MDC 2 EXAM 1 100% Answered Correctly!!

Benign cells - ANSWER Normal cells growing in the wrong place or at the wrong time Benign Cell Features - ANSWER o Harmless o Do not usually require intervention o Slow growing o Tight Adherence o Specific morphology o Small nuclear-to-cytoplasmic ratio o Specific differentiated functions o Tight adherence o Orderly growth o No migration o Normal chromosomes Benign cell looks similar to a - ANSWER healthy cell Examples of Benign cells - ANSWER o Skin Tag o Mole o Nasal Polyp o Uterine Fibroids o Endometriosis Malignant cells - ANSWER indicates cancer and can be harmful to normal body tissues and result in death Malignant cell features - ANSWER o Large nucleus o Migration o Doesn't stop and replicates (No contact inhibition) o Loose adherence o Rapid or continuous cell division o Loss of cellular regulation o Abnormal chromosomes ( or 23) Seven warning signs of cancer - ANSWER o C-Change in bowel or bladder patterns o A-A sore that doesn't heal o U-Unusual bleeding or d/c o. T-Thickening or lump on breast or elsewhere o I-Indigestion or difficulty swallowing o O-Obvious change in wart or mole o N-Nagging cough or hoarseness Cancer development stages of malignancy - ANSWER o Initiation o Promotion o Progression o Metastasis Initiation (Stage of malignancy) - ANSWER Normal cells are damaged and irreversible Promotion - ANSWER Repeated exposureEnhances growth of malignant cells Progression - ANSWER Increase in production of malignant cells Metastasis - ANSWER Cells move from primary site to the rest of the body Carcinogenesis/oncogenesis - ANSWER cancer development Cancer classification - ANSWER o Grading o Ploidy o Staging o TNM o Doubling time and mitotic index Grading - ANSWER Looking under microscope and determine level/degree of mutation of cancer cell from normal cells o Ex. 1= No mutation o 4= Severe mutation Ploidy - ANSWER Number of chromosomes Staging - ANSWER How large is the primary tumor and how far has it spread TNM - ANSWER o T-Tumor (How large is primary or 2nd) o N- Node (Are regional lymph nodes invaded by cancer cell) o M-Metastasis (0=None, 1=There is metastasis) Doubling time and mitotic index - ANSWER Period of time required for that quantity to double in size (Tells how aggressive cancer grows) o Stage 1=Localized o Stage 4= Spread across the body Cancer prevention primary - ANSWER o Sunscreen o Avoid smoking o Removal of "at risk" tissue (mole) o Chemoprevention o Vaccine (HPV) Cancer prevention secondary - ANSWER o Mammogram o Pap smear o Prostate test Cancer prevention tertiary - ANSWER People who are already affected and getting treatment (examples below) o Chemo o Radiation o Surgery, etc. Types of cancers - ANSWER carcinoma, sarcoma, melanoma, lymphoma, leukemia, blastoma Carcinoma - ANSWER malignant tumors of glandular (lining) tissues Sarcoma - ANSWER malignant tumor of connective (bone) tissues Melanoma - ANSWER pigment producing skin cancer Lymphoma - ANSWER malignant tumor of lymphoid tissue Leukemia - ANSWER white blood cell tumor Blastoma - ANSWER malignant tumors of less differentiated, embryonal tissue Lab Diagnostic Tests - ANSWER o CBC o Blood protein testing o Tumor marker test o Circulation tumor cell tests Imaging Diagnostic Tests - ANSWER o CT Scans o MRI o X-ray o Ultrasound o Mammogram o Nuclear medicine scans Endoscopy Diagnostic Tests - ANSWER o Bronchoscopy o Colonoscopy o Cystoscopy o Laparoscopy o Laryngoscopy o Mediastinoscopy o Thoracoscopy o Upper Endoscopy Biopsy Diagnostic Tests - ANSWER o Breast biopsy o Bone marrow biopsy o Organ/tissue specific Risk factors - ANSWER o Older age. o A personal or family history of cancer. o Using tobacco. o Obesity. o Alcohol. o Some types of viral infections(HPV) o Specific chemicals. o Exposure to radiation, including