medsurg exam 2 NEW

cancer

disease characterized by uncontrolled & unregulated growth of cells

normal vs cancer cell characteristics

normal:
-proliferation (growth) occurs when necessary
-control with contact inhibition (boundary cells feel)
-immature to mature cell differentiation

cancer:
-proliferation occurs haphazardly
-no contact inhibition
-differentiation can dedifferentiate

initiation

mutation in the genetic structure

promotion

reversible proliferation of the altered cells (supports cancerous cells)

progression

final stage, increased tumor growth rate, invasiveness increases, metastasis occurs

immunologic surveillance

the response of the immune system to antigens of the malignant cells

immunologic escape

cancer cell gets through immune system

lymphocyte types

t cells: destroy the cells of own body that have been taken over by viruses or have become cancerous

b cells: produce antibodies that are used to attack invading bacteria, viruses, toxins

natural killer cells: distinguish b/n infected & uninfected host cells, target & kill infected cells

macrophages

phagocytize foreign substances and help activate T cells

cancer causative agents

pesticides, uv exposure, alcohol intake, obesity, chemicals/asbestos...

there are a lot of causative agents, too much of anything can be harmful

your risk of getting cancer is determined by...

-WHO you are (genetics)
-WHERE you live (environment)
-HOW you live (lifestyle) (most control here)

cancer primary prevention

smoking, losing weight, PPE upon chemical exposure

healthy practices that avoid exposure to known carcinogenic agents

cancer secondary prevention

screening strategies to detect cancer early
mammogram 40yo, self admin. breast or prostate exam

7 warning signs of cancer (CAUTION)

c) change in bowel or bladder habits
a) a sore that does not heal
u) unusual bleeding/discharge from any body orifice
t) thickening or a lump in breast or body tissue
i) indigestion or difficulty swallowing
o) obvious change in wart or mole
n) nagging cough or hoarseness

screening vs diagnostic testing

screening:
-cheaper
-usually asymptomatic but at risk individuals
-simple testing method
-purpose is to detect potential disease indicators

diagnostic:
-$$$
-symptomatic individuals wanting to establish dx
-may be more complex/invasive
-purpose is to confirm presence/absence of disease

cancer diagnostics

-lab tests
-radiography (radiation shows image of tissues, bones)
-cytology (shows tissues under microscope)
-biopsy (sample of tissue removed)
-endoscopy (through gi tract)

tumor grading

classification of tumor cells by type of tissue, depending on how 'normal' it is

tumor staging

extent of spread of disease
I. limited disease
II. nodal involvement
III. metastasis to surrounding area
IV. distant metastasis (furthest spread)

tnm classification

t) tumor size
n) spread to nodes (lymph nodes)
m) metastasis to distant organ sites

metastasis

spread of cancer cells beyond their original site in the body

metastases

secondary tumors that separate from the original (primary) tumor

breast cancer that travels to the bone is considered...

breast cancer! (not bone cancer)

metastatic cells are not a new type of cancer cell

benign

-well-differentiated
-slow growing
-remains encapsulated
-does not metastasize
-usually harmless

malignant

-un-differentiated
-rapid growth
-invades adjacent tissue
-metastasizes
-always harmful, will kill if untreated

main sites of metastasis

-brain/cerebrospinal fluid
-lung
-liver
-adrenals
-bone

prostate cancer metastasizes to...

bone

breast cancer metastasizes to...

bone, liver, brain, lung

colon cancer metastasizes to...

liver

lung cancer metastasizes to...

brain, bone

goals of cancer treatment

cure, control, palliation

clinical trials/research (phases)
(for cancer that is not responding to normal treatment)

phase I: optimal dosing, scheduling, toxicity
phase II. effectiveness w/ certain tumors, max tolerable doses, ADRs
phase III. effectiveness of new med as compared with conventional tx
phase IV. further investigates meds, new uses, scheduling & toxicity

complete response (cr)

disappearance of all target lesions

partial response (pr)

at least a 30% decrease in the sum of the longest diameter of target lesion

stable disease (sd)

neither partial response nor progressive disease

progressive disease (pd)

at least a 20% increase in the sum of the longest diameter of lesions since tx started or the appearance of new lesions

surgery (as a cure)

