- Superior vena cava syndrome (SVCS) signs
- Facial/upper-body swelling, distended neck veins, dyspnea — often from a mediastinal/lung tumor.
- Primary prevention
- Actions that reduce cancer risk before disease occurs — e.g., smoking cessation, HPV vaccine, sun protection, healthy diet.
- Secondary prevention
- Early detection of cancer through screening so disease is found at a treatable stage (mammography, colonoscopy, Pap test).
- Tertiary prevention
- Care after a cancer diagnosis to limit complications and disability and improve quality of life (rehab, surveillance).
- Mammography screening
- USPSTF recommends biennial screening mammography for average-risk women ages 40–74.
- Colorectal cancer screening start age
- Average-risk adults begin screening at age 45 (colonoscopy every 10 years or stool-based tests).
- Pap test and HPV
- Cervical cytology (Pap) with HPV co-testing detects precancerous cervical changes; HPV is the main cause of cervical cancer.
- Low-dose CT lung screening
- Annual low-dose CT for adults 50–80 with a 20 pack-year history who currently smoke or quit within 15 years.
- PSA testing
- Prostate-specific antigen is used to screen for prostate cancer; shared decision-making is recommended due to overdiagnosis risk.
- TNM staging system
- T = primary tumor size/extent, N = regional lymph node involvement, M = distant metastasis.
- Tumor grade
- Describes how abnormal cancer cells look vs normal cells; higher grade = poorly differentiated and more aggressive.
- Carcinoma in situ (stage 0)
- Abnormal cells confined to the layer where they began with no invasion through the basement membrane.
- Most common cancer metastasis sites
- Liver, lungs, bone, and brain are the most frequent sites of distant metastasis.
- BRCA1/BRCA2 mutations
- Inherited mutations greatly increasing breast and ovarian cancer risk; guide enhanced screening and risk-reducing surgery.
- Lynch syndrome
- Hereditary nonpolyposis colorectal cancer; mismatch-repair gene mutations raising colorectal, endometrial, and other cancer risk.
- Genetic counseling
- Required before/after hereditary cancer testing to assess risk, ensure informed consent, and interpret results.
- Carcinogen
- An agent (chemical, radiation, virus) that promotes cancer development; e.g., tobacco, asbestos, UV, HPV, hepatitis B/C.
- Tobacco and cancer
- Leading preventable cause of cancer, linked to lung, head/neck, bladder, pancreatic, and many other cancers.
- HPV vaccine
- Prevents infection with high-risk HPV types that cause cervical, anal, oropharyngeal, and other cancers.
- Survivorship care plan
- A document summarizing treatment received plus a follow-up plan for surveillance, late effects, and health maintenance.
- Palliative care
- Care focused on relieving symptoms and improving quality of life; can be given alongside curative treatment at any stage.
- Hospice care
- Comfort-focused care for terminal illness, generally a prognosis of 6 months or less, with no curative treatment.
- Hospice eligibility criterion
- Typically a physician-certified prognosis of 6 months or less if the disease follows its usual course.
- Advance directive
- Legal document stating a patient's care wishes if they cannot speak for themselves (living will, durable power of attorney).
- Durable power of attorney for health care
- Names a surrogate (health care proxy) to make medical decisions when the patient is incapacitated.
- DNR order
- Do-not-resuscitate order directing that CPR not be performed if the heart or breathing stops.
- Clinical trial phase I
- First-in-human study evaluating safety, toxicity, and the maximum tolerated dose in a small group.
- Clinical trial phase II
- Evaluates efficacy and further assesses safety of a treatment for a specific cancer type.
- Clinical trial phase III
- Compares the new treatment to standard therapy in large randomized groups to confirm efficacy.
- Clinical trial phase IV
- Post-marketing surveillance gathering long-term safety and effectiveness data after approval.
- Informed consent for trials
- Voluntary agreement after disclosure of purpose, risks, benefits, alternatives, and the right to withdraw.
- Care coordination/navigation
- Patient navigation removes barriers and coordinates the cancer-care continuum across providers and settings.
- Five-year survival rate
- Percent of patients alive 5 years after diagnosis; a common benchmark, not a cure guarantee.
- Incidence vs prevalence
- Incidence = new cases in a period; prevalence = all existing cases at a point in time.
- Most common cancer in U.S. women
- Breast cancer is the most commonly diagnosed cancer in women; lung cancer causes the most cancer deaths.
- Most common cancer in U.S. men
- Prostate cancer is most commonly diagnosed in men; lung cancer causes the most cancer deaths.
- Tumor markers
- Substances (e.g., CA-125, CEA, PSA, AFP, CA 19-9) used to aid diagnosis, prognosis, and monitor treatment response.