ultraviolet radiation from the sun. o Alcohol Types of therapy - ANSWER surgery, radiation, chemotherapy, radiation therapy, immune therapy, photodynamic therapy hormonal therapy Surgery - ANSWER cells can escape during surgery sometimes, causing clients to have to deal with an altered appearance Radiation - ANSWER Destroy cancer cells with minimal damaging effects of surrounding normal cells; maintain safe environment Chemotherapy - ANSWER Treatment of cancer with chemical agents. Used to cure and increase survival time. Adjuvant therapy - ANSWER = Chemotherapy + surgery or radiation. Cytotoxic effects exerted on healthy cells and cancer cells Immunotherapy (biological response modifiers and targeted therapy) - ANSWER -Modify patient's biologic responses to tumor cells. Can have direct antitumor activity. - Can interfere with cancer cell differentiation, transformation, metastasis. -Can improve immune function Monoclonal antibodies(immunotherapy) - ANSWER Bind to target antigens (often specific cell surface membrane proteins) Prevents protein from functioning, - prevents cell division. E.g- Rituximab (Rituxan) Tyrosine Kinase Inhibitors(immunotherapy) - ANSWER Inhibits activation of tyrosine kinase inhibitors- disrupt growth and cellular regulation of some types of cancer cells Epidermal Growth Factor/ Receptor Inhibitors(immunotherapy) - ANSWER Block epidermal growth factor from binding to cell surface receptor; prevents cancer cell division Vascular Endothelial Growth Factor/Receptor Inhibitors(immunotherapy) - ANSWER prevents binding of VEGF with its receptors on surfaces of endothelial cells present in blood vessels. Prevents formation of new blood vessels within the tumor Multikinase Inhibitors (MKIs)(immunotherapy) - ANSWER Inhibit activity of specific kinases in cancer cells and tumor blood vessels Proteasome Inhibitor(immunotherapy) - ANSWER Prevents formation of a large complex of proteins into cells; impair tumors cellular regulation ability Angiogenesis inhibitors(immunotherapy) - ANSWER Targets mammalian target of rapamycin; reduces concentration of vascular endothelial growth factor, disrupts cell division. Photodynamic therapy - ANSWER Selective destruction of cancer cells via chemical reaction triggered by types of light Hormonal therapy - ANSWER Changing usual hormone responses. Some hormones make hormone sensitive tumors grow more rapidly (Decreasing the hormone amounts to hormone sensitive tumors can slow cancer growth rate). Steroids, steroid analogues, enzyme inhibitors Surgical classification types - ANSWER prophylaxis, diagnosis, cure, control, palliation,assessing therapy effectiveness and reconstruction Prophylaxis(Surgical classification type) - ANSWER remove cancerous tissue to prevent cancer development Diagnosis(Surgical classification type) - ANSWER removal for testing or examination to rule out cancer "biopsy" Cure(Surgical classification type) - ANSWER removes all cancerous tissue Control(Surgical classification type) - ANSWER removes part of tumor when removal of entire tumor is impossible Palliation - ANSWER surgery to provide symptom relief, is NOT curative Assessing therapy effectiveness - ANSWER (Surgical classification type) Reconstruction(Surgical classification type) - ANSWER increases function or appearance or both. S/E of Surgery - ANSWER removal can lead to changes in appearance, activity level, depression, grief, and decreased enjoyment of life S/E of Radiation - ANSWER Acute and long-term site-specific changes, vary according to site, Local skin changes and hair loss, altered taste sensations, Fatigue, Bone marrow suppression. S/E of Chemotherapy - ANSWER extravasation, infection risk, bone marrow suppression, neutropenia, anemia, thrombocytopenia, clotting risks, chemotherapy-induced