1. Focused Assessment
1.1. Vital Signs at least Q8H
1.1.1. Pain Level
1.1.1.1. Especially terminally ill patients
1.1.1.2. Reassess before and after pain interventions
1.1.2. Blood pressure & heart rate
1.1.2.1. Sepsis
1.1.2.2. Superior vena cava syndrome
1.1.2.3. Tumor lysis syndrome
1.1.2.3.1. Hyperkalemia
1.1.3. Temperature
1.1.3.1. Possible infection
1.1.3.1.1. Sepsis
1.2. S/S of infection
1.2.1. Skin and mucous membrane
1.2.2. Mouth
1.2.3. Lung sounds
1.3. Venous Access Device
1.3.1. Every 30 to 60 minutes during chemo
1.3.1.1. A client is receiving a chemotherapeutic agent intravenously through a peripheral line. What is the nurse’s first action when the client reports burning at the site?
1.3.1.1.1. Check for a blood return.
1.3.1.1.2. Slow the rate of infusion.
1.3.1.1.3. Discontinue the infusion.
1.3.1.1.4. Apply a cold compress.
1.4. Oncologic Emergencies
1.4.1. Sepsis
1.4.1.1. Septic Shock
1.4.1.2. Disseminated intravascular coagulation (DIC)
1.4.1.2.1. Clotting
1.4.1.2.2. Bleeding
1.4.2. SIADH
1.4.2.1. Euvolemia
1.4.2.2. Dilutional hyponatremia
1.4.2.2.1. Cerebral (brain) edema
1.4.3. Spinal Cord Compression
1.4.3.1. Back pain
1.4.3.2. Target various systems
1.4.3.2.1. Neuromuscular
1.4.3.2.2. Cardiovascular
1.4.3.2.3. Respiratory
1.4.3.2.4. GI
1.4.3.2.5. GU
1.4.4. Hypercalcemia
1.4.4.1. "Stones, Bones, Groans, Overtones"
1.4.4.1.1. Kidney stones
1.4.4.1.2. Skeletal/bone pain
1.4.4.1.3. GI Effects
1.4.4.1.4. Neuropsych
1.4.5. Tumor Lysis Syndrome
1.4.5.1. Hyperkalemia
1.4.5.1.1. Cardiac dysrhythmias
1.4.5.2. Hyperuricemia
1.4.5.2.1. Acute kidney injury
1.4.5.3. Hyperphosphotemia
1.4.5.3.1. 2/2 acute kidney injury
1.4.6. Superior Vena Cava Syndrome
1.4.6.1. Edema of face & around the eyes
1.4.6.2. Laryngeal edema
1.4.6.2.1. Cough
1.4.6.2.2. Stridor
1.4.6.3. Cerebral edema
1.4.6.3.1. Confusion
1.4.6.3.2. Headache
1.4.6.3.3. Comatose
1.4.6.4. Distention of veins (head, neck, chest)
1.4.6.4.1. Facial Plethora
1.4.7. Questions
1.4.7.1. Question 1
1.4.7.1.1. A patient with advanced metastatic lung cancer experiences fatigue, weakness, nausea, and vomiting. The patient's blood report shows a high level of calcium in the blood. How should the nurse interpret this lab finding?
1.4.7.2. Question 2
1.4.7.2.1. A patient with lung cancer develops headaches, facial edema, periorbital edema, and distention of the veins in the head, neck, and chest. The nurse expects that what will be included in the patient's treatment plan? Select all that apply.
1.4.7.3. Question 3
1.4.7.3.1. A patient with multiple myeloma is sleeping most of the day, has no energy or appetite, and does not seem to care about anything. The patient also reports nocturia. Which complication of cancer is this most likely caused by?
1.4.7.4. Question 4
1.4.7.4.1. A patient with lung cancer presents with intense, localized, persistent back pain and motor and sensory disturbances. What nursing interventions would be helpful to this patient? Select all that apply.
1.4.7.5. Question 5
1.4.7.5.1. The nurse is caring for a patient receiving an initial dose of chemotherapy to treat a rapidly growing metastatic colon cancer. The nurse is aware that this patient is at risk for tumor lysis syndrome (TLS) and will monitor the patient closely for which abnormality associated with this oncologic emergency?
1.4.7.6. Question 6
1.4.7.6.1. A patient with cancer develops sudden onset of chest heaviness, shortness of breath, tachycardia, hoarseness, and a reduced level of consciousness with muted heart sounds. The nurse expects that the immediate treatment plan for this patient will include what interventions? Select all that apply.
1.4.7.7. Question 7
1.4.7.7.1. A patient with cancer of the esophagus presents with weight gain without edema, anorexia, and oliguria. The patient's serum sodium is 120 mEq/L. Which nursing measures would help to relieve the patient's symptoms? Select all that apply.
