N240, Oncology Nursing

N240, Oncology Nursing Biopsy - Answer-Percutaneous Needle Aspiration - Fine needle - Large core Endoscopic Surgical - Incisional - Excisional Cancer board - Answer-to assess a case, present with all infos so to determine to best tx. Hormones in breast, prostate cancer? Is the cause is hormonal, need to fix this issue too hormone deprivation therapy Goal of Cancer - Answer-Cure, Control & Palliation Factors that determine treatment (tumor board) - Answer-Comorbidities Age: slow growing prostate cancer in old men Cell type: aggressive tumor has a faster growing rate, older and larger tumor is harder to tx. Location and size of tumor: METS: spread? Degree of a tumor is important for chemo therapy Extent of disease (metastasis) (staging) 0, I, II, III, IV (mets) Grading: I-IV, well differentiated (I: similar to the parent cells) v. Poorly differentiated (IV: much different from its parents) & (X) unable to be assessed TNM Tumor Grading: I-IV - Answer-well differentiated (I: similar to the parent cells) v. Poorly differentiated (IV: much different from its parents) (X) unable to be assessed TNM - Answer-T (x,0,IS,1,2,3,4): T2 (a tumor of size of 2); IS (in suito, encapsulated, not grown its cells yet) N (x,0,1,2,3): nodes (how many nodes are affected, not specific but rather like there is a lot/not a lot) M (x,0,1): metasis, x (not yet assessed) T: radiation and surgical N and M: tx is chemotherapy (few cases may affect T as well, but mostly just N and M) Surgical therapy - Answer-Cure (Complete removal or Debulk) - Remove what is required with a margin - Preventative measures used to reduce surgical seeding of cancer cells - Usual sites of regional spread may be removed Control: curing or slowing down Palliative: improving the quality of life Reconstructive: mammoplasty Prophylactic: no cancer in the body, but client is at high risk Radiation therapy - Answer-Emission and distribution of energy which results in ionization and excitation which breaks DNA bonds in causing loss of proliferation ALARA: Lethal tumor dose (LTD) & maximal tolerated tissue dose - Give enough radiation to kill cancer but low enough dose to not cause any extra side effects Normal tissue can recover, but CA cells unable to recover Germ cells has faster metabolic rate, can regenerate faster: skin, hair, bone marrow, GI, taste (can replace itself later on) or ovary (once they are damaged, they are damaged) Goal: Cure, Control, Palliation Radiation: Internal (brachytherapy) - Answer-Can be done intraoperatively or without surgery Temporary sealed devices: much more significant radiation to other does not stay long, usually 2-3 days, or could be minutes. Ex: monocytes (5-10 minutes, precaution is only during this 5 minutes, catheter usually stays in for whatever cessions they have, usually not seen unless working in a radiology dept) Usually afterloaded: the central line catheter will be placed in surgery or in radiation, after the placement of catheter, the client will then go to the a specialized room for radiation. Radiologist with protection will then place radiation therapy into the catheter. ALARA Time: - only 30 minutes in the room for a whole shift. Not 30 minutes in one time. Very limited personal visits (nurse, doctor, nurse maybe). - Times you can get close: head to toe, checking for the placement of the device once a shift (marker present and how much is external) Distant Shielding: wear a special apron Dosimeter: monitored by radiology department, every nurse has her own. - Once I hit the target, I cant no longer take care of that client. If full --- no longer can take care of this type of client ever. - Goes to job to job. Other safety precaution: bodily fluids. Wear 3 sets of gloves when risk for touching any fluids. Wash hands with gloves on until all sets washed until bare hands. Flushing 3 times. Anything in the room will be incarnated. Others cant be burned will be specially cleaned. How can the device be dislodged? Pt movement (bedrest), discourage coughing, BW (will have a BM cleansing such as a enemar, on clear liquids afterward, do not want BM; so after discharge may need teaching on having a BW) Systemic (I131) Radiation precaution for about 7 days after (review in endocrine notes) Radiationg: Permanent sealed implants - Answer-Small, usually used in prostate Can be in places right in or around the tumor, will emit radiation, then it is done after half life Leaves in for life, not removed Does not affect MRI, does no harm Very little exposure to others. Only concern: women can be pregnant, pregnant or little kids (affects the cells still actively growing) tell kids to get not too close to the patient - Pregnant: sleep with pillow in between - Kids: not sit on lap with grandpa Radiation: External (teletherapy) - Answer