H&Hw1 - oncology

2 kinds of infiltration emergencies

1. Cardiac Tamponade 2. Carotid Artery Rupture

6 kinds of metabolic emergencies?

1. SIADH (syndrome of inappropriate antidiuretic hormone secretion) 2. hypercalcemia 3. Tumour lysis syndrome 4. septic shock 5. DIC (disseminated intravascular coagulation 6. Thromboembolism

Hematological emergencies caused from? (3)

1. hemorrhage *causes:* 1. erosion of blood vessels in tumor 2. GI ulcer 3. Thrombocytopenia

Once a ????? weight loss occurs, it is difficult to maintain the nutritional status.

4.5-kg (10-lb)

the nurse will expect the Dr. to order nutritional supplements when how much weight loss is noted?

5% also when pt. has potential for protein & calorie malnutrition

top 3 cancers?

breast/prostate colorectal lung

what is the leading cause of death in Canada?

Cancer

Stage 0:

Cancer in situ

Primary cause of death in cancer patients ?

infection!

extravasation

infiltration of drugs into tissues surrounding the infusion site), causing local tissue damage. {See next slide for figure}

Stomatitis

inflammation of the oral mucosa

Nx

regional lymph nodes unable to be assessed clinically

Cancer incidence is [blank?] for women and [blank] among men

rising in women decreasing in men

common sites of infection? occurs due to?

*Some sites of infection* Lungs Genitourinary tract system Mouth, rectum Peritoneal cavity, blood *Occurs due to* Ulceration Compression of vital organs by the tumour Neutropenia caused by disease or treatment

What are some of the key ways that you can think of to reduce your cancer risk?

1) **Don't smoke** 2) Limit alcohol 3) Reduce exposure to carcinogens- smoking, sun exposure, hazardous chemicals, 4) Eat balanced diet 5) Exercise (30 minutes- 5 times/ week) 6) Maintain healthy weight 7) Follow cancer screening guidelines 8)Know the early warning signs of cancer

Common side effects of chemotherapy and radiation 6

1) Bone marrow suppression 2) Fatigue 3) GI disturbances 4) Integumentary and mucosal reactions 5) Pulmonary effects 6) Reproductive effects

Radiation Therapy

1) Local treatment modality 2) One of the oldest nonsurgical methods of cancer treatment 3) 50% of all cancer patients will receive radiation therapy.

oncology Emergencies can be? (4 kinds)

1) Obstructive 2) Metabolic 3) Infiltrative 4)Hematological

3 kinds of Obstructive emergencies?

1) Superior vena cava syndrome 2) spinal cord compression 3) 3rd space syndrome

People with cancer have how many times the risk of thromboembolism, compared with non-cancer patients? why?

7 TIMES!!!!! Hypercoagulability 1) Tumour cells activate clotting cascade 2) Inflammation promotes coagulation 3) Some chemotherapy drugs activate clotting (e.g. tamoxifen)

A 58-year-old woman has breast cancer that has metastasized to the liver. On which fact about metastatic cells does the nurse understand that the treatment plan for the patient is based? a.They become more unlike the cells of the primary site as mutations occur in the tumour cells at both sites. b.They are identical to the cells in the breast, having passively been spread through blood and lymph vessels. c.They do not proliferate as rapidly as the malignant cells in the primary site and are therefore less sensitive to treatment. d.They retain the characteristics of the malignant cells in the breast and have the same response to treatment as the primary tumour does.

ANS: A As the primary and metastatic sites develop, the cells quickly become more heterogeneous as they repeatedly undergo spontaneous genetic mutations.

A patient with Hodgkin's disease is undergoing external radiation therapy on an outpatient basis. After 2 weeks of treatment, he tells the nurse that he is so tired he can hardly get out of bed in the morning. What is an appropriate goal for the nurse to plan with this patient? a.Establish a daily walking program. b.Exercise vigorously when fatigue is not as noticeable. c.Consult with a psychiatrist for treatment of depression. d.Maintain bed rest until the radiation treatment is completed.

ANS: A Mild physical activity programs are usually within the abilities of patients undergoing external radiation therapy and have been found to improve symptoms of fatigue, lessen anxiety, and facilitate sleep in cancer patients.

