MedSurg Final, adv. medsurg FINAL
The client has finished the first round of chemotherapy. Which statement made by the client indicates a need for further teaching by the nurse?
"I can continue taking my vitamins and herbs because they make me feel better."
A client is recovering from a craniotomy with tumor debulking. Which comment by the client indicates to the nurse a correct understanding of what the surgery entailed?
"I guess the doctor could not remove the entire tumor.
The nurse is caring for a client is scheduled for chemotherapy followed by autologous stem cell transplant. Which of the following statements by the client indicates a need for further teaching?
"I hope they find a bone marrow donor who matches."
A nurse is caring for a 29-year-old female client, who was diagnosed with acute lymphocytic leukemia. The client is preparing for an allogeneic bone marrow transplant. Which statement by the client demonstrates she understands the informed consent she gave about the diagnosis and treatment?
"I'll only need chemotherapy treatment before receiving my bone marrow transplant."
A young female client has received chemotherapeutic medications and asks about any effects the treatments will have related to her sexual health. The most appropriate statement by the nurse is
"You will need to practice birth control measures."
how does hormone therapy work to treat prostate cancer
**androgens stimulate the growth and function of the prostate androgen suppression therapy - reduces the androgen production by the testicles - blocks the action of the androgens by the body - blocks production of the androgens throughout the body
how does hormone therapy work to treat breast cancer
**if the tumor is estrogen-progesterone, it can be used - blocks the receptors on the tumors - blocks the estrogen production - blocks the estrogen receptors
What is a tracheoesophageal puncture?
- A small hole is made in the back wall of the trachea. The hole extends from the back wall of the trachea into the front wall of the esophagus, directly behind the trachea. - The TEP prosthesis has a one-way valve that allows air to go from the trachea through the prosthesis into the esophagus, but it prevents liquids and food from moving from the esophagus through the prosthesis into the trachea.
What are the diagnostic tests used to diagnose pancreatic cancer? A patient has an elevated CA level. What does this mean?
- Abdominal ultrasounds - Contract enhanced CT scan. - MRI - ERCP - Tissue biopsy - May require stent insertion. - Lab testing o Elevated or rising CA (19-9) means the tumor is growing.
What are some risk factors for BPH>
- Age - Race/ethnicity (black men) - Family history - Genetic mutations- BRCA1 and BRCA2, HNPCC - Diet- no conclusive evidence - Smoking - Obesity- does not appear to be a risk factor (all men should be screened)
What is BPH?
- As men age, the prostate continues to grow, leading to BPH. - The enlarged prostatic tissue can cause an obstruction of the urethra causing urinary symptoms. o BPH is not prostatic cancer and does not develop into cancer.
Why are only 20% of patients with pancreatic cancer eligible for surgery?
- Because pancreatic cancer typically metastasizes pretty quickly. o Surgery can be done when: § Tumor is local. § Tumors are in the head of the pancreas. § No metastasis § Comorbidities of the pt § Proximity of tumor to major blood vessels. Even with surgery, risk of recurrence is high.
What are the current USPSTF guidelines regarding colon cancer screen in asymptomatic adults. What is the cologuard test?
- Beginning at age 45 years until 75. - Colonoscopy o Every 10 years o Required a bowel prep and anesthesia. - Flexible sigmoidoscopy o Every 5 years o Requires less invasive bowel prep. o Does not examine the entire colon. o Can be done without anesthesia. - Decal occult blood testing o Yearly o Direct examination of stool. - FIT/FIT DNA (fecal immunochemical test) o Yearly o Direct examination of stool - Virtual colonoscopy - Cologuard o At-home colon screening test.
What are some protective factors against developing breast cancer?
- Breastfeeding for 1 year - Greater numbers of live births - Earlier age at first live birth - Physical activity - Maintaining ideal body weight. - Healthy diet.
What is the prognosis for someone with pancreatic cancer?
- Cancer spreads to lymph nodes, then commonly to liver (fatal within 1-3 years after diagnosis).
What is a colostomy? Have you ever taken care of a patient with a colostomy? Have you talked to the patients about their psychosocial concerns? What were they?
- Colostomy: removal and cancer and surrounding colon o Yes, psychosocial concerns include: § Body image changes § Role changes § Sexuality § Coping behaviors § Fear/anxiety.
What are some common complications of colon surgery.
- Complications: o Infection o Bowel obstruction/perforations o Anastomosis leak o Bleeding o Fistula development o Ileus
What are the nutritional concerns associated with pancreatic cancer? What nutritional education should be given to patients with pancreatic cancer?
- Concerns: o Pancreatic enzymes o Cachexia/food issues (trouble digesting food high in sugar) § High calorie, low fat, small, frequent meals. o Jaundice o Glucose monitoring. Monitor and maintain a healthy weight. ... Stay hydrated. ... Eat small, frequent meals. ... High-protein foods with every meal. ... Consider the use of liquid supplements or shakes. ... Choose foods that are easy to digest. ... Choose essential whole grain foods. ... Choose colorful foods.
List manifestations of early and advanced cervical cancer:
- Early - o Asymptomatic. - Later- o Vaginal discharge o Pain during sex o Abnormal vaginal bleeding o Postmenopausal bleeding - Advanced - o Foul smelling discharge o Lower abdominal pain, back pain, weight loss, urinary/rectal symptoms.
Name two environmental and one genetic cause of lung cancer. What is the primary cause of lung cancer?
