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Adult III test 2
| Question | Answer |
|---|---|
| a multisystem inflammatory autoimmune disease, complex disorder of multifactorial origin resulting from interactions among genetic, hormonal, environmental, and immunologic factors | systemic lupus erythematosus |
| SLE typically effects the | skin, joints, serous membranes, renal, hematologic, and neurologic systems |
| an autoimmune inflammatory response resulting in swelling and pain is caused my antibodies to | DNA and RNA |
| it is most common is young? and has a strong genetic factor | women |
| the etiology of SLE | unknown |
| prognosis is good but consistent with many | remissions and exacerbations |
| most pts do quite well on a course of medications, but some progress rapidly with | severe organ involvement and death |
| A review of medications is indicated before a diagnosis is made because | certain meds may produce lupus like symptoms in pts |
| sometimes occurs after the onset of menarche, with the use of oral contraceptives, and during and after pregnancy | onset or exacerbation of disease symptoms |
| the most common environmental triggers | sun exposure and sunburns |
| may also serve as a stimulus for immune hyperactivity | infectious agents |
| butterfly rash, fatigue, anemia, fever malaise, joint pain | hallmark signs and symptoms |
| Dermatologic complications | alopecia, butterfly rash, discoid erythema, palmar erythema, mucosal ulcers |
| caridopulmoary complications | endocarditis, myocarditis, pericarditis, plerual effusion, pneumonitis, raynaud's phenomenon |
| Urinary complications | glomerulonephritis, hematuria, proteinuria |
| Musculoskeletal complications | arthritis, myositis, synovitis, swan neck deformity |
| cenral nervous system complications | stroke, seizures, peripheral neuropathy, psychosis, organic brain syndrome |
| hematopoietic complications | anemia, leukopenia, lymphadenopathy, splenomegaly, thrombocytopenia |
| gastrointestinal complications | abdominal pain, diarrhea, dysphagia, nausea and vomiting |
| reproductive complications | menstrual abnormalities |
| criteria for diagnosis of systemic lupus erythematosus | malar rash, discoid rash, photosensitivity, oral ulcers, arthritis, serositis, renal disorder, neuroligic disorder, hematologic disorder, immunoligc disorder, antinuclear antibody |
| in SLE antinuclear antibody test will show | positive-antibodies are present in the blood |
| pt with SLE, a CBC will show | anemia due to hemolysis of RBCs, low WBC, low platelets |
| pt with SLE, urine tests will reveal | excess protein or cellular casts if the kidneys are affected |
| a pt with SLE have a positive or negative rheumatoid factor | positive |
| Other common test results | + small antibodies, cardiolipin antibodies, and double-stranded DNA |
| the drugs used for treatment should match | the stage the pt is in at the time |
| Treatment of systemic signs is dependent on the | organ system involved |
| Drug therapy for SLE | NSAIDS, antimalarials, immunosuppressants, and analgesic |
| nursing diagnoses for SLE | impaired mobility, disturbed body image, ineffective protection, chronic pain |
| four overall disease management goals | pain management, achieve maximum symptom management, avoid activities that cause disease exacerbation, maintain optimal role function and positive self image |
| nursing interventions include accurately recording the severity of symptoms and documenting the response to therapy, specifically | fever pattern, joint inflammation, limitation of motion, location and degree of discomfort, and fatigue |
| Monitor the pts weight and fluid intake if corticosteriods are prescribed beacuse of the fluid-retention effect of these drugs and the possibility of | renal failure |
| why is a 24hr-urine specimen collected | for samples of protein and creatinine clearance |
| observe for signs of bleeding that result from drug therapy such as | pallor, skin bruising, headaches, personality changes, seizures, and forgetfulness |
| Irritation of the nerves of the extremities may produce | numbness, tingling, and weakness of hands and feet |
| does the family of a SLE pt need emotional support? | yes |
| true of false: Even strong adherence to the treatment plan is a guarantee against exacerbation, because the course of the disease is predictable | false, it is not guaranteed because the disease is unpredictable |
| the nurse should encourage to minimize precipitating factors such as | fatigue, sun exposure, emotional stress, infection, drugs, and surgery |
| four nursing interventions to keep in mind for a pt with SLE | avoid sunlight, cover butterfly rash with cosmetics, reduce stress, monitor for infections |
