Cancer/Final Exam Flashcards
Pathophysiology of Cancer
When the cell is dividing DNA malfunctions. The abnormal cells do not die and continue to reproduce. Overgrowth of cells.
Oncogene is activated as result of DNA mutation > tumor suppression is disabled by cancer, the cell keeps dividing (in normal circumstances in inhibits cell division when there is an abnormal cell) > cellular mutation (DNA)
Stages of cancer development
Initiation: irreversable mutation to DNA
Promotion: mutated cells stimulated to divide
Progression: increased growth (speed and invasiveness)
Normal Cells Vs. Cancer Cells
Normal cells: contact inhibition, develop differentiation, contribute to homeostasis
Cancer Cells: no contact inhibition, poorly differentiated (anaplastic - divide rapidly), do not contribute to homeostasis.
Benign Tumor
Local (does not spread) Well defined borders pushes other tissue out of the way slow growth encapsulated easily removed does not tend to recur
Malignant Tumor
invasive doesn't stop at tissue border (spreads) invades and destroys surrounding tissue rapid growth metastasizes to distant sites not always easy to remove can recur
How can tumors be classified?
I. origin
II. specific type of tissue it originates
III. grade
IV. stage - according to TNM system
carcinoma definition
cancer of epithelial tissue - most common
Sarcoma definition
cancer of connective and supportive tissue (bone, cartilege)
myeloma definition
plasma cells cancer (bone marrow)
leukemia definition
blood (aka liquid cancer)
lymphoma definition
lymph node cancer (AKA solid cancer)
Grading of cancer
higher the grade (grade 4) worse prognosis
Classification by stage
T: size of tumor (1-4)
N: lymph nodes (0-3)
M: metastases (0 or 1)
Calcium normal value
8.5-10
metabolic cancer complications
Humoral Hypercalcemia of Malignancy (HHM)
- increased calcium levels D/T bone resorption
Symptom of Inappropriate Antidiuretic Syndrome
- impaired h2o excretion. Increased absorption of urine, pt. .cannot urinate. Edema, low sodium
Tumor Lysis Syndrome
- rapid release of intracellular content into blood (h2o, protein)
- rapid shrinkage of tumor D/T treatment
- excess thirst, muscle weakness, cramps
Hematologic Cancer Complications
Febrile Neutropenia
- decreased neutrophils, WBC low
- patient can get infection easily
Hyperviscosity Syndrome
- increased blood viscosity leading to decreased blood flow
- D/T tumor or treatment
- @ risk for DVT, PE, clot
Structural Cancer Complications
Superior Vena Cava Syndrome
- compromised venous drainage D/T obstruction
- dypnea, chest pain
- raise HOB
Malignant Epidural Spinal Cord Compression
- when cancer metastasize to spine
- neuropathy, numbness
Malignant Pericardial Effusions
- extra fluid collects inside sac around heart D/T cancer in pericardia, lungs
Diet to avoid cancer
- avoid processed food
- increase fiber
eat balanced diet
Prevention of Cancer
- healthy diet
- smoking cessation
- sunscreen
- physically active
- limit alcohol
- regular screening
- vaccinate against Hep B and HPV
Cancer Treatment Goals
- cure
- palliation
- control
Chemotherapy Overview
- treatment of choice for malignancies
- systemic or local
- cytotoxic drugs
- interfere with DNA synthesis and mitosis
Chemotherapy Administration
Oral, injection, infusion
Central catheter or port, no infusion on reg. IV D/T necrotizing tissue if infiltrated
Extravaasation, vesicant
Special PPE, must be certified to admin Chemo, 48-72 hours patient has hazardous waste
Chemotherapy Side Effects
Immunosuppression - most significant. Monitor neutrophil/WBC
Neurological symptoms (confusion, brain fog)
GI symptoms (N/V)
Alopecia
Weight loss
Reproductive organs impacted - early menopause
N/V Nursing Management
Most common side effect of chemo
Give antiemetics (ondansetron, metoclopramide, dexamethasone)
Decrease food order, give small amount of bland food/fluids
