med surg 11 chapter 15

staging of a tumor is done to communicate the

size of the tumor, if lymph nodes are involved, and if there is metastasis

MoAbs

spleen cancer cells cancer cells+ hybridomas monoclonal antibody culture dish back into hybrid

Palifermin (Kepivance)

First drug approved for decreasing oral mucositis (OM) Currently indicated only for patients with hematologic malignancies (can stimulate proliferation of malignant cells of nonhematologic origin) Synthetic form of human keratinocyte growth factor (KGF) Stimulates proliferation, differentiation, and migration of epithelial cells

stage 2:

limited local spread

multiple myeloma

malignant tumor of bone marrow cells

staging

multiple needle or incisional biopsies in tissues where matastasis is suspected or likely

Myelosuppression, induced chemotherapy results in:

pancytopenia and increases the risk for infection, bleeding and fatigue

deep tissue massage and other manipulative therapies are contraindicated in

patients with open wounds, radiation dermatitis, thrombocytopenia, VTE, and coagulation disorders, and in those taking anticoagulations

myeloma tissue of origin

plasma cells

viral carcinogen

viruses capable of causing cancer such as, Epstein Barr, Hep B and HPV

men over 50 should screen their?

prostate (DRE) and (PSA)

incisional biopsy

removal of a wedge of suspected tissue from a larger mass

curative surgery

removes all cancer tissue

organ infiltration pain description

distention, crampy

allogenic

from another donor

syngenic

from identical twin

autoogous

from self

metastisis malignant

gains access to the blood and lymphatic channnels and spreads to other areas of the body or grows across body cavities such as the peritoneum

Helicobacter pylori infection is associated with an increased risk of

gastric cancer

leukemia tissue of origin

hematopoetic cells in bone marrow WBC lymphocytes RBCs

Sipuleucel-T

is indicated for men with metastatic prostate cancer that is no longer responding to hormone therapy, it is the only therapuetic vaccine currently FDA approved

hyperthermia

is thought to alter cellular membrane permeability when used chemotherapy when used with chemo, allowing for an increased uptake of the chemotherapuetic agent. side effects: burns, fatigue, hypotension, peripheral neuropathies, thrombophlebitis, N/V/D, and electrolyte imbalance

lymphoma tissue of origin

lymphocytes

spinal cord compression

pain worse upon movement weak/flaccid paralysis bladder or bowel distention impaired blood supply to nerve tissue inflammation, edema, venous stasis **control pain intermittent catheter

promotion

repeated exposure to carcinogens causes proliferation and expansion

hypercalcemia

resulting from calcium released from bones into blood stream s/s fatigue, anorexia, N/V, constipation, and polyuria serious signs: severe muscle weakness, diminished DTRs, paralytic ileus, dehydration, and changes in ECG **monitor serum calcium levels, oral or parenteral fluids , meds that lower the calcium level and control N/V, prepare for dialysis, encourage walking to prevent breakdown of bone

how often should men and women over age of 50 screen for colonoscopy?

every 10 years

stage 3:

extensive local and regional spread

pallitive surgery

improve quality of life

chemotherapy

kills or inhibits the reproduction of neoplastic cells and kills normal cells; the effects can be systemic due to administration systemically side effects: fatigue, alopecia, N/V, mucositis, skin changes, and myelosuppression (neutropenia, anemia, and thrombocytopenia)

some chemotherapy agents could hemorrhagic cystitis which could lead to

life threatening hemorrhage so protect the bladder with IV hydration and diuresis

leading causes of cancer death in the US in order

lung, prostate, and colorectal cancer in men and lung, breast, and colorectal cancer in women.

tertiary prevention

nurse giving a patient transportation to a chemotherapy appointment

anaplasia

pattern of growth in which cells lack normal characteristics and differ in shape and organization with respect to their cells of origin

alloHSCTs

primarily used for diseases of the bonemarrow and are dependent on the availability of a human leukocyte antigen matched donor

lymphatic spread

primary site rich in lymphatics are more susceptible to early metastatic spread

secondary prevention

screening and early detection

ischemia pain description

sharp, throbbing

barium study

show movement of the GI tract

"chemo brain"

-Intellectual decline -Decreased attention -Decreased memory -Decreased processing -Poor executive function (organization) -Decreased motor performance

indications of extravasation during administration of vesicant agents include the following:

-absence of blood return -resistance to flow of IV fluid -burning or pain, swelling, or redness at the site

on educating the patient to avoid carcinogens, what would you include in your teaching?

