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oncology test 2

Terms in this set (141)

root of word hospice
hopes meaning "host"
what are the main principles of hospice
-death must be accepted
pts care managed by team who communicates regularly
-manage pain and sx
-view pt and family as one
-home care of dying necessary
-bereavement care provided to family
-research and education ongoing
routine home care
all services provided are included in the daily rate to the hospice --- most used
inpatient respite care
A 5-day inpatient stay, provided on occasional basis to relieve the family caregivers.
continuous care
care that occurs in the patient's place of residence when a patient requires continuous care for a minimum of 8 hours in a 24-hour period; continuous care is only furnished during brief periods of crisis and only as necessary to maintain the terminally ill patient at home
general inpatient care
inpatient stay for symptom management that cannot be provided in the home
most common hospice diagnoses
dementia
health disease
lung disease
when do clonal stem cell disorders occur
when the contorl mechanism fails and indolent clone cells evolve to more agressive clone cells
where do hematopoietic malignancy orginiate
hematopoietic stem cell, myeloid or lymphoid stem cell
leukemia
proliferation of a particular cell type - granulocytes , lymphocytes, infrequently erythrocytes or megakaryocytes
lymphoma
neoplasms of lymphoid tissue, usually derived from by lymphocytes
myltiple myeloma
malignancy of the most marture form of by lymphocyte - the plasma cell
4 types of leukemia
AML, CML, ALL, CLL
acute myeloid leukemia
Defect in stem cell that differentiate into all myeloid cells: monocytes, granulocytes, erythrocytes, and platelets
most common nonlymphocytic leukemia
AML
what cancer affects all ages with peak incidence at age 67
acute myeloid lukemia
acute myeloid leukemia (AML) manifestations
fever, infection, weakness and fatigue, bleeding tendencies, pain from enlarged liver or spleen, bone pain HYPERPLASIA OF GUMS
prognosis of aml
highly variable
hallmark sign of AML
bone marrow analysis showing excess immature leukocytes called BLAST CELLS
treatment of AML
chemo - induction therapy
HSCT
induction therapy
usually requires hospitalization for several weeks. based on pts physical status and hx. over 70 not good candiates
supporative care of aml
may be the only option , death occurs in months, antimicrobial therapy and transfusions
chronic myeloid leukemia
Mutation in myeloid stem cell with uncontrolled proliferation of cells - philadelphia chromosome : chromosome 22
three stages of cml
chronic, transformational and blast crisis
age factor for cml
uncommon under 20 increase incidence with age, mean age 64
manifestations of CML
initially asymptomatic, malasie, anorexia, weight loss, confusion or SOB caused by leukostasis, enlarged tender spleen or enlarged liver
treatment of CML
imatinib mesylate (gleevec) , chemp and HSCT
Imatinib (Gleevec)
blocks signals in leukemic cells that express BCR-ABL protein
acute lymphocytic leukemia
Uncontrolled proliferation of immature cells from LYMPHOID STEM CELL (LYMPHOBLASTS)
ALL
MOST COMMON IN YOUNG CHILDREN, boys more often than girls. peak age 4
manifestations of ALL
pain from enlarged liver/spleen, bone, CNS, headache and vomiting
treatment for ALL
chemo, HSCT, monoclonal antibody therapy, corticosteroids
cell of origin in all
75% b-lymphocyte
25% t-lymphocyte
cancer thats very responsive to tx
acute lymphocytic leukemia
chronic lymphocytic leukemia
common malignancy of older adults, most prevalent type of adult leukemia, mean age 72
CLL is derived from
b lymphocytes
survival of CLL
2-14 years depending on stage. its a very aggressive disease
manifestations of CLL
b sx - fever, drenching sweats mostly at night, unintentional weight loss
treatment for CLL
early stage watch and wait, begin after shows sx, chemo, monoclonal antibody therapy, IVIG for recurrent infections, HSCT
risk factor of CLL
agent orange
sx and complications of leukemia
anemia, infection, bleeding, weakness, fatigue
lab test for leukemia
leukocyte count, ANC count, hematocrit, platelets, creatinine and electrolyte level, coagulation and heptatic functions, Cultures as needed
diagnoses for leukemia
risk of infection, bleeding, impaired oral mucous membrane, imbalanced nutrition and fluid volume, fatigue, imbalanced fluid volume, self care deficits , anxiety, spiritual distress
collaborative problems and potential complications of leukemia
infection, bleeding, renal dysfunction , tumor lysis syndrome
tumor lysis syndrome
hyperkalemia may occur =requires insulin to reduce serum potassium = monitor serium potassium and blood glucose levels
