PCN: unit 8 (Cellular regulation)

Treatments for Cancer: _____ Future (In Trials):___________ (genetic understanding of the disease (gene therapy; personalized medicine).

Precision Medicine

_____ and _____ sodas are used FOR NAUSEA

SPRITE AND GINGER ALE

Treatments for Cancer: ______ Electrosurgery; Laser; photodynamic (light sensitizing agent injected and exposed to laser light); RFA (radiofrequency causes heat).

Surgery / Freeze (cryotherapy & Cryoablation):

Chemotherapy affects bone marrows ability to make _____

new blood cells.

Types of Immunotherapy for cancer: _______ treatment that boosts the natural ability of T cells to fight cancer. Immune cells are taken from the tumor. Those that are most active against the cancer are selected or changed in the lab to better attack the cancer cells, grown in large batches, then put back into their body through an IV. T-cell transfer therapy may also be called adoptive cell therapy, adoptive immunotherapy, or immune cell therapy.

T-cell transfer therapy:

Treatments for Cancer: _____ Targets the changes in cancer cells that help them grow, divide, and spread; can become resistant to them; use with other therapies, such as chemotherapy and radiation. • Stop cancer cells from growing; stop signals that help form blood vessels; deliver cell-killing substances to cancer cells

Target therapy

After teaching the parents of a child newly diagnosed with leukemia about the disease, which of the following descriptions given by the mother best indicates that she understands the nature of leukemia?

"The disease is a type of cancer characterized by an increase in immature white blood cells." Leukemia is a neoplastic, or cancerous, disorder of blood forming tissues characterized by a proliferation of immature white blood cells. Leukemia is not an infection, inflammation or allergic disorder. They have a low mature WBC count?

List the Warning Signs of Cancer: ⋆C ⋆A ⋆U ⋆T ⋆I ⋆O ⋆N • Unexplained weight loss -(10 # or more) pancreas/ esophagus & stomach, lung • Fever (more common if it has spread) • Leukemia/ lymphoma • Fatigue: Leukemia, colon, stomach • Pain: Colon, bone, testicular, brain

Change in bowel or bladder function A sore that does not heal Unusual discharge or abnormal bleeding Thickening or lump in the breast or other tissue Indigestion or difficulty swallowing Obvious change in a wart or a mole Nagging cough or hoarseness

Treatments for Cancer: _____ stop or slow growth of cancer cells; may be used to ease cancer symptoms; shrink tumors before surgery.

Chemotherapy

Which of the following has been associated with fatigue from cancer chemotherapy? A. Decreased quality of life B. Increased risk of infection C. Improved disease prognosis D. Increased pain

A. Decreased quality of life; Negative outcomes due to fatigue may include diminished quality of life, loss of self esteem, depression, caregiver strain and fatigue, social isolation, decreased functional status and poor disease prognosis. Increased risk of infection is not related to fatigue but is related to immunosuppression secondary to chemotherapy. Fatigue does not indicate an improved prognosis. It does not cause increased pain. Cancer pain is caused by many factors, including bone metastasis, nerve compression, infiltration of the tumor into normal structures, and ischemia.

When the nurse is teaching the client and family how to manage possible nausea and vomiting at home , which of the following should be discussed? A. Eating frequent, small meals throughout the day B. Eating three normal meals a day C. Eating only cold foods with no odor D. Limiting the amount of fluid intake

A. Eating frequent, small meals throughout the day; Dietary suggestions to reduce adverse effects of cancer and cancer therapies include a soft bland diet low in fat and sugar . Frequent small meals are usually better tolerated. It is not necessary to restrict the diet to cold foods. Fluid intake should be encouraged to avoid dehydration

The nurse is teaching a 17 year old client and the clients family about what to expect with high dose chemotherapy and the effects of neutropenia. What should the nurse teach as the most reliable early indicator of infection in a neutropenic client? A. Fever B. Chills C. Tachycardia D. Dyspnea

A. Fever; Fever is an early sign requiring clinical intervention to identify potential causes. Chills and dyspnea may or may not be observed. Tachycardia can be an indicator in a variety of clinical situations when associated with infection. It usually occurs in response to an elevated temperature or change in cardiac function.

