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NURS 1250 > Cancer/Final Exam > Flashcards

Cancer/Final Exam Flashcards

1
Q

Pathophysiology of Cancer

A

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)

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2
Q

Stages of cancer development

A

Initiation: irreversable mutation to DNA

Promotion: mutated cells stimulated to divide

Progression: increased growth (speed and invasiveness)

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3
Q

Normal Cells Vs. Cancer Cells

A

Normal cells: contact inhibition, develop differentiation, contribute to homeostasis

Cancer Cells: no contact inhibition, poorly differentiated (anaplastic - divide rapidly), do not contribute to homeostasis.

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4
Q

Benign Tumor

A 
Local (does not spread)
Well defined borders
pushes other tissue out of the way
slow growth
encapsulated
easily removed
does not tend to recur
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5
Q

Malignant Tumor

A 
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
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6
Q

How can tumors be classified?

A

I. origin
II. specific type of tissue it originates
III. grade
IV. stage - according to TNM system

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7
Q

carcinoma definition

A

cancer of epithelial tissue - most common

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8
Q

Sarcoma definition

A

cancer of connective and supportive tissue (bone, cartilege)

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9
Q

myeloma definition

A

plasma cells cancer (bone marrow)

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10
Q

leukemia definition

A

blood (aka liquid cancer)

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11
Q

lymphoma definition

A

lymph node cancer (AKA solid cancer)

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12
Q

Grading of cancer

A

higher the grade (grade 4) worse prognosis

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13
Q

Classification by stage

A

T: size of tumor (1-4)
N: lymph nodes (0-3)
M: metastases (0 or 1)

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14
Q

Calcium normal value

A

8.5-10

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15
Q

metabolic cancer complications

A

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
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16
Q

Hematologic Cancer Complications

A

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
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17
Q

Structural Cancer Complications

A

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

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18
Q

Diet to avoid cancer

A
  • avoid processed food
  • increase fiber
    eat balanced diet
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19
Q

Prevention of Cancer

A
  • healthy diet
  • smoking cessation
  • sunscreen
  • physically active
  • limit alcohol
  • regular screening
  • vaccinate against Hep B and HPV
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20
Q

Cancer Treatment Goals

A
  • cure
  • palliation
  • control
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21
Q

Chemotherapy Overview

A
  • treatment of choice for malignancies
  • systemic or local
  • cytotoxic drugs
  • interfere with DNA synthesis and mitosis
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22
Q

Chemotherapy Administration

A

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

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23
Q

Chemotherapy Side Effects

A

Immunosuppression - most significant. Monitor neutrophil/WBC

Neurological symptoms (confusion, brain fog)

GI symptoms (N/V)

Alopecia

Weight loss

Reproductive organs impacted - early menopause

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24
Q

N/V Nursing Management

A

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

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25
Q

Mucositis (stomatitis) Nursing Actions

A

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

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26
Q

Constipation Nursing Actions

A

High fiber diet

Encourage fluids

ambulate

stool softener as ordered

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27
Q

Diarrhea Nursing Actions

A

Low residue diet - small meals

encourage fluids

anti-diarrheal meds as ordered, probiotics containing lactobacillus

maintain good skin care

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28
Q

Anemia/Fatigue Nursing Actions

A

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)

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29
Q

Leukopenia Nursing Action

A

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))

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30
Q

Thrombocytopenia Nursing Actions

A 
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
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31
Q

Alopecia Nursing Management

A

Tell patient ahead of time
suggest scarves, hats, wigs
remind hair loss is temporary

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32
Q

Radiation Overview

A

Localized
- internal, external, systemic

Sealed Sources
- placed inside body

External Beam
- outside body

Stay away 6 ft. Thicker PPE

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33
Q

BPH

A

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

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34
Q

BPH Risk Factors

A
  • age (old age)
  • diabetes
  • overweight (d/t hormones stored in fat, increased intraabdominal pressure)
  • erectile dysfunction (not cause BPH, BPH cause this)
  • family hx
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35
Q

S&S of BPH

A
  • weak urine stream
  • frequent urination
  • dribbling after urinating
  • urge to urinate
  • leakeage of urine
  • nocturia
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36
Q

BPH Precautions

A
  • 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
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37
Q

BPH Diagnostics

A 
DRE (digital rectal exam)
PSA
Uroflow
Bladder Scan
Cystoscopy
Prostate ultrasound
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38
Q