myelodysplastic syndrome MDS
disorder of myeloid stem cell diagnoses with CBC or bone marrow biopsy
occurs in older adults 65-70 years old
MDS
only cure for myelodysplastic syndrome
HCST
other tx for Myelodysplastic syndrome
blood transfusion, bone marrow stimulating agents, immunosuppressive therapy in some, chelation therapy, myeloid growth factors
chelation therapy
used for iron overload , iron binds to agent then excreted in urine
polycythemia vera
proliferative disorder of myeloid stem cell. bone marrow is hypercelluar, erythrocyte, leukocyte, platelet elevated . mean age 65
diagnosis of polycythemia vera
JAK2 mutation and LOW erythropoietin levels
elevated hemoglobin or hematocrit
polycythemia vera sx
RUDDY COMPLEXION and spleenomegaly, HTN, generalized pruritis, erythomelaglgia
essential thrombocythemia
Stem cell disorder within the bone marrow
also called thrombocythemia
manifestations of et
many are asymptomatic, diagnosis results of CBC
sx of et
usually occur from vascular occlusion - headache, enlarged spleen, hemorrhage
primary myelofibrosis
chronic myeloproliferative disorder with in the stem cell
primary myelofibrosis characteristics
marrow fibrosis or scarring, extramedullary hematopiesis, leukocytosis, thrombocytosis and anemia
sx of primary myelofibrosis
enlarged spleen, fatigue, pruritus, bone pain, weight loss, infection, bleeding, cachexia
risks of pv
thrombosis complications, CVA,MI, bleeding from dysfunctional platelets
polycythemia vera tx
phlebotomy -500ml chemo, management of athersclerosis, allopurinol to prevent gout, asprin for pain, platelet aggregation inhibitors, interferon
tx for et
based on risk for developing thrombosis or hemorrhage, and presence of sx
affect women 2x more than men, 65*70
essential thrombocythemia
disease of older adults 65-70, survival 2-10 yrs
primary myelofibrosis
pancytopenia
deficiency of all types of blood cells common in primary myelofibrosis
primary myelofibrosis
chronic myeloproliferative disorder with in the stem cell
primary myelofibrosis tx is based on
reducing the burden of the disease by decreasing sx and splenomegaly and improving blood count. splenectomy may be used to control significant problems
primary myelofibrosis tx
blood transfusions, erythroid stimulating agents for anemia, HSCT(younger), splenectomy
lymphoma
neoplasm of lymphoid origin
lymphoma starts where
usually in lymph nodes, can involve lymphoid tissue in spleen, gi tract, liver, or bone marrow
two major categories of lymphoma
Hodgkin lymphoma
Non-Hodgkin lymphoma
how is lymphoma classified
according to degree of cell differentation and origin of predominant malignant cells
hodgkin disease
relatively rare malignancy that has a high cure rate
unicentric
initiates in a single node - hodgkin
hallmark sign of hodgkin
reed sternberg cells
manifestations of hodgkin
Painless enlarged lymph node, weight loss, night sweats, fever, generalized pruritus, coughing trouble breathing or chest pain, malaise, recurrent infections,, splenomegaly
treatment for hodgkin
determined by stage and may include chemo, radiation therpay, or both, HSCT for advanced
reed sternberg cell
large abnormal lymphocytes that may contain more than one nucleus
non hodgkin lymphoma
lymphoid tissues become infiltrated with malignant cells, spread is unpredictable and localized disease is rare
nhl is increased in
autoimmune deficiencies, prior tx for cancer, organ transplant, viral infection, exposure to pesticides
manifestations of NHL
lymphadenopathy(most common) b sx, and sx associated wtih lymphomatous masses ( pressure on area)
NHL tx
determined by type and stage, interferon, chemo, radiation, HSCT
multiple myeloma
malignant disease of most mature form of b lymphocyte - the plasma cell
incidence increase with age, median 70, 5 yr survival no cure
multiple myeloma
multiple myeloma manifestaions
bone pain BACK AND RIBS, osteoprosis and fractures related to bone destruction, hypercalcemia, renal imapriment and failure, anemia
most common cause of hypercalcemia crisis
multiple myeloma
multiple myeloma tx
auto hsct, chemo, corticosteroids, radiation therpay
new drugs for mm
IMiDs thalidomide analogs, monoclonal antibody
bone is being destroyed by tumor growth in what disease
multiple myeloma mm
disorders of the female reproductive tract
cervical, uterine, vaginal, vulvar, ovarian cancer
cervical cancer signs and sx
depend on location - vaginal discharge, pain, bleeding, systemic sx (weight loss and anemia)
vital steps for cervical cancer
prevention
screenings
early detection
care of pts in cervical cancer
similar to that of abdominal surgeries.
cervical cancer risk factors
-Human papilloma virus (HPV) infection
-Smoking
-Early age at first sexual intercourse.
