Encourage daily hygienc, regular oral care, and perineal care after each stool to prevent infection.
Interventions should the nurse plan to use for a client experiencing neutropenia?
Breast, lung and colorectal cancers
3 Cancers found in females in order of highest occurrence?
Activities that could result in injury and bleeding.
The nurse instructs the client receiving chemotherapy that which of the following should be avoided to reduce the risks assoicated with thrombocytopenia?
Condition of low platelets.
T|F It is normal to have one testicle that does not remain descended into the scrotal sac.
True. Lying down can lead to reflux, casuing nausea.
T|F A client at risk for nausea should not lie down for at least 30 minutes after meals, to avoid aspiration.
True. This promotes a more complete exhalation and facilitates removal of secretions from the bronchial tree.
T|F Pursed-lip breathing, back pressure is created to keep the airways open.
T|F An undescended testicle is one risk for testicular cancer.
T|F Un explained rapid weight loss may be the first symtpom assoicated wit cancer and immediate evaluation is required.
* Painless swelling of scrotum
* Dull pain in scrotum
* Nodules in between testes and cord
* Dragging senation in scrotum
Manifestations of testicular cancer?
Once per month, 1 week after beginning menstruation.
When should BSE be performed?
** BRCA1 and BRCA2 gene mutation
** Client who had Hodgkin's disease
**Smoker, age 40+
Risk for developing breast cancer?
T|F Estrogen replacement may increase breast cancer risk?
True. 67% of all cancer occurs in people over age 65, necessitating early screening and detection.
T|F Scrfeening the elderly for cancer is essential?
T|F Once stomatitis develops, meticulous oral hygiene must continue with a soft toothbrush or toothettes, fluoride-containing toothpaste, and rinsing with a dilute baking soda solution.
dry mucous membranes
Side effects of fluorouracil (5-FU)?
Every 3 years.
When should females ages 20 - 39 get a breast examination?
Monthly, at the same time each month to aid in remembering to do it regularly.
When should breast examinations be done?
Vinca alkaloid, Vincristine (Oncovin) and Vinblastine (Velban) cause neurotoxic effects of constipation
Neurotoxicity is a side effect of which chemotherapy drug classification and medication?
Side effect of Fluorouracil (5-FU) and belomycin (Blenoxane)
Side effect of Gemcitabin (Gemzar) and mitoxantrone (Novantrone)?
True. Also late menopause.
T|F Early menstruation before the age of 12 is a risk factor for breast cancer.
Ibuprofen (Motrin). Medications that inhibit platelet aggregation should be avoided.
During the nadir period (the period of reconstruction), which of the following medications should be avoided?
Aspirin, ibuprofen and indomethacin(
Examples of medications that inhibit platelet aggregation?
T|F External radiation poses no risk of radiation exposure to contacts, even during intimate physical contact?
Music therapy, and hypnosis
Mind-body therapy that is allow during radiation therapy and chemotherapy?
False. Progressive relaxation and guided imagery, hypnosis
T|F Yoga, acupuncture and chiropractic practieces are used in hospital settings?
True. Frozen, then stored until treatment.
T|F Bone marrow is usally harvested from the iliac crest?
Dry mucous membranes, fatigue, and loss of hair
Common side effects of chemotherapy?
Generally causes no warning signs or symptoms in the early stages.
What are the early signs of Ovarian Cancer?
Homogeneous immunoglobulin in the urin or serum
Multiple myeloma is characterized by what?
Leukocyte proliferation is characteristic of what?
T|F Multiple myeloma is a neowplastic proliferation of the plasma cells.
True. Hair washing should be limited to 2 to 3 times per week.
T|F Washing the hair during chemotherapy treatment daily will promote further hair loss.
Removal of the entire breast, underlying chest muscles, and lymph nodes
What is a radical mastectomy?
Removal of breast tissue and lymph nodes under the arm
What is a modified radical mastectomy?
Removal of the complete breast only
What is a simple mastectomy?
Removal of the tumor and surrounding tissues
What is a lumpectomy?
A lung or mediastinal tumor can compress the superior vena cava, obstructing blood flow, leading to the early symptoms of facial and arm edema
Complication of superior vena cava syndrome?
T|F Lymph node biopsy is performed to assess any metastasis form the primary site of cancer
Regional lymph nodes.
A common metastatic site for breast cancer?
B/C of the immunosuppression, the client is at severe risk of infection. Precautionary measures such as a private room and protective isolation must be instituted to protect the client from sources of infection.
Type of isolation for severely leukopenic client who is receiving radiation therapy?
True. A client's prior nausea history is indicative of her individual nausea threshold and is predictive o fhow chemotherapy-induced nausea will be handled.
T|F A person susceptibility to nausea is dependent on the past history.
