NUR 114 Cellular Regulation

Metastasis

-Abnormal cells invade surrounding tissue and gain access to lymph and blood vessels carrying them to other areas of the body -mets- spreading to other areas -to identify this check lymph nodes, breast cancer check lymph nodes in armpits -PET scan whole body then biopsy from those cancerous areas metastasis is positive if its positive in 5/7 lymph areas

Nutrition and hydration at the end of life

-Anorexia- Pharmacologic agents to stimulate appetite -Cachexia- weakness and wasting of the body due to severe chronic illness -Artificial nutrition and hydration

Chemotherapy drugs

-Antimetabolites -Antitumor antibodies -Antimitotic agents -Alkylating agents -Topoisomerase inhibitors -Miscellaneous chemotherapeutic agents -Combination chemotherapy

Proxy Directives

-Appointment and authorization of another person to make medical decisions on behalf of the person who created the advance directive when he or she can no longer speak for himself or herself -An important addition to the living will or medical directive that specifies the signer's preferences

THE DEATH VIGIL/ Signs death is near

-As death nears, the patient may: withdraw, sleep for longer intervals, become somnolent -Death is generally preceded by: Increased intervals between respirations, A weakened and irregular pulse, Diminished blood pressure, Skin color changes or mottling

Nursing care for radiation therapy patients

-Avoid direct skin exposure to sunlight -Care for xerostomia (dry mouth) -Bone exposed to radiation more vulnerable to fracture -Intervention for fatigue (Sleep & exercise) -water hard candy for dry mouth -exercise- modify for individual -shield face and eyes if radiation to head -Teach accurate objective facts to help patient cope -Do not remove markings -Administer skin care -Use lotions to protect skin according to department policy

palliative care

-Care designed not to treat an illness but to provide physical and emotional comfort to the patient and support and guidance to his or her family. -Comprehensive symptom management, psychosocial care, and spiritual support needed to enhance the quality of life for any person with advanced illness -Interdisciplinary collaboration -Settings: Hospitals, Skilled nursing facilities, Outpatient -does not cure disease -o2 pain medicine/ keep from suffering/ not doing anything heroic/ hospice can be at home die in peace

Hormonal Manipulation

-Changing usual hormone responses -Some hormones make hormone-sensitive tumors grow more rapidly -Decreasing the hormone amounts to hormone-sensitive tumors can slow cancer growth rate -Steroids, steroid analogues, enzyme inhibitors

Features of Benign Tumor Cells

-Continuous or inappropriate cell growth -Specific morphology -Small nuclear-to-cytoplasmic ratio -Specific differentiated functions -Tight adherence -No migration -Orderly growth -Normal chromosomes

legislative issues

-DNR orders -Advanced directives -Living will -Proxy directive -Durable power of attorney -Assisted suicide legislation -2 doctors sign off on dnr -chemical code- only give meds to revive -assisted suicide- cancer, arthritis, CHF

Principles of hospice care

-Death must be accepted -Patient's total care best managed by interdisciplinary team whose members communicate regularly -Pain, other symptoms must be managed -Patient, family should be viewed as single unit of care -Home care of dying necessary -Bereavement care must be provided to family members -Research, education should be ongoing

after death care

-Determination is made through a physical examination that includes auscultation for the absence of breathing and heart sounds -Family is allowed & encouraged to spend time with deceased -Privacy should be honored -Cultural rituals allowed (bathing, prayer, wrapping, etc.)

Diagnosis of cancer

-Determine presence, extent of tumor -Identify possible disease metastasis -Evaluate functions of involved and uninvolved body systems and organs -Obtain tissue and cells for analysis, including evaluation of tumor stage and grade -tumor could be cause of pain/ pet scan, x-ray, ct scan -Nurses don't stage and grade we just interpret

Communication

-Develop level of comfort and expertise in communicating with seriously/terminally ill CLIENTS/families -Communication should be tailored to the level of understanding and values -Arrangements should be made to have the discussion at a time that is best for everyone -Create the right setting -Space should be conducive to seating all at eye level -get eye to eye with patient

Surgical treatment

-Diagnostic surgery -Biopsy: excisional, needle, incisional -Tumor removal: wide excision, local excision -Prophylactic surgery: remove for pain management/ before start other stages -Palliative surgery: make the patient comfortable -Reconstructive surgery: tumor causing patient to be disfigured go in there and fix it

Treatment Issues

-Dosage -Scheduling -Administration -Extravasation -Vesicants -probs with administration- timing, scheduling cause so many patients, hard time getting medicine in

Metastasis occurs through:

