Content Analysis and Inference Quiz

Oncology Nursing

• Oncology nursing focuses on cancer and its treatment.
• Cancer is a disease process where an abnormal cell is transformed by genetic mutations in cellular DNA.
• Oncology is the branch of medicine dealing with the study, detection, treatment, and management of cancer.
• Oncology nursing involves the study, detection, and management of cancer, as well as neoplasia.
• The role of an oncology nurse involves providing information and education on cancer prevention and early detection.

True or False

• More than half of people diagnosed with cancer are not cured currently.
• Cancer often has warning signs, indicating the illness does not come on suddenly.
• Most cancers are not hereditary.
• Common treatments for cancer include surgery, radiation, and chemotherapy.
• A well-balanced diet can help manage side effects during cancer treatment.

True or False

• HPV, a virus linked to some cancers, is contagious.
• Men can develop breast cancer (it's rare).
• Chemotherapy isn't the only cancer treatment.
• Not everyone loses hair during chemotherapy.
• A positive attitude can positively affect a patient's experiences and emotional well-being and should not be considered a treatment.

Objectives

• Compare normal cell structure and function with cancer cells.
• Differentiate between benign and malignant tumors.
• Identify known carcinogenic agents and factors.
• Explain the importance of health education and preventive care in reducing cancer incidence.
• Differentiate between surgical procedures used in cancer treatment (diagnosis, prevention, pain relief, and reconstruction).
• Describe the roles of various cancer treatments (surgery, radiation, chemotherapy, targeted therapy, stem cell transplants, etc.).
• Discuss nursing care related to common cancer-related problems (skin integrity, hair loss, nutrition, body image concerns).
• Identify potential cancer-related complications and associated nursing care.
• Describe hospice care for advanced cancer patients.
• Identify assessment parameters and nursing management for oncologic emergencies.

What is Cancer?

• Cancer is a disease process where abnormal cells transform due to genetic mutations in cellular DNA.

What is Oncology?

• Oncology is the branch of medicine focused on the study, detection, treatment, and management of cancers.

Proliferative Patterns

• Atrophy, hypertrophy, hyperplasia, metaplasia, dysplasia, anaplasia, and neoplasia are all proliferative processes associated with cellular changes.

Cancer Terminology

• neo: new
• plasia: growth
• plasm: substance
• trophy: size
• oma: tumor
• a: none
• ana: lack
• hyper: excessive
• meta: change
• dys: bad, impaired

Cancer Types

• Epithelial tissues = carcinoma
• Glandular tissues = adenocarcinomas
• Connective, muscle, and bone tissues = sarcomas
• Brain and spinal cord tissues = gliomas
• Pigmented cells = melanomas
• Plasma cells = myelomas
• Lymphatic tissue = lymphomas
• Leukocytes = leukemia
• Erythrocytes = erythroleukemia

Benign vs. Malignant Tumors

• Benign tumors remain localized.
• Benign tumors grow slowly.
• Benign tumors do not spread easily.
• Malignant tumors invade tissues.
• Malignant tumors can metastasize (spread).
• Malignant tumors can grow quickly.

Malignant Cells

• Contain tumor-specific antigens.
• Contain less fibronectin.
• Cancer cell nuclei are often large and irregularly shaped (pleomorphism).
• Often contain chromosomal abnormalities and fragility of chromosomes.
• Mitosis (cell division) occurs more frequently in malignant cells.

Invasion and Metastasis

• Mechanical pressure pushes tumor cells into surrounding tissues.
• Malignant cells are less adherent and break off primary tumors to invade nearby structures.
• Enzymes (e.g., proteinases, collagenases, plasminogen activators, lysosomal hydrolyses) cause tissue damage.

Lymph Node Spread

• Cancer cells enter lymphatic channels via interstitial fluid.
• Malignant cells invade lymph vessels.
• Cancer cells can lodge in lymph nodes or travel between lymphatic and venous circulations.

Hematogenous Spread

• Malignant cell dissemination travels through the bloodstream.
• Cancer cells attach to the endothelium to access the blood stream.

Angiogenesis

• The formation of new blood vessels is crucial for tumor growth and spread.

Defenses Against Tumors

• T cell (cellular) immunity.
• B cell (humoral) immunity.
• Phagocytic cells..

Carcinogenesis

• Carcinogenesis is a three-step process (initiation, promotion, and progression).

