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Nursing 210: Module V, Unit B
Patient with Maligant Disorders
136
Nursing
Undergraduate 2
12/09/2009

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Cards

Term
What is leukemia?
Definition
a group of malignant disorders affecting the blood and blood forming tissues of the bone marrow, lymph system, and spleen
Term
What age groups does leukemia occur in?
Definition
all
Term
What happens to cells in leukemia?
Definition
accumulation of dysfunctinoal cells due to loss of regulation in cell division
Term
What is the ratio of children to adults affected with leukemia?
Definition
1:10
Term
What causes leukemia?
Definition

- no single event

- combination of genetic and environmental influences

Term
What are some possible environmental factors in the cause of leukemia?
Definition

- chemical agents

- chemotherapeutic agents

- viruses

- radiation

- immunologic deficiencies

Term
Describe cell maturity in acute and chronic luekemia.
Definition

acute: clonal proliferation of immature hemoatopoietic cells

 

chronic: mature forms of WBC and onset is more gradual

Term
What are the two types of acute luekemia as classified by type of white blood cell?
Definition

- acute lymphocytic luekemia (ALL)

- acute myelogenous leukemia (AML), also called acute nonlymphoblastic leukemia (ANLL)

Term
What are the classifications of chronic luekemia by type of WBC?
Definition

- chronic myelogenous leukemia (CML)

- chronic lymphocytic leukemia (CLL)

Term
What percentages of luekemia does AML account for?
Definition
25% of all leukemias, 85% of acute adult leukemias
Term
Describe the onset of AML.
Definition

- abrupt, dramatic onset

- serious infectinos or abnormal bleeding

Term
Describe the pathophysiology of AML.
Definition

- uncontrolled proliferation of myeloblasts

- hyperplasia of bone marrow and spleen

Term
What is the incidence of ALL?
Definition

- most common type of leukemia in children

- 15% of acute leukemia in adults

Term
What is the pathophysiology of ALL?
Definition
- immature lymphocytes proliferate in the bone marrow
Term
What are the s and sx of ALL?
Definition

- may appear abruptly

- fever, bleeding

- insidious with progressive weakness and fatigue

- CNS manifestations especially common in ALL and can be a serious problem

Term
What is the pathophysiology of CML?
Definition

- excessive mature neoplastic granulocytes in bone marrow

- move in peripheral blood in massive numbers

- ultimatley infiltrate liver and spleen

Term
What is the Philadelphia chromosome?
Definition
genetic marker for CML
Term
Describe the cyclical nature of CML.
Definition
chronic, stable phase followed by acute, aggressive (blastic) phase
Term
What is the pathophysiology of CLL?
Definition

- production and accumulation of functionally inactive by long-lived, mature appearing lymphocytes

- B cell involvement

Term
What is the major symptom of CLL?
Definition
- lymph node enlargement present throughout body, with increased incidence of infection
Term
Describe complications in CLL.
Definition

- early-stage complications are rare

- may develope as disease advances

- pain, paralysis from pressure caused by enlarged lymph nodes

Term
What are clinical manifestations of leukemia usually related to?
Definition
bone marrow failure: overcrowding by abnormal cells, inadequate production of normal marrow elements
Term
What do inadequate bone marrow elements cause in leukemia?
Definition

- anemia

- thrombocytopenia

- decreased number and function of WBCs

Term
What are clinical manifestations of luekemia caused by leukemic cells?
Definition

- splenomegaly

- hepatomegaly

- lymphadenopathy

- bone pain

- menigeal irritation

- oral lesions

- solid masses known as chloromas

Term
What diagnostic studies are used to diagnose and classify leukemia?
Definition

- peripheral blood evaluation

- bone marrow evaluation

Term
What diagnostic studies are used to identify cell subtype and stage in leukemia?
Definition

- morphologic

- histochemical

- immunologic

- cytogenic methods

Term
What is the goal for collaborative care of leukemia?
Definition

- attein remission, either complete, partial, or molecular

- prognosis is directly related to ability to maintain a remission

Term
What is the mainstay of treatment for leukemia?
Definition
- combinatino chemotherapy
Term
What are the three purposes of combination chemotherapy when treating luekemia?
Definition

- decrease drug resistance

- decrease drug toxicity using multiple drugs

- interrupt cell growth and numerous points

Term
What is the goal of stem cell transplantation in luekemia?
Definition
totally eliminate leukemic cells using a combination of chemotherapy with or without total body irradiation
Term
Who are some candidates for bone marrow donation for a luekemic patient?
Definition

