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Med- Surg 2012 sprin
Oncology
| Question | Answer |
|---|---|
| cell consist of | cell membrane, cytosol (cytoplasm,) cell organelles, nucleus |
| what is the genetic code | sequence of amino acids needed for protein synthesis |
| How are mutations caused | a structural change in the DNA code of a cell |
| Mitosis - how does it work> | process of cell reproduction - 1 cell divides into 2 |
| do all cells undergo mitosis? | some cells undergo mitosis and some do not |
| 3 functions of the cell cycle | 1- cells are always actively dividing 2- cells leave the cycle after a certain point and die 3- cells temporarily leave the cycle and remain inactive until reentry into the cycle |
| tissue | group of cells with similar structure and function |
| 4 types of human tissue | epithelial, connective, muscle , nerve |
| how is a particular cancer named? | depends o the cell from which they are primary |
| oncology | the branch of medicine that deals with tumors including study, development, diagnosis, treatment, and prevention |
| neoplasm | -cells that produce abnormal -they may not contain cancerous cells -they are usually not detected until approx 1 cm and contains 500 cells |
| benign | - noncancerous cell - not normal to the body - slower growth of tumors - cells closely resemble original tissue - do not generally result in death unless pressure is exerted on a vital organ |
| malignant | -growth with cancerous cells - infiltrates surrounding tissue and spreads - tumor grows -quickly -primary site -secondary or metastatic site - |
| what is a primary site? | where the cancer cell originates |
| what is a secondary or metastatic site? | area to which the cancer travels (spreads) to |
| where does cancer begin? | all cancers begin in cells (caused by mutations in DNA code of a cell) |
| How do mutations disrupt the cell? | mutations disrupt cell division leading to the growth of abnormal malignant cells |
| characteristics of cancerous cells | - poorly constructed - can form anywhere in the body, at any time , from any cell - multiplies quickly |
| what is cancer | -group of related diseases with varying causes, manifestations, treatments and prognosis - caused by mutations of cellular genes |
| what is the characteristic of cancer cells | - cancerous cells adopt characteristics of the cell it changes - they have no limits to cell divisions |
| what are the 2 steps of growth and reproduction of cancer cells | 1- initiation 2 promotion |
| what is initiation (in relation to cancer) | initiation - causes an alteration in the genetic structure of the cell - results in the cell becoming more susceptible to carcinogens and causing the cell to become cancerous |
| what is promotion ( in relation to cancer) | promotion - results after repeated exposure to carcinogens causing the initated cells to mutate (even after long latency periods) - formation of a tumor due to cell mutation |
| what can increase a persons risk for cell mutation? | any substance that weakens or alters the immune system |
| can a healthy immune system kill cancer cells? | Yes, a healthy immune system can kill cancer cells, however cancer cells duplicate faster than those of the immune system - initial attacks may be fended off- repeated attacks will wear they healthy system down |
| Common risk factor of cancer | - oncoviruses -radiation -chemical / irritants - heredity - diet - hormones - poor immune function |
| cancer classification 4 types (found Where) | carcinoma ( epithelial) sarcoma - ( bone / muscle) leukemia ( bone marrow/ blood) lymphoma ( immune system) |
| Where does Carcinoma originate: | Epithelial |
| where does sarcoma originate | bone and or muscle |
| where does leukemia originate | bone Marrow or blood |
| where does lymphoma originate | immune system |
| in situ | used to describe cancerous cells that remain in one area (localized) - usually detected microscopically and once removed surgically , requires no further tx |
| what is encapsulated? why is it beneficial? | encapsulated - with in a membrane the abnormal cells are generally in one area |
| metastasis | spread of the tumor from the primary site to another area in the body (secondary) |
| metastasis involves 3 steps: | 1- cells invade blood or lymph vessels 2- cells move by mechanical means cells lodge and grow in a new location |
| What does metastatic tumors carry with them? | metastatic tumors carry with them the characteristics of the primary tumor site |
| what are 4 of the most common metastatic sites | liver lungs bones brain |
| what is the most common type of cancer in adults | skin |
| what is the most preventable type of cancer - | Skin |
| what increases the risk of skin cancer | Exposure to UV rays increases risk |
| what can be done to reduce the risk of skin cancer | protective clothing and sunscreen reduce risk |
| what sex has the highest occurrence of cancer | Men |
| what are the 3 leading cancer causes of death in men? | 1- lung cancer 2 prostate cancer 3 colon cancer |
| what are the 3 leading cancer causes of death in women? | 1- Lung cancer 2- Breast cancer 3- colon / rectum |
| what is crucial for prevention and treatment | early detection |
| what 3 main things would you educate your client on regarding cancer? | 1 risk factors 2 self examination 3 cancer screening programs |
| Early Detection and prevention CAUTION what does this letter stand for? C | Change in bowel or bladder habits |
| Early Detection and prevention CAUTION what does this letter stand for? A | a sore that does not heal |
| Early Detection and prevention CAUTION what does this letter stand for? U | unusual bleeding or discharge |
| Early Detection and prevention CAUTION what does this letter stand for? T | thickening or lump in breast or other tissue |
| Early Detection and prevention CAUTION what does this letter stand for? I | indigestion or swallowing difficulties |
| Early Detection and prevention CAUTION what does this letter stand for? O | obvious change in wart or mole |
| Early Detection and prevention CAUTION what does this letter stand for? N | Nagging cough or hoarseness |
| American Cancer Society recommends: Baseline Mammogram | beginning at age 35-39 then >40 annually (asymptomatic women - w/o 1st degree relatives affected) |
| American Cancer Society recommends: initial pap smear and pelvic exam | By age 21 (or when the female becomes sexually active) |
