The new shit Flashcards
This deck was created by combining two or more decks
What is the modifiable risk factor for the development of cancer of the bladder?
- Previous exposure to chemicals.
- Pelvic radiation therapy.
- Cigarette smoking.
- Parasitic infections of the bladder.
- Cigarette smoking. The risk is directly proportional to the amount of smoking.
Local complications from IV therapy
- infiltration- leakage of a nonvesicant IV solution or medication into the extra vascular tissue. Signs= edema, ski tightening, burning sensation, cool to touch.
- phlebitis- inflammation of the vein . Signs= pain, redness, edema, vein hard and cordlike
Primary intention healing
Surgical wounds and lacerations are usually closed by primary intention.
Wound margins are secured with sutures, staples, or steri-strips.
If no complications develop wounds close by primary intention usually heal in 7-14 days.
Prophylactic surgery is?
The removal of at risk tissue to prevent cancer development.
Men should get prostate screening when?
50 and older. Every 3 to 5 years. PSA and DRE ( not Doctor DRE.) yearly.
Systemic inflammation signs
Fever, increased pulse and respiratory rate, shift to left, malaise, nausea, anorexia
Affects body systems, widespread
Inflammation
Infection
- response to an injury to tissues. Does not mean there is an infection.
- invasion of a susceptible host by a pathogen, causing disease.
The patient has bladder cancer, what questions do you ask?
Any: pain on urination?
Blood in urine?
Cloudy urine?
Increased frequency or urgency in urination?
respiratory acidosis
co2 above 45, pH below 7.35, they are hypo ventilating, also caused by narcotics, COPD, head/neck trauma, obesity, cushings, asthma, smoking. give them pain meds, tell them to cough and deep breathe, mechanically ventilate, steroids, low flow o2, give narcan for opioid overdose, make sure their LOC is WNL (earliest sign of hypoxia)
addisons disease
hypo function of the adrenal cortex, due to surgery, autoimmune disease, trauma, tumors, atrophy of the gland, they are going to have a bronzy appearance due to an increases MSH and have increased potassium and low sodium, give them d50 w/ insulin, and a loop diuretic, they are going to have hypoglycemia, weight loss, nausea, anorexia, diarrhea, the goal is to replace glucocorticoids and mineralcorticoids by giving a synthetic aldosterone (cortisone, Florinef) make sure they take this med with meals to prevent to GI upset or bleed. pt may have addisonian crisis (hypovolemic shock due to lack of aldosterone
Secondary intention healing
Non surgical wounds are left open to heal. They have significant tissue loss and the wound cavity must fill with granulation tissue which eventually becomes scar tissue. May take weeks or months to heal.
Delays in healing
- nutritional deficiencies- slow tissue repair. Increase protein!! Zincs vitamin a and vitamin e and b6.
- corticosteroids- suppress immune response.
- age altered immune response -thymus shrinks tcells have nowhere to mature resulting in very little tcells.
- DM- decrease O2 and slows capillary growth.
- stress-impedes immune system
Culture sensitivity
Cultures isolate the organism to figure out which med that the organism is most susceptible to.
MATCH DRUG TO THE BUG
You suspect your client has skin cancer. What would you do to assess?
Examine skin areas for moles or warts (gross)
Ask the patient about changes in the moles, such as color, edges, sensation.
Mononuclear phagocytes
Recognize foreign material, detect if it is dangerous, and then will destroy it.
Prostaglandins
- produced from metabolism of arachidonic acid.. Potent vasodilator. Causes FEVER. NSAIDS BLOCK PROSTAGLANDINS and vasodilation.
- give enteric coated NSAID to pt with gerd.
Chemotherapy has this goal
To decrease cancer cells at primary and metastatic cancer sites. It does this at the cellular level.
normal ABG levels
pH- 7.35-7.45
HCO3- 21-28
pCo2- 35-45
02- 80-100
hypothyroidism
under active thyroid gland due to thyroidectomy, atrophy of the gland, autoimmune disorders, there is an increased TSH and a decreased t3 and t4, people have slow metabolism, happens to women more than men, they also have cardiomegaly, activity intolerance, high cholesterol, slurred slow speech, altered LOC, and are overweight, treat with synthroid and if they had a thyroidectomy make sure they take this med all their life. put them on a low calorie diet
Which of the following is more likely to develop cancer?
- A thirty year old man who lives in Ann arbor?
2 a 40 year old woman who lives on a farm in wisconsin. - A 70 year old man who lives in new York city?
- A 20 year old man who lives in Orlando, Florida?
The seventy year old mans due to pollution and oth factors. Plus he is most likely a Yankees fan and that Is worse than cancer.
The nurse is taking the social history from a client diagnosed with small cell carcinoma of the lung or lung cancer. Which information is significant for this disease?
- The client worked with asbestos for a short time many years ago.
- The client has no family history for this type of lung cancer.