Encourage high protein, high carb diet, SFF
medications to stimulate appetite
Mucositis (stomatitis) Nursing Actions
Encourage fluids and nonstimulant foods, avoid extremely hot/cold foods
Oral care- soft toothbrush
Oral cryotherapy - ice cube in mouth 30 min prior to chemo
Constipation Nursing Actions
High fiber diet
Encourage fluids
ambulate
stool softener as ordered
Diarrhea Nursing Actions
Low residue diet - small meals
encourage fluids
anti-diarrheal meds as ordered, probiotics containing lactobacillus
maintain good skin care
Anemia/Fatigue Nursing Actions
teach pt to avoid over exhaustion, conserve energy, rest
remain active
encourage adequate nutrition
O2 as ordered
colony stimulating factors as ordered - epoetin alfa (epogen, procrit)
Leukopenia Nursing Action
Assess absolute neutrophil count
good handwashing and hygene of patient
private room, no fresh flowers
was fruits and veggies, no raw eggs or meat
avoid crowds/sick people
good room ventilation
colony stimulating factors (filgrastrim (Neupogen), argramostim (Leukine))
Thrombocytopenia Nursing Actions
Observe for bleeding Apply pressure at venipuncture sites for 5 mins avoid IM or subQ injections Avoid sharp objects avoid use of NSAIDS platelets as ordered
Alopecia Nursing Management
Tell patient ahead of time
suggest scarves, hats, wigs
remind hair loss is temporary
Radiation Overview
Localized
- internal, external, systemic
Sealed Sources
- placed inside body
External Beam
- outside body
Stay away 6 ft. Thicker PPE
BPH
not cancer yet.
Prostrate enlargement
Decrease outflow of urine D/T urethra obstruction
Nodules in prostrate gland, hyperplasia of stromal/epithelial cells
bladder wall becomes thickend D/T incrased pressure of urine remaining in the bladder
androgen levels decreased with age
increased estrogen possible cause
BPH Risk Factors
- age (old age)
- diabetes
- overweight (d/t hormones stored in fat, increased intraabdominal pressure)
- erectile dysfunction (not cause BPH, BPH cause this)
- family hx
S&S of BPH
- weak urine stream
- frequent urination
- dribbling after urinating
- urge to urinate
- leakeage of urine
- nocturia
BPH Precautions
- reduce alcohol ( it contricts bladder)
- decrease salt (causes retention, UTI)
- do not allow bladder to get full
- perform kegal
- avoid use of androgens if sex steroid therapy
BPH Diagnostics
DRE (digital rectal exam) PSA Uroflow Bladder Scan Cystoscopy Prostate ultrasound
Pharmacology BPH
Alpha-Adrenergic Blockers
- Tamsulosin (flomax) - relax bladder muscle
- Terazosin (Hytrin) - relax BV
Alpha-Reductase inhibitors
- Finasteride (Proscar) - decrease size of prostrate
Surgery BPH
-Transurethral Needle Ablation (TUNA)
Shrinks prostrate, allows urine to flow
Foley for up to 4 weeks
may suffer from retrograde ejaculation
- Transurethral Resection of the prostate (TURP)
a lot of trauma/blood
continuous bladder irrigation
removal of prostate gland through penis
may suffer from retrograde ejaculation
TURP syndrome - excessive absorption of electrolyte-free irrigation fluids. Low Na. Life threatening
Postoperative Nursing Care
Avoid heavy lifting Avoid NSAID Void as soon as urge Drink 2000-3000 mL fluids/day avoid alcohol, caffeine, spicy foods
Prostate Cancer
Most common cancer in men
Adenocarcinoma
Prostate makes fluid for semen
metastasis common to lymph node/bones
Prostate Cancer Risk Factor
Age (D/T decreased androgen)
Race (african american, carribean)
family hx
obesitiy (high level of insulin like hormone)
smoking
environmental exposure (fertilizer, smoke)
diet (high dairy, processed meat)
Prostate Cancer Manifestation
asymptomatic early dysuria polyuria nocturia hematura/hematospermia discomfort/pain while sitting ED
Prostate Cancer Diagnostic
PSA DRE Early Prostate Cancer Antigen-2 (look for increased protein) Gleason Scale (higher # worse prognosis) trans rectal ultrasound