When administering vesicant chemotherapeutic agents intravenously, what is an important consideration? a.Stop the infusion if swelling is observed at the site. b.Administer the drug by intravenous (IV) push. c.Administer the chemotherapy through a small-bore catheter. d.Administer the drug only through a central vascular access device.

ANS: A Protect the patient from extravasation through careful attention to chemotherapy delivery and assessment of venous access. Swelling, redness, and the presence of vesicles on the skin are other signs of extravasation that would require the nurse to stop the infusion.

A 40-year-old divorced mother of four school-aged children is hospitalized with metastatic cancer of the ovary. The nurse finds the patient crying, and the patient tells the nurse that she does not know what will happen to her children when she dies. What is the most appropriate response? a."Why don't we talk about the options you have for the care of your children." b."You are going to live for a long time yet, and your children will be just fine." c."I wouldn't worry about that right now. You need to concentrate on getting well." d."Won't your ex-husband take the children when you can't care for them anymore?"

ANS: A Psychosocial care is an important aspect of cancer care. Supportive care includes services and strategies to help cancer patients and their families cope with the cancer experience. This response expresses the nurse's willingness to listen and recognizes the patient's concern.

A patient is receiving chemotherapy for a large tumour of the liver. For which of the following reasons does the nurse recognize that the expected response to this therapy is limited? a.The fewer the cancer cells, the greater is the response to chemotherapy. b.Large tumours become encapsulated, preventing exposure to chemotherapeutic agents. c.The patient's natural defences are compromised by the presence of numerous tumour cells. d.Large tumours have a greater number of undifferentiated cells.

ANS: A The lower the tumour burden is (i.e., the fewer the cancer cells), the greater the response to chemotherapy.

A patient with a large stomach tumour that is attached to the liver is scheduled to have a debulking procedure. What should the nurse explain that the expected outcome for this surgery will be? a.Relief of pain by cutting sensory nerves in the stomach b.Reduction of the tumour burden to enhance adjuvant therapy c.Control of the tumour growth by removal of malignant tissue d.Promotion of better nutrition by relieving the pressure in his stomach

ANS: B A debulking or cytoreductive procedure may be used if the tumour cannot be completely removed (e.g., is attached to a vital organ). When this occurs, as much tumour as possible is removed, and the patient may be given chemotherapy or radiation therapy.

3. A patient tells the nurse that he read that asbestos is a carcinogen and asks whether that means it causes cancer. Which of the following explains what a carcinogen is? a.Any agent or condition that can promote the proliferation of altered, mutated cells b.Any chemical, physical, or genetic agent that can irreversibly alter cellular DNA, causing abnormal cells to be produced c.Any agent or condition that causes chronic irritation and stimulation of tissue, resulting in uncontrolled overgrowth of tissue d.A specific, known chemical or physical agent that can start uncontrolled cellular proliferation by fracturing cellular DNA

ANS: B Carcinogens are cancer-causing agents capable of producing cellular alterations and may be chemical, radioactive, or viral in nature.

A patient undergoing external radiation has developed a dry desquamation of the skin in the treatment area. Which of the following statements by the patient indicates to the nurse that the teaching about management of the skin reaction has been effective? a."I can use ice packs to relieve itching and scaling in the treatment area." b."I can lubricate the area with a nonmedicated, nonperfumed moisturizing lotion." c."I will expose the treatment area to a sun lamp daily to increase blood supply to the area." d."I should scrub the area with warm water to remove the scales and apply alcohol to toughen the skin."

ANS: B Dry skin should be lubricated with a nonirritating lotion or solution that contains no metal, alcohol, perfume, or additives that irritate the skin.

Interleukin-2 (IL-2) is used as adjuvant therapy for a patient with metastatic renal cell carcinoma. Which of the following does the nurse recognize as a goal of therapy with this agent? a.Selectively altering the DNA of malignant cells b.Enhancing the patient's immunological response to tumour cells c.Stimulating malignant cells in the resting phase to enter mitosis d.Preventing the bone marrow depression common with the use of chemotherapeutic agents

ANS: B IL-2 enhances the ability of the patient's own immune response to suppress tumour cells.

