Exam 4 · Week 10 · Standalone study page
M10 · Oncologic Disorders & End-of-Life Care
This page keeps all of the original course information, while reducing the decision to one module: cancer care, treatment effects and comfort.
▸M10Oncologic Disorders & End-of-Life CareWeek 10
💡 The one idea
Chemotherapy kills fast-dividing cells — it cannot tell cancer from healthy tissue. Every classic side effect is simply the body’s other fast-dividing cells: bone marrow, hair follicles, and the lining of the gut.
| Fast-dividing tissue | Result | What you watch for |
|---|---|---|
| Bone marrow | Myelosuppression | Infection, bleeding, fatigue |
| Hair follicles | Alopecia | Body image; hair regrows |
| GI lining | Mucositis, nausea, diarrhea | Nutrition, mouth care |
🚨 Neutropenia is the one that kills
ANC < 500 Severe neutropenia. A fever is now an emergency — the patient cannot mount normal signs of infection, so temperature may be the only clue.
In a neutropenic patient, a single temperature of 100.4F / 38C is a medical emergency. Report it immediately.
Nadir — the lowest count — is typically 7–10 days after a dose. That is the highest-risk window.
✅ Neutropenic precautions
- Private room; strict hand hygiene is the single most effective measure
- No fresh flowers or standing water — they harbor organisms
- No raw fruit, vegetables or undercooked food
- Avoid crowds and anyone with an infection
- No rectal temperatures, suppositories or enemas - they break mucosa
| Oncologic emergency | Recognize it by | Priority |
|---|---|---|
| Spinal cord compression | Back pain first, then weakness, then bowel/bladder change | Steroids, radiation — act on the back pain |
| Superior vena cava syndrome | Facial and neck swelling, distended veins, dyspnea | Elevate head, radiation |
| Tumor lysis syndrome | High K⁺, phosphate, uric acid; low calcium | Hydration, allopurinol |
| Hypercalcemia | Confusion, constipation, weakness | Hydration, bisphosphonates |
⭐ Back pain in a cancer patient is never “just” back pain
It is the first sign of spinal cord compression, and it appears before any weakness. Acting at the pain stage preserves the ability to walk; waiting for weakness does not.
💐 End-of-life care — what the exam rewards
Hospice is comfort-focused care when curative treatment stops, usually a prognosis of 6 months or less. Palliative care is comfort alongside treatment and can start at diagnosis.
For pain at end of life, there is no maximum opioid dose when titrated to comfort. Respiratory depression is not a reason to under-treat dying patients’ pain.
The most therapeutic response is usually the one that stays and listens rather than reassuring or redirecting.
⭐ High-yield — what the exam actually asks
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- CAUTION: Change in bowel/bladder, A sore that will not heal, Unusual bleeding or discharge, Thickening or lump, Indigestion or dysphagia, Obvious change in a wart or mole, Nagging cough or hoarseness.
- Prevention tiers: primary = remove the risk (do not smoke, HPV and hep B vaccine); secondary = screening; tertiary = preventing recurrence and complications.
- Biopsy confirms the diagnosis. Imaging and tumor markers support but never replace tissue. Grading = how abnormal the cells look; staging = TNM = how far it has spread.
- External beam radiation: she is NOT radioactive. Priority is skin protection — no rubbing with a towel, no ointments unless infected, avoid midday sun.
- Brachytherapy: she IS radioactive while the source is in. Stay
6 feetaway,30 minmaximum exposure, private room with the door closed. A dislodged seed is picked up with tongs into a lead container, never by hand. Strain urine7–10 days. At home: separate bedrooms and toilets, flush repeatedly.
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- Chemo: antiemetics before and after. Small frequent nutrient-dense meals; cold or room-temperature food is better tolerated; stop fluids ~
1 hrbefore meals; plastic utensils cut the metallic taste; megestrol for appetite. - Stomatitis: normal saline or bicarb rinses, never alcohol-based mouthwash, topical anesthetic before meals, avoid spicy/acidic/salty, ~
2 Lwater/day. Alopecia starts7–10 daysafter treatment. - Extravasation from a peripheral line: stop the infusion first, notify the provider, give the antidote subQ around the site, attempt to aspirate. Do not remove the catheter and do not flush. Ice is right (it localizes the drug; heat would spread it). A central line is the ideal chemo route.
- HSCT: conditioning leaves her profoundly pancytopenic — strict reverse isolation through engraftment. Watch for GVHD in allogeneic transplants (skin, GI, liver), affecting
30–50%of allogeneic recipients. - Oncologic emergencies — SVC syndrome: facial, neck and upper-body swelling with distended veins, worse lying flat → keep the HOB up. Tumor lysis syndrome: after starting chemo, potassium, phosphorus and uric acid all up, calcium down → arrhythmias and AKI; prevent with aggressive hydration plus allopurinol or rasburicase. Spinal cord compression: new back pain is the first sign — delay means permanent paralysis.
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- Palliative care can run alongside curative treatment at any stage. Hospice requires a terminal prognosis (typically
≤6 months) and a shift to comfort-focused goals.
🎧 From the LSC exam-prep recording
What the faculty actually said in the review session for this week — their numbers, their worked calculations, their priority rulings. On an exam, this beats the textbook.
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- Hospice = terminal, prognosis 6 months or less, curative treatment stopped. Palliative runs alongside curative treatment at any stage. “Curative treatment discontinued” plus “at home” is their cue for hospice at home. Follow the client’s stated goal, not the one you would pick. The client, not the family, decides while she is capable.
- Neutropenic fever is the one "give antibiotics without proven infection" exception.
ANC 800 with temp 100.8°Foutranks post-cisplatin vomiting, petechiae and a pain request. Cultures plus IV antibiotics, likely admission. - ANC cutoffs they used: <1,500 neutropenic, <500 severe.
- Neutropenic teaching corrections: no sushi or raw food even from a good restaurant · discard drinks left out over 1 hour · avoid gardening and cat litter · report temp over
100°F. - Stomatitis: salt-and-soda rinses before and after meals, avoid glycerin- and alcohol-containing mouthwashes, at least 2 L water, lidocaine gel or analgesia before meals so she can actually eat.
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- SVC syndrome: metastatic chest tumor, dyspnea, facial swelling and erythema, JVD, neck tightness. Oncologic emergency → high-dose radiation plus corticosteroids (steroids shrink the inflammation around the tumor).
- Tumor lysis labs: ↑K, ↑phosphate, ↓calcium, ↑uric acid, ↑creatinine — phosphate leaks out and binds serum calcium down. Aggressive IV fluids, allopurinol, sodium polystyrene for the potassium, diuretics for output. Methotrexate is chemo, not a treatment.
