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NUR 326 (cancer, clot, inflammation)
Terms in this set (66)
cancer prevention- primary
reduce the risk
EX: regular exercise, normal body weight, avoid tobacco/ alcohol, wear sunscreen, have healthy diet, and have immunizations
cancer prevention- secondary
EX: aims to reduce impact of disease by early detection when treatment outcomes are most optimal
cancer prevention- tertiary
monitoring/ preventing recurrence
EX: had cancer and now is cancer free so patient going to clinic to make sure it is still gone
Risk factors for cancers are
1. advancing age
3. poor nutrition
4. physical activity
8. hormonal therapies
not having availability for health care, food, or the things that are healthy in the community
CAUTION (7 warning signs)
1. change in bowel or bladder habits
2. a sore that does not heal
3. unusual bleeding or discharge from any orifice
4. thickening or a lump in breast or elsewhere
5. indigestion or difficulty swallowing
6. obvious change in a wart or mole
7. nagging cough or hoarseness (for > 1wk)
What are the 4 most common diagnostic test for cancer?
2. Radiographic imaging
3. Endo/ colonoscopy
4. Lab test (tumor markers/ genetic testing)
what are the 4 different diagnostic surgeries or biopsy's?
1. sentinel lymph node
3. Incisional (wedge removed)
4. Needle (sample)
Tumor Size: T1
Tumor Size: T2
Tumor Size: T3
> 5 centimeters
Tumor Size: T4
tumor has broken through skin or attached to chest wall
Lymph Node Status: N-0
surgeon can't feel any nodes
Lymph Node Status: N-1
surgeon can feel swollen nodes
Lymph Node Status: N-2
Nodes feel swollen and lumpy
Lymph Node Status: N-3
swollen nodes located near collarbone
Metastasis Sizes: M-0
tested nodes are cancer free
Metastasis Sizes: M-1
tested nodes show cancer cells or micro metastasis
How are cancer cells graded?
through pathologic classification- cell differentiation
and also through grade I-IV
With cancer patients you are caring for who?
the patient and their family
surgery can _____ cancer if found early
-primary treatment and control
(may be done by removing only necessary tissue/ sparing normal tissue or by debulking in conjunction w chemo/radiation)
genetic markers and family history
-the cure is not possible
-the goal is to improve quality of life
radiation therapy can be _____
radiation therapy is what?
-target beams that are full of energy that damage or destory cancer cell DNA
approx. ______ % of cancer patients undergo radiation therapy at some point during treatment
what is the most common radiation therapy?
External radiation (teletherapy)
what is external radiation?
radiation from a megavolt machine
what are the 3 types of external radiations?
1. gamma knife technology- cobalt (uses gamma rays from radioisotope cobalt)
2. Cyclotron - neutrons or protons
(the newest forms of radiation)
3. Linear accelerator- ionizing radiation
external treatments are done when?
generally 5 days/wks x 15 to 30 min/day x 2 to 7 wks
what should you teach your patient about the markings on their body?
do NOT scrub the markings off
What is internal radiation (brachytherapy) ?
temporary or permanent implantation/ insertion of radioactive materials into or close to tumor
-minimal exposure to healthy tissue
-commonly used in combination with external radiation
what is a temporary (high dose rate) for internal radiation?
a hollow catheter placed into tumor site and filled with radioactive material for 5 to 15 minutes. Removed after each treatment. Repeated 2-3 times over several days.
what is a permanent (low dose rate) for internal therapy?
quantity/ placement of seeds determined by tailored computer- generated plan
what are the 7 patient care rules for internal radiation therapy?
1. private room w/ sign on the door
2. limit visitors 30 min and maintain 6 feet away
3. no pregnant nurses or visitors
4. wear a lead apron is providing care in from of source
5. keep lead container and tongs in the room. Only touch materials with tongs.