Pharmacology BPH

A

Alpha-Adrenergic Blockers

  • Tamsulosin (flomax) - relax bladder muscle
  • Terazosin (Hytrin) - relax BV

Alpha-Reductase inhibitors
- Finasteride (Proscar) - decrease size of prostrate

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39
Q

Surgery BPH

A

-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
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40
Q

Postoperative Nursing Care

A 
Avoid heavy lifting
Avoid NSAID
Void as soon as urge
Drink 2000-3000 mL fluids/day
avoid alcohol, caffeine, spicy foods
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41
Q

Prostate Cancer

A

Most common cancer in men
Adenocarcinoma
Prostate makes fluid for semen
metastasis common to lymph node/bones

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42
Q

Prostate Cancer Risk Factor

A

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)

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43
Q

Prostate Cancer Manifestation

A 
asymptomatic early
dysuria
polyuria
nocturia
hematura/hematospermia
discomfort/pain while sitting
ED
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44
Q

Prostate Cancer Diagnostic

A 
PSA
DRE
Early Prostate Cancer Antigen-2 (look for increased protein)
Gleason Scale (higher # worse prognosis)
trans rectal ultrasound
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45
Q

Pharmacology Treatment Prostate Cancer

A
  • Hormone Therapy (most common)
  • Androgen Suppression/deprivation therapy
  • leuprolide acetate, degarelix

Anti-Androgens; androgen receptor blocker
- flutamide

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46
Q

Colon Cancer

A

most in rectum, sigmoid

adenomatous polyps develop into adenocarcinoma

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47
Q

Colon Cancer Risk Factor

A 
IBD
Family hx
genetics (familial adeonmatous polyposis, lynch syndrome)
lifestyle (sedentary)
diet (high fat, low fiber)
obesity
alcohol/tobacco
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48
Q

Colon Cancer S&S

A

rectal bleeding
weight loss
changes in bowel habits
cramping, pain, anemia

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49
Q

Colon Cancer Treatment

A

Chemotherapy - leucovorin with fluorouricil

radiation - in combination with chemo

targeted therapy

immunotherapy - pembrolizumab

palliative care

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50
Q

Vascular Endothelial Growth Factor (vegf)

A

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

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51
Q

Endoscopic Mucosal Resection

A

for polyps > 10 mm (1 cm)

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52
Q

Health Screening Colon

A

sigmoidoscopy every 5 years or colonoscopy every 5-10 at age 50.

screenings start at age 45

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53
Q

Lung Cancer

A

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

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54
Q

Risk Factors for Lung Cancer

A 
smoking
2nd hand smoke
radon
environmental factors
radiation therapy
diet
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55
Q

S&S of lung cancer

A 
persistant cough
SOB
coughing up blood
weight loss
repeated resp infections
shoulder, arm, chest, back pain

lung cancer metasizes to spine

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56
Q

Lung Cancer Treatment

A

targeted drugs

immunotherapy - pembrolizumab

chemotherapy - methotrexate, cisplatin, paclitaxel

radiation

sx: lobectomy, pnumoectomy, wedge resection, segmental resection

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57
Q

Breast Cancer

A

most common cancer in women

overgrowth of cells cause tumor

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58
Q

noninvasive breast cancer

A

not yet spread into blood or lymphatic system
ductal carcinoma in situ - milk duct
lobular carcinoma in situ - milk gland

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59
Q

invasive breast cancer

A

spread to sorrounding breast tissue
invasive ductal carcinoma more common
invasive lobular carcinoma less common

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60
Q

risk factors breast cancer

A 
gender
age (40 +)
hormones
environmental
family hx BRCA 1 BRCA 2
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61
Q

modifiable risk factors breast cancer

A 
alcohol
smoking
sedentary
oral contraception
use of chemical hair products
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62
Q

manifestations of breast cancer

A

hard, immobile, irregular lump common on upper outer quaderant

abnormal nipple discharge/ rash

dimpling

nipple pain, ulceration, retraction

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63
Q

screening breast cancer

A

self exam
mammogram screening 40-44
annual 45-54
every other year 55+

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64
Q

Breast Cancer Pharmacotherapy

A

hormone therapy - selective estrogen receptor modulator
- tamoxifen citrate

targeted drugs - tratuzmab

chemotherapy - doxorubicin

radiation

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65
Q

postoperative care breast cancer

A 
elevate effected arm
prevent fluid accumulation
pain med schedule
promote lymphatic drainage
ROM
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66
Q

