End-Stage Disease Process Flashcards
1
Q
Pleural effusion: occurs
A
when there is a discrepancy between the secretion and absorption of fluid in the pleural space
2
Q
Pleural effusion: secretion rates
A
increased and/or fluid absorption becomes restsricted, causing excessive fliud to collect
3
Q
Pleural effusion: onset
A
can be slow or rapid
4
Q
Pleural effusion: patient present with ?
A
dyspnea
5
Q
Pleural effusion: dyspnea
A
results from the collapse of the lung due to increased pleural fluid pressure inability to expand lung leads to complaints of dyspnea
6
Q
Pleural effusion: as affected area increases
A
dyspnea distress increases orthopnea ( breathlessness in the recumbent position) tachypnea anorexia malaise and fatigue
7
Q
Pleural effusion: pt c/o
A
dry, nonproductive cough aching, heaviness, or dull pain in chest
8
Q
Pleural effusion: treatment
A
palliative and symtomatic in nature dependent on: surrounding circumstances overall patient condition proximity to death
9
Q
Pericardial effusion: definition
A
accumulation of fluid or tumor cells within the pericardial sac
10
Q
Pericardial effusion: affect
A
nearly 20% of patients with lung cancer during advanced stages of disease patienbts with
11
Q
Pericardial effusion: associated with
A
breast cancer leukemia lymphoma
12
Q
Pericardial effusion: prognosis
A
poor
13
Q
Pericardial effusion: caused by
A
cancerous cells treatments used for malignancies nonmalignant causes
14
Q
Pericardial effusion: identifying causes
A
pericarditis congestive heart failure uremia myocardial infarction autoimmune disease infections hypothyroidism renal and hepatic failure
15
Q
Pericardial effusion: clinical signs dependent on
A
amount of fluid how quickly it accumulates general health of cardiac tissue
16
Q
Pericardial effusion: most common symptom
A
dyspnea patient may be unable to speak more than one word with each breath
17
Q
Pericardial effusion: symptoms
A
dyspnea chest heaviness dry cough generalized weakness tachycardia
18
Q
Pericardial effusion: tachycardia
A
body tries to compensate for the reduced cardiac output
19
Q
Hemoptysis: definition
A
expectoration of blood from lower respiratory tract
20
Q
Hemoptysis: occcurs
A
in patients with advanced cancer because of metastasis or infection
21
Q
Hemoptysis: cause
A
advanced cancer with metastasis infections bronchitis
22
Q
Hemoptysis: initial assessment
A
distinguish from gastrointestinal and nasopharyngeal bleeding
23
Q
Hemoptysis: signs and symptoms
A
cough dyspnea wheezing chest pain fever night sweats weight loss
24
Q
Hemoptysis: severity
A
determined by amount of blood produced within a 24 hour period
25
Hemoptysis: mild
production of less than 15-20 ml of blood within 24 hours
26
Hemoptysis: moderate
expectoration of greater than 20 ml, but less than 200 ml
27
Hemoptysis: massive
200 to 600 ml within 24 hour period occurs in fewer than 5% of cases, but is life-threatening and associated with 85% mortality rate
28
Hemoptysis: primary risk
asphyxiation from blood clots in airway
29
Superior vena cava syndrome: definition
result of a partial occlusion of the superior vena cava
30
Superior vena cava syndrome: results
decreased blood flow from the head and neck to the right atrium
31
Superior vena cava syndrome: cause
cancerous growths
32
Superior vena cava syndrome: considered
emergency condition
33
Superior vena cava syndrome: symptoms
headache facial edema hoarseness dyspnea swollen arms
34
Superior vena cava syndrome: rapid onset
loss of circulation can be life-threatening
35
Superior vena cava syndrome: onset
rapid or acute
36
Superior vena cava syndrome: subtle signs
swelling in morning hours increasing discomfort with bending forward or stooping
37
Superior vena cava syndrome: common complaine
dyspnea
38
Superior vena cava syndrome: physical findings
vein distention in neck and chest ruddy complexion or cyanosis tachypnea stridor orthopnea hoarseness nasal stuffiness periorbital and conjunctival edema
39
Superior vena cava syndrome: progressing symptoms
mental status changes
40
Superior vena cava syndrome: mental status changes
progressing from a stupor, coma, and seizures until time of death
41
Hypercalcemia: definition
