week 9 Cancer

Question 1

what assessments are done to diagnose cancer?

Answer 1

health hx, family hx, physical exam, specific dx tests, and ultimately biopsy

Question 2

two types of non-invasive (in situ) breast ca

Answer 2

ductal carcinoma
lobular carcinoma

Question 3

is inflammatory breast cancer invasive or in-situ?

Answer 3

invasive

Question 4

can ductal carcinoma be invasive?

Answer 4

yes- it breaks through the duct walls into surrounding breast tissue

Question 5

which type of breast ca is rare but highly aggresive and characterized by diffuze erythema, and peau d’orange?

Answer 5

inflammatory breast ca

Question 6

which of the following is NOT a risk factor for breast ca?
- age >65
- nulliparity or 1st child after 30
-oral contraception
- obesity
-alcohol
- smoking
- high socioeconomic status, jewish heritage

Answer 6

smoking not listed on slide

Question 7

after what age do you have a mammogram every 2 years?

Answer 7

50

Question 8

which type of breast surgery will require radiation post-surgery?

Answer 8

lumpectomy

Question 9

with a sentinal node dissection, how many nodes are usually taken?

Answer 9

1-4

Question 10

what is a DIEP flap?

Answer 10

when tissue is taken from lower abdomen and moveed up to reconstruct breast

Question 11

post-op mastectomy: how long will drains be in place?

Answer 11

at least 5 days

Question 12

what are three main nursing care priorities related to post-op mastectomy:

Answer 12

care for incisions and drains, control pain, restore arm mobility

Question 13

what are some oral meds given as an adjunct with
mastectomy:

Answer 13

hormones, estrogen receptor blockers, biological and targeted therapy

Question 14

post-op mastectomy: patients will be taught to care for these at home

Answer 14

drains

Question 15

post-op mastectomy: what is the progression of drainage color?

Answer 15

red at first, then pink, then apple juice color

Question 16

post-op mastectomy: criteria for drain removal?

Answer 16

removed after a couple weeks typically (when less than 30ccs in 24 hr period for 2-3 consecutive days)

Question 17

Post Mastectomy: goals (name 3)

Answer 17

• prevent contractures/muscle shortening
• improve lymph and blood circulation
• gradually increased function over 4-6 weeks

Question 18

Post Mastectomy: nursing interventinos to restore arm mobility

Answer 18

-analgesics before exercise
- warm water compresses/soaks
-

Question 19

Post Mastectomy: nursing interventions/teaching to prevent lymphedema

Answer 19

elevate arm, no elastic bandages post op, avoid sun and trauma, no BP or venipuncture, teach when problem becomes emergent

Question 20

Post Mastectomy: nursing interventions to TREAT lymphedema when it occurs (4 ish categories)

Answer 20

• massage/compression (neumatic or bandages) to move fluid
• diuretics
• isometric exercises
• elevation

Question 21

what parts of the body does leukemia affect?

Answer 21

bone marrow, lymph system and spleen

Question 22

what is leukemia?

Answer 22

accumulation of dysfunctional blood cells in bone marrow and lack of production of normal ones

Question 23

what are the results of leukemia?

Answer 23

thrombocytopenia, decreased WBC, decreased platelets

Question 24

5 organs/tissues that leukemia cells infiltrate typically

Answer 24

spleen, liver, lymph nodes, bones, meninges

Question 25

three phases of chemotherapy for leukemia

Answer 25

- induction stage to achieve remission - consolidation phase - maintenence phase

Question 26

what percent of leukemia patients achieve remission with chemo?

Answer 26

70%

Question 27

describe nursing care priorities during induction stage of leukemia tx

Answer 27

focuses on neutropenia, thrombo-cytopenia, anemia

Question 28

what types of cells are given to treat pancytopenia in leukemia treatment? how are they aquired?

Answer 28

stem cells. harvested from donor, pt's own, or identical twin

Question 29

which cells are most affected by chemotherapy treatments?

