Chemotherapy
What are the 3 stages of cancer?
1) Initiation: mutation in cell's genetic structure
2) Promotion: reversible proliferation of the altered cells
3) Progression: increased growth rate of the tumor, increased invasiveness, and metastasis
What is SIADH?
What is the action?
Too much ADH from tumor leads to excessive hyponatremia
Restore sodium level
When and where do skin reactions occur?
Develops 1-24 hours after treatment
Only occur locally in the treatment field; areas of skinfolds or where skin is subjected to pressure
What age should women start getting annual mammograms?
40 years old
What are the common sites of metastasis?
Lungs
Liver
Bone
Brain
Adrenal glands
Side effects of chemotherapy
Delayed effects: Bone marrow suppression, alopecia, N/V, mucositis, skin rashes, altered bowel function, cumulative neurotoxicities
What is pericardial effusion and neoplastic cardiac tamponade?
fluid in pericardium causing pressure on the heart
What are some nursing implications for skin reactions caused by radiation?
Lubricate dry skin w/ nonirritating lotion or aloe vera, prevent infection, facilitate wound healing, protect irritated skin temp, avoid constricting garments, harsh chemicals, and deodorants, help pt deal with hair loss
Do NOT uses heating pads, ice, and hot water bottles
What are BRCA 1 and BRCA 2?
Alterations in these genes can increase a person's risk for...
Tumor suppressor genes that regulate cell growth and prevent cells from going through the cell cycle, produce proteins that help repair damaged DNA
Breast, ovarian, and pancreatic cancer
A patient has recently been diagnosed with stage II cervical cancer. Which statement by the nurse best explains the diagnosis?
A) “The cancer is found at the point of origin only.”
B) “Tumor cells have been identified in the cervical region.”
C) “The cancer has been identified in the cervix and the liver.”
D) “Your cancer was identified in the cervix and has limited local spread.”
D) “Your cancer was identified in the cervix and has limited local spread.”
Stage II cancer is associated with limited local spread. Stage 0 denotes cancer in situ or at the point of origin only; stage I denotes tumor limited to the tissue of origin with localized tumor growth. Stage III denotes extensive local and regional spread. Stage IV denotes metastasis such as to the liver.
Nursing management for this side effect...
Bone marrow suppression (myelosuppression)
Biggest concern is infection, so monitor fever of 100.4 or higher
Lowest blood cell counts (nadir) often occur 7-10 days after starting therapy
What is tumor lysis syndrome and how does it present?
Metabolic complication characterized by rapid release of intracellular components in response to chemo/radiation
Presents w/ hyperkalemia, hypocalcemia, hyperuricemia, hyperphosphatemia, weakness/muscle cramps, N/V
What is internal radiation called and what is it?
implantation or insertion of radioactive materials into or near the tumor, minimal exposure to healthy tissue
How many copies of the BRCA gene does everyone have?
2 copies, one from each parent
Question 3 of 26
The patient is receiving immunotherapy and targeted therapy for ovarian cancer. What medication would the nurse expect to administer before therapy to combat the most common side effects of these therapies?
D) Acetaminophen (Tylenol)
Acetaminophen is administered before therapy and every 4 hours to prevent or decrease the intensity of the severe flu-like symptoms, especially with interferon which is frequently used for ovarian cancer. Morphine sulfate and ibuprofen will not decrease flu-like symptoms. Ondansetron is an antiemetic but is not used first to combat flu-like symptoms such as headache, fever, chills, and myalgias.
Nursing management for anorexia
Small, frequent, high protein/caloric meals (ex: skim milk powder, cheese, honey, brown sugar, peanut butter)
Monitor carefully to avoid weight loss (weigh twice weekly), involve dietician before treatment
What is superior vena cava syndrome?
Obstruction of venous system with increased venous pressure and stasis
Facial and neck edema with slow progression to respiratory distress
What is ALARA?
How should healthcare professionals approach treating a pt with brachytherapy?
As low as reasonably achievable
Limit the amount of time near pts being treated to protect self
Time, distance, and shielding is essential to keep healthcare professionals safe from internal source of radiation
Risk factors for breast cancer
Early menarche or late menopause (the longer you bleed, the higher your risk)
Nulliparity, first child born after 30, breast cancer hx, high doses radiation exposure to chest, and previous cancer of breast, uterus, or ovaries
What is the difference between benign vs malignant?
Main difference is malignant tumor cells invade and metastasize
Benign: encapsulated, normally differentiated cells, does NOT metastasize
Malignant: rarely encapsulated, poorly differentiated cells, capable of metastasis
What is an extravasation injury?
What causes it?
What is the immediate action to take if it occurs?
Infiltration of drugs into tissues surrounding the infusion site
It is d/t chemo, because many chemo drugs may be irritants or vesicants that can damage the vein
Stop the infusion immediately!
What is hypercalcemia and its treatment?
What is hyperuricemia and how to prevent it?
Hypercalcemia: fatigue, muscle weakness, polyuria, constipation, progresses to coma and seizures
- Tx: restore fluids with IV saline, loop diuretics
Hyperuricemia: occurs with rapid necrosis of tumor cells as with chemo, can result in renal damage and failure
- Prevention: alopurinol (zyloprim)
Warning/caution signs of cancer
Change in bowel or bladder habits
Sore that does not heal
Unusual bleeding or discharge from any body orifice
Thickening or a lump in the breast or elsewhere
Indigestion or difficulty swallowing
Obvious change in a wart or mole
Nagging cough or hoarseness
Diagnosis of breast cancer
Sentinel lymph node
- First node confronted as tumor cell spreads through the lymphatic system
Biopsy is the gold standard, it can help determine extent of cancer and is usually the first step
Patients may reduce the risk of developing cancer using health promotion strategies. Identify modifiable strategies which can reduce the risk of developing cancer. (SATA)
A) Stop smoking
B) Use sunscreen
C) Limit alcohol us
D) Undergo genetic testing
E) Maintain a healthy weight
F) Receive appropriate immunizations
A) Stop smoking
B) Use sunscreen
C) Limit alcohol use
E) Maintain a healthy weight
F) Receive appropriate immunizations
Changing a person’s lifestyle can limit cancer promotors, which is key in cancer prevention. Immunizations such as human papilloma virus (HPV) can prevent cervical cancer. Use of sunscreen (SPF 15 or greater) can prevent cell damage and development of skin cancer. Smoking can initiate or promote cancer development. Alcohol use combined with smoking can promote esophageal and bladder cancers. Management of weight can reduce the risk of cancer. Genetic testing (i.e., APC gene) identifies the predisposition to some cancers but is not modifiable.