Regulation/Protection
Ploidy
- description of cells by chromosome number & appearance- cancer cells can gain or lose whole chromosomes during the malignant transformation phase - remaining chromosomes may have structural abnormalities
Staging of cancer
- determines the exact location of the cancer and degree of metastasis.
Cryotherapy
- freezing of the cancer cells which will cause subsequent necrosis & tissue sloughing
Antimetabolites
- impair cell division
Alkylating agents
- inhibit cell division by disrupting RNA & DNA synthesis
Photodynamic therapy
- injected with agent that sensitizes cells to light then laser light is focused on tumor
Antitumor
- interrupts DNA or RNA synthesis
Hysterectomy
- laparoscopic, vaginal, open depending on extend of disease
Limited cutaneous SSc
- limited to sites away from face -CREST Syndrome -Lab finding similar to SLE -Upper & Lower GI studies -Other labs depending on organs involved -Response to drug therapy can help differentiate from SLE
Diffuse cutaneous SSc
- over most of body Edema to upper extremities (1st symptom) Diffuse scleroderma likely to cause major organ damage especially in renal & cardiovascular systems
Antimitotic
- prevents cancer cells from dividing or divides only once
Interleukins (ILs)
- regulate inflammation & immunity
Conization
- removal of cone shaped section of cervical tissue & sent to lab for examination
RA - Nursing Interventions- Nonpharmacological
- rest, positioning, heat & ice packs -ice for acute inflammation (small bag of corn or frozen peas can be used as ice pack) -heat for stiffness, comfort (hot shower to relieve morning stiffness) -Heated paraffin (wax) dips -Finger & hand exercises
CEA (carcinoembryonic antigen)
- screening blood test that identifies a protein that is commonly found in some cancers, can be used to assess effectiveness of treatment
photodynamic therapy (PDT)
- use of certain types of lasers -agent given IV to sensitize cells to light, cancer cells will eliminate agent more slowly than normal cells so after 48-72 hours, most of the drug is concentrated in cancer cells.
ESR (erythrocyte sedimentation rate)
-"Sed rate" -confirms inflammation or infection anywhere in body -elevated ESR supports dx of unspecific inflammatory disease -useful to monitor course of disease -higher ESR, increase progession of disease Its normal value is less than 30 mm/hr
Diagnosis of Juvenile idiopathic arthritis
-ANA (antinuclear antibodies) -ESR/CRP, -Leukocytes -slit-lamp eye exam -x-rays (can indicate soft tissue swelling and joint space widening from excess synovial fluid in the joint)
Prostate Cancer - Interventions
-Active surveillance if asymptomatic -Surgical >Transurethral resection of the Prostate (TURP) >Laparoscopic radical prostatectomy >Open >Bilateral orchiectomy (removal of both testicles) -Nonsurgical >Radiation (external or internal) >Chemotherapy (Cisplatin) -Hormone Therapy - cancer is hormone sensitive so may use androgen deprivation >Luteinizing hormone releasing hormone agonists or anti-androgens >Lupron
colon cancer risk factors
-Age > 50 -Family hx -Crohns or UC -Diet: high fat, high red meat, low fruits, low fiber -African Americans -Smoking -Obesity -DM
Prostate Cancer - Diagnosis
-Assessment of urination -Digital rectal exam (DRE) -Hard and stony with irregularities or indurations -Transrectal ultrasound -Biopsy (prostate, lymph nodes) -Other imaging studies: MRI, CT, bone scans, LFTs
Breast cancer - inherited gene mutation
-BRCA1 or BRCA2 genes -Primary prevention: surgical or chemoprevention: vitamin D, tamoxifen -Even if no family history, the risk for general, non-familial breast cancer increases with age
mastectomy reconstruction
-Breast implant -May need tissue expanders first to create a pocket for implant
Signs of SLE
-Butterfly rash: major manifestation - dry, scaly, raised rash on face, -Alopecia, -Mouth ulcers, -Polyarthritis, -Fatigue/Weakness,
Monitor with BRM's
-CBC, -Liver, -GI disturbances, -Avoid live vaccines & alcohol, -Teratogenic effects
Crest syndrome
-Calcinosis (calcium deposits in skin), -Raynaud's (parts of body are numb & cool, -esophageal dysmotility, -Sclerodactyly (thickening & tightening of skin), -Telangiectasia (dilated small blood vessels)
Lung Cancer - Treatment
-Chemotherapy -Targeted Therapy -Radiation -Photodynamic therapy -Surgical Intervention - removal of tumor only, lung segment, lobectomy, pneumonectomy
systemic lupus erythematosus (SLE)
-Chronic, -Progressive, -Inflammatory connective tissue disorder (autoimmune) -characteristics exacerbations ("flare") & remissions -Multiple organ (damage, destruction), vasculitis leading to ischemia - Potentially fatal - must wear bracelet
JIA TREATMENT GOALS
-Chronic, progressive, systemic inflammatory autoimmune disease -Transformed autoantibodies (Rheumatoid factors [RFs]) attack healthy tissues, particularly synovium, causing inflammation. Then the articular cartilage, joint capsule, ligaments and tendons are affected and then eventually the bone is invaded and destroyed. -Affects primarily synovial joints - inflammation leads to pannus: vascular granulation tissue that erodes cart
Signs of Scleroderma
-Crest syndrome -Arthralgia -Pitting edema of hand & fingers (fingers sausage ) -skin taunt & shinny -GERD Common in both types -Progresses to dysphagia -Periungual lesions -Severe cases: digit necrosis --> autoamputation of the distal digits -Myocardial fibrosis >ECG changes >Dysrhythmias >Chest pain -Fibrosis of alveoli and interstitial tissues -Pulmonary arterial HTN
lung cancer diagnostic tests
-Cytologic Testing - early morning sputum, thoracentesis fluid -CXR (chest x-ray) -Lung CT -MRI -Thoracoscopy/bronchoscopy -Needle Biopsy -PET Scan
Cervical Cancer Treatment
-Electrosurgical excision -Laser -Cryosurgery -Radiation and chemo for late stages -Conization (remove part of cervix) -Hysterectomy -
JIA - Biologic disease- modifying antirheumatic drugs -
-Enbrel (etanercept), -Humira (adalimumab), -Remicade (infliximab). -Maybe used in combination with methotrexate -Patient/parent teaching about risk for infection - when to hold the med and when to contact health care provider -Need negative TST prior to starting therapy
Treatment Rheumatic Fever
-Eradication strep, -Prevent permanent cardiac damage, ***Penicillin is first choice , -Long-term prophylaxis
teletherapy radiation
-External Beam RT -Most common form of radiation. There is a defined outlined precise target area. They make a mold to shield and protect the surrounding areas.