- Brachytherapy staff safety: limit time · ≥6 feet when not providing care · your own dosimeter, never shared · lead apron · rotate caregivers, the opposite of normal continuity · pregnant staff not assigned at all · linens and dressings stay in the room.
- Radiation skin care: mild soap with fingertips, not a washcloth · nothing unprescribed on the site · loose soft clothing · SPF 15 is not enough, cover or avoid sun · never wash off the ink marks — they are how the beam is aimed, and it is the single most repeated radiation question they set.
- CINV: cold and bland foods, add protein powders for calories, antiemetics before and after treatment, rest after meals, loose clothing.
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- Their palliative SATA framing: pain control, small frequent meals, wigs and turbans, light activity are in. Daily weights and strict balanced-meal rules are out — they are rigid metrics, not comfort.
- Calc: 1 g ceftriaxone to 250 mg/mL →
4 mLdiluent.
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- Hospice is covered by most health plans including Medicare and Medicaid. That is a teaching point for families weighing their options, not a detail.
- Palliative care treats the patient and the family as one unit, and it continues into bereavement after the death.
- External beam radiation skin care: mild soap, warm water, fingertips only. No ice, no heat, no unprescribed powders or ointments, no sun on the field. Moisturise with the approved lotion and stay hydrated.
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- Stomatitis: no alcohol-based mouthwash — it burns an open surface. Saline or a prescribed rinse instead.
- Nutrition on chemotherapy: add protein and calories. Do not avoid dairy — it is calories she needs. Do not eat only raw fruit and vegetables — she is immunocompromised and cannot fight the bacteria on them.
- Tumor lysis syndrome: cells die so fast they dump their contents — potassium, phosphate and uric acid — into the blood. Hydration and monitoring; watch the potassium.
- Neutropenia: an ANC of 800 against a normal of 2,500 to 6,000 is significant. Protective precautions, no fresh flowers, no raw produce. Staff radiation safety is time, distance and shielding.
⚠️ Exam traps
- Palliative ≠ hospice. This is asked constantly.
- External beam clients are not radioactive; brachytherapy clients are.
- Do not flush an extravasated line. The instinct to flush is the wrong answer.
⚠️ What it turns into — the complication for each one
The disorder cards below run definition, causes, signs, diagnostics, management and nursing. This is the part they do not have, and it is where the exam lives: so what happens if this is missed or left? The complications here come in two kinds: what the tumor does, and what the treatment does. The oncologic emergencies are the ones with a time limit.
| Disorder | What it turns into |
|---|---|
| Cancer: pathophysiology and staging | Metastasis, cachexia, paraneoplastic syndromes, pathological fracture, and pain that is undertreated more often than it is overtreated |
| Chemotherapy and radiation care | Myelosuppression — neutropenia, anemia, thrombocytopenia, with the nadir around 7–10 days. Mucositis, nausea and vomiting, alopecia, extravasation causing tissue necrosis, cardiotoxicity, nephrotoxicity, infertility, and radiation skin injury |
| Oncologic emergencies | Superior vena cava syndrome, spinal cord compression (back pain first — act before the weakness), tumor lysis syndrome with hyperkalaemia, hyperphosphataemia, hyperuricaemia and acute kidney injury, hypercalcaemia, cardiac tamponade, SIADH and sepsis |
| Leukemia and lymphoma | Infection, bleeding and anemia from marrow failure, CNS involvement, tumor lysis when treatment starts, and graft-versus-host disease after transplant |
| Palliative and end-of-life care | Uncontrolled pain, dyspnea, terminal secretions and delirium. For the family, complicated grief; for staff, moral distress. Undertreating pain for fear of hastening death is the commonest failure here |
🔬 Oncology and end-of-life care, section by section
The disease and its staging, then the treatments and their toxicities, then the emergencies to catch early, then the care that matters when cure is no longer the goal. Same six sections every time.
Cancer: Pathophysiology and StagingOpenClose
Definition and Overview
Cancer is uncontrolled cell growth with the ability to invade nearby tissue and spread to distant sites. A benign tumor grows locally, stays encapsulated and does not metastasise; a malignant one does all three. The process runs initiation → promotion → progression, and everything about prognosis and treatment depends on how far it has spread, not on how big it is.
Causes and Risk Factors
Modifiable: tobacco (the largest single cause), alcohol, obesity, physical inactivity, diet, sun and tanning-bed exposure, and infections — HPV, hepatitis B and C, H. pylori, Epstein–Barr virus. Occupational and environmental: asbestos, benzene, radon, radiation. Non-modifiable: age, family history, and inherited mutations such as BRCA1 and BRCA2 and Lynch syndrome.
Clinical Manifestations
The seven classic warning signs spell CAUTION: Change in bowel or bladder habits; A sore that does not heal; Unusual bleeding or discharge; Thickening or a lump; Indigestion or difficulty swallowing; Obvious change in a wart or mole; Nagging cough or hoarseness. Add unexplained weight loss, persistent fatigue, night sweats and unexplained pain. Many cancers are silent until they are advanced — which is why screening asymptomatic people is the point.
Assessment and Diagnostic Findings
Tissue biopsy is the only thing that diagnoses cancer; imaging and tumor markers suggest it. Grading describes how abnormal the cells look (G1 well differentiated to G4 undifferentiated). Staging describes spread, by the TNM system — Tumour size, Nodes involved, Metastasis, combined into stages I to IV. Imaging with CT, MRI, PET and bone scan; tumor markers such as PSA, CA-125, CEA and AFP for monitoring rather than diagnosis. Screening: mammography, colonoscopy, cervical cytology with HPV testing, low-dose CT for heavy smokers.
Medical Management
Treatment is chosen by type, stage, grade and the client's own goals: surgery, radiation, chemotherapy, hormone therapy, targeted therapy, immunotherapy and stem cell transplantation, usually in combination. The intent is stated and matters — curative, control, or palliative — and the client should be able to say which one applies to them.
Nursing Management and Client Education
Prevention and early detection are nursing work: teach smoking cessation, sun protection, HPV and hepatitis B vaccination, weight and alcohol, and the screening schedule for the client's age and risk. Teach the CAUTION signs plainly. During the diagnostic period, the waiting is its own ordeal — explain what each test is for and when results come. Make sure the client knows the stage, the intent of treatment, and their options, because informed consent here is a conversation, not a signature, and it is often the nurse who discovers the client did not understand. Address body image, fertility preservation before treatment starts, work and finances, and get the referrals in early rather than late.
