Cancer and Pain Management Quiz

NUR2229 Exam Revision 2024

• Exam revision covers pain, oncology, and palliative and end-of-life care.
• Revision layout includes pain revision, oncology revision, and palliative and end-of-life care revision.

Pain: Learning Outcomes (Weeks 4 and 6)

• Definitions and types of pain
• Components of the pain pathway and response
• Physiological changes associated with pain
• Pain assessment processes and tools
• Psychosocial aspects of pain
• Principles of optimal pain management
• Pain management plan use
• Use of WHO pain ladder and suggested changes
• Different medications for pain management
• Multi-modal analgesia use
• Non-pharmacological pain management methods
• Complementary and alternative therapies

Transduction

• Response to tissue injury
• Sensory receptors activated by noxious stimuli
• Release of chemical mediators (e.g., prostaglandins, substance P, bradykinin)
• Conversion of energy types
• Generation of action potential

Transmission

• Three phases: injury site to spinal cord (dorsal horn), spinal cord to brain stem and thalamus, thalamus to cortex
• Carried by A-delta and C fibres
• Crossover at dorsal horn to interneurons
• Neurons carry impulse

Perception

• Conscious experience of pain
• Structures activated in the brain (reticular activating system, somatosensory system, limbic system, cortical structures)

Modulation

• Signals from brain travelling downwards
• Chemicals (e.g., enkephalins, endorphins, serotonin, noradrenaline)
• Dampens pain experience
• Signals can be enhanced or inhibited
• Influences pain perception and variability

Gate Theory

• Existence of a "gate" (dorsal horn)
• Facilitates or inhibits pain signals
• Descending and ascending fibres meet at the gate
• Gate open/closed depending on received information (e.g., rubbing)
• Activity such as rubbing can close the gate, reducing pain
• Emotions and past experience can open the gate, increasing pain

Pain Terms

• Allodynia: pain from a stimulus not normally painful
• Analgesia: absence of pain sensitivity
• Hyperalgesia: excessive pain sensitivity
• Paraesthesia: abnormal burning, tingling, or numbing sensation

Elements of the Pain Pathway

• Classification of pain (acute, chronic)
• Pain nature (nociceptive, non-nociceptive)
• Pain sources (visceral, nociceptive, neuropathic)
• Pain threshold: point at which a person feels pain
• Pain tolerance: level of pain a person can endure

Assessment and Tools for Acute Pain

• Uni-dimensional scales (numerical, visual analog, verbal)
• Multidimensional scales (behavioural, functional)
• PQRST, OPQRSTUV, initial pain assessment tools

Persistent Pain

• Persistent pain assessment (includes acute assessment + other)
• Numerical, visual analogue, verbal rating scales
• Brief pain inventory (long and short forms), McGill pain questionnaire (long and short forms)

Oncology: Definition

• Cancer is a disease characterized by uncontrolled growth and spread of abnormal cells
• Cancer cells derived from normal cells (neoplastic transformation)

Oncology Nursing: Learning Outcomes (Week 4 & 6)

• Changes in carcinogenesis, tumour growth and staging
• Common neoplastic conditions and associated physical/psychosocial issues
• Factors related to sexuality, culture, and diversity in individuals with cancer
• Clinical management of cancer conditions, side effects and treatment complications
• Non-pharmacological measures in cancer
• Role of nurse/midwife in interprofessional oncology team

Cancer Cell Biology and Cancer Differentiation

• Loss of cellular proliferation is a cancer feature
• Normal cells have differentiation characteristics
• Well-differentiated cancers vs. Poorly differentiated
• Undifferentiated (no clear cell of origin)

Tumour Growth

• Time from a single cell to detectable tumour size (doubling time)
• Palpable tumour size is usually at around 30 doublings
• Cancer death usually occurs at around 40 doublings

Oncogenes

• Oncogenes are mutated forms of proto-oncogenes, normal growth promoting genes in normal cells (growth factor, cell survival, cell cycle control)

Cancer Cell Biology

• Body cells exposed to environmental/personal factors, impacting cellular growth and function
• Transformed, abnormal, and harmful cancer cells

