Chapter 5 Cancer Care
The clinic nurse is caring for a client who has just been diagnosed with a tumor. The client says to the nurse "The doctor says my tumor is benign. What does that mean?" What is the nurse's best response?
"Benign tumors don't usually cause death." Benign tumors remain at their site of development. They may grow large, but their growth rate is slower than that of malignant tumors. They usually do not cause death unless their location impairs the function of a vital organ, such as the brain.
An oncology clinic nurse is reinforcing prevention measures for oropharyngeal infections to a client receiving chemotherapy. Which statement by the client indicates that teaching was successful? "I use an alcohol-based mouthwash every morning." "I lubricate my lips with petroleum jelly." "I clean my teeth gently several times per day." "I replace my toothbrush every month."
"I clean my teeth gently several times per day." The client demonstrates understanding when he states that he'll clean his teeth gently several times per day. Frequent gentle cleaning of the mouth or rinsing reduces bacteria build-up in the oral cavity, thus reducing the risk for oropharyngeal infection. Changing the toothbrush each month reduces the bacteria in the mouth for the first few uses only. Petroleum jelly moistens the lips, but doesn't prevent breakdown of the mucous membranes or reduce the risk for oropharyngeal infection. Alcohol-based products cause drying of the mucous membrane, increasing the likelihood of oropharyngeal infection.
The nurse is caring for a client is scheduled for chemotherapy followed by autologous stem cell transplant. Which of the following statements by the client indicates a need for further teaching? "The doctor will remove cells from my bone marrow before beginning chemotherapy." "I hope they find a bone marrow donor who matches." "I will need to attend follow-up visits for up to 3 months after treatment." "I will receive chemotherapy until most of the cancer is gone, and then I will get my own stem cells back."
"I hope they find a bone marrow donor who matches." An autologous stem cell transplant comes from the client not from a donor. The doctor will remove the stem cells from the bone marrow before beginning chemotherapy and treat the client until most if not all the cancer is eliminated before reinfusing the stem cells. Clients are at risk for infection and will be closely monitored for at least 3 months, but not in protective isolation.
The nurse instructs a client receiving chemotherapy on actions to prevent the development of stomatitis. Which client statement indicates to the nurse that teaching has been effective?
"I will brush my teeth after every meal." Stomatitis is an inflammatory process of the mouth, including the mucosa and tissues surrounding the teeth. Manifestations of stomatitis include changes in sensation, erythema, and edema, or if severe, painful ulcerations, bleeding, and infection. It commonly develops within 3 to 14 days after receiving certain chemotherapeutic agents. Actions to prevent the development of stomatitis include brushing the teeth with a soft toothbrush for 90 seconds after every meal.
A client receiving chemotherapy has a nursing diagnosis of Deficient diversional activity related to decreased energy. Which client statement indicates an accurate understanding of appropriate ways to deal with this deficit? "I'll play card games with my friends." "I'll eat lunch in a restaurant every day." "I'll bowl with my team after discharge." "I'll take a long trip to visit my aunt."
"I'll play card games with my friends." During chemotherapy, playing cards is an appropriate diversional activity because it doesn't require a great deal of energy. To conserve energy, the client should avoid such activities as taking long trips, bowling, and eating in restaurants every day. However, the client may take occasional short trips and dine out on special occasions.
A 66-year-old man is receiving radiation therapy and chemotherapy for the treatment of small cell lung cancer. The nurse has assessed him many times since he was admitted to the hospital. This morning, he admits that his greatest challenge he is currently facing is his overwhelming fatigue. How should the nurse respond to this patient's statement? "Your fatigue is actually a sign that your body is redirecting its energies toward healing and away from more common functions like mobility." "That must be incredibly difficult for you. How would you rate your fatigue if you had to give it a number from 1 to 10?" "That's entirely normal, given what your body is going through and how much treatment you're currently getting." "I'm sure you'll agree that fatigue, even when it's severe, is much preferable to pain. It's fortunate that your pain is now well-controlled."
"That must be incredibly difficult for you. How would you rate your fatigue if you had to give it a number from 1 to 10?" An empathic response followed by further assessment best facilitates therapeutic relationships and appropriate interventions. Cancer-related fatigue is not a sign of healing, and it is inappropriate to downplay the patient's complaints.
The clinic nurse is caring for an adult oncology client who reports extreme fatigue and weakness after the first week of radiation therapy. Which response by the nurse would best reassure this client? "Try not to be concerned about these symptoms. Every client feels this way after having radiation therapy." "Even though it is uncomfortable, this is a good sign. It means that only the cancer cells are dying." "These symptoms usually result from radiation therapy; however, we will continue to monitor your laboratory studies and test results." "These symptoms are part of your disease and are an unfortunately inevitable part of living with cancer."
"These symptoms usually result from radiation therapy; however, we will continue to monitor your laboratory studies and test results." Fatigue and weakness result from radiation treatment and usually do not represent deterioration or disease progression. The symptoms associated with radiation therapy usually decrease after therapy ends. The symptoms may concern the client and should not be belittled. Radiation destroys both cancerous and normal cells.
diagnostic evaluation is guided by information obtained through a complete history and physical examination.