HLA matched

- sibling

- volunteer

- identical twin

- own stem cells

Term
What are the three methods of harvesting stell cells?
Definition

- stem cells from bone marrow

- obtained from peripheral blood

- umbilical cord blood which is rich in hematopoeitic stem cells

Term
What are complications of bone marrow transplantation?
Definition

- graft vs. host disease

- failure to engraft

- infection

Term
What are the overall goals of nursing management planning for the pt with leukemia?
Definition

- understand and cooperate with treatment plan

- experience minimal side effects and complications of the disease and treatment

- feel hopefuly and supported during periods of treatment, relapse, and remission

Term
What are key points to remeber when developing a nursing care plan for a pt with leukemia?
Definition

- many physical and physchological needs: cancer evokes great fear, equate with death, the family may need help

- patient is empowered by knowledge of disease and treatment can have a more positive outlook and improved quality of life

- ongoing care is necessary to monitor for signs and symptoms of disease control or relapse

Term
What should the nurse teach the luekemic patient and significant others?
Definition

- diligence in disease management

- need for follow up care

- when to seek medical attention

Term
What are risk factors for breast cancer?
Definition

- female

- age 50+

- personal hx of breast cancer, colon cancer, endometrial cancer, ovarian cancer or lobular carcinoma in situ

- benign breast disease w/ atypical hyperplasia

- early menarche <12

- late menopause >55

- full term pregnancy after age 30; nuliparity

- weight gain after menopause

- exposure to ionizing radiation

Term
What are diagnostic tests for breast cancer?
Definition

- CBC, platelet count

- calcium and phosphorus levels

- liver function tests

- chest x-ray

- if indicated, for staging: bone scane, CT scane (chest, abdomen, pelvis) and MRI

Term
Where is breast cancer most likely to occur in the breast?
Definition
upper outside quandrant
Term
What are the qualifications for Stage 1 Breast Cancer?
Definition

T1 N0 M0

 

- tumor < 2 cm

- no nodes

- no metastases

Term
What are the qualifications for Stage II breast cancer?
Definition

T1-2 N0-1 M0

 

- tumor > 2cm, < 5cm

- no nodes +, not fixed

- no metatases

Term
What are the qualfications for Stage III breast cancer?
Definition

T 3-4 N 2-3 M0

 

- tumor >5 cm --any size to skin, chest wall

- nodes: + fixed above or below clavicle

- not metastases

Term
What are the qualifications for Stage IV breast cancer?
Definition

T any N any M1

 

Tumor: any

Nodes: + or -

Metastases: + for distant

Term
Describe collaborative care for breast cancer.
Definition

- therapeutic regiment dictated by clinical stage classification of cancer

- single most powerful prognostic factor afer primary therapy is presence or absence of malignant cells in lymph nodes

- collaborative care includes: surgery, radiation therapy, chemotherapy, hormonal therapy, biologic and targeted therapy

Term
What are the surgical treatment options for breast cancer?
Definition

- lumpectomy

- quadrectomy

- simple mastecomy

- modified radical mastectomy

- radical mastectomy

- reconstructive plastic

Term
What are important post operative nursing actions for the pt who has undergone surgery for breast cancer?
Definition

- assess for hemorrhage: vital signs, check under pt, check dressings, check drains

- relieve pain

- promote activity: T, C, DB, IS and hand/arm exercises

- psychologic concerns

- prevent lymphedema

Term
What is lymphedema?
Definition

- accumulation of lymph in soft tissues

- can occur as a result of excision or radiation of lymph nodes

- when axillary nodes cannot return lymph fluid to central circulation, fluid accumulates in arm, causing obstructive pressure on veins and venous return

Term
What are nursing care interventions to prevent lymphedema?
Definition

- nurse should use and teach patient to take measures to prevent or decrease lymphedema after ALND

- blood pressure readings, venipunctures, and injections should not be done on affected arm

- elastic bandages should not be used in early postoperative period

Term
What are means of helping to restoring arm function on affect side after masectomy and axillary lymph node dissection?
Definition

- one of most important post op goals

- place in semi-Fowler's position with arm on affected side elevated on a pillow

- flexing and extending fingers should begin in recovery room and progressive increase in activity should be encouraged

- postoperative arm and should exercises are insituted gradually at surgeon's direction

- postoperative discomfort can be minimized by administering analgesics around 30 minutes prior to exercise

- when showering is appropriate, warm water has a soothing effect and decreaes joint stiffness

