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HS3-Test #3 Review
Health Sciences 3 (Mohawk College)
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FHealth Sciences 3- Test #3 Review
Pharmacological therapy for Gastrointestinal Disorders
1. Identify a common drug regimen protocol that is effective in the treatment of peptic
ulcers.
Triple therapy includes 2 antimicrobial
medications as a proton pump inhibitor or a
histamine 2 recptor antagonist plus an antacid.
Triple Therapy = 2 ABX + PPI/HRA + Antacid
5. Complete the following chart for
histamine receptor antagonists used in the
treatment of peptic ulcers. Some
information is provided for you.
Pharmacology
a) drug names – generic and
trade
c) uses (used for)
i) interactions
Description
-cimetidine (Tagamet), famotidine (Pepcid)
-used to heal and/or prevent active or benign gastric
ulcers.
Benzodiazepines, beta blockers, calcium channel
blockers, caffeine. Cimetidine has a higher risk for
interaction than the others.
6. Complete the following chart for antacids used in the treatment of peptic ulcers.
Some information is provided for you.
f) side effects
-diarrhea /c magnesium antacids.
-constipation /c aluminum and calcium antacids.
Hypophosphatemia.
Aluminum Antacid (Amphogel) –Constipation
Magnesium Antacid (Maalox, Mylanta) –Diarrhea
Calcium Antacid – kidney stones & rebound
Hyperacidity.
Hypersensitivity, severe renal failure, electrolyte
disturbances, GI obstruction, and unknown etiology of
severe abdominal pain.
h) contraindications
7. Complete the following chart for proton pump inhibitors used in the treatment
of peptic ulcers. Some information is provided for you.
m) nursing considerations
 health teaching
-capsule must be taken whole and not crushed,
opened, or chewed.
-continue taking even if feeling better.
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-hyperglycemia may occur /c diabetes.
Not interchangeable.
Pantoprazole can cause hyperglycemia, omeprazole
can cause hypoglycemia.
8. Complete the following chart for cytoprotective agents used in the treatment of
Ss. Some information is provided for you.
Pharmacology
a) drug names – generic and
trade
b) drug classifications
d) mechanisms of action
Description
-misoprostol (Cytotec)
-cytoprotective agent.
Prostaglandin Analogue -very effective in reducing the
incidence of gastric ulcers in pts who are taking
NSAIDs. Inhibits gastric acid secretion by protecting
the gastric mucosa from injury
 by enhancing the local production of mucous or
bicarbonate in the stomach
 promoting local cell regeneration
 maintaining mucosal blood flow.
9. Complete the following chart for GI anti-inflammatory drugs used to treat IBD. Some
information is provided for you.
Pharmacology
a) drug names – generic and
trade
-sulfasalazine, mesalamine
Description
c) uses (used for)
-used primarily to treat UC.
-also used to treat RA by inhibiting the WB from releasing
inflammatory chemicals.
-unlabelled use – Crohn’s.
10. Complete the following chart for Imodium, used as symptomatic therapy in IBD.
Some information is provided for you.
l) nursing considerations
 administration
-administered PO only /c clear fluids to help prevent
dehydration for 48 hours only.
Documentation of each administration (after each bout
of diarrhea). Opioid antagonist on hand in case of
overdose and CNS depression develops. Maintain 2L
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day fluids to maintain hydration, and prevent
dehydration and electrolyte imbalances.
11. Complete the following chart for the anti-microbial ciprofloxacin, used to treat IBD.
Some information is provided for you.
-patient must use sunscreen, hat, protective clothing to
prevent phototoxicity reactions during therapy, and for 5
days after therapy is finished. Side effects and allergic
reactions need to be reported if present. Perform frequent
oral hygiene to prevent dry mouth.
m) nursing considerations
 health teaching
12. Complete the following chart for immune suppressants used to treat IBD. Some
information is provided for you.
Pharmacology
a) drug names – generic and
trade
c) uses (used for)
Description
-azathioprine (Imuran), cyclosporine (Sandimmune)
Imuran (Long term management of chron’s and
Severe rheumatoid arthritis). Sand immune (used
prophylactically in organ transplants to prevent
rejection and in RA and psoriasis)
Abnormal Cell Growth
1. Define the following terms relating to cancer:
Term
Definition
anaplasia
Change of cells into an immature/less differentiated form. Formation of a
malignancy.
angiogenesis
Formation of new blood vessels by tumours.
apoptosis
Programmed cell death or cell suicide.
ascites
Accumulation of excess fluid in the peritoneal cavity.