- Sentinel lymph node biopsy
- Sampling the first node(s) draining a tumor to assess regional spread while sparing extensive dissection.
- Tumor of unknown primary
- Metastatic cancer found without an identifiable original site after workup; managed by tissue type and immunohistochemistry.
- End-of-life goals of care
- Conversations clarifying patient values to align treatment with comfort, dignity, and quality of life near death.
- Nursing process in oncology
- Systematic approach: assessment, diagnosis, planning, implementation, and evaluation applied to cancer care.
- Evidence-based practice
- Integrating best research evidence with clinical expertise and patient values to guide care decisions.
- ONS scope and standards
- Oncology Nursing Society defines the professional scope, competencies, and standards of oncology nursing practice.
- USP <800> standard
- Sets handling requirements for hazardous drugs to protect personnel, patients, and the environment.
- Hazardous drug PPE
- Double chemo-rated gloves, gown, eye/face protection, and respirator as indicated when handling cytotoxic agents.
- Closed-system transfer device (CSTD)
- Device that prevents escape of hazardous drug or vapor during preparation and administration.
- Chemotherapy spill kit
- Contains absorbent pads, chemo gloves/gown, goggles, respirator, and waste bags to manage cytotoxic spills.
- Safe handling of excreta
- Body fluids of patients on hazardous drugs are treated as contaminated for 48 hours (longer for some agents).
- ECOG performance status
- 0 = fully active to 4 = completely disabled/bedridden; guides treatment tolerance and eligibility.
- Karnofsky performance status
- Scale from 100 (normal) to 0 (death) rating functional ability and self-care.
- Patient education principles
- Assess readiness/literacy, use plain language and teach-back, and reinforce with written/visual materials.
- Teach-back method
- Having the patient restate information in their own words to confirm understanding.
- Health literacy
- A patient's ability to obtain, understand, and use health information to make decisions.
- Cultural competence
- Delivering care responsive to patients' cultural beliefs, language, and health practices.
- Patient autonomy
- The ethical principle respecting a competent patient's right to make their own treatment decisions.
- Beneficence and nonmaleficence
- Acting in the patient's best interest (beneficence) and avoiding harm (nonmaleficence).
- Justice (ethics)
- Fair, equitable distribution of resources and access to cancer care.
- Veracity and fidelity
- Truth-telling (veracity) and keeping commitments/maintaining trust (fidelity) in the nurse-patient relationship.
- Chemotherapy double-check
- Two qualified practitioners independently verify drug, dose, route, rate, and patient before administration.
- Right verification before chemo
- Confirm right patient, drug, dose, route, time, and informed consent prior to administration.
- Oncology nursing assessment
- Comprehensive evaluation of disease, treatment effects, symptoms, function, nutrition, and psychosocial needs.
- Patient navigation
- Guiding patients through the health system, addressing barriers to timely, coordinated cancer care.
- Documentation in oncology
- Accurate records of drug administration, vital signs, reactions, education, and patient response are legally required.
- Body surface area (BSA) dosing
- Most chemotherapy doses are calculated per m² of BSA using height and weight.
- Vesicant administration competency
- Only specially trained/credentialed nurses should administer vesicant chemotherapy.
- Chemotherapy verification of blood return
- Confirm patency and blood return before and during IV chemo to prevent extravasation.
- Hand hygiene in neutropenia
- Strict hand hygiene is the single most effective measure to prevent infection in immunocompromised patients.
- Quality improvement
- Ongoing process to measure and improve patient outcomes and safety in oncology care.
- Patient-reported outcomes
- Symptom and quality-of-life data reported directly by patients to guide and evaluate care.
- Shared decision-making
- Collaborative process where clinician and patient choose treatment based on evidence and patient values.
- Telehealth in oncology
- Remote monitoring and visits expanding access to oncology care, symptom management, and survivorship follow-up.
- Oral chemotherapy adherence
- Patient self-administration requires education on schedule, storage, handling, and missed-dose management.
- Chemotherapy waste disposal
- Cytotoxic waste is segregated into designated yellow hazardous-drug containers, never regular trash.
- Extravasation documentation
- Record site, drug, volume, symptoms, interventions, photos, and notification per policy.
- Nursing diagnosis example (oncology)
- e.g., Risk for infection related to neutropenia; guides individualized interventions.
- Interdisciplinary team
- Oncology care involves physicians, nurses, pharmacists, dietitians, social workers, and chaplains.
- Standardized chemo order sets
- Pre-built, evidence-based order templates reduce dosing errors and improve safety.
- Verbal chemo orders
- Generally prohibited except in emergencies; chemotherapy orders should be written/electronic and double-checked.
