evolve q's - ch 15 cancer

Pt is fatigued post chemo or radiation- what do you recommend?

15-30 min walk daily to help improve prognosis - "pace activity"

Previous administrations of chemotherapy agents to a cancer patient have resulted in diarrhea. Which dietary modification should the nurse recommend? A) A bland, low-fiber diet B) A high-protein, high-calorie diet C) A diet high in fresh fruits and vegetables D) A diet emphasizing whole and organic foods

A) A bland, low-fiber diet Patients experiencing diarrhea secondary to chemotherapy or radiation therapy often benefit from a diet low in seasonings and roughage before the treatment. Foods should be easy to digest and low in fat. Fresh fruits and vegetables are high in fiber and should be minimized during treatment. Whole and organic foods do not prevent diarrhea.

The laboratory reports that the cells from the patient's tumor biopsy are grade II. What should the nurse know about this histologic grading? A) Cells are abnormal and moderately differentiated. B) Cells are very abnormal and poorly differentiated. C) Cells are immature, primitive, and undifferentiated. D) Cells differ slightly from normal cells and are well-differentiated.

A) Cells are abnormal and moderately differentiated. Grade II cells are more abnormal than grade I and moderately differentiated. Grade I cells differ slightly from normal cells and are well-differentiated. Grade III cells are very abnormal and poorly differentiated. Grade IV cells are immature, primitive, and undifferentiated; the cell origin is difficult to determine

What do you do when someone has tumor lysis syndrome? TLS

Allupurinol - Hydrate them and give bicarbonate to help protect the kidneys Good thing that ends bad- tenor dies too quickly but potassium will go up in the blood stream

How do you treat neutropenia?

Anticipate an order for 2 sets of blood cultures and start IV ATB within 1 hr.

Common vascular side effects with angiogenesis inhibitors used with immunotherapy & targeted therapy

Arterial thrombi Hemorrhage HTN impaired wound healing Proteinuria

The nurse is caring for a patient receiving an initial dose of chemotherapy to treat a rapidly growing metastatic colon cancer. The nurse is aware that the patient is at risk for tumor lysis syndrome (TLS) and will monitor for which abnormality associated with this oncologic emergency? A) Hypokalemia B)Hypocalcemia C) Hypouricemia D) Hypophosphatemia

B)Hypocalcemia TLS is a metabolic complication characterized by rapid release of intracellular components in response to chemotherapy. This can rapidly lead to acute renal injury. The hallmark signs of TLS are hyperuricemia, hyperphosphatemia, hyperkalemia, and hypocalcemia.

The patient was told that he would have intraperitoneal chemotherapy. He asks the nurse when the IV will be started for the chemotherapy. What should the nurse teach the patient about this type of chemotherapy delivery? A) It is delivered via an Ommaya reservoir and extension catheter. B) It is instilled in the bladder via a urinary catheter and retained for 1 to 3 hours. C) A Silastic catheter will be percutaneously placed in the abdomen for chemotherapy administration. D) The arteries supplying the tumor are accessed with surgical placement of a catheter connected to an infusion pump.

C) A Silastic catheter will be percutaneously placed in the abdomen for chemotherapy administration. Intraperitoneal chemotherapy is delivered to the peritoneal cavity via a temporary percutaneously inserted Silastic catheter and drained from this catheter after the dwell time in the peritoneum. The Ommaya reservoir is used for intraventricular chemotherapy. Intravesical bladder chemotherapy is delivered via a urinary catheter. Intraarterial chemotherapy is delivered via a surgically placed catheter that delivers chemotherapy via an external or internal infusion pump

naseau and vomiting is most common after what type of treatment?

Chemotherapy

The patient is receiving immunotherapy and targeted therapy for ovarian cancer. What medication should the nurse expect to administer before therapy to combat the most common side effects of these medications? A) Morphine sulfate B) Ibuprofen (Advil) C) Ondansetron (Zofran) D) Acetaminophen (Tylenol)

D) Acetaminophen (Tylenol) Acetaminophen is administered before therapy and every 4 hours to prevent or decrease the intensity of the severe flu-like symptoms, especially with interferon which is frequently used for ovarian cancer. Morphine sulfate and ibuprofen will not decrease flu-like symptoms. Ondansetron is an antiemetic but is not used first to combat flu-like symptoms of headache, fever, chills, myalgias, and so on.

The nurse is caring for a patient suffering from anorexia secondary to chemotherapy. Which strategy would be most appropriate to increase the patient's nutritional intake? A) Increase intake of liquids at mealtime to stimulate the appetite. B) Serve three large meals per day plus snacks between each meal. C) Avoid the use of liquid protein supplements to encourage eating at mealtimes. D) Add items such as skim milk powder, cheese, honey, or peanut butter to selected foods.

