Adult Oncology Nursing: Cancer Care, Treatment, Emergencies & Cases

What is carcinogenesis?

The process by which normal cells become cancerous, involving initiation, promotion, and progression.

What occurs during the initiation phase of carcinogenesis?

A carcinogen damages the DNA of a cell, leading to potential mutation.

What is the difference between benign and malignant tumors?

Benign tumors are well-differentiated, encapsulated, and do not spread, while malignant tumors are poorly differentiated, invasive, and can metastasize.

What is metastasis?

The process by which malignant cells invade surrounding tissues, enter the lymphatic and blood vessels, and establish new tumors in distant organs.

What are common carcinogens?

Tobacco, alcohol, sunlight, radiation, certain chemicals, and chronic inflammation.

What is the greatest single risk factor for cancer?

Age.

What are the three levels of cancer prevention?

Primary (preventing cancer), Secondary (early detection), and Tertiary (treating cancer and preventing complications).

What is the goal of primary prevention?

To reduce the risk of developing cancer through lifestyle changes and vaccinations.

What is the purpose of secondary prevention?

To detect cancer early through screenings and tests.

What does tertiary prevention involve?

Treating cancer and managing treatment side effects to improve quality of life.

What is the TNM staging system?

A system that classifies cancer based on Tumor size (T), Node involvement (N), and Metastasis (M).

What does Tis indicate in TNM staging?

Carcinoma in situ, meaning the cancer is still above the basement membrane and has not invaded deeper tissues.

What does N0 mean in TNM staging?

No regional lymph nodes contain cancer.

What does M1 indicate in TNM staging?

The cancer has metastasized to distant organs.

What are the goals of cancer treatment?

Cure, control, and palliative care.

What is curative surgery?

Surgery aimed at completely removing the tumor with a margin of healthy tissue.

What is palliative surgery?

Surgery that relieves symptoms without treating the cancer.

What is the role of genetic counseling in cancer risk?

To assess family history and guide testing for inherited mutations that increase cancer risk.

What are common oncologic emergencies?

Hypercalcemia, tumor lysis syndrome, SIADH, spinal cord compression, superior vena cava syndrome, and DIC.

What is myelosuppression?

A decrease in bone marrow activity leading to reduced blood cell production, often a side effect of cancer treatment.

What are neutropenic precautions?

Measures taken to protect patients with low white blood cell counts from infections.

What nursing care is prioritized for patients experiencing nausea and vomiting during treatment?

Implementing antiemetic protocols and monitoring hydration and nutrition.

What is the significance of BRCA mutations?

They significantly increase the risk of breast and ovarian cancers and can be inherited from either parent.

What is the purpose of imaging in cancer diagnosis?

To suspect the presence of cancer, while tissue biopsies confirm the diagnosis.

What is the importance of monitoring new symptoms in cancer patients?

To differentiate between symptoms caused by cancer progression and those caused by treatment.

What is the role of palliative care in cancer treatment?

To provide relief from symptoms and improve quality of life when curative treatment is not possible.

What is the nursing care focus during cancer surgery?

Airway management, pain control, wound care, mobility, and prevention of venous thromboembolism.

What should patients avoid on the arm after node dissection?

No blood pressures, sticks, or constriction.

What is the hardest part of waiting for a pathology report?

The waiting itself.

What is external beam radiation therapy?

A machine aims beams at the tumor from outside the body.

What are the side effects of external beam radiation?

Local reactions plus fatigue, skin reactions, mucositis, diarrhea, and marrow suppression.

What is the purpose of ink or dye markings on the skin during radiation therapy?

To mark the treatment field, which must stay on.

What is brachytherapy?

A sealed source of radiation placed in or near the tumor.

What is the difference between sealed and unsealed internal radiation sources?

Sealed sources emit radiation while in place; unsealed sources involve radioactive liquids that make body fluids radioactive.

What is the main action of chemotherapy?

It interferes with DNA or cell division, causing dividing cells to die.

What are the classifications of chemotherapy agents?

Alkylating agents, antimetabolites, antitumor antibiotics, plant alkaloids, hormones.

What is the purpose of administering chemotherapy in cycles?

To allow normal cells to recover between doses.

What are common side effects of chemotherapy?

Alopecia, mucositis, nausea, diarrhea, anemia, neutropenia, and infertility.

What is neutropenic fever?

A single temperature of 100.4 °F (38 °C) in a neutropenic patient, which is a medical emergency.

What precautions should be taken for a patient with neutropenia?

Private room, hand hygiene, dedicated equipment, and screening visitors.

What is the significance of the nadir in chemotherapy?

It is the lowest point of blood cell counts after chemotherapy, occurring 7 to 14 days post-treatment.

What should patients do if they develop a temperature of 100.4 °F or higher?

Call immediately and do not take acetaminophen first.

What is the role of antiemetics in chemotherapy?

To prevent nausea and vomiting associated with chemotherapy.

What are the three patterns of chemotherapy-induced nausea and vomiting?

Acute, delayed, and anticipatory.

What should be monitored in patients receiving chemotherapy?

Hydration and electrolytes.

What is extravasation in the context of chemotherapy?

The leakage of a vesicant drug into surrounding tissue, which can cause severe damage.

What should be done if extravasation is suspected?

Stop the infusion immediately, leave the catheter in, aspirate, and call for help.

What is the recommended action for staff when administering chemotherapy?

Use double gloves and an impermeable gown, and dispose of everything in hazardous waste.

What should be done to prevent line infections in chemotherapy patients?

Use sterile technique, perform hand hygiene, and monitor for signs of infection.

What are the signs of line infection to watch for?

