MDC 2 EXAM 1 with complete solutions

Benign cells - Answer- Normal cells growing in the wrong place or at the wrong time Benign Cell Features - Answer- o Harmless o Do not usually require intervention o Slow growing o Tight Adherence o Specific morphology o Small nuclear-to-cytoplasmic ratio o Specific differentiated functions o Tight adherence o Orderly growth o No migration o Normal chromosomes Benign cell looks similar to a - Answer- healthy cell Examples of Benign cells - Answer- o Skin Tag o Mole o Nasal Polyp o Uterine Fibroids o Endometriosis Malignant cells - Answer- indicates cancer and can be harmful to normal body tissues and result in death Malignant cell features - Answer- o Large nucleus o Migration o Doesn't stop and replicates (No contact inhibition) o Loose adherence o Rapid or continuous cell division o Loss of cellular regulation o Abnormal chromosomes (< or > 23) Seven warning signs of cancer - Answer- o C-Change in bowel or bladder patterns o A-A sore that doesn't heal o U-Unusual bleeding or d/c o. T-Thickening or lump on breast or elsewhere o I-Indigestion or difficulty swallowing o O-Obvious change in wart or mole o N-Nagging cough or hoarseness Cancer development stages of malignancy - Answer- o Initiation o Promotion o Progression o Metastasis Initiation (Stage of malignancy) - Answer- Normal cells are damaged and irreversible Promotion - Answer- Repeated exposure>Enhances growth of malignant cells Progression - Answer- Increase in production of malignant cells Metastasis - Answer- Cells move from primary site to the rest of the body Carcinogenesis/oncogenesis - Answer- cancer development Cancer classification - Answer- o Grading o Ploidy o Staging o TNM o Doubling time and mitotic index Grading - Answer- Looking under microscope and determine level/degree of mutation of cancer cell from normal cells o Ex. 1= No mutation o 4= Severe mutation Ploidy - Answer- Number of chromosomes Staging - Answer- How large is the primary tumor and how far has it spread TNM - Answer- o T-Tumor (How large is primary or 2nd) o N- Node (Are regional lymph nodes invaded by cancer cell) o M-Metastasis (0=None, 1=There is metastasis) Doubling time and mitotic index - Answer- Period of time required for that quantity to double in size (Tells how aggressive cancer grows) o Stage 1=Localized o Stage 4= Spread across the body Cancer prevention primary - Answer- o Sunscreen o Avoid smoking o Removal of "at risk" tissue (mole) o Chemoprevention o Vaccine (HPV) Cancer prevention secondary - Answer- o Mammogram o Pap smear o Prostate test Cancer prevention tertiary - Answer- People who are already affected and getting treatment (examples below) o Chemo o Radiation o Surgery, etc. Types of cancers - Answer- carcinoma, sarcoma, melanoma, lymphoma, leukemia, blastoma Carcinoma - Answer- malignant tumors of glandular (lining) tissues Sarcoma - Answer- malignant tumor of connective (bone) tissues Melanoma - Answer- pigment producing skin cancer Lymphoma - Answer- malignant tumor of lymphoid tissue Leukemia - Answer- white blood cell tumor Blastoma - Answer- malignant tumors of less differentiated, embryonal tissue Lab Diagnostic Tests - Answer- o CBC o Blood protein testing o Tumor marker test o Circulation tumor cell tests Imaging Diagnostic Tests - Answer- o CT Scans o MRI o X-ray o Ultrasound o Mammogram o Nuclear medicine scans Endoscopy Diagnostic Tests - Answer- o Bronchoscopy o Colonoscopy o Cystoscopy o Laparoscopy o Laryngoscopy o Mediastinoscopy o Thoracoscopy o Upper Endoscopy Biopsy Diagnostic Tests - Answer- o Breast biopsy o Bone marrow biopsy o Organ/tissue specific Risk factors - Answer- o Older age. o A personal or family history of cancer. o Using tobacco. o Obesity. o Alcohol. o Some types of viral infections(HPV) o Specific chemicals. o Exposure to radiation, including ultraviolet radiation from the sun. o Alcohol Types of therapy - Answer- surgery, radiation, chemotherapy, radiation therapy, immune therapy, photodynamic therapy hormonal therapy Surgery - Answer- cells can escape during surgery sometimes, causing clients to have to deal with an altered appearance Radiation - Answer- Destroy cancer cells with minimal damaging effects of surrounding normal cells; maintain safe environment Chemotherapy - Answer- Treatment of cancer with chemical agents. Used to cure and increase survival time. Adjuvant therapy - Answer- = Chemotherapy + surgery or radiation. Cytotoxic effects exerted on healthy cells and cancer cells Immunotherapy (biological response modifiers and