Etiology (Causes of Cancer)

• Viruses and bacteria
• Physical agents (e.g., sunlight)
• Chemical agents (e.g., tobacco, environmental pollutants, occupational pollutants)
• Genetic factors
• Hereditary factors
• Dietary factors
• Hormonal factors.

Etiology for Specific Types: Breast Cancer

• Family history
• High-fat diet
• Obesity after menopause
• Early menarche, late menopause
• Alcohol consumption
• Postmenopausal estrogen and progestin
• Having first child after age 30

Etiology for Specific Types: Cervical Cancer

• Multiple sexual partners.
• Early sexual activity
• Exposure to HPV (human papillomavirus).
• Smoking

Etiology for Specific Types: Colorectal Cancer

• Family history.
• Low fiber diet.
• History of rectal polyps..

Etiology for Specific Types: Esophageal Cancer

• Heavy alcohol consumption.
• Smoking

Etiology for Specific Types: Lung Cancer

• Cigarette smoking
• Asbestos, arsenic, and radon exposure.
• Secondhand smoke

Etiology for Specific Types: Skin Cancer

• Excessive exposure to UV radiation.
• Fair complexion.
• Work with coal, tar, pitch or creosote
• Multiple or atypical nevi (moles)

Etiology for Specific Types: Stomach Cancer

• Family history.
• Heavy diet in smoked, pickled, or salted foods.

Etiology for Specific Types: Testicular Cancer

• Undescended testicles
• Mother's hormone exposure during pregnancy

Etiology for Specific Types: Prostate Cancer

• Increasing age.
• Family history.
• High animal fat diets.

Cancer Classification

• Solid tumors
• Hematological cancers

Cancer Grading

• Grade X: Grade cannot be determined.
• Grade 1: Cells differ slightly from normal cells and are well-differentiated.
• Grade 2: Cells are abnormal and are moderately differentiated.
• Grade 3: Cells are very abnormal and are poorly differentiated.
• Grade 4: Cells are immature and undifferentiated.

Cancer Staging

• T: Extent of the primary tumor
• N: Presence/absence of regional lymph node metastasis.
• M: Presence/absence of distant metastasis.

Cancer Staging: Primary Tumor (T)

• TX: Primary tumor cannot be assessed.
• T0: No evidence of primary tumor
• Tis: Carcinoma in situ
• T1, T2, T3, T4: Increasing size and/or local extent of the primary tumor.

Cancer Staging: Regional Lymph Nodes (N)

• NX: Regional lymph nodes cannot be assessed.
• N0: No regional lymph node metastasis.
• N1, N2, N3: Increasing involvement of regional lymph nodes.

Cancer Staging: Distant Metastasis (M)

• MX: Distant metastasis cannot be assessed.
• M0: No metastasis
• M1: Distant metastasis.

Cancer Prevention

• At least one-third of cancers are preventable.
• Early detection and treatment are crucial.
• Awareness of risk factors and warning signs is essential.

Warning Signs of Cancer

• Change in bowel or bladder habits
• A sore that does not heal
• Unusual bleeding or discharge
• Thickening or lump in breast or elsewhere
• Indigestion
• Obvious change in a wart or mole
• Nagging cough or hoarseness
• Unexplained anemia
• Sudden and unexplainable weight loss.

Prevention and Detection; Recommendations

• Promote awareness of risk factors.
• Promote healthy behaviors.
• Limit alcohol use.
• Hepa B infant vaccinations.
• STD control.
• Changing risk-related behaviors.
• Teaching skills for early detection.
• Promote programs participation.
• Maintain a healthy weight: balance calories and physical activity
• Adopt an active lifestyle: 30 - 60 min. of exercise for adults, 60 min for children/adolescents
• Consume a healthy diet, emphasizing plants: plenty of fruits and vegetables; limit processed and red meats.
• Detection of breast cancer: monthly breast self-examinations (BSE) and yearly mammograms from age 40.
• Colon/rectal cancer: yearly fecal occult blood test, digital rectal exam, flexible sigmoidoscopy every five years, colonoscopy every 10 years; starting at age 50 for fecal occult blood test.
• Uterine cancer: yearly pap smear for sexually active women and women age 18 and older.
• Prostate cancer: yearly digital rectal exam (DRE) and prostate-specific antigen (PSA) test from age 50.