D) Add items such as skim milk powder, cheese, honey, or peanut butter to selected foods. The nurse can increase the nutritional density of foods by adding items high in protein and/or calories (e.g., peanut butter, skim milk powder, cheese, honey, brown sugar) to foods the patient will eat. Increasing fluid intake at mealtime fills the stomach with fluid and decreases the desire to eat. Small frequent meals are best tolerated. Supplements can be helpful.

When caring for the patient with cancer, what does the nurse understand as the response of the immune system to antigens of the malignant cells? A) Metastasis B)Tumor angiogenesis C) Immunologic escape D) Immunologic surveillance

D) Immunologic surveillance Immunologic surveillance is the process in which lymphocytes check cell surface antigens and detect and destroy cells with abnormal or altered antigenic determinants to prevent these cells from developing into clinically detectable tumors. Metastasis is increased growth rate of the tumor, increased invasiveness, and spread of the cancer to a distant site in the progression stage of cancer development. Tumor angiogenesis is the process of blood vessels forming within the tumor itself. Immunologic escape is the cancer cells' evasion of immunologic surveillance that allows the cancer cells to reproduce.

A 64-yr-old male patient who is receiving radiation to the head and neck as treatment for an invasive malignant tumor complains of mouth sores and pain. Which intervention should the nurse add to the plan of care? A) Provide ice chips to soothe the irritation. B) Weigh the patient every month to monitor for weight loss. C) Cleanse the mouth every 2 to 4 hours with hydrogen peroxide. D) Provide high-protein and high-calorie, soft foods every 2 hours.

D) Provide high-protein and high-calorie, soft foods every 2 hours. A patient with stomatitis should have soft, nonirritating foods offered frequently. The diet should be high in protein and high in calories to aid healing. Extremes of temperature are to be avoided. Saline or water should be used to cleanse the mouth (not hydrogen peroxide). Patients should be weighed at least twice each week to monitor for weight loss.

A 70-yr-old man who has end-stage lung cancer is admitted to the hospital with confusion and oliguria for 2 days. Which finding would the nurse report immediately to the health care provider? A) Weight gain of 6 lb B) Nausea and vomiting C) Urine specific gravity of 1.004 D) Serum sodium level of 118 mEq/L

D) Serum sodium level of 118 mEq/L Lung cancer cells are able to manufacture and release antidiuretic hormone (ADH) with resultant water retention and hyponatremia. Hyponatremia (serum sodium levels less than 135 mEq/L) may lead to central nervous system symptoms such as confusion, seizures, coma, and death. The other options listed are also symptoms of hyponatremia but are not as critical to report to the health care provider.

A 33-yr-old patient has recently been diagnosed with stage II cervical cancer. Which statement by the nurse best explains the diagnosis? A. "The cancer is found at the point of origin only." B. "Tumor cells have been identified in the cervical region." C. "The cancer has been identified in the cervix and the liver." D. "Your cancer was identified in the cervix and has limited local spread."

D. "Your cancer was identified in the cervix and has limited local spread." Stage II cancer is associated with limited local spread. Stage 0 denotes cancer in situ or at the point of origin only; stage I denotes tumor limited to the tissue of origin with localized tumor growth. Stage III denotes extensive local and regional spread. Stage IV denotes metastasis such as to the liver.

If you see chills, fever or myalgia with immunotherapy what do you do?

Don't stop! Increase fluids and give acetaminophen before and PRN Q4 hrs after

What will you have when you have inadequate portion in blood?

Expect to see anasarca - total body edema

What are the side effects of immunotherapy?

Fever, chills, myalgia

oncogenic viruses

HPV cervical cancer and head and neck - increases mucous membrane secretions

Don't give packed RBCs unless?

Hemoglobin is less than 8 Normal: 12-16

Standard tx for hypercalcemia?

Hydration, diphosphate, loop diuretics

nausea and vomiting is not common in which types of therapies?

Immunotherapy, targeted and hormonal

Progression phase of cancer

Invasive - CREATES ITS OWN BLOOD SUPPLY

Initiation

Irreversible

What hormone is used as an appetite stimulant for cachexia? (Malnutrition that leads to muscle wasting)

Magestrol

How to look at cancer tissue under microscope?

PET scan is +, get cells from tissue with a biopsy and then diagnose

Angiogenesis

Process of defective cells being so high it creates its own blood supply

Promoting factors of cancer

This one is reversable dietary fat, obesity, cigarette smoking, alcohol

Don't give platelets unless?

Until level is below 20,000 Norm is 150,000-400,000