Lung changes with Scleroderma
-Fibrosis of alveoli & interstitial tissue, -Pulmonary arterial HTN
Colon Cancer Assessment
-History >Cancer >Bowel Disease >Family >Alcohol, smoking, diet -Change in bowel & stool -Bleeding -Fatigue -Weight Loss -Pain
Breast Cancer - Screening/Testing
-Imaging >Mammogram - controversy about when to begin & how often - follow MD's recommendation >Tomosynthesis- 3D images >Ultrasound >CT/MRI -Needle Biopsy >Breast Tissue >Lymph Nodes -Labs - liver enzymes, calcium & alkaline phosphatase
Cancer Etiology - Personal Factors
-Immune Function - protects body from foreign invaders and non-self cells (cells that are no longer normal). >Cancer increased in immunosuppressed >Adults over 60 >Organ transplant recipients (anti-rejection drugs) >Acquired immunodeficiency syndrome (AIDS) -Genenetics >Inherited cancers: breast, prostate, ovarian >Down Syndromes: increased risk for leukemia
Glucocorticoids
For acutely active exacerbation flare ups (fever, rash, pericarditis) - use low dose for short amount of time, tapper off. (Prednisone, Cortizone)
GI signs with Scleroderma
GERD, -dysphagia, -reflux-esophagitis & ulceration, -diminished peristalsis, -malabsorption, -malodourous diarrheal stool
Gilo
Glial cells in brain
Prednisone (Deltasone)
Glucocorticoid may be given in high dose for short duration or as a low chronic dose (pulse therapy) anti inflammatory Side effects: risk of infection, osteoporosis, adrenal suppression, fluid retention, GI discomfort, hyperglycemia, hypokalemia.
Cancer Treatment - Common Side Effects
IMMUNITY and CLOTTING • GI function • Peripheral nerve SENSORY PERCEPTION • Central motor and sensory function • Respiratory and cardiac function • Comfort and quality of life
Which drugs are used for the treatment of clients with rheumatoid arthritis that inhibit tumor necrosis factor-A?
Infliximab, etanercept, and golimumab These are BRMs used in the treatment of rheumatoid arthritis that inhibit tumor necrosis factor (TNF)-
Monitor with Humira
Injection site reaction
Initiation malignant transformation
Irreversible, change in gene expression
periungual lesions
Ischemic skin lesions that appear in groups as small, brownish spots, most commonly around the nail bed.
Late signs of Rheumatoid Arthritis
Joint - deformities Systemic - -Osteoporosis, -Sever fatigue, -Anemia, -Weight loss, -Subcutaneous nodules, -Peripheral neuropathy, -Vasculitis, -Pericarditis, -Fibrotic lung disease, -Sjogren's syndrome, -Kidney disease, -Felty's disease
Late assessment of Rheumatoid Arthritis
Joint - deformities, -Swan neck, -Ulnar deviation, -Boutonniere deformity, -Carpal tunnel, -TMJ, -Fell puffy, -Decreased ROM, -Muscle atrophy, -Tendon rupture, -Rheumatoid nodules, -periungual lesions, -peripheral neuropathy, -Cardiac & Respritory complications, eyes
Early assessment of Rheumatoid Arthritis
Joint - hands: warm, stiff, red, swollen, tender/painful One hot spot = Joint infection Systemic - Fever, Fatigue, Weakness, Anorexia, Paresthesia
Early signs of Rheumatoid Arthritis
Joint-inflammation Systemic - Fever, Fatigue, Weakness, Anorexia, Paresthesia
What is involved in Rheumatic Fever
Joints, Skin, Brain, Serous Surfaces, Heart (Mitral Valve)
What is the name of the rare immunologically mediated disease characterized by deposition of dense collagen in skin and other organs?