Chemotherapy and Radiation CareOpenClose
Definition and Overview
Chemotherapy kills rapidly dividing cells throughout the body, which is why it works and why its side effects land on the other rapidly dividing tissues: bone marrow, the lining of the mouth and gut, hair follicles and gonads. Radiation damages DNA in a targeted field, so its effects are mostly local — with fatigue as the systemic exception.
Causes and Risk Factors
Everyone receiving these treatments is at risk; severity rises with dose, combination regimens, previous treatment, age, renal or hepatic impairment, and poor nutritional status. Specific drug toxicities to know: doxorubicin is cardiotoxic; cisplatin is nephrotoxic and ototoxic; vincristine is neurotoxic; bleomycin is pulmonary toxic; methotrexate is hepato- and nephrotoxic.
Clinical Manifestations
Myelosuppression is the most dangerous: neutropenia (infection), thrombocytopenia (bleeding) and anemia (fatigue), with the nadir usually 7 to 14 days after a cycle. Then nausea and vomiting, mucositis and stomatitis, diarrhea or constipation, alopecia, taste changes and anorexia, fatigue, peripheral neuropathy, and infertility. Radiation adds skin reactions in the treatment field — redness, dryness, then moist desquamation — and site-specific effects such as dry mouth, oesophagitis, cystitis or diarrhea depending on what is in the field.
Assessment and Diagnostic Findings
CBC with differential and absolute neutrophil count before every cycle, plus renal and liver function and electrolytes. Weight and nutritional intake. Oral assessment every shift using a mucositis scale. Skin assessment of the radiation field. Pain, neuropathy (ask about numbness, tingling and buttons and zips), and functional status. Echocardiogram or MUGA for ejection fraction before and during anthracyclines, audiometry with cisplatin, pulmonary function tests with bleomycin.
Medical Management
Antiemetics given before chemotherapy and on a schedule afterwards — 5-HT3 antagonists, dexamethasone, and NK1 antagonists. Growth factors (filgrastim) for neutropenia and erythropoiesis-stimulating agents or transfusion for anemia. Mouth care protocols and topical anaesthetics for mucositis. Dose reduction or delay for toxicity. Radiation is delivered as external beam or brachytherapy, where the source is implanted.
Nursing Management and Client Education
Chemotherapy is a hazardous drug — wear the required protective equipment, use a closed system, and follow the spill and disposal protocol, including for body fluids for at least 48 hours afterwards. Watch the IV site continuously for extravasation — burning, swelling or loss of blood return means stop the infusion immediately, leave the needle in place, aspirate, and follow the antidote protocol. Teach neutropenic and bleeding precautions and the 100.4°F rule. Mouth care with a soft brush and a saline or bicarbonate rinse four or more times a day, and no alcohol-based mouthwash. Small, bland, cool, frequent meals; nutrition referral early. Prepare the client for hair loss before it happens and discuss wigs, scarves and scalp care. For the radiation field: wash gently with mild soap and lukewarm water, pat dry, do not scrub off the markings, no lotions, powders or deodorants unless approved, no heat or ice, cotton clothing, and protect the area from sun for life. For a client with a radiation implant: time, distance and shielding — limit time in the room, stay as far away as practicable, wear a dosimeter, and no pregnant staff or visitors and no children in the room. Address fatigue, sexuality and fertility openly; nobody else may raise them.
Oncologic EmergenciesOpenClose
Definition and Overview
Six complications of cancer or its treatment that can kill quickly and are frequently missed because they are attributed to the cancer generally. Recognising them early is the nursing contribution, because each has a specific and effective treatment.
Causes and Risk Factors
Risk depends on the tumor. Superior vena cava syndrome: lung cancer and lymphoma, and central venous catheters. Spinal cord compression: breast, lung and prostate cancer with bone metastases. Hypercalcaemia: bone metastases, myeloma, and squamous lung cancer. Tumor lysis syndrome: bulky, rapidly dividing tumors — leukemia, high-grade lymphoma — shortly after treatment begins. SIADH: small cell lung cancer. Cardiac tamponade: pericardial metastases and radiation.
Clinical Manifestations
SVC syndrome: facial and upper-body swelling, distended neck and chest veins, dyspnea, and a face that looks worse in the morning. Spinal cord compression: new or worsening back pain is the earliest sign and precedes weakness — act on the pain, because once the client cannot walk, walking rarely returns; then leg weakness, sensory level, and bowel or bladder dysfunction. Hypercalcaemia: the classic 'stones, bones, groans and psychiatric overtones' — fatigue, weakness, nausea, constipation, polyuria, confusion, and dysrhythmias. Tumor lysis: high potassium, phosphate and uric acid with low calcium, causing dysrhythmias, tetany, seizures and acute kidney injury. SIADH: hyponatraemia with confusion and seizures. Tamponade: hypotension, distended neck veins and muffled heart sounds.
Assessment and Diagnostic Findings
Match the assessment to the risk. Neurological examination including gait, strength, sensory level and bladder function in anyone with cancer and new back pain, plus urgent MRI of the whole spine. Electrolytes with calcium, phosphate, potassium, uric acid and creatinine before and during the first cycles for tumor lysis risk. Serum sodium and osmolality for SIADH. CT chest for SVC syndrome; echocardiography for tamponade. Continuous cardiac monitoring for the electrolyte emergencies.
Medical Management
SVC syndrome: radiation or chemotherapy to shrink the tumor, stenting, corticosteroids. Cord compression: high-dose dexamethasone immediately, then radiation or surgical decompression — hours matter. Hypercalcaemia: aggressive normal saline hydration, then bisphosphonates (zoledronic acid) or denosumab; calcitonin for a rapid effect. Tumor lysis: prevention with hydration and allopurinol or rasburicase before treatment; then correct the electrolytes and consider dialysis. SIADH: fluid restriction and treat the tumor. Tamponade: pericardiocentesis.
Nursing Management and Client Education
Report new back pain in a client with cancer the same day — do not wait for the morning round. For SVC syndrome, elevate the head of the bed, avoid tight clothing, and do not use the upper extremities for IV access or blood pressure. For hypercalcaemia and tumor lysis, push fluids, monitor cardiac rhythm and strict intake and output, and institute seizure and fall precautions. For cord compression, log-roll, assess strength and sensation each shift, and manage bowel and bladder proactively. Teach every client on treatment which symptoms mean calling immediately — new back pain, facial swelling, confusion, severe weakness, decreased urine output, or a fever — and give it to them in writing, because nobody remembers a list given on a chemotherapy day.
