Cellular Regulation

Both _______________&_______________ can cause constipation

doxorubicin & Vincristine

Warning signs of cancer

"CAUTION" Change in bowel or bladder habits A sore that does not heal Unusual bleeding or discharge Thickening or Bump in breast or elsewhere Indigestion or Dysphagia Obvious change in wart or mole Nagging cough or hoarseness UNEXPLAINED WEIGHT LOSS

**What medication is contraindicated for a patient with thrombocytopenia?**

**ASPIRIN**

What are signs and symptoms of hemolytic reactions from blood administration?

**HEMOGLOBULINURIA** **Low back pain** Hypotension Tachycardia Apprehension Chest pain Fever Chills

What is bone marrow suppression?

-caused by treatment NOT cancer -decrease in WBC, RBC, and platelets -Increased risk for bleeding

When should breast exams be done

1 Week after your period starts

What are blood administration guidelines?

2 nurse check ONLY 4 hours of administration ONLY WITH normal saline

How long should vitals be taken for a patient with blood administration?

15 AFTER start of administration 1 HOUR AFTER START of administration 30-60 minutes AFTER blood is DONE

Osteosarcoma is most common in

15 year olds LONG bones like femur

Vitals should be taken _________ minutes before blood administration

15-30 minutes MAX

Normal platelet count

150,000-400,000

Treatment for NON hodgkin's lymphoma and hodgkin's lymphoma

1ST-RADIATION 2ND-CHEMOTHERAPY

Nursing Interventions for Mucositis:

Assess mouth every 4 hours Frequent mouth care NO mouthwash NO floss or waterpik Use disposable toothbrushes Drink Fluids

**Nursing Interventions for ANEMIA**

Administer Epoetin Alpha subcutaneously once a week Transfuse 2 units of PRBC's over 4 hours Assess for shortness of breath

Normal WBC

4500-11000

How long are chemo precautions for IV MEDS necessary for

48 hours

No pregnant women should be around a chemo patient within ________ since their last chemo treatment

48-72 hours

How long are chemo precautions for ORAL MEDS necessary for

72 hours

Which of the provider's orders should be implemented immediately? A. Administer D5 1/2 NS at 125 mL/hr B. Administer clear liquid diet C. Apply support stockings D. CBC, Ca level, and basic metabolic panel

A. Administer D5 1/2 NS at 125 mL/hr FOR DEHYDRATION

The nurse is teaching a client about the risk factors associated with colorectal cancer. The nurse determines that further teaching is necessary related to colorectal cancer if the client identifies which item as an associated risk factor? A. Age younger than 50 years B. History of colorectal polyps C. Family history of colorectal cancer D. Chronic inflammatory bowel disease

A. Age younger than 50 years

A child diagnosed with lymphoma is receiving extensive radiation therapy. The MOST common side effect of this treatment is: A. Fatigue. B. Seizures. C. Neuropathy. D. Lymphadenopathy

A. Fatigue. Fatigue is the most common side effect of radiation therapy. For children the fatigue may be especially distressing because it means that they cannot keep up with their peers. Seizures are unlikely because irradiation would not usually involve the cranial area for treatment of lymphoma. Neuropathy is a side effect of certain chemotherapeutic agents. Lymphadenopathy is one of the findings of lymphoma.

Nursing considerations related to the administration of chemotherapeutic drugs include: A. Many chemotherapeutic agents are vesicants that can cause severe cellular damage if the drug infiltrates. B. Good handwashing is essential when handling chemotherapeutic drugs, but gloves are not necessary. C. Infiltration will not occur unless superficial veins are used for the intravenous infusion. D. Anaphylaxis cannot occur because the drugs are considered toxic to normal cells.

A. Many chemotherapeutic agents are vesicants that can cause severe cellular damage if the drug infiltrates. Chemotherapeutic agents can be extremely damaging to cells. Nurses experienced with the administration of vesicant drugs should be responsible for giving these drugs and be prepared to treat extravasations if necessary. Gloves are worn to protect the nurse when handling the drugs, and the hands should be thoroughly washed afterward. Infiltration and extravasations are always a risk, especially with peripheral veins. Anaphylaxis is a possibility with some chemotherapeutic and immunologic agents.