(1) determine the presence of a tumor and its extent, (2) identify possible spread (metastasis) of disease or invasion of other body tissues, (3) evaluate the function of involved and uninvolved body systems and organs, and (4) obtain tissue and cells for analysis to assist in the evaluation of tumor type, stage, grade, and molecular and genetic changes.
thrombocytopenia
(a decrease in platelets)
xerostomia
(dryness of the mouth)
Wide or radical excisions
(en bloc dissections) include removal of the primary tumor, lymph nodes, adjacent involved structures, and surrounding tissues that may be at high risk for tumor spread. This surgical method can result in disfigurement and altered functioning. However, wide excisions are considered if the tumor can be removed completely and the chances of cure or control are good.
stomatitis
(inflammation of the mucous membrane of the mouth),
A nurse is teaching a client with bone marrow suppression about the time frame when bone suppression will be noticeable after administration of floxuridine. What is the time frame the nurse should include with client teaching? 2 to 4 days 21 to 28 days 24 hours 7 to 14 days
7 to 14 days Bone marrow suppression becomes noticeable 7 to 14 days after floxuridine administration. Bone marrow recovery occurs in 21 to 28 days.
A client is undergoing chemotherapy treatment for prostate cancer and has lost considerable weight due to nausea and vomiting. Which nursing intervention is appropriate for the client?
Adjusting the client's meal plan before and after chemotherapy The nurse should readjust the client's meal plan before and after chemotherapy administration. The nurse should take into consideration the client's likes and dislikes and avoid foods with strong odors. The nurse should ensure adequate fluid hydration before, during, and after drug administration when the client has side effects of nausea and vomiting.
Following surgery for adenocarcinoma, the client learns the tumor stage is T3,N1,M0. What treatment mode should the nurse anticipate? Adjuvant therapy is likely. Repeat biopsy is needed before treatment begins. No further treatment is indicated. Palliative care is likely.
Adjuvant therapy is likely. T3 indicates a large tumor size, with N1 indicating regional lymph node involvement so treatment is needed. A T3 tumor must have its size reduced with adjuncts like chemotherapy and radiation. Although M0 suggest no metastasis, following with adjuvant (chemotherapy or radiation therapy) treatment is indicated to prevent the spread of cancer outside the lymph to other organs. The tumor stage IV wound be indicative of palliative care. A repeated biopsy is not needed until after treatment is completed.
A patient with a diagnosis of renal cell carcinoma is being treated with chemotherapy. During a previous round of chemotherapy, the patient's tumor responded well to treatment but the chemotherapy caused intense nausea and vomiting. How should the patient's potential nausea and vomiting be addressed during this current round of treatment? Provide the patient with antiemetics at his first complaint of nausea. Administer antiemetics if the patient vomits or believes he will soon vomit. Prioritize nonpharmacological treatments over medications. Administer antiemetics in anticipation of the patient's nausea.
Administer antiemetics in anticipation of the patient's nausea. The prevention of chemotherapy-induced nausea and vomiting is a priority. It is inappropriate to reject pharmacological treatments or to wait until the patient experiences nausea and/or vomiting before providing medication.
3 forms of metastasis
Angiogenesis, lymphatic spread, Hematogenous spread
Which class of antineoplastic agents is cell cycle-specific?
Antimetabolites (5-FU)
Which type of vaccine uses the client's own cancer cells, which are killed and prepared for injection back into the client?
Autologous Autologous vaccines are made from the client's own cancer cells, which are obtained during diagnostic biopsy or surgery. Prophylactic vaccines, such as the polio vaccine, are given to prevent people from developing a disease. Therapeutic vaccines are given to kill existing cancer cells and to provide long-lasting immunity against further cancer development. Allogeneic vaccines are made from cancer cells that are obtained from other people who have a specific type of cancer.
patient teaching for radiation
Avoid alcoholic beverages, tobacco, highly spiced foods, and commercial mouthwashes containing alcohol. Once you begin to experience pain or sensitivity in your mouth, avoid foods and drinks that are too hot or too cold. Room temperature is best. Avoid carbonated drinks such as soda or sparkling water. Avoid acidic fruits and juices like tomato, orange, lemon, grapefruit, and pineapple. Avoid rough, crunchy foods such as pretzels, nuts, and chips. Inspect your mouth daily and report any changes to your nurse or doctor. For a dry mouth, drink 8 oz of water or other noncaffeinated beverage every 2 to 3 hours. Keep a cool mist humidifier running, especially at night. Moisturize lips frequently with water-based moisturizer (e.g., lanolin type product). Discuss with your provider the risks/benefits of utilizing pain medications premeals.
Mrs. Unger is a 53-year-old woman who was diagnosed with breast cancer following a process that began with abnormal screen mammography results. Mrs. Unger, her oncologist, and surgeon have agreed on a mastectomy as treatment and have discussed the importance of rigorously assessing whether her cancer has metastasized. What action will best detect possible metastasis of Mrs. Unger's breast cancer? Careful grading of the tumor cells Serial bone marrow biopsies Gauging her response to radiation therapy Biopsy of the axillary lymph nodes
Biopsy of the axillary lymph nodes The transport of tumor cells through the lymphatic circulation is the most common mechanism of metastasis. Tumor emboli enter the lymph channels by way of the interstitial fluid, which communicates with lymphatic circulation. Breast tumors frequently metastasize in this manner through axillary, clavicular, and thoracic lymph channels.
