NUR 1648 NURSING 3 FNAL EXAM STUDY GUIDE
Summer 18 Nursing III Final study guide
Cancer: Chapters 21 and 22
Thrombocytopenia deficiency of platelets in the blood. This causes bleeding into the
tissues, bruising, and slow blood clotting after injury. /neutropenia the presence of
abnormally few neutrophils in the blood, leading to increased susceptibility to infection.
It is an undesirable side effect of some cancer treatments. /anemia a condition marked by
a deficiency of red blood cells or of hemoglobin in the blood, resulting in pallor and
weariness.
Primary/secondary prevention/ Primary Prevention
Avoidance of known or potential carcinogens is an effective prevention strategy when a cause
of cancer is known and avoidance is easily accomplished. For example, teach adults to use skin
protection during sun exposure to avoid skin cancer. Most lung cancer can be avoided by not
using tobacco and eliminating exposure to loose asbestos particles. Teach all adults about the
dangers of cigarette smoking and other forms of tobacco use (see the Health Promotion and
Maintenance feature in Chapter 27). Teach adults who are exposed to carcinogens in the
workplace to use personal protective equipment that reduces direct contact with this substance.
As more cancer causes are identified, avoidance may become even more effective.
Modifying associated factors appears to help reduce cancer risk. Absolute causes are not
known for many cancers, but some conditions appear to increase risk. Examples are the
increased incidence of cancer among adults who consume alcohol; the association of a diet high
in fat and low in fiber with colon cancer, breast cancer, and ovarian cancer; and a greater
incidence of cervical cancer among women who have multiple sexual partners (ACS, 2017).
Modifying behavior to reduce the associated factor may decrease the risk for cancer
development. Therefore teach all adults to limit their intake of alcohol to no more than one
ounce per day and to include more fruits, vegetables, and whole grains in their diets. Instruct
women about the importance of limiting the number of sexual partners and to use safer sex
practices to avoid exposure to viruses that can increase the risk for cervical cancer (see Table
21-6 for a listing of cancer-causing viruses).
Removal of “at-risk” tissues reduces cancer risk for an adult who has a known high risk for
developing a specific type of cancer. Examples include removing moles to prevent conversion
to skin cancer, removing colon polyps to prevent colon cancer, and removing breasts to prevent
breast cancer. Not all “at-risk” tissues can be removed (e.g., those that are part of essential
organs).
Chemoprevention is a strategy that uses drugs, chemicals, natural nutrients, or other
substances to disrupt one or more steps important to cancer development. These agents may be
able to reverse existing gene damage or halt the progression of the transformation process. Only
a few agents have been found effective for chemoprevention. These include the use of aspirin
and celecoxib (Celebrex) to reduce the risk for colon cancer, the use of vitamin D and
,tamoxifen to reduce the risk for breast cancer, and the use of lycopene to reduce the risk for
prostate cancer (ACS, 2017).
Vaccination is a newer method of primary cancer prevention. Currently the only vaccines
approved for prevention of cancer are related to prevention of infection from several forms of
the human papilloma virus (HPV). These vaccines are Gardasil and Cervarix. As more cancer-
causing viruses are identified, it is hoped that vaccines will be developed to prevent those viral
infections.
Secondary Prevention
Regular screening for cancer does not reduce cancer incidence but can greatly reduce some
types of cancer deaths. Teach all adults the benefits of participating in specific routine screening
techniques annually as part of health maintenance. General screening recommendations are
listed in chapters discussing cancers by organ system. The age and type of participation in
specific screening tests are different for adults who have an identified increased risk for a
specific cancer type. In addition, there is some controversy about when the age and frequency
for screening has the greatest benefit. Examples of recommended screenings include (ACS,
2017):
• The choice of annual mammography for women 40 to 44 years of age, annual mammography
for women 45 to 54 years of age, and annual or biennial mammography for women over 55
years of age
• Annual clinical breast examination for women older than 40 years; every 3 years for women
age 20 to 39 years.
• Colonoscopy at age 50 years and then every 10 years
• Annual fecal occult blood for adults of all ages
• Digital rectal examination (DRE) for men older than 50 years
Because cancer development clearly involves gene changes (either inherited gene mutations
or acquired damage-induced gene mutations), adults can be screened for some gene mutations
that increase the risk for cancer. A few examples of known gene mutations that increase cancer
risk are found in the BRCA1 gene, the BRCA2 gene, and the CHEK2 gene (which increase the
risk for breast cancer) and mutations in the APC, MLH1, and MSH2 genes (which increase the
risk for colon cancer).