Leukemia and LymphomaOpenClose
🖼️ InfographicsLeukemiaLymphoma
Definition and Overview
Leukemia is cancer of the blood-forming cells in the marrow: abnormal white cells crowd out normal production, so the client ends up with too few functional white cells, red cells and platelets even though the white count may be enormous. Lymphoma is cancer of the lymphatic system — Hodgkin, marked by Reed–Sternberg cells and a predictable spread from node group to node group, and the far more varied non-Hodgkin lymphomas.
Causes and Risk Factors
Previous chemotherapy or radiation, benzene and other chemical exposure, ionising radiation, Down syndrome and other genetic conditions, immunosuppression and organ transplantation, and viruses — Epstein–Barr virus, HTLV-1, HIV, H. pylori. Acute lymphocytic leukemia peaks in childhood; acute myeloid and chronic leukaemias are diseases of later life. Hodgkin lymphoma has a bimodal peak in young adults and after 55.
Clinical Manifestations
Leukemia presents through what is missing: infection and fever from neutropenia, fatigue and pallor from anemia, and bruising, petechiae and bleeding from thrombocytopenia, plus bone and joint pain, weight loss, night sweats, and enlarged liver, spleen and lymph nodes. Lymphoma presents as painless, firm, enlarged lymph nodes, classically in the neck, with the 'B symptoms' — fever, drenching night sweats and unexplained weight loss of more than 10% — which are part of the staging. In Hodgkin lymphoma, pain in an enlarged node after drinking alcohol is an unusual but classic feature.
Assessment and Diagnostic Findings
CBC with differential and peripheral blood film, then bone marrow aspiration and biopsy, which is definitive for leukemia, with cytogenetics and flow cytometry to classify it and guide treatment. Lymph node biopsy — excisional, not fine needle — for lymphoma. Lumbar puncture for central nervous system involvement. PET-CT for staging. Uric acid, potassium, phosphate and renal function for tumor lysis risk. Baseline cardiac and pulmonary function before anthracyclines and bleomycin.
Medical Management
Combination chemotherapy is the backbone, in phases for acute leukemia — induction, consolidation and maintenance — with central nervous system prophylaxis. Targeted therapy such as tyrosine kinase inhibitors for chronic myeloid leukemia, and monoclonal antibodies such as rituximab for B-cell lymphoma. Radiation for localized lymphoma. Haematopoietic stem cell transplantation for high-risk or relapsed disease. CAR T-cell therapy for selected refractory disease. Supportive care with transfusion, growth factors and antimicrobial prophylaxis.
Nursing Management and Client Education
Infection and bleeding are what harm these clients day to day — full neutropenic and bleeding precautions, and the 100.4°F rule taught to the client and the family. Meticulous mouth care; assess the mouth every shift. Monitor for tumor lysis syndrome in the first days of treatment: hydration, allopurinol, strict intake and output and electrolytes. Central line care with strict asepsis. Manage nausea proactively and protect nutrition. Plan rest around the anemia. Prepare for and support through hair loss, and address fertility before treatment begins — sperm banking and oocyte preservation cannot be done later. After stem cell transplant, teach the prolonged immunosuppression, the signs of graft-versus-host disease (rash, diarrhea, jaundice), and that vaccinations must be repeated. Recognize the length of this: months of treatment, lost work and school, and a family under sustained strain.
Palliative and End-of-Life CareOpenClose
Definition and Overview
Palliative care is specialised care focused on relieving symptoms and improving quality of life, and it can be given alongside curative treatment, at any stage, from the day of diagnosis. Hospice is a form of palliative care for a client whose prognosis is around six months or less if the disease follows its usual course, and where the goal has shifted from cure to comfort. Confusing the two is the commonest misunderstanding, and it costs clients months of symptom relief they could have had.
Causes and Risk Factors
Any serious illness qualifies for palliative care — not only cancer, but heart failure, COPD, kidney failure, dementia and neurological disease. Referral is too often delayed by the belief that it means giving up, by clinicians reluctant to raise it, and by families who understandably hear it as abandonment.
Clinical Manifestations
The symptoms that need managing at the end of life: pain, dyspnea, nausea, constipation, anorexia, fatigue, anxiety, and delirium. In the final days, expect decreased intake and no thirst, profound weakness, sleeping most of the time, mottling and coolness of the extremities, irregular Cheyne–Stokes breathing, incontinence, and noisy respirations from pooled secretions — the 'death rattle', which distresses the family far more than the client. Hearing is thought to be among the last senses to go.
Assessment and Diagnostic Findings
Ask what the client understands and what matters to them — that is the assessment. Symptoms assessed with tools the client can use even when weak. Establish advance directives, a health care proxy, and code status, and make sure a POLST or MOLST is completed and travels with the client. Assess spiritual and cultural needs and practices around dying and the body afterwards, and assess the family's understanding and coping separately.
Medical Management
Symptom control is the treatment. Opioids for pain and for dyspnea — and there is no ceiling dose when titrating to comfort in a dying client; laxatives with every opioid; antiemetics; benzodiazepines for anxiety and antipsychotics for delirium; anticholinergics such as glycopyrrolate for secretions; oxygen or a fan for breathlessness. Non-drug measures throughout. Hospice provides the interdisciplinary team, 24-hour access, equipment, and bereavement support to the family for a year afterwards.
Nursing Management and Client Education
Treat pain adequately. The fear that opioids given to relieve suffering will hasten death is largely unfounded, and the principle of double effect supports treating symptoms properly even so — but say so out loud, because families carry that fear silently. Withholding analgesia from a dying client to avoid 'oversedation' is not caution; it is undertreated suffering. Reposition rather than suction for the death rattle, and explain to the family that it does not distress the client. Mouth care hourly, small ice chips and lip balm; explain that artificial nutrition and hydration do not prolong life or reduce suffering at this stage and can add to it — the family needs permission to stop urging food. Keep talking to the client and encourage the family to, because hearing persists. Honour cultural and religious practices and ask rather than assume. Give the family anticipatory guidance about what the last hours look like, so nothing frightens them by surprise, and tell them they can touch and hold their person. Support them afterwards, and attend to your own grief too — this work accumulates.
🧠 Mind maps 3
One per disorder, built from the structure of your ATI chapter.
🎯 Who gets it
- Cancer incidence rises with age; highest among older adults.
- Sex patterns: females favor breast/lung/colorectal/uterine/skin cancer; males favor prostate/lung/colorectal/bladder/skin cancer.
- Immunosuppression and chronic skin trauma/burn scars raise cancer risk.
- Race raises specific risks: testicular (white), prostate/colorectal/pancreatic (Black), liver (Mexican American).
👀 What you see
- Benign tumors grow slower, resemble nearby tissue, and stay localized unless they compress vessels/nerves.
