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Krystan: Semester Two Nursing School > 2800 Exam Three > Flashcards

2800 Exam Three Flashcards

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1
Q

GERD

A

Gastroesophageal reflux disease

Mucosal damage caused by reflux of acid into the esophagus

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2
Q

What are some things that affect lower esophageal sphincter pressure?

A

Meds like bethanechol and metoclopramide

Things like alcohol, chocolate, fatty foods, nicotine, and tea

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3
Q

What are clinical manifestations of GERD?

A 
Heartburn 
Dysphasia
Dyspepsia 
Regurgitation 
Respiratory symptoms
Hoarse voice
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4
Q

What are complications associated with GERD?

A 
Chronic cough
Worsening asthma
Sleep disruption
Esophageal strictures
Respiratory complaints
Esophagitis
Barrett’s esophagus
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5
Q

Esophagitis

A

Inflammation of the esophagus that causes ulceration and scar tissue formation

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6
Q

Barrett’s esophagus

A

Metaplasia of esophageal cells. A precancerous condition that increases risk for esophageal cancer

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7
Q

What are some lifestyle changes that can help with GERD?

A

Avoid factors that trigger symptoms
Weight loss
Stress management
Smoking cessation

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8
Q

What are some nutrition suggestions for patients with GERD?

A

Avoid foods that irritate esophagus (like fat, chocolate, citrus fruits, caffeine, etc)
Avoid foods that decrease LES pressure
Avoid eating late evening meals
Have small frequent meals

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9
Q

How long should patients with GERD stay upright after eating?

A

2-3 hours

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10
Q

How should patients with GERD try sleeping?

A

With head elevated (possibly putting blocks under mattress to prop up head)

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11
Q

Clothing recommendation for GERD patients?

A

Avoid tight clothes and belts

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12
Q

PUD

A

Peptic ulcer disease

Open sores in stomach or intestines caused by the erosion of GI mucosa due to the action of pepsin and hydrochloric acid

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13
Q

What is a chronic ulcer?

A

An ulcer that has been there for a long time and eroded through muscular wall with the formation of fibrous tissue

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14
Q

What usually causes a chronic ulcer?

A

H. Pylori or chronic NSAID use

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15
Q

What are clinical manifestations of PUD?

A 
Burning epigastric pain 1-2 hours after meals
Aggravated by food
Cramplike pain
Bloating
Belching
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16
Q

What are some complications associated with PUD?

A

Hemorrhage from ulcers
Perforation of an ulcer
Gastric outlet obstruction caused by fibrous tissue

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17
Q

What can gastric outlet obstruction with PUD cause?

A

Edema
Inflammation
Pylorospasm
Scar tissue formation

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18
Q

What are therapies and recommendations for those with PUD?

A 
Rest
Smoking cessation 
Diet modification 
Drug treatment 
Stress management
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19
Q

What are health promotion interventions for PUD?

A 
Early detection
Effective treatment
Having patients take NSAIDs with food
Rest
Stress reduction
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20
Q

What would be considered an emergency situation with PUD?

A

Throwing up blood or any other sign of GI bleeding

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21
Q

What is a potential surgery for those with PUD?

A

Partial gastrectomy (removing part of the stomach)

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22
Q

What complication can a partial gastrectomy commonly cause?

A

Dumping syndrome

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23
Q

Explain dumping syndrome

A

Stomach loses control of the gastric chyme entering the stomach, allowing the hypertonic fluid to enter the intestine. This draws lots of water into the bowel, and everything moves through the GI tract very rapidly

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24
Q

What are symptoms of dumping syndrome?

A 
Weakness
Dizziness
Sweating
Palpitations 
Cramps
Excessive abdominal sounds 
Urge to defecate
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25
Q

What can reduce the chance of dumping syndrome?

A 
Rest after meals
Have smaller, more frequent meals
Drink fluids before meals
Avoid concentrated sweets 
Increase protein and fat intake
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26
Q

Constipation

A

Difficult, infrequent, hard to pass stools or feeling of incomplete evacuation

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27
Q

What are manifestations of constipation?

A

Hard, dry, absent, or difficult to pass stools
Bloating
Abdominal distension
Increased flatulence and rectal pressure
Hemorrhoids

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28
Q

What often causes constipation in children?

A 
Fear
Stress
Environmental changes
Normal development 
Deliberately holding it, especially when potty training
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29
Q

What is encopresis?

A

When a child resists having a bowel movement

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30
Q

What can encopresis cause?

A

Impaction or fecal incontinence

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31
Q

What are valsalva maneuvers?

A

Straining to evacuate

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32
Q

Why are valsalva maneuvers serious?

A

They can lead to hemorrhoids
It can also decrease venous return to the heart due to increasing abdominal pressure. When pressure releases, the increased return to the heart is hard on the heart and can cause lightheadedness, syncope, or even death

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33
Q

What are some important teachings related to constipation?

A 
Fiber and fluid intake 
Regular exercise 
Keep a log of BMs
Regular time to defecate 
Avoid laxatives 
Don’t delay defecating if you need to go
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34
Q

What is inflammatory bowel disease?

A

Chronic inflammation of the GI tract with periods of exacerbation and remission

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35
Q

Ulcerative colitis

A

IBD that’s limited to the colon, usually in the mucosal layer

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36
Q

Who are some at risk populations to develop ulcerative colitis?

A

Adolescents
Those living in developed/industrialized countries
Those with family history of it

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37
Q

Crohn’s disease

A

IBD that can involve any segment of the GI tract from the mouth to the anus

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38
Q

What abnormal GI developments are common with Crohn’s disease?