| American Cancer Society recommends: Pap smear / Pelvic exam (If Normal) | normal X 3 consecutively, q2-3years unless risk factors are present |
| American Cancer Society recommends: Pap smear / Pelvic exam (After age 70) | normal x 3 consecutively , paps no longer required |
| American Cancer Society recommends: colorectal screening options | 1- annual stool test for occult 2 flexible sigmoidoscopy q5 years 3- annual stool test for occult and flexible sigmoidoscopy q5 years 5- double contrast barium enema 6- colonoscopy q 10 years |
| What is the preferred method for a colorectal screening? | annual stool test for occult and flexible sigmoidoscopy q5 years |
| At what age should (normal) screening for prostate begin? | At age 50 screening for prostate should begin ** earlier if risk factors are present |
| What is a PSA level indicative of? | Prostate cancer |
| What is generally included in a prostate exam? | Digital rectal exam and PSA (Prostate Specific Antigen) blood testing |
| Genetic Testing (related to Cancer) | - cancer is a genetic disease - Genetic factors play an important role in cancer cell development - - associated genetic mutation is found in all cells and represents an inherited susceptibility to cancer for all family members who carry the mutation |
| examples of cancers influenced by genetics: | * Cowden syndrome * familial adenomatous polyposis * familial melanoma syndrome * Hereditary breast / ovarian cancer * hereditary nonpolyposis colon cancer * neurofibromatosis type 1 * retinoblastoma |
| Family history assessment- the nurse should... | * info about maternal/paternal family * obtain cancer hx >3< generations * clustering of cancers occuring younger ages, multiple primary cancers in 1 individual, paired organs, 2+ close relatives w/same cancer (hereditary cancer syndrome) |
| Dietary factors (related to cancer) | * are linked to environmental cancers ** the risk of cancer increase w/ long-term ingestion of carcinogen or co-carcinogens or chronic absence of protective substances in the diet |
| dietary substances can be | proactive (protective) carcinogenic co-carcinogenic |
| dietary substances that appear to increase the risk of cancer includes: | fats, alcohol, salt-cured or smoked meats, nitrite/nitrate - containing foods; red and processed meats |
| Alcohol increase the risk of which cancers? | mouth , pharynx, larynx, esophagus, liver, colorectum, and breast |
| greater consumption of vegetables and fruits is associated with ... | decreased risk of lung, esophageal, stomach and colorectal cancers |
| high caloric intake is associated with | increased cancer risk |
| Obesity is clearly associated with what types of cancer? | endometrial, post menopausal breast cancers, colon, esophagus, and kidney cancers *** Evidence for increased risk of cancer in pancreas; gallbladder; thyroid; ovary; cervix; prostate; and for multiple myeloma and Hodgkin lymphoma *** |
| Vaccines- (in relation to cancer) What protects against the HPV virus | Guardasil |
| Biopsy | |
| laboratory tests | |
| cytological study | |
| radiological studies | |
| nuclear imaging procedures | |
| Ultrasound | |
| MRI | |
| Endoscopy | |
| What is Staging (TNM), what is it used for. | International staging system used to classify solid tumors by - size and tissue involvement, - extent of lymph node involvement - and Metastasis |
| TNM - Classification system T- | T- Primary tumor the extent of the primary tumor ( size of tumor and tissue involvement) |
| TNM - Classification system N | N - the absence or presence and extent of regional lymph node metastasis |
| TNM - Classification system M | M- the absence of presence of distant metastasis |
| What are the numerical subsets of the TNM components | indicate the progressive extent of the malignant disease |
| TNM - Classification system Tx | Primary tumor can not be assessed |
| TNM - Classification system T0 | no evidence of primary tumor |
| TNM - Classification system Tis | carcinoma in situ (localized) |
| TNM - Classification system T1, T2, T3, T4 | increasing size of local extent of the primary tumor |
| TNM - Classification system Nx | regional lymph nodes can not be assessed |
| TNM - Classification system N0 | no regional lymph node metastasis |
| TNM - Classification system N1, N2, N3 | increasing involvement of regional lymph nodes |
| TNM - Classification system Mx | distant metastasis can not be assessed |
| TNM - Classification system M0 | no distant metastasis |
| TNM - Classification system M1 | distant metastasis |
| Grading | refers to the classification of the tumor cells - to measure how aggressive the tumor is |
| Grading aids in ... | * predicts long term results * response to treatment * chance of survival |
| How are cancer cells graded? | Based on how much they resemble normal mature cells |
| GRADING Well differentiated | cells of tumor greatly resembles cells of normal tissue |
| GRADING Moderately differentiated | some of the tumor cells resemble normal tissue and some do not |
| GRADING poorly differentiated | majority of cells are differentiated |
| GRADING undifferentiated | all cells are abnormal |
| surgery | excision of a tumor and surrounding tissue |
| prophylactic | surgical removal of anything that poses a risk |
| Palliative | care and comfort for Symptom control |
| Reconstructive | cosmetic purposes or for return of function of a body part |
| Why is Radiation therapy used? | * used to destroy the rapid dividing cancerous cells * may involve the use of radioisotopes |
| side effects of radiation | fatigue; nausea & vomiting; anorexia (lack of appetite); mucositis; Xerostomia; skin reactions; bone marrow depression |
| * What is palliative for | for Sx control |
| * what is curative for? | for localized tumors |
| what is numerical staging in cancer? | |
| Numerical Staging what does this number stand for? 0 | cancer in situ ( limited to surface cells) |
| Numerical Staging what does this number stand for? 1 | cancer limited to the tissue of origin, evidence of tumor growth |
| Numerical Staging what does this number stand for? 2 | limited local spread of cancer cells |
| Numerical Staging what does this number stand for? 3 | extensive local and regional spread |
| Numerical Staging what does this number stand for? 4 | distant metastasis |