A chemotherapeutic agent known to cause alopecia is prescribed for a female patient. To maintain the patient's self-esteem, what should the nurse plan? a.Suggest that the patient limit social contacts until her hair regrows. b.Encourage the patient to purchase a wig or turban and wear it as her hair loss begins. c.Have the patient wash her hair daily with a mild shampoo to stimulate her scalp and promote hair growth. d.Inform the patient that her hair loss will not be permanent and that her hair will grow back as it was before.

ANS: B One intervention for alopecia is for the nurse to suggest ways to cope with hair loss (e.g., hair pieces, scarves, wigs).

5. In teaching about cancer prevention, why does the nurse stress promotion of exercise, normal body weight, and a low-fat diet? a.General aerobic health is an important defence against cellular mutation. b.Obesity is a factor that promotes cancer growth; if it is reversed, the risk of cancer can be decreased. c.People who are overweight usually consume large amounts of fat, which is a chemical carcinogen. d.The development of fatty tumours, such as lipomas, is increased when fatty tissue is abundant.

ANS: B Promoting factors include dietary fat, obesity, cigarette smoking, and alcohol consumption. The withdrawal of or reduction in these factors can reduce the risk of cancer development.

A patient has been receiving interferon therapy for treatment of cancer. For what common side effects should the nurse assess the patient? a.Nausea, vomiting, and diarrhea b.Fever, chills, fatigue, and malaise c.Opportunistic infections, such as candidiasis d.Renal damage with increased serum blood urea nitrogen and creatinine

ANS: B Side effects of interferon include flulike syndrome (fever, chills, myalgia, headache), cognitive changes, fatigue, nausea, vomiting, anorexia, and weight loss.

4. When teaching a patient who smokes about the relationship of smoking to the development of cancer, how should the nurse explain tobacco smoke as a "complete" carcinogen? a.Exposure to the smoke always causes cellular changes. b.Tobacco smoke is capable of both initiating and promoting cancer growth. c.Cancer will always develop when people who smoke are exposed to other carcinogens. d.Tobacco smoke serves as a vehicle for the spread of cancer cells during the progression stage of cancer.

ANS: B Some carcinogens (called complete carcinogens) are capable of both initiating and promoting the development of cancer. Tobacco is an example of a complete carcinogen, capable of initiating and promoting cancer.

After 3 weeks of radiation therapy, a patient has lost 4.5 kg and does not eat well because nothing tastes good. What is an appropriate nursing diagnosis for the patient? a.Risk for infection related to poor nutrition b.Ineffective therapeutic regimen management related to refusal to eat c.Imbalanced nutrition: less than body requirements related to anorexia d.Ineffective health maintenance related to lack of knowledge of nutritional requirements during radiation therapy

ANS: B The patient is not eating; therefore, the nurse needs to encourage small, frequent meals of high-protein, high-calorie foods (e.g., Ensure or other supplements) to achieve an effective therapeutic regimen management and avoid weight loss.

The nurse is teaching a postmenopausal patient with breast cancer about the expected outcomes of her cancer treatment. The nurse evaluates that the teaching has been effective when the patient makes which of the following statements? a."If I have no recurrence in the tumour for 5 years after treatment, I will be cured of my cancer." b."Because my tumour is slow-growing, it will be many years before I can be considered cured of cancer." c."Cancer can be cured only with surgery, and other treatments are used to control the symptoms cancer causes." d."Cancer is never considered cured, and the goal of treatment is control of tumour growth over a long period of time."

ANS: B The patient with a tumour that has a slower mitotic rate (e.g., postmenopausal breast cancer) needs 20 or more disease-free years before she can be considered cured of cancer.

Which of the following is a characteristic of a malignant neoplasm? a.Usually encapsulated b.Normally differentiated c.Moderate to marked vascularity d.Cells similar to parent cells

ANS: C A characteristic of a malignant neoplasm is moderate to marked vascularity. Malignant neoplasms are rarely encapsulated, are poorly differentiated, and the cell characteristics are abnormal, bearing little resemblance to parent cells.

