Week 1 info for exam 1

When a cancer pt comes in what are the most important items to look at first?

Their vitals and most important if they have a temperature

temperature = infection

What is cancer?

Group of complex diseases whose manifestations depend on the affected body system - \n Marked by __uncontrolled growth and spread of abnormal cells__

What is Oncology?

The study of cancer

Cancer is the # _____ leading cause of death in the U.S.

\n 2nd most common cause of death in the US

What is a Neoplasm? \n

1. Mass of new tissue that grows \n independently of its surrounding \n structures
2. Has no physiological purpose

What is a Benign growth?

It does not endanger life or health (BUT it Depends on the location within the body) - tumor cells that only grow locally and cannot spread by invasion or metastasis and are encapsulated.

What is a Malignant growth?

if not treated, a growth will recur, continue to grow, and \n spread and eventually kill the host. - cells that invade neighboring tissues which can enter the blood and metastasize to different parts of the body

Characteristics of a benign growth within the body

usually encapsulated.

normally differentiated form the cells around it

absent of metastasis

rare reoccurrence

slight vascularity

expansive mode of growth

fairly normal looking like parent cells is how they would be characterized.

Characteristics of a malignant growth within the body

rarely encapsulated.

poorly differentiated form the cells around it

capable of metastasis

possible reoccurrence

moderate to marked vascularity.

infiltrated and expansive mode of growth

cells are abnormal and become less like parent cells is how they would be characterized.

top 10 sites of metastasized cancer in the body on males

colorectal

lung

prostate

liver

stomach

skin

lymphoma

nasopharyngeal

kidney

urinary bladder

top 10 sites of metastasized cancer in the body on females

breast

colorectal

lung

corpus uteri

ovarian

skin

stomach

cervical

lymphoma

thyroid

Biggest reason for the lower level of breast cancer seen recently?

preventative bilateral Mastectomy

Who is at risk of cancer?

People exposed to carcinogens \n People exposed to Radiation

Elderly Immunocompromised Individuals with history \n of frequent trauma \n Caucasian woman-> 40yo (breast cancer) \n Caucasian Men-> testicular cancer \n African American men->Prostate cancer \n Family history (these individuals are usually \n diagnosed 15-20 yrs earlier than those \n without family history) \n Smokers, drinkers, individuals who work with chemicals

Some viruses and bacteria’s like Mono, HPV, hepatitis B or C, HIV \n Low socioeconomic status \n Those who live in an area with poor air quality

and those with high levels of Stress

\n

Carcinogens causative agents

* Chemicals (use PPE to protect from exposure)
* Radiation- (lead aprons)
* Viruses (HIV can weakens immune system from lymphomas & Kaposi sarcoma)
* Hormones
* Immune conditions (wear mask, avoid those who are ill)
* Inherited mutations

 

What is the Goal for tumors?

Reduce and remove as well as to prevent a cancer becoming malignant.  

Actual risk factors for developing cancer.

\n • Age \n • Immune function \n • Chronic Irritation and tissue trauma \n • Race \n • Genetic predisposition \n • Chemical, tobacco and alcohol exposure \n • Viruses and bacteria

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• Radiation: Sun, UV light or radiation \n • Sexual lifestyles \n • Poverty \n • Obesity \n • Chronic GERD \n • Air Pollution

Match the following risk factors with their corresponding cancers RISK FACTORS:

* GENETIC PREDISPOSITION
* Tabacco
* VIRUSES AND BACTERIA
* RADIATION
* CHRONIC GERD
* AGE, IMMUNE FUNCTION, CHRONIC IRRITATIONAND TISSUE TRAMA
* DIET HIGH IN FAT AND PROCESSED FOODS

\
\
CANCERS:


1. Everything
2. Cervical cancer
3. Barrettes Esophagus
4. Colon cancer and breast cancer
5. Skin cancer
6. Colon cancer
7. Lung cancer