Almost always associated with severe advanced liver disease.
atypical
Cells that are abnormal but not necessarily cancerous.
benign
Non-cancerous.
cachexia
Is a wasting syndrome that presents with weight loss, fatigue, and loss of
muscle mass.
carcinogenesis
Creation of cancer.
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differentiation
Process where a less specialized cell become a more specialized cell.
free radicals
Atoms or groups of atoms that can be formed when oxygen interacts with
certain molecules.
in situ
In its original place or in position.
infiltrate
Cells a beginning to invade/spread or permeate into another area.
invasion
When the tumour infiltrates the tissue
malignant
A cancerous growth
metastasis
The spread of a secondary malignancy to a distant site from the primary
tumour
neoplasm
A new abnormal growth of tissue
oncology
The study and treatment of tumours
proliferation
A very rapid increase in the number of cells
polyp
A protruding mass of overgrown tissue from the mucous membrane.
quiescence
Means inactive or dormant.
stem cell
Generic cells developed in bone marrow.
tumour
Abnormal growth of tissue due to uncontrolled progressive multiplication of
the cells.
2. Tumour nomenclature is a classification process whereby
tumours are named and classified according to the type of
tissue and the location of the tumour. Define the following
terms related to tumour nomenclature:
Term
adenocarcinoma
Definition
Malignant tumour formed from epithelial tissues in glands.
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adenoma
A benign tumour formed from epithelial tissues in glands.
carcinoma
Invasive malignant tumour formed from epithelial cells.
leukemia
Variety of blood or bone marrow cancers.
lymphoma
cancer in lymph cells.
osteoma
Benign bone tumour.
papilloma
Small benign epithelial tumour on the skin or mucous membrane Ie wort or
polyp.
sarcoma
Malignant tumour formed from connective tissue.
3. Explain the differences between solid tumours and haematological tumours.
Solid tumour is an abnormal growth of body tissue cells that is not blood, lymph or bone.
Hematological tumours come from blood, bone marrow or lymph (generally derived from
myeloid or lymphoid stem cells in bone marrow).
4. Neoplasms are considered either benign or malignant. Complete the following
comparison chart relating to benign and malignant tumors:
Feature
Benign
Rate of growth
Malignant
Rapid growth
Relatively slow
Cell differentiation
Similar to normal cells
Differentiated
Mitosis fairly normal
Varies in size and shape
Large nuclei
Many undifferentiated cells
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Spread
Remains localized
No systemic effects
Invades/infiltrates nearby tissues
Metastasizes to distant sites via blood and
lymph
Systemic effects present (weight loss,
anemia, infections, bleeding)
Seriousness
Only life threatening in brain
Life threatening
Encapsulation
Frequently
No capsule
Tissue Destruction
Rarely
Yes
6. What are anti-oxidants? List some food sources of antioxidants.
Molecules that can safely interact with free radicals without
turning into cancer cells. They alter the free radicals and stop
the chain reaction before the free radicals are able to stop the
cell damage. Antioxidants are found in A C E Vitamins.
Vitamin A-beta carotene- found in liver, egg yolk, milk, butter,
carrots, squash, broccoli, tomato, cantaloupe, peaches, all
colorful fruits, and vegetables.
Vitamin C- citrus fruits and juices, green peppers, cabbage,
spinach, broccoli, and kale, Cantaloupe, kiwi, and strawberries.
Vitamin E-nuts and seeds, vegetable and fish oils. Whole grains especially wheat germ, cereals
are fortified with vitamin E.
7. By describing the pathogenesis, of metastasis, explain how cancer cells gain access
to the circulatory system.
Cancer cells move about and spread by digging through connective tissue, squeezing through
capillary walls, and cutting through blood vessels by using the enzymes and proteins that they
make and contain. The enzymes breakdown the walls of the blood vessels because the
capillary structure is only one layer thick and easier to penetrate than larger blood vessels.
