Rasmussen Adult 3 Exam 1 with NCLEX Oncology Questions

Tumor Lysis Syndrome and Hypercalcemia

(intracellular) potassium is destroyed and leaks out into the bloodstream so you end up with HYPERCALCEMIA. Hypercalcemia causes cardiac dysrythmias so treat with Lasix, kayexolate, glucose and insulin (You need the insulin because the sugar drops when the potassium is put back in the cell)

What does a normal cell look like?

*Normal morphology: look like cells from which they arose *Highly differentiated with specific functions *Cohesive; do not migrate *Secretes fibronectin and stick with like cells within the tissue *Exhibit contact inhibition: when surrounded by other healthy same cells, cell division stops *Apoptosis = cell death

What do abnormal cells look like?

*Uncontrolled cell division (proliferate) *Anaplasia: Large, variable shaped nuclei because of increased cell division activity *Aneuploidy (abnormal # chromosomes) *Poorly differentiated *Non-cohesion; migrate (by which routes?) *Do not secrete fibronectin; secrete enzymes that contribute to abnormal interactions with nearby tissues, allowing invasion of those tissue *No contact inhibition *Too little apoptosis occurs, resulting in malignant cells that will not die. *Angiogenesis: tumor creates its own blood supply

Brain Cancer

-Benign brain tumors can be fatal -Assessment: depends on tumor location in the brain; the age of a patient Infant's sutures are open, symptoms may be found late #2 most common cancer in children (Leukemia is #1) (Cancer.org) Signs of increased ICP: a headache, especially on awakening, vomiting unrelated to eating Visual symptoms i.e. diplopia; papilledema Supratentorial Personality changes and seizures Infratentorial Ataxia, visual disturbances, delayed or precocious puberty, growth failures -Therapy: Surgery, laser surgery, radiation, chemotherapy Complications: hydrocephalus, seizures, sensorimotor deficits, endocrine issues - will need to be managed Nutritional support Monitor LOC, observe for increased ICP; Increasing systolic BP, widening pulse pressures, bradycardia, irregular respirations Regulate fluid status with elevated ICP What is the normal ICP? 5 - 15 mmHg Seizure precautions - what are they? What should always be at the bedside? Monitor daily weights, I&O, urine sp gr. For signs of DI or SIADH Post-op positioning: infratentorial incision - flat, neck slightly extended. Gradual elevation. Supratentorial incision: head elevated 30 degrees or per surgeon's orders Keep head and neck midline to promote arterial and venous blood flow Monitor VP shunt Eye care, pain management (no sedation - why?) Assess sensory-perception Education

Prostate Cancer

-Often no symptoms in early stages; tumor may be found during digital prostate exam Screening: PSA and DRE (digital rectal exam). If positive, biopsy -Risk Factors: >50y/o, black male, FH, high fat, low fiber diet, occupational exposure to chemicals or pesticides, cadmium -Assessment: GU: dysuria, frequency, reduced stream, hematuria, nocturia, abnormal prostate on digital rectal exam MS: back pain, migratory bone pain, joint pain Neurological: nerve pain, muscle spasms, bowel and bladder dysfunction, lower extremity weakness Fatigue, weight loss -Therapy: Hormones, radiation, brachytherapy, prostatic cryosurgery, conventional surgery

Skin Cancer

1.) Basal cell carcinoma (BCC) This is the most common type of skin cancer. 2.) Squamous cell carcinoma (SCC) SCC is the second most common type of skin cancer. 3.) Melanoma Melanoma is the deadliest form of skin cancer. 4.) Actinic Keratoses (AK) These dry, scaly patches or spots are precancerous growths.

Staging of Malignant tumors: TNM

1.) TX: Main tumor cannot be measured. 2.) T0: Main tumor cannot be found. 3.) Tis = Carcinoma in situ, early/has not spread 4.) 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

CAM categories

1.)Whole medical systems Traditional Chinese, Ayurveda, homeopathy, osteopathy, naturopathy 2. Mind-body medicine 3. Biologically based practices 4. manipulative and body based practices 5. Energy medicine

Stage 1

A small cancer or tumor that has not grown deeply into nearby tissues. It also has not spread to the lymph nodes or other parts of the body. It is often called early-stage cancer.

Cancer cells exhibit which of the following behaviors? (Select all that apply): A. Anaplasia B. Poor differentiation C. Apoptosis D. Angiogenesis

A,B,D

The nurse includes which of the following in teaching regarding the warning signs of cancer? Select all that apply. A. Persistent constipation B. Scab present for 6 months C. Curdlike vaginal discharge D. Axillary swelling E. Headache

A,B,D: Change in bowel habit, A sore that does not heal, A lump or thickening in the breast or elsewhere is a warning signal of cancer.

The registered nurse is teaching a nursing student about the importance of observing for bone marrow suppression during chemotherapy. Select the person who displays bone marrow suppression. A. Client with hemoglobin of 7.4 and hematocrit of 21.8 B. Client with diarrhea and potassium level of 2.9 mEq/L C. Client with 250,000 platelets D. Client with 5000 white blood cells/mm3

A. Bone marrow suppression causes anemia, leukopenia, and thrombocytopenia; this client has anemia demonstrated by low hemoglobin and hematocrit.

The nurse suspects that which client has the highest risk for breast cancer? A. Older adult woman with high breast density B. Nullipara older adult woman C. Obese older adult male with gynecomastia D. Middle-aged woman with high breast density

A. People at high increased risk for breast cancer include women aged 65 years and older with high breast density.

A female client with cancer is being evaluated for possible metastasis. Which of the following is one of the most common metastasis sites for cancer cells? a. Liver b. Colon c. Reproductive tract d. White blood cells (WBCs)

Answer A. 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.

