NUR215 Exam

Managing Vomiting in Cancer Patients Undergoing Chemotherapy

• Administer antiemetics before each chemotherapy session
• Antiemetics help prevent nausea and vomiting and maintain hydration and electrolyte balance
• Encourage small, frequent meals before treatments, rather than large meals

Cancer Prevention Patient Education

• Avoid known carcinogens such as tobacco
• Wear sunscreen daily to protect against UV exposure
• Prevent or treat infectious diseases linked to cancer, including Hepatitis B and C, HPV, HIV, and H. Pylori
• Maintain a healthy weight through regular, moderate to vigorous physical activity
• Consume a healthy, plant-based diet
• Limit alcohol consumption to one drink daily for women and two for men
• Recognize family cancer risks for assessment, prophylactic interventions, and altered screening practices
• UV protection is critical by using broad-spectrum sunscreen even on cloudy days

Neutropenia Precautions Due to Chemotherapy

• Monitor complete blood count (CBC)
• Check patient temperature for infection signs, informing the care team if temp is greater than or equal to 100.4 F
• Restrict visitors with any signs of illness
• Emphasize handwashing for all patients and visitors to limit infection risk
• Advise those with neutropenia to avoid crowds and wear protective masks if indicated

Chemotherapy Before Surgery

• Given to shrink tumors for easier surgical removal, known as neoadjuvant therapy

Post-Surgical Cancer Treatment

• Radiation and chemotherapy may be used to target any remaining cancer cells

CAUTION Mnemonic for Early Cancer Detection

• Change in bowel or bladder habits
• A sore that doesn’t heal
• Unusual bleeding or discharge
• Thickening or lump
• Indigestion or difficulty swallowing
• Obvious change in a wart or mole
• Nagging cough or hoarseness

Minimizing Radiation Exposure

• Oncology nurses should use appropriate personal protective equipment, along with following the institutions self-care standards
• Nurses handling radioactive waste from brachytherapy patients should take extra precautions
• Educating family members about radiation exposure prevents harm to others

Skin and Infection Risk

• An opening in the skin increases the risk of infection

Tracheobronchial Obstruction Signs

• Dyspnea with stridor is the most common sign
• Wheezing is possible if the bronchi are involved
• Breath sounds are absent and chest excursion is reduced in severe and late-stage obstruction
• Patients are more hypoxic than hypercarbic

External Radiation Therapy

• Avoid washing off or distorting any square markings on the patient's skin
• Use gentle care by only using pH-neutral soap with no scrubbing to prevent irritation

Skin Breakdown with Radiation

• Monitor for skin breakdown at treatment sites, reporting redness, peeling, or cracking promptly to reduce infection risk

Platelet Count

• The normal platelet count is 150,000 to 450,000
• Thrombocytopenia (extremely low platelets) is a priority
• Avoid NSAIDs like ibuprofen to reduce bleeding risk and implement safety measures to prevent injury or bruising

Cor Pulmonale

• Right-sided heart failure caused by lung issues that enlarges the right ventricle
• Symptoms include shortness of breath, bulging neck veins, leg and belly swelling, fatigue, chest pain, and fainting

Palliative Care and Extravasation

• Symptom management is the priority
• If extravasation suspected, stop the infusion immediately

Tumor Lysis Syndrome

• Recognize the electrolyte imbalances to prevent potentially fatal complications
• Tumor lysis syndrome is a group of metabolic abnormalities from cancer treatment
• Large amounts of tumor cells are killed, releasing contents into the bloodstream
• Can manifest as muscle weakness, irregular heartbeats, and confusion

Foods High in Potassium

• Spinach
• Baked potato
• Tomato juice
• Mushrooms
• Sweet potato
• Vegetable juice cocktail
• Banana
• Cantaloupe
• Low-fat milk
• Kidney beans
• Avocado
• Kiwi
• Strawberries
• Orange

Altered Taste Sensation with Chemotherapy

• Nurses should educate patients on trying new spices to stimulate appetite, brushing teeth twice a day, and rinsing between meals and snacks

Stomatitis and Oral Care

• Stomatitis is an inflammatory condition affecting the oral mucosa (definition) and periosteum
• Patients should use saline rinses every 2 hours to prevent dryness and reduce mouth sores from chemotherapy