Curative Care

A

purpose is to cure a disease

cure is acheivable

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67
Q

Palliative Care

A

comfort care
goal is to focus on quality of life for pt and family
includes prevention, relief, reduction
could transition to hospice

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68
Q

Hospice Care

A

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

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69
Q

Self Determination Act 1990

A

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

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70
Q

advanced directive

A

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

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71
Q

medical power of attorney

A

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

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72
Q

living will

A

“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

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73
Q

DNR CC

A

person receive any care to alleviate suffering but no resuscitative measures to sustain life

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74
Q

DNR CC - Arrest

A

patient receive care until the time he/she experiences cardiac or respiratory arrest

abscense of palpable pulse
absence of spontaneous respiration

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75
Q

Assisted Suicide

A

end of life options act - california

physician can decline d/t moral, religious views

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76
Q

uniform determination of death act

A

defines death
irreversable cessation of circulatory and respiratory functions - clinical death

irreverseable cessation of all functions of brain including brain stem - biological death

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77
Q

Bereavement

A

Experience of losing a loved one

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78
Q

Grief

A

intense physical and psychological distress

avoidance (MOST Common)
confrontation - reality sinking in
restoration: restore balance

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79
Q

Coping

A 
permission to feel loss
accept social support
be realistic about course of greiving
remeber the deceased
when ready, invest in new activities
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80
Q

Role of the nurse during end of life

A

6 C’s

care
control
composure
communication
continuity
closure
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81
Q

Grief Reactions

A 
denail/isolation
anger
bargaining
depression
acceptance
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82
Q

Caring For Client

A

effective communication
avoid too strict of a routine
encourge communication
explore with family ways to communicate with pt

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83
Q

Family Care

A 
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
84
Q

signs of imminent death

A

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

85
Q

Ethics definition

A

system of moral principles that attempt to determine what is right and wrong

86
Q

morals definition

A

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

87
Q

values definition

A

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

88
Q

values clarification definition

A

process of identifying, examining, developing invidual values
ongoing

89
Q

ethical dilemma

A

when an individual must choose between two equally unfavorable alternatives

90
Q

beneficence definition

A

obligation to do good, not harm

91
Q

nonmaleficence definition

A

prohibition of intentional harm

92
Q

justice definition

A

fairness, obligation to treat like cases similarly

93
Q

fidelity definition

A

obligation to be faithful

keep promises

94
Q

veracity definition

A

tell the truth, don’t intentionally mislead patient

95
Q

Futility definition

A

do not have a potential for creating a positve outcome

96
Q

deontology

A

morality of an action is based on the intention behind the decision rather than the outcome that results

97
Q

utilitarianism

A

supports what is best for most people. The greater good. medicare. disaster triage

98
Q

ANA Code of Ethics

A

statement of ethical obligation and duties of a nurse
non-negotiable ethical standards
guides the behavior of professional nurse

99
Q

Provision 1

A

practice with compassion and respect

100
Q

Provision 2

A

primary commitment is to the patient

101
Q

Provision 3

A

nurse promotes and advocates for the rights of patient

102
Q

Provision 4

A

responsibility and accountability for each nurse’s action belong to the nurse

103
Q

Provision 5

A

maintain competence

104
Q

Provision 6

A

responsible for ethical environment

105
Q

Provision 7

A

advance nursing profession through research and scholarly inquiry

106
Q

Provision 8

A

collaborates with others

107
Q

Provision 9

A

maintain integrity of profession

108
Q

Pneumonia Interventions

A 
antibiotic, antifungal, antiviral
bronchodilators
mucolytics, expectorants
IV fluids
O2
diet high in protein
rest
chest physiotherapy
109
Q

pneumonia manifestations

A 
headache
mood swings
confusion
dyspnea
cough
crackles
sputum
hemoptosis
hypoxia
tachycardia
fever
chills
malaise
110
Q

pneumonia pathophysiology

A

affects the parenchyma
caused by aspiration of particles through nasopharynx which get trapped in cilia and lead to aveolar edema. Causes hypoxia and dyspnea