During chemotherapy, an oncology client has a nursing diagnosis of impaired oral mucous membrane related to decreased nutrition and immunosuppression secondary to the cytotoxic effects of chemotherapy. Which nursing intervention is most likely to decrease the pain of stomatitis? a. Recommending that the client discontinue chemotherapy b. Providing a solution of hydrogen peroxide and water for use as a mouth rinse c. Monitoring the client's platelet and leukocyte counts d. Checking regularly for signs and symptoms of stomatitis

Answer B. To decrease the pain of stomatitis, the nurse should provide a solution of hydrogen peroxide and water for the client to use as a mouth rinse. (Commercially prepared mouthwashes contain alcohol and may cause dryness and irritation of the oral mucosa.) The nurse also may administer viscous lidocaine or systemic analgesics as prescribed. Stomatitis occurs 7 to 10 days after chemotherapy begins; thus, stopping chemotherapy wouldn't be helpful or practical. Instead, the nurse should stay alert for this potential problem to ensure prompt treatment. Monitoring platelet and leukocyte counts may help prevent bleeding and infection but wouldn't decrease pain in this highly susceptible client. Checking for signs and symptoms of stomatitis also wouldn't decrease the pain.

A male client with a cerebellar brain tumor is admitted to an acute care facility. The nurse formulates a nursing diagnosis of Risk for injury. Which "related-to" phrase should the nurse add to complete the nursing diagnosis statement? a. Related to visual field deficits b. Related to difficulty swallowing c. Related to impaired balance d. Related to psychomotor seizures

Answer C. A client with a cerebellar brain tumor may suffer injury from impaired balance as well as disturbed gait and incoordination. Visual field deficits, difficulty swallowing, and psychomotor seizures may result from dysfunction of the pituitary gland, pons, occipital lobe, parietal lobe, or temporal lobe — not from a cerebellar brain tumor. Difficulty swallowing suggests medullary dysfunction. Psychomotor seizures suggest temporal lobe dysfunction.

A male client with a nagging cough makes an appointment to see the physician after reading that this symptom is one of the seven warning signs of cancer. What is another warning sign of cancer? a. Persistent nausea b. Rash c. Indigestion d. Chronic ache or pain

Answer C. Indigestion, or difficulty swallowing, is one of the seven warning signs of cancer. The other six are a change in bowel or bladder habits, a sore that does not heal, unusual bleeding or discharge, a thickening or lump in the breast or elsewhere, an obvious change in a wart or mole, and a nagging cough or hoarseness. Persistent nausea may signal stomach cancer but isn't one of the seven major warning signs. Rash and chronic ache or pain seldom indicate cancer.

A female client with cancer is scheduled for radiation therapy. The nurse knows that radiation at any treatment site may cause a certain adverse effect. Therefore, the nurse should prepare the client to expect: a. hair loss. b. stomatitis. c. fatigue. d. vomiting.

Answer C. Radiation therapy may cause fatigue, skin toxicities, and anorexia regardless of the treatment site. Hair loss, stomatitis, and vomiting are site-specific, not generalized, adverse effects of radiation therapy.

A 35 years old client has been receiving chemotherapy to treat cancer. Which assessment finding suggests that the client has developed stomatitis (inflammation of the mouth)? a. White, cottage cheese-like patches on the tongue b. Yellow tooth discoloration c. Red, open sores on the oral mucosa d. Rust-colored sputum

Answer C. The tissue-destructive effects of cancer chemotherapy typically cause stomatitis, resulting in ulcers on the oral mucosa that appear as red, open sores. White, cottage cheese-like patches on the tongue suggest a candidal infection, another common adverse effect of chemotherapy. Yellow tooth discoloration may result from antibiotic therapy, not cancer chemotherapy. Rust-colored sputum suggests a respiratory disorder, such as pneumonia.

The nurse is interviewing a male client about his past medical history. Which preexisting condition may lead the nurse to suspect that a client has colorectal cancer? a. Duodenal ulcers b. Hemorrhoids c. Weight gain d. Polyps

Answer D. Colorectal polyps are common with colon cancer. Duodenal ulcers and hemorrhoids aren't preexisting conditions of colorectal cancer. Weight loss — not gain — is an indication of colorectal cancer.

A client, age 41, visits the gynecologist. After examining her, the physician suspects cervical cancer. The nurse reviews the client's history for risk factors for this disease. Which history finding is a risk factor for cervical cancer? a. Onset of sporadic sexual activity at age 17 b. Spontaneous abortion at age 19 c. Pregnancy complicated with eclampsia at age 27 d. Human papillomavirus infection at age 32

Answer D. Like other viral and bacterial venereal infections, human papillomavirus is a risk factor for cervical cancer. Other risk factors for this disease include frequent sexual intercourse before age 16, multiple sex partners, and multiple pregnancies. A spontaneous abortion and pregnancy complicated by eclampsia aren't risk factors for cervical cancer.

Ginger

Anti coagulation precautions

Chamomile

Anxiety/restlessness Possible allergic reactions

End of life care

Assess the client's ability to cope with end of life interventions Identify end of life needs of the client (e.g., financial concerns, fear, loss of control, role changes) Recognize the need for and provide psychosocial support to the family/caregiver Assist the client in resolution of end of life issues Provide end of life care and education to clients Grief, loss, family dynamics

In which oncology stage does prolonged, repeated exposure to a carcinogen stimulate cellular proliferation, giving rise to a large number of daughter cells containing the mutation created by the initiator? A. Initiation B. Promotion C. Progression D. Metastasis

B

The nurse reviews the chart of the client admitted with a diagnosis of glioblastoma with a T1NXM0 classification. Which explanation does the nurse offer when the client asks what the terminology means? A. "Two lymph nodes are involved in this tumor of the glial cells, and another tumor is present." B. "The brain tumor measures about 1 to 2 cm and shows no regional lymph nodes and no distant metastasis." C. "This type of tumor in the brain is small with some lymph node involvement; another tumor is present somewhere else in your body." D. "Glioma means this tumor is benign, so I will have to ask your health care provider the reason for the chemotherapy and radiation."

