Unit 22 Altered Cell Proliferation: Solid Tumors Flashcards Preview

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Flashcards in Unit 22 Altered Cell Proliferation: Solid Tumors Deck (43):
1

What is considered a low ANC (absolute neutrophil count)?
What can this be an indication of?

ANC less than 500 is critical

Can be indication of the need to reduce chemo dosage or delay of next therapy

2

Describe colorectal cancer.

3rd most common cancer is US

Rare before age of 30

Early dx = great prognosis

Late dx = poor prognosis

3

What are general, lifestyle, and genetic risk factors for Colon Cancer?

General:
-Age
-DM2
-IBD
-Polyps

Lifestyle:
-Inactivity
-ETOH
-Tobacco
-Poor diet

Genetics:
-Family hx
-Inherited (HN gene, FAP gene- full of polyps, by age 40 most likely to develop cancer)

4

What are Colorectal Cancer manifestations?

Local:
-Changes in stool (blood, shape, frequency, "melena stool"
-Abdominal fullness
-Symptoms of obstruction (constipation, hard stools)

Systemic:
-Weight loss (tumor increases metabolism
-N/V
-Weakness
-Anemia (from bleeding, fatigue presents)

5

What are Colorectal Cancer Diagnostic Labs?

Stool for guiac/ occult blood

CBC - to check for anemia

LFT (liver function tests)

CEA (carcino embryonic antigen):
-Commonly used to monitor PT's for effectiveness of Rx
-Level should be 0
-Indicates if there is cancer
-If tumor removed CEA level should drop

6

What are Colorectal Cancer Diagnostic Radiology procedures?

CT scan

Colonoscopy/sigmoidoscopy

Double contrast barium enema w/X-ray

7

What is the surgical collaborative management of Colorectal cancer?
How does the nurse prep the PT before these procedures?
After colectomy what should the nurse assess?

-Colon resection with or w/o colostomy
-R hemicolectomy (remove right portion of colon, small intestine to transverse colon)
-L hemicolectomy
(removed left portion of colon, transverse to sigmoid
-Total colectomy
-Abdomino-perineal resection
(assess for pain and bleeding post-procedure)



PT NPO
No food coloring or meat before
Go Lyte-ly (solution to clear bowels)

Bowel sounds

8

What is stomatitis?

Alteration in oral mucosa secondary to radiation, inflammation of the oral tissuesama

9

What is the medical collaborative management of Colorectal Cancer?

Chemotherapy:
-Antimetabolites (5-FU)
-Tumor profiling to treat w/ most effective Chemo

Biotherapy:
-Monoclonal antibodies (bevacizumab)

Radiation:
-Cyberknife

10

What is a sign of left sided colorectal cancer?

Narrow stools

11

What is the most common treatment for colorectal cancer?

Surgical resection

12

What is adjuvant care?
Give example.

Additional treatment

Ex: Chemo if lymph node involvement or metastasis
-5-FU with leucovorin and oxaliplatin
-radiation before or after sx

13

What is the most common site of metastasis colorectal colon cancer?

Liver

14

What is the nursing colostomy care?

Assess stoma every 8 hrs, should be red/shiny

Cleanse skin and apply skin barrier

Record volume, color, and consistency of stool

Mild edema and bleeding are normal,
Moderate to severe edema and bleeding are not

Teach ostomy self-care

15

What can an increase in CEA (carcinoembryonic antigen) indicate?

Cancer has returned or metastasized

16

Describe the Prostate/Prostate Cancer.

-Prostate needs male hormones like testosterone to grow.
-Located under the bladder

Most prostate cancer is acquired

Most common occurring cancer in men

Second leading cause of death among men

17

What are Prostate Cancer Risk factors?

Advancing age

Family hx

Genetics (BRCA-2 gene)

Race/ethnicity

Lifestyle (poor diet, STD's, smoking, etc)

18

What are prostate cancer manifestations?

Early: Asymptomatic

Later on:
-Signs and symptoms of bladder obstruction
-Loss of bladder control
-Hematuria or blood in semen
-Bone pain
-Difficulty obtaining erection

19

When should digital rectal exams be done?

Age 40 for men with several close relatives with prostate cancer or cancer at an early age.

Age 45 for men at high risk for all cancers.

Age 50 for all men who do not have major health problems.

20

What are the diagnostic test for Prostate Cancer?
What diagnoses?

***Biopsy*** (diagnoses)

Digital rectal exam

PSA

Trans-rectal ultrasound

CT of pelvis

Bone scan for metastasis

21

What is the collaborative management for Prostate Cancer?

Watchful waiting (prostate cancer progresses slowly)

Drug therapy

Radiation (external/teletherapy or internal/brachytherapy)

Surgery (TURP)

22

What is the drug therapy for Prostate Cancer?
What does this drug do?
What are the adverse effects?