-carcinogens such as not smoking, limiting alcohol intake, increase activity levels, using sunscreen with minimum of SPF 15, limiting sun exposure and using condoms

replicating cells are most vulnerable to the disruptive effects of radiation during what phases of cell cycle?

early S, G1, and G2 and mitosis

5-Fluorouracil (5FU) is classified as which type of antineoplastic agent?

Antimetabolite (S phase) **side effects: N/V/D, bone marrow suppression, stomatitis

patients receiving oxaliplatin must be instructed to avoid drinking cold fluids or going outside with hands and feet exposed to cold temps to avoid exacerbation of theses sx. _______ may cause peripheral neuropathies and hearing loss due to damage to the acoustic nerve

Cisplatin

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.

oral radioactive iodine treatment

Iodine 131 is a systemic internal radiation that is excreted through body fluids, especially urine. Flushing the toilet twice after every use will avoid the exposure of others to radioactive exposure

A client is receiving the cell cycle-nonspecific alkylating agent thiotepa (Thioplex), 60 mg weekly for 4 weeks by bladder instillation as part of chemotherapy regimen to treat bladder cancer. The client asks the nurse how the drug works. How does thiotepa exert its therapeutic effects?

It interferes with DNA replication and RNA transcription

A client has received several treatments of bleomycin. It is now important for the nurse to assess

Lung sounds

Distant Metastasis (M)

Mx distant metastasis cannot be measured M0 no distant metastasis M1 distant metastasis (other parts of the body)

If extravasation occurs

STOP!! a kit should be readily available with emergency equipment and antidote meds

petechia and eccymosis are early signs of what?

bleeding and thrombocytopenia

before a person is considered for Autologous HSCT what must be evaluated?

blood work

sarcoma tissue of origin

bone cartilage adipose smooth muscle fibrous tissue membranes lining body cavities blood vessels

nerve compression pain description

burning, sharp, tingling

stage 4:

cancer has spread to distant areas of body

stage 0:

carcinoma in situ

prevention of infection

careful hygiene practices report fever 100.4 for more than an hour check vitals every 4 hrs monitor WBC each day inspect all sites of entry use stool softners meticulous personal hygiene change central venous catheter dressings every 48 hr avoid IM injections put pt in private room if WBC is <1000 avoid animal excreta

excisional biopsy

complete removal of the entire lesion

tumor lysis syndrome

when large quantities of tumor cells are destroyed rapidly and intracellular components such as potassium and uric acid are released into the bloodstream faster than the body can get rid of them. Can cause severe tissue damage and death, Hyperkalemia, hyperphosphatemia with reistant hypocalcemia, and hyperuricemai occur; hyperuricemia can lead to acute kidney injury. s/s: neurologic: fatigue, weakness, memory loss, altered mental status, muscle cramps, tetany, numbness, tingling, seizures cardiac: elevated BP, shortened QT , widened QRS. altered T waves, cardiac arrest GI: anorexia, nausea, vomiting, cramps, diarrhea renal: flank pain, oliguria, anuria, kidney injury, acidic urine pH **hemodialysis, Allopurinol (inhibit conversion of nucleic acids to uric acid), Kayexalate-hyperkalemia (poop), aggressive fluid hydration, sodium bicarbonate to IV fluids, diuresis if urine output is not sufficient

3 doses of HPV vaccines are given

within 6 months

client education for radiation therapy

-wash irritated area gently each day with warm water alone or with mild soap and water and thoroughly rinse soap off without a washcloth -take care not to remove the markings that indicate exactly where the beam of radiation is to be focused. - dry the irradiated area with patting motions rather than rubbing motions; use a clean soft towel -No use of powders, ointments, lotions, or creams on the skin at the radiation site unless they are prescribed by the radiologist -avoid wearing belts, buckles, jewlery, straps, or any other clothing that may bind or rub the skin at radiation site. -avoid sunlight to area after tx -avoid heat exposure

when should women start screening for mammograms?

40-45 years old and yearly

The client is to receive cyclophosphamide (Cytoxan) 50 mg/kg intravenously in divided doses over 5 days. The client weighs 176 pounds. How many mg of cyclophosphamide will the client receive each day?

800

A patient is taking vincristine, a plant alkaloid for the treatment of cancer. What system should the nurse be sure to assess for symptoms of toxicity?