Hypercalcemia procudes a generalized slowing of functions through neuromuscular depression ie, constipation, increased urination, hyporeflexia and confusion.
Hypercalcemia causes what?
A client with hypercalcemia caused by malignant myeloma might exhibit what?
Malignant myeloma may cause what?
T|F Radiation is palliative treatment for spinal cord compression to reduce the tumor size and relieve compression.
Radiation therapy is often used as a supplement to shrink tumors.
What is radiation therapy often used for?
painful spasms due to the wide diameter of the catheter and the retention balloon in the bladder
Client with a three-way Foley catheter usually experience what?
Which drug class is prescribed for clients with a three-way-irrigation catheter?
urge to void. This is due to the pressure exerted by the balloon in the internal sphincter of the bladder and the wide diameter of the catheter that is used for the purpose of irrigation.
Common complaint from clients undergoing bladder irrigation after prostate surgery?
uterine cancer. Postmenopausal bleeding is not normal, with or without pain.
A postmenopausal client experiencing painless vaginal bleeding is a sign of?
Localized tumors are often treated with lumpectomy.
How are small tumors treated?
Prostate, lung and colorectal cancer
Order of the three most highest incidence in men?
The most common and most lethal complication of leukostasis?
Complications assoicated with leukostasis
In a client with chronic myelogenous leukemia (CML), the nurse should monitor for high white blood cell counts caused by which complications?
Leukostasis occurs as the leukemic blast cells accumulate and invade the vessel walls,causing rupture and bleeding.
How does Leukostasis occurs?
WBC > 50,000/mm3
Abnormal range for circulating blasts that puts a client at risk for leukostasis?
Keep the affected arm elevated above heart level.
Intervention for client following mastectomy for breast cancer?
To reduce the risk of edema after lymph node removal on the affected side. ROM can be started immediately after surgery.
What is the purpose of keeping the affected arm elevated above heart level?
initiate oxygen and IV access
Immediate interventions for the client with cardiac tamponade?
Reduce the potential for tumor resistance and tolerable treatment side effects.
Advantage of combination chemotherapy?
The toxicities of a particular drug
Dose limtations of chemotherapy are determined by which of the following client or drug-related factors?
evaluate renal function studies.
Important consideration when adminstering gallium nitrate for a client with multiople myeloma is to?
T|F Gallium nitrate can impair renal function as evidenced by elevated urea and creatinine levels.
Peak T waves, muscle spasm and increased gastric motility
Signs of Hyperkalemia?
Cigarette smoking. Chronic cigarette smoking can produce elevated CEA levels.
A client has had blood drawn for carcinoembryonic antigen (CEA). What habits could produce a falsely elevated level?
measures the amount of this protein that may appear in the blood of some people who have certain kinds of cancers, especially large intestine (colon and rectal) cancer. It may also be present in people with cancer of the pancreas, breast, ovary, or lung.
carcinoembryonic antigen (CEA) test?
Both benign and malignant (harmless and cancerous) conditions can increase the CEA level. Benign conditions which can elevate CEA include smoking, infections, inflammatory bowel disease, pancreatitis, cirrhosis of the liver, and some benign tumors in the same organs in which an elevated CEA indicates cancer.
What conditions can cause an elevated CEA?
Leukocyte and erythrocyte counts.
Chemotherapeutic agents cause some degree of bone marrow suppression which results in what decreased lab values
Communicaton to reduce possible anxiety caused by outcomes. Fear intense pain if not addressed first.
For post-test client what is the first priority following a full body scan?
Risk of infection.
A client with leukemia is undergoing the "conditioning phase" for a bone marrow transplant (BMT). What is the priority nursing diagnosis?
Conditioning phase depresses bone marrow function, and infection is the major cause of death for clients with leukemia
What is the conditioning phase?
Immune deficiency early in the disease. Immunosuppressive therapy makes the client more susceptible to infection and hemorrhage b/c of a compromised bone marrow function.
Signs exhibited by a client with Hodgkin's disease
infections. The immunosuppression leading to an inability to fight infection is the priority to prevent complications leading to death.
complications associates with bone marrow suppression?
T|F In nursing the goal is to assist clients to perform as many normal daily activities as possible.
altered gait, reflexes and ileus in client receiving chemotherapy
Signs of neurotoxicity?
Myelosuppression since hematopoietic cells divide rapidly, the are most vulnerable to chemotherapy.
The most common and lethal side effect of chemotherapy?
A condition in which bone marrow activity is decreased, resulting in fewer red blood cells, white blood cells, and platelets. Myelosuppression is a side effect of some cancer treatments.
What is myelosuppression?
Severe myelosuppression is called?
T|F In the elderly and immunocompromised client, even a slight elevation of temperature may indicate an infection and must be investigated and treated immediately.
T|F A client is a risk to others as long as the radiation implant is present?