When a patient has a strong family history of either breast or colon cancer, create a three-
generation pedigree to more fully explore the possibility of genetic risk. If a pattern of risk
emerges, inform the person about the possible benefits of genetic screening and advise him or
her to talk with an oncology health practitioner or genetics professional for more information.
Genetic screening can help an adult at increased genetic risk for cancer to alter lifestyle factors,
participate in early detection methods, initiate chemoprevention, or even have at-risk tissue
removed. Genetic screening has some personal risks, as well as potential benefits (see Chapter
5).
education P a t i e n t a n d F am i l y E d u c a t i o n: P r e p a r i n g f o r S e l f - M a n a g em e n t
Dietary Habits to Reduce Cancer Risk
• Avoid excessive intake of animal fat.
,• Avoid nitrites (prepared lunch meats, sausage, bacon).
• Minimize your intake of red meat.
• Keep your alcohol consumption to no more than one or two drinks per day.
• Eat more bran.
• Eat more cruciferous vegetables such as broccoli, cauliflower, Brussels sprouts, and cabbage.
• Eat foods high in vitamin A (e.g., apricots, carrots, leafy green and yellow vegetables) and
vitamin C (e.g., fresh fruits and vegetables, especially citrus fruits).
warning signs
C Changes in bowel or bladder habits
A A sore that does not heal
U Unusual bleeding or discharge
T Thickening or lump in the breast or elsewhere
I Indigestion or difficulty swallowing
O Obvious change in a wart or mole
N Nagging cough or hoarseness
Staging Staging of Cancer—TNM Classification
Primary Tumor (T)
, Tx Primary tumor cannot be assessed
T0 No evidence of primary tumor
Tis Carcinoma in situ
T1, T2, T3, T4 Increasing size and/or local extent of the primary tumor
Regional Lymph Nodes (N)
Nx Regional lymph nodes cannot be assessed
N0 No regional lymph node metastasis
N1, N2, N3 Increasing involvement of regional lymph nodes
Distant Metastasis (M)
Mx Presence of distant metastasis cannot be assessed
M0 No distant metastasis
M1 Distant metastasis
Summer 18 Nursing III Final study guide
Cancer: Chapters 21 and 22
Thrombocytopenia deficiency of platelets in the blood. This causes bleeding into the
tissues, bruising, and slow blood clotting after injury. /neutropenia the presence of
abnormally few neutrophils in the blood, leading to increased susceptibility to infection.
It is an undesirable side effect of some cancer treatments. /anemia a condition marked by
a deficiency of red blood cells or of hemoglobin in the blood, resulting in pallor and
weariness.
Primary/secondary prevention/ Primary Prevention
Avoidance of known or potential carcinogens is an effective prevention strategy when a cause
of cancer is known and avoidance is easily accomplished. For example, teach adults to use skin
protection during sun exposure to avoid skin cancer. Most lung cancer can be avoided by not
using tobacco and eliminating exposure to loose asbestos particles. Teach all adults about the
dangers of cigarette smoking and other forms of tobacco use (see the Health Promotion and
Maintenance feature in Chapter 27). Teach adults who are exposed to carcinogens in the
workplace to use personal protective equipment that reduces direct contact with this substance.
As more cancer causes are identified, avoidance may become even more effective.
Modifying associated factors appears to help reduce cancer risk. Absolute causes are not
known for many cancers, but some conditions appear to increase risk. Examples are the
increased incidence of cancer among adults who consume alcohol; the association of a diet high
in fat and low in fiber with colon cancer, breast cancer, and ovarian cancer; and a greater
incidence of cervical cancer among women who have multiple sexual partners (ACS, 2017).
Modifying behavior to reduce the associated factor may decrease the risk for cancer
development. Therefore teach all adults to limit their intake of alcohol to no more than one
ounce per day and to include more fruits, vegetables, and whole grains in their diets. Instruct
women about the importance of limiting the number of sexual partners and to use safer sex
practices to avoid exposure to viruses that can increase the risk for cervical cancer (see Table
21-6 for a listing of cancer-causing viruses).
Removal of “at-risk” tissues reduces cancer risk for an adult who has a known high risk for
developing a specific type of cancer. Examples include removing moles to prevent conversion
to skin cancer, removing colon polyps to prevent colon cancer, and removing breasts to prevent
breast cancer. Not all “at-risk” tissues can be removed (e.g., those that are part of essential
organs).