- Environmental: o Smoking o Occupations and environmental exposures - Genetic: o Genetic susceptibility. SMOKING IS THE MAIN CAUSE
What is some discharge teaching of colon surgery with a stoma?
- Esterstomal therapist consult - Home care nursing support - Stoma care - Supplies needed - Changing the appliance - Foods to avoid - Instruct patient on SS of infection - Instruct patient how to resume normal life activities including work, travel, sex, and provide psychological support - Follow up oncology care for chemo/radiation - Patients who are of reproductive age may want to bank sperm or eggs prior to tx.
What are some side effects associated with radiation therapy?
- Fatigue - Urinary frequency - Dysuria - ED - Diarrhea - Rectal bleeding - Inflammation of rectum, bowel, and bladder - Skin problems - Cystitis - Urethral strictures
What are the extra-thoracic manifestations of lung cancer?
- Headache - CNS disturbances, - Bone pain - Hepatomegaly.
What are the local-regional manifestations of lung cancer?
- Local-regional: o Cough, dyspnea, hemoptysis, wheezing, chest pain, lymphadenopathy, hoarseness, pneumonia, Pancoast syndrome, pleural effusion, pericardial effusion, SVC syndrome, dysphasia.
At what stage of the disease process do patients experience symptoms? Why does this make screening important?
- Lung cancer may be present for several years before symptoms develop. o Symptoms occur when the tumor: § Interferes with lung function. § Metastasizes § Causes paraneoplastic syndromes. · Tumor secretes substances such as calcium, anti-diuretic hormone holding on to a lot of fluid. § Causes oncologic emergencies. (When signs and symptoms are present, the cancer is usually advanced.)
What are common long term side effects of breast cancer treatment?
- Lymphedema - Cognitive changes - Depression/anxiety - Fatigue - Bone health - Neuropathy - Fear of recurrence - Radiation induced complications (pneumonitis, breast fibrosis, and or necrosis) -Fertility -Sexual health and intimacy concerns -Body image - Hot flashes, early menopause.
What should the nurse monitor in a patient with a 3-way bladder irrigator?
- Maintain continuous bladder irrigations. o (This removed clotted blood from the bladder and ensures the drainage of urine. o Flow rate- titrate to produce pink output.) - Catheter may require a manual irrigation if it becomes clogged. - I/Os.
How is prostate cancer diagnosed?
- Men should be asked about urinary symptoms - Digital rectal exam - Prostate-specific antigen (PSA nl= 0-4 ng/mL- controversial) - Transrectal ultrasound (TRUS) - Needle biopsy - Tests done to assess for metastasis: (Bone scan, ultrasounds, CT scan, MRI, PET scan) - No radiologic testing is recommended for screening - MRI may be used if prostate cancer is suspected but biopsy is negative - Tumor grading is based on the biopsy- Gleason's scoring scale - Tumor is states according to the TNM scale
When is watchful waiting used?
- Monitoring approach but the men do not undergo repeat prostate biopsies - Men receive palliative treatment if they experience symptomatic progression of their disease
What is the patho of BPH?
- Most are slowly growing, treatable, and curable. - Spreads by direct extension, lymphatic system, and bloodstream. - Most are adenocarcinomas (lining internal organs) - Androgen dependent
What are some risk factors associated with cervical cancer?
- Most important o HPV! - Co-factors: o First sexual intercourse before 16 o Multiple sex partners o Having a male partner who has multiple sex partners o HIV o Immunosuppression o Smoking o Long-term use of birth control pills o Presence of STIs
What should the nurse monitor in a patient post oral surgery?
- Nursing care for surgical patients: o Check doppler's (can be internal or external) q 1 hour. o Mouth care. o Graft skin for (color, blanching, warmth) o Drains o Pain management o Airway o Swallowing and nutrition o Communication o Mobility
What are some nursing indications post surgery?
- Nursing indications: o Routine post op care § Pain control, pulmonary, ambulation, wound assessments. o Semi-fowlers. o Monitor for hyperglycemia. o Assess for signs of sepsis. o Monitor for bleeding. o NG tube to low continuous suction, I/Os including gastric suction.
Describe the pathophysiology by which HPV leads to cervical cancer.
- Patho: o HPV infects the epithelial cells of the skin and mucous membranes. o Starts as precancerous changes: § Squamous intraepithelial lesions (SIL)- reported after cytology. § Cervical intraepithelial neoplasia (CIN)- reported after biopsy. o Can take several years to penetrate the basement membrane and become invasive, o Progresses to squamous cell carcinoma (80%) or adenocarcinoma (15%) o Cervical cancer cells spread by direct invasion of accessory structures including the vaginal wall, pelvic wall, bladder, or rectum.
A patient is experiencing is complaining of dyspnea and dyspnea post lobectomy. Lungs are diminished upon auscultation. A chest x-ray shows fluid over left lower lobe. What do you suspect is occurring? Why? What can be done for this patient?
- Pleural effusion: o Due to diminished lung sounds and fluid over lobe. - Tx: o Thoracentesis o Chest tube insertion o Pleurodesis
What are the prognostic indicators for cervical cancer?
- Prognosis depends on the extent of the disease at the time of diagnosis. - Tumor size- worse prognosis as tumor size increases. - Younger women- prognosis is generally worse in younger women.
Which patients are legible for prophylactic treatments? What are these treatments?
- Prophylactic surgery o Removal of both breasts reduces the risk of breast cancer by 90% or more.
