Study Guide for Oncology Exam
Oncology Exam Study Guide
Test Blueprint
Cancer
Cancer
 Malignant growth of cells:
 Reproduce rapidly.
 Become more abnormal as they grow.
 Very invasive.
 High metabolic rate.
 Risk factors:
 Smoking.
 Ultraviolet light.
 Ionizing radiation.
 Age.
 Alcohol use.
 Exposure to carcinogenic substances.
 Chronic inflammation.
 Diet.
 Hormonal influences.
 Immunosuppression.
 Infectious agents.
 Obesity.
 Family history.
 Some factors are modifiable and some are not.
 Symptoms:
 Pain.
 Weight loss.
 Weakness, fatigue.
 Change in bowel habits.
 Sore that does not heal.
 Unusual bleeding.
 Palpable mass or thickening of tissue.
 Indigestion or difficulty swallowing.
 Obvious change in wart or mole.
 Nagging cough or hoarseness.
 Nursing responsibilities:
 Assist with activities of daily living.
 Monitor enteral or parenteral nutrition.
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Offer small, frequent portions of high-calorie and high-protein diet
consisting of soft foods.
 Administer stool softeners.
 Reposition every 2 hours or more frequently for client comfort.
 Perform range of motion.
 Assist with ambulation.
 Administer analgesics.
 Provide emotional support.
Client education: lifestyle modifications.
Nursing Focus & Concepts
Cancer
Definition:
 Group of diseases.
 Result from unregulated growth of malignant cells.
 Affects structure and function of healthy cells.
Concepts:
 Cellular Regulation.
 Cancer.
 General Risk Factors.
Assessment:
 Family history of cancer.
 Modifiable risk factors.
 Immunization profile for those cancers that respond to immune
proliferation.
 Presence of warning symptoms of cancer:
 Change in bowel or bladder habits.
 A sore that does not heal.
 Unusual bleeding or discharge.
 Thickening or lump in the breast or elsewhere.
 Indigestion or difficulty in swallowing.
 Obvious change in a wart or mole.
 Nagging cough or hoarseness.
 Other signs and symptoms.
 Client’s cancer screening practices.
Diagnosis:
 Potential-prone health maintenance.
 Potential for poor or delayed health management.
 Readiness for enhanced health management.
Planning:
 Anticipate incongruence between client’s knowledge of individual personal
risk profile and health management behaviors.
 Plan education regarding disease and prevention.

Encourage active participation in identifying changes in behaviors to
reduce cancer risks.
Implementation:
 Help clients decrease modifiable risk factors through health teaching.
 Topics:
 Protected and moderate sun exposure.
 Elimination of use of tobacco products.
 Moderation of alcohol consumption.
 Weight management.
 Consumption of plant-based low fat diet.
 Avoidance of environmental and occupational carcinogens.
 Participation in cancer screening tests.
Evaluation:
 Client will verbalize personal modifiable risk factors.
 Client will discuss lifestyle changes client has incorporated to reduce
cancer risks.
Interdisciplinary Focus & Medical
Management
Cancer
Definition:
 Group of diseases.
 Result from unregulated growth of malignant cells.
 Affects structure and function of healthy cells.
Physiology:
 Normal cells:
 Reproduce.
 Grow in structured, regulated pattern.
 Die at specific time in life cycle.
 Stop growing when contact other cells.
 Anchor to other cells to connect with nutrient base.
 Maintain the specific structure and function of parent cell.
 Immune system recognizes and kills cell mutations.
Pathophysiology:
 Cancer initiated by exposure to cancer causing substance.
 Triggers genetic mutations.
 Defective in structure and function.
 Mutated cells grow uncontrollably if not killed by immune system.
Risk Factors:
 Conditions or occurrences that alter probability of developing cancer:
 Situations can be intentionally changed (modifiable):
 Sedentary lifestyle.
 Poor diet.
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Excessive alcohol use.
Unprotected exposure to ultraviolet light.
Smoking.
Use of tobacco products.
 Unable to be controlled (nonmodifiable):
 Age.
 Family history.
