Cancer/ Immunology
fibromyalgia causes (4 bolded)
*Infections*: Prior illnesses may trigger fibromyalgia or make symptoms of the condition worse *Genetics*: *Trauma*: People who experience physical or emotional trauma may develop fibromyalgia. The condition has been linked with post-traumatic stress disorder *Stress*: Like trauma, stress can create long-reaching effects your body deals with for months and years. Stress has been linked to hormonal disturbances that could contribute to fibromyalgia
Nursing Intervention: Internal Radiation (8)
*Place client in private room or isolation room* *Place sign on door* *Wear a dosimeter film badge* *Limit visiting to 30 minutes and maintain a distance of 6 feet* *No pregnant or children under age of 18* *Wear lead apron for care* *Follow facility protocol for removal of dressings, and linens* *Teach client about implants, elimination, and precautions*
Infection
*Prevention and prompt treatment of infection is essential in patients with cancer* Typical signs of infection (swelling, redness, drainage, and pain) may not occur in myelosuppressed patients because of decreased circulating WBCs and a diminished local inflammatory response
Radiation Therapy
*Second most common treatment, radiation therapy, or radiotherapy, uses high-energy ionizing radiation to kill cancer*. Two types: *External: does not cause client to become radioactive* *Internal: causes bodily fluids to be contaminated* *Limit exposure: isolate, limit visitors, use caution*
Tumor Staging and Grading
*Staging: determines size of tumor, existence of metastasis* TNM T: extent of primary tumor N: lymph node involvement M: extent of metastasis *Grading: classification of tumor cells* The degree of DIFFERENTIATION Stage 1- Low grade Stage 4- high grade
Drugs used in chemotherapy are called
*antineoplastics* because they inhibit the growth and reproduction of malignant cells *Chemotherapy is the treatment of choice for metastatic cancers*. It is also the treatment most responsible for increasing cancer cure rates in recent years.
Cachexia 2
*•Cachexia, a state of malnutrition and protein (muscle) wasting occurs in conjunction with lung, pancreatic, stomach, bowel, and prostate cancers, but rarely with breast cancer* •*In some cases, untreated cachexia is the cause of death*
Primary and Secondary Prevention
*•Primary prevention: interventions that keeps a cancerous process from ever developing and includes health counseling, education, environmental controls, and product safety* •*Secondary prevention: involves detection, screening to achieve early diagnosis, intervention*
s/s tumor lysis syndrome
- Depend on the extent of metabolic abnormalities. - Neurologic: fatigue, weakness, memory loss, AMS, muscle cramps, tetany, numbness and tingling, seizures - Cardiac: elevated BP, shortened QT complex, widened QRS waves, altered T waves, dysrhythmias, cardiac arrest - Renal: flank pain, oliguria, anuria, renal failure, acidic urine pH. - GI: anorexia, n/v, abdominal cramps, diarrhea, increased bowel waves - Other: gout, malaise, pruritis Diagnostic: - Electrolyte imbalances identified by serum electrolye and UA - EKG to detect cardiac dysrhythmias Medical management: - Prophylactic IV, Allopurinol, IV hydration - loop diuretic if UO isn't sufficient
Signs and symptoms: renal cancer
- Many renal tumors produce no symptoms and are discovered on a routine physical exam as a palpable abdominal mass. - s/s which only occur in 10% of patients include ν hematuria: painless, can be intermittent and microscopic or continuous and gross ν a mass in the flank ν pain in the back from the pressure produce by compression of the ureter, extension of the tumor into the perinreanl area, or hemorrhage into the kidney tissues. ν Colicky pain occur if a clot or mass of tumor cell passes down the ureter - Symptoms from metastasis ν Unexplained weight loss ν Increasing weakness ν Anemia
s/s of lung cancer