| because SLE is most common is women during childbearing age what should be considered | treatment during pregnancy |
| may have resulted from renal involvement and the previous use of high dose corticosteriod and chemotherapy drugs. | infertility |
| common problems during pregnancy with a SLE pt | spontaneous abortion, and stillbirth, intrauterine growth retardation |
| what systems of the body could be affected during pregnancy in a SLE pt | renal, cardiovascular, pulmonary, and CNS (particular) |
| may become as important as medical treatment in help the pt cope with the disease | supportive therapies |
| true or false: counsel the pt and caregiver that SLE has a good prognosis for the majority of people | true |
| The obvious effects of skin lesions and alopecia may cause isolation for the pt with SLE, affecting his or her self-esteem and body image but pain and fatigue are cited | most often interfering with quality of life |
| this type of therapy can help the pt remain involved in day-to-day activities | pacing techniques and relaxation |
| help the pt develop and accomplish reasonable goals for improving or maintaining | mobility, energy levels, and self esteem |
| encompasses a broad range of diseases of multiple causes that can arise in any cell of the body capable of evading regulatory controls over proliferation and diffferentiation | cancer |
| two major dysfunctions present in the process of cancer | defective cellular proliferation and defective cellular differentiation |
| normally, most tissues of the human adult contain a population of predetermined, undifferentiated cells known as | stem cells |
| means that the stem cells of a particular tissure will ultimately differentiate and become mature, functioning cells of that tissue and only that tissue | predetermined |
| the time from when a cell enters the cell cycle to when the cell divides into two identical cells | generation time of the cell |
| normally the process of cellular division and proliferation is activated only in the presence of cellular | degeneration or death |
| this will also occur if the body has a physiologic need for more cells | cellular proliferation |
| another explanation for the phenomenon of proliferation control in normal cells is | contact inhibition |
| cells that respect the boundaries and territory of cells surrounding them. they will not invade a territory that is not their own. the neighboring cells are thought to inhibit cellular growth through the physical contact of the surrounding cell membranes | Normal cells |
| grown in tissue culture are characterized by loss of contact inhibition. these cells have no regard for cellular boundaries and will grow on top of one another and also on top of or between normal cells | cancer cells |
| usually proliferate at the same rate as the normal cells of the tissue from which they arise. the divide indiscriminately and haphazardly. sometimes they produce more than two cells at the time of mitosis | cancer cells |
| are viewed as the target or the origin of cancer development.The DNA is substituted and permanently rearranged. When this happens it is mutated | stem cells |
| once the stem cell has mutated, once of three things can occur | 1) cell can die 2) repair itself 3) cell can survive and pass along the damage to its daughter cell |
| mutated cells that survive have the potential to become | malignant |
| A common misconception regarding the characteristics of cancer cells if that the rate of proliferation is | more rapid than that of any normal body cell |
| the different is that proliferation of the cancer cells is indiscriminate and continuous. In this way, with each cell division creating two or more offspring cells, there is | continuous growth of a tumor mass |
| 1x2x4x8x16 and so on is termed the | pyramid effect |
| the time required for a tumor mass to double in size is known as its | doubling time |
| this is normally an orderly process that progresses from a state of immaturity to a state of maturity | cellular differentiation |
| as cells differentiate, this potential is repressed and the mature cell is capable of performing | only specific functions |
| under normal conditions the differentiated cell is stable and will not | undifferentiate (revert to a previous undifferentiated state) |
| two types of normal genes can be affected by mutation are | protooncogenes and tumor supressor genes |
| are normal cellular genes that are important regulators of normal cellular processes, they promote growth | protooncogenes |
| these genes supress growth | tumor supressor genes |
