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Flashcards in Final Deck (44)
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1
Q

What are some the psychosocial services provided for oncology patients by social workers?

A
  • physical, psychological, social, emotional, spiritual, and financial support needs to ensure best possible outcome.
  • provided to patients and their caregivers.
2
Q

What does the Oncology Social Work Role include

A
  • meet with patients and their families to assess needs, discuss adjustment and arrange practical referrals.
  • to provide psychosocial support/counseling
    make community referrals and provide resource information: i.e. Cancer Care, Private Pay Home Care agencies, Continuum resources.
3
Q

What are some recommendations for cancer care that are stated in The Institute of Medicine report entitled “Cancer Care for the Whole Patient Meeting Psychosocial Health Needs”

A
  • all cancer patients and their families should receive cancer care that ensures the provision of appropriate psychosocial health services.
  • designing a plan that: links patients with needed psychosocial services, coordinates biomedical and psychosocial care, engages and supports patients in managing their illness and health.
4
Q

What are common emotional and practical concerns of cancer patients?

A
  • fear of dying, anxiety, depression, and anger
  • physical, emotional, and intimacy issues are also common.
  • social, financial, and physical issues include costs of cancer, employment, discrimination, insurance, & negotiating health care system, disfigurement, side-effects.
5
Q

oncology patients’ key stress periods

A
  • time of diagnosis and pre-treatment
  • treatment period
  • end of treatment/remission
  • recurrence/relapse
  • terminal phase: pivotal visits- should trigger a referral.
6
Q

The American College of Surgeons made a new requirement in 2012. What is it?

A
  • the cancer committee will need to develop and implement a process to integrate and monitor on-site psychosocial distress screening and referral for the provision of psychosocial care as standard for cancer patients
  • universal screening.
7
Q

factors affecting a patient’s adjustment to the cancer diagnosis

A
  • severity of illness (prognosis) & treatment plan
  • psychological stability
  • social supports
  • age
  • socioeconomic status
  • coping styles
  • family functioning style
  • cultural & religious & spiritual identity
  • personal & social values of cancer patients & society
8
Q

the important unmet needs of cancer patients

A

help dealing with emotional problems

9
Q

the barriers to effective communication between providers and patients

A
  • patients may be functionally illiterate
  • treatment plans are very complex
  • multiple providers and spread out locations (different physical locations and providers for chemotherapy, radiation, radiology, etc.) can present communication challenges.
  • patients and families are often reluctant to ask questions and afraid to discuss the dying process
10
Q

cultural barriers between providers and patients

A
  • many ethnic minority and medically underserved populations face cultural, socioeconomic, and institutionalized barriers to cancer prevention and treatment, and experience poorer cancer survival rates than whites.
  • other barriers: fatalism regarding diagnosis, lack of social support, and mistrust of medical & scientific establishment, beliefs/understanding about cancer and treatments
  • language barrier can affect treatment options
  • Many Chinese seek alternative therapies and fear telling their oncologist
  • Chinese & Mexican cultures value importance of family members taking care of the elderly. Families felt that they should be informed of the cancer diagnosis/prognosis instead of the patient. In the Chinese culture, disclosing poor prognosis is often considered unethical.
11
Q

How does nurses’ understanding of patients’ spirituality or religion affect patients’ care?

A
  • it impacts the quality of life for chronically and terminally ill patients. Addressing spiritual issues has a positive impact on the patient’s psychological well-being.
  • understanding a patient’s spirituality is important to understanding the patient as how he/she deals with illness, death and bereavement.
  • take care not to impose your culture, values, and beliefs on the patient and family.
12
Q

properties of stem cells

A

have capacity for unlimited self renewal
have ability to differentiate into all types of mature blood cells
- myeloid cells can further differentiate to RBC, platelets, and neutrophils
- lymphoid cells: provide the foundation for adaptive immune system.