What are common clinical manifestations of SVC syndrome? (Think about heart anatomy and blood flow)
- SS: o Obstructed venous flow from the head and neck which produce the symptoms. § Edema of neck and face § Headache § Dizziness and syncope § Visual disturbances § Periorbital edema (Pt can get edematous, red in the face, veins are engorged with blood.)
How are patients with a cervix screened for cervical cancer? How often should a patient with a cervix be screened for cervical cancer?
- Screenings: o Pap smear: cells are scraped from the cervix and reviewed to determine if there are cellular changes. § Ages 21-29: pap smear every 3 years. § Ages 30-65: pap smear every 3 years and HPV co-testing evert 5. § Screening can stop after age 65. o HPV DNA: the presence of DNA from HPV. § Indicated for women 30 years or older and in women who have had an abnormal pap test.
What are nursing interventions indicated post radical prostatectomy?
- Similar to that of other patients undergoing abdominal/pelvic surgery - Maintain bladder irrigations via 3-way foley - Monitor I/Os - Observe for hemorrhage or clots- normal to occur for 24-36 hours post op - Increase fluids to 2-3 L per day - Monitor for bleeding and infection - Ambulate early - Monitor for bladder spasms
How is HPV spread?
- Spread by: o Sexual contact- vaginal, oral, or anal. o Direct skin to skin contact. o Does not require penetrative sexual intercourse to be spread.
What are the non-small cell lung cancer types and how is it treated?
- Squamous - Adenocarcinoma - Large cell CA. - Treatments: o Early surgery is an option. § Many are found incidentally, chest CT, lesion in lung. o Chemo/radiation o Targeted therapy and immunotherapy not curing disease, but gives pt more time.
What is the process of radical prostatectomy?
- Surgical procedure in which the entire prostate gland, ejaculatory ducts, and seminal vesicles are removed. - Not for patients with high-risk prostate cancer - Can be considered curative for cancers localized within the prostate - Cane be performed by several methods - A drain will be inserted, usually in the right lower area of the incision.
What are treatments for oral cancer?
- Surgical resection (ablative): glossectomy, mandibulectomy, maxillectomy, neck dissection. - Reconstruction: skin graft, free flaps, titanium plate. - Chemotherapy: cisplatin, carboplatin, cetuximab. - Radiation therapy: intensity-modulated radiotherapy (MRT) - Immunotherapy: checkpoint inhibitors (Keytruda, opdivo), available through clinical trial.
What are some manifestations of oropharyngeal cancer?
- Symptoms: o A sore in the back of the mouth that will not heal. o A tonsil that is larger on one side o Blood in saliva o Mouth pain o Difficulty chewing, swallowing or speaking. o Persistent sore throat o Intolerance to eating or drinking citrus foods. o Severe ear pain o Lump or pain in the neck o Pain when swallowing o Bad breath
Describe the signs and symptoms laryngeal cancer.
- Symptoms: o Hoarseness, voice changes o A sore throat that does not goal away. o Constant coughing o Pain when swallowing o Ear pain o Trouble breathing o Weight loss o A lump or mass in the neck
How do nurses perform trach care?
- Tracheostomy care: o Suction Q2-4 hours/prn o Humidification o Clean the inner cannular at least Q2-4 hours if lots of secretions. o Sterile technique vs. clean technique o Use of saline o Dressing changes o Change dirty trach ties prn.
What are some other treatments for cervical cancer?
- Treatment depends on the stage of the disease at diagnosis: o Surgery: § Hysterectomy. § Laser surgery § Cryosurgery § Pelvic exenteration- removal of all the contents of the pelvis. o Radiation § External beam radiation § Internal radiation- brachytherapy o Chemo
What treatments are there available for laryngeal cancer?
- Treatments: o Surgical resection: laser excision (early stage), laryngectomy, neck dissection o Chemotherapy: cisplatin, carboplatin, cetuximab. o Radiation therapy: intensity-modulated radiotherapy (IMRT) o Move towards organ preservation.
What are the current USPSTF guidelines on screening for lung cancer in asymptomatic patients?
- USPSTF: o No screening recommendations for the general public. o High risk patients: § In asymptomatic adults aged 55-80 with a 30-pack year history and currently smoke or who have quit in the last 15 years. § Annual low-dose CT scan.
What are some manifestations of advanced disease of prostate cancer?
- Urethral obstruction - Hydronephrosis causing post AKI - Back pain - Referred pain in legs and abdomen - Bowel and bladder dysfunction/incontinence - Fatigue, anorexia, weight loss - Rectal obstruction - Coagulation abnormalities - Lower extremity edema and leg weakness - Pancytopenia from bone marrow involvement
When is active surveillance used?
- Used for men with a very low risk localized prostate cancer - PSA and digital rectal exam every 6 months - Biopsies every 6 months - Patients must deal with uncertainties - Complications of the treatment are greater than inconvenience of symptoms
What role does hormone therapy play in breast cancer treatment?
- Used in women who had a tumor that has positive estrogen receptor sites. o Used as adjuvant therapy after surgery. o Selective estrogen receptor modulator - Aromatase inhibitors used on post-menopausal women to block estrogen production in the adrenal glands. - Metastatic disease to slow growth of tumors.
Name common manifestations of pancreatic cancer.
- Usually presents late and early signs are vague: o Jaundice, clay-colored stools, dark urine o Unexplained weight loss, anorexia, nausea o Early satiety o Fatigue o Abdominal, back pain o New onset diabetes o Gas, fatty stools
A patient tells you vape pens have no health risks; how would you respond?