| mutations that alter the expression of protooncogenes can activate them to function as | oncogenes ( tumor inducing genes) |
| the protooncogenes has been described as the genetic lock that keeps the cell in its mature functioning state. when "unlocked" from exposure to carcinogens of oncogenic viruses. abilities and properties the cell has in fetal development are expressed | genetic alterations and mutations occur |
| Oncogenes interfere with normal cell expression under some conditions, causing the cell to become ? this cell regains a fetal appearance and function | malignant |
| genes that function to regulate cell growth. Mutations that alter these genes render them inactive, resulting in a loss of their action | tumor suppressor genes |
| tumors can be classifies into two different classes | benign or malignant |
| benign neoplasms are | well differentiated |
| range from well differentiated to undifferentiated | malignant neoplasms |
| the major different between malignant and benign neoplasms is malignant tumor cells have the ability | to invade and metastasize |
| the cause and development of each type of cancer cell are likely to be ? and may arise spontaneously from causes that are thus far unexplained | multifactorial |
| the natural history of cancer is an orderly process comprising several stages and occurring over a period of time. These stages include | initiation, promotion, and progression |
| the first stage, is a mutation in the cell's genetic structure resulting from an inherited mutation (an error that occurs during DNA replication)or following exposure to a chemical, radiation, or viral agent | initiation |
| initiation is irreversible, but not all altered cells go on to establish a tumor because many undergo ? and is not yet a tumor cell because it has not established the ability to self-replicate and grow | apoptosis (programmed cell death) |
| The DNA alteration may remain undetected throughout the lifetime of an individual unless further events stimulate | development of a tumor |
| many carcinogens are detoxified by protective enzymes and harmlessly excreted. If this fails, carcinogens can enter the cell's nucleus and alter DNA, which may cause the cell to | die or repair itself |
| if cell death or repair does not occur before cell division, the cell will replicate into daughter cells, each with the | same genetic alteration |
| common characteristics of carcinogens are that their effects in the stage of initiation are usually | irreversible and additive |
| three types of carcinogens | chemical, radiation, and viral |
| persons exposed to certain chemicals over a period of time have a great incidence of certain cancers than others. The long latency period from time of exposure to development of cancer make it hard to identify | cancer causing chemicals |
| are capable of interacting with DNA and immunosuppressive agents have the potential to cause neoplasms in humans | drugs |
| can cause cancer in almost any body tissue and the dose that causes cancer is not known, and there is a debate surrounding the effect of exposure to a low dose over a period of time | radiation |
| when cells are exposed to a source of radiation, damage occurs to | one or both strands of DNA |
| certain malignancies have correlated with radiation as a carcinogen agent such as | leukemia, lymphoma, and thyroid cancer |
| higher incidence of bone cancer occurs in persons exposed to radiation in certain occupations such as | radiologists, radiation chemists, and uranium miners |
| thyroid cancer has a higher incidence in those persons who have received radiation to the head and neck area for treatment of variety of disorders such as | acne, tonsilitis, sore throat, or enlarged thyroid gland |
| the most common type of cancer among whites is the US and is poorly responsive to systemic treatment. evidence suggests that UV radiation secondary to sunlight exposure is linked to the development. | skin cancer |
| Certain DNA and RNA viruses, termed oncogenic, can transform the cells they infect and induce | malignant transformation |
| have been identified to increase an individual's susceptibility to development of certain cancers. Based on current knowledge it is believed that only 10% of cancers have this link | cancer related genes |
| a single alteration of the genetic structure of the cell is not sufficient to result in cancer. The odds of cancer development are increased with the presence of | promoting agents |
| the second stage in the development of cancer, characterized by the reversible proliferation of the altered cells. An increase in the altered cell population, the likelihood of additional mutations is increased | promotion |
