EXAM 1 Flashcards
1
Q
Definition of chronic illness
A
Chronic illness is a medical condition/health problem associated with symptoms or disabilities that require long term care greater than 3 months
- REQUIRES LONG TERM CARE GREATER THAN 3 MONTHS
2
Q
WHAT DOES CHRONIC ILLNESS REQUIRE
A
REQUIRES THAT
- people learn to live with symptoms and disabilities
- come to terms with identity change
- manage regimens necessary to keep symptoms under control
3
Q
Factors that influence the development of a chronic illness
A
- increasing age
- socioeconomic status
- an impaired ability to manage healthcare.
4
Q
Characteristics of chronic illness that are impacted by culture
A
○ Western- cure oriented
○ Stoic- illness accepted not treated
○ Punishment for sins- does not seek help, follow advice or learn self care
○ nurse/md as authority- expected to be told what to do
○ society should care for them- doesn’t learn self care, family refuses active role
5
Q
Common issues for a patient with chronic illness
A
- DECREASED MOBILITY.
PERSON = Protect, Elimination, Rest/sleep/activity, Self concept, Oxygenation
Nutrition
= Nurses fix by getting pt to walk, turn of bed bound and use special rehab strategies when appropriate
6
Q
Chronic Pain
A
- can be musculoskeletal, neuropathic or disease process related
- Nurses follow WHO standards for pain management, relieve management issues like fear of addiction, tolerance and abuse
7
Q
how do nurses deal with people with chronic pain
A
- Nurses follow WHO standards for pain management, relieve management issues like fear of addiction, tolerance and abuse,
8
Q
what do nurses use to deal with people with decreased mobility due to chronic illness
A
Nurses fix by getting pt to walk, turn if bed bound and use special rehab strategies when appropriate
9
Q
how do nurses help with fatigue due to chronic illness
A
Nurses help by spacing activities apart to provide ample time w/rest, and assist with exercise
10
Q
how is depression different from fatigue
A
- is different from fatigue in that it is a state of feeling sad, distressed and hopeless, having a loss of interest in things that have been enjoyable, a lack of energy for normal activities
- Family and social issues can cause depression as well as their lives changed due to chronic illness, impairing the normal family/work balance, causing social isolation, and caregiver role strain
11
Q
how can nurses help with physiological adaptations
A
- by identifying the source, provide coping mechanisms, alter perceptions and listen without fixing in an effort to support the patient has the self-fix
12
Q
what COGNITIVE declines during old age in Chronically ill/impaired older adult as
A
declines during old age- short term memory recall
13
Q
what COGNITIVE declines during middle adulthood in Chronically ill/impaired older adult as
A
- mental performance speed
- synthesis of new info
- fluid intelligence
14
Q
what COGNITIVE improves with aging
A
- vocabulary
- verbal reasoning
- intelligence
15
Q
long term memory and aging
A
■ Long term memory doesn’t change with aging)
16
Q
nutrition in Chronically ill/impaired older adults
A
SCALES Assessment
- Sadness/mood change
- Cholesterol (HIGH)
- Albumin (LOW)
- Loss/gain of weight
- Eating problems and Shopping and food preparation problems
17
Q
SPICES tool in older adults
A
- Sleep disorders - Problems with eating/feeding
- Incontinence
- Confusion
- Evidence of falls
- Skin breakdown
18
Q
drug receptor interactions in Chronically ill/impaired older adults
A
- more sensitive in brain
- making psychoactive drugs more POTENT
19
Q
metabolism in Chronically ill/impaired older adults
A
- liver mass shrinks over time
- decreasing blood flow and enzyme activity
- decreasing metabolism to ½-⅔ the rate of young adults, PROLONGING
20
Q
absorption in Chronically ill/impaired older adults
A
- gastric emptying slows with motility
- decreasing capacity of cells to absorb and use active transport
21
Q
CIRCULATION in Chronically ill/impaired older adults
A
- medications may have overdose effects (ANTIHYPERTENSIVES MAY OVERSHOOT EVEN IF ITS THE CORRECT THERAPEUTIC DOSE= DUE TO LESS VASCULAR NEURO CONTROL)
22
Q
excretion in Chronically ill/impaired older adults
A
- renal blood flow, GFR, renal tubular secretion/reabsorption