111
Q

Pneumonia Diagnostic Tests

A 
CBC
sputum culture
urine test
PCR
CT scan

look for neutrophils

112
Q

metabolic alkalosis causes

A

over use of antacids
diuretic therapy
loss of acid via GI tract

113
Q

metabolic acidosis causes

A 
diabetic ketoacidosis
hyperchloremic aciosis
kidney disease
lactic acidosis
aspirin poisoning
dehydration starvation
114
Q

Respiratory alkalosis causes

A

hyperventiliation
stimulation of respiratory center
exhaling too much CO2

115
Q

respiratory acidosis causes

A

airway obstruction
depression of respiratory center
chronic respiratory problems

116
Q

Uncompensated vs. partially compensated vs. fully compensated

A

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

117
Q

HCO3 Normal Range

A

22-28

above 28 = alkalosis
below 22 = acidosis

changes in HCO3 indicate metabolic disturbances

118
Q

PaCO2

A

normal 35-45

above 45 = acidosis
below 35 = alkalosis

move in opposite direction of pH

indicate respiratory

119
Q

pH

A

normal 7.35-7.45

less than 7.4 acidosis
greater than 7.4 alkalosis

120
Q

COPD diagnostic findings

A 
- 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

121
Q

Bronchitis Symptoms COPD

A
  • productive cough
  • cough that lasts longer than 3 months
  • fatigue
  • dyspnea
  • cyanosis
  • rhonci
122
Q

COPD patho

A

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.

123
Q

emphysema symptoms

A
  • Wheezing
  • Cough
  • use of accessory muscles
  • increased respiratory rate with prolonged expiratory phase
  • anorexia/weight loss
  • wheezing
124
Q

Increased Intacranial Pressure Manifestations

A

increased BP
decreased MAP
slow breathing

125
Q

What is the Monroe-Kellie Hypothesis?

A

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.

126
Q

normal ICP

A

5-15

127
Q

normal MAP value

A

65-105

128
Q

normal CPP

A

50-100

129
Q

What causes IIP?

A
  • intracranial mass lesions (tumors)
  • cerebral edema
  • increased CSF production
  • decreased CSF absorption
  • obstructive hydrocephalus
  • obstruction of venous outflow
  • idopathic ICH
130
Q

Cushings Triad

A
  • HTN
  • bradycardia because of compression of vegas nerve
  • bradypnea because of compression of brain stem
131
Q

IIP Clinical Manifestations

A

ALOC - most sensitive indicator
-headache, drowsiness, pupillary changes, widening pulse pressure, purposeless movements, hyperthermia (late stage), posturing

132
Q

Mannitol

A

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

133
Q

What is the pathophysiology of a stroke?

A

blood flow to an area of the brain is cut off

134
Q

What are some risk factors for a stroke?

A

> 65, men, HTN, DM, smoking

135
Q

ischemic vs hemorraghic stroke

A

ischemic: bloackage D/T tumor/clot
hemorrahic: bleeding into brain

136
Q

What is a transient Ischemic attack?

A

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

137
Q

What are some risk factors for a stroke?

A

lack of excercise, sleep apnea, heavy alcohol, smoking/drugs, diabetes, cardiovascular disease, high cholesterol, HBP, obesity

138
Q

Stroke Pharmacology

A

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)

139
Q

What is TPA?

A

“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

140
Q

What is osteoporosis?

A

Chronic, progressive, metabolic bone disease resulting in decreased bone density. Bone reabsorption (osteoclast) exceeds bone deposition (osteoblast)

vitamin D an calcium deficient

141
Q

Does osteoporosis have symptoms?

A

Yes, but it’s usually a silent disease

Symptoms are: height loss, dowager’s hump, low back pain, fragility related fractures

142
Q

What are risk factors for osteoprosis?

A 
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
143
Q

What medications are a risk factor for osteoporosis

A

Corticosteroids - affect absorption of Ca and increase osteoclast
Antiseizure drugs
Aluminum coated antacids
Excessive thyroid hormotes

144
Q

What medication would be prescribed for osteoporosis?

A

Bisphosphanates (fosamax)
calcitonin (miacalcin)
Calcium and vitamin D

145
Q

What is a good diet for someone with osteoporosis?

A

dairy, spinach, canned salmon, sardines

146
Q

What are some preventive measures someone with osteoporsis can take?

A

Exercise - 30 min/day
Heat therapy
smoking cessation
avoid alcohol

147
Q

what is osteoarthritis?