 Exposure to ionizing radiation.
 Exposure to certain chemical substances:
 Aromatic amines.
 Aniline dyes.
 Pesticides.
 Formaldehyde.
 Arsenic.
 Soot.
 Tars.
 Asbestos.
 Benzene.
 Nickel and zinc ores.
 Polyvinyl chloride.
 High consumption of:
 Fat.
 Alcohol.
 Salt-cured or smoked meats.
 Nitrates and nitrate-containing foods.
 Overweight or obesity.
 Prolonged estrogen replacement therapy.
 Some viruses:
 Epstein-Barr virus.
 Herpes simplex virus Type 2.
 Human papillomavirus.
Signs and Symptoms:
 Warning symptoms:
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Change in bowel or bladder habits.
A sore that does not heal.
Unusual bleeding or discharge.
Thickening or lump in the breast or elsewhere.
Indigestion or difficulty in swallowing.
Obvious change in a wart or mole.
Nagging cough or hoarseness.
Vague systemic symptoms:
 Unexplained weight loss.
 Fever.
May also be malignancy specific - affects function of organ or body system
involved.
Diagnostic Tests:
 Lab tests.
 X-rays.
 Sonographic imaging.
 Biopsy.
 Endoscopic procedures.
 Tests to define precise molecular makeup of tumor - specific treatment
selection.
Treatment:
 Influenced by:
 Cell type.
 Tumor makeup.
 Stage of disease.
 Surgical removal of tumor and affected structures.
 External or internal radiation.
 Antineoplastic medications.
 Prevention:
 Stop smoking cigarettes and cigars.
 Increase consumption of fresh vegetables.
 Increase fiber intake.
 Increase intake of foods rich in vitamin C.
 Practice weight control.
 Reduce intake of dietary fat.
 Consume salt-cured, nitrate-cured, and smoked foods in
moderation.
 Limit alcohol intake.
 Avoid overexposure to the sun and use sunscreen.
 Avoid working around carcinogens, such as asbestos, or wear
protective gear.
Complications:
 Continued growth of cancer cells.
 Adverse effects of treatment.
 Malnutrition.
 Infection.
 Hypercalcemia.
 Pain.
 Obstruction or infiltration of organs with tumor cells.
Expected Outcomes:
 Reducing risk factors and increasing screening is goal of American
Cancer Society.
 Early detection and intervention improve prognosis.
Oncology overview & Oncological emergencies overview: 7 questions
Chemo and radiation purpose and side effects: 5 questions
Specific cancers: 18 questions (breakdown below)
Leukemia/Lymphoma: 3 questions
Breast: 5 questions
Cancer: Breast
Cancer: Breast
 Indications:
 Small, mobile, painless lump.
 Rash.
 Changes in color.
 Puckering or dimpling of skin (more advanced cases).
 Axillary adenopathy.
 Risk factors:
 Family history of mother, sister, or daughter developing premenopausal
breast cancer.
 Age greater than 50.
 Menses beginning before age 12.
 Menopause after age 55.
 Male breast cancer can also occur.
 Encourage mammography.
 Treatment: surgery and/or radiation, chemotherapy.
Mammogram:
 Radiography of the breast.
 Used as screening tool for breast cancer.
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Lung: 2 questions Cancer: Lung
Malignancy in epithelium of respiratory tract.
Cigarette smoking is the primary risk factor.
Screening by CT scan for people at risk.
Limited treatment options - more developing.
Often poor prognosis.
Indications:
 Change in respiratory patterns.
 Persistent cough.
 Bloody or purulent sputum.
 Unexplained dyspnea.
 Unexplained weight loss.
 Recurring pulmonary system problems.
 Pain in:
 Arm.
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Shoulder.
Chest.
Back.
Treatments:
 Surgery.
 Chemotherapy.
 Radiation.
Nursing considerations re surgery:
 Preoperative and postoperative teaching, especially related to
respirations.
 Maintenance of chest tube drainage system.
Nursing interventions re chemotherapy and radiation:
 Gentle and careful skin care.
 Administration of antiemetics and analgesics.