-oldest form of tx
-varies on type of cancer
-ectomy- removal of something (oldest type, simply removing the tumor)

surgery (as control, palliation, rehab, support)

-secondary surgery to help with pain, obstruction, hemorrhage
-support through central venous access devices, G-tube

radiation (adjuvant therapy)

local treatment modality, more direct treatment, external is more common

risk for skin damage, erythema 1 hr after first dose, bone marrow suppression

chemotherapy (adjuvant therapy)

systemic therapy using chemicals to eliminate/reduce \# of malignant cells

biologic/targeted therapy (adjuvant therapy

alters immune relation b/n cancer tumor & body, helps body help itself

most common method of chemotherapy administration

IV!!!
(also given oral, IM, intracavitary, intraarterial, intrathecal, SQ, topical)

common cancer-related treatment problems (common w/ chemo patients)

-infection (bone marrow suppression) !!!
-bleeding/anemia !!!
-pain
-fatigue
-alopecia
-skin rashes
-anorexia (protein-calorie malnutrition)
-cachexia (muscle-wasting conditions)

acute chemotherapy side effects

anaphylactic, hypersensitivity reaction, IV site problems, cardiac dysrhythmias

delayed chemotherapy side effects

n, v, d, mucositis, alopecia, skin rashes, constipation, neurotoxicities, renal toxicities, bone marrow suppression

long-term chemotherapy side effects

damage to heart, liver, kidneys, lungs, infertility, secondary cancer

bone marrow suppression (myelosuppression) or immunosuppression

leukopenia/neutropenia
thrombocytopenia
anemia

labs: CBC, WBC w/ differential, platelets

leukopenia

deficiency of white blood cells

neutropenia

deficiency of neutrophils (bacteria cannot be ingested)

thrombocytopenia

low platelet count, bleeding risk

anemia

low RBC, chills, paleness, energy down

nadir

lowest blood count in treatment
normally 7-10 days after treatment

neutropenia/leukopenia nursing considerations

-reverse isolation (do not expose patient to anything)
-no raw foods
-no flowers/plants
-no litter box/dog poop/diapers
-avoid crowds
-strict hand-washing by all

thrombocytopenia nursing considerations

-avoid trauma to mouth (taco chips, hard candies)
-electric razor, soft toothbrush, no flossing
-assess for bleeding (gums, stool, urine)
-avoid injections, aspirin, rectal temps

anemia nursing considerations

-energy conservation, rest periods
-monitor hemoglobin and hematocrit
-diet high in protein and iron (meats, leafy veggies, eggs, nuts, legumes)

neupogen/nuelasta

stimulates WBC growth

aransep, epogen, procrit

stimulates RBC growth

immunotherapy

-uses immune system to fight cancer
-some types are called biologic therapy
-se: flu-like symptoms

palliative care

supportive medical and nursing care that keeps the patient comfortable but does not cure the disease

hospice

a home providing care for the sick, especially the terminally ill, 6 mts. or less to live

breast cancer etiology

unknown/not understood

breast cancer risk factors

female
over age 50
prolonged hormone stimulation
early menarche (before age 12)
late menopause (after age 51)
family hx
personal hx of colon, endometrial, or ovarian cancer
obesity- fat cells store estrogen
alcohol intake

breast cancer patho & manifestations

found within milk producing gland or milk duct

detected as a lump, nipple discharge, can cause indurations or dimpling

breast cancer diagnostics

mammogram
ultrasound
MRI
fine-needle aspiration
needle biopsy
staging

breast cancer collaborative care

surgical: mastectomy, axillary node dissection (remove lymph nodes), breast-conserving surgery

