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Oncology

hyperplasia: tumor cells, growth in size of tissue due to extra cells. (this is cancer) hypertrophy: enlargement of the tissue due to enlargement of existing cells. (this is not cancer) anaplsia: less differentiated cells results in less maturity of the cells, which results in increased malignancy

Carcinogenesis: malignant formation 1. initiation: contact with a carcinogen 2. promotion: repeated exposure to carcinogen, results in mutant cells that can reproduce 3. progression: altered cells have increased malignancy, invade other tissues Carcinogenic agents and factors. 75% of all cancer is associated with environment 1. viruses and bacteria: some viruses do exists, bacteria itself most likely does not cause cancer, but the inflammation process associated with bacteria can cause cancer. 2. physical factors: sunlight, radiation ect. 3. chemical: smoke 4. genetic and familial factors: almost all cancer run in families to some degree 5. diet: fats, nitrates, red meats, alcohol 6. hormones: oral contraceptives 7. role of immune system: designed to catch bad cells and destroy them, when immune system fails, cancer follows Prevention: primary prevention is key, approx 1/3 of all cancers can be prevented using primary prevention women over age of 20 should do self breast exams. men and women over 50 should rectal exam women greater than 18 need pap smears

Cancer management:
1. cure: early detection is key 2. control: limit metastases 3. palliation Surgery is almost always primary treatment, if available. 1. tumor removal 2. prophylactic surgery: removing non-vital tissue that are at a increased risk 3. reconstructive surgery 4. palliative surgery: removing tissue that may affect other vital organs even though cancer is non-removable

Radiation therapy:
1. Cure, control, palliative 2. External radiation: most common 3. Internal radiation, aka brachytherapy, like implanted seeds. Low does radiation patients remain on bed rest to make sure not to displace the internal seeds 4. Radiation effects: can be toxic to surrounding tissue: Fast mitosis cells are more effected by radiation, this is why bone marrow, lymph tissue, hair, GI, and reproductive organs become effected by radiation. Well oxygenated tumors are more effected by radiation Nursing care for patient with radiation therapy: 1. limit visitor activity: cant be within 6 ft, limit time frame ect. 2. no pregnant women 3. wear dosimeters to record level of radiation exposure

Chemotherapy:

agents used to destroy tumor cells that interfere with cellular function and replication 1. treats mostly systemic disease 2. goals include: cure, control and palliative 3. often used with radiation due to synergistic effects 4. need prolonged treatment for necessary eradication of tumor so patients own immune system may take over and remove the rest of tumor 5. like radiation, active mitosis type cells are most sensitive to chemo. 6. do not need to know specific drug names that correlate with chemo agent types, so smile. Administration 1. can be IV or PO 2. problem of extravasation: when the IV blows the vein, huge problem with IV chemo, can cause severe damage to interstitial tissue. on test: first thing nurse does is turn off IV if one suspects a blown IV (such as redness, swelling, pain ect) 3. fluid and electrolyte imbalances: from vomiting, replace as needed. 4. risk for infection 5. Risk for bleeding 6. protection of caregivers

Bone Marrow Transplants: used for hematological cancers (like luekemia) and solid tumors
Types: 1. Allogeneic: outside donor (specific tissue type), destroy all bone marrow first, then replace with someone elses marrow 2. Autologous: self donation (with a transplant after) 3. Syngeneic: identical twin Graft versus host disease: number one problem is rejection of new bone marrow from an allogeneic transplant Liver dysfunction: number 1 cause of death

Onocoligic Emergencies:
1. Superior vena cava syndrome: tumor occludes SVC, which leads to back up into head 2. spinal cord compression: permanent neurological impairment 3. Pericardial effusion/ cardiac tamponade: from radiation and chemo 4. Syndrome of inappropriate secretion of antidiuretic hormone: from pituitary tumor 5. Tumor lysis syndrome: development of acute renal failure.

Management of Patients with HIV and AIDS


Transmission: by blood and body fluids, casual contact does not cause transmission, prenatal infections typically occur during delivery, needle sticks common cause of transmission for health care workers Treatment: must start within 72 hours to be effective. This will be on the test. CD4 lymphocytes: these cells are part of the cell mediated immunity, they are in circulation and monitoring body system for foreign pathogens in a healthy person. 1. HIV has high affinity for CD4 lymphocytes 2. since virus kills CD4 cells, body is not able to recognize when body is infected and therefore becomes susceptible to infections. 3. opportunistic infections are what kill people, not the actual HIV virus.