A

Strictures and fistulas

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39
Q

Clinical manifestations of IBD

A 
Diarrhea
Weight loss
Abdominal pain
Fever
Fatigue
Rectal bleeding
Anemia
Dehydration 
Blood in stool 
Skin breakdown around perineum
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40
Q

What are some GI complications of IBD?

A 
Hemorrhage
Perforation
Abscesses 
Fistulas
Toxic megacolon
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41
Q

What are some systemic complications of IBD?

A

Anemia
Nutritional deficiencies
Colorectal cancer risk

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42
Q

What are potential surgical options for IBD?

A

Resection of diseased area with reanastamosis of remaining intestine
Strictureplasty to open narrow areas
Proctocolectomy with creation of an ostomy bag

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43
Q

What are some nutrition considerations for patients with IBD?

A

High calorie/vitamin/protein
Low residue and lactose
Iron and vitamin D supplementation
Elemental or parenteral nutrition may be needed

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44
Q

What nursing interventions will be priority for patients with IBD?

A 
Fluid and electrolyte balance 
Nutrition assessment
Energy conservation
Anemia correction
Diarrhea control and skin care 
Stress management
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45
Q

What does the acronym DRIP tell us about?

A

Causes of incontinence

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46
Q

DRIP acronym

A

D: delirium, dehydration, depression
R: restricted mobility, rectal impaction
I: infection, inflammation, impaction
P: polyuria, polypharmacy

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47
Q

Best intervention for stress incontinence

A

Pelvic strengthening exercises

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48
Q

Best intervention for urge incontinence

A

Bladder retraining

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49
Q

Best intervention for overflow incontinence

A

Catheterization

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50
Q

Best intervention for reflex incontinence

A

Self-catheterization

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51
Q

What is reflex incontinence?

A

No warning before incontinent episode occurs

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52
Q

Best intervention for functional incontinence?

A

Getting to the patient quickly and frequent toileting

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53
Q

What kind of incontinence do men usually have?

A

Overflow incontinence due to BPH

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54
Q

What kind of incontinence do women usually have?

A

Stress and urge incontinence due to childbirth and weak pelvic floor muscles

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55
Q

What are some complications of incontinence?

A

UTI’s
Insomnia
Social isolation
Skin breakdown

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56
Q

What are some lifestyle modifications that can help with incontinence?

A 
Smoking cessation
Weight reduction
Reduction of bladder irritants
Alcohol avoidance
Good bladder schedule
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57
Q

What are some common bladder irritants?

A

Caffeine
Aspartame
Citrus

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58
Q

What is timed voiding?

A

Toileting on a fixed schedule (usually every 2-3 hours)

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59
Q

Should patients struggling with incontinence reduce their fluid intake?

A

No, because that increases UTI risk

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60
Q

What are some examples of pelvic floor muscle rehabilitation?

A

Kegel exercises
Vaginal weight training
Biofeedback
Electrical stimulation

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61
Q

When can one expect to see changes with pelvic floor muscle exercises?

A

Within 4-6 weeks

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62
Q

What are kegel exercises?

A

Tightening and relaxing pelvic floor muscles to build strength. Usually done 40-50 times per day

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63
Q

What are containment devices?

A

Catheters (or condom catheters or female urethral inserts)

Absorbent pads

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64
Q

What is BPH?

A

Increased size of prostate gland due to increased cell proliferation. Leads to urinary retention

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65
Q

What are the irritative symptoms of BPH?

A

Inflammation, infection, nocturia, frequency and urgency, dysuria, bladder pain, incontinence

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66
Q

What are obstructive symptoms of BPH?

A

Decreased caliber and force of urine stream, intermittent urine, dribbling urine

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67
Q

What are potential complications of BPH?

A

Acute urinary retention
UTI
Hydronephrosis

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68
Q

What does Inter professional care for BPH look like?

A

Drug treatment

Minimally invasive or surgical therapy

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69
Q

What is a TURP?

A

Transurethral resection of the prostate, which is a minimally invasive procedure and the current most effective intervention for BPH

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70
Q

What is the most common cause of decreased output during post-op continuous bladder irrigation?

A

Blood clots

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71
Q

When should men get PSA screenings?

A

Every two years after age 55

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72
Q

What are some health promotion considerations relating to BPH?

A

PSA screenings
Avoiding caffeine and bladder irritants if they’re an issue
Urinating every 2-3 hours
Adequate fluid intake

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73
Q

What are post-operative care considerations when clients have surgery for BPH?

A

Catheter care

Bladder irrigation

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74
Q

What complications can occur after BPH surgery?

A

Hemorrhage
Bladder spasms
Urinary incontinence
Infections

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75
Q

What is continuous bladder irrigation?

A

Continuous flushing of the bladder with saline to remove clotted blood and ensure drainage

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76
Q

What should the nurse do if outflow is less than inflow with CBI?

A

Assess patency of tube

If blocked, stop the infusion and call the doctor

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77
Q

What causes bladder spasms?

A

Irritation of the bladder mucosa from the surgical process

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78
Q

What can relieve pain from bladder spasms and decrease the spasms?

A

Not urinating around the catheter
Using antispasmodics
Relaxation techniques

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79
Q

What are some potential changes in sexual function after prostate surgery?

A

ED
Retrograde ejaculation
Anxiety

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80
Q

How long may it take for complete sexual function to return after prostate surgery?

A

Up to one year

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81
Q

How long may it take for the bladder to return to normal capacity after prostate surgery?

A

Up to 2 months

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82
Q

What interventions can help patients regain continence after prostate surgery?

A

Drink 2-3 liters of fluid daily
Urinate every 2-3 hours
Avoid bladder irritants

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83
Q

What are some teaching points when sending a patient home after prostate surgery?

