week 1 - cancer pt.2

Question 1

Patients with a history of GERD, can develop a change in the esophageal lining, and can develop what condition where PRE-cancerous cells develop?

Answer 1

Barrett’s Esophagus

Question 2

The primary risk factor of developing pharyngeal or laryngeal (esophageal/ throat) cancer is smoking and chewing tobacco. What are some other risk factors?

Answer 2

-poor oral hygiene
-canned + smoked foods w/ nitrosamine (nitrates)

Question 3

What are the diagnostic tools used in pharyngeal or laryngeal cancer?

Answer 3

-EGD biopsy
-CAT/ PET scan/ MRI
-endoscopy

Question 4

What clinical manifestations should be monitored for when diagnosing pharyngeal or laryngeal cancers?

Answer 4

-lump in the neck/ throat
-cough
-change in voice quality
-colds
-can’t swallow
-ear infections
-weight loss
-regurgitation of undigested food
-halitosis + hiccups

Question 5

what is it called when the esophagus is surgically removed?

Answer 5

esophagectomy

Question 6

What medication is used in patients with hypothyroidism to supplement the thyroid and improve function?

Answer 6

Synthroid

Question 7

what is dumping syndrome and how does it relate to throat cancer and an esophagectomy?

Answer 7

-food (sugar) is moving too quickly to your small intestines from your stomach causing blood sugar and fluid shifts

**this is a common complication of throat and stomach surgeries, like am esophagectomy

Question 8

which kind of feeding tube is usually placed in the RUQ below the xipoid process and ribs?

Answer 8

PEG tube (percutaneous Endoscopic Gastrostomy)

Question 9

Which kind of feeding tube is a type of PEG tube but this tube is placed through the abd wall and directly into the stomach?

Answer 9

G-Tube (Gastrostomy Tube)

Question 10

Which kind of feeding tube is placed directly into the Jejunum (small intestine) - this tube is used for meds and feeding when the stomach isn’t accessible?

Answer 10

J-Tune (Jejunostomy Tube)

Question 11

TPN .vs. PPN

Answer 11

TPN- total nutritional needs, the patient won’t consume food any other way, higher concentration/ denser formula so it’s given in bigger veins like the neck + chest, long term (weeks to months)

PPN- this is supplemental nutrition in conjunction with oral intake or a feeding tube, diluted/ thinner formula so it goes through peripheral veins, temporary use (only up to 2 weeks)

Question 12

which cancer is the #1 cause of death in the US?

Answer 12

lung cancer

Question 13

Which cancer is the #2 cause of death in the US?

Answer 13

breast cancer

Question 14

how often should women over the age of 40 be getting a mammogram?

Answer 14

annually

also important to perform SBE (self breast exams) to look for changes in tissue, areolas and in the lymph nodes

Question 15

When performing a SBE (preferably one week after menses) what kinds of things should your patient be educated on to look for?

Answer 15

-lumps, dimpling, puckering, bulging
-a nipple that has become inverted or changed position
-redness, soreness, rash, swelling
-discharge from the nipple
-

Question 16

You can get genetic testing if you have familial history to see if you have the breast cancer genes, what are those genes?

Answer 16

BRCA1, BRCA2 and HER2

Question 17

which is the MOST COMMON type of breast cancer?

Answer 17

Ductal Carcinoma In Situ (DCIS)
starting in the milk ducts or lobules

Question 18

Which hormones are looked at to determine the treatment of breast cancer based on their sensitivity to BRCA1, BRCA2 and HER2?

Answer 18

Estrogen Receptor (ER) and Progesterone Receptor (PR)

if the cancer cells are ER or PR positive it can be treated with hormone blocking drugs - if they’re ER or PR negative, hormone blocking drugs won’t work at blocking cancer growth

Question 19

True or False?
A post op breast patient CAN NOT have a blood pressure taken on the affected side(s).

Answer 19

TRUE

Question 20

What are the preferred drugs used when breast cancer cells are ER or PR positive post operatively?

Answer 20

Tamoxifen + Raloxifene

(Evista)

Question 21

What is the surgery called that is a partial removal of breast tissue?

Answer 21

Lumpectomy

Question 22

After a mastectomy, why is it so important to have the patients arm(s) elevated on pillows post op?

Answer 22

to promote fluid return in the lymph nodes

Question 23

After a mastectomy, what are 3 other things besides a blood pressure that can not be done on the affected arm?

Answer 23

-NO IV.s
-NO injections
-NO venipunctures

Question 24

Tissue Flap Procedures are one of the ways to reconstruct the breasts after a mastectomy. This is where you take tissue from other body areas to reconstruct the breast. What are the 3 common areas to take tissue from?