- The client has numerous twttoo’s covering his upper and lower arms ( and heather likes him).
- The client smoke two packs a day for twenty years.
4 smoking two packs a day for twenty years. Smoking is the number one risk factor for lung cancer.
Cancer control or cytoreductive surgery is?
Removing part of the tumor and leaving a known amount of the tumor.
What is stage two on the histologic grading scale?
Cells are more abnormal and moderately differentiated.
What should the nurse do when handling cancer drugs?
Use extreme care. Double gloves, do not let the medication touch you in any way.
Uterine cancer checks should be done when?
18 and older, with an annual pap smear.
Stage 3: remodeling phase
During this phase, wound is restored to its greatest strength. The new scar tissue never regains the strength that the tissue had prior to injury.
The client diagnosed with lung cancer is being discharged. Which statement made by the client indicates that more teaching is needed?
- It doesn’t matter if I smoke now, I already have cancer.
- I should see the oncologist at my scheduled appointment.
- If I begin to run a fever I should notify my doctor.
- I should plan for periods of rest throughout the day.
- Quit smoking you idiot,
Clients who are receiving radiation therapy should avoid?
The sun, large groups,sick people. But especially the sun!
Isotonic fluid
Nothing enters cell nothing leaves cell.
- 0.9% sodium chloride
- lactated ringers solution
- 5% dextrose in water
- ringers solution
What does C.A.U.T.I.O.N. stand for?
Changes in bowel or bladder habits A sore that does not heal Unusual bleeding or discharge Thickening or lump in the breast or elsewhere Indigestion or difficulty swallowing Obvious change in wart or mole Nagging cough or hoarseness
These are the seven warning signs of cancer.
Risk factors for delays wound healing
- infection
- compromised blood supply
- malnutrition
- chronic disease such as cancer, diabetes, and aids
- treatment with anticoagulants, chemo
- age (very young and very old)
- obesity
Defective cellular proliferation is?
Cancer cells that divide. Normal cels respect other cells boundaries but cancer cells do not. Stem cells are targeted. DNA is substituted or rearranged. Continuous growth of tumor mass.
Tertiary intention healing
Open wounds that are eventually closed by suturing or skin grafting are treated as wounds healing by secondary intention while they are open and as wounds healing by primary intention once they are closed.
Side effects of chemo are?
Platelt suppression or thrombocytopenia, decreased rbc, decreased WBC, hair loss, nausea, vomiting, fatigue, anorexia.
Wound staging: stage 1
Non Blanchable erythema of intact skin
Men and women should get a colon/rectal screening when?
Age 50 and older. Every 3-5 years after. Use a flexible sigmoidoscopy or colonoscopy.
Non surgical wounds
Wounds due to trauma! ( burns, skin tears) leg ulcers ( venous and arterial) pressure ulcers, diabetic ulcers, and dermatological lesions.
Women should get breast cancer screenings when?
At age 40, and the. An annual mammogram and complete breast exam, also monthly self. Resist exam. Or as Thorpe says, have some man do it for you/ to you.
Bone marrow transplants are harvested from where?
Iliac crest, or sternum
Your patient is in denial about his positive cancer test, and is making comments to deny the results.. What is the best nursing action.
1” face it you are a dead man.”
2 accept his comment.
3 “ maybe you will get better?”
4 advise him to check himself out of the hospital.
5 “ cancer doesn’t kill everyone, but yeah you are going to die. Ever see the Bucket List?”
Accept his comments
Hypotonic solution
Pulls fluid into the cells.
- 0.45% sodium chloride
- 0.33% sodium chloride
- 0.2% sodium chloride
- 2.5% dextrose in water
You suspect your client has lung cancer. How do you assess?
Observe skin and mucous membranes for color.
How many words can the patient say between breaths?
Ask the patient about:
Cough?
Hoarseness?
Smoking history? Exposure to inhalation irritants?
Shortness of breath?
Activity tolerance?
Frothy or bloody sputum?
Pain in the arms or chest?
Difficulty swallowing?
3 stages of wound healing.
Stage 1: inflammatory
This phase begins at time of wounding and continues for 3-5 days. Removal of bacteria and cellular debris happens in this stage.
The ability of cancer cells to spread is called?
Metastasize
hypokalemia
potassium less than 3.5- caused by loops, steroids, ng tubes vomiting, diarhhea, metabolic alkalosis, these pts have arrhythmia, shallow respirations, low BP, altered LOC, hypoactive bowel sounds, distended abdomen, leg cramps give IV at 10 an hour ONLY on a pump never IV push, monitor site for phlebitis because k is a vesicant and is very irritating to skin, increase potassium intake, give supplements STOP digoxin because of possible dig toxicity
Defective cellular differentiation
Malignant transformation
Protoncogenes - normal regulatory cell genes, promote growth.
Normal tumor suppression genes - inhibit growth.
Carcinogens - cause mutations of DNA.