A

Catheter care
Incontinence management
Maintain fluid intake (2-3 liters/day)
Observe for signs and symptoms of infection
Prevent constipation
Avoid lifting/driving/sexual intercourse for specified amount of time

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84
Q

What is cirrhosis?

A

A chronic progressive disease of the liver. Cirrhosis is end stage liver disease, where there is extensive degeneration/destruction of liver cells

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85
Q

What are the most common causes of cirrhosis?

A

Chronic hepatitis C and alcohol-induced liver disease

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86
Q

What is cardiac cirrhosis?

A

Hepatic derangement due to long term right sided heart failure

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87
Q

What are early assessment findings with cirrhosis?

A

Fatigue

Enlarged liver

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88
Q

What are some dermatologic manifestations of cirrhosis?

A

Jaundice

Spider angiomas

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89
Q

Why does jaundice happen in liver failure?

A

Buildup of bilirubin due to decreased ability to conjugate and excrete bilirubin into the small intestine

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90
Q

What are spider angiomas?

A

Small, dilated blood vessels with a bright red center and spider-like branches. Often happen on face and neck

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91
Q

What are hematologic problems common in cirrhosis?

A

Thrombocytopenia
Leukopenia
Anemia
Coagulation issues

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92
Q

Why is anemia an issue in cirrhosis?

A

Inadequate RBC production
Poor diet/malnutrition
Poor folic acid absorption
Bleeding from varices

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93
Q

Why are there coagulation issues with cirrhosis?

A

Liver is unable to produce prothrombin and other clotting factors

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94
Q

What is a normal PT level/time?

A

11-13.5 seconds

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95
Q

How is PT changed with cirrhosis?

A

Increased/longer PT

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96
Q

What are common manifestations of coagulation problems with cirrhosis?

A 
Epistaxis
Púrpura 
Petechiae 
Easy bruising
Gingival bleeding
Heavy menstrual bleeding
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97
Q

What is portal hypertension?

A

Increased venous pressure in portal circulation due to blood flow obstruction

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98
Q

What can portal hypertension cause?

A

Splenomegaly
Esophageal varices
Ascites

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99
Q

What are esophageal varices?

A

Complex of enlarged veins at the lower part of the esophagus that are very fragile and can rupture easily

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100
Q

What is the most life-threatening complication of liver failure?

A

Bleeding from varices

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101
Q

Why is peripheral edema an issue in cirrhosis?

A

Decreased oncotic pressure from impaired albumin synthesis and increased pressure from portal hypertension

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102
Q

What is ascites?

A

Accumulation of serous fluid in peritoneal or abdominal cavity due to portal hypertension and hypoalbuminemia

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103
Q

What is encephalopathy?

A

Neuropsychotic manifestation of cirrhosis due to increased ammonia and inflammation. Causes confusion and other mental changes

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104
Q

What is asterixis?

A

Flapping tremors unique to cirrhosis. Patient cannot hold out arms and hands without hand flapping up and down

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105
Q

What are nutritional recommendations for ascites?

A 
Low sodium
Low fat 
High carb
Possible protein restriction 
Folic acid supplements
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106
Q

Why might protein restriction be needed after ascites flare ups?

A

Protein can cause increased ammonia buildup

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107
Q

What medications could help with ascites?

A

Diuretics

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108
Q

What surgical procedure is often used for ascites?

A

Parecentesis

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109
Q

What is the goal of management of hepatic encephalopathy?

A

Reduction of ammonia formation (lactulose)

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110
Q

What can be done to prevent cirrhosis?

A

Abstaining from alcohol

Adequate nutrition for at risk individuals

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111
Q

What can help cirrhosis patients manage anorexia/nausea/vomiting?

A

Oral hygiene

Having snacks and favorite foods available for when the patient is hungry

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112
Q

What can be done to help cirrhosis patients with pruritis?

A 
Baking soda
Bath oils
Calamine lotion 
Antihistamines
Short nails to prevent scratching injury
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113
Q

What might stool and urine look like for cirrhosis patients?

A

Dark brown urine

Gray/tan stool

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114
Q

What position would help with dyspnea due to ascites?

A

Semi-Fowler’s or Fowler’s

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115
Q

What are some interventions to help with skin care for cirrhosis patients?

A

Alternating air pressure mattress
ROM
Elevating lower extremities
Frequent moving and repositioning

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116
Q

What do we teach cirrhosis patients about activity and rest?

A

Strength conservation and adequate rest are crucial

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117
Q

What are assessment findings of type one diabetes?

A 
Polyuria 
Polyphagia 
Polydipsia 
Weakness
Fatigue
DKA
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118
Q

What are assessment findings for type two diabetes?

A 
Slow healing
Fatigue
Recurrent infections 
Visual changes
3Ps
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119
Q

What are collaborative interventions for diabetic clients?

A 
Eye exam 
Dental exam
Neuro exam
Podiatry 
Kidney function monitoring
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120
Q

What are recommendations for carbs for diabetics?

A

Monitor carbs by carb counting or exchange lists

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121
Q

What all counts as carbs for the diabetic patients?

A 
Fruits
Veggies
Grains
Legumes
Low fat milk
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122
Q

What are recommendations for fat intake for diabetic patients?

A

Minimize trans fats and saturated fats
Limit cholesterol to less than 200 mg/day
2 or more servings of fish per week

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123
Q

What are protein recommendations for diabetic patients?

A

Usually individualized to the patient, but high protein for weight loss is usually not recommended

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124
Q

What are recommendations for alcohol intake for diabetic patients?

A

Limited to moderate intake: max one per day for women or two per day for men
Drink with food

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125
Q

What can drinking alcohol on an empty stomach cause in a diabetic and why?