* GENETIC PREDISPOSITION - 4. Colon cancer and breast cancer
* Tabacco - 7. Lung cancer
* VIRUSES AND BACTERIA - 2. Cervical cancer
* RADIATION - 5. Skin cancer
* CHRONIC GERD - 3. Barrettes Esophagus
* AGE, IMMUNE FUNCTION, CHRONIC IRRITATIONAND TISSUE TRAMA - 1. Everything
* DIET HIGH IN FAT AND PROCESSED FOODS - 6. Colon Cancer

Preventions for cancer include

\n Making healthy lifestyle choices \n • Avoid smoking \n • Limited alcohol consumption \n • Exercise \n • Wearing sunscreen \n • Avoid prolonged sun exposure \n • Follow occupational safety protocols \n • Eat foods that are high in antioxidants such as Vitamin C \n coffee and blueberries

Clinical manifestations of cancer

Anorexia-Cachexia Syndrome

Pain (acute/chronic) - Direct from tumor involvement \n • Side effects of cancer therapies \n • Psychological stress

Psychological Stress - feeling that Cancer as death sentence.

* Feeling that Cancer is a punishment.
* Anger
* Fear
* Body image concerns

\

What is Anorexia-Cachexia \n Syndrome?

Cachexia  wasted appearance (since the chemo can cause nausea and vomiting so the pt does not get enough nutrients into their body

What are sources of Anorexia in Cancer?

\n • Neoplastic cells divert nutrition \n • Pain, infection contribute to anorexia \n • Catabolism of body’s tissues, muscle proteins \n • Cancers of GI system impair nutrient use

When should a Mammogram be preformed, how often and to prevent what?

Start at the age of 40, done annually for women to prevent or catch breast cancer in the early stages.

When should a Clinical breast exam be done and how often?

Annually for women older than 40

For women 20-39 years old every 3 years

When should a Fecal Occult Blood test be performed?

Annually for adult of all ages to test for colorectal cancer

When should a Colonoscopy be performed and how often?

Start at the age of 50 and then every 10 years For colon cancer

When should a Digital rectal exam be done and how often?

For men older than 50 years old, annually - For colorectal cancer

When should Screening for gene mutations happen?

With clients who have a strong family history of \n breast or colon cancer

How often should Testicular Self Examination be done?

Monthly - For testicular cancer

What is Classification of a tumor?

naming of tumor

* Named for tissue or cell of origin

What is Grading of a tumor?

aggressiveness of tumor

* Evaluates the amount of differentiation of the cell
* Estimates rate of growth

What is the Staging of a tumor?

spread within or beyond tissue of origin

What is TNM staging system? \n

T = • Tumor - Relative tumor size, depth of invasion, surface spread \n N = • Node - Presence and extent of lymph node involvement \n M = • Metastases - Presence of absence of distant metastases

Tumor staging labels from Tx, T0, Tis, T1-T4

TX: unable to measure tumor

T0: No evidence of a tumor

Tis: Tumor has not grown into nearby tissue

T1-T4: tissue has grown into nearby tissue and 1 is smallest to 4 being metastasized

Lymph nodes staging labels form Nx, N0, N1-N3

NX: unable to evaluate lymph nodes

N0: No cancer found in lymph nodes

N1-N3: cancer has spread into lymph nodes and the numbers are how many lymph nodes are effected.

Staging for metastasis from M0 and M1

M0: Cancer has not spread to other parts of the body

\
M1: Cancer has spread to other parts of the body

cancer diagnostic tests

Biopsy

Cytological examination \n Tumor marker

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Oncological imaging- detects mass \n • X-ray, CT, MRI \n • Ultrasound \n • Nuclear imaging \n • Angiography

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Direct visualization \n • Sigmoidoscopy, cystoscopy, endoscopy-direct visualization of areas involved

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Laboratory tests \n • Blood- detects pancytopenia as the patient is responding to treatment \n • Urine, other body fluids

What is a Biopsy?