| important distinction between initiation and promotion is that the activity of promoters is | reversible |
| Changing a person's lifestyle to modify risk factors can reduce the chance of cancer development. Approximately half of cancer related death is US are related to these promoting factors | dietary fat, obesity, cigarette smoking, and alcohol consumption |
| the promoting factors are an example of ? and capable of initiating and promoting cancer | complete carcinogens |
| a period of time, ranging from 1 to 40 years, elapses between the initial genetic alteration and the actual clinical evidence of cancer. Is now theorized to comprise both the initiation and promoting stages on the natural history of cancer | latent period |
| A tumor that is 1.0 cm (0.4 inch) (the size usually detectable by palpation) | contains 1 billion cancer cells |
| is the smallest that can be detected by current diagnostic measures, such MRI | 0.5 cm tumor |
| the final stage in the natural history of a cancer. Characterized by increased growth rate of the tumor, increased invasiveness, and metastasis | progression |
| the spread of cancer to another site. Some cancers have affinity for a particular site and others are unpredictable. Most frequent sites; lungs, brain, bone, live, and adrenal glands | metastasis |
| Metastasis is a multistep process. A tumore increases in size, development of its own blood supply is critical for survival and growth. The formation of blood vessels within the tumor is | tumor angiogenesis |
| are able to detach from the primary tumor, invade the tissue surrounding the tumor, and penetrate walls of lymph and vascular vessels for metastasis to a distant site | certain subpopulations (segments) of tumor cells |
| involves several steps beginning with the penetration of blood vessels by primary tumor cells via the release of metalloproteinase enzymes. Enter circulation, travel through body, and adhere to small blood vessels of distant organs | Hematogenous metastasis |
| after adhering to blood vessels, the are able to penetrate them by releasing the same types of enzymes. Most do not survive this process because of mechanical mechanisms and cells of the immune system | hematogenous metastasis |
| Even though some cells do not survive hematogenous metastasis, the combination of tumor cells, platelets, and fibrin deposits may protect some tumor cells from | destruction in blood vessels. |
| In the lymphatic system, tumor cells may be trapped in the first lymph node confronted or the may bypass regional lymph nodes and travel to more distant lymph nodes | skip metastasis |
| the immune system has the potential to distinguish cells that are | normal (self) and abnormal (nonself) cells |
| Since cancer cells arise from normal human cells and, although they are mutated and thus different, the immune response that is mounted against cancer cells may be | inadequate to effectively kill them |
| in this process lymphocytes are continually check cell surface antigens and detect and destroy cells with abnormal or altered antigenic determinants. This response of the immune system to antigens of malignant cells is | immunologic surveillance |
| The process by which cancer cells evade the immune system is | immunologic escape |
| theorized mechanisms by which cancer cells can escape immunologic surveillance | suppression of stimlation on T cells, weak surface antigens, development of tolerance, suppression of immune response, induction of suppressor T cells, and blocking antibodies |
| antigens that are found on both the surfaces and inside cancer cells, as well as fetal cells. Are an expression of the shift of cancer cells to a immature metabolic pathway, usually associated with embryonic or fetal periods of life. | oncofetal antigens |
| Tumors can be classified according to | anatomic site, histology(grading), and extent of disease(staging) |
| tumor classification systems are intended to provide a standardized way to | communicate the status, assist in determining the most effective treatment, evaluate the treatment plan, predict prognosis, compare for statistical purposes |
| the tumor is identified by the tissue of origin, the anatomic site, and the behavior of the tumor (benign or malignant) | anatomic classification |
| benign tumors have what suffix | -oma |
| malignant tumors have what suffix | -carcinoma, -sarcoma, and -oma |
| papilloma and carcinoma are found | surface epithelium |
| adenoma and adenocarcinoma are found | glandular epithelium |
| fibroma and fibrosarcoma are found | fibrous tissure |
| chondroma and chondrosarcoma are found | cartilage |
| rhabdomyoma and rhabdomyosarcoma are found | striated muscle |
