NURS 372 EXAM 1 QUESTIONS AND CORRECT ANSWERS, WITH COMPLETE SOLUTION.

NURS 372 EXAM 1 QUESTIONS AND CORRECT ANSWERS, WITH COMPLETE SOLUTION. Causes of Cancer 1. Age (increased risk for people over 65) 2. Gender (more cancers deaths in men than women per year) 3. Geographic location 4. Genetics (accounts for 15% of cancers. Cancers with familial relationships include breast, colon, lung, ovarian, and prostate) 5. Immune disturbance (viruses increase risk: Epstein-Barr, herpes, papillomavirus, hep B, cytomegalovirus (CMV)) 6. Chemical agents (exposure to carcinogens) 7. Race (higher rates of cancer in African Americans) 8. Tobacco, Alcohol, Diet What is the best test to confirm cancer? Biopsies; make sure to know med hx beforehand and if on blood thinners Primary Prevention of Cancer - Avoid/Limit tobacco & alcohol use - Fight off Infections (HPV, HIV, H. Pylori) - Limit UV radiation & use sunscreen - Achieve and maintain a healthy weight throughout life - adequate rest - learn and practice self exams - reduce stress - have regular leisure/relaxation time - Adopt a physically active lifestyle. - Consume a healthy, balanced diet with an emphasis on plant food Breast Cancer Screenings - Women 45 - 54 y/o = mammography screening - Can start at 40 y/o if fly hx - 55+ = biennial screening Cervical Cancer Screening - Women 21 - 65 y/o = PAP screen q 3 yrs - Women 30 - 65 y/o = PAP + HPV screening (preferred) - Women 66+ y/o = can choose not to get PAP Endometrial Cancer Screening - watch for menopausal bleeding Prostate Cancer Screenings - Screening not routinely recommended - Men > 50 y/o with 10+ year life expectancy - Digital rectal exam and PSA Testicular Cancer Screenings - Can occur at any age; commonly dx: 20 - 34y/o - self-exams!!! Colorectal Cancer Screenings - Screening begins @ 50 y/o for average risk - Non-invasive exams (Fecal Occult Blood test (FOBT), fecal immunochemical test (FIT), Stool DNA) - Home testing recommended - Various endoscopic exams (Flex sig q 5 years), colonoscopy q 10 years) Lung Cancer Screenings - Smokers w/ 30 pack-year HX (quit 15 yrs to be a non smoker) - LDCT (low dose helical CT scan)- expensive and not done often CAUTION C - hange in bowel or bladder habits A - sore that does not heal U - nusual bleeding or discharge from any body orifice T - hickening or a lump in the breast or elsewhere I - ndigestion or difficulty in swallowing O- bvious change in a wart or mole N - agging cough or hoarseness Clinical Staging Classification System of Cancer Stage 0: Cancer in situ Stage I: Tumor limited to the tissue of origin; localized tumor growth Stage II: Limited local spread Stage III: Extensive local and regional spread Stage IV: Metastasis Benign Tumors vs Malignant Tumors Benign: well differentiated; usually encapsulated; metastasis is absent; rarely recur Malignant: range from well differentiated to undifferentiated; able to metastasize; frequent recurrence; rarely encapsulated; moderate to marked vascularity How many years until considered cancer free? 5 yrs Goal of Cancer Treatments - Cure (surgery) - Control (debulking/cytoreductive procedure, chemo, radiation) - Comfort (Palliative) Neoadjuvant therapy administration of therapeutic agents before a main treatment (hormone therapy prior to radical radiotherapy for adenocarcinoma of the prostate) Adjuvant therapy therapy that is given in addition to the primary, main, or initial therapy to maximize its effectiveness; modifies the effect of another agent (marijuana TX in conjunction with opioids for pain management) Cancer Treatment: Chemo - Action: Use of chemicals given as a systemic therapy for cancer; mainstay for most solid tumors and hematologic cancers; can offer cure, control, or palliative care; cannot distinguish between normal and cancer cells - Implications: may pose an occupational hazard (drugs may be absorbed through skin, inhalation, during preparation, transportation, and administration); only properly trained personnel should handle drugs; monitor and report infection or bleeding - Methods of Admin: Oral, IM, IV (most common), Intracavitary, Intrathecal, Intraarterial Central vascular access device (VAD) administration placement in large blood vessels; frequent, continuous, or intermittent administration; can be used to administer other fluids (blood, electrolytes, etc.) Regional Administration of Chemo delivery of drug directly into tumor site; higher concentrations of drug can be delivered with less systemic toxicity; delivery methods are