Nervous system

Regional lymph nodes (N)

Nx regional lymph nodes cannot be assessed N0 no regional lymph nodes metastasis N1, N2, N3 increasing involvement of regional lymph

local excision

The tumor is removed

Primary Tumor (T) Classification

Tx primary tumor cannot be assessed (measured) T0 no evidence of primary tumor Tis carcinoma in situ T1, T2, T3, T4 increasing size and/or local extent of the primary tumor

when should men and women screen for colorectal?

ages 50+ fecal occult blood test

wide excision

the tumor plus a wide margin of normal tissue around it is excised

bone metastasis pain description

throbbing, aching

extravasation of a vesicant could result in:

tissue necrosis so never use the hand or wrist and prevent extravasation by confirming patency of IV device

tumor markers (CEA, CA 125) are monitored:

to help determine the effectiveness of chemotherapy

Blood borne metastasis

tumor cells enter the blood, which is the most common cause of cancer spread

stage 1:

tumor limited to the tissue of origin; localized tumor growth

malignant cell

undifferentiated and may bear little resemblance to the normal cells of the tissue from which they arose

grade 1

cells differ slightly from normal cells (mild dysplasia) and are well differentiated (low grade)

What are considered carcinogens?

chemical agents, environmental factors, dietary substances, viruses, defective genes, and medically prescribed interventions.

carcinogenesis initiation

chemicals and exposure of that can cause cancer (mutation in the cellular DNA

wellcovorin and fluoroucil (5-FU)

chemotherapy agent to tx colorectal cancer

superior vena cava syndrome

compression of vena cava by tumor and obstructs venous circulation that goes to the head, neck, arms and thorax s/s: dyspnea, cough, hoarseness, chest pain, and facial swelling, sensation of skin tightness, edema in upper body, difficulty swallowing, engorged jugular, ICP, visual disturbances, HA, change in mental status **avoid upper extremity venipuncture and BP measurements, avoid tight clothing and jewelery, semi fowlers position, monitor pts fluid volume, assess for thoracic related problems such as mucositis

Control/Debulking Surgery

consists of removing a large portion of a locally invasive tumor, such as advanced ovarian cancer

treatment goals of cancer

cure, control, pallitation

examples of vesicants

dactinomycin (cosmegen), daunorubicin (DaunoXome), doxorubicin (Adriamycin), nitrogen mustard (Mustargen), mitomycin (Mutamycin), vinblastine (Velban), and vincritine (Oncovin). **always have antidote available nearby if reaction occurs and discontinue vesicant immediately

radiation therapy

destroys cancer cells, with minimal exposure of normal cells to the damaging effects of radiation; the damage cells die or become unstable and divide. Effective on tissues directly with the path of the radiation beam. side effects: local skin changes and irritation, alopecia, fatigue, altered taste sensation; the effects vary according to the site of tx.

lymphatic or venous obstruction pain description

dull, aching, tightness

organ obstruction pain description

dull, crampy, gnawing

primary prevention

education, vaccines

carcinoma tissue origin

epithelial

extravasation

escape of fluid from a blood vessel into surrounding tissue

vesicants

agents that, if deposited into the subq or surrounding tissues, cause inflammation; tissue damage; and possibly necrosis of tendons, muscles, nerves, and blood vessels

when should women start screening with pap smears and how often?

ages 21-29 every 3 years unless abnormal pap, then once a year

progression

altered cells exhibit increasingly malignant behavior

graft versus host disease

an immune response against the recipients tissues (skin, gastrointestinal tract, liver) the first 100 days are crucial for pts, the immune system and blood making capacity must recover sufficiently to prevent infection and hemorrhage marked by: mucosal inflammation of the eyes and the entire gastro tract with diarrhea that may exceed 2 L per day; and biliary stasis with abdominal pain, hepatomegaly, and elevated liver enzymes progressing to jaundice

seratonin receptor blockers (ondansetron, granisetron), dopaminergic receptor blockers (metoclopramide, prochlorperazine)

are used to decrease N/V along with small frequent meals

solid tumors

associated with the organs from which they develop, such as breast and lung cancer

The nurse is teaching a client newly diagnosed with cancer about chemotherapy. The nurse tells the client he'll receive an antitumor antibiotic. The nurse knows that this type of medications is:

cell-cycle nonspecific

grade1V

cells are immature (anaplasia) and undifferentiated; cell of origin is difficult to determine.

grade 11

cells are more abnormal and are moderately differentiated (moderate dysplasia)

grade 111

cells are very abnormal and are poorly differentiated (severe dysplasia)