- number of nephrons decline, extending half life of renal excreted drugs, remaining in the body longer
23
Q
distribution in Chronically ill/impaired older adults
A
- lean body mass falls
- ADIPOSE TISSUE INCREASES
- total water declines, increasing concentration of water soluble drugs (causing the overshoot)
- plasma protein levels decrease = reducing sites for protein bound drugs
- increased levels of drug in blood dDUE TO PROLONGED HALF LIVES
24
Q
ERRORS caused by older adults:
A
- decreased vision
- forgetfulness
- use of OTC drugs or prescription for someone else
- lack of financial resources
- failure to understand instructions/importance of treatment
- refusal to take meds due to undesired side effect
- polypharmacy
25
management of chronically ill/ older adults in acute/ambulatory care
● ID older adults at risk for iatrogenesis (effects from treatment)
● consider early discharge with ADL assistance, and meds management
● encourage the development and use of interprofessional teams, special care units and other individuals who focus on needs of pt
● implement standard protocols to screen for at risk conditions (UTIs, falls, delirium)
● implement mobility programs to prevent functional decline
● monitor for skin changes
● focus of safety
● advocate for referral to appropriate COMMUNITY based services
26
evaluation of chronically ill/older adults
● are there changes in ADLs, mental status or IADLs or S&S of disease
● does the individual consider their health state improved
● does the individual think the plan is helpful
● does the individual AND caregiver think care is worth time and cost
● document changes that support interventions
27
pre-trajectory phase of chronic illness
when the person is at risk
28
trajectory phase of chronic illness
the onset of symptoms or disability
29
stable phase of chronic illness
symptoms and disability are managed
30
unstable stable phase of chronic illness
- exacerbation of symptoms
- development of complications
- reactivation of illness in remission (flareup)
31
acute phase of chronic illness
- sudden, severe symptoms or complications usually require hospitalization (like pain)
32
crisis phase of chronic illness
critical life threatening situation
33
comeback phase of chronic illness
recovery after an acute episode
34
downward phase of chronic illness
- symptoms and disability continue to worsen despite attempts to gain control
35
dying phase of chronic illness
- gradual or rapid decline despite all efforts, needs hospice
36
What are the medicare criteria for Home care?
MARY HANSON IS UGLY RUDE CUNT
```
○ doctor orders (Mary
○ homebound status (Hanson
○ intermittent skilled nursing care (Is
○ unstable condition (Ugly
○ reasonable and measurable goals (Rude
○ certified agency (Cunt
```
37
Home Care discharge planning
○ Can their illness be managed at home
○ Can they perform ADLs or assisted ADLs on their own
○ Is their illness unstable, but manageable, not requiring hospital admission
○ OT/PT, DOCUMENT, how many visits can they get
38
● What challenges do home care nurses face/part of their assessment process?
- Head to TOE
■ sensitive issues- advanced directives, informed consent, payor, sexuality
■ ethical/legal- confidentiality while involving family, resources; cost, avoiding legal risk for self and agency
■ safety (part of assessment)
● cords, cooking and refrigeration facilities, heating and cooling, cleanliness, transportation (for them), ability to buy food and pay for rent, safety of family members, rugs
● emergency preparedness- risk in neighborhood, with equipment used for treatment, provide practical info on preparation, possibility of care delivery during an event
○ NEEDS A GO BAG (see below)
39
home care bag Technique
○ Keep it sanitary (not on floor, tripping hazard)
○ As mentioned in class, in case of a disaster, a home care nurse should have a bag prepared for the patient, how to get out of apartment, who to contact
○ The bag should include a list of their current medications, their current providers, a list of who to contact if disaster/nurse not there- NOT THE NURSES NUMBER- the agency number, emergency contacts, maybe first aid supplies, water, nutrition, list of allergies; if possible spare medications/means of retrieving them, potential evacuation routes
40
What is rehabilitation?