A nurse plans a community education program related to prevention of the cancer with the highest death rates in both women and men. What should the nurse include in the teaching plan? A. Smoking cessation B. Screening with colonoscopy C. Regular examination of reproductive organs D. Use of sunscreen as protection from ultraviolet light

A. Smoking cessation

Interventions for pts with Alopecia

ACKNOWLEDGE their feelings first

Sign and symptoms of Leukemia- "ANT"

ANEMIA NEUTROPENIA THROMBOCYTOPENIA bruising bleeding (nosebleeds) infection

The nurse is monitoring the intravenous (IV) infusion of an antineoplastic medication. During the infusion, the client complains of pain at the insertion site. On inspection, the nurse notes redness and swelling and that the infusion of the medication has slowed in rate. The nurse suspects extravasation and should take which actions? Select all that apply. a. Stop the infusion. b. Notify the health care provider (HCP). c. Prepare to apply ice or heat to the site. d. Restart the IV at a distal part of the same vein. e. Prepare to administer a prescribed antidote into the site. f. Increase the flow rate of the solution to flush the tissue.

ANSWER: A B C E Redness, swelling and a slowed infusion indicates signs of extravasation. If this is suspected, the infusion is stopped and the HCP is notified. Ice or heat may be prescribed for application to the site and an antidote may be prescribed to be administered into the site. Increasing the flow rate can increase tissue damage. Restarting an IV in the same vein can increase damage to site and vein

The nurse is providing medication instructions to a client with breast cancer who is receiving cyclophosphamide. The nurse should tell the client to take which action? a. Take the medication with food. b. Increase fluid intake to 2000 to 3000 ml daily. c. Decrease sodium intake while taking medication. d. Increase potassium intake while taking medication.

ANSWER: B Hemorrhagic cystitis is an adverse effect that can occur with use of cyclophosphamide. The client needs to be instructed to drink copious amounts of fluid during the administration of this medication. Clients should monitor urine for hematuria. It should be taken on an empty stomach. It can cause hyperkalemia and the client would not be instructed to alter sodium intake.

A client is starting radiation therapy for lung cancer. What should the nurse include in the patient teaching about skin care? Select all that apply. A. Wash off the radiation markings after every treatment B. Wear soft clothing over the skin at the radiation site C. Use your hand instead of a washcloth to cleanse the irradiated skin D. Dry the irradiated skin with a patting motion E. Apply any over the counter lotion to the irradiated skin

ANSWER: B C D Do not remove the ink or dye markings because they identify exactly where the beam of radiation is to be focused. Use only powders, ointments, lotions or creams on your irradiated skin that are prescribed by the radiation oncology department.

A client with ovarian cancer is being treated with vincristine. The nurse monitors the client knowing that which manifestation indicates an adverse side effect? a. Diarrhea b. Hair loss c. Peripheral neuropathy d. Chest pain

ANSWER: C An adverse effect specific to vincristine is peripheral neuropathy which occurs with almost every client. It can be manifested with tingling and numbness in the finger and toes. Depression of the Achilles tendon reflex may be the first clinical sign indicating peripheral neuropathy. Constipation rather than diarrhea is most likely. Hair loss occurs with most every antineoplastic medication. Chest pain is unrelated to this medication.

DO NOT administer Filgrastim when the WBC is _______

Above 10

When should a testicular self-examination be performed and how?

After showers-2 hands rolling motion-feeling for bumps

Characteristics of hodgkin's lymphoma

Age 10-30 Reed sternberg cells Increased cure rate

Characteristics of NON hodgkin's lymphoma

Age 60-70 NO reed sternburg cells MEN and older adults RAPID ONSET LESS differentiated

What are types of blood transfusion reactions?

Allergic Febrile Hemolytic

Chemotherapy can cause

Alopecia Bone marrow suppression Nausea & vomiting GI upset

What drug is considered a oral aromatase inhibitor?