- Malignant tumors look abnormal, grow fast, and invade surrounding tissue, vessels, and lymphatics.
- Findings vary by tumor site; expect pain plus physiologic changes if organ function is disrupted.
🧪 What confirms it
- Tumor markers and screening labs (e.g., PSA) help identify cancerous tumors.
- Diagnostics (imaging such as MRI, CT, fluoroscopy, PET, nuclear scan, plus biopsy) find tumor size and location.
- TNM system stages cancer by Tumor, Node, and Metastasis extent.
- T staging: TX unknown, T0 none found, Tis in situ, T1-T4 rising size/extent.
🩺 What you do
- Malnutrition: give antiemetics/antacids, encourage oral hygiene, and limit liquids at meals to avoid early fullness.
- Malnutrition: track albumin, ferritin, and transferrin; individualize meal plan and involve dietary services.
- Constipation/obstruction: opioids slow bowel motility; give stool softeners/laxatives, push fluids, fiber, activity.
- Paraneoplastic syndrome: recognize new neuro changes; treat with steroids, immune factors, plasmapheresis, or irradiation.
💬 What you teach
- Learn how to manage expected treatment side effects.
- Eat adequate protein, carbohydrates, and calories during treatment.
Read left to right: who gets it → what you see → what confirms it → what you do → what goes wrong. Cover a column and rebuild it out loud.
🧪 What confirms it
- Labs assess for cancer or its effects (electrolyte imbalance, organ dysfunction).
- CBC: elevated WBCs and blast cells can suggest leukemia is present.
- Elevated liver function tests can signal primary or metastatic liver cancer.
- Tumor marker assays detect elevated proteins like CEA, PSA, alpha-fetoprotein.
🩺 What you do
- Take a full health history and physical exam, including family cancer/genetic history.
- Inspect for skin/color, symmetry, movement, or function changes; auscultate heart, lung, bowel sounds and major arteries.
- Palpate gently for masses; some exams (e.g., digital rectal exam) are provider-only.
- Percuss for dullness over the lungs, bowel, or an enlarged liver, suggesting tumor or inflammation.
💬 What you teach
- Perform breast or testicular self-exams at home, if desired.
- Report any general cancer warning sign to the provider promptly.
- Watch for bowel/bladder habit changes or a new shape/texture change in the skin.
Read left to right: who gets it → what you see → what confirms it → what you do → what goes wrong. Cover a column and rebuild it out loud.
🩺 What you do
- Tailor nursing care to the specific cancer procedure or treatment involved.
- Include family in cancer pain care and management planning.
- Watch for GI bleeding (bloody stools, coffee-ground emesis) with NSAID use.
- Cap acetaminophen at
4 g/dayshort-term or3 g/daylong-term; avoid it in liver disease.
💊 Drugs
- Multimodal pain control can combine NSAIDs, opioids, antidepressants, anticonvulsants, steroids, and local anesthetics.
- Non-opioid options, such as acetaminophen, ketorolac, aspirin, ibuprofen, and celecoxib, suit mild-to-moderate pain.
💬 What you teach
- Take NSAIDs with food to prevent GI upset, and never crush enteric-coated forms.
- Avoid driving or hazardous tasks until opioid effects are known, and skip alcohol.
- Rise slowly from lying or sitting to limit orthostatic hypotension from opioids or clonidine.
Read left to right: who gets it → what you see → what confirms it → what you do → what goes wrong. Cover a column and rebuild it out loud.
🎥 Lecture recordings 4
Tap a card to open that recording in Google Drive. The same list lives in the lecture library.
All NUR 258 recordings →🖼️ Infographics 14
Tap a card to open the matching graphics in your infographic library.
📄 Simple Nursing handouts for this module — 10 of them, straight from your Drive.
📋 Active Learning Templates 3
One per disorder. Every row is filled from that section of the ATI chapter — print it, cover the right, rebuild it.
📋 General Principles of Cancer6 parts
Filled from ATI chapter 89, row by row from that chapter’s own sections — 12 of 12 rows have content.
🧭 What it isAlterations in Health (Diagnosis) · Health Promotion & Disease Prevention
Alterations in Health (Diagnosis)
- Covers cancer as abnormal, invasive cell growth from genetic mutations, how tumors are named by origin tissue after metastasis, incidence and mortality data, and how benign tumors differ from malignant ones.
Health Promotion & Disease Prevention
- Eat a low-fat diet rich in fruit, vegetables, and lean protein; limit sugar, salt, and processed or red meat.
- Maintain a healthy weight/BMI and get regular physical activity.
- Avoid all tobacco product use to lower cancer risk.
- Limit alcohol to
1 drink/dayfor females,2 drinks/dayfor males (assigned at birth). - Avoid risky behaviors: drug use, needle sharing, unprotected sex.
- Limit exposure to environmental hazards like radiation or chemicals; wear PPE.
👀 How it shows upAssessment — Risk Factors · Assessment — Expected Findings
Assessment — Risk Factors
- Cancer incidence rises with age; highest among older adults.
- Sex patterns: females favor breast/lung/colorectal/uterine/skin cancer; males favor prostate/lung/colorectal/bladder/skin cancer.
- Immunosuppression and chronic skin trauma/burn scars raise cancer risk.
- Race raises specific risks: testicular (white), prostate/colorectal/pancreatic (Black), liver (Mexican American).
- Chronic hepatitis B/C infection raises liver cancer risk over time.
- HTLV and Epstein-Barr virus infection raise lymphoma and leukemia risk.
- HPV causes most cervical cancer; HIV raises lymphoma and Kaposi sarcoma risk.
- H. pylori infection raises stomach cancer and gastric lymphoma risk.
Assessment — Expected Findings
- Benign tumors grow slower, resemble nearby tissue, and stay localized unless they compress vessels/nerves.
- Malignant tumors look abnormal, grow fast, and invade surrounding tissue, vessels, and lymphatics.
- Findings vary by tumor site; expect pain plus physiologic changes if organ function is disrupted.
🧪 How it is confirmedLaboratory Tests · Diagnostic Procedures
Laboratory Tests
- Tumor markers and screening labs (e.g., PSA) help identify cancerous tumors.
Diagnostic Procedures
- Diagnostics (imaging such as MRI, CT, fluoroscopy, PET, nuclear scan, plus biopsy) find tumor size and location.
- TNM system stages cancer by Tumor, Node, and Metastasis extent.
- T staging: TX unknown, T0 none found, Tis in situ, T1-T4 rising size/extent.
- N staging: NX unknown, N0 no node spread, N1-N3 rising node involvement.
