NUR 2356: REVIEWED_MULTIDI MENSIONAL CARE I EXAM STUDY GUIDE (Latest 2020 / 2021)

NUR 2356: REVIEWED_MULTIDI MENSIONAL CARE I EXAM STUDY GUIDE (Latest 2020 / 2021.) Define cellular regulation? Cellular regulation is the genetic and physiologic processes that control cellular growth, replication, differentiation, and function to maintain homeostasis. Define Immunity? protects the body from foreign invaders and non-self-cells Define Mitosis? Mitosis makes one cell divide into two new cells that are identical to each other and to the cell that began mitosis. Define Neoplasia? Any new or continued cell growth not needed for normal development or replacement of dead and damaged tissues In relation to the biology of normal cells…. Define Specific morphology? Specific morphology is the feature in which each normal cell type has a distinct and recognizable appearance, size, and shape. Define a small nuclear-to-cytoplasmic ratio? means that the nucleus of a normal cell occupies a relatively small amount of space inside the cell. Define differentiated function? Means that every normal cell has at least one function it performs to contribute to whole-body function. For example, skin cells make keratin, liver cells make bile, cardiac muscle cells contract, and red blood cells make hemoglobin. Define Tight Adherence occurs because normal cells make sticky cell adhesion molecules (CAMs) that protrude from the membranes, allowing cells to bind closely and tightly together. Exceptions are blood cells that circulate freely as individual cells. Red blood cells and white blood cells produce no CAMs and do not usually adhere together. Define nonmigratory means that normal cells do not wander throughout the body (except for blood cells). Normal cells are nonmigratory because they are tightly bound together with CAMs, which prevents cells from wandering from one tissue into the next. Thus the normal liver does not overgrow and crowd out the space the right kidney should occupy. Defining orderly and well regulated growth by cellular regulation is a very important feature of normal cells. They divide (undergo mitosis) for only two reasons: (1) to develop normal tissue or (2) to replace lost, damaged, or aged normal tissue. Even when they are capable of mitosis, normal cells divide only when body conditions are just right. Cell division (mitosis), occurring in a well-recognized pattern, is described by the cell cycle. Fig. 19.2 shows the phases of the cell cycle. Living cells not actively reproducing are in a reproductive resting state termed G 0. During the G0 period, cells actively carry out their functions but do not divide. Normal cells spend most of their lives in the G0 state rather than in a reproductive state. Define contact inhibition is the part of cellular regulation that stops further rounds of cell division when the dividing cell is completely surrounded and touched (contacted) by other cells. Of the normal cells that can divide, each cell divides only when some of its surface is not in direct contact with another cell. Once a normal cell is in direct contact on all surface areas with other cells, it no longer undergoes mitosis. Thus normal cell division is contact inhibited. Define Apoptosis is programmed cell death. Not only do normal cells have to divide only when needed and have to perform their specific differentiated functions, some cells also have to die at the appropriate time to ensure optimum body function. Thus normal cells have a finite life span. When this DNA is gone, the cell responds to cellular regulation signals for apoptosis. This ensures that each organ has an adequate number of cells at their functional peak. Define Euploidy having a complete set of chromosomes, is a feature of most normal human cells. These cells have 23 pairs of chromosomes, the correct number for humans. In relation to abnormal cells- the cells growth is changed or the cell function is changed therefore considered abnormal~ this can begin to have features of a benign tumor and cancer (malignant)cells Characteristics of Normal and Abnormal Cells Characteristic Normal Cell Benign Tumor Cell Malignant Cell Cell division None or slow Continuous or inappropriate Rapid or continuous Appearance Specific morphologic feature Specific morphologic feature Anaplastic Nuclear-to-cytoplasmic ratio: Smaller Smaller Larger Differentiated functions: Many Many Some or none Adherence Tight Tight Loose Migratory No No Yes Growth Well regulated Expansion Invasion Chromosome Diploid (euploid) Diploid (euploid) Aneuploid Mitotic index Low Low High Define benign tumor cells? A type of abnormal cell growth in which normal cells grow in the wrong place or at the wrong time as a result of a problem with cellular regulation. List some examples or areas that may have benign tumor cells? Breast Cancer • Bone • Lung • Liver • Brain Lung Cancer • Brain • Bone • Liver • Lymph nodes • Pancreas Colorectal Cancer • Liver • Lymph nodes • Adjacent structures Prostate Cancer • Bone (especially spine and legs) • Pelvic