Cellular Regulation Part 1: Cancer Q's 14-21

Chemotherapy Side effects

-Access issues (device infection, extravasation or vesicants) -Myelosuppression (infection, bleeding, anemia) -Leukopenia, infection -Anorexia, mucositis, N/V, diarrhea -Alopecia -"Chemo brain" -Reproductive dysfunction

Secondary Prevention (screening)

-Before symptoms develop -Goal: early detection for treatment at an early stage -Who needs further testing? -Recommendations change with latest scientific evidence

Radiation Side effects

-Myelosuppression & N/V less common (infection, bleeding, anemia) -Skin changes: Erythema-> dry desquamation -> wet desquamation -Pulmonary tissue damage -Damage to pericardium (pericarditis) -Reproductive dysfunction

Assessment: assess for neoplastic growth

-Visible lesions -asymmetry -palpable masses -abnormal sounds -presence of blood

Oncologic Emergency: Metabolic: SIADH

-associated with lung and brain cancers -retention of H2O --> decrease Na+ CM: -n/v (early signs) -lethargy -hostility -seizures -coma -hyponatremia Management: -N.S. IV -Furosemide -Phosphates

Osteosarcoma

-rare -bone cancer: long bones i.e. femur Risk factors: teenagers/young adults, previous radiation, genetics CM: -swelling near bone -bone/joint pain -bone injury w/o cause Primary Prevention: decrease exposure to radiation Secondary: can be missed b/c of sports DX: biopsy: incisional, percutaneous, fine needle, scans Interventions: chemo, sx Management: manage bone pain, pain while resting increased, fervent fractures, amputation/incision care, rehab, psychosocial Complications: hypercalcemia, anemia

Wilms' Tumor (nephroblastoma)

-rare -kidney cancer -3-4 y.o. -not deadly Risk factors: -family hx/genetics -A.A. and asians have lower risk CM: -Abnormal mass -Abdominal swelling -Abdominal pain -Fever -Blood in urine -N/V -Loss of appetite -SOB -HTN Primary prevention: none secondary prevention: u/s Interventions: chemo, nephrectomy, radiation Management: tx complication --> other cancers, manage fatigue and weakness, nutrition --> slowed growth and development, genetic testing, monitor kidneys, psychosocial support --> changes in sexual deelopment

Common complications

1. Pancytopenia: decrease in WBC, RBC, platelets (neutropenia) 2. Thrombocytopenia secondary to disease or tx 3. Hypoxemia due to anemia 4. Bone Marrow Transplant Complications: -Failure of stem cells to engraft -Graft-versus-host disease -Phlebitis (veins in the liver up to one-month post)

List 7 ways that surgery can be utilized in clients with cancer.

1. Prevention- removal of non-vital organs to prevent cancer 2. Diagnosis- biopsies 3. Palliative- tumor debulking for relief of pain, obstruction, hemorrhage 4. Supportive- insertion of G tube, suprapubic catheter, etc 5. Rehabilitative- reconstructive surgery 6. Curative/control- excise tumors 7. Staging for treatment

Primary Prevention (health promotion)

1.Eliminate smoking/ limit alcohol use 2.Physical activity 3.Eat a balanced diet/ maintain a healthy weight 4.Use sunscreen with a factor of 15 SPF or higher 5. Prophylactic sx (i.e. BRCA1 gene)

Normal Platelets Range

150-400

The nurse is teaching a nursing student how to care for a client with acute lymphocytic leukemia (ALL) on neutropenic precautions. Which of the following actions would require follow up with the student? a. The student encourages the client to eat more fresh fruits and vegetables b. The student requires all visitors to wear a mask c. The student is diligent in handwashing prior to procedures d. The student ensures that the client bathes each day

a. The student encourages the client to eat more fresh fruits and vegetables

The nurse understands that to limit radiation exposure, the following must be considered a. Waves, placement, personnel b. Time, distance, shielding c.Medication and biologic response d. Contamination, hazards, PPE

b. Time, distance, shielding Rationale: Patients with radiation precautions should be placed in private rooms, 6 feet away from the source of radiation, no more than 30 minutes a day (cumulative), and no visitors who are pregnant or children

