CANCER 1st Tutor Session Everyone has cancer cells in their body but not everyone goes through

promotion.. 1 stage..initiation..everyone goes through inititation - cell changes from different factors sunlight! carcinogen e"posure etc# most of the time our bodies fight these effects $N% STATE..&R'('T)'N can ta*e 1-+, years depending on ris* factors! genetics etc -atent period..the 1-+, years &R'.RESS)'N STA.E... /hat causes cancer..the proliferation ..normal cells have contact inhibition..they die..cancer cells dont...%ifferentiation... Stem Cells have the most amount of potential dna#..they can become anything as cells progress they become speciali0ed and have less potential Cancer cells gain more potential.. they can regain embryonic appearance and funtion. Cancer cells start off as speciali0ed but go bac*1ard

Cancer cells proliferate at the same rate as a regular cell... .)! hair follicle! 1bc! platelets all have a fast turn over rate...cancer in these areas have fast gro1th malignant cells unecapsulated ..to invade and metastasi0e )nititation is irreversible hpv! hiv! hep b! epstein barr...all viruses that can cause a cancer complete promoter...something that causes inititation and proliferation e". being a smo*er# Cancer patients all e"perience severe fatigue because of tumor angiogenisis anemia occurs# even before chemo. )f patients are anemic suggest diet changes! iron rich foods! 2it C! supplements! moderately tolerated e"ercise 1al*ing everyday! $,3, mins# obesity high ris* for cancer...4at cells release hormones 5rain! bone! lung! liver and adrenal glands are common areas for cancer Staging - e"tent of the disease local and regional spread# tnm .rading - loo* shape and appearance of the cell metaplasia#

Anatomical Classification6 carcinoma endoderm-s*in!brain!glands ectoderm-#! sarcomas mesoderm#! leu*emia7lymphomas 8 1arning signs of cancer... CA9T)'N! Chemo )rritants - cause phlebitits inflammation of the vessel# 2esicants - cause tissue damage C2A%s should be used for vesicants to lo1er chance of tissue damage )f e"travasation occurs pain! s1elling# Stop infusion! cold compresses )2 )ntrarterial..into arteries )ntraperitoneal ...into abdominal cavity..d1elling time..adminsitered for $-+ hrs! then drained...pt may have abdominal pain! ascities! infection! paralytic ileus! perforation )ntathecal into spine intraventricular into ventricles of brain#...patient 1ill e"perience headache! nausea vomitting! nuchal rigidity ..)C&- *eep patient supine! decrease lights7decrease stimuli! shunts may be necessary to release s1elling )ntravesicle :#... into bladder..may e"perence bladder spasms!

hematuria! uti .)! ;air follicles! bone marro1 1ill be most affected by chemo possible#Acute side effects - anaphala"is 1orst#! e"travation! cardiac dysrhythmias! N72 %elayed - mucositosis! rashes! Chronic - organ damage! $nd malignancies Radiation - usually done before chemo ..1or*s locally Chemo is done after radiation and in later spread cancers ...has a systemic effect -o1 beam Energy - used for s*in and superficial cancers ;igh 5eam - for deeper cancers 4ractioni0ation - doses split ..< days a 1ee* for $-= 1ee*s &atient must go through simulation before receiving radiation Simulation - pin point cancer..body measured and mar*ed for e"act spots radiation 1ill be adminsitered A-ARA - As lo1 as reasonably achievable .. Shielding! 1rist band monitors the amount of radiation you have been e"posed to -- everyone has a lifetime ma" dose#

5one marro1 suppresion occurs 1ith radiation and chemo &elvis and sternum are the areas 1here myeolosuppresion is most effected R5C live 1$, dyas neutophils - 1-$ 1ee*s &latelets - all the time anemia and neutropenia 1ill be seen before anemia# neutropenic patient..reverse isolation! no fresh fruits7vegetables7plants... pts psychosocial is important ...they 1ill be limited to visitors-but still have visitors.. monitor for infection... 1ill receive gro1th factors neumega! epogen! neupogen.. .ro1th factors ta*e some time... they stimulate but they 1ill ta*e the amount of time that it normally ta*es for 1bc! rbcs and platelet to gro1 spontaneous bleeding may occur if platelet counts are belo1 $,!,,,...monitor for bleeding in mucous membranes! mouth7nose. epita"is#! petechia....mouth care important - no flossing! encourage rinsing..no alcohol based mouth1shes!..dont use ra0ors! needle stic*s should been done as little as possible - smallest gauge needles shoudl be used..$,7$$ Anemia - chec* 5lood levels ... ;.5 > ;CT ;.5 belo1 87= may need tranfusions

;CT should be above 3=? .) effects - N72 - can give reglan! 0ofran! emend N72 causes electrolyte! fluid and acid7base imbalance %ysphagia - trouble s1allo1ling dycgeusia taste loss#! - season foods! moisten foods! provide food the paitents en@oy 'dynophagia - painful s1allo1ing ...give patient soft foods! smaller portions! meds- lidocaine *eep N72! diarrhea logs %iarrhea - metabolic acidosis! dehydration! fluid7electrolyte! acid7base imbalance....reduce fiber! lo1 residue diet! no roughage! nuts! avoid oily food....you 1ant to decrease motility ..monitor for hemmoroids! s*in brea* do1n...sits baths radiation to the bo1els can cause temporary lactose intolerance Radiation assects glands that ma*e salivia ..chemo can cause dryness..mucositosi7stomatitis Stomatitis- monitor for infection! freAuent oral care ..saline7hurricane rinses! artifical saliva! nystatin ..no toothbrush! no flossing! no alcohol based mouth1ashes...no e"tremem temps no hot no cold al1ays monitor gag refle"es

soft diet..increase protein and calories!...decrease fiber and residue 1eigh patient $" 1ee* S*in reactions occur in the main s*in folds .. (ay cause crac*ing s*in! infection 1ith radiation monitor s*in reactions...dry and 1et desAuamation *eep dry s*in moist 1ith aloe and eucerin!aAuaphor do not use petroleum @elly# *eep 1et s*in dry Chemo can cause desAuamation on palms of hands and feet ...chemo dose may be held a 1ee* or t1o in order for healing Alopecia 1ith chemo is reversible - may start to return in 3-+ 1ee*s Radiation may be irreversible 1hen hair does gro1 bac* it may go1 bac* thic*er! different color7te"ture E"plain hair loss and options ot patient..encourage 1ig fitting7purchase before hair loss

Radiation6 &ulmonary to"icity pneumonitis can occur 1-3 months after radiation delayed reaction# ..increase in cough! fever! night s1eats! ..give e"pectorant for productive cough ...cough suppresant for non productive..corticosteroids to reduce inflamation...bed rest becasue patient 1il have lo1e '$ rate ... &umonary fibrosis Chronic reaction#... &ulmonary Edema - fluid escaping into pulmonary space..noncardiogenic Cardio - radiation induced heart disease can occur... %o"irubicin and danorubicin can cause this Abdominal radiation for male# must use shield 5iological7Targeted therapies 6 affect @ust the tumors /ill cause patient to have fluli*e symptoms - lo1 grade fever..give patient tylenol...monitor for capillary lea* syndrome! orthostatic hypotension secondary cancers - radiation and chemo can cause leu*emias