Cancer Screening; Biopsy

• Types include needle, incisional, and excisional.
• Staging is also a part of cancer screening.

Cancer Screening; Methods

• Mammography
• Pap test
• Stool for occult blood
• Sigmoidoscopy
• Colonoscopy
• Skin inspection

Tumor Markers

• Oncofetal antigens (e.g., Carcinoembryonic antigen (CEA), alpha-fetoprotein).
• Hormones (e.g., ADH, calcitonin, catecholamines, HCG, PTH).
• Isoenzymes (e.g., neurospecific enolase (NSE), prostatic acid phosphatase (PAP).
• Tissue-specific antigens (e.g., prostate-specific antigen (PSA).

Questions (partial)

• Question 1: Provide definition for dysplasia.
• Question 2: Discuss how breast cancer is diagnosed.
• Question 3: Describe the purpose of breast self-examination.
• Question 4: Explain how HPV infection is a risk factor for cervical cancer.
• Question 5: Identify a pre-existing condition that may suggest colorectal cancer.
• Question 6: Describe early detection guidelines for breast cancer in 47-year-old women.
• Question 7: Identify a warning sign of cancer different than a nagging cough.
• Question 8: Describe American Cancer Society guidelines for women regarding mammogram frequency.
• Question 9: Describe the ABCD method for skin lesion assessment.
• Question 10: Explain actions a male client over 52 can take to identify prostate cancer early.

Radiation Therapy

• Internal radiation therapy (brachytherapy): implanted, ingested, injected into the affected tissue or body cavity.
• External radiation therapy (teletherapy): use of a machine to deliver radiation to a body area.
• Side effects of brachytherapy: fatigue. anorexia. immunosuppression.
• Side effects of teletherapy: tissue damage, ulcerations, nausea/vomiting/diarrhea, radiation pneumonia, fatigue, alopecia, and immunosuppression.

Brachytherapy: Education

• Avoid close contact with others until treatment ends.
• Continue daily activities unless contraindicated.
• Rest as needed.
• Maintain a balanced diet and fluid intake.
• Excreted body fluids may be radioactive; double flush toilets.

Brachytherapy: Nursing Management

• Minimize time spent near radiation sources.
• Keep a minimum distance of 6 feet from radiation sources.
• Use lead shields.
• Place clients in private rooms.
• Ensure safe handling and disposal of body fluids.
• Pregnant women and children in restricted areas.

Chemotherapy

• Routes: IV, oral, intrathecal, topical, intra-arterial, intracavity, and intravesical.

Chemotherapy; Agents

• Alkylating agents (e.g., Cyclophosphamide (Cytoxan), Busulfan (Myleran), Mecholorethamine (Mustargen)).
• Antimetabolites (e.g., 5-fluorouracil (5-FU), Methotrexate).
• Cytotoxic antibiotics (e.g., Bleomycin (Blenoxane), Doxorubicin (Adriamycin)).
• Hormones and Hormone Antagonists (e.g., Diethylstilbestrol (DES), Tamoxifen (Nolvadex), Prednisone).
• Plant alkaloids (e.g., Vinca alkaloids, Etoposide)

Chemotherapy; Side Effects: Bone Marrow Suppression

• Leukopenia: Avoid crowds, infections, and young children. Avoid undercooked meat and raw fruits/vegetables.
• Thrombocytopenia: Use an electric razor, avoid contact sports (contact sports and other activities that may increase risk of bleeding such as playing contact sports), apply ice and seek medical attention if trauma occurs; avoid dental work or other invasive procedures. Avoid aspirin and aspirin-containing products.

Chemotherapy; Side Effects: GI Effects

• Education: Eat small, frequent, low-fat meals; avoid spicy and fatty foods; avoid extremely hot foods.
• Administer antiemetics prior to chemotherapy.

Chemotherapy; Side Effects: Stomatitis/Mucositis

• Education: Use a soft toothbrush, mouth swabs; avoid alcohol-containing mouthwashes, lemon glycerin solutions, and dental floss; consider chlorhexidine mouthwash.

Chemotherapy; Side Effects: Alopecia (Hair Loss)

• Education: encourage the client to choose a wig in advance; wash hair two or three times per week with mild shampoo, and pat hair dry. Avoid using a blow dryer.