B. T1 means that the tumor is increasing in size to about 2 cm, and that no regional lymph nodes are present in the brain. M0 means that no distant metastasis has occurred.

The nurse is caring for a patient receiving an initial dose of chemotherapy to treat a rapidly growing metastatic colon cancer. The nurse is aware that this patient is at risk for tumor lysis syndrome (TLS) and will monitor the patient closely for which of the following abnormalities associated with this oncologic emergency? A. Hypokalemia B. Hypocalcemia C. Hypouricemia D. Hypophosphatemia

B. TLS is a metabolic complication characterized by rapid release of intracellular components in response to chemotherapy. This can rapidly lead to acute renal failure. The hallmark signs of TLS are hyperuricemia, hyperphosphatemia, hyperkalemia, and hypocalcemia.

The nurse anticipates administering which medication to treat hyperuricemia associated with tumor lysis syndrome (TLS)? A.Recombinant erythropoietin (Procrit) B. Allopurinol (Zyloprim) C. Potassium chloride D. Radioactive iodine 131

B. Tumor lysis syndrome results in hyperuricemia, Allopurinol decreases uric acid production and is indicated in TLS.

Basal cell carcinoma (BCC)

BCCs develop after years of frequent sun exposure or indoor tanning. BCC are common on the head, neck, and arms, yet can form anywhere on the body, including the chest, abdomen, and legs. Early diagnosis and treatment for BCC is important. BCC can invade the surrounding tissue and grow into the nerves and bones, causing damage and disfigurement.

Anti coagulation precautions

Bilberry Chondroitin Sulfate Feverfew Garlic Ginger Ginkgo Fish oil VE

Myelosuppression

Blood components decreased, bone marrow suppression. Characterized by anemia, neutropenia, thrombocytopenia.

Which teaching is most appropriate for a client with chemotherapy-induced neuropathy? A. Bathe in cold water. B. Wear cotton gloves when cooking. C. Consume a diet high in fiber. D. Make sure shoes are snug.

C. A high-fiber diet will assist with constipation due to neuropathy. Cotton gloves may prevent harm from scratching; protective gloves should be worn for washing dishes and gardening. Wearing cotton gloves while cooking can increase the risk for burns

Which statement made by the client allows the nurse to recognize whether the client who is receiving brachytherapy for ovarian cancer understands the treatment plan? A. "I may lose my hair during this treatment." B. "I must be positioned in the same way during each treatment." C. "I will have a radioactive device in my body for a short time." D. "I will be placed in a semiprivate room for company."

C. Brachytherapy refers to short-term insertion of a radiation source.

A client being treated for advanced breast cancer with chemotherapy reports that she must be allergic to one of her drugs because her entire face is swollen. What assessment does the nurse perform? A. Asks whether the client has other known allergies B. Checks the capillary refill on fingernails bilaterally C. Examines the client's neck and chest for edema and engorged veins D. Compares blood pressure measured in the right arm with that in the left arm

C. The client's swollen face indicates possible superior vena cava syndrome, which is an oncologic emergency. Manifestations result from the blockage of venous return from the head, neck, and upper trunk. Early manifestations occur when the client arises after a night's sleep and include edema of the face, especially around the eyes, and tightness of the shirt or blouse collar. As the compression worsens, the client develops engorged blood vessels and erythema of the upper body, edema in the arms and hands, dyspnea, and epistaxis. Interventions at this stage are more likely to be successful. Late manifestations include hemorrhage, cyanosis, mental status changes, decreased cardiac output, and hypotension. Death results if compression is not relieved.

Warning signs of Cancer

C: Changes in bladder/bowel habits A: A sore that does not heal U: Unusual bleeding or discharge T: Thickening or lump on breast, testicle or other part of body I: Indigestion/ difficulty swallowing O: Obvious changes in wart or mole (color, size, texture) N: Nagging cough/hoarseness

Why would you give fresh frozen plasma?

Clotting factor (platelets)

Promoters

Compounds that stimulate tumor development

CAM

Comprises of diverse therapies and healing systems that are considered to be outside of mainstream health care. Complimentary: In conjunction with of mainstream health care. Alternative: outside of mainstream health care.

The nurse is discussing treatment options with the client newly diagnosed with breast cancer. Which statement by the client indicates a need for further teaching? A. "Hormonal therapy is only used to prevent the growth of cancer. It won't get rid of it." B. "I might have chemotherapy before surgery." C. "If I get radiation, I am not radioactive to others." D. "Radiation will remove the cancer, so I might not need surgery."

D. Typically, radiation therapy follows surgery to kill residual tumor cells. Radiation therapy plays a critical role in the therapeutic regimen and is effective treatment for almost all sites where breast cancer can metastasize. The purpose of radiation therapy is to reduce the risk for local recurrence of breast cancer.

A nurse is caring for a client with neutropenia. Which clinical manifestation indicates that an infection is present or should be ruled out? A. Coughing and deep breathing B. Evidence of pus C. Fever of 102 deg. F or higher D. Wheezes or crackles

D. Wheezes or crackles in the neutropenic client may be the first symptom of infection in the lungs.

Black Cohash

For hot flashes, night sweats, menopause, PMS, induce labor Estrogen-like effects

At what HEM level would a transfusion

HEM of 7 or below

Normal lab values

Hemoglobin = men are 13.5 to 17.5 and women are 12.0 to 15.5 Neutrophils = 1.5 to 8.0 (1,500 to 8,000/mm3) Platelets = 150,000 to 450,000 platelets per microliter of blood. Over 450,000 is Thrombocytosis.

