Unit 20 Altered Cell Overview/Pain control Flashcards Preview

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Flashcards in Unit 20 Altered Cell Overview/Pain control Deck (39):
1

Defnine Malignancy.

Abnormal regulation of growth

2

Describe the Proliferative Patterns, Benign and Malignant.

Benign:
-Well differentiated
-Encapsulated (stays where it is)
-Slow growth
-No metastasis
-Local effects
-No tissue destruction

Malignant:
-Undifferentiated "dysfunctional"
-Infiltrates
-Rapid growth
-Metastasis
-Systemic effects (anemia, cachexia, infections)
-Tissue Destruction

3

What is the most common cancers for men and women?

Men:
-Prostate
-Lung

Women:
-Breast
-Lung

4

What are characteristics of a cancer cell?

Undifferentiated (Dysfunctional):
-polymorphic and pleomorphic

Autonomous self sufficiency of growth signals:
-Resists apoptosis (resistant to "death")
-Multiplies indefinitely (immortal)

Angiogenesis (grows on it's own)

Metastasis (spreads):
-invades local tissue and instant tissue

5

What is Carcinogenesis? What is the process?

Process by which cancer arises.

Initiation:
-gene mutation from carcinogens (smoking, etc)

Promotion:
-repeated exposure (cell multiplication)

Progression:
-cancer developed at this point
-increase in malignancy, angiogenesis

6

What are the mechanisms of metastasis?

Lymphatic spread (most common)
-travels next to circulatory system

Hematogenous spread
-tumor piece breaks off and travels/grows in capillaries

Angiogenesis
-own blood supply to jump to next organ , new blood vessels form from pre-existing ones

7

What is the Cell Cycle?

G0 = doing what it should be doing

G1 = Growth

S = DNA replicates (good time to kill a cancer cell)

G2 = prepare to divide / repairs

Mitosis = Mother cell becomes 2 daughter cells

8

What is proto oncogenes?
What are tumor suppressor genes?

ON switch for cellular growth

OFF switch for cellular growth
(in cancer they do not shut off)

9

What are examples of the following carcinogens:
-Viruses, bacteria
-Physical agents
-Chemical agents
-Genetic susceptibility
-Dietary factors
-Hormonal agents
-Immune system failure

Viruses, bacteria: HPV, HIV, HEP B

Physical agents: Sunlight, radiation, tobacco

Chemical agents: Nitrogen mustard

Genetic susceptibility: BRCA (breast cancer), down syndrome at risk for leukemia

Dietary factors: alcohol, etc

Hormonal agents: estrogen

Immune system failure: HIV

10

What is the primary prevention of cancer?

>To ensure it never develops:
-Education

-Vaccination

-Avoidance of known carcinogens

-Modifications of associated factors

>Removal of at risk tissue

11

What is secondary prevention for cancer?

Screening for early detection and Rx

Examples:
-Self exams
-Clinical exams
-Blood, urine, and stool tests, etc.

12

What is the new protocol for mammograms within the age ranges?
What is the new protocol for clinical self breast exams?

40-44 optional
45-54 anual
55+ once every two years

New protocol is to not do them (which is bologna sandwich)

13

Describe the testicular self-exam.

After a shower:
-Gently locate right testicle
-Roll between your thumb and fingers
-Repeat on left side

Contact MD if lump is found

14

What is the screening guidelines for early detection of prostate cancer by the ACS?

Age 50 men who at average risk and are expected to live at least 10 years or more:
- Have conversation

Age 45 for men at high risk:
-First degree relative dx'd with prostate cancer at early age (< 65)
-do testing

Age 40 for men at even higher risk:
- > one first degree relative who had prostate cancer at an early age,
-do testing

15

What are the screening guidelines for men and women for Colorectal Cancer?

Beginning at age 50, should follow one of the following examination schedules:
>Tests that find polyps and cancer
-Flexible sigmoidoscopy every 5 years
-Double-contrast barium enema every 5 years
-CT colonography every 5 years
-Colonoscopy every 10 years

>Tests that find mainly cancer
-Guaiac fecal occult blood test every year
-Fecal immunochemical test every year
-Stool DNA test every 3 years

16

What is the lung cancer screening protocol?
Who would be excluded?

Low dose CT scan for High Risk PT's who:

-Are age 55-74 y.o, with no signs of symptoms of lung cancer

-Active or former smoker with a 30 pack hx

-Active smoker: should also be vigorously urged to enter smoking cessation program

-Former smoker: must have quit within the past 15 years

General excluded ppl:
-Life limiting co-morbid conditions.
-Metallic implants or devices in chest or back
-Requirement for home O2 supplementation

17

What are early cancer warning signs?

