Exam 1: Pain, Wound/Inflammation, Genetics Flashcards
1
Q
What are some psychological effects of pain?
A
Affective: anger, fear, depression and anxiety
Behavioral: Grimacing, irritability, coping skills
2
Q
What are some physiological effects of pain?
A
- Increased HR, BP, R/R
- Urinary retention
- Immobility
- Weakness, fatigue
- Hyperglycemia
- Constipation
3
Q
What are some important assessments associated with pain?
A
Pain Pattern
Location
Intensity
Quality
Associated Symptoms
Management Strategies
Impact of Pain
Patient’s Belief, Expectations, and Goals
4
Q
Assessing pain pattern gives what type of information?
A
The pain’s onset and duration
5
Q
Short-lasting, moderate to severe pain that occurs in patients whose baseline persistent pain is otherwise mild to moderate and fairly well controlled can be defined as what?
A
Break-through pain
6
Q
Pain that occurs before the expected duration of a specific analgesic is known as what?
A
End-of-dose failure
7
Q
When end-of-dose failure occurs, what is usually the next step?
A
A change in dose or scheduling
8
Q
What are the different types of pain scales?
A
- Number scale (appropriate for most adults)
- Verbal descriptor (mild, mod, severe)
- Wong-Baker FACES (cognitive, language barrier, children)
9
Q
What type of scale should you use for infants and neonates?
A
The CRIES scale
C: crying
R: increase in oxygen requirement from baseline
I: increase in VS from baseline
E: expression on face
S: sleeping
10
Q
What pain scale should used for children 2 months - 7 years
A
FLACC scale
F: Facial expression
L: leg movement
A: activity
C: crying
C: consolability
11
Q
Assessing the associated symptoms of pain can provide what type of information?
A
Any aggravating symptoms that increase the pain or make pain better
12
Q
Why is it important to assess a patient’s belief, expectations, and goals with pain management?
A
Knowing how a patient views pain, their own expectations of pain, and what their particular goals can help ensure there is successful pain management
- Can also let you know if you need to educate pain on whether their expectations and goals of pain management are appropriate and reachable
13
Q
What are the 9 principles of pain assessment and management?
A
- Patient have right to appropriate assessment and pain management
- Pain is always subjective
- Physiologic and behavioral signs are not reliable or specific for pain
- Assessment approaches must be appropriate for the patient population
- Pain can exist even when no physical cause can be found
- Different patients have different levels of pain in response to comparable stimuli
- Patients with chronic pain may be more sensitive to pain and other stimuli
- Acute pain that is not adequately controlled can result in physiologic changes that increase the chance of developing persistent pain
14
Q
What are important factors to keep in mind with pain assessment in nonverbal patients?
A
- Obtain self-report when possible
- Never assume nonverbal persons are unable to communicate
- Observe for behaviors that can indicate pain
- Obtain surrogate reports of pain from professional and family caregivers
- Try to use analgesics and reassess patient to observe for decrease in pain-related behaviors
15
Q
What are some ways a nonverbal patient can communicate?
A
Blinking, hand gestures, writing
16
Q
What are some behaviors you can observe in a nonverbal patient that may be indicative of pain?
A
- Grimacing
- Frowning
- Rubbing a painful area
- Groaning
- Restlessness
17
Q
What are some barriers to pain management?
A
- Fear of addition: uncommon in pts taking opioids as directed by HCP team
- Fear of tolerance: normal physiologic response, drug can be changed
- Concerns of side effects: teach that some side effects decrease w/ time, can also start therapy to prevent certain side effects @ same time as opioid (i.e, constipation)
- Forgetting to take analgesic: pain containers, start regimen, use methods for record keeping
- Economic Status: ability to afford medication, have access to medication, etc.
18
Q
What are some important factors to remember when providing pain management in patients with a history of substance abuse?
A
- Patients may be reluctant to take opioid analgesics or may require stronger doses
- Stress of unrelieved pain may contribute to relapse in recovery or increase drug use in actively using pts
- When patient’s acknowledge substance abuse:
- Determine types and amounts of drugs used, avoid these
- Use single opioid to avoid withdrawal symptoms
- Be aware of own attitude about people w/ substance abuse
19
Q
What are the common Non-opioid medications for pain management?
A
- Acetaminophen
- Aspirin
- NSAIDS
20
Q
What are some important factors to know regarding Non-opioid medications?
A
- Have analgesic ceiling
- No physical tolerance or dependence
- Available without prescription
- Allow for lower dosing of opioid when used in conjunction (opioid-sparing effect)
21
Q
Non-opioids are said to have analgesic ceilings. What does this mean?
A
Increasing the dose beyond the safe limit doesn’t produce a greater analgesic effect
22
Q
NSAIDS have been linked to higher risks for what?
A
Cardiovascular events:
Myocardial Infarction, stroke, etc.
23
Q
Non-opioid medications for pain management: Salicylates
A
Aspirin
- Used for mild to moderate pain, antiplatelet
- Common side effects: increased risk for bleeding (GI in particular)
24
Q
Non-opioid medications for pain management: Acetaminophen
A
- Mild to moderate pain, antipyretic
- NO antiplatelet or anti-inflammatory effects
- Metabolized by liver: chronic dosing of more than 3g/day, acute overdose, or patient’s w/ severe liver disease can lead to Hepatoxicity
25
Non-opioid medications for pain management: NSAIDs
**Naproxen, Ibuprofen, Celecoxib, Dicoflenac**
* Mild to moderate pain, anti-inflammatory properties
* Side effects: GI: irritation, ulceration, hemorrhage, toxicity
* Don't give to patient's w/ hx of PUD, 65+, using corticosteroids, anticoagulants
26
What type of medications are used when pain levels exceed 7
Opioids
27
What are side effects common to opioid use?