- Vape pens still contain unhealthy chemicals such as nicotine, volatile organic compounds, ultra fine particles, heavy metals such as nickel, tin and led, cancer-causing chemicals, and flavoring that is linked to a serious lung disease.
Describe, in basic terms, a Whipple procedure.
- Whipple: (survival rates go from 8% to 25%) o Removes the head of the pancreas, the duodenum, and a portion of the common bile duct, gall bladder, and sometimes part of the stomach. o The remaining intestine bile duct and pancreas are reconnected.
4 main side effects of radiation
- anorexia - fatigue - bone marrow suppression - skin reactions
skincare interventions following radiation
- avoid creams, lotions, deodorants, and perfumes - cleanse using mild soaps - assess for redness and signs of infection - avoid using irritants - do not expose to cold or sunlight
what are biopsies done to determine
- cancer vs non - staging - degree of differentiation - genetics - to see if they have estrogen, progesterone, or human epithelial growth factor receptors
types of cancer cells
- carcinomas - sarcomas - leukemia - lymphomas and myelomas
oncologic emergencies
- cardiac tamponade - septic shock - SVC syndrome - spinal cord compression - tumor lysis syndrome - hypercalcemia
warning signs of cancer
- changes in bowel/bladder habits - sore that does not heal - unusual bleeding - thickening or lump in breast or other place - obvious change in mole - nagging cough
types of oncologic procedures
- curative - debulking - palliative - reconstructive - supportive
risk factors of cancer
- diet - age - genetics - gender - stress - poverty - occupation - immunosuppression - infection - drugs - tobacco and alcohol use - recreational drug use - sun exposure - chronic inflammation
side effects of chemotherapy
- hair loss - dry mouth/mouth sores - skin changes - n/v - diarrhea - bone marrow suppression - organ toxicities - sexual dysfunction/infertility - sleep disturbances - cognitive impairment
breast cancer screening
- mammograms every 1 to 2 years for women age 40 years and older - genetic testing
side effects of immunotherapy
- pain - swelling - flu-like symptoms - palpitations - diarrhea - increase or decrease in BP
nursing considerations - patients with internal radiation seeds
- private room - sign indicating radiation is present - wear dosimeter film badge - pregnant nurse should not care for this patient - limit visitors - encourage patient to do own self-care - led shield apron - organize tasks to spend less time in the room - rotate staff
side effects of targeted therapies
- problems with clotting and wound healing - increased BP - fatigue - mouth sores - loss of hair color
types of carcinomas
- squamous cell - adenocarcinoma - basal cell carcinoma
common cancer treatments
- surgery - chemotherapy - radiation - targeted therapies most patients have a combination of both
symptoms of cancer
- thickening of breasts or or other body part - change in the size, shape, and structure of breast skin or nipple - new or preexisting mole - a sore that does not heal - cough that does not go away - changes in bowel and bladder habits - discomfort after eating/appetite changes - unintentional weight gain and loss - weak/tired - night sweats
characteristics of cancer
- undifferentiated cells look similar to normal cells - invades surrounding tissue - rapid growth - spread to other parts of the body through vessels or lymphatic channels - can cause damage to the tissues and organs - evades growth suppressors - resists cell death
10 ways to prevent cancer
- vaccinations - avoid UV - limit alcohol - stop smoking - breastfeed - be active - do not take supplements to "prevent cancer" - decrease consumption of salty, processed foods - decrease red meat intake - eat fruits, veggies, whole grains, and legumes
prostate cancer screening
-Start screening at age 50; High risk begin discussions at 40-45 -If PSA < 2.5; test q 2yrs -If PSA > 2.5; annual testing -If PSA > 4.0; refer for evaluation - digital rectal exam
What 3 things should the nurse educate the patient following a radical prostatectomy?
1. Feelings of urge to void while catheter indwelling are noted and normal- check for catheter obstruction 2. Avoid attempts to void around the catheter (strain to urinate around catheter) 3. No sex for 6 weeks
What are 10 manifestations of oral cancer?
1. Sore, irritation, lump or thick patch in mouth, lip, or throat 2. A white or red patch in mouth 3. A feelings that something is caught in your throat 4. Difficulty chewing or swallowing (dysphagia) 5. Difficulty moving jaw or tongue (dysarthria) 6. Swelling in your jaw 7. Numbness in your tongue or other areas of your mouth 8. Pain in one ear without hearing loss (otalgia)
The highest rate of HPV infections occur between which ages?
15-59 years of age - Transmission of HPV: o Peak transmission is in adolescence and young adulthood.
What is a 3-way Foley catheter?
3-way Foley catheters are indwelling catheters with three ports - one for urine drainage, one for Foley balloon inflation and a third port for bladder irrigation to prevent or manage blood clots.
The client is to receive cyclophosphamide (Cytoxan) 50 mg/kg intravenously in divided doses over 5 days. The client weighs 176 pounds. How many mg of cyclophosphamide will the client receive each day? Enter the correct number ONLY.
800
What is a trachelectomy?
A trachelectomy is removal of the cervix, upper vagina and parametrium (tissue surrounding the cervix). Pelvic lymph nodes may also be removed. It can be used to treat some cases of early stage cervical cancer in women who wish to keep their fertility and ability to carry a child. The delivery of the baby is through C-section.
Following surgery for adenocarcinoma, the client learns the tumor stage is T3,N1,M0. What treatment mode should the nurse anticipate?