In order for cancer cells to move through the body, cancer cells rearrange their structure and
attach to the normal cells outside of the normal cells’ cell membrane. Normal cells can sense
that cancer cells are trying to get through them, so they will develop these proteins and create a
thick wall to prevent the cancer cells from spreading, BUT cancer cells secrete enzymes & cut
through the wall & they’re able to spread into the bloodstream. Once they’re in the bloodstream,
they can float through the circulatory system until they find a suitable location to settle creating
another tumor.
8. Identify the predisposing factors and risk factors for cancer in general.
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There are a number of risk
factors which are associated
with the development of cancer.
The interplay of these various
risk factors is complex.
The Canadian Cancer Society
has outlined several rules for
healthy living to reduce the risk
of cancer, such as:








be a non-smoker
eat a healthy diet
be physically active
every day
stay at a healthy
weight
limit alcohol use
limit exposure to UV rays & other radiation
know your body – screening
demonstrate home and workplace health and safety practices
Cancer can be treated more effectively when diagnosed at an early stage. The warning signs of
cancer include:








unusual bleeding or discharge anywhere in the body
change in bowel or bladder elimination
change in a wart or mole
a sore that does not heal
unexplained weight loss
anemia accompanied by persistent fatigue
persistent cough or hoarseness without reason
a solid, painless lump
9. Cancer staging classifies cancer according to the clinical extent and spread of the
disease. Staging is useful in determining the choice of treatment for individual patients,
estimating prognosis, and comparing the results of different treatment regimens. What
are the criteria upon which cancer staging
systems are based?
TNM
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o Size of the primary
Tumor
o Extent of local growth
(whether within/outside
the oran
TNM




Size of the primary Tumor
Extent of local growth (whether within/outside the organ)
Lymph Node involvement
Presence of distant Metastasis
13. For each of the following tumor markers, identify which type of cancer can be
traced:
a) PSA: Prostate cancer
b) BRCA 15-3: Breast cancer
c) CEA: pancreatic, GI, lung, stomach,
liver, and various types of breast cancer.
Because cancer is a collection of diseases
rather than one disease, each kind of
cancer is treated in its own way. You will
learn about the three most common cancer
treatment modalities (chemotherapy, radiation, surgery) in a subsequent learning
package.
Types of Cancer
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1. Complete the following chart related to breast cancer. Some information has been
provided for you.
Disease Process
Breast Cancer
Pathophysiology
Hormone sensitive - some breast cancer cells have estrogen receptors. The
estrogen that attaches to these receptors causes the cancer cells to
reproduce and grow. They do this by inhibiting MLK 3 which is a protein that
normally causes cell death. The cancer cells are able to reproduce and don’t
die. The tumour then grows and spreads
Epidemiology
Second most common cancer in Canadian women. - 70 women in Canada
are diagnosed every day - 13 women will die each day in Canada
(age, gender,
ethnicity, family
history)
Etiology/risk factors
Non-modifiable: gender (female), age, genetics, family history, personal
health history, Race (white highest, Korean American women, vietnamesamerican, Chinese American women are the less at risk) (black women are
less likely to contract cancer, but more likely to die from it due to the social
determinants of health), not having children menses-early onset + late
menopause (having more cycles increases the risk because of estrogen and
progesterone production in the body).
Modifiable: oral contraceptives, hormone replacement therapy, ETOH, diet,
exercise, alcohol, obesity, and weight (especially for fat in the waist area), not
having children can also slightly increase the risk. There is no research to
show smoking causes breast cancer, other kinds yes. *Anti-perspirants, bra
underwire, abortions or miscarriages, silicone breast implants are also not
connected to breast cancer
*There is not enough research for a link between pesticides and breast
cancer.
Clinical behaviors
a lump that is irregular, singular, firm-hard consistency which is fixed and non
moveable and poorly defined. Swelling or skin/nipple
irritation/redness/scaliness on a part of the breast. Nipple/skin retraction.
Nipple discharge.
Diagnostics
-physical examination, blood tests (breast cancer tumour markers- BRCA 1 on
chromosome 17, BRCA 2 on chromosome 13, CEA, WBC’s (infection or
cancer), mammography, ultrasonography, biopsy.