A

Hypoglycemia, because the liver is busy processing the alcohol and cant do glycogenesis

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126
Q

How do diabetic exchange lists work?

A

Patient gets to choose specific number of helpings of food items per meal or snack

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127
Q

What are teaching points related to exercise for diabetic patients?

A

Doesn’t have to be strenuous to be effective
Exercise after eating
Wear good footwear
Warm up and cool down properly
Monitor blood glucose before, during, and after exercise

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128
Q

What are chronic complications associated with diabetes?

A 
Stroke
Hypertension 
Dermopathy
CAD
Nephropathy
Atherosclerosis
Gastroparesis 
Neuropathy
Infection
Gangrene 
Neurogenic bladder 
Erectile dysfunction
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129
Q

What can prevent diabetic retinopathy?

A

Annual eye exam

Blood sugar and hypertension control

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130
Q

What can be done to prevent nephropathy in diabetes?

A

Annual screening and aggressive control of BP and blood glucose

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131
Q

Sensory neuropathy

A

Affects PNS (hands/feet bilaterally) causing numbness, tingling, and pain

132
Q

Autonomic neuropathy

A

Can affect all body systems, causing things like diarrhea, incontinence, urinary retention, and postural hypotension

133
Q

What are important teachings related to diabetic foot care?

A 
Wash daily with soap and warm water
Pat dry
Examine daily for breaks in skin or injuries 
Prevent cracking
Avoid open toed shoes 
Don’t go barefoot
Don’t cut off circulation
134
Q

What can be done to minimize complications of infection in diabetics?

A

Prompt and vigorous treatment
Hand hygiene
Avoiding sick people
Annual vaccines

135
Q

What should diabetics know about medical identification and travel?

A

Wear a medical alert band
Plan ahead for travel
Get up and take a walk every couple hours if sitting for a long time
Bring all labels for meds and medical equipment

136
Q

What are gerontologic considerations for clients with diabetes?

A

Over 25% of those over 65 have it with higher rates of death and complications
More likely to be unaware of hypoglycemia
Many more comorbidities in these patients

137
Q

What is hyperthyroidism?

A

Hyperactivity of thyroid (increased TH synthesis and release)

138
Q

What is Graves’ disease?

A

Autoimmune disease characterized by thyroid enlargement and excess TH secretion

139
Q

In whom and when does Graves’ disease most often develop?

A

Women between the age of 20 and 40

140
Q

What are clinical manifestations of hyperthyroidism?

A 
Goiter
Increased HR
Hypertension
Increased appetite
Weight loss
Thin nails
Hair loss
Dyspnea/increased RR
Nervousness
Restlessness
Diarrhea
Heat intolerance
141
Q

What is exophthalmos?

A

Bilateral protrusion of eyeballs from their orbits that is often present in hyperthyroidism

142
Q

What can be complications of exophthalmos?

A

Double vision
Corneal ulcers
Vision loss

143
Q

What is a goiter and when is it seen?

A

Enlarged thyroid gland seen in hyper/hypothyroidism

144
Q

What is a crisis complication of hyperthyroidism? How does it present?

A 
Acute thyrotoxicosis (thyroid storm) 
S/S: tachycardia, HF, agitation, delirium, seizures, increased BP, bounding pulse, nervousness, tremors, attention issues
145
Q

What are potential therapies for hyperthyroidism?

A

Radioactive iodine
Surgical treatment
Drugs (beta blockers, anti thyroid drugs)

146
Q

What are nutrition recommendations for hyperthyroidism?

A 
High calorie (often 4000-5000 calories/day)
High protein
Frequent meals
Increase carbs
Avoid high fiber and spicy foods (increased diarrhea risk)
Drink a lot of fluids
Avoid caffeine 
Adequate iodine intake
147
Q

What is hypothyroidism?

A

Deficiency of thyroid hormone that causes metabolic slowing

148
Q

What are manifestations of hypothyroidism?

A 
Fatigue
Lethargy
Impaired memory
Slowed speech
Weight gain
Decreased cardiac output 
Dry skin
Constipation
Low activity tolerance
149
Q

Why is myxedema?

A

Serious adult hypothyroidism that alters physical appearance, causing puffiness, edema, and a mask-like effect

150
Q

What are collaborative cares for patients with hypothyroidism?

A

TH replacement (lifetime therapy)
Monitor TH levels
Nutritional therapy
Teaching

151
Q

What should ambulatory clients with hypothyroidism know to report to their provider?

A

Signs of overdose on TH (will look like hyperthyroidism)

152
Q

When should thyroid replacement drugs be taken?

A

In the morning before food

153
Q

What else should hypothyroidism patients be taught?

A

Take measures to prevent skin breakdown
Avoid sedatives
Take measures to minimize constipation
Avoid enemas

154
Q

What is cancer?

A

Group of diseases characterized by uncontrolled and unregulated cell growth

155
Q

What are the most common types of cancer for men?

A

Prostate
Lung
Colon

156
Q

Most common types of cancer for women?

A

Breast
Lung
Colon

157
Q

What are the priorities of the nursing role as relates to cancer?

A

Screen for cancer
Help individuals decrease cancer risk
Help patients comply with cancer treatment
Help patients and families cope with diagnosis

158
Q

What are carcinogens?

A

Cancer causing agents like chemicals, radiation, or viruses that are capable of producing cell alterations

159
Q

What is metastasis?

A

Rapid growth of a primary cancer tumor leading to cancer spread to other sites in the body

160
Q

What is the difference between benign and malignant neoplasms?

A

Benign: well-differentiated tumor
Malignant: less differentiated, more likely to metastasize

161
Q

Why is tumor classification important?