A

alteration of bone remodeling process. cartilage that cushions ends of bones wears down. Hands and weight bearing joints are effected. Caused idiopathic or secondary

148
Q

OA clinical manifestations

A

pain with joint movement, stiffness, crepitus, hypertrophied joints, heberden’s node, bouchard’s node,

149
Q

OA risk factors

A 
Over 55
BMP
Repetitive stress
Women
obesity
work related - poor posture
genetic influences
150
Q

OA Diagnostic studies - Labratory

A

synovial fluid - remains clear/yellow
CRP increased
ESR increased

151
Q

OA Pharmacology

A

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

152
Q

Joint Surgery potential complications

A 
DVT
Compartment Syndrome - very painful
Infection
Bleeding - monitor H&H
dislocation - position properly, proper transfer
153
Q

What is Rheumatoid Arthritis?

A

Autoimmune disease
marked by periods of remission/exaceration
Effects small joints, synovial joint lining. Synovial fluid becomes inflammed

154
Q

RA clinical manifestations

A

Early stage: paraesthesia, anorexia, night sweats, weakness, warm/swollen/painful joints, mild/moderate pain

Late stage: joint stiffness, atrophy, chronic pain, multiple organ involvement

155
Q

RA Labratory Test

A 
Rheumatoid Factor - increased
CBC- WBC increased
ANA: positive
Anti-CCP antibodies - positive
Synovial Fluid: cloudy
156
Q

What is a good diet for someone with RA?

A

cardiac diet, low cholesterol, low sodium

157
Q

RA pharmacology

A

NSAID, corticosteroids for acute exacerbation, DMARD

158
Q

Politics definition

A

The way in which people in a society try to influence decision making and the allocation of resources (money, time, personnel)

159
Q

Expert Power

A

possessing the knowledge/skill that someone else needs

160
Q

legitimate power

A

power bestowed by a particular status or role

ex. RN license

161
Q

referent power

A

gained by having others admiration/respect

162
Q

reward power

A

anything desirable - promotion, award, etc.

163
Q

coercive power

A

based on the ability to punish

164
Q

8 ways to influence political process

A
  1. become informed
  2. vote for those who reflect views
  3. vote for officers
  4. express opinion through letters/public forum
  5. communicate directly with legislators
  6. work for or contribute to nursing organization or political action committee
  7. work for candidates who support your views
  8. testify
165
Q

Hypoglycemia

A

Low blood sugar
less than 45-60
consider any unconcious person hypoglycemic

166
Q

Hypoglycemia S&S

A 
sweating
pallor 
irritability
hunger
lack of coordination
sleepiness
167
Q

hypoglycemia management

A

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

168
Q

hyperglycemia

A

elevated blood glucose
180-200
DKA - greater than 250
HHS greater than 600

169
Q

hyperglycemia S&S

A 
dry mouth
increased thirst
weakness
headache
blurred vision
polyuria
170
Q

hyperglycemia management

A

maintain airway/o2
decrease BS - insulin drip, monitor blood glucose every 1-2 hours
improve dehydration

171
Q

CAD Risk Factors

A

Age, gender, race, ethnicity, family history, DM, hyperlipidemia, HTN, smoking, inactivity, obesity, unmanaged stress

172
Q

CAD Treatment Goals

A

Relieve chest pain, reduce extent of myocardial damage, maintain cardiovascular stability, manage risk factors

173
Q

Nitrates

A

Treat angina. Produce coronary artery and peripheral vasodilation. Take 3.

174
Q

What is a good diet for somebody with HTN?

A

low cal., low fat, low sodium

175
Q

HTN risk factors

A

age, ethnicity, smoking, high salt intake, health problems, inactive lifestyle, alcohol, high stress, obesity

176
Q

Pharmacology for HTN

A

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

177
Q

Left Sided Heart Failure

A

Prevents delivery of oxygenated blood. Main cause of right sided heart failure. There are 2 types: systolic heart failure, diastolic heart failure

178
Q

Left sided heart failure symptoms

A
  • paroxysmal nocturnal dyspnea (most common)
  • cough,
  • pulmonary congestion: cough, crackles, wheezes, blood tinged sputum, tachapnea
  • restlessness
  • confusion
  • tachycardia
  • exertional dyspnea
  • fatigue
  • cyanosis
179
Q