-Extension into surrounding tissues -Blood vessel penetration -Release of tumor cells -Invasion -Local seeding -Bloodborne metastasis -Lymphatic spread

Side effects of chemotherapy

-Hair loss -Dry ulcered mouth, chapped lips -lost thin eyebrows/ lost thinning hair/ lost sparse eyelashes -lost fragile split nails -swollen blistered hands and feet -Difficulty swallowing -N/V -Diarrhea *[GI tract replicate often] -Fatigue -Bleeding -Susceptibility to infection -Foggy brain aka "chemo brain"

Chemo client-centered nursing care

-Infection risk -Chemotherapy-induced nausea and vomiting (CINV) -Mucositis -Alopecia -Changes in cognitive function- advised not to make any life decision/ chemo brain -Peripheral neuropathy- sensation doesn't always come back/ be careful with burns cuts falls -Anemia- get PRBC, plasma, epigen to help boost system -Bone marrow suppression -Impaired clotting

Hope nursing interventions

-Listening attentively -Encouraging sharing of feelings -Providing accurate information -Encouraging, supporting patient's control over his or her circumstances, choices, environment whenever possible -Assisting CLIENTS to explore ways for finding meaning in their lives -Encouraging realistic goals -Facilitating effective communication within families -Making referrals for psychosocial, spiritual counseling -Assisting with development of supports in home or community when none exist

Side effects of hormone therapy

-Masculinizing effects in women -Feminizing effects in men (gynecomastia) -Risk for venous thromboembolism -Acne -Hypercalcemia -Liver dysfunction -Bone loss -Venous Thromboembolism -women grow facial hair/ men grow breast tissue -common gallbladder removed after chemo started

Immunotherapy: Biological Response Modifiers (BRMS)

-Modify patient's biological responses to tumor cells -Cytokines—enhance immune system -Interleukins, interferons -Side effects—generalized, sometimes severe inflammatory reactions, peripheral neuropathy, skin rashes

Syndrome of inappropriate antidiuretic hormone (SIADH)

-Most commonly found in carcinoma of the lung -Water is reabsorbed to excess by kidneys; put into system circulation -Collaborative care: Patient safety, Restore normal fluid balance, Supportive care -retaining fluid/ swollen/ daily weights/ get LR

Cancer Etiology and Genetic Risk

-Oncogene activation -Chemical carcinogenesis -Physical carcinogenesis -Viral carcinogenesis -Dietary factors -Personal factors: Immune function, Advancing age, Genetic risk

Antiemetic therapy

-Ondansetron (Zofran) -Granisetron (Kytril) -Granisetron transdermal (Sancuso) -Dolasetron (Anzemet) -Palonosetron (Aloxi) Drug combinations are individualized for best effect -mix take Tylenol Benadryl then one of meds listed/ Zofran is standard/ kytril too

Managing Physiologic Responses

-Patient's goals should direct care management -Anticipating and planning interventions for symptoms is a cornerstone of both palliative and end-of-life care -Pain: Preventable or treatable in most cases, Pain assessment -Dyspnea: Most prevalent symptoms of end of life, Treatment varies depending on underlying cause

Barriers to Improving End-of-Life Care

-Physicians reluctance to refer to hospice: -Difficulties in making a terminal prognosis (especially for those CLIENTS with noncancer diagnoses) -The strong association of hospice with death -Advances in "curative" treatment options in late-stage illness -Financial pressures on health care providers that may cause them to retain rather than refer hospice-eligible CLIENTS -physicians lose money don't want to discharge to hospice

Nursing Care of the Patient Undergoing Radiation Therapy

-Promote healing, patient comfort, quality of life -Assessment -Skin -Nutritional status -Well-being -Protecting caregivers

Brachytherapy

-Radioactive seeds or sources are placed in or near the tumor itself, giving a high radiation dose to the tumor while reducing the radiation exposure in the surrounding healthy tissues.

Features of malignant cancer cells

-Rapid or continuous cell division -Anaplasia -Large nuclear-to-cytoplasmic ratio -Specific functions lost -Loose adherence -Migration -No contact inhibition -Rapid or continuous -Abnormal chromosomes

General Disease-Related Consequences of Cancer

-Reduced immune and blood-producing function -Altered GI structure and function- diarrhea, stop eating and drinking, slow peristalsis -Motor and sensory deficits -Decreased respiratory function -immune system- anxious immune system compromised

Primary cancer prevention

-Reducing cancer risk in healthy people (education for prevention). -reducing the risks of disease through health promotion -risk reduction strategies: Vaccinations, Immunizations, Activity Lifestyle, Nutrition