nausea and vomiting, mucositis, alopecia, cognitive changes, chemotherapy-induced peripheral neuropathy. S/E of Immunotherapy Monocle antibodies - ANSWER allergic reactions, skin, mucous membranes, GI tract S/E of Immunotherapy Tyrosine kinase inhibitors - ANSWER Fluid retention, electrolyte imbalances, bone marrow suppression S/E of Immunotherapy EGFRI's - ANSWER skin reactions, adverse effects on heart S/E of Immunotherapy VEGF's - ANSWER hypertension, impaired wound healing, bone marrow suppression S/E of Immunotherapy Multikinase inhibitors - ANSWER hypertension, GI distress, mucositis, mild neutropenia thrombocytopenia S/E of Immunotherapy Proteasome inhibitors - ANSWER GI distress, decreased taste sensation, peripheral neuropathy S/E of Immunotherapy Angiogenesis inhibitors - ANSWER bone marrow suppression, headache, GI distress, muscle pain joint pain S/E of Photodynamic therapy - ANSWER avoid sunlight? S/E of Hormonal manipulation - ANSWER Masculinizing effects in women. Feminizing effects in men (gynecomastia). Fluid retention. Acne. Hypercalcemia. Liver dysfunction. Venous thromboembolism Oncological emergency classification types - ANSWER Sepsis, Intravascular coagulation, syndrome of inappropriate antidiuretic hormone, spinal cord compression, hypercalcemia, superior vena cava syndrome, tumor lysis syndrome. Sepsis (septicemia) - ANSWER blood stream infection Sepsis s/s - ANSWER low grade fever Sepsis treatment - ANSWER IV antibiotics Intravascular coagulation - ANSWER extensive and abnormal clotting often caused by gram-negative sepsis Intravascular coagulation s/s - ANSWER bleeding from many sites -pain -ischemia -strokes like symptoms - dyspnea -tachycardia -reduced kidney function -bowel necrosis Intravascular coagulation treatment - ANSWER anticoagulants (depending on stage), clotting factors if hemorrhaging, IV antibiotics. Syndrome of Inappropriate Antidiuretic Hormone - ANSWER - excessive amounts of water that results in hyponatremia SIAH S/S - ANSWER Hyponatremia Weakness muscle cramps Anorexia Polyuria Polydipsia Myalgia (muscle pain & ache) loss of appetite fatigue weight gain confusion Weakness Coma Seizure death SIAH Treatment - ANSWER Fluid correction Furosemide therapy Correction of serum sodium imbalance SIAH Intervention - ANSWER Monitor I&O Monitor lab values Implement seizure precautions Manage comfort Spinal cord compression - ANSWER Tumor compression of spinal cord Spinal cord compression S/S - ANSWER symptoms vary depending on location and severity of compression Late paraplegia Incontinence Loss of sensory function New onset backpain that worsens when laying dow Constipation Spinal cord compression Treatment - ANSWER Radiation Surgical intervention Spinal cord compression Interventions - ANSWER Assess for neurological defecits Manage pain Prevent skin breakdown Spinal cord compression treatment/intervention - ANSWER corticosteroids -radiation -surgery. Hypercalcemia - ANSWER is associated with lung, kidney, breast and multiple myeloma cancers early symptoms of hypercalcemia - ANSWER nonspecific, skeletal pain, kidney stones, altered cognition, loss of appetite, constipation, loss of deep tendon reflexes, paralytic ileus, ECG changes Myalgia Headache Hypercalcemia Treatment - ANSWER IV hydration normal saline, loop diuretics, Inpatient monitoring Phosphate replacement I.V bisphosphates, calcitonin, oral glucocorticoids. Hypercalcemia Intervention - ANSWER Assess s/s Administer fluids Monitor I&O Superior vena cava syndrome(SVCS) - ANSWER vena cava compressed by tumor or clots SVCS S/S - ANSWER edema in face and eyes engorged blood vessels and erythema in the upper body, edema in arms and hands dyspnea, stridor Dysphagia Cough SVCS Treatment - ANSWER Chemo Metal stent Radiation SVCS Interventions - ANSWER