- Usually asymptomatic until late in its course - s/s depends on location, size, and degree of obstruction - THE MOST FREQUENT SYMPTOM OF LUNG CANCER IS COUGH OR CHANGE IN A CHRONIC COUGH starts at dry persistent without sputum production. Obstruction of airway can cause the cough to become productive due to infection - Dyspnea is prominent in patients early in their disease. - Hemoptysis or blood tinged sputum - Chest or shoulder pain - Fever in some patients
s/s spinal cord compression
- back pain 1st s/s - local inflammation, edema, venous stasis, and impaired blood supply to nervous tissue - neck pain - pain exacerbated by movement, supine recumbent position, coughing, sneezing, or the Valsalva maneuver - neuro deficits, weakness - neurologic dysfunction and related motor and sensory deficits (numbness, tingling, and feelings of coldness in the affected area, inability to detect vibration. Loss of positional sense) - motor loss ranging from subtle weakness to flaccid paralysis - bladder and or bowel dysfunction depending on level of compression
Signs and symptoms: Hypercalcemia
- fatigue - weakness - confusion - decreased level of responsiveness - hyporeflexia - nausea - vomiting - constipation - ileus - polyuria - polydipsia - dehydration - dysrhythmias
Fibromyalgia: (3 bolded treatment)
Chronic pain syndrome that involves chronic fatigue, generalized muscle aching, stiffness, sleep distrubances and functional impairment often have other rheumatologic conditions. Neurogenic. Treatment: *Pain relievers*: Your doctor may recommend over-the-counter pain relievers, such as ibuprofen (Advil) or acetaminophen (Tylenol). Prescription versions, such as tramadol (Ultram), maybe be used in extreme cases. They're used sparingly to reduce the risk of side effects and dependence *Antidepressants*: Antidepressants, such as duloxetine (Cymbalta) and milnacipran (Savella), are sometimes used to help treat anxiety or depression associated with fibromyalgia. These medicines may also help improve sleep quality *Antiseizure drugs*: Gabapentin (Neurontin) was designed to treat epilepsy, but it may help reduce symptoms in people with fibromyalgia. The U.S. Food and Drug Administration also approved pregabalin (Lyrica) for the treatment of fibromyalgia NSAIDS.
Tumor Lysis syndrome:
Hyperkalemai, hyperphosphatemia (hypocalcemia) hyperricema: myocardium Affects all systmes. Hydration very important. Sodium bicarbonate. Diursis Allopurinol hypertonioc dextrose and regular insulin. Hemodialysis . - Depend on the extent of metabolic abnormalities. - Neurologic: fatigue, weakness, memory loss, AMS, muscle cramps, tetany, numbness and tingling, seizures - Cardiac: elevated BP, shortened QT complex, widened QRS waves, altered T waves, dysrhythmias, cardiac arrest - Renal: flank pain, oliguria, anuria, renal failure, acidic urine pH. - GI: anorexia, n/v, abdominal cramps, diarrhea, increased bowel waves - Other: gout, malaise, pruritis
tumor lysis syndromd
Hyperkalemai, hyperphosphatemia (hypocalcemia) hyperricema: myocardium Affects all systmes. Hydration very important. Sodium bicarbonate. Diursis Allopurinol hypertonioc dextrose and regular insulin. Hemodialysis . Occurs following radiation, biotherapy, or chemotherapy Occurs when tumor cells release their contents, leading hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia Can progress to clinical toxic effects, including renal insufficiency, cardiac arrhythmias, seizures, and death due to multiorgan failure.
Secondary Prevention: Nursing
Identification of patients at high cancer risk Cancer screening *Self-breast exam* *Self-testicular exam* *Screening colonoscopy* *PAP test* Public, patient education
Anaphylaxis:
IgE antibodies. Emergenkcy. Penicillin big cause. Foods, medications, insect sting nd latex. Multipe organ systems. Faster the onset the more sever the reaction. Emergency kit with Epinephrine. Medical identifiers. Immunotherapy after bug sting. CPR oxygen epinephrine, IV. At risk patines: older, hypertension, arteriopathies ischemic heart disease. *Antihistamines and corticosteroids* may also be administered. Shock, cardiac arrest, does NOT cause hypertension.
