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CHPN Exam > End-Stage Disease Process > Flashcards

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

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2
Q

Pleural effusion: secretion rates

A

increased and/or fluid absorption becomes restsricted, causing excessive fliud to collect

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3
Q

Pleural effusion: onset

A

can be slow or rapid

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4
Q

Pleural effusion: patient present with ?

A

dyspnea

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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

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6
Q

Pleural effusion: as affected area increases

A

dyspnea distress increases orthopnea ( breathlessness in the recumbent position) tachypnea anorexia malaise and fatigue

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7
Q

Pleural effusion: pt c/o

A

dry, nonproductive cough aching, heaviness, or dull pain in chest

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8
Q

Pleural effusion: treatment

A

palliative and symtomatic in nature dependent on: surrounding circumstances overall patient condition proximity to death

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9
Q

Pericardial effusion: definition

A

accumulation of fluid or tumor cells within the pericardial sac

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10
Q

Pericardial effusion: affect

A

nearly 20% of patients with lung cancer during advanced stages of disease patienbts with

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11
Q

Pericardial effusion: associated with

A

breast cancer leukemia lymphoma

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12
Q

Pericardial effusion: prognosis

A

poor

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13
Q

Pericardial effusion: caused by

A

cancerous cells treatments used for malignancies nonmalignant causes

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14
Q

Pericardial effusion: identifying causes

A

pericarditis congestive heart failure uremia myocardial infarction autoimmune disease infections hypothyroidism renal and hepatic failure

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15
Q

Pericardial effusion: clinical signs dependent on

A

amount of fluid how quickly it accumulates general health of cardiac tissue

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16
Q

Pericardial effusion: most common symptom

A

dyspnea patient may be unable to speak more than one word with each breath

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17
Q

Pericardial effusion: symptoms

A

dyspnea chest heaviness dry cough generalized weakness tachycardia

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18
Q

Pericardial effusion: tachycardia

A

body tries to compensate for the reduced cardiac output

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19
Q

Hemoptysis: definition

A

expectoration of blood from lower respiratory tract

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20
Q

Hemoptysis: occcurs

A

in patients with advanced cancer because of metastasis or infection

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21
Q

Hemoptysis: cause

A

advanced cancer with metastasis infections bronchitis

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22
Q

Hemoptysis: initial assessment

A

distinguish from gastrointestinal and nasopharyngeal bleeding

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23
Q

Hemoptysis: signs and symptoms

A

cough dyspnea wheezing chest pain fever night sweats weight loss

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24
Q

Hemoptysis: severity

A

determined by amount of blood produced within a 24 hour period

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25
Q

Hemoptysis: mild

A

production of less than 15-20 ml of blood within 24 hours

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26
Q

Hemoptysis: moderate

A

expectoration of greater than 20 ml, but less than 200 ml

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27
Q

Hemoptysis: massive

A

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

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28
Q

Hemoptysis: primary risk

A

asphyxiation from blood clots in airway

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29
Q

Superior vena cava syndrome: definition

A

result of a partial occlusion of the superior vena cava

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30
Q

Superior vena cava syndrome: results

A

decreased blood flow from the head and neck to the right atrium

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31
Q

Superior vena cava syndrome: cause

A

cancerous growths

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32
Q

Superior vena cava syndrome: considered

A

emergency condition

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33
Q

Superior vena cava syndrome: symptoms

A

headache facial edema hoarseness dyspnea swollen arms

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34
Q

Superior vena cava syndrome: rapid onset

A

loss of circulation can be life-threatening

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35
Q

Superior vena cava syndrome: onset

A

rapid or acute

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36
Q

Superior vena cava syndrome: subtle signs

A

swelling in morning hours increasing discomfort with bending forward or stooping

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37
Q

Superior vena cava syndrome: common complaine

A

dyspnea

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38
Q

Superior vena cava syndrome: physical findings

A

vein distention in neck and chest ruddy complexion or cyanosis tachypnea stridor orthopnea hoarseness nasal stuffiness periorbital and conjunctival edema