Biopsy is used to determine whether mass is benign or malignant. It also helps with the decision for treatment

What is a Cytological examination?

A histological and cytological examination by light or electron microscopy; detects cancer cells.

What is a Tumor marker?

protein molecule detectable in serum or other body fluid

• Antigens \n • Hormones \n • Proteins \n • Enzymes

Treatment of cancer with no lump detected?

\n Chemotherapy \n and Stem Cell Therapy

Treatment of cancer when a lump id detected?

Surgery AND \n • Chemotherapy \n • Brachytherapy or Radiotherapy is \n indicated for localized tumors \n that have are near body openings

Cancer therapies

ABLATION PROCEDURES include?

\

Radiofrequency Ablation

Cryotherapy

Microwave Thermotherapy :

What are ABLATION PROCEDURES?

used to destroy cancer cells

What is Radiofrequency Ablation?

delivers electric current to the cancer

What is Cryotherapy?

Uses liquid nitrogen on the cancer

What is Microwave Thermotherapy?

It uses microwaves to heat and destroy tissue

What is Chemotherapy?

It Uses anticancer drugs

When METHOETREXATE is used to help in cancer therapy how many times a week is a dose administered?

DOSING IS ONCE A WEEK

What is Photodynamic Therapy :

It Uses photosensitizing agents that is absorbed by all the cells

What is something important to remember when taking a cancer pt who has radiation treatments to the restroom?

Always double flush and have them only use radiation pt appointed restrooms

What is Targeted Therapy:

molecular based medication therapy

Why would surgery be used in cancer treatment?

\n Surgery - often primary treatment \n • Indicated to diagnose, stage and treat \n certain types of cancer \n • Removal of cancerous lesion and \n portion of normal surrounding tissue \n • Prophylactic \n • Curative \n • Control \n • Palliative \n • Reconstructive

What is the goal for chemotherapy?

Goal is to kill most possible cancer cells, allow client’s immune system to complete process

Side effects of chemotherapy

include?

Specific side effects include fatigue, alopecia, nausea and vomiting, mucositis, skin changes \n and myelosuppression.

what are the 6 Six categories \n of pharmacologic cancer therapy?

• Alkylating agents \n • Antitumor antibiotics \n • Antimetabolites \n • Hormones and hormone antagonists \n • Biological response modifiers \n • Natural products

What is Brachytherapy?

implanted radiation therapy  

in a Cancer pt what electrolyte should you assess if they have loose stools?

assess potassium levels in pt

Should cancer pts be in a private or semiprivate hospital room?

Cancer pts need to be in a private room since they are immunocompramised (semiprivate means that they have a curtain in the middle of the room separating the beds) 

Adverse effects of methotrexate in cancer pts

Can anyone other than the DR or Nurse chart in the pts chart such as the CNA or LVN?

Anyone caring for the pt can chart – but they won't have access to everything in the pts chart (don’t ever chart something that someone else has taken)  

Define Thrombocytopenia –

anything below 150,000 

Lab values for myelosuppression. \n Platelets

WBC

ANC

RBC \n Hgb

Platelets =

WBC =

ANC =

RBC = \n Hgb =

Among the 3 \n myelosuppression problems \n which one is priority?

* ANEMIA
* THROMBOCYTOPENIA
* NEUTROPENIA

* THROMBOCYTOPENIA

OVERVIEW OF CHEMOTHERAPY SIDE EFFECTS INCLUDE? \n

• ANOREXIA \n • NAUSEA \n • VOMITING \n • DIARRHEA \n • ALOPECIA \n • BONE MARROW SUPPRESSION

NAUSEA, VOMITING, \n ANOREXIA FROM \n CHEMOTHERAPY nursing actions

\n Ensure antiemetic are given before chemotherapy based on and \n response and duration of CINV (Chemotherapy induced nausea \n and vomiting) \n • Administer antiemetic for several days after each treatment even \n when CINV appears to be controlled \n • Reduce vomiting cues such as odor and emesis basins \n • Implement nonpharmacological methods to reduce nausea \n (visual imagery, relaxation, acupuncture, distraction) \n • Perform calorie count to determine intake \n • Provide liquid nutritional supplement as needed. \n • Add protein powders to food or tube feedings \n • Administer megestrol to increase appetite if prescribed \n • Assess for findings of dehydration or fluid and electrolyte \n imbalance \n Perform mouth care before meals to enhance appetite