Lymph node grading

-Regional lymph nodes (N) -NX: Cancer in nearby lymph nodes cannot be measured. -N0: There is no cancer in nearby lymph nodes. -N1, N2, N3: Refers to the number and location of lymph nodes that contain cancer. The higher the number after the N, the more lymph nodes that contain cancer. -The N = the number of nearby lymph nodes that have cancer.

effective listening

-Resist the impulse to fill the "empty space" in communication with talk. -Allow the patient and family sufficient time to reflect and respond after asking a question. -Prompt gently: "Do you need more time to think about this?" -Avoid: Distractions (noise, interruptions), The impulse to give advice, Canned responses: "I know just how you feel" -Ask questions -Assess understanding—your own and the patient's—by restating, summarizing, and reviewing

Superior vena cava syndrome

-Seen in lung cancer that obstructs the SVC and causes distended head and neck veins with edema, blue discoloration of arms and face -Superior vena cava compressed or obstructed by tumor growth -Can lead to painful, life-threatening emergency -Signs—facial edema, Stokes' sign, edema of arms and hands, dyspnea, erythema, epistaxis -see blue veins or on darker person see raised veins/put on ventilator, pull fluids off

photodynamic therapy

-Selective destruction of cancer cells via chemical reaction triggered by different types of laser light -Patient teaching- patients eyes need protection -General sensitivity to light for up to 12 weeks after injection of photosensitizing drug

Oncologic Emergencies

-Sepsis -DIC -SIADH -Spinal Cord Compression -Hypercalcemia -Superior Vena Cava Syndrome -Tumor Lysis Syndrome -Sepsis, disseminated intravascular coagulation -Collaborative management: Prevention (best measure), IV antibiotic therapy, Anticoagulants, cryoprecipitated clotting factors -need to let us know if they are bleeding

spiritual care

-Spirituality contains features of religiosity; however, the two concepts are not interchangeable -Spirituality includes domains: How a person derives meaning and purpose from life, One's beliefs and faith, sources of hope, Attitudes toward death -Spiritual assessment mnemonic—FICA

Carcinogenic Agents and Factors

-Viruses, bacteria -Physical agents: sunlight, radiation, chronic irritation -Chemical agents: tobacco, asbestos -Genetic, familial factors -Life style factors -Hormonal agents -what you clean with, sedentary lifestyle, hormones- to many can change cells , family history- where'd they come from, age

targeted therapy

-a developing form of anti-cancer drug therapy that uses drugs or other substances to identify and attack specific cancer cells without harming normal cells -External events indicate to cells that cell division is needed -Overall cancer cells have more active signal transduction pathways and transcription factors that lead to excessive division of cancer cells

Advanced Directives

-are written documents that allow competent people to document their preferences regarding -Use or abatement of medical treatment at the end of life -Specify their preferred setting for care -Communicate other valuable insights into their values and beliefs

Hormone fed can cause what

-can cause rapid growth -2 most rapid growth periods- utero and puberty

most common hospice diagnoses

-dementia -heart disease- CHF, heart attack, stroke -lung disease- copd emphysema -cancer

What should you do if you are doing chemo and want kids?

-depending on patient's age and outlook on life and future -may want save sperm and eggs

Extravasation

-escape of fluid from a blood vessel into surrounding tissue -especially bad with chemo/ eats away at tissue -can happen with infiltration/ heal from inside out -Most common nursing intervention is PREVENTION!

Hypercalcemia

-excessive calcium in the blood -Occurs most often with bone metastasis -Fatigue, loss of appetite, nausea and vomiting, constipation, polyuria, severe muscle weakness, loss of deep tendon reflexes, paralytic ileus, dehydration, ECG changes -Collaborative management: Oral hydration, Normal saline IV, Drug therapy, Dialysis -best thing is to hydrate them/ above 10.5 medical emergency- do dialysis immediately

homeostasis and cancer

-homeostasis need to maintain the body -cancer happens when metabolism is out of balance cell can mutate -cannot always identify at birth -environmental factors- increase risk -benign cells- overgrowth anywhere

radiation sickness symptoms

-immediate- vomiting and diarrhea, reduction in number of blood cells -delayed- cataracts, temporary sterility, cancer, genetic damage, anemia, and risk of infection -1/10 patients gets nauseated/ depends on location/ pretreat with Zofran -lingering effects

What do nurses need to know for chemo?