Surgery - Type

• Primary treatment
• Prophylactic
• Palliative
• Reconstructive

Testicular Cancer

• Most common between ages 15 and 40.
• Metastasis occurs to lungs, liver, bone, and adrenal glands.
• Prevention: regular testicular examinations.
• Assessment: painless swelling, dragging sensation, palpable lymphadenopathy

Interventions; Testicular Cancer

• Prepare the patient for treatment (radiation or unilateral orchiectomy)
• Discuss and provide information on reproduction options and fertility.
• Post-operative care: Monitor for bleeding, infections, wound drainage; monitor intake and output; notify physician immediately if any issues arise. Perform/instruct in monthly testicular self-examination of remaining testicle when appropriate/necessary.

Cervical Cancer

• Pre-invasive cancer: limited to cervix.
• Invasive cancer: affects cervix and other pelvic structures.
• Metastasis typically confined to pelvis via lymphatic spread.
• Pre-malignant changes follow a continuum.
• Assessment: painless vaginal bleeding, foul smelling vaginal discharge, pelvic/lower back/leg/groin pain, anorexia/weight loss, urinary/fecal leakage, dysuria/hematuria, cytological changes on pap test.

Interventions; Cervical Cancer

• Nonsurgical: Chemotherapy, Cryosurgery, External Radiation, Internal Radiation Implants, Laser therapy.
• Surgical: Hysterectomy, pelvic exenteration.

Post-operative Care; Hysterectomy

• Estrogen replacement if ovaries were removed.
• No vaginal entry, douching, or intercourse for 4-6 weeks.
• Avoid bending forward knees.

Ovarian Cancer

• Rapid growth and spread; often bilateral.
• Metastasis occurs via direct spread to pelvic organs, spread through lymph drainage or via peritoneal seeding.
• Prognosis is usually poor due to late diagnosis.
• Exploratory laparotomy for diagnosis and tumor staging.
• Assessment: Abdominal discomfort or swelling, gastrointestinal disturbances, and dysfunctional vaginal bleeding.

Interventions; Ovarian Cancer

• External radiation if tumor has spread to other organs.
• Chemotherapy post-operatively for all stages.
• Intraperitoneal chemotherapy.
• Immunotherapy to manage the immune response of the ovary and promotes tumor resistance.
• Total abdominal hysterectomy and bilateral salpingo-oophorectomy sometimes needed.

Endometrial Cancer

• Slow-growing tumor, usually associated with menopausal years.
• Metastasis occurs through lymphatic spread to ovaries and pelvis, blood to lungs, liver, and bone; or intra-abdominally to the peritoneal cavity.

Precipitating Factors; Endometrial Cancer

• History of uterine polyps.
• Nulliparity.
• Polycystic ovary disease.
• Estrogen stimulation.
• Late menopause.
• Family history.

Precipitating Factors; Endometrial Cancer - Continued

• Postmenopausal bleeding
• Watery/serosanguinous vaginal discharge
• Low back/pelvic/abdominal pain
• Enlarged uterus in advanced stages

Interventions; Endometrial Cancer

• Nonsurgical: External radiation, internal radiation, chemotherapy, hormonal manipulation(progesterone therapy, medication such as medroxyprogesterone (Depo-Provera), megestrol acetate(Megace) ) or antiestrogen (tamoxifen (Nolvadex)).
• Surgical: Total abdominal hysterectomy, bilateral salpingo-oophorectomy.

Breast Cancer

• Classified as invasive when it penetrates the surrounding mammary duct tissue.
• Common sites for metastasis: bones, lungs, brain, liver.
• Diagnosis: breast biopsy via needle aspiration or surgical removal of the tumor, microscopic examination of cells.
• Prevention: Monthly breast self-examinations (BSE).

Assessment; Breast Cancer

• Mass felt during BSE, usually in upper outer quadrant or beneath nipple.
• A fixed, irregular mass (except in late stages).
• Nipple retraction or elevation
• Asymmetry (affected breast being higher).
• Bloody or clear nipple discharge
• Skin dimpling, retraction, or ulceration
• Skin edema/peau d'orange skin
• Axillary lymphadenopathy
• Lymphedema of the affected arm
• Symptoms of bone and lungs metastasis
• Presence of lesions on mammography.

