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Adult III test 2

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
Created by: 605946556