Systemic Sclerosis (Scleroderma)
Lab test support dx of RA, but no single test or group of test can confirm it.
TRUE!
Cancer Prevention - Primary
-Avoidance of known or potential carcinogens -Modification of associated factors -Removal of "at-risk" tissues -Chemoprevention: >Aspirin + Celebrex = colon cancer >Vit D + tamoxifen = breast cancer >Lycopene = prostate cancer -Vaccination
Chemotherapy Induced Peripheral Neuropathy
-Altered sensation in hands & feet - may or may not resolve -Impaired gait/balance, orthostatic hypotension, erectile dysfunction, pain, taste alteration, severe constipation ***priority for nursing care of patients experiencing CIPN is teaching them to prevent injury
Minor Signs Rheumatic Fever
-Arthralgia, -Fever, -Elevated ESR & CRP
myocutaneous flap
Flap of skin, fat, and muscle transferred from donor site to the operative site
Topoisomerase inhibitors
- cause cell death by disrupting enzyme essential for DNA synthesis and cell division
seven warning signs of cancer CAUTION
*C*hange in bowel or bladder habits *A* sore that does not heal *U*nusual bleeding or discharge from any body orifice *T*hickening or a lump in breast or elsewhere *I*ndigestion or difficulty swallowing *O*bvious changes in a wart or mole *N*agging cough or hoarseness
Breast Self-Examination
- 1 week after menstrual period - decreased swelling & tenderness
Cisplatin (Platinol)
- Treatment for cancer. - If a client has reported fatigue it is important to check the pts most recent CBC. The client I likely to be anemic as a result of myelosuppression (bone marrow suppression) from the chem. The pt may require tx for the anemia (transfusion, medications) and further chemo may be need to be delayed until the blood counts are higher.
Targeted therapy
- agents that work to disrupt cell division but only directed at cancer cell that has that genetic mutation or target
DMARD: Hydroxychloroquine
- antimalarial drug that helps decrease joint and muscle pain. -SE: mild stomach discomfort, light-headedness, headache. -Report blurred vision as can cause retinal damage. Eye exam before starting drug and Q 6 months.
grading of tumors
- classifies cellular aspects of the cancer - some cells are "more malignant" than others - more aggressive & less sensitive to treatment
Breast Cancer - Assessment
-Irregular, poorly defined mass -Dimpling - advanced disease -Peau d'orange (orange peel skin) - late stage breast cancer IBC: >Swelling, skin redness, pain >Seldom presents as a palpable lump >May not show up on mammogram -Males: >Hard, painless, sub-areolar mass Gynecomastia >Nipple discharge, retraction, erosion, or ulceration
Colon Cancer - Diagnostics
-Labs - CEA, fecal occult blood, CBC, LFTS -Barium Enema -CT -MRI -Colonoscopy/sigmoidoscopy ***Colonoscopy is the definitive test for the diagnosis
Loop Electrosurgical Excision Procedure (LEEP)
-Local anesthetic in cervix -Thin loop wire electrode uses electrical current to cut away affected tissue - both diagnostic and treatment
Meds for Sjogren's Syndrome
-Methotrexate, -Cycophosphamide, -Steroids, -Cyclosporine, -Hydroxychloroquine, -Pilocarpoie, -Cyclosporine (eyes)
Breast Cancer - Health Maintenance Risks
-Modifiable risk factors: >Avoid obesity >Minimize alcohol -Breast feeding for 1 year or more -Discuss risks and benefits of HRT in menopause -Environmental estrogens: >DDT in pesticides >BPA in plastic containers >PFOA in nonstick cookware
Signs of Diffuse Scleroderma
-No edema, -tightening, hardening, thickening skin, -loss elasticity, joint contractures may occur, -Ulcerations may occur, -ROM decreased, -major organ damage especially in renal & cardiovascular system
prostate cancer
-One of the slowest growing and predictable -Can have 100% cure rate if found early -Metastasizes to nearby lymph nodes, bones, lungs and liver -Most are androgen-sensitive *Androgen-sensitive means sensitive to male hormones - testosterone and DHT (dihydrotestosterone)
Lung Cancer - Palliative
-Oxygen therapy -Drug therapy >Bronchodilators, corticosteroids, mucolytics -Radiation therapy -Thoracentesis - removal of fluid for lung expansion -Dyspnea management >Oxygen, morphine, positioning -Pain Management -Hospice care
Cervical Cancer- Diagnostic Assessment
-Pap smear >Follow ACS guidelines -Colposcopy - apply acetic acid and with magnification & bright filter light to enhance visualization -Cervical biopsy -Endocervical scraping of endo cervix wall >Small amount of bleeding expected for up to 2 weeks
Cardiovascular signs with Scleroderma
-Periungual lesions, -Rayaud's, -Digit necrosis, -Myocardial fibrosis (ECG changes, Dysrhythmias, chest pain)
Prostate Cancer - Screening
-Prostate-specific antigen testing (PSA); normal is < 2.5ng/ml -Age 50 or family history - maybe earlier -Check before DRE because can cause an abnormal elevation of results -Early prostate cancer antigen (EPCA-2) - sensitive and specific -One of the 1st symptoms is bladder obstruction: >difficulty starting urination, frequent bladder infections, urinary retention, hematuria (sign of late cancer), nocturia. >Pain during intercourse esp when ejaculating.