1.5. Adverse effects of CA treatment
1.5.1. Bone marrow suppression
1.5.1.1. Anemia
1.5.1.1.1. What is the priority problem for a client experiencing chemotherapy-induced anemia?
1.5.1.2. Neutropenia
1.5.1.2.1. Risk for infection
1.5.1.2.2. Older Adults at GREATEST RISK
1.5.1.2.3. Check VS Q4H
1.5.1.2.4. Monitor WBC daily
1.5.1.2.5. Inspect mouth and perianal Q8H
1.5.1.2.6. Check IV site Q4H
1.5.1.3. Thrombocytopenia
1.5.1.3.1. Risk for bleeding
1.5.2. Chemo-Induced N/V (CINV)
1.5.2.1. Risk for dehydration
1.5.2.2. Acute, delayed or anticipatory
1.5.3. Oral Toxicity
1.5.3.1. Mucositis
1.5.3.1.1. Risk for superinfection
1.5.3.1.2. May be painful
1.5.3.2. Xerostomia
1.5.3.3. Gingival bleeding
1.5.3.3.1. 2/2 thrombocytopenia
1.5.4. Chemo-induced peripheral neuropathy
1.5.4.1. Risk for INJURY
1.5.5. Alopecia
1.5.5.1. Transient and almost always reversible
1.5.5.2. Risk for disturbed body image
1.5.6. Thrombosis
1.5.6.1. Hormonal therapy
1.6. Diagnostic and laboratory studies
1.6.1. CBC
1.6.1.1. Pancytopenia
1.6.1.1.1. WBC and ANC
1.6.1.1.2. H/H
1.6.1.1.3. Platelet
1.6.1.1.4. Nadir
1.6.2. CMP
1.6.2.1. K+
1.6.2.1.1. Tumor lysis syndrome
1.6.2.2. Na+
1.6.2.2.1. SIADH
1.6.2.3. BUN & Cr
1.6.2.3.1. Baseline function
1.6.2.3.2. Dehydration
1.6.2.4. LFTs
1.6.2.4.1. Baseline funtion
1.6.2.4.2. Metastatsis
1.6.2.5. Ca
1.6.2.5.1. Hypercalcemia of malignancy
1.6.2.5.2. Metastasis to the bones
1.6.3. Biopsy
1.6.3.1. Pathology studies
1.6.3.1.1. Staging and Grading
1.6.4. Tumor Markers
1.6.4.1. CEA
1.6.4.1.1. Colorectal CA
1.6.4.2. CA-125
1.6.4.2.1. Ovarian CA
1.6.4.3. CA 19-9
1.6.4.3.1. Pancreatic CA
1.6.4.4. AFP
1.6.4.4.1. Testicular CA
1.6.4.4.2. Liver CA
1.6.4.5. PSA
1.6.4.5.1. Prostate CA
1.6.5. Imaging
1.6.5.1. MRI
1.6.5.2. CT
1.6.5.3. US
1.6.5.4. X-Ray
1.6.6. Questions
1.6.6.1. Following a surgery for colorectal cancer, the patient still has persistent carcinoembryonic antigen (CEA) levels. Which is a correct interpretation of high CEA levels?
1.6.6.1.1. a. The tumor has spread to other organs.
1.6.6.1.2. b. The tumor has not been completely removed.
1.6.6.1.3. c. The patient is suffering from chronic liver disease.
1.6.6.1.4. d. Carcinoembryonic antigen is not a reliable indicator.
2. Risk factors
2.1. Family history
2.1.1. e.g., breast cancer
2.1.2. e.g., colorectal cancer
2.2. Exposure to carcinogens
2.2.1. Lips, oral, tonsil, pharynx
2.2.1.1. Tobacco, ETOH, HPV-16
2.2.2. Esophagus
2.2.2.1. Tobacco, ETOH, H. pylori
2.2.3. Stomach
2.2.3.1. Tobacco, H. pylori
2.2.4. Colon, rectum
2.2.4.1. Tobacco, ETOH
2.2.5. Anus
2.2.5.1. HIV, HPV-16
2.2.6. Liver
2.2.6.1. ETOH, Hepatitis B & C, tobacco
2.2.7. Pancreas
2.2.7.1. Tobacco
2.2.8. Lungs
2.2.8.1. Tobacco, secondhand smoke, asbestos, coal, paint, etc.
2.2.9. Mesothelium (pleural & peritoneum)
2.2.9.1. Asbestos, Painting
2.2.10. Kaposi sarcoma
2.2.10.1. HIV
2.2.11. Skin (melanoma)
2.2.11.1. Solar radiation, UV tanning devices
2.2.12. Breast
2.2.12.1. ETOH, estrogen-Progesterone contraceptives, estrogen-progesterone menopausal therapy
2.2.13. Vulva, vagina & penis
2.2.13.1. HPV-16
2.2.14. Uterus & cervix
2.2.14.1. Estrogen-progesterone contraceptives, HIV, various types of HPV, tobacco
2.2.15. Endometrium
2.2.15.1. Estrogen–progesterone menopausal therapy, tamoxifen
2.2.16. Leukemia & Lymphoma
2.2.16.1. EBV, HIV, H. pylori, tobacco
2.3. Types of carcinogens
2.3.1. Tobacco
2.3.1.1. 30% of all cancers
2.3.1.2. > 60 chemicals in tobacco are carcinogenic
2.3.1.3. Secondhand non-smokers
2.3.1.3.1. Greatest risk for lung CA
2.3.2. Diet
2.3.2.1. Animal fats and proteins
2.3.2.2. Processed or preserved foods
2.3.2.2.1. Nitrites
2.3.3. Obesity
2.3.3.1. Increase inflammatory process
2.3.4. Infection including STI
2.3.4.1. H. pylori, hepatitis, HPV, HIV
2.3.5. Physical Inactivity
2.3.5.1. Increased insulin & IGF, Increased obesity, Increased inflammatory process, Decreased immune response
2.3.6. UV Rays
2.3.6.1. Basal cell & squamous cell carcinoma
2.3.7. Synthetic chemicals
2.3.7.1. Air, soil, foods, personal care products, toys, household products, medications, etc.