A client undergoes a biopsy of a suspicious lesion. The biopsy report classifies the lesion according to the TNM staging system as follows: Tis, N0, M0. What does this classification mean? No evidence of primary tumor, no abnormal regional lymph nodes, and no evidence of distant metastasis Carcinoma in situ, no demonstrable metastasis of the regional lymph nodes, and ascending degrees of distant metastasis Can't assess tumor or regional lymph nodes and no evidence of metastasis Carcinoma in situ, no abnormal regional lymph nodes, and no evidence of distant metastasis
Carcinoma in situ, no abnormal regional lymph nodes, and no evidence of distant metastasis Tis, N0, M0 denotes carcinoma in situ, no abnormal regional lymph nodes, and no evidence of distant metastasis. No evidence of primary tumor, no abnormal regional lymph nodes, and no evidence of distant metastasis is classified as T0, N0, M0. If the tumor and regional lymph nodes can't be assessed and no evidence of metastasis exists, the lesion is classified as TX, NX, M0. A progressive increase in tumor size, no demonstrable metastasis of the regional lymph nodes, and ascending degrees of distant metastasis is classified as T1, T2, T3, or T4; N0; and M1, M2, or M3.
Which occurs when fluid accumulates in the pericardial space and compresses the heart? SIADH Cardiac tamponade Superior vena cava syndrome (SVCS) DIC
Cardiac tamponade Cardiac tamponade is an accumulation of fluid in the pericardial space. SVCS occurs when the superior vena cava is compressed or invaded by a tumor, lymph nodes are enlarged, intraluminal thrombosis obstructs venous circulation, or drainage occurs from the head, neck, arms, and thorax. SIADH is the continuous, uncontrolled release of ADH. DIC is a complex disorder of coagulation or fibrinolysis that results in thrombosis or bleeding.
A client diagnosed with cancer makes the following statement to the nurse: "I guess I will tell my health care provider to forego the chemotherapy. I do not want to be throwing up all the time. I would rather die." Which of the following facts supports the use of chemotherapy for this client? Most clients believe the discomfort is well worth the cure for cancer. Chemotherapy treatment can be adjusted to optimize effects while limiting adverse effects. Nausea and vomiting are only a factor for the first 24 hours after treatment. Clinical trials are opening up new cancer treatments all the time.
Chemotherapy treatment can be adjusted to optimize effects while limiting adverse effects. Chemotherapy is not one drug for all clients. The therapy can be specifically designed to optimize effects while limiting adverse effects with supplemental anti emetics to control the nausea and vomiting. It is true that nausea and vomiting are most prevalent in the first 24 hours after each chemotherapy treatment but this does not eliminate the fears expressed by this client. No one can state the worth of any treatment, and a cure is never promised. Clinical trials open up new options for treatment, but the process is lengthy and is not a certainty for a client in need of immediate treatment.
radiation side effects
Chronic anemia alopecia (hair loss), erythema, and shedding of skin stomatitis (inflammation of the mucous membrane of the mouth), xerostomia (dryness of the mouth), change and loss of taste, and decreased salivation. esophageal irritation with chest pain and dysphagia. Anorexia, nausea, vomiting, and diarrhea Xerostomia and taste changes may never return to normal. leukopenia (decreased WBCs), and thrombocytopenia (a decrease in platelets) increased risk for infection and bleeding until blood cell counts return to normal. shortness of breath, dizziness, fatigue, decreased oxygen saturation, and decreased activity tolerance. Bone marrow suppression, gonadal toxicity, skin changes, salivary changes, and GI side effects, such as nausea, may occur acutely. changes to the CNS, head and neck, lungs, heart, liver, pancreas, gastrointestinal system, gynecologic organs, urinary tract and prostate, spleen and lymph nodes, and bone and soft tissues
Which primary cancer treatment goal is prolonged survival and containment of cancer cell growth?
Control
biopsy, must be performed to obtain a tissue sample for the analysis of cells suspected to be malignant. and is an example of ------- surgery
Diagnostic surgery
A client with terminal small-cell lung cancer has been given a six-month prognosis and wants to die at home. The health care team believes the condition warrants inpatient care. The nurse might suggest which compromise? Panel the client for a personal care home. Discuss a referral for rehabilitation hospital. Discuss a referral for acute care. Discuss a referral for hospice care.
Discuss a referral for hospice care. Hospice care can be provided in several settings. Because of the high cost associated with free-standing hospices, care is often delivered by coordinating services provided by both hospitals and the community. The primary goal of hospice care is to provide support to the client and family. Clients who are referred to hospice care generally have fewer than six months to live. Each of the other listed options would be less appropriate for the client's physical and psychosocial needs.
You are a nurse working on a bone marrow transplant (BMT) unit. Your patient is scheduled to receive a bone marrow transplant. What information will you provide to the patient's visitors? Wear hospital scrubs when entering the patient's room. Do not visit if they've had a recent infection. Bring plants to improve air quality. Take the patient to the cafeteria for meals.