radiation therapy
-Purpose is to destroy cancer cells, provide disease control, or relieve symptoms with minimal damaging effects to surrounding normal cells. -Gamma rays generally used because of ability to deeply penetrate tissues
Colon Cancer Treatment
-Radiation -Chemotherapy >Vascular endothelial growth factor (VEGF) inhibitors >Epidermal growth factor receptor inhibitor (EGFRI) -Surgical Management >Colon Resection >Colectomy >Possible colostomy >Abdominoperineal (AP) resection
Diagnostics of Rheumatoid arthritis
-Rheumatoid factor, -Antinuclear antibody, -serum compliment proteins (C3 & C4), -ESR, -High-sensitivity C-reaction protein, Late proggression - CBC, Platelets, Anti-cyclia citrullinated peptide (anti-CCP), -Arthrocentesis (aspirate synovial fluid), -X-ray, MRI, CT, Bone & Joint scan
Labs for SLE
-Rheumatoid factors, -CBC, -ESR, -ANA, -False-positive syphilis
Breast Cancer
-Second most commonly diagnosed cancer in women after skin cancer -Non-Invasive - ductal and lobular carcinoma in situ: have not invaded the tissues outside of the ducts and milk-producing glands -Invasive - most common - infiltrating ductal carcinoma -Inflammatory breast cancer (IBC) - rare and highly aggressive
Oncological Emergencies
-Sepsis/Septicemia -Disseminated Intravascular Coagulation (DIC) -SIADH -commonly caused by cancer cells especially small cell lung cancer -Spinal Cord Compression (SCC) -Hypercalcemia -Superior Vena Cava Syndrome -Tumor Lysis Syndrome- tumor sensitive to treatment
Treatment for Scleroderma
-Skin protection, -Reduce vasospasm & constriction (temp, avoid smoking, sm. frequent meals) -Swallow precautions (HOB 60 degrees, 1-2 hrs after meal) -limit spicy foods, caffeine, alcohol antacids or histamine antagonist -Joint protection -Energy conversion; ADL's
Breast Cancer - Treatment
-Surgical >Breast-conserving - Lumpectomy, >Partial Mastectomy >Simple Mastectomy - entire breast removed & some lymph nodes >Modified Radical Mastectomy - entire breast removed & some lymph nodes as well as some chest wall muscle -Chemotherapy and/or Radiation - maybe used to shrink tumor first before removal or afterwards in combination to kill any residual cells or if metastasis has occurred >Neoadjuvant therapy - chemo before surgery to shrink tumor >Adjuvant therapy - after surgery
Treatment of Rheumatoid arthritis
-Surgical - Synovectomy, Total joint arthroplasty -Ice = inflammation -Heat = stiffness -Plasmapheresis (Plasma treated to remove antibodies (sever, life threatening) -Omega-3,6 fatty acids -Low stress
RA - Nursing Interventions- Surgical
-Synovectomy (remove inflamed synovium) -Total joint arthroplasty
Lung Cancer
-Third leading cause of new cancer -Leading cause of cancer-related death -Major risk factor is smoking -Exposure to second hand smoke puts individuals at greater risk than non-smokers -Chronic inhalation of carcinogens -Metastasis to lymph nodes, bone, liver, brain, adrenal glands
A nurse is creating a plan of care for range-of-motion exercises for a client with rheumatoid arthritis who has severe pain and swelling of the joints in both hands. What should the plan include?
Applying heat or cold before the exercises
Colorectal Cancer
-Third most common cause of cancer death -Not common before 40 but is increasing -2/3 of colon cancer in descending colon/rectum -Polyps - benign but can become malignant over time -Spread by blood/lymph -Metastasize to other abdominal organs, brain, bone -Bowel obstruction, perforation, peritonitis, abscess, fistula
Systemic Sclerosis (Scleroderma)
-Uncommon chronic, inflammatory, autoimmune connective tissue disease -Women > men; 25 - 55 years -Maybe misdiagnosed at first as SLE -->Less common than SLE but higher mortality rate -Inflamed tissue becomes fibrotic then sclerotic (hardens) -Do not respond well to steroids and immunosuppressants used in lupus so mortality rate is high
Cancer Prevention - Secondary
-Use of screening strategies to detect cancer early. >Cure or control more likely -Participate in specific routine screenings. -Genetic screening.
