Exam 1 Flashcards
Grade 1 Cancer Cells
cells differ slightly from normal cells
Grade 2 Cancer Cells
Cells are more abnormal (moderately differentiated)
Grade 3 Cancer Cells
Cells are very abnormal (poorly differentiated/ high grade)
Grade 4 Cancer Cells
cells are immature (undifferentiated/high grade)
Grade 5 Cells
grade cannot be assessed
If a cell if more differentiated what does that mean?
The patient has a poorer prognosis
What is the main treatment for cancer?
Chemotherapy
What effect does chemotherapy have on cells?
It eliminates/ reduces the # of cancer cells in the primary cancer site
what are the two categories of chemotherapy?
Cell cycle nonspecific and cell cycle specific
What is the way we maximize effectiveness when administering chemotherapy?
Specific and nonspecific are usually given together to maximize effectiveness
What should do nurse do to manage symptoms of bone marrow suppression from chemotherapy?
•Monitor CBC (Esp. neutrophils)
•Monitor Platelets (Thrombocytopenia) +avoid bleeding risks
•Monitor RBC (Anemia)
•Monitor body temperature
What should the nurse do to manage fatigue symptoms from chemotherapy/radiation?
•Teach energy conversation strategies
What should the nurse do to manage GI symptoms from chemotherapy/radiation?
•Give antiemetic 1hr prior to tx
•Place on low fiber diet (avoid dairy)
•Take lukewarm sitz baths
•Monitor for skin breakdown
•Tell pt to keep record of episodes
What should the nurse do to manage symptoms of mucositis from chemotherapy/radiation?
•Frequent oral assessments
•Q6 months dental visits
•Educate taste loss is common
what should the nurse do to manage symptoms of anorexia from chemotherapy/radiation?
•Monitor for weight loss
•Offer small frequent meals, high protein
•Monitor for dehydration
What should the nurse do to manage skin reactions from chemotherapy/radiation?
•Avoid hot packs,tight clothes, harsh chemicals
•Use nonirritating lotion, cover with vaseline covered gauze
•Place cold cap on head prior to Tx to avoid alopecia
What should the nurse do to manage pulmonary effects from chemotherapy/radiation?
Monitor for cough, dyspnea, and pulmonary edema
What should the nurse do to manage cognitive effects from chemotherapy/radiation?
monitor for “chemo” brain
patient will have difficulty thinking and remembering
Warning Signs for Cancer “CAUTION”
C- Change in bowel/ bladder habits
A- A sore that does not heal
U-Unusual bleeding
T-Thickening of lump
I- Indigestion/ difficultly swallowing
O- Obvious change in wort
N- Nagging cough
What are life threatening emergencies that occur due to cancer treatment?
•Spinal Cord Compression
•Superior Vena Cava Syndrome
•Third Space Syndrome
•Hypercalcemia
•SIADH
•Tumor lysis syndrome
•Cardiac Tamponade
•Cardiac artery rupture
How should the nurse manage cancer pain?
•Preform pain assessments routinely
•Ask PQRST questions
•Use drug therapy (NSAIDs + Opioids)
What are isotonic solutions used for?
Hydration
Examples of Isotonic solutions
0.9% NS, LR, D5W
What are hypotonic solutions used for?
Tx for N/V, DKA, Hemorrhages, Cardiac and renal patients
Examples of Hypotonic solutions
0.45% saline, 1/4 Saline, 1/3 Saline
What are hypertonic solutions used to treat?
Fluid overload, TBI, Burns, Hyponatremia, Ascites
Example of Hypertonic solutions
3% Saline, 5% Saline, D10W, 5% Dextrose w/ LR, 5% Dextrose w/ 0.45%
What are ways we can move fluid from the body?
•Dialysis
•Diuretics (Oral or IV)
•Fluid + Sodium restriction
•Pleural Effusion
What is 1st spacing?
normal distribution of fluid
What is 2nd spacing?
abnormal accumulation of fluid (edema)
What is third spacing?
Fluid is trapped
Common w/ burns, acities, trauma
Why do geriatric patients have difficulties moving fluid?
kidneys decrease in renin and there is subcutaneous tissue loss
Define hypervolemia
excess intake of fluids
Define Hypovolemia
loss of body fluid
What nursing interventions are important for fluid volume imbalances?