targeted therapy) - Answer- -Modify patient's biologic responses to tumor cells. Can have direct antitumor activity. - Can interfere with cancer cell differentiation, transformation, metastasis. -Can improve immune function Monoclonal antibodies(immunotherapy) - Answer- Bind to target antigens (often specific cell surface membrane proteins) Prevents protein from functioning, - prevents cell division. E.g- Rituximab (Rituxan) Tyrosine Kinase Inhibitors(immunotherapy) - Answer- Inhibits activation of tyrosine kinase inhibitors- disrupt growth and cellular regulation of some types of cancer cells Epidermal Growth Factor/ Receptor Inhibitors(immunotherapy) - Answer- Block epidermal growth factor from binding to cell surface receptor; prevents cancer cell division Vascular Endothelial Growth Factor/Receptor Inhibitors(immunotherapy) - Answer- prevents binding of VEGF with its receptors on surfaces of endothelial cells present in blood vessels. Prevents formation of new blood vessels within the tumor Multikinase Inhibitors (MKIs)(immunotherapy) - Answer- Inhibit activity of specific kinases in cancer cells and tumor blood vessels Proteasome Inhibitor(immunotherapy) - Answer- Prevents formation of a large complex of proteins into cells; impair tumors cellular regulation ability Angiogenesis inhibitors(immunotherapy) - Answer- Targets mammalian target of rapamycin; reduces concentration of vascular endothelial growth factor, disrupts cell division. Photodynamic therapy - Answer- Selective destruction of cancer cells via chemical reaction triggered by types of light Hormonal therapy - Answer- Changing usual hormone responses. Some hormones make hormone sensitive tumors grow more rapidly (Decreasing the hormone amounts to hormone sensitive tumors can slow cancer growth rate). Steroids, steroid analogues, enzyme inhibitors Surgical classification types - Answer- prophylaxis, diagnosis, cure, control, palliation,assessing therapy effectiveness and reconstruction Prophylaxis(Surgical classification type) - Answer- remove cancerous tissue to prevent cancer development Diagnosis(Surgical classification type) - Answer- removal for testing or examination to rule out cancer "biopsy" Cure(Surgical classification type) - Answer- removes all cancerous tissue Control(Surgical classification type) - Answer- removes part of tumor when removal of entire tumor is impossible Palliation - Answer- surgery to provide symptom relief, is NOT curative Assessing therapy effectiveness - Answer- (Surgical classification type) Reconstruction(Surgical classification type) - Answer- increases function or appearance or both. S/E of Surgery - Answer- removal can lead to changes in appearance, activity level, depression, grief, and decreased enjoyment of life S/E of Radiation - Answer- Acute and long-term site-specific changes, vary according to site, Local skin changes and hair loss, altered taste sensations, Fatigue, Bone marrow suppression. S/E of Chemotherapy - Answer- extravasation, infection risk, bone marrow suppression, neutropenia, anemia, thrombocytopenia, clotting risks, chemotherapy-induced nausea and vomiting, mucositis, alopecia, cognitive changes, chemotherapy-induced peripheral neuropathy. S/E of Immunotherapy Monocle antibodies - Answer- allergic reactions, skin, mucous membranes, GI tract S/E of Immunotherapy Tyrosine kinase inhibitors - Answer- Fluid retention, electrolyte imbalances, bone marrow suppression S/E of Immunotherapy EGFRI's - Answer- skin reactions, adverse effects on heart S/E of Immunotherapy VEGF's - Answer- hypertension, impaired wound healing, bone marrow suppression S/E of Immunotherapy Multikinase inhibitors - Answer- hypertension, GI distress, mucositis, mild neutropenia thrombocytopenia S/E of Immunotherapy Proteasome inhibitors - Answer- GI distress, decreased taste sensation, peripheral neuropathy S/E of Immunotherapy Angiogenesis inhibitors - Answer- bone marrow suppression, headache, GI distress, muscle pain joint pain S/E of Photodynamic therapy - Answer- avoid sunlight? S/E of Hormonal manipulation - Answer- Masculinizing effects in women. Feminizing effects in men (gynecomastia). Fluid retention. Acne. Hypercalcemia. Liver dysfunction. Venous thromboembolism Oncological emergency classification types - Answer- Sepsis, Intravascular coagulation, syndrome of inappropriate antidiuretic hormone, spinal cord compression, hypercalcemia, superior vena cava syndrome, tumor lysis syndrome. Sepsis (septicemia) - Answer- blood stream infection Sepsis s/s - Answer- low grade fever