MOC-1 EXAM 4

pathogenesis of cancer

uncontrolled growth of cells that immune system cannot control 1. defective cell proliferation (growth) 2. defective cell differentiation as cancer cells advance, they take away nutrients from normal cells

what are the stages of cancer?

1. Phase I-Initiation: first changes, mutation of cells' genetic structure often caused by carcinogens or genetic link 2. Phase II- Promotion: characterized by reversible proliferation of altered cells, usually by behavioral changes Latent period- 1-40 years of increased mitotic rate- tumor must reach a critical mass to be detected 3. Phase III- Progression phase: development of cancer, increased tumor growth and metastasis

how do immune cells destroy cancer cells?

differentiate them by outside tumor associated antigens and kill if working correctly

oncofetal antigens

found on tumor cells, in fetal cells, and on tumor cell surfaces

examples of oncofetal antigens

CA-125 (ovarian carcinoma) PSA (prostate cancer) HER-2 (breast cancer)

pap smear

screens for cervical cancer

mammogram

screens for breast cancer

before a physical prostate examination, you would make sure to....

get blood drawn before so PSA level is not impacted by examination

grading of abnormal cells

grade 1: cells differ slightly from normal and well differentiated grade 2: cells are more abnormal and moderately differentiated grade 3: cells are very abnormal and poorly differentiated grade 4: cells are immature and undifferentiated; difficult to identify cell of origin

carcinoma

cancer originating from skin, glands, and mucus in GI, GU, or respiratory tract

sarcoma

cancer that originate from muscle, bone, connective tissue, or fat

lymphoma and leukemia

cancer that originates from hematopoietic system

clinical staging classifications of cancer

0: cancer in situ I: tumor limited to tissue of origin, localized tumor growth II: limited local growth III: extensive local and regional spread IV: metastasis

tnm staging classification system

anatomic extent of disease t- tumor size and invasiveness n- spread to lymph nodes m-metastasis

clinical staging

done at completion of diagnostic work to guide effective treatment selection

surgical staging

determined by surgical work--being used less frequently

excisional biopsy

take out whole mass and analyze most accurate

incisional biopsy

cut into tumor and then analyze risk of spreading or missing it

needle biopsy

pull out needle then analyze often misses

complications of cancer

1. malnutrition--cancer cachexia and wasting have them eat foods they enjoy 2. infection--often in areas of cancer avoid infection 3. cancer pain

dysgeusia

altered taste perception

chemotherapy

use of chemicals as a systemic therapy for cancer goal = reduce # of cancer cells IV, IM, PO, topical, subQ affects cells that rapidly divide like bone marrow, hair, ova, sperm, hair

NADIR rating

lowest blood cell count after a treatment cycle of chemo

if IV extravasation (IV fluid spills out) you should...

stop the infusion immediately signs: redness and tingling, burning

external radiation (teletherapy)

radiation fields marked on skin appropriate skin care necessary

internal radiation

patient is emitting radiation while in place placed in body cavity (ex. uterine cancer) family cannot visit so be attentive to them

ALARCA

for radiation; as low as reasonably possible

dry desquamation

redness and tenderness avoid extreme temperatures

wet desquamation

pain, drainage, and increased risk of infection

monoclonal antibodies

part of tumor taken out and placed in mouse mouse creates antibodies antibodies placed in patient

superior vena cava syndrome

occurs in cancer patients when superior vena cava is blocked very bad

colony stimulating factors

a type of hematopoietic growth factor given when NADIR rate is low stimulates WBC

erythropoiesis

stimulates RBC

conductive hearing loss

impairment of sound transmission caused by otosclerosis, otitis, impacted cerumen, perforation of TM, narrowing of ear canal sometimes speaks softer than normal bc own voice is loud hearing aids recommended

sensorineural hearing loss

damage to neural component of hearing often caused by drugs or chemo can often hear but unable to decipher

central and functional hearing loss

patient unable to interpret sound (speech) b/c of injury to the brain that deals w/ speech

health promotion to prevent hearing loss

ototoxic medications (salicylates, aminoglycosides, antimalarial agents) ototoxic chemicals monitoring tinnitus avoiding high decibel environments

presbycusis

sensorineural hearing loss associated with those 50+ years old

refractive errors

most common problem defect that prevents light rays from diverging into a single focus on retina causes: irregular corneal curvature length of eye, focusing of lens

myopia

focusing light rays in FRONT of retina "Nearsightedness" unable to see far distances

hyperopia

light rays focus behind retina "farsightedness" unable to see up close

presbyopia

aging of eyes with age

nursing management questions for visual changes

how long has this been occurring? when did it start? how does this affect your normal functioning? what are your coping strategies?

