Howard Realubit, Cohort 65

Cancer Prep Assignment

Please be succinct and concise. This should serve as a study guide. References for completing concept map should be
your Lewis text, book slides, Saunders text, other course related text books and/or posted materials on Sekai (Do not
Google for answers). Submit through Sekai prior to the start of class. Late assignments not accepted.
Define the following key terms:
1. carcinogens, p. 250
a. Carcinogens are chemical, viral, or radiative substances that cause cancer. They are detoxified by protective
enzymes that secrete them out of the body. Should this mechanism fail, the substances may enter the nucleus
and subsequently, the DNA.
2. carcinoma in situ, p. 254
a. Carcinoma in situ is a localized neoplasm with no intention of invasion. It has all the other histologic
characteristics of cancer.
3. metastasis, p. 251
a. Metastasis refers to the spread of the cancer to a distant site.
4. nadir, p. 265
a. The lowest point in a patients CBC that can lead to neutropenia after receiving chemotherapy or radiation.
5. vesicants, p. 25
a. Vesicants are irritants that when titrated into the skin cause severe local tissue breakdown and necrosis.
Irritants, in general, may irritate the intima of the vein, but vesicants will cause greater damage.
Answer the following questions:
1. Describe the two major dysfunctions in cancer development.
2. Describe the difference between benign and malignant.
a. Benign means that the cancer is localized. Malignant means that the cancer has metastasized to another site.
3. List four diagnostic tests for cancer detection.
a.
4. List the warning signs of cancer.
a. Warning signs include the abbreviation: CAUTION

i. C change in bowel or bladder status

ii. A a sore that does not heal
iii. U unusual bleeding or discharge from an orifice
iv. T tumor
v. I invigoration
vi. O optional
vii. N new cough
5. List cancer prevention/reduction strategies

Eat a balanced diet that includes vegetables and fresh fruits (see Fig. 40-1 and Table 40-1), whole grains, and adequate
amounts of ber. Reduce dietary fat and preser- vatives, including smoked and salt-cured meats contain- ing high nitrite
concentrations.

Reduce or avoid exposure to known or suspected car- cinogens and cancer-promoting agents, including ciga- rette smoke
and sun exposure.

Limit alcohol intake.

Participate in regular exercise (i.e., 30 minutes or more of moderate physical activity ve times weekly).

Maintain a healthy weight.

Obtain adequate, consistent periods of rest (at least 6 to 8 hours per night).

Eliminate, reduce, or change the perception of stressors and enhance the ability to e ectively cope with stressors

Have a regular physical examination that includes a health history. Be familiar with your own family history and your risk
factors for cancer.

Learn and follow the American Cancer Societys recom- mended cancer screening guidelines for breast, colon, cervical, and
prostate cancer. ARNING SIGNS

Limit alcohol use.

Get regular physical activity.

Maintain a normal body weight.

Obtain regular colorectal screenings.

Avoid cigarette smoking and other tobacco use.

Get regular mammography screening and Pap tests.

Use sunscreen with a sun protection factor of 15 or higher.

Practice healthy dietary habits, such as reduced fat consumption and increased fruit and vegetable consumption.
Learn and practice self-examination (e.g., breast or tes- ticular self-examination).
Know the seven warning signs of cancer, and inform the health care provider if they are present
Seek immediate medical care if you notice a change in what is normal for you and if cancer is suspected.
6. Describe methods of cancer classification
a. Cancer classification includes anatomical and TNM staging. Anatomical classification involves sites such as
epithelial, connective tissue, nervous tissue, and hematopoietic:
i. Epithelial Tissue: benign (-oma); malignant (-carcinoma)
ii. Connective Tissue: benign (-oma); malignant (-sarcoma)
iii. Nervous Tissue: benign (-oma); malignant (-oma)
iv. Hematopoietic: (no suffixes)
7. Describe the differences between curative, controlling and palliative cancer treatment.
a. Curative seeks to eradicate the cancer using local chemo or radiative therapy. The longer the remission
duration, the higher the chances of cure.
b. Controlling is maintenance therapy of cancer that cannot be eradicated but is responsive to treatment.
c. Palliative cares purpose is to make the patient comfortable and allowing the body to maintains its function.
This may include inserting a GI feeding tube, prophylactic surgery to fix bone metastasis, and inserting central
venous lines.
8. What are the late effects of chemotherapy and radiation?