Contributing factors for Cancer

Heredity, Environment, & Lifestyle

A diet full of these things may lead to colon cancer

High fat diet and red meat

Viral Hemorrhagic fever (EBOLA)

Incubation period of - 10 days Abrupt onset of fever, myalgia, headache, nausea and vomiting, abdominal pain, diarrhea and chest pain Rash on trunk develops approximately 5 days after onset Bleeding (petechiae, bruises and hemorrhages) occur as disease progresses

How Smallpox spreads

Incubation period: 7 to 17 days No symptoms, not contagious Initial symptoms: high fever, head and body aches, vomiting. Lasts 2-4 days. Person may be contagious After 4 days: a rash appears first on the tongue and mouth. Red spots develop into sores that break open and spread large amounts of the virus into the mouth and throat. Person is highly contagious Rash spreads to entire body After 7 days: (day 3 of rash) the rash becomes raised bumps, fluid filled with a depression in center (dimple) Then becomes a pustule Forms crust and scabs Person is contagious until all the scabs have fallen off

Stage 2 & 3

Indicate larger cancers or tumors that have grown more deeply into nearby tissue. They may have also spread to lymph nodes but not to other parts of the body.

Bilberry

Inhibits platelet aggregation like aspirin

Pathophysiology of cancer

Malignant cells (Cancer) are abnormal, serve no useful function, and are harmful to normal body tissues. Have abnormal chromosomes that could be broken, rearranged, or seen with mutated genes.

Squamous cell carcinoma (SCC)

People who have light skin are most likely to develop SCC, yet they can develop in darker-skinned people. SCC often looks like a red firm bump, scaly patch, or a sore that heals and then re-opens. SCC tend to form on skin that gets frequent sun exposure, such as the rim of the ear, face, neck, arms, chest, and back. SCC can grow deep in the skin and cause damage and disfigurement. Early diagnosis and treatment can prevent this and stop SCC from spreading to other areas of the body.

Endometrial Cancer Risks

Prolonged estrogen stimulation, early menarche or late menopause, exogenous estrogen, obesity, increasing age, nulliparity or delayed pregnancy, FH, polycystic ovary syndrome, hx of ovarian tumors

Feverfew

RA/fever/headache se= Interacts with blood thinners Interacts with theophylline Do not take if pregnant Withdrawal symptoms

Malignant tumor growth

Rate of growth varies, usually rapid Metastasized Rarely contained within capsule Irregular, more immobile when palpated Little resemblance to parent tissue May recur after removal Fatal without treatment Carcinoma, sarcoma, lymphoma/leukemia, blastoma

Superior Vena Cava Syndrome

Results from impairment of blood flow through the SVC to the right atrium due to obstruction or compression. Most often from a malignancy S/S: dyspnea, facial swelling, neck distention, cough Tx: steroids, surgery

Anemia

S+S= fatigue, SOB, tachycardia, chest pain, headache, mental status changes

Smallpox versus chickenpox

SMALLPOX = Deep, hard lesions Round, well circumscribed Confluent or umbilicated Lesions at same stage of development CHICKEN POX = Superficial Not well circumscribed Confluence and umbilication uncommon Lesions at all stages of development

START Triage

Simple triage and rapid treatment (START) is a triage method used by first responders to quickly classify victims during a mass casualty incident (MCI) based on the severity of their injury. Triage

Brain Cancer precautions

Sit up from 20-30 degrees, do not flex, log roll, have increased ICP (normal ICP is 5-15)

Benign tumor growth

Slow, steady growth Remains localized Usually contained within a capsule Smooth, well defined, movable when palpated Resemble parent tissue Crowds normal tissue Rarely recurs after removal Rarely fatal Adenomas, fibroids, hemangiomas, lipomas

Cancer Grading

The degree of malignancy or cell differentiation of the tumor cells

Tumor Lysis Syndrome

Tumor cells release their contents into the bloodstream, either spontaneously or in response to therapy. Hyperphosphatemia, hypocalcemia, hyperkalemia, hyperuricemia Consequences: renal insufficiency, cardiac arrhythmias, seizures, death due to multiorgan failure TLS is a positive sign that cancer treatment is effective in destroying cancer cells

Principle of double effect

Used to explain the permissibility of an action that causes a serious harm, such as the death of a human being, as a side effect of promoting some good end. *Physician giving order for morphine to ease the pain even though it may hasten death.*

Smallpox

Viral cause: Variola virus Transmission: droplet nuclei expelled from the mouth of an infected person or by aerosol Contaminated clothing or bed linen could also spread the disease 300 million people died of smallpox in the 20th century Humans are the only natural host of variola Eradicated from the natural environment in 1977 (World Health Organization)

Care of client having prostate surgery

Watch closely for 24 hours for hemorrhage. Maintain post-op assessments (bowels, lungs, pain, I&O). Monitor drainage on dressings. Straining to void will increase pain. CBI (continuous bladder irrigation) to prevent clots, sterile technique used. Check for NV, hyponatremia and bradycardia.

Grading of Malignant Tumors

X = cannot be graded

Neoplasm

also referred to as a tumor, is an abnormal mass of cells. A neoplasm can be benign or malignant.

Care of the client who is terminal, including assessment and interventions

provide comfort measures (dim lights, warm blanket, etc.) and pharmacological comfort measures, help ensure a dignified death, assist with grieving, consider use of CAM, supports, therapeutic communication. Assessment for palliative care patient should be done to ensure comfort and dignity. Emotional and cognitive assessment. Areas to focus on for developing tools include continuity of care, advance care planning, spirituality, grief and bereavement, and development of measures that are feasible in a variety of settings.

Metastasis

spread of malignant tumor to a location distant to the primary neoplasm.