Who is affected most by SLE
-White Women, -20-40
Cervical Cancer - Assessment
-Yearly Check Ups -Pre-invasive Cancer is asymptomatic -Classic symptom - painless vaginal bleeding -Late Symptoms >Pain >Watery, blood-tinged vaginal discharge that becomes dark and foul-smelling >Leg pain along sciatic nerve >Flank pain - hydronephrosis >Unexplained weight loss >Dysuria >Pelvic pain >Hematuria
Zofran (ondansetron)
-antiemetic; -antiserotonergic (blocks serotonin receptor in GI tract and CTZ) -IV or oral -s/s: Bradycardia, hypotension vertigo headache
hormonal therapy for breast cancer
-blocks effect and source of estrogen, promoting tumor regression -estrogen can increase growth of breast cancer cells if cells are estrogen receptor positive -an adjuvant to primary treatment -for patients with recurrent or metastatic cancer **Estrogen receptor (ER) positive **Progesterone receptor (PR) positive **Selective estrogen receptor modulators (SERMs)- Tamoxifen
Changes in Cognitive function -"Chemo brain"
-difficulty with concentration, memory loss, learning new information - can last months to years -Listen to patient concerns, provide reassurance that others have experienced the same symptoms, promote safety, provide resources for cognitive training. -Avoid alcohol, recreational drug use, activities that increase risk for head injury **priorities for nursing care are supporting the patient who reports this side effect and providing resources for cognitive training
Aromatase inhibitors (AIs)
-postmenopausal women -Usually follows treatment with tamoxifen -Loss of bone density
JIA- Glucocorticoids
-provide prompt anti-inflammatory response for acutely active exacerbations or systemic features (fever, rash, pericarditis) -Use lowest effective dose for shortest time possible then tapered off - may be given PO, IV, eye drops or intra-articular joint injection -Teaching re: potential side effects - risks of infection, weight gain, Cushingoid features, hypertension, diabetes, osteoporosis, mood/sleep changes, avascular necrosis -Dietary considerations - low calorie and low salt -Active exercise program
Considerations with BRM's
-risk for infection - any signs emergency, -Need negative TB test before therapy, -May be used w/Methotrexate
Interferons (IFNs)
-slow tumor cell division, inhibit expression of oncogenes, stimulate growth & activation of NK cells (natural killer)
Extravasation Treatment
-stop infusion -discontinue administration set -aspirate drug if possible -apply COLD compress -document condition of site ***Most important nursing intervention is prevention
Which medication should the nurse anticipate the healthcare provider will prescribe to relieve the pain experienced by a client with rheumatoid arthritis?
Aspirin
3 stages of malignant transformation
1. initiation: irreversible event - change in gene expression by anything that can damage cellular DNA (carcinogens) 2. promotion: enhanced growth of initiated cell by substances called promoters. 3. progression: - continued change, becoming more malignant over time
Sjorgen's Syndrome
Autoimmune disorder it attacks the glands that make tears and saliva. This causes a dry mouth and dry eyes.
Side effects of Glucocorticoids
Fluid Accumulation Electrolyte imbalance Susceptibility to infection Behavioral Changes Hyperglycemia Peptic Ulcer Delayed wound healing Visual disturbances Weight Gain
When does Rheumatic fever occur
2-6 weeks after an untreated or partially treated group A beta-hemolytic streptococcal infection of the upper respiratory tract.
benign
Cell Division- continuous or inappropriate Adherence - Tight Migratory - None Growth - Expansion Appearance - specific morphologic features
Cancer Development
Cells normally "grow" by cell mitosis - Some cells slow with maturity of the person but other cells continue to be replaced rapidly. -From normal cells (parent cell) there is a change in one cell after mitosis. -Cancer cells were once normal but then something triggers genetic mutation within cell and strict processes for control of normal growth and function are lost.
Vesicants
Drugs capable of causing pain, inflammation and blistering of skin, underlying flesh and structures leading to tissue death & necrosis
normal leukocyte range
4500-11000
_______?______ with _______?________ offer the best chance at preventing the joint deformities associated with rheumatoid arthritis, because they can move each involved joint through its full range of motion.
Active exercises with alternated periods of rest,
Psoriatic arthritis
An inflammatory arthritis associated with psoriasis of the skin rash w/ silvery scale on elbows and knees, pitting nails and swollen fingers.
rheumatic fever
A disease that can result from inadequately treated strep throat or scarlet fever a disease that can affect the heart, joints, brain, and skin
Which assessment findings will the nurse expect for the client with late-stage rheumatoid arthritis - SATA A - Bony nodes in finger joints B - Subcutaneous nodules C - Severe weight loss D - Joint deformity E - Thrombocytosis
A, B, C, D, E
Which health teaching by the nurse is important for clients diagnosed with systemic lupus erythematosus? SATA A - Take frequent rest periods to prevent fatigue B - avoid green leafy vegetables to prevent bleeding C - Avoid sun exposure to prevent disease flare-ups D - Report fever to your health care provider imediately E - use a mild soap for bathing to prevent sin irritation
A, C, D, E
Methotrexate (Rheumatrex)
Anti-Rheumatic - slow acting. May take 4 to 6 weeks to begin to control joint inflammation. - at risk for infection. - avoid crowds, ill people -avoid alcohol to prevent liver toxicity - mouth sores, lung inflammation (dyspnea) - folic acid is given to help decrease some of the side effects. -strict birth control because of birth defects; do not breastfeed.
