1
Q
What are the 3 main treatments for cancer?
A
- Chemotherapy
- Radiation
- Surgery
2
Q
Why are tubes commonly seen with cancer clients?
A
Many cancer clients have had surgery to remove a tumor and will typically have some type of tube temporarily (and sometimes permanently):
- colostomy
- tracheostomy
- nephrostomy
- chest tubes
Review tubes.
3
Q
Define:
Metastasis
A
When the cancer has moved from its original source to a different part of the body or system.
4
Q
Define:
Benign neoplasm
A
A non-cancerous tumor.
5
Q
How are many cancers diagnosed?
A
By using a scope and biopsying the area.
The client may also have a CT scan or MRI to look for a tumor. There are also some blood tests.
6
Q
Risk factors:
Cancer
A
Focus on problems that cause gene mutation:
- smoking and excessive alcohol
- chemicals in the environment
- sun exposure and chronic skin irritation
- chronic inflammation
- obesity and poor diet
- increased age
- immunosuppressed
- radiation
- viral infections
7
Q
How many stages of cancer are there?
A
There are 5 stages of cancer:
0, I, II, III, IV
The higher the number, the more severe the cancer.
8
Q
What are the warning signs of cancer?
A
- change in bowel or urinary habits (especially bleeding)
- sores that don’t heal
- unusual bleeding or discharge
- lumps (in breasts)
- a change in a mole
- nagging cough or hoarseness
9
Q
What are some common anti-neoplastic medications (chemo meds)?
A
- rituximab
- methotrexate
- anastrozole
10
Q
Why are all chemotherapy meds considered “high alert meds”?
A
Because they have adverse effects of bleeding and infection.
LPNs cannot give chemotherapy.
11
Q
What causes the many side effects of chemo meds?
A
Chemo meds kill cancer cells, but they also affect all tissue cells that are rapidly dividing.
This puts the client at a high risk of infection and bleeding.
12
Q
Define:
Neutropenia
A
A low neutrophil count that indicates there is a high risk of infection.
13
Q
What are the signs and symptoms of infection?
A
- increased temperature >100 F (38C) (or 1 degree over baseline)
- increased pain, swelling, and redness
- green/yellow/foul-smelling discharge
- pneumonia/flu/cold symptoms
14
Q
Define:
Thrombocytopenia
A
A low platelet count that indicates there is a high risk of bleeding.
15
Q
What are the signs and symptoms of bleeding?
A
- decreased platelets < 150,000 (< 20,000 is critical)
- petechiae: red dots on skin
- ecchymosis: bruising
- blood from any orifice (urine, stool, nose, gums)
- large drops in hemoglobin and hematocrit
16
Q
What are the interventions for the adverse effect of chemotherapy: neutropenia?
A
Neutropenic precautions:
- private room
- no fresh fruits or flowers in room
- freshwater for drinking
- avoid ill people
- meticulous hand hygiene and wear gloves
- no live vaccines
- avoid invasive procedures
- fruits and vegetables need to be washed and cooked before eating
- assess for signs and symptoms of infection
17
Q
What are the interventions for the adverse effect of chemotherapy: thrombocytopenia?
A
Bleeding precautions:
- prevent falls
- no straining (give stool softeners)
- no nail clippers (use a file)
- no straight edge razors (use electric)
- avoid shots
- soft toothbrush
18
Q
What 2 medications increase the risk of bleeding and should be avoided with a client on bleeding precautions?
A
NSAIDs and aspirin
19
Q
How long should pressure be applied for clients on bleeding precautions?
A
5 - 10 minutes
20
Q
What is tumor lysis syndrome?
A
When cells get damaged from chemotherapy and uric acid is released in the bloodstream.
Client will need increased fluids to flush out kidneys and allopurinol to decrease uric acid.
21
Q
What are the interventions for the side effect of chemotherapy: nausea/vomiting?
A
- give antiemetics before eating
- provide bland foods
22
Q
What are the interventions for the side effect of chemotherapy: diarrhea?
A
- replace fluids
- monitor fluid and electrolyte balance
- give antidiarrheals
- avoid foods that are irritating to stomach (spicy, caffeine and fiber)
23
Q
What are the interventions for the side effect of chemotherapy: stomatitis/mucositis?
A
- provide oral hygiene
- avoid alcohol mouth wash
- give nystatin to prevent oral candidiasis
- mild foods
- diet high in protein and calories
24
Q
What are the interventions for the side effect of chemotherapy: constipation?