Factors Contributing to Infection (4 bolded)
Impaired skin, mucous membrane integrity *Chemotherapy* *Radiation therapy* Biologic response modifiers Malignancy *Malnutrition* Medications Urinary catheter *Intravenous catheter*
Cancer in general
In 2011, more than 1.5 million Americans were diagnosed with cancer affecting various locations within the body *Cancer is second only to cardiovascular disease as a cause of death in the United States*
Ra remissions
In most patients, the disease follows an intermittent course and allows normal activity However, 10% of patients suffer total disability from severe articular deformity and associated extra-articular symptoms, or both Prognosis worsens with the development of nodules, vasculitis, and high titers of rheumatoid factor (RF) Joint deformities In advanced rheumatoid arthritis, marked edema and congestion cause spindle-shaped interphalangeal joints and severe flexion deformities
Nonhodgkins lymphoma
Involve malignant B lymphocytes and T lymphocytes In contrast to Hodgkin lymphoma the lymphoid tissues involved are largely infiltrated with malignant cells. The spread of these malignant lymphoid cells occurs unpredictably and true localized disease is uncommon.
GOUT:
Most common form of inflammatory arthritis. Men more liekely to get it. Hyperuricemia (increased serum uric acid) can cuause urate crstal deposition. TOPHi. Great toe, hands and ear. Kidney stones can devolp Manifestations: acute gouty arthritis, tophi grouty nphropathy, uric and urinary calculi. Abrupt onset often occurs at night, awakening the patient with server pain, reness swelling and warmth of the affected joint. Definite diagnosit: polarized light microscopy of the synovial fluid of the involved joint. Uric acid crystals are seen within the polmorphonclear leukocytes in the fluid. Avoid purine rich foods.(alcohol. meats) Weight loss decreasing alcohol consumption and avoiding certain medication.s
Diagnostic RA
Positive RF test occurs in 75% to 80% of patients (as indicated by a titer of 1:160 or higher) Synovial fluid analysis usually shows increased volume and turbidity but decreased viscosity and complement (C3 and C4) levels, with WBC count possibly exceeding 10,000/μ l Serum globulins are elevated ESR is elevated Complete blood count shows moderate anemia and slight leukocytosis
Hodgkin's lymphoma
Rare malignancy w/ high cure rate. REED-STERNBERG CELL
Primary Prevention: Nursing
Teach client: *Avoid known carcinogens* *Lifestyle, dietary changes to reduce cancer risk* *Public, patient education*
True or False? Malignant tumors spread by way of blood and lymph channels to other areas of the body.
True
Typical signs of infection (swelling, redness, drainage and pain) may not occur in myelosuppressed patients because of decreased circulating WBC's and a diminshed local inflammatory response. True or false
True
Diagnostics fibromyalgia
Updated guidelines recommend that a diagnosis be made if you experience an ongoing, widespread pain for three months or longer. This also includes pain that has no identifiable cause related to any other conditions There isn't a lab test that can detect fibromyalgia. Instead, blood testing may be used to help rule out other potential causes of chronic pain *PTSD* can trigger it
Electrolyte imbalnces in Tumor lysis sydnome include: a. Hyperkalemia b. Hypernatremia c. Hypochloremia. d. All of the above .
a. Hyperkalemia
Nursing interventions related to the management of cancer related anorexia include: (Choose all that apply) a. Position the patient to enhance gastric emptying b. Assess for constipation and/ or intenstinal obstruction c. Offer a wide vareity of foods wtih low calories density d. Administer and assess effects of prescribed treatments for n/v and delayed gastric emptying.
a. Position the patient to enhance gastric emptying b. Assess for constipation and/ or intenstinal obstruction d. Administer and assess effects of prescribed treatments for n/v and delayed gastric emptying.