Paclitaxel (Taxol)
Antimitotic (cytotoxic antineoplastic) It can treat lung, ovarian, and breast cancer -Can cause anaphylaxis, bone marrow suppression, bradycardia, heart block, MI, alopecia -Do not use w/ hypersensitivity to castor oil
Mesna (Mesnex)
Drugs used to protect against Chemotherapy Toxicity prevent hemorrhagic cystitis from ifosfamide and cyclophosphamide
________ __________ mobilize exudate in the joints and relieve stiffness and pain.
Active exercises (e.g., alternating extension, flexion, abduction, and adduction)
Signs of Sjogren's syndrome
Dry - Eyes, Mouth, Vagina
Tests/Diagnostics for Cancer
Blood Tests - CEA (Carcinoembryonic Antigen) >Other lab tests specific to type of cancer Radiological Studies - X-ray, CT, PET, MRI Specimens - biopsy
Osteo
Bone
RA test that detects inflammation
ESR, C-reaction protein
Promotion malignant transformation
Enhanced growth of initiated cell by substance cell promters
Adreno
Epithelial glands
Major Signs of Rheumatic Fever
Carditis, Polyarthritis, Subcutaneous nodes, Erytherma Marginatum, Chorea
malignant
Cell Division - Rapid or continuous Adherence - Loose Migratory - Yes: metastasis Growth - Invades surrounding tissues Appearance - anaplastic - no has specific appearance of parent cells
Cancer Etiology - External Factors
Chemical - tobacco, asbestos, asphalt fumes, benzene, gasoline, diesel exhaust... many others Physical carcinogens: radiation, chronic irritation >UV radiation - sun exposure, tanning beds, germicidal lights >Ionizing radiation - x rays, cosmic radiation >Chronic irritation - GERD - chronic irritation of throat, larynx from reflux can lead to gastric cancer. Skin cancer with burn scars etc Viral - oncoviruses - HPV, Epstein-Barr, Hep B & C
_____________ or ______________ given to decrease impact on normal cells
Chemoprotectants; cytoprotectants
Juvenile Idiopathic Arthritis (JIA)
Chronic, childhood arthritis - Inflammation of joint, leads to erosion, destruction, fibrosis, adhesion & ankyloses
Rheumatoid Arthritis - Pathophysiology
Chronic, progressive, systemic inflammatory autoimmune disease Transformed autoantibodies (Rheumatoid factors [RFs]) attack healthy tissues, particularly synovium, causing inflammation. Then the articular cartilage, joint capsule, ligaments and tendons are affected and then eventually the bone is invaded and destroyed. Affects primarily synovial joints - inflammation leads to pannus: vascular granulation tissue that erodes cart
Discoid rash
Coinshaped rash. Commonly found in patients with SLE.
Progression malignant transformation
Continued change, becomes more malignant over time, tumor & vascular endothelial growth factor VEGF
Methotiexate
DMARD - immunosuppressive - monitor bone marrow suppression, low WBC & Platelets, increased liver enzyme or serum creatinine
Leukocytes (White Blood Cells)
Defend the body against infection and remove debris 4,500 to 11,000 WBC per microliter (4.5 to 11.0 × 109/L
Antinuclear antibodies (ANA)
Detects Autoimmune disease measures titer of group of antibodies that destroy cell nuclei & cause cell death in those with autoimmune disease
types of Scleroderma
Diffuse cutaneous - over most of body Limited cutaneous - sites away from face
Etanercept (Enbrel)
Disease-modifying antirheumatic drug (DMARD). Interrupts complex immune responses, preventing disease progression. Uses: slow joint degeneration and progression of rheumatoid arthritis. **Tell pt to report signs of site reaction
Non-pharmacologic interventions with Chemotherapy
Distraction, massage, guided imagery, complementary therapies
First sign of Scleroderma
Fingers look like sausages (edema)
Renal
Kidney
Diet while on Glucocoticoids
Low calorie, low salt
Renal changes with scleroderma
Malignant HTN & death
Meds for Scleroderma
Medications Force disease into remission >Systemic steroids & immunosuppressant in lg. doses - often unsuccessful -Bosetan (Tracleer) -> Improved pulmonary HTN -> liver toxicity, birth defects -Tyrosine Kinase inhibitor (TKIs) - ->Nilotinib (Tasigna) ->Imatinib mesylate (Gleevec) -NSAIDs for inflammation and pain
Treatment SLE
Medications: -Steroids, -NSAIDs, -Hydroxychloroqine (eye exam), Immunosuppressant: -methotrexate, -cyclophosphamide, -mycophenolate, -azathiprine - Risk for infection -Belimumab - IV/SQ - mAb (risk for infection, no live vaccines 30 days) -Plasmapheresis -Kidney transplant -antihypertensive -low-dose asprirn -Calcim -Vit. D
Meds to treat Juvenile idiopathic arthritis
NSAIDS, DMARD, BMARD, Glucocorticoids
Meds for Rheumatoid arthritis
NSAIDs, DMARDS, Glucocorticoids
Neuro
Nerve tissue
JIA - Therapeutic Management
No Cure Major goals of therapy -Control pain -Preserve joint ROM and function -Minimize effects of inflammation such as joint deformity -Promote normal growth and development Medication - Suppress inflammation and pain
Treatment for juvenile idiopathic arthritis
No cure, Control pain, PT/OT, eye exams, splints, dietary mgmt. Comfort measures
Sjogren's syndrome
Obstruction of secretory ducts & glands by inflammatory cells and immune complexes - seen with advanced RA
Metastatic / secondary
Originates from some part of the body and spread by blood or lymph (same cell different location)
melano
Pigment producing cells
lung cancer complications
Poor oxygenation >Bronchioles- tumor can obstruct >Tumor can cause compression of other parts of the lung
Diagnostics of Rheumatic Fever
Positive throat culture, Rapid-strep antigen test, Elevated strep antibody titer