Stem Cell Transplant - from umbilical cord! bone marro1 ileum or sternum#! peripheral blood donor must have gro1th factor a 1ee* or t1o before## Allogenic - from someone 1ho is a match may see graft vs host disease--the donor blood may attac* the recipient..recipient 1ill be immunocompromised# Syngenic - from identical t1ins Autologus - 4rom self /ith autologus you 1ill be given high doses of chemo to get rid of as much cancer as possible and then harvested $-+ 1ee*s to 1or*...1hile 1aiting pancytopenia is a concern! bleeding issues! anemia! infection# (alnutrtion6 increase protein! calories! decrease vegetables and ra1 foods..1atch for 1eight loss of <? (onitor albumin.. if you see more albumin you have less blood volume fluid# normal albumin level is 3.<-< ..if above < the patient is dehydrated )f albumin is belo1 belo1 3.< patient is malnourished lac* of pure protien in the blood &t should inform doctor if temp is 1,,.+ or more

Emergencies6 'bstructive - e" vena cava syndrome! cvad can cause Compression -- spinal cord compression ! can cause pain! affect movement ! cervical can affect upper body! heart! lungs! lumbar affects lo1er legs!bo1els 2asalva manuever... bearing do1n and pop ears ... it increases pressure in head ..close nostrils and mouth and try to breath out..to pop ears# it decreases your heart rate but also increases 57&..can also fi" heart rythym in some instances# ! affects supraglottic s1allo1 2asalva maneuver can aggravate spinal cord compression# -aminectomy - cutting out of tumor round spine 3rd space syndrome ..shifting of fluid from vascular into tissue ..initially you 1ill see hypovolemia-tachycardia! decrease in 57&! urine output do1n! administer fluid but 1atch out for revocery hypervolemia-decrease in ;7r but decrease in 57& ... then restrict fluid..maintain )7' (etabolic emergencies caused by ectopic hormones Siadh S7S - 4-AT..fatigue! lethary! anore"ia! thirst ....retaining fluid.. electolytes 1ill be dilute-hyponatremia sei0ures! oliguria! decrease refle"es! can treat 1ith NaCl ... dysrythmia -anytime there is a change in electrolytes > '$#

;ypercalcemia - dehydration and lac* of movement can cause hypercalcemia# can cause *idney problems... give fluids and then loop diuretics Tumor -ysis Syndrome - tumor or normal cells brea* up too rapidly..all the iside contents are spilling into the body...hyperuricemia dna floating around after spilling out of cells#give allopurinal ! hyperphosphatemia! hyper*alemia! hypocalcemia ...usually happens 1ithim $+-+=hrs of chemo Tumor -ysis Syndrome treatment -- fluids to flush out and allopurinol Cardiac Tamponade - fluid around heart - heart cant beat ..this is an emergency ..must be drained Carotid Artey Rupture - spurtting of blood... apply pressure and yell for help )f patient is too sedated ..1a*e them up and administer o"ygen ...if overdosed they 1ill need narcan ..but this 1ill cause severe 1ithdra1al at the moment -ARBN.EA-Trach

S7S air1ay obstruction ..Stridor-coughing breathing ! gasping for air ! accessory muscles being used! retractions! 1hee0ing musical sounds# restlessness! tachycardia! cyanosis Early signs of Hypoxia - RAT early signs#- Restessness! An"iety! tachycardia....5E% late signs# ! bradycardia! e"treme restlessness! %yspnea aspiration! pneumonia! cricodthyroidotomy-cut into Tracheotomy - procedure to administer tracheostomy &recutaneous Tracheostomy better than trach in 'R ..local anesthesia used..lo1ers post op complications7less bleeding Tracheostomy better than endotracheal intubation..patient can move! be a1a*e! eat! less trauma around entry area endotracheal intubation - patient must be sedated ..tube do1n throat..affects speech! eating etc ..patient cant move out of bed Cleaning trach - sterile procedure .. &t needs humidified air ..reduces secretions 9ncuffed trach can be used if patient has epiglottis function Cuffed can cause erosion if left inflated for too long or if over inflated. )f patient cant cough out secretions you must suction... suction top of cuff before deflating so pt doesnt aspirate ..then deflate cuff during e"halation ..reinflate cuff during inhalation.

monitor the amount of air daily .. Cno1 amount to fill do not change tape until $+hrs after trach inserted 1st tube change is done by surgeon 8 days after insertion change tube once a month if tube is accidently dislodged move obturator so air can flo1 through tube::: 1atch video on trach care# assess respiratoy distress ..alleviate breathing problems in semi fo1lers .. p.<3,7<31..trach care tables in boo* inner canula care done 3" a day..assess need for suctioning every $hours not done routinely - only 1hen needed and not on someone that can cough secretions out# 5aseline must be established for &ulse o"! ;R and rythym must be done if ;R drops $, beats or increases by +, stop suctioniong See table $8-D Chec*ing for aspiration... add blue food coloring to a small amount of 1ater and let patient drin* or monitor glucose in secretions ...secretions normally have lo1 glucose content... shouldnt see glucose in secretions or the blue food coloring ..this means that food71ater is getting into lungs...5est 1ay is to have speech

therapist do a gag and s1allo1 test Speech 1ith trach6 if on a fulltime mechanical ventilator this is a closed pressure system - cuff must be inflated to maintain the closed pressure system# ..)f part time the cuff does not need to be inflated 1hen not on# deflate cuff a little to allo1 air to pass over vocal cords. ..no food or 1ater at this time /hen a fenestrated tube is used it allo1s air to pass through and over 1ithout deflating the cuff fenestrated tube poses aspiration because of holes in top of tube..mucus can also clog holes and crust around it ..1ill impair speech-must be chec*ed# fenestrated tubes also pose ris* for tracheal polyps cancer ris*# Cannot spea* 1ith cuff.. must be deflated can spea* 1ith tube 1ith no cuff for patient 1ith no aspiration ris*# Spea*ing tracheostomy tube - you dont deflate cuff for it to 1or* 1hich is better for person 1ith ris* of aspiration can be used 1ith pt that has aspiration ris* or on mechanical vent# ...air is pumped in from an '$ source outside the body ..must be on.. air bypasses cuff &assy-(uirSpea*ing Tracheostomy - allo1s air and spea*ing upon e"piration ...valve has a diaphragm in it ..it closes 1hen e"haling to go up over the vocal cords cuff must be deflated#..cannot be used on pt that has ris* for aspiration or pt 1ith respiratory distress

...p.<3< decanulation - only do 1hen patient can spontaneously breathe and prodcutively cough After removal..it 1ill close on its o1n..cover 1ith occlusive dressing... splint 1hen coughing!snee0ing etc Head and Neck Cancer increased ris* 1ith age! tobacco use! alcohol abuse ! ;&2! decreased vegetable and fruit inta*e usually caught late &alpate lymph node! leu*opla*ia! erythropla*ia in mouth7on tongue 1hite or red patch# Total larngectomy - 1ill have a trach for the rest of life. ***watch trach videos on youtube -------------------------------------------------------------------------------------------------------continued session# ;ead and Nec* Chapt $8 EEAir1ay obstruction can be complete - emergency or

partial 1ill hear stridor coughing sound#! see retractions accessory muscles! restlessness! tachycardia! later on 1ill see cyanosis in the event of complete air1ay obstruction6 loo* in mouth! heimlich! endotracheal intubation may be necessary Tracheotomy - procedure to ma*e the hole..usually done in 'R if done at bedside percutaneous tracheotomy- local anestetic less anesthesia ! less bleeding! less chance of post op infection Trach better than intubation tube because 1ith intubation endotracheal# must be sedated ! cant eat! trauma! may need to be done numerous times! immobility because bed bound! Emust 1atch phosphate levels found in intracellular# 3.<-< normal level Trach can eat! no need for sedation! can tal*! less trauma! can ambulate Trach Care6 suctioning air1ay 1hen you hear secretions...no suctioning if patient can cough it out! ..assess air1ay..no routine suctioningonly 1hen needed Cleaning around stoma Changing trach ties prevent s*in brea*do1n! infection#