The nurse determines a key priority in management of tumor lysis syndrome is (choose all that apply) a. Serum electrolyte analyis b. EKG monitoring c. Constipation prevention d. Seizure precatutions
a. Serum electrolyte analyis b. EKG monitoring d. Seizure precatutions
The nurse determines the priority nursing management in treatment of spinal cord compression includes: a. steroid administration b. antibiotic therapy c c.Radiation tehrapy d. Beta blocker administration
a. steroid administration
Neutropenia
an abnormally low absolute neutrophil count (ANC), is associated with an increased risk of infection As the ANC declines below *1,000* cells/mm3, the risk of infection rises *Nadir is the lowest ANC after myelosuppressive chemotherapy, targeted therapy, or radiation therapy that suppresses bone marrow function*
The nurse recognizes signs and symptoms of superior vena cava syndrome include: a. Lower extremity edema b. increased urien output c. Edema of the neck, arms, hands , thorax, and stridor d. Nausea
c. Edema of the neck, arms, hands , thorax, and stridor
The nurse recognizes a priority intervetnino postoperative nephrectomy related to renal cell carcinoma a. daily weights b. abominal girth measurements c. pain management d. Administration of erythopoietin stimulating agents.
c. pain management
Hypercalcemia
calcium released from the bones is more than the kidneys can excrete or the bones can reabsorb. s/s: fatigue, weakness, confusion, decreased level of responsiveness, hypreflexia, n/v/ c, ileus polyuria polydipsia dehydration and dysrhythmias Hypercalcemia is potentially life-threatening metabolic abnormality resulting when the calcium released from the bones is more than the kidneys can excrete or the bones can reabsorb. May results from production of cytokines, hormonal substances, and growth factors by cancer cells, or by the body in response to substances produced by cancer cells; which lead to bone breakdown and calcium release. Most commonly seen in breast, lung, and renal cancers; myeloma; and some types of leukemia.
Lymphoma:
come from lymph nodes. Hodgkin Lymphona: high cure rate. First degree relatives. Uicentric. Reed-Sternberg cell gigantic tumor cella. Epstein Barr virus. ESR erythrocyte sedimentation rate. CBC EsR, bone marrow biopsy CT x-ray PET scan. Palpable lymph node chains. Prolonged remissions Long-term surveillance is crucial. Non Hodkin Lymphomas: Largley infiltrated with malignant cells.
The nurse understands that cancer related cachexia is associated with cytokines produced by the body to in response to a tumor to a complex inflmmatory-immune response present in patients whose tumors have metasasized and causes: a. anorexia b. weight loss c. alterations in metabolism d. all of the above.
d. all of the above.
Gout follows an
intermittent course and commonly leaves patients symptom-free for years between attacks It can lead to chronic disability or incapacitation and, rarely, severe hypertension and progressive renal disease Prognosis is good with treatment Cause of primary gout remains unknown, it appears to be linked to a genetic defect in purine metabolism, which causes hyperuricemia (overproduction of uric acid), retention of uric acid, or both
Hypercalcemia is commonly seen in breast, lung and renal cancer, myeloma and some types of leukemia true or false
true
True or False the most common cause of bleeding in cancer patients is thrombocytopenia
true
In gout
urate deposits lead to painfully arthritic joints It can strike any joint but occurs most commonly in the feet and legs Primary gout usually occurs in men age 30 and older and in postmenopausal women
cytotoxic drugs
which kill immunocompetent cells
adrenergics
which stimulate the sympathetic nervous system
7 signs of cancer C-A-U-T-I-O-N
*C*hange in bowel or bladder habits *A* sore that does not heal *U*nusual bleeding or discharge *T*hickening or lump in the breast, testicles, or elsewhere *I*ndigestion or difficulty swallowing *O*bvious change in the size, color, shape, or thickness of a wart, mole, or mouth sore *N*agging cough or hoarseness
Malignant Process
*Cell proliferation: uncontrolled growth with ability to metastasize and destroy tissue, and cause death* Cell characteristics: presence of tumor-specific antigens, altered of shape, structure, metabolism Metastasis: Lymphatic spread Hematogenous spread
Benign Tumors