| osteoma and osteosarcoma are found | bone |
| meningioma and meningeal sarcoma are found | meninges |
| ganglioneuroma and neuroblastoma are found | nerve cells |
| Hodgkin's lymphoma and non-Hodgkin's lymphoma are found | lymphoid tissue |
| multiple myeloma is found | plasma cells |
| lymphocytic and myelogenous leukemia is found | bone marrow |
| the appearance of cells and the degree of differentiation are evaluated pathologically. | histologic grading |
| four grades are used to evaluate abnormal cells based on the degree to which the cells resemble the tissue of origin. poorly differentiated have a worse diagnosis than those clearer in appearance of normal tissue origin | grade I, II, III, IV, X |
| cells differ slightly from normal cells and are well differentiated | grade I |
| cells are more abnormal and moderately differentiated | grade II |
| cells are very abnormal and poorly differentiated | grade III |
| cells are immature and primitive and undifferentiated; cell of origin is difficult to determine | grade IV |
| grade cannot be assessed | grade X |
| classifying the extent and spread of the disease. Is based on the anatomic extent of disease rather than cell appearance | staging |
| The five stages of cancer | Stage 0,I,II,III,IV |
| cancer is situ | stage 0 |
| tumor limited to the tissue of origin; localized tumor growth | stage I |
| limited local spread | stage II |
| extensive local and regional spread | stageIII |
| metastasis | stage IV |
| is used to determine the anatomic extent of the disease involvement according to three parameters: tumor size and invasiveness, presence of absence of regional spread to lypmh nodes, and metastasis to distant organs sites | TNM classification |
| diagnostic studies that may be performed to assess for exent of disease include | radiologic studies, ultrasound, CT, MRI, PET scans |
| reduces the incidence of cancer and may favorably affect survival of patients who have cancer | elimination of modifiable predisposing risk factors |
| An important aspect of nursing care is to | educate the public about prevention and early detection |
| cancer prevention and early detection include | reduce or avoid carcinogens, eat a balanced diet, regular exercise, obtain adequate rest, regular health examination, eliminate stressors, 7 warning signs, cancer screening timely, learn and practice self-examination, and seek immediate care if a change |
| the goal of public education is to motivate people to | recognize and modify behavior patterns that may negatively effect health, and to encourage awareness of and participation in health promoting behaviors |
| seven warning signs of cancer (CAUTION) | change in bowel or bladder, a sore what wont heal, unusual bleeding or discharge, thickening or lump, indigestion or difficulty swallowing, obvious change in wart or mole, nagging cough or hoarseness |
| while the patient is waiting for the results of the diagnostic studies you should | be available to actively listen to the pts concerns and skilled in techniques that will engage the pt and the family or significant others in discussion about their fears. |
| it is important to avoid communication patterns that may hinder exploration of feelings and meanings such as | providing false reassurances, redirecting the discussion, and generalizing |
| studies or procedures that may be included in the process of diagnosing cancer | cytology studies, tissue biopsy, CXR, CBC & CMP, live function studies, endoscopic exams, radioisotope scans, PET scans, tumor markers, genetic markers, and bone marrow examination |
| the removal of a tissue sample for pathologic review. Various methods are used depending on location and size of the suspected tumor | biopsy |
| commonly performed for tissue that can be safely reached through the skin | precutaneous biopsy |
| may be used for lung or other intraluminal lesions (esophageal, colon, bladder) | endoscopic biopsy |
| often necessary to obtain a piece of tumor tissue | surgical procedure |
| may be accomplished with a small-guage aspiration needle that provides cells from the mass for cytologic examination | fine-needle aspiration (FNA) |
| cutting needles will deliver an actual piece of tissue that can be analyzed with the advantage of preserving the histologic architecture of the tissue specimen | Large-core biopsy |
| involves the surgical removal of the entire lesion, lymph node, nodule, or mass | excisional biopsy |
| if excisional biopsy is not feasible, a partial excision may be performed with a scalpel or dermal punch | incisions biopsy |