- M staging: MX unknown, M0 no metastasis, M1 metastasis present.
🩺 What you doNursing Care · Medications · Therapeutic Procedures
Nursing Care
- Malnutrition: give antiemetics/antacids, encourage oral hygiene, and limit liquids at meals to avoid early fullness.
- Malnutrition: track albumin, ferritin, and transferrin; individualize meal plan and involve dietary services.
- Constipation/obstruction: opioids slow bowel motility; give stool softeners/laxatives, push fluids, fiber, activity.
- Paraneoplastic syndrome: recognize new neuro changes; treat with steroids, immune factors, plasmapheresis, or irradiation.
- SIADH (lung/brain cancers) dilutes sodium; watch for early nausea, then lethargy, seizures, or coma.
- SIADH: give furosemide,
0.9%saline, or hypertonic saline; recheck sodium since these risk fluid overload. - Hypercalcemia (breast/lung/head-neck, myeloma, bone mets): anorexia, shortened QT, kidney stones; give
0.9%saline, furosemide, pamidronate, phosphates. - SVC syndrome (breast/lung mets): facial/periorbital edema, dyspnea, epistaxis; sit up in semi-Fowler's, urgent high-dose radiation.
- Cancer-related DIC: watch for bleeding, replace clotting factors/plasma; heparin can slow the consumption cascade.
Medications
From this module — built from the notes above on this page, not a section of the ATI chapter.
- Chemotherapy kills dividing cells, which is why the toxicities hit marrow, gut lining and hair.
- Antiemetics scheduled, not as needed — anticipatory nausea is very hard to reverse once learned.
- Growth factors to shorten neutropenia; allopurinol and hydration for tumor lysis risk.
- Targeted therapy and immunotherapy have their own pattern — immune-related colitis, hepatitis, pneumonitis and thyroiditis rather than marrow suppression.
- Handle chemotherapy and the client’s body fluids with cytotoxic precautions for the period specified.
Therapeutic Procedures
From this module — built from the notes above on this page, not a section of the ATI chapter.
- Surgery for diagnosis, cure, debulking or palliation.
- External beam radiation: mark the field and do not wash the markings off; gentle skin care, no heat, cold, perfume or shaving to the field.
- Internal radiation (brachytherapy): the client is the source. Apply time, distance and shielding; restrict pregnant staff and young children.
- Stem cell transplantation, with prolonged neutropenia and graft-versus-host risk.
- Central venous access for long courses; teach line care and infection signs.
💬 Around the patientClient Education · Interprofessional Care
Client Education
- Learn how to manage expected treatment side effects.
- Eat adequate protein, carbohydrates, and calories during treatment.
Interprofessional Care
From this module — built from the notes above on this page, not a section of the ATI chapter.
- Oncologist, radiation oncologist and surgeon — decisions are made in multidisciplinary meeting, not singly.
- Oncology pharmacist for protocol dosing and interactions.
- Dietitian — weight loss and mucositis change what treatment is tolerable.
- Palliative care alongside treatment, introduced early rather than at the end.
- Social work, chaplaincy and psychology; survivorship follow-up for late effects.
⚠️ What goes wrongComplications
Complications
From this module — built from the notes above on this page, not a section of the ATI chapter.
- Neutropenic sepsis — fever in a neutropenic client is an emergency: cultures and antibiotics within the hour.
- Thrombocytopenia — bleeding precautions, soft toothbrush, electric razor, no rectal temperatures or suppositories.
- Tumor lysis syndrome — high potassium, phosphate and uric acid, low calcium, with acute kidney injury.
- Superior vena cava syndrome and spinal cord compression — both oncological emergencies.
- Mucositis, malnutrition, anemia, and the late effects of treatment including second cancers.
📋 Cancer Screening and Diagnostic Procedures6 parts
Filled from ATI chapter 90, row by row from that chapter’s own sections — 12 of 12 rows have content.
🧭 What it isAlterations in Health (Diagnosis) · Health Promotion & Disease Prevention
Alterations in Health (Diagnosis)
- Covers cancer screening guidelines by age and risk for breast, colorectal, prostate, cervical, and lung cancer, common clinical warning signs, and diagnostic workup — biopsy types, imaging modalities, and lab and genetic testing — used to confirm and stage disease.
Health Promotion & Disease Prevention
From this module — built from the notes above on this page, not a section of the ATI chapter.
- Primary prevention stops it happening: no tobacco, limit alcohol, sun protection, HPV and hepatitis B vaccination, healthy weight.
- Secondary prevention finds it early: mammography, cervical screening, colonoscopy, low-dose CT for eligible smokers.
- Screening detects; it does not prevent. The exceptions are colonoscopy and cervical screening, which remove pre-cancerous lesions and so do both.
- Identify who is not average risk — family history, known mutation, previous radiation — because they screen earlier and more often.
- Ask what stops someone attending: cost, transport, childcare, fear, or nobody ever explaining it.
👀 How it shows upAssessment — Risk Factors · Assessment — Expected Findings
Assessment — Risk Factors
From this module — built from the notes above on this page, not a section of the ATI chapter.
- Tobacco, alcohol, obesity, inactivity, and diets high in processed meat.
- Sun and tanning bed exposure; occupational carcinogens and asbestos.
- Oncogenic infections: HPV, hepatitis B and C, H. pylori, Epstein-Barr.
- Inherited syndromes: BRCA1/2, Lynch syndrome, familial adenomatous polyposis.
- Previous radiotherapy, chronic inflammation, immunosuppression, and increasing age.
Assessment — Expected Findings
From this module — built from the notes above on this page, not a section of the ATI chapter.
- CAUTION — Change in bowel or bladder habits, A sore that does not heal, Unusual bleeding or discharge, Thickening or lump, Indigestion or difficulty swallowing, Obvious change in a wart or mole, Nagging cough or hoarseness.
- Add unexplained weight loss and unexplained persistent fatigue, which are always significant.
- ABCDE for a mole — Asymmetry, Border, Color, Diameter, and Evolving, which is the most important letter.
- A normal screening result is not a guarantee — new symptoms are reported between screens, not saved for the next one.
🧪 How it is confirmedLaboratory Tests · Diagnostic Procedures
Laboratory Tests
- Labs assess for cancer or its effects (electrolyte imbalance, organ dysfunction).
- CBC: elevated WBCs and blast cells can suggest leukemia is present.
- Elevated liver function tests can signal primary or metastatic liver cancer.
- Tumor marker assays detect elevated proteins like CEA, PSA, alpha-fetoprotein.
- Urine, stool, tissue, blood, or fluid samples are checked for excess proteins/DNA patterns.