Hormone Modulator:
-leuprolide (lowers estrogen in women and testosterone in men)

Inhibits growth of hormone dependent tumors

Adverse effects:
-Mood changes
-Hot flashes
-Acne
-Impotence
-Decreased libido

23

After TURP (Transurethral resection of the prostate) sx, what should be done and why?

What if there is blood in the drainage bag?

Continuous bladder irrigation to prevent clots!

If there is blood in drainage bag turn up infusion rate

24

What are testicular cancer risk factors?

An undescended testicle

Family hx of testicular cancer

HIV infection

Caucasian

Age 15-40

High cure rate

25

What are the manifestations of testicular cancer?

-PAINLESS lump or swelling in either testicle

-Dull ache in the lower abdomen or the groin

-Sudden build-up of fluid in the scrotum

-Pain or discomfort in a testicle or in the scrotum

-Heaviness in scrotum

26

What are the assessments for testicular cancer?

Monthly testicular self-exams

Blood tests: AFP (alfa fetal protein), hCG

Ultrasound

Tissue biopsy

27

What is the treatment for testicular cancer?

Orchiectomy (testicle removal)

Chemo

Radiation

Banking sperm

28

How can skin cancer present in African Americans?

Black line in the middle of nails

29

What are risk factors for Skin Cancer?

A lighter natural skin color

Family hx

Hx of sunburns

Hx of indoor tanning

Exposure to sun through work and play

Skin that burns, freckles, reddens easily

Blue or green eyes

Blond or red hair

Large number of moles

30

What are the types of skin cancer?

Non-melanomas:
-Basal cell carcinoma (white and waxy)
-Squamous cell carcinoma (give 5-FU)

Malignant Melanoma

31

What are the warning signs of Melanoma? (ABCDEs)

A symmetry

B order irregularity

C olor

D iameter 1/4 inch
(should be no bigger than pencil eraser)

E volution

32

What is the diagnosis for skin cancer?

Shave biopsy

Punch biopsy

Incisional and Excisional

33

What is the treatment for Basal Cell and Squamous Cell?

What is the goal?

Goal: eradicate the tumor

Treatment/management:
-Surgical excision
-Mohs' micrographic surgery
-Electrosurgery
-Cryosurgery
-Radiation therapy

34

Describe Malignant Melanoma.
What age range is most at risk?
What genes spontaneously mutates?

Neoplastic growth of melanocytes

Most lethal

Age 20-45 years

Widespread metastasis

Spontaneous mutation in B-RAF gene is responsible for about 50% of all cases

35

What is the treatment for Melanoma?

Surgical excision

Immunotherapy w/pembrolizumab

Combination chemotherapy
-isolated limp perfusion

Radiation therapy

36

What is Superior Vena Cava Syndrome?
Symptoms?
What is the treatment?
What is the nursing care?

SVC is partially blocked or compressed, usually by tumor.

Symptoms:
-Enlarged vessels above SVC
-Periorbital edema
-Hoarseness/cough
-Dysphagia
-Late stage - ICP

Tx: Shrink tumor w/chemo or radiation

Nursing care:
-HOB elevated
-No valsava maneuver
-Remove constrictive clothing and rings
-Avoid venipuncture in arms

37

Describe Spinal Cord Compression.
Symptoms?
Treatment?

Tumor presses against spine.

Symptoms:
-PAIN!
-Numbness
-Neuroloss
-Incontinence

Tx: Shrink tumor, steroids

38

What are symptoms of pericardial effusion/tamponade?
Why could this happen?

Chest tumor pressing up against heart

Symptoms:
-muffled/distant heart sounds
-narrow pulse pressure

39

What are the symptoms of Hypercalcemia?
What is the treatment?
What is the normal range?
What can it be a common complication of?

Hypercalcemia can be a common complication of most cancers.

Symptoms:
-Lethargy
-Polyuria
-Muscle weakness

Tx:
-Increase fluid intake ~3-4L/day

Normal Ca range 8.5-11

40

What is DIC?
What could cause this regarding cancer?
What is the tx?

-Disseminated Intravascular Coagulation
-Bleeding and clotting

Some leukemias, and chemotherapies can cause this

Tx: Fresh Frozen Plasma, Platelets, Underlying cause

41

What are the symptoms and treatment of SIADH?
What is the tx?

-Decreased serum Na+
-ALOA

Tx: Fluid restriction, possibly 3% NS

42

What is Tumor Lysis Syndrome?

What is the tx?

Complication during treatment of cancer, large amounts of tumor cells are killed off (lysed) at the same time by the treatment, releasing their contents into the bloodstream.

Intracellular cancer contents spill out which:
-Increase uric acid
-Increase phosphorus
-K+ > 5.5
-Can cause kidney failure

Tx: Increase fluids prior to chemo treatment

43

What are options to address Chemotherapy Induced Nausea and Vomiting (CINV)?

-Small frequent foods

-metoclopramide

-Avoid bad smells

-Suggest foods that the patient enjoys

-ondansetron

-Guided imagery

-Medical marijuana