| primary factors that determine the therapeutic approach are the ? and other important considerations in determining the treatment plan are the ? | tumor histology and staging outcomes; pts physiologic, psychologic status, and personal desires |
| the goal of the treatment plan for many cancers that cant be completely eradicated but are responsive to anticancer therapies and, as with other chronic illnesses such as DM and HF, can be maintained for long periods of time with therapy | control |
| can also be a goal of the treatment plan, with this treatment goal, relief or control of symptoms and the maintenance of a satisfactory quality of life are the primary goals rather than cure of control of the disease process | palliation |
| the goals of cure, control, and palliation are achieved through the use of four treatment modalities for cancer | surgery, radiation therapy, chemotherapy, and biologic and targeted therapy |
| is the oldest from of local cancer treatment, and in the early days it was the only effective method of cancer diagnosis and treatment | surgery |
| can be used to eliminate or reduce the risk of cancer development in pts who have underlying conditions that increase their risk of developing cancer | surgical intervention |
| has proven to be successful in reducing cancer incidence for selected malignancies, but pts considering this must weigh the risk and benefits | prophylactic removal of nonvital organs |
| the objective is to remove all of as much resectable tumor as possible while sparing normal tissue | to satisfy the goals of cancer cure or control |
| examples of surgical procedures used for cure and control include | radical neck dissection, lumpectomy, mastectomy, pneumonectomy, orchiectomy, thyroidectomy, nephrectomy, and hysterectomy and oophorectomy |
| may be used if the tumor cant be completely removed (attached to vital organ) as much of the tumor as possible is removed, and pt is given chemo and radiation. This can make chemo and radiation more effective. | debulking or cytoreductive procedure |
| when cure or control of cancer is no longer possible, the focus shifts to preservation of quality of life at the highest possible level for the longest period of time. these are the now the primary goals | supportive care and palliation of symptoms |
| examples of supportive care are | insertion of feeding tube, colostomy, venous access devices, removal of metastatic lesions |
| examples of surgical procedures for palliation of symptoms include | debulking/radiation therapy, colostomy for bowel obstruction, laminectomy for spinal for compression |
| the use of chemicals as a systemic therapy for cancer, and is now mainstay of cancer therapy used in treatment of most solid tumors and hematologic malignancies. Can offer cure for some, control for long periods, and maybe palliative relief of symptoms | chemotherapy |
| to eliminate or reduce the number of malignant cells present in the primary tumor and metastatic tumor site | the goal of chemotherapy |
| several factors determine the response of cancer cells to chemotherapy | mitotic rate of the tissue, size of tumor, age of tumor, location of tumor, presence of resistant tumor cells |
| the effects of the chemotherapeutic agents are described in relationship to the cell cycle. the two major categories of chemotherapeutic drugs are | cell cycle phase-nonspecific and cell cycle phase-specific |
| have their effect on the cells during all phases of the cell cycle, including those in the process of cellular replication and proliferation and those in the resting phase | cell cycle phase nonspecific chemotherapeutic drugs |
| exert their most significance effects during specific phases of the cell cycle | cell cycle phase specific chemotherapeutic drugs |
| most common route for chemotherapy | IV route |
| IV administration of antineoplastic drugs include venous access difficulties, device or catheter related infection and extravasation which is | infiltration of drugs into tissues surrounding this infusion site and causing local tissue damage |
| many chemotherapeutic drugs may be either | irritants or vesicants |
| will damage the intima of the vein, causing phlebitis and sclerosis and limiting future peripheral venous access, but will not cause tissue damage if infiltrated | irritants |
| if inadvertently infiltrated into the skin, may cause severe local tissue breakdown and necrosis. should be immediately turned off. | vesicants |
| involves the delivery of the drug directly to the tumor site. advantage is that higher concentrations of drug can be delivered with reduced systemic reactions | regional chemotherapy administration |
| several regional methods have been developed | intraarterial, intraperitoneal, intrathecal or intraventricular, and intravesical bladder |