Rehab is the dynamic, health oriented process that assists an ill/disabled individual to:
○ achieve the greatest level of physical, mental, spiritual, social and economic functioning for the individual within realistic limits
- achieve acceptable QOL, self respect and independence focus on existing abilities rather than disabilities
41
What is the primary emphasis of rehabilitation?
- To promote the success of rehab through motivation
- planning WITH PATIENT, setting SMART goals
- designing strategies tailored to the individual and remaining non-judgemental!
REHAB IS TEAMWORK!!!
42
Who’s on the Rehab TEAM?
- physiatrist- physician who specializes in rehab
- Physical Therapist: focuses on musculoskeletal and neurological issues (strength, gait, balance, ambulation, alignment and posture)
- Occupational Therapy: training for ADL, adaptive devices to aid in ADLs, and working on FINE motor control
- Speech therapist: focuses on speech, communication and swallowing issues
- nurse:
■ generalist- prioritize and coordinate care with rehab program and specialists, advocate for pt, educate pt and delegate goals and principles when assigning tasks to UAP, participating in discharge planning
■ rehab nurse specialist (just in case)- works as case manager to coordinate with team and carry a caseload and consultant in complex situations
43
What is hospice care?
- It is the concept of care that provides compassion, concern and support for persons in the last phases of a terminal disease that enable patients to live fully, comfortably and die pain free with dignity. Only when there is no curative care for patients, but don’t need to be dying.
- CHEYNE STOKES & DEATH RATTLE = go over transition, oral thrush (nystatin flush), kennedy ulcer- nonblanchable CLOSED SORE
44
What are the criteria for admission to hospice care?
- The patient must desire services
| - The patient must be eligible for services
45
What are some patient concerns during hospice care
- COMFORT DIGNITY AND RESPECT
○ Does it improve my quality of life?- yes, it reduces pain, depression and other symptoms through active engagement and treatment
○ Is it costly? It is cheaper than hospital admissions but it does cover 5-10% of the population
○ What about my son/daughter, I'm worried about them? it alleviates the burden of care from the family, allowing the service to manage their care, allowing the family to be there for them in their time of need
■ improves overall family satisfaction
46
Venous Access Device (VAD) or CVAD
Catheters placed in large blood vessels (subclavian/jugular vein) to permit frequent, continuous, rapid or intermittent administration of fluids and drugs
- It is useful in patients with limited peripheral vascular access or need LONG TERM ACCESS.