intraarterial, intraperitoneal, intrathecal, and intravesical Intraarterial Chemotherapy delivers drug through arteries supplying tumor; method has been used for the treatment of osteogenic sarcoma, cancers of the head and neck, bladder, brain, and cervix, melanoma, primary liver cancer, and metastatic liver disease Intraperitoneal Chemotherapy delivers drug to peritoneal cavity for treatment of peritoneal metastases; chemotherapy is generally infused into the peritoneum in 1 to 2 L of fluid and allowed to "dwell" in the peritoneum for a period of 1 to 4 hours; following the "dwell time," the fluid is drained from the peritoneum. Intrathecal or Intraventricular Chemotherapy Involves lumbar puncture and injection of chemotherapy into subarachnoid space Intravesical Bladder Chemotherapy Agent added to bladder by urinary catheter and retained for 1 to 3 hours Management of Cancer Pain - Drug options for pain management (Morphine, Dilaudid); think about addiction - Analgesics taken on a scheduled basis - with additional doses for breakthrough pain - Relaxation therapy and imagery Management of Cancer Treatment Related Nausea - prophylactic administration of antiemetics (Zofran) - avoid offending odors - assess for signs & symptoms of alkalosis, dehydration, and I & O - tell caregiver to avoid eating in front of pt who is on chemo - monitor carefully to avoid weight loss - weigh twice weekly - recommend small, frequent meals & nutritional supplements (cold foods, bland foods, avoid spicy) Management of Cancer Treatment Related Diarrhea - increase fluids - OTC Imodium (antidiarrheals) - assess for signs & symptoms of alkalosis, dehydration, and I & O - monitor carefully to avoid weight loss - weigh twice weekly - recommend small, frequent meals & nutritional supplements Management of Cancer Treatment Related Mucositis - Use saliva substitutes or drink water frequently - Choose soft, nonirritating, high-protein, high-calorie foods - Nystatin (anti-fungal), Peridex (anti-microbial) - Avoid extreme temperatures, alcohol, and tobacco Management of Cancer Treatment Related Anorexia - Nonirritating, low-fiber, high-calorie, high-fat, high-protein diet (egg whites!) - Take daily weights and give TPN supplements when weight loss is noted or potential for protein and calorie malnutrition (10 lbs) - Appetite enhancers (Marinol/Megace) - Monitor albumin and prealbumin levels - Family teaching crucial Management of Cancer Treatment Related AKI - watch for nephrotox leading to electrolyte disturbances, fluid volume deficit/overload, and reduced drug metabolism - Monitor for renal impairment (BUN/Cr.) - DC nephrotoxic drugs - If they are on dialysis give chemo b/c kidneys have already failed Management of Cancer Treatment Related BM Suppression - Usually occurs 7-10 days after chemotherapy - Most common side effect of chemotherapy - reductions in RBCs, WBCs and platelets result in infection (neutropenia) and hemorrhage (Thrombocytopenia, Anemia) Chemo induced Neutropenia (Nadir) - Dx: Absolute granulocyte count (% of WBC available to fight infections); neutropenic if neutrophil count is < 1500; chemotherapy held if neutrophil < 1000 - Symptoms: S/S of infection: fever, cough, dysuria, chills, tenderness, & pain - Interventions: administer stool softeners for constipation (no tearing where bacteria can get in), implement good handwashing, have a private room, peeled fruit/veggies only(NOT RAW), no flowers, only well vistors, monitor temperature - Treatment: remove offending drugs or agents; Neupogen - 4-8 mcg/kg/day SQ or IV; Neulasta - 6 mg SQ every chemo cycle Chemo Induced Thrombocytopenia - Dx: Platelet count lower than 150,000 (150-350) - Interventions: chemo held if platelets under 100,000; avoid drugs that promote bleeding (ASA, NSAIDs), and unnecessary invasive procedures (IM injections, rectal temps, NG tubes, excessive needle sticks); monitor for bleeding esp if platelets under 50,000 - Symptoms: petechiae, ecchymosis, bleeding, spleenomegly, ↓ B/P - Treatment: Neumega (oprelvekin)- colony stimulating factors that stimulate platelet production, platelet transfusion Cancer Induced Anemia - Symptoms: fatigue, dyspnea, palpitations, tachycardia, H/A, dizziness - Interventions: rest/conserve energy, consult dietician, change positions slowly; surgical pt also at risk - Treatment: Epogen (epoetin) SQ weekly- colony stimulating factor that stimulates erythropoiesis and packed RBC transfusions; Iron supplements, nutrition, possible blood transfusions Treatment for Cancer Related Fatigue