Diagnostic Procedures
- Imaging (CT, MRI, PET, ultrasound, x-ray) is a secondary tool used near diagnosis to gauge severity.
- Imaging shows tumor size, borders, and detects metastasis to other organs/structures.
- Dye or contrast (IV pyelogram, barium enema) improves visualization on imaging.
- Imaging is also used to monitor the client during remission.
- Digital imaging is usually more accurate and easy to share across the care team.
🩺 What you doNursing Care · Medications · Therapeutic Procedures
Nursing Care
- Take a full health history and physical exam, including family cancer/genetic history.
- Inspect for skin/color, symmetry, movement, or function changes; auscultate heart, lung, bowel sounds and major arteries.
- Palpate gently for masses; some exams (e.g., digital rectal exam) are provider-only.
- Percuss for dullness over the lungs, bowel, or an enlarged liver, suggesting tumor or inflammation.
- Report unexpected findings to the provider and explain the need for further testing.
- Before biopsy: confirm consent, withhold anticoagulants, and check coagulation studies.
- After biopsy: watch for bleeding (dressing staining, hypotension, tachycardia); keep on bed rest until sedation clears.
- Position post-biopsy per site, e.g., right side after liver biopsy; ensure adequate oxygenation.
- Watch for contrast dye allergy: dyspnea, tachycardia, restlessness.
Medications
From this module — built from the notes above on this page, not a section of the ATI chapter.
- No medication is given for screening itself.
- Bowel preparation before colonoscopy — teach the regimen carefully; a poor prep means a repeat procedure.
- Sedation for colonoscopy and some biopsies; arrange an escort home.
- Contrast media for CT — check renal function and iodine allergy, and hold metformin per policy.
- Chemoprevention in selected high-risk people, such as tamoxifen for high-risk breast cancer.
Therapeutic Procedures
- Biopsy gives a definitive diagnosis: tissue origin, cell type, and surface receptors.
- Biopsy samples can be taken during endoscopy, laparoscopy, or thoracotomy.
- Shave biopsy: a scalpel or razor samples outer skin layers of a raised lesion.
- Needle biopsy (fine/core) aspirates fluid/tissue near the skin surface; bone marrow aspiration diagnoses leukemia/lymphoma.
- Incisional/excisional biopsy cuts out part or all of a tumor.
- Punch biopsy (an excisional type for skin cancer) samples
2-6 mmof subcutaneous fat.
💬 Around the patientClient Education · Interprofessional Care
Client Education
- Perform breast or testicular self-exams at home, if desired.
- Report any general cancer warning sign to the provider promptly.
- Watch for bowel/bladder habit changes or a new shape/texture change in the skin.
- Watch for trouble eating, chewing, swallowing, or appetite loss.
- Watch for non-healing sores/wounds or a persistent cough/hoarseness.
- Watch for unexplained pain, night sweats, fatigue, weight change, or unusual bleeding.
Interprofessional Care
From this module — built from the notes above on this page, not a section of the ATI chapter.
- Provider for the individual screening schedule; oncology once a diagnosis is made.
- Radiology and pathology — the tissue diagnosis is what everything else depends on.
- Genetic counselor for inherited risk, before and after testing.
- Navigator or case manager to hold the sequence of appointments together.
- Social work for cost, transport and time off work, which decide attendance more than knowledge does.
⚠️ What goes wrongComplications
Complications
From this module — built from the notes above on this page, not a section of the ATI chapter.
- False positives — anxiety, further tests, and sometimes unnecessary treatment.
- False negatives — false reassurance and delayed diagnosis.
- Procedural risks: bleeding, perforation at colonoscopy, pneumothorax after lung biopsy.
- Overdiagnosis — finding disease that would never have caused harm.
- Contrast-induced kidney injury and allergic reaction.
📋 Pain Management for Clients Who Have Cancer6 parts
Filled from ATI chapter 93, row by row from that chapter’s own sections — 12 of 12 rows have content.
🧭 What it isAlterations in Health (Diagnosis) · Health Promotion & Disease Prevention
Alterations in Health (Diagnosis)
- Explains cancer pain assessment and management, covering acute versus chronic pain, neuropathic, visceral, and somatic pain types, nonverbal pain indicators, common barriers to control, and the palliative goal of comfort without curing disease.
Health Promotion & Disease Prevention
From this module — built from the notes above on this page, not a section of the ATI chapter.
- Prevent pain rather than chase it — scheduled around-the-clock analgesia with breakthrough doses available.
- Assess at every contact; cancer pain changes as the disease does.
- Correct the fears that cause under-treatment: addiction is rare when opioids treat real pain, and needing more usually means the disease has progressed, not that they are addicted.
- Start a bowel regimen the same day the opioid starts — constipation is certain, not possible.
- Address total pain: physical, emotional, social and spiritual together.
👀 How it shows upAssessment — Risk Factors · Assessment — Expected Findings
Assessment — Risk Factors
From this module — built from the notes above on this page, not a section of the ATI chapter.
- Bone metastases, nerve involvement and visceral organ distension.
- Treatment-related: post-surgical, chemotherapy-induced peripheral neuropathy, mucositis, radiation dermatitis.
- Under-treatment is more likely in older people, those with cognitive impairment, and those who do not share the clinician’s language.
- Previous substance use disorder — a reason for careful planning, never a reason to withhold analgesia.
- Depression and anxiety amplify reported pain and are treatable.
Assessment — Expected Findings
From this module — built from the notes above on this page, not a section of the ATI chapter.
- Bone pain: deep, aching, worse on movement and at night.
- Neuropathic pain: burning, shooting, electric, with numbness or tingling — and it responds poorly to opioids alone.
- Visceral pain: deep, poorly localized, often with nausea.
- Expect breakthrough pain even on a well-controlled background regimen.
- New back pain with leg weakness or bladder change is spinal cord compression — an emergency, not a pain-control problem.
🧪 How it is confirmedLaboratory Tests · Diagnostic Procedures
Laboratory Tests
From this module — built from the notes above on this page, not a section of the ATI chapter.
- No test measures pain — self-report is the measure.
- Renal and hepatic function, because they change opioid clearance and dosing.
- Calcium — hypercalcemia of malignancy causes bone pain, confusion and constipation, and is treatable.
- CBC before NSAIDs where platelets are low.
- Alkaline phosphatase and imaging where bone metastasis is suspected.
Diagnostic Procedures
From this module — built from the notes above on this page, not a section of the ATI chapter.
- Structured assessment: site, quality, severity, timing, what makes it better or worse, and what it stops them doing.