 Provide mouth care.
 Appealing small frequent meals high in calories and protein.
 Hair care, including coping with alopecia.
 Balance rest with activity.
Nursing Focus & Concepts
Cancer: Lung
Definition:
 Originates in the lungs.
 Two categories:
 Small cell or oat cell cancer is rapidly growing and metastasizes
quickly.
 Non-small cell cancer:
 Adenocarcinoma.
 Squamous cell carcinoma.
 Large cell carcinoma.
Concepts:
 Cancer.
 Cancer: Lung.
Assessment:
 Assess:
 History of symptoms.
 Onset of disease.
 Exposure to inhaled carcinogens.
 Current stage of tumor(s).
 Determine client/family knowledge of disease and treatment plan.
 Assess:
 Respiratory status.
 Presence of cough.
 Color of sputum.
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Pin level.
Mobility.
Monitor:
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Vital signs.
Oxygen level.
 Assess psychological well-being.
 Assess social support system.
Diagnosis:
 Alterations in respiratory function resulting in impaired tissue perfusion.
 Acute or chronic pain.
 Potential for anxiety, fear, and anticipatory grief.
 Lack of knowledge.
 Imbalanced nutrition.
Planning:
 Prepare to educate client/family about treatment plan:
 Surgery.
 Radiation.
 Chemotherapy.
 Biological therapies.
 Provide information about smoking cessation.
 Provide referrals to client and family as appropriate.
Implementation:
 Teach strategies to improve breathing while reducing work of breathing:
 Splinting while coughing.
 Elevating head of bed.
 Using relaxation exercises.
 Sleeping with vaporizer.
 Monitor food and fluid intake.
 Encourage small, frequent meals with protein-rich foods.
 Provide oxygen as needed.
 Medicate for pain.
 Teach about medications, adverse effects, and signs/symptoms to report.
 Determine client/family response to illness.
 Make referrals as needed.
 Provide active listening.
Evaluation:
 Client/family will verbalize understanding of treatment plan.
 Client will be able to participate in activities of daily living without dyspnea
or pain.
Interdisciplinary Focus & Medical
Management
Cancer: Lung
Definition:
 Originates in the lungs.
 Two categories:
 Small cell or oat cell cancer is rapidly growing and metastasizes
quickly.
 Non-small cell cancer:
 Adenocarcinoma.
 Squamous cell carcinoma.
 Large cell carcinoma.
Physiology:
 The lungs function to:
 Transfer inhaled oxygen into the circulatory system.
 Transfer exhaled carbon dioxide from the circulatory system into
the air.
 Exchange of oxygen and carbon dioxide occurs in the alveoli.
Pathophysiology:
 Development of lung cancer not fully understood.

In the majority of cases, precancerous mutations in the genetic material of
the cells of the lungs are caused by:
 Aging.
 Exposure to tobacco.
 Inhaled carcinogens such as radon or asbestos.
 Small cell and non-small cell cancerous tumors arise from different types
of cells according to different pathogenic processes, and in response to
different genetic mutations.

Precancerous lesions can be detected years before the development of
cancer tumors.
Risk Factors:
 Smoking is the greatest risk for lung cancer.
 Genetic susceptibility.
 Exposure to carcinogens:
 Radon.
 Asbestos.
 Soot.
 Tar.
 Arsenic.
 Chromium.
 Nickel.
 Air pollution.
 Aging.
Signs & Symptoms:
 Cough.
 Dyspnea.
 Frequent, unresolved respiratory infections.
 Chest pain.
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Wheezing.
Hemoptysis.
Fever.
General weakness.
Individuals with lung cancer may not have symptoms for years.
Diagnostic Testing:
 Needle biopsy.
 Fiber-optic bronchoscopy.
 Positive electron tomography (PET) scan.
Treatment:
 Surgical resection.
 Radiation.
 Chemotherapy.
 Biological therapies.
 Palliative care.
Complications:
 Metastasis:
 Lymph nodes.
 Bones.
 Liver.
 Central nervous system.
 Malignant pleural effusion.
 Venous thrombosis.