| How is radiation administered? | Externally and Internally |
| what is meant by Externally? | |
| What is meant by Internally? | |
| what three factors are important in protection from Radiation Exposure? | time; distance; shielding |
| what is the desired action of chemotherapy | - Cytotxic cells destroy cancer cells **more effective with multiple drugs ** may be used pre-op or post-op |
| what routes can be used for Chemo administration? | Oral; IM; IV |
| What are vesicant drugs? | |
| Central Lines External | |
| Central lines Internal | |
| Side effects of Chemo? | Bone marrow depression; Stomatis; alopecia (temp); reproductive alterations; neurotoxicity |
| Side effects of Chemo? Bone Marrow Depression | Leukemia (decreased WBCs; Thrombocytopenia (Decreased Platelets); Anemia (decreased RBCs) |
| Side effects of Chemo? Stomatis | |
| Side effects of Chemo? Alopecia | Hair loss (usually temporary) |
| Side effects of Chemo? reproductive alterations | Clients may choose to store eggs or sperm for later use |
| Side effects of Chemo? neurotoxicity | |
| Nursing Dx For Chemo pts. | Chronic pain; risk for infection; risk for injury; imbalanced nutrition; self care deficit; anticipatory grieving ; care giver role strain; social isolation; ineffective sexuality pattern; disturbed body image |
| Nursing Dx For Chemo pts. (Interventions) Chronic pain | |
| Nursing Dx For Chemo pts. (Interventions) risk for infection | |
| Nursing Dx For Chemo pts. (Interventions) risk for injury | |
| Nursing Dx For Chemo pts. (Interventions) imbalanced nutrition | |
| Nursing Dx For Chemo pts. (Interventions) self care deficit | |
| Nursing Dx For Chemo pts. (Interventions) anticipatory grieving | |
| Nursing Dx For Chemo pts. (Interventions) care giver role strain | |
| Nursing Dx For Chemo pts. (Interventions) social isolation | |
| Nursing Dx For Chemo pts. (Interventions) ineffective sexual pattern | |
| Nursing Dx For Chemo pts. (Interventions) disturbed body image | |
| What are oncology emergencies | |
| Oncology emergency Superior Vena Cava Syndrome | * may occur with lung cancer * tumor blocks circulation resulting in edema of the head and neck (cranial pressure) * radiation may be used to shrink the tumor |
| Oncology emergency Spinal Cord Compression | * cancer may metastasize to the spine resulting in spinal cord compression * very painful- results in motor function loss |
| Oncology emergency Hypercalcemia | * elevated calcium serum levels > 11mg/dl * calcium is released into the blood * IV meds used to decrease Ca levels |
| Oncology emergency Pericardial Effusion (Cardiac Tamponade) | *tumor invades pericardial sac, fluid builds up in the sac, the heart is compressed * result- decreased C/O (may lead to death) * |
| What are some treatment options for Cardiac Tamponade (pericardial Effusion) | * Drain Fluid * Sclerosing Agents |
| What is DIC? What Happens with DIC | *Disseminated Intravascular Coagulation ** fibrin and platelets activated abnormally causing all of the blood clotting proteins to be "Used Up" or destroyed resulting in abnormal fusion |
| How is DIC treated? | |
| What are 2 primary determining factors in Cancer Tx? | * The type of cancer * The stage of the cancer |
| Briefly Describe the following Cancer Tx goal. Elimination (cure) | * recover from specific cancer w/ Tx * Alert for recurrence * May involve rehab w/ physical/occupation therapy |
| What are the three seasons of survival? | 1- diagnosis/ treatment 2- extended survival; ( treatment completed and watchful waiting) 3- permanent survival- risk of recurrence is small |
| Briefly Describe the following Cancer Tx goal. Prevent Metastasis | |
| Briefly Describe the following Cancer Tx goal. Decrease/reduce cellular growth | |
| Briefly Describe the following Cancer Tx goal. Palliation | |
| Briefly Describe the following Cancer Tx goal. Control | control of sx and progression of cancer * continued surveillance * tx when indicated (e.g. some bladder cancer; prostate cancer) |
| Surgery can be used for what? | * Dx * prophylaxis * tx * reconstruction * palliation |
| What types of surgery can be performed | fine needle aspiration ; core biopsy; incisional biopsy; excisional biopsy ; endoscopy; laproscopy; reconstructive ; and surgery in conjunction w/other tx (may be shrunk by radio/chem then surgically removed) |
| treatment (tx) options | Chemotherapy |
| Chemotherapy - Principles | * based on ability of drug to kill cancer cells * normal cells also damaged which produces side effects * Effect is greates with rapidly dividing cells * different drugs act on tumor cells in different phases of the growth cycle |
| Effect of chemo is greatest with rapidly dividing cells. Give 2 prime examples and describe why they are affected | *GI Tract- plenty of nutrients and blood * Hair - grows extremely fast |
| 4 phases of the cell cycle | * G1 * S * G2 (* Mitosis M Phase ) * G0 |
| G1 cell cycle phase | - gap 1 phase; cell enlarges, synthesizes proteins to prepare for DNA replication |
| S Cell cycle Phase | Synthesis (S) phase - _ DNA replicates and Chromosomes Duplicate |
| G2 cell cycle phase | Gap 2 phase: cell prepares for mitosis ** Mitosis M Phase** Mitosis occurs w/ 2 copies of cell (daughter cells) |
| G0 cell cycle Phase | Resting Phase |
| Chemotherapy (in relation to Cell Phases) | - Chemo includes phase-specific and non-phase specific drugs for specific type cancers - often combinations of drugs in specific protocols over varying time periods |
| Chemo Kill-Cell hypothesis | with each cell a percentage of cancerous cells are killed but some remain; repeating chemo kills more cells until those left can be handled by the body's immune system |
| Classes of Chemo Drugs Alkylating agents action | = create deficits in tumor DNA = these deficits hinder cell growth and division = MOST ACTIVE in G1 (G 0 phase) |
| Classes of Chemo Drugs Alkylating agents Examples | Nitrogen Mustard; Cisplatin; Cytoxan; Myleran |
| Classes of Chemo Drugs Common cancers treated w/ Alkylating agents | * Hodgkins, lymphocarcinoma, lung cancer, * chronic leukemia, chronic myelogenous leukemia * multiple myeloma, adenocarcinoma of lung/breast |
| Classes of Chemo Drugs Alkylating agents adverse side effects | * permanent sterility * Permanent bone marrow failure * Hair Loss (alopecia) * Hemorrhagic Cystitis (inflammation of bladder) * renal tubular necrosis * pulmonary fibrosis |
