Med Surg - Ch 22

SBRT - Stereotactic body radiotherapy

This method uses three-dimensional tumor imaging to identify the exact tumor location, which allows more precise delivery of higher radiation doses and spares more of the surrounding tissue

Intra-arterial Route

Used to deliver a higher dose locally

Neoadjuvant Therapy

Used to shrink a tumor before surgery or radiation

Intraventricular Route

Ventricles of the brain

Emetogenic

Vomiting inducing

Side Effects of Radiation

-Acute and long-term site-specific changes -Vary according to site -Local skin changes and hair loss -Altered taste sensations -Fatigue -Bone marrow suppression

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

Teletherapy*

-External -Not harmful to others -External beams

Cancer affects...

-Impaired immunity and clotting -Altered GI function -Altered peripheral nerve function -Motor and sensory deficits -Cancer pain -Altered respiratory and cardiac function

Side Effects of Hormone Therapy

-Masculinizing effects in women -Feminizing effects in men (gynecomastia) -Fluid retention -Acne -Hypercalcemia -Liver dysfunction -Venous thromboembolism

Brachytherapy*

-Means "short" or "close" therapy, with the radiation source in direct, continuous contact with the tumor tissues for a specific period of time. -Harmful to others -Direct contact -Implanted into body -Preg. nurse not aloud to do

Extraversion*

-Most important intervention is prevention -Drug leaks into the surrounding tissues

Oncologic Emergencies

-Sepsis (septicemia) -Intravascular coagulation -SIADH -Spinal cord compression -Hypercalcemia -Superior vena cava syndrome -Tumor lysis syndrome

What is the expected outcome related to hair loss for a patient who is undergoing chemotherapy?

A. Hair loss may be permanent. B. Viable treatments exist for the prevention of alopecia. C. Hair regrowth usually begins about 1 month after completion of chemotherapy. D. New hair growth will likely be identical to previous hair growth in color and texture. ANSWER: C

A patient who is receiving radiation therapy for breast cancer is most likely to experience which side effect?

A. Fatigue B. Mucositis C. Hair loss D. Nausea and vomiting ANSWER: A

Tumor Lysis Syndrome

A positive sign of effective treatment

When is the patient with acute leukemia at greatest risk of developing tumor lysis syndrome?

A. After the first cycle of chemotherapy B. After the second cycle of chemotherapy C. After the last cycle of chemotherapy D. Anytime during the patient's treatment course ANSWER: A

Which assessment findings in a client who has neutropenia from cancer chemotherapy indicate to the nurse that severe disseminated intravascular coagulation (DIC) is present? (Select all that apply.)

A. The client is bleeding from the nose, IV sites, and rectum. B. The client's temperature is 99F (37.2C). C. The client's pulse rate is 130 beats per minute. D. The client's respiratory rate is 24 breaths per minute. E. The client's white blood cell count is 3200/mm3 (3.2 × 109/L) F. The client's hourly urine output is 100 mL. ANSWER: A, C, D

Which statements regarding care of the client receiving radiotherapy in the form of unsealed radioactive isotopes guide the nurse's care planning? (Select all that apply.)

A. The client may have restrictions on who can visit and for how long. B. The client must be in total isolation while the isotopes are in place. C. When "seeds" are used for prostate cancer therapy, the client must have them removed before he leaves the hospital. D. The client's urine and stool must be handled as radioactive material. E. The nurse must ensure that all personnel entering the client's room use appropriate precautions. F. Only those female nurses who are past menopause can be assigned to care for this client. ANSWER: A, D, E

Which client report indicates to the nurse that spinal cord compression may be present?

A. The client reports having a headache for the past 7 hours. B. The client has reduced breath sounds in the left lung. C. The client has worsening mid-thoracic back pain. D. Pedal edema is now present bilaterally. ANSWER: C

The client who received combination chemotherapy 7 days ago for breast cancer calls the oncology clinic to report a temperature of 100.5F (38.06C) and has no other symptoms of infection. What is the nurse's best response?

A."This is a normal immune-related response to the chemotherapy." B. "Please go to the nearest emergency room for a full workup for infection." C. "You are most likely dehydrated. Come to the clinic now for IV fluids." D. "There is no concern at this time but call if your temperature reaches 101.5F (38.6C)." ANSWER: B

Oral agents can't be...

Crushed, split, broken, or chewed

Radiation Therapy

Alter cellular regulation and destroy cancer cells with minimal exposure of the normal cells to the damaging actions of radiation

Nausea and vomiting is controlled by...

Antimetic therapy

Interleukins

Are substances the body makes to help regulate inflammation and boost immunity

IMRT - Intensity modulated radiation therapy

Breaks up the single beam into thousand of smaller beams that allow better focus on the tumor

Vesicants

Chemicals that damage tissue on direct contact

SCC

Damage occurs either when a tumor directly enters the spinal cord or when the vertebrae collapse from tumor degration of the bone

Thrombocytopenia

Decreased number of platelets

Neutropenia

Decreased numbers of neutrophil white blood cells leading to immunosuppression

Anemia

Decreased numbers of red blood cells and hemoglobin

Cachexia

Extreme body wasting

Combination Chemotherapy

Giving more than one specific anticancer drug

Alopecia

Hair loss

Radiation

The amount of radiation absorbed by the tissue

Intravesicular Route

Into the bladder

Intrathecal Route

Into the spinal cord

Teletherapy

Is radiation delivered from a source outside the patient

Exposure*

Is the amount of radiation delivered to a tissue

Photodynamic Therapy

Is the selective destruction of cancer cells through a chemical reaction triggered by different types of laser light

Hypercalcemia

Most often occurs in patients with bone metastasis

Radiation Dose*

One that can kill the cancer cells with an acceptable level of damage to normal tissues

Mucositis

Open sores on mucous membranes

People handling Chemotherapy drugs need to wear

PPE --Eye protection --Masks --Double gloves (or "chemo" gloves) --Gown

Dose-dense Chemotherapy

Protocols involve giving chemotherapy rounds closer together, supplemented with bone marrow growth factors to prevent neutropenia

Chemotherapy

The treatment of cancer with chemical agents that kill cancer cells and disrupt cellular regulation

Adjuvant Therapy

When chemotherapy is used to kill remaining cancer cells following surgery or radiaion

Intraperitoneal Route

Within the abdominal cavity