Unit 21 Altered Cell Treatment Flashcards Preview

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Flashcards in Unit 21 Altered Cell Treatment Deck (40):
1

What is the most common type of breast cancer?

Adenocarcinoma, from hormones

2

What are risk factors for breast cancer?

-Genetics
-Female gender
-Age
-Multiparty
-Nulliparty
-First child after age 30
-Early menarche and late menopause
-Obesity, increased dietary fat
-Alcoholism
-Exogenous hormones

3

What are 80% of the 5-10% inherited breast cancers caused by?
What would you do for these PT's?

Mutation in the BRCA 1 or BRCA 2 genes

Preventive surgery and chemo prevention w/ tomaxicin

4

What is the clinical presentation of Breast Cancer?

-Lump in breast (non-tender, fixed, hard, irregular borders)

-Peau de orange (orange peal)

-Nipple discharge of any kind

-Pain due to metastasis

-Redness

-Ulceration

-Edema

-Dilated veins

5

What are many of the diagnostics markers used for?

Seeing which medication works best

6

What is the definitive dx for breast cancer?

Tissue diagnosis (biopsy)

7

What are diagnostic tests for breast cancer?

>Physical exam

>Imaging:
-mammography, MRI, ultrasound

>Evaluation for metastasis disease:
-CT scan, bone scan

>Markers:
- Human epidermal growth factor receptor (HER2)
- Estrogen receptor (ER)
- Progesterone receptor (PR)
- Carcinoembryonic antigen (CEA)

8

What are the ways of performing breast biopsy?

-Fine needle aspiration (least invasive)

-Ultrasound guided needle aspiration

-Stereotactic core biopsy (laying down on table one)

-MRI guided needle aspiration

Surgical method:
-Lumpectomy (removal of lump)

9

What are the kinds of Mastectomy?

Lumpectomy: lump removed, shows same effect as traditional removal with radiation

Simple: whole breast

Modified Radical: breast and nodes

Radical: breast, nodes, and muscles

10

What is the Sentinel Lymph Node?

First lymph node from the tumor (cancer)

11

What is the prevention for the axillary node dissection complication, Lymphedema?

-Avoid BP, injections, and blood draws in affected extremity
-Use sunscreen > 15 spf
-Wear gloves for gardening
-Use cooking mitt for removing objects from oven
-Avoid cutting cuticles
-Use electric razor for shaving armpit
-Avoid lifting objects > 5 to 10 lbs
-Soap and water w/ointment if break in skin occurs

If redness, swelling, or fever occurs, call surgeon or nurse

12

What is the management of already developed Lymphedema?

Compression sleeves and garments

Exercises

Avoid constricting clothing

Keep skin lubricated and clean

Surgical correction

13

What are nonsurgical breast cancer treatments?

Radiation therapy

Chemotherapy

Hormone therapy

Targeted therapy

14

Describe Radiation therapy and it's treatment from breast cancer.

For curative, control, or palliative purposes

-Given before, sequentially with chemotherapy, or after chemotherapy

-External radiation called Teletherapy, outside the body

-Internal radiation called Brachytherapy, implants inside body

-About 6 weeks

15

What are acute and chronic radiation side effects?

Acute:
-Toxicity - localized to where beam is pointed, increased chances if chemo at same time
-Desquamation (skin peeling)
-Nausea (if abdomen treated)
-Effects on GI system
-Effects on bone marrow (anemia, decreased platelets)
-System effects (fatigue, anorexia)

Chronic:
-Infertility
-Secondary Cancers
-Memory loss
-Fibrosis
-Renal damage

16

What is the care of the PT with radioactive implants?
PT instructions and
Care providers instructions

PT instructions:
-Bedrest
-Private room and bath
-No lotions, perfumes, razors
-Use plain water or very milf soap, no washclothes
-No constrictive clothing
-Keep markings
-Avoid sun exposure and ice packs

Care provider instructions:
-Use long-handled forceps to place in lead container
-No pregnant personnel
-Limit time under 30 minutes
-Keep distance from PT minimum 6 ft
-Dispose of urine and feces properly (flush twice)
-Wear dosimeter badge
-Signage for PT room

17

What are nursing considerations for Wet Desquamation?

Do not disrupt any blisters that have formed

Avoid frequent washing of area

Report any blistering

Use *prescribed* creams or ointments

If area weeps, apply nonadhesive absorbent dressing

If area is w/o drainage apply moisture hydrocolloid dressings/gels

Consult MD if eschar forms

18

What is Chemotherapy?
What can it be used for?

Agents used to destroy tumor cells by interfering with cellular function and replication

Curative, control, palliative

19

Define the following terms:
Alopecia
Emetic potential
Myelosuppression
Nadir
Extravasion

Alopecia - bald/hair loss

Emetic potential - emesis/vomiting (most chemo drugs)

Myelosuppression - bone marrow activity decreased, low WBCs, RBC's, Hgb.

Nadir - 10-28 days into chemotherapy, absolute bone marrow depression

Extravasation - infiltration into skin (emergency)

20

What are chemotherapy Rx's (antineoplastics) used in breast cancer?

cyclophosphamide

doxorubicin

tamoxifen

trastuzumab

methotrexate

21

How are chemo medications classified?
What cells are they mostly effective against?

Most effective agains rapidly dividing cells



Classified by cell cycle-specific or non specific and by their action

22

What is the PPE for handling chemo, administering materials, and body fluid?

Double chemotherapy-tested gloves

Gowns

Protective eyewear

23

What is the nursing protocol for Extravasation from Vesicant Chemotherapy?