A client is undergoing a left modified radical mastectomy for breast cancer. Postoperatively, blood pressure should be obtained from the right arm, and the client's left arm and hand should be elevated as much as possible to prevent which condition? A. Lymphedema B. Trousseau's sign C. IV infusion infiltration D. Muscle atrophy

A. Lymphedema; Lymphedema is a common postoperative effect of modified radical mastectomy and lymph node dissection. Elevation of the left arm and hand will allow gravity to assist lymph drainage. Other preventive measures include exercises in which the arms are elevated. Although muscle atrophy is a potential adverse effect if the client doesn't exercise her left arm, it wouldn't be prevented by elevation.

If tumor shrinks the stage does what: Some cancers use a different staging system.

Always referred to as the original stage.

Many of the s/s of leukemia are related to: • ______ • Low platelets • Low WBC's. • infections

Anemia

A 40 year old female is losing most of her hair as a result of chemotherapy. Which of the following statements best explains chemotherapy induced alopecia? A. "The new growth of hair will be gray" B. "The hair loss is temporary" C. "New hair growth will always be the same texture and color as it was before chemotherapy"? D. "The client should avoid use of wigs when possible"

B. "The hair loss is temporary"; Alopecia from chemotherapy is temporary. The new hair will not be necessarily gray, but the texture and color of new hair growth may be different. Clients who will be receiving chemotherapy should be encouraged to purchase a wig while they still have hair so that they can match the color and texture of their hair. Loss of hair, or alopecia, is a serous threat to self-esteem and should be addressed quickly before treatment.

Laboratory findings indicate a child with leukemia is also anemic. The nurse interprets this finding most likely results from which of the following? A. Inadequate dietary folic acid intake B. Decreased red blood cell production C. Increased destruction of red blood cells by lymphocytes D. Progressive replacement of bone marrow with scar tissue

B. Decreased red blood cell production; The anemia seen in children with leukemia is caused by the bone marrow's overproduction of immature white blood cells at the expense of producing red blood cells and platelets. Treatment for the anemia may include Erythropoietin (also known as EPO): a growth factor that stimulates the production of red blood cells.

A 10 year old with leukemia is taking immunosuppressive drugs. The child should: A. Continue with her immunizations. B. Not receive any live attenuated vaccines. C. Receive vitamin and mineral supplements. D. Stay away from her peers.

B. Not receive any live attenuated vaccines; If immunosuppressed, patient can develop severe forms of the disease (measles, mumps rubella, oral polio vaccine if given the live vaccine). Inactivated vaccines may be given if necessary, but the client is not able to adequately produce needed antibodies and it is recommended that immunizations be delayed for 3 months after the immunosuppressive drugs have been discontinued.

After doing well for a period of time, a child with leukemia develops an overwhelming infection The child's death is imminent. Which of the following statements offers the nurse the best guide in making plans to assist the parents in dealing with their child's imminent death? A. Knowing that the prognosis is poor helps prepare relatives for the death of children B. Relatives are especially grieved when a child does well at first but then declines rapidly C. Trust in health care personnel is most often destroyed by a death that is considered untimely D. It is more difficult for relatives to accept the death of an older child than that of a toddler

B. Relatives are especially grieved when a child does well at first but then declines rapidly; It has been found that parents are more grieved when optimism is followed by defeat. The nurse should recognize this when planning various ways to help the parents of a dying child. It is not necessarily true that knowing about a poor prognosis for years helps prepare parents for a child's death. Death is still a shock when it occurs.

Cancer prevalence is defined as: A. The likelihood cancer will occur in a lifetime B. The number of persons with cancer at a given point in time C. The number of new cancers in a year D. All cancer cases more than 5 years old

B. The number of persons with cancer at a given point in time; The word prevalence in a statistical setting is defined as the number of cases of a disease present in specified population at a given time

_____ tumors: local cohesive Well-defined borders Pushes other tissues out of the way Slow growth Encapsulated Easily removed Does not recur

Benign

A client with a family history of cancer asks the nurse what the single most important risk factor is for cancer. Which of the following risk factors would the nurse discuss? A. Family history B. Lifestyle choices C. Age D. Menopause or hormonal events

C. Age; More than 50% of the cancers occur in people who are older than age 65; single most important factor in determining risk would be age.