 Syndrome of inappropriate antidiuretic hormone (SIADH).
 Superior vena cava syndrome.
Expected Outcomes:
 Survival is improved when the disease is diagnosed early, while still
localized.
 Survival rates are generally lower for lung cancer than for most other
cancers.
Nursing Focus & Concepts
Smoking and Lung Cancer
Definition:
 Cigarette smoking causes lung cancer.
 Secondhand smoke:
 Smoke from other people’s:
 Cigarettes.
 Pipes.
 Cigars.
 Also causes lung cancer.
Concepts:
 Cellular Regulation.
 Lung Cancer.

Smoking.
Assessment:
 Signs and symptoms of lung cancer.
 Amount of smoking each day.
 Amount of secondhand smoke in environment.
Diagnosis:
 Change in oxygenation.
 Decreased cardiac output.
 Decreased tissue integrity.
Planning:
 Plan for referral to behavioral modification resources and smoking
cessation program.
 Plan treatment program for lung cancer.
 Plan for change in environment to eliminate secondhand smoke.
Implementation:
 Encourage client to express feelings and concerns about effect of cancer
on family unit.
 Ensure client participates in care.
 Contact appropriate support groups.
 Teach to facilitate airway clearance:
 Coughing.
 Deep breathing.
 Hydration measures.
 Discuss symptoms to report to the provider:
 Increased dyspnea.
 Hemoptysis.
 Severe stridor.
 Wheezing.
 Chest pain.
Evaluation:
 Client will maintain a patent airway.
 Client will maintain current weight.
 Client will verbalize understanding of:
 Disease.
 Treatment.
 Prognosis.
 Client will develop a plan to stop smoking.
Interdisciplinary Focus & Medical
Management
Smoking and Lung Cancer
Definition:
 Cigarette smoking causes lung cancer.

Secondhand smoke:
 Smoke from other people’s:
 Cigarettes.
 Pipes.
 Cigars.
 Also causes lung cancer.
Physiology:
 Lungs expand and contract up to 20 times a minute.
 Supply oxygen for distribution to tissues all over body.
 Expel carbon dioxide created throughout body.
Pathophysiology:
 Smoking causes lung cancer by damaging cells that line lungs.
 Smoke contains multiple carcinogens.
 Changes in lung tissue begin almost immediately when smoke is inhaled.
 Initially, body able to repair damage.
 Normal cells lining lungs increasingly damaged with each exposure.
 Damage causes cells to act abnormally.
 Cancer may develop.
Risk Factors:
 Smoking even a few cigarettes a day.
 Smoking occasionally.
 Risk increases with:
 Number of years a person smokes.
 Number of cigarettes smoked each day.
 Quitting smoking:
 Lowers risk of lung cancer.
 Higher risk than if never smoked.
 Lowers risk at any age.
 Secondhand smoke.
Signs and Symptoms:
 Coughing that gets worse or does not go away.
 Chest pain.
 Shortness of breath.
 Wheezing.
 Coughing up blood.
 Feeling very tired all the time.
 Weight loss with no known cause.
 Frequent upper respiratory infections.
Diagnostic Tests:
 X-ray.
 Computerized tomography scan.
 Sputum cytology.
 Biopsy.
Treatment:
 Surgery.
 Chemotherapy
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Radiation therapy.
Targeted medication therapy.
Complications:
 Shortness of breath.
 Hemoptysis.
 Pleural effusion.
 Respiratory failure.
 Metastasis.
 Death.
Expected Outcomes:
 Diagnosis of cancer in early stages with surgical removal results in best
outcomes.
 Prognosis depends on type of lung cancer.
Bladder: 3 questions
Cancer: Bladder
Cancer: Bladder
 Usually located at base involving ureters and bladder neck.
 Signs and symptoms:
 Hematuria (common).
 Change in voiding or urine.
 Back and/or pelvic pain.
 Treatment: surgery involves creating a urinary diversion.
 Risk factors:
 Environmental carcinogens.
 Bacterial urinary tract infections (UTIs).
 Bladder calculi.
 High urinary pH.