Client Education with chemotherapy

Some antiemetics can provide treatment if given before meals \n • Eat several small meals a day if better tolerated \n • Eat low fat dry foods (cracker, toast) and avoid drinking liquids during meals can prevent nausea \n • Select foods that are served cold and do not require cooking. Cooking foods can emit odors that simulate nausea \n • Encourage consumption of high protein, high calorie, nutrient dense foods and avoidance of low or empty calorie foods. Use meal supplements as needed \n • Use Plastic eating utensils, suck on hard candy and avoid consuming red meats to prevent or reduce the sensation of metallic taste \n • Create a food diary to identify items that can trigger nausea

Managing side effects of anorexia include?

\n ○Provide high calorie diet \n ○Sneak in calories \n ○Use topical anesthetics gel for oral \n lesions to improve oral intake \n before meals

What is MUCOSITIS?

inflammation in the mucus lining of the \n upper GI tract from the mouth to the stomach

Managing the side \n effects of MUCOSITIS

Examine the client’s mouth several times a day and \n inquire about the presence of oral lesions \n • Document the location and size of lesions, obtain a \n specimen for culture and report them to the provider \n • Avoid using glycerin-based mouth wash or mouth swabs \n for client care. Nonalcoholic, anesthetic mouthwashes are \n recommended. \n • Administer a topical anesthetic prior to meals \n • Discourage consumptions of salty, acidic or spicy foods \n Offer oral hygiene before and after each meal. Use \n lubricating or moisturizing agents to counteract dry \n mouth. \n • Patients can be given anesthetic gels for painful oral \n lesions before meals to improve oral intake

MUCOSITIS AND STOMATITIS \n INTERVENTIONS

• Rinse the mouth with a solution of 0.9 NaCl, room temp tap water or salt and soda water. Frequency is guided by intensity of \n mucositis \n • Perform gentle flossing and brushing using soft bristled toothbrush or foam swab to avoid traumatizing the oral mucosa. \n • Rinse the mouth before and after meals. \n • Avoid mouthwash that contains alcohol \n • Take meds to control infection such as nystatin or acyclovir \n • Choose soft bland foods and supplements that are high in calories (mashed potatoes, scrambled eggs, cooked cereal, milk shakes, \n ice cream, frozen yogurt, bananas and breakfast mixes) Avoid spicy, salty, acidic rough or hard food. \n • Avoid drinking alcohol and the use of tobacco \n • Drink at least 2 L of water per day... If no restrictions

Managing the side \n effects of Alopecia

\-->Inform pt hair loss is temporary \n ○Male pattern baldness \n ○The hair that comes back maybe different \n ○Do not use a tourniquet \n ○Discuss purchase of wig before starting \n chemotherapy \n ○Advise mothers to bring their child’s \n favorite hat

Managing the side effects of Rash and dryness, photosensitivity reactions

\n ○Skin care; avoid alcohol and harsh soap \n ○Avoid exposure to sun, heat \n ○Use sun-block lotions \n ○Wear long sleeve shirts, big hats, umbrellas

Managing the Side Effects of \n Diarrhea or constipation: \n

○ Avoid hot food, \n ○ high fiber food which increases peristalsis \n ○ Monitor for electrolyte imbalance for diarrhea

Items a cancer pt undergoing chemo should avoid.

fresh fruit/veggies

fresh flowers

no raw foods

limit visitors

only drink from bottles or filtered water.