Maintain airway Administer oxygen Tumor lysis syndrome - ANSWER large number of tumor cells are destroyed quickly and contents of those cells (potassium and purines) are released into the blood stream Tumor lysis syndrome s/s - ANSWER Hyperkalemia Hypocalcemia Hyperuricemia Acute Renal failure* Acidosis Tumor lysis syndrome treatment - ANSWER Inpatient monitoring Fluid resuscitation Correction of acidosis Hemodialysis Allopurinol or uricase therapy Tumor lysis syndrome intervention - ANSWER Maintain ABCs Monitor vitals and cardiac rhythm Manage electrolyte balance Prepare patient for hemodialysis Malignant pericardial effusion - ANSWER Develops due to fluid accumulation around the pericardial sac Malignant pericardial effusion s/s - ANSWER Dyspnea Fatigue Distended neck veins Distant heart sound Tachycardia Orthopnea Malignant pericardial effusion Treatment - ANSWER Radiation Surgical Intervention Malignant pericardial effusion nursing interventions - ANSWER Assess for neurological deficits Manage pain Prevent skin breakdown Hospice care - ANSWER Model for quality, compassionate care for those facing life-limiting illness or injury Usually less than 6 months to live Palliative Care - ANSWER Philosophy of care for those with life-threatening disease Provided by physician, nurse practitioner, or team Assessment findings - ANSWER o Weakness o Sleeping more o Anorexia o Changes in organ system function o Cold, mottled, cyanotic extremities o Changes in breathing pattern o Decreased LOC Interventions=responding - ANSWER o Needs and preferences met o Control of symptoms of distress o Meaningful interactions with family o Peaceful death Managing Breathlessness/dyspnea - ANSWER o Opioids, bronchodilators, diuretics, antibiotics, anticholinergics, benzodiazepines o Oxygen (for comfort) o Electric fan for air circulation o Reposition Managing Nausea/vomiting - ANSWER o Antiemetic agents,Prochlorperazine (Compazine),Ondansetron (Zofran),Dexamethasone (Decadron, Deronil, Dexasone) Metoclopramide (Reglan, Maxeran) o Remove any source of odors o Comfortable room temperature o Aromatherapy Managing Agitation/delirium - ANSWER o Assess for pain, urinary retention, constipation, other reversible cause o Pharmacologic agents o Music therapy; aromatherapy Managing Refractory symptoms of distress - ANSWER o Proportionate palliative sedation Lab values for normal ranges - ANSWER o Sodium 136-145 o Potassium 3.5-5 o Calcium 9-10.5 o Chloride 98-106 o Magnesium 1.8-2.6 o What Three hormones control fluid and electrolyte imbalance? - ANSWER Aldosterone (adrenal gland), Antidiuretic hormone (vasopressin) (pituitary gland), Natriuretic peptides (cells in the heart and ventricles) Aldosterone (adrenal gland) - ANSWER o Secreted when sodium levels in the extracellular fluid are low o Prevents both water and sodium loss o Triggers kidneys to reabsorb water and sodium from urine back into blood (increases blood osmolarity and blood volume o Promotes kidney potassium excretion Antidiuretic hormone (vasopressin) (pituitary gland) - ANSWER o Released in response to change in blood osmolarity o Retains only water INDIRECTLY regulates electrolyte excretion and retention Natriuretic peptides (cells in the heart and ventricles) - ANSWER o Secreted in response to increased blood volume and pressure o NP binds to receptors in nephrons, creates opposite effect of aldosterone o Sodium reuptake is inhibited, urine output is increased (reduces BP/BV) Renin angiotensin II pathway (urine output= indicator of perfusion) - ANSWER o When kidneys sense blood pressure, volume, osmolarity, or oxygen levels are low, they secrete renin to RAISE them to normal levels o Renin activates angiotensin 1 angiotensin 1 is activated by the enzyme angiotensin converting enzyme (ACE) and converted