6. may have nurse wear dosimeter film badge to record exposure
7. do not remove linens or dressings
what are the most affected areas when dealing with radiation associated toxicities?
those with rapid proliferation (skin, gi tract, and bone marrow)
what are systemic effects that are shown when you have radiation toxicity?
fatigue and anorexia
client family education should include
1. use mild soap
2. no perfumed things
3. use hydrophilic lotions
4. avoid tight clothing, getting too hot or UV lights
5. avoid scratching
6. use electric razor
7. inspect skin
8. protect from sun (photosensitive)
- agents are used to prevent cancer cells from multiplying, invading, or metastasizing
-provides systemic treatment
- toxicity can be acute or chronic
- most common adverse effects are nausea, vomiting, and hair loss
Chemotherapy : Cell kill and the cell cycle
-percentage of cells are killed with each cycle
-repeated doses over prolonged period
- multiple therapies to target different phases of the cell cycle
preparation and handling of chemotherapy agents
May pose an occupational hazard
Drugs may be absorbed through
Inhalation during preparation, transportation, and administration
Only properly trained personnel should handle drugs
______ stays in the room with a patient with chemotherapy
clients with cancer are at greater risk for
What factors are effected with undernutrition of chemotherapy?
-oral/ Gi problems
(w limited protein calorie intake)
- increased metabolic needs and demands ( hypoalbuminemia/ insufficient proteins)
what drugs are most effected by chemotherapy?
highly proteins drugs
what is cancer related cachexia?
- decrease intake does not fully explain severe impairment nutrition (80% of patients experience this)
what are the side effects or consequences of cytotoxic effects of chemotherapy?
- anorexia (loss of appetite and taste buds)
- decrease dietary intake
- metabolic abnormalities, anorexia, early satiety/ reduced food intake, decrease of lean of body mass, edema, fatigue, and impaired immune function (why patients are always sick)
what are the gastrointestinal interventions for chemotherapy?
1. identify the trigger
2. administer antiemetic before chemo
3. adequate fluid hydration before and after
4. adjust diet before and after drug admin
5. small frequent meals and no fluids with meals (fluid between the meals)
7. oral care
hematopoietic system: myelosuppression includes
neutropenia, leukopenia, anemia, and thrombocytopenia
is an infection which is the leading cause of death during treatment
minimizing the risk for bleeding
nurses teaching for thrombocytopenia
1. teach how to use electric razor
2. stool softener
3. frequent monitoring of platelets, PT, PTT
4. assess meds
what is the lab value to determine thrombocytopenia?
< 100,000/ mm3
what is the platelet count that puts you at risk for spontaneous bleeding?
< 10,000 mm3
what should patients with thrombocytopenia do?
1. assess for bleeding: in stool urine, skin bruising/ petechia, epistaxis
2. avoid injections
3.avoid urinary catheters
4. apply pressure for longer periods of time for IV/IM sites until it fully stops bleeding
5. Hgb/ Hct may show blood loss
6. hypotension/ tachycardia- hypovolemia, dehydration
what teaching should we make for a child bearing age female before chemo?
- ask about children
-once you start there is no going back
____ % of patients who receive chemo experience dermatitis
chemotherapy patients are very
What are oncologic emergencies?
1. superior vena cava syndrome
2. spinal cord compression
3. tumor lysis syndrome
5. cardiac tamponade
6. increased ICP
what is the personal protective protocol for patients receiving chemo?
- double layer of powder free gloves
- long sleeve, disposable gowns made of polyethylene coated polypropylene or other laminate materials
what is the disposal method for chemo ?
- closed system, puncture and leak proof containers labeled " hazardous: chemotherapy contained linens"
-above referenced container maintained in the infusion center soiled utility room for outpatient settings
- above referenced container maintained in patient room
-empty containers, flushed tubing, or gowns and gloves that were not spilled on
-must be incinerated but not as a hazardous waste
- unfused or partially used chemo, contaminated gowns or gloves, and spill cleanup material
- treat as hazardous waste
- HW containers
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