47
advantages of Venous Access Device (VAD/CVAD)
- immediate access
- reduced venipunctures
- decreased risk of extravasation
48
disadvantages of Venous Access Device (VAD/CVAD)
- increased risk of systemic infection
| - invasive
49
catheter occlusion complication of VAD/CVAD
- clamped or kinked
- tip against the vessel wall
- thrombosis
- precipitate buildup in lumen
50
embolism complications of VAD/CVAD
- catheter breaks
- dislodged thrombus
- entry of air into circulation
51
infection complications of VAD/CVAD
- contamination during insertion/use
- migration of organisms along catheter
- immunosuppressed patient
52
catheter migration complications of VAD/CVAD
- improper suture
- trauma
- forceful flushing
- spontaneous
53
pneumothorax complications of VAD/CVAD
perforation of visceral pleura
54
Assessment of VAD/CVAD
- inspect the catheter and the insertion site, pain
- change dressings based on institution policy (use transparent ones), flush often
- assess for signs and symptoms of infection, embolism, pneumothorax, or occlusion/extravasation
● when do we use VAD- long term
55
What is TPN
- Total Parenteral Nutrition (given by IV fluids through VAD or Peripheral)
- usually given in preparation for surgery when TPO or if unable to consume foods properly without complication or to manage current nutritional intake based on recommendations from attending physician
- FINAL- watch the site, dated, (hyperalimentation), use for cancer, malnourished; customized for patient
56
Burns prevention
- set water heater temp no higher than 120F/48.9
- practice fire drills
- don't remove radiator cap from hot car
- avoid overhead electrical wires and underground wires when outside
- don't run cords under carpets/rugs, store flammable liquids away from fire source
57
how to avoid electrical burns
avoid frayed wiring, check if power is shut off prior to repair and avoid wet when touching
58
how to avoid inhalation burn
ensuring detectors are working
59
how to avoid flame/contact/scald
- caution when handling hot foods, mindful of surroundings, flammable liquids, candles, smoking in designated areas
- checking water before using
60
coordinated national programs for burns
child resistant lighters, non flammable children's clothing, tap water anti scald devices, stricter building codes, hard wired smoke detectors/alarms and fire sprinklers
61
Types of burn (Thermal burns)
- caused by flame, flash, scald, or contact with hot objects
| - severity depends on temperature of burning agent and duration of contact
62
types of burn (Chemical burns)
result from contact with acids, alkalis and organic compounds that are hard to manage because they cause protein hydrolysis and liquefaction (continues to damage after neutralized up to 72hrs)
- result in injuries to skin, eyes, resp, liver and kidney and should be removed from the source immediately
63
what does smoke inhalation predicts?
it predicts mortality in burn and needs to be treated quickly
64
what is metabolic asphyxiation of smoke inhalation
mainly due to CO poisoning as inhaled CO displaces O2 causing hypoxia (20%+ levels of CO)
- carboxyhemoglobinemia and death may not have any burn injury on skin
65
what is upper airway smoke inhalation
- injury to mouth, oropharynx and/or larynx due to thermal (hot air, steam or smoke) that causes swelling that can be massive, and come on quickly
- eschar and edema may narrow/obstruct breathing where swelling from scald burns can be lethal
66
what is lower airway smoke inhalation
- injury to trachea, bronchioles and alveoli, related to length of exposure to smoke or toxic fumes
* pulm edema may not appear for 12-48 hrs and manifest as ARDS
67
Electrical burns
- result from coagulation necrosis cause by intense heat generated from an electrical current
- may result from direct damage to nerves and vessels causing TISSUE ANOXIA and death; with severity dependent on amount of voltage, tissue resistance, current pathways, surface area, duration of flow
- MORE SEVER WHEN THEY PASS THROUGH VITAL ORGANS THAN OTHER TISSUES
- can also ignite on patients clothing (thermal flash)
68
electrical burn assessment
- can be difficult to assess, occurring below the skin (Iceberg effect)
- may cause spasms strong enough to fracture bones, dysrhythmias/cardiac arrest, severe metabolic acidosis and myoglobinuria (can cause acute tubular necrosis or acute kidney injury eventually)
69
inhalation injury priority assessment
presence of facial burns, singed nasal hair, hoarseness, painful swallowing, darkened oral and nasal membranes, carbonaceous sputum, history of being burned in enclosed space, clothing burns around neck and chest