 Elevated cholesterol intake.
 Pelvic radiation.
 Pelvic cancers.
 Metastisis to the bone lymphs, liver lungs
Colorectal: 1 questions
Ovarian/Cervical: 2 questions
Cancer: Cervical
Cancer: Cervical
 Early cervical cancer is asymptomatic.
 Later indications:
 Abnormal bleeding.
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Especially postcoital bleeding.
Risk factors:
 Most caused by human papillomavirus.
 Multiple sex partners.
 First coitus prior to age 20 years.
 Early childbearing.
 HIV infection.
 Smoking.
 Lower socioeconomic status.
 Chronic cervical infections.
Nursing considerations:
 Preparation of client for:
 Tests.
 Biopsy.
 Internal radiation therapy.
 Pap smear to detect cancer.
 Vaccination of children for prevention of HPV.
Nursing Focus & Concepts
Cancer: Cervical
Definition:
 Cancer of cervix.
 Results from cellular changes to cervix.
 Cervical dysplasia is precursor.
Assessment:
 Sexual history.
 HPV DNA testing from Pap smear specimen.
 Colposcopy (microscopic examination of lower genital tract).
Implementation:
 Follow-up closely with clients with positive results on HPV test - repeat
testing.
 Provide emotional support to clients.
 Refer for counseling and treatment.
 Educate clients about:
 Sexual health is part of overall health.
 Regular gynecologic examinations recommended.
 Regular Pap screens.
 Risk factors.
 Safer sex practices:
 Limit number of sexual partners.
 Use latex condoms.
 Treatment for sexually transmitted diseases should be sought and
treatment followed.
 Counsel young clients to postpone sexual activity.
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Multiple sex partners for women no longer unusual.
Nonjudgmental approach necessary to good care.
Refer for administration of HPV vaccine, as appropriate.
Interdisciplinary Focus & Medical
Management
Cancer: Cervical
Definition:
 Cancer of cervix.
 Results from cellular changes to cervix.
 Cervical dysplasia is precursor.
Pathophysiology:
 Thought to result from cellular changes to cervix by insults from infections
or multiple sex partners.
 Viruses alter DNA of cervical cells, leading to cervical dysplasia.
 Cervical dysplasia is precursor to cervical cancer.
 Addition of sperm from many different partners may promote process.
Risk factors:
 Multiple sex partners.
 Early age of first sexual intercourse (before 18, or within 1 year of
menarche).
 Infection with:
 Herpes simplex virus 2.
 Human papillomavirus (HPV) types 16, 18, 45, 58.
 HIV.
 Possibly cytomegalovirus.
 Smoking.
 Lack of access to health care.
 Nonmonogamous male partner.
Prostate: 2 question
Cancer: Prostate
Cancer: Prostate
 Malignant tumor of the prostate gland.
 Signs and symptoms:
 Difficult urination.
 Urinary hesitancy and frequency.
 Dribbling.
 Interruption or reduction of stream.
 Nocturia.
 Diagnosed:
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Prostate specific antigen (PSA).
Digital rectal exam (DRE).
Ultrasound.
Biopsy.
Treatment:
 Surgical removal.
 Teletherapy.
 Brachytherapy.
 Cryosurgery.
 Hormone antineoplastic agents.
Cancer: Colorectal
Cancer: Colorectal
 Malignancy of the colon or rectum.
 Risk factors:
 Family history.
 Inflammatory bowel disease.
 Polyps.
 Consumption of high-fat and low-fiber diet.
 Age.
 Ethnicity (African American at highest risk).
 Obesity.
 Smoking.
 Alcohol use.
 Processed and/or red meat intake.
 Signs and symptoms:
 Depend on location of tumor.
 Change in bowel habits.
 Rectal bleeding.
 Melena.
 Anemia.
 Positive fecal occult blood test.
 Stools may contain microscopic or gross amounts of blood.
 If tumor partially blocks colon, stools become narrow in appearance.
 Client education:
 Colorectal screening.
 Lifestyle modification.