brachytherapy radiation
Radiation source is within the client who emits radiation and is a hazard to those around for a period of time. -Sealed or solid - implanted within or near tumor cells - seeds, needles, rods >Patient no longer radioactive once source is removed. -Unsealed - suspended in body fluids - given oral, IV, instilled in body cavities **Patient in ISOLATION while emitting radiation
Erytherma Marginatum
Rash with pink rings, and lines
Cancer Management - Surgical
Reasons for Surgery: -Prophylactic - remove "at risk" tissue -Diagnostic - biopsy -Curative Surgery - remove all cancer tissue -Cancer Control - remove part but not all of the tumor - debulking -Palliative - improve quality of life but not a cure -Second-look - examine tissues to see determine if treatment was effective -Reconstructive or rehabilitative - increases function, enhances appearance or both
prostate cancer risk factors
Risk factors: -Advancing age -1st degree relative; genetics -Race -Diet- fiber, high fat diet -Vasectomy -Environmental toxins
Which has a higher mortality rate Scleroderma or SLE
Scleroderma
SLE - Diagnostic Criteria: SOAP BRAIN MD
Serositis, Oral ulcer, Arthritis, Photosensitivity Blood counts - low, Renal, ANA, Immunologic, Neurologic Malar rash, Discoid rash
periungual lesions
Small, brownish spots, most commonly around the nail bed
Life threatening symptom of Rheumatoid Arthritis
Subflexion 1 & 2 vertebrae - keep neck straight and neutral
Treatment of Sjogren's Syndrome
Symptomatic relief Optho-artificial tears Oral-water, gum
Cancer Management
The purpose is to cure or control the disease while minimizing the side effects of therapy. Consists of: -Surgery -Radiation - internal, external -Chemotherapy - various routes -Hormonal -Immunotherapy - biologic response modifiers, molecularly targeted therapy -Photodynamic therapy
cervical cancer
Third most common cancer of female genital system Usually in 30's-40's Human Papilloma Virus (HPV) >HPV vaccine Gardasil/Cervarix
Latency period
Time from initiation to overt tumor - varies from months to years
Targeted Therapy Medication
Trastuzumab (Herceptin) - 1st targeted drug for breast cancer
Vascular endothelial growth factor (VEGF)
Triggers growth of new capillaries into tumor
One of the biggest problems is the misperception by patients and nononcology nurses that these drugs are less toxic than IV chemotherapy
True! they are just as toxic
Paraneoplastic Syndrome
Tumors can secrete hormones -ADH - cause SIADH -ACTH - Cushings -FSH - gynecomastia -Parathyroid hormone - increased serum calcium -Ectopic insulin - hypoglycemia
How many signs do you need with Rheumatic Fever
Two major, or One major and two minor
Assessment of Rheumatic Fever
VS, Heart Sounds, Change in ECG
In RA synovial fluid is analyzed for
WBC, Rheumatoid factor, cloudiness
Cortisone (Steroids)
Wt gain, Na+ retention, K+ Loss NEVER STOP SUDDENLY injection into joint (have pt ice and rest for 24 hrs after procedure) Chronic use can cause infection, hypertension, weight gain, osteoporosis, glaucoma, hyperglycemia (DM).
What can NSAIDs be given with for GI irritation
Zantac
rheumatoid arthritis
a chronic autoimmune disorder in which the joints and some organs of other body systems are attacked
Rheumatoid Arthritis
a chronic, progressive, systemic inflammatory autoimmune disorder in which the joints and some organs of other body systems are attacked - Women more than men - SYMMETRICAL
Undifferentiated arthritis
a common inflammatory form of arthritis involving joint swelling, pain, and stiffness that cannot be classified as a specific rheumatologic disorder.
Nurses must have what to administer chemo?
a complete and approved chemotherapy program in order to administer
ankyloses
abnormal stiffening and immobility of a joint due to fusion of the bones
After assessing a client with rheumatoid arthritis, the nurse suspects Sjögren's syndrome. Which manifestations are consistent with Sjögren's syndrome?
advanced rheumatoid arthritis, includes such symptoms as: -xerostomia (dry mouth) -keratoconjunctivitis sicca (dry eyes)
Oligoarthritis JIA
also called pauciarticular juvenile rheumatoid arthritis, -affects fewer than five joints in the first six months that the child has the disease. -The joints most commonly affected are the knee, ankle, and wrist -Persistent oligoarthritis: maintaining a mild level of disease, with 4 or fewer joints affected. -Extended oligoarthritis: affecting 5 or more joints after the first 6 months of disease, with a course much like polyarticular JIA.
systemic lupus erythematosus (lupus)
an autoimmune disorder characterized by a red, scaly rash on the face and upper trunk. in addition to the skin, this condition also attacks the connective tissue in other body systems, especially joints
Reglan (metoclopramide) is a (an) _______ that is most effective when given prophylactically (at least 30 min prior to chemo/radiation)
antiemetic -s/s: Drowsiness
Hydroxychloroquine
antimalarial drug that decreases joint and muscle pain - SE: mild stomach pain, light-headedness, headache, blurred vision
Arthrocentesis
aspirate synovial fluid to relieve pressure & analyze fluid cells for WBC, cloudiness, volume, rheumatoid factor. -Teach pt to ice and rest joint for 24 hrs after. -If increased pain or swelling - see PCP immediately.
felty's disease
autoimmune disease characterized by the triad of rheumatoid arthritis, enlargement of the spleen and too few neutrophils in the blood.