Do not visit if they've had a recent infection. Before engraftment, patients are at a high risk for infection, sepsis, and bleeding. Visitors should not visit if they've had a recent illness or vaccination. Plants should not be brought to the BMT patient. The patient cannot go to the cafeteria for meals. Disposable hospital gowns are worn when entering the patient's room.
What intervention should the nurse provide to reduce the incidence of renal damage when a patient is taking a chemotherapy regimen?
Encourage fluid intake to dilute the urine.
A patient will be having an endoscopic procedure with a diagnostic biopsy. What type of biopsy does the nurse explain will remove an entire piece of suspicious tissue? Incisional biopsy Needle biopsy Punch biopsy Excisional biopsy
Excisional biopsy Excisional biopsy is most frequently used for small, easily accessible tumors of the skin, breast, and upper or lower gastrointestinal and upper respiratory tracts. In many cases, the surgeon can remove the entire tumor as well as the surrounding marginal tissues. The removal of normal tissue beyond the tumor area decreases the possibility that residual microscopic malignant cells may lead to a recurrence of the tumor. Incisional biopsy is performed if the tumor mass is too large to be removed. In this case, a wedge of tissue from the tumor is removed for analysis. Needle biopsy is performed to sample suspicious masses that are easily and safely accessible, such as some masses in the breasts, thyroid, lung, liver, and kidney. A core needle biopsy uses a specially designed needle to obtain a small core of tissue that permits histologic analysis.
The client is receiving a vesicant antineoplastic for treatment of cancer. Which assessment finding would require the nurse to take immediate action? Extravasation Bone pain Stomatitis Nausea and vomiting
Extravasation The nurse needs to monitor IV administration of antineoplastics (especially vesicants) to prevent tissue necrosis to blood vessels, skin, muscles, and nerves. Stomatitis, nausea/vomiting, and bone pain can be symptoms of the disease process or treatment mode but does not require immediate action.
grading
GX Grade cannot be assessed G1 Well differentiated G2 Moderately differentiated G3 Poorly differentiated G4 Undifferentiated
oral hygiene for radiation
Gentle oral hygiene is essential to remove debris, prevent irritation, and promote healing If systemic symptoms, such as weakness and fatigue, occur, the patient may need assistance with activities of daily living and personal hygiene symptoms are a result of the treatment and do not represent deterioration or progression of the disease.
The tumor is assigned a numeric value ranging from I to IV (Box 5-2).
Grade I tumors, also known as well-differentiated tumors, closely resemble the tissue of origin in structure and function. Tumors that do not clearly resemble the tissue of origin in structure or function are described as poorly differentiated or undifferentiated and are assigned grade IV. These tumors tend to be more aggressive and less responsive to treatment than are well-differentiated tumors.
Chemotherapeutic agents have which effect associated with the renal system? Hypophosphatemia Increased uric acid excretion Hypercalcemia Hypokalemia
Increased uric acid excretion Chemotherapeutic agents can damage the kidneys because of their direct effects during excretion and the accumulation of end products after cell lysis. Urinary excretion of uric acid increases with the use of chemotherapeutic agents. Hyperkalemia, hyperphosphatemia, and hypocalcemia can occur from the use of chemotherapeutic agents.
When caring for an older client who is receiving external beam radiation, which is the key point for the nurse to incorporate into the plan of care? Inspect the skin frequently. The use of disposable utensils and wash cloths Avoid showering or washing over skin markings. Time, distance, and shielding
Inspect the skin frequently. Inspecting the skin frequently will allow early identification and intervention of skin problems associated with external radiation therapy. The external markings should not be removed, but clients may shower and lightly wash over the skin. Time, distance, and shielding are key in the management of sealed, internal radiation therapy and not external beam radiation. The use of disposable utensils and care items would be important when caring for clients following systemic, unsealed, internal radiation therapy.
A client has just been diagnosed with multiple myeloma (a cancer of the plasma cells) and will be initiating chemotherapy. The nurse at an outpatient clinic reviews the medications the client has been taking at home. The medications include pantoprazole for gastroesophageal reflux disease (GERD) and an over-the-counter calcium supplement to prevent osteoporosis. What interventions should the nurse take? Select all that apply.
Instruct the client to discontinue calcium. Ask the client about nausea and vomiting. Teach the client to report abdominal pain.
Which of the following is a characteristic of a malignant tumor? It is usually slow growing. It gains access to the blood and lymphatic channels. It demonstrates cells that are well differentiated. It grows by expansion.
It gains access to the blood and lymphatic channels. By this mechanism, the tumor metastasizes to other areas of the body. Cells of malignant tumors are undifferentiated. Malignant tumors demonstrate variable rate of growth; however, the more anaplastic the tumor, the faster its growth. A malignant tumor grows at the periphery and sends out processes that infiltrate and destroy surrounding tissues.
A nurse is teaching a client about the rationale for administering allopurinol with chemotherapy. Which example would be the best teaching by the nurse?