- Patient identifiers
- Use at least two identifiers (name and date of birth) before any treatment administration.
- Confidentiality (HIPAA)
- Protected health information must be safeguarded and disclosed only as legally permitted.
- Advocacy role
- The oncology nurse advocates for patient wishes, informed choice, and access to needed resources.
- Continuing education
- Maintaining oncology competency through certification, ONS resources, and ongoing professional development.
- Reproductive precautions for staff
- Pregnant or breastfeeding staff should minimize/avoid handling hazardous drugs per policy.
- Survivorship clinic role
- Provides surveillance, late-effect management, and health promotion for cancer survivors.
- Sociocultural assessment
- Evaluating language, beliefs, support, and resources to individualize and improve adherence.
- Alkylating agents
- Damage DNA by adding alkyl groups, causing cross-links; cell-cycle nonspecific (e.g., cyclophosphamide, cisplatin).
- Cyclophosphamide toxicity
- Can cause hemorrhagic cystitis; mesna and hydration are used as uroprotection.
- Cisplatin toxicity
- Nephrotoxic and ototoxic; requires aggressive hydration; highly emetogenic.
- Antimetabolites
- Mimic normal metabolites to disrupt DNA/RNA synthesis; cell-cycle (S-phase) specific (e.g., methotrexate, 5-FU).
- Methotrexate rescue
- Leucovorin (folinic acid) rescue limits methotrexate toxicity to normal cells after high-dose therapy.
- Antitumor antibiotics
- Interfere with DNA (e.g., doxorubicin); generally cell-cycle nonspecific.
- Doxorubicin cardiotoxicity
- Anthracycline with cumulative dose-related cardiotoxicity; monitor cardiac (ejection) function.
- Vinca alkaloids
- Inhibit microtubule formation, arresting mitosis (M-phase); e.g., vincristine, vinblastine.
- Vincristine neurotoxicity
- Major dose-limiting toxicity is peripheral neuropathy; vincristine is a potent vesicant.
- Vincristine route warning
- Vincristine is fatal if given intrathecally — it must ONLY be given IV.
- Taxanes
- Stabilize microtubules to block mitosis (M-phase); e.g., paclitaxel, docetaxel; risk of hypersensitivity.
- Paclitaxel premedication
- Corticosteroids, H1 and H2 blockers are given to prevent hypersensitivity reactions.
- Topoisomerase inhibitors
- Block topoisomerase enzymes to prevent DNA repair; e.g., irinotecan, etoposide, topotecan.
- Irinotecan diarrhea
- Causes early (cholinergic, treated with atropine) and late (severe, treated with loperamide) diarrhea.
- Cell-cycle specific drugs
- Act on cells in a particular phase; given by continuous infusion or divided doses (e.g., antimetabolites).
- Cell-cycle nonspecific drugs
- Act on cells in any phase, including resting; effective against large tumors (e.g., alkylators, anthracyclines).
- Vesicant
- A drug that causes severe tissue damage/necrosis if it leaks into surrounding tissue (e.g., anthracyclines, vinca alkaloids).
- Irritant
- A drug that causes inflammation or pain at the site without necrosis if it extravasates.
- Extravasation immediate action
- Stop the infusion, leave the catheter, aspirate residual drug, and follow the drug-specific antidote protocol.
- Dexrazoxane
- Antidote for anthracycline extravasation and a cardioprotectant against anthracycline cardiotoxicity.
- Hyaluronidase
- Antidote for vinca alkaloid extravasation; promotes drug dispersion and absorption.
- Warm vs cold compress
- Cold for most vesicants; warm compress for vinca alkaloids and oxaliplatin extravasation.
- Monoclonal antibodies (-mab)
- Target specific antigens on cancer cells; e.g., rituximab (CD20), trastuzumab (HER2), cetuximab (EGFR).
- Trastuzumab
- HER2-targeted antibody for HER2-positive breast cancer; can cause cardiotoxicity (monitor cardiac function).
- Rituximab
- Anti-CD20 antibody for B-cell lymphomas; risk of infusion reactions, especially with the first dose.
- Tyrosine kinase inhibitors (-nib)
- Oral targeted drugs blocking signaling pathways; e.g., imatinib, erlotinib, sorafenib.
- Imatinib
- TKI targeting BCR-ABL in chronic myeloid leukemia; a landmark targeted therapy.
- Immune checkpoint inhibitors
- Block PD-1, PD-L1, or CTLA-4 to unleash T cells against cancer (e.g., nivolumab, pembrolizumab, ipilimumab).