Peau d’orange appearance of the skin of the breasts (dimpling like the skin of
an orange).
3. Briefly describe the following types of breast cancer:
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a) ductal carcinoma in situ (DCIS) Malignant; most common type of non-invasive breast
cancer. Confined to the ducts and doesn’t spread through the fatty tissues of the breasts.
Mammogram is the best diagnostic test for this type
b) infiltrating ductal carcinoma (IDC) Starts to go deeper into the breast tissue from the duct
and invades the breast tissue leaving the possibility for metastasis; malignant. Most common
non-invasive type of cancer. This is the most common type of breast cancer overall. 80% of all
invasive cancers
c) infiltrating lobular carcinoma (ILC) Starts in the miIk glands or the lobules of the breast
tissue and can spread to other parts of the body. Approx. 1 in 10 cases of invasive breast
cancers.
d) lobular carcinoma in situ (LCIS) Tumor that hasn’t spread beyond the milk glands.
Increases the risk of developing another type of cancer later as this one in many resources isn’t
even considered a cancer
4. Explain what is meant when a tumor is hormone dependent.
This means that the cells that make up the tumor require hormones such as estrogens,
progesterone, or testosterone to survive, reproduce and grow.
5. Complete the following chart related to colon cancer. Some information has been
provided for you.
Disease Process
Colorectal Cancer
Pathophysiology
Complex multiple gene abnormalities & mutations, abnormal DNA, arise from
colon polyps.
Epidemiology
-women who smoke have an increased risk over men who smoke, men
develop colon polyps more than women. Peaks at ages 60-70 years, African
American and Jewish have highest incidence.
(age, gender, ethnicity,
family history)
Second most commonly diagnosed cancer in Canada, second leading cancer
death in men, third leading cancer death in women.
Etiology/risk factors
Family history, autosomal dominant mutation of chromosome 5, Personal
history of previous cancers, diet, and nutrition (increased saturated fat,
refined sugars, processed foods, decreased in ACE vitamins and fibre).
High intake of processed meats like lunch meat that have nitrates or
preservatives that are carcinogenic, Stress, smoking, alcohol, sedentary
lifestyle, inflammatory bowel disease, ulcerative colitis > Crohn’s, diabetes.
A tall adult height related to growth hormones and exposure to ionizing
radiation
Signs & Symptoms
Insidious - develops for years asymptomatically. Changes in bowel habits and
patterns.
Diagnostics
-colonoscopy & biopsy.
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8. Complete the following chart related to prostate cancer. Some information has been
provided for you.
Disease Process
Pathophysiology
Prostate
-a multi-step process.
-genetic mutations stimulated by androgens (- specifically testosterone as well
as various growth factors. The testosterone stimulates receptors on prostate
cells causing genetic mutations and abnormal sequences in cell reproduction).
-various growth factors.
-arise in glandular tissue of epithelial cells (these epithelial cells turn into
cancer cells because something is triggering them to. - risk factors - Insidious asymptomatic for years)
Epidemiology
-advancing age.
(age, gender,
ethnicity, family
history)
-African ancestry, Caucasian, Hispanic, Asian.
Etiology/risk factors
-genetic, environmental, hormonal theories.
-family history (a father or brother having prostate cancer, increases a person’s
risk 2-3x If the person has more than two family members have prostate cancer
the risk increases to 5x If the man is African American and has one first degree
relative with prostate cancer the risk is increased 10x).
-high saturated fat diet.
-testosterone.
-lack of vitamin D, genital human papillomavirus, STDs, obesity.
Exposure to high levels of cadmium or dioxin.
Clinical behaviors
In the early stages asymptomatic over time, urinary patterns change, blood in
the urine or semen, painful ejaculation, frequency or feeling of having to
urinate, urgency, non-forceful urine stream or interrupted urine stream,
incomplete bladder emptying, burning or pain with urination, nocturia, dysuria,
anuria.
Late stages, there will be bone pain especially in the back, hips, thighs and
neck, weight loss and bowel and bladder incontinence
Diagnostics
-blood work (PSA, CEA tumor markers), ultrasound, biopsy for cytology and
cytology.
Most common screening for prostate cancer is the digital rectal exam.
10. Complete the following chart related to leukemias and lymphomas. Some
information has been provided for you.