Systolic Heart Failure

A
  • 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
180
Q

Diastolic Heart Failure

A
  • 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
181
Q

Right Sided Heart Failure

A
  • Oxygen depleted blood
  • heart loses ability to move o2 depleted blood into lungs
  • Caused by left sided heart failure
182
Q

Right sided heart failure symptoms

A
  • edema
  • ascites
  • fatigue
  • enlarged liver and spleen
  • distended jugular vein
  • anorexia and GI distress
  • weight gain
183
Q

Heart Failure Pharmacotherapy

A

ace inhibitors: “pril”
beta blockers: “LOL”
diuretics
vasodilators

184
Q

6 P’s of peripheral vascular disease

A 
Pain
Paresthesia
poikilothermia
paralysis
pallor
pulselessness
185
Q

Peripheral Artery Disease

A

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

186
Q

PAD manifestations

A

Claudation
rest pain
ulceration
gangrene

187
Q

PAD Risk Factors

A 
CAD/PAD
Diabetes
HTN
obesity
smoking
> 50
188
Q

PAD Risk Factor Modifaction

A 
Antiplatelet Therapy
Lipid lowering agents
glycemic control
BP control
smoking cessation
lifestyle modication heart healthy diet
Excercise
189
Q

DVT

A

vein blockage or valve leakage in leg veins, blood flows back and pools in legs

hemdynamic changes/veno status –> endothelial injury/dysfunction –> hypercoagulability

190
Q

DVT manifestions

A

edema, vericous veins, skin changes/discoloration, skin ulceration

191
Q

DVT Risk Factors

A 
> 50
obesity
smoking
family history
hormonal fluctuation
poor lyfestyle choices
192
Q

DVT nursing management

A 
avoid long periods of sitting or standing
elevate legs
exercise regularly
lose weight
hygiene
193
Q

Pancreatitis

A

inflammation of pancreas - located LUQ behind stomach

autodigestion of pancreas, trypsin released too early

caused by:
Gallstone - most common - blocks bile duct
Alcoholism

194
Q

Risk factors for pancreatitis

A 
T: toxic - metabolic (alcohol)
I: idiopathic (unknown)
G: genetic
A: autoimmune
R: recurrent/sever acute pancreatitis

O: obstructive: gallstone, fat, tumor, duct scars

195
Q

Pharmacotherapy Pancreatitis

A

NSAID (1st line), opioid analgesic, H2 Blockers, Proton Pump Inhibitor, Antibiotic (preventative), Pancreatic Enzymes

196
Q

Nursing Management Pancreatitis

A
  • 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
197
Q

Peptic Ulcer Disease Patho

A

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

198
Q

etiology of PUD

A
  • NSAID use (most common cause)
  • alcohol, smoking, stress, antbiotic (docucycline, clindomycin)
  • zollinger-ellison (tumor in pancrease which incrase hormone that stimulates stomach acid
199
Q

Avoid with PUD

A
  • chocolate
  • coffee
  • brined/fermented
  • fatty
  • spicy
  • acidic
200
Q

S&S of PUD

A 
bloating, belching D/T distention
N/V
weight loss
anemia D/T bleeding
guaic positive ( check H&H)
201
Q

Pharmacotherapy for PUD

A

antacids, H2 receptor agonist, PPI, cytoprotective agents, antibiotics

202
Q

Complications of PUD

A 
Pyloric Obstruction
- anorexia, N/V
Hemmorhage
- anemia
Perforation/Peritonitis (lethal!!!)
- rigid, board like abdomen
- rebound tenderness
- no bowel sounds
- hypotension, tachycardia, shallow respirations
203
Q

Nursing Management of PUD

A
  • V/S and I/O
  • assess repirations and gastric status
  • maintain NG tube
  • observe for distention
  • small, frequent meals
  • minimize stress
204
Q

IBD Patho

A

chronic inflammation of GI tract (autoimmune!!). Chrons or Ulcerative Colitis

205
Q

Ulcerative Colitis S&S

A 
Diarrhea, mucousy, bloody
LLQ pain
bloody stools
fever (rare)
anemia
weight loss
dehydration
206
Q

Chron’s S&S

A
  • always diarrhea
  • abdominal pain (RUQ)
  • steatorrhea
  • fever
  • anemia
  • weight loss
  • skip lesions
207
Q

Nursing Management IBD

A

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

NURS 1250 (6 decks)

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