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NUR2229 > Week 4 - Oncology nursing > Flashcards

Week 4 - Oncology nursing Flashcards

1
Q

What is a multidisciplinary care?

A

The forefront concept in providing exemplary cancer care.
It is well documented and accepted that multidisciplinary care represents best practice in terms of treatment planning and care for cancer patients.

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2
Q

An effective multidisciplinary approach can result in:

A
  • Improved treatment planning through consideration of a full therapeutic range and thus improved outcomes,
  • Improved team communication,
  • Survival benefit,
  • Increased recruitment into clinical trials,
  • Detection of emotional needs of patients
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3
Q

What is a Multidisciplinary Cancer Care Meeting?

A

A multidisciplinary care meeting is a deliberate face to face (or video-conference) meeting involving a range of health professionals having expertise in diagnosis and management of cancer. The purpose of the meeting is to facilitate best practice management of all patients with cancer.

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4
Q

What is chemotherapy?

A

Chemotherapy, often called ‘chemo’, uses medicines to destroy cancer cells. Chemotherapy is used on its own or in combination with other types of treatment. Your doctor may recommend chemotherapy to shrink a tumour before surgery, to destroy remaining cancer cells after surgery, or to improve symptoms and prolong life, where it is not possible to cure the cancer.

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5
Q

Chemotherapy side effects:

A
  • Fatigue (tiredness)
  • Nausea, vomiting and loss of appetite
  • Pain or soreness, such as headaches, muscle pain or nerve pain
  • Sores in the throat or mouth
  • Changes to the skin, such as itching, redness, dryness and acne
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6
Q

What is radiation therapy?

A

Uses radiation to destroy cancer cells. Although radiation also damages normal cells, cancer cells are especially sensitive to its effects. This makes radiation therapy an effective treatment for many cancer types.

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7
Q

Acute radiation side effects:

A
  • Skin problems, especially at the radiation site, such as dryness, itchiness, peeling and blistering (similar to sunburn)
  • Fatigue (tiredness)
  • Hair loss in treatment area
  • Mucle aches
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8
Q

What cancer treatments are there?

A
  • Surgery
  • Radiation
  • Chemotherapy
  • Targeted therapy (eg. herceptin)
  • Immunotherapy (eg. pembrolizumab)
  • Hormone therapy
  • Transplant
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9
Q

What is neoadjuvant cancer treatment?

A

Refers to all treatments that are administered before the primary cancer treatment (e.g. radiotherapy or chemotherapy used to shrink a tumour prior to surgery)

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10
Q

What is adjuvant cancer treatment?

A

Refers to therapy that is administered after the primary treatment (e.g. chemotherapy administered after radiation treatment when radiation is the primary treatment)

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11
Q

What is the cell kill hypothesis?

A

Cell kill hypothesis states that a chemotherapy concentration given for a defined period of time, kills a constant fraction of the cells in the population, independent of the number of cells. Because only a fraction of the cancer cells are killed with each treatment, repeated doses must be administered to reduce the size of the tumour. The fractional killing of tumours in response to treatment is due to the cell-cycle specificity of the chemotherapy.

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12
Q

Cell cycle specific chemotherapy:

A

Agents act on the cells in a specific phase. They are most effective against cancers that are rapidly growing.

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13
Q

Cell cycle non-specific chemotherapy:

A

Agents act on cells no matter what phase of the cell cycle they are in. Because they also affect cells in the resting (G0) phase, they are effective against slow growing tumours and rapidly dividing tumours.

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14
Q

Chemotherapy routes of administration:

A
  • Oral: by mouth
  • Topical: on the surface of the skin as a cream
  • Intravenous: into a vein
  • Intramuscularly: into a muscle
  • Subcutaneously: under the skin
  • Intra-arterial: into an artery
  • Intrathecal: into the central nervous system via the cerebrospinal fluid
  • Intrapleural: into the chest cavity
  • Intraperitoneal: into the abdominal cavity
  • Intravesical: into the bladder
  • Intralesional: into the tumour
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15
Q

Anaemia - Low red blood cell count, why is it important?

A

Low red blood cell count = low haemoglobin (hb) count Low hb = less oxygen being carried around the body and the patient can become fatigued, short of breath, tachycardic and anaemic.

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16
Q

Leucopenia - Low white blood cell count, why is it important?

A

White blood cells fight infection and a reduction in the number of white blood cells in the body means that the patient can become immunocompromised and at greater risk of infection

17
Q

Thrombocytopenia - Low platelet count, why is it important?

A

The function of platelets is to maintain haemostasis. Low platelet count means the patient is at greater risk of bruising and bleeding.