to angiotensin 2 Angiotensin 2 - ANSWER constricts arteries and veins, lowers GFR rates to reduce urine output, signals kidneys to promote aldosterone Hypervolemia (Excess fluid volume) - ANSWER Increased fluid in the extracellular space caused by the abnormal retention of water and sodium in approximately the same proportions in which they normally exist in the ECF. Causes of Excess fluid volume (hypervolemia) - ANSWER o Heart failure o Excess fluid intake o Renal failure o Increased sodium intake Hypervolemia s/s - ANSWER o Ascites. o Aphasia, o muscle twitching, o tremors, o seizures. o Bounding pulses. o lethargy, o disorientation, o confusion o coma o Crackles* o Distended neck and peripheral veins. o Edema variable from dependent o Elevated central venous pressure. o Extra heart sounds S3. o Hypertension. o Productive cough. o Shortness of breath. o Sudden weight gain Hypovolemia (deficient fluid volume) - ANSWER occurs when loss of extracellular fluid exceeds the intake of fluid. Decreased fluid in ECF Causes of hypovolemia - ANSWER o Burns o Severe diarrhea o Gastric intubation o Hemorrhage o Diabetic ketoacidosis (DKA)* o Diabetes insipidus o Diuretics o Adrenal disease o Recovery phase of acute renal failure* Hypovolemia s/s - ANSWER o Abdominal distention. o Fever o Confusion, restlessness. o Dark concentrated urine. o Decreased urine volume. o Decreased central venous pressure. o Flattened neck veins. o Hypotension. o Pale, moist, clammy skin. o Tachycardia. o Tachypnea. o Weak pulses. Hyperkalemia - ANSWER is defined as serum potassium level above 5.0 mEq/L. Hyperkalemia cause - ANSWER o Renal disease o Renal failure o Treatment side effects (NSAIDs,diuretics, and massive transfusion with banked blood) o Metabolic acidosis o Ketoacidosis o Burns o Trauma o Addison's disease Hyperkalemia s/s - ANSWER o Bradycardia o Hypotension o Tall, peaked T waves o Prolonged PR interval o Wide QRS o Asystole o VFib o Paresthesia o Weakness o Diarrhea o Spastic colon o Hyperactive bowel sounds Hypokalemia - ANSWER is defined as serum potassium level below 3.5 mEq/L. Hypokalemia Causes - ANSWER o Diabetic ketoacidosis o Acute kidney failure o Cushing's syndrome o Diuretics o Beta blockers o Laxatives o Magnesium deficiency Hypokalemia s/s - ANSWER o Diarrhea o Slows down heart* o Cardiac standstill* o Hypotension* o Bradycardia* o SEVERE V-fib (Ventricles quiver)* o Shallow breathing o Hyporeflexia o Weakness o Cardiovascular o Thready weak pulse o Dysrhythmia o AMS o Lethargy o Hypoactive bowel sounds o Constipation o Nausea/vomiting Potassium has a huge impact on the - ANSWER heart (can be deadly) Hypernatremia - ANSWER Sodium levels greater than 149 Hypernatremia causes - ANSWER o Dehydration o Decreased water intake o Excessive water loss o Diabetes insipidus Hypernatremia s/s - ANSWER o Red flushed skin* o Edema* o Excess thirst (due to high sodium)* o Swollen dry tongue* o Lethargy o Irritability o Confusion o Drowsy o Stupor o Twitching o Muscle weakness o Hypovolemia o Hypotension o Hypervolemia o Bounding pulse o Hypertension Hyponatremia - ANSWER Sodium levels below 130 Hyponatremia causes - ANSWER o Excessive water intake o SIADH* o Increase in antidiuretic hormone o Fluid volume depletion o Profuse diaphoresis Hyponatremia s/s - ANSWER o Nausea o Headache o Fatigue o Confusion* o Weak thready pulse* o HTN o Cerebral edema o Increased ICP o Weakness o Cramps o Cardiovascular o Hypovolemia o Weak thready pulse o Tachycardia* o Hypotension o Dizziness o Hypervolemia o Bounding pulse Hypercalcemia - ANSWER calcium greater than 10.9 Hypercalcemia causes - ANSWER o Addison's disease o Paget's disease o Hyperthyroidism o Sarcoidosis o Lithium o Tamoxifen o Thiazide Diuretics Hypercalcemia s/s - ANSWER o Weakness o ↓DTR o Altered LOC