| Classes of Chemo Drugs Anti-metabolites Action: | specific for S phase * interfere with nucleic acid synthesis |
| Classes of Chemo Drugs Anti-metabolites Examples: | * Methotrexate * 5 fluorouracil |
| Classes of Chemo Drugs Anti-metabolites Cancers commonly treated: | - acute lymphobalstic leukemia (ALL) - osteosarcoma - colon carcinoma - rectal carcinoma - breast carcinoma - pancreatic carcinoma |
| Classes of Chemo Drugs Anti-tumor Antibiotics action: | non-phase specific; interfere w/ DNA |
| Classes of Chemo Drugs Anti-tumor Antibiotics Examples | Adriamycin; bieomycin |
| Classes of Chemo Drugs Anti-tumor Antibiotics Toxic effect: | damage to cardiac muscle |
| Classes of Chemo Drugs Anti-tumor Antibiotics common cancers treated: | *acute lymphoblastic leukemia (ALL) * acute myeoblastic leukemia (AML) * cancer of breast, thyroid, lungs |
| Classes of Chemo Drugs Mitotic Inhibitors Action | prevent cell division during M- Phase |
| Classes of Chemo Drugs Mitotic Inhibitors-Plant Alkaloids | vincristine, vinblastine- derived from plant alkaloids |
| Classes of Chemo Drugs Mitotic Inhibitors-Plant Alkaloids Toxic effects : | * affects neurotransmission * decreased DTRs (deep tendon reflexes) * paralytic ileus |
| Classes of Chemo Drugs Mitotic Inhibitors Taxoids: | * act during G2 phase * inhibit cell division * |
| Classes of Chemo Drugs Mitotic Inhibitors-Tabxoids Toxic effects | * alopecia * bone marrow depression |
| Classes of Chemo Drugs Mitotic Inhibitors cancers commonly treated : | - combo txc of acute leukemia - hodgkin's and non-hodgkins - kaposi's sarcoma - testicular cancer - **BREAST CANCER UNRESPONSIVE TO OTHER TREATMENTS**** -small cell lung cancer |
| Classes of Chemo Drugs Hormones -Action: | Stage Specific G1 |
| Classes of Chemo Drugs Hormones -Examples: | Corticosteroids |
| Classes of Chemo Drugs Hormones - Commonly treated Cancers | - Leukemia - Lymphoma |
| Classes of Chemo Drugs * Hormone Antagonist -Action: | block hormones on hormone binding tumors ( breast, prostate, endometrium; cause tumor regression) |
| Classes of Chemo Drugs * Hormone Antagonist - example | -tamoxifen (breast) - flutamide (prostate) |
| Classes of Chemo Drugs * Hormone Antagonist - toxic effects | altered secondary sex characteristics |
| EFFECTS OF CHEMO | - tissues(fast growing) frequently affected - mucus membranes - hair cells - bone marrow - reproductive organs ( all fetal toxic, impair ability to reproduce |
| major side effects of chemo/ common nursing interventions - GI System (nausea/vomiting) | - admin antimetics routinly q4 hrs - antimetic before chemo is started - withhold fluids/food 4-6 hours prior to chemo - bland foods in small amounts post chemo |
| major side effects of chemo/ common nursing interventions - GI System ( Diarrhea) | - admin antidiarrheals - maintain good perineal care - clear liquids as tolerated - monitor potassium (K); Sodium (Na) Chloride (Cl) levels (electrolytes are excreted thru stool) |
| major side effects of chemo/ common nursing interventions - GI System (Stomatitis) | - provide/teach good oral hygiene - no commercial mouth wash - rinse w/viscous lidocane pre-meal (analgesic effect) - rinse w/H20 (or water sol. lube H202)after meals - (KY Jelly) for cracked lips - suck Popsicle/moister |
| major side effects of chemo/ common nursing interventions - Hematologic System (thrombocytopenia) | -avoid bumps/bruises / physical injury - avoid ASA products & IM Injections _ Monitor CBC Closely - Assess/teach s/s increased bleed tendencies- epistaxis, petechiae, ecchymoses |
| major side effects of chemo/ common nursing interventions - Hematologic System (Leukopenia) | ** Decreased White Blood Cells*** - careful hand-washing techniques - reverse isolation if WBC < 1000/mm3 - assess s/s respiratory infection -avoid crowds/persons known to have infections |
| major side effects of chemo/ common nursing interventions - Hematologic System (Anemia) | *** Low RBC*** - provide adequate rest periods - monitor hemoglobin/hematacrit - protect client from injury - admin O2 prn |
| major side effects of chemo/ common nursing interventions -Iintegument system- (alopecia) | *** Hair Loss*** - hair loss not permanent offer support/encouragement - scalp tourniquets/scalp hypotherima ice packs (may minimize hair loss with some agents) - Buy wig before treatment) |
| major side effects of chemo/ common nursing interventions Renal System | - may cause direct damage to kidney by excretion of metabolites - encourage fluids/frequent voiding to prevent buildup of metabolites in bladder - increased excretion of uric acid may damage kidneys |
| major side effects of chemo/ common nursing interventions Renal System- [ALLOPURINOL/ZYLOPRIM] | _admin [ALLOPURINOL/ZYLOPRIM] as ordered to prevent uric acid formation - encourage fluids with admin allopurinol |
| major side effects of chemo/ common nursing interventions REPRODUCTIVE SYSTEM | -damage may occur to *male/female results infertility; * chromosome mutagenic/ damage; * - |
| major side effects of chemo/ common nursing interventions REPRODUCTIVE SYSTEM Males are encourage to do what? | * bank sperm before strarting chemo * use reliable methods of contraception during chemo ( and for a period after) |
| major side effects of chemo/ common nursing interventions NEUROLOGIC SYSTEM | * plant alkaloids (i.e vincristine) cause neurologic damage with repeated doses * Peripheral Neuropathies, hearing loss, loss of DTRs, Parlytic ileus |
| Who can administer chemotherapy agents? | Only trained and certified personnel, according to established guidelines |
| What preparations/precautions should be made when administering Chemo Agents | - protect personnel from toxic effects - extreme care for proper dosage; double check w/ physician orders, and pharmacist's preparation **PROPER MANAGEMENT OF CLIENT'S EXCREMENT |
| WHAT WAYS CAN CHEMO AGENTS BE ADMINISTERED? | - ORAL - BODY CAVITY (INTRAPERITONEAL / INTRAPLEURAL) INTRAVENOUS |
| WHAT ARE CHEMO AGENTS BE ADMINISTERED INTRAVENOUS | |
| Radiation therapy | Can be used to cure (i.e. thyroid carcinomas , localized cancers of head/neck; cancers x;cervix/uterine; |
| Radiation therapy May be used to control | malignant tumor when surgery is not optional |
| Radiation therapy May be used | Where local nodal metastasis is resent |