18
Q

Oncology nursing considerations:

A
  • Educate the patient so that the patient knows what side effects to anticipate and what to do about them
  • Advise the patient to listen to their body and rest when required
  • Educate the patient on the importance of taking their temperature each day and to come to the emergency department immediately if their temperature reaches 38 degrees Celsius or above, or if they are unwell
  • Blood tests including FBC are taken prior to every cycle of chemotherapy to monitor the patient’s bone marrow function
19
Q

There are five recognised oncology emergencies that patients undergoing treatment for cancer are at risk of developing:

A
  1. Neutropenic Sepsis (also known as febrile neutropenia)
  2. Spinal Cord Compression (SCC)
  3. Tumor Lysis Syndrome (TLS)
  4. Superior Vena Cava (SVC) obstruction
  5. Hypercalcemia
20
Q

Non-pharmacological interventions in cancer management can be categorised into four groups;

A
  1. Psychoeducational interventions (e.g. education, counselling and supportive interventions)
  2. Cognitive behavioural methods (e.g. meditation, relaxation techniques or guided imagery) 3. Exercise and complementary therapies (e.g. acupuncture, acupressure, electrical stimulation, yoga, herbs and massage)
  3. Multi-modal interventions (e.g. combined more than one type of intervention)
21
Q

How are chemotherapy drugs classified?

A

Classified according to their cycle activity. Can either be cell cycle phase specific or cell cycle phase non-specific

22
Q

Chronic radiation therapy side effects:

A
  • Swelling
  • Skin thickening
  • Joint stiffness
23
Q

Rare radiation therapy side effects:

A
  • Bone fractures

- Second tumours

24
Q

Interprofessional oncology team can consist of:

A
  • Nurses
  • Pharmacists
  • Physician assistants
  • Rehabilitation clinicians
  • Palliative care clinicians
  • Clinicians providing psychosocial support and spiritual workers
  • Physicians providing oncology care
25
Q

What 3 things are done in an oncology emergency?

A

Recognise: a comprehensive patient assessment is vital
Could the patient be neutropenic?

React: early interventions save lives
MET calls  
Broad spectrum antibiotics  
Fluid resuscitation  
Investigations (Blood cultures, CXR, MSU/CSU, swab CVAD’s, wounds, stool & sputum spec)

Review: Frequent monitoring of patient to escalate care
Fluid replacement and - consider HDU/ICU for septic patients
Possible renal filtering and vasopressin support as required
Review blood results and culture results
Change antibiotics as required

26
Q

What is neutropenic sepsis?

A

Most common oncology emergency. Neutrophils form part of the wider immune response and are particularly vulnerable to standard cytotoxic agents. Without enough neutrophils, patients are highly susceptible to infection and the severity of sepsis.

27
Q

What is spinal cord compression?

A

Occurs when cancer grows in or near the spine compressing the spinal cord and spinal nerves. This results in swelling and reduced blood supply to the cord and nerves.

28
Q

Symptoms of spinal cord compression:

A
  • Back pain
  • Loss of sensory function
  • Reduced power and strength
29
Q

Diagnosis of spinal cord compression:

A

MRI, CT, Bone Scan + Clinical Exam

30
Q

Treatment of spinal cord compression:

A
  • High dose steroids
  • Monitoring of BGL due to likely hyperglycaemia
  • Urgent radiation oncology review
31
Q

What is tumour lysis syndrome?

A

Metabolic disturbance which results from sudden injury and death of cancer cells usually within 3 days following treatment, the damaged cells release intracellular components causing sudden and severe electrolyte imbalance.

32
Q

Monitoring of tumour lysis syndrome:

A
  • Aggressive hydration
  • Strict FBC
  • Monitoring urine pH and administering IV Sodium bicarbonate to alkalize body pH
33
Q

What is hypercalcaemia?

A

Is a disorder in metabolic function, characterised by a serum calcium above 2.6 mmol

34
Q

Symptoms of hypercalcaemia:

A
  • Confusion
  • Vomiting
  • Dehydration
  • Seizures
35
Q

Treatment of hypercalcaemia:

A

Reduce serum Ca+ level and maintain renal function with IV fluids

36
Q

What is superior vena cava obstruction?

A

Caused by a mechanical obstruction from tumor

37
Q

Symptoms of superior vena cava obstruction:

A
  • Swelling of face, neck and arms
  • Dyspnoea
  • Reduced perfusion
38
Q

Treatment of superior vena cava obstruction:

A

Reducing the size of obstruction by radiation therapy or surgery

NUR2229 (6 decks)

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