13
Q

purpose of a bone marrow transplant

A
  • supportive measure: restore patient’s own bone marrow after intense myelotoxic therapies used in an attempt to eradicate the cancerous process
  • potentially curative: eliminate and replace malignant cells with healthy donor stem cells capable of regenerating the recipient’s hematopoietic system.
14
Q

methods used to extract hematopoietic stem cells

A

bone marrow harvest: sterile surgical procedure with large-bore needles repeatedly inserted into the posterior iliac crests after the patient has received general anesthesia.
apheresis: use growth factors to expand and increase hematopoietic stem cells into vasculature 4-5 days. cycles through machine which separates the components, then the WBCs are extracted (where the stem cells are).

15
Q

description of bone marrow

A

soft, spongy matter stored in the bones that is a rich source of hematopoietic stem cells

16
Q

the purpose of the CD34+ test

A

test that cell numbers are adequate for transplantation.

17
Q

the difference between autologous and allogeneic transplants

A

autologous: infusion of one’s own stem cells (previously collected and frozen)
allogeneic: infusion of related donor stem cells, infusion of unrelated volunteer donor stem cells, umbilical cord.

18
Q

diseases treated with stem cell transplants

A

non-Hodgkins lymphoma
Hodgkins lymphoma
multiple myeloma

19
Q

benefits and risks of autologous transplants versus allogeneic transplants

A
autologous benefits:
- no risk of graft vs. host or rejection
- does not require immunosuppressive treatment
- less toxicity than allogeneic
autologous risks:
- number of collected stem cells returned to the patient may not be enough for full engraftment.
- there is a possibility that the cancer cells may contaminate an autograft, even when obtained during a remission.
allogenic benefits
- avoids contamination of cancer cells
- graft vs disease effect
allogenic risks
- graft failure
- infection
- graft vs. host
20
Q

important nursing actions in the peritransplant period and during stem cell infusions

A
peritransplant
-clean room
-prophylactic antibacterials, antivirals, antifungals
-immunosuppressant therapy
-platelet and RBC transfusions
-dietary precautions
-nutritional support
during infusion
-vital signs including o2 sat
-cardiac monitoring
-monitor for chest pain, bradycardia, tachycardia, SOB, agitation, restlessness, diaphoresis, fever/chills, flushing, urticaria, hypo/hypertension.
21
Q

cytoreduction chemotherapy

A
  • very high dose chemo and/or radiotherapy
  • destroys bone marrow as a consequence of trying to kill residual cancer cells
  • minimal to no chance host bone marrow will recover without stem cell support
22
Q

Graft versus Host Disease

A
  • an immunologic response of donor lymphocytes contained in the graft against the recipient/patient’s tissues which are identified as foreign.
  • causes varying degrees of injury to the host’s tissues
  • acute and chronic.
23
Q

survival statistics associated with lung cancer and stage the majority of lung cancer patients present

A

overall 5 year survival: 15%

most diagnoses in advanced stage

24
Q

reason for the decrease in death rates seen in lung cancer patients over the last decade

A

reduction in tobacco exposure

25
Q

demographic category has the strongest association between lung cancer and smoking

A

more so in women than men: hormonal, molecular, genetic

26
Q

main categories of lung cancer

A

squamous cell carcinoma
adenocarcinoma
large cell carcinoma
small cell lung carcinoma

27
Q

the most common category of lung cancer

A

NSCLC: non small-cell lung carcinoma

make up 75-80% of all lung cancers in the US

28
Q

category of lung cancer is associated with a neuroendocrine type of tumor

A

SCLC: small cell lung carcinoma

neuroendocrine tumor occurring in the central airways

29
Q

How are oncogenes involved in the growth of cancers?

A

oncogenes are dysregulated causing over-expression and mutations

  • transcription factors
  • growth factors
  • receptors
  • signal transducers
30
Q

What does optimum sensitivity refer to in screening of patients for cancer?