Benign tumor

tissue of origin + -oma (-oma means tumor in Greek) e.g. adenomas (gland + tumor) Surrounded by a fibrous capsule; not cancerous; grow locally; causes pressure on vital organs (obstruction, pain, seizures or overproduction of hormones

Endemic

usual or constant presence of an infectious agent or disease within a defined geographic area

Secondary tumor sites

when cancer cells move from the primary location by breaking off and establish remote colonies. Metastasis

Tx for alteration in cellular regulation

• Surgery • Radiation • Chemotherapy • Hormone therapy • Stem Cell transplantation • Complementary and Alternative therapy

Colon Cancer

-Starts in bowel wall or begins as polyps in colon/rectum -Can cause abscesses or fistulas, bowel obstruction, hemorrhage, perforations leading to peritonitis -Assessment: May not have early signs; screening imperative (fecal occult blood, colonoscopy) Anorexia, vomiting, weigh loss, cachexia, malaise, anemia Abdominal distension, bloody stools, altered bowel patterns Tumors in ascending colon: diarrhea Tumor in descending colon: constipation or diarrhea, or flat, ribbon-like stools from partial obstruction Abdominal mass is a late sign -Risk Factors: >60 y/o, high fat diet, low fruits and vegies, heavy alcohol, smoker, obesity, sedentary lifestyle. Hx polyps, IBS, & genetic syndromes (FAP, APC1130K mutation, HNPCC) Monitor for complications of cancer Bowel perforation: distended abdomen, fever, shock. (What vitals would you expect to see with shock?) Intestinal obstruction: pain, distention, constipation, vomiting (fecal matter). Early on - hyperactive BS, followed by hypoactive/absent BS -Therapy: Radiation therapy (to reduce tumor) Surgery - bowel resection: ileostomy or colostomy What type of stools will you see with each? Monitor for post op infections ALWAYS Pain management, emotional support, education for (ostomy care, diet, etc...)

Interacts with hormones

1.) Potentiates hormone replacements Black cohosh Ginseng 2.) Decreases effectiveness of oral contraceptives Milk thistl

Cancer treatments

1.) Surgery - used to remove solid cancers 2.) External radiation - beam to skin to tumor. treatment is 15-30 minutes a day 5 days a week for 2-7 weeks. Keep skin intact. Watch for Myelosuppression if going through large bone. 3.)Internal radiation - Brachytherapy = implanted seeds. Remember little time as possible, always shield (use ppe), and distance (6' ) 4.) Chemo - is cell specific can kill multiple with use of multiple times and meds. Goal is tumor death. Can kill healthy cells too. Most rapidly to reproduce are attacked the most (abnormal cells). Biggest complaint is fatigue due to anemia from myelosuppression so get on procrit. Always wear gloves when handling chemo drugs. 5.) Hematopoietic stem cell transplant - in blood and bone marrow.

Breast Cancer

1.)Risk factors: female, >50 y/o, hx br ca/biopsy, FH, nulliparity or delayed first pregnancy, early menarche (<12) or late menopause (>50). BRCA1 or BRCA2 mutation, postmenopausal obesity, high fat diet, alcohol, prolonged exposure to exogenous estrogens, radiation to chest wall 2.) Assessment: A lump; not tender, though may be dimpling breast tissue, asymmetrical breasts, swollen and tender regional lymph nodes. Diagnostics: mammography, ultrasound, PET, MRI, tissue biopsy, sentinel node biopsy 3.)Therapies: Surgery, radiation, chemotherapy, hormonal therapy Mastectomies Nursing management of client undergoing a mastectomy Client teaching

Oncogenesis/Carcinogenesis

4 stages 1.) Initiation = non-reversible - when a carcinogen (chemical, radiation, viral, bacterial or familial) invades and damages DNA. This is the "initiated cell." Daughter cells carry the mutation *Oncogene (becomes excessive) *Tumor suppressor genes 2.)promotion = prolonged, repeated exposure by a "promotor" stimulates cellular proliferation of the cell, giving rise to a large number of daughter cells containing the mutation created by the initiator. Reversible. 3.)Progression = tumor grows; becomes more anaplastic and less differentiated. Angiogenesis occurs. 4.)Metasastasis =Spread of malignant tumor to other parts of the body via direct invasion/blood or lymph circulation

The nurse has received in report that the client receiving chemotherapy has severe neutropenia. Which of the following does the nurse plan to implement? Select all that apply. A. Assess for fever. B. Observe for bleeding. C. Administer pegfilgrastim (Neulasta). D. Do not permit fresh flowers or plants in the room. E. Do not allow his 16-year-old son to visit. F. Teach the client to omit raw fruits and vegetables from his diet.

A,C,D,F: Any temperature elevation in a client with neutropenia is considered a sign of infection and should be reported immediately. Administration of biological response modifiers, such as filgrastim (Neupogen) and pegfilgrastim (Neulasta), is indicated in neutropenia to prevent infection and sepsis. All fruits and vegetables should be cooked well; raw fruits and vegetables may harbor organisms, as well as Flowers and plants. Thrombocytopenia cause bleeding, not low neutrophils.The client is at risk for infection, not the visitors, if they are well. However, very small children, who may get frequent colds and viral infections, may pose a risk.

When caring for a client with cachexia, the nurse expects to note which symptom? A. Weight loss B. Anemia C. Bleeding tendencies D. Motor deficits

A. Cachexia results in extreme body wasting and malnutrition. Severe weight loss is expected.

A patient's tumor was staged using the TNM system. The tumor was staged as Tis N0 M0. The nurse realizes that this staging means: A. tumor in situ, no node involvement, no presence of metastasis. B. large tumor, no node involvement, presence of metastasis. C. medium tumor, multiple nodes involvement, no presence of metastasis. D. large tumor, single node involvement, unable to assess metastasis.