| o Radiation therapy May be used Neoadjuvantly | (prior to local definitive tx) w/without chemo to reduce size of tumor- enabling surgical resection |
| Radiation therapy May be used o Prophylactically | – prevent spread of primary to secondary (i.e. irradiating brain to prevent leukemic infiltration or metastic lung cancer |
| o Palliative radiation | Relieve sx of metastic cancer ( esp. brain, bone, soft tissue) ;Tx oncologic emergencies |
| oncologic emergencies | Superior vena cava syndrome; Bronchial airway obstruction; Spinal cord compression |
| 2 types ionizing radiation | – both can lead to tissue disruption; Electromagnetic (x-rays/ gamma rays); Particulate ( electrons, beta &/or alpha particles, protons, neutrons |
| What is the MOST HARMFUL DISRUPTION of chemo | Direct alteration of DNA molecule with in cells |
| Cells most vulnerable to radiation disruptive effects | During DNA synthesis/ mitosis (early S, G1, M phases); |
| Body tissues w/ frequent cell division | Bone marrow, lymphatic tissue, epithelium of GI tract, hair cells, gonads |
| Slower growing / at rest tissues are | relatively radio resistant or less sensitive to the effects |
| Slower growing / at rest tissues Examples are: | Muscle cartilage, connective tissue, cartilage |
| Radiation therapy –what is meant by localized tx | – only tissues w/in tx field will be affected by radiation tx |
| What is meant by Radio sensitive tx- | still allows for cell regeneration of normal tissue |
| Well oxygenated tumors | – more sensitive to radiation |
| Sensitivity enhanced in what | in smaller tumors w/ rapid cell division (high proliferation) and poorly differentiated (no longer resembling tissue of origin [primary] |
| Why would you use Combo chemo/ radiation | – takes advantage of radio sensitizing effects of chemo- improved survival benefit- minimize side effects of therapy |
| How is Radiation dosage determined | Depends on sensitivity of target tumors (tissues) ;Size of tumor ; Tolerance of surrounding tumor |
| What is considered a Lethal tumor dose | Eradicates 95% of tumor.- preserving normal tissue |
| Explain External beam radiation | Total radiation dose delivered over several weeks – |
| What are daily doses called? | Fractions |
| What is the benefit of External beam radiation? | Allow healthy tissue to repair / regenerate; Greater cell kill – rapid division cells – receive more exposure; Tumors shrink from outside in # |
| Radiation therapy administration | Variety of ways ;Depends on radiation used; location of cancer and type of cancer targeted |
| Radiation primary applications | Teletherapy (external beam radiation; Brachytherapy (internal radiation; System (radioisotopes; Contact or surface molds |
| Most commonly used form of radiation/ | – External Beam Radiation Therapy [EBRT] |
| IMRT- intensity modulated radiation therapy | Higher doses delivered to tumor (sparing important healthy structures around it |
| Administration of IMRT | Standard daily fractions or Hyper fractions twice daily fractions (shortens duration of tx schedule |
| IGRT- image guided radiation therapy | Continuous monitoring w/ CT /Ultrasound during tx ; Allows for auto adjustment- as tumor changes shape/position ; Spares health tissues/organs around tumor ; Reduces side effects |
| Gamma rays | one of the oldest forms of EBRT |
| SBRT- stereotactic Body Radiation Therapy | Another form of EBRT; High doses- deep body penetration; Control deep seated tumors that cannot be treated surgically or otherwise; 1-5 days for tx – high doses/short tx time |
| Proton therapy | Utilizes high liner energy transfer [LET] |
| Advantage of Proton therapy | High energy dose to a deep seated tumor with NO ENERGY exiting thru pt healthy tissue behind the tumor ; TX of deep tumors in close proximity of critical structures [i.e. heart, major blood vessels]: |
| Radiation therapy administration | Variety of ways ;Depends on radiation used; location of cancer and type of cancer targeted |
| Radiation primary applications | Teletherapy (external beam radiation; Brachytherapy (internal radiation; System (radioisotopes; Contact or surface molds |
| Most commonly used form of radiation/ | – External Beam Radiation Therapy [EBRT] |
| IMRT- intensity modulated radiation therapy | Higher doses delivered to tumor (sparing important healthy structures around it |
| Administration of IMRT | Standard daily fractions or Hyper fractions twice daily fractions (shortens duration of tx schedule |
| IGRT- image guided radiation therapy | Continuous monitoring w/ CT /Ultrasound during tx ; Allows for auto adjustment- as tumor changes shape/position ;Spares health tissues/organs around tumor ; Reduces side effects |
| Gamma rays | one of the oldest forms of EBRT |
| SBRT- stereotactic Body Radiation Therapy | Another form of EBRT; High doses- deep body penetration;Control deep seated tumors that cannot be treated surgically or otherwise; 1-5 days for tx – high doses/short tx time |
| Proton therapy | Utilizes high liner energy transfer [LET] |
| Advantage of Proton therapy | High energy dose to a deep seated tumor with NO ENERGY exiting thru pts healthy tissue behind the tumor; TX of deep tumors in close proximity of critical structures [i.e. heart, major blood vessels]: |
| Internal radiation implantation BRACHYTHERAPY | High dose to localized area; |
| How are Specific radioisotope selected? | On basis of its half-life |
| Can be implanted by what means? | needles, seeds, beads, or catheters into body cavities/intestinal compartments |
| Body cavities include | – vagina; abdomen; pleura |
| Intestinal compartments | – breast; prostate |
| What is the time frame for treatment? | Temp or perm |
| Temp HDR | - high dose radiation – short term tx |
| Perm LDR | – low dose radiation – long term treatment |
| Benefits of HDR | Shorter tx time; Lower dose radiation; Reduced exposure to personnel; Typically outpatient procedure – over several days (visits) ; |
| How can it be used? | can be used for intra-luminal, interstitial, intracavity and surface lesions |
| Intraluminal brachytherapy | |
| Catheter/hollow tubes inserted into lumen of organs, radioisotope delivered as close as possible to tumor | |
| Intraluminal brachytherapy Tx for | – obstructive lesions on bronchus; esophagus or bile duct |
| Intracavity | Radioisotopes – in specially positioned applications after placement verified by x-rays |
| Intracavity Tx for | gynecologic cancers |