Answer 29

bone marrow-stem cells, epithelial cells in GI ova or testes hair follicles

Question 30

many chemotherapy drugs are _____

Answer 30

vesicants

Question 31

compare the radioactivity of temporary to permanent radiation implants (internal radiation)

Answer 31

temporary have high radioactivity, permanent emit at a low level and pt can be discharged

Question 32

what are the three principles of radiation precautions

Answer 32

time, distance, shielding

Question 33

what labs should a nurse monitor during chemo and radiation treatment (regarding myelosuppression)

Answer 33

HGB, HCT

Question 34

what can a patient with neutropenia NOT have in the room? (2 things)

Answer 34

flowers and fruit

Question 35

what is the blood work to monitor if someone is having chemo and radiation to assess their risk for infection?

Answer 35

ANC - absolute neutrophil count

Question 36

if pt with low ANC is febrile, what happens?

Answer 36

we initiate Abx therapy immediately

Question 37

what drug can we give to treat neutropenia?

Answer 37

colony stimulating factor (filgrastim-neupogen)

Question 38

why can we not give ginger to someone with pancytopenia?

Answer 38

because it affects coagulation while they are lacking clotting factors

Question 39

because of TNF causing nausea/vomiting and diarrhea, we want to assess for _______ (r/t fluid), _______ (r/t ph), and monitor _____ during tx

Answer 39

dehydration, alkalosis, weight

Question 40

after chemo and radation, how long do we teach pts to avoid sun?

Answer 40

1 year

Question 41

a patient who is nearing the end of their cancer treatment is planning to spend a day at an outdoor pool. what will we tell them?

Answer 41

avoid direct sun or extreme heat if pool is chlorinated, don't go in to prevent desquamation or rash

Question 42

what should pt be taught about oral hygeine during treatment?

Answer 42

rinse with saline after each meal and before bed, soft toothbrush, small sips of water ++ to replace saliva

Question 43

loss of sensation to hands and feet impaired gait and balance orthostatic hypotension Neuropathic pain Erectile dysfunction Loss of fine motor function (playing an instrument) Loss of taste discrimination, constipation what are these a result of?

Answer 43

chemo induced peripheral neuropathy (CIPN)

Question 44

How do we treat CIPN?

Answer 44

there are no known evidence-based interventions

Question 45

related to female sexuality, what would I teach a patient undergoing tx?

Answer 45

use lubrication and a vaginal dilator after radiation

Question 46

describe immunotherapy, monoclonal antibodies, endocrine therapy and targeted therapies

Answer 46

new cancer-treating drugs that can work directly on ca cells or utilize endogenous immunity to attck ca, or slow growth. pts often undergo clinical trials to test these

Question 47

BIG ONE! what is SVC syndrome?

Answer 47

obstruction of superior vena cava by tumor, or blood clot in CVAD

Question 48

what are the signs of SVC (KNOW THIS!)

Answer 48

facial edema, periorbital edema, distention of neck and chest, headache, seizures, eventually obstruced airway and decfeased cardiac output

Question 49

how do we treat SVC syndrome?

Answer 49

radiation, chmo, surgery if its the tumor. remove the CVAD if that's the problem

Question 50

besides SVC syndrom,e, what is an obstructive oncological emergency?

Answer 50

spinal cord compression

Question 51

if patient has constipation, bakc pain, and loss of reflexes, what might i suspect?

Answer 51

spinal cord compression

Question 52

what are three metabolic complications/emergencies of cancer?

Answer 52

SIADH, Hypercalcemia, tumor lysis syndrome

Question 53

what are the four hallmark signs of tumor lysis syndrome?

Answer 53

hyperuricemia hyperphosphatemia hyperkalemia hypocalcemia

Question 54

patient has Hyperuricemia Hyperphosphatemia Hyperkalemia Hypocalcemia as a result of rapic destruction of tumor cells. what will i monitor and how will i treat?

Answer 54

monitor urine otput and urinary function labs. hydrate them and treat with allopurinal

Question 55

if a patient has bone cancer, what is a metabolic complication i am worried about? what is the worst case scenario if this goes untreated? how is this treated?

Answer 55

hypercalcemia, coma hydration, diuretic, biophospate infusion like Pamidronate

Question 56

what oncological emergency can occur when microorganisms enter the bloodstream from wounds, CVADs, etc?

Answer 56

easily leads to sepsis due to myelosuppression. septic shock leads to DIC, which leads to depletion of clotting factors (=bleeding) and clots (=organ damage)