Oncogenes - tumor inducing genes arise from mutations.
Cellular response
- migration of WBCs to inflammation site.
- neutrophils (largest percentage of WBCs 80%) respond to acute bacterial invasion, appear in 6-12hrs.
- bands are immature neutrophils which increase the neutrophil count. This is called SHIFT TO THE LEFT.
The nurse is caring for clients on an oncology unit. Which neutropenia precautions should be implemented?
- Hold all nenipuncture sites for at least five minutes.
- Limit fresh fruits and flowers.
- Place all clients in reverse isolation.
- Have the clients use a soft-bristle toothbrush.
Limit fresh fruits and flowers. They may carry bacteria and the client will have a low WBC.
Wound!
Wounds disrupt the clients first line of defense against injury an infection; the intact skin and mucosa!
DUH!
Normal electrolyte levels
k- 3.5-5.0 (potassium) na- 136-145 (sodium) ca- 9.0-10.5 ( calcium) mg- 1.3-2.1 (magnesium) phosphorous- 3.0-4.5 cl- 98-106 (chloride) albumin- 3.4-5 hemoglobin 12-16 female 14-18 male hematocrit 36-47 female 42-52 male
Stage 2: proliferative phase
This phase begins 1-4 days post injury and lasts up to 3 weeks. New vessel formation, collagen formation and epithelizAtion are te major processes so that new tissue develops.
thyroidectomy
removal of all ( total) or part of the thyroid gland (subtotal) women who are of child bearing age usually have a subtotal thyroidectomy and before either surgery is done the client must have a normal (euthroid) state with iodine if they have a total then they must take synthroid lifelong and if they have a partial they may still produce some thyroid hormone. teach them how to support their head and neck while turning before surgery also teach them how to cough and deep breathe before surgery, and after surgery have calcium gluconate at the bed side because the surgery will cause hypocalcemia and look for chvoteks and trousseaus and stridor can be the first sign of hypocalcemia. check the front and back of their dressings to make sure they are not bleeding have a crash cart, calcium and a trach kit at the bedside also, the parathyroid glands may accidently be removed so this is a risk of doing the surgery
What are the routes for chemo administration?
IV, intra arterial, intra peritoneal, intrathecal ( through the cns), intra viscal ( through the bladder), or implanted pumps.
TNM stands for?
T is for tumor size
N is for spread to lymph Nodes
M is for Metastasis.
What is the first stage of cancer?
Initiation or the mutation of the cells DNA, for example: smoking.
calcium
when calcium is up, phosphate is down, when calcium is low, the pt can have trousseaus and chvoteks, nerve impulses, skeletal, muscle contractions, if pt had thyroid or neck surgery they can also have low calcium,
Defenses
- skin is a mechanical barrier to microorganisms. It is the biggest barrier.
- mucous membranes -saliva washes away particles
- vaginal mucosa
- respiratory- cilia traps microbes (the little hairs)
What is brachytherapy?
Internal, insertion of radioactive material into or close to a tumor. This makes the client radioactive.
cushings syndrome
excessive secretion of cortisol from the adrenal glands, excess glucocorticoids, excess secretion of ACTH and aldosterone, pt’s will have weight gain, pinpoint pupils, low potassium and high sodium, high blood glucose, delayed wound healing and poor nutrition, do strict i&O’s and a low sodium diet, and restrict fluid, highest risk is a patient on long term steroids, if they have an adrenalectomy it’s to remove the adrenal glands due to hyperfunction, if they can’t operate on pt due to cancer of adrenal cortex, MITOTANE is given
metabolic alkalosis
HCO3 above 28 pH above 7.45, k is low, caused by antacid use (tums) TPN therapy, they are going to complain of muscle weakness, vomiting, you want to give antiemetics
hyperkalemia
potassium above 5- caused by excessive intake, too much IV, k sparing diuretics(aldactalone,spiractalone) can cause muscle weakness, arrythmias, cardiac arrest, GI upset, give k-exelate, give a loop, give insulin d50
The client diagnosed with lung cancer has been told it has metastasized to the brain. Which intention should the nurse implement?
- Discuss implementing an advance directive.
- Explain the use of chemotherapy for brain involvement.
- Teach the client to discontinue driving.
- Have the significant other make decisions for the client.
- Discuss an advance directive
PEG tube
Type of feeding tube placed through the skin into the stomach without major surgery.
The patient has colorectal cancer. What questions should you ask?
Ask the patient whether bowel habits have changed over the past year.
Is there obvious blood in the stool?