Which of the following medication orders to help relieve discomfort in a child with leukemia should the nurse question? A. Acetaminophen (Tylenol) B. Acetaminophen with codeine ( Tylenol with codeine) C. Ibuprofen (Motrin) D. Propoxyphene hydrochloride (Darvon)

C. Ibuprofen (Motrin); Ibuprofen prolongs bleeding time and is contraindicated in client with leukemia. Non- narcotic drugs other than ibuprofen or aspirin, such as acetaminophen (Tylenol), may be prescribed to control pain; if severe: maybe narcotics.

Which of the following statements would the nurse use to describe to the parents why their child with leukemia is at risk for infections? A. "Play activities are too strenuous." B. "Vitamin C intake is reduced over a period for time." C. "The number of red blood cells in inadequate for carrying oxygen." D. "Immature white blood cells are incapable of handling an infectious process."

D. "Immature white blood cells are incapable of handling an infectious process." The normal amount of WBC are capable of fighting an infection is decreased. Although there is an increased number of immature white blood cells, they are unable to combat infection. Therefore, a child with leukemia is subject to infection. The major morbidity and mortality factor associated with leukemia is infection resulting from the presence of granulocytopenia (decreased granulocytes/ type of WBC's).

Which of the following nursing diagnoses should the nurse identify as the priority when dealing with a child newly diagnosed with leukemia and the child's family? A. Risk for injury related to malignant process B. Pain related to treatment modalities C. Imbalanced nutrition: less than body requirements related to loss of appetite D. Anticipatory grieving related to diagnosis and potential loss of child

D. Anticipatory grieving related to diagnosis and potential loss of child; Most commonly the newly diagnosed child and parents are overwhelmed when first informed of the diagnosis. The family and child go through the beginning stages of grieving in anticipation of what may occur. The priority would be anticipatory grieving. While the child may be at risk for injury or have a loss of appetite, the priority nursing diagnosis and care centers around the diagnosis of leukemia. Provide EMOTIONAL support in coping with the diagnosis.

A 32 year old female meets with the nurse on her first office visit since undergoing a left mastectomy. When asked how she is doing , the woman says her appetite is still not good but no weight loss, she is not getting much sleep because she doesn't go to bed until her husband is asleep due to fear of intimacy , and she is really anxious to get back to work. Which of the following nursing interventions should the nurse explore to support the clients current needs

D. Ask open-ended questions about sexuality issues related to her mastectomy; The content of the client comments suggests that she is avoiding intimacy with her husband by waiting until he is asleep before going to bed. Addressing sexuality issues is appropriate for a client who has undergone a mastectomy.

After teaching a child with leukemia scheduled for a bone marrow aspiration about the procedure, the nurse determines that the teaching has been successful when the child identifies which of the following as the puncture site? A. Right lateral side of the right wrist. B. Middle of the chest C. Distal end of the thigh D. Back of the hip bone

D. Back of the hip bone; Although bone marrow specimens may be obtained from various sites, the most commonly used site in children is the posterior iliac crest (back of the hip bone). This area is close to the body's surface but removed from vital organs. The area is large so specimens can easily be obtained. For infants, the proximal tibia and the posterior iliac crest are used. The middle of the chest of sternum is the usual site for bone marrow aspiration in an adult.

A nurse is teaching the family of an 8 year old boy with acute lymphocytic leukemia about appropriate activities. Which of the following activities should the nurse recommend? A. Home schooling B. Restriction from participating in athletic activities C. Avoiding trips to the shopping mall D. Being treated as "normal" as much as possible

D. Being treated as "normal" as much as possible; Any child with a chronic illness should be treated as normally as possible. Unless the child has severe bone marrow depression, he should be allowed to go to school with others and go to the mall. If the child is in remission, athletic activities are allowed.