a. Late effects of chemotherapy involve damage to the kidneys, liver and lungs that may manifest during or after
treatment. Nausea and vomiting can also appear.
b. Differential rate of cells can affect the effectiveness of radiation therapy. The higher the mitotic rate of the
cells, the more acute is the response to radiation. Late effects include cumulative radiation which can lead to
physiologic effects.
9. How is neutropenia calculated? What are neutropenic precautions?
a. Neutropenia is defined as absolute neutrophil count (ANC) of less than 1000 cells/L (1x10^9/L). Severe
neutropenia is less than 500 cells/L. Normal range is 2200 to 7700 cells/L.
b. Neutropenic precautions involve assessing low-grade fever, that may indicate infection and possibly sepsis.
Fever of 100.4degF [38degC] and severe neutropenia is a medical emergency. Blood cultures should be drawn
STAT and antibiotics administered within the hour.
Concept Maps
Complete one concept map for each disease listed below. Content should fit on one page. You may adjust text boxes
sizes as needed.
1. Non Hodgkins Lymphoma
2. Hodgkins lymphoma
3. AML
4. ALL
5. CML
6. CLL

Disease: Non-Hodgkins Lymphoma

Cause(s): Idiopathic

Pathophysiology: Unknown etiology.

Maybe chromosomal translocations,
infections,
factors,
Nursing Dxenvironmental
(Priorities)
immunodef. status.
1. Activity intolerance related
to decreased oxygencarrying capacity of blood
secondary to proliferation
of WBC
2. Ineffective peripheral

Subjective
data: Common on
Objective
physical
people with
assessment
dataimmunodef.
Syndromes and/or using
immunosuppressive
meds,
Medications/Treatments:
Chemo or
chemo, radiation therapy
radiation therapy; H.pylori gastric lymph tx
with ATB or antiviral therapy. Monoclonal
antibodies.

Objective-Diagnostic tests and

labs: CBC followed by bone marrow
aspiration.
Patient teaching: Radiation
Nursing Interventions:
safety issues; Peripheral T-cell
lymph
tx assess
similarfor
to interm./high
1. During
ADL,
dyspnea on
grade
B-cell
lymph
without
exertion, HA, HTN (activity
rituximab b/c not CD20
intolerance)
2. Assess for edema for lymphedema
and limb hypoxia from
chemo/radiation therapy (tissue
perfusion)

Disease: AML Acute Myelogenous Lymphoma

Nursing Dx (Priorities)

Cause(s): Unknown;
possible Epstein-Barr virus,
genetic predisposition; toxin
exposure; HIV

Subjective data: Painless

lymph node enlargement

1. Acute pain related to disease

process, surgical intervention, or
tx effects

Objective-Diagnostic tests and

labs: PET, CT

2. Chronic pain related to direct

tumor involvement
Pathophysiology: AML: uncontrolled
proliferation of myeloblasts,
hyperplasia of bone marrow. Clinical
manifestations usually related to
replacement of normal hematopoietic
cells in marrow by leukemic
myoblasts and infiltration of other
organs & tissue.

Patient teaching:

Objective physical
assessment data:
Lymphadenopathy &
constitutional sx. Fever, night
sweats, weight loss.
Lymphomas in leukemic
phase.

Medications/Treatments: ABVD (standard);

BEACOPP; Chemotherapy: Brentuximab
vedotin; intensive autologues or allogenic
HSCT; combo

Nursing Interventions: largely based on

managing problems related to disease,
pancytopenia, other SESupport through
tx consequencesAddress physical,
psychologic, social, spiritual
consequencesFertility
issues.Secondary delayed
consequences.

Disease: ALL-Acute Lymphocytic Leukemia

Nursing Dx (Priorities)

Cause(s): Unknown;
possible Epstein-Barr virus,
genetic predisposition; toxin
exposure; HIV

Subjective data: Painless

lymph node enlargement

1. Acute pain related to disease

process, surgical intervention, or
tx effects

Objective-Diagnostic tests and

labs: PET, CT

2. Chronic pain related to direct

tumor involvement
Pathophysiology: ALL: immature small
lymphocytes prolif. In bone marrow;
most are B cell origin. Majority of
patients have fever at time of origin.