| HDR/LDR brachytherapy | – depending on extent of disease |
| LDR | |
| Requires hospitalization tx over several days | |
| NURSING CARE ESSENTIAL | to maximize effective and safe delivery of therapy and prevent complications |
| LDR Nursing Care for PT | : bed rest; specially prepped private room for 72 hours; Log roll to prevent displacement of intracavity delivery device |
| Indwelling urinary catheter- keep bladder empty | |
| Low residual diet / antidiarrheal meds- prevent bowel movement/ displacement during therapy | |
| Visitors – time limits – to prevent radiation exposure | |
| HDR | |
| Typically outpatient procedure [delivered over several days] | |
| Interstitial implants | Provide local radiation source |
| Interstitial implants Treat | - prostate; pancreatic; breast cancers |
| Implantation time can be | Temp or perm |
| Interstitial implants consist of | : seeds; needles; wires; small catheters |
| Interstitial implants stability | INFREQUENT dislodge |
| Interstitial implants the further tissue is from radiation source | - lower the radiation dosage is to the tissue |
| Most frequently used type of interstitial implants | Prostate seed therapy |
| Prostate seed therapy Small radioactive seed placed | direct into prostate gland (ultrasound guidance) |
| Prostate seed therapy Placement is considered | Permanently placed |
| Prostate seed therapy Appropriate safety precautions | (several days) risk of radiation exposure to others |
| Mammo-site-implantation | breast cancer |
| Mammo-site-implantation Advantages | Reduce tx time 5 days vs 6-8 weeks ; Less radiation exposure to healthy tissue/ adjacent organs (heart/lungs) less skin reaction, improved cosmesis of breast; |
| Mammo-site-implantation NURSE MANAGEMENT | Instruct on rigorous catheter care and wound care management;Pt. tx as out pt. w/ double lumen catheter projecting form base |
| Radiation therapy administration | Variety of ways; Depends on radiation used; location of cancer and type of cancer targeted |
| Radiation therapy administration TYPES | Teletherapy (external beam radiation; Brachytherapy (internal radiation;System (radioisotopes;Contact or surface molds |
| Most commonly used form of radiation/ | – External Beam Radiation Therapy [EBRT] |
| IMRT- intensity modulated radiation therapy | Higher doses delivered to tumor (sparing important healthy structures around it |
| Administration of IMRT | Standard daily fractions or Hyper fractions twice daily fractions (shortens duration of tx schedule |
| IGRT- image guided radiation therapy | Continuous monitoring w/ CT /Ultrasound during tx;Allows for auto adjustment- as tumor changes shape/position;Spares health tissues/organs around tumor;Reduces side effects |
| Gamma rays | one of the oldest forms of EBRT |
| SBRT- stereotactic Body Radiation Therapy | Another form of EBRT;High doses- deep body penetration;Control deep seated tumors that cannot be treated surgically or otherwise;1-5 days for tx – high doses/short tx time |
| Proton therapy | Utilizes high liner energy transfer [LET] |
| Advantage of Proton therapy | High energy dose to a deep seated tumor with NO ENERGY exiting thru pts healthy tissue behind the tumor ;TX of deep tumors in close proximity of critical structures [i.e. heart, major blood vessels]: |
| Internal radiation implantation BRACHYTHERAPY | High dose to localized area ;Specific radioisotope selected on basis of its half-life |
| Can be implanted by means of | needles, needs, beads, or catheters into body cavities/intestinal compartments |
| Body cavities include | – vagina; abdomen; pleura |
| Intestinal compartments | – breast; prostate |
| Temp or perm | Temp HDR- high dose radiation – short term tx;Perm LDR – low dose radiation – long term treatment |
| Benefits of HDR | Shorter tx time ; Lower dose radiation; Reduced exposure to personnel; Typically outpatient procedure – over several days (visits) ;Can be used for intraluminal , interstitial, intracavity and surface lesions |
| Intraluminal brachytherapy | Catheter/hollow tubes inserted into lumen of organs, radioisotope delivered as close as possible to tumor |
| Tx for | – obstructive lesions on bronchus; esophagus or bile duct |
| Intracavity Tx | gynecologic cancers |
| Intracavity Tx | Radioisotopes – in specially positioned applications after placement verified by x-ras |
| HDR/LDR brachytherapy – | depending on extent of disease |
| LDR | Requires hospitalization tx over several days |
| NURSING CARE ESSENTIAL | to maximize effective and safe delivery of therapy and prevent complications |
| PT: | bed rest; specially prepped private room for 72 hours; Log roll to prevent displacement of intracavity delivery device |
| Indwelling urinary catheter- | keep bladder empty |
| Low residual diet / antidiarrheal meds- | prevent bowel movement/ displacement during therapy |
| Visitors – | time limits – to prevent radiation exposure |
| HDR | Typically outpatient procedure [delivered over several days] |
| Interstitial implants | Treat- prostate; pancreatic; breast cancers |
| Interstitial implants | Temp or perm AND INFREQUENT dislodge |
| Consist of : | seeds ; needles; wires; small catheters |
| Interstitial implants | Provide local radiation source |
| The further tissue is from radiation source | - lower the radiation dosage is to the tissue |
| most frequently used type of interstitial implants | Prostate seed therapy |
| Prostate seed therapy | Permanently placed Small radioactive seed placed direct into prostate gland (ultrasound guidance) |
| Appropriate safety precautions | (several days) risk of radiation exposure to others |
| Radioisotopes > | used as radio-immunotherapy for tx of refractory non-Hodgkin’s lymphoma (NHL) |
| Currently 2 radio immunotherapy tx avail for NHL | Ibritumomab tiuxetan (Zevalin) ; Iodine 131 tositumomab (Bexxan) |
| Toxicity | Localized to region being irradiated, May be increased if concomitant chemo is used |
| Acute local reactions | Normal cells in tx area are destroyed - > cellular death exceeds cellular regeneration |
| Body tissue most affected | That with rapid proliferation (cell regeneration) ,Skin, epithelial lining of GI tract and oral cavity ; bone marrow |
| common side effect can include alopecia | Altered skin integrity |