A. tumor in situ, no node involvement, no presence of metastasis.

Cancer Risk Factors

Alteration in cellular regulation can lead to the development of cancer. There are risk factors that promote the development of this life-altering disease process. Some of these factors include: • Age • Heredity • Environment o Pollution o Radiation o Work exposure • Lifestyle o Smoking o Diet o Risky sexual behaviors o Drug use

For a female client newly diagnosed with radiation-induced thrombocytopenia, the nurse should include which intervention in the plan of care? a. Administering aspirin if the temperature exceeds 102° F (38.8° C) b. Inspecting the skin for petechiae once every shift c. Providing for frequent rest periods d. Placing the client in strict isolation

Answer B. Because thrombocytopenia impairs blood clotting, the nurse should inspect the client regularly for signs of bleeding, such as petechiae, purpura, epistaxis, and bleeding gums. The nurse should avoid administering aspirin because it may increase the risk of bleeding. Frequent rest periods are indicated for clients with anemia, not thrombocytopenia. Strict isolation is indicated only for clients who have highly contagious or virulent infections that are spread by air or physical contact.

A male client is in isolation after receiving an internal radioactive implant to treat cancer. Two hours later, the nurse discovers the implant in the bed linens. What should the nurse do first? a. Stand as far away from the implant as possible and call for help. b. Pick up the implant with long-handled forceps and place it in a lead-lined container. c. Leave the room and notify the radiation therapy department immediately. d. Put the implant back in place, using forceps and a shield for self-protection, and call for help.

Answer B. If a radioactive implant becomes dislodged, the nurse should pick it up with long-handled forceps and place it in a lead-lined container, then notify the radiation therapy department immediately. The highest priority is to minimize radiation exposure for the client and the nurse; therefore, the nurse must not take any action that delays implant removal. Standing as far from the implant as possible, leaving the room with the implant still exposed, or attempting to put it back in place can greatly increase the risk of harm to the client and the nurse from excessive radiation exposure.

The client with prostate cancer asks why he must have surgery instead of radiation, even if it is the least invasive type. What is the nurse's best response? A."It is because your cancer growth is large." B. "Surgery is the most common intervention to cure the disease." C. "Surgery slows the spread of cancer." D. "The surgery is to promote urination."

B. Because some localized prostate cancers are resistant to radiation, surgery is the most common intervention for a cure.

The nurse is assessing a client with lung cancer. Which symptom does the nurse anticipate finding? A. Easy bruising B. Dyspnea C. Night sweats D. Chest wound

B. Dyspnea is a sign of lung cancer, as are cough, hoarseness, shortness of breath (SOB), bloody sputum, arm or chest pain, and dysphagia.Night sweats is a symptom of the lymphomas.

Which manifestation of an oncologic emergency requires the nurse to contact the health care provider immediately? A. New onset of fatigue B. Edema of arms and hands C. Dry cough D. Weight gain

B. Edema of the arms and hands indicates worsening compression of the superior vena cava consistent with superior vena cava syndrome. The compression must be relieved immediately, often with radiation therapy, because death can result without timely intervention.

Which medication does the nurse plan to administer to a client before chemotherapy to decrease the incidence of nausea? A. Morphine B. Ondansetron (Zofran) C. Naloxone (Narcan) D. Diazepam (Valium)

B. Ondansetron is a 5-HT3 receptor blocker that blocks serotonin to prevent nausea and vomiting. Diazepam is a benzodiazepine, which is an antianxiety medication only. Lorazepam, a benzodiazepine, may be used for nausea.

Which action is most important for the nurse to implement to prevent nausea and vomiting in a client who is prescribed to receive the first round of IV chemotherapy? A. Keep the client NPO during the time chemotherapy is infusing. B. Administer antiemetic drugs before administering chemotherapy. C. Ensure that the chemotherapy is infused over a 4- to 6-hour period. D. Assess the client for manifestations of dehydration hourly during the infusion period.

B. When emetogenic chemotherapy drugs are prescribed, the client should receive antiemetic drugs before the chemotherapy drugs are administered. This allows time for prevention of chemotherapy-associated nausea and vomiting; however, the antiemetic therapy cannot stop until all risks for nausea and vomiting have passed. Clients become nauseated and vomit even if they are NPO.

Lung Cancer (SMOKING)

Bronchogenic Carcinoma Leading cause of death from malignancy; 5 year survival rate less than 15% Risk Factor: cigarette smoking, passive smoking, occupational and environmental exposures; exposure to radiation Assessment: Symptoms show late in course of disease Persistent cough with or without hemoptysis, localized CP, dyspnea, unilateral wheezing, difficulty swallowing, anorexia and weight loss, enlarged neck lymph nodes, mass visible on x-rays; tumor cells in sputum Therapy: Surgery (pneumonectomy; lobectomy; segmentectomy; wedge resection Chemo, radiation; laser, immunotherapy Position to optimize oxygenation Chest tubes Pain management Emotional support and education

The client who has undergone breast surgery is struggling with issues concerning her sexuality. What is the best way for the nurse to address the client's concerns? A. Allow the client to bring up the topic first. B. Remind the client to avoid sexual intercourse for 2 months after the surgery. C. Suggest that the client wear a bra during intercourse. D. Teach the client that birth control is a priority.

C. Clients may prefer to lay a pillow over the surgical site or wear a bra or camisole to prevent contact with the surgical site during intercourse.