overabundance of ionized calcium in the blood
42
Hypercalcemia: occurs
in up to 10% of cancer patients
43
Hypercalcemia: highest rates of occurrence
breast cancer multiple myeloma
44
Hypercalcemia: causes
hyperparathyroidism lithium therapy vitamin D milk-alkali syndrome
45
Hypercalcemia: untreated
50% mortality rate
46
Hypercalcemia: symptoms depend on
amount of excess calcium
47
Hypercalcemia: untreated
irreversible renal damage coma death
48
Hypercalcemia: presenting complaints
fatigue lethargy nausea polyuria confusion
49
Hypercalcemia:left unchecked
combination of nausea and polyuria can again increase concentrations of calcium in blood through dehydration
50
Hypercalcemia: symptoms
vomiting anorexia constipation
51
Hypercalcemia:electrocardiogram
show evidence of a shortened QT interval and possible arrhythmias
52
Hypercalcemia: assessments
avoid attaching symptoms to other disease processes in the already ill patient
53
Hypercalcemia: treatment to lower calcium levels
hydration with saline bisphosphonates diuretics glucocorticoids
54
Death pronouncement: prior
to time of death, a plan should be in place for who will be contacted when death occurs, regardless of location
55
Death pronouncement: procedures
vary between state to state
56
Death pronouncement: nurses
vary by state
57
Death pronouncement: inpatient setting
organizational policy should be follwed
58
Death pronouncement: hospice setting
nurse makes a visit for patient assessment
59
Death pronouncement: nurse visit
patient assessment verbally conveys absence of vital signs and pertinent information to physician contacts funeral home or mortuary may be necessary to contact police or coroner
60
Death pronouncement: contact coroner
if circumstances of death were unusual, associated with a traumatic event, or occurred within 24 hours of hospital admission
61
Central ascites: cause
results from compressoin of the portal venous or lymphatic system compression from tumor invasion
62
Central ascites: process
decrease in pressure as a result of limited limited protein intake and the catabolic state associated with cancer
63
Peripheral ascites: cause
results from deposits of tumor cells on the parietal or visceral peritoneum blockage occurs at this level rather than in the liver parenchyma
64
Peripheral ascites: presence of macrophages
increases capillary permeability and contributes to increasing fluid retention
65
Mixed type ascites: definition
combination of both peripheral and central ascites
66
Types of ascites
central peripheral mixed chylous malignant malignant
67
Chylous malignant: defintion
occurs when cancer cells invade the retroperitoneal space, causing lymph flow obstruction for the lymph nodes or pancreas
68
Malignant ascites
generally has poor prognosis
69
Malignant ascites: tumor cells
make difficult to reduce fluid accumulation
70
Ascites: cancer associated with
ovarian endometrial breast colon gastric pancreatic
71
Ascites: less common sources
mesothelioma non-Hodgkin lymphoma prostate cancer
72
AIDS dementia complex: cause
exact cause unknown
73
AIDS dementia complex: result
primary result of disease process itself
74
AIDS dementia complex: theory of cause
HIV infection stimulates an invasion of macrophages in brain (microglia) These release cytokines that directly damage nervous tissue by disrupting neurotransmitter functions cause encephalopathy
75
AIDS dementia complex: affects
15% of all AIDS patients
76
AIDS dementia complex: prognosis
poor disease not reversible
77
AIDS dementia complex: retrovirals
can delay onset
78
AIDS dementia complex: children
CNS HIV infection in children tends to have a more dramatic and pronounced effect than that in adults
79
AIDS dementia complex: Characterized by
gradual memory loss decreased concentration decreased cognition mood disorders
80
AIDS dementia complex: physical symptoms
ataxia incontinence seizures
81
Amyotrophic lateral sclerosis: defintion
rapidly progressing degenerative neuromuscular disease with an unknown origin
82
Amyotrophic lateral sclerosis: main area of involvement
motor neurons of the brain and spinal cord
83
Amyotrophic lateral sclerosis: first symptom
about half of patients will have difficulty swallowing