- Immune-related adverse events (irAEs)
- Autoimmune toxicities from checkpoint inhibitors — colitis, dermatitis, pneumonitis, endocrinopathies; often treated with steroids.
- CAR-T cell therapy
- Patient's T cells are engineered to express a chimeric antigen receptor targeting cancer (e.g., CD19 in leukemia/lymphoma).
- Cytokine release syndrome (CRS)
- Systemic inflammatory response after CAR-T/immunotherapy: fever, hypotension, hypoxia; may need tocilizumab.
- Tocilizumab
- IL-6 receptor blocker used to treat severe cytokine release syndrome.
- Tamoxifen
- Selective estrogen receptor modulator for hormone-receptor-positive breast cancer; increases thromboembolism and uterine cancer risk.
- Aromatase inhibitors
- Block estrogen synthesis in postmenopausal women (anastrozole, letrozole); cause arthralgia and bone loss.
- Hormonal therapy mechanism
- Blocks hormones that drive growth of hormone-sensitive cancers (breast, prostate).
- Androgen deprivation therapy
- Lowers testosterone to treat prostate cancer (e.g., leuprolide); side effects include hot flashes and bone loss.
- External beam radiation therapy
- Delivers radiation from an outside machine to the tumor; the most common radiation form.
- Brachytherapy
- Internal radiation placing a sealed radioactive source in or near the tumor.
- Radiation safety: time, distance, shielding
- Minimize time near the source, maximize distance, and use shielding to reduce exposure.
- Care of brachytherapy patient
- Limit visitor/staff time, keep distance, use a lead shield, and never touch a dislodged source with bare hands.
- Radiation skin reaction (dermatitis)
- Use gentle, fragrance-free care; avoid sun, heat, friction, adhesive tape, and metallic deodorant on the field.
- Radiation skin care marking
- Do not wash off radiation field markings; they guide precise daily treatment.
- Radioactive iodine (I-131) precautions
- Body fluids are radioactive; isolate, increase fluids/voiding, and follow distance precautions per policy.
- Fractionation
- Dividing total radiation dose into smaller daily fractions to spare normal tissue while killing tumor.
- Autologous HSCT
- Stem cells are collected from the patient, then reinfused after high-dose therapy.
- Allogeneic HSCT
- Stem cells come from a matched donor; carries graft-versus-host disease risk but adds graft-versus-tumor effect.
- HLA matching
- Human leukocyte antigen matching between donor and recipient reduces rejection and GVHD risk in allogeneic transplant.
- Engraftment
- Donor/autologous stem cells begin producing blood cells, shown by a rising ANC, typically 2–4 weeks post-transplant.
- Graft-versus-host disease (GVHD)
- Donor immune cells attack recipient tissues — classically skin (rash), gut (diarrhea), and liver (jaundice).
- Graft-versus-tumor effect
- Beneficial donor immune attack on residual cancer cells after allogeneic transplant.
- Surgery in cancer
- Used for diagnosis, staging, cure, debulking, palliation, prevention, and reconstruction.
- Intrathecal chemotherapy
- Drug given into cerebrospinal fluid (via lumbar puncture or Ommaya reservoir) to treat CNS disease.
- Intraperitoneal (IP) chemotherapy
- Drug instilled into the peritoneal cavity, often for ovarian cancer, for high local concentration.
- Implanted port care
- Access with a noncoring (Huber) needle using sterile technique; flush with saline/heparin per protocol.
- Nadir
- The lowest blood-cell count after chemotherapy, usually 7–14 days post-treatment, when infection risk peaks.
- Biotherapy
- Treatment using biologic agents (interferons, interleukins, monoclonal antibodies) to modify the immune response.
- Neoadjuvant therapy
- Treatment given before primary therapy (often surgery) to shrink the tumor.
- Adjuvant therapy
- Treatment after primary therapy to eliminate residual micrometastatic disease and reduce recurrence.
- Acute CINV
- Chemotherapy-induced nausea/vomiting occurring within 24 hours of treatment.
- Delayed CINV
- Nausea/vomiting occurring more than 24 hours after chemotherapy (peaks 2–3 days), common with cisplatin.
- Anticipatory CINV
- Conditioned nausea/vomiting before treatment triggered by prior experiences; managed with anxiolytics and behavioral techniques.
- 5-HT3 receptor antagonists
- Antiemetics like ondansetron, granisetron; first-line for acute CINV (watch QT prolongation, constipation).
- NK1 receptor antagonists
- Aprepitant/fosaprepitant added to prevent delayed CINV from highly emetogenic chemo.
- Dexamethasone for CINV
- Corticosteroid used with 5-HT3 and NK1 antagonists to enhance antiemetic control.