nodes Melanoma • GI tract • Lymph nodes • Lung • Brain Primary Brain Cancer • Central nervous system Review the benign tumor cell characteristics as we talked about up above and also now. Specific morphology occurs with benign tumors. They look like the tissues they come from, retaining the specific morphology of parent cells. Smaller to nuclear cytoplasmic ratio is a feature of benign tumors just like completely normal cells. Specific differentiated functions continue to be performed by benign tumors. For example, in endometriosis, a type of benign tumor, the normal lining of the uterus (endometrium) grows in an abnormal place (e.g., on an ovary or elsewhere in the abdominal or even the chest cavity). This displaced endometrium acts just like normal endometrium by changing each month under the influence of estrogen. When the hormone level drops and the normal endometrium sheds from the uterus, the displaced endometrium, wherever it is, also sheds. Tight adherence of benign tumor cells to one another occurs because they continue to make cell adhesion molecules. No Migration or wandering of benign tissues occurs because they remain tightly bound and do not invade other body tissues. Orderly growth is more with normal growth patterns occurring in benign tumor cells even though their growth is not needed. The fact that growth continues beyond an appropriate time or occurs in the wrong place indicates some problem with cellular regulation , but the rate of growth is normal. The benign tumor grows by expansion. It does not invade. Euploidy (normal chromosomes) are usually found in benign tumor cells, with a few exceptions. Most of these cells have 23 pairs of chromosomes, the correct number for humans. Define the features of a malignant cancer cell that is abnormal. Anaplasia is the cancer cells’ loss of the specific appearance of their parent cells. As a cancer cell becomes more malignant, it becomes smaller and rounded. Thus many different types of cancer cells look alike under the microscope, rather than looking like their parent cells. • A larger nuclear-cytoplasmic ratio occurs because the cancer cell nucleus is larger than that of a normal cell and the cancer cell is smaller than a normal cell. The nucleus occupies much of the space within the cancer cell, especially during mitosis, creating a large nuclear-tocytoplasmic ratio. • Specific functions are lost partially or completely in cancer cells. Cancer cells serve no useful purpose. • Loose adherence is typical for cancer cells because they do not make cell adhesion molecules. As a result, cancer cells easily break off from the main tumor. • Migration occurs because cancer cells do not bind tightly together and have many enzymes on their cell surfaces. These features allow the cells to slip through blood vessel walls and between tissues, spreading from the main tumor site to many other body sites. The ability to spread by undergoing metastasis is unique to cancer cells and is a major cause of death. Cancer cells invade other tissues, both close by and more remote from the original tumor. Invasion and persistent growth make untreated cancer deadly. • Contact inhibition does not occur in cancer cells because of lost cellular regulation , even when all sides of these cells are in continuous contact with the surfaces of other cells. This persistence of cell division makes the disease difficult to manage. • Rapid or continuous cell division occurs in many types of cancer cells because they do not respond to checkpoint control of cell division because of gene changes that reduce the effectiveness of cellular regulation , and they re-enter the cell cycle for mitosis almost continuously. In addition, these cells also do not respond to signals for apoptosis. Most cancer cells have a lot of the enzyme telomerase, which maintains telomeric DNA. As a result, cancer cells do not respond to apoptotic signals and have an unlimited life span (are “immortal”). • Abnormal chromosomes in which the chromosome number and/or structure is not normal (aneuploidy) are common in cancer cells as they become more malignant. Chromosomes are lost, gained, or broken; thus cancer cells can have more than 23 pairs or fewer than 23 pairs. Cancer cells also may have broken and rearranged chromosomes with mutated genes. Migration Define Metastasize and how it works. Metastasis occurs when cancer cells move from the primary location by breaking off from the original group and establishing remote colonies. These additional tumors are called metastatic tumors or secondary tumors. Even though the tumor is now in another organ, it is still a cancer from the original altered tissue. For example, when breast cancer spreads to the lung and the bone, it is still breast cancer in the lung and bone—not lung cancer and not bone cancer. Metastasis occurs through many steps, as shown in Fig. 19.3. Describe the difference between a benign tumor and a cancer fill tumor? Benign tumor cells are normal cells growing in the wrong place or at the