to remove the bladder.

69

What is a common tube after a cystectomy?

Urinary diversion tube such as:

  • ileal conduit: small pouch made from intestines
  • urostomy: stoma that comes out

70

At what age is prostate cancer more common?

After 50 years old

71

How is prostate cancer diagnosed?

  • Rectal exam - HCP will assess for pea-sized nodules
  • Prostate-specific antigen level (PSA) is increased

72

What are the characteristic symptoms of prostate cancer?

  • painless hematuria
  • urinary obstruction

73

What is a prostatectomy?

A prostatectomy is a surgery to remove the prostate.

74

What is a common surgery for prostate cancer?

Transurethral resection of the prostate (TURP)

A scope is inserted and the prostate tissue is removed.

75

What symptom is common after a TURP?

Bladder spasms are common after a TURP: give antispasmodics.

76

What is end-of-life care?

End-of-life care is provided to a client who is dying and needs to be comforted.

Clients with late-stage cancer or a poor prognosis may need this.

77

What does end-of-life care focus on?

  • pain control and comfort (palliative care)
  • therapeutic communication
  • bereavement care for the family