 Colonoscopy starting at age 45 or earlier if risk factors
Acute vs Chronic
Cancer: Leukemia
Cancer: Leukemia
 Cancer of blood-forming tissues of bone marrow, spleen, lymph nodes.
 Pathophysiology:
 Abnormal, uncontrolled destructive proliferation of one type of white
blood cell and its precursors.
 Immature cells overproduced faster than needed.
 Newer, immature cells not able to replace and function as mature
cells.
 Predisposing factors:
 Viruses.
 Ionizing radiation.
 Genetic predisposition.
 Absorption of chemicals:
 Benzene.
 Pyridine.
 Aniline dyes.
 Signs and symptoms:
 Mouth and throat ulcerations.
 Pneumonia.
 Septicemia.
 Anemia.
 Thrombocytopenia.
 Leukocytosis.
 Erythropenia.
 Fatigue.
 Lethargy.
 Bone and joint pain.
 Bleeding gums.
 Ecchymosis.
 Petechiae.
 Retinal hemorrhage.
 Weakness.
 Pallor.
 Weight loss.
 Hepatomegaly.
 Splenomegaly.
 Headache.
 Disorientation.
 Altered leukocyte count (15,000-5,000/mm3).
 Convulsions.
 Infections.
 Diagnosis: bone marrow aspiration.
 Classifications:
 Acute:
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
Rapid onset.
Progresses to fatal termination within days to months.
More common in children and young adults.
 Chronic and AML:
 Gradual onset.
 Slower, more protracted course.
 More common between 25 and 60 years.
 Nursing care:
 Monitor for bleeding and infections.
 Good oral care.
 High-calorie, protein, and vitamin diet.
 Frequent feedings of soft easy-to-eat foods.
 Antiemetics.
 Neutropenic precautions.
 Strict handwashing,
 Prevent development of decubitus.
 Administer blood transfusions.
 Administer chemotherapy and medications.
 Monitor for adverse effects of chemotherapy:
 Nausea.
 Vomiting.
 Diarrhea.
 Stomatitis.
 Alopecia.
 Skin reactions.
 Bone marrow depression.
 Client education:
 Preventive measures for bleeding and infections.
 Avoid crowd or persons with known infections.
Acute Lymphoid Leukemia (ALL):
 Involves the blood-forming tissues of the bone marrow, spleen, and lymph
nodes.
 Due to immunocompromised state, important to prevent infection by not
allowing child to share toys with other children, good handwashing.
 Do not offer child raw vegetables, raw fruits.
Acute Myeloid Leukemia (Acute Myelogenous Leukemia [AML]):
 Any of a group of hematological malignancies in which neoplastic cells
develop from myeloid, monocytic, erythrocytic, or megakaryocytic
precursors.
 Common leukemia in adults.
 Anemia and thrombocytopenia may also occur.
 Complete remission possible.
Chronic Lymphocytic Leukemia (CLL):
 Increased production in blast cells causing the bone marrow to enlarge
into the bone and the spleen and liver to enlarge.
 Three phases:
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Chronic.
Transformation.
Acute or accelerated or blast crisis.
 Signs and symptoms:
 Leukocytes exceeding 100,000/mm3.
 Painful splenomegaly.
 Painful hepatomegaly.
 Decreased perfusion to brain causing confusion and restlessness.
 Shortness of breath.
 Malaise.
 Anorexia.
 Weight loss.
 Bone pain.
 Fever.
 Anemia.
 Thrombocytopenia.
 Increased basophils.
 Treatment:
 Tyrosine kinase inhibitor.
 Allogeneic transplant.
 Bone marrow transplant.
 Peripheral blood stem cell transplant.
 Chemotherapy.
 Leukapheresis.
 Client education:
 Avoid:
 Grapefruit juice.
 Antacids.
 Large doses of acetaminophen.
 Signs and symptoms of infection.
 Bleeding precautions.
 Ways to avoid infections.
Tumor Lysis:
 Occurs 3-7 days after treatment begins.
 Symptoms:
 Hyperuricemia.
 Hypocalcemia.
 Hyperkalemia.
 Hyperphosphatemia.