*Cell well-differentiated cells resemble normal cells of the tissue from which the tumor originated* *Tumor grows by expansion and does not infiltrate the surrounding tissues; usually encapsulated* Rate of growth is usually slow, does not spread by metastasis Does not usually cause death unless its location interferes with vital functions
Malignant Tumors
*Cells are undifferentiated* *Grows at the periphery and overcomes contact inhibition to invade and infiltrate surrounding tissues* Gains access to the blood and lymphatic channels and metastasizes to other areas of the body Usually causes death unless growth can be controlled
Chemotherapy
*Chemo goal is to kill cancer outright and or to inhibit growth of cancer cells* *-primary chemo is expected to control or cure the cancer; can be given acute or long term control* *-adjuvant chemo complements another therapy; for example, chemo to reduce a tumor can make surgery more effective.* *-palliative chemo can be used to slow tumor growth for pain control and symptom relief*
Definition of Cancer:
*Disease process that begins when abnormal cell is transformed by genetic mutation of cellular DNA* Metastasis: abnormal cells have invasive characteristics, infiltrate other tissues Malignant cancer cells: demonstrate uncontrolled growth that does not follow physiologic demand
fibromyalgia risks (3 bolded)
*Gender*: *Women* account for between 80 and 90 percent of all fibromyalgia cases. The reason for this isn't known *Family history*: If you have a family history of the condition, you may be at a greater risk for developing it *Disease*: Although fibromyalgia isn't a form of arthritis, having a rheumatic disease like lupus or rheumatoid arthritis may also increase your risk
Thrombocytopenia;
; decrease in the circulating platelet count. Less than 100,000. Often results fromfrom bone marrow depression. Enlarged spleen. hep b and c can cause. Early sign watch for : petechial and ecchymoses. May administer IL-11
Nursing consideration with Cachexia
Nursing considerations: - Educate about side effects of treatment - Monitor lab data (albumin, ferritin, transferrin) - Encourage oral hygiene (mild mouth wash and rinse, soft toothbrush) - Encourage food preference - Encourage supplemental drinks and snacks - Collaborate with dietary services
Gout management
Analgesics, such as acetaminophen (Tylenol) or ibuprofen (Motrin), relieve the pain associated with mild attacks Acute inflammation requires concomitant treatment with oral *colchicine* (Colcrys) at the first sign of a gout flare *Indomethacin* (Indocin) in therapeutic doses may be used instead but are less specific Resistant inflammation may require *corticosteroids* or I.V. drip or I.M. corticotropin or joint aspiration and an intra-articular corticosteroid injection
Tophi management
Apply hot or cold packs to inflamed joints Unless contraindicated, urge the client to drink plenty of fluids (up to 2 qt [2 L] per day) to prevent calculi formation Monitor serum uric acid levels regularly Alkalinize urine with sodium bicarbonate or another agent if ordered Watch for acute gout attacks that may occur 24 to 96 hours after surgery Even minor surgery can precipitate an attack. Before and after surgery, administer colchicine as ordered to help prevent gout
Pain
Approximately 60% to 90% of all individuals with progressive malignancy will experience pain *Pain usually does not occur until advanced stages of disease* Most common causes are metastatic bone disease, venous or lymphatic obstruction, or nerve compression
Rheumatoid Arthritis:
Autoimmune disease sex hormones may be linked. S/S: Early: symmetric join pain and morning joint stiffness lasting longer than 1 hour. Over time: symmetric joing pain, swelling, warmth, erythema, lack of function. Palpation of the joints revelas spongy or boggy tissue. Fluid can be aspirated fromth e inflamed joing. Starts at small joints of the hands, wrists and feet. Mkoves to knees shoulders hips elbos ankles, cervical spine and temporomandibular joints are affected. Raynauud's pheomonem. RF factor big indication. ESR and CRP elevated. ANA may be positive. Goal: decrease joing pain and swelling , achieve clinical remission, decreae the likelihood of joint deformity and minimize disability. Ttreatment: NSIDS *SMArD* Arthopasty. Surgical repair and replacement of the joint. Get good nutrition.