- Highly emetogenic chemo regimen
- Examples include cisplatin and anthracycline/cyclophosphamide; require triple-agent antiemetic prophylaxis.
- Mucositis/stomatitis
- Painful inflammation/ulceration of the oral and GI mucosa from chemo/radiation; impairs intake and risks infection.
- Oral care for mucositis
- Use a soft toothbrush and frequent saline or sodium bicarbonate rinses; avoid alcohol-based and irritating products.
- Mucositis assessment
- Inspect the oral cavity regularly; grade severity and screen for candidiasis or herpes infection.
- Chemo-induced diarrhea
- Manage with loperamide, hydration, and a low-fiber diet; severe cases risk dehydration and electrolyte loss.
- Constipation in oncology
- Common from opioids and vinca alkaloids; prevent with stimulant laxatives plus stool softeners and hydration.
- Opioid-induced constipation
- Anticipate with every opioid order; treat prophylactically with a stimulant laxative (e.g., senna), not fiber alone.
- Cancer-related fatigue
- The most common cancer symptom; manage with exercise, energy conservation, and treating anemia/sleep/mood issues.
- WHO analgesic ladder
- Step 1 nonopioids, step 2 weak opioids, step 3 strong opioids, each plus adjuvants, escalating with pain severity.
- Around-the-clock dosing
- Persistent cancer pain is best controlled with scheduled long-acting analgesics, not as-needed only.
- Breakthrough pain
- Transient flare of pain over baseline; treated with a short-acting opioid (about 10–20% of the 24-hour dose).
- Neuropathic pain
- Burning/tingling nerve pain treated with adjuvants such as gabapentin, pregabalin, or duloxetine.
- Opioid side effects
- Constipation (does not resolve), sedation, nausea, and respiratory depression; constipation needs ongoing prophylaxis.
- Naloxone
- Opioid antagonist that reverses opioid-induced respiratory depression.
- Equianalgesia
- Converting between opioids using equivalent doses; reduce the dose ~25–50% for incomplete cross-tolerance when switching.
- Myelosuppression
- Bone marrow suppression lowering WBCs, RBCs, and platelets — the most common dose-limiting chemo toxicity.
- Neutropenia (ANC)
- Absolute neutrophil count below 1,500; severe neutropenia is ANC < 500 cells/mm³ with high infection risk.
- ANC calculation
- ANC = WBC × (% segs + % bands) ÷ 100, expressed in cells/mm³.
- Neutropenic precautions
- Strict hand hygiene, avoid sick contacts, no fresh flowers/raw produce per policy, and prompt fever reporting.
- Granulocyte colony-stimulating factor
- Filgrastim/pegfilgrastim stimulate neutrophil production to shorten neutropenia; bone pain is a common side effect.
- Chemo-induced anemia
- Manage with iron evaluation, transfusion if symptomatic, and ESAs in select cases; assess fatigue and dyspnea.
- Erythropoiesis-stimulating agents
- Epoetin/darbepoetin raise hemoglobin in chemo-induced anemia; carry thrombosis and tumor-progression cautions.
- Thrombocytopenia
- Low platelets increasing bleeding risk; serious bleeding risk rises as platelets fall below 20,000–50,000/mm³.
- Thrombocytopenia precautions
- Use a soft toothbrush, electric razor, avoid IM injections/NSAIDs/aspirin, and prevent falls; monitor for bleeding.
- Platelet transfusion threshold
- Prophylactic platelets are often given when counts fall below 10,000/mm³ or for active bleeding.
- Chemo-induced peripheral neuropathy
- Numbness, tingling, and weakness from agents like vinca alkaloids, taxanes, and platinums; assess safety/falls.
- Neuropathy safety teaching
- Protect hands/feet from heat and injury, inspect skin daily, and use caution due to impaired sensation.
- Alopecia
- Hair loss is usually temporary; reassure that regrowth typically begins 1–3 months after treatment ends.
- Hand-foot syndrome
- Palmar-plantar erythrodysesthesia from agents like capecitabine; redness, pain, peeling of palms/soles.
- Anorexia and cachexia
- Loss of appetite with muscle/weight wasting; manage with small frequent meals, appetite stimulants, and dietitian referral.
- Lymphedema
- Limb swelling from impaired lymph drainage after node removal/radiation; managed with compression and manual lymph drainage.
- Lymphedema prevention teaching
- Protect the at-risk limb from injury, infection, and constriction (no BP, blood draws, or tight items).
- Sexual dysfunction in cancer
- Common from treatment, hormones, fatigue, and body image; address openly and offer counseling/resources.
- Fertility preservation
- Discuss before gonadotoxic therapy; options include sperm banking, egg/embryo cryopreservation, and ovarian protection.