A nurse is assessing a 42 year old client who has been receiving chemotherapy. The client has a platelet count of 22,000 cell/mm3 and has petechiae on the lower extremities. The nurse should advise the client to: A. Increase the amount of iron in the clients diet B. Apply lotion to the lower extremities C. Elevate the legs D. Consult the oncologist

D. Consult the oncologist; Petechiae are tiny purplish, hemorrhagic spots visible under the skin; usually appear when platelets are depleted. Bleeding gums or oozing of blood may accompany the petechiae and the client should seek medical assistance immediately .

While being educated by the nurse about breast self-examination, a client asks what the rationale is for moving her arms in different positions while standing in front of a mirror. The nurse explains that these positions are use to.

Emphasize any change in shape or contour of the breast; All arm positions, except when the arms are relaxed by the sides, will accentuate skin changes. When the arms are raised over the head, visualization of the underside of the breasts is easier. When the hands are placed on the hips and arms are pressed forward, the breast tissue is pushed outward, which accentuates dimpling and puckering. Breast self examination is not an uncomfortable procedure. Although masses may be seen on inspection, palpation is a more important maneuver for detecting masses. Nipple discharge is assessed by gently squeezing the nipples.

A 15 year old has been admitted to the hospital with the diagnosis of acute lymphocytic leukemia. Which of the following signs and symptoms require the most immediate nursing intervention? A. Fatigue and anorexia B. Fever and petechiae C. Swollen neck lymph glands and lethargy D. Enlarged liver and spleen

Fever and petechiae; Fever and petechiae associated with acute lymphocytic leukemia indicate a suppression of normal white blood cells and thrombocytes by the bone marrow and put the client at risk for other infections and bleeding. The nurse should initiate infection control and safety precautions to reduce these risks. Fever may be the only sign of infection and may be low grade. Other signs/ symptoms may be absent due to neutropenia. Immediate action is needed when a fever is present; antibiotics are recommended within 60 min of fever!

What is the single most important nursing intervention for a patient with AGC/ANC below 500/cmm?

Handwashing

When a person has leukemia, we must be protective: Number one protective measure is: ___________ -No sick people visiting etc. -Especially as neutrophil counts fall

Handwashing

Treatments for Cancer: _____ May lessen the chance the cancer will return; stop or slow growth. Make a tumor smaller before surgery or radiation therapy/ called neo-adjuvant therapy. Ease cancer symptoms: i.e. prevent symptoms in men with prostate cancer who are not able to have surgery or radiation therapy.

Hormone Therapy

Types of Immunotherapy for cancer: _______ drugs that block immune checkpoints. These checkpoints are a normal part of the immune system and keep immune responses from being too strong. By blocking them, these drugs allow immune cells to respond more strongly to cancer.

Immune checkpoint inhibitors:

Types of Immunotherapy for cancer: _______ Enhance the body's immune response against cancer. Some of these agents affect specific parts of the immune system, whereas others affect the immune system in a more general way.

Immune system modulators:

Treatments for Cancer: _____ Help own body fight disease; cancer cells can thrive because they are able to hide from the immune system •Some: Mark cancer cells: easier for the immune system to find and destroy them. • Boosts immune system to work better against cancer. • Cancer immunizations; personalized vaccines • Other

Immunotherapy

__________: a disorder of the blood forming tissue; proliferation of immature WBCs.

Leukemia

What should you monitor for in radiation/brachytherapy?

Maintaining skin integrity is a priority with radiation therapy.

_____ tumors: Invasive noncohesive Does not stop at tissue border Invades and destroys surrounding tissue Rapid growth Metastasizes at distant sites Not always easy to remove Can recur

Malignant

Types of Immunotherapy for cancer: _______ Immune system proteins created in the lab that are designed to bind to specific targets on cancer cells. Some monoclonal antibodies mark cancer cells so they will be better seen and destroyed by the immune system. Monoclonal antibodies may also be called therapeutic antibodies.

Monoclonal antibodies

Treatments for Cancer: _____ (bone marrow; bloodstream; umbilical cord)• Restore blood-forming stem cells (travel to the bone marrow) after very high doses of chemotherapy or radiation therapy.

Stem Cell transplant

Types of Immunotherapy for cancer: _______ __________: work against cancer by boosting the immune system's response to cancer cells. Treatment vaccines are different from the ones that help prevent disease.

Treatment vaccines