SLE
Autoimmune disease that affects nearlyi every organ in the body. Fight antibodies in body. Genetic, immunologic, hormonal and environmental. S/S: fever, malise, weith loss and anorexia. Butterfly-shaped erythematous rahs across the bridge of the nose and cheeks. Discoid rash. Provoked by sunlight or artificial UV light. Joint swelling , tenrerall and pain on movement. Pericarditis. Nephritis. Psychosis, cognitive impairment, sizures , peripheral and cranial neuropathies transvers eyelitis and strokes. ANA. Therapy: NSAIjD, corticosteroids, antimalarial agesnts and cytotoxic ageents Belimumab
Which specific agents or factors are associated with the etiology of cancer? a. Dietary and genetic factors b. Hormonal and chemical agents c. Viruses d. All of the above
d. All of the above
S/S of hypercalcemia include: a. Dysrythmias b. Fatigue and weakness c. n/v d. all of the above.
d. all of the above.
Cancer Diagnosis
BIOPSY: *The most definitive* CT, MRI: Tumor Markers is a biomarker found in blood, urine, or body tissues that can be elevated by the presence of one or more types of cancer
Breast Cancer:
BRCA1 BRCA 2. Once treated for breast cancer, the risk of developing breast cancer in same or opposite breast is signifcanlty increased. Hormonal factors: Estrogen. Mastectomy. S/S: Usually found in upper outer quandratn. Lesions are non-tender, fixed rather than mobile and hard ith irregular borders. Complaints of diffuse breast pain and tenderness with menstruation are usually associated with benigh breast disase. ALND prognostic
fibromyalgia trigger points
Back of the head Tops of shoulders Upper chest Hips Knees Outer elbows Trigger points are no longer the focus of diagnosis for fibromyalgia. Instead, doctors may make a diagnosis if you report widespread pain for more than three months and have
Superior vena cava obstruction (SVCO)
Cancerous tumor that is compressing the superior vena cava *Shortness of breath is the most common symptom, followed by face or arm swelling* Treatment: Glucocorticoids, stenting, ventilator support
Extravasation:
Chemotherapy agents are additionally classified by their potential to damage tissue if they inadvertently leak from a vein into surrounding tissue (*extravasation*) The consequences of extravasation range from mild discomfort to severe tissue destruction, depending on whether the agent is classified as a nonvesicant, irritant, or vesicant
Cancer Complications
Constipation Paraneoplastic syndrome: T cells attack normal cells: treat by administering steroids, plasmapheresis, irradiation Alopecia: Suggest ways to assist in coping with hair loss: Encourage patient to wear own clothes, retain social contacts *Explain that hair growth usually begins again once therapy is completed*
Secondary gout develops during the course of other diseases, such as obesity
Diabetes mellitis, hypertension, polycythemia, leukemia, myeloma, sickle cell anemia, and renal disease Can also follow drug therapy, especially after *hydrochlorothiazide or pyrazinamide* Pathophysiology In gout, increased concentration of uric acid leads to tophi (urate deposits) in joints or tissues These crystals trigger an immune response, causing local necrosis or fibrosis. What to look for Gout develops in four stages:
ANA Titer Test
Diagnosis the rheumatic diseases and for the detection of anti-nucleoprotein factor and patterns associated with certain autoimmune diseases. The test is positive at a titer of 1:20 or 1:40, depending on the laboratory A positive result does not necessarily confirm a disease. The ANA titer is positive in most individuals diagnosed with systemic lupus erythematosus (SLE); it may also be positive in individuals with systemic sclerosis (scleroderma) or rheumatoid arthritis. An ANA titer result can be false positive in some individuals.