A patient hospitalized with ovarian cancer tells the nurse that she thinks her husband does not care for her anymore since she has become ill because he rarely visits her. On one occasion when the husband was present, he told the nurse he just could not stand to see his wife so ill and never knew what to say to her. What is an appropriate nursing diagnosis in this situation? a.Impaired home maintenance related to perceived role changes b.Risk for caregiver role strain related to burdens of caregiving responsibilities c.Interrupted family processes related to effect of illness on family members d.Compromised family coping related to disruption in lifestyle and necessary role changes

ANS: C A diagnosis of cancer may precipitate a crisis in the lives of the patient and his or her family, with repercussions affecting all aspects of their lives; therefore, interrupted family processes are evident in this situation.

2. A patient has been told by his physician that the tumour in his bowel is poorly differentiated. He asks the nurse what is meant by "poorly differentiated." On what knowledge should the nurse base the response to the patient's question? a. Cancer cells develop a new gene, called an oncogene, which promotes continuous, immature reproduction of cells. b.Poorly differentiated cells are fetal cells that do not have time to mature as a result of the rapid division of malignant cells. c.Normal cells revert to a more fetal appearance and function, probably because of mutation of cellular genes called proto-oncogenes. d.Normal mature cells with specific functions become immature, nonfunctioning cells when chemical agents, such as oncogenes, cause cell mutation.

ANS: C An undifferentiated cell has an appearance more like that of a stem cell or a fetal cell and less like that of a normal cell of the organ or tissue. The DNA in cancer cells is always different from that of normal cells.

Approximately what percentage of Canadians will develop cancer during their lifetimes? a.12% b.27% c.43% d.55%

ANS: C Approximately 43% of Canadians will develop cancer during their lifetimes.

Which stage would a patient with Hodgkin's disease be experiencing when there is extensive local and regional spread of the cancer cells? a.Stage I b.Stage II c.Stage III d.Stage IV

ANS: C In stage III, there is extensive local and regional spread of the disease. This staging system is commonly used for Hodgkin's disease and cervical cancer.

16. A patient with metastatic cancer of the colon experiences severe vomiting following each administration of chemotherapy. What is an important nursing intervention for the patient? a.Weigh the patient twice a week. b..Have the patient eat full meals when nausea is not present. c.Administer prescribed antiemetics 1 hour before the treatments. d.Offer dry crackers and carbonated fluids immediately following the treatments.

ANS: C The introduction into the oncology settings of antiemetic clinical practice guidelines and effective implementation of the guidelines are essential methods for managing this treatment side effect. Administration of antiemetics before treatment will alleviate the patient's experience of nausea and vomiting.

While she is being prepared for a biopsy of a lump in her right breast, the patient asks the nurse what the difference is between a benign tumour and a malignant tumour. Which of the following explanations about benign tumours best describes the difference from malignant tumours? a.Benign tumours frequently recur in the same site. b.Benign tumours do not cause damage to adjacent tissue. c.Benign tumours do not spread to other tissues and organs. d.Benign tumours are simply an overgrowth of normal cells.

ANS: C The major difference between malignant and benign tumours is that benign tumours never metastasize, whereas malignant tumours invade adjacent tissues and spread to distant tissues.

A patient undergoes a needle biopsy of the prostate. What type of tumour classification can be provided from a needle biopsy? a.Clinical status of the patient with cancer b.Staging of the extent and spread of the tumour c.Appearance of cells and degree of differentiation d.TNM staging with size, node involvement, and presence of metastasis

ANS: C This examination will determine whether the tissue is benign or malignant, the anatomic tissue from which the tumour arises, and the degree of cellular differentiation (i.e., how closely the specimen cells resemble the normal cells of the tissue).

Which one of the flowing malignancies has been linked to radiation? a.Cervical cancer b.Breast cancer c.Thyroid cancer d.Lung cancer

ANS: C Thyroid cancer has been linked to effects of radiation exposure, along with leukemia, lymphoma, bone cancer, and childhood cancers.