Anastrozole

Which of the following are side effects of chemotherapy? Select all that apply. a. Alopecia b. Thrombocytopenia c. Increased appetite d. Sleep disturbances e. Forgetfulness

Answer: A B D E Alopecia (loss of hair), thrombocytopenia (decreased numbers of platelets), sleep disturbances and forgetfulness (chemo brain) are all common side effects. Chemotherapy causes a patient to have a decreased appetite not an increased appetite due to nausea and vomiting.

The nurse and an unlicensed assistive personnel (UAP) are caring for a client in neutropenic precautions. Which action by the UAP requires further teaching by the nurse? a. The UAP washes her hands before entering and leaving the patient room. b. The UAP enters the patient room with a basket of fresh fruit. c. The UAP enters the patient room without wearing a mask or gown. d. The UAP stops a sick visitor from entering the patient room.

Answer: B No fresh fruits or flowers should be taken into the room of a neutropenic patient because they can carry bacteria on them. A neutropenic client is at a higher risk for infection.

The nurse suspects that a child is having an adverse reaction to a blood transfusion. The FIRST action by the nurse should be to: A. notify the physician. B. take vital signs and blood pressure and compare them with baseline. C. dilute infusing blood with equal amounts of normal saline. D. stop the transfusion and maintain a patent intravenous line with normal saline and new tubing.

Answer: D These actions should be performed after the blood transfusion is stopped and infusion of normal saline has begun. Blood should not be diluted; it should be returned to the blood bank if an adverse reaction has occurred. This is the priority nursing action. If an adverse reaction is occurring, it is essential to minimize the amount of blood that is infused.

**Nursing Interventions for Thrombocytopenia**

Avoid IM injections and venipunctures Transfuse platelets STAT Use a soft toothbrush Use only electric razor Administer docusate PO every day Assess for sudden onset of change in level of consciousness (Risk for brain bleed) Assess stools for bleeding DO NOT take aspirin DO NOT blow your nose forcefully or cough hard Monitor for petechiae AVOID RECTAL SUPPOSITORIES

What should the nurse avoid doing with a patient with a Wilm's tumor?

Avoid palpating

A patient with acute myelogenous leukemia is starting chemotherapy. When teaching the patient about the induction stage of chemotherapy, what is an appropriate statement? A. "The drugs are started slowly to minimize side effects." B. "You will be at increased risk for bleeding and infection." C. "High doses will be administered every day for several months." D. "Most patients have more energy and are resistant to infection."

B. "You will be at increased risk for bleeding and infection." Rationale: Induction is aggressive treatment that seeks to bring about remission by the destruction of leukemic cells. During induction therapy, the bone marrow is severely depressed by the chemotherapy agents, and neutropenia, thrombocytopenia, and anemia may occur. High-dose chemotherapy is administered immediately after the induction phase.

The nurse is instructing a client to perform a testicular self examination. The nurse should provide the client with which information about the procedure? A. To examine the testicles while lying down B. Best time for the examination is after a shower C. Gently feel the testicle with one finger to feel for a growth D. That testicular self examination should be done at least every six months

B. Best time for the examination is after a shower

A child is status post-hematopoietic stem cell transplantation (HSCT) and is preparing for discharge home. Based on the nurse's knowledge of HSCT, which concepts are important to include in the discharge teaching plan of care? (Select all that apply.) A. Preparing the child to return to school within 6 weeks B. Keeping the child on a high-calcium diet C. Avoiding live plants and fresh vegetables D. Avoiding influenza vaccinations E. Practicing good hygiene

B. Keeping the child on a high-calcium diet C. Avoiding live plants and fresh vegetables E. Practicing good hygiene Children should have a diet high in calcium or be placed on calcium supplements to reduce the risk of osteopenia. Live plants and fresh vegetables should be avoided because they carry bacteria. Practicing good hand hygiene is essential to prevent the spread of infection. Children cannot return to school for 6 to 12 months after HSCT. Either in-hospital or home schooling is required. Children and their families should be encouraged to get a yearly influenza vaccination.

An ANC of ______________ has a high risk of infection

BELOW 500

Packed RBC will be administered for patients with a hemoglobin _________

BELOW 7

What is the difference between benign and malignant tumors?