- Infection prevention in neutropenia
- Hand hygiene, avoiding crowds and live vaccines, oral/skin care, and reporting any fever immediately.
- Nutrition in cancer care
- Maintain protein-calorie intake; manage taste changes, early satiety, and consider enteral support if oral intake fails.
- Dyspnea management
- Treat the cause; use oxygen, positioning, fans, and opioids/anxiolytics for refractory breathlessness.
- Xerostomia
- Dry mouth from radiation/medications; manage with frequent sips, saliva substitutes, and good oral hygiene.
- Dysgeusia
- Altered taste from chemo/radiation; manage with flavor changes, oral care, and zinc as indicated.
- Radiation-induced fatigue
- Cumulative fatigue during/after radiation; manage with rest, exercise, and addressing anemia.
- Hiccups (singultus)
- Persistent hiccups in cancer can be distressing; treated with agents such as chlorpromazine or baclofen.
- Pruritus
- Itching from disease, drugs, or cholestasis; manage with skin moisturizers, antihistamines, and treating the cause.
- Capsaicin/topical analgesics
- Used as adjuvants for localized neuropathic pain in some patients.
- PRN vs scheduled antiemetics
- Prophylactic scheduled antiemetics are preferred for emetogenic chemo; PRN agents cover breakthrough nausea.
- Mucositis pain control
- Topical anesthetics, mucosal coating agents, and systemic analgesics for severe oral pain affecting intake.
- Bowel regimen on opioids
- Start a stimulant laxative when opioids begin and titrate to keep bowels moving.
- Hydration for tumor lysis prevention
- Aggressive IV hydration supports renal clearance and reduces metabolic complications during high-cell-kill therapy.
- Cold cap/scalp cooling
- Reduces chemo blood flow to hair follicles to limit alopecia with some regimens.
- Sleep disturbance
- Common in cancer; address pain, anxiety, steroids, and sleep hygiene; limit late stimulants.
- Hot flashes management
- From endocrine therapy/menopause; options include SSRIs/SNRIs, gabapentin, and lifestyle measures.
- Ascites
- Fluid accumulation in the peritoneal cavity (e.g., ovarian cancer); managed with paracentesis and symptom control.
- Malignant pleural effusion
- Fluid around the lung causing dyspnea; managed with thoracentesis, pleurodesis, or indwelling catheter.
- Pressure injury prevention
- Reposition, manage moisture/nutrition, and protect skin in debilitated cancer patients.
- Wound/fungating tumor care
- Manage odor, exudate, and bleeding with appropriate dressings and metronidazole for odor control.
- Diarrhea electrolyte risk
- Severe diarrhea causes dehydration and loss of potassium/magnesium; replace fluids and electrolytes.
- Antiemetic for anticipatory nausea
- Benzodiazepines (e.g., lorazepam) plus behavioral techniques help anticipatory CINV.
- Granisetron transdermal
- A 5-HT3 patch provides multi-day antiemetic coverage for moderately/highly emetogenic chemo.
- Olanzapine for CINV
- Added to antiemetic regimens to prevent nausea, especially delayed and breakthrough CINV.
- Radiation enteritis
- Bowel inflammation from pelvic/abdominal radiation causing cramping/diarrhea; managed with diet and antidiarrheals.
- Radiation pneumonitis
- Lung inflammation weeks to months after thoracic radiation; cough and dyspnea, treated with corticosteroids.
- Esophagitis from radiation
- Painful swallowing during chest radiation; managed with topical/systemic analgesia and soft diet.
- Cystitis from pelvic radiation
- Bladder irritation causing urgency/dysuria; manage hydration and symptomatic relief.
- Bone-directed therapy
- Bisphosphonates/denosumab reduce skeletal events in bone metastases; monitor for jaw osteonecrosis and hypocalcemia.
- Spiritual/comfort measures
- Integrate non-pharmacologic comfort (relaxation, music, presence) into supportive symptom care.
- Cannabinoids for symptoms
- Dronabinol/nabilone may help refractory nausea and appetite when standard antiemetics fail.
- Acupuncture/integrative therapies
- Evidence supports acupuncture and similar therapies as adjuncts for nausea, pain, and hot flashes.
- Febrile neutropenia definition
- Single oral temp ≥ 38.3°C (101°F) or ≥ 38.0°C for 1 hour with ANC < 500 cells/mm³ — a medical emergency.
- Febrile neutropenia priority action
- Obtain blood/site cultures and start broad-spectrum IV antibiotics within 1 hour — do not delay for results.
- Neutropenic fever and antipyretics
- Report fever immediately; avoid masking it before evaluation, and never give rectal meds/temps in neutropenia.
