AC 2 Final Exam Flashcards
What are the ABCDEs of skin cancer?
Asymmetry
Border irregularity
Color
Diameter at least 1/4 in.
Evolution
What is an actinic keratoses?
Premalignant lesions
More common in men
What is a squamous cell carcinoma (SCC)?
Cancer of epidermis
Metastasis common
Can be related to chronic skin damage
Most common in people with darker skin
Looks scaly, slightly red
What is a basal cell carcinoma (BCC)?
Basal cell layer of epidermis
Metastasis rare
Genetic, chronic irritation
Starts as small fleshy bumps
Looks shiny, red, elevated
What’s a melanoma?
Pigmented cancer arising in melanin producing epidermal cells
Highly metastatic
Genetic, excessive UV exposure
What are the 4 types of skin cancer?
Actinic keratoses
Squamous cell carcinoma
Basal cell carcinoma
Melanoma
How is skin cancer/lesion treated?
Electrodesiccation and curettage (dig out)
Surgical excision (margins of 5 cm are best)
Mohs (for high risk or large BCC)
Cryosurgery (freezing area)
What kind of diagnostic study is done for scabies?
Scraping
How is contact dermatitis managed?
Obtain hx to identify causative agent
Avoidance therapy (once cause identified)
Steroid to suppress inflammation
Cool/moist dressings over topical steroids and increase absorption
No occlusive dressing with steroid
What is psoriasis?
A scaling disorder related to dermal inflammation
Abnormal growth of epidermal cells in the outer skin layers
Autoimmune rx, lifelong with exacerbation & remissions
What are the physical cues of scabies?
Shows up in folds, warm, moist areas
Pruritic
Blisters (small, red)
Can mimic contact dermatitis
Why is herpes zoster (singles) in eye a medical emergency?
It can lead to blindness
What are the characteristics of stage 1 pressure ulcer?
Redness that does not blanche when pressed
Reversible damage with the removal of pressure and shear force
Irregular erythema
Induration
Boggy or firm
What are the characteristics of stage 2 pressure ulcer?
Damage that includes epidermis, dermis, or both
Shallow ulcer, blister or abrasion
What are the characteristics of stage 3 pressure ulcer?
Injury to SubQ tissue
Goes to the underlying fascia, but not through
May have undermining
Deeper crater
What are the characteristics of stage 4 pressure ulcer?
Injury to the tissue that goes through the fascia
Includes structural visibility involvement: muscle, bone, tendon/ligament
May have osteomyelitis or septic arthritis
When is a pressure ulcer unstageable?
When unable to determine the depth of tissue damage due to necrotic tissue covering wound bed
How can you prevent pressure ulcers?
Frequent repositioning, avoid over sedation
Barrier cream if incontinent
Pressure reduction with mattresses/cushion
Assessment
Adequate nutrition & hydration (30-35kcal/kg, 1-1.5g/kg protein, 1mL/kcal fluid)
The Norton scale is used to
Identify risk of pressure ulcer
Less the number, higher the risk
Scale of 5 to 20
How is pressure ulcer treated?
Pain control
Keep what is wet wet and what is dry dry
What prophylactic treatment should be given to a patient who is on continuous opioid analgesic?
Treat constipation
Why can pain assessment in older adults be difficult?
Due to multiple chronic conditions
High incidence of cognitive impairment
How can you assess pain in cognitive impaired patients?
Baseline information (VS, agitation, ability to walk, stand, move, eating pattern, appetite, sleep pattern, elimination habits, etc.)
Talk with family or caregivers
What are some behavioral symptoms that indicates pain?
Tense body language
Sad facial expression
Fidgeting
Persistent verbalizations
Verbal outbursts
Wandering, tearful, delusions, hallucination
What kind of pain is easily controlled with short acting analgesics?
Acute pain
What kind of pain is associated with post-op, procedural, traumatic injuries?
Acute pain
PCA pump is used for this type of pain
Acute pain
What is the characteristic of chronic pain?
Persists at fluctuating intensity
What are some manifestations of chronic pain?
Depression
Eating, sleep disturbances
Impaired function
What kind of pain is opioids, NSAIDs less effective?
Neuropathic pain
How is chronic pain treated?
Basal pain meds + different therapies for pain spikes
Predictable spikes: short acting agent prior to event
Unpredictable spikes: have short acting readily available
According to the WHO analgesic ladder, what kind of pain meds can you give for mild pain (1-3/10)?