A nurse is caring for a client with suspected Non-Hodgkin's lymphoma. Which of the following would the nurse anticipate taking place *first*? A.Palpation of the liver and spleen B.Percussion of upper abdominal quadrants for tympany C.Endoscopy D.Needle biopsy

A.Palpation of the liver and spleen

7 Warning Signs of Cancer: CAUTION

C-changes in bowel and bladder A-a sore that doesn't heal U-unusual bleeding or discharge T-thickening or lump I-indigestion or difficulty swallowing O-obvious change in wart or mole N-nagging cough or hoarseness

Oncologic Emergency: Metabolic: Hypercalcemia

Ca2+ >11 mg/dL -Most common emergency -Most common cause: Bone with metastasis release more ca2+ into the ECF than can be filtered by the kidneys and excreted in the urine *CM*: -Nausea -Constipation -Polyuria -Mental status changes: -Somnolence -Combativeness -Confusion Management: -Watch for constipation -Careful I&O with increased fluids -K+ supplementation -Increase oral fluids -Eat salty foods -Remain physically active -Limit dairy and Vit D foods

Assessment: Hx

Early --> asymptomatic Complains of: -Bleeding -Pain -Cough -Fatigue -Anorexia/weight loss -Fever/infections

Oncologic Emergencies: Hematologic

Examples: -anemia, thrombocytopenia, neutropenia, DIC Management: -Observe for bleeding, apply pressure as needed -Transfusions, clotting factors (plasma) -Heparin

Oncologic Emergency: Obstructive: Superior Vena Cava Syndrome

What it is: SVC collects blood that drains from the head and neck and upper thoracic cavity Issue: Blockage-> pleural effusion-> facial, chest, arm, and neck edema-> impaired cardiac filling *CM*: -Periorbital and conjunctival edema -Facial swelling -Stoke's sign -Visual disturbances, headaches, Altered LOC -Distention of veins in the thorax (late) -Dysphagia, dyspnea, cough, hoarseness -Tachypnea -Pleural effusion -More prominent in AM due to lying down for longer Management: AVOID: -chest and neck catheter placement -lying flat -valsalva DO: -short term intubation -O2 therapy -Medications -Elevation of arms -Assess for complications

The nurse is caring for a client with a diagnosis of lung cancer and a history of thoracic radiation. The client is experiencing cough, fever, and night sweats. The nurse suspects a.Pneumonitis b. Pulmonary fibrosis c.Tuberculosis d. Empyema

a. Pneumonitis Pneumonitis is a risk of thoracic radiation, exhibits those symptoms. Pulmonary fibrosis may happen, but late stage. TB and Empyema are not risks of radiation

The nurse is caring for a client that received chemotherapy 36 hours ago. The client complains of weakness, muscle cramps, diarrhea, and has an elevated potassium level. The nurse also anticipates finding a.Hyperuricemia b. Hypercalcemia c.Hypophosphatemia d. Thrombocytopenia

a.Hyperuricemia Rationale: The client is experiencing tumor lysis syndrome, which manifests 24-28 hours after chemo. Cell destruction leads to increased levels of K+ and uremic acid. You would expect calcium to be low, phosphate to be high. Platelets are not typically affected.

You are assessing a patient who has received chemotherapy. Which of the following would be of the most concern and require further evaluation? a.Dry mucous membranes and reports of thirst b. Areas of ecchymosis on various sites of the body c.Reports of intense fatigue and feelings of exhaustion d. Hair loss on scalp and dryness of the skin

b. Areas of ecchymosis on various sites of the body Rationale: A, B, and D are expected complications and require treatment, but are not a priority. B indicates a risk for bleeding.