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Disease Process
Pathophysiology
Leukemias
Lymphomas
-uncontrolled proliferation of malignant
leukocytes.
-proliferation of malignant
lymphocytes in lymphatic system.
-overcrowded bone marrow.
-cellular gene mutations.
-decreased production of normal
hematopoietic cells.
-rapid abnormal growth of lymphoid
cells & tissues.
-genetic aberrations during mitosis.
-chromosomes 9 and 22, and the
Philadelphia chromosome.
Epidemiology
(age, gender,
ethnicity, family
history)
Most common childhood/adolescent
cancer but are still more common in
adults.
Affects men more than women
US, Canada, Sweden and New Zealand
are the countries with the highest
incidence
Etiology/risk factors
-radiation exposure, cigarette smoke,
exposure to benzene (gasoline,
lubricants, dyes, pesticides).
-high familial tendency.
-increased risk with Down syndrome.
-chemotherapy.
14% of all childhood cancers.
Affects men more than women
More prevalent than leukemia
Greatest incidence, North
American, British, Eastern and
Western European, Asian and
Scandinavian ethnicities
-family history.
-exposure to mutagenic chemicals.
-exposure to radiation.
-infections.
-immune suppression related to
organ transplantation.
-infections.
-secondary to another cancer.
Clinical behaviors
bone marrow depression, fatigue,
bleeding, anemia, thrombocytopenia,
fever and chills, infection, petechiae,
ecchymosis, bruising, hematuria, ,
hepatomegaly, splenomegaly.
painless lymphadenopathy, fever,
night sweats, pruritus, feeling of
abdominal fullness, ascites, fatigue,
weight loss, back pain, leg swelling.
Diagnostics
Blood tests, bone marrow biopsy
blood tests, CT scan, chest x-ray,
biopsy
11. Briefly describe the following types of leukemia:
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a) acute lymphocytic leukemia Most common blood cancer in children and adults. Comes
from hematopoietic cells - specifically T and B lymphoblasts in bone marrow. Usually has a very
sudden onset. These cancer cells have structural changes in their chromosomes and
abnormalities that cause abnormal cell developments. Lymphocytes cannot differentiate
normally into T and B cells and become cancer cells instead. Bone marrow produces large
numbers of immature lymphocytes turning into leukemic cells. The tumor will develop and grow
in the bone marrow, taking up space which in return decreases the bone marrow’s ability to
make RBC’s - decreased hematopoiesis, decreased leukocytes, thrombocytes and
erythrocytes.
Signs and Symptoms:
● bone and joint pain
● due to decreased thrombocytes, there is easy
bruising and bleeding
● due to decreased leukocytes, there is fever,
anorexia and weight loss
● due to decreased erythrocytes, there is petechiae
and bruising
● lymphadenopathy - swollen glands in the neck,
groin, axilla
● night sweats
● increased risk for infections
b) acute myelocytic leukemia Most common in adults. Mainly a disease of older people but
can be seen in children and young adults as well. It comes from Myeloid cells in bone marrow
(myeloblasts). There is an uncontrolled growth, proliferation of immature WBC’s With normal
hematopoiesis, the myeloblasts normally will gradually mature into a normal adult WBC which
further differentiates into one of the five types of WBC’s - with acute myeloid leukemia, it only
takes a single myeloblasts to accumulate genetic changes that freeze the cell in its immature
state and it can’t differentiate into a specialized WBC Can occur anywhere along the pathway of
immature cells becoming one of the five WBC’s When the leukemia tumor is developing and
growing in bone marrow, it displaces and interferes with the development of normal blood cells
in bone marrow. Without treatment the prognosis is usually within a few weeks - few months
with treatment there is a 20-40% 5-year survival rate without relapse- which will usually occur in
the first five years.
c) chronic lymphocytic leukemia Involves mature and fully differentiated WBC’s More
common in older adults and rarely occurs in children. There are two types: Mild and
asymptomatic or a very severe, aggressive form. Malignancy of B lymphocytes which make
antibodies. There is infiltration of neoplastic lymphocytes in bone marrow. With this leukemia,
some people survive without treatment for many years while other have aggressive treatment
and still have a rapid, fatal disease.
