chapter 8

Before chemotherapy, a female patient expresses concerns regarding hair loss. She says that her partner will no longer love her because she will not be as attractive. An appropriate nursing problem statement would be: 1. Fear of rejection due to anticipated loss of hair. 2. Inability to cope with perceived loss of relationship. 3. Lack of power over effects of chemotherapy. 4. Deficient skin integrity related to hair loss.

1

Pain is not unique to cancer but is a common occurrence in cancer patients. An important point to keep in mind when employing pain control efforts is to: 1. always try one type of intervention at a time and give it a chance to work before switching to a different intervention. 2. seek a combination of interventions to offer the best pain control. 3. try to avoid opioids to protect the patient from drug addiction. 4. refer the patient for psychological counseling if pain becomes an issue.

1.

A terminally ill female patient reminiscing about the "good old days" becomes increasingly confused. She talks of seeing relatives who have died. Which nursing intervention(s) would be appropriate? (Select all that apply.) 1. Discuss the patient's behaviors with the family. 2. Force oral fluids. 3. Encourage the family to talk to the patient in quiet tones. 4. Promote a calm environment. 5. Apply physical restraints.

1. 3. 4.

A 40-year-old woman is scheduled for external radiation therapy for breast cancer. To help the patient cope with her illness and the effects of radiation therapy, what should the nurse help her to focus on? (Select all that apply.) 1. Complying with scheduled radiation therapies 2. Taking precautions on exposing other family members 3. Protecting the skin by applying lotion 4. Wearing snug-fitting clothing 5. Understanding the therapeutic effects and side effects of the treatment

1. 5.

state how much total fat intake you should have daily

30% of total calories

state the survival rate given by the ACS for cancer in locolized stages

5 years

A nursing assistant says to the LPN/LVN, "I can't believe that Mrs. Feld, who is so sick and so near death, still enjoys a good laugh." Which of these ideas should the nurse use as the basis for discussing Mrs. Feld's behavior? a. Humor is a healthful part of everyone's life. b. The patient's behavior indicates that she may be suicidal. c. Use of humor at this time shows an inability to face reality. d. It is inappropriate for the assistant to encourage humor at this time.

A

A patient is scheduled for a computed tomography (CT) scan. To prepare the patient appropriately, the nurse should provide the patient with which information? a. "The test is noninvasive." b. "The test provides for direct visualization." c. "The test requires a small surgical incision." d. "The test involves the use of a powerful magnet."

A

A patient undergoes chemotherapy and loses her hair. Which of these findings is most indicative that the patient has satisfactorily adjusted to her alopecia? a. The patient uses humor about her hair loss. b. The patient washes her remaining hair daily. c. The patient visits a patient who has had hair loss. d. The patient is making arrangements to buy a wig.

A

A patient who is in the terminal stages of his illness says to the LPN/LVN, "Get out of here! You do everything so slowly. Leave me alone!" Which of these responses by the nurse is most appropriate? a. "You sound very angry today." b. "You cannot talk to me that way." c. "I'm leaving until you stop being so angry." d. "I'm sorry the way I work annoys you so much."

A

A patient is scheduled to receive external radiation therapy. Which potential side effects should the nurse include in patient teaching points? (Select all that apply.) a. Fatigue b. Loss of taste c. Mental slowness d. Skin reaction at site of exposure e. Potential contamination to others

A, B, D

explain why a patient with malignant neoplasm will have a rapid weight loss

Altered taste of food- more metallic taste; Anorexia (loss of appetite) often associated with changes in taste and with inflammation of the mouth and tongue.

state the population with the highest rate of skin cancer in the world

Australians

A patient is receiving hormone therapy for treatment of prostate cancer. The nurse should inform the patient that he is likely to experience which effect? a. Loss of body fat b. Breast development c. Menstrual-like bleeding d. An increase in facial hair

B

A patient who is near death has the following nursing diagnosis—Impaired gas exchange related to fluid in the lungs. Which intervention is most appropriate? a. Suction the patient as needed. b. Place the patient in the Fowler position. c. Teach the patient how to do pursed-lip breathing. d. Encourage the patient to cough and breathe deeply at least every 3 hours.

B

Major measures to help prevent cancer in patients should be taught by the nurse at every given opportunity. What are those things that should be taught to patients about the prevention of cancer? (Select all that apply.) a. Increase alcohol intake. b. Maintain a normal weight. c. Decrease ascorbic acid in the diet. d. Abstain from nitrite and nitrate food additives. e. Have your drinking water supply checked for contaminants.

B,D,E

state the site with the greatest number of cancer deaths in women.

Bronchus and lung cancer- 71,660 deaths

A patient has recently been diagnosed with cancer. What is the best initial nursing intervention for this patient? a. Provide literature about the specifics of the cancer b. Introduce the patient to a recovering cancer patient c. Encourage the patient to verbalize feelings and fears d. Reassure the patient that "everything will work out fine"

C

A patient who has been prescribed an antineoplastic drug for his newly diagnosed cancer asks the nurse what the most common side effect is for these drugs. What is the nurse's most accurate response? a. "An elevated temperature is a common side effect." b. "Gastrointestinal upset is the most common side effect." c. "These drugs almost always cause a vitamin B12 deficiency." d. "Most of these drugs cause some degree of bone-marrow depression.