84
Amyotrophic lateral sclerosis: common symptom
distal weakness
85
Amyotrophic lateral sclerosis: progression
weakness affects both upper and lower neurons
86
Amyotrophic lateral sclerosis: death results from
respiratory failure due to weakness in the diaphragm decreased laryngeal and lingual functionality
87
Amyotrophic lateral sclerosis: high concern
swallowing and oral nourishment loss of motility in tongue and hypopharynx
88
Amyotrophic lateral sclerosis: loss of motility in tongue and hypopharynx: result
in loss of ability to manipulate food creates speech and communication barriers
89
Parkinson: definition
common disease of CNS
90
Parkinson: progressoin
slow progression of motor skill compli8cations
91
Parkinson: motor skill complications
resting tremors excessive slowness in activity rigidity
92
Parkinson: classic signs
pill-rolling movements in hands loss of facial expression difficulty initiating movements gait changes
93
Parkinson: initial s/s
generalized weakness aching fatigue malaise slight tremor of extremity
94
Parkinson: symptoms result from
imbalance between dopamine-activated and acetylcholine-activated neural pathways in basal ganglia
95
Parkinson: symptoms found in population
older than 65 years
96
Parkinson-like symptoms caused by
medication toxicity head trauma other degenerative conditions
97
Leukemia: classified as
acute chronic
98
Leukemia: classification dependent on
type of cell that it originates from and the genetic chromosomal or growth factor deviation present in malignant cells
99
Leukemia: hematological malignancies
evolve from immature blood cells, multiplying profusely and compromising the integrity of normal blood cells
100
Leukemia: clinical findings
infection anemia fever enlarged liver, spleen, kidneys
101
Leukemia: pain/tenderness
over sternum or other bones and joints
102
Leukemia: s/s
pallor petechia purpura anemia infection hemorrhage
103
Palliative sedation: definition
is a treatmennt method focused on controlling and easing symptoms that have proven otherwise refractory or unendurable in nature
104
Palliative sedation: originally named
terminal sedation
105
Palliative sedation: emphasis
differences between symptom management and euthanasia
106
Palliative sedation: purpose
symptom control does not hasten or cause death
107
Palliative sedation: medications
midazolam propofol
108
Palliative sedation: relief provided
through varying levels of unconsciousness
109
Palliative sedation: used for
calm persistent agitation and restlessness pain control confusion shortness of breath muscle twitching or seizures anguish
110
Lymphoma: presents as
Hodgkin disease non-Hodgkin lymphoma
111
Lymphoma: s/s
painless lymph node swelling (may become painful after alcohol consumption) generally in upper body general fatiuge rapid and unexplained weight loss intermittent fevers significant night sweats frequent infections itching without an apparent rash unexplained back pain
112
Lymphoma: complaints
upset stomach bowel changes
113
Lymphoma: physical assessment
enlarged liver or spleen
114
Lymphoma: less common s/s of non-Hodgkin
night sweats itching
115
Lymphoma: s/s later stages
anemia thrombocytopenia
116
End stage liver failure: s/s
fatigue ascites jaundice
117
End stage liver failure: s/s result from
low or nonfunctional lymphatic system
118
End stage liver failure: complications
itching dark colored urine gray- or clay-colored stool easy bruising internal bleeding mental confusion (encephalopthy) hepatic coma
119
End stage liver failure: urgent conditions
sudden fever over 101 dyspnea evident or suspected internal bleeding severe abdominal pain severe dehydratoin
120
End stage liver failure: treatment
palliative care for symptoms patients would require liver transplant to survive
121
SVC Syndrome
122
AIDS virus: attaches to
CD4 cell surface protein of T-4 lymphocytes with a viral envelope of glycoprotein (gp120)
123
AIDS virus: CD4 cell surrface protein
binds to CD4 receptors and coreceptors (CXCR4 and CCR5)
124
HIV virus: type
retrovirus that quickly infects circulating immune cells
fijnds safe harbor in body reservoirs that are inaccessible to drug therapy
125
HIV: retrovirus enzyme