A
  • the ability to detect individuals with the disease
  • sensitivity= true positives/true positives+false negatives
  • optimum sensitivity is imperative for screening
31
Q

What have researchers discovered about tobacco and the risk of cancer?

A

it is the primary cause of lung cancer

increases risk for 14 other cancers: oropharynx, esophagus, urinary bladder

32
Q

What are important education points for individuals who want to quit smoking?

A

behavior is a big piece of smoking cessation
chronic condition that may require multiple interventions and repeated quit attempts
nicotine addiction; wanting-craving-needing

33
Q

What are the local regional, extra-thoracic, and systemic manifestations (symptoms) of lung cancer?

A

local regional
- cough, dyspnea, hemoptysis, wheezing, chest pain, lymphadenopathy, hoarseness, pneumonia, effusion, SVCs
extra-thoracic
- headache, CNS disturbances, GI, hepatomegaly
systemic
- weakness, fatigue, anorexia, cachexia, weight loss, anemia, paraneoplastic syndromes.

34
Q

Superior Vena Cava Syndrome

A
  • obstruction of superior vena cava from tumor, clot, radiation fibrosis, or infection
  • increased venous pressure causing venous stasis in the head, neck, upper arms, and upper chest.
  • dyspnea, facial swelling, cough, worsening symptoms with forward bending.
35
Q

Syndrome of Inappropriate Antidiuretic Hormone (SIADH)/lab values are associated with SIADH

A
  • abnormal production of ADH resulting in water retention and hyponatremia
  • not uncommon in SCLC
  • peripheral edema is absent, & renal, adrenal, and thyroid function is normal
  • may note tiredness, headache, weakness, muscle cramps, decreased appetite. Can have confusion or personality changes, GI symptoms, decreased urine output, thirst, lethargy, and loss of DTR.
  • severe hyponatremia ( plasma osmolality
  • euvolemia
36
Q

phases of cancer survivorship

A

active

extended: months
permanent: years

37
Q

fundamental principles of cancer survivorship

A
  • cancer isn’t over the day treatment is over
  • the impact of a cancer diagnosis and cancer treatment has a lifelong impact on cancer patients and their loved ones
  • cancer patients and their loved ones need access to high-quality, long term follow up care.
38
Q

essential elements of cancer survivorship care should include

A
  • surveillance for disease recurrence
  • surveillance for the development of secondary cancers
  • psychosocial distress screening
  • screening and management of late and long-term effects
  • health prevention and health maintenance
39
Q

factors increase cancer survivors risk for secondary cancer

A
  • genetics
  • risk taking behaviors (smoking, sun exposure)
  • therapy prescribed for primary cancer: radiation, - chemotherapy
  • females
  • treated at a younger age
  • diagnosed with Hodgkin’s or soft tissue sarcoma
  • exposure to alkylating agents
40
Q

four basic moral attitudes

A
  • an unconditional respect for human life and dignity even in situations of extreme weakness and/or vulnerability
  • the acceptance of human finitude and death
  • a nonjudgemental embrace of cultural difference and diversity
  • willingness to persevere in the prevention of pain, the promotion of holistic health, and insuring the dignity of a peaceful and “good” death
41
Q

definition of the term “ethics”

A

the “science” of the methods of analysis of “good and evil”, ought and never, beneficial and harmful, should and should nots.

42
Q

definition of the term “morals”

A

the “doing” of ethics based on world view combined with personal feeling, belief, culture, ethnicity, economic status, cultural mores, religious background, integration, analysis and implementation/evaluation.

43
Q

four basic principles of contemporary bioethics

A
  • nonmaleficence: do no harm (minimize harm)
  • beneficence: do good, act in patient’s best interest
  • autonomy: right to self-determination, informed and knowledgeable, “aware”
  • justice: allocation of health care resources wisely and according to need
44
Q

traditional principles in medical ethics

A
  • respect for human life and death
  • therapeutic proportionality: benefit to risk ratio
  • double effect
  • truthfulness in communication
  • prevention
  • nonabandonment