Prevention: 1. Standard precautions 2. Safe sex 3. Do not share injection equipment 4. blood screening and treatment of blood products HIV life cycle: dont need to know the specifics 1. effects the treatment of HIV 2. effective treatment means interrupting this lifecycle at as many places at a time, due to the high mutation of the disease 3. enzyme immuno assay: detects antibodies against HIV. 4. viral lobe test: detects HIV-RNA in blood plasma

Stages of HIV disease


1. Primary infection: infection to viral set point (the number of virus that it takes for body to respond) a. someone can have a negative test even if they have the disease because they have not reached the viral set point yet. b. can still pass on the disease however c. symptoms include: none to flu-like symptoms 2. HIV asymptomatic: category A a. Still have greater than 500 CD4 cells b. upon reaching viral set point, chronic asymptomatic state begins c. body has sufficient immune response to defend against pathogens 3. HIV symptomatic: category B a. CD4 drops to 200 - 499 b. patients develops symptoms or conditions related to HIV infection , which are not classified as category C (basically non-life threatening infections) 4. AIDS: a. category C b. less than 200 CD4, below 100 the immune system is considered significantly impaired. c. susceptible to life threatening disease. typically includes: carposes sarcoma, cervical cancer, pneumonia. Treatment: treatment and protocols are continually evolving, do not need to know specific drug names common side effects of medications: dyslipidemia, hyperglycemia, peripheral neuropathy, cardiomyopathy, pancreatitis, diarrhea, anorexia, liver dysfunction, redistribution of adipose tissue. Clinical manifestations: 1. Pneumonocystic carini pneumonia (PCP) a. most common b. nonspecific symptoms 2. mycobacterium avium complex 3. tuberculosis 4. oral candidiasis: may progress to esophagus and stomach 5. diarrhea 6. Wasting syndrome: 10% weight loss and chronic diarrhea, protein energy malnutrition, GI malabsorption 7. Kaposis sarcoma: lesions, can involve multiple organ systems 8. B-cell lymphomas 9. HIV encepthalopathy: progressive cognitive, behavioral and motor decline 10. depression

Breast Disorders
Risk factors: 1. female 2. age

3. personal and family history including genetic mutations 4. hormonal factors 5. exposure to radiation 6. history of benign breast disease 7. obesity 8. obesity, not sure why I wrote that twice, but I dont want to renumber the list. 9. high-fat diet 10. alcohol intake 11. early menarche 12. nuliparity. 13. first birth after age of 30 14. radiation exposure 15. late menopause Guidelines for early detection 1. women in 20 - 30s breast exam every 3 years 2. mammography annually beginning at age 40 3. breast exam perfromed days 5 - 7 after frist day of menses Benign: breast pain, cysts, fibroadenomas, benign proliferative breast disease Malignant: breast cancer Treatment: Surgery: many forms Non-surgical management of Breast cancer: 1. radiation, hold off till 6 weeks after surgery 2. chemo 3. hormonal therapy Key points: 1. metastasis usually occurs through the lymph system 2. common systems affected by metastasis: liver, bone, brain. 3. more differentiated cells, like all cells, is a good thing. 4. regular border are better than irregular borders 5. moveable is better than not-movable 6. smaller is better than bigger

Ovarian cancer
Facts: 1. threefold increase risk for breast cancer 2. BRCA-1 gene: increased risk for breast and ovarian cancer 3. BRCA-2 gene: increased risk for male and female breast cancer and ovarian cancer 4. 75% are detected in late stages, because it is deep in cavity and therefore is found late Risk factors: same as breast cancer . oral contraceptives, however, are a protective measure for ovarian cancer Clinical Manifestations: 1. increase abdominal girth 2. pelvic pressure 3. bloating 4. back pain 5. indigestion 6. flatulence

7. leg and pelvic pain Medical management: 1. Surgical: hysterectomy 2. Chemo, radiation, brachytherapy

Uterine Cancer
Risk Factors: 1. Age 2. Postmenopausal bleeding 3. Obesity 4. Estrogen therapy: oral contraceptives, HT 5. Nulliparity 6. Late menopause Testing: annual exam, need to evaluate for irregular bleeding Medical management: 1. Total abdominal hyterectomy with bilateral salpingo-oopherectomy 2. CA-125: genetic marker 3. Radiation, Chemotherapy, Brachytherapy

Cervical cancer:
Ranked number 3 female cancer Risk factors: 1. sexual activity 2. HPV 3. HIV 4. smoking 5. low socioeconomic status 6. nutritional deficiencies 7. chronic cervical infection Prevention: primary intervention is education and smoking cessation 1. pelvic exams 2. eduation 3. smoking cessation 4. HPV immunization Clinical manifestations: 1. rare to have symptoms in early stage 2. watery thin discharge 3. irregular bleeding Late stage manifestations: 4. leg pain 5. dysuria 6. rectal bleeding 7. edema of extremities Medical Management: For preinvasive: LEEP, conization Invasive: Brachytherapy (this will be on the test), surgery

Complications: sepsis, bladder dysfunction from chemo or surgery

Disseminated Intravascular Coagulation


Facts: 1. this is disorder that is caused by an underlying disease process 2. disorder including massive clotting that uses up all clotting factors, massive bleeding follows after clotting factors are used up 3. Symptoms: tissue ischemia (pain), then bleeding Lab test will show: 1. decreased PLT 2. increased PT and INR and PTT 3. decreased fibro 4. increased D dimmer, then decreased D dimmer once clotting factors are used up Triggers include shock, sepsis, arbruptioplacenta, chemo, cancer Planning: 1. monitor vital signs including blood pressure, pulse 2. maintain fluid balance 3. maintain cardiac output 4. enhance coping, patients will have sense of impending doom. 5. monitor for organ failure, pulmonary circulation problems, change in LOC, chest pain, excessive bleeding Interventions: fresh frozen plasma (this is important because FFP will include all necessary clotting factors)