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39
Q

Superior vena cava syndrome: progressing symptoms

A

mental status changes

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40
Q

Superior vena cava syndrome: mental status changes

A

progressing from a stupor, coma, and seizures until time of death

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41
Q

Hypercalcemia: definition

A

overabundance of ionized calcium in the blood

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42
Q

Hypercalcemia: occurs

A

in up to 10% of cancer patients

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43
Q

Hypercalcemia: highest rates of occurrence

A

breast cancer multiple myeloma

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44
Q

Hypercalcemia: causes

A

hyperparathyroidism lithium therapy vitamin D milk-alkali syndrome

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45
Q

Hypercalcemia: untreated

A

50% mortality rate

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46
Q

Hypercalcemia: symptoms depend on

A

amount of excess calcium

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47
Q

Hypercalcemia: untreated

A

irreversible renal damage coma death

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48
Q

Hypercalcemia: presenting complaints

A

fatigue lethargy nausea polyuria confusion

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49
Q

Hypercalcemia:left unchecked

A

combination of nausea and polyuria can again increase concentrations of calcium in blood through dehydration

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50
Q

Hypercalcemia: symptoms

A

vomiting anorexia constipation

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51
Q

Hypercalcemia:electrocardiogram

A

show evidence of a shortened QT interval and possible arrhythmias

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52
Q

Hypercalcemia: assessments

A

avoid attaching symptoms to other disease processes in the already ill patient

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53
Q

Hypercalcemia: treatment to lower calcium levels

A

hydration with saline bisphosphonates diuretics glucocorticoids

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54
Q

Death pronouncement: prior

A

to time of death, a plan should be in place for who will be contacted when death occurs, regardless of location

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55
Q

Death pronouncement: procedures

A

vary between state to state

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56
Q

Death pronouncement: nurses

A

vary by state

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57
Q

Death pronouncement: inpatient setting

A

organizational policy should be follwed

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58
Q

Death pronouncement: hospice setting

A

nurse makes a visit for patient assessment

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59
Q

Death pronouncement: nurse visit

A

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

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60
Q

Death pronouncement: contact coroner

A

if circumstances of death were unusual, associated with a traumatic event, or occurred within 24 hours of hospital admission

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61
Q

Central ascites: cause

A

results from compressoin of the portal venous or lymphatic system compression from tumor invasion

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62
Q

Central ascites: process

A

decrease in pressure as a result of limited limited protein intake and the catabolic state associated with cancer

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63
Q

Peripheral ascites: cause

A

results from deposits of tumor cells on the parietal or visceral peritoneum blockage occurs at this level rather than in the liver parenchyma

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64
Q

Peripheral ascites: presence of macrophages

A

increases capillary permeability and contributes to increasing fluid retention

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65
Q

Mixed type ascites: definition

A

combination of both peripheral and central ascites

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66
Q

Types of ascites

A

central peripheral mixed chylous malignant malignant

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67
Q

Chylous malignant: defintion

A

occurs when cancer cells invade the retroperitoneal space, causing lymph flow obstruction for the lymph nodes or pancreas

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68
Q

Malignant ascites

A

generally has poor prognosis

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69
Q

Malignant ascites: tumor cells

A

make difficult to reduce fluid accumulation

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70
Q

Ascites: cancer associated with

A

ovarian endometrial breast colon gastric pancreatic

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71
Q

Ascites: less common sources

A

mesothelioma non-Hodgkin lymphoma prostate cancer

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72
Q

AIDS dementia complex: cause

A

exact cause unknown

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73
Q

AIDS dementia complex: result

A

primary result of disease process itself

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74
Q

AIDS dementia complex: theory of cause

A

HIV infection stimulates an invasion of macrophages in brain (microglia) These release cytokines that directly damage nervous tissue by disrupting neurotransmitter functions cause encephalopathy

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75
Q

AIDS dementia complex: affects

A

15% of all AIDS patients

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76
Q

AIDS dementia complex: prognosis

A

poor disease not reversible

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77
Q

AIDS dementia complex: retrovirals

A

can delay onset

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78
Q

AIDS dementia complex: children

A

CNS HIV infection in children tends to have a more dramatic and pronounced effect than that in adults

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79
Q

AIDS dementia complex: Characterized by

A

gradual memory loss decreased concentration decreased cognition mood disorders

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80
Q

AIDS dementia complex: physical symptoms

A

ataxia incontinence seizures

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81
Q

Amyotrophic lateral sclerosis: defintion

A

rapidly progressing degenerative neuromuscular disease with an unknown origin

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82
Q

Amyotrophic lateral sclerosis: main area of involvement

A

motor neurons of the brain and spinal cord

83
Q

Amyotrophic lateral sclerosis: first symptom

A

about half of patients will have difficulty swallowing

84
Q

Amyotrophic lateral sclerosis: common symptom

A

distal weakness

85
Q

Amyotrophic lateral sclerosis: progression

A

weakness affects both upper and lower neurons

86
Q

Amyotrophic lateral sclerosis: death results from

A

respiratory failure due to weakness in the diaphragm decreased laryngeal and lingual functionality