•Daily weights (2lb is significant)
•Monitor labs (BUN, Hct, Sodium)
•Offer fluids q1-2 hours
•Assess RR, Crackles in lungs, SOB
How is hypernatremia treated?
Replace with isotonic or hypotonic solutions
how should the nurse manage hypernatremia?
•monitor sodium levels
•initiate seizure precautions
•place on sodium restricted diet
How is hyponatremia treated?
Hypertonic solution, usually small amounts of 3% sodium chloride
how should the nurse manage hyponatremia?
•Place on fluid restriction
•Hold diuretics
•Initiate seizure precautions
Why should you not increase sodium levels too fast?
Can result in damage to nerve cells in the brain
What is the treatment for hyperkalemia?
Diuretics and dialysis
how should the nurse manage hyperkalemia?
•hold oral and other potassium intake
•Monitor EKG and BP
What is the treatment for hypokalemia?
Replace orally or IV but should not exceed 10 mEq per hour
What are the risk factors for developing skin cancer?
•having skin cancer
•blonde or red hair
•suntanning or indoor tanning bed
•living near equator
•family hx
•outdoor occupations
What is actinic keratosis and what causes it?
most common precancerous lesions, usually caused by sun damage
What are the characteristics of actinic keratosis?
Flat, scaly, wart like
What is basal cell carcinoma?
most common form of skin cancer but least deadly
What are the characteristics of basal cell carcinoma?
pearly, eroded papule
What is squamous cell carcinoma?
Most aggressive form of skin cancer
What are the characteristics of squamous cell carcinoma?
thin, scaly, horn like
What is a superficial burn?
a 1st degree burn that effects only the outer layer of the skin
What are characteristics of a superficial burn?
painful, erythema, blanches, swelling
What is a deep/partial thickness burn?
a second degree burn that involves the outer layer (epidermis) and part of the dermis
What are the characteristics of a deep/partial thickness burn?
red, shiny, wet, fluid filled vesicles
What is a full thickness burn?
3rd and 4th degree burns that’s destroy all three layers of skin and sometimes the subcutaneous tissue
What are the characteristics of a full thickness burn?
Dry, waxy, leathery, white
What is the emergent phase of burns?
The time needed to resolve the immediate issues resulting from the burn injury
How does a burn patients fluid and electrolyte shifts present clinically?
•Low BP + High HR
•High Hct due to fluid loss
•Potassium + Sodium elevated due to the rapid shift and it staying there
•Third spacing will occur
What is the parklins formula?
4ml x % Body Surface x Weight (kg)
According to the parklins formula, how should fluid be given?
Give 1/2 of the total in 1st 8 hours
1/4 in the next 8 hours
1/4 in the last 8 hours
What is type 1 diabetes?
Patient produces little to no insulin
What are the characteristics of T1DM?
Symptoms are abrupt
•polyuria
•polyphagia
•polydipsia
•sudden weight loss
What is Type 2 diabetes?
Doesn’t use insulin properly, insulin resistant
what are the characteristics of T2DM?
often show no symptoms, often due to obesity, family hx, lack of exercise
How is diabetes diagnosed?
A1C 6.5 or greater
Fasting Plasma Glucose of 126 or higher
2 hour plasma glucose level of 200 or higher
What are the names of rapid acting insulin?
Lispro (Humalog), Avart (Novolog)
What is the onset, peak and duration of rapid acting insulin?
Onset 10-30 min
Peak 30 min-3 hours
Duration 3-5 hours
What are the names of short acting insulin?
Novolin R, Humulin R
What is the onset, peak, and duration of short acting insulin?
Onset 30 min- 1 hour
Peak 2-5 hours
Duration 5-8 hours
What are the names of intermediate acting insulin?
NPH (Humulin N, Novolin N)
What is the onset, peak, and duration of intermediate acting insulin?
onset 1.5-4 hours
peak 4-12 hours
Duration 12-18 hours
What should you get during the first 24-48 hours of a smoke inhalation injury?
Bronchoscopy
What are the names of long acting insulin?