A
- fluids
- fiber
- walking
25
What are the **interventions** for the side effect of chemotherapy: **alopecia (hair loss)**?
* get fitted for wig before chemo starts
* headwraps
* be gentle on hair
26
What are the **interventions** for the side effect of chemotherapy: **infertility**?
* use a sperm bank
* use contraceptives
27
What is **radiation therapy**?
A type of cancer treatment that uses **beams of intense energy to kill cancer cells**.
28
What is the **difference** between external radiation and internal radiation?
1. _External radiation_ is when a **beam is directed toward a client**: the client is not radioactive.
2. _Internal radiation_ is when **radiation is inserted into the client** for a certain amount of time: the client is radioactive.
29
What are the 2 **types** of internal radiation?
1. Sealed radiation
2. Unsealed radiation
30
What is **unsealed radiation**?
Internal radiation that is given by IV, oral or placed in a body cavity.
## Footnote
Anything that is excreted is radioactive for 24 hours.
31
What is **sealed radiation**?
Internal radiation that is implanted into the client's body.
## Footnote
Client is radioactive, but excretions are NOT radioactive. The client is no longer considered radioactive once the implant is removed.
32
What are the general **side effects** of radiation (regardless of where the radiation is directed at)?
**Skin irritation** and **fatigue**.
## Footnote
Radiation can damage skin cells.
33
Because external radiation is directed at the skin, what is the **teaching** for skincare?
**Focused on being gentle to the skin**:
* wash area gently with mild soap or just water
* don't wash off markings for radiation
* pat area dry (no rubbing)
* avoid sun and heat
* no lotions or creams
* no belts or constrictive clothing over site
34
What type of **hospital room** does a client get who has internal radiation?
A **private room and private bathroom** because of radioactivity.
35
How do nurses **reduce their exposure** to radioactive clients?
* clumping nursing care (doing more things at once)
* rotate staff
* 30 minutes maximum for direct client care in a shift
* wear a dosimeter badge
* wear lead shields
36
Who should **_NOT_** be around a client with internal radiation?
* pregnant nurses or pregnant visitors
* children \< 16 years old
37
How **far away** should visitors stand from a client with internal radiation?
At least **6 feet away**.
38
Where should **dirty bed linens** be placed for a client with internal radiation?
**In the room** until client is ready to leave.
39
Does there have to be **dedicated equipment** in the room for a client with internal radiation?
**No.** The equipment can leave and enter the room without any risk to other clients.
40
What is the **intervention** if the radiation implant falls out of the client?
**Use long-handled forceps** and place the implant in a lead container.
## Footnote
Notify the HCP.
41
What is a **bone marrow transplant**?
The **replacement of stem cells** that were destroyed by chemotherapy or radiation.
## Footnote
These stem cells will grow to make RBCs, WBCs, and platelets.
42
Which types of **cancers** typically get a bone marrow transplant?
**Blood cancer** such as:
* **leukemia**
* **lymphoma**
* **multiple myeloma**.
43
What is the **priority** **assessment** after a bone marrow transplant?
Assess for bleeding and infection.
44
What type of **pain meds** are given to clients with cancer pain?
Opioids
## Footnote
Morphine is the most common.
45
What are the **3 main types** of blood cancers?
1. leukemia
2. lymphoma
3. multiple myeloma
46
# Describe:
Leukemia
A **blood cancer that starts in the bone marrow and travels through the bloodstream**. The mutated cells crowd out healthy blood cells.
## Footnote
It causes decreased counts of WBCs, RBCs, and platelets, causing bleeding and infection.
47
# Describe:
Lymphoma
A **blood cancer of WBCs (lymphocytes) that mutate**, grow out of control and **collect in the lymph nodes**.
## Footnote
There is painless swelling of enlarged lymph nodes.
48
What is the **difference** between Hodgkin's lymphoma and Non-Hodgkin's lymphoma?
_Hodgkin's lymphoma_ originates in a **single lymph node or a chain of nodes.**
_Non-Hodgkin's lymphoma_ originates from **other cells or organs** and goes to the lymph nodes.
## Footnote
Hodgkin's lymphoma - average age of onset is 15 - 25 years old or \> 60 years old.
Non-Hodgkin's lymphoma - average age of onset is 60 and most clients have this type.