Adjuvant therapy is likely.
5-Fluorouracil (5FU) is classified as which type of antineoplastic agent?
Antimetabolite
A client is receiving external radiation to the left thorax to treat lung cancer. Which intervention should be part of this client's care plan?
Avoiding using soap on the irradiated areas
What are the 2 types of invasive breast cancer?
Cancer cells invade surrounding breast tissue: § Invasive ductal carcinoma: § Invasive lobular carcinoma:
What is invasive ducal carcinoma?
Cells starts in the ducts, 70-80% of all breast cancers.
How is the Gardasil-9 vaccine different from the Cervarix vaccine?
Cervarix prevents infection with types 16 and 18, and Gardasil prevents infection with types 6, 11, 16, and 18. Both vaccines are still used in some other countries.
A client diagnosed with acute myelocytic leukemia has been receiving chemotherapy. During the last 2 cycles of chemotherapy, the client developed severe thrombocytopenia requiring multiple platelet transfusions. The client is now scheduled to receive a third cycle. How can the nurse best detect early signs and symptoms of thrombocytopenia?
Closely observe the client's skin for petechiae and bruising The nurse should closely observe the client's skin for petechiae and bruising. Daily laboratory testing may not reflect the client's condition as quickly as subtle changes in the client's skin. Performing a cardiovascular assessment every 4 hours and checking the clients history for a congenital link to thrombocytopenia don't help detect early signs and symptoms of thrombocytopenia.
What is an exploratory laparotomy?
Done while you are under general anesthesia, The surgeon makes a cut into the abdomen and examines the abdominal organs.
What does it mean to be drug resistant?
Drug resistance: - Tumor cells can become drug resistant so a combination of agents are generally used. - When multiple agents are used, drug resistance is reduced but there are more side effects and toxicities. (Pt can get very sick and septic WITH LOTS OF SIDE EFFECTS) - Can be used in combo with surgery and radiation - Several rounds are generally necessary
What are the 2 types of noninvasive breast cancer?
Ductal carcinoma in situ Lobular carcinoma in situ
The nurse is teaching a healthy lifestyle class to a group of adolescents. The nurse recommends
Exercising at least 60 minutes per day doing moderate to vigorous activities at least 5 days per week
A patient with uterine cancer is being treated with internal radiation therapy. What would the nurse's priority responsibility be for this patient?
Explain to the patient that she will continue to emit radiation while the implant is in place.
The client is receiving a vesicant antineoplastic for treatment of cancer. Which assessment finding would require the nurse to take immediate action?
Extravasation
A nurse is administering daunorubicin through a peripheral I.V. line when the client complains of burning at the insertion site. The nurse notes no blood return from the catheter and redness at the I.V. site. The client is most likely experiencing which complication?
Extravasation The client is exhibiting signs of extravasation, which occurs when the medication leaks into the surrounding tissues and causes swelling, burning, or pain at the injection site. Erythema is redness of the skin that results from skin irritation. Flare is a spreading of redness that occurs as a result of drawing a pointed instrument across the skin. Thrombosis is the formation of clot within the vascular system.
What are the systemic manifestations of lung cancer?
Fever, weakness, fatigue, anorexia, cachexia weight loss, anemia, symptoms associated with paraneoplastic syndromes.
What is the most common cause of oropharyngeal cancer?
HPV Type 16 is the most common cause of or opharyngeal cancer - education - GET YOUR HPV VACCINE!!!!
What foods should the nurse suggest that the patient consume less of in order to reduce nitrate intake because of the possibility of carcinogenic action?
Ham and bacon
What would you say to a parent who says they do not want their 10 year daughter vaccinated against HPV because doing so would give her license to become sexually active? (This happens all the time.)
I would say she needs it!
A client receiving chemotherapy has a nursing diagnosis of Deficient diversional activity related to decreased energy. Which client statement indicates an accurate understanding of appropriate ways to deal with this deficit?
I'll play card games with my friends."
Which statement by a client undergoing external radiation therapy indicates the need for further teaching?
I'm worried I'll expose my family members to radiation."
When caring for an older client who is receiving external beam radiation, which is the key point for the nurse to incorporate into the plan of care?
Inspect the skin frequently.
For a client newly diagnosed with radiation-induced thrombocytopenia, the nurse should include which intervention in the care plan?
Inspecting the skin for petechiae once every shift
A patient will be receiving radiation for 6 weeks for the treatment of breast cancer and asks the nurse why it takes so long. What is the best response by the nurse?
It will allow time for the repair of healthy tissue."
What are some common late manifestations of prostate cancer?
Late manifestations/urinary obstructions: - Frequency - Incomplete emptying of bladder - Hesitancy - Nocturia - Urgency - Hematuria - Dysuria - Decreased force of urinary system - Sexual dysfunction
A decrease in circulating white blood cells (WBCs) is referred to as
Leukopenia
lung cancer screening
Low dose helical CT between ages 55 and 80 if >30 pack year smoke history
The nurse performs a breast exam on a client and finds a firm, non-moveable lump in the upper outer quadrant of the right breast that the client reports was not there 3 weeks ago. What does this finding suggest?
Malignant tumor
In which phase of the cell cycle does cell division occur?
Mitosis
are patients that undergo brachytherapy radioactive?
NO - there are catheters that deliver the radioactive seeds and retrieve them - once seeds and catheters are removed, they are no longer radioactive
A nurse is teaching a community class about how to decrease the risk of cancer. Which food should the nurse recommend?