Lantus, Levemir
What is the onset, peak, duration of long acting insulin?
onset 0.8-4 hours
NO PEAK
Duration 16-24 hours
What levels do you check after inhalation injury?
Lactic Acid
Carbon Monoxide level (Coximeter or Carboxyhemoglobin)
What is the treatment for carbon monoxide toxicity?
Give 100% oxygen, non rebreather or hyperbaric
What test should be done for a patient with electrical burns and why?
EKG, arrhythmia’s may have occurred
Where do you send circumferential burn patients?
burn center
What do you cover large thermal burns with?
Wrap in clean sheet/ blanket
What are the clinical findings in the emergent phase of burns?
Pain
Blisters
Paralytic ileus
Shivering
Altered mental status
What pain med should a burn patient be treated with and why?
IV Fentanyl, Only opioid that does not lower blood pressure
What is the treatment route for paralytic ileus in burn patients?
Get the patient fed ASAP (tube feed, etc)
When do we start fluid resuscitation for burn patients?
Greater than 15% total body surface area
What immunization is given routinely to burn patients?
Tetanus
What is the somogyi effect?
Hyperglycemia in the morning due to blood glucose decreasing in the middle of the night resulting in rebound hyperglycemia
What are symptoms of somogyi effect?
Pt reports night sweats or terrors
What is the treatment to prevent somogyi effect?
Give snack before bed
What is the dawn phenomenon?
Hyperglycemia in the morning due to excess release of cortisol and growth hormone in early hours
What is the treatment to prevent dawn phenomenon?
Increase insulin dose or the time it is administered
What is the most common respiratory issue with DKA and Hyperglycemia?
Kussumal respirations
What is the nursing management for DKA and hyperglycemia?
IV fluids, Insulin therapy, EKG, LOC, electrolytes
How many carbs should be given if a patient is hypoglycemic and what type of carbs?
15g and fruit juice
What carbs should be avoided to a hypoglycemic patient?
Carbs containing fats (Milk and Ice cream)
If a patient is unconscious, what is the treatment for hypoglycemia?
Give IV dextrose, IM/SubQ Glucagon, do not give anything oral
What is acromegaly?
Overproduction of growth hormone
What is SIADH?
Symptom of inappropriate antidiuretic syndrome
overproduction of ADH which can then cause FVE or FVD
What are S/S of SIADH?
Low urine output
increased weight
thirst
headaches, n/v, cramping
what nursing management should be implemented for SIADH?
Monitor Na+ levels
accurate i/os
place on fluid restriction
daily weights
give diuretic’s
What is cushing’s syndrome?
excess ACTH (cortisol) produced
What is addison’s disease?
Too little cortisol produced
What is diabetes insipidus?
not enough ADH produced to regulate how it handles fluids
what are s/s of diabetes insipidus?
nocturia, polyuria
in severe cases low bp high Hr
How is diabetes insipidus diagnosed?
a water deprivation test for 8-12 hours
What meds are used for diabetes insipidus?
Chloropropamide, Tegretol, Thiazide diuretics, NSAIDS
What is the most common form of hyperthyroidism?
Graves’ disease
What are the s/s of hyperthyroidism?
Irritable, decrease attention span, increased appetite, decreased weight, goiter, tachycardia, htn
What are treatment options for hyperthyroidism?
antithyroids, iodine, beta blockers or a thyroidectomy
What are the s/s of hypothyroidism?
low energy, weight gain, cold intolerance, myxedema, low BP, Low HR, decreased appetite
What is important to educate to your hypothyroidism patients?
treatment is life long and to eat a low calorie diet
What is hypothyroidism treated with?
levothyroxine in low doses
Hormones of the endocrine system
FLAT PEG
FSH
LH
ACTH
TSH
Prolactin
Endorphin
Growth Hormone
What is the relationship of plasma osmolarity and ADH release?
When osmolarity increases it triggers your body to make ADH. This then tells the kidneys to keep more water inside your blood vessels and will result in your urine to become more concentrated
What is the normal urine specific gravity level ?
1.005-1.030
What will the result of a urine specific gravity be of a patient who has SIADH or Diabetes Insipidus?
urine specific gravity will be low