| Skin reactions graded by | severity along continuum ranging from Erythema and dry desquamation (flaking of skin >>>TO >>>Moist desquamation (dermis exposed, skin oozing serous fluid),Potentially ulceration |
| common side effect | Re-epithelialization occurs (after cessation of tx )Alterations on oral mucosa secondary to Stomatis ( inflammation of oral tissue) ,Xerostomatis ( dryness of the mouth) ,Change or loss of taste |
| ,Entire gastrointestinal mucosa may be involved | ,Decreased salivation Esophageal irritation with chest pain and dysphagia may result |
| may occur if stomach or colon is in irradiated field | Anorexia, nausea, vomiting , diarrhea – |
| Symptoms subside – gastro-epithelialization | occurs after cessation of tx |
| Bone marrow cells | proliferate rapidly (iliac crest, sternum) |
| PT is at risk for infection / bleeding until | wbc counts return to normal Chronic anemia may occur |
| Systemic side effects common to radiation pts. | Fatigue; malaise; anorexia may be secondary to substances released when tumor cells breakdown ,Temporary- most subside with cessation of tx |
| Late Effect of radiation (months- yrs. after tx ceases) | Various body tissues ; usually chronic; are not reversible,May affect lungs, heart, CNS, bladder ,Toxicity may intensify when radiation combined w/other tx modalities |
| System symptoms | Weakness fatigue - Result of tx DO NOT represent deterioration / progression of disease process |
| Contact with health care providers guided by | Principles of time; distance; shielding ; Guides set by radiation safety officer |
| Pt w/ seed implants | – can typically return home with proper teaching ,Radiation exposure to others is minimum |
| Pt may or may not require special precaution / hospitalization | Dependent on dose / and energy emitted by systemic radionuclide *** Explain rational to patient for precaution to prevent undue feeling of isolation |
| • Admin of chemo intravenous | use of vascular access device because of threat of extravasation (leakage into tissue) and long term therapy |
| • Types of vascular access devise | PICC- (peripherally inserted tunnel catheters) ; tunneled catheters ( Hickman/ Groshong) ; surgically implanted ports (accessed with 90 degree angle needle) |
| • Central Venous Access | |
| • Groshong | |
| • Hickman | |
| • PICC | |
| • Surgically implanted port | portacath |
| • Peripheral IV infusion | discouraged for chemo – (central line preferable) |
| • Always check placement by | aspirating blood sample and discarding- NEVER push blood back in |
| • Peripheral IV Infusion(high Risk Extravasation) | most chemo drugs vesicants ; STOP INFUSION; apply cold compress; DOCUMENT time/date/site/ Size/type of IV; drug being infused; approximate amount infused |
| • Peripheral IV | know and adhere to Hospital Policy; chemo administration; extravasation kits (antidotes to particular meds) |
| • Nursing Care for chemo clients | assess and manage toxic effects of drugs; side effects of drugs |
| • Chemo side effects | manage nausea and vomiting; inflammation and ulceration of mucus membranes; hair loss; anorexia; nausea and vomiting with specific nursing and medical interventions |
| • Monitor lab results (chemo) | drugs withheld if blood counts seriously low (blood/blood product admin); dehydration; oncologic emergency. |
| • Teach chemo clients about : | fatigue, immunosuppression cautions |
| • Provide chemo clients and family with | emotional and spiritual support |
| • Why is Surgery performed | diagnosis, staging and sometimes tx of cancer |
| • What does surgery involve? | removal of body part, organ, sometimes w/altered function (e.g. colostomy ) |
| • Why is Debulking used | decrease size of tumor in advanced cases |
| • Example of reconstruction/ rehabilitation | breast implant post mastectomy |
| • Why give psychological support? | to help client deal w/surgery and w/ cancer dx |
| • Radiation therapy | uses ionizing radiation to kill /limit growth of cancer cells |
| • How does radiation work | injures cell membrane, destroys or alters DNA so cells cannot reproduce – affects both good and bed cells and therefore causes side effects |
| • Principles of radiation localized vs. generalized | localized effects are related to body of area being treated; generalized effects may be related to cellular break down |
| • Why is radiation tx of choice for some tumors? | it kills or reduces size of tumor, relieves pain and obstruction (those that cannot be surgically removed this is good alternative) |
| • Delivery of radiation therapy | teletherapy (external) delivered in uniform dose to tumor ; Brachytherapy – delivers high dose to tumor less to other tissues – radiation source placed in / next to tumor |
| • Internal radiation therapy- sealed implants vs. unsealed implants | (sealed) radioisotope enclosed container – DOES NOT circulate the body, clients body fluids should not become radiation contaminated (unsealed) radioisotope NOT encased- circulates in body- contaminates body fluids |
| • Types of radiation energy emitted_ | GAMMA (electromagnetic or X-rays) penetrate deeper areas of body; most common form of external radiation therapy |
| • vesicants, | which have the potential to cause severe or irreversible tissue injury and necrosis |
| • Complications related to extravasation | are possible w/many medications, but it is a particular concern with cytotoxic/chemotherapeutic drugs used in the treatment of cancer, since these are often highly toxic medications that must be administered in controlled fashion to avoid adverse events. |
| • Factors controlling exposure to radiation | Half-life; Time; Distance; Shielding |
| • Half-life- | time required for half of the radioactive atoms to decay ; each isotope has a different half-life ; at the end of half-life danger from exposure decreases |
| • Time | the sorter the duration the less the exposure |
| • Distance - | the greater the distance from the radiation source- the less the exposure |
| • Shielding | all radiation can be blocked; rubber gloves ; thick lead or concrete stops gamma rays |
| • Health care workers / exposure | at greater risk from internal than external sources; film badge can measure the amount of exposure received; no pregnant nurses of visitors allowed near radiation source |
| • Goals/ radiation therapy | mas tumor control with minimal damage to normal tissues; |
| • Caregiver goals / radiation therapy | must protect selves by using shield, distancing and limiting time with client, following safety protocols |