no handling pet feces

no buffets

no sharing of utensils

precautions for a client who has Thrombocytopenia. \n

○ Institute bleeding precautions \n ○ Avoid IV and injections. When needle sticks are necessary, use the \n smallest gauge needle possible. \n ○ Apply pressure for approximately 10 min after blood is obtained \n ○ Handle patient gently and avoid trauma \n ○ Administer thrombopoietic medication such as oprelvekin to stimulate \n platelet production. Monitor platelet count and be prepared to administer \n platelets if count falls below 10000 mm3 \n ○ Handle patient gently, even when taking BP or removing tapes

managing the side effects of Anemia, low H&H- SOB, activity intolerance, fatigue in a cancer pt \n

○ Balanced rest and activity and adequate nutrition \n ○ Well-balanced diet: small, frequent, high calorie, \n high protein, high carb diet that requires a little \n chewing \n ○ Assist in self care and mobility activities \n ○ Humidified oxygen therapy prn as ordered, monitor \n resp and O2 sat

managing the side effects of Pulmonary Toxicity \n

○ Monitor for lung sounds \n ○ Encourage TCDB

Managing the side effects of Infertility \n

○ Discuss the potential effects of infertility may be \n irreversible \n ○ Encourage pre-treatment husband and wife \n counseling

Managing the side effects of Hemorrhagic cystitis, hematuria and dysuria \n

○ Increase fluid intake to 2,000 to 3,000 ml/day

Side effects of radiation therapy include

\n local skin changes and \n irritation, alopecia, nausea and vomiting, \n fatigue (most common side effect of radiation) \n and altered taste sensation, the effects vary \n according to the site of the treatment.

What is radiation therapy?

\n Application of external beams or high-energy \n protons to kill cancer cells \n • Used for \~50% of clients with cancer \n • Localized treatment \n • May precede surgery to shrink tumor \n • May follow surgery to kill cancer cells left \n behind \n • May be used as palliation for inoperable \n cancers

Radiation therapy reminders when dealing with the pt

Limit visitors to 30 minutes per day. Visitors should be at least 6 feet from the source

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Save bed linens and dressing until the source is removed. Then place the linens and dressings in the designated containers

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Other equipment can be removed from the room at any time.

Client Education Guide: Radiation Therapy for Cancer \n

• Wash the irradiated agent gently each day with warm water alone or with mild soap and water

\n • Use the hand rather than a washcloth to wash the area

\n • Rinse soap thoroughly from the skin

\n • Take care not to remove the markings that indicate exactly where the beam of radiation is to be focused.

\n • Dry the irradiated area with patting motions rather than rubbing motions.

\n • No powders, ointments, lotions or creams on the skin at the radiation site unless they are prescribed by the radiologist

\n • Avoid wearing belts, buckles, straps or any type of clothing that binds or \n rubs the skin at the radiation site

\n • Avoid exposure of the irradiated area to the sun

\n • Avoid heat exposure.

\n • Pat the area dry. Do NOT scrub.

\n • Use tepid water

How do you care for a client with a \n Sealed Radiation Implant?

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• Place the client in a private room with a private bath

\n • Place a radiation precaution sign on the client’s door

\n • Organize nursing tasks to minimize exposure to the radiation source

\n • A client with a radiation implant should be discussed during huddle

\n • Limit time to 30 minutes per care provider per shift.

\n • Wear a dosimeter film badge to measure radiation exposure

\n • Lead shielding may be used to reduce exposure to radiation

\n • The nurse should never care for more than 1 client with a radiation implant at 1 time

\n • Do not allow a pregnant nurse to care for client

\n • Do not allow children younger than 16 years or a pregnant women to visit the client

PRIORITY NURSING
ACTIONS FOR
DISLODGED IMPLANT

1. Encourage the client to lie still
2. Use a long-handled forceps to retrieve the radioactive source
3. Never touch the radiation source.
4. Deposit the radioactive source in a lead container
5. Contact the oncologist.
6. Place all equipment and linens in designated containers.
7. Prohibit visitors from entering.