87
Q

Amyotrophic lateral sclerosis: high concern

A

swallowing and oral nourishment loss of motility in tongue and hypopharynx

88
Q

Amyotrophic lateral sclerosis: loss of motility in tongue and hypopharynx: result

A

in loss of ability to manipulate food creates speech and communication barriers

89
Q

Parkinson: definition

A

common disease of CNS

90
Q

Parkinson: progressoin

A

slow progression of motor skill compli8cations

91
Q

Parkinson: motor skill complications

A

resting tremors excessive slowness in activity rigidity

92
Q

Parkinson: classic signs

A

pill-rolling movements in hands loss of facial expression difficulty initiating movements gait changes

93
Q

Parkinson: initial s/s

A

generalized weakness aching fatigue malaise slight tremor of extremity

94
Q

Parkinson: symptoms result from

A

imbalance between dopamine-activated and acetylcholine-activated neural pathways in basal ganglia

95
Q

Parkinson: symptoms found in population

A

older than 65 years

96
Q

Parkinson-like symptoms caused by

A

medication toxicity head trauma other degenerative conditions

97
Q

Leukemia: classified as

A

acute chronic

98
Q

Leukemia: classification dependent on

A

type of cell that it originates from and the genetic chromosomal or growth factor deviation present in malignant cells

99
Q

Leukemia: hematological malignancies

A

evolve from immature blood cells, multiplying profusely and compromising the integrity of normal blood cells

100
Q

Leukemia: clinical findings

A

infection anemia fever enlarged liver, spleen, kidneys

101
Q

Leukemia: pain/tenderness

A

over sternum or other bones and joints

102
Q

Leukemia: s/s

A

pallor petechia purpura anemia infection hemorrhage

103
Q

Palliative sedation: definition

A

is a treatmennt method focused on controlling and easing symptoms that have proven otherwise refractory or unendurable in nature

104
Q

Palliative sedation: originally named

A

terminal sedation

105
Q

Palliative sedation: emphasis

A

differences between symptom management and euthanasia

106
Q

Palliative sedation: purpose

A

symptom control does not hasten or cause death

107
Q

Palliative sedation: medications

A

midazolam propofol

108
Q

Palliative sedation: relief provided

A

through varying levels of unconsciousness

109
Q

Palliative sedation: used for

A

calm persistent agitation and restlessness pain control confusion shortness of breath muscle twitching or seizures anguish

110
Q

Lymphoma: presents as

A

Hodgkin disease non-Hodgkin lymphoma

111
Q

Lymphoma: s/s

A

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
Q

Lymphoma: complaints

A

upset stomach bowel changes

113
Q

Lymphoma: physical assessment

A

enlarged liver or spleen

114
Q

Lymphoma: less common s/s of non-Hodgkin

A

night sweats itching

115
Q

Lymphoma: s/s later stages

A

anemia thrombocytopenia

116
Q

End stage liver failure: s/s

A

fatigue ascites jaundice

117
Q

End stage liver failure: s/s result from

A

low or nonfunctional lymphatic system

118
Q

End stage liver failure: complications

A

itching dark colored urine gray- or clay-colored stool easy bruising internal bleeding mental confusion (encephalopthy) hepatic coma

119
Q

End stage liver failure: urgent conditions

A

sudden fever over 101 dyspnea evident or suspected internal bleeding severe abdominal pain severe dehydratoin

120
Q

End stage liver failure: treatment

A

palliative care for symptoms patients would require liver transplant to survive

121
Q

SVC Syndrome

A
122
Q

AIDS virus: attaches to

A

CD4 cell surface protein of T-4 lymphocytes with a viral envelope of glycoprotein (gp120)

123
Q

AIDS virus: CD4 cell surrface protein

A

binds to CD4 receptors and coreceptors (CXCR4 and CCR5)

124
Q

HIV virus: type

A

retrovirus that quickly infects circulating immune cells

fijnds safe harbor in body reservoirs that are inaccessible to drug therapy

125
Q

HIV: retrovirus enzyme

A

enzyme called reverse transcriptase to convert the HIV viral RNA to a viral DNA

126
Q
A
127
Q

HIV: reverse transcriptase

A

allows viral DNA to take over the host cell DNA of lymphocytes, macrophages and other immune system cells