| delivers the drug to the tumor via the arterial vessel supplying the tumor. Complications: bleeding, embolism, pain, aterial injury, catheter migration or dislodgement, and occlusion | intraarterial chemotherapy |
| the delivery of chemotherapy to the peritoneal cavity for treatment of peritoneal metastases from primary colorectal and ovarian cancers and malignant ascites. Complcations: pain, occlusion, dislodgemnt, migration, distention, ileus, intestine perforation | intraperitoneal chemotherapy |
| a method to treat metastasis to the CNS, involves lumbar puncture and injection of chemotherapy into the subarachnoid space. Complications: HA, N&V, fever, >ICP, nuchal rigidity | intrathecal or intraventricular chemotherapy |
| instillation of chemotherapy into the bladder promotes destruction of cancer cells and reduces the incidence of recurrent disease. Complications: dysuria, urinary frequency, hematuria, cystitis, UTI, and bladder spasms | intravesical bladder chemotherapy |
| Chemotherapy is most effective when the | tumor burden is low, therapy is not interupted, and the pt receives the intended dose. |
| a local treatment modality for cancer, and one of the oldest methods of cancer treatment. The emission and distribution of energy through space or a material medium. | radiation |
| the local energy in ionizing radiation and resultant generation of free radicals act to break the chemical bonds in ? and damage to these may be either lethal or sublethal | DNA |
| cause sufficient chromosomal disruption that cell is unable to replicate, or may also impair protein synthesis functions necessary for survival | lethal damage to DNA |
| there is potential for repair in between radiation doses, or potential for accumulated damage to occur with repetitive doses, which ultimately leads to cell death | sublethal damage to DNA |
| is a part of radiation treatment planning used to accurately localize the tumor and ensure setup position reproducibility | simulation |
| radiation can be delivered two ways | externally (teletherapy) and internally (brachytherapy) |
| there are multiple setting in which radiation may be used | definitive or primary therapy, neoadjuvant therapy, adjuvant therapy, prophylaxis, disease control, and palliation |
| the most common form of radiation treatment delivery | teletherapy |
| close or internal radiation treatment, consists of implantation or insertion of radioactive materials directly into the tumor or in close proximity adjacent to the tumor | brachytherapy |
| vital to health care professional safety when caring for the person with a source of internal radiation | the principles of ALARA (as low as reasonably achievable) and time, distance, and shielding |
| what to teach pts to help decrease fear and anxiety, encourage adherence, and guide self-management | treatment regimen, supportive care options, and what to expect during the course of treatment |
| is one of the most common effects of chemotherapy and, to a lesser extent, it can also occur with radiation | myelosuppression |
| is common is pts receiving chemo and can place them at serious risks for life threatening infection and sepsis. will prompt treatment delay or modification. prevent infections by hand hygiene, monitor temp | neutropenia |
| can result in spontaneous bleeding or major hemorrhage. avoid procedures and avoid risk factors of injury that cause bleeding. risk of serious bleeding when platelets <50,000 | thrompocytopenia |
| common in patients undergoing either radiation or chemo and generally has later onset | anemia |
| problems caused by chemotherapy and radiation | fatigue, N,V&D, stomatitis, mucositis, esophagitis,anorexia, alopecia, radiation skin changes, chemo induced skin changes,pneumonitis, pericarditis and myocarditis,cardiotoxicity,reproductive dysfunction, |
| consists of agents that modify the relationship between the host and the tumor by altering the biologic response of the host to the tumor cells | biologic therapy or biologic response modifier |
| biologic agents may affect host-tumor response in three ways | direct antitumor effect, restore, augment, or modulate host immune system mechanisms, interfering with cancer cells' ability to metastasize or differentiate |
| interferes with cancer growth by targeting specific cellular receptors and pathways that are important in tumor growth | targeted therapy |
| are used to support cancer patients through the treatment of the disease | hematopoietic growth factors |
