Med/Surg II - Exam I

Cancer pathophysiology

Cancer is caused by genetic changes that impact how cells operate including inherited traits, errors in cell division, environmental factors

how are cancers named?

cancers are named by the body part origin and cel type

Progression to malignancy

- hyperplasia

- dysplasia

- carcinoma in situ

hyperplasia

extra cells but normal appearance

dysplasia

cells look abnormal

carcinoma in situ

cancer cells that can't move yet

how does cancer form their own blood supply?

angiogenesis

Angiogenesis

cancer cells can create their own blood supply

metastasis

cancer may start out in one location and spread

primary tumor

first place the cancer arises

secondary tumors

When cells detach from the primary tumor and are carried elsewhere in the body

malignant cell characteristics

- no apoptosis so no cell death

- angiogenesis allowing the tumor to survive on their own

Cancer staging

- T (tumor)

- N (node)

- M (metastsized)

T = cancer staging

size and extent of the primary tumor

N = cancer staging

number of nearby lymph nodes that show cancer

M = cancer staging

whether the cancer has metastasized

Stage 0 cancer staging

abnormal cells are present but have not spread

stage I cancer staging

cancers can be les serious and have a better prognosis

stage II-III

larger tumor or regional spread

stage IV

distant metastasis

In situ

abnormal cells confined to origin

localized

cancer in one organ only

regional

spread to nearby lymph nodes or tissues

Distant

metastasized to distant body parts

unknown

insufficient information to stage

primary prevention

concerned with reducing cancer risk in individuals with no genetic mutations

secondary prevention

involves detection and screening to achieve early diagnosis and intervention

tertiary prevention

relates to reducing the impact of the disease to promote wellbeing and quality of life

referred pain

pain felt in a location different from the source

cancer infection risk

chemotherapy reduces white blood cells causing neutropenia which causes an increased infection risk

Gi issue with cancer patients

- N/V

- altered taste

- oral mucositis

- malnutrition/anorexia

- constipation/impaction/obstruction

- diarrhea

- lymphedema

- peripheral neuropathy

- fertility issues

lymphedema symptoms

- swelling

- heaviness

- tightness

- decreased mobility

- itching

- burning

- sleep disturbance

peripheral neuropathy symptoms

- numbness

- tingling

- weakness

- balance issues

- autonomic dysfunction

what does peripheral neuropathy increase risk for?

- falls

- burns

- injury

Sleep disturbance contributing factors

- anxiety

- depression

- situational stress

- pain

- corticosteroids

- medication withdrawal

sleep disturbances can be an early sign of what?

delirium

delirium

Neuropsychiatric disorder affecting cognition, attention, and awareness

when does delirium in cancer patients often occur?

advanced cancer near the end of life but could be reversible if non-terminal cancer

cancer caused cognitive impairement

- concentration problems

- decreased organization

- delayed processing

- memory deficits

cancer fatigue

affects about 80% of clients

chronic fatigue

long-lasting fatigue unrelieved by rest and impacts daily function

causes of fatigue

- chemotherapy-related anemia

- immune/inflammatory changes

- cortisol shifts

- emotional factors (depression, anxiety, fear)

- sleep disorders

- cognitive impairment

- medications (opioids)

hypercalcemia causes

- bone invasion

- increased calcium or vitamin D from cancer

hypercalcemia symptoms

- confusion

- dehydration

- weakness

- N/V

- decreased appetite

- constipation

hypercalcemia prevention

consume 2-4L of fluid daily

hypercalcemia treatment

- IV NS

- calcitonin

Superior Vena Cava (SVC) syndrome cause

tumor compresses the SVC causing impaired blood flow

Superior Vena Cava (SVC) syndrome signs

- facial edema

- neck/arm swelling

- hoarse voice

- cough

- dyspnea

- chest/shoulder pain

Superior Vena Cava (SVC) syndrome treatment

- reduce tumor

- stent placement

what are neutropenic precautions

- positive pressure room

- no raw or undercooked food

- no raw veggies or fruits

- no fresh flowers/plants

- avoid crowds

- wear a mask in public

Radiation dermatitis cause

radiation therapy

Radiation dermatitis s/s

- erythema

- irritation

- swelling

- blisters

- changes in pigmentation

- dry, flaky, itching, or peeling skin

Radiation dermatitis interventions

- Avoid rough clothing

- gentle washing with mild cleansing agents

- avoid adhesive tape

- avoid heat and cold therapy

- utilizing sun protection

Chemo medication safety

- chemotherapy gown

- double chemo gloves

- face and eye protection if risk of splashing or emesis

- mask if risk of inhalation

Central venous catheter

- tip rests in SVC

- usually inserted at jugular or subclavian vein

Peripherally inserted central catheters (PICCs)