Aspirin
Acetaminophen
NSAIDs
Coanalgesics
According to the WHO analgesic ladder, what kind of pain meds can you give for moderate pain (4-6/10)?
Codeine
Hydrocodone
Oxycodone
Nonopioid analgesic
Coanalgesics
According to the WHO analgesic ladder, what kind of pain meds can you give for severe pain (7-10/10)?
Morphine
Oxycodone
Hydromorphone
Fentanyl
Nonopioid analgesics
Coanalgesics
What is the maximum mg of acetaminophen per day?
4000mg
Demerol (meperidine) can cause ____ in older adults
Tremors and seizures
What are some non-pharmacologic pain treatment?
Massage
Yoga
Music
Aromatherapy
Acupuncture
Hypnosis
Hot/cold packs
What are some examples of coanalgesics?
Antidepressants
Anticonvulsants
Corticosteroids
Etc
What are the 5 important elements of the WHO 3-step model of analgesic dosing?
By mouth
By the clock
By the ladder
For the individual
With attention to detail
What does hospice care do?
Management of pain and control of symptoms
At home or free standing hospice facility
Hospice pays for meds for comfort measures
Individualized plan of care
What is the eligibility for hospice care?
Prognosis of 6 months or less (however benefit is not limited to 6 months)
Hospice services include
Physician, nursing care
Medical appliances and supplies
Drugs for management and comfort
Homemaker and home health aide services
Short term inpatient and respite care
Counseling
Bereavement services
Can palliative care be part of hospice?
Yes
What is the difference between hospice and palliative care?
Similar; both focuses on comfort and symptom management.
Hospice is more of individual, while palliative cares patient and family as unit
Quality of life, not quantity
What are the 5 stages of dying according to Elisabeth Kubler-Ross?
Denial
Anger
Bargaining
Depression
Acceptance
What are the common symptoms at the end of life?
Dyspnea
Constipation
Fatigue
Anorexia and cachexia
Cough
N/V
Anxiety
Delirium
What medications are used to manage EOL dyspnea?
Opioids
Bronchodilators
Diuretics
What non-pharmacologic treatments are used to treat EOL dyspnea?
Humidified O2
Counseling
Pursed lip breathing
Energy conservation
Fans, HOB elevation
Music/massage
How is anorexia & cachexia treated during EOL?
Dietary consultation
Medications (appetite stimulant?)
Parenteral/enteral nutrition
Odor control
Counseling
How is stomatitis/dysphagia treated during EOL?
Social activity of eating
Treat infections, obstructions and reflux
Diet modifications
Benefit vs. burden of feeding tubes
Oral hygiene
Oral lubricants
How is EOL fatigue treated?
Meds (steroids, antidepressants, EPO, blood transfusion)
Nonpharm (rest, conserve energy, PT/OT)
How is EOL N/V managed?
Anticholinergics
Steroids
Benzodiazepines
Antinausea drugs (zofran, granisetron)
When should antinausea meds administered when managing EOL N/V?
Before symptoms occurs
How is EOL cough treated?
Chest PT
Humidification
Elevate HOB
Suction
Cough suppressants
How is EOL anxiety managed?
Antidepressants
Benzodiazepines
What are some s/s of death?
Dehydration
Decreased urine output
Cold & mottled extremities
VS changes
Respiratory congestion including respiratory bubbling
Changes in breathing patterns
Confusion
Decreased/lack of swallowing reflex
What are some psychological/spiritual symptoms of death?
Fear of abandonment, dying process, unknown
Nearing death awareness
Withdrawal from family, friends, cargivers
What is the nurses’ role in EOL?
Know your own feeling about death and EOL issues
Start discussion early
Make sure patient and family is communicating
Listen
What are some nursing cares at the end of life?
Pain/symptom relief
Skin integrity
Bowel/bladder care
Oral care, ice chips, eye care
What does possible melanoma look like?
Asymmetrical
Well-defined border
Color can be dark with fleck of other colors
Diameter more than 6-7mm
Can be elevated
How is Mohs done?
Local anesthesia
Cut some out, look in the microscope. If more cancer cells in the area, cut more. Repeat until cancer cell gone
What is the palliative care priority?
Pain management
Does RA cause pain with activity that improves with rest?
No. It’s quite the opposite
Can a person with osteoporosis lose height?
Yes
Prednisone long-term use can cause
Fractures
What medication is given to RA patients when all the treatment fails?
Methotrexate
What are some post-op knee replacement care?