Oranges
Which type of surgery is used in an attempt to relieve complications of cancer?
Palliative
What is lobular carcinoma in situ?
Proliferation of cells in the lobules but do not invade through wall of lobule. LCIS increases the risk of developing breast cancer in either breast by 7-12 times.
Which of the following does a nurse have to assess during the bone marrow transplant (BMT) procedure?
Psychological status
What is Pyridium and how does it treat bladder spasms?
Pyridium is a pain reliever that affects the lower part of your urinary tract (bladder and urethra). Pyridium is used to treat urinary symptoms such as pain or burning, increased urination, and increased urge to urinate.
A male client has been unable to return to work for 10 days following chemotherapy as the result of ongoing fatigue and inability to perform usual activities. Laboratory test results are WBCs 2000/mm³, RBCs 3.2 x 10¹²/L, and platelets 85,000/mm³. The nurse notes that the client is anxious. Which of the following is the priority nursing diagnosis?
Risk for infection related to inadequate defenses
What side effects of chemotherapy and hormone therapy do you think are most psychologically distressing to patients? (As it relates to prostate cancer only) (Hint: there are two big ones)
Sexual dysfunction and incontinence
What is small cell lung cancer and how is it treated?
Small cell: o Rapid cell growth and centrally located. o Most malignant and virulent with early metastases. o Associated with paraneoplastic syndromes. o Almost all cases are associated with cigarette smoking. o If untreated, prognosis Is 2-4 months. - Treatments: o Combination of chemo/radiation and palliation. o Rarely surgical intervention. o Combined radiation and chemo give best results.
What are some long-term consequences of head and neck cancer?
Spinal Accessory Nerve Palsy Cervical Dystonia/muscle spasms Shoulder Dysfunction Trismus Dysphagia/aspiration Strictures GERD Lymphedema Fatigue Body and self-image Altered/loss of taste Hearing loss/vertigo Sleep disturbances Sleep Apnea Speech/voice changes Hypothyroidism Dental caries/disease Xerostomia Osteoradionecrosis Oral infection/candidiasis Depression/Anxiety
A client with a brain tumor is undergoing radiation and chemotherapy for treatment of cancer. The client has recently reported swelling in the gums, tongue, and lips. Which is the most likely cause of these symptoms?
Stomatitis
What is the long-term prognosis for people diagnosed with breast cancer?
The 5-year relative survival rate for women in the United States with non-metastatic invasive breast cancer is 91%. The 10-year relative survival rate for women with non-metastatic invasive breast cancer is 85%.
A nurse is administering daunorubicin (DaunoXome) to a patient with lung cancer. Which situation requires immediate intervention?
The I.V. site is red and swollen
Why do the signs symptoms of ovarian/endometrial cancer commonly get overlooked by providers? (But not by thorough family nurse practitioners)?
The single greatest risk factor for ovarian cancer is family history.
A patient is scheduled for cryoablation for cervical cancer and tells the nurse, "I am not exactly sure what the surgeon is going to do." What is the best response by the nurse?
The surgeon is going to use liquid nitrogen to freeze the area."
A 36-year-old man is receiving three different chemotherapeutic agents for Hodgkin's disease. The nurse explains to the client that the three drugs are given over an extended period because:
The three drugs have a synergistic effect and act on the cancer cells with different mechanisms.
Which statement is true about malignant tumors?
They gain access to the blood and lymphatic channels. By gaining access to blood and lymphatic channels, a tumor can metastasize to other areas of the body. Cells of malignant tumors are undifferentiated. Malignant tumors demonstrate variable rates of growth; however, the more anaplastic the tumor, the faster its growth. A malignant tumor grows at the periphery and sends out processes that infiltrate and destroy surrounding tissues.
Why should all patients post radical prostatectomy receive stool softeners?
To avoid irrigating the surgical site by preventing straining when moving bowels.
The client is diagnosed with a benign brain tumor. Which of the following features of a benign tumor is of most concern to the nurse?
Tumor pressure against normal tissues
Which of the following would be inconsistent as a common side effect of chemotherapy?
Weight gain
cervical cancer screening
Women 21-65 Pap smear with cytology Q3 years Women 30-65 Pap smear with HPV testing Q5 years
How often should people with breasts be screened with a mammogram?
Women age 40 to 54 should get mammograms every year. Women 50 and older should switch to mammograms every 2 years, or can continue yearly screening. Screening should continue as long as a woman is in good health and is expected to live 10 more years or longer.
carcinogens
a substance or an agent that can cause the cells to become cancerous by altering the genetic structure
how is cancer a genetic disease?
all cancers are genetic - most are not inherited but a result of something else that causes DNA damage when the cell divides - DNA can be copied incorrectly - causing a mutation
what procedure must be performed to determine if a cell is cancerous vs normal?
biopsy
adenocarcinomas
cancer that arises in the glands that line the inside of the organs
sarcoma
cancer that begins in connective/supportive tissue (bone, muscle, cartillige, fat, blood vessels)
squamous cell carcinoma
cancer that begins in the flat cells in the skin, lining of the trachea, and the esophagus
what are carcinomas
cancer that begins in the skin and/or organ tissue
leukemia
cancer that starts in blood forming tissue (bone marrow) and causes large amounts of abnormal bone cells to be produced
malignant neoplasms
cancerous growths that grow aggressively, invade other tissues and organs and spread to other parts of the body
lymphoma and myeloma
cancers that begin in the cells of the immune system
A nurse is performing a home visit for a client who received chemotherapy within the past 24 hours. The nurse observes a small child playing in the bathroom, where the toilet lid has been left up. Based on these observations, the nurse modifies the client's teaching plan to include:
chemotherapy exposure and risk factors.