Pharmacology Treatment Prostate Cancer
- Hormone Therapy (most common)
- Androgen Suppression/deprivation therapy
- leuprolide acetate, degarelix
Anti-Androgens; androgen receptor blocker
- flutamide
Colon Cancer
most in rectum, sigmoid
adenomatous polyps develop into adenocarcinoma
Colon Cancer Risk Factor
IBD Family hx genetics (familial adeonmatous polyposis, lynch syndrome) lifestyle (sedentary) diet (high fat, low fiber) obesity alcohol/tobacco
Colon Cancer S&S
rectal bleeding
weight loss
changes in bowel habits
cramping, pain, anemia
Colon Cancer Treatment
Chemotherapy - leucovorin with fluorouricil
radiation - in combination with chemo
targeted therapy
immunotherapy - pembrolizumab
palliative care
Vascular Endothelial Growth Factor (vegf)
Targeted therapy
protein that helps tumor form new blood vessels - targeted drugs will stop)
Epidermal Growth Factor (EGFR)
protein that helps cancer cells grow - targeted drugs will block receptors
Endoscopic Mucosal Resection
for polyps > 10 mm (1 cm)
Health Screening Colon
sigmoidoscopy every 5 years or colonoscopy every 5-10 at age 50.
screenings start at age 45
Lung Cancer
leading cause of cancer death
mutation of damaged bronchial epithelial cells into neoplastic cells
chronic irritation - hyperplasia of goblet cells - cilia less effective
if irritation continuous basal cells proliferate
Risk Factors for Lung Cancer
smoking 2nd hand smoke radon environmental factors radiation therapy diet
S&S of lung cancer
persistant cough SOB coughing up blood weight loss repeated resp infections shoulder, arm, chest, back pain
lung cancer metasizes to spine
Lung Cancer Treatment
targeted drugs
immunotherapy - pembrolizumab
chemotherapy - methotrexate, cisplatin, paclitaxel
radiation
sx: lobectomy, pnumoectomy, wedge resection, segmental resection
Breast Cancer
most common cancer in women
overgrowth of cells cause tumor
noninvasive breast cancer
not yet spread into blood or lymphatic system
ductal carcinoma in situ - milk duct
lobular carcinoma in situ - milk gland
invasive breast cancer
spread to sorrounding breast tissue
invasive ductal carcinoma more common
invasive lobular carcinoma less common
risk factors breast cancer
gender age (40 +) hormones environmental family hx BRCA 1 BRCA 2
modifiable risk factors breast cancer
alcohol smoking sedentary oral contraception use of chemical hair products
manifestations of breast cancer
hard, immobile, irregular lump common on upper outer quaderant
abnormal nipple discharge/ rash
dimpling
nipple pain, ulceration, retraction
screening breast cancer
self exam
mammogram screening 40-44
annual 45-54
every other year 55+
Breast Cancer Pharmacotherapy
hormone therapy - selective estrogen receptor modulator
- tamoxifen citrate
targeted drugs - tratuzmab
chemotherapy - doxorubicin
radiation
postoperative care breast cancer
elevate effected arm prevent fluid accumulation pain med schedule promote lymphatic drainage ROM
Curative Care
purpose is to cure a disease
cure is acheivable
Palliative Care
comfort care
goal is to focus on quality of life for pt and family
includes prevention, relief, reduction
could transition to hospice
Hospice Care
care, comfort, quality of life with person with serious illness approaching end of life
six months or less left to live
final phase of palliative care
Self Determination Act 1990
law requiring health care to inform patient about advanced directive especially with terminal illness
done with social worker
required upon admission to health care institution by federal law
right to accept or refuse medical care
advanced directive
legal document
2 witness and notary required
planning for future care based on pt. values, belief, and preferences
no expiration under Ohio law
takes effect when patient permanently unconscious
medical power of attorney
legal document