| effective, lifesaving procedures for the treatment of a number of malignant and nonmalignant diseases. safe use of high doses of chemo and radiation for pts whose tumors developed resistance or failure to respond. pts may have long term effects | bone marrow transplant (BMT) and peripheral stem cell transplant (PSCT) |
| originally called bone marrow transplant is now called | hematopoietic stem cell transplantation (HSCT) |
| whether the diagnosis is a malignant or nonmalignant disease the goal of HSCT is ? HSCT eradicates tumor cells and clear the marrow to make way for the transplanted healthy stem cells | cure |
| HSCTs are categorized as | allogeneic, syngeneic, or autologous |
| The sources of stem cells include the | bone marrow, peripheral circulating blood, and umbilical cord blood |
| stem cells are acquired from a donor who, through HLA tissue typing, has been determined to be HLA matched to the recipient. often family. common indications: leukemias, multiple myeloma, lymphoma | allogeneic transplantation |
| is a type of alloegeneic transplant that involves obtaining stem cells from one identical twin and infusing them into the other. | syngeneic transplantation |
| patients receive their own stem cells back following myeloablative chemotherapy. the aim is to rescue | autologous transplantation |
| hematopoieteic stem cells are harvested from a unique donor or from the recipient via | two different methods |
| in one type the procedure for HSCT is performed in the operating room using general anesthesia, multiple bone marrow aspirations are carried out to obtain | a specific quantity of stem cells |
| in the other type of procedure for HSCT is peripheral stem cell transplant obtained from the peripheral blood in an outpatient procedure by | separates the stem cells from the blood circulating through the machine and returns the remaining blood components to the donor. |
| bacterial, viral, and fungal infections are common following HSCT. what should be done prophylactally to reduce this incidence | antibiotic therapy |
| a potentially serious complication of allogeneic transplant is when T lymphocytes from the donated recognize the recipient as foreign and begin to attack certain organs such as skin, liver, and GI tract | graft-versus-host disease |
| complications resulting from cancer | malnutrition, altered taste sensation,infection, superior vena cava, third space symdrome,spinal cord compression, intestinal obstruction, symdrome of inappropriate antidiuretic hormone secretion, hypercalemia, tumor lysis, septic shock, DIC |
| results from obstruction of the superior vena cava by a tumor or thrombosis. facial edema, distention of veins in head, neck, and chest, HA, and seizures. common cause of lung cancer, non-Hodgkin's, and breast cancer | superior vena cava syndrome |
| neurologic emergency cause by the presence of a malignant tumor in the epidural space of the spinal cord. most common in breast, lung, prostate, GI, and renal tumors and melanoma. Back pain, intense localized and persistent. motor weakness&dysfunction | spinal cord compression |
| involves a shifting of fluid from the vascular space to the interstitial space that primarily occurs secondary to extensive surgical procedures, biologic therapy, or septic shock. hypovolemic, hypotension, tachy, low central venous pressure, <urine output | third spacing symdrome |
| inappropriate antidiuretic hormone secretion results from abnormal or sustained production of ADH with resultant H2O retention and hyponatremia. most frequently in lung, but occurs in pancreas, brain, colon, ovary, prostate, esophagus | syndrome of inappropriate antidiuretic hormone secretion |
| can occur in the presence of cancer that involves metastatic disease of the bone or multiple myeloma, or when a parathyroid hormone like sustance is secreted by cancer cells in the absence of bony metastasis | hypercalcemia |
| a metabolic complication characterized by rapid release of intracellular components in response to chemo, including K, phosphate, and DNA & RNA | tumor lysis syndrome |
| the four hallmark signs of TLS is | hyperuricemia, hyperphosphatemia, hyperkalemia, and hypocalcemia |
| results from fluid accumulation in the pericardial sac, constriction of the pericardium by tumor, or pericarditis secondary to radiation therapy to chest. SOB, tachy, cough, dysphagia, N&V, muted heart sounds, pulsus paradoxus | cardiac tamponade |
| occurs most frequently in pts with cancer of the head and neck secondary to invasion of the arterial wall by tumor of to erosion following neck surgery or radiation therapy. bleeding can manifest | carotid artery rupture |
| pain assessment in cancer patients | location, intensity, quality, pattern, relief measures |
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