Early ambulation - can be full weight bearing
Pain management
CPM (knee in neutral position)
What medication is used to manage gout pain?
NSAIDs
What supplements are needed for elderly?
Vitamin A, C, D
Calcium
Why is community resources good for cancer patients and for grief support?
Let their feelings out without judgement, feeling validation, can get tips from other people who have been through a same/similar situation, trauma bond
How is pernicious anemia managed?
B12 injection monthly then oral B12
What’s included in low cholesterol diet?
More greens
Lean meat
Chicken, turkey, fish
Limit red, fatty meat
What should you do when you are infusing T-PA but the patient starts getting confused?
Stop infusion
May be a sign of bleeding
What education is needed for pt with PVD?
Good shoes
Skin care to prevent ulcers
Dry between toes
Foot care
When can we give Alteplase (t-PA)?
Ischemic stroke
BP < 185/110
Within 4.5 hours of onset
No active bleeding
What are some symptoms of cataract?
Painless, blurred vision
Decrease in ability to perceive color
When can you expect for your vision to be improved after the cataract surgery?
On the day of surgery
Can otitis media cause N/V?
Yes, because it’s affecting middle ear
Can heating pad help with earache?
Yes
Does cataract surgery require general anesthesia and an overnight hospital stay?
No; it’s just some eyedrops to numb and they do surgery. You are awake
How long should you hold your breath after inhaling albuterol?
10 seconds
What are some a/e of captopril when used the first time?
Orthostatic/postural hypotension
Hyperkalemia
Low BP
What is the simple test used to immigrants at Ellis Island to check for heart failure?
Walking up the steps
According to the Heart Failure Core Measure Set, what should be done for the patient with HF before discharge?
ACE inhibitors
Cardiac diet (no added salt, limit Na to 2g/day)
ECHO for EF
What’s the purpose of Alzheimer’s meds?
Improve symptoms
What is the main reason for fall in elderly?
Muscle weakness
What diagnostic tool is used for COPD pt with cough?
Spirometry used over x-ray
Does COPD every get better?
No.
They can only hope for improved QOL. Bronchodilators help with this goal
Is there a vaccine for herpes zoster?
Yes; Recombinant zoster (shingles) vaccine
Herpes zoster can cause some
Neuralgia
What can pt with dermatitis put on their skin to prevent exacerbation from hot, dry, air/heat?
Emollients
What diagnostic test is used to diagnose CLL?
Bone marrow aspiration
What kind of therapy is used for CLL?
Targeted therapy
We don’t want to expose too much
What are some causes of iron deficiency anemia?
Lack of iron consumption
Bleeding
Low hemoglobin
How does A. fib compromise cardiac output?
Atrium don’t have time to fill, so ventricle can’t pump adequate blood throughout the body -> decreased perfusion
What kind of food should you give to pt with Parkinson’s?
Soft, thickened food
No finger foods (too hard)
What activity/movement can help Parkinson’s pt with ambulation?
Marching in place
Why are deadbolts sometimes necessary in Alzheimer’s patients?
Safety risk
An elderly woman was possible raped and comes to the ER. The nurse must call the poilice immediately
False.
Talk to manager first, follow the policy/facility protocol
If not, pt will lose in court
Why do we not give prophylactic antibiotic to neutropenic patients?
Due to risk of antibiotic resistance
What do you need to monitor in patients who is getting radiation therapy to sites containing bone marrow?
Infection; can lower WBC
NSAIDs should be avoided in elderly due to risk of
Kidney impairment
Can you give sublingual morphine to a dying patient who can’t swallow?
Yes
Sublingual does not require swallowing
Benefit vs. risk
What kind of breathing is a sign of death?
Cheyne-Stokes
Can fentanyl patches cause respiratory suppression/depression in elderly?
Yes
What are the 4 cardinal symptoms of Parkinson’s?
Tremors
Postural instability
Bradykinesia
Muscle rigidity
What is the priority assessment when someone presents to the ED with complaints of stroke?
Onset of time; when was the last time you were normal?
To see if we can start t-PA or not
What is the main complication of A. fib?
Stroke r/t blood clot
How do you treat scabies?
Permethrin cream
What is the name of the rash caused by heat and skin/skin friction? Often occurs under the breast or in the axilla
Intertrigo (type of dermatitis)
Adjunctive (additional) drugs used for pain include
Antidepressants, anticonvulsants, corticosteroids
What are the signs of PVD?