* Constipation
* N&V
* Sedation
* Respiratory depression
* Pruritus
28
A patient currently on opioids is experiencing constipation. What education and intervention can be provided?
* Common side effect with opioid use
* Interventions:
* Increase fluid intake
* Increase physical activity
* Increase food high in fiber: prunes, chia seeds, pears, lentils
* Short-term laxative use
29
A patient with opioid use is experiencing respiratory depression and sedation. What are some priority interventions?
* Vigorously stimulate to keep the patient awake
* Apply oxygen to patient
* Administer naloxone
30
Adjuvant medication is more effective for what type of pain?
Neuropathic
31
What is the difference between neuropathic and nociceptive pain?
Neuropathic is caused by nerve damage
Nociceptive is caused by damage to somatic or visceral tissue → painful stimuli triggers pain
32
Adjuvant medications: alpha 2 - adrenergic agonists
* Clonidine (Duraclon)
* Tizanidine (Zanaflex)
Useful for neuropathic pain
33
Adjuvant medications: Anesthetic (local)
* Capsaicin: helpful w/ pain associated w/ arthritis, postherpetic neuralgia, diabetic neuropathy
* Lidocaine: applied to skin before before venipuncture or lumbar puncture, may be effective for postherpetic neuralgia
34
Adjuvant medications: Anaesthics (Oral, Systemic)
* Lidocaine patch: postherpetic neuralgia
* Mexiletine: diabetic neuropathy, neuropathic pain
35
Adjuvant medications: Tricyclic antidepressants
* Amitriptyline
* Desipramine
* Doxepine
* Imipramine
* Nortriptyline
Useful in neuropathic pain
36
Adjuvant medications: SNRI Antidepressants
* Duloxetine
* Milnacipran: fibromyalgia
* Venlafalxine: multimodal therapy for acute pain
Useful in neuropathic pain
37
Adjuvant medications: other antidepressants
Useful in neuropathic pain, headaches
38
Adjuvant medications: anti seizure drugs
**Carbamazepine, Phenytoin, Gabapentin, Pregabalin**
* Neuropathic pain
* Fibromyaglia (pregabalin)
* Multimodel for acute pain (gabapentin, pregabalin)
39
Adjuvant medications: Cannabinoids
**Dronabinol**
* Neuropathic pain
* Certain pain syndromes
40
Adjuvant medications: GABA-Receptor agonist
**Baclofen**
* Neuropathic pain
* Muscle spasms
41
What are the benefits of Adjuvant medications?
* Can be used in conjunction with opioid and nonopioid analgesics for pain treatment
* Can help decrease doses of opioid medications
* Can help treat pain that isn't as responsive to opioid and nonopioid medications
42
This type of pain management allows patients to administer self doses of analgesic within a prescribed time period. What is it called?
Patient-controlled analgesia
43
What are some important education points to provide to patients who are using PCA pumps?
* Only the patient should be administering the medication
* Patient cannot OD on PCA → doses are preset and cannot give more than max preset dose per house
* Important to administer analgesic before pain is severe
44
What are some physical pain relief strategies that are nonpharmacologic?
* Massage
* Exercise
* TENS unit
* Acupunture
* Heat and Cold therapy
45
Nonpharmacologic physical pain relief strategies: Massage
* Simple massage techniques can be performed by RN
* More complex technique (trigger point, deep muscle) may need to be performed by specially trained personnel
* Additional cost may be associated depending on technique needed
46
Nonpharmacologic physical pain relief strategies: exercise
* Can be done easily @ home
* RN can assist but PT should supervise exercise program
* If ROM or simple exercise needed, no additional cost need. If more in depth exercise program needed, additional cost may be associated
47
Nonpharmacologic physical pain relief strategies: TENS unit
* Delivers electric current through electrodes applied to skin @ painful region
* PT is responsible for delivering but RN can be trained in technique
* Additional cost may be associated w/ use of TENS
48
Nonpharmacologic physical pain relief strategies: Acupuncture
* Very thin needles inserted into body @ designated points
* Requires a NP, specifically trained personnel to perform
* Additional cost associated w/ acupuncture
49
Nonpharmacologic physical pain relief strategies: Heat & Cold therapy
* Can be easily done @ home
* Little to no cost associated
* No special education to perform
* Don't apply therapy longer than 20 minutes, make sure barrier between skin and thermal
* Acute pain is best treated w/ ice
50
Nonpharmacologic cognitive pain relief strategies: distraction
* Redirect attention away from pain & onto something else
* Simple but powerful technique
* Doesn't require special education
* No cost associated
* Easily done @ home
51
Nonpharmacologic cognitive pain relief strategies: Hypnosis
* Structured technique that enables pt to achieve state of heightened awareness & _focused concentration that can be used to alter pain perception_
* Should only be delivered and monitored by specially trained clinicians
* Will have additional cost associated
52
Nonpharmacologic cognitive pain relief strategies: relaxation strategies
* Reduce stress, decrease acute anxiety, distract from pain, ease, muscle tension, promote sleep