wrong time as a result of a problem with cellular regulation . Examples include moles, uterine fibroid tumors, skin tags, endometriosis, and nasal polyps. Cancer (malignant) cells are abnormal, serve no useful function, and are harmful to normal body tissues. Define Carcinogenesis and oncogenesis. Care of these patients/ education. Carcinogenesis usually takes years and depends on several tumor and patient factors (Jorde et al., 2016; McCance et al., 2019). Three interacting factors influence cancer development: exposure to carcinogens, genetic predisposition, and immunity .These factors account for variation in cancer development from one adult to another, even when each adult is exposed to the same hazards. Carcinogens: Substances that change the activity of a cell’s genes so the cell becomes a cancer cell. Cellular regulation is the genetic and physiologic processes that control cellular growth, replication, differentiation, and function to maintain homeostasis. Cellular regulation when cells divide for normal growth and replacement of dead or damaged tissues. At other times they are turned off, controlled, or suppressed by products of “suppressor genes.” When a normal cell is exposed to any carcinogen (initiator), the normal cell’s DNA can be damaged and mutated. The mutations damage suppressor genes, preventing them from producing proteins that control cellular regulation for the expression of proto-oncogenes ( genes that code for the positive cell cycle regulators). Define malignant transformation? Malignant transformation is the term given to the process whereby either normal, metaplastic, or benign neoplastic tissue, becomes a cancer. Describe the term Carcinogens and give examples of ones that may be chemical, physical, or a virus. Substances that change the activity of a cell’s genes so the cell becomes a cancer cell are carcinogens. Carcinogens may be chemicals, physical agents, or viruses. More than 62 agents, substances, mixtures, and exposures are known to cause cancer in humans, and about another 186 are suspected to be carcinogens Chemical Trichloroethylene (TCE) Industrial solvent Sunlight Physical Physical carcinogens include hard and soft materials, fibrous particles, non fibrous particles, and gel materials. Ultraviolet rays from sunlight and ionizing radiation from X-rays and from radioactive materials in industry and in the general environment. Repeated local injury (e.g., wounding) or recurring irritation (e.g., chronic inflammation) to a part of the body are other examples of potential physical carcinogens. Virus Human immunodeficiency virus type 1 (HIV-1) Human T-cell lymphotropic virus type 1 (HTLV-1) Epstein-Barr virus (EBV) Kaposi sarcoma-associated herpesvirus (KSHV) Merkel cell polyomavirus (MCV) K What does the latency period refer to in cell promotion or development? Define a primary tumor? Identified by the tissue from which it arose (parent tissue) Describe what happens in each step of metastasis? What are some common sites of metastasis in cancer? ) TABLE 21-2 Understand the reason why cancer is diagnosed based on its area of involvement, which stage and grade of the tumor. Define Ploidy? Ploidy is the description of cancer cells by chromosome number and appearance. Normal human cells have 46 chromosomes (23 pairs), the normal diploid number (euploidy). When malignant transformation occurs, changes in the genes and chromosomes also occur. Some cancer cells gain or lose whole chromosomes and may have structural abnormalities of the remaining chromosomes, a condition called aneuploidy. The degree of aneuploidy increases with the degree of malignancy. Some chromosome changes are associated with specific cancers, and their presence is used for diagnosis and prognosis. One example is the Philadelphia chromosome abnormality often present in chronic myelogenous leukemia cells (see Chapter 37). Other gene changes in cancerous tumors alter the tumor’s susceptibility to specific treatment. Some changes form the basis of “targeted therapy” for cancer (see Chapter 20). Define Staging? Staging determines the exact location of the cancer and whether metastasis has occurred. Cancer stage influences selection of therapy. Staging is done by clinical staging, surgical staging, and pathologic staging. Clinical staging assesses the patient’s symptoms and evaluates tumor size and possible spread. Surgical staging assesses the tumor size, number, sites, and spread by inspection at surgery. Pathologic staging is the most definitive type, determining the tumor size, number, sites, and spread by pathologic examination of tissues obtained at surgery. Define aneuploidy? What makes up the TNM system? (3 things) T- original primary tumor, N- whether the cancer has spread to the nearby lymph nodes, & M- whether cancer has metastasized to distant parts Staging of Cancer—TNM Classification Primary Tumor (T) Tx Primary tumor cannot be assessed T0 No evidence of primary tumor Tis Carcinoma in situ T1, T2, T3, T4Increasing size and/or local extent of the