patient designates individual to make all healthcare decisions
takes effect when patient can no longer make informed healthcare decisions
attending physician must certify patient is unable to make own decision
living will
“wishes”
legal document
states treatment preferences when patient unable to make decision/choices on own
describes under what conditions an attempt to prolong life should be started or stopped
DNR CC
person receive any care to alleviate suffering but no resuscitative measures to sustain life
DNR CC - Arrest
patient receive care until the time he/she experiences cardiac or respiratory arrest
abscense of palpable pulse
absence of spontaneous respiration
Assisted Suicide
end of life options act - california
physician can decline d/t moral, religious views
uniform determination of death act
defines death
irreversable cessation of circulatory and respiratory functions - clinical death
irreverseable cessation of all functions of brain including brain stem - biological death
Bereavement
Experience of losing a loved one
Grief
intense physical and psychological distress
avoidance (MOST Common)
confrontation - reality sinking in
restoration: restore balance
Coping
permission to feel loss accept social support be realistic about course of greiving remeber the deceased when ready, invest in new activities
Role of the nurse during end of life
6 C’s
care control composure communication continuity closure
Grief Reactions
denail/isolation anger bargaining depression acceptance
Caring For Client
effective communication
avoid too strict of a routine
encourge communication
explore with family ways to communicate with pt
Family Care
give little information at a time allow family to assist in non technical aspects of care encourge rest show acceptance of grief prepare family for changes
signs of imminent death
altered LOC (most common)
vitals decrease
changes in breathing (dyspnea, chyne stokes, death rattle)
skin changes (cyanosis, motling, xerostomia)
sensory changes - illusions, hallucination,dealusions of grandeur
near death awareness
give atropine/scopolamine for death rattle
Ethics definition
system of moral principles that attempt to determine what is right and wrong
morals definition
basic standards for what is considered right or wrong
defined by larger group or society
authority comes from outside individual
law reflects moral values of society
personal/private standards of right/wrong
values definition
personal beliefs about truth and worth that form our morals
values conflict: when we must choose between two things, both of which are important to use
values clarification definition
process of identifying, examining, developing invidual values
ongoing
ethical dilemma
when an individual must choose between two equally unfavorable alternatives
beneficence definition
obligation to do good, not harm
nonmaleficence definition
prohibition of intentional harm
justice definition
fairness, obligation to treat like cases similarly
fidelity definition
obligation to be faithful
keep promises
veracity definition
tell the truth, don’t intentionally mislead patient
Futility definition
do not have a potential for creating a positve outcome
deontology
morality of an action is based on the intention behind the decision rather than the outcome that results
utilitarianism
supports what is best for most people. The greater good. medicare. disaster triage
ANA Code of Ethics
statement of ethical obligation and duties of a nurse
non-negotiable ethical standards
guides the behavior of professional nurse
Provision 1
practice with compassion and respect
Provision 2
primary commitment is to the patient
Provision 3
nurse promotes and advocates for the rights of patient
Provision 4
responsibility and accountability for each nurse’s action belong to the nurse
Provision 5
maintain competence
Provision 6