Sepsis treatment - Answer- IV antibiotics Intravascular coagulation - Answer- extensive and abnormal clotting often caused by gram-negative sepsis Intravascular coagulation s/s - Answer- bleeding from many sites -pain -ischemia -strokes like symptoms - dyspnea -tachycardia -reduced kidney function -bowel necrosis Intravascular coagulation treatment - Answer- anticoagulants (depending on stage), clotting factors if hemorrhaging, IV antibiotics. Syndrome of Inappropriate Antidiuretic Hormone - Answer- - excessive amounts of water that results in hyponatremia SIAH S/S - Answer- Hyponatremia Weakness muscle cramps Anorexia Polyuria Polydipsia Myalgia (muscle pain & ache) loss of appetite fatigue weight gain confusion Weakness Coma Seizure death SIAH Treatment - Answer- Fluid correction Furosemide therapy Correction of serum sodium imbalance SIAH Intervention - Answer- Monitor I&O Monitor lab values Implement seizure precautions Manage comfort Spinal cord compression - Answer- Tumor compression of spinal cord Spinal cord compression S/S - Answer- symptoms vary depending on location and severity of compression Late paraplegia Incontinence Loss of sensory function New onset backpain that worsens when laying dow Constipation Spinal cord compression Treatment - Answer- Radiation Surgical intervention Spinal cord compression Interventions - Answer- Assess for neurological defecits Manage pain Prevent skin breakdown Spinal cord compression treatment/intervention - Answer- corticosteroids -radiation -surgery. Hypercalcemia - Answer- is associated with lung, kidney, breast and multiple myeloma cancers early symptoms of hypercalcemia - Answer- nonspecific, skeletal pain, kidney stones, altered cognition, loss of appetite, constipation, loss of deep tendon reflexes, paralytic ileus, ECG changes Myalgia Headache Hypercalcemia Treatment - Answer- IV hydration normal saline, loop diuretics, Inpatient monitoring Phosphate replacement I.V bisphosphates, calcitonin, oral glucocorticoids. Hypercalcemia Intervention - Answer- Assess s/s Administer fluids Monitor I&O Superior vena cava syndrome(SVCS) - Answer- vena cava compressed by tumor or clots SVCS S/S - Answer- edema in face and eyes engorged blood vessels and erythema in the upper body, edema in arms and hands dyspnea, stridor Dysphagia Cough SVCS Treatment - Answer- Chemo Metal stent Radiation SVCS Interventions - Answer- Maintain airway Administer oxygen Tumor lysis syndrome - Answer- large number of tumor cells are destroyed quickly and contents of those cells (potassium and purines) are released into the blood stream Tumor lysis syndrome s/s - Answer- Hyperkalemia Hypocalcemia Hyperuricemia Acute Renal failure* Acidosis Tumor lysis syndrome treatment - Answer- Inpatient monitoring Fluid resuscitation Correction of acidosis Hemodialysis Allopurinol or uricase therapy Tumor lysis syndrome intervention - Answer- Maintain ABCs Monitor vitals and cardiac rhythm Manage electrolyte balance Prepare patient for hemodialysis Malignant pericardial effusion - Answer- Develops due to fluid accumulation around the pericardial sac Malignant pericardial effusion s/s - Answer- Dyspnea Fatigue Distended neck veins Distant heart sound Tachycardia Orthopnea Malignant pericardial effusion Treatment - Answer- Radiation Surgical Intervention Malignant pericardial effusion nursing interventions - Answer- Assess for neurological deficits Manage pain Prevent skin breakdown Hospice care - Answer- Model for quality, compassionate care for those facing life-limiting illness or injury Usually less than 6 months to live Palliative Care - Answer- Philosophy of care for those with life-threatening disease Provided by physician, nurse practitioner, or team Assessment findings - Answer- o Weakness o Sleeping more o Anorexia o Changes in organ system function o Cold, mottled, cyanotic extremities o Changes in breathing pattern o Decreased LOC Interventions=responding - Answer- o Needs and preferences met o Control of symptoms of distress o Meaningful interactions with family o Peaceful death Managing Breathlessness/dyspnea - Answer- o Opioids, bronchodilators, diuretics, antibiotics, anticholinergics, benzodiazepines o Oxygen (for comfort) o Electric fan for air circulation o Reposition Managing Nausea/vomiting - Answer- o Antiemetic agents,Prochlorperazine (Compazine),Ondansetron (Zofran),Dexamethasone (Decadron, Deronil, Dexasone) Metoclopramide (Reglan, Maxeran) o Remove any source of odors o Comfortable room temperature o Aromatherapy Managing Agitation/delirium - Answer- o