primary tumor Regional Lymph Nodes (N) Nx Regional lymph nodes cannot be assessed N0 No regional lymph node metastasis N1, N2, N3 Increasing involvement of regional lymph nodes Distant Metastasis (M) Mx Presence of distant metastasis cannot be assessed M0 No distant metastasis M1 Distant metastasis Understand table 21-5 in your book! The tumor, node, metastasis (TNM) system is used to describe the anatomic extent of cancers. The TNM staging systems have specific prognostic values for each solid tumor type. Table 19.5 shows a basic TNM staging system. TNM staging is not useful for leukemia or lymphomas (see Chapter 37). Additional specific staging systems include the Dukes staging system for colon and rectal cancer and the Clark levels method for staging skin cancer. Define oncogene regulation? Proto-oncogenes normally regulate cell division, but can be changed into oncogenes through mutation, which may cause cancers to form. What are some external factors that can cause cancer or put a patient at risk for developing cancer? Some of these may be considered carcinogens. Chart 21-6 Virus Malignancies Epstein-Barr virus Burkitt lymphoma, B-cell lymphoma, nasopharyngeal carcinoma Hepatitis B virus Primary liver carcinoma Hepatitis C virus Primary liver carcinoma, possibly B-cell lymphomas Human papillomavirus Cervical carcinoma, vulvar carcinoma, penile carcinoma, other anogenital carcinomas, and head and neck carcinoma Human lymphotropic virus type I Adult T-cell leukemia Human lymphotropic virus type II Hairy cell leukemia What are some examples to educate the patient with cancer about in relation to their dietary concerns? Dietary Habits to Reduce Cancer Risk • Avoid excessive intake of animal fat. • Avoid nitrites (prepared lunch meats, sausage, bacon). • Minimize your intake of red meat. • Keep your alcohol consumption to no more than one or two drinks per day. • Eat more bran. • Eat more cruciferous vegetables such as broccoli, cauliflower, Brussels sprouts, and cabbage. • Eat foods high in vitamin A (e.g., apricots, carrots, leafy green and yellow vegetables) and vitamin C (e.g., fresh fruits and vegetables, especially citrus fruits). The Seven Warning Signs of Cancer C Changes in bowel or bladder habits A A sore that does not heal U Unusual bleeding or discharge T Thickening or lump in the breast or elsewhere I Indigestion or difficulty swallowing O Obvious change in a wart or mole N Nagging cough or hoarseness What is some other information that needs to be gathered during the initial phase for a patient that might be at risk for cancer? Cancer Type Assessment Consideration Colorectal cancer Ask the patient whether bowel habits have changed over the past year (e.g., in consistency, frequency, color). Ask whether the patient has noticed any obvious blood in the stool. Test at least one stool specimen for occult blood during the patient’s hospitalization. Urge the patient to have a baseline colonoscopy. Encourage the patient to reduce dietary intake of animal fats, red meat, and smoked meats. Encourage the patient to increase dietary intake of bran, vegetables, and fruit. Lung cancer Observe the skin and mucous membranes for color. How many words can the patient say between breaths? Ask the patient about: • Cough • Hoarseness • Smoking history (including use of electronic cigarettes or “vaping”) • Particulate matter exposure to inhalation irritants • Exposure to asbestos • Shortness of breath • Activity tolerance • Frothy or bloody sputum • Pain in the arms, shoulders, or chest • Difficulty swallowing Prostate cancer Ask the patient about: • Hesitancy • Change in the size of the urine stream • New onset pain in the lower back or legs • History of persistent urinary tract infections Skin cancer Examine skin areas for moles or warts. Ask the patient about changes in moles (e.g., color, edges, sensation). Recommend use of sunscreen and protective clothing when outdoors. Leukemia Observe the skin for color, petechiae, or ecchymosis. Ask the patient about: • Fatigue • Bruising • Bleeding tendency • History of infections and illnesses • Night sweats and/or fevers Bladder cancer Ask the patient about the presence of: • Pain on urination • Blood in the urine • Cloudy urine • Increased frequency or urgency What is cancer prevention and how can we be a part of this topic? Primary preventionAvoidance of known or potential carcinogens is an effective prevention strategy when a cause of cancer is known and avoidance is easily accomplished. For example, teach adults to use skin protection during sun exposure to avoid skin cancer. Most lung cancer can be avoided by not using tobacco and eliminating exposure to loose asbestos particles (ACS, 2019b). Teach all adults about the dangers of cigarette smoking and other forms of tobacco use (see the Health Promotion and Maintenance box in Chapter 24). Teach adults who are exposed to carcinogens in the workplace to use personal protective equipment that reduces direct contact with this substance. As more cancer causes are