AD2 Exam 1 - AI Generated Flashcards from Notes/Powerpoints/Textbook

Three factors influencing cancer development

Exposure to carcinogens, genetics, immunity

What are environmental carcinogens?

Chemical, physical, or viral agents that cause cancer.

Most preventable carcinogen

Tobacco.

Which tissues are at greatest risk from tobacco exposure?

Mouth, throat, and lungs; tissues in direct contact with tobacco.

How can viral carcinogens contribute to cancer?

Viruses break down DNA strands and insert their genetic material; examples include Epstein-Barr virus and HPV.

Examples of physical carcinogens

Ionizing and UV radiation, including X-rays, sunlight, and tanning beds.

Dietary factors suspected of increasing cancer risk

High intake of red meat and animal fats, low fiber, and preservatives; the relationship is described as poorly understood.

How does age affect cancer risk?

Cancer risk increases with age.

What does cancer genetic testing tell a person?

It identifies potential inherited risk; it does not diagnose cancer and may guide more frequent screening or prevention.

The Seven Warning Signs of Cancer: CAUTION: C

Changes in bowel or bladder habits.

The Seven Warning Signs of Cancer: CAUTION: A

A sore that does not heal.

The Seven Warning Signs of Cancer: CAUTION: U

Unusual bleeding or discharge.

The Seven Warning Signs of Cancer: CAUTION: T

Thickening or a lump in the breast or elsewhere.

The Seven Warning Signs of Cancer: CAUTION: I

Indigestion or difficulty swallowing.

The Seven Warning Signs of Cancer: CAUTION: O

Obvious change in a wart or mole.

The Seven Warning Signs of Cancer: CAUTION: N

Nagging cough or hoarseness.

Primary cancer prevention

Strategies intended to prevent cancer from occurring.

Secondary cancer prevention

Screening to detect cancer early, when cure or control is more likely.

Examples of primary cancer prevention

Avoid carcinogens, modify associated risk behaviors, remove at-risk tissue when indicated, use chemoprevention, and HPV vaccination.

What is chemoprevention?

Using drugs, chemicals, natural nutrients, or other substances to interrupt steps in cancer development.

Cancer-prevention vaccines

HPV vaccines, which prevent infection from several HPV forms.

What is the purpose of cancer screening?

Screening may not reduce cancer incidence, but can reduce cancer deaths through early detection.

How can cancer affect immunity and clotting?

Disease or treatment, especially chemotherapy, can suppress bone marrow, reduce neutrophils and immunity, affect platelets, and cause anemia.

GI effects of cancer and treatment

Nausea, vomiting, diarrhea, appetite loss, malnutrition/cachexia, and possible obstruction or compression by abdominal tumors.

Cancer-related peripheral neuropathy findings

Numbness, tingling, neuropathic pain, altered gait, and balance changes; reduced sensation raises injury and infection risk.

How can cancer affect respiratory/cardiac function?

Tumors may invade organs or compress airways and chest vessels, causing dyspnea; radiation and some chemotherapy agents may affect cardiac function.

How can cancer affect comfort and quality of life?

Advanced cancer may require pain management and interprofessional/palliative support; teach side effects of pain medication, including constipation.

Effects of bone metastases

Bone becomes thinner and fractures may occur with minimal trauma; cancer may also invade bone, brain, or compress nerves, causing motor/sensory deficits.

Localized versus metastatic cancer

Localized cancer remains near its origin; metastatic cancer has spread to distant sites such as brain, liver, or bone.

Purpose of radiation therapy

High-energy radiation damages cancer-cell DNA to kill cells, cure cancer, or relieve symptoms while minimizing damage to nearby normal tissue.

Radiation therapy is what type of treatment?

A local treatment to tissues in the radiation field.

Exposure versus radiation dose

Exposure is the amount of radiation delivered to tissue; dose is the amount absorbed and is less than exposure because some energy is lost.

Three factors determining absorbed radiation dose

Intensity of exposure, duration of exposure, and distance from the source to cells.

External-beam radiation: is the patient radioactive afterward?

No. The source is outside the patient, so the patient is not radioactive after treatment.

How does IMRT reduce normal tissue exposure?

It breaks a single beam into many smaller beams with different intensities aimed at specific tumor areas.

How does SBRT protect surrounding tissue?

Three-dimensional tumor imaging permits precise delivery of higher doses to the tumor.

What are Gamma Knife and CyberKnife?

Radiosurgery techniques that use carefully targeted ionizing radiation, including for brain tumors, instead of a cutting blade.

Why are skin markings or masks used for radiation?

To locate the tumor precisely and position the patient the same way for each treatment; teach patients not to remove tattoo markings.

What is brachytherapy?

Internal radiation in which a source is placed in or near the tumor for a specified time or left as an implant.