- A consistent numeric or descriptive scale, used the same way each time.
- Reassess after every intervention and record it.
- Imaging — bone scan, MRI — for new or changing pain, which often means new disease.
- Function is the better outcome measure: sleeping, eating, walking, and getting out of the chair.
🩺 What you doNursing Care · Medications · Therapeutic Procedures
Nursing Care
- Tailor nursing care to the specific cancer procedure or treatment involved.
- Include family in cancer pain care and management planning.
- Watch for GI bleeding (bloody stools, coffee-ground emesis) with NSAID use.
- Cap acetaminophen at
4 g/dayshort-term or3 g/daylong-term; avoid it in liver disease. - Manage acute severe pain with scheduled opioids for
24 to 48 hrrather than PRN dosing. - Monitor opioid clients for respiratory depression; keep naloxone available to reverse effects.
- Give stimulant laxatives to prevent opioid-induced constipation.
- Avoid TCAs in clients with seizure disorders or a cardiac history.
- Monitor anticonvulsant clients for electrolyte, liver, and blood count changes, plus rash.
Medications
- Multimodal pain control can combine NSAIDs, opioids, antidepressants, anticonvulsants, steroids, and local anesthetics.
- Non-opioid options, such as acetaminophen, ketorolac, aspirin, ibuprofen, and celecoxib, suit mild-to-moderate pain.
Therapeutic Procedures
From this module — built from the notes above on this page, not a section of the ATI chapter.
- The analgesic ladder, and moving up it promptly rather than exhausting each step.
- Adjuvants: gabapentinoids and certain antidepressants for neuropathic pain, corticosteroids for nerve and bone pain, bisphosphonates for bone metastases.
- Radiotherapy for painful bone metastases; nerve blocks and intrathecal analgesia for refractory pain.
- Non-drug measures alongside: heat, cold, positioning, massage, relaxation, distraction.
- Convert route when swallowing fails — transdermal, subcutaneous or buccal.
💬 Around the patientClient Education · Interprofessional Care
Client Education
- Take NSAIDs with food to prevent GI upset, and never crush enteric-coated forms.
- Avoid driving or hazardous tasks until opioid effects are known, and skip alcohol.
- Rise slowly from lying or sitting to limit orthostatic hypotension from opioids or clonidine.
- Antidepressant or SNRI pain relief can take
2 to 3 weeksto take effect. - Avoid alcohol and driving early in anticonvulsant therapy; report rash or tremors.
- Take corticosteroids with food, and never stop them abruptly.
- Transdermal fentanyl has a slow onset but lasts
48 to 72 hr.
Interprofessional Care
From this module — built from the notes above on this page, not a section of the ATI chapter.
- Palliative care team for complex pain; pain service for interventional options.
- Pharmacist for opioid rotation and equianalgesic conversion, where errors are easy and serious.
- Radiation oncology for painful metastases.
- Psychology, physiotherapy and occupational therapy — function and mood change reported pain.
- Chaplaincy or spiritual care where the distress is not physical.
⚠️ What goes wrongComplications
Complications
From this module — built from the notes above on this page, not a section of the ATI chapter.
- Constipation — universal with opioids, and prevented rather than treated.
- Respiratory depression — rare with careful titration; sedation precedes it, so a rousable client is being watched, not rescued.
- Nausea and sedation, both usually settling within days of a dose change.
- Under-treated pain is itself the commonest complication — it costs sleep, appetite, mobility and mood.
- Opioid-induced neurotoxicity — myoclonus, confusion, hyperalgesia — usually needing an opioid switch.
📝 Notes & key concepts
The lines from this module that carry a number, a dose or an absolute rule — the ones that decide questions. Everything else is on the cards above.
- Prevention tiers: primary = remove the risk (do not smoke, HPV and hep B vaccine); secondary = screening; tertiary = preventing recurrence and complications.
- Biopsy confirms the diagnosis. Imaging and tumor markers support but never replace tissue. Grading = how abnormal the cells look; staging = TNM = how far it has spread.
- External beam radiation: she is NOT radioactive. Priority is skin protection — no rubbing with a towel, no ointments unless infected, avoid midday sun.
- Brachytherapy: she IS radioactive while the source is in. Stay
6 feetaway,30 minmaximum exposure, private room with the door closed. A dislodged seed is picked up with tongs into a lead container, never by hand. Strain urine7–10 days. At home: separate bedrooms and toilets, flush repeatedly. - Chemo: antiemetics before and after. Small frequent nutrient-dense meals; cold or room-temperature food is better tolerated; stop fluids ~
1 hrbefore meals; plastic utensils cut the metallic taste; megestrol for appetite. - Stomatitis: normal saline or bicarb rinses, never alcohol-based mouthwash, topical anesthetic before meals, avoid spicy/acidic/salty, ~
2 Lwater/day. Alopecia starts7–10 daysafter treatment. - Extravasation from a peripheral line: stop the infusion first, notify the provider, give the antidote subQ around the site, attempt to aspirate. Do not remove the catheter and do not flush. Ice is right (it localizes the drug; heat would spread it). A central line is the ideal chemo route.
- HSCT: conditioning leaves her profoundly pancytopenic — strict reverse isolation through engraftment. Watch for GVHD in allogeneic transplants (skin, GI, liver), affecting
30–50%of allogeneic recipients. - Oncologic emergencies — SVC syndrome: facial, neck and upper-body swelling with distended veins, worse lying flat → keep the HOB up. Tumor lysis syndrome: after starting chemo, potassium, phosphorus and uric acid all up, calcium down → arrhythmias and AKI; prevent with aggressive hydration plus allopurinol or rasburicase. Spinal cord compression: new back pain is the first sign — delay means permanent paralysis.
- Palliative care can run alongside curative treatment at any stage. Hospice requires a terminal prognosis (typically
≤6 months) and a shift to comfort-focused goals. - Hospice = terminal, prognosis 6 months or less, curative treatment stopped. Palliative runs alongside curative treatment. Follow the client's stated goal, not the one you would pick. The client, not the family, decides while she is capable.
- Neutropenic fever is the one "give antibiotics without proven infection" exception.
ANC 800 with temp 100.8°Foutranks post-cisplatin vomiting, petechiae and a pain request. Cultures plus IV antibiotics, likely admission. - ANC cutoffs they used: <1,500 neutropenic, <500 severe.
- Neutropenic teaching corrections: no sushi or raw food even from a good restaurant · discard drinks left out over 1 hour · avoid gardening and cat litter · report temp over
100°F.
🎯 Module quiz
Questions for this module. They also feed the Mega Quiz.
Nothing here yet — drop it in when you have it