-knowledge about drug use -dosage ranges -side/adverse effects -schedule -specific precautions -PPE (Personal Protective Equipment)- must be used when administering oral and IV chemotherapy! -they are immunocompromised/ draw blood through port don't want patients being stuck peripherally

Steps of metastasis

-malignant transformation -tumor vascularization -blood vessel penetration -arrest and invasion

Tertiary cancer prevention

-management of disease to prevent progression, recurrence, or complications includes monitoring tumor markers and detecting second primary tumors early in those who are long term survivors -lung CA diagnosed- smoking cessation -focus on monitoring preventing recurrence of the primary cancer -Screening for development of secondary malignancies in cancer -keep from spreading or reoccur/ chemo surgery hormone therapy

malignant tumor characteristics

-mass of abnormal cells resulting from uncontrolled cancer cell division -indicates cancer

spinal cord compression

-occur either when a tumor directly enters the spinal cord or when the vertebrae collapse from tumor degradation of the bone -Tumors may begin in the spinal cord but more often spread from the lung, prostate, breast, and colon. -It may cause back pain before nerve deficits occur. -Neurologic problems are specific to the level of spinal compression and can lead to paralysis, which is usually permanent. -major back pain/ steroid or spinal block

Tumor Lysis Syndrome (TLS)

-oncologic emergency with rapid lysis of malignant cells -usually the result of chemotherapy or sometimes radiation -may occur 24 hours-7 days after antineoplastic therapy is initiated -develops when chemotherapy or irradiations causes the destruction of a large number of rapidly dividing malignant cells -intracellular contents are rapidly released into the bloodstream -Large numbers of tumor cells destroyed rapidly, results in intracellular contents being released into bloodstream faster than the body can eliminate them -Collaborative management: Prevention, Hydration, Drug therapy -a lot of K in system/ cardiac issues

bone biopsy

-physician extracts a specimen of the bone tissue for microscopic examination; may confirm presence of infection or neoplasm -painful, extensive, 5-8 in needle, going through layers hurts, bone doesn't hurt

Teletherapy

-radiation therapy administered by a machine that is positioned at some distance from the patient. -Typically a teletherapy unit can rotate around a patient, thus allowing the use of multiple beams that intersect at the tumor and lowering the dose to surrounding normal tissue.

Benign tumor characteristics

-remains localized and does not spread to distant sites -does not usually require intervention -tissue name + "-oma"

Chemotherapy

-treatment of cancer with drugs -Agents used in attempt to destroy cancer cells by interfering with cellular function, replication -May be combined with surgery, radiation therapy, or both -Curative, control, or palliative -Cell kill and cell cycle -Adjuvant therapy = Chemotherapy + surgery or radiation -Cytotoxic effects exerted on healthy cells and cancer cells -many variations of how much and how long of chemo -hair loss when it crosses blood brain barrier -Treatment of cancer with chemical agents -Major role in cancer therapy -Cures and increases survival time -Some selectivity -Normal cells most affected: skin, hair, intestinal tissues, spermatocytes, blood-forming cells

Secondary cancer prevention

-use of screening strategies to detect cancer early, at a time when cure or control is more likely -screening and early detection activities -identify pre-cancerous lesions and early stage cancer in individuals who lack signs and symptoms of cancer: Genetic screening in high risk clients

Four Levels of Hospice Care

1) Routine home care 2) Inpatient respite care 3) Continuous care 4) General inpatient care

Malignant transformation occurs through:

1. Initiation 2. Promotion 3. Progression 4. Metastasis -is a process/ may not be detectable in initiation/ change in moles not good -usually self-detected or partner detected

gynecomastia

Abnormal development of breast tissue in males

Stage 3

Any level of tumor invasion, up to 4 regional lymph nodes

Stage 4

Any level of tumor invasion; many lymph nodes affected with distant metastasis

A family is asking why their father with end-stage COPD is being referred to hospice care. The best response from the nurse would be: A. Hospice care provides complete pain control B. Hospice assists the family and patient to prepare for death C. Hospice will follow the patient's choice for "DNR" status D. Hospice is provided in the home and will allow the family to be involved in the decisions for care

B

arrest and invasion

Cancer cells clump up in blood vessel walls and invade new tissue areas. If the new tissue areas have the right conditions to support continued growth of cancer cells, new tumors (metastatic tumors) will form at this site.

Blood vessel penetration

Cancer cells have broken off from the main tumor. Enzymes on the surface of the tumor cells make holes in the blood vessels, allowing cancer cells to enter blood vessels and travel around the body.