Which of the following patients should the nurse asses first?

\n a. A patient who is obtaining a long-acting Fentanyl patch \n b. A patient with an ANC of 500 with a temp of 101\*F \n c. A patient who has dry mouth after radiation therapy \n d. A patient with a platelet count of 85000 after chemotherapy

A patient with an ANC of 500 with a temp of 101\*F

Risk factors for

\

1. lung cancer
2. colon cancer
3. BREAST CANCER
4. LARYNGEAL CANCER
5. ESOPHAGEAL CANCER
6. SKIN CANCER
7. BRAIN CANCER

\
a. persistent dry cough

b. Hoarseness that does not go away.

c. Dysphagia

d. Diarrhea, constipation, \n Irregular bowel movement, melena, \n hematochezia , weight loss

e. A mole with an \n asymmetric border and color change

f. Lump in the breast, \n hardening, asymmetry, \n Peau D’Orange

g. TIA, signs of increased ICP, \n seizures, headaches that starts in the morning and gets worse through out the day, uneven pupil size or reaction to light and accommodation

1. persistent dry cough
2. Diarrhea, constipation, \n Irregular bowel movement, melena, \n hematochezia , weight loss
3. Lump in the breast, \n hardening, asymmetry, \n Peau D’Orange
4. Hoarseness that does not go away.
5. Dysphagia
6. A mole with an \n asymmetric border and color change
7. TIA, signs of increased ICP, \n seizures, headaches that starts in the morning and gets worse through out the day, uneven pupil size or reaction to light and accommodation

What are the 7 major signs of cancer?

1. change in bowel or bladder habits


2. a sore that doesn’t heal
3. unusual bleeding or discharge
4. thickening or lump in the breast or elsewhere
5. indigestion or difficulty swallowing
6. obvious change in wart or mole
7. nagging cough or hoarseness

True or false: Pain is a emergency

NO, always follow ABC (airway, breathing, circulation)  

Should an An acutely ill patient should be assessed prior to interview to confirm they are stable?

YES, (As you walk into the room your are physically looking at the pts and seeing who is stable for an assessment or who is unstable)

True or false?  Vocabulary and Verbal   \n Reasoning improve with  age?

True

True or False? Long-term memory   \n remains constant with  aging?

true

True or false Short-term memory   \n improves with aging?

false

What is included in a nursing diagnosis?

\

\n • Risk for Infection \n • Risk for Injury \n • Imbalanced Nutrition: Less Than Body Requirements \n • Impaired Tissue Integrity \n • Acute Pain \n • Anxiety \n • Disturbed Body Image \n • Anticipatory Grieving

What is included in the nurses plan of care?

\n • Nursing goals may include that client will \n • Demonstrate no signs of infection \n • Sustain no injuries \n • Consistently rate pain at a level of 3 or less \n • Maintain weight within normal range \n • Remain hydrated \n • Vocalize feelings related to cancer \n • Relate potential side effects of chosen therapies, list strategies for coping

What is included in the nurses Implementation? \n

Prevent infection \n • Monitor vital signs \n • Monitor WBC counts frequently \n • Teach client to avoid crowds, small children, people with infections \n • Protect skin and mucous membranes \n • Encourage client to consume diet high in protein, minerals, vitamins

How long should s/s of a illness be present to be considered chronic?

3-6 months

When determining if an \n older adult is malnourished, the nurse should?

assess: mood

review: labs to determine protein and fat intake

inspect: teeth and mouth

ask about: how they get food, how often and what it is

inspect: teeth and oral mucosa

assess: depression

ask about: transportation needs to access grocery’s and other food services

What is polypharmacy?

The use of multiple medications by a person who has more than one health problem

Ways to help with older adult medication compliance

on admission complete a medication form and do that on discharge