When does Juvenile idiopathic arthritis present
before 16, usually 1-3
C-reactive protein (CRP)
blood test used to measure the level of inflammation in the body
hemangio
blood vessel
myelosuppression
bone marrow suppression of leukocytes, erythrocytes, platelets. -Anemia, thrombocytopenia, neutropenia
Amifostine (Ethyol)
chemo-protectant that reduce kidney damage by cisplatin
Monitor with Remicade
chest pain, difficult breathing during infusion, BP, infusion site
Rheumatic Fever
complication of Streptococcal disease that may damage heart valves
Antimitotic agents
cytotoxic drugs that interfere with the formation of tubules so cells cannot separate during cell division
Biological Response Modifiers (BRMs)
decreased immune response & inflammations - Enbrel (2X wk,SQ), -Remicade (IV infusion), -Humira (SQ, every 2 wks)
tumor
develops own blood supply - vascular endothelial growth factor (VEGF) triggers growth of new capillaries into tumor.
DMARD
disease-modifying antirheumatic drug Methrotrexate & Sulfasalazine
Anti-cyclic citrullinated peptide (anti-CCP)
early RA detector, or marker for aggressive, corrosive late - most specific test for RA
Biological Response Modifiers (BRMs)
enhance or alter the patient's biologic responses to cancer cells. -BRMs have a variety of effects -Two common types of BRMs for cancer therapy are: >interleukins >interferons some agents can: >stimulate specific immune system components to attack and destroy cancer cells; >other agents block cancer cell access to an essential function or nutrient needed for cell survival.
ESR
erythrocyte sedimentation rate - indicates inflammation
Cushingoid
group of symptoms (including moon face, buffalo hump)
alopecia
hair loss **priority nursing actions are to teach patients how to avoid scalp injury and to help them cope with this body image change.
During the acute phase, _____________ of the joints reduces pain and inflammation.
immobilization Active exercises are contraindicated during the acute inflammatory phase; joints need to be immobilized
DMARD: Methotrexate (Rheumatrex)
immunosuppressive, low dose 25 mg PO weekly - takes 4 - 6 weeks to begin to decrease inflammation. -Goal to decrease joint pain and swelling. -Monitor for bone marrow suppression - WBC & platelets, increases liver enzymes or serum creatinine
Enthesitis
inflammation of the entheses, the sites where tendons or ligaments insert into the bone
uveitis
inflammation of the uvea in the eye
Arthralgia
joint pain; neuralgic pain in a joint or joints
Signs of juvenile idiopathic arthritis
joint swelling, loss motion, pain, warm, stiffness - especially in morning, growth disturbances, inflammation in other tissues not just joints
Who is most effected by Rheumatic Fever
late school age, early adults
Prolonged use of steroids may cause ____________as a result of bone marrow depression.
leukopenia
hepato
liver
Thrombocytopenia
low platelet count
Lympho
lymphoid tissue
ANA test
measures group of antibodies that destroy nuclei of cells and cause tissue death in pts w/ autoimmune diseases
Rheumatoid Factor (RF)
measures the presence of unusual antibodies of IgG, & IgM - seen in a number of connective tissue diseases The normal reference range for RF is less than 15 IU/mL or less than 1:16
meningio
meninges
what to monitor in periungual lesions
number, location - daily Ischemia - small brown spots around nail beds Lesions = vasculities
What is affected in children with systemic sclerosis
only skin
Mucositis
painful inflammation of oral mucous membranes
Rheumatoid nodules
painless 1-2 cm subqutaneous nodules; develop in 30% of RA patients - may become infected, and occur in LUNGS (Pulmonary problems)
What is it called when all bone marrow cells are low?
pancytopenia
Plasmapheresis
plasma is treated to remove antibodies causing the autoimmune reaction causing the disease (severe, life-threatening cases)
Malar Rash
red macular lesions distributed over the forehead, cheeks, and chin, resembling the pattern of a butterfly
eye changes in Rheumatoid arthritis
reddened sclera, irregular shape pupil, visual disturbances
what is affected in adults with systemic sclerosis
skin & organs
Anti-cyclic citrullinated peptide (anti-CCP)
specific and sensitive for early RA detection; or marker for aggressive, erosive late-stage
Chorea
sudden, rapid, jerky, purposeless movement involving limbs, trunk, or face
Arthrocentesis is:
surgical puncture of a joint to remove fluid
subluxation
the partial displacement of a bone from its joint, one joint slips past another
nadir
time when bone marrow activity and WBCs are at lowest levels. -Increase risk for infection & bleeding; hypoxia, fatigue. -Sepsis can lead to death during treatment. -May be managed with growth factors to stimulate bone marrow production of cells
slit-lamp examination
visual testing of the cornea, lens, fluids, and membranes of the interior of the eye using a narrow beam of light
Who is most effected by Systemic Sclerosis
women, 25-55