Shortness of breath, facial edema, trunk and upper extremity edema, neck and chest vein distention, cough, hoarseness, and stridor are the major clinical signs indicative of which oncologic emergency? a.Cardiac tamponade b. Superior vena cava syndrome c.Disseminated intravascular coagulation (DIC) d. All of the above

b. Superior vena cava syndrome

A nurse is caring for a malnourished, nauseated client with osteosarcoma undergoing chemotherapy. Which of the following interventions is the best option to include in the plan of care? a.Increase the client's red meat consumption b. Serve meals as warm and odorous as possible c.Administer ondansetron 30 minutes prior to meals d. Encourage the client to drink large volumes of oral fluids during a meal

c. Administer ondansetron 30 minutes prior to meals Rationale: Red meat can increase nausea, as can warm meals that produce an odor. Large volumes of fluids can fill the client up so that they eat less. Ondansetron (Zofran) will help alleviate nausea.

Which of the following needs to be reported immediately to a health care provider? a. White vaginal discharge 2 weeks after internal radiation for cancer of the cervix b. Mild diarrhea after 3 weeks of external radiation for cancer of the cervix c.A fever of 100.8 after the third week of chemotherapy d. No bowel movement for 2 days after colonoscopy

c.A fever of 100.8 after the third week of chemotherapy Rationale: C is the most priority. Any fever in patients receiving chemo can indicate a serious infection due to neutropenia. It is often low grade in these clients because their immune response is so suppressed, so any fever, can indicate a serious complication.

The nurse is caring for a client receiving chemotherapy through their Groshong port when they start to complain of pain at the insertion site. Which of the following nursing interventions would be priority? a.Ask the client to rate their pain on a scale of 0-10 b. Flush the site with 20 mL of Normal Saline c.Aspirate and remaining fluid from the lined. d. Apply heat to the site of extravasation

c.Aspirate and remaining fluid from the line Rationale: Immediately stop the medication and remove any excess from the line/skin. Assessment of pain follows this action when using vesicants. Heat may encourage absorption of the medication

The nurse is administering cortisone to a client with cancer to depress the immune system. This treatment would be an example of a.Biologic therapy b. Targeted therapy c.Hormonal therapy d. Gene therapy

c.Hormonal therapy Rationale: Biologic or immunotherapy creates an environment that is inhospitable to cancer cells or attacks the cells directly by use of cytokines, vaccines, antibodies etc. Targeted therapy targets specific receptors that are important for cell growth (ie kinase inhibitors). Gene therapy introduces new genetic material, and is being researched.

The nurse is caring for a client with a positive finding of basal cell carcinoma following a shave biopsy of a skin lesion. The client asks, "Does this mean that I have cancer?" The best response by the nurse is a."Don't worry, basal cell carcinomas are highly treatable." b. "Let's wait and see what you doctor has to say about this." c."We will need to excise the lesion to obtain clear margins." d. "The test confirmed the presence of cancerous cells."

d. "The test confirmed the presence of cancerous cells." Rationale: The nurse should only address the information that is for sure, not make assumptions on treatment.

The nurse is caring for a client diagnosed with colon cancer who is experiencing anorexia. The most appropriate nursing action would be to a.Serve food in isolation to encourage focus b. Select moist, bland foods c. Use diversional activities as appropriated. d. Recommend a food diary to track calories and fluids

d. Recommend a food diary to track calories and fluids Rationale: food should be served in a pleasant environment, with gentle encouraging. Moist bland foods are best for mucositis, esophagitis, etc. Diversional activities are for N/V.

a nurse is caring for a client schedule to receive external radiation to the neck for cancer of the larynx. during the pre-tx exam, the nurse explains to the client that the most likely side effect would be

dysphagia also: hoarseness, dry mouth, loss of taste, skin redness Rationale: only the area of tx is affected by radiation

Radiation and Chemo both put patients at risk for ______________ _______________

secondary malignancies

Side effects of Cancer tx

•Stomatitis, mucositis, esophagitis •Nausea and vomiting •Anorexia •Diarrhea & constipation •Hepatoxicity •Anemia •Leukopenia •Thrombocytopenia •Alopecia •Pericarditis/myocarditis •Cardiotoxicity •Chemo skin changes (photosensitivity, hyperpigmentation) •Hemorrhagic cystitis •Reproductive dysfunction •Nephrotoxicity •Intercranial pressure •Peripheral neuropathy •Cognitive changes •Pneumonitis •Hyperuricemia •Fatigue