enzyme called reverse transcriptase to convert the HIV viral RNA to a viral DNA
126
127
HIV: reverse transcriptase
allows viral DNA to take over the host cell DNA of lymphocytes, macrophages and other immune system cells
128
HIV: viral DNA produces
viral proteins that assemble into virions using viral enzyme protease
129
HIV: reproductive cycle
can produce up to 100 billion virions with minor protective mutations
130
HIV: disease severity
CD4 count
131
HIV: CD4 count \< 500 cells/mm3
found in early symptomatic stage
132
HIV: CD4 count\<200 cells/mm3 + viral load greater than 100,000
late symptomatic stage
133
Terminal weaning: definition
slow withdrawal of life-supporting ventilators
134
Terminal weaning: performed by
gradually reducing the amount of inspired oxygen (FIO2)
and/or
programmed ventilator rate
135
Terminal weaning: leads to
developement of hypoxemia and hypercarbia that is fatal to patient
136
Terminal weaning: occurs
gradually over many hours
137
Terminal extubation: definition
abrupt withdrawal of the endotracheal tube and subsequently the mechanical ventilator support
138
Terminal extubation: causes
death, because patient is dependent on it for life
139
Terminal extubation: initiated after
administration of sedative and/or analgesics to patient
140
Cerebral metastases: occurs
in up to 40% of all cancer patients
141
Cerebral metastasis: neurological changes
may be first idnetified symptoms in some silent forms of cancer
142
Cerebral brain metastasis: s/s
headaches
nausea and vomiting
confusion
lethargy
143
Cerebral brain metastasis: headache
intial complaint in 50% of all patients
144
Cerebral brain metastasis: headache: caused by
increased intracranial pressure from tumor growth, brain swelling, or a blockage on the cerebral spinal fulid pathway (hydrocephalus)
145
Cerebral metastasis: tumor
can cause location-specific weakness
numbness
language deficits
visual disturbances
other stroke-like symptoms
seizures (15% of patients)
146
Cerebral metastasis: Behavior changes
depression
apathy
memory problems
changes in personality
147
Advanced renal cancer: early s/s
occur asymptomatically in the early stages
148
Advanced renal cancer: symtoms begin
as conditiojn worsens
149
Advanced renal cancer: first s/s
gross hematuria
dull aching pain
palpable abdominal mass
150
Advanced renal cancer: s/s of well advanced cancer
All three are present:
hematuria
dull aching pain
palpable abdominal mass
151
Advanced renal cancer: most common s/s
hematuria
152
Advanced renal cancer: hematuria
most common symptom
may not be noticed unti lit has reached the gross stage where it is visible to the naked eye
153
Advanced renal cancer: other late s/s
fever
anemia
weight loss
night sweats
elevated erythrocyte sedimentation rate
dyspnea
hypertension
hypercalcemia
polycythemia
154
Advanced renal cancer: polycythemia
excess of red blood cells causes
headaches
dizziness
vein inflammation
itchiness
general feeling of bloating
155
Advanced renal cancer: hypercalcemia casues
tiredness
decreased appetite
frequent urination
thirst
nausea and vomiting
confusion
difficulty concentrating
constipation
156
AIDS patient susceptible to
bacterial
viral
fungal
parasitic infections
types of cancers
157
158
AIDS patient: types of cancer
kaposi sarcoma
CNS
non-Hodgkin lymphoma
159
AIDS patient: bacterial infections
Streptococcus pneumoniae
myocbacterium avium-intracellulare
nyobacterium avium complex
tuberculosis
salmonellosis
syphilis
bacillary angiomatosis
160
AIDS patient: viral infections
cytomegalovirus
viral hepatitis
herpes simplex
human papillomavirus
progressive multifocal leukoencephalopathy
161
AIDS patient: fungal infections
candida albicans
histoplasma capsulatum
cryptococcal meningitis
162
AIDS patient: parasitic infections
pneumocystis carinii pneumonia
toxoplasmosis
cryptosporidium
163
AIDS patient: rate of infection
exceed rates found within the general population
164
Cutaneous malignancy: assessment
location
wound appearance
surrounding skin
itching or deep or superficial pain
when is it most noticeable
potential complications
165
Cutaneous malignancy: location of wound
does location impair mobility or areas that are difficult to dress?