Apoptosis

• Programmed death of cells maintaining healthy tissues to balance cell division

The Metastatic Cascade: 8 Stages

• Tumour initiation, progression, proliferation, angiogenesis
• Invasion/intravasation, extravasation, colony formation, evasion of host defences

TNM Staging

• Tumour (size and extent of primary tumor)
• Nodes (nearby lymph node involvement)
• Metastasis (spread to other sites)

Cancer Screening and Statistics

• Information on breast, bowel, and cervical cancer screening programs

Modifiable Risk Factors

• Quitting smoking, limiting alcohol, eating healthily, sun protection, maintaining a healthy weight, regular exercise

Cancer Treatments

• Surgery (with radiation like brachytherapy vs. external radiotherapy), chemotherapy, targeted therapy (e.g. Herceptin, hormonal therapy), immunotherapy (e.g pembrolizumab)

Chemotherapy

• Agents that cannot distinguish between normal and malignant cells to target rapidly dividing cells
• Works by interfering with DNA replication
• Aims for the cell to undergo apoptosis (programmed cell death)
• Adjuvant vs. neoadjuvant treatments

Chemotherapy Drugs

• Classified according to their cell cycle activity (phase specific vs. non-specific)

Cell Kill Hypothesis

• Chemotherapy concentration for a defined period kills a consistent fraction of cells in the population irrespective of the initial number.
• Goal is to reduce the tumour size to 0 with successive fractional kills

Radiotherapy

• Controlled dose of radiation kills or damages cancer cells (internal or external treatment)

Other Treatments

• Psychoeducational interventions
• Cognitive behavioural methods
• Exercise and complementary therapies
• Multimodal interventions

Oncology Emergencies

• Neutropenic Sepsis, Spinal Cord Compression, Tumor Lysis Syndrome, Superior Vena Cava obstruction, Hypercalcaemia

Interprofessional Oncology Team

• A multidisciplinary team including specialists like pharmacists, occupational therapists, medical oncologists, social workers, GPs, surgeons, nurses, palliative care specialists, physiotherapists, radiotherapists, dietitians, psychologists

Palliative and End-of-life learning outcomes (Weeks 3 and 5)

• Principles of assessment and management of clinical and supportive care needs
• Palliative care management issues, symptom control and health promotion
• Challenges in family and person-centred care at the end of life
• Role of the nurse/midwife in the interprofessional team
• Medico-legal and ethical aspects for end of life care
• Discussing contemporary end of life issues, dilemmas
• Models for loss, grief and bereavement
• Self-reflection of own experiences
• Communicating effectively to support individuals, families and others
• Differentiating between uncomplicated and complicated grief responses

Elements of Palliative Care

• Palliative care available to all with a progressive disease, regardless of diagnosis
• Affirming life and recognising dying as inevitable
• Not intended for speeding up or delaying death

Advance Care Planning

• Victorian Medical Treatment Planning and Decisions Act (2016)
• Advance Care Directives, Instructional Preferences, Values

Provision of Palliative Care

• Various locations for palliative care (community based and hospital based)

Nursing Careers in Palliative Care

• Generalist nurse, specialist palliative care nurse, clinical nurse specialist, palliative care nurse consultant, nurse practitioner

Loss, Grief and Bereavement

• Experience of death, dying and grief are impacted by personality, social factors, religion relationship with others, concurrent stress, and how the person died

Palliative and End-of-Life Care

• Including the patient and family in the care team.
• Palliative care responsible for family/carers post-bereavement.
• Bereavement risk assessment for families and significant others

Terms

• Grief: personal response to loss.
• Bereavement: period after a loss.
• Mourning: outward expression of grief.

Key Theorists

• Elizabeth Kubler-Ross (stage model): denial, anger, bargaining, depression, acceptance
• William Worden (task model): task model for grief has four tasks.
• Margaret Strobe and Henk Schut (dual process model)

Voluntary Assisted Dying

• Details on the Victorian Parliament's legislation on voluntary assisted dying

Exam Format

• 2-hour E-assessment with 1 short case study for each domain.
• Domain questions included (pain, oncology, palliative and end-of-life care)

Test your knowledge on pain sensitivity, cancer treatments, and assessment tools related to acute and persistent pain. This quiz covers important terms, theories, and classifications in the field of oncology and pain management.