Benign-abnormal cells with excessive growth not capable of metastasis Malignant-abnormal growth patterns and ability to disseminate to distant sites

What is an oral aromatase inhibitor do?

Blocks the production of estrogen

Anastrozole can cause ______side effects:

Bone fractures and Osteoporosis

What is a kind of biopsy?

Bone marrow aspiration

Internal radiation is also known as

Brachytherapy

Nursing care of the child with myelosuppression from leukemia or chemotherapeutic agents should include: A. Restricting oral fluids. B. Instituting strict isolation. C. Using good handwashing. D. Giving immunizations appropriate for age.

C. Using good handwashing. There is no indication that fluids should be reduced. Strict isolation is not necessary. Good handwashing is the most effective means of preventing disease transmission. The child should not receive any live vaccines. The immune system is not capable of responding appropriately to the vaccine.

What is used to diagnose Wilm's tumor?

CT scan

What diagnostics are for Ewing Sarcoma

CT scan FIRST Bone Biospy

NON hodgkin's lymphoma and hodgkin's lymphoma places where it can develop

Cervical Axillary Groin Neck

What is the 3 common treatment plans for cancer?

Chemotherapy Radiation Surgery

Acute Lymphocytic Leukemia (ALL) is more common in________

Children

What is needed before blood administration?

Consent

Care needed for a bone marrow biopsy

Consent Inform pt that it is painful Hold pressure on site Monitor for infection Monitor for anesthesia complications Monitor for fluid loss **Premedicate with a benzodiazepine (Lorazepam) TIMEOUT

In DIC ____________ will be _____________

D-Dimer will be elevated

Community health nurse is instructing a group of young female clients about breast self examination. The nurse should instruct the client to perform the examination at which time? A. At the onset of menstruation B. Every month during ovulation C. Weekly at the same time of day D. 1 week after menstruation begins

D. 1 week after menstruation begins

What is a major sign of Wilm's tumor?

DISTENDED STOMACH

Why would a patient with cancer need knee-high support stockings?

DVT prevention Chemotherapy increases the patients risk of developing a DVT

What is Thrombocytopenia?

Decreased RBC & Decreased Platelets

What is anemia?

Decreased RBC and Decreased Hgb

What is Neutropenia?

Decreased WBC and Decreased ANC (BELOW 500)

What is given to patients 30 minutes before a blood transfusion to prevent a febrile reaction?

Diphenhydramine and Acetaminophen WITH ORDERS

Chemo precautions for ORAL MEDS

Double flush toilet Double glove Double-check w/another nurse

Chemo precautions for IV MEDS

Double glove or Chemo gloves Eye Protection Mask Gown

Anastrozole is used to treat

ER-positive Breast Cancer

Interventions for GI disturbances:

Fluids **DOCUSATE SODIUM** Increase Fiber Increase Cruciferous vegetables (broccoli, cauliflower, Brussel sprouts)

What are signs and symptoms of allergic reactions from blood administration?

Facial flushing Hives/Rash Severe-Increased anxiety-Wheezing-Hypotension

What are signs and symptoms of febrile reactions from blood administration?

Fever Chills Anxiety Headache Tachycardia Tachypnea

If a patient is at a increased risk for infection what is most important for the patient and the nurse to do?

GOOD hand washing

Peripheral neuropathy can be treated with ______ or _________

Gabapentin Pregabalin

Phantom limb pain medications that we would administer

Gabapentin Pregabalin (Lyrica)

Nursing care needed for a bone marrow aspiration?

Hold pressure after for 5-10 minutes Monitor for bleeding and infection

What labs will be effected for a patient with Ewing Sarcoma

INCREASED Alkaline Phosphatase INCREASED calcium (from bursting and going into blood)

A dosimeter radiation badge is needed with_____________

INTERNAL radiation

Bone Marrow Transplant how it works

Increase chemo and radiation before administration to kill all cells then give new bone marrow to allow good cells to regenerate

What is a big red flag as a complication from blood administration?

Increased temperature even 2 degrees

What is filgrastim?