1. Infiltration noticed, infusion stopped and disconnect tubing

2. Identify agent

3. Leave cannula in place and try to aspirate drug

4. Neutralize as ordered, if antidote available use

5. Notify healthcare provider

24

What are the two mechanisms of anti-neoplastic drugs?

1. affect cell survival

2. boost the immune system in its efforts to combat the abnormal cells

25

What are the effects of anti-neoplastics Rx's on the cell cycle non-specific and the cell cycle specific?

Cell Cycle Non-Specific:
-Cytotoxic in ANY phase of the cell cycle
-Both proliferating and non-proliferating cells killed
-Dose dependent

Cell Cycle Specific:
-Cytotoxic during a specific phase of the cell cycle
-Only proliferating (rapidly producing) cells killed
-Schedule dependent

26

Describe the Alkylating Agent, cycophosphamid.
How are they administered?
What are the adverse effects?
Nursing considerations?

-Broad spectrum

Administration: IV, IM Pleural, PO

Adverse effects: Hemorrhagic cystitis (bleeding bladder), alopecia, N/V, loss of fertility, pancytopenia

Nursing considerations:
-Dose limiting toxicity
-Education: contraception, drink H20 and empty bladder, keep head warm

27

Describe the anti-neoplastic antibiotic, doxorubicin.
How is it given?
What are the adverse effects?
Nursing considerations?

-Specific to certain tumors
-Derived from bacteria

Must be given IV

Adverse effects:
-cardiopulmonary toxicity
-usual N/V, loss of fertility, pancytopenia
-red urine

Nursing considerations:
-Need baseline cardiac tests (EKG, ECHO)
-Dose limiting, there is a lifetime maximum dose.

28

Describe the miotic inhibitor, vincristine.
How is it given?
What are the adverse effects?
Nursing Considerations?

-Used for leukemia, lymphoma, neuroblastoma, thyroid cancer, brain tumors.

-Kills cells as the process of mitosis begins

Administered IV

Adverse effects: Low blood count, renal/hepatotoxicity, N/V, alopecia, *neuropathy*

Nursing consideration:
-Vesicant necrosis and cellulitis if extravasation occurs

29

Describe the antimetabolities medication, methotrexate.
How can healthy cells be recused with this Rx?
How is it administered?
Adverse effects?
Nursing considerations?

-Rapidly dividing cancer cells can't use this essentially nutrient imposter to live.

-Works on multiple cancers

Rescue healthy cells w/ leucovorin

Administration: IV, IM, Intrathecal, PO

Adverse effects:
-Mouth sores
-N/V
-Alopecia
-Bone marrow suppression

Nursing considerations:
-No folic acid
-Increase fluid intake
-Avoid pregnancy

30

Describe the hormone modulator, leuprolide.
How is it administered?
What are the adverse effects?
What are the nursing considerations?

-Used in cancers that are sensitive to hormone-dependent tumors

-For prostate and breast cancer

Administration: SC, IM

Adverse effects:
-Hot flashes
-Ankle edema
-Gynecomastia
-Depression

Nursing considerations:
-Category X drug, avoid pregnancy

31

Describe the hormonal agent, tamoxifen.
How is it administered?
What are the adverse effects?

-For metastatic, ductal carcinoma insitu, ovarian, and to *preventive* cancer

Administration:
-PO

Adverse effects:
-Blood clots
-Hot flashes
-Vaginal discharge
-Edema
-Weight loss

32

Describe the monoclonal antibody Rx, bevacizumab.
What is the administration?
Adverse effects?
Nursing considerations?

-Enhances PT's own ability to fight cancer cell invasion
-Specific drug for specific cancers

Administation:
-IV
-Avastin second line Rx
-Antibodies attach to specific receptors

Adverse effects:
-Pulmonary edema
-Flu-like symptoms

Nursing considerations:
-Watch bleeding

33

Describe the medication, trastuzumab.
What are the side effects?

-Use as monotherapy for treatment of metastatic breast cancer that has relapsed following prior chemotherapy

-For tumors that overexpress the HER2
(Human Epidermal growth factor 2)

Side effects:
-Cardiotoxicity
-CHF with or without symptoms

34

What are the following agents used to treat/what do they do.
allopurinol
Interferon
Interleukins
ondansetron
metaclopramide

allopurinol - treat high uric acid levels

Interferon - makes cancer cells more vulnerable to killing by T cells

Interleukins - stimulates the immune system

ondansetron - prevent N/V

metoclopramide - antiemetic, used in GERD

35

What is erythropoietin, filgrastim, and sagramostim?

What class of Rx's are they?

erythropoietin - stimulates the production of red blood cells

filgrastim - Increases WBC's

sargramostim - Increases bone marrow


Colony Stimulating Factor

36

What are adverse effects of chemotherapy?

Toxicity
N/V
Diarrhea
Stomatitis
Myelosuppression
Renal damage
Potential sterility
Neurologic effects

37

What are nursing interventions for Alopecia?

Discuss potential hair loss and regrowth

Explore impacts on self image

Prevent or minimize hair loss

Cut long hair before treatment

Wear sunscreen and hat outside

38

What are nursing interventions for Impaired Oral Muscosa?

Avoid ETOH, tobacco, and spicy food

Normal saline mouth rise q2h

Soft toothbrush

Myocostatin

39

What are nursing interventions for fatigue?

Rest periods

Promote sleep

Adequate protein intake

OK to exercise

Blood transfusions for anemia

40

At what tumor diameter should the nurse evaluate and report of cancer is present?

1 cm