Thrombocytopenia Precautions

• Thrombocytopenia is a bleeding disorder where use of NSAIDs and blood thinners should be avoided
• Tachycardia and hypotension can indicate complications

Breast Cancer Metastasis

• Breast cancer spreads to the bones, lungs, liver, and brain so patient education helps manage expectations

Adequate Cancer Meal

• A protein-rich meal is best, such as peanut butter, macaroni and cheese, and vanilla pudding

Tumor Diagnosis

• A biopsy is the only way to determine if a tumor is cancerous

Alopecia

• Hair will grow back after chemotherapy treatment, but texture or color may differ

TNM Cancer Staging

• T: Tumor size
• N: Number of lymph nodes involved
• M: Presence of metastases
• Higher numbers in the TNM system indicate a larger tumor or spread

Cancer Stages

• Stage 1: Small tumor without obvious spread
• Stage 2: Invasion of deeper tissues or local lymph node involvement
• Stage 3: Large or locally invasive tumors
• Stage 4: Metastasis (hematological malignancies are stage 4 at diagnosis)

Neutropenic Patient Interventions

• Use neutropenic precautions
• Restrict visitors with signs of illness
• Emphasize handwashing
• Avoid crowds, use protective masks, and avoid fresh flowers, fruits, and vegetables

Vena Cava Syndrome Manifestations

• Dyspnea
• Swelling of the face or upper body
• Jugular vein distention in chest cancer patients

Disseminated Intravascular Coagulation (DIC) Signs

• Ecchymosis
• Petechiae
• Nosebleeds
• Bleeding gums
• Black, tarry stools
• Hematuria

Delegation to UAP

• Unlicensed Assistive Personnel (UAP) can assist with non-invasive tasks like oral hygiene, but observation and interventions should be handled by nurses

Chemotherapy and Infection Risk

• WBC should be monitored due to the high risk of infection

Occupational Exposure Protocol

• Report exposure to blood or bodily fluids immediately
• Obtain consent for HIV screening if the patient status is unknown
• Wash the area under running water
• Do not squeeze the injured area

Weakened Immune System Sign

• Persistent oral thrush

HIV and AIDS

• Eight or more new infections in one year can indicate a problem

Lipodystrophy

• A group of genetic/acquired disorders which impact healthy fat tissue

Increased Viral Load

• An increase in viral load in HIV-positive patients taking antiretroviral medication is a priority

Patient Support

• Listen to concerns
• Be nonjudgmental to support isolation feelings

Allergic Reaction (Anaphylaxis) Intervention

• Primary mediator is histamine, causing dyspnea and shortness of breath, with possible hypotension, tachycardia, and anaphylactic shock
• Discontinue agent, administer epinephrine IM, administer oxygen, and have resuscitation equipment
• Other medications: methylprednisolone, diphenhydramine, and albuterol
• Educate on signs/symptoms and EpiPen use

High-Calorie, High-Protein Diet

• Prevents malnutrition in late-stage HIV patients experiencing weight loss and diarrhea

AIDS Precautions

• Utilize universal precautions
• Handwashing for 15-30 seconds is most important
• Use personal protective equipment based on exposure risk

AIDS and Infection

• Patients with AIDS exhibiting signs and symptoms of infections are the priority

HIV Transmission

• HIV is transmitted through breast milk, promote formula feeding

Initial HIV Infection Symptoms

• Flu-like symptoms like fever, aches, and swollen lymph nodes

Occupational Exposure

• Educate healthcare workers to report cuts/scrapes immediately and follow standard precautions

HIV Medication Adherence

• Consistency is key for viral suppression and resistance reduction, and patients should be educated on taking medications daily

HIV and AIDS Infection Control

• Key interventions include standard precautions and PPE to protect both patients and staff
• Address body image issues in HIV patients
• Reassure changes like lipodystrophy are common and offer counseling as needed

Patient Care

• Obtain consent to discuss patient information and use simple terms for complex conditions
• Offer factual responses without promising outcomes, encourage patients to express feelings and ask questions
• Use open-ended questions, focusing on what to expect before radioactive implants, reducing nurse exposure, actions to reduce chemotherapy agent exposure, and complications from peripheral infusion therapy