nursing implementation for visual changes

-walk ahead of patient and use arm to guide, describe environment -do not smother the patient's environment or demean -maintain eye contact -assess need for aid -communicate in normal tone

blepharitis

bilateral inflammation of lid margins crusty and scaly can be treated with antibiotic ointment or baby shampoo

conjunctivitis

infection (s. aureus) or inflammation of conjunctiva treated with antibiotic drops can also be allergic or viral

adult inclusion conjunctivitis (AIC)

caused by chlamydia trachomatis not same chlamydia as genital, but the risk is high for genital if you have this too

hordeolum (Sty)

lump in eyelid usually caused by inflammation from staph. aureus use a warm compress makeup is often a vector

eye drop administration

stagger method = stagger drops bc eye can only take so much liquid do not let tip touch actual eye

ABCDE for assessing melanomas

A- asymmetrical B-borders irregular C- color D- diameter > 6mm E- Evolving

if you have an eye infection/ inflammation, how can you prevent future infection?

make sure to throw away all eye makeup products that have been infected careful sharing with others

how can you support those that are blind/ with visual issues?

do not baby them or put them in a wheel chair if not necessary guide with elbow and describe places

what is the most dangerous skin cancer to have?

melanoma basal cell/ squamous cell carcinoma does not metastasize as much

osteoporosis

chronic disease marked by low bone mass and easily fractured bones RF: older women, thinner (UNDER 25 BMI), low calcium, sedentary, smoking

assessment findings for osteoporosis

-kyphosis (curvature of spine) -gradual loss of height

diet changes for osteoporosis

more calcium + vitamin D for absorption all dairy, beans (white)

fosemax

osteoporosis med that inhibits bone resorption take 30 min before eating and sit up because of GI effects

calcitonin

osteoporosis med that inhibits bone resorption

what is the #1 concern for osteoporosis patients?

eliminating the risk of falls because bones break easily remove clutter rugs good footwear careful on icy surfaces

osteoarthritis

slow, progressive inflammatory disorder of freely moving joints gradual loss of arterial cartilage osteocyte formation NOT symmetrical

osteoarthritis assessment findings

joint pain Heberden's nodes and Bouchard's nodes one leg shorter than the other NOT SYMMETRICAL EFFECTS

Heberden's nodes

osteoarthritic nodes found in distal fingers

Bouchard's nodes

osteoarthritic nodes found in proximal fingers

medications for osteoarthritis

NSAIDs or acetaminophen corticosteroids if not severe NO SYSTEMIC DRUGS because not necessarily on both sides

rheumatoid arthritis

immune complexes mix with rheumatoid factor to cause SYMMETRICAL inflammation of joints

meds for rheumatoid arthritis

-NSAIDs -systemic drugs: DMARDs and BRMs

SE of NSAIDs

GI bleed (tarry stool) nephrotoxicity ulcers HTN

stages of rheumatoid arthritis

1- mild- synovial membrane swelling with excess WBC not on x ray 2- moderate- increased joint inflammation gradual destruction of cartilage 3-severe- joint cartilage eroded 4- end stage- inflammatory process subsides

lab work for rheumatoid arthritis

ESR= (erythrocyte sediment rate) "how heavy RBC is" that relates to inflammation C-reactive protein= indication of level of inflammation

fibromyalgia

chronic, widespread muscle pain and fatigue negative psychological effect increased pain perception

SLE (lupus)

autoimmune disorder marked by butterfly rash, Swan neck deformed phalanges, and malaise

gout

joint pain caused by increased uric acid big toe decrease purines (alcohol and red meat), decrease weight

CAUTION warning signs for cancer

C = Change in bowel or bladder habits. A = A sore that does not heal. U = Unusual bleeding or discharge. T = Thickening or lump in the breast, testicles, or elsewhere. I = Indigestion or difficulty swallowing. O = Obvious change in the size, color, shape, or thickness of a wart, mole, or mouth sore. N = Nagging cough or hoarseness.

testicular self exam

perform monthly same day during warm shower use both hands to feel each testis separately palpate gently using thumb and first 2 fingers report, hardened lump, scrotal swelling, dull ache

breast self cancer

Monitor for any change in size, contour, dimpling. Perform exam every month, 2 to 3 days after your period. Use finger pads of the three middle fingers.

cancer screening guidelines

Men/ - PSA test (prostate-specific antigen) - Testicular self-exam Women Breast Cancer - Mammogram (50-74, early as 40) Cervical Cancer - Pap test (21+) Colon Cancer - begin screening after 50-75 Lung Cancer - LDCT screening for smokers - typically, between 55-80

cancer with highest death rates

lung

kubler ross stages

denial, anger, bargaining, depression and acceptance