Interventions; Breast Cancer

• Nonsurgical: Chemotherapy, radiation therapy, hormonal manipulation (post-menopausal women).
• Surgical: Breast procedures with possible reconstruction, oophorectomy for estrogen receptor + tumors, ablative therapy with adrenalectomy or chemical ablation.

Gastric Cancer

• Malignant tumor in the stomach.
• Risk Factors: Diet high in complex carbs, grains, and salt, low in fresh green leafy vegetables and fresh fruit, smoking, alcohol ingestion, use of nitrates, history of gastric ulcers.
• Assessment: fatigue, weight loss, nausea/vomiting, indigestion, epigastric discomfort, dysphagia, anemia, ascites, palpable mass.

Interventions; Gastric Cancer

• Assessment: Monitor vital signs, hemoglobin & hematocrit/transfusions; nutritional status (small, bland, easily digestible meals w/ supplements). Give pain medication, prepare for chemo/radiation as prescribed, prepare for surgical resection of tumor as prescribed.
• Interventions: Monitor, Endoscopy

Interventions; Gastric Cancer - Continued

• Subtotal gastrectomy (Billroth I or II), total gastrectomy, esophagojejunostomy, removal of stomach with attachment of esophagus to jejunum/duodenum.

Pancreatic Cancer

• Common neoplasm affecting the pancreas.
• Linked to diabetes, alcohol use, pancreatitis, smoking, high-fat diet, and environmental chemicals.
• Tumors usually detected late, resulting in a poor prognosis.
• Assessment: Nausea, vomiting, jaundice, unexplained weight loss, clay-colored stools, glucose intolerance, abdominal pain.

Interventions; Pancreatic Cancer

• Radiation therapy
• Chemotherapy
• Whipple's procedure (similar to gastric surgery/care).

Intestinal Cancer

• Malignant lesions developing as polyps in the colon or rectum.
• Complications include bowel perforation, peritonitis, abscess formation, fistula, hemorrhage, and complete intestinal obstruction.
• Metastasis occurs via circulatory/lymphatic systems or by direct extension.
• Assessment: Blood in stool, anorexia/vomiting, malaise, anemia, abnormal stools; ascending colon tumor-diarrhea; descending -constipation/ribbon-like stools/partial obstruction; rectal-alternating constipation and diarrhea, guarding or abdominal distention, palpable abdominal mass (late), cachexia.

Interventions; Intestinal Cancer

• Monitor for signs of complications (bowel perforation, peritonitis, abscess, and fistula). Monitor for low blood pressure, rapid/weak pulse, and high temp.

• Note early sign of intestinal obstruction is increased peristaltic activity which produces increased bowel sounds, with hypoactive sounds as the obstruction progresses in intensity

• Prepare for radiation/surgical resection (preoperative).

• use chemotherapy post-operatively to control symptoms/spread.

Colon Cancer

• Cancer of the large intestine (colon).
• Most cases originate as benign clumps of cells (adenomatous polyps).
• Over time, some polyps become colon cancers.
• Assessment: Change in bowel habits, rectal bleeding, blood in stool, persistent abdominal discomfort (cramps,gas, pain), abdominal pain with bowel movements, feeling like bowel is not emptying completely, weakness/fatigue, unexplained weight loss.

Risk Factors; Colon Cancer

• Age, personal history colorectal cancer/polyps, inflammatory intestinal conditions, inherited disorders, family history of colon cancer/polys, diet low in fiber/high in fat & calories, sedentary lifestyle, diabetes, obesity, smoking, alcohol, radiation therapy.

Early Detection; Colon Cancer

• Annual digital rectal examination from age 40, annual stool blood test from age 50, annual inspection of the colon (sigmoidoscopy) at age 50.

Lung Cancer

• Malignant tumor of the lung, primarily or metastatic.
• Lungs are common targets for metastasis.
• Bronchogenic carcinoma spreads via direct extension and lymphatic dissemination.
• Four major types: small cell (oat cell), epidermal (squamous cell), adenocarcinoma, and large cell anaplastic carcinoma.
• Diagnosis made via chest x-ray (lesions/masses), bronchoscopy and sputum studies (for cytological analysis of cancer cells).

Etiology; Lung Cancer

• Cigarette smoking
• Environmental pollutants
• Occupational pollutants.