A client receiving high-dose chemotherapy who has bone marrow suppression has been receiving daily injections of epoetin alfa (Procrit). Which assessment finding indicates to the nurse that today's dose should be held and the health care provider notified? A. Hematocrit of 28% B. Total white blood cell count of 6200 cells/mm3 C. Blood pressure change from 130/90 mm Hg to 148/98 mm Hg D. Temperature change from 99° F (37.2 C) to 100 F (37.8 C)

C. Epoetin alfa and other erythropoiesis-stimulating agents (ESAs) such as darbepoetin alfa (Aranesp) and epoetin alfa (Epogen, Procrit) increase the production of many blood cell types, not just erythrocytes, which increases the client's risk for hypertension, blood clots, strokes, and heart attacks, especially among older adults. Dosing is based on individual client hemoglobin and hematocrit levels to ensure that just enough red blood cells are produced to avoid the need for transfusion but not to bring hemoglobin or hematocrit levels up to normal. The increased blood pressure is an indication to stop this therapy immediately.

A 33-year-old patient has recently been diagnosed with stage II cervical cancer. The nurse would understand that the patient's cancer A. Is in situ. B. Has metastasized. C. Has spread locally. D. Has spread extensively.

C. Stage II cancer is associated with local spread. Stage 0 denotes cancer in situ; stage III denotes extensive regional spread, and stage V denotes metastasis.

The registered nurse would correct the nursing student when caring for a client with neutropenia secondary to chemotherapy in which circumstance? A. Student scrubs the hub of IV tubing before administering an antibiotic. B. Nurse overhears the student explaining to the client the importance of handwashing. C. Student teaches the client that symptoms of neutropenia include fatigue and weakness. D. The nurse observes the student providing oral hygiene and perineal care.

C. Symptoms of neutropenia include low neutrophil count, fever, and signs and symptoms of infection; the student should be corrected.

A 72-year-old client recovering from lung cancer surgery asks the nurse to explain how she developed cancer when she has never smoked. Which factor may explain the possible cause? A. A diagnosis of diabetes treated with insulin and diet B. An exercise regimen of jogging 3 miles 4x/wk C. A history of cardiac disease D. Advancing age

D. Advancing age is the single most important risk factor for cancer. As a person ages, immune protection decreases.

A client's tumor was staged using the TNM system. The tumor was staged as T3 N1 M1. The nurse realizes that this staging means: A. Tumor in situ, no node involvement, metastasis. B. Medium tumor, no node involvement, presence of metastasis. C. Medium tumor, multiple nodes involvement, no presence of metastasis. D. Large tumor, lymph node involvement, metastasis

D. Large tumor, lymph node involvement, metastasis

Which of the following nursing diagnoses is most appropriate for a patient experiencing myelosuppression secondary to chemotherapy for cancer treatment? A. Acute pain B. Hypothermia C. Powerlessness D. Risk for infection

D. Myelosuppression is accompanied by a high risk of infection and sepsis. Hypothermia, powerlessness, and acute pain are also possible nursing diagnoses for patients undergoing chemotherapy, but the threat of infection is paramount.

Which assessment finding indicates to the nurse that the client is at high risk for a malignant breast lesion? A. 1-cm freely mobile rubbery mass discovered by the client B. Ill-defined painful rubbery lump in the outer breast quadrant C. Backache and breast fungal infection D. Nipple discharge and dimpling

D. Nipple discharge and dimpling are high-risk assessment findings for a malignant breast lesion.

The nurse presents a cancer prevention program to teens. Which of the following will have the greatest impact in cancer prevention? A. Avoid asbestos. B. Wear sunscreen. C. Get the human papilloma virus (HPV) vaccine. D. Do not smoke cigarettes.

D. Tobacco is the single most important source of preventable carcinogenesis.

A client diagnosed with widespread lung cancer asks the nurse why he must be careful to avoid crowds and people who are ill. What is the nurse's best response? A. "With lung cancer, you are more likely to develop pneumonia and could pass this on to other people who are already ill." B. "When lung cancer is in the bones, it becomes a bone marrow malignancy, which stops producing immune system cells." C. "The large amount of mucus produced by the cancer cells is a good breeding ground for bacteria and other microorganisms." D. "When lung cancer is in the bones, it can prevent production of immune system cells, making you less resistant to infection."

D. Tumor cells that enter the bone marrow reduce the production of healthy white blood cells (WBCs), which are needed for normal immune function. Therefore clients who have cancer, especially leukemia, are at an increased risk for infection. Other people are not at risk for becoming infected as a result of contact with a person who has lung cancer. Lung cancer that has spread to the bone is still lung cancer; it is not a bone marrow malignancy. It is true that the person with lung cancer may produce more mucus, which can harbor microorganisms, but this is not the main reason why the client should avoid crowds and people who are ill.

Cancer Staging

Describes the extent of spread of the tumor within the body from the site of origin

Oncological emergencies

Hypercalcemia Superior vena cava syndrome Tumor lysis syndrome (includes hypocalcemia) Syndrome of inappropriate antidiuretic hormone (SIADH) Spinal cord compression Pleural effusion and cardiac tamponade Anaphylaxis Septic shock Disseminated intravascular coagulation (DIC) Increased intracranial pressure

Primary tumor sites

Identified by the tissue from which it arose (parent tissue) Located in vital organs - such as brain or lungs, can grow and either lethally damage the vital organ or interfere with that organs ability to preform its vital function Other areas such as the breast, can grow but will not cuase death

Advanced Cancer effects

Immunity and clotting GI function Peripheral nerve sensory perception Central motor and sensory function Respiratory and cardiac function

Stage 0

In situ, which means "in place;" have not spread to nearby tissues; highly curable, usually by removing the entire tumor with surgery.

Progression on Smallpox

Incubation Period Prodrome Stage Macules Papules Vesicles Pustules Scabs Scars

Diagnostic tests for Cancer

Laboratory tests Radiographic tests Biopsy -Needle; stereotactic -surgical -Bone marrow aspiration Pet Scans Bronchoscopy Colonoscopy Endoscopy (EGD)

Cinnamon

Lower blood glucose SE= Cassia cinnamon contains coumarin, the parent compound of warfarin, a medication used to keep blood from clotting. Due to concerns about the possible effects of coumarin, in 2006, the German Federal Institute for Risk Assessment warned against consuming large amounts of cassia cinnamon.