MAY SHOW ARDS SYMPTOMS SUCH AS = shortness of breath, tachypnea, low BO, confusion
70
1st degree/superficial
sunburns or low intensity flash, superficial scald; involves the epidermis with part of the dermis possible that appears red and blanches with pressure, dry, minimal or no edema and possible blisters; usually tingles, is painful but soothed by cooling and will peel and itch within a few days
71
2nd degree/partial thickness
scalds, flash flames and contact, involves the epidermis and a portion of the of the dermis that appears as blistered, mottled red base that disrupts the epidermis, with a weeping surface and edema, causing pain and sensitivity that resolves in 2-3 weeks with some scarring and depigmentation possible
72
3rd degree/full thickness:
caused by a flame, prolonged exposure to hot liquids, electric current, chemicals or contact that involves the epidermis, dermis and sometimes the subQ layer and maybe connective tissue and muscle, appears as dry, pale white red brown, leathery or charred with some coagulated vessels visible with edema. May not feel pain but head toward hypovolemic shock and hemolysis and myoglobinuria possible, the eschar may slough and grafts are necessary with scars and loss of contour and function possible
73
4th degree/full thickness + fat, fascia, muscle, and or bone
prolonged exposure or high voltage injury that affects deep tissue, muscle and bone, charring the skin/area leading to hypovolemic shock, myoglobinuria and possible hemolysis. amputation is likely as grafting has no benefit due to the depth of the injury
74
Respiratory Obstruction body parts
face, neck, chest
75
what body part burns requires self care
hands, feet, joints, eyes
76
what body part burn can easily lead to infection
ears, nose, butt, perineum
77
circumferential of extremities burn complications
CIRCULATION PROBLEMS DISTAL to burn
- MAY DEVELOP COMPARTMENT SYNDROME
78
priority intervention of burns
INHALATION Met asphyxiation = 100 humidified air
- PRIORITY IS ABCDE = airway clearance, bronchodilators, MUCOLYRICS (PRN), foley is inserted, NG tube inserted and placed to suction, assess for injuries
ON THE SCENE= prevent injury to rescuer,
- STOP injury (extinguish flames, cool burn, irrigate chem burn)
- ESTABLISH ABCDE
- START O2 and large O2
- REMOVE constrictive objects and cover wounds
- DO secondary survery and NOTE if theres a cervical injury
79
medications for burn patients
- analgesics = morphine, hydromorphone/dilaudid
- sedative = haloperidol/haldol, lorazepam/ativan, midazolam
- tetanus vax
- antimicrobials
- VTE prophylaxis (heparin, lovenox, NSAIDs)
80
when is fluid resuscitation required for burn patients
- 20% or higher of body burns
| - consider the risks of under and over with Lacted ringers (hypovolemic/hypervolemic?)
81
Interventions for acute respiratory failure due to burns
- check for inc difficulty breathing
- onset of adventitious sounds
- S&S of hypoxia
- dec breath sounds
- wheezing
- tachypnea
- stridor and sputum (soot)
82
intervention fluid and electrolyte imbalance
- 3rd spacing etc
hyperkalemia- push fluids and monitor status and output
83
what is distributive shock due to shift
fluids move (3rd spacing) to accomodate fluid loss)
84
intervention for acute kidney injury
monitor output and increase fluid rate if too slow
85
intervention for compartment syndrome
- fasciotomy
| - debridement
86
what is paralytic ileus
decrease bowel movement due to the decreased perfusion/fluid displacement. that it almost comes to a “halt” fluid resuscitation
87
curling’s ulcer
- stress-induced ulcer of the stomach or duodenum that occurs in relation to extreme physical stress, such as in massively burned patients
- This is due to the fact that an extensive burn causes more stress on the entire body than any other injury
88
neurologic concerns of a burned patient
- remember the 5 Ps: Palor, pain, pulselessness, paresthesia and paralysis
- may have decreased sensation in area
- treating wounds and maintaining fluids
89
endocrine changes of burn patient
secretion of hormones to accommodate loss of fluids, replenish the fluids then recheck
90
What are vesicants?
- Vesicants are chemicals that cause tissue damage on direct contact, NOT TO BE CONFUSED with irritants
-
91
examples of vesicants
amsacrine, carmustine, dactinomycin and daunorubicin
EXTRAVASION IS A KNOWN RISK WITH THESE MEDICATIONS
because the IV needle can move leading the drug to leak into surrounding tissues
- Since these cause direct damage, it is important to find S&S of extravasation ASAP and to stop the medication and remove the IV
92
What is Neutropenia?