A 63-year-old man has terminal cancer of the liver and is cared for by his wife at home. His abdominal pain has become increasingly severe, and he now says it is intense most of the time. Which of the following actions by the patient will the nurse recognize as evidence that teaching regarding pain management has been effective? a.The patient limits the use of opiate analgesics to prevent addiction. b.The patient resigns himself to the fact that pain is an inevitable consequence of cancer. c.The patient uses pain medication only when the pain becomes more than he can tolerate. d.The patient takes analgesics around the clock on a regular schedule, using additional doses for breakthrough pain.

ANS: D Analgesic medications should be given on a regular schedule, around the clock, with additional doses as needed for breakthrough pain.

6. During a routine health examination, the patient tells the nurse that she has a family history of colon cancer. What should the nurse advise the patient to do? a.Schedule a sigmoidoscopy every year after the age of 40. b.Schedule a digital rectal examination every 6 months after the age of 45. c.Have a sigmoidoscopy for baseline at the age of 50 and every 5 years afterward. d.Discuss specific testing with her doctor because her risk for colon cancer is increased.

ANS: D If the patient has a higher known risk (a first-degree relative with colorectal cancer or a history of inflammatory bowel disease or benign polyps), then screening should be individualized and started before the age of 50.

A 32-year-old male patient who recently married is to undergo radiation therapy for Hodgkin's disease. He expresses concern to the nurse about the effect of chemotherapy on his sexual function. What is the best response to the patient's concerns? a."The radiation will make you sterile, but sexual performance will not be impaired." b."You may have some temporary erectile dysfunction during the course of the radiation, but normal sexual function will return." c."Radiation does not cause the problems with sexual functioning that occur with chemotherapy or surgical procedures used to treat cancer." d."It is possible you may have some changes in your sexual function, and you may want to consider pretreatment harvesting of sperm if you want children."

ANS: D Pretreatment status may be a significant factor because a low sperm count and loss of motility are seen in individuals with testicular cancer and Hodgkin's disease before any therapy. Compromised reproductive function in men may also result from erectile dysfunction following pelvic radiation and its related vascular and neurological effects. Potential infertility can be a significant consequence for the individual, and counselling is indicated. Pretreatment harvesting of sperm or ova may be considered.

Prevalence is the total number of people who are living with cancer. It is more often and more usefully defined as those still alive how many years after the initial cancer diagnosis? a.1 year b.2 years c.5 years d.10 years

ANS: D Prevalence is more often and more usefully defined as those that are still alive 10 years after the initial diagnosis of cancer.

11. External beam radiation is planned for a patient with cancer of the colon. Because the treatment area is in the lower abdomen and pelvic area, which of the following measures should the nurse teach the patient is important to prevent complications from the effects of the radiation? a.Maintain a high-residue, high-fat diet. b.Test all stools for the presence of blood. c.Inspect the mouth and throat daily for the appearance of thrush. d.Perform perianal care with sitz baths and meticulous cleaning.

ANS: D Radiation to the lower abdomen will affect organs in the radiation path, such as the bowel. Nausea, vomiting, and diarrhea are early responses to irradiation of the gastrointestinal tissue and may occur immediately following the first treatment.

A patient receiving external radiation and chemotherapy for oropharyngeal carcinoma has a denuded and swollen oral mucosa. He has ulcerations over his bucca and tongue, and his saliva is thick and ropey. What is an appropriate intervention for the nurse to teach the patient? a.Maintain a liquid diet until the acute reaction subsides. b.Use cotton-tipped applicators dipped in hydrogen peroxide to clean his teeth. c.Gargle and rinse his mouth several times a day with a commercial antiseptic mouthwash. d.Rinse his mouth before and after each meal and at bedtime with a solution of salt and sodium bicarbonate.

ANS: D The patient should be taught how to perform oral care at least before and after each meal and at bedtime. A saline solution of 1 teaspoon of salt in 1 litre of water is an effective cleansing agent. One teaspoon of sodium bicarbonate may be added to the oral care solution to decrease odour and alleviate pain.

Management of Hypercoagulability

Anticoagulant therapy Heparin Low molecular weight heparin ASA Warfarin/Coumadin Inferior Vena Cava (IVC) filter

M1

Distant Metastases

Irritants:

Damage intima of vein, but not tissue

Chemotherapy Regional Administration

Delivery of drug directly into tumour site Higher concentrations of drug can be delivered with less systemic toxicity.