The root cause of cancer is damage to cellular deoxyribonucleic acid (DNA) which can be caused by many factors, or carcinogens. What factors can be carcinogenic? Select all that apply.
dietary substances environmental factors viruses
what is the difference between a differentiated and undifferentiated cells
differentiated cells have been changed in form and matured from being generalized to having a specific function undifferentiated cells have not acquired a special function/structure
colorectal screening
fecal occult blood test annually after age 50 - sigmoidoscopy - colonoscopy
basal cell carcinoma
found in the basal cells on top of the skin
The nurse is working with a client who has had an allo-hematopoietic stem cell transplant (HSCT). The nurse notices a diffuse rash and diarrhea. The nurse contacts the physician to report that the client has symptoms of
graft-versus-host disease.
advantage of using internal radiation seeds vs external radiation
internal radiotherapy gives a higher dose with fewer side effects because the radiation is delivered from inside of the body - closer to the targeted location therefore it is not impacting healthy cells
medical marijuana and cancer
medical marijuana is indicated for symptom management, reducing anxiety, helping neuropathic and other types pain
benign neoplasms
noncancerous localized growths with well defined borders and are frequently encapsulated
What are some non-modifiable risk factors of colon cancer?
o >50 years old o Family/personal hx of colon cancer o Genetic alterations § Familial adenomatous polyposis § Hereditary non-polyposis colorectal cancer (HNPCC) o Hx of inflammatory bowel disease, ovarian, and breast cancer. o Diabetes. o Women with a history of endometrial, ovarian, and breast cancer have increased risk.
What are some non-modifiable risk factors of pancreatic cancer?
o Age o Sex o Race o Inherited genetics
What are some symptoms of breast cancer?
o Asymptomatic o Palpable mass or lump o Swelling of all or part of a breast o Change in the shape of the breast. o Skin dimpling (resembles an orange peel) o Breast or nipple pain o Nipple retraction o Nipple or breast skin that is red, dry, flaking, or thickened. o Nipple discharge (other than milk) o Swollen lymph nodes under the arm or near clavicle.
What are some genetic risk factors for breast cancer?
o BRCA1 mutation (45-81%) o BRCA2 mutation (27-85%) o Other genetic mutations PALB2, CHEK2, and ATM o For men, lifetime risk of cancer is 1.8% for BRCA1 mutation and 8.3% for BRCA2 mutation. o These mutations increase the risk of other cancers such as ovarian, pancreatic, gastric, colon, lung, cervical, prostate and testicular.
What are the most common treatments for breast cancer?
o Decision regarding the type of treatment based on: § Size of tumor, number of lymph nodes, presence of estrogen/progesterone receptors, amount of HER2 protein (84% are hormone and 14% are HER2+) o Surgery § Mastectomy: Removal of the entire breast. o Chemo/radiation o Hormone therapy o Targeted therapy.
What some common cues associated with ovarian cancer?
o Dyspnea on exertion and 91% on RA o Weight gain with early satiety o Pain 6/10 scale o New hyperglycemia, anemia, elevated CEA, low calcium o Post-menopausal o No gynecology or PCP visits recently o No pos-menopausal bleeding
Define superior vena cava syndrome.
o Either a partial or complete obstruction of the SVC. o Obstruction caused by tumor, thrombosis, radiation fibrosis or infection lymph nodes. o Clots caused by catheters, ports. o Most commonly seen in small cell lung cancer
What is stomal care?
o Monitor and document ostomy for color, amount, and drainage. o Stoma should be beefy red. o Assess for BS and flatus.
Describe the pathophysiology of colon cancer.
o Most begin as adenomatous polyps. o Most colon cancers are adenocarcinoma. o Cancer starts in the mucosal layer then grows outward. o Can then invade blood vessels or lymph nodes. o Can also spread by direct extension. o Metastasis to regional lymph nodes is most common. § Slow growing 5-15 years before manifestations § Often ss not evident until advanced disease § Rectal bleeding is the initial symptom.
What is adenocarcinoma lung cancer?
o Most common type of lung cancer. o Common in women and non-smokers. § Most likely to arise in the periphery of the lung, spreading and not causing symptoms until disease has progressed.
What are some manifestations with ovarian cancer?
o Non-specific: increased abdominal girth, pelvic pressure, bloating, back pain, constipation, abdominal pain, urinary urgency, indigestion, flatulence, increased waist size, leg pain, and pelvic pain. o All women with GI symptoms with NO KNOWN CAUSE should be evaluated for a potential ovarian cancer. o OFTEN IGNORED o Accumulation of fluid (ascites) is common. o VAGUE, UNDIAGNOSED, PERSISTENT GI SYMPTOMS SHOULD ALTER THE NURSE ABOUT POSSIBLE OVARIAN MALIGNANCY o **vaginal bleeding in a post-partum female that is unexpected is HIGHLY SUSPEICIOUS FOR ENDOMETRIAL CANCER*
What are some modifiable risk factors of colon cancer?
o Obesity o Alcohol consumption o Smoking o Lots of red meat eating o Low calcium o Very low intake of whole-grain fiber, fruits and veggies.