responsible for ethical environment
Provision 7
advance nursing profession through research and scholarly inquiry
Provision 8
collaborates with others
Provision 9
maintain integrity of profession
Pneumonia Interventions
antibiotic, antifungal, antiviral bronchodilators mucolytics, expectorants IV fluids O2 diet high in protein rest chest physiotherapy
pneumonia manifestations
headache mood swings confusion dyspnea cough crackles sputum hemoptosis hypoxia tachycardia fever chills malaise
pneumonia pathophysiology
affects the parenchyma
caused by aspiration of particles through nasopharynx which get trapped in cilia and lead to aveolar edema. Causes hypoxia and dyspnea
Pneumonia Diagnostic Tests
CBC sputum culture urine test PCR CT scan
look for neutrophils
metabolic alkalosis causes
over use of antacids
diuretic therapy
loss of acid via GI tract
metabolic acidosis causes
diabetic ketoacidosis hyperchloremic aciosis kidney disease lactic acidosis aspirin poisoning dehydration starvation
Respiratory alkalosis causes
hyperventiliation
stimulation of respiratory center
exhaling too much CO2
respiratory acidosis causes
airway obstruction
depression of respiratory center
chronic respiratory problems
Uncompensated vs. partially compensated vs. fully compensated
Uncompensated: pH abnormal, either HCO3 or CO2 normal, either HCO3 or CO2 abnormal
Partially Compensated: pH abnormal, both CO2 and HCO3 abnormal
Full Compensation: pH normal, both CO2 and HCO3 abnormal
HCO3 Normal Range
22-28
above 28 = alkalosis
below 22 = acidosis
changes in HCO3 indicate metabolic disturbances
PaCO2
normal 35-45
above 45 = acidosis
below 35 = alkalosis
move in opposite direction of pH
indicate respiratory
pH
normal 7.35-7.45
less than 7.4 acidosis
greater than 7.4 alkalosis
COPD diagnostic findings
- ABG - respiratory acidosis CBC increased RBC decreased FEV1 decrease FVC increased RV increased airway resistance
diagnosed as FEV1/FVC ratio of less than 70% in addition to manifestations
Bronchitis Symptoms COPD
- productive cough
- cough that lasts longer than 3 months
- fatigue
- dyspnea
- cyanosis
- rhonci
COPD patho
bronchitis: loss of cilia leads to hypertrophy/hyper secretion in goblet cells/mucous glands. Chronic inflammation occurs and obstructs airflow
emphysema: yperinflation of lungs, respiratory acidosis
breakdown of elastin in lung tissue leads to increased size of airspace. Increase of alveolar space causes loss of elastic recoil, air trapping, and imbalance of lung proteases. Diffuse airway narrowing.
emphysema symptoms
- Wheezing
- Cough
- use of accessory muscles
- increased respiratory rate with prolonged expiratory phase
- anorexia/weight loss
- wheezing
Increased Intacranial Pressure Manifestations
increased BP
decreased MAP
slow breathing
What is the Monroe-Kellie Hypothesis?
Cerebral spinal fluid, intravascular blood, and brain tissue must all exist in equilibrium. If there is a change in any of these, it will result in IIP.
normal ICP
5-15
normal MAP value
65-105
normal CPP
50-100
What causes IIP?
- intracranial mass lesions (tumors)
- cerebral edema
- increased CSF production
- decreased CSF absorption
- obstructive hydrocephalus
- obstruction of venous outflow
- idopathic ICH
Cushings Triad
- HTN
- bradycardia because of compression of vegas nerve
- bradypnea because of compression of brain stem
IIP Clinical Manifestations
ALOC - most sensitive indicator
-headache, drowsiness, pupillary changes, widening pulse pressure, purposeless movements, hyperthermia (late stage), posturing
Mannitol
used for IIP
Osmotic Diuretic, pulls h2O out of brain. It begins to lower ICP in 1-5 minutes. Measure I&O while on it - normal urine 30 mL/hour
Thins blood
Starting dose 1.5-2 g/kg IV infusion
What is the pathophysiology of a stroke?
blood flow to an area of the brain is cut off
What are some risk factors for a stroke?