cuff tracheostomy tubes ..to prevent aspiration and anchor tube Ecuff pressure ..$, hg7mm or $<cm7h$, over pumping 1ill cause ersion of esophagus use minimum use techniAue..pump up then decrease .1 Cuff pressure changes over time becasue the cuff pressure e"pands the area..after long term use may need an increase in pressure to prevent aspiration ..to chec* for aspiration use blue dye! glucose test or speech therapist to test .lucose test may sho1 false positive if there is any blood in the mucous %eflating cuff only on e"halation because secretions are on top of cuff ..deflating on inhalation 1ill pull secretions into air1ay reinflate cuff only on inhalation monitor cuff pressure daily (onitor Stoma site <-8 days post trach since stoma is immature Surgeon does trach care! first tube change! movement! for the first 1ee* post op bedside precautions6 $nd trach set! ambu bag..if trach is dislodged try to put it bac* in ... use obturator to put outer canula into trach ..if cant be inserted

assess respiratory distress ..raise bed into semi fo1lers positions! cover stoma! bag through mouth ..if laryngectomy there is obstruction so bag the stoma site patient must have humidified air..moistens and decreases secretions change tube appro"imately once a month after first tube change by surgeon 'nce stoma is fully healed after several months a patient can go home and clean their o1n trach Trach Care ..table $D-8 > $8-8 reassess respiratory every $ hrs )f vitals change from baseline 1hile suctioning adminsiter o"ygen ..if baseline is still off! notify doctor Suctioning6 ;ypero"ygenate ..1,,? '$ for 1 minute suction 1,-1< seconds no suction on 1ay in

suction intermittent on 1ay out 1hile t1irling catheter '"ygenate again repeat suction .. donFt suction more than t1ice at a time also suction mouth# )f there is increase or decrease of $, breaths per minute! dysrhythmias! ;B&ER'GB.ENATE chec* breath sounds..should be clear..record time! amount! character! patients reaction Cuff..pushing against esophagus can cause dysphagia...may cause 1eight loss! anore"ia &atient 1ith ris* for aspiration may have inflated cuff 5est 1ay to chec* cuff for aspiration is calling in speech therapist 1hen ta*e out )nner canula! deflate cuff! cap %ecanulating - complete removal of trach the stoma 1ill begin to close on its o1n in $-3 days -ARBN.EA- CANCER6 columnar cells changing to sAuamous (a@or indicator for cancer6 Age

<, H Tobacco use alcohol decreased fruit and vegetable inta*e ;&2 virus males infectd $-3" more than females

(ain S7S6 ;oarseness Cough Asymmetry of throat pain is later sign as tumors e"pand# athralgia ear pain# %ysphagia Cranial nerve 11 assess6 palpate throat7nec* leu*opla*ia 1hite patch# erythropla*ia red7dar* patch#

Staging6 TN(...e"tent of spread .rade6 loo*! appearance! histology TN( used for solid tumors not leu*emias# 5rachytherapy- patient radioactive# 1ear bracelet to measure e"posure 1ear protective shield if seed comes out cover patient and call %r! or use forceps and put in lead container if available Teletherapy - e"ternal ..patient never radioactive Cordectomy ..no trach reAuired..removal of 1 vocal cord..can still spea* ;emi-aryngectomy ..needs temporary trach..can still spea* Supraglottic -aryngectomy ...removal of epiglottis .. aspiration ris*...patient needs cuffed trach temporary trach# Total laryngectomy reAuires permanent trach..laryn"! voice bo". epiglotal region..everything removed# can never go s1imming again# Complications6

hoarseness Esophageal speech needed to spea* 1ith total laryngectomy..air pulled in and speech 1ith trapped air ..must be taught..tal* 1ith burping... side effect6 flatulence cant be heard by deaf7hard of hearing Radical Nec* %)ssection - (ost organs there removed...must be careful of carotid artery ..rupture or burst may occur...put pressure! call for help ..emergency )f parathyroid removed must 1orry about calcium levels if thyroid removed must be on synthroid &ost op first $+-+=hrs on tpn or ppn after 1ill be on feeding tube then test must be done for s1allo1 mechanism superglottic s1allo1 - done to prevent aspiration..for people that have no epiglottis ...s1allo1! cough! close air1ay then s1allo1.. teaching6 start off 1ith carbonated beverages ..avoid 1atery or thin liAuids but soda in this case is o*..for patient to be able to feel location... Teaching Supraglottic S1allo1table $8-=

ta*e deep breath perform 2alsalva maneuver pinch nostrils close mouth! try to blo1 out air! bear do1n# place food in mouth! s1allo1 some food 1ill enter air1ay 1ill be on top of closed vocal cords# Cough to move food# Then can s1allo1

Radiation for -aryngeal6 complications6 Stromatitis from "erostomia of radiation hitting parotid glands#...moisten mouth! sugarfree candy! encourage 1ater... once platelets fall belo1 <,!,,, use s1ab or sponge instead of soft brush.. 1hen count falls belo1 $,!,,, patient 1ill need transfusion# S*in for dry s*in6 aloe ! eucerin! aAuaphor /et S*in6 Ceep dry loose clothing! avoid sun e"posure

Assess patient for dysphagia after lung or upper radiation

chemo and radiation affect hair follicles! bone marro1! .) cellshigher mitotic rate cells# Radiation in chest area 1ill affect sternum blood production .. --------------------------------------------------------------------------------------------------------9N. CANCER6 leading cause of cancer deaths %eeper the smo*er inhales and longer they hold the smo*e! the higher chance of lung cancer E-cigarrettes can also cause cancer..it is an irritant..any irritatant can lead to cancers Cleaning solutions! gasolines! hydrocarbons Starts in the bronchus..entry area of lungs detectable at 1cm earliest signs6 hoarseness! nagging cough hypersecretions at first (etaplasia - abnormal change of cells :#Non-small Cell 1orse..! most prevalent =,? of cases :#Small Cell - $,? of cases

&araneoplastic Syndrome.. tumor secretes parathyroid hormone! causes hypercalcemia! lead to renal stones! renal failure#.. patient needs fluids to flush out e"cessive calcium 1ith diuretics#! phosphate levels 1ill drop )&&A assessment6 inspect! palpate! percuss! auscultate# (ass in lung can be inspected on "ray &ercuss..1ill hear dullness not hyper-ressonance# Thoracentesis..can be done at bedside...needle inserted into side of lung Staging6 TN( used Screening recommendations dont e"ist can encourage smo*ing cessation Surgery not recommended for small cell :# Chemo is the only real treatment for small cell once metastisi0ed chemo is the only effective treatment# e".Cisplatin! Carboplatin! Cyclophosphamide! %ocita"il &hotodynamic Therapy - gets rid of the mass after radiation or

chemo has *illed the cells Stent used to prevent thrombosis..prevents bloc*age Table $=-18..assessment must al1ays obatin patients understanding or *no1ledge of their condition...Nurse should not be the first person to inform patient of their condition ..this is the %r.s @ob Assess 5reath sounds! ;eart Sounds -ess o"ygen means brain and heart b7p 1ill slo1! ;R 1ill increase! dysrythmias# 1ill be effected...assess Cardiac > -'C ...may see Superior 2ena Cava Syndrome patient receiving chemo 1ill have a central line in vena cava or carotid..cause rupture or bloc*age#! I2%! &eriorbital edema! dysphagia! N72 administer antiemetic# Thrombophlebitis ..inflamation caused by irritants 2esicants cause e"travassation tension pneumothora"...emergency chec* for *in* in chest tube or clog..fluid builds up and lung collapses observe for subcutaneous emphysema..1ill sound li*e rice