Assessment; Lung Cancer

• Dyspnea, hemoptysis, chronic coughing/changes cough patterns, wheezing, chest/abdominal pain, cachexia (fatigue & weight loss), dysphonia, clubbing of fingernails, dysphagia.

Interventions; Lung Cancer

• Monitor vital signs, breathing patterns/sounds for impairment; assess for tracheal deviation; pain management (analgesics);Fowler's position; supplemental oxygen/humidification to moisten/loosen secretions; monitor pulse oximetry
• Provide respiratory treatments/bronchodilators/corticosteroids; high-calorie/protein/vitamin diet; activity as tolerated and rest; monitor bleeding/infections/electrolyte imbalances.

Laryngeal Cancer

• Malignant tumor of the larynx, often presenting as malignant ulcerations with underlying infiltration.
• Common metastasis: lungs.
• Diagnosis: laryngoscopy, biopsy, positive cytological study.

Etiology; Laryngeal Cancer

• Cigarette smoking
• Exposure to environmental pollutants
• Exposure to radiation
• Voice strain

Assessment; Laryngeal Cancer

• Persistent hoarseness/sore throat, painless neck mass, feeling of lump in throat, burning sensation in throat, dysphasia, change in voice quality, dyspnea, weakness/weight loss, hemoptysis, foul breath odor.

Interventions; Laryngeal Cancer

• Position patient in Fowler's position for optimal air exchange. Monitor respiratory status. Monitor for signs of aspiration if eating/drinking. Administer oxygen as prescribed. Provide respiratory treatments as prescribed. Provide activity as tolerated. Provide a high-calorie/high-protein/high-vitamin diet. Provide nutritional support(total parenteral nutrition/nasogastric tube feedings/gastrostomy/jejunostomy tube as prescribed). Administer analgesics as prescribed.

Leukemia

• Malignant exacerbation of leukocytes (usually immature) in bone marrow.
• Can be acute (sudden onset/short duration) or chronic (slow onset/persistent).
• Affects bone marrow, causing anemia, leukopenia, production of immature cells, thrombocytopenia, and decline in immunity.

Etiology; Leukemia

• Genetic factors
• Viral factors
• Immunological factors
• Environmental factors
• Exposure to radiation
• Medications

Classification; Leukemia

• Acute Lymphocytic
• Acute Myelogenous
• Chronic Myelogenous
• Chronic Lymphocytic.

Assessment; Leukemia

• Anorexia/fatigue/weakness/weight loss
• Anemia
• Bleeding (nosebleeds, gum bleeding, rectal bleeding, increased menstrual flow)
• Petechiae
• Prolonged bleeding after minor abrasions or lacerations
• Elevated Temp
• Lymphadenopathy and splenomegaly
• Palpitations, tachycardia, orthostatic hypotension
• Pallor, dyspnea on exertion, headache, bone pain/joint swelling, normal/elevated/reduced white blood cell count, decreased hemoglobin/hematocrit, decreased platelets, positive bone marrow biopsy identifying leukemic blast phase cells.

Interventions; Leukemia

• Monitor vitals, monitor breathing patterns, assess for tracheal deviation, manage pain with analgesics, position in fowlers, administering oxygen, respiratory treatments, high calorie/protein/vitamin diet, activity as tolerated, monitor for bleeding/infection/electrolyte imbalance.

Multiple Myeloma

• Malignant proliferation of plasma cells within the bone.
• Excess abnormal plasma cells invade bone marrow, form tumors, destroying bone; invades lymph nodes, spleen, and liver.
• Abnormal plasma cells produce abnormal antibodies (myeloma proteins/Bence Jones proteins) in blood and urine.

Assessment; Multiple Myeloma

• Bone pain, especially in pelvis/spine/ribs.
• Weakness and fatigue.
• Recurrent infections.
• Anemia
• Bence-Jones proteinuria and elevated total serum protein level.
• Osteoporosis.
• Thrombocytopenia and granulocytopenia.
• Elevated calcium/uric acid levels.
• Renal failure.
• Spinal cord compression/paraplegia.
• Monitor for bleeding, infection, and skeletal fractures.

Interventions; Multiple Myeloma

• Monitor for bleeding, infection, skeletal fractures.
• fluids 3 to 4 liters a day to address hypercalcemia, hyperuricemia, proteinuria, problems.
• Encourage ambulation to manage/prevent renal problems/bone resorption.
• Provide skeletal support to prevent fractures during movement/ambulation.
• Provide a hazard-free environment.
• Instruct the patient in home care measures.
• Monitor for signs of infection.