Have you had a colonoscopy
hypernaturemia
sodium over 145- caused by steroids, sweating, cushings pt, over infusing IV, infection, fever pt will have a decreased LOC, muscle twitching, full bounding pulse, pad the side rails because they can seize, give a loop, hypotonic IV, eat low sodium less than 2 gram, stop smoking, exercise, fresh fruits and veggies
hyperthyroidism
sustained release of thyroid hormone (over active) increased level of t3 and t4 and a decreased level of TSH, causes are autoimmune (graves) or goiters, everything speeds up so tachycardia, increased metabolism, increased systolic BP, frequent bowel movements, fast RR, warm moist skin, muscle weakness, restlessness, increased temperature give an anti thyroid med PTU, a b-blocker to manage their hypertension and tachycardia(propranolol, inderal) an iodine solution SSKI, Lugol) and tapazole
Radiation has some side effects. Pick the one the nurse should expect to see
- Bone marrow suppression
2 kidney swelling
3 finger nail clubbing
4 becoming a Yankee fan
1 bone marrow suppression.
What is stage three on the histologic grading scale?
Cells are abnormal and poorly differentiated.
Complication of bone marrow transplants include:
Infections, bacterial, fungal and viral
Describe grade four in the histologic grading scale?
Cells are immature and primitive. It is the worst of all the stages.
metabolic acidosis
HCO3 below 21 pH below 7.35, caused by renal disease, uncontrolled diabetic, DKA, seizures, diarhhea(out your ass) k-sparings, your gonna see and increases RR, kussmauls respirations, give k-exelate to get rid of k, also give d50 w/ insulin
Precautions the nurse should take for the bone marrow transplant client.
Protective isolation, and use hepa filters for the room.
You suspect your client has leukemia. How do you assess?
Observe the skin for color or ecchymosis Ask the patient about: Fatigue? Bruising? Tendency to bleed? History of infections or illnesses. Night sweats? Unexplained fevers?
Who is a pat smear?
Former guitarist for nirvana and the foo fighters.
Sump tubes and drains
The term SUMP indicates a tube or drain with an air vent.
Air vent acts as irrigant.
Air flows down the tube an back through the suction tube.
Continuous suction is needed.
PEJ tube
Feeding tube placed through a larger gastrostomy tube that is already placed in the stomach. Placed in the small intestine
Cancer cells are
Abnormal, serve no useful function, and are harmful to normal tissues.
hypoalbuminemia
low protein, caused by dehydration, malnutrition, dehydration, starving, dieting, burns liver disease, chronic infection
loop diuretics
examples (lasix,bumex) they lose k+, calcium and sodium, given for SIADH and FVE, know BP, k level, creatinine, BUN before you give also STOP them when a pt has FVD or is dehydrated or metabolic alkalosis K low)
A 53 year old client is receiving an inserted radiologic device to treat her cancer of the cervix. In caring for the client what should you not do?
1. Allow guests to stay for only thirty minutes.
2 alleviate clients anxiety by maintaining close contact.
3. Not bring anything new into or out of the room
4 warm up your dinner by placing it on the clients radioactive site.
2 don’t maintain close contact with the client. Keep space to avoid radiation.
Diagnostic surgery or biopsy is ?
The removal of all or part of a suspected lesion for examination or testing.
What is TDS in caring for a radioactive client?
Time, Distance, and Shielding. This limits the nurse’s exposure to radioactive materials.
Full thickness
Wounds that involve a subq layer or extend into muscle or bone are considered full thickness wounds.
Ex. Deep leg ulcers, stage 3 or 4 pressure ulcers and deep burns
Nursing dx is impaired tissue integrity
How often should you get a sigmoidoscopy?
- Whenever you feel like it.
2 age 40 and every five years after.
3 age 50 and every 3-5 years after.
4 age 50 and every 10 years after that.
Age 50 and every 3 - 5 years after.
Curative surgery is?
Focuses on the removal of all cancer tissue.
What happens in colonoscopy
A hollow tube is passed through the rectum.
A person who is immuno suppressed is more or less likely to get cancer?
More
What is the third stage of cancer?
Progression or increased growth of tumor, increased invasion, or metastasis.
Localized inflammation signs
Redness, heat, pain, and swelling
What is the histologic grading of cancer’s first stage?
Grade 1 - cells differ slightly for normal cells. They are well differentiated.
Systemic complications of IV therapy
Involves entire vascular system.
Ex. Circulatory overload, speed shock, allergic reaction, catheter embolism, pneumothorax, hemothorax, cyclothorax, hydrothorax, air embolism
Lymphocytes
- B lymphocytes mature in bone marrow. These produce protein based antibodies and immunoglobulins.
- T lymphocytes mature in thymus. These attack antigens and are antigen specific.
The nurse writes a problem of “impaired gas exchange” for a client diagnosed with cancer of the lung. Which interventions should be included in the plan of care. Select all that apply.
- Apply o2 nasal cannula
- Have the dietician plan for six small meals a day
- Place the client in respiratory isolation.
- Asses vital signs for a fever.
- Listen to lung sounds every shift.
1, 2, 4, 5
Partial thickness
Wound that involve the epidermis and extend Into but not through the dermis are considered partial thickness.