crispies..crac*les...mar* spots 1here heard &rimary prevention for lung cancer - smo*ing cessation7avoiding smo*ing Secondary - chec* sputum ;ypovolemic shoc*..1ill see increased ;R first! then decrease 5& )ncrease 5eta Carotine! 2it C! 2it E ..for all cancers -----------------------------------------------------------------------Tutoring NEGT TEST6 A lot of aftercare drain care! positioing radical nec* dissection radical mastectomy ... 5reast cancer chemo agent ..;erceptin trach - suctioning ...steps @p draincare and hemovac#- 1ill see blood in the begining...after

first $ days a mi" of clear and blood..after that should be clear..shouldnt smell ...drastic changes are an issue either infection! hemmorhage care6 empty! measure! note smell and color.. cant ta*e bath 1ith @p drain in..must be removed before a bath can be ta*en...other1ise sponge bath -ung Cancer 1 leading cause of death $nd cause - breast %ifference bet1een lung cancer and other cancers - it is not genetic ..other cancers can be. -ung cancer is due to life choices! environmental factors and7or secondary metastasis a lot of blood flo1 and high turn over rate of cells Smo*ing..type of cigarettes and depth of inhalation increases chance of cancer ...e-cigarettes can still cause cancer - there is nicotine in them men have higher death rate than 1omen from lung cancer...though 1omen can smo*e same amount of cigarettes of as a man and get lung cancer faster 'riginally cells are columnar loo*ing ..as they are affected they

turn into sAuamous epithelial metaplasia-changing# ...sAuamous cells replicate -ung cancer usually starts in the main rt or lt# bronchus..then to bronchiole..then to alveoli As air comes do1n the trachea most of the air is concetrated in the bronchus 1st thing you see is - sputum from the irritation in the lungs#.. ECough 1ith productive sputum! then persistent pneumonitis fever!chills!cough# ...eventually fibrosis occurs! shortness of breath and 1hee0ing use pulse o"! listen for breath sounds on both sides!! pain unilaterally usually hemoptysis spitting up blood#- not a common sign...later sign of a lot of damage anore"ia! fatigue! 1eight loss! nausea! vomitting ! anemic angiogenesis ..tumor is ma*ing its o1n blood supply# . tumor in esophagus..touble s1allo1ing! mucositis Tumor in chest area concerns6 heart! superior vena cava svc syndrome#-to fi"6 radiation to reduce si0e of tumor that is pushing on svc# before doing chemo if necessary# ...simulation must be done before raditaion map out and mar* tumor before procedure# -ung cancer can spread to lymph nodes...if it accumulates in a lymph nodes you get lymphadenopathy s1ollen lymph node# -ymphadema - selling because fluid accumulates and canFt drain becasue of bloc*ages

(ediastinum involvement - fluid accumulation in pleural sac ..1onFt be able to e"pand the lungs Cardiac Tamponade - fluid build up around the heart - need immediate pericardiacentesis :#..to drain fluid if fluid builds up becasue its bloc*ed it 1ill lea* out- into spaces it isnt supposed to %iagnostics6 Chest Gray can be done to see CT scan is the best non-invasive procedure Sputum cytology can be done 5iopsy - gives definitive TN( 1ould be done -- because its a solid tumor -eu*emias arent staged 1ith TN(...there is no tumor - it is every1here in the blood NonSmall is better to get than small cell...nonsmall is a surgical candidate Small cell usually only has D-8 month prognosis

Smo*ing cessation is the *ey even if you have smo*ed your 1hole life... even if you have lung cancer. Surgeries - nonsmall cell early stages 1-3A# 3b-+ is bad prognosis..regional spread and metastisis# &neumonectomy - entire lung removed -obectomy-1 lobe removed Segmental or 1edge - smaller than lobe removed 5efore surgery pulmonary function tests must be done to see if the patient can survive 1ith parts of lung missing Radiation can be used for small cell and Non-small cell...to shrin* tumor causing bloc*age# )f you have bronchial obstruction 1hee0ing 1ould be heard# )f you have Super 2ena Cava Syndrome After radiation care - s*in irritation! esophagitis! &hotodynamic therapy - laser light better than radiation because it targets better..patient given )2 of photo ..travels to tumor cells and stays there...tumors are e"posed to light patient must not be e"posed to light before test even pulseo" light can affect it# ..1hen tumor cells are e"posed to the light they die

radiation gets tumor and everything before s*in# and after ***Tumor ysis !yndrome6 cells burst and spill into EC4 ...patient becomes ;yp*er*alemic! ;yperphosphatemia! ;ypocalcemia! ;yperuricemia uric acid comes from the inner parts of the cells#...you 1ill see *idney issues ... must be cleared up right a1ay....patients fluid is hypertonic... flush it out...hydrate patient 1ith NS..then a diuretic lasi" - loop diuretic --dont 1ant a potassium sparing because patient is hyper*alemic already#... allopurinol to correct the hyperuricemia ;ypocalcemia - t1itching hypercalcemia - muscle 1ea*ness &araneoplastic Syndrome usually in small cell but can occur in nonsmall cell#..tumor secretes hormones that are not normal and cause things li*e S)A%;! %)abetes )nsipidus! &arathyroid secretion etc- hyper or hypocalcemia .. listen to recording# ..1ill have either too much or too little of certin hormones Cranial Radiation for brain cancer ....methotre"ate and cyterabineonly t1o drugs that cross blood brain barrier# --------------------------------------------------------------------------------------$nd and 3rd Tutor Session

5reast -

;igher hormone levels increase ris* to breast cancers ;er $ is mar*er if receptors for these hormones are on the cells then you give then a bloc*ing agent because cell responds to the hormones . triple negative breast cancer means dont respond to ....listen to recording "ost#astectomy Care Elevate affected side at level of the heart or slightly higher# to maintain drainage After care for 5reast cancer ..immediately follo1ing surgery in &AC9# start e"ercising the fingers! hand! 1rist ...arm raises and range of motion after 1ound has healed No heavy lifting (ontior for edema Never 57& or )2 in affected arm )f double mastectony then finger stic* done in toes! )2 in legs or C2A% and 5& done in leg Assess for drainage ... should decrease over time color!amount!odor# &rovide privacy for client

Clinical breast e"am $,-3, year olds every 3 years! +, ..every year Self 5reast E"am should for menstruating 1oman every month after period ends ..for non-menstruating 1omen they should choose a date birthday day# and do it on that day every month 9pper outer part of breast is most common spot 9sually 5C tumors are hard mass#! nonmobile! non-tender may eventually become painful because it is pushing on surrounding area )&&A - )nspection! &alpation! &ercussion! Auscualtate inspect breasts for symmetry! color! orange peel loo* inflammatory 5C#!nipple discharge....then palpate .. 'nce there is node involvement it becomes serious... once node involvement node resection nd7or chemo is neessary before node involvement other options available Receptor positive tumor is a good thing lo1er proliferation rate# because can be treated 1ith bloc*ing agents... if not responding to estrogen receptor negative# 1e canFt treat it 1ith bloc*ing agents hirmone therapy ...they 1ill need chemo

