The more blasts a person has the ...?
worse the prognosis
Name three complications of bone marrow transplant
- failure to graft
- Graft vs. host (fighting the disease but goes haywire - rash/peeling skin, jaundice, NVD)
- Veno-occlusive disease (small veins in liver become obstructed)
What is Veno-occlusive disease?
small veins in the liver (only liver affected) become obstructed
hepatomegaly, abdominal pain, ascites, jaundice
What is the treatment for veno-occlusive disorder?
Mild = supportive care
Severe = palliative
The term for cell division
What are mitosis cells?
- cells that divide throughout our lifetime
- increased chance for malignancy
What type of cells go through mitosis?
- Mucous membranes
- Hair / skin
- Bone marrow
- Bladder / renal
tissue growth but secondary to cell enlargement
increase in tissue growth secondary to increased number of cells
cancer development (malignant transformation)
percentage of actively dividing cells within a tumor
any new or continued cell growth that is not needed for normal development
always abnormal but not always malignant
programmed cell death (RBC’s live 120 days)
Cancer cells do not respond to what signals?
What is the term for normal chromosomes?
What type of normal cells growing in the
wrong place at the wrong time (hyperplasia) can be deadly?
Benign tumors grow by ...?
Cancer cells grow by ...?
Name the characteristics or features of malignant cells
- rapid and continuous cell division
- migration - enzymes that let them slip into blood vessels
- no utility - no real function
- Loose adherence - break off easily
- no contact inhibition - invade other tissue
- anaplasia - no longer look like their parents
- abnormal chromosomes - the more abnormal increases malignancy
Name the process of INITIATION - how cancer develops
- First step in carcinogenesis
- Changes a normal cell into a cancer cell (malignant transformation)
- Overexpression of oncogenes (gene mutation)
what is malignant transformation in the INITIATION phase of cancer development?
Changes a normal cell through loss of cellular regulation
In the PROMOTION phase of cancer what happens?
- Progression - cells becoming more malignant
- cancer develops it's own blood supply
Identification of a tumor from the tissue of which it arose is named ?
The primary tumor (original tumor)
cancer cells move from the primary location (build a colony some place else)
How do cancer cells metastasize?
Staging for cancer uses what method?
- T - Tumor
- N - Node
- M - Metastasis
Name the staging for the primary tumor
- Tx-Primary tumor cannot be assessed
- T0-No evidence of primary tumor
- Tis-Carcinoma In Situ
- T1, T2, T3, T4-Increasing size and/or local extent of the primary tumor
Name the staging for Lymph Nodes
- Nx-Regional lymph nodes cannot be assessed
- N0-No regional lymph node metastasis
- N1, N2, N3-Increasing involvement of regional lymph nodes
Name the staging for Distant Metastasis
- Mx-presence of distant metastasis cannot be assessed
- M0-No distant metastasis
- M1-Distant metastasis
amount of time it takes for a tumor to double in size – the quicker the time the worse it is
What are three interacting factors that influence cancer development?
- exposure to carcinogens (environmental)
- immune function
Name risk factors related to cancer (external)
- age (#1 risk factor)
- diet: high fat, low fiber
- exposure to asbestos
- chronic and high alcohol intake
- obesity, poverty
- infections (hep, epstein-barr, h-pylori, gerd
What does CAUTION stand for?
- C - change in bowel or bladder habits
- A - a sore that doesn't heal
- U - unusual bleeding or discharge
- T - thickening or lump in the breast or elsewhere
- I - indigestion or difficulty swallowing
- O - obvious change in warts or moles
- N - nagging cough or hoarseness
in addition to: weight loss, fatigue, pain, nausea, anorexia
Name some things we can do to prevent cancers
- Preventing the occurrence – removing at risk tissues
- Getting HPV vax
- Staying out of tanning beds
- Secondary prevention
- Colonoscopy – removing polyp = primary preventiion
General consequences of cancer (not specifics) – just cancer itself – not with chemo or tx
- 1.) decreases immune function and blood producing abilities
- 2.) affects GI tract (all liver, mouth…)
- 3.) motor and sensory deficits – bone and brain
- 4.) reduced gas exchange – breathing, etc.
