Unit 21 Altered Cell Treatment Flashcards
(40 cards)
What is the most common type of breast cancer?
Adenocarcinoma, from hormones
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
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
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
What are many of the diagnostics markers used for?
Seeing which medication works best
What is the definitive dx for breast cancer?
Tissue diagnosis (biopsy)
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)
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)
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
What is the Sentinel Lymph Node?
First lymph node from the tumor (cancer)
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
What is the management of already developed Lymphedema?
Compression sleeves and garments
Exercises
Avoid constricting clothing
Keep skin lubricated and clean
Surgical correction
What are nonsurgical breast cancer treatments?
Radiation therapy
Chemotherapy
Hormone therapy
Targeted therapy
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
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
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
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
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
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)
What are chemotherapy Rx’s (antineoplastics) used in breast cancer?
cyclophosphamide
doxorubicin
tamoxifen
trastuzumab
methotrexate
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
What is the PPE for handling chemo, administering materials, and body fluid?
Double chemotherapy-tested gloves
Gowns
Protective eyewear
What is the nursing protocol for Extravasation from Vesicant Chemotherapy?
- Infiltration noticed, infusion stopped and disconnect tubing
- Identify agent
- Leave cannula in place and try to aspirate drug
- Neutralize as ordered, if antidote available use
- Notify healthcare provider
What are the two mechanisms of anti-neoplastic drugs?
- affect cell survival
2. boost the immune system in its efforts to combat the abnormal cells