It lowers serum and uric acid levels. The use of allopurinol with chemotherapy is to prevent renal toxicity. Tumor lysis syndrome occurrence can be reduced with allopurinol's action of reducing the conversion of nucleic acid byproducts to uric acid, in this way preventing urate nephropathy and subsequent oliguric renal failure. Allopurinol does not stimulate the immune system, treat anemia, or prevent alopecia.
What disadvantages of chemotherapy should the patient be informed about prior to starting the regimen? It causes a systemic reaction. It functions against disseminated disease. It attacks cancer cells during their vulnerable phase. It targets normal body cells as well as cancer cells.
It targets normal body cells as well as cancer cells. Chemotherapy agents affect both normal and malignant cells; therefore, their effects are often widespread, affecting many body systems.
A client with cancer is being evaluated for possible metastasis. What is one of the most common metastasis sites for cancer cells? Reproductive tract Liver Colon White blood cells (WBCs)
Liver The liver is one of the five most common cancer metastasis sites. The others are the lymph nodes, lung, bone, and brain. The colon, reproductive tract, and WBCs are occasional metastasis sites.
The nurse working on a bone marrow unit knows that it is a priority to monitor which of the following in a client who has just undergone a stem cell transplant?
Monitor the client closely to prevent infection
A nurse is caring for a client after a bone marrow transplant. What is the nurse's priority in caring for the client? Monitor the client's toilet patterns. Monitor the client to prevent sepsis. Monitor the client's physical condition. Monitor the client's heart rate.
Monitor the client to prevent sepsis.
As a nurse who provides care for many patients with cancer, you are aware that cancer makes patients susceptible to many other health problems. Which of the following assessments addresses the leading cause of death among patients who have cancer? Arranging for serial electrocardiograms (ECGs) or cardiac telemetry whenever possible Assessing patients' lower legs for redness, swelling, or pain on dorsiflexion Auscultating patients' lungs thoroughly and monitoring oxygen saturation levels Monitoring white blood cell (WBC) counts and assessing patients' integumentary systems
Monitoring white blood cell (WBC) counts and assessing patients' integumentary systems For patients in all stages of cancer, the nurse assesses risk factors for infection and observes for clinical signs and symptoms, as infection is the leading cause of death in cancer patients. The nurse monitors laboratory studies to detect early changes in WBC counts. Common sites of infection, such as the oropharynx, skin, perianal area, urinary tract, gastrointestinal tract, and respiratory tract, are assessed frequently. Infectious processes are a more common cause of death than respiratory illnesses, cardiac disease, or deep vein thrombosis (DVT).
According to the tumor-node-metastasis (TNM) classification system, T0 means there is Distant metastasis No distant metastasis No evidence of primary tumor No regional lymph node metastasis
No evidence of primary tumor T0 means that there is no evidence of primary tumor. N0 means that there is no regional lymph node metastasis. M0 means that there is no distant metastasis. M1 means that there is distant metastasis.
Which type of surgery is used in an attempt to relieve complications of cancer? Palliative Prophylactic Reconstructive Salvage
Palliative Palliative surgery is performed to relieve complications of cancer. Prophylactic surgery involves removing nonvital tissues or organs that are likely to develop cancer. Reconstructive surgery may follow curative or radical surgery and is carried out in an attempt to improve function or to obtain a more desirable cosmetic effect. Salvage surgery is an additional treatment option that uses an extensive surgical approach to treat the local recurrence of a cancer after the use of a less extensive primary approach.
During which step of cellular carcinogenesis do cellular changes exhibit increased malignant behavior? Prolongation Progression Initiation Promotion
Progression
Which nursing action best demonstrates primary cancer prevention? Encouraging yearly Pap tests Facilitating screening mammograms Promoting and providing vaccines Teaching testicular self-examination
Promoting and providing vaccines Primary prevention is concerned with reducing the risks of cancer in healthy people through practices such as promoting vaccines that prevent cancer. Secondary prevention involves detection and screening to achieve early diagnosis, as demonstrated by Pap tests, mammograms, and testicular exams.
A patient is admitted for an excisional biopsy of a breast lesion. What intervention should the nurse provide for the care of this patient? Clarify information provided by the physician. Provide aseptic care to the incision postoperatively. Provide time for the patient to discuss her concerns. Counsel the patient about the possibility of losing her breast.
Provide time for the patient to discuss her concerns. Patients who are undergoing surgery for the diagnosis or treatment of cancer may be anxious about the surgical procedure, possible findings, postoperative limitations, changes in normal body functions, and prognosis. The patient and family require time and assistance to process the possible changes and outcomes resulting from the surgery. The nurse serves as the patient advocate and liaison and encourages the patient and family to take an active role in decision making when possible. If the patient or family asks about the results of diagnostic testing and surgical procedures, the nurse's response is guided by the information that was conveyed previously. The nurse may be asked to explain and clarify information for patients and families that was provided initially but was not grasped because of anxiety and overwhelming feelings. It is important that the nurse, as well as other members of the health care team, provide information that is consistent from one clinician to another.
A client has been receiving chemotherapy to treat cancer. Which assessment finding suggests that the client has developed stomatitis?