Malignant Process

Cell proliferation: -Genetically altered cells clone and proliferate abnormally -Evading normal intra/extracellular processes such as growth regulating and immune system defenses -Abnormalities in cell signaling processes lead to cancer development -Ultimately metastasis occurs

bereavement care

Continuation of care, usually up to 1 year, for the family after loss of a loved one -counseling

Cancer

Disease process that begins when a cell is transformed by genetic mutation of cellular DNA

metastasis grading

METASTASIS (M) -Distant metastasis (M) -MX: Metastasis cannot be measured. -M0: Cancer has not spread to other parts of the body. -M1: Cancer has spread to other parts of the body. -The M = whether the cancer has metastasized. This means that the cancer has spread from the primary tumor to other parts of the body.

T grading

Primary tumor (T) -TX: Main tumor cannot be measured. -T0: Main tumor cannot be found. -T1, T2, T3, T4: Refers to the size and/or extent of the main tumor. The higher the number after the T, the larger the tumor or the more it has grown into nearby tissues. T's may be further divided to provide more detail, such as T3a and T3b. -Grading: pathologic classification of tumor cells: I-IV -TX- to large or no borders to it -T0- may not have cancer -The T = the size and extent of the main tumor. The main tumor is usually called the primary tumor.

Stage 1

Tumor invades up to muscle layer

Stage 2

Tumor invades up to other organs or perforates peritoneum

Most common cancer in women

breast cancer

Tumor vascularization

cancer cells secrete tumor angiogenesis factor (TAF) stimulating the blood vessels to bud and form new channels that grow into the tumor

Carcinogenesis/Oncogenesis

cancer development

Explain cell growth by hypertrophy

cells get larger

Malignant cancer cells

cells or processes that are characteristic of cancer

Benign cancer cells

cells that are not cancerous

Cancer Management

cure, control, palliation

Staging

determines the size of the tumor, the existence of local invasion, lymph node involvement, and distant metastasis

If a patient is immunocompromised where to draw blood?

draw blood through port don't want patients being stuck peripherally

Biggest symptom we see with radiation

fatigue

side effects of radiation

less recovery time, can impair sexual function, may not eliminate all tumor cells, surgery is not possible after radiation -Vary according to site -Local skin changes and hair loss (likely permanent depending on total absorbed dose) -Altered taste sensations -Fatigue related to increased energy demands -Inflammatory responses that cause tissue fibrosis and scarring -Bone marrow suppression- where fatigue comes from/ rbcs come from here/ may do transfusion -marking session (indigo purple) before treatment don't wash area don't clean it off/ that marking is what they use to treat cancer/ notify if break in skin integrity will postpone treatment and allow area to heal/ can use aloe to help/ nothing with alcohol or perfume to it

What brings people to hospital dealing with cancer?

lump or mass, pain, haven't been feeling well (lingering), unexplained weight loss, unexplained bleeding (colon cancer usually presents with this)

Explain cell growth by hyperplasia

number of cells increase

palliation

palliative care/ comfort/ could be curative also by taking off a little of the tumor to make them more comfortable

Best way to receive chemo?

picc line or port (best)

Most common cancer in men

prostate cancer

Grief

refers to the personal feelings that accompany an anticipated or actual loss -patients family take advantage of programs -our role is recognizing signs of depression and grief

malignant transformation

some normal cuboidal cells have undergone malignant transformation and have divided enough times to form a tumorous area within the cuboidal epithelium

Oldest form of cancer treatment

surgery

control

surgically, chemo, radiation/ slow the growth/ chemo into direct tumor or given in port

Death

the permanent cessation of respiratory and circulatory functions

Naming Glandular tissue

tissue name + "adenocarcinoma"

Naming Epithelial Tissue

tissue name + "carcinoma

Naming Mesenchymal tissue

tissue name + "sarcoma"

radiation therapy

treatment of neoplastic disease using ionizing radiation to impede the proliferation of malignant cells -Curative, control, or palliative -external radiation -Internal radiation- radioisotopes insert in area/ prostate, ovarian -Radiation reactions -Brachytherapy -Toxicity -to reduce size of tumor, maybe only thing they need -is everyday 5 days/week for up to 6 weeks (max)/ lasts 15-20 mins/ is radioactive be careful with how they dispose of waste products (wipes, gauze go into blue bag)/ can slow down growth hormones keep away from children pregnant women

hospice care

treatment of the terminally ill in their own homes, or in special hospital units or other facilities, with the goal of helping them to die comfortably, without pain -Coordinated program of interdisciplinary services provided by professional caregivers and trained volunteers to CLIENTS with serious, progressive illnesses that are not responsive to cure -Root of the word hospice is hospes, meaning "host" -diagnosis of less than a year to live/ ALS/ respite care- caregiver gets break