Ex: adhesive tape burns, sunburn, blisters, some skin tears, and stage 2 pressure ulcers
Nursing dx is impaired ski integrity
respiratory alkalosis
co2 below 35, pH above 7.45, caused mostly by fear and anxiety, also aspirin toxicity, they are hyperventilating (give a mask or paper bag) give mucomyst for aspirin tox
hyponaturemia
less than 136 low sodium caused by diuertics, ace inhibitors, addisons patient, diarrhea and vomitting, drowning, renal failure, diabetic, may have altered LOC, cerebral edema, anxious, hyper, muscle weakness, twitching, orthostatic hypotension, tachycardia treat the cause, increase intake, give normal saline or lactated ringers (isotonic) or a hypertonic IV solution, restrict fluids to people with water intoxication (dilutional hyponaturemia) (low na but over hydrated)
Dehiscence and evisceration
Dehiscence- separation of wound edges.
Evisceration- wound separates intestines intrude.
Cover with sterile saline, then call dr!!!
What is the second stage of cancer?
Promotion or enhancement of growth of initiated cells.
Hot cold compress
Heat-therapeutic, promotes muscle relaxation, vasodilates and increases circulation to site.
Cold- relieves swelling and inflammation.
On 20 min off 20 min to prevent reverse vasoconstriction. In the hospital there will be a regulator. Don’t lay on it, no longer than 20 min
Anaplasia is
A featured of cancer cells, they lose the specific appearance of their parent cells.
Wound assessment
Look at size, color, odor, exudate, location, length, width, depth in cm.
Drainage tube
Tube used for discharge of matter.
Device used for allowing escape of pus, serum, blood or other drainage from a wound, abscess, etc.
Cellular response (cont)
-monocytes are second to arrive, appearing within 3-7 days. Thy clean the area. “they move from vascular system into cellular system where organism is attacking and become macrophages which CHOMP destroy bacteria, create pus, and clean up area for healing to occur.”
Vascular response
Stage 1-Hyperemia- increased blood flow which is good it gets WBCs to site, increased capillary permeability and edema.
Stage 2-neutrophilia- neutrophils really increase, pus forms and the shift has occurred.
Stage 3-tissue repair And replacement- induction of healthy cell division and scar formation occurs.
Vancomycin and gentamycin
Look at kidney function (BUN and Cre) and oto function because it can be ototoxic!
These people are more susceptible to cancer
Older clients, autoimmune disorder clients, immuno compromised clients, and steroid users.
Your suspect your client has prostate cancer. What questions do you ask?
Ask your client about: Hesitancy in urination. Change of size of the urine stream? Pain in the back of the legs? History of UTI's?
Surgical wounds
Are incisions made during surgical procedures. Skin grafts and donor sites are also considered surgical wounds.
Defective cellular proliferation is?
Cancer cells that divide. Normal cels respect other cells boundaries but cancer cells do not. Stem cells are targeted. DNA is substituted or rearranged. Continuous growth of tumor mass.
Cancer cells are
Abnormal, serve no useful function, and are harmful to normal tissues.
What is the first stage of cancer?
Initiation or the mutation of the cells DNA, for example: smoking.
You suspect your client has lung cancer. How do you assess?
Observe skin and mucous membranes for color.
How many words can the patient say between breaths?
Ask the patient about:
Cough?
Hoarseness?
Smoking history? Exposure to inhalation irritants?
Shortness of breath?
Activity tolerance?
Frothy or bloody sputum?
Pain in the arms or chest?
Difficulty swallowing?
TNM stands for?
T is for tumor size
N is for spread to lymph Nodes
M is for Metastasis.
addisons disease
hypo function of the adrenal cortex, due to surgery, autoimmune disease, trauma, tumors, atrophy of the gland, they are going to have a bronzy appearance due to an increases MSH and have increased potassium and low sodium, give them d50 w/ insulin, and a loop diuretic, they are going to have hypoglycemia, weight loss, nausea, anorexia, diarrhea, the goal is to replace glucocorticoids and mineralcorticoids by giving a synthetic aldosterone (cortisone, Florinef) make sure they take this med with meals to prevent to GI upset or bleed. pt may have addisonian crisis (hypovolemic shock due to lack of aldosterone
respiratory acidosis
co2 above 45, pH below 7.35, they are hypo ventilating, also caused by narcotics, COPD, head/neck trauma, obesity, cushings, asthma, smoking. give them pain meds, tell them to cough and deep breathe, mechanically ventilate, steroids, low flow o2, give narcan for opioid overdose, make sure their LOC is WNL (earliest sign of hypoxia)
Describe grade four in the histologic grading scale?
Cells are immature and primitive. It is the worst of all the stages.
What is stage two on the histologic grading scale?
Cells are more abnormal and moderately differentiated.
What is the second stage of cancer?
Promotion or enhancement of growth of initiated cells.
Precautions the nurse should take for the bone marrow transplant client.
Protective isolation, and use hepa filters for the room.