Chemoprevention is a strategy that uses drugs, chemicals, natural nutrients, or other
substances to disrupt one or more steps important to cancer development. These agents may be
able to reverse existing gene damage or halt the progression of the transformation process. Only
a few agents have been found effective for chemoprevention. These include the use of aspirin
and celecoxib (Celebrex) to reduce the risk for colon cancer, the use of vitamin D and
,tamoxifen to reduce the risk for breast cancer, and the use of lycopene to reduce the risk for
prostate cancer (ACS, 2017).
Vaccination is a newer method of primary cancer prevention. Currently the only vaccines
approved for prevention of cancer are related to prevention of infection from several forms of
the human papilloma virus (HPV). These vaccines are Gardasil and Cervarix. As more cancer-
causing viruses are identified, it is hoped that vaccines will be developed to prevent those viral
infections.
Secondary Prevention
Regular screening for cancer does not reduce cancer incidence but can greatly reduce some
types of cancer deaths. Teach all adults the benefits of participating in specific routine screening
techniques annually as part of health maintenance. General screening recommendations are
listed in chapters discussing cancers by organ system. The age and type of participation in
specific screening tests are different for adults who have an identified increased risk for a
specific cancer type. In addition, there is some controversy about when the age and frequency
for screening has the greatest benefit. Examples of recommended screenings include (ACS,
2017):
• The choice of annual mammography for women 40 to 44 years of age, annual mammography
for women 45 to 54 years of age, and annual or biennial mammography for women over 55
years of age
• Annual clinical breast examination for women older than 40 years; every 3 years for women
age 20 to 39 years.
• Colonoscopy at age 50 years and then every 10 years
• Annual fecal occult blood for adults of all ages
• Digital rectal examination (DRE) for men older than 50 years
Because cancer development clearly involves gene changes (either inherited gene mutations
or acquired damage-induced gene mutations), adults can be screened for some gene mutations
that increase the risk for cancer. A few examples of known gene mutations that increase cancer
risk are found in the BRCA1 gene, the BRCA2 gene, and the CHEK2 gene (which increase the
risk for breast cancer) and mutations in the APC, MLH1, and MSH2 genes (which increase the
risk for colon cancer).
When a patient has a strong family history of either breast or colon cancer, create a three-
generation pedigree to more fully explore the possibility of genetic risk. If a pattern of risk
emerges, inform the person about the possible benefits of genetic screening and advise him or
her to talk with an oncology health practitioner or genetics professional for more information.
Genetic screening can help an adult at increased genetic risk for cancer to alter lifestyle factors,
participate in early detection methods, initiate chemoprevention, or even have at-risk tissue
removed. Genetic screening has some personal risks, as well as potential benefits (see Chapter
5).
education P a t i e n t a n d F am i l y E d u c a t i o n: P r e p a r i n g f o r S e l f - M a n a g em e n t
Dietary Habits to Reduce Cancer Risk
• Avoid excessive intake of animal fat.
,• Avoid nitrites (prepared lunch meats, sausage, bacon).
• Minimize your intake of red meat.
• Keep your alcohol consumption to no more than one or two drinks per day.
• Eat more bran.
• Eat more cruciferous vegetables such as broccoli, cauliflower, Brussels sprouts, and cabbage.
• Eat foods high in vitamin A (e.g., apricots, carrots, leafy green and yellow vegetables) and
vitamin C (e.g., fresh fruits and vegetables, especially citrus fruits).
warning signs
C Changes in bowel or bladder habits
A A sore that does not heal
U Unusual bleeding or discharge
T Thickening or lump in the breast or elsewhere
I Indigestion or difficulty swallowing
O Obvious change in a wart or mole
N Nagging cough or hoarseness
Staging Staging of Cancer—TNM Classification
Primary Tumor (T)
, Tx Primary tumor cannot be assessed
T0 No evidence of primary tumor
Tis Carcinoma in situ
T1, T2, T3, T4 Increasing size and/or local extent of the primary tumor
Regional Lymph Nodes (N)
Nx Regional lymph nodes cannot be assessed
N0 No regional lymph node metastasis
N1, N2, N3 Increasing involvement of regional lymph nodes
Distant Metastasis (M)
Mx Presence of distant metastasis cannot be assessed
M0 No distant metastasis
M1 Distant metastasis