- Tumor lysis syndrome (TLS)
- Massive tumor cell breakdown releasing intracellular contents, causing metabolic and renal emergency.
- TLS electrolyte pattern
- ↑K⁺, ↑PO₄, ↑uric acid, and ↓Ca²⁺ from rapid cell lysis.
- TLS prevention/treatment
- Aggressive IV hydration plus allopurinol or rasburicase to lower uric acid; monitor electrolytes and renal function.
- Rasburicase
- Recombinant urate oxidase that rapidly lowers uric acid in tumor lysis syndrome.
- TLS highest risk
- Bulky, rapidly proliferating tumors (acute leukemias, high-grade lymphomas) at treatment initiation.
- Superior vena cava syndrome (SVCS)
- Obstruction of the SVC causing facial/upper-extremity edema, distended veins, and dyspnea; often lung cancer/lymphoma.
- SVCS nursing action
- Elevate the head of bed, give oxygen, avoid upper-extremity venipuncture/BP, and prepare for radiation or stenting.
- Spinal cord compression
- Tumor pressing on the cord; back pain (earliest sign), then weakness, sensory loss, and bowel/bladder dysfunction.
- Spinal cord compression priority
- Recognize early back pain, give corticosteroids (dexamethasone), and arrange urgent imaging/radiation or surgery.
- Hypercalcemia of malignancy
- Most common metabolic emergency in cancer; from bone metastases or PTH-related protein.
- Hypercalcemia symptoms
- Fatigue, confusion, constipation, polyuria, nausea — 'stones, bones, groans, and psychiatric overtones.'
- Hypercalcemia treatment
- Aggressive IV normal saline hydration plus bisphosphonates (and calcitonin); monitor cardiac and neuro status.
- SIADH
- Syndrome of inappropriate ADH causing water retention, dilutional hyponatremia, and low serum osmolality (e.g., small cell lung cancer).
- SIADH treatment
- Fluid restriction; hypertonic saline for severe symptomatic hyponatremia; correct sodium slowly to avoid CPM.
- DIC
- Disseminated intravascular coagulation: widespread clotting consumes factors, then causes bleeding (e.g., APL, sepsis).
- DIC lab findings
- Low platelets and fibrinogen, prolonged PT/PTT, and elevated D-dimer; treat the underlying cause and support.
- Sepsis in cancer
- Life-threatening response to infection; recognize fever, tachycardia, hypotension, and altered mentation early.
- Sepsis bundle priority
- Cultures, broad-spectrum antibiotics within 1 hour, IV fluid resuscitation, and lactate measurement.
- Cardiac tamponade
- Fluid in the pericardial sac compressing the heart; from malignant effusion.
- Cardiac tamponade signs (Beck's triad)
- Hypotension, muffled heart sounds, and jugular venous distension; pulsus paradoxus may be present.
- Cardiac tamponade treatment
- Emergency pericardiocentesis to relieve pressure; monitor hemodynamics closely.
- Increased intracranial pressure
- From brain metastases/edema; headache, vomiting, altered consciousness, and pupillary changes.
- Increased ICP management
- Corticosteroids (dexamethasone) for edema, head elevation, and seizure precautions; avoid maneuvers that raise ICP.
- Cushing's triad
- Late sign of dangerously high ICP: hypertension (widened pulse pressure), bradycardia, and irregular respirations.
- Malignant bowel obstruction
- Tumor blocking the GI tract; nausea, vomiting, distension, pain; managed with decompression and symptom control.
- Hemorrhage in cancer
- Bleeding from tumor erosion, thrombocytopenia, or DIC; apply pressure, support volume, and replace blood products.
- Hypersensitivity/anaphylaxis
- Rapid allergic reaction to chemo/biologics: flushing, dyspnea, hypotension, urticaria — stop the drug immediately.
- Anaphylaxis priority action
- Stop the infusion, maintain the airway, give epinephrine, oxygen, IV fluids, and antihistamines/steroids.
- Highest-risk hypersensitivity agents
- Platinums (carboplatin/oxaliplatin), taxanes, asparaginase, and monoclonal antibodies are frequent culprits.
- Extravasation as an emergency
- Vesicant leakage requires immediate stop, aspiration, antidote, and documentation to prevent tissue necrosis.
- Typhlitis (neutropenic enterocolitis)
- Life-threatening cecal inflammation in neutropenic patients: fever, RLQ pain, diarrhea; managed with antibiotics and bowel rest.
- Pulmonary embolism
- Cancer is hypercoagulable; sudden dyspnea, chest pain, tachycardia — give oxygen and anticoagulation.