A 
To facilitate standardized communication 
To assist in determining treatment
To help with treatment evaluation 
Prognosis prediction
Comparison between similar cancers
162
Q

What is staging (of cancers) and why is it important?

A

Classifying cancer by extent of the disease

163
Q

What is a biopsy?

A

A pathology evaluation of part of a tumor to see whether it is benign or malignant and to begin to plan treatment options

164
Q

What are the three treatment goal options for patients with cancer?

A

Cure
Control
Palliation

165
Q

What does “late effects” mean when it comes to cancer?

A

Effects that can occur as a side effect of cancer treatment even years after treatment has ended

166
Q

What are some examples of late effects?

A 
Strictures
Fistulas
Radiation necrosis
Cardiac toxicity
Cataracts
Renal insufficiency 
Hepatitis
Osteoporosis 
Skin cancer 
Neurocognitive dysfunction
167
Q

What is the primary cause for all lung cancers?

A

Smoking

168
Q

What are other common causes of lung cancer?

A

Pollution
Radiation
Asbestos

169
Q

How will lung cancer often present itself?

A

It will appear as a chronic pneumonia that is not responsive to treatment

170
Q

What are some other presenting manifestations of lung cancer?

A 
Often nonspecific symptoms
Persistent cough
Dyspnea
Wheezing
Chest pain
171
Q

What can be unique about the chest pain associated with lung cancer?

A

It is often localized or on only one side of the body

172
Q

What causes the later manifestations of lung cancer?

A

Metastasis of cancer

173
Q

What are some later manifestations of lung cancer?

A 
Anorexia 
Fatigue
Weight loss
N/V
Hoarseness
Dysphagia 
Palpable lymph nodes
Oxygenation issues
174
Q

What test is needed for definitive diagnosis of lung cancer? How is it obtained?

A

Biopsy of cancerous area, obtained by bronchoscopy

175
Q

What are screening recommendations for lung cancer?

A

Annual screening in those between 55 and 80 with a smoking history

176
Q

What does a 30 pack year history of smoking mean?

A

One pack a day for 30 years

177
Q

How long can it take for lung cancers to grow enough to become visible on x-ray?

A

8-10 years

178
Q

What are nursing interventions to help prevent lung cancer?

A

Smoking prevention or cessation

Modeling healthy behaviors

179
Q

What are some treatments for lung cancer?

A 
Surgical removal of tumor
Radiation
Chemo (for non-resectable tumors)
Targeted therapy
Immunotherapy
180
Q

What symptoms should lung cancer patients report to their provider?

A 
Hemoptysis 
Dysphagia 
Chest pain
Hoarseness
Severe pain
181
Q

What are lymphomas?

A

Malignant neoplasms in bone marrow and/or lymphatic structures that causes disruption of proliferation of WBCs

182
Q

What is Hodgkin’s lymphoma?

A

Proliferation of abnormal giant lymphocytes with multiple nuclei located in the lymph nodes

183
Q

What are the abnormal multi-nucleated cells indicative of HL called?

A

Reed-Sternberg cells

184
Q

What are assessment findings for patients with Hodgkin’s lymphoma?

A

Enlarged cervical, auxiliary, or inguinal lymph nodes that are often movable and non-tender
Weight loss
Fatigue
Weakness
Fever
Tachycardia
Alcohol induced pain at the site of disease

185
Q

What are “B symptoms” of Hodgkin’s lymphoma?

A

Fever
Drenching night sweats
Weight loss

186
Q

What do care options for HL look like?

A

Least amount of treatment to achieve a cure, usually chemo and/or radiation

187
Q

What are secondary cancers?

A

Cancers occurring ten or more years after Hodgkin’s lymphoma (often lung, breast, or skin cancer)

188
Q

What are some things the nurse will need to manage with Hodgkin’s lymphoma?

A 
Pain
Side effects 
Pancytopenia 
Emotions/coping
Evaluating long term effects
189
Q

What is non-Hodgkin’s lymphoma?

A

The most commonly occurring blood cancer; a heterogenous group of malignant neoplasms

190
Q

Lymphadenopathy

A

Swelling of lymph nodes

191
Q

What are clinical manifestations of NHL?

A

Painless lymph node enlargement
Symptoms in the area where the disease has spread
Other similar symptoms to HL

192
Q

When B symptoms are likely to be found in NHL?

A

High grade lymphomas in the leukemic phase

193
Q

What types of treatment are used for NHL?

A

Chemo
Radiation
Antibiotic or antivirals if basis is infection

194
Q

What are some nursing considerations for managing NHL?

A 
Managing problems related to the disease or side effects of treatment
Understanding disease progression
Patient support and education
Pain control
Fertility issues for patient 
Infection prevention strategies
195
Q

End stage renal disease

A

GFR of less than 15 mL/min, dialysis or transplant required

196
Q

Why is there an increasing prevalence of CKD?

A

Aging population
Obesity and inactivity
Increase in diabetes and hypertension

197
Q

What is uremia?

A

When kidney function declines to a point where symptoms develop in multiple body systems

198
Q

What are metabolic disturbances with CKD?

A

Increased BUN and creatinine
Increased triglycerides
Altered carbohydrate metabolism

199
Q

Normal GFR rate

A

90-120 mL/min

200
Q

Normal BUN level

A

7-20 mg/dL

201
Q

Normal serum creatinine level

A

0.6-1.2 mg/dL

202
Q

What happens to insulin metabolism in ESRD?

A

Kidneys stop excreting insulin, so diabetics might need less insulin once they start dialysis

203
Q

What are major electrolyte imbalances with CKD?

A 
Sodium
Potassium
Calcium
Phosphate
Magnesium
Acid and bicarb
204
Q

What will happen to sodium levels with CKD?