Patient teaching:

Objective physical
assessment data:
Lymphadenopathy &
constitutional sx. Fever, night
sweats, weight loss.
Lymphomas in leukemic
phase.

Medications/Treatments: ABVD (standard);

BEACOPP; Chemotherapy: Brentuximab
vedotin; intensive autologues or allogenic
HSCT; combo

Nursing Interventions: largely based on

managing problems related to disease,
pancytopenia, other SESupport through
tx consequencesAddress physical,
psychologic, social, spiritual
consequencesFertility
issues.Secondary delayed
consequences.

Disease: CML-Chronic Myelogenous Leukemias

Nursing Dx (Priorities)

Cause(s): Unknown;
possible Epstein-Barr virus,
genetic predisposition; toxin
exposure; HIV

Subjective data: Painless

lymph node enlargement

1. Acute pain related to disease

process, surgical intervention, or
tx effects

Objective-Diagnostic tests and

labs: PET, CT

2. Chronic pain related to direct

tumor involvement
Pathophysiology: CML: excessive
development of mature neoplastic
granulocytes in bone marrow.
Patient teaching:

Objective physical
assessment data:
Lymphadenopathy &
constitutional sx. Fever, night
sweats, weight loss.
Lymphomas in leukemic
phase.

Medications/Treatments: ABVD (standard);

BEACOPP; Chemotherapy: Brentuximab
vedotin; intensive autologues or allogenic
HSCT; combo

Nursing Interventions: largely based on

managing problems related to disease,
pancytopenia, other SESupport through
tx consequencesAddress physical,
psychologic, social, spiritual
consequencesFertility
issues.Secondary delayed
consequences.

Disease: CLL-Chronic Lymphocytic Leukemia

Nursing Dx (Priorities)

Cause(s): Unknown;
possible Epstein-Barr virus,
genetic predisposition; toxin
exposure; HIV

Subjective data: Usually

older patients.

1. Acute pain related to disease

process, surgical intervention, or
tx effects

Objective-Diagnostic tests and

labs: PET, CT

2. Chronic pain related to direct

tumor involvement
Pathophysiology: CLL: pressure on
nerves from enlarged lymph nodes
cause pain/paralysis. Mediatinal node
enlargement leads to pulm sx.

Patient teaching:

Objective physical
assessment data:
Lymphadenopathy &
constitutional sx. Fever, night
sweats, weight loss.
Lymphomas in leukemic
phase.

Medications/Treatments: ABVD (standard);

BEACOPP; Chemotherapy: Brentuximab
vedotin; intensive autologues or allogenic
HSCT; combo

Nursing Interventions: largely based on

managing problems related to disease,
pancytopenia, other SESupport through
tx consequencesAddress physical,
psychologic, social, spiritual
consequencesFertility
issues.Secondary delayed
consequences.

Disease: Hodgekins Lymphoma

Cause(s): Unknown;
possible Epstein-Barr virus,
genetic predisposition; toxin
exposure; HIV

Subjective data: Painless

lymph node enlargement

Nursing Dx (Priorities)
1. Acute pain related to disease
process, surgical intervention, or
tx effects

Objective-Diagnostic tests and

labs: PET, CT

2. Chronic pain related to direct

tumor involvement
Pathophysiology: Lymph node
structure destroyed by hyperplasia of
monocytes & macrophages. (+)
presence of Reed-Sternberg cells
from biopsy. Arises from single
usually cervical lymph node and
spreads to other lymph nodes.

Patient teaching:

Objective physical
assessment data:
Lymphadenopathy &
constitutional sx. Fever, night
sweats, weight loss.
Lymphomas in leukemic
phase.

Medications/Treatments: ABVD (standard);

BEACOPP; Chemotherapy: Brentuximab
vedotin; intensive autologues or allogenic
HSCT; combo

Nursing Interventions: largely based on

managing problems related to disease,
pancytopenia, other SESupport through
tx consequencesAddress physical,
psychologic, social, spiritual
consequencesFertility
issues.Secondary delayed
consequences.