-Multiple sexual partners and/or partners who have multiple partners.
-Multiple pregnancies
hysterectomy
surgical removal of the uterus
total hysterectomy
removal of the uterus and the cervix
radical hysterectomy
excision of the uterus, ovaries, uterine tubes; lymph nodes, upper portion of the vagina, and the surrounding tissues (abdominal)
cervical cancer diagnoses
anxiety rt diagnoisis of cancer, fear of pain, disturbed body image, acute pain rt surgery, deficient knowledge .. make sure they understand their options
cervical cancer complications
hemorrhage, DVT, bladder dysfunction, infection
self and continuing care of cervical cancer pts
surgical incision care, bowel and urinary function, resuming activities slowly, shower, activities to avoid, sx to report,follow up
interoperative radiation therapy
applied directly to affected area during surgery
internal ( intracavity irradiation )
application inserted, packed, xray, private room, indwelling cath, bed rest, positioning restrictions,
safety interventions for intracavity radiation
follow precautions, distance, shielding, film badges, no pregnant or children, educuate family and pt. monitor device do not touch
breast physical assessment
inspection, palpation, lymph nodes
mastalgia
pain in the breast
fibroadenomas
solid mass, 15-35, smooth, firm rubbery , hard and well defined
ductual carcinoma in situ
proliferation of malignant cells inside the milk ducts w/o invasion into surrounding tissues
invasive cancer
infiltrating ductal carcinoma, inflitrating lobular, medullary carcinoma. mucinous carcinoma under 50, tubular ductal, inflammatory
mucinous carcinoma
postmenopausal
tubular ductal carcinoma
axillary metastis uncommon
infiltrating lobular carcinoma
well defined thickening in breast
inflammatory carcinoma
very aggressive, very rare, orange peel look chemo then radiation
infiltrating ductal carcinoma
80% of all cases - ductal system invades surrounding tissue "solid irregular mass"
womens risk factor for developing breast cancer over a life time
13% or 1 in 8
risk factors of breast cancer
no single, specific cause. combo of genetic, hormonal, environment. 80% occur sporadic with no family hx, some evidence with long term smoking and working night shift
what does long term surveillance focus on
early detection
high risk women in breast cancer
mri and yearly mammogram 2x a year at 25
chemoprevention
the use of natural or synthetic substances such as drugs or vitamins to reduce the risk of developing cancer, or to reduce the chance that cancer will recur
who should use chemoprevention
women at high risk
chemoprevention drugs
tamoxifen and raloxifene
most common site of breast cancer
upper outer quadrant
lesions in breast cancer
non tender, fixed, hard with irregular borders. differentiates with benign condition
advanced signs of breast cancer
skin dimpling, nipple retraction, skin ulceration
modified radical mastectomy
the surgical removal of the entire breast and all of the axillary lymph nodes under the adjacent arm
total mastectomy
excision of the entire breast, nipple, areola, and the involved overlying skin- leaves the nodes
breast conservative tx
completely excise tumor with clear margins while acceptable cosmetics
sentinel node biopsy
a biopsy of the first lymph node to come into contact with cancer cells as they leave the organ of origination and start spreading into the rest of the body
lymph node dissection
removal of possible cancer-carrying lymph nodes for pathologic examination
breast cancer post op diagnoses
pain / discomfort, peripheral neurovascular dysfuction, disturbed body image, impaired coping, self care deficit, risk for sexual dysfunction, deficient knowledge
after breast surgery edcuation
know drain management, arm exercises to regain mobility , hand and arm care.
breast removal complications
lymphedema, hematoma or seroma formation, infection
when are jp drains removed after breast surgery
output is less than 30ml in 24hr period - usually 7-10 days
when to shower after breast surgery
second day post op, clean with soap and water. dependent on immediate reconstruction
arm exercises for breast surgery
3x daily for 20 min until full range of motion is restored - usually 4-6 weeks. for affected side
lifting restrictions
No lifting over 5-10lbs for 4-6 weeks
collateral circulation time frame
4 weeks
selective estrogen receptor modulators
tamoxifen
aromatase inhibitor
anastrazole, letrozole, exemestane
tissue transfer procedure
transverse rectus abdominal myocutaneous flap
mammoplasty
reconstruction breast surgery
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