;er-$ ! estrogen! progesterone negative -- triple negative breast cancer is the 1orst ... palliative treatment usually 1ith radiation or chemo ..1ill have recurrence all the time -umpectomy - breast conservation therapy - tumor removed only ..contraindicated if small breasts and large tumor...multi focal tumors! at nipple Cant do radiation is you have active lupus or had radiation at same site Radical (astectomy - everything removed can have breast reconstruction surgery during surgery or after#..follo1 care up every D months for $ years and then every year after that ...and 5SE every month every....EEE highest chance of recurrence at surgical site ... &ost (astectomy &ain Syndrome... can cause fro0en shoulder from not moving arm...treat 1ith NSA)%S! Topical lidocaine!Antidepressants..etc $reast reconstruction flap - primary care is flap perfussion6 assess for color! palpate! cap refil! ...if you chec* a patient and there is poor flap perfussion ..N'T)4B %'CT'R T%&# procedure muscles from abdomen moved to chest under flap#..no1 there are t1o surgical sites to assess... better than silicone gel implant

/ont lactate or have nipple erection after surgery assess for &erfussion! infection! drainage Tamo"ifen and ;erceptin for receptor positive tumor ... ma@or side effect is visual acuity..must notify dr if there are visual issues .oal is to have range of motion in +-D 1ee*s..give pain med before R'( ! elevate arm to level of heart even 1hen sleeping To relieve acute lymphadema6 massage decongestive therapy#! 1rap 1ith pressure bandage! intermittent compression sleeves not overnight#! e"ercise! ..diuretics if nothing else is 1or*ing 4itted 1eighted bra as prosthesis +-= 1ee*s after surgery No lifting anything for at least D 1ee*s after surgery ..and not more than 1, pounds after -umps during menstrual cycle fibroadenoma..not cancer usually -ymphatic mapping ... in@ected 1ith blue dye radioisotope# ..patient may be blue all over Sentinnel -ymph Node6 node right after closest to# affected lymph node

&agetFs %isease - nipple affected ..death rate high! starts off as severe itch! bloody discharge! becomes open 1ound..can be biopsied but only treatment is a mastectomy (astitis - can happen during breat feeding..infection in glands )nflammatory 5reast %isease - loo*s li*e mastitis..is aggressive ..s*in 1ill loo* li*e an orange! assymetry! redness! heat..surgery is too late... chemo and7or radiation more common..goal is control ;yperestrogenism :# - alcholo abusers have higher levels of estrogen so it predisposes them to breast cancer 5enign breast disease and breast cancer difference ..benign cells are typical..malignant cells are atypical Secondary &revention..screenings..if you have atypical cells you are at much higher ris* for breast cancer ---------------------------------------------------------------------------------------;ematology +th Tutor Session R5Cs - +-D!,,,!,,,

Shistocyte - malformed R5C canFt carry right amount of o"ygen or perform proper R5C functions#..body 1ill compensate and try to ma*e more R5Cs... more problems 1ill arise Reticulocyte - immature R5C /5C- +-1,!,,, 5ands ....shift to the left ...larger number of ne1 /5Cs...seen 1ith leu*emia or infection /5C production s 1or*ing overtime#

Neutrophils... <,-8,? of /5Cs# ...less than 1,,, neutropenic..less than <,, severe if count of /5C 1,,!,,, the normal functioning /5Cs R5Cs &-T are cro1ded out and pancytopenia happens... and you 1ill have symptoms of anemia! thrmbocytopenia! infection immature cells go into the organs and 1ill have hepatomeglia and other problems ANC- Absolute Neutrophil Count..less than 1,,, ! less than <,, severely neutropenic 5est 1ay to protect patient from infection6 ;AN% /AS;)N. 5east 1ay to protect staff6 isolation! protection! mas*! gloves Neutropenia - lo1 number and rapid decrease of cells..the faster

the drop and longer the duration the higher the li*elyhood of developing long term problems or death can be from chemo drugs! deficiencies in vitamins! reactions ..most common cause is immunosupression and chemotherapeutic patients ...radiation to sternum and iliac crest# Normal 4lora - most infection start from normal flora in neutropenic patients... assess pt for even the slightet increase in basal temp ... can go Auic*ly from lo1 grade fever to septic shoc* ..monitor for pain... /5C count 1ill be high bands to the left# but be neutropenic ..obtain blood cultures from $ sites..start antibiotic treatment right a1ay 1ith neutropenia not vancomycin though first- that is last line..they 1ould get vanco after cultures done# A"illary temp for pancytopenic patient &latelets - 1<,!,,, - +,,!,,, ...under 1<,!,,,-thrombocytopenia

Normal evels' /5C - +!,,,-1,!,,, ANC - $<,,-D,,, R5C - +.<-<.1 f# +.<-<.J m#

&-T ;.5

- 1<,!,,,-+,,!,,, - 1$-1Dg7dl f# 1+-1=g7dl m# +,-<+? m#

;CT - 3D-+D? f# &T 11-1D &TT 18-$3 )NR $-3 59N- D-$, CREAT)N)NE ,.<-$.,

Creatinine Clearance - 8,-13<ml7min Na- 13<-1+< C- 3.< -< Ca- =.D-1,.$

(g- 1.<-$.< &h- $.+-+.+

)ron! 4olic Acid! 5-1$! 5-D for R5C production dar* green leafy vegetables! beans! red meats# -ymphadema - S1elling ...edema accumulation due to failure of the lymph system..can be caused 1hen nodes are removed! lymphoma! fracture causing bloc*age of a node leading to compartment syndrome# Nodes - drain fluid )nflamed lymph nodes - due to infection! lymphoma inflammation -node 1ill fill 1ith fluid! 1bc! puss 1ith lymphoma it 1ill be hard non-tender#! hard! immoble Assessing lymph nodes...loo* for symmetry! palpate both sides to compare..if it is not painful! it is hard! doesnt move may be lymphoma ....;odg*ins -ymphoma - nodes can sometimes be tender to the touch because it is pushing on something else- ta*e note if it is also

hard Start from the nec* do1n.. most are nodes are cervical# A5' ...A5 universal recipient ' universal donor Rh factor..loo* out for it &os or Neg ...ta*e note that they match from donor to recipient. ...if mismatched the reaction 1ill cause clotting can lead to %)C 1atch patient for fever! chils! bac*! pain Testing for Rh - Rogam for mother if her and baby donFt match :# Chec* this ..Coums test 5one marro1 aspiration usually done from sternum or iliac crest &osterior iliac crest is preferred! then anterior iliac crest! then sternum &t in prone position during aspiration of posterior 5aseline 27S before procedure &ain during aspiration even though under local anesthesia comfort patient during procedure....after aspiration cover site 1ith sterile pressure dressing! monitor v7s until patient stable! assess site for bleeding! 1ith 27S due to blood loss 1ill see ;R speed up then 5& 1ill drop! respiration 1ill increase after ;R increases# )f

site is bleeding ! put pressure on site ... patient should lay on site for pressure..if bed is too soft! roll up to1el and put it underneath# listen to recording#...about thic* blood and 57& Thrombocytopenia can be inherited..can happen due to certain food ingestion blood thinning foods li*e garlic! Auinine! tonic 1ater# )mmune Thrompocytopenia &urpura )T&#- abnormal destruction of circulating platelets...for some reason antibodies covering platelets are attac*ed 1hen they pass through the spleen- as they start to be destroyed the body cant *eep up 1ith ma*ing ne1 ones may see large bruised areas of s*in# .... this destruction is a an autoimmune response...pt 1ill usually be given corticosteroids....patient 1ill have other issues after being on the corticosteroids that must be monitored ...spleen can be removed give &lt 1hen plt level is belo1 1,!,,,# )T& - usually females and over +,! in presence of infection 1ill see petechiae! then purpura! then echymosis# TT& - Thrombotic Thrombocytopenic &urpura - not auto immune! not as common! involves fever 1ithout infection! renal abnormalities ...blood starts to clot ...due to enhanced clotting of platelets you 1ont have enough platelets every1here else similiar to process of %)C but not as bad# .. can happen due to drug to"icity chemo! oral contraceptives#... give pt heparin and &lt 1hen

