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tumor Lysis Syndrome
a large number of cells are destroyed rapidly, resulting in intracellular contents (K+ & purines) being eliminated into the bloodstream faster than the body can eliminate them.
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Tumor lysis syndrome can cause what
cardiac dysfunction from hyperkalemia and Kidney failure from uric acid crystal accumulation in tubules
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treatment for tumor lysis syndrome
- hydrate with 3-5 liter daily
- drug therapy with Allopurinol or Rasburicase to treat uric acid and IV insulin and glucose to decrease hyperkalemia
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how is radiation given
radiation is usually given in a series of divided doses because of the varying responses of all cancer cells within a given tumor
small doses daily then they rest ex; 5 on 2 off
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why is radiation given in small doses daily
it has a greater destruction of cancer cells and reducies destruction of normal cells
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what is teletherapy
- an external beam
- it is delivered from outside the body so the patient is not radioactive or hazardous
- the exact point of the cancer is located and marked and the pt receives the radiation in the same spot while in the same position everytime
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brachiotherapy
- the radiation is inside the pt
- the pt will emit radiation
- where PPE
- limit time with pt
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a nurse caring for a radioactive pt must wear a _____.
dosimeter, it measures the radiation exposure
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what is the purpose of radiation therapy for cancer?
to destroy cancer cells and have minimal damaging affects to the surrounding tissue/cells
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what is the purpose of cancer management?
to prolong survival time or improve the quality of life
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consequences of cancer on the human body
- reduced immunity and blood producing functions
- altered GI structure and functions
- motor and sensory deficits
- decreased resp function
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what are some side effects of radiation therapy
- skin changes and hair loss are local but are often perm.
- development of aversion/dislike the taste of red meat
- radiation induced fatigue can be debilitating and last for months
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what is the definition of chemotherapy
the treatment of cancer with chemical agents, used to cure, to increase survival time and improve quality of life
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discuss the term exposure
exposure is the amount of radiation delivered to a tissue
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discuss the term dose, when talking about radiation therapy
- radiation dose is the amount of radiation absorbed by the tissue
- radiation dose is always less than exposure because some energy is always lost on the way into the tissue
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sealed radiation sources are contained so they
DO NOT contaminate your clients urine, sweat, blood or vomitus
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an unsealed source of radiation ____
DOES contaminate your clients blood, sweat, urine and vomitus
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you should never remove any ___ from a patient going through radiation therapy. Why?
- never remove any markings
- the marks are used to make sure the patient is in the same place in the same position every time they have radiation tx
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skin care is important for patients undergoing radiation Tx.
what is important to know about when to apply skin care medications
never put ointment, lotion medication on patients skin before they go for radiation
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some tissues are more sensitive than radiation than others include
- ova and sperm
- hair folicles
- mucous membranes
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patient that have had radiation therapy should avoid the sun for how long after
at least a year after last Tx
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______ tissue can tolerate more radiation than the _____ can
breast
liver
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normal cells that are affected by chemotherapy are ___
those that divide rapidly, skin, hair, intestinal tissues, spermatocytes, and blood forming cells
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nursing intervention for young male going to start chemotherapy
sperm bank
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what is extravasation? what is your role as a nurse regarding extravasation?
a serious complication of IV infusion when the drug leaks into the surrounding tissues most important nursing intervention is Monitor close to prevent leakage
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what is nadir
- the time when bone marrow activity and WBC counts are at their lowest.
- patient will feel miserable, sick, weak
- Do Not give 2 chemotherapy drugs with same nadir
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what are vesicants?
chemicals that damage the skin on direct contact
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Dose-Dense Chemotherapy
- higher doses of chemo given more often
- used in aggressive cancer treatment
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how do you clean the mouth for patient on chemotherapy
soft bristled tooth brush or swab
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if stomatitis is present what food should be avoided
hot, spicy, hard food
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side effects of chemotherapy
- anemia, neutropenia, alopecia, mucositis
- diarrhea, constipation, weakness, fatigue
- chemo brain
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what is chemo brain
- a mild cognitive
- it causes memory lapses, trouble concentrating, trouble remembering details, slower thinking, slower processing
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what ia anemia
- decreased number of red blood cells and hemoglobin
- s/s tiredness, weakness, fatigue
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neutropenia
- decreased number of white blood cells
- s/s infection
- this is a life treating event it requires isolation of the patient
- treat with Neulasta, or Neuvagen
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thrombocyctopenia
- decreased numbers of platelets
- s/s bruising, bleeding, risk for injury
give platelets
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sepsis
- blood infection
- cancer patient are high risk because decreased immune function
- DIC a problem with clotting process, caused by gram negative sepsis in cancer patients
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SIADH
syndrome of antidiuretic hormone
- cancer is a common cause
- water is reabsorbed by the kidney and put back into circulation
- restrict fluid and add sodium
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Hypercalcemia
- occurs most often in pts with bone metastasis
- then cancer in the bone causes the bone to release calcium into the blood stream
s/s fatigue, loss of appetite, n/v, constipation, muscle weakness, dehydration
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Superior Vena Cava
- pt has some type of cancer that is pressing on the superior vena cava
- that might limit their ability to breath, facial edema, epitaxis, strokes sign, change in mental status, may turn blue
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Tumor Lysis Syndrome
- a large number of tumor cells are busted up and being released into the bloodstream faster than the body can eliminate them.
- cardiac dysfunction from hyperkalemia and acute renal failure for uric acid crystal accumulation in tubules
- hydrate 3-5 liters day
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