128
Q

HIV: viral DNA produces

A

viral proteins that assemble into virions using viral enzyme protease

129
Q

HIV: reproductive cycle

A

can produce up to 100 billion virions with minor protective mutations

130
Q

HIV: disease severity

A

CD4 count

131
Q

HIV: CD4 count < 500 cells/mm3

A

found in early symptomatic stage

132
Q

HIV: CD4 count<200 cells/mm3 + viral load greater than 100,000

A

late symptomatic stage

133
Q

Terminal weaning: definition

A

slow withdrawal of life-supporting ventilators

134
Q

Terminal weaning: performed by

A

gradually reducing the amount of inspired oxygen (FIO2)

and/or

programmed ventilator rate

135
Q

Terminal weaning: leads to

A

developement of hypoxemia and hypercarbia that is fatal to patient

136
Q

Terminal weaning: occurs

A

gradually over many hours

137
Q

Terminal extubation: definition

A

abrupt withdrawal of the endotracheal tube and subsequently the mechanical ventilator support

138
Q

Terminal extubation: causes

A

death, because patient is dependent on it for life

139
Q

Terminal extubation: initiated after

A

administration of sedative and/or analgesics to patient

140
Q

Cerebral metastases: occurs

A

in up to 40% of all cancer patients

141
Q

Cerebral metastasis: neurological changes

A

may be first idnetified symptoms in some silent forms of cancer

142
Q

Cerebral brain metastasis: s/s

A

headaches

nausea and vomiting

confusion

lethargy

143
Q

Cerebral brain metastasis: headache

A

intial complaint in 50% of all patients

144
Q

Cerebral brain metastasis: headache: caused by

A

increased intracranial pressure from tumor growth, brain swelling, or a blockage on the cerebral spinal fulid pathway (hydrocephalus)

145
Q

Cerebral metastasis: tumor

A

can cause location-specific weakness

numbness

language deficits

visual disturbances

other stroke-like symptoms

seizures (15% of patients)

146
Q

Cerebral metastasis: Behavior changes

A

depression

apathy

memory problems

changes in personality

147
Q

Advanced renal cancer: early s/s

A

occur asymptomatically in the early stages

148
Q

Advanced renal cancer: symtoms begin

A

as conditiojn worsens

149
Q

Advanced renal cancer: first s/s

A

gross hematuria

dull aching pain

palpable abdominal mass

150
Q

Advanced renal cancer: s/s of well advanced cancer

A

All three are present:

hematuria

dull aching pain

palpable abdominal mass

151
Q

Advanced renal cancer: most common s/s

A

hematuria

152
Q

Advanced renal cancer: hematuria

A

most common symptom

may not be noticed unti lit has reached the gross stage where it is visible to the naked eye

153
Q

Advanced renal cancer: other late s/s

A

fever

anemia

weight loss

night sweats

elevated erythrocyte sedimentation rate

dyspnea

hypertension

hypercalcemia

polycythemia

154
Q

Advanced renal cancer: polycythemia

A

excess of red blood cells causes

headaches

dizziness

vein inflammation

itchiness

general feeling of bloating

155
Q

Advanced renal cancer: hypercalcemia casues

A

tiredness

decreased appetite

frequent urination

thirst

nausea and vomiting

confusion

difficulty concentrating

constipation

156
Q

AIDS patient susceptible to

A

bacterial

viral

fungal

parasitic infections

types of cancers

157
Q
A
158
Q

AIDS patient: types of cancer

A

kaposi sarcoma

CNS

non-Hodgkin lymphoma

159
Q

AIDS patient: bacterial infections

A

Streptococcus pneumoniae

myocbacterium avium-intracellulare

nyobacterium avium complex

tuberculosis

salmonellosis

syphilis

bacillary angiomatosis

160
Q

AIDS patient: viral infections

A

cytomegalovirus

viral hepatitis

herpes simplex

human papillomavirus

progressive multifocal leukoencephalopathy

161
Q

AIDS patient: fungal infections

A

candida albicans

histoplasma capsulatum

cryptococcal meningitis

162
Q

AIDS patient: parasitic infections

A

pneumocystis carinii pneumonia

toxoplasmosis

cryptosporidium

163
Q

AIDS patient: rate of infection

A

exceed rates found within the general population

164
Q

Cutaneous malignancy: assessment

A

location

wound appearance

surrounding skin

itching or deep or superficial pain

when is it most noticeable

potential complications

165
Q

Cutaneous malignancy: location of wound

A

does location impair mobility or areas that are difficult to dress?