- exercises are designed to prevent contractures and muscle shortening, maintain muscle tone, and improve lymph and blood circulation

Term
What are adjuvent therapies to surgery for breast cancer?
Definition

- radiation therapy after breast conservation surgery

- systemic therapies: chemotherapy or hormonal therapy

Term
How is radiation used to treat breast cancer?
Definition

- primary treatment

- adjuvant therapy

- palliative treatment for pain caused by local recurrence and metastases

Term
How does breast cancer respond to chemotherapy?
Definition
one of the solid tumors that is most responsive to chemotherapy
Term
When do breast cancer pts often receive chemotherapy?
Definition
preoperatively to decrease size of primary tumor
Term
What are the most common side effects of chemotherapy in breast cancer pts?
Definition

- GI

- bone marrow

- hair follicles

Term
What action does hormonal therapy have on breast cancer?
Definition

- block or destroy estrogen receptors

- suppress estrogen synthesis through aromatase

Term
What are the uses of hormonal therapy in the breast cancer pt?
Definition

- adjuvant to primary treatment

- patients with recurrent or metastatic cancer

Term
What is Herceptin (trastuzumab)? How is it used to treat breast cancer?
Definition

- monoclonal antibody to HER-2

- once antibody attaches to antigen, it is taken to cells and eventually kills them

- can be used alone or in combinatino with other chemotherapies

Term
What are some of the psychoglogical conerns of breast cancer pts and how can nurses help to treat them?
Definition

- fear of mutilation

- disfigurment

- loss of sexuality and attractiveness

- fear of death

- nursing: encourage, inform, identify, support systems and groups

Term
How many new cases and how many deaths are there per year of cervical cancer?
Definition

- 3000 new cases

- 5000 deaths

Term
How much has the number of cervical cancers dropped b/t '52 and '92, and what is the reason for this drop?
Definition

- dropped by 74%

- PAP screening

Term
What are the two main types of cervical cancer and what percentage of cervical cancer does each compose?
Definition

- squamous cell, 80-90%

- adenocercinoma, 10-20%

Term
What are risk factors for cervical cancer?
Definition

- multiple sexual partners

- family hx

- immunosuppression

- multiple pregnancies

- low socio-economic status

- poor nutrition

- smoking

- HPV

Term
What is the number one risk factor for cervical cancer?
Definition
- HPV
Term
What types of HPV are high risk for cervical cancer?
Definition
16, 18, 31, 33, 45
Term
What types of HPV are high risk for condyloma?
Definition
6 and 11
Term
How is HPV spread?
Definition
skin to skin contact, sexually transmitted
Term
What types of HPV does Gardasil protect against, and what percentage of cervical cancers do these make up?
Definition

- 6, 11, 16, 18

- 70% cases of cervical cancer, 90% cases of genital warts

Term
What age group is HPV recommended for?
Definition
girls ages 9-25; series of injections over 6 months
Term
What are some s and sx of a woman who has HPV?
Definition

- warts on genitals

- asymptomatic

- may clear on its own

- may develop changes in the cells of cervix (dysplasia) that left untreated will go on to become cervical cancer

Term
What is dysplasia in relation to cervical cancer?
Definition

- progression of normal cells to abnormal cells

- left untreated, can progress to cervical carcinoma in situ

Term
What is the clinical staging of cervical cancer?
Definition

- precursor lesions

- dysplasia: not cancer, can be treated with cryotherapy or laser therapy

- sever dysplasia

- carcinoma in situ, conization

Term
How is pre-invasive cervical cancer treated?
Definition
- hysterectomy: uterus, ovaries, fallopian tubes
Term
How is invasive cervical cancer treated?
Definition

- radical hysterectomy w/ lymph nodes

- radiation

Term
What is pre-op care for a pt undergoing surgery for cervical cancer?
Definition
 bowel prep and foley
Term
What is post op nursing management for a pt with cervical cancer?
Definition

- monitor VS

- check for infection, hemorrhage

- leg exercises

- DVT prophylaxis

- monitor for urinary retention and ileus

- pad counts to check for hemorrhage

Term
How is radiation used to treat cervical cancer?
Definition

- internal intracavitary

- applicator inserted in OR

- loaded

Term
What is an important nursing consideration for a pt undergoing radiation for cervical cancer?
Definition
time, distance, shielding
Term
What are nursing care actions for a pt who has had a cervical radiation implant?
Definition