Increases the WBC in a Neutropenic patient

A temperature of 100 or greater with a patient with cancer put them at risk for ______

Infection

**Nursing Interventions for neutropenia**

Inspect IV sites every 4 hours for signs of infection No fresh flowers, raw food, fruit baskets in the room Administer Filgrastim subcutaneously once a week Avoid crowds and sick people Assess for sudden onset of change in the level of consciousness (FOR SEPSIS) Place in reverse isolation Monitor ANC count DO NOT eat yogurt, paprika, pepper, lunch meat, and soft cheeses

Cancer patients receiving ________ radiation should not be around pregnant women

Internal radiation (Brachytherapy)

You want to give a suppository to a patient receiving __________

Internal radiation (Brachytherapy)

Internal Radiation uses __________ medication

Iodine 131

Separation anxiety signs

Isolating selves Regression

What is a bone marrow aspiration most likely to diagnose?

Leukemia

Adverse side effects of Doxorubicin:

Loss of appetite Bone marrow suppression Nausea & Vomiting Risk for bleeding Risk for infection Changes in color of urine Nail beds darkening Photosensitivity (avoid sun)

What vaccines are live vaccines?

MMR Varicella and NASAL flu

Normal Hgb range

Male: 14-18 g/dL Female: 12-16 g/dL

Normal RBC count

Male: 4.7-6.1 Female: 4.2-5.4

Normal Hct range

Male: 42-52% Female: 37-47%

What would you teach a patient with stomatitis?

Mouthwash with normal saline

Side Effects of Cyclophosphamide that STAND OUT:

Mucositis Hemorrhagic Cystitis Changes in skin color and fingernails

Children may _________ admit they have pain

NOT

Narcotics are _________ for children

NOT

What is Ondansetron (Zofran) given for?

Nausea

Adverse side effects of Cyclophosphamide:

Nausea & Vomiting Decreased appetite Weight loss Abdominal pain Diarrhea Hair loss **Mucositis** Changes in skin color & fingernails **Hemorrhagic cystitis**(blood in urine) Bone Marrow Suppression

Vincristine is most often used for

Non-hodgkin's, Hodgkin's, Acute lymphocytic leukemia or acute myelocytic leukemia

Why would D5 1/2 NS be prescribed for a cancer patient with vomiting and dehydration?

Normal saline is less harsh on the GI system

Chronic Lymphocytic Leukemia (CLL) is more common in ________

Older adults

What antiemetics can be given before chemotherapy?

Ondansetron (Zofran) Promethazine Famotidine (pepcid) Haloperidol

What are some risk factors for cancer?

Overweight Sedentary lifestyle Age Lack of physical activity Limited finances Limited health care coverage Family history

Non-Hodgkin's Lymphoma signs and symptoms

PAINLESS enlarged lymph nodes

Hodgkin's Lymphoma signs and symptoms

PAINLESS enlarged lymph nodes Fever night sweats Fatigue Unintentional weight loss

Sign and symptoms of Ewing Sarcoma

Pain Swelling Low grade fever

What is a common side effect of vincristine?

Peripheral neuropathy Constipation

Side Effects of Doxorubicin that STAND OUT:

Photosensitivity Changes in color of urine Nail beds darkening

What teaching is necessary for a 16 year old with cancer?

Plan time for school Encourage visitors from peers

Nursing interventions for Nausea & Vomiting

Premedicate with: Ondansetron (Zofran) or Promethazine or Famotidine (pepcid) or steroids

What is important to do when a patient is at risk for bone marrow suppression?

Preventing infection by HANDWASHING

Which of the following are side effects of Doxorubicin? Select All That Apply. A. Bone Marrow Suppression B. Nausea & Vomiting C. Hemorrhagic Cystitis D. Mucositis E. Photosensitivity

Rationale: A-B-E Bone Marrow Suppression, Nausea & Vomiting, and Photosensitivity are all side effects of Doxorubicin. Hemorrhagic Cystitis and Mucositis are specific side effects of Cyclophosphamide (Drug class: Alkalating agent)

What discharge teaching is necessary for a child post op from a post hematopoietic stem cell transplantation (BONE MARROW TRANSPLANT)?

Return to school in 6-12 months HIGH calcium diet Avoid live plants and fresh vegetables Take flu vaccines Good handwashing

What is ruled out before a diagnosis of Ewing Sarcoma

Rule out trauma and infection

How long should the nurse stay in the patients room for blood administration?