Red, open sores on the oral mucosa
After being seen in the oncology clinic, a client with severe bone marrow suppression is admitted to the hospital. The client's cancer therapy consisted of radiation and chemotherapy. When developing the care plan for this client, which nursing diagnosis takes priority? Risk for infection Anxiety Imbalanced nutrition: Less than body requirements Risk for injury
Risk for infection Risk for infection takes highest priority in clients with severe bone marrow depression because they have a decrease in the number of white blood cells, the cells that fight infection. Making clients aware that they are at risk for injuries can help prevent such injuries as falls. The nurse should institute the facility's falls prevention protocol and supply assistive devices, such as a walker, cane, or wheelchair, when needed. Imbalanced nutrition: Less than body requirements is also of concern but doesn't take priority over preventing infection. Anxiety is likely present in clients with severe bone marrow depression; however, anxiety doesn't take priority over preventing infection.
The nurse is preparing to assess a client whose chart documents that the client experienced extravasation when receiving the vesicant vincristine during the previous shift. The documentation also notes that an antidote was administered immediately. The nurse prepares to assess for which conditions? Select all that apply.
Sloughing tissue Tissue necrosis Effectiveness of the antidote Extravasation of vesicant chemotherapeutic agents can lead to erythema, sloughing, and necrosis of surrounding tissue, muscle, and tendons. To reduce the likelihood and severity of symptoms due to extravasation of a vesicant, antidotes matched to the vesicant are administered. Nurses caring for a client who experienced extravasation of a vesicant should assess for sloughing tissue, tissue necrosis, erythema, and effectiveness of the antidote.
The nurse is caring for a client with a benign breast tumor. The tumor may have which characteristic? Ability to invade other tissues Slow rate of growth Undifferentiated cells Causes generalized symptoms
Slow rate of growth Benign tumors have a slow rate of growth and well-differentiated cells. Benign tumors do not invade surrounding tissue and do not cause generalized symptoms unless the location of the tumor interferes with the functioning of vital organs.
A client with a brain tumor is undergoing radiation and chemotherapy for treatment of cancer. The client has recently reported swelling in the gums, tongue, and lips. Which is the most likely cause of these symptoms?
Stomatitis The symptoms of swelling in gums, tongue, and lips indicate stomatitis. This usually occurs 5 to 10 days after the administration of certain chemotherapeutic agents or radiation therapy to the head and neck. Chemotherapy and radiation produce chemical toxins that lead to the breakdown of cells in the mucosa of the epithelium, connective tissue, and blood vessels in the oral cavity.
A nurse is administering daunorubicin (DaunoXome) to a patient with lung cancer. Which situation requires immediate intervention?
The I.V. site is red and swollen.
What should the nurse tell a client who is about to begin chemotherapy and is anxious about hair loss? Alopecia related to chemotherapy is relatively uncommon. The client should consider getting a wig or cap prior to beginning treatment. The hair will grow back within 2 months post therapy. The hair will grow back the same as it was before treatment.
The client should consider getting a wig or cap prior to beginning treatment. If hair loss is anticipated and causing the client anxiety, a wig, cap, or scarf should be purchased before therapy begins. Alopecia develops because chemotherapy affects the rapidly growing cells of the hair follicles. Hair usually begins to grow again within 4 to 6 months after therapy. Clients should know that new growth may have a slightly different color and texture.
A 36-year-old man is receiving three different chemotherapeutic agents for Hodgkin's disease. The nurse explains to the client that the three drugs are given over an extended period because: The three drugs can be given at lower doses. The second and third drugs increase the effectiveness of the first drug. The three drugs have a synergistic effect and act on the cancer cells with different mechanisms. The first two drugs are toxic to cancer cells, and the third drug promotes cell growth.
The three drugs have a synergistic effect and act on the cancer cells with different mechanisms. Multiple drug regimens are used because the drugs have a synergistic effect. The drugs have different cell-cycle lysis effects, different mechanisms of action, and different toxic adverse effects. They are usually given in combination to enhance therapy. Dosage is not affected by giving the drugs in combination. The second and third drugs do not increase the effectiveness of the first. It is not true that the first two drugs are toxic to cancer cells while the third drug promotes cell growth.
The home health nurse is performing a home visit for an oncology client discharged three days ago after completing chemotherapy treatment for non-Hodgkin lymphoma. The nurse's priority assessment should include examination for the signs and symptoms of which complication? Syndrome of inappropriate antidiuretic hormone (SIADH) Tumor lysis syndrome (TLS) Disseminated intravascular coagulation (DIC) Hypercalcemia
Tumor lysis syndrome (TLS)TLS is a potentially fatal complication that occurs spontaneously or more commonly following radiation, biotherapy, or chemotherapy-induced cell destruction of large or rapidly growing cancers such as leukemia, lymphoma, and small-cell lung cancer. DIC, SIADH, and hypercalcemia are less likely complications following this treatment and diagnosis.
metatasis
Tumors also have the capacity to invade and spread from their original site to other organs in the body. This process is known as -------------. ------------ formation is the major cause of death in most patients with cancer. The most common sites of ---------- include the bones, lungs, liver, and central nervous system (CNS).
patient teaching for radiation
Use a bland mouth rinse (such as salt water or baking soda and water) often. Gently swish and gargle with this before and after meals and at bedtime. You may use it more often as needed to soothe a dry or sore mouth. To make the mouth rinse, mix 1 teaspoon of baking soda or 1 teaspoon of table salt with 16 oz of water. Use fluoride preparations daily as instructed by your dentist. Brush your teeth using a soft-bristled toothbrush three to four times a day. Floss your teeth daily. Dentures should be left out if they are irritating to the gums or are poorly fitting.