> 65, men, HTN, DM, smoking
ischemic vs hemorraghic stroke
ischemic: bloackage D/T tumor/clot
hemorrahic: bleeding into brain
What is a transient Ischemic attack?
a mini stroke. blood flow to the brain is blocked for only a short time. caused by blood clots. if not treated 10-15 % will have a major stroke within 3 months
What are some risk factors for a stroke?
lack of excercise, sleep apnea, heavy alcohol, smoking/drugs, diabetes, cardiovascular disease, high cholesterol, HBP, obesity
Stroke Pharmacology
Thrombolitics (TPA), blood thinners (anti-platelet, anticoagulants) - w/i 4 hours of stroke
BP lowering meds (ACE, ARB, B Blockers, Ca Channel blockers, diuretics)
Cholesterol lowering medications (fibrates, niacin, resins, statins)
What is TPA?
“clot buster” AKA alteplase. Gold standard for ISCHEMIC stroke, contraindicated for hemorrhagic.
Must lower SBP <185 and DBP <110
No major surgical procedures within 14 days
What is osteoporosis?
Chronic, progressive, metabolic bone disease resulting in decreased bone density. Bone reabsorption (osteoclast) exceeds bone deposition (osteoblast)
vitamin D an calcium deficient
Does osteoporosis have symptoms?
Yes, but it’s usually a silent disease
Symptoms are: height loss, dowager’s hump, low back pain, fragility related fractures
What are risk factors for osteoprosis?
After 35 women disease: DM, HTN, kidney disease Lifestyle Smoking Excessive alcohol: slows osteoblast and liver dysfunction - liver imp. for activating Vit. D Diet low in Ca Excessive caffeine : increased urination of Ca and Vit D
What medications are a risk factor for osteoporosis
Corticosteroids - affect absorption of Ca and increase osteoclast
Antiseizure drugs
Aluminum coated antacids
Excessive thyroid hormotes
What medication would be prescribed for osteoporosis?
Bisphosphanates (fosamax)
calcitonin (miacalcin)
Calcium and vitamin D
What is a good diet for someone with osteoporosis?
dairy, spinach, canned salmon, sardines
What are some preventive measures someone with osteoporsis can take?
Exercise - 30 min/day
Heat therapy
smoking cessation
avoid alcohol
what is osteoarthritis?
alteration of bone remodeling process. cartilage that cushions ends of bones wears down. Hands and weight bearing joints are effected. Caused idiopathic or secondary
OA clinical manifestations
pain with joint movement, stiffness, crepitus, hypertrophied joints, heberden’s node, bouchard’s node,
OA risk factors
Over 55 BMP Repetitive stress Women obesity work related - poor posture genetic influences
OA Diagnostic studies - Labratory
synovial fluid - remains clear/yellow
CRP increased
ESR increased
OA Pharmacology
Acetominophen: 4g/4000 mg /day
NSAID: watch for GI bleed
COX-2-Inhibitor: newer NSAID, antirheumatic
Corticosteroids: harmful effects on cartilege, only give 3-4 injections/year
Topical NSAID: Icy hot
Glucosimine, chondrotin: dietary supplement, decrease pain
Joint Surgery potential complications
DVT Compartment Syndrome - very painful Infection Bleeding - monitor H&H dislocation - position properly, proper transfer
What is Rheumatoid Arthritis?
Autoimmune disease
marked by periods of remission/exaceration
Effects small joints, synovial joint lining. Synovial fluid becomes inflammed
RA clinical manifestations
Early stage: paraesthesia, anorexia, night sweats, weakness, warm/swollen/painful joints, mild/moderate pain
Late stage: joint stiffness, atrophy, chronic pain, multiple organ involvement
RA Labratory Test
Rheumatoid Factor - increased CBC- WBC increased ANA: positive Anti-CCP antibodies - positive Synovial Fluid: cloudy
What is a good diet for someone with RA?