Place in private room and visitors should maintain a distance of 6 feet and limit visits to 10 to 30 minutes.
What kind of precautions must be taken by the nurse to protect others when a client has a radiation implant ?
T|F For 6 hours following intravesicular chemotherapy, the toilet should be disinfected after each use to ensure that the biohazard of excreted chemotherapy drug is contained.
T|F Physiological needs take priority over psychosocial and learning needs.
Extravasation of the chemotherapeutic agent, especially if the agen is a vesicant. Ensure patency of vein.
Complication of intravenous administration of chemotherapy?
Long handled forceps
What should be used to pick up a dislodged internal radiation implant?
True. No one should directly touch the implant. Should be placed into a lead container not a biohazard bag they do not offer protection from radiation.
T|F direct handling of a internal radiation implant causes exposure to radiation?
True to avoid accidental cuts that will cause bleeding.
T|F A client with a decreased platelet count sould be counseled to avoid using razors?
extravasation. Drug administration should be stopped and attempt to aspirate.
Potential tissue irritation from chemotherapeutic agents is called?
seeping of blood, lymph, or serum into tissues.
seeping of chemotherapeutic drugs into a tissue
What is extravasation?
The patient complains of burning, stinging, pain or any acute change at the injection site.Induration, erythema, venous discoloration or swelling is observed at the site. Slowed infusion rate. Blanching and coolness of skin area.
Signs of extravasation?
Paclitaxel (Taxol). When administering Paclitaxel, PVC bags and infusion sets should be avoided because of leaching of DEPH (plasticizer)
The nurse would avoid using IV solution bags and infusion sets made from polyvinyl choloride (PVC) when administer which chemotherapy agent?
The site should be treated with the appropriate antidote and observed for 3-4 weeks
The best nursing action should an extravasation of a vesciant occur?
True, protocols should be in place to administer the antidote immediately after an extravasation is observed to neutralized the vesicant and minimized tissue trauma.
T|F Vesicant therapy will cause tissue irritation with eventual sloughing without the appropriate antidote.
Cancer of the plasma cells in bone marrow.
In multiple myeloma, a group of abnormal plasma cells (myeloma cells) multiplies, raising the number of plasma cells to a higher than normal level. Since these cells normally make proteins, the level of abnormal proteins in your blood also may go up. Health problems caused by multiple myeloma can affect your bones, immune system, kidneys and red blood cell count
What is multiple myeloma?
Plasma cells help the body's immune system fight disease by producing substances called antibodies. In multiple myeloma, plasma cells grow out of control and form tumors in the bone marrow. The excess growth of plasma cells interferes with the body's ability to make red blood cells, white blood cells, and platelets. This causes anemia, which makes a person more likely to get infections and have abnormal bleeding.
What causes multiple myeloma?
•Bone or back pain
•Increased susceptibility to infection
•Symptoms of anemia (such as tiredness, shortness of breath, and fatigue)
Symptoms of multiple myeloma
•Blood chemistry levels of calcium, total protein, and abnormal kidney function
•Complete blood count (CBC) reveals low numbers of red and white blood cells and platelets
or Bence-Jones protein analysis
• immunoglobulins (nephelometry)
Bone x-rays show fractures or hollowed out areas of bone.
Tests and diagnosis used to identify multiple myeloma
The lowest point as, for example, the lowest blood count after chemotherapy, the lowest concentration of a drug in the body, etc.
What Is Nadir?
Side effect of Chemotherapy. Cells are constantly produced and grow rapidly in the bone marrow. As a result, they are sensitive to the effects of chemotherapy. Until bone marrow cells recover from chemotherapy damage, abnormally low numbers of WBCs, RBCs, and/or platelets. This is called bone marrow suppression or myelosuppression.
Whait is bone marrow suppression ?
Can include fatigue (due to anemia), easy bruising (due to a low platelet count), and infections (occurring secondary to a low white blood cell count).
Symptoms of Bone Marrow Suppression?
anemia, neutropenia, or thrombocytopenia.
Bone marrow suppression can cause what?
Chronic myelogenous leukemia (CML) is a slow-growing bone marrow cancer resulting in too many white blood cells. CML is caused by a change in the genetic code of some of the cells in the bone marrow.
What is Chronic myelogenous leukemia (CML)?
A digital rectal examination and prostate cancer (PSA) yearly.
The American Cancer Society recommends what kind of screening for males over 50?
Sudden onset of high fever/low grade fever
Abnormal bleeding (example: nosebleeds, gingival bleeding, purpura, ecchymoses, petechiae)
Bruising (even if it's a minor trauma)
Prolonged menses (females)
■Be alert for signs of serious bleeding, such as headache with change in responsiveness, blurred vision, hemoptysis, hematemesis, melena, hypotension, tachycardia, dizziness
Signs of leukemia?