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78 Terms
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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
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
cancer originating from skin, glands, and mucus in GI, GU, or respiratory tract
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
altered taste perception
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
for radiation; as low as reasonably possible
dry desquamation
redness and tenderness avoid extreme temperatures
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wet desquamation
pain, drainage, and increased risk of infection
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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
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
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
focusing light rays in FRONT of retina "Nearsightedness" unable to see far distances
light rays focus behind retina "farsightedness" unable to see up close
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
bilateral inflammation of lid margins crusty and scaly can be treated with antibiotic ointment or baby shampoo
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infection (s. aureus) or inflammation of conjunctiva treated with antibiotic drops can also be allergic or viral
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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
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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
chronic disease marked by low bone mass and easily fractured bones RF: older women, thinner (UNDER 25 BMI), low calcium, sedentary, smoking
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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)
osteoporosis med that inhibits bone resorption take 30 min before eating and sit up because of GI effects
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
slow, progressive inflammatory disorder of freely moving joints gradual loss of arterial cartilage osteocyte formation NOT symmetrical
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osteoarthritis assessment findings
joint pain Heberden's nodes and Bouchard's nodes one leg shorter than the other NOT SYMMETRICAL EFFECTS
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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
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
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
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
kubler ross stages
denial, anger, bargaining, depression and acceptance