Radiation has some side effects. Pick the one the nurse should expect to see
- Bone marrow suppression
2 kidney swelling
3 finger nail clubbing
4 becoming a Yankee fan
1 bone marrow suppression.
normal ABG levels
pH- 7.35-7.45
HCO3- 21-28
pCo2- 35-45
02- 80-100
metabolic alkalosis
HCO3 above 28 pH above 7.45, k is low, caused by antacid use (tums) TPN therapy, they are going to complain of muscle weakness, vomiting, you want to give antiemetics
hyperthyroidism
sustained release of thyroid hormone (over active) increased level of t3 and t4 and a decreased level of TSH, causes are autoimmune (graves) or goiters, everything speeds up so tachycardia, increased metabolism, increased systolic BP, frequent bowel movements, fast RR, warm moist skin, muscle weakness, restlessness, increased temperature give an anti thyroid med PTU, a b-blocker to manage their hypertension and tachycardia(propranolol, inderal) an iodine solution SSKI, Lugol) and tapazole
thyroidectomy
removal of all ( total) or part of the thyroid gland (subtotal) women who are of child bearing age usually have a subtotal thyroidectomy and before either surgery is done the client must have a normal (euthroid) state with iodine if they have a total then they must take synthroid lifelong and if they have a partial they may still produce some thyroid hormone. teach them how to support their head and neck while turning before surgery also teach them how to cough and deep breathe before surgery, and after surgery have calcium gluconate at the bed side because the surgery will cause hypocalcemia and look for chvoteks and trousseaus and stridor can be the first sign of hypocalcemia. check the front and back of their dressings to make sure they are not bleeding have a crash cart, calcium and a trach kit at the bedside also, the parathyroid glands may accidently be removed so this is a risk of doing the surgery
Your patient is in denial about his positive cancer test, and is making comments to deny the results.. What is the best nursing action.
1” face it you are a dead man.”
2 accept his comment.
3 “ maybe you will get better?”
4 advise him to check himself out of the hospital.
5 “ cancer doesn’t kill everyone, but yeah you are going to die. Ever see the Bucket List?”
Accept his comments
What does C.A.U.T.I.O.N. stand for?
Changes in bowel or bladder habits A sore that does not heal Unusual bleeding or discharge Thickening or lump in the breast or elsewhere Indigestion or difficulty swallowing Obvious change in wart or mole Nagging cough or hoarseness
These are the seven warning signs of cancer.
cushings syndrome
excessive secretion of cortisol from the adrenal glands, excess glucocorticoids, excess secretion of ACTH and aldosterone, pt’s will have weight gain, pinpoint pupils, low potassium and high sodium, high blood glucose, delayed wound healing and poor nutrition, do strict i&O’s and a low sodium diet, and restrict fluid, highest risk is a patient on long term steroids, if they have an adrenalectomy it’s to remove the adrenal glands due to hyperfunction, if they can’t operate on pt due to cancer of adrenal cortex, MITOTANE is given
The patient has colorectal cancer. What questions should you ask?
Ask the patient whether bowel habits have changed over the past year.
Is there obvious blood in the stool?
Have you had a colonoscopy
hyponaturemia
less than 136 low sodium caused by diuertics, ace inhibitors, addisons patient, diarrhea and vomitting, drowning, renal failure, diabetic, may have altered LOC, cerebral edema, anxious, hyper, muscle weakness, twitching, orthostatic hypotension, tachycardia treat the cause, increase intake, give normal saline or lactated ringers (isotonic) or a hypertonic IV solution, restrict fluids to people with water intoxication (dilutional hyponaturemia) (low na but over hydrated)
You suspect your client has leukemia. How do you assess?
Observe the skin for color or ecchymosis Ask the patient about: Fatigue? Bruising? Tendency to bleed? History of infections or illnesses. Night sweats? Unexplained fevers?
respiratory alkalosis
co2 below 35, pH above 7.45, caused mostly by fear and anxiety, also aspirin toxicity, they are hyperventilating (give a mask or paper bag) give mucomyst for aspirin tox
calcium
when calcium is up, phosphate is down, when calcium is low, the pt can have trousseaus and chvoteks, nerve impulses, skeletal, muscle contractions, if pt had thyroid or neck surgery they can also have low calcium,
Your suspect your client has prostate cancer. What questions do you ask?
Ask your client about: Hesitancy in urination. Change of size of the urine stream? Pain in the back of the legs? History of UTI's?
Anaplasia is
A featured of cancer cells, they lose the specific appearance of their parent cells.
Men should get prostate screening when?
50 and older. Every 3 to 5 years. PSA and DRE ( not Doctor DRE.) yearly.
What is the modifiable risk factor for the development of cancer of the bladder?
- Previous exposure to chemicals.
- Pelvic radiation therapy.
- Cigarette smoking.
- Parasitic infections of the bladder.