level is belo1 1,!,,, no NSA)%S! coumadin ! heparin for thrombocytic patients ;)T - ;eparin )nduced Thrombocytopenia - caused by broad! increased use of heparin! ... main issue is venous thrombosis - clotting in the venous system can lead to %2T! 1ill see s1elling distal to the area! pain!..can lead to pulmonary embolism! C2A stro*e#... need to treat clot..but need to avoid ;)T ... &t7&TT 1ill be about normal 1ith )T&! TT&! ;)T raised troponin level means heart damage# Neumega can be given for thrombocytopenia Neupogen for neutrophils Epogen or &rocrit for R5Cs

for Thrombocytic &atients6 )f unsure 1hat is causing thrombocytopenia - pt 1ill receive corticosteroids &latelet transfusion - if at 1,!,,, or belo1 or if at <,!,,, and

actively bleeding Early bleeding signs6 nose bleed! gingival bleeding! for nose bleed - pressure on bridge of nose! lean for1ard.. after < mins still bleeding use ice..if still bleeding after 1, mins contact ;C& or go to ER /ear fitted shoes not open toe! no heels# to prevent falls leading to bleeding! trauma to an*les7@oints (inimum amount of in@ections - SubK...pressure for < minutes! ice pac*! stay 1ith patient ...no )( in@ection because muscle has more blood supply 4or 1omen6 1atch menstrual cycle..<,ml 1 soa*ed sanitary nap*in ..no tampons can tell ho1 much blood and may lead to infection! ...may be given hormones to decrease mensetruation until thrombocytopenia is resolved %iet6 no nuts! - nothing to damage on the 1ay in or out! bland foods spicy! acidic foods may lead to .R%- damage esophagus causing bleeding#! no orange @uice! tomato! citrus... Avoid lemon glycerin s1abs! sugared gum7candy can cause

dryness7irritation %o not bend 1ith head lo1er than 1aist - pressure build up can cause bleeding in the upper mucosal membranes ---------------%)C- clots form... sepsis to"ins in blood# ..immune repsonse to to"ins - platelets attach to the to"ins causing clotting...other factors are acting li*e blood thinner...so lo1 platelets in system because they are at site of clots# and blood thinning going on...1ill have heavy bleeding ...1ill see %2T and throbocytopenia at the same time....pt bleeding-losing volume.... give patient blood chec* blood type#! heparin because the platelets in the ne1 blood 1ill go to clotting sites#... 1ill see an increased %-dimer! increase clotting time &T7&TT# ..4%& increase destroy fibrin# .. 1ill also see shistocytes because R5C are damaged sAuee0ing through clots Signs of bleeding in %)C...pale! petechiae! oo0ing from eyes!nose!)2 site! hematuria! internal bleeding distented abdomenmeasure girth#!bloody stool! increased respirations! hemoptysis! orthopnea positional breathing# difficulty sleeping so pt 1ill use a lot of pillo1s to prop themselves up to breath better#! tachycardia! decrease 57&! confusion! di00yness! -'C! pupils! 1ea*ness! clubbing! s1elling! later signs6 necrosis due to no perfusion .. listen to recording# clots lead to6 obstruction6 shortness of breath! dysrythmias! venous distension I2%#! paralytic ileus! 1ill hear hyperresonnance 1ith obstruction! Clotting in *idney area oliguria!

Care6 belo1 1,!,,, get platelets! or <,!,,, and actively bleeding )f thrombus is present they get heparin or lo1 molecular 1eight heparin ------------(yeloidy %ysplastic Syndrome - composition of 1hat bone marro1 is producing is different ..hypercellular actions are causing changes ...pancytopenic - highest prevalence in males over 8, ..cause un*no1 but results from an issue in stem cells ploidy# in 3,? of cases becomes A(-. 1ith A(- you 1ill see more -eu*emic cells much more immature#.. (%S progression is lo1er than A(Care for (%S - if the (%S isnt that bad they 1ill get Erythropoeitin ...for higher ris* patient 1ill get ;ST stem cell transplant# ... ;ST contraindicted in6 ----eu*emia6 &# - =<? occurs in adults ! onset can be abrupt!dramatic. patient 1ill have signs of pancytopenia S7S6 infections due to drop in neutrophils# ! fatigue! anemia! bleeding! mouth sores! everything drops all blood levels# ...D,-8,yr olds

C# - &hiladelphia chromosome mar*er ... starts off chronic and leads to acute-blastic phase immature cell phase# ..chronic phase can be controlled by treatment ..once becomes acute patient may only live a fe1 months...S7S6 not many...may see fever! bleeding..pea* onset +<

& - children! mostly $-Jyr olds... only about 1<? of cases are adults usually their prognosis is very bad#...childrenFs prognosis is good- have a J,? chance of remission they also have more stem cells so treatment can be done# 4irst signs6 high fever! pallor! petechia! fatigue! @oint pain! abdominal pain... 1ill see pancytopenia -- 1ill see CNS manifestations ..1ill see leu*emic meningitis because the cells infiltrate the meninges ... philadelphia mar*er seen in some cases# Treatment6 chemo! (ethotre"ate! Cyterabine for 5rain treatment !.cross 555 Radiation to head 1ill lead to permanent Alopecia

C most common leu*emia in adults <,-8,yr olds..overporduction but functionally inactive 5cells..infilltrate bone marro1! spleen! liver..1ill see lymph node enlargement similar to lymphoma.....early signs 1ill be fatigue slight over period of time..patient may see changes in things they used to do

i.e hobbies! time they 1a*e up! sleep patterns#! C-- usually becomes A(-# ...leu*emic cells 1ill high../5C count 1ill be high but patient 1ill be neutropenic 'verall... S7S6 anemia! thrombocytopenia! neutropenia! -eu*emic cells bunch up into a solid mass Chloroma...if /5C 1,,!,,, do a leu*ophoresis - 1ill receive ;ydro"yurea to reduce the one that are floating around too many circulating 1ill cause all other problems# Acute -eu*emic Treatment6 )nduction phase ..attempt to bring about remission- aggressive treatmenet - chemo- patient 1ill severely ill becasue bone marro1 and healthy cells 1ill be affected too ..pancytopenic precautions neutropenic precautions#! psychosocial support! Consolidation &hase6 continue chemo dose but 1ill be longer to get hidden leu*emic cells from tissues7organs (aintainence phase..less dose to get any leu*eic cells that are left 'nce acute# -eu*emia returns after remission it becomes chronic

&neumococcal vaccine! re-diagnosis! - every < years and annual flu shot

(#"H)#&!' Hodkins - usually 1<-3<yr olds! <,H...multinucleated cells... better than non.-hodg*ins# diploidy double amount of chromosomes:# Reed-Sternberg cells mar*er found in lymph nodes lymph node aspiration or biopsy# common in males! people thath have had Epstein 5ar! ;)2! most prevalent in cervical nodes ... have 'C%starts from one and goes to sentinnel node..in order# ..nodes 1ill be hard! non-mobile! non-tender usually tender if pushing on something# S7S6 after nodal involvement6 1eight loss! fatigue! fever! anore"ia 1hen cervical nodes pushing on esophagus#....5 symptoms6 4ever! Night S1eats! /eight -oss..if you have all of them you have ;odg*ins ;odg*ins patients 1ill have uncurable severe itch pruritis#every1here ..cant be treated -ate Signs6 hepatosplenomegally! S2C! I2%! blood flo1 to brain! pressure to brain causing sei0ures Treatment C;E(' -A52% Adryomycin! 5leomycin! 2inblastine! %acarba0ine# Non-Hodkins- 1ill have aneuploidy abnormal cells# have A%%@umps around ... multiple lymph nodes affected# mostly 5cellsslight t-cell involvement...affects all ages ...usually involved 1ith ;)2 patients! on chemo! radiation...may be related to previous

Epstein 5arr infection.. &rimary sign6 painless lymph node enlargement Treatment 6 chemo or radiation to nodes! or systemic ! comfort! palliation!