Ionizing radiation that targets cells - what is the purpose?
- to destroy cancer cells
- minimal damaging effects on surrounding normal cells
- maintain a safe environment
External radiation therapy is called ?
Name some side effects of radiation therapy
Internal radiation therapy is called ?
Brachytherapy (seeds, IV)
Patient and family teaching regarding skin care for radiation
- wash the area gently
- use hand rather than a washcloth
- rinse thoroughly
- careful not to remove tattooed area
- dry with a clean towel by patting
- use only powders, ointments, lotions or creams that the radiation oncology RX'd
- wear soft clothing and not binding in the area
- avoid sun exposure
- avoid heat exposure
Unsealed radioactive IV or oral what precautions are needed?
urine and feces are radioactive - follow policy guidelines
Sealed radioactive seeds or needles - what precautions are needed?
- private room / private bath
- radioactive material sign
- portable lead shields between pt and door
- keep door closed
- wear dosimeter film badge (shows exposure)
- wear lead apron
- no caregivers pregnant or male/female trying to conceive
- limit each visitor to 30 min/day
- don't touch radioactive source
What is the purpose of Chemotherapy?
interferes with different stages of the cancer
What is NADIR?
the lowest point of the cell counts
Name Neutropenic precautions
- private room
- handwashing alcohol-rub prior to touching pt or belongings
- room and bathroom cleaned at least 1xday
- do not share supplies with other patients
- limit the number of health care personnel entering
- monitor V/S Q4H including temp
- inspect mouth at least Q8H
- inspect skin and mucous membranes at least Q8H
- inspect open areas (IV, wounds) Q4H for signs of infection
- change dressings daily
- obtain cultures
- assist in coughing and deep-breathing exercises
- encourage activity
- change IV tubing daily or according to unit protocol
- keep equipment in the room
- limit visitors to healthy adults
- aseptic technique for all invasive procedures
- monitor WBC daily
- avoid indwelling catheters
- restrict fresh flowers and plants
To prevent infection (when WBC counts are low) - what to teach patients
- Wear a condom or partner wear condom
- wear disposable gloves under garden gloves
- report any s/s of infection (T 100)
- rake temp once a day
- don't change litter boxes
- don't drink anything standing at room temp for longer than 1 hour
- clean toothbrush at least weekly dishwasher or bleach
- bathe daily with antimicrobial soap
Best practice for patient safety to prevent injury for the patient with Thrombocytopenia
- handle pt gently
- use and teach UAP to use lift sheet
- avoid IM injections
- No enemas if suppositories lube liberally
- smallest gauge needle monitor IV Q4H
- apply pressure to needle stick for 10 MIN
- apply ice to trauma
- urine/stool for blood
- electric razor
- no nose blowing
- wear shoes when ambulating
- clear pathways
What is mucositis?
Sores in mucous membranes - often the entire GI tract
Nursing care for patients with mucositis
- frequent oral hygiene
- examine mouth Q4H
- soft-bristled brush to teeth and tongue Q8H
- no alcohol or glycerin mouthwash
- swish and spit room temp water, NS, or salt/soda 4xday
- 2+L H2O/day
- dentures only during meals
What do we need to tell chemo patients about allopecia?
- 1.) tell them most likely going to happen
- 2.) consider depression – coping mech
- 3.) protect head
Why are we assessing for back pain with cancer patients?
Spinal cord compression
This is a blockage pressing down on superior vena cava
Superior vena cava syndrome
Name S/S of superior vena cava syndrome
- weak peripheral pulses
- low BP
- edema of face (especially around eyes)
What is tumor lysis syndrome?
uric acid builds up from a large number of tumor cells being destroyed rapidly
How can we keep patients from getting kidney failure with Tumor Lysis syndrome?
keep patient VERY well hydrated to keep kidneys functioning