spinal cord compression diagnostic
Diagnostic: - Percussion tenderness at the level of compression - Abnormal reflexes - Sensory and motor abnormalities - MRI is preferred - May utilized spinal xray, CT, bone scans, - CT myelogram for pts unable to get MRI
HIV:
Diarrhea related to enteric pathogens or HIV infection. Risk for infection related to immunodeficiency, Ineffective airway clearance related to Pneumocystis pneumonia increased bronchial secretions and decreased ability to cough related to weakness and fatigue. Inmbalaned nutrition; less than body requirements related to decreased oral intake . Opportunistic infectiolns; impaired breathing; wasting syndrome and fluid and electrolyte imbalances; advere\sre reaction to medications. *Not transfered through secretions like sweat*
Fibromyalgia disorder
Disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory and mood issues Researchers believe that fibromyalgia amplifies painful sensations by affecting the way the brain processes pain signals chronic pain syndrome
Signs and Symptoms RA:
Fatigue, malaise, anorexia, persistent low-grade fever, weight loss, and lymphadenopathy Eventually the client may develop joint pain, tenderness, warmth, and swelling Usually, joint symptoms occur bilaterally and symmetrically Other symptoms may include morning stiffness; paresthesia in the hands and feet; and stiff, weak, or painful muscles
Lung cancer
Main cancer that kills. Smoking a big factor. Cough that changes in character should arouse suspicion of lung cancer. Dyspnea prominent early in the disasese.
Top 4 causes of cancer deaths
Male: *•Lung, •Prostate* •Colon/rectum •Pancreas Female: *•Lung •Breast* •Colon/rectum •Pancreas
spinal cord compression
Malignant spinal cord compression (MSCC) happens when cancer grows in, or near, the spine and presses on the spinal cord and nerves. Most often associated with cancers that metastasize to the bone such as breast, lung, and prostate cancers. Also seen in renal cell cancer, lymphomas, and multiple myeloma.
spinal cord compression medical management
Medical management: - Vertebroplasty - used to stabilized vertebrae when patients have pain without neurologic dysfunction. - Chemotherapy - Treat underlying cause, early steroid intervention, pain meds *Steroids, mobibility, spinal precautions, radiation*
Nursing intervention for cancer (3)
Monitor temperature and WBC. Report fever greater than 100. Neutropenic precautions if ANA falls below 1000, mm3
Root words
Neo- new Plasia- growth Plasm- substance Trophy- size Oma- tumor Statis- location
Tumor lysis syndrome (7 bolded)
Occurs when tumor cells release their contents, leading hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia Can progress to clinical toxic effects, *including renal insufficiency, cardiac arrhythmias, seizures, and death due to multiorgan failure* Treatment: *Prophylactic IV Allopurinol , IV hydration*
Renal cancer:
Often no symptoms are discovered on a routine physical exam . s/s only 10% hematuria, pain and a mas in the flank. Diagnostic tools: IV urography, cystoscopic exam, renal angiograms, ultrasonography or a CT scan. Nephrectomy: removal of the kidoeny and tumor , Renal artery embolization. aFter surgry catheters and drains in place to maintain a patent UT, to remove drainage and to permit accurage measurement of urine output. Yearly physical exam and chest x-ray because late metases are not uncommon.
s/s of fibromyalgia
Pain Anxiety Concentration and memory problems -- known as "fibro fog" Depression Fatigue Irritable bowel syndrome Morning stiffness Painful menstrual cramps Sleep problems Swelling, numbness, and tingling in hands, arms, feet, and legs Tender points Urinary symptoms
Which type of surgery is being done when lesions that are removed are likely to develop into cancer? a. Diagnostic b. Palliative c. Prophylactic d. Reconstructive
Prophylactic
Superior vena cava
SOB, cough hoarasness, chest pain. Edema: neck arms hands and thorax. X ray CT scan MRI. Medical: radiation, chemo, anticoagulant, Cancerous tumor that is compressing the superior vena cava. Can also be compressed by enlarged lymph nodes, intraluminal thrombus that obstructs benous circulation dn the drainage of head neck arms and thorax. Typically associated with lung cancer, can also occur with breast and testicular cancers, thymoma, lymphoma, and mediastinal metastases. If untreated can lead to cerebral anoxia (not enough oxygen reaches the brain), laryngeal edema, bronchial obstruction, and death.