| • Treatment schedules / radiation | planed according to radio sensitivity of tumor, tolerance of client; Monitor Blood Cell Count |
| • Radiation therapy /side effects | skin (external radiation ) blanching, erythema, sloughing, oozing, burning |
| Radiation therapy /side effects (SKIN) | AVOID foreign substances; medicated solutions(oint./pwdrs); pressure, trauma, skin infection; WASH w/ plain H20 Pat dry Avoid soap; talcum powder; constricting/irritating clothing; (exposure heat/sun/ cold) ((sterile dressing(sloughing) micro pore tape)) |
| • Radiation therapy /side effects (ANOREXIA/ NAUSEA/ VOMITING | mealtime NOT directly pre/post tx; bland foods; small attractive meals; avoid extreme temps; admin antiemetic’s as ordered pre meals |
| • Radiation therapy / SE (DIARRHEA) | encourage low residue, bland , high protein foods; admin antidiarrheal as ordered; GOOD PERINEAL Care; Monitored electrolytes (NA< K <Chl) |
| • Radiation therapy / SE (ANEMIA/LEUKOPENIA/THROMBOCYTOPENIA) | Isolate from known infections; frequent rest periods; high protein diet; pt. avoid injury; assess for bleeding ; Monitor CBC, leukocytes, platelets; AVOID ASA; shaving- (electric razor , soft toothbrush, no flossing |
| • Biotherapy | modification of biologic process result in malignancies; based on immune surveillance hypothesis; used for hematological malignancies, renal and melanoma; monoclonal antibodies (inoculate animal w/tumor antigen- retrieve antibodies against tumor for human |
| • Photodynamic therapy | client given photosensitizing compound which concentrates in malignant tissue; later given laser tx to destroy tissue |
| • Bone marrow transplant/ stem cell transplant | stimulation of nonfunctioning marrow or replace bone marrow; common tx for leukemia; tx for solid tumors elsewhere in body (breast/brain) destroys bone marrow (BMT may be done as result- autologous if possible) |
| • Pain Control | directly from cancer; treatment or unrelated- necessary for continuing function or comfort in terminally ill pts. |
| • Goal of pain control | max relief w/ min side effects |
| • Pain Medications | multiple combos of analgesics (narcotic/non-narcotic) ((adjuvants – steroids/antidepressants)) includes ATC(around the clock) schedule w/additional meds for breakthrough pain |
| • Pain medication routes | multiple routes; may involve injections of anesthetics into nerve, surgical severing of nerves; may need to progress to stronger pain meds as pain increases and client develops tolerance to pain meds |
| • Nursing DX – ANXIETY | therapeutic interactions w/ client /family; community resources such as ACA (American cancer society) “I Can Cope” ; availability of community resources for terminally ill (hospice care in patient; home care ) |
| • Nursing Dx- DISTURBED BODY IMAGE | loss of body parts (amputations) ; appearance changes (skin. Hair, ) altered functions ( colostomy) cachexia appearance, loss of energy , ability to be productive – fear of rejection |
| • Nursing DX ANTICIPATORY GRIEVING | facing death and making preparations for death; offer realistic hope that cancer tx may be successful |
| • Nursing Dx RISK FOR INFECTION: | most tx suppressed immune function increasing risk for infections |
| • Nursing DX RISK FOR INJURY | organ obstruction; pathological fractures (bones weaken due to suppression caused by chemo/ radiation) |
| • Nursing DX ALTERED NUTRITION less than body requires: | consultation dietician, lab evaluation of nutritional status; manage problems w/ eating, anorexia, nausea, vomiting ; may involve use of parenteral nutrition |
| • Nursing DX IMPAIRED TISSUE INTERGRITY; | oral, pharyngeal, esophageal tissues (due to chemo, bleeding due to low platelet counts, fungal infections as in thrush) - ; tch inspection ; frequent oral hygiene, specific non-irritating products, thrush control |
| • Oncological emergencies | pericardial effusion and neoplastic cardiac tamponade ; superior vena cava syndrome; Sepsis and septic shock ; Spinal Cord Compression; obstructive uropathy; hypercalcemia; hyperuricemia ; SIADH; |
| • Oncologic emergencies pericardial effusion and neoplastic cardiac tamponade | compression of heart by fluid in pericardial sac, compromised cardiac output |
| • Oncologic emergency pericardial effusion and neoplastic cardiac tamponade tx | pericardiocentesis |
| • Oncologic emergencies superior vena cava syndrome; | obstruction of venous system w/increased venous pressure and stasis; facial and neck edema with slow progression of respiratory distress |
| • Oncologic Emergency superior vena cava syndrome; Treatment | respiratory support; decrease tumor size with radiation therapy or chemo |
| • Oncologic Emergency Sepsis and septic shock concern | Concern: early recognition of infection |
| • Oncologic Emergency Sepsis and septic shock Treatment | Prompt treatment required |
| • Oncologic Emergency – Spinal Cord Compression - Concern | pressure from expanding tumor can cause irreversible paraplegia ; back pain initial symptom with progressive paresthesias – leg pain and weakness |
| • Oncologic Emergency – Spinal Cord Compression Treatment | early detection and radiation or surgical decompression |
| • Oncologic emergency – obstructive uropathy concern | blockage of urine flow; undiagnosed can lead to renal failure |
| • Oncologic emergency – obstructive uropathy Treatment | restore urine flow |
| • Oncologic emergency – Hypercalcemia – concern | high calcium from ectopic parathyroid hormone or metastasis |
| • -Oncologic emergency – Hypercalcemia- behaviors | fatigue , muscle weakness; polyuria; constipation; progressing to coma; seizures |
| • - Oncologic emergency – Hypercalcemia- Treatment | restore fluids with IV saline, loop diuretics, more definitive tx |
| • Oncologic emergency – Hyperuricemia- concern | occurs with rapid necrosis of tumor cells as with chemo; can result in renal damage and failure |
| • Oncologic emergency – Hyperuricemia treatment | PREVENTION AND TREATMENT WITH FLUIDS AND ALLOPURINOL (Zyloprim) |
| • Oncologic emergency – SIADH- concern | SYNDROME OF INAPPROPRIATE ANTIDIURETIC HORMONE SECRETION) ectopic ADH production from tumor leads to excessive hyponatremia |
| • Oncologic emergency – SIADH- Treatment | restore sodium level |
Created by:
Kyn269
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