#* T+" E #(E )#& - 5one damage because neoplastic cells infiltrate bone marro1 ...can also be called &lasma Cell (yeloma... more prevalent in males D<... caused by radiation! ben0ine! chemical! pesticides! insecticides! ... 5cells over production! nonfunctioning..they migrate bac* into the bone marro1 and cause destruction# .. .....monitor patient for ;ypercalcemia ...Treat ;ypercalcemia - ;ydrate patient to flush calcium (-protein mar*er! 5ence-Iones protein mar*er can be found in urine#--large molecules ..they 1ill cause *idney bloc*age eventually leading to *idney failure S7S6 insidious until advance..by then you have s*eletal pain - bone damage has occurred ... usually the pain is during movement ...can have pathological fractures.. calcium being released into blood 1ill have problems from hypercalcemia- ...bone marro1 being destroyed so you 1ill have pancytopenia destruction of all blood cells-1bc!rbcs!thrombocytes# Treat pancytopenia! hypercalcemia fluid then diuretic#... 5one

pain- try to prevent fractures! limit stress or activities that can cause bone trauma ! heavy lifting! ... 1al*ing necessary to *eep things moving .. early stage6 1atch patient L1atchful 1aitingL not really a cure# treat other symptoms 1ith corticosteroids..ambulation! hydration for hypercalcemia treatment...

5lood &roducts6 for transplant ...blood ta*en out of donor ..platelets ta*en out and blood returned to donor platelets can be stored 1-< days at room temp blood cannot - must be refrigerated need $ nurses to verify blood product and patients type must sha*e bag before administering so blood doesnt clot.. blood must be started 1ithin 3,mins :# and infused 1ithin + hours minimum 1J gauge for blood :# blood not mi"ed 1ith anything e"cept Normal Saline...not -R! Not de"trose! no crystalloids ..1ill cause R5C hemolysis flush line 1ith NS before giving meds .. remain 1ith patient for first <,mls 1<mins#...assess v7s every 1< mins for an hour ..should be infused 1ithin + hours...

&riority6 you 1ill see A(- patient before C(- patient A is acute#
------------------------------------------------------------------------------------------------------------

-ast tutor session before test# -aryngeal Cancer Complications6 obstruction! hemmorrhage! carotid artety problems! metastasis! complications from treatmenets Trach6 done in 'r..can be done at bedside--bedside better6 less blood loss! less cutting! less infection ris* Cuff to prevent aspiration... inflate cuff during inhalation... deflatine on e"halation... Suction before deflating.. suction mouth last ..dont go bac* in throat after doing mouth cuff pressure ...$, mm7mercury...$<mm71ater use minimum lea* techniAue..fully inflate and 1ithdra1 ,.1 Cuff si0e 1ill increase over time Chart for teaching supraglottic s1allo1! trach cleaning! cuff pressure or any teaching# ... steps6 teach! return demonstration!

post chart on wall with steps,for 1hile patient in still in hospital# ....pamphlets to go home 1ith %ecanulation6 obturator! trach set! ambubag near bedside..use forceps or finger to open if necessary if trach is fresh and it slips out ..pull on suture lines to open it and get trach bac* in p.$+3 of saunders# %r al1ays does first change tube! ties etc#after surgery .. /hen suctioning.. insert catheter until you feel resistance ----patient should be on humidified air to prevent mucous plug..in the event of mucous plug insert 3-<ml saline bullet and suction not recommended regulary# Tube change once a month open established stoma shouldnt have anything covering it that has a large amount of fabric 1ool! gau0e pads 1ith fibers#... 1, secs to suction intermittent suction# No routine suction...only 1hen needed baseline vitals before suction...o"ygenate..suction..o"ygenate .oal for suctioning6 better air1ay clearance...should hear clear breath sounds and increased pulse o" level

After trach is done..patient should be in semi fo1lers position...may see blood tinged mucous right after insertion )f secretions are bubbling out of fresh trach... position patient first-it facillitates better breathing most noninvasive thing to do#... then suction...

To clean trach tube...sterile techniAue...1 part pero"ide! $ parts sterile 1ater NS# to clean..soa* cannula! use brush...tap to remove excess water--- dont sha*e#...may use sterile gau0e but may leave fibers No surgery to close stoma...1ill close on its o1n once trach is removed

eukoplakia ,white patch on tongue.---early sign of laryngeal cancer Stomatitis7mucositosis...oral care6 clean 1ith ba*ing soda 1tsp to =o0 1ater! or pero"ide 163 1ith 1ater! hurricaine solution lidocaine! benadryl!antacid ...is a prescribed medication #..clean teeth after meals and before bed...no alcohol rinses or lemon glycerin s1abs
-----------------

Radical nec* dissections and 5C6 / &"!..main concern6 perfusion...chec* perfusion6 s*in should not be ;'T or C'-% - hot means infection! cold means no blood flo1 ..doppler can be used to chec* blood flo1 )f 4-A& feels cold6 they donFt need o"ygenation... Call doctor if there is a choice to collect assessment date do that# Supraglottic S1allo1.... ;igh protein high calorie after surgery Carbonated 1ater or soda for supraglottic s1allo1 study Gerostomia.. early sign of stomatitis dont s1allo1 lidocaine solutions...1ill numb s1allo1ing ;&2...ris* factor for laryngeal cancer ------------------------------------------------;)2! ;ep 5! Epstein 5arr! ;&2... infections that can lead to cancers

-------------------------------------------------9N. CANCER Cigarette smo*ing is M1 cause E-cigarettes can still pose ris*...irritation &romote smo*ing cessation to all patients Small Cell is 1orse than non-Small cell cancer =,? of lung cancer is non-Small cell No petroleum @ellies to s*in after radiation After radiation Aloe for dry desAuamination! *eep 1et s*in dry &araneoplastic syndrome - hormones or e"tra hormones being secreted ...parathyroid hormone! A%; etc 0" drain--to re-establish suction' s1uee2e pump /+%!T---then cap Early signs6 cough! hoarseness! sputum

%ont give false reassurance to patients

After bone marro1 aspiration lay patient on affected side 1ound#to put pressure on 1ound to stop bleeding 'nce there is nodal involvement ..then you have to 1orry about metastasis &ulmonary function tests must ne done before removal of any *ind Radiation to chest area6 ..1orried about bone marro1 suppressionbecause it is in area of sternum &hotodynamic therapy...chemical given!! goes to cancer cell... += hours later a light is shined on them and *ills the cancer cell..problems6 very e"pensve! ta*es a lot of time! cant be e"posed to any light &atient must go through simulation before radiation therapy (etastasis to 5rain 5one 5lood -iver and Adrenal most common ----------------------------------------