Radiation precautions with brachytherapy implants

While solid implants are in place, the patient emits radiation; excreta are not radioactive. Once a removable source is removed, the patient is no longer radioactive.

Radiation therapy side effects

Radiation dermatitis, altered taste, hair loss, fatigue, fertility problems, tissue fibrosis/scarring, and risk of secondary malignancies.

What is systemic cancer therapy?

Antineoplastic chemotherapy or immunotherapy used to kill cancer cells or disrupt cellular regulation throughout the body.

Neoadjuvant chemotherapy

Chemotherapy used to shrink cancer before surgery or radiation.

Adjuvant chemotherapy

Chemotherapy used to kill remaining cancer cells after surgery or radiation.

Why can chemotherapy affect normal tissues?

Cytotoxic chemotherapy kills cancer cells and normal cells throughout the body.

Chemotherapy routes

IV, intrathecal into CSF, intraperitoneal into the abdominal cavity, intravesicular into the bladder, topical, and intraarterial.

What is chemotherapy extravasation?

Chemotherapy leaks from the vein/IV into surrounding tissue.

Chemotherapy side effects

Bone marrow suppression, alopecia, mucositis, peripheral neuropathy, cognitive changes, and nausea/vomiting.

What is the chemotherapy nadir?

The time when bone marrow activity and WBC counts are lowest, usually 7-10 days after administration, depending on the drug.

Key chemotherapy safety priorities

Prevent infection and monitor for bleeding.

Chemotherapy safety when moving or assisting a patient

Use caution; use the smallest suitable needle for injections/venipunctures; inspect IV sites every 4 hours for bleeding; report trauma, bleeding, or bruising; use firm-soled shoes and fall precautions.

Cancer-related sepsis: who is at risk?

Patients with cancer who have neutropenia and impaired immunity from treatment.

What is sepsis?

Organisms enter the bloodstream through a site of skin breakdown and cause severe infection; severe sepsis may lead to life-threatening septic shock.

What causes superior vena cava (SVC) syndrome?

Tumor growth or a clot compresses/obstructs the SVC, congesting blood returning from the body.

SVC syndrome: common findings

Engorged upper-body vessels, erythema/hyperpigmentation of upper body, arm/hand edema, and dyspnea; symptoms are more apparent supine.

SVC syndrome: alarming sign of rapid progression

Stridor, suggesting narrowing of the pharynx or larynx.

Late SVC syndrome findings

Hemorrhage, cyanosis, mental-status changes, decreased cardiac output, and hypotension.

What causes tumor lysis syndrome (TLS)?

Rapid destruction of many tumor cells releases intracellular contents faster than the body can eliminate them.

TLS: who is at risk?

Patients with high-grade cancers or bulky tumor burden, including those receiving chemotherapy or radiation.

TLS: signs and symptoms

Lethargy, nausea, vomiting, anorexia, flank pain, muscle weakness/cramps, seizures, altered mental status, increased potassium, and possible cardiac dysfunction/ECG changes.

What is disseminated intravascular coagulation (DIC)?

A clotting disorder with extensive abnormal clotting in some vessels and bleeding from others; sepsis can trigger it.

DIC treatment described in the notes

Treat sepsis and give heparin to reduce clotting unless the patient is bleeding.

What causes sickle cell disease?

A genetic mutation in the beta chains of hemoglobin causes abnormal hemoglobin HbS.

How do sickled cells cause organ damage?

Crescent-shaped RBCs clump and block vessels, reducing blood flow and oxygen delivery; repeated crises cause hypoxia, ischemia, cell death, scarring, and organ failure.

Organs commonly affected by sickle cell disease

Spleen, liver, heart, kidneys, brain, joints, bones, and retina.

Triggers of sickle-cell sickling/crisis

Hypoxia, dehydration, high altitude, infection, smoking, stress, weather changes, strenuous exercise, and blood loss.

Most common symptom during sickle-cell crisis

Pain.

Cardiovascular findings in sickle-cell crisis

Shortness of breath, fatigue, weakness, murmurs/S3, increased JVD, tachycardia with low-to-normal BP, cool extremities, slow capillary refill, and diminished distal pulses.

Respiratory findings with sickle-cell crises: Acute chest syndrome

Pulmonary infiltrates on x-ray, fever, chest pain, extremity pain, tachypnea, cough, and wheezing; a major cause of death in adults with SCD.

Core nursing care during sickle-cell crisis

Maintain hydration, oxygenation, perfusion, and comfort; treat the acute problem and reduce triggers.

Hydration and positioning for sickle-cell crisis

Give oral or IV fluids to prevent/correct dehydration; position HOB about 30 degrees and avoid knee gatch.

Pain management for sickle-cell crisis

Analgesics including opioids, then NSAIDs as noted; opioids are high-alert and PCA may be needed. Warm compresses and a warm room are nonpharmacologic options.