Skin Cancer

• Is a malignant lesion of the skin that may or may not metastasize.
• Common causes include chronic friction/irritation to a skin area and UV radiation exposure.
• Diagnosis is confirmed through skin biopsy and the presence of cancer cells.

Assessment; Skin Cancer

• Changes in color, size, or shape of existing lesions.
• Pruritus (itching).
• Local tenderness/soreness
• Appearance of skin cancer lesions (waxy nodule, irregular/circular/bordered lesions, small/red/nodular lesions, oozing/bleeding/crusting lesions).

Interventions; Skin Cancer

• Instruct the patient regarding preventive measures; instruct monitoring for lesions, moles or lesions that are subject to chronic irritation.
• Avoid contact with irritants. Instruct to avoid sun exposure (11 am to 3 pm).
• Provide protective clothing/sun screen.
• Assist with surgical lesion excisions as prescribed.

Leukemia

• A malignant acceleration in the number of leukocytes, typically at an immature stage in the bone marrow.
• May be acute (sudden onset/short-term) or chronic (slow onset/long-term).
• A malignant acceleration in the number of leukocytes, typically at an immature stage in the bone marrow.
• May be acute (sudden onset/short-term) or chronic (slow onset/long-term).

Hodgkin's Disease

• Malignant lymph node disease originating from a single lymph node/chain of nodes.
• Typically involves other lymph nodes, tonsils, spleen, and bone marrow.
• Characterized by the presence of Reed-Sternberg cells in the affected lymph nodes.
• Assessment: Fever, malaise/fatigue/weakness, night sweats, loss of appetite/significant weight loss, anemia/thrombocytopenia, enlarged lymph nodes (cervical nodes most affected first), presence of Reed-Sternberg cells in nodes, positive computed tomography scan of the liver/spleen.

Hodgkin's Disease; Staging

• Stage I: Involvement in a single lymph node region or extra-lymphatic tissue site
• Stage II: Involvement in two or more lymph node regions on the same side of the diaphragm, or localized involvement in an extra-lymphatic tissue.
• Stage III: Involvement of lymph node regions on both sides of the diaphragm.
• Stage IV: Diffuse or disseminated involvement into one or more extra-lymphatic organs.

Interventions; Hodgkin's Disease

• Extensive external radiation of the involved lymph node regions for stages I-II.
• Radiation plus multiagent chemotherapy for extensive disease/most stages.
• Monitor for side effects related to both chemo and radiation therapy.
• Monitor for signs of infection & bleeding.
• Educate and maintain infection/bleeding precautions
• Discuss options for sperm banking if appropriate.

Multiple Myeloma

• Malignant proliferation of plasma cells within the bone.
• Excessive plasma cells invade bone marrow, form tumors, and destroy bone; invades/spreads to lymph nodes, spleen, liver.
• Abnormal plasma cells produce abnormal antibodies (myeloma proteins/Bence-Jones proteins) in blood and urine.

Assessment; Multiple Myeloma

• Bone pain (pelvic, spine, ribs).
• Weakness/fatigue.
• Recurrent infections.
• Anemia.
• Elevated total serum protein, Bence-Jones proteinuria
• Osteoporosis
• Thrombocytopenia and granulocytopenia
• Elevated calcium/uric acid levels.
• Renal failure.
• Spinal cord compression, paraplegia

Interventions; Multiple Myeloma

• Monitor for signs of bleeding, infection and skeletal fractures.
• Encourage fluids (3-4 liters daily) to counteract/manage hypercalcemia/hyperuricemia/proteinuria.
• Encourage ambulation to reduce renal and bone resorption complications.
• Provide skeletal support during movement and ambulation to prevent pathological fractures.
• Provide/maintain a hazard-free environment.
• Educate the patient in home care measures (infection symptoms/prevention).

Additional Considerations

• Specific patient populations (e.g., children, older adults) may have unique considerations.
• Care should be provided with attention to the patient's individual circumstances and needs, while ensuring safety and well-being.

Test your skills in analyzing content by identifying its primary focus and aspects that may be lacking. This quiz will challenge you to infer what information is missing and to deduce the intended use based on length and structure. Hone your analytical abilities with this engaging quiz.