Stage III:

Extensive local and regional spread

how many Canadians will develop cancer?

HALF :(

most common administration method of chemo?

IV

Stage II:

Limited local spread

Stage IV:

Metastasis

the nurse should like totally monitor which lab values in regards to malnutrition?

Monitor albumin and prealbumin levels.

Vesicants:

Severe local tissue breakdown and necrosis It is extremely important to monitor for and promptly recognize symptoms associated with extravasation of a vesicant and to take immediate action if it occurs. The infusion should be immediately turned off, and protocols for drug-specific extravasation procedures should be followed to minimize further tissue damage.

Stage I:

Tumor limited to the tissue of origin; localized tumor growth

Intravesical bladder

Type of regional delivery method Agent added to bladder by urinary catheter and retained for 1 to 3 hours Complications of intravesical bladder chemotherapy include dysuria, urinary frequency, hematuria, cystitis, urinary tract infection, and bladder spasms.

Intra-arterial

Type of regional delivery method Delivers drug through arterial vessel supplying tumour Intra-arterial: Method has been used for the treatment of osteogenic sarcoma; cancers of the head and neck, bladder, brain, and cervix; melanoma; primary liver cancer; and metastatic liver disease.

Intraperitoneal

Type of regional delivery method Delivers drug to peritoneal cavity for treatment of peritoneal metastases Intraperitoneal: Chemotherapy is generally infused into the peritoneum in 1 to 2 L of fluid and allowed to "dwell" in the peritoneum for a period of 1 to 4 hours. Following the "dwell time," the fluid is drained from the peritoneum.

Intrathecal or intraventricular

Type of regional delivery method Involves lumbar puncture and injection of chemotherapy into subarachnoid space Intrathecal/intraventricular: Commonly used for breast, lung, and GI tumors, leukemia, and lymphoma.

Cachexia

a condition of physical wasting away due to the loss of weight and muscle mass that occurs in patients with diseases such as advanced cancer or AIDS

Dry Desquamation

are uncomfortable and result in pruritus. Lubricate the dry skin with a nonirritating lotion emollient (such as aloe vera) that contains no metal, alcohol, perfume, or additives that can be irritating to the skin.

T1-T4

ascending degrees of increase in tumour size & involvement

N1-N3

ascending degrees of nodal involvement

Cancer mortality is? a) decreasing in men, increasing in women b) decreasing in both men and women c) decreasing in women, increasing in men

b) decreasing in both men and women

-oma

benign

Rupture of the carotid artery occurs most frequently in patients with ?

cancer of the head and neck secondary to invasion of the arterial wall by tumour or to erosion following surgery or radiation therapy.

Tis

carcinoma in situ is a commonly used term in classification of cancer. It is defined as a lesion with all the histological features of cancer except invasion. If left untreated, carcinoma in situ eventually becomes invasive.

becks triad

cardiac tamponde 1. low arterial BP 2. distended neck veins 3. distant, muffled heart sounds

-sarcoma

connective tissue tumors, malignant

Myelosuppression:

decreased ability of the bone marrow to produce blood cells

what is a carcinoma?

epithelial cancer cell

-carcinoma

epithelial tissue tumors , malignant

Alopecia

hair loss

hematopoietic Tissue tumours - lymphoid tissue

hodgkin's disease, non-hodgkin's lymphoma

Pulsus paradoxus

is an abnormally large decrease in systolic BP during inspiration (> 10mmHg)

hematopoietic Tissue tumours - bone marrow

lymphocytic & myelogenous leukemia

Ectopic

means in an abnormal place or position

hematopoietic Tissue tumours - plasma cells

multiple myeloma

Mo

no distant metastases

No

no evidence of disease in lymph nodes

To

no evidence of primary tumor

Instruct outpatients with a risk for neutropenia to call their health care provider with a temperature of ??????? or greater

of 38° C or greater. The classic manifestations of infection are often subtle or absent in a patient with neutropenia and a depressed immune system

Wet desquamation

of tissues generally produces pain, drainage, and increased risk of infection.