- Cigarette smoking. The risk is directly proportional to the amount of smoking.
Uterine cancer checks should be done when?
18 and older, with an annual pap smear.
Prophylactic surgery is?
The removal of at risk tissue to prevent cancer development.
Normal electrolyte levels
k- 3.5-5.0 (potassium) na- 136-145 (sodium) ca- 9.0-10.5 ( calcium) mg- 1.3-2.1 (magnesium) phosphorous- 3.0-4.5 cl- 98-106 (chloride) albumin- 3.4-5 hemoglobin 12-16 female 14-18 male hematocrit 36-47 female 42-52 male
These people are more susceptible to cancer
Older clients, autoimmune disorder clients, immuno compromised clients, and steroid users.
Who is a pat smear?
Former guitarist for nirvana and the foo fighters.
What is TDS in caring for a radioactive client?
Time, Distance, and Shielding. This limits the nurse’s exposure to radioactive materials.
How often should you get a sigmoidoscopy?
- Whenever you feel like it.
2 age 40 and every five years after.
3 age 50 and every 3-5 years after.
4 age 50 and every 10 years after that.
Age 50 and every 3 - 5 years after.
The client diagnosed with lung cancer is being discharged. Which statement made by the client indicates that more teaching is needed?
- It doesn’t matter if I smoke now, I already have cancer.
- I should see the oncologist at my scheduled appointment.
- If I begin to run a fever I should notify my doctor.
- I should plan for periods of rest throughout the day.
- Quit smoking you idiot,
hypokalemia
potassium less than 3.5- caused by loops, steroids, ng tubes vomiting, diarhhea, metabolic alkalosis, these pts have arrhythmia, shallow respirations, low BP, altered LOC, hypoactive bowel sounds, distended abdomen, leg cramps give IV at 10 an hour ONLY on a pump never IV push, monitor site for phlebitis because k is a vesicant and is very irritating to skin, increase potassium intake, give supplements STOP digoxin because of possible dig toxicity
The ability of cancer cells to spread is called?
Metastasize
The patient has bladder cancer, what questions do you ask?
Any: pain on urination?
Blood in urine?
Cloudy urine?
Increased frequency or urgency in urination?
Curative surgery is?
Focuses on the removal of all cancer tissue.
Chemotherapy has this goal
To decrease cancer cells at primary and metastatic cancer sites. It does this at the cellular level.
loop diuretics
examples (lasix,bumex) they lose k+, calcium and sodium, given for SIADH and FVE, know BP, k level, creatinine, BUN before you give also STOP them when a pt has FVD or is dehydrated or metabolic alkalosis K low)
Men and women should get a colon/rectal screening when?
Age 50 and older. Every 3-5 years after. Use a flexible sigmoidoscopy or colonoscopy.
Defective cellular differentiation
Malignant transformation
Protoncogenes - normal regulatory cell genes, promote growth.
Normal tumor suppression genes - inhibit growth.
Carcinogens - cause mutations of DNA.
Oncogenes - tumor inducing genes arise from mutations.
The nurse is caring for clients on an oncology unit. Which neutropenia precautions should be implemented?
- Hold all nenipuncture sites for at least five minutes.
- Limit fresh fruits and flowers.
- Place all clients in reverse isolation.
- Have the clients use a soft-bristle toothbrush.
Limit fresh fruits and flowers. They may carry bacteria and the client will have a low WBC.
Clients who are receiving radiation therapy should avoid?
The sun, large groups,sick people. But especially the sun!
A person who is immuno suppressed is more or less likely to get cancer?
More
hypernaturemia
sodium over 145- caused by steroids, sweating, cushings pt, over infusing IV, infection, fever pt will have a decreased LOC, muscle twitching, full bounding pulse, pad the side rails because they can seize, give a loop, hypotonic IV, eat low sodium less than 2 gram, stop smoking, exercise, fresh fruits and veggies
Which of the following is more likely to develop cancer?
- A thirty year old man who lives in Ann arbor?
2 a 40 year old woman who lives on a farm in wisconsin. - A 70 year old man who lives in new York city?
- A 20 year old man who lives in Orlando, Florida?
The seventy year old mans due to pollution and oth factors. Plus he is most likely a Yankees fan and that Is worse than cancer.
What should the nurse do when handling cancer drugs?
Use extreme care. Double gloves, do not let the medication touch you in any way.
Cancer control or cytoreductive surgery is?
Removing part of the tumor and leaving a known amount of the tumor.
You suspect your client has skin cancer. What would you do to assess?
Examine skin areas for moles or warts (gross)
Ask the patient about changes in the moles, such as color, edges, sensation.
hypoalbuminemia
low protein, caused by dehydration, malnutrition, dehydration, starving, dieting, burns liver disease, chronic infection
Women should get breast cancer screenings when?
At age 40, and the. An annual mammogram and complete breast exam, also monthly self. Resist exam. Or as Thorpe says, have some man do it for you/ to you.