- bedrest

- foley

- packing

- low residual diet

- no peri-care

- turn, leg exercises, hob elevated 15 degress

- assess for increase in temp, n/v

- check applicator

Term
What is good psychological nursing care for a pt with surgical cancer?
Definition

- relieve anxiety

- understand, allow to verbalize

- id strengths

- explanation of pre-op, prep, and post-op routines

- accept self as altered: concerns, fears, questions, reassurance, sexual relations, emotional stability

Term
What are risk factors for colon cancer?
Definition

- family or personal hx of colorectal cancer

- increased age

- colorectal polyps: inflammatory bowel disease, adult onset diabetes

- lifestyle factors: obestiy, smoking, alcohol, lg amounts of red meat, diet with increased fat and decreased fiber, limited physical activity

Term
What are signs and symptoms of colon cancer?
Definition

- change in bowel habits, diarhhea alternating with constipation

- change in size, shape, consistency, or frequency of bowel habits

- blood in stool, usually occult

- anemia, pallor, fatigue, wt loss

Term
What are sign and symptoms of a right sided lesion in colon cancer?
Definition

- dull abd pain

- melena

Term
What are signs and symptoms of a left sided lesion in colon cancer?
Definition

- obstruction

- pain

- cramps

- narrow stool (ribbon like)

- constipation

- distention

- bright red blood

Term
What are signs and symptoms of a rectal lesion in colon cancer?
Definition

- tenesmus (painful straining when passing stool)

- rectal pain

- incomplete evacuation

- bloody stools

- alt const/diarrhea

Term
How is colon cancer diagnosed?
Definition

- rectal exam

- stool

- barium enema

- sigmoidoscopy

- colonoscopy

- CEA

- DREs

Term
What are additional studies to confirm dx of colon cancer?
Definition

- tissue biopsies

- lab studies: CBC, coag studies, liver function tests

- CT scan or MRI helpful in detecting liver metastases, retroperitoneal and pelvic disease, depth of penetration of tumor in bowel wall

Term
What is the treatment of choice for colon cancer?
Definition
surgery
Term
What is the usual surgical option for colon cancer in situ?
Definition
colonoscopy
Term
What are the two types of bowel/colon resections?
Definition

- partial colectomy

- hemi-colectomy

- perineal resection

- diverting colostomy

Term
What is good emotional nursing care pre-op for the pt undergoing surgery for colon cancer?
Definition

- assess pt and family

- help pt and family with grieving, guilt, change in body image, loss of self-esteem, social isolation, job worries, sexual concerns

Term
What is good educational nursing care for the pre-op pt undergoing surgery for colon cancer?
Definition

- very individualized, some need information, some don't want to know anything

- plan of care

- enterstomal therapist

- ostomy support group

Term
Describe physical preparation nursing care for the pre-op pt undergoing surgery for colon cancer?
Definition

- bowel prep to reduce amount of stool in bowel

- antibacterial - given to decrease po in intestinal flora

- correct anemia

Term
Describes post op nursing care for pt undergoing surgery for colon cancer?
Definition

- vs

- i and o s

- ngt

- foley

- dvt prophylaxis

- wound care

- colostomy care

- check for edema

Term
What complications should the nurse assess for in the post-op colon cancer pt?
Definition

- paralytic ileus

- obstruction

- infection

- dehiscence

- evisceration

- fistula, stoma prolapse, retraction

Term
For what is chemotherapy used in the patient with colon cancer?
Definition

- post op to lower risk of recurrence

- treat known metasases

Term
How is radiation used to treat colon cancer?
Definition

- shrink tumor

- decrease risk of recurrence

- relieve symptoms

Term
What are risk factors for lung cancer?
Definition

- cigarette smoking (age, inhalation, type, PPD, # years)

- secondary smoke

- environmental

- occupational exposure

- diet

- radon

Term
What are the two types of lung cancer?
Definition

- non-small cell lung cancer

- small cell lung cancer

Term
On what do the symptoms of lung cancer depend?
Definition

- location and size of tumor

- metastases

Term
What are the symptoms of lung cancer?
Definition

- cough (dry, non productive)

- wheeze

- blood tinged sputum

- fever

- pain

Term
Howis lung cancer diagnosed?
Definition

- chest x-ray

- CT scan

- MRI

- PET

- diagnosis id by malignant cells

- sputum specimens obtained for cytologic studies: fiberoptic bronchoscope, metiastinoscopy, video-assisted thoracoscopy, pulmonary angiography

Term
What are diagnostic studies for a metastatic work-up for lung cancer?
Definition