What are common physical and psychosocial concerns following a hysterectomy?
o Patients need emotional support since the surgical outcome is pending and anxiety is high. § Loss of uterus/female organs can impair self-esteem/self-image, "no longer feel like a woman." § Stigma with the "cancer diagnosis/prognosis." § Concern with "death and dying" - patients usually die from complications R/T the disease progression. § Plans for aftercare/living will. § Employment/financial concerns. § Treatment planning.
How is breast cancer diagnosed?
o Physical exam/clinical breast exam/history o Mammogram o Ultrasound o MRI- used in high risk patients or breast implants o Biopsies § Breast cancer cells are tested for estrogen receptors, progesterone receptors, and HER2 proteins.
What is large cell CA?
o Poorly differentiated. o Tumors arise in the periphery of the lung.
What are important nursing considerations of colon surgery?
o Post-surgical care o NPO until peristalsis returns. o Assess NG patency and drainage. o Monitor I/Os and electrolytes. o Monitor for BS/gas. o Antacids and PPIs o Ostomy care/teaching o Psychosocial issues
What is squamous non-small cell lung cancer?
o Present as central tumors, uncommon among non-smokers. o Tend to be slow growing tumors associated with hypercalcemia. § More centrally located, cough and airway obstructions earlier, tumor pushing on airways.
What are some common pulmonary complications seen post lobectomy? What are major signs and symptoms of these pulmonary complications? Always remember ABC LOC VS when answering questions regarding nursing indications post surgery!
o Pulmonary: § Atelectasis, dyspnea, cough, management of COPD, pulmonary embolism, vocal cord injuries, bronchopleural fistula, bronchospasm, pneumonia, emphysema. o Cardiac: § Increased risk of post op a-fib and HF o Incisional care/prevention and early recognition of infection § High risk of PE (DVT) § Vocal cord injury § Changes in voice, weaker or raspy § Fistulas from radiation before surgery o Empyema: pocket of an infection § Go in with chest tube or pig tail to drain purulent drainage. o Infection § Higher risk of developing problems § Fever white count § Incisional care § Smoking cessation
What treatments are available for oropharyngeal cancer?
o Radiation o Concurrent chemotherapy and radiation o Clinical trials § De-escalation with TORS § Reduce radiation. § Immunotherapeutic, targeted therapies.
According to the USPSTF, which patients should have genetic screening for breast cancer?
o Recommends risk assessment for women who have a personal or family hx of breast, ovarian, fallopian tube or perineal cancer, or whose ancestry is associated with having BRCA1 and BRCA2 mutations as well as follow-up counseling.
What is a mammogram?
o Screening of a asymptomatic patient in an attempt to detect abnormal lesions of the breast when they are small, non-palpable and confined to the breast.
What are some modifiable risk factors of pancreatic cancer?
o Smoking or smokeless tobacco o Heavy alcohol consumption o Diabetes o Chronic pancreatitis o Diet o Obesity
An oncologist advises a client with an extensive family history of breast cancer to consider a mastectomy. What type of surgery would the nurse include in teaching?
prophylactic
What is a mastectomy?
surgical removal of a breast
Define hysterectomy
surgical removal of the uterus
how does chemotherapy treat cancer
targets different phases of the cell cycle by halting growth, stopping the division of cells, and interferes with replication
carcinogenesis
the process where normal cells turn into cancerous cells involves A 3 step process - initiation, promotion, progression
adjuvant
treatment given after surgery
neoadjuvant
treatment given before surgery
what is immunotherapy
treatment that helps the immune system fight cancer - detects and destroys the abnormal cells preventing and curving the growth of cancer
what is targeted therapy
treatment that targets proteins that control how cancer cells grow, divide, and spread
what are neoplasms
tumors - a mass or collection of cells that grow independently of its surrounding structure and have no purpose
metastasize
when the cancer spreads to other tissues throughout the body
What are some treatments for SVC syndrome?
§ Chemo and radiation. LIFE THREATENING INJURY - Give palliative radiation to treat it. - Treat tumor so does not cause SVC syndrome. § Help control some complications of these symptoms.
Other types of breast cancer:
§ Inflammatory: · Rare 1-5% of all breast cancers. · Very aggressive, skin looks like an orange peel. § Paget disease of the breast: · Rare, presents as a red, scaly lesion of the nipple. § Medullary carcinoma: · Grows in a capsule inside the duct. · Seen in women younger than 50 with a favorable prognosis. § Mucinous carcinoma: · Presents in women who are post-menopausal and over 75, favorable prognosis and slow growing. § Tubular carcinoma: (favorable prognosis).
What are some EARLY manifestations of colon cancer?
§ May be asymptomatic. § Vague abdominal pain § Increased flatulence § Minor changes are bowel movements with or without bleeding
What is triple negative breast cancer?
§ No estrogen, progesterone or HER 2 receptors. § Hormone therapy cannot be used. § These tumors tend to be aggressive and recur and metastasize early.
What are some LATE manifestations of colon cancer?
§ Severe pain § Anorexia § Weight loss § Sacral/sciatic pain § Jaundice § Ascites § Pruritis § Hepatomegaly.
What is invasive lobular carcinoma?
· Begins in the lobules, cells tend to grow in a single-file strand. · May not produce a lump, making it more difficult to diagnose.
What is ductal carcinoma in situ?
·Malignant cells within the mammary ducts without invasion into surrounding tissue. (Not every case develops into cancer but if not treated, can develop into invasive carcinoma).