adjuvant therapy: radiation, chemotherapy

immunotherapy/targeted therapy

potential complications post-op/breast cancer

lymphedema, hematoma, seroma, infection

lymphedema

swelling due to an abnormal accumulation of lymph fluid within the tissues

hematoma

solid swelling of clotted blood within the tissues

seroma

accumulation of serum beneath the surgical incision

colon cancer etiology

family hx
more common in men
mortality highest in African Americans
50 years old or more

colon cancer risk factors

lifestyle factors
diet (high fat/red meat)
low exercise
smoking
alcohol
IBD for 10 years or longer

colon cancer diagnostics

history & physical (gi changes)
rectal exam
testing stool for occult blood
barium enema
colonoscopy
CT scan
MRI
CEA
ultrasound

colon cancer collaborative care

surgery is only cure (may need colostomy)
adjuvant therapy (radiation, chemotherapy)
biologic therapy (can be combined w/ surgery)

skin cancer etiology & risk factors

effects everyone w/ skin, defect in skin cells
sun worshipers
tanning beds
family hx
fair skin, light colored eyes
exposure to tar & systemic arsenicals

skin cancer patho & manifestations

melanoma vs nonmelanoma (basal & squamous cell)
manifestations: skin lesions

ABCD's of skin cancer

a) asymmetry
b) borders irregular
c) color variegation
d) diameter larger 6 mm

skin cancer diagnostics

history
self examination
clinical eval
skin biopsy (staging)

skin cancer collaborative care

-surgical (melanoma nor nonmelanoma (basal, squamous))
-adjuvant therapy (melanoma only)
radiation or chemotherapy
-immunotherapy or targeted therapy (melanoma only

basal cell skin cancer

most common skin cancer, appears in sun exposed areas, small waxy nodules with pearly borders, usually on face, rarely metastasizes, can lead to loss or ear, nose, lips

more annoying than life threatening

squamous cell skin cancer

on sun-damaged or normal skin, can be invasive, metastasized via lymph/blood, rough, thickened, scaly, prognosis depends on depth of invasion (how deep?), lesions may develop from precancerous conditions (keratosis, leukoplakia)

melanoma skin cancer

most serious/deadly type of skin cancer, peak years from 20-45 y/o, uv light exposure, tanning beds, 1/3 occur in existing moles (have dermatologist review lesions)

lung cancer etiology & risk factors

environmental exposures
smoking/exposure to smoke
inhaled carcinogens
men are at greater risk

lung cancer path & manifestations

patho unknown/not understood
manifestations: clinically silent, starts with cough, hemaptosis (cough with blood)- bad sign

lung cancer diagnostics

chest x-ray
MRI
CT scan
sputum cytology
bronchoscopy w/ biopsy & washings
PET scan (shows where it spread)

lung cancer collaborative care

surgical
adjuvant therapy (radiation, chemotherapy)

prognosis of lung cancer is poor, it is usually found in late stages

what parts of the body does chemotherapy affect the most?

systems with the fastest growing cells:
-integumentary system
-gi tract
-bone marrow

what are the fluid highway of the body?

lymph nodes (once cancer spreads here, we don't know where it may have gone)

why is infection during chemotherapy so dangerous?

chemotherapy causes bone marrow suppression, meaning the body is not making enough WBC's to fight the infection

3 things to focus on when treating any disease

diet changes
activity
medication

troponin level and meaning

0.4-0.6 (no higher)
determines presence of acute cardiac injury

BNP level and meaning

0-99
shows signs of chronic heart failure

left sided heart failure

fluid build-up in lungs

right sided heart failure

fluid build-up in vascular system

what lab is important to monitor constantly for a HF patient?

potassium (hypo/hyperkalemia cause irregular heart rhythm)

diet changes for HF patient

low sodium (2 g diet), low fat, low fluids

preload

the degree of muscle fiber stretch present in the ventricles at the end of diastole

afterload

the resistance against which the ventricles must pump in order to eject blood

contractility

the pumping ability of the heart

stroke volume

the amount of blood pumped by the left ventricle with each heart beat

ejection fraction

EF is the % of blood emptied from the ventricle during contraction (systole)

left ventricle ejection fraction

55-60%