What is the Most Common Route of Cancer Cell Metastasis?

Lymphatic vessels

Tumor Lysis Management

Management: prevent kidney injury, cardiac dysrhythmias; prevent with low-intensity initial treatment -Hyperuricemia: Allopurinol, rasburicase -Hyperkalemia: IV infusion of glucose plus insulin to promote redistribution of potassium from the extracellular to the intracellular space -Hyperphosphatemia: oral phosphate binders and the same solution of glucose plus insulin used for the control of hyperkalemia. Hyperphosphatemia may lead to hypocalcemia, which usually resolves as phosphate levels are corrected. -Hypocalcemia: As a rule, do not correct hypocalcemia unless evidence of neuromuscular irritability exists, as indicated by a positive Chvostek or Trousseau sign.

Melanoma

Melanoma frequently develops in a mole or suddenly appears as a new dark spot on the skin. Early diagnosis and treatment are crucial. Knowing the ABCDE warning signs of melanoma can help you find an early melanoma.

Dong Quai

Menstrual, PMS SE= Dong Quai is known to interact with and increase the activity of warfarin.

Cancer leads to death because

Metastasis Disruption of critical physiologic processes

Cervical Cancer Risks

Multiple sex partners, cigarettes, early coitus, hx STD's, HPV, immunosuppression, vitamin deficiencies

Aloe Vera

Originated from: traced back 6,000 years to Egypt Uses: topical as a gel; contains strong laxative compounds; food flavoring Effectiveness: heal superficial wounds and burns. SE =Inhibits healing of deep surgical wounds

Advanced directives

PSDA - documentation can include a DPOAHC, living will, DNR, and written advanced directives

Actinic Keratoses (AK)

People who get AKs usually have fair skin. Most people see their first AKs after 40 years of age because AKs tend to develop after years of sun exposure. AKs usually form on the skin that gets lots of sun exposure, such as the head, neck, hands, and forearms. Because an AK can progress to a type of skin cancer called squamous cell carcinoma (SCC), treatment is important.

Echinacea

Stimulate immune system, help respiratory infections se= gi issues and allergies

Emergency Severity Index

The Emergency Severity Index (ESI) is a five-level emergency department (ED) triage algorithm that provides clinically relevant stratification of patients into five groups from 1 (most urgent) to 5 (least urgent) on the basis of acuity and resource needs. The Agency for Healthcare Research and Quality (AHRQ) funded initial work on the ESI.

Bio-terrorist event

The deliberate release of germs or other biological substances that cause illness or death. Many agents must either be inhaled, enter through a cut in the skin or be eaten to cause illness. Some biological agents, such as anthrax, are not contagious. Others, like the smallpox virus, spread from one person to another.

Initiators

The mutagens that predispose cells to develop tumors

Stage 4

This stage means that the cancer has spread to other organs or parts of the body. It may also be called advanced or metastatic cancer.

Cranberry

UTI because the acidic juice will decrease the ability of bacterial growth by altering the pH

Ginseng

boost immune system/lower blood sugar SE = Headaches and sleep and GI problems; allergic reactions. Breast tenderness, menstrual irregularities, and high blood pressure People with diabetes should use extra caution with Asian ginseng, especially if they are using medicines to lower blood sugar or taking other herbs, such as bitter melon and fenugreek, that are also thought to lower blood sugar.

The client receiving chemotherapy will experience the lowest level of bone marrow activity and neutropenia during which period? A. Peak B. Trough C. Nadir D. Adjuvant

chemotherapy will experience the lowest level of bone marrow activity and neutropenia during which period? A. Peak B. Trough C. Nadir D. Adjuvant C. The lowest point of bone marrow function is referred to as the nadir. The peak of bone marrow function occurs when the client's blood levels are at their highest.Trough, which means low, is typically used in reference to drug levels.

Malignant tumor

connective tissue origin name + sarcoma. E.g., osteosarcoma Epithelial tissue origin name + carcinoma. E.g., squamous cell carcinoma Metastasis Angiogenesis

Pandemic

epidemic of infectious disease that spreads through populations across a large region; for instance, a continent, or global.

Neutropenia

grade 1 = 1500 grade 2 = less than 1000 grade 3 = under 500 Precautions - private rooms, pt wears a mask when transporting, protect from infection, restrict ill visitors, monitor WBC/vitals, educate to manage active bleeding and use bleeding precautions, avoid crowds.

Internal events; roles and responsibilities

hospital incident commander = assumes overall leadership for implementing emergency plan. ED physician or administrator. Medical Command physician = decides number and acuity and resource needs of patients. calls in specialty resources. makes decisions on who needs higher level of care. triage officer = rapid eval of each incoming person. Public info officer = designated liason to press

Kava ('awa)

insomnia/anxiety SE = Kava has been reported to cause liver damage, including hepatitis and liver failure (which can cause death). Kava has been associated with several cases of dystonia (abnormal muscle spasm or involuntary muscle movements). Kava may interact with several drugs, including drugs used for Parkinson's disease. Long-term and/or heavy use of kava may result in scaly, yellowed skin. Avoid driving and operating heavy machinery while taking kava because the herb has been reported to cause drowsiness.

malignant

invade and destroy nearby tissues and spread via metastasis.

Garlic

is an anticoagulant

End of life Meds

nausea = benadryl & others antidepressants anticonulsants corticosteroids

Benign

not cancerous; does not metastasize.

Epidemic

number of cases of an infectious agent or disease (outbreak) clearly in excess of the normally expected frequency of that disease. (ex. Flu). Spreads

Neupogen (Filgrastim)

prevent neutropenia by creating more neutrophils. Monitor labs.