Signs and Symptoms:
● With aggressive form; enlarged lymph
nodes
● hepatosplenomegaly
● fever
● abdominal pain
● weight loss
● progressive anemia
● thrombocytopenia
d) chronic myelogenous leukemia
Most often occurs in middle-ages adults and children. Originates in stem cells in bone marrow there is a type of stem cell that is a granular site which differentiate into neutrophils, basophils
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and eosinophils, these stem cells contain a Philadelphia chromosome. Parts of two
chromosomes - 9 and 22 - switch places. The fusion of these two genes creates a protein which
activates a cascade of proteins which control the cells cycle, speeding up cell division. This
protein also inhibits DNA repair, causing genes to become unstable and deviant which causes
the cell to develop even more genetic abnormalities.
There are three phases to this leukemia:
1. chronic phase - lasts months or years and usually asymptomatic
2. accelerated phase - more severe state of disease where the leukemia cells grow quickly fever, bone pain and splenomegaly
3. blast crisis phase - patient will experience bleeding, infection related to bone marrow
suppression, night sweats, fatigues, weakness, fever, feeling of pressure under the limbs due to
splenomegaly.
12. Briefly describe the following types of lymphoma:
a) Hodgkin’s lymphoma Localized with an orderly spread of cells. Comes from abnormal gene
arrangements of B lymphocytes. These are known as reed Sternberg cells.
They do not undergo apoptosis the way that they should as they are transforming into cancer
cells - the inhibition of apoptosis, is thought to be linked to viruses such as the Epstein Barr
virus It occurs in 15-40 and over 55 Approx. 10-15% of cases are diagnosed in children and
adolescence. Having a history of mononucleosis increases the risk. A definitive diagnosis is
made with a biopsy of lymph node tissues, looking for the reed Sternberg cells
Signs and Symptoms:
● Enlarged lymph nodes – painless
● fever
● pruritus
● night sweats
● back pain
● a feeling of abdominal fullness
● fatigue
● ascites
● weight loss
● leg swelling
b) non-Hodgkin’s lymphoma There are over 30 types and have a higher mortality. Causes can
include impaired immune system, exposure to viruses, usually starts in lymph nodes and with
intensive combinations of chemo, complete remission can be achieved in 60-80% of people.
Haphazard spread of cells. It is common for the cancer to go outside of the nodes.
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Cancer in Children
According to the Canadian Cancer Society, childhood cancer is relatively uncommon, however it
is the second leading cause of death in children. Compared with adults, cancer generally grows
and spreads faster in children. As well, “children are more likely to develop leukemia and
lymphoma than adults” (http://www.cancer.ca/en/cancer-information/cancer-101/childhoodcancer-statistics/?region=on).
13. What is the most commonly diagnosed childhood cancer?
Leukemias. They often don’t develop carcinomas because they often take years and years to
develop.
14. What are the three types of cancer that account for the majority of new cancer cases
in children in Canada?
 leukemias
 lymphomas
 brain tumors - nervous system cancers
15. Explain the correlation between parental exposure and childhood cancer.
There is research that shows a correlation between parental exposure to carcinogens before
conception, during pregnancy, in utero and in breast milk. - If a father were to be a painter and is
around chemical fumes and paint fumes for extended periods of time, this could put him at a risk
for cancer. Once that same dad has a child, could increase his child’s chance of getting cancer.
It is a slight risk. - A mother who smokes during pregnancy can increase risk for cancer in that
woman's child.
16. Why do children rarely develop carcinomas?
This is because these cancers most commonly result from environmental carcinogens and
require a long period of time to develop - usually several years to decades.
Cancer Treatments
3. Define the following terms relating to chemotherapy:
Term
Definition
adjuvant therapy
is treatment that is given in addition to the primary treatment or the
main the initial treatment. So we give the primary chemotherapy
drug and then we can give other chemotherapy drugs that work
along with the primary chemo drug.
anti-neoplastic
These are a classification of drugs that are used to treat cancer.
curative
Tendency to overcome disease and be able to promote recovery
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cytotoxic
Characteristic of being poisonous to cells.
extravasation
The leakage of IV medications into tissue space.
myelosuppression
Bone marrow suppression or bone marrow depression. In other
words, we are suppressing or decreasing or inhibiting the function
of bone marrow. myelosuppression is a side effect, an adverse
effect of chemotherapy and it results in dangerously decreased
numbers of red blood cells, white blood cells and platelets.