Which of the following would be inconsistent as a common side effect of chemotherapy?
Weight gain Common side effects seen with chemotherapy include myelosuppression, alopecia, nausea and vomiting, anorexia, and fatigue.
When T lymphocytes
When ------------, the soldiers of the cellular immune response, recognize tumor antigens, other -------------- that are toxic to the tumor cells are stimulated. These ----------- proliferate and are released into the circulation. In addition to possessing cytotoxic (cell-killing) properties, ------------- can stimulate other components of the immune system to rid the body of malignant cells.
Palliative surgery is performed
When cure is not possible, the goals of treatment are to make the patient as comfortable as possible and to improve quality of life as defined by the patient. ----- ------ --- ------ to relieve complications of cancer, such as ulcerations, obstructions, hemorrhage, pain, and malignant effusions.
Several factors are considered when determining a treatment plan, including the tumor type, stage, and grade; functional or performance status (PS),
a measure of how well a patient is able to perform ordinary tasks and carry out daily activities, of the patient; comorbidities; and organ function. Evaluation of PS was standardized using a physician-rated scale, now known as Karnofsky Performance Status (KPS), ranging from 0 (dead) to 100 (well-functioning) with 10-point increments. The simpler 6-point Eastern Cooperative Oncology Group (ECOG) PS scale (0 [fully active] to 5 [dead]) was introduced to evaluate patient reaction to chemotherapy, along with patient-reported pain, nausea, and appetite
radiation safety for patients
avoid using ointments, lotions, or powders gently cleanse the skin with lukewarm water and a mild, nondeodorant soap using the fingertips or a soft washcloth (no scrubbing) and then gently pat the area dry. any perfumed lotion or powder; avoid applying makeup Emollients such as Aquaphor® may be used as directed by the radiation oncologist to soothe and moisturize irritated skin emollients should not be used up to 4 hours before the treatment time. Lotions and emollients may amplify the effects of the radiation on the skin Electric razors should be used for shaving, but aftershave products should be avoided. avoid constrictive clothing that may irritate skin. Loose, cotton clothing is usually most comfortable. avoiding sun exposure, wind, extreme temperatures, heating lamps, heating pads, and ice packs to the area being treated. Avoid itching skin, and avoid applying tape
The nurse is completing an admission assessment for a client receiving interstitial implants for prostate cancer. The nurse documents this as external beam radiation therapy. a contact mold. brachytherapy. systemic radiation.
brachytherapy. Brachytherapy is the only term used to denote the use of internal radiation implants.
Hematogenous spread
cancerous cells invade the circulatory system and spread via blood vessels
chemotherapy,
chemotherapy, antineoplastic agents are used in an attempt to destroy tumor cells by interfering with cellular functions, including replication. Chemotherapy is used primarily to treat systemic disease rather than localized lesions that are amenable to surgery or radiation. The goals of chemotherapy (cure, control, palliation) define the medications to be used and the aggressiveness of the treatment plan.
internal radiation implantation, or brachytherapy,
delivers a high dose of radiation to a localized area. The specific radioisotope for implantation is selected based on its half-life, which is the time it takes for half of its radioactivity to decay. This internal radiation can be implanted by means of needles, seeds, beads, or catheters into body cavities (e.g., vagina, abdomen, pleura) or interstitial compartments (e.g., breast). With internal radiation therapy, the farther the tissue is from the radiation source, the lower the radiation exposure. This spares the noncancerous tissue from the radiation dose and toxicity. Brachytherapy may also be administered orally, as with the isotope iodine-131, which is used to treat thyroid carcinomas.
The nurse is evaluating the client's risk for cancer. The nurse should recommend the client change which lifestyle choice?
eats red meat such as steaks or hamburgers every day
The nurse can help relieve the patient's fear and anxiety by
explaining the tests to be performed, the sensations likely to be experienced, and the patient's role in the test procedures. The nurse encourages the patient and family to voice their fears about the test results, supports the patient and family throughout the test period, and reinforces and clarifies information conveyed by the primary care provider.
A complete diagnostic evaluation includes identifying the stage and grade of the tumor. This is accomplished before the treatment begins to provide baseline data for
for evaluating outcomes of therapy and to maintain a systematic and consistent approach to ongoing diagnosis and treatment.