A

Can increase, decrease, or stay normal

205
Q

What happens to calcium and phosphate levels in CKD?

A

Phosphate increases

Calcium decreases

206
Q

Why is anemia an issue in CKD?

A

Decreased epo production and RBC production
Dialysis blood loss
Increased PTH inhibiting erythropoiesis
Iron deficiency

207
Q

Why are there increased bleeding tendencies in CKD?

A

Defect in platelet function

Increased factor 8 and fibrinogen

208
Q

Why do patients with CKD experience higher incidence of cardiovascular disease?

A

Hypertension
Vascular calcification
Arterial stiffness
High potassium and lipid levels

209
Q

How does CKD affect the musculoskeletal system?

A

Mineral and bone disorders (decreased activated vitamin D and serum calcium, increased phosphate leading to osteomalacia)

210
Q

What are skin changes with CKD?

A

Pruritus
Itching
Uremic frost (only with very high BUN levels)

211
Q

What is the preferred method to determine kidney function?

A

GFR

212
Q

What is the top goal for patients with CKD?

A

Preserve existing kidney function

213
Q

What can be done to prevent CKD?

A

Early detection and treatment
Monitor BP/treat high BP early and aggressively
Ensure proper diabetes detection and treatment
Screening for high risk populations

214
Q

What do clients with CKD need to know to report to a provider?

A

SOB
Weight gain
Increased BP
Edema

215
Q

What are advantages to peritoneal dialysis?

A 
Can be started immediately
Less complicated and can be done at home 
Portable
Fewer dietary restrictions
Easier on the heart
Better for diabetic patients
216
Q

What are disadvantages of PD?

A 
Peritonitis
Greater protein loss
Infections at catheter site
Self-image issues 
Hyperglycemia
Contraindicated for patients with lots of abdominal surgeries or problems
Education/training needed
217
Q

Once a PD cath is healed, what does daily catheter care look like?

A

Clean with soap and water
Pat dry
No dressing change needed
no sitting in baths of water

218
Q

What are the three phases of a PD exchange?

A

Inflow
Dwell
Drain

219
Q

How long is the inflow period?

A

10 minutes

220
Q

What happens during PD dwell and how long is it?

A

Diffusion and osmosis occur between solution and the blood

Can be 20-30 minutes up to 8 hours depending on the method

221
Q

How long is the drain phase of PD?

A

15-30 minutes

222
Q

What can facilitate a faster drain period?

A

Massaging abdomen or changing positions

223
Q

What is automated PD?

A

Cycler delivers and regulates fluid exchanges while the patient sleeps (4 or more exchanges per night with fluid left in peritoneum during day)

224
Q

What is continuous ambulatory peritoneal dialysis?

A

Exchanges are done by the patient every few hours during the day (average of 4 hour dwell time)

225
Q

What would indicate that peritonitis is occurring?

A

Abdominal pain
Rebound tenderness
Cloudy peritoneal effluent
Increased WBC count

226
Q

What other complications can PD cause?

A 
Exit site infection
Hernias 
Lower back problems
Bleeding
Protein loss
Pulmonary complications
227
Q

What are the advantages of hemodialysis?

A 
Rapid fluid removal
Rapid urea/creatinine removal
Effective potassium removal
Less protein loss
Decreased serum triglycerides 
Can be done at home
228
Q

What are disadvantages of hemodialysis?

A 
Vascular access problems
Diet and fluid restrictions 
Heparin use
Lots of equipment
Hypotension
Anemia
Surgical placement of access
Fatigue
229
Q

Thrill

A

Buzzing sensation

230
Q

Bruit

A

Whooshing sound of blood in access

231
Q

What are hypotension assessment findings?

A 
Lightheaded ness
Nausea
Vomiting
Seizures 
Vision changes
Chest pain
232
Q

How do we treat and prevent hemodialysis complications?

A 
Frequent monitoring of BP
Correct dry weights
Rinse back all blood
Infection control
Hep C screening and vaccinations
233
Q

what is cerebral palsy?

A

a group of permanent disorders of the development of movement and posture

234
Q

what causes cerebral palsy?

A

some disruption of blood flow to the brain of an infant or young child (could be hypoxia or stroke, etc)

235
Q

what developmental milestones might be delayed in CP?

A 
rolling over
raising head
sitting up
crawling
walking
236
Q

what are some possible motor signs of CP?

A 
persistent primitive reflexes
poor head control after 3 months old
limp posture
unable to sit up on own by 8 months of age 
favoring one side of the body 
clenching fists after 3 months
237
Q

what are common feeding issues with CP?

A

gagging
choking
tongue pushing soft food out of the mouth

238
Q

what are behavioral findings in CP?

A

extreme irritability and crying
failure to smile
lack of interest in surroundings

239
Q

what muscle tone alterations may be seen with CP?

A

muscle contractures

240
Q

what are some associated disabilities for those with CP?

A

altered learning and reasoning
seizures (up to 85% of those with CP)
vision/hearing impairment
impaired behavior and relationships

241
Q

what does intellect look like for those with CP?

A

usually normal or slightly impaired, may be more altered in more severe cases

242
Q

what is constraint therapy?

A

constraining the strong side of the body in a child with CP to force use/strengthening of the weak side of the body

243
Q

what are some common complications of CP?

A 
respiratory infection
malnutrition 
failure to thrive 
injury
contractures
back pain/spasms/tight muscles 
incontinence
244
Q

what are some factors that contribute to complications in CP?

A 
weight gain 
poor posture
spinal deformities
discontinuing PT
walking when it is increasingly difficult
incorrect or inappropriate surgery
245
Q

what kinds of therapy are crucial help maximize functional ability in CP?