Dangerously low numbers of erythrocytes, leukocytes and
thrombocytes.
palliative
Refers to any care that we provide to alleviate or reduce or remove
symptoms, regardless of whether a cure is involved or not,
palliative means to alleviate or relieve symptoms. We can cure the
cancer by removing it, and the patient may still receive palliative
care that relieves or removes the symptoms after the surgery.
prophylactic
Preventative measure. Greek that means an advanced guard.
Prophylactic is any measure that we take to sort of fend off disease
or any kind of unwanted consequence of a disease or illness.
tumour suppressor genes
Also known as anti-oncogenes. These are genes that protect cells
from turning into cancer cells. Normal healthy cells have these
tumour suppressor genes and so these genes will help inhibit the
normal cells so ere are lots of mechanisms. We have apoptosis
and we have natural killer lymphocytes but yet cancer you can see
the very nature of the disease. It s relentless. With its
characteristics of immortality and enzymes and no sense of contact
with other tissues and cells. Tumour suppressor genes are genes
that normal cells have that prevent a normal cell turning into a
cancer ell but if this gene becomes mutated, because of something
a trigger or a risk factor that causes the cell to start to become
mutated, for example free radicals, if the genes are mutated, then
the cell loses its ability to be able to not turn into a cancer cell and
therefore the cell now turns into a cancer cell
vesicant
A chemical compound that causes severe skin irritation, irritation in
the eyes. It causes severe mucus, mucosal, lining pain and
irritation. Chemotherapy drugs are vesicants. They kill cells. They
kill tumours and cancer tissues. They can also kill healthy tissues
as well. These are chemicals, these are drugs that can cause
severe skin, eye, mucosal irritation and pain.
7. Complete the following chart relating to the common side effects of anti
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neoplastic drugs:
Rapidly proliferating
cells in these areas
Signs and symptoms experienced
by the patient
Effect of the damage
Bone marrow suppression (bone
marrow is not making enough
blood cells) Erythrocytopenia
Anemia - weakness, fatigued, lack of
energy, pale, Inability to complete
ADL’s due to decrease of oxygen.
Leukopenia or Neutropenia
(neutrophils)
Infection (*important to keep patient
and environment CLEAN*)
Thrombocytopenia
Bleeding, hemorrhage, bruising, skin
breakdown (Be careful while
repositioning patients, no shearing),
hematuria (blood in urine),
hemoptysis (blood in the sputum)
hair follicles
Follicles are damaged, leads to
alopecia
Hair loss
GI tract
Mucous membrane cells in the
lining of the GI tract / epithelial
cells are damaged.
Can cause ulceration and
bleeding in the stomach and/or
intestine.
bone marrow

erythrocytes

thrombocytes

leukocytes
nausea
vomiting
anorexia
stomatitis (inflammation of the oral
cavity also known as mucositis).
9. Bone marrow depression decreases the production of erythrocytes, leukocytes, and
thrombocytes. Define the following terms which are side effects of thrombocytopenia:
Term
Definition
coffee ground emesis
Partially digested blood in the stomach that is vomited up. Old blood
from an ulceration due to chemo. Can be anywhere in the GI tract. Nausea and vomiting - Pt may vomit up old, dry blood.
ecchymosis
Bruising
epistaxis
Nosebleed - Chemo damages the cells in the nasal cavity
hemoptysis
Blood in sputum
hematoma
Bruising - Collection of blood outside the vessel
hematuria
Blood in urine
melena
Black, tarry stool associated with a GI bleed somewhere
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15. Significant adverse effects of opioid analgesics are central nervous system
depression and gastrointestinal disorders. Describe the signs and symptoms of the
adverse effect of opiates on each of the following systems:
a) central nervous system: Suppresses the respiratory center in the brain and causes a
decrease of respirations (*Super important to assess respirations for one full minute*)
b) gastrointestinal: Constipation. Decrease in action of smooth muscle cells in the GI tract.