D

tumor markers

a blood test to detect biochemical substances synthesized and released into the bloodstream by cells.

leukemia

a malignant disease of the blood forming organs, marked by abnormal proliferation and development of leukocytes and their precursors in the blood and bone marrow

carcinoma

a malignant growth made up of epithelial cells

melanoma

a malignant, darkly pigmented mole or tumor of the skin

maturation

a permanent change in the DNA sequence of a gene

TNM staging

a system that identifies cancer by how much the malignancy has spread

sarcoma

a tumor, often highly malignant, composed of cells derived from connective tissue

promoters

a type of epigenetic carcinogen that promotes neoplastic growth only after initiation by another sustance

hematoma

another word for bruise

lymphoma

any neoplastic disorder of lymphoid tissue

carcinogen

any substance or agent that produces or increases the risk of developing cancer in humans or lower animals.

explain promoters

are substances that are not carcinogenic alone, but cause known carcinogens to lead to cancer at a faster rate

State the type of cancer that can develop if exposed to asbestos, ionizing radiation, and sunlight

asbestos- lung, peritoneal, and pericardial cancer. ionizing radiation- leukemia, tumors of most organs. sunlight- skin cancer

what does BRM stand for?

biologic response modifiers

Vesicants

blistering; causing or forming blisters

list major side effects for antitumor antibiotics

bone marrow depression, cardiotoxicity, stomatitis, alopecia, Bleomycin: pneumonitis, and pulmonary fibrosis

state the site with the greatest number of new cancer diagnoses for women in 2015.

breast cancer- 231,840 cases

what is gynecomastia?

breast development in males

list cruciferous veggies

cabbage broccili brussel sprouts kohlrabi cauliflower carrots yellow squash sweet poatoes red grapes berries red cherries

transformation

change into something else

palliative care

comfort care

explain how to block the formation of nitrosamines

eat nitrites in combination with vitamin C, the formation of nitrosamines is blocked

list nursing interventions for a patient who has fear r/t dx of cancer

encourage verbalization and identification of specific fears assess spiritual needs; contact minister or others as patient desires help him to explore ways to cope with fear offer support by active listening, offering hope in some form, and being there for patient encourage expression of fears to significant others

explain how a patient can manage fatique

fatigue management includes avoiding unnecessary bed rest, maintaining a good balance between energy and activity, minimizing emotional distress, maintaining ADLs, using energy saving devices, and prioritizing activites. Maintaining a good nutritional status with high protein intake will keep up energy levels.

what is alopecia?

hair loss

list the cancers that can result from viruses

hep b hiv hpv epstein- barr T-cell lymphotropic virus

occult blood

hidden blood

list the risk factors for breast cancer

history of breast cancer, history of some forms of breast biopsy, close relatives with history of breast cancer, early menarche, late menopause, never had children, first child after 30 y/o, lengthy exposure to cyclic estrogen, higher educational and socioeconomical status, consumption of alcohol.

list the risk factors for ovarian cancer

history of ovarian cancer among close relatives, history of breast cancer, history of never having children

list the risk factors for colon & rectal cancer

history of rectal polyps, rectal polyps run in the family, history of inflammatory bowel disease.

list medications that are BRM drugs

interferons interleukins colony stimulating factrors monoclonal anitbodies vaccines gene therapy non specific immunomodulating agents

brachytherapy

internal radiation therapy

state the food that can help slow diarrhea

low fiber foods such as; bananas and cheese

There are two types of tumors: benign and malignant. A difference between the two types is:

malignant cells do not know when to stop multiplying, whereas benign cells have controlled patterns of reproduction and follow signals to stop.

state side effects of males taking estrogens for prostate cancer

may experience a feminizing effect with decreased facial hair, a redistribution of body fat, breast development, smoothing of facial skin, and the risk of thrombus formation

metastasis

movement of cancer cells from the original cancer site to other areas of the body

list the characteristics of malignant neoplasm

neoplasm is new growth of tissues or tumor, which is not beneficial. The word benign indicates a neoplasm that is harmless. Malignant uncontrolled growth that can lead to death, grows differently than normal cells. Cells that exhibit malignant growth are known as cancer.

neoplasm

new growth of tissue or tumor

benign

not very harmful; nonmalignant

cytotoxic

poisonous to cells

prognosis

prediction of survival

biopsy

removal of living cells for the purpose of examining them microscopically

list the four main types of malignant tumors

sarcoma carcinoma leukemia lymphoma

state what the patient should be actively doing through out treatment

seeking additional information

oncogenes

several cancer causing genes

explain the effect of prolonged stress

stress can make the immune system less effective in ridding the body of invading organisms and decreases the bodys ability to destroy abnormal cells

encapsulated

surrounded by a fibrous capsule

state how the family of a dying patient should handle delirium

talk to the patient in quiet tones while remaining calm

deoxyribonucleic acid (DNA)

the primary genetic material of all cellular organisms

incidence

the rate at which certain events occur

cytology

the study of cells and their origin, structure, function, and pathology

explain the TNM staging system

the three basic parts of the system are- T for primary tumor. N for regional nodes, and M for metastasis. The number written beside each letter indicates how much the malignancy has spread and attacked the other tissues

explain the desired effect of BRM drugs

they essentially make the immune system function better. BRMs stimulate the immune system to recognize cancer cells and to institute action to destroy them

explain a CA-125 test

this test is used to detect the presence of ovarian cancer or its occurrence after therapy

explain how pain can be controlled at end of life

transdermal fentanyl patches had helped eliminate the burden of pain

malignant

uncontrolled growth that can lead to death

list the warning signs of cancer

unusual bleeding or discharge a sore throat that doesnt heal a change in bowel or bladder habits a lump in the breast or part of the body a nagging, persistant cough an obvious chnage in a mole difficulty swallowing

list major side effects for mitotic inhibitors

viscristine: peripheral neuropathy, constipation. vinblastine: bone marrow depression

state the recommendations to begin mammograms, fecal occult blood test, and flexible sigmoidoscopy

woman 40-44 should consider getting a mammogram. ages 45-54 must get a mammogram yearly. starting at age 50 both M and F should get a flexible sigmoidoscopy every 5 years. starting at age 50 fecal occult blood testing should be done yearly.