- Neutropenia is a low white count (absolute count <1000/mm^3) that can increase risk for infections.
- There is a chance for this when receiving treatment (in particular leukemia (AML, ALL, CML, CLL)) and precautions should be taken including (NEUPOGEN!Filgrastim)
- take temperature 2x daily and call if its above 100.5
93
foods to avoid NEUTROPENIA
- fresh fruit & vegetables, raw meats & fish, natural cheeses, raw eggs, frozen/dried fruit,
anything carrying bacteria
94
WHAT TO AVOID NEUTROPENIA
- don't use rectal suppositories, thermometers and enemas
- avoid fresh flowers, plants
- don't have any dental work done, unless emergent
- avoid large crowds, crowded facilities (malls, theaters, restaurants)
- do not receive immunizations unless approved, avoid those that just got immunized w/in 2wk
- keep sick family members away
- wash hand frequently
- BATHE daily
- stay active
95
when to call MD neutropenia
- temperature, cough, SOB, sore/swollen throat/mouth, redness, pain or swelling at catheter site/port, weakness/flu like symptoms, chills, mental confusion, chest pain, ab pain, rash
96
ACS warning signs: CAUTION
- Change in bowel/bladder habits
- A sore that doesn't heal
- Unusual bleeding/discharge
- Thickening or lump in breast/elsewhere
- Indigestion/difficulty swallowing
- Obvious change in mole/wart
- Nagging cough/hoarseness
97
Biological Response Modifiers
- are agents that are capable of changing the relationship between the tumor and the host by increasing the host’s immune function
- includes INTERFERON, INTERLEUKIN-2
- a boost to the immune system that can have some flu like symptoms and changes in lab values
- flu like symptoms, fatigue, anorexia/weight loss, ALTERATION IN LIVER FUNCTION TESTS, N/V/D
98
Side effects of chemo agents
- FATIGUE #1
- alteration in taste sensation
- alopecia (systemic but temporary for 2-3 wks and regrows 1-2 months after completion)
- increase chance of bleeding
- bone marrow suppression (neutropenia, anemia, thrombocytopenia (NAT)
99
Nadir Sepsis
- low blood count (ANC<500; normal 1500+)
- Mucositis, rash, wt loss, diarrhea
- CONSTIPATION→ obstruction (ESPECIALLY VINS)
- bladder problems (like UTIs all your urias),
- infertility/sterility (harvest before)
100
WHAT CONDITIONS ARE VERY RESPONSIVE TO CHEMOTHERAPY
- leukemia,
- lymphoma
- SCLC
101
WHAT CONDITIONS ARE VERY RESPONSIVE TO CHEMOTHERAPY
- breast
- testicular
- prostate
- head and neck
- leukemia
102
WHAT CONDITIONS ARE occasionally responsive
- colorectal
- CNS
- multiple myeloma
- ovarian
- uterine
103
what conditions are UNRESPONSIVE to chemo
- renal
- pancreatic
- bladder
- liver
- NSCLC
104
Bone marrow transplant complications - leukemia, lymphoma and multiple myeloma
○ sepsis, hepatic veno-oclusive disease, fever, infection, bone vs graft, bleed
○ neutropenia- WBC (absolute count <1000/mm^3)
○ anemia- decreased RBCs
○ thrombocytopenia (less 50k). keep it above 20k or guve neumega
105
Factors when ordering of chemo
○ depends on cell type, location of cancer, extent of growth, what part of the cell cycle is it (active dividing), effect on normal functions, frequency and duration, goal of treatment (eradication or control), response to treatment, cycles/rounds
- chemo may cause N/V so antiemetics (compazine, reglan, zofran, kytril, marinol) or steroids (decadron) may be used
- keep them hydrated especially on chemo drugs that are nephrotoxic
- have leucovorin available
106
Superior Vena Cava Syndrome
- compression or invasion of the SVC by tumor, enlarged lymph nodes, intraluminal thrombus that obstructs VENOUS CIRCULATION or drianiage of the head, neck, arms and thorax
107
what cancers are associated with Superior Vena Cava Syndrome
lung, breast, testicular cancers, thymoma, lymphoma and mediastinal mets,
108
Superior Vena Cava Syndrome can lead to??