;ematology6 *no1 all normal levels -ymphadema fluid in lymph system not draining#can occur at anytime..especially to people 1ith node removal ..if removed you are on lymphadema 1atch forever Elevated arm to level of heart..not above .....use compression sleeve or glove ...if you cant reduce the lymphadema you can have perfussion problems R5Cs..need iron! folic acid and cobalamin... nontender! hard3 fixed lymph nodes 1ould be cancerous ... )T& immune throbocytopenic purpura ...Spleen problems immune#...1ont see d-dimers clot formation# .. not enough clotting going on# %)C 1ill see d-%imers and increase in &t7&tt clots happening Nin bigger veinsOand less platelets every1here else#

Corticosteroids for auto immune problems Thrombocytopenic patients6 mouth care! epita"is lean for1ard 1ith pressure on bridge of nose..if still bleeding use ice..if still bleeding after 1,71<mins call doctor# ! proper shoes to prevent falls! after subA in@ections hold pressure at in@ection site for 1, mins... avoid )(s... Neumega may be given to add more platelets.. menstruating 1omen - monitor pads 1 full eAuals <,mls#- no tampons! hormones may be given to lessen or stop menstruation can be scheduled if person 1ill be pancytopenic li*e for a patient that 1ill receive radiation#! no bending over! Neutropenia - neutophils belo1 +!,,,... belo1 1!,,, is a problem precautions enacted..belo1 <,, is horrible...(ain 1ay to prevent infection6 /AS; ;AN%S ... reverse isolation! no fresh7ra1 foods! limited visitors! no live vaccines (%S- (yelodysplastic Syndrome - abnormal bone marro1 cells...similar to but not as bad as leu*emia.. but both are putting out immature cells but leu*emis cell are ('RE immature can lead to leu*emia A(- - adults usually A-- - children usually C-- - has CNS involvement prolhylactic cranial radiation may be used..(ethotre"ate! Cytarabine ..because they cross blood brain barrier#

C(- - "hiladelphia Chromosome ...1ont see increase in neutrophil count... most patients remain indiagnosed when you have Chronic disorder,C 3 C# . you wouldnt worry much about chronic fatigue-wouldnt be a priority,its expected. Treatments for -eu*emia... )nduction - high dose of chemo 1ill be on strict reverse isolation! pancytopenic precautions! ;epa mas*! bleeding precuations etc# Consolidation6 further chemo to get any hiding cells (aintainence phase- -onger time to maintain remission

total body radiation before marro1 transplant

)ntrathecal in spinal cord# administration of chemo drugs ...uneven distribution -ymphomas6 ;odg*ins - 1st lymph node involvement is sentinnel

Non-;odg*ins is all over ..hard to treat by radiation or removal Reed-Steinberg cell for ;odg*ins ....not non hodg*ins Cervical node is most common start ;odg*ins patient - e"treme itch puritis# /ill have non-tender fi"ed! hard tumor ;odg*ins prognosis is better than non-;odg*ins ;odg*ins is diploid Non-hodg*ins is aneuploidy - damaged more severe# Chemo treatment6 drug pneumonic A52%# Non-;odg*ins6 much 1orse ..treament drug pneumonic RC;'&# -------------------------------(ultiple (yelomas -- bone destruction....calcium into blood.. ;ypercalcemic patient muscle 1ea*ness! *idney

stones#...treatment6 4luids..then diuretic 5ENCE I'NES mar*er for (ultiple (yeloma Ioint pain! fractures! (ove patient 1ith chuc* or sheet! encourage 1al*ing! fluid dehydration and immobility can cause calcium increase in blood# Treatments6 Corticosteroids! Chemo (&T- (elphalan! &rednison! Thalidamide# 5lood &roducts6 1hen giving blood product..$ RNS need to chec* patient! blood mathc etc must be used 1ithin 3, mins! must finish infusing in +hrs...if ta*es longer than + thro1 a1ay... 1J gauge needle for blood can give platelets at room temperature..not refrigerator can stay out 1-< days.... sha*e bag so platelets dont clump... B tubing.. must give blood product only with Normal !aline ..nothing else ...-R is a crystalline solution..and no de"trose (ust stay 1ith patient 1< minutes or until <,mls transfusses..no more than $mls per minute chec* patient every 3, mins during infusion..

after infusion complete chec* for at least an hour $" in 1 hour# ----------------------------------------------5reast Cancer6 ;arder to treat becasue the mitotic rate of breast cells are slo1er...chemo and radiation are most effective against high mitotic rate cells A"illary node involvement ..once you have + or more it is very bad ;ormones can cause 5C..contraceptives! nuliparity.. estrogen hormones from adipose tissue# 9pper outer Auadrant is most common spot 5enign - typical cells! encapsulation! differentiated (alignant - atypical cell! undifferentiated Estrogen receptor status6 if cells have receptors for estrogen estrogen receptor positive# patient can be given estrogen li*e med antagonist# so it sits on the cell and bloc*s estrogen then the cancer cell cant get estrogen and cant gro1...

Triple Negative 5reast Cancer ...negative to ;er-$! estrogen &rogesterone.... not much treatment ;erceptin - treatment for people positive to ;ER-$ receptor Tamo"ifen treatment for receptor positive ;erceptin -- ma@or side effect6 cardioto"icity ... signs of cardioto"icity6 peripheral edema! dysrhythmias! Tamo"ifen6 (a@or side effect6 visual problems... contraindicated for glaucoma patients (odified Radical (astectomy - muscle still there to rebuild -umpectomy - @ust tumor removed... contraindicated if breast is too small in relation to si0e of tumor - radiation 1ould be done then chemo ...cant do surgery is in all different Auadrants ot near nipple 4or $ years ! 5SE!! Tumor may come bac* at same site (astectomy &ain Syndrome - immobility due to pain ... priority is *eep it at level of heart to prevent compartment syndrome... 5rachytherapy - seeds.... are radioactive

5reast reconstruction 4-A& surgery ...priority is perfusion6 TRA( 4-A& - trans abdominal rectus muscle used 1ith 4lap .... problem is $ surgical sites to monitor no1 0" 4rain care can hold 566mls --grenade at end...must be pressed to restablish suction

&ennRose... tube hanging out Arm Care of affected side - no finger stic*s! no )2! No 5&! protect arm7hand from any in@uries! no sun burn! 1ear gloves 1hen gardening! dont clean up dog poop or liter bo"es

)mmediately after mastectomy start off 1ith finger! hand! 1rist e"ercise... give anagesic 3, mins before! semi fo1lers! elevated arms! ..sho1er 1ith 1arm 1ater-not hot or cold! -ymphadema - elevation! decongestion therapy massage! compression band- remove 1hen sleeping# E"plain to patient they 1ill al1ays be at ris* for lymphadema

5reast Reconstruction6 tissue e"panders ...slo1 increase to e"pand tissue and then filling 1ith saline -ater on if there is bac* pain ...could be from spinal cord compression 5reast implants - after1ard need 1ell fitted bra no sho1ering 1ith I& drain in no lifting more than 1,lbs for at least $-3 1ee*s -umps 1ith menstruation that go a1ay is normal S5E <-8 days after menses.... after menopause date of bday or anniversary same day every month -----------------------------------'ncologic Emergencies6 Radiation for S2C .. Spinal Cord compression ..laminectomy S)A%; from paraneoplastic syndrome# Tumor -ysis Syndrome ... give lasi"! allopurinol

)nflammatory 5C..1orst type - orange peel s*in! red 1arm s*in..surgery usually too late...1ill be for control not cure &agets %isease - tumor in nipple...high death rate! unilateral bloody discharge