Brown discoloration, redness, itching and burning
What is the most common type of skin cancer?
Basal cell carcinoma
How do you know if tamsulosin is working?
Able to pass urine
Tamsulosin is for BPH
What are some interventions for acute HF?
Fluid restriction
Diuretic
Monitor VS, edema
Low sodium diet
What is the best COPD prevention?
Smoking cessation
What is the most common cause of skin cancer?
Sun damage
Other than ABCDEs of skin cancer, what are some more signs of skin cancer?
Open sore that doesn’t heal for 3 weeks
Spot/sore that burns, itches, stings, crusts or bleeds
Which skin cancer metastasis easily/commonly?
Squamous cell carcinoma
What skin condition is caused by contact with an irritant/allergen and results in cell-mediated immune reaction?
Contact dermatitis
How is psoriasis treated?
Topical steroids
Topical tar
UV light
How is shingles treated?
Antivirals
Pain management
What does an elevated BNP indicate?
Ventricular stretch
Usually with FVO
What are some signs of FVO?
Edema, SOB, crackles, tachycardia
What are some signs of right sided HF?
Ascites
Edema
JVD
When does palliative care begin?
When someone has a terminal diagnosis
What are the 7 factors of geriatric syndrome?
Immobility
Falls
Constipation
Urinary incontinence
Delirium
Polypharmacy
Frailty
What indicates high risk of fall during TUG test?
If patient takes 12 seconds or more
Where does nutrition assessment start?
Mouth
What is the most difficult symptom in BPH?
Nocturia
What BPH medication decreases usable testosterone/decrease production to reduce prostate size?
Finasteride
What OTC supplement/med is commonly used in BPH?
Saw palmetto
What should you do if there’s increased bleeding after TURP?
Increase fluid through cath to flush out & stop bleeding
How does Parkinson’s progress?
Unilateral, pill rolling tremor -> bilateral tremor, mask like face -> postural instability -> akinesia -> completely dependent
How is Parkinson’s diagnosed?
By exclusion
What’s the big s/e of Levodopa?
Orthostatic hypotension
Thrombolic stroke is caused by
Atherosclerosis
What type of stroke occurs frequently during activity?
Hemmorhagic
What’s the most important nursing care for post-op endarterectomy of TIA?
Maintain BP (BP too high -> rupture)
Bleeding (enlarged neck, deviated trachea, respiratory distress)
What’s the FAST assessment?
Facial drooping
Arm weakness
Speech difficulty
Time to call 911
What’s the ABCS of heart health to prevent stroke?
Aspirin when appropriate
BP control
Cholesterol management
Smoking cessation
What is the nursing care priority for HF patient?
Fluid volume management
Monitor urine output, BP/HR, LOC, temp of extremities
L. sided HF is treated with
ACE inhibitors
ARBs
Concerning weight change in HF
+ >2lbs overnight
+ >5lbs from goal weight
- > 5lbs from goal weight
When is chemical cardioversion used?
When pt hemodynamically stable
Adenosine 6/12 mg
When is electrical cardioversion used?
When pt hemodynamically unstable
When we can’t use chemical (upcoming ablation)
Synchronized to deliver electrical current on the R wave
What is Sick Sinus Syndrome?
Dysfunctional SA node to HR fluctuates from bradycardia to tachycardia and vice versa
What are the physical assessment findings of PAD?
Cool temp
Absent hair growth
Ulcer on lower leg
Intermittent claudication
Muscle atrophy
Where’s the PVD ulcer usually located?
Foot; upper foot ulceration
In which venous condition would you NOT elevate lower extremities?
Arterial; away from the body
A patient is on ACE inhibitor, Beta blocker, and diuretic. You notice pt’s HR and BP are low. What medications will you hold?
Hold ACE inhibitor and Beta blocker
But give diuretic
Chronic bronchitis (blue bloaters) s/s
Overweight
Cyanotic
Elevated Hgb
Peripheral edema
Rhonchi and wheezing
Emphysema (pink puffers) s/s
Older and thin
Severe dyspnea
Quiet chest (not much air movement)
Hyperinflation & flatten diaphragms in CXR due to trapped air
DEXA scan is used to diagnose
Osteoporosis
What are the B symptoms?
Fevers
Night sweats
Unintentional weight loss
Infections
What’s a big thing in multiple myeloma?
Bone pain
How is multiple myeloma diagnosed using blood test?
C: elevated calcium
R: renal insufficiency
A: anemia
B: bone lesion