What is the histologic grading of cancer’s first stage?
Grade 1 - cells differ slightly for normal cells. They are well differentiated.
Side effects of chemo are?
Platelt suppression or thrombocytopenia, decreased rbc, decreased WBC, hair loss, nausea, vomiting, fatigue, anorexia.
metabolic acidosis
HCO3 below 21 pH below 7.35, caused by renal disease, uncontrolled diabetic, DKA, seizures, diarhhea(out your ass) k-sparings, your gonna see and increases RR, kussmauls respirations, give k-exelate to get rid of k, also give d50 w/ insulin
hyperkalemia
potassium above 5- caused by excessive intake, too much IV, k sparing diuretics(aldactalone,spiractalone) can cause muscle weakness, arrythmias, cardiac arrest, GI upset, give k-exelate, give a loop, give insulin d50
What happens in colonoscopy
A hollow tube is passed through the rectum.
hypothyroidism
under active thyroid gland due to thyroidectomy, atrophy of the gland, autoimmune disorders, there is an increased TSH and a decreased t3 and t4, people have slow metabolism, happens to women more than men, they also have cardiomegaly, activity intolerance, high cholesterol, slurred slow speech, altered LOC, and are overweight, treat with synthroid and if they had a thyroidectomy make sure they take this med all their life. put them on a low calorie diet
A 53 year old client is receiving an inserted radiologic device to treat her cancer of the cervix. In caring for the client what should you not do?
1. Allow guests to stay for only thirty minutes.
2 alleviate clients anxiety by maintaining close contact.
3. Not bring anything new into or out of the room
4 warm up your dinner by placing it on the clients radioactive site.
2 don’t maintain close contact with the client. Keep space to avoid radiation.
The nurse writes a problem of “impaired gas exchange” for a client diagnosed with cancer of the lung. Which interventions should be included in the plan of care. Select all that apply.
- Apply o2 nasal cannula
- Have the dietician plan for six small meals a day
- Place the client in respiratory isolation.
- Asses vital signs for a fever.
- Listen to lung sounds every shift.
1, 2, 4, 5
What is brachytherapy?
Internal, insertion of radioactive material into or close to a tumor. This makes the client radioactive.
Diagnostic surgery or biopsy is ?
The removal of all or part of a suspected lesion for examination or testing.
What is the third stage of cancer?
Progression or increased growth of tumor, increased invasion, or metastasis.
What are the routes for chemo administration?
IV, intra arterial, intra peritoneal, intrathecal ( through the cns), intra viscal ( through the bladder), or implanted pumps.
The client diagnosed with lung cancer has been told it has metastasized to the brain. Which intention should the nurse implement?
- Discuss implementing an advance directive.
- Explain the use of chemotherapy for brain involvement.
- Teach the client to discontinue driving.
- Have the significant other make decisions for the client.
- Discuss an advance directive
Bone marrow transplants are harvested from where?
Iliac crest, or sternum
The nurse is taking the social history from a client diagnosed with small cell carcinoma of the lung or lung cancer. Which information is significant for this disease?
- The client worked with asbestos for a short time many years ago.
- The client has no family history for this type of lung cancer.
- The client has numerous twttoo’s covering his upper and lower arms ( and heather likes him).
- The client smoke two packs a day for twenty years.
4 smoking two packs a day for twenty years. Smoking is the number one risk factor for lung cancer.
Complication of bone marrow transplants include:
Infections, bacterial, fungal and viral
What is stage three on the histologic grading scale?
Cells are abnormal and poorly differentiated.
Men should get prostate screening when?
50 and older. Every 3 to 5 years. PSA and DRE ( not Doctor DRE.) yearly.
Defective cellular differentiation
Malignant transformation
Protoncogenes - normal regulatory cell genes, promote growth.
Normal tumor suppression genes - inhibit growth.
Carcinogens - cause mutations of DNA.
Oncogenes - tumor inducing genes arise from mutations.
Cancer control or cytoreductive surgery is?
Removing part of the tumor and leaving a known amount of the tumor.
What are the routes for chemo administration?
IV, intra arterial, intra peritoneal, intrathecal ( through the cns), intra viscal ( through the bladder), or implanted pumps.
What is TDS in caring for a radioactive client?
Time, Distance, and Shielding. This limits the nurse’s exposure to radioactive materials.
TNM stands for?
T is for tumor size
N is for spread to lymph Nodes
M is for Metastasis.
What is stage three on the histologic grading scale?
Cells are abnormal and poorly differentiated.
What is the histologic grading of cancer’s first stage?
Grade 1 - cells differ slightly for normal cells. They are well differentiated.
What is the second stage of cancer?
Promotion or enhancement of growth of initiated cells.
Who is a pat smear?
Former guitarist for nirvana and the foo fighters.
Cancer cells are
Abnormal, serve no useful function, and are harmful to normal tissues.