49
# Describe:
Multiple myeloma
A **blood cancer that develops in the bone marrow** and affects plasma cells (a type of WBC). These mutated cells accumulate in the bone marrow and weaken the bone.
## Footnote
There is a high risk of fractures: prevent falls and injuries.
50
What is the average **age** of onset for testicular cancer?
15 - 40 years old
51
What are the **characteristic signs and symptoms** of testicular cancer?
* may feel pulling sensation on testicles
* painless swelling
* able to feel a mass
52
What is an **orchiectomy**?
A surgery to **remove the testicles**.
53
At what **age** should yearly mammograms begin?
45 years old
54
What are the **characteristic signs and symptoms** of breast cancer?
* a mass or lump that doesn't move
* abnormal discharge from nipples
* dimpling of the skin
55
What is a **mastectomy**?
A surgery to **remove a breast**.
56
What are the post-operative **interventions** on the side where the mastectomy was done?
1. nothing invasive is to be done on affected side: no needle sticks, no blood pressures
2. elevate the affected arm to prevent edema: may need a pressure sleeve
3. Monitor JP drain
57
What are the **complications** after a mastectomy?
Infection and lymphedema.
58
How much **weight** can a client carry on the affected side of the mastectomy?
Avoid carrying anything more than a few pounds (1 kg) for at least 6 weeks.
## Footnote
No heavy purses or bags.
59
What is to be **avoided** on the side of the mastectomy because of the risk of infection?
* avoid cuts, bruises, and burns
* wear gloves with gardening and cooking
* Teach client to avoid injuries as much as possible
60
What type of **clothing** is worn after a mastectomy?
Wear **loose clothing** to prevent constriction.
61
What are the **risk factors** for colon cancer?
* diet high in red meat and low in fiber
* chronic inflammation
62
What is the **priority** **assessment** for a client with esophageal or mouth cancer?
Assess for breathing, swallowing, and aspiration.
63
What are the **priority interventions** for a client with esophageal or mouth cancer?
Due to **pain in the mouth and throat**:
* give pain meds
* assess nutritional status
64
What is the **priority assessment** for a client after surgery to remove a gastric or intestinal tumor?
Assess for bloody stools, hemorrhage, peritonitis, and intestinal blockages.
65
What is a **common tube** after an intestinal or colon surgery to remove a tumor?
Ileostomy or colostomy.
66
What is a **common tube or procedure** after the removal of a lung tumor?
Chest tubes or a thoracentesis.
67
How can cervical cancer be **prevented**?
By getting the **human papillomavirus (HPV) vaccine.**
68
What is a **cystectomy**?
A surgery to **remove the bladder**.
69
What is a **common tube** after a cystectomy?
**Urinary diversion tube such as:**
* **ileal conduit:** small pouch made from intestines
* **urostomy:** stoma that comes out
70
At what **age** is prostate cancer more common?
After 50 years old.
71
How is prostate cancer **diagnosed**?
* **Rectal exam** - HCP will assess for pea-sized nodules
* **Prostate-specific antigen level (PSA)** is increased
72
What are the **characteristic symptoms** of prostate cancer?
* painless hematuria
* urinary obstruction
73
What is a **prostatectomy**?
A surgery to **remove the prostate.**
74
What is a common **surgery** for prostate cancer?
Transurethral resection of the prostate (TURP)
## Footnote
A scope is inserted and the prostate tissue is removed.
75
What **symptom** is common after a TURP?
Bladder spasms.
## Footnote
Give antispasmodics to relieve discomfort.
76
What is **end-of-life care**?
Provided to a client who is dying and needs to be comforted.
## Footnote
Clients with late-stage cancer or a poor prognosis may need this.
77
What does end-of-life care **focus** on?
* pain control and comfort (palliative care)
* therapeutic communication
* bereavement care for the family
78
What electrolyte is a concern for a client with multiple myeloma?
Hypercalcemia due to invasion of the bones.
79
At what age and how often are colonoscopy screenings done?
45 years old and done once every 10 years.
80
What is the intervention if the drainage suddenly stops with continuous bladder irrigation?
Dislodge a blood clot through aspiration or irrigation of the 3-way urinary foley.
81
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Brainscape's [NCLEX-RN (5) Adult Health](https://www.brainscape.com/learn/nclex-rn?utm_source=crosslink&utm_medium=in-app&utm_campaign=in-app) Flashcards
## Footnote
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