Angiogenesis in cancer
formation of new blood vessels by the cancer cells to get more nutrients
Patients who are immunocompromised
have been shown to have an increased incidence of cancer. Organ transplant recipients who receive immunosuppressive therapy to prevent organ rejection have an increased incidence of lymphoma, Kaposi sarcoma, squamous cell cancer of the skin, and cervical and anogenital cancers. Patients with immunodeficiency diseases, such as AIDS, have an increased incidence of Kaposi sarcoma, lymphoma, and rectal, head, and neck cancers.
carcinogenesis include
include viruses and bacteria, physical agents, chemical agents, genetic or familial factors, dietary and lifestyle factors, and hormonal agents.
intracavity
injection into a body cavity such as the peritoneal and chest cavity
Cancer precision medicine
is a strategy that allows the selection of a treatment based on the patient's genetic makeup. In the case of cancer, the treatment is tailored to consider the genetic changes that may occur in an individual's tumor. molecularly-targeted agents alter the function of specific molecular targets in cell signaling, proliferation, apoptosis, angiogenesis, metabolism, migration, or invasion. "the use of therapeutics that are expected to confer benefit to a subset of patients whose cancer displays specific molecular or cellular features has already transformed cancer care—both common and rare malignancies can be targeted by specific therapies to improve clinical outcomes in patients
TNM system
is frequently used for many solid tumor types
Two common surgical approaches used for treating primary tumors are
local and wide excisions:
time
no more than 30 minutes per 8-hour shift.
A nurse is caring for a client with prostate cancer and assesses bleeding gums and hematuria. What serum indicator should the nurse relate the bleeding?
platelet count of 60,000/mm3
Primary prevention efforts focus on
preventing or delaying onset of cancer- teaching and counseling skills to encourage participation in cancer prevention programs, minimize exposure to known carcinogens, and to adopt healthy lifestyles, avoidance of tobacco products, achieving and maintaining a healthy body weight, encouraging physical activity, following a healthy eating pattern at all ages (one that limits or does not include red and processed meats, sugar sweetened beverages, or highly processed foods and refined grain products), and avoiding alcohol intake. Vaccinations. The ACS recommends routine HPV vaccination between ages 9 and 12 years to achieve higher on time vaccination rates, which will lead to increased numbers of cancers prevented. For individuals at high risk for cancer, surgical and preventive therapy interventions. bilateral risk-reducing mastectomy reduces the risk of developing breast cancer by 90% in high-risk females such as carriers of BRCA mutations. estrogen receptor modulators (SERMs), like tamoxifen, and aromatase inhibitors (AIs) form the mainstay of endocrine treatment in breast cancer.
Shielding
refers to the use of a lead shield to buffer the exposure to radiation.
"N" is used to describe
regional lymph node involvement of a tumor
Prophylactic surgery involves
removing nonvital tissues or organs that are likely to develop cancer. Colectomy (surgical resection of the colon), mastectomy (removal of breast), and oophorectomy (surgical procedure to remove one or both of the ovaries)
lymphatic spread
spread through the lymphatic system
distance
stand at least 6 feet from the patient to minimize exposure.
In radiation therapy,
the application of cell-destroying radiation to kill cancerous tissues Radiation may be used to cure the cancer, as in head and neck, prostate, lung, and bladder cancers. A key goal and main challenge of radiation therapy is the elimination of tumors without any concurring damages of the surrounding healthy tissues and organs
Grading refers to
the classification of the tumor cells. Grading systems seek to define the type of tissue from which the tumor originated and the degree to which the tumor cells retain the functional and histologic characteristics of the tissue of origin. examination of cells from tissue scrapings, body fluids, secretions, or washings), biopsy, or surgical excision.
secondary prevention focuses on
the early detection of cancer with the goal of identifying cancer in early stages before symptoms develop. aware of factors such as race, cultural influences, access to care, provider-patient relationship, level of education, income, and age, which influence the knowledge, attitudes, and beliefs people have about cancer. cancer-screening events that focus on cancers with the highest incidence rates or those that have improved survival rates if diagnosed early, such as breast cancer. These events offer education and examinations, such as mammograms, for minimal or no cost. Often these programs are targeted at people who lack access to health care or cannot afford to participate on their own. In developing these programs, nurses must use strategies that are culturally sensitive to foster participation.
Tertiary prevention includes
the management of the disease and prevention of progression to later stages.
After surgery, the nurse assesses
the patient's responses to the surgery and monitors the patient for possible complications, such as infection, bleeding, thrombophlebitis, wound dehiscence, fluid and electrolyte imbalance, and organ dysfunction. The nurse also provides for the patient's comfort. Postoperative teaching addresses decreasing the risk for complications, including deep vein thrombosis (DVT) and pneumonia, as well as education on wound care, activity, nutrition, and medication information.
"M" is used to identify
the presence of distant metastases of the primary tumor
"T" is used to describe
the size of the primary tumor and its invasion into adjacent tissues
Staging determines
the size of the tumor and the extent of disease.
Treatment options and prognosis are based on
the stage and grade of disease as well as the molecular and genetic profile.
health care team are guided by principles of ----- ----- ------- to minimize exposure of personnel to radiation.
time, distance, and shielding
Chemotherapeutic agents may be administered in the hospital, clinic, or home setting by a variety of routes including
topical, oral, IV, intramuscular, subcutaneous, arterial, intracavitary, and intrathecal routes.
A local excision is warranted
when the mass is small. It includes removal of the mass and a small margin of normal tissue that is easily accessible.