Cachexia
Severe muscle wasting and weight loss associated with illness. Cachexia, a state of malnutrition and protein (muscle) wasting occurs in conjunction with lung, pancreatic, stomach, bowel, and prostate cancers, but rarely with breast cancer. Appetite is lost early in the process, the body becomes cata olic in a dysfunctional way and supplementation by gastric feeding (tube feeding) or parenteral nutrition. Dexamethasone (Decardon. Megestrol acetate (Megace) and dronabinol (marinol) Cachexia: severe muscle wasting and weight loss. Profound protein loss. Cytokines.
RA:
Systemic inflammatory disease that primarily attacks peripheral joints and surrounding muscles, tendons, ligaments, and blood vessels Spontaneous remissions and unpredictable exacerbations mark the course of the disease. Potentially crippling, RA usually requires lifelong treatment and sometimes surgery
gout teach
Teach adequate fluid intake to prevent complication Adjunctive therapy emphasizes a few dietary restrictions, primarily avoiding alcohol and high-purine foods Obese patients should try to lose weight because obesity puts additional stress on painful joints
Leukemia
Too many leukocytes WBCs for too long time. Can aggress rapidly. Neuropena: weakness anf fatigue, dyspnea on exertion and pallor from anemia; petechial ecchymoses and bleeding tendines. Diagnosisti: CBC, blast cells Worry about DIC. ANC absolute neutrophil count - Systemic: weight loss, Fever, frequent infections - Lungs: SOB - Muscular: weakness - Bone or joints: pain and tenderness - Psychological: fatigue, loss of appetite - Lymph nodes: swelling - Spleen or liver enlargement - Skin: night sweats, easy bleeding or bruising, purple patches
Gout: Tophi
Tophi is a deposit of uric acid crystals, in the form of monosodium urate crystals, in people with longstanding hyperuricemia (high levels of uric acid in the blood) Encourage bed rest, but use a bed cradle to keep covers off extremely sensitive, inflamed joints Give pain medication as needed, especially during acute attacks Administer anti-inflammatory medication and other drugs as ordered Watch for adverse effects Be alert for GI disturbances with colchicine
Spinal Cord Compression is commonly caused by nerve root compression by metastatic paraverbal tumors taht extend in to the epidural space. True or false
True
Treatment of chronic gout aims
decrease serum uric acid levels A continuous maintenance dosage of alopurinol may be ordered to suppress uric acid formation or control uric acid levels and prevent further attacks Can cause renal damage Colchicine prevents recurrent acute attacks until uric acid returns to its normal level, but the drug doesn't affect the acid level *Uricosuric agents*—such as probenecid—promote uric acid excretion and inhibit accumulation of uric acid, but
Stomatitis:
inflmaation process of the mouth including mucosa and tissues surrounding the teeth. Often occurs afte chemo and radiation therapy. Palifermin (Kepivance). s/s: Mild redness (erythema) and edema; sever fomrs include pain ulcerations, bleeding and secondary infection. Possible causes: chemotherapy, radiation severe drug allergy, myelosupprsion. If patint recejiving radiation therapy has poor dentition, extraction of the teeth before radiation treatment in the oral cavity is often initicated to prevent infection.
Nursing consideration stomatitis
mouth care: bruising, flossing rinsing. Soft-bristled toothbrush and nonabrasive toothpast. Avoid alcohol-basd mouth rinses and hot or spicy foods. Apply topical anti-inflmmatory, antibiotic and anesthetic agents.