A

PT, OT, and speech therapy

246
Q

what can aid in mobility for clients with CP?

A

braces
wheelchairs
orthotics for legs and feet
play therapy

247
Q

what can be done to help with feeding and nutritional issues with CP?

A

monitor weight gain closely
tailor diet to child’s needs
manual jaw control to stabilize and help with swallowing
gastrostomy to supplement oral feeding

248
Q

what is a stroke?

A

ischemia or hemorrhage in the brain causing death of brain cells and loss of function in those areas of the brain

249
Q

what are manifestations of a stroke on the right side of the brain?

A

spatial-perceptual problems
motor function disruption
left side paralysis or neglect
rapid actions
short attention span
minimizing problem or pretending its not there
problems with judgement and impulse control

250
Q

what are manifestations of a stroke on the left side of the brain?

A 
right side paralysis
language issues 
impaired left/right discrimination
caution 
fear of falling/fear in general
slow performance in tasks
depression
anxiety
251
Q

why are those with a left side of the brain stroke more likely to be depressed?

A

they are more aware of the deficits they have and more likely to be discouraged by them

252
Q

what motor deficits are associated with stroke?

A 
mobility issues
respiratory dysfunction 
swallowing and speech issues 
gag reflex problems
deficits in self care ability
253
Q

aphasia

A

impaired ability to communicate

254
Q

expressive aphasia

A

patient can no longer comprehend language but can still speak (but they only speak nonsense)

255
Q

receptive aphasia

A

loss of ability to produce language, but can still understand

256
Q

global aphasia

A

total inability to communicate (cannot speak or understand)

257
Q

what are some good tips to communicate with clients with impaired speech?

A 
use good non-verbals
use hand gestures and pictures 
have the family assist with communication 
be positive and patient
use speech therapy 
treat them as an adult
ask simple questions 
present one idea at a time
258
Q

what is dysarthria?

A

disturbance in muscular control of speech, mainly affecting pronunciation and articulation

259
Q

what are potential impacts of stroke on affect?

A

exaggerated or uncontrolled emotional responses
depression
frustration
unpredictability

260
Q

how can intellectual functioning be impacted by stroke and how does it differ with each side of the brain?

A

memory and judgement issues can affect either side of the brain, but right sided strokes will be more cautious and fearful while left sided strokes are often more impulsive

261
Q

what is homonymous hemianopsia?

A

also known as a “field cut”, refers to patient experiencing blindness in the same half of visual fields of both eyes

262
Q

what do clients with homonymous hemianopsia tend to do?

A

forget about or ignore everything on the other side of their visual field (the unseen side)

263
Q

what is agnosia?

A

inability to recognize an object by sight, touch, or hearing

264
Q

what is apraxia?

A

inability to carry out learned sequential movements on demand (like brushing teeth or other self-care activities)

265
Q

what are some impacts of stroke on elimination?

A

urinary frequency, urgency, or incontinence
constipation
usually temporary effects or effects due to not being able to verbalize needs

266
Q

what are some preventative actions to prevent strokes?

A 
control of diabetes and hypertension
drug therapy
treatment of cardiac problems
smoking avoidance/cessation
cholesterol control
healthy diet
limit alcohol
267
Q

what do rehabilitation prognoses for stroke patients depend on?

A

type of stroke and extent of damage

268
Q

how can respiratory complications be avoided with stroke patients?

A 
frequent airway assessment
oxygen
suctioning 
optimal positioning
deep breathing 
oral care for the mechanically ventilated
269
Q

how can musculoskeletal complications of stroke be avoided?

A 
PROM/ROM
positioning
transfer carefully and correctly
pay attention to weak side when positioning and transferring 
don't pull on arms
use splints and supports as needed
270
Q

how can integumentary complications of stroke be avoided?

A

provide pressure relief
ensure good hygeine
mobilize early and often

271
Q

how can GI complications of stroke be avoided?

A 
prevent constipation
check for impaction
adequate fluid and fiber intake 
promote physical activity 
bowel retraining
272
Q

how can urinary complications of stroke be avoided?

A

remove catheter ASAP
avoid bladder over-distension
assist patient to a normal position for voiding
offer bedpans

273
Q

what is included in bladder retraining?

A

fluids between 7 am and 7 pm
scheduled toileting every 2 hours
assessing for distension
observing for signs of needing to void

274
Q

what is silent aspiration?

A

fluid entering the lungs with no obvious signs or symptoms from the patient

275
Q

what are symptoms of dysphagia?

A 
pain with swallowing
being unable to swallow
pocketing food in the mouth 
drooling
hoarse voice 
regurgitation
heartburn 
feeling like food is stuck in the throat
276
Q

what interventions can prevent aspiration?

A 
position unconscious patient on their side
liquid meds
have suctioning available
thicken foods and beverages 
elevate head to eat 
cut food up
small frequent meals
avoid milk products
277
Q

how can we help patients with strokes cope with sensory/perceptual alterations?

A

help them with their neglected side
arrange items within their perceptual field
ensure safety measures are taken

278
Q

how should one help a stroke patient displaying an uncontrollable outburst of emotion?

A

distract them

279
Q

what is parkinson’s disease?

A

chronic progressive neurodegenerative disorder characterized by slowness in initiation and execution of movements

280
Q

What does TRAP stand for?

A 
manifestations of parkinson's 
Tremors
Rigidity 
Akinesia
Postural Instability
281
Q

what is the triad of parkinsons?

A

akinesia
bradykinesia
postural instability

282
Q

akinesia

A

absence or loss of control of voluntary movement (includes pill rolling tremors)

283
Q

bradykinesia

A

slowness of movement, problems with facial and hand movements, getting “frozen” in place, shuffling gait

284
Q

how can clients with parkinson’s prevent getting “frozen”?