 Most likely to occur with non-Hodgkin lymphoma or leukemia.
Nursing Focus & Concepts
Cancer: Leukemia
Definition:

Imbalance in the ratio of red to white blood cells associated with the
overgrowth of immature WBCs in bone marrow.
 Four subtypes:
 Acute lymphocytic (or lymphoblastic) leukemia.
 Chronic lymphocytic (or lymphoblastic) leukemia.
 Acute myeloid leukemia.
 Chronic myeloid leukemia.
Concepts:
 Cancer.
 Cancer: Leukemia.
Assessment:
 Type of leukemia and stage of disease.
 Client/family knowledge of condition.
 History of and current signs of hemorrhagic problems.
 Psychological response to diagnosis.
 Level of support.
 Coping strategies.
Diagnosis:
 Lack of knowledge about disease and treatment.
 Fatigue.
 Activity intolerance.
 Potential for infection.
 Potential for bleeding.
 Anticipatory grieving.
 Psychological potential for ineffective coping.
Planning:
 Prepare information for client/family:
 Disease.
 Stage of illness.
 Treatment plan.
 Anticipate referrals for social support, especially if client is a child.
Implementation:
 Monitor labs.
 Maintain protective isolation, if indicated.
 Maintain hand hygiene.
 Limit social contact, especially those with contagious illnesses.
 Assist with:







Activities of daily living.
Skin and oral hygiene.
Mobility.
Avoid invasive procedures when possible.
Monitor vital signs and oxygenation and report deviation from normal.
Promote rest and adequate nutrition.
Provide education about illness, including signs and symptoms of infection
or bleeding, and treatment.


Ask about response to illness, support system, and coping strategies.
Provide active listening, relaxation exercises, and referrals to social
services as indicated.
Evaluation:
 Client will tolerate treatment without further bleeding, infection, or injury.
 Client/family will verbalize understanding of illness and treatment plan.
 Client/family will demonstrate adequate coping.
Interdisciplinary Focus & Medical
Management
Cancer: Leukemia
Definition:
 Imbalance in the ratio of red to white blood cells associated with the
overgrowth of immature WBCs in bone marrow.
 Four subtypes:
 Acute lymphocytic (or lymphoblastic) leukemia.
 Chronic lymphocytic (or lymphoblastic) leukemia.
 Acute myeloid leukemia.
 Chronic myeloid leukemia.
Physiology:
 WBCs primarily function as part of the immune system.
 Neutrophils act as phagocytes, as do the less prevalent monocytes and
macrophages.

Eosinophils are involved in a number of immune responses, especially
allergic reactions.
 Basophils release histamine and heparin when tissues are inflamed.
 B cell and T cell lymphocytes develop antibodies to particular antigens.
Pathophysiology:
 Stem cells in the bone marrow are slowly transformed into immature, nonfunctional, malignant cells.
 Leukemic cells are transported throughout the body:
 Central nervous system.
 Skin.
 Gastrointestinal tract.
 Testes.
 Lymph nodes.
 Spleen.
 Liver.
 Internal hemorrhaging and infections occur.
Risk Factors:
 Males.
 Individuals with chromosomal abnormalities.
 Exposure to tobacco products.



Hazardous chemicals.
Ionizing radiation.
Retroviruses.
Signs & Symptoms:
 Fatigue.
 Malaise.
 Lethargy.
 Dyspnea on exertion.
 Palpitations.
 Tachycardia.
 Pale or discolored skin.
 Recurrent or frequent infections.
Diagnostic Testing:
 Complete blood count with differential.
 Platelet levels determine secondary thrombocytopenia.
 Bone marrow aspiration and biopsy are used to confirm the diagnosis.
Treatment:
 Chemotherapy directed at destroying bone marrow cells.
 Hematopoietic growth factors.
 Radiation.
 Bone marrow and stem cell transplantation.
Complications:
 Leukemia is always fatal without treatment.
 Survival depends on:
 Type of leukemia.
 Age at onset.
 Stage when treatment begins.