Answer 24

TRAM flap - Abdomen
Latissimus Dorsi flap - back
DIEP flap - this is also from the abdomen, but muscle is preserved

Question 25

Tissue expanders are ________ implants placed under the skin + chest muscle after a mastectomy. They are gradually filled with ______ over several weeks to stretch the skin and create space for permanent implants.

Answer 25

temporary; saline

Question 26

What are the 2 main types of lung cancer?

Answer 26

-Small cell lung cancer (SCLC) -Non small cell lung cancer (NSCLC)

Question 27

which type of lung cancer is -more invasive -spreads more rapidly -metastasizes more quickly?

Answer 27

Small cell lung cancer (SCLC)

Question 28

What are some risk factors for lung cancer?

Answer 28

-smoking/ second hand smoke -radon -asbestos -arsenic -uranium -chromium -nickel -soot -tar -diesel -air pollution -HIV -infection -radiation

Question 29

If there is cancer in the visceral pleura, this means cancer is where in the lungs?

Answer 29

in the lining that covers the lungs

Question 30

If there is cancer in the parietal pleura, this means cancer is where?

Answer 30

somewhere in the lining that covers the entire thoracic cavity

Question 31

What is the space called that's in between visceral pleura and the parietal pleura?

Answer 31

the pleural space

Question 32

What kinds of signs and symptoms will you see with lung cancer?

Answer 32

-bloody sputum -coughing that doesn't go away -SOB -chest pressure -decreased appetite + swallowing

Question 33

What is the complication called when there is air in the pleural space?

Answer 33

pneumothorax

Question 34

What is the complication called when there is blood in the pleural space?

Answer 34

hemothorax

Question 35

What is the complication called when there is air collecting in the pleural space and it can't escape, compressing the heart, lungs and major blood vessels?

Answer 35

tension pneumothorax

Question 36

What is the complication called when the visceral + pleural lining is inflamed, resulting in the 2 rubbing together causing a really sharp chest pain?

Answer 36

pleurisy or pleuritis

Question 37

Pleural effusion is when their is ______ accumulation in the pleural space.

Answer 37

fluid

Question 38

_______ is when a needle is put into the thoracic cavity to drain fluid.

Answer 38

Thoracentesis

Question 39

What is the difference between PLEURODESIS and PLEUROCENTESIS?

Answer 39

pleurodesis - Talc is put into the pleural space to cause inflammation and scarring to adhere the chest wall to the lungs to prevent fluid from re-accumulating pleurocentesis- a temporary procedure where a needle is used to remove fluid from the pleural space

Question 40

What is the incision called when it's into the thoracic area?

Answer 40

thoracotomy

Question 41

A lobectomy is the _______ of a lobe of the lung.

Answer 41

removal

Question 42

Make sure to encourage the use of incentive spirometry post op to prevent what?

Answer 42

pneumonia

Question 43

Why is it important to monitor for tracheal deviation after a lobectomy? What is causing that complication?

Answer 43

when there is a lobe of the lung removed there is nothing their filling that space - the way air is moving, it can cause the trachea to shift to the affected side - towards the empty space to "fill it"

Question 44

how do you verify the placement of a chest tube?

Answer 44

x-ray

Question 45

What should be included in your assessment of a patient with a chest tube?

Answer 45

-air leaks -kinks in the tubing -ABC's + lung expansion -output

Question 46

When assessing chest tube output, should their be a gradual increase or decrease in amount hourly?

Answer 46

there should be a gradual decrease in output hourly

Question 47

can you raise a chest tube above the patients heart?

Answer 47

no.

Question 48

what is it called when there is a collection of purulent fluid or pus?

Answer 48

empyema

Question 49

what are 3 side effects/ complications of repeated thoracentesis?

Answer 49

-pain -depleted protein + electrolytes -pneumothorax

Question 50

What are the 2 ways a pleurodesis procedure can be performed?

Answer 50

thoracoscopically or through a chest tube

Question 51

when performing a pleurodesis via chest tube, after the agent is inserted, you need to clamp the chest tube, how long does the chest tube need to be clamped for?

Answer 51

60-90 minutes

Question 52

during a pleurodesis, after the chest tube is clamped, the patient needs to be put into many different positions to achieve what?

Answer 52

even distribution of the agent, make sure it's in contact with all the pleural space

Question 53

After a chest tube pleurodesis is completed, why is the chest tube drainage continued for several days following?

Answer 53

to prevent fluid from reaccumulating and and promote the adhesion of the visceral and parietal pleura