- bone scan

- bone marrow aspiration

- liver scan

- brain scan

- CT scan/MRI

- pulmonary function tests

Term
What does collaborative care for lung cancer include?
Definition

- surgical therapy

- radiation therapy

- chemotherapy

- biologic and targeted therapy

Term
How is radiation used for treating lung cancer?
Definition

- may cure small percentage

- controls lesions

- palliation

Term
What are complications of radiation and lung cancer?
Definition

- esophagitis

- pneumonitis

- pulmonary fibrosis

- heart issues

Term
How is chemotherapy used to treat lung cancer?
Definition

- manipulate tumor growth

- treat metastasis

- SCLC

- combination therapy

Term
Is chemotherapy generally curative or palliative?
Definition
curative, yes; palliative no
Term
What are lung surgeries for cancer?
Definition

- pneumonectomy

- lobectomy

- segmental resection

- thoraccscopy or VATS

Term
What are pre-op nursing interventions for lung cancer surgery?
Definition

-know baseline data for respiratory and cardiovascular systems

- stop smoking

- teach C& BD/incentive spirometry

- pain management

- possiblity of chest tubes

- improve understanding of surgical procedure and self care techniques

- relieve anxiety

Term
What are nursing interventions post-op for lung cancer?
Definition

- effective breathing pattern

- adequate airway clearance

- adequae oxygenation of tissues

- minimal to no pain

- realistic attitude toward treatment and prognosis

Term
What is the age on onset with acute myelogenous leukemia?
Definition

- increase in incidence with advancing age

- peak age b/t 60-70 years of age

Term
What is the pathology of AML?
Definition
affects the hematopoietic stems cells of monocyte, granulocyte, erythrocyte, and platelet cell lines
Term
What are the manifestations of AML?
Definition

- risk of infection

- weakness

- fatigue

- liver pain

- spleen pain

- headache

- lymphadenopathy

- vomiting

- bone pain

Term
What is the treatment for AML?
Definition

- chemotherapy

- administration of blood products

- bone marrow transplant

Term
What is the age of onset of ALL?
Definition

- before 4 years of age

- peak incidence b/t 2-9

Term
What is the pathology of ALL?
Definition
maligant proliferation of lymphocytes
Term
What are the manifestations of ALL?
Definition

- leukopenia

- anemia

- thrombocyteopenia

- low platelets

- low erythrocytes

Term
What is the treatment for ALL?
Definition
- chemotherapy
Term
What is the age of onset for CML?
Definition

- 25-60 yrs of age

- peak incidence around 45 yrs of age

Term
What is the pathology of CML?
Definition
affects myeloid stem cells, but more normal cells are present than in AML
Term
What are the manifestations of CML?
Definition

- same as AML, but less severe

- leukocytosis

- spelnomegaly

Term
What is the treatment for CML?
Definition
same as AML
Term
What is the age of onset of CLL?
Definition

- 50-70 yrs of age

- rare below 30 years

- predominance in men

Term
What is the pathology of CLL?
Definition

- same as ALL, but is often mild

- maybe asymptomatic

Term
What are manifestations of CLL?
Definition

- often none

- enlarged lymph glands

- anemia risk of infection

Term
What is treatment for CLL?
Definition
chemo if disease is severe
Term
What are the indications for lopectomy?
Definition

- lung cancer

- bronchiectasis

- TB

- emphesematous bullae

- benign lung tumors

- fungal infections

Term
What are infections for lobectomy?
Definition

- most common lung surgery

- two chest tubes inserted post-operatively

- remaining lung tissue expands to fill up space

Term
What are indications for pnemonectomy?
Definition

- lung cancer

- extensive TB

- bronchiesctasis

- lung abscess

Term
What are considerations for a pneumonectomy?
Definition

- done only when lobectomy or segmental resection will not remove all diseased lung

- drainage tubes are not generally used

- fluid gradually fills space where lung has been removed

- position on back or operative side only

Term
What are indications for a segmental resection?
Definition

- bronchiesctasis

- TB

Term
What are considerations for a segmental resection?
Definition

- technically difficult

- done to remove lung segment

- chest tubes inserted

- remaining lung tube expands to fill space

Term
What are indications for wedge resection?
Definition

- lung biopsy

- excision of small nodules

Term
What are considerations for a wedge resection?
Definition
chest tubes need posteropertively
Term
What are indications for a VATS?
Definition

- biopsy

- excision of peripheral or mediastinal lung lesions

Term
What are considerations for a VATS?
Definition
chest tubes need postoperatiely
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