cerebral anoxia, laryngeal edema, bronchial obstruction and death
109
Diagnosis of Superior Vena Cava Syndrome
- chest x ray
- thoracic CT
- venogram
110
clinical manifestations of Superior Vena Cava Syndrome
SOB, hoarseness, chest pain, facial swelling
- edema of neck, arms, hands, and thorax
- skin tightness
- difficulty swallowing and stridor
- engorged/distended jugular/temporal and arm veins
- dilated thoracic vessels
- increased ICP (visual disturbances, headache, AMS)
111
treatments of superior vena cava syndrome
- radiation to shrink tumor
- chemotherapy
anticoagulant/ thrombolytic therapy
- stents/bypass grafts
- oxygen
- corticosteroids and diuretics
112
nursing intervention for superior vena cava syndrome
- AVOID SUPINE, USE SEMI FOWLER
- monitor CMs cardiopulmonary and neuro status
- avoid upper extremities for venipuncture
- avoid tight clothing around fingers, wrist and neck
- facilitate breathing and drainage
- use semi-fowlers (AVOID SUPINE
- promote energy conservation
- monitor fluid status
- radiation side effects
- chemo side effects and postop care when appropriate
113
gradings of cancer
- G1- well differentiated and closely resemble normal cells, low grade of malignancy, slow growth
- G2- moderately differentiated, retain characteristics of normal cells
- G3: poorly differentiated, but tissue of origin established with some normal cells left
- G4- poorly differentiated and retain no normal cell characteristics, hard to determine origin
114
Staging of cancer
TNM system = tumor, node, extent pf metastasis
T = 0 no evidence of lesion, 1 confined to organ (superficial), 2 localized with deep invasion into adjacent tissue, 3 advanced lesion but confined to anatomic region/organ of origin, 4 advanced lesion extending into adjacent organs
N = 0- no evidence, 1 palpable moveable nodes limited to site, 2-4 progress in size, and location
M = 0- none, 1 isolated to one organ, 2 multiple to one organ with no impairment to function, 3 multiple organs with minimal impairment, 4 multiple organs with significant functional impairment
115
What to expect with External radiation / teletherapy
a machine directs the high energy rays and particles at the cancer (line accelerator) where the higher the voltage used, the greater penetration
- treatment is usually 2-3 for palliation, 6-7 weeks for cure/control and done 5 days a week either inpatient or outpatient with individualized scheduling
116
Do's and dont's of external radiation
- get plenty of rest, eat right
- AVOID wearing tight fitting clothes
- no soaps, lotions, powders on radiation site
- no adhesive tape, use electric shaver, protect area from sun
117
what is
| Lymphedema
- accumulation of lymph in soft tissue, maybe after sampling or radiation bc nodes cant return fluid to central circulation
- seen in arm, hand or breast causing obstructive pressure on veins and venous return
118
acute lympedema interventions
- complete decongestive therapy via massage
- mobilization of subQ fluid accumulation
- use compression bandage
- pneumatic compression sleeve
- elevate arm
- isometric exercises
119
Breast cancer risks
- family hx, environmental factors, genetics (5-10% hereditary; 1st degree relative 1.5-3x), early menarche & late menopause, 60yo+
- modifiable- excessive wt gain during adult, sedentary, smoking, dietary fat intake, obesity, alcohol, environment (radiation)
FOR MEN: hyperestrogenism, fam hx, radiation, BRCA 1/2
120
Cervical cancer treatments
- internal radiation
| - intravenous = cisplatin, topotecan, paclitaxel, isofamide, 5FU
