Cancer Nursing *nle

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  P]1TI1T1Th1URSE1J! ONCOLOGY WHAT YOU  NEED TO KNOW Cancer is the second leading cause of death in the Untied Stales. One in three Americans will suffer from sonic form of cancer. Before we begin the review, test your general knowledge base with the questions on the next page: 1. The location of cancer with the highest mortality rate is the  ___________ 2. In males, the two locations with the highest incidence of cancer are: A.  ______________ B.  ________________ 3. In females, the Iwo locations with the highest incident of cancer are: A.  _______________ B.  _________________ 4. Three general signs and symptoms of cancer include: A.  ______________ B.  _________________ C.  ________________ 5. A  ___________ is a substance that can cause changes in a cell that can lead to cancer. 6. The number one risk factor for developing lung cancer is  ________________ 7. A diet high in  _________ and low in  __________  places an individual at increased risk of colon cancer. 8. Infection with the human immunodeficiency virus (HIV) increases the risk of developing which two types of cancer? A.  ______________ B.  ________________ 9. Three host factors that increase the risk of developing cancer that cannot be controlled include: A.  _______________ B.  _________________ C.  ________________ 10. When a tumor spreads from its primary site, it is called a 11. List the five most common sites of tumor migration: A.  _______________ B.  ________________ C.  _______________ D.  ______________ E.  _________________  Nurses can educate their clients to decrease their risk of developing cancer by instructing them to: ã Avoid lung irritants including tirst - and second-hand smoke ã Eat low -fat, high-tiber diets ã Limit alcohol intake ã Avoid direct exposure to sunlight by using sunscreen and protec tive clothing ã Practice safe sex (barrier contraception) ã Participate in regular cancer screening programs, based on age and risk groups CANCER TYPES AND LOCATIONS It is helpful to recognize types of cancer associated with different tissue types and sites for the NCLEX-RN. Try the exercise below to test your understanding of basic anatomy and physiology. Remember: The  base/root word of the cancer usually identifies the tissue type, i.e., osteo =  bone.  12.  —    surface epithelial A. Ostcosarcoma 13. glandular epithclial B. Rhabdomyosarcoma 14. fibrous connective tissue C. Adenosarcoma 15. adipose tissue D. Chondrosarcoma 16. cartilage E. Neurolemic sarcoma 17.  —     bone F. Fibrosarcoma 18. blood vessels G. Leukemia 19.  —    lymph vessels H. Squamous cell sarcoma 20.  —    smooth muscle I. Hemangiosarcoma 21.  —    striated muscle J. Liposarcoma 22.  —    gliul tissue K. Lymphangiosarcoma 23. nerve sheath L. Leiomyosarcoma 24.  —     blood M. Glioma BASIC CANCER SCREENING GUIDE For the NCLEX-RN, you should  be familiar with the general guidelines for cancer screening summarized in the table below: TUMOR STAGING The TNM system of classification for breast cancer is based on evaluating the spread of disease. T=tumors size. The range is T0-T4, with TO being no evidence of tumor and t$ being an extensive tumor that extends into the chest wall or skin. N=Lymph node involvement. The range is from NO-N3. NO indicates that flO nodes are involved; N3 indicates that there is extensive involvement in the ipsilatcral internal mammary nodes. M= metastasis; MO = no metastasis; M 1 signifies that metastases are present. ã When a tumor is staged by the TNM system as T2 NO MO, it means: and TUMOR MARKERS Tumor markers are monitored for decreases or increases that may correlate closely with responses to treatment and reoccurrence or spread of disease. u-fetoprotein is a fetal antigen normally not expressed during adulthood. It can oficu be detected in the blood of clients with liver cancer and germ cell tumors of the ovary and testes. Carcinoembryonic Test Who? Age Frequency Pap smear, Pelvic examination Women Age 18 or when sexually active and  beyond Yearly Breast self exam Women Age 20 and beyond Monthly Breast clinical exam Women Age 20 and beyond Yearly Testicular self exam Men Age 16 and beyond Monthly Sigmoidoscopy Men and Age 50 and beyond Every 3 years  women Stool occult blood Men and women Age 50 and beyond Yearly Digital rectal exam (prostate check for men) Men and women Age 40 and beyond Yearly Mammography Women Age 35 and beyond Ages 35-40: one baseline exam Ages 4 1-50: every 2 years Ages 51 and beyond: yearly antigen (CEA) is an embryonic antigen present in 75  percent of clients with colorectal cancer. It can be monitored through simple blood wok. A recently popularized tumor marker to follow in men over 40 years old is the prostatic acid phosphatase enzyme. It is usually elevated with prostate enlargement either from cancer or benign prostatic hypertrophy. If a 48-year-old male has a routine prostate-special antigen screening test and there is a significant increase from last year’s value, what type of cancer would it most likely indicate?  _________________  NURSING CARE OF THE CLIENT RECEIVING RADIATION Approximately 50  percent of client with cancer receive some form of radiation, especially those with carcinoma, Hodgkin’s disease, or cancer of the larynx and cervix. The therapeutic goals of radiation include: ã Cure ã Tumor reduction for comfort ã Maintenance of tumor size during chemotherapy or preparation for surgery Radiation can immediately kill cells or interrupt cell replication by directly hitting the target cells or by interacting with critical cell components. Since DNA synthesis is inhibited by radiation, rapidly dividing cells are affected the most, including cancer cells, gastrointestinal cells, and bone marrow cells. The vascular changes associated with radiation are dose-dependent. Immediately after radiation, expect the irradiated area to be reddened and dry. After several treatments, the small vessels in the area may be damaged or destroyed. With low-dose radiation, the cells can repair themselves between treatments. TRUE OR FALSE? ã The m arks indicating the area to be treated with radiation should be washed off immediately after the treatment to avoid skin breakdown. ã —    The client should wear light, loose clothing. ã The client may use moisturizing lotions. ã —    Clients should use sunscreen on treated areas when they are outside ã —    typical side effects Ofl radiation therapy include mucositis, nausea, vomiting, and hair loss. ã A client receiving internal radiation may have radioactive excretions. ã A client receiving external radiati on may have radioactive excretions. SIDE EFFECTS OF RADIATION  The adverse effects of radiation therapy vary from client to client. Nutrition must be addressed and an individualized plan followed for each client. For example. clients receiving radiation to their body anywhere Form the lung up may experience severe dry mouth at any time during and after the treatment. This can progress and cause dysphagia. thus compromising nutritional intake. Moist, sofi foods and a lot of liquid should be encouraged with these clients. Radiation to the lower gastrointestinal tract can cause constipation or diarrhea.  Nutritional Concerns of Lower Gastrointestinal Radiation Therapy Constipation Encourage fluids Increase dietary fiber (unless enteritis is present)  _____________________ Increase physical activity as tolerated Diarrhea Low-fiber diet  _____________________ Protect skin from excoriation  NURSING CARE OF TIlE CLIENT RECEIVING ChEMOThERAPY Only nurses trained in handling chcmotherapcutic medication should administer them. For the NCLEX-RN, you need to know some general principles for the administration f chemotherapy: ã 34. All drugs must be mixed using the proper protective gear, including: A.  _____________ B.  ______________ C.  ______________ ã 35. The five rights of drug administration are: A.  ______________ B.  _______________ C.  _______________ D.  ______________ E.  ________________ ã Monitor lab values and know when to hold the medication based on white blood cell count, platelet count, or creatinine changes. ã The normal range for white blood ceLl count is (36.)  ________________ ã The normal range for platelets is (37.)  __________________ ã The normal creatinine range is (38.)  _________________ ã Use a 39 (large / small) bore needle in the most (40. distal / proximal) vein that is accessible and large enough to tolerate the amount of fluid to be delivered. ã Prepare IV site aseptically to avoid infection. ã Frequently ensure proper line place ment to avoid tissue infiltration or necrosis. ã 41. Signs and symptoms of tissue infiltration include: A.  ______________ B.  _________________ C.  ________________ D.  _______________ E.  _________________ ã Check for signs and symptoms of infection be fore and after chemotherapy. The risk of infection increases dramatically when the neutrophils fall to 1 ,000/mL. ã Double check that drugs are mixed properly and the correct amount of fluid is given to the client before, during, and after chemotherapy. Many drugs can be toxic to the kidneys if not diluted enough. ã Monitor for signs and symptoms of chemotherapy -induced toxicity, including a discrepancy in input and output that could signal renal failure, fever, nausea, vomiting, and bone marrow suppression. ã in an oncology client a fever that may signal an underlying infection if one that is over 101.3° Fahrenheit (38° Celsius) for 24 hours or more.

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Jul 23, 2017
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