cardiac diet, low cholesterol, low sodium
RA pharmacology
NSAID, corticosteroids for acute exacerbation, DMARD
Politics definition
The way in which people in a society try to influence decision making and the allocation of resources (money, time, personnel)
Expert Power
possessing the knowledge/skill that someone else needs
legitimate power
power bestowed by a particular status or role
ex. RN license
referent power
gained by having others admiration/respect
reward power
anything desirable - promotion, award, etc.
coercive power
based on the ability to punish
8 ways to influence political process
- become informed
- vote for those who reflect views
- vote for officers
- express opinion through letters/public forum
- communicate directly with legislators
- work for or contribute to nursing organization or political action committee
- work for candidates who support your views
- testify
Hypoglycemia
Low blood sugar
less than 45-60
consider any unconcious person hypoglycemic
Hypoglycemia S&S
sweating pallor irritability hunger lack of coordination sleepiness
hypoglycemia management
15 g of fast acting carb - OJ, soda, milk, lifesavers, glucose tablet for MILD
for SEVERE glucagon, dextrose 50%
15/15 rule - check blood sugar, treat, wait 15 mins, recheck, repeat of <70
hyperglycemia
elevated blood glucose
180-200
DKA - greater than 250
HHS greater than 600
hyperglycemia S&S
dry mouth increased thirst weakness headache blurred vision polyuria
hyperglycemia management
maintain airway/o2
decrease BS - insulin drip, monitor blood glucose every 1-2 hours
improve dehydration
CAD Risk Factors
Age, gender, race, ethnicity, family history, DM, hyperlipidemia, HTN, smoking, inactivity, obesity, unmanaged stress
CAD Treatment Goals
Relieve chest pain, reduce extent of myocardial damage, maintain cardiovascular stability, manage risk factors
Nitrates
Treat angina. Produce coronary artery and peripheral vasodilation. Take 3.
What is a good diet for somebody with HTN?
low cal., low fat, low sodium
HTN risk factors
age, ethnicity, smoking, high salt intake, health problems, inactive lifestyle, alcohol, high stress, obesity
Pharmacology for HTN
diuretics: first drug of choice. Thiazide
beta blockers: “LOL”
ACE Inhibitor: “pril” block angiotensin which causes BV to open
angiotensin 2 receptor blcoekrs: “tan”
calcium channel blockers: amlodipine, diltiazem
Left Sided Heart Failure
Prevents delivery of oxygenated blood. Main cause of right sided heart failure. There are 2 types: systolic heart failure, diastolic heart failure
Left sided heart failure symptoms
- paroxysmal nocturnal dyspnea (most common)
- cough,
- pulmonary congestion: cough, crackles, wheezes, blood tinged sputum, tachapnea
- restlessness
- confusion
- tachycardia
- exertional dyspnea
- fatigue
- cyanosis
Systolic Heart Failure
- pumping problem
- reduced ejection fraction
- inability of heart to contract enough to push blood foward
- stretch and thin chambers 0 heart gets bigger
- increased afterload
- impaired contrile ability
- incompetent valves
- cardiomyopathy
Diastolic Heart Failure
- filling problem
- preserved ejection fraction - it could remain normal
- inability of left ventricle to relax, resulting in fluid backing up into lungs
- increased preload
- left ventriclular hypertrophy
Right Sided Heart Failure
- Oxygen depleted blood
- heart loses ability to move o2 depleted blood into lungs
- Caused by left sided heart failure
Right sided heart failure symptoms
- edema
- ascites
- fatigue
- enlarged liver and spleen
- distended jugular vein
- anorexia and GI distress
- weight gain
Heart Failure Pharmacotherapy
ace inhibitors: “pril”
beta blockers: “LOL”