121
salpingectomy/oophorectomy (cervical cancer treatment)
may have distention, use abdominal binder
122
hysterectomy post op intervention
- monitor for ab distention (food/fluid restrict/ambulation)
- prevent DVT (position change, avoid high fowlers, pressure under knees, encourage leg exercises
- POST OP = no menstruation, activity restriction, no sex 4-6wks, sensation wont return for months
123
surgical menopause
more severe symptoms due to withdrawal of hormones
124
pelvic exenteration
radical surgery WHEN ALL ELSE FAILS involving removal of uterus, ovaries, fallopian tubes, vagina, bladder, urethra and pelvic lymph nodes
125
post care for pelvic exenteration
- significant physical, emotional and social adjustments (urinary/fecal diversions, reconstructed vagina, onset of menopause)
- assess physical and emotional adjustments regularly- rehab keeps pace with acceptance of change
- RECOVERY IS LONG (understand & support, expressions, followup)
126
Risk factors Bladder cancer
- smoking (#1- 2x more likely, components are filtered by kidneys and concentrated in urine)
- occupational exposure (aromatic amines- benzidine & beta-naphthylamine- dye
- hairdresser, machinist, painter, printer, truck driver
- DM med pioglitazone/actos
- arsenic in drinking water
- men, caucasians (2x than AA)
- age (68-69yo)
- chronic bladder infections
- history of bladder cancer
- birth defects involving bladder
- pelvic radiation
- low fluid intake
127
Ovarian cancer risk factors
#1 nulliparity
- increasing age
- fam history
- high fat/low fiber
- obesity
- increased number of ovarian cycles
- use of infertility drugs, alcohol and TALCUM POWDER
- LOW breast feeding
- multiparity
- Oral contraceptives 5+
- early age at birth of first child
128
Objective Data
| Assessment Ovarian cancer
```
- new/persistent/worsening:
pelvic/ab/back pain
- bloating, indigestion, gas, nausea, heartburn, urinary urgency/freq
- alternating constipation/diarrhea
- difficulty eating/feel full fast
- vaginal bleeding
```
129
LATE CHANGES OVARIAN CANCER
- ab enlargement w/ ascites
- unexplained wt loss/gain
- menstrual changes
130
radiotherapy post op
- monitor for N/V, diarrhea, urinary discomfort, dryness (sex prob), resume after few weeks
-
131
chemotherapy post op
- monitor for upset stomach, Vomiting, anorexia, alopecia, mouth/vag sores, changes in menstrual cycle, premature menopause
132
Tumor markers for specific cancers
- may only need laryngeal
○ Lung: CEA, CA125, NSE
note- LARYNGEAL HAS NO TUMOR MARKERS
133
Signs and symptoms of Prostate cancer
- may have no symptoms or LUTS (lower urinary tract symptoms) similar to BPH (urgency, hematuria
134
late sign and symptoms of prostate cancer
- nocturia, retention, interruption of urinary stream, can't pee
135
PSA Prostate cancer
normal is 0-4ng/mL
small cancers found in older, slow growing ones not treated- may not need to be annual but recommended for men 50-69yo, african american men (45yo+) and has a 1st degree relative with PC
136
diagnosis of prostate cancer
- biopsy of prostate when PSA is continuously elevated
- Digital Rectum Exam is abnormal and used to confirm after transrectal US
- MRI/US fusion biopsy
- increase in PAP (prostatic acid phosphatase), bone
- ct scan for mets
- MRI using endorectal probe
137
Assessment skin cancer
- men, moles, fair skin (20x whites than african americans, fam hx, immunosuppression, excessive exposure to UV radiation
- severe sunburns as child
- xeroderma pigmentosum (Auto recess)
- exposure to coal tar (psoriasis)
- arsenic compounds and radium