Expected Outcome: With effective treatment, about 50% of adults will survive to
5 years.
1.
2. Differentiate Hodgkin disease from non-Hodgkin lymphomas.
3. Be able to identify the various labs that may be altered from massive cell
destruction during chemo.
1. Tumor lysis syndrome
4. Explain why do we use multiple chemotherapeutic agents for some cancers
5. Describe and explain the rationale for the nursing care for the sequelae of cancer
1. lymphedema
2. neutropenia
3. bleeding
6. Describe and explain the possible complications of various cancer surgeries such
as colon, bladder, breast, etc.
1. Stoma care and assessment
2. Patient teaching
3. Precautions
__________________
Total 30 questions
*Know Key Terms at the beginning of each chapter in this unit, review chapter
highlights, end of chapter questions, and unit review questions.
*Complete the assignments-If there are things that you do not understand, review that
material.
*Read and review LeMone. Look at Chapter reviews here as well.
*Review Unit Objectives:
7. Explain known carcinogens and identify risk factors for cancer.
1. Common risk factors
1. Diet
2. Lifestyle
3. Occupational/environmental
4. Gender
5. Race
6. Genetic/familial hx
7. Pt history
8. Compare mechanisms and characteristics of normal cells and malignant cells.
9. Describe physical and psychological effects of cancer.
10. Know the seven warning signs of cancer***
11. Describe and compare laboratory and diagnostic tests for cancer.
12. Discuss the role of chemotherapy in cancer treatment and classify
chemotherapeutic agents.
1. Side effects and treatment
2. Reason for combination therapy
3. Patient teaching involved
4. Labs to monitor
13. Compare and contrast the role of surgery, radiation therapy, and biotherapy in the
treatment of cancer.
1. Internal vs external radiation
2. Radiation side effects and treatment
3. Patient teaching involved in radiation therapy
14. Explain causes and discuss the nursing interventions for common oncologic
emergencies.
1. Signs and symptoms
2. Labs to watch
3. How to treat
4. Assessments a nurse would find
5. What intervention a nurse would perform for each.
15. Relate the physiology and assessment of the hematologic system and related
systems to commonly occurring hematologic disorders.
1. Thrombocytopenia
2. Anemia
3. Leukocytopenia
16. Describe the pathophysiology of specific hematologic disorders.
1. Bleeding precautions
17. Explain nursing implications for medications and other treatments prescribed for
specific hematologic disorders.
18. Discuss indications for and complications of bone marrow or stem cell
transplantation, as well as related nursing care.
1. Precautions for patients
2. How to care for the patient post op
19. Describe the major types of leukemia and the most common treatment modalities
and nursing interventions.
For the specific cancers, don't forget about the relevant information we covered in
class:
1.
2.
3.
4.
5.
6.
Patient profile
Risk factors (Unique to each specific cancer)
Manifestations
Assessment/Diagnosis
Interventions
Nursing care
20. Lastly, don't forget about the normal values you are expected to know.
21. Common Values:
1. Blood Gases:
1. PaCO2: 35-45 mmHg (4.66-5.98 kPa).
2. PaO2: 80-100 mmHg (10.6-13.33 kPa).
3. pH: arterial 7.35-7.45.
2. Calcium: 9-10.5 mg/dL (2.25-2.62 mmol/L.
3. Chloride: 98-106 mEq/L (98-106 mmol/L).
4. Glucose (fasting): 74-106 mg/dL (4.1-5.9 mmol/L).
5. Magnesium: 1.3-2.1 mEq/L (0.65-1.05 mmol/L).
6.
7.
8.
9.
Potassium: 3.5-5.0 mEq/L (3.5-5.0 mmol/L).
Sodium: 136-145 mEq/L (136-145 mmol/L).
Urea Nitrogen (BUN): 10-20 mg/dL (3.6-7.1 mmol/L).
Creatinine Clearance (24 hour): Male 107-139 mL/min (1.78-2.32
mL/sec), Female 87-107 mL/min (1.45-1.78 mL/sec).
10. pH: 4.6-8.0.
11. Protein: 0-8 mg/dL.