- port at peripheral vein

- tip rests in SVC

PICC and CVC care education

- Keep all dressings dry and intact

- Monitor for manifestations of infection at the insertion site

- Prevent the catheter from getting pulled

- Initiate a flushing schedule

extravasation prevention

Ensure the intravenous access is functioning properly before medication administration

extravasation s/s

- pain

- swelling

- redness

extravasation treatment

- Stop the infusion

- Notify the provider

- Under some circumstances, aspirate any remaining drug from the line

- Apply hot or cold therapy

- Administer antidote medications to minimize tissue damage

- Serious extravasation may require surgical management

prevalence of breast cancer

accounts for about 31% of newly diagnosed cancers annually in American gynecologic clients

what reduces breast cancer death rate?

improved screening and detection protocols

breast cancer biomarkers

help guide treatment selection

what gene mutations increase risk for breast cancer and why?

- BRCA1/BRCA2

- because they impair DNA repair

non-invasive type of breast cancer and where it is located

- in situ breast cancer

- confined to milk ducts

invasive breast cancer type

spreads beyond the initial site into nearby breast tissue

most common type of breast cancer

ductal breast cancer

modifiable risk factors for breast cancer

- obesity

- alcohol use

- radiation exposure

- hormone therapy

- low physical activity

- breastfeeding less than 1 year

nonmodifiable risk factors for breast cancer

- genetics

- advanced age

- family history

- dense breast tissue

- early menarche

- late menopause

breast cancer s/s

- Mass or lump

- Swelling

- Discharge

- Nipple retraction

- Skin changes that may resemble an orange peel

- Swollen lymph nodes in the axillary or under the collar bone

breast cancer diagnostics

- mammography usually after 40

- galactography

- ultrasonography

- MRI

- biopsies

lumpectomy

removes the tumor while conserving breast tissue for small, localized cancer

quadrantectomy

removal of a portion of the breast with the tumor

simple mastectomy

removes breast tissue only - no lymph nodes

modified radial mastectomy

removes entire breast, much of the skin, and axillary lymph nodes

bilateral mastectomy

both breasts removed

when is radiation indicated?

- tumors greater than 5cm

- invasion of chest wall/skin

- lymph node involvement

Chemotherapy cycle lengths

3-6 month cycles

Chemotherapy medcations

- cyclophosphamide

- methotrexate

- 5-fluorouracil (CMF)

- doxorubicin

- epirubicin

treatment for hormone-receptor positive breast cancer

hormone therapy

how does Tamoxifen work?

treats hormone-receptor positive breast cancer by blocking the estrogen receptors on cancer cells

how does Aromatase inhibitors work?

suppress estrogen production

what is targeted therapy used to treat?

treats HER2/neu positive breast cancers

Monoclonal antibodies targeted therapy

attack the HER2 protein

what is the most common lung cancer and where does it originate?

- originates from epithelial cells in the lungs

- non-small cell lung cancer (NSCLC)

- can occur anywhere from the bronchi to the alveoli

Squamous cell carcinoma origin

carcinoma generally originates in the large, central airways

adenocarcinoma

arise from peripheral lung tissue

bronchioalveolar carcinoma

arise from peripheral lung tissue

small cell lung cancer characteristics

- develops when genes that affect DNA repair are damaged

- often develops in the central airways

- can be aggressive and grow quickly

lung cancer risk factors

- smoking (main cause)

- radon gas

- environmental exposure

lung cancer s/s

- Cough

- Hemoptysis

- Shortness of breath

- Fatigue

- Weight loss

- Chest pain

- Respiratory infections

- New wheezing

- Hoarse voice

- asymptomatic in early stages

lung cancer diagnostics

- chest x ray

- low-dose computed tomography (best for early detection)

- biopsy

- bronchoscopy

- sputum cytology

lung biopsy

Removal of tissue and or fluid from the pleural space

bronchoscopy

Visualizes blockages or tumors; biopsies may be obtained during the procedure.

sputum cytology

Sputum is collected to determine the presence of cancer cells

lung cancer treatment and therapies

- surgery

- chemotherapy

- radiation

- targeted therapy

lobectomy

removal of a lobe of a lung

pneumonectomy

the surgical removal of all or part of a lung

wedge resection

excision of a small portion of the lung along with healthy tissue that surrounds the lung

role of the nurse in lung cancer treatment

- medication administration

- surgical care

- teaching

- care coordination