identified, avoidance may become even more effective. Modifying associated factors appears to help reduce cancer risk. Absolute causes are not known for many cancers, but some conditions appear to increase risk. Examples are the increased incidence of cancer among adults who consume alcohol; the association of a diet high in fat and low in fiber with colon cancer, breast cancer, and ovarian cancer; and a greater incidence of cervical cancer among women who have multiple sexual partners (ACS, 2020). Modifying behavior to reduce the associated factor may decrease the risk for cancer development. Therefore teach all adults to limit their intake of alcohol to no more than 1 ounce per day and to include more fruits, vegetables, and whole grains in their diets. Instruct women about the importance of limiting the number of sexual partners and to use safer sex practices to avoid exposure to viruses that can increase the risk for cervical cancer (ACS, 2019b) (see Table 19.6 for a listing of cancercausing viruses). Removal of “at-risk” tissues reduces cancer risk for an adult who has a known high risk for developing a specific type of cancer. Examples include removing moles to prevent conversion to skin cancer, removing colon polyps to prevent colon cancer, and removing breasts to prevent breast cancer. Not all “at-risk” tissues can be removed (e.g., those that are part of essential organs). Chemoprevention is a strategy that uses drugs, chemicals, natural nutrients, or other substances to disrupt one or more steps important to cancer development. These agents may be able to reverse existing gene damage or halt the progression of the transformation process. Only a few agents have been found effective for chemoprevention. These include the use of aspirin and celecoxib to reduce the risk for colon cancer, the use of vitamin D and tamoxifen to reduce the risk for breast cancer, and the use of lycopene to reduce the risk for prostate cancer (ACS, 2020). Vaccination is a newer method of primary cancer prevention (ACS, 2019b). Currently the only vaccines approved for cancer prevention are related to prevention of infection from several forms of human papillomavirus (HPV). These vaccines are Gardasil and Cervarix. As more cancercausing organisms are identified, it is hoped that vaccines will be developed to prevent those infections. Secondary PreventionRegular screening for cancer does not reduce cancer incidence but can greatly reduce some types of cancer deaths. Teach all adults the benefits of participating in specific routine screening techniques annually as part of health maintenance. General screening recommendations are listed in chapters discussing cancers by organ system. The age and type of participation in specific screening tests are different for adults who have an identified increased risk for a specific cancer type. In addition, there is some controversy about the age at which and frequency with which screening has the greatest benefit. Examples of recommended screenings include (ACS, 2020): • The choice of annual mammography for women 40 to 44 years of age, annual mammography for women 45 to 54 years of age, and annual or biennial mammography for women older than 55 years • Annual clinical breast examination for women older than 40 years, and every 3 years for women age 20 to 39 years • Annual fecal occult blood test for adults of all ages • Digital rectal examination (DRE) for men older than 50 years Because cancer development clearly involves gene changes (either inherited gene mutations or acquired damage-induced gene mutations), adults can be screened for some gene mutations that increase the risk for cancer (Lacovara & Bohnenkamp, 2018). A few examples of known gene mutations that increase cancer risk are found in the BRCA1 gene, the BRCA2 gene, and the CHEK2 gene (which increase the risk for breast cancer) and mutations in the APC, MLH1, and MSH2 genes (which increase the risk for colon cancer). When a patient has a strong family history of either breast or colon cancer, create a threegeneration pedigree to more fully explore the possibility of genetic risk (Mahon, 2016). If a pattern of risk emerges, inform the person about the possible benefits of genetic screening and advise him or her to talk with an oncology health practitioner or genetics professional for more information. Genetic screening can help an adult at increased genetic risk for cancer to alter lifestyle factors, participate in early detection methods, initiate chemoprevention, or even have at-risk tissue removed. Genetic screening has some personal risks as well as potential benefits (see Chapter 6). Teach patients to avoid tanning beds, encourage them to get cancer screenings for their age group, increase the patient’s knowledge about cancer, obtain a family history, and teach out patients the 7 warning signs? (CAUTION) What are the current lab values for K, NA, Ca, Phosphorus, Magnesium? Na+ 136-145 mEq/L K+ 3.5-5 mEq/L Ca++ 9.0-10.5 mg/dL Mg 1.3-2.1 mg/dL Phosphorus 3.0 –4.5 mg/dL