STAY for 15 minutes CAN NOT LEAVE FOR ANYTHING

What should you do if their is a reaction to blood?

STOP infusion-DO NOT START NS Vitals Call HCP Start NEW NS Don't get rid of blood

How is cancer prevented/teaching along with it?

Smoking cessation Sunscreen Decrease alcohol consumption Limit sexual partners (cervical cnacer) Removal of moles the use of aspirin and celecoxib (Celebrex) to reduce the risk for colon cancer Vaccines- Gardasil and Cervarix ANNUAL SCREENINGS

Neutropenic precautions for the nurse

Strict hand washing Mask on patient when leaving room NO MASK UNLESS NURSE IS SICK Own vitals machine NO children under 14 or sick children

Complications of NON hodgkin's lymphoma and hodgkin's lymphoma

Superior vena cava syndrome

External Therapy is also known as

Teletherapy

The more distal the prognosis of Ewing Sarcoma ________

The better the prognosis

metastasis

The spread of cancer cells beyond their original site

Is an order for blood draws and IV fluids needed when a patient has a port?

YES ALWAYS NEEDS AN ORDER FOR EACH INDIVIDUALLY

Constipation is commonly caused by what medication?

Vincristine

What is important teaching for patients taking vincristine?

Water temperature checks Check feet daily

How is a bone marrow aspiration done?

a small incision in the skin, then inserts a hollow needle through the bone and into the bone marrow. Using a syringe attached to the needle, a sample of the liquid portion of the bone marrow is withdrawn

A client is admitted to the hospital with a suspected diagnosis of Hodgkin's disease. Which assessment finding would the nurse expect to note in the client? a. Enlarged lymph nodes b. Fatigue c. Weight gain d. Weakness

a. Enlarged lymph nodes Hodgkin's disease is a chronic progressive neoplastic disorder of lymphoid tissue characterized by the painless enlargement of lymph nodes with progression to extra lymphatic sites, such as the spleen and liver. Weight loss is most likely to be noted. Fatigue and weakness may occur but are not related significantly to the disease.

After a donor has bone marrow harvested, the nurse should monitor the donor for the following except? a. Signs of infection b. Fluid overload c. Bleeding at donor site d. Anesthesia complications

b. Fluid overload The donor and donor site should be monitored for infection, anesthesia complications and bleeding. The donor needs to be monitored for fluid loss not fluid overload.

Radiation

beam that kills cells

PAN culture

blood, urine, sputum

Ewing sarcoma is

bone cancer rare after 30 NOT as common but more malignant MORE often in men

Early menses increases the risk of

breast cancer

During treatment with doxorubicin (Adriamycin), the nurse must monitor closely for which potentially life-threatening adverse effect? a. Nephrotoxicity b. Peripheral neuritis c. Cardiomyopathy d. Ototoxicity

c. Cardiomyopathy

Increased calcium can cause

cardiac rhythm changes

Ewing sarcoma is most common in the

femur tibia ulna humerus pelvis

Interventions for anorexia

foods like mashed potatoes-mac and cheese-smoothies AVOID spicy foods

Y-tubing steps

for blood administration Prime tubing w/NS Clamp NS Prime blood Blood time doesn't start until it hits patient

Osteosarcoma is most commonly confused with

growing pains

sodium polystyrene sulfonate is used to treat

hyperkalemia

Acute Lymphocytic Leukemia (ALL)

immature lymphocytes predominate

Extravasation

infiltration of drugs into tissues surrounding the infusion site

Chronic Leukemia

is BETTER because it grows SLOWER

Acute Leukemia

is WORSE because it grows FASTER

Stump care

keep elevated prone leg

Increased WBC indicates

leukocytosis

SIADH is a complication from

lung cancer

Are immunocompromised patients and parents allowed to receive live vaccines?

no!

_________ is normal in younger cancer patients

regression

Pain management for infants

skin to skin (kangaroo care) Pacifier

Dosimeter radiation badge measures

time distance shield

Hyperkalemia can cause

tumor lysis syndrome