Fever, chills, redness, drainage, tenderness at the site.

What is the importance of flushing a port monthly?

To maintain patency and prevent clot formation.

What dietary recommendations are given to chemotherapy patients?

Small, bland, cold meals and fluids between meals.

What should patients avoid to reduce the risk of infection during neutropenia?

Crowds, sick people, raw food, and gardening without gloves.

What should be inspected daily in a neutropenic patient?

Mouth, skin, line sites, and perineum.

What type of toothbrush should be used for patients with low blood counts?

Soft-bristle toothbrush or toothette; no flossing.

What is the recommended pain reliever for patients who cannot take aspirin or NSAIDs?

Acetaminophen.

What dietary recommendations are given for patients experiencing nausea?

Small, frequent, high-protein, high-calorie meals; cold foods if smells trigger nausea.

What is hypercalcemia and what level is considered an emergency?

Calcium above 10.5 mg/dL; above 12 to 13 is an emergency.

What are the symptoms of hypercalcemia?

Weakness, fatigue, low reflexes, constipation, nausea, confusion, lethargy.

What is the initial treatment for hypercalcemia?

IV normal saline followed by a bisphosphonate.

What is Tumor Lysis Syndrome?

Rapid cell death releasing potassium, phosphate, and uric acid into the blood.

What symptoms indicate Tumor Lysis Syndrome?

Falling urine output, nausea, vomiting, muscle cramps, peaked T waves.

What is SIADH and which cancer is it most often associated with?

Syndrome of Inappropriate Antidiuretic Hormone secretion, often associated with small cell lung cancer.

What are the signs of SIADH?

Scant, concentrated urine, weight gain without edema, low sodium levels.

What is the first sign of Spinal Cord Compression?

New back pain, worse lying down, radiating like a band.

What should be done if a patient with cancer reports new back pain?

Report immediately; anticipate dexamethasone and MRI.

What is Superior Vena Cava Syndrome?

Compression of the superior vena cava by a tumor or lymph node mass.

What are the early signs of Superior Vena Cava Syndrome?

Face and neck swelling, distended neck and chest veins, dyspnea.

What is Disseminated Intravascular Coagulation (DIC)?

A condition where clotting and bleeding occur simultaneously.

What are the signs of DIC?

Oozing from IV sites, petechiae, blood in urine or stool.

What is palliative care?

Symptom relief and support at any stage of illness, alongside curative treatment.

What is hospice care?

Care for patients with a prognosis of six months or less, focusing on comfort.

What does the acronym CRAB stand for in Multiple Myeloma?

Calcium high, Renal failure, Anemia, Bone pain.

What is the average age of diagnosis for Multiple Myeloma?

65 to 70 years old.

What is the primary treatment for Multiple Myeloma?

Chemotherapy with immunomodulators and proteasome inhibitors.

What should be monitored in a patient with hypercalcemia?

Cardiac monitor and fall precautions.

What dietary changes should be made for a patient with cachexia?

Small, frequent meals with high protein and calories; supplements between meals.

What is the nursing intervention for a patient with SIADH?

Fluid restriction and daily weight monitoring.

What is the role of the nurse in palliative care?

To provide support, manage symptoms, and facilitate communication about patient wishes.

What is the recommended action for patients experiencing mucositis?

Saline or baking soda rinses every 2 to 4 hours; soft brush for oral care.

What is the significance of weight monitoring in cancer patients?

To assess nutritional status and prevent cachexia.

What should be avoided in patients with low blood counts?

IM injections and venipuncture; use the smallest needle and apply pressure after sticks.

What are common symptoms of advanced cancer?

Fatigue, pallor, decreased platelets and neutrophils, recurrent infections.

What are lytic lesions and their associated symptoms?

Lytic lesions cause bone pain, pathologic fractures, and spinal cord compression.

What is the recommended fluid intake for patients with certain cancers?

3 liters a day unless restricted, to support kidneys and manage calcium levels.

What is the significance of a breast lump in a 47-year-old woman?

A breast lump, especially if ignored for a year, may indicate breast cancer.

What does the staging T3 N2 M1 indicate?

Large tumor, several lymph nodes involved, distant metastasis present.

Why is a port used for chemotherapy?

A port provides access to a large vein for safe administration of chemotherapy.

What are some key components of a cancer patient's discharge plan?

Follow-up with oncology, support groups, and information on advance care planning.

What calcium level is considered high and may cause muscle weakness?

A calcium level of 13.1 mg/dL can lead to muscle weakness and other symptoms.

What is the nursing problem associated with Gary's social history?

Gary lives alone and may lack support during his cancer treatment.

What emergency condition is indicated by swelling and shortness of breath?

Superior vena cava syndrome.

What are the first nursing actions for a patient with superior vena cava syndrome?

Assess vital signs, provide oxygen, and notify the healthcare provider.

What should not be done for a patient with superior vena cava syndrome?

Do not place the patient in a supine position.

What are bleeding precautions for a patient with thrombocytopenia?

Use soft toothbrushes, avoid straight razors, and monitor for signs of bleeding.

What is the role of genetic testing in breast cancer?

Genetic testing can identify inherited risks, such as BRCA gene mutations.

What is the best response to a patient concerned about their daughters' breast cancer risk?

Discuss genetic testing options rather than immediate mammograms.

What are the signs of dehydration in a cancer patient?

Dry mucous membranes, lightheadedness, and tachycardia.

What is the importance of pain control in cancer care?

Effective pain control improves quality of life and allows for better participation in treatment.

What are the implications of a patient's insurance lapse in cancer care?

It may affect access to treatment and support services.