- Acute promyelocytic leukemia and DIC
- APL is strongly associated with DIC at diagnosis; treated with ATRA and aggressive blood-product support.
- Hyperleukocytosis/leukostasis
- Very high blast counts cause sludging in vessels (dyspnea, neuro changes); managed urgently with leukapheresis/cytoreduction.
- Seizure precautions
- Pad rails, suction at bedside, and protect the patient in those with brain metastases or metabolic derangements.
- Pericardial effusion symptoms
- Dyspnea, chest fullness, and tachycardia; can progress to tamponade — monitor closely.
- Infusion reaction vs anaphylaxis
- Mild infusion reactions may allow rate adjustment/premedication; true anaphylaxis requires stopping and emergency care.
- Bowel perforation
- Surgical emergency presenting with sudden severe abdominal pain, rigidity, and signs of peritonitis/sepsis.
- Airway obstruction (tumor)
- Head/neck or mediastinal tumors can obstruct the airway — stridor and dyspnea require emergent management.
- Hypovolemic shock from bleeding
- Tachycardia, hypotension, and pallor; restore volume with fluids/blood and control the bleeding source.
- Calcium correction for albumin
- Low albumin lowers total calcium; assess ionized calcium when interpreting levels in cancer patients.
- Electrolyte monitoring in emergencies
- Frequent monitoring of K⁺, Ca²⁺, PO₄, and renal function is essential during high cell-kill therapy.
- Methotrexate toxicity rescue (emergency)
- Severe high-dose methotrexate toxicity is treated with leucovorin and, if needed, glucarpidase.
- Coping and adjustment
- Patients use varied strategies to manage the cancer experience; assess and support adaptive coping.
- Anxiety in cancer
- Common with diagnosis, treatment, and surveillance; screen routinely and offer counseling and anxiolytics as needed.
- Depression in cancer
- Underrecognized and treatable; screen for persistent low mood, hopelessness, and suicidal ideation.
- Distress screening
- Routine screening (e.g., a distress thermometer) identifies psychosocial needs across the cancer continuum.
- Body image changes
- Surgery, alopecia, and weight changes affect self-image; provide support, prostheses, and counseling resources.
- Grief and bereavement
- Normal response to loss; support anticipatory grief and provide bereavement resources to families.
- Anticipatory grief
- Grieving that begins before an expected loss; allow expression and provide support.
- Complicated grief
- Prolonged, intense grief impairing function; refer for specialized mental-health support.
- Spiritual care
- Address meaning, hope, and faith needs; involve chaplaincy and respect diverse beliefs.
- Family and caregiver support
- Caregivers face burden and burnout; assess needs and connect them to respite and support resources.
- SPIKES protocol
- Framework for breaking bad news: Setting, Perception, Invitation, Knowledge, Empathy, Strategy/Summary.
- Therapeutic communication
- Active listening, open-ended questions, silence, and empathy to support patient expression.
- Financial toxicity
- Economic burden of cancer care harming well-being and adherence; refer to social work and assistance programs.
- Sexuality and intimacy
- Cancer and treatment affect sexual health; initiate open, nonjudgmental discussion and offer resources.
- Survivorship psychosocial needs
- Fear of recurrence, identity changes, and reintegration challenges require ongoing support.
- Fear of recurrence
- A common, persistent survivor concern; validate feelings and provide coping strategies and follow-up plans.
- Cultural beliefs and care
- Respect cultural views on illness, disclosure, decision-making, and death to deliver patient-centered care.
- End-of-life cultural/spiritual beliefs
- Honor diverse rituals and preferences around dying, the body, and mourning.
- Support resources
- Connect patients to support groups, peer mentoring, counseling, and community organizations.
- Hope and meaning
- Foster realistic hope and help patients find meaning; this supports coping and quality of life.
- Caregiver education
- Teach caregivers symptom monitoring, medication management, and when to seek help.
- Denial as coping
- Mild denial may be protective early on; assess whether it interferes with necessary care decisions.
- Suicide risk assessment
- Screen distressed patients directly; ensure safety and refer urgently when ideation is present.
- Delirium vs depression
- Differentiate acute fluctuating confusion (delirium) from sustained low mood (depression) for correct treatment.
- Quality of life
- A central oncology outcome encompassing physical, psychological, social, and spiritual well-being.
- Cultural humility
- Ongoing self-reflection and respect for patients' cultural identities, not assuming expertise about any group.
- Family meetings
- Structured discussions to share information, clarify goals of care, and support shared decisions.
- Palliative psychosocial support
- Integrate emotional, social, and spiritual care alongside symptom management throughout illness.
- Children and cancer in the family
- Provide age-appropriate communication and support for children of patients facing serious illness.