166
Cutaneous malignancy: wound appearance
size
color
tunneling
% of viable and necrotic tissues
bleeding and exudates
odor and presence of infection
167
Cutaneous malignancy: wound appearance affects
type of treatment and bandage types that may be needed
168
Cutaneous malignancy: assess surrounding skin for
redness
fragility
nodular
macerated
radition-related damage
169
Cutaneous malignancy: assess surrounding skin to determine
extent of tissue damage or metastasis
170
Cutaneous malignancy: pain?
is there itching or deep or superficial pain
including aching, stabbing, burning, or stinging
when is it most noticeable?
171
172
Cutaneous malignancy: potential complications
nearby major blood vessels, organs, airway
potential for hemorrhage, vessel obstruction or compromised airway
173
Death Rattle: definition
term used to describe gurgling or rattling noise made from accumulation of excessive secretoins in throat
174
Death rattle: assciated with
last stages of dying process
175
Death rattle: patient lacks
inability to swallow secretions causing buildup of fluid
176
Death rattle: medications
anticholinergic agents
177
Death rattle: anticholinergic agents
antisecretory properties
should be given at first sign of moisture
can stop further buildup but can't dry up secretions already present
178
Death rattle: fluids may be removed by
suction or oral care
179
Death rattle: medication names
scopolamine
hyoscine hydrobromide
atropine
180
Bladder contractility: agents used to decrease
extended-release agents
anticholinergics
181
Bladder contractility: extended release and transdermal agents
tolterodine (extended-release)
trospium cholride (extended-release)
oxybutynin (extended-release and tr4ansdermal)
182
Bladder contractility: tolterodine dose
2 - 4 mg
183
Baldder contractility: trospium chloride: dose
20 mg
184
Bladder contracility: oxybutynin dose
extended-release 5-15 mg
transdermal patch 3.9mg
185
Bladder contractility: anticholinergics
propantheline
oxybutynin (immediate release)
hyoscyamine (tablets or sublingual)
dicyclomine hydrochloride
flavoxate
belladonna
opium suppositories
186
Bladder contractility: propantheline dose
7.5 - 30 mg
187
Bladder contractility: immediate release oxybutynin
7.5- 15 mg
188
Bladder contractility: hyoscyamine dose
0.125 mg--.375 mg
189
Bladder contractility: dicyclomine hydrochloride: dose
10 - 20 mg
190
Bladder contractility: flavoxate: dose
100 mg
191
Bladder contractility: medications MOA
work to decrease frequency of uination urges and/or increase bladder capacity
192
Bladder contractility: medication S/E
dry mouth
flushing
constipation
drowsiness
blurred vision
193
Stress urinary incontinence: medications
Tricyclic antidepressants:
pseudoephedrine
imipramine
194
Hemorrhagic cystitis: medications
aminocaproic acid
silver nitrate and alum (ammonium or potassium salt)
formalin (aqueouis formaldehyde)
195
Hemorrhagic cystitis: aminocaproic acid: dose
loading dose of 5 g orally or parenterally
followed by hourly doses of 1 to 1.25 g
196
Hemorrhagic cystitis: aminocaproic acid: MOA
acts as a fibrinolysis inhibitor
197
Hemorrhagic cystitis: aminocaproic acid: risk
clot retention
decreased blood pressure
198
Hemorrhagic cystitis: aminocaproic acid: do not use
in patients with upper urinary tract bleeding or vesicoureteral reflux
199
Hemorrhagic cystitis: aminocaproic acid: time for treatment
to take effect is 8-12 hours
200
Hemorrhagic cystitis: silver nitrate and alum: administer
in an irrigation solution
intermittently or continuously
201
Hemorrhagic cystitis: silver nitrate and alum: causes
chemical cauterization of vessels
may cause functional obstruction or aluminum toxicity
202
Hemorrhagic cystits: silver nitrate and alum: irrigation
requires an average of 21 hours ot complete the treatment process
203
Hemorrhagic cystitis: Formalin (aqueous formaldehyde): act to
repair bladder mucosa
painful and requires anesthesia
204
Hemorrhagic cystitis: formalin (aqueous formaldehyde): may cause
fibrosis
papillary necrosis
fistual
peritonitis