diuretics
vasodilators
6 P’s of peripheral vascular disease
Pain Paresthesia poikilothermia paralysis pallor pulselessness
Peripheral Artery Disease
Narrow, weak, blocked arteries
Result of build up of fat and cholesterol
Arterioslerosis
Atheroslecrosi
athermatous plaque formation in intima of vessel –> calcification of medial layer and loss of elasticity –> inadequate blood supply to tissues leads to tissue hypoxia
PAD manifestations
Claudation
rest pain
ulceration
gangrene
PAD Risk Factors
CAD/PAD Diabetes HTN obesity smoking > 50
PAD Risk Factor Modifaction
Antiplatelet Therapy Lipid lowering agents glycemic control BP control smoking cessation lifestyle modication heart healthy diet Excercise
DVT
vein blockage or valve leakage in leg veins, blood flows back and pools in legs
hemdynamic changes/veno status –> endothelial injury/dysfunction –> hypercoagulability
DVT manifestions
edema, vericous veins, skin changes/discoloration, skin ulceration
DVT Risk Factors
> 50 obesity smoking family history hormonal fluctuation poor lyfestyle choices
DVT nursing management
avoid long periods of sitting or standing elevate legs exercise regularly lose weight hygiene
Pancreatitis
inflammation of pancreas - located LUQ behind stomach
autodigestion of pancreas, trypsin released too early
caused by:
Gallstone - most common - blocks bile duct
Alcoholism
Risk factors for pancreatitis
T: toxic - metabolic (alcohol) I: idiopathic (unknown) G: genetic A: autoimmune R: recurrent/sever acute pancreatitis
O: obstructive: gallstone, fat, tumor, duct scars
Pharmacotherapy Pancreatitis
NSAID (1st line), opioid analgesic, H2 Blockers, Proton Pump Inhibitor, Antibiotic (preventative), Pancreatic Enzymes
Nursing Management Pancreatitis
- Rest pancreas NPO
- NG tube, prevent intraabdominal pressure
- TPN
- high carb, high protein, low fat diet
- IV access
- Prevent hypovolemia (watch for fluid overload)
- assess I/O, skin turgor
- CIWA protocol
Peptic Ulcer Disease Patho
Disruption of the mucosal barrier of the stomach due to H Pylori or ulcer of the lining of the stomach, duodenum, lower esophagus
mucosal injury D/T increaed gastric acid HCL and Pepsin
etiology of PUD
- NSAID use (most common cause)
- alcohol, smoking, stress, antbiotic (docucycline, clindomycin)
- zollinger-ellison (tumor in pancrease which incrase hormone that stimulates stomach acid
Avoid with PUD
- chocolate
- coffee
- brined/fermented
- fatty
- spicy
- acidic
S&S of PUD
bloating, belching D/T distention N/V weight loss anemia D/T bleeding guaic positive ( check H&H)
Pharmacotherapy for PUD
antacids, H2 receptor agonist, PPI, cytoprotective agents, antibiotics
Complications of PUD
Pyloric Obstruction - anorexia, N/V Hemmorhage - anemia Perforation/Peritonitis (lethal!!!) - rigid, board like abdomen - rebound tenderness - no bowel sounds - hypotension, tachycardia, shallow respirations
Nursing Management of PUD
- V/S and I/O
- assess repirations and gastric status
- maintain NG tube
- observe for distention
- small, frequent meals
- minimize stress
IBD Patho
chronic inflammation of GI tract (autoimmune!!). Chrons or Ulcerative Colitis
Ulcerative Colitis S&S
Diarrhea, mucousy, bloody LLQ pain bloody stools fever (rare) anemia weight loss dehydration
Chron’s S&S
- always diarrhea
- abdominal pain (RUQ)
- steatorrhea
- fever
- anemia
- weight loss
- skip lesions
Nursing Management IBD
Diet
- NPO w/ IVF during flare up
- small, frequent meals low residue, lactose free, elemental
- high protein, high vitamin, high carlorie
IV access for antibiotics, transfusion
monitor V/S, I/O, daily weight, stool for occult blood, lab values
Educate: NO alcohol, NO smoking, LOW stress