A

rocking from side to side

285
Q

what are characteristics of parkinson’s postural instability?

A

being unable to stop oneself from going forward or backward, often having a forward tilt to posture

286
Q

what are potential complications of parkinson’s?

A 
dyskinesias
weakness
dementia
depression
dysphagia
malnutrition
infection
falls
orthostatic hypotension
pain
hallucinations
287
Q

what are some interprofessional cares for parkinsons?

A 
drug treatment
PT 
OT
surgery
deep brain stimulation
diet treatment
288
Q

what are nutritional considerations for parkinsons?

A 
easily chewed and swallowed foods
high fiber foods
cut up food
have 6 small meals
ensure adequate vitamin b6
allow plenty of time for meals
289
Q

what are key exercise focuses for parkinson’s clients?

A

strength and stretching

290
Q

what can we do for parkinson’s patients to prevent falls and “freezing” episodes?

A

have them think about stepping over lines on the floor or stepping over rice kernels
have them lift their toes when walking
have them rock from side to side to keep moving

291
Q

how can we modify the environment for parkinson’s patients to maximize independence?

A

remove rugs and excess furniture
elevate toilet
simplify clothing
use chairs with arms

292
Q

epilepsy

A

continuing predisposition to seizures with cognitive, social, psychological, or neurobiological consequences

293
Q

what is a seizure?

A

a transient uncontrolled electrical discharge of neurons in the brain that disrupts normal functioning

294
Q

what are common triggers or causes for seizures?

A 
acidosis
electrolyte imbalance 
hypoglycemia
hypoxia
alcohol or drug withdrawal
dehydration
lupus
lung/liver/kidney disease
diabetes
hypertension
septicemia
295
Q

what are the phases of seizure activity?

A

prodromal/aural, then ictal, then postictal

296
Q

prodromal/aural phase

A

sensations or behavior changes that precede a seizure

297
Q

what can be some signs in the prodromal/aural phase of a seizure?

A

smell manifestations
fear
headache
hearing noises

298
Q

ictal phase

A

from first symptoms to the end of seizure activity

299
Q

postictal phase

A

recovery from the seizure

300
Q

what are generalized seizures?

A

seizures that involve both sides of the brain

301
Q

tonic clonic seizures are also known as

A

grand mal seizures

302
Q

what is involved in a tonic-clonic seizure?

A

losing consciousness
falling
stiffening muscles (tonic) then jerking limbs and body (clonic)
can include cyanosis, salivation, incontinence, and biting of the tongue or cheek

303
Q

what is an absence seizure?

A

a brief blank staring/zoning out seizure

more common in children and very hard to detect

304
Q

what is a myoclonic seizure?

A

sudden excessive jerk or twitch of the body and extremities

305
Q

atonic seizures are also known as…

A

drop seizures

306
Q

what is an atonic seizure?

A

tonic episode or loss of muscle tone, usually less than 15 seconds in length

307
Q

what is a tonic seizure?

A

sudden extreme muscle stiffness

308
Q

what is a clonic seizure?

A

loss of consciousness, then loss of muscle tone, then rhythmic limb jerking

309
Q

what are focal seizures?

A

also known as focal seizures, usually begin in one area of the brain and manifest based on the function of the involved brain area

310
Q

what is a simple focal seizure?

A

the patient is conscious but may experience unusual feelings or sensations

311
Q

what feelings or sensations might be experienced in a simple focal seizure?

A

joy or anger

smells or sounds not actually present

312
Q

what is a complex partial seizure?

A

change in level of consciousness, eyes are open but patient cannot interact, strange behavior and potential dangerous or embarrassing actions may occur

313
Q

what is an automatism?

A

a repetitive, purposeless action

314
Q

what are psychogenic seizures?

A

they closely resemble epileptic seizures but there is no electrical abnormality in the brain. often manifest because of physical or emotional trauma or abuse

315
Q

what is status epilecticus?

A

continuous seizure activity for over 5 minutes

316
Q

why is status epilecticus dangerous?

A

because it can become an ABC issue (hypoxia, dysrhythmias, etc)

317
Q

what are psychosocial complications of epilepsy?

A 
lifestyle interruptions
ineffective coping
depression
social stigma
transportation hindrances
bipolar or other psychiatric diagnoses
318
Q

which diagnostic test is most useful for epilepsy?

A

EEG

319
Q

what are health promotion measures for epilepsy patients?

A

wearing a helmet when head injury could happen
improved infant care
have at risk patients avoid alcohol and sleep deprivation

320
Q

what is included in seizure precautions?

A 
rescue equipment at bedside
bed in low position
padded side rails
airway assessment
environmental safety
321
Q

what are some things to do when a seizure occurs?

A

put patient on left side
help patient to the floor
dont restrain them and loosen any restrictive clothing

322
Q

what are some things to assess when a seizure occurs?

A 
onset
course and nature of seizure
length of each phase
body parts involved
airway status
autonomic signs
preceding signs of seizure
323
Q

what do we do after a patient has a seizure?

A 
assess vitals
ensure comfort and rest
quiet/non-stimulating environment
reorient them
check memory
assess pupils and airway
324
Q

when should an epileptic patient call EMS regarding a seizure?

A 
if injury occurs
if seizure occurs in water
longer than 5 minutes
pregnancy 
diabetes
325
Q

what are some important teaching points for epileptic patients and caregivers?

A 
take meds exactly as directed
wear medical alert bracelet
stay calm
have family observe start and stop times
eat regularly
maintain safety during seizure (don't put anything in mouth!)

Krystan: Semester Two Nursing School (13 decks)

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