166
Q

Cutaneous malignancy: wound appearance

A

size

color

tunneling

% of viable and necrotic tissues

bleeding and exudates

odor and presence of infection

167
Q

Cutaneous malignancy: wound appearance affects

A

type of treatment and bandage types that may be needed

168
Q

Cutaneous malignancy: assess surrounding skin for

A

redness

fragility

nodular

macerated

radition-related damage

169
Q

Cutaneous malignancy: assess surrounding skin to determine

A

extent of tissue damage or metastasis

170
Q

Cutaneous malignancy: pain?

A

is there itching or deep or superficial pain

including aching, stabbing, burning, or stinging

when is it most noticeable?

171
Q
A
172
Q

Cutaneous malignancy: potential complications

A

nearby major blood vessels, organs, airway

potential for hemorrhage, vessel obstruction or compromised airway

173
Q

Death Rattle: definition

A

term used to describe gurgling or rattling noise made from accumulation of excessive secretoins in throat

174
Q

Death rattle: assciated with

A

last stages of dying process

175
Q

Death rattle: patient lacks

A

inability to swallow secretions causing buildup of fluid

176
Q

Death rattle: medications

A

anticholinergic agents

177
Q

Death rattle: anticholinergic agents

A

antisecretory properties

should be given at first sign of moisture

can stop further buildup but can’t dry up secretions already present

178
Q

Death rattle: fluids may be removed by

A

suction or oral care

179
Q

Death rattle: medication names

A

scopolamine

hyoscine hydrobromide

atropine

180
Q

Bladder contractility: agents used to decrease

A

extended-release agents

anticholinergics

181
Q

Bladder contractility: extended release and transdermal agents

A

tolterodine (extended-release)

trospium cholride (extended-release)

oxybutynin (extended-release and tr4ansdermal)

182
Q

Bladder contractility: tolterodine dose

A

2 - 4 mg

183
Q

Baldder contractility: trospium chloride: dose

A

20 mg

184
Q

Bladder contracility: oxybutynin dose

A

extended-release 5-15 mg

transdermal patch 3.9mg

185
Q

Bladder contractility: anticholinergics

A

propantheline

oxybutynin (immediate release)

hyoscyamine (tablets or sublingual)

dicyclomine hydrochloride

flavoxate

belladonna

opium suppositories

186
Q

Bladder contractility: propantheline dose

A

7.5 - 30 mg

187
Q

Bladder contractility: immediate release oxybutynin

A

7.5- 15 mg

188
Q

Bladder contractility: hyoscyamine dose

A

0.125 mg–.375 mg

189
Q

Bladder contractility: dicyclomine hydrochloride: dose

A

10 - 20 mg

190
Q

Bladder contractility: flavoxate: dose

A

100 mg

191
Q

Bladder contractility: medications MOA

A

work to decrease frequency of uination urges and/or increase bladder capacity

192
Q

Bladder contractility: medication S/E

A

dry mouth

flushing

constipation

drowsiness

blurred vision

193
Q

Stress urinary incontinence: medications

A

Tricyclic antidepressants:

pseudoephedrine

imipramine

194
Q

Hemorrhagic cystitis: medications

A

aminocaproic acid

silver nitrate and alum (ammonium or potassium salt)

formalin (aqueouis formaldehyde)

195
Q

Hemorrhagic cystitis: aminocaproic acid: dose

A

loading dose of 5 g orally or parenterally

followed by hourly doses of 1 to 1.25 g

196
Q

Hemorrhagic cystitis: aminocaproic acid: MOA

A

acts as a fibrinolysis inhibitor

197
Q

Hemorrhagic cystitis: aminocaproic acid: risk

A

clot retention

decreased blood pressure

198
Q

Hemorrhagic cystitis: aminocaproic acid: do not use

A

in patients with upper urinary tract bleeding or vesicoureteral reflux

199
Q

Hemorrhagic cystitis: aminocaproic acid: time for treatment

A

to take effect is 8-12 hours

200
Q

Hemorrhagic cystitis: silver nitrate and alum: administer

A

in an irrigation solution

intermittently or continuously

201
Q

Hemorrhagic cystitis: silver nitrate and alum: causes

A

chemical cauterization of vessels

may cause functional obstruction or aluminum toxicity

202
Q

Hemorrhagic cystits: silver nitrate and alum: irrigation

A

requires an average of 21 hours ot complete the treatment process

203
Q

Hemorrhagic cystitis: Formalin (aqueous formaldehyde): act to

A

repair bladder mucosa

painful and requires anesthesia

204
Q

Hemorrhagic cystitis: formalin (aqueous formaldehyde): may cause

A

fibrosis

papillary necrosis

fistual

peritonitis

CHPN Exam (6 decks)

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