Prevention is important as it can lead to paralytic ileus (paralyzed bowel) and can include
ambulation, ROM which stimulates circulation. Increased fluid intake
20. Describe the differences between internal and external radiotherapy.
Internal: also know as brachytherapy or implantation. It delivers a high dose of radiation
to a localized area, it can be implanted through needles,
seeds, beads, catheters into body cavities or into interstitial
compartments i.e. breast tissue.
Intra cavity radioisotopes are frequently used to treat
gynecological cancers because they are put in place for a
period of time and then removed.
May also be administered orally for example: Isotope I used
to treat thyroid cancer. Interstitial implants can be temporary,
or permeant and it is important to remember to emit radiation
while in situ (minimal time, distance and contact) with the
patient for nurses and family. Utilize strict precautions when
caring for patients with radiation implants.
External: Three types:
 External beam teletherapy: generated by a linear
accelerator these machines produce higher energy x
rays and deliver their dose of radiation to deeper
structures with less harm to the skin and less scattering
of the radiation once in the body
 Gamma rays: Produced by spontaneous decay of
naturally occurring radioactive elements such as cobalt
60. Cobalt 60 machine is aimed at the tumour inside of
the patient and then the radiation dose is delivered
from the outside to the inside of the body. This type of
external radiation the skin has fewer if any adverse side
effects.
 Particle beam: Subatomic particles such as neutrons, protons and heavy ions are
accelerated throughout the body tissue, its also known as high linear energy
transfer radiation. Spreads throughout the body and damages target cells and
any cells in its pathway. This type of therapy is used for more radiation resistant
type of tumours because its mechanism of action and power.
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22. How is the dosage of radiation determined?
Determined by the sensitivity of the target tissues to the radiation and the size of the
tumour. Lethal tumour dose is a dose that will eradicate 95% of the tumour yet preserve
normal tissue.
24. What health teaching should you provide to patients related to waterproof ink
markings?
Don’t use harsh soaps, don’t wash them off, don't use scented perfume or cream. Use
warm water to wash skin, do not use harsh chemicals that could cause rash.
Radiation therapy causes damage to rapidly reproducing cells. This includes cancer
cells and normal body cells, especially cells near the area of the body receiving
radiation.
25. Outline the effects radiation therapy may have on bone marrow and blood cell
production.
Can cause myelosuppression and therefore decreased blood cell production.
26. Describe how each of the following can adversely affect a patient:
a) erythrocytopenia: can cause anemia, hypoxia
b) leukopenia: Infection development, frequent colds, resp infections, bronchitis.
c) thrombocytopenia: Bruising and bleeding easily, risk for hemorrhage
27. Describe the generalized systemic side effects radiation therapy may have
on:
a) hair growth: radiation therapy can cause alopecia or hair loss, thinning hair
b) epithelial cells of the: can also cause thrush or candida in the mouth and the
mucosal lining of the GI tract can also be damaged from oral cavity to anal opening.
Can also experience ulceration, mucous membrane damage, nausea, vomiting,
diarrhea.
28. What health-teaching information would you provide to patients and families
relating to radiation therapy?
Risks for anemia, infection, bleeding, bruising (how to prevent those). Explaining
procedure and answer questions to relieve anxiety and fears.
The governing principles when a patient is receiving radiation. How to limit time distance and
contact. Health teach them about how to protect their skin, oral cavity, mouth care...etc. Prevent
skin dryness
Cancer Surgery
29. Complete the following chart comparing various types of cancer surgeries:
Type of Surgery
Purpose/Function
Description
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diagnostic
Determine benign / malignant
Determine location / size
Take a biopsy - Perform surgery Surgical removal of suspected tissue
palliative
Removes or alleviates the
symptoms
Perform surgery for comfort
primary treatment
To get rid of the tumour or as much
as possible - Two types: local and
wide excision
Removal of tumour and the healthy
tissue around the surgery to ensure
everything is removed
prophylactic
Prevention
Removing a body part to prevent cancer
from happening in first place - Removing
tissue that is highly likely to have cancer
ie colectomy or mastectomy.
reconstructive
To improve appearance post-op /
post-treatment - Improve
confidence or alleviate
depression/anxiety around physical
appearance
Cosmetic surgery - Usually happens
after primary surgery - Improve function
or obtain a more desirable cosmetic
effect - Can be in one surgery or stages
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