Hydroxyurea: purpose and key teaching

Stimulates fetal hemoglobin production and may reduce sickling and pain episodes; it is teratogenic, so pregnancy testing and strict contraception are needed during therapy and for at least 1 month after stopping.

L-glutamine (Endari): purpose

May reduce oxidative stress in RBCs, decrease sickling, increase RBC lifespan, and reduce or delay SCD complications.

Crizanlizumab: purpose

Monoclonal antibody that binds selectin and reduces adhesion and frequency of vaso-occlusive crises.

Sickle-cell patient education

Avoid triggers, stay hydrated, seek prompt infection treatment, follow vaccination schedules, and understand medication side effects.

Most common anemia worldwide and its basic cause

Iron-deficiency anemia, caused by inadequate iron supply from blood loss, poor GI absorption, or inadequate diet.

What should be evaluated in an adult with iron deficiency?

Abnormal bleeding, especially GI bleeding; notes list colon polyps, H. pylori, bleeding ulcers, and celiac disease as possibilities.

Iron-deficiency anemia findings

Microcytic RBCs with chronic deficiency, weakness, pallor/ash-gray skin, fatigue, reduced exercise tolerance, mouth-corner fissures, and possibly low ferritin.

Causes/risk factors for iron-deficiency anemia listed in notes

Bariatric surgery, blood loss, breastfeeding, dietary deficiency, menstruation, pregnancy/recent delivery, surgery, or trauma.

Purpose of iron administration

Restore iron for erythropoiesis and improve anemia; overdose may be fatal.

Oral iron teaching

Take as prescribed, preferably on an empty stomach; GI upset, constipation, dark stool, nausea, and abdominal pain may occur. Avoid milk, calcium, and antacids; take with orange juice or vitamin C.

IM iron administration safety

Use the Z-track method to prevent staining if iron leaks into subcutaneous tissue.

IV iron safety

Verify the exact formulation, assess allergies/prior reactions, obtain baseline vital signs, monitor for hypotension, and stop for serious reactions; use extreme caution with systemic infection.

What causes vitamin B12/pernicious anemia?

B12 deficiency; pernicious anemia results from lack of intrinsic factor needed for B12 absorption and is autoimmune.

Vitamin B12 sources listed in notes

Clams, oysters, fish, eggs, milk, fortified cereals, and beef liver; consider dietary consultation for vegan/vegetarian patients.

Why does B12 deficiency affect nerves?

B12 helps maintain the myelin sheath and nerve function; deficiency can cause numbness, poor balance, and confusion.

Vitamin B12 deficiency anemia findings

Fatigue, exercise intolerance, dyspnea, weakness, tachycardia, pallor, numbness/weakness in hands or feet, unsteady gait, depression, mental changes, memory loss, glossitis, jaundice, and weight loss.

What type of anemia is B12 deficiency?

Megaloblastic/macrocytic anemia with abnormally large cells due to impaired DNA synthesis.

Causes of B12 deficiency listed in notes

Vegan or low-protein diet, small-bowel resection, chronic diarrhea, diverticula, tapeworm, intestinal bacterial overgrowth, malabsorption, gastrectomy, gastritis, or autoimmune lack of intrinsic factor.

Treatment for B12/pernicious anemia

Correct poor nutrition, give vitamin B12 IM (injections are needed for pernicious anemia), and folic acid supplementation as noted.

Why is leukemia described as bone-marrow failure?

Leukemia can cause thrombocytopenia and leukopenia; immature WBCs do not provide normal infection protection even if the total WBC count is high.

Major causes of death/major risks in leukemia

Infection and hemorrhage; protect from infection and injury due to poor clotting.

Leukemia: skin findings

Ecchymoses, petechiae, open/infected lesions, and pallor of conjunctivae, nail beds, palmar creases, and around the mouth.

Leukemia: GI and renal findings

Bleeding gums, anorexia, weight loss, enlarged liver/spleen, and hematuria.

Leukemia: musculoskeletal, cardiopulmonary, and neurologic findings

Bone/joint pain or swelling, tachycardia with basal activity, orthostatic hypotension, palpitations, exertional dyspnea, fatigue, headache, and fever.

Definitive test for leukemia

Bone marrow biopsy.

Possible leukemia lab findings

Low hemoglobin/hematocrit, low platelets, and abnormal WBC count.

Leukemia nursing priorities

Prevent infection, detect/control infection early, reduce cross-contamination (private room if possible), avoid standing water in room items, prevent injury/bleeding, and manage fatigue.

Leukemia treatments listed in notes

Chemotherapy, targeted therapy, immunotherapy, and stem-cell transplant; acute leukemia is treated aggressively and chronic leukemia less aggressively.