Think CAUTION:

C hanging bowel/bladder habits

A sore throat that doesn't go away

U nusual bleeding

T hickening or lump

I ndigestion or difficulty swallowing

O bvious change in wart or mole

N agging cough or harseness

18

What are tumor makers for?
Give some examples.

Point to, but do not dx cancer

Examples:
-PSA (prostate specific antigen)
-AFP (alfa fetal protein) -think, why would adult secrete this?
-CEA (carcinoembryonic antigen)
-CA 125 (cancer antigen 125)
-b-HCG (beta- Human chrionic gonadotropin)
-Bence Jones proteins in urine

19

What are diagnostic tests that dx cancer?

Bone marrow biopsy

Endoscopic biopsy

Needle biopsy

Surgical biopsy

20

What confirms Cancers?

Biopsy

21

How is Cancer graded?

Grade 1: closely resembles normal tissue

Grade 2: Tissue still has well-formed glands, but they are larger and further apart

Grade 3: Glands are recognizable, but they are beginning to invade other tissues

Grade 4: Only a few recognizable glands, neoplastic clumps seen

Grade 5: No recognizable gland cells

22

How is Cancer staged?

T = primary tumor

N = Nodes

M = Metastasis

23

Describe the staging of cancer, Primary Tumor (T).

Tx- primary tumor cannot be assessed

T0- no evidence of primary tumor

Tis- carcinoma in situ (removed even though not metastasized

T1 to T4 - Increasing size and local extent of primary tumor

24

Describe the staging of cancer, Regional Lymph Nodes (N).

Nx -regional lymph node cannot be assessed

N0 - no regional lymph node metastasis

N1 to N3 - increasing involvement of regional lymph nodes

25

Describe the staging of cancer, Distant Metastasis (M).

Mx - Metastasis cannot be assessed

M0 - No distant metastasis

M1 - presence of distant metastasis

26

What does metastasis essentially mean?

Cancer spread to "distant" organs

27

What are radiology diagnostic tests used for cancer?

PET scan - ionized solution into vein, shows cancer

CT scan

Bone scan

Ultrasound

Xrays

28

What is the leading cause of cancer related death in men and women in the US?

What are the risk factors?

Lung cancer


-Tobacco smoke
-Secondhand smoke
-Smog
-Radon
-Genetics

29

What is the pathophysiology of Lung Cancer?

> 90% arise from the epithelium of bronchus

8 to 10 years to reach 1 cm (that's why we CT)

Liver, brain, bone are most common sites of metastasis

30

What are the types of lung cancer?

>Small Cell or Oat Cell carcinoma
(rapid growing, worst one)

>Non-small Cell carcinoma
-squamous cell
-large cell
-adenocarcinoma

31

Post Bronchoscopy what should the nurse check for?

Return of gag reflex

32

What do the following tumor markers test for?
EGFR gene
ALK gene

EGFR - Non-small cell lung cancer

ALK - Non-small cell lung cancer

33

What are the ways to manage the potential side effects of opioids such as:
Sedation
Constipation
N and V
Itching
Respiratory depression

Sedation: rest, put on fall risk

Constipation: ducosate sodium, increase fiber and fluids

N and V: take w/ food, oldonasterone

Itching: anti-histamine, calamine lotion

Respiratory depression: O2, stimulate breathing, naxolone

34

What do you not want to supplement oxycodone with and why?

Acetaminophen

4,000 mg a day limit. of acetaminophen

35

What is adjuvant medication refer to?

Enhances effectiveness of opioid analgesics

36

What are common side effects of the following adjuvant medications:
antidepressants
anticonvulsants
corticosteroids

antidepressants:
-nausea
-constipation
-insomnia
-increase weight gain
-decreased libido

anticonvulsants:
-dizziness
-drowiness
-rash
-bone marrow suppression

corticosteroids:
-immunosuppression
-Increased weight gain
-muscle weakness
-ecchymosis
-osteoporosis

37

What are causes of malnutrition in cancer PT's?

The medications

Depressed moods

Changes in taste

GI disturbances

N and V

Diarrhea

Early satiated (fullness)

38

What is cancer cachexia?

Wasting syndrome characterized by weight loss, anorexia, asthenia (weakness), and anemia.

PT's have weight loss that cannot be reversed with normal nutritional support

39

What are ways to improve nutrition in cancer PT's?

Small amounts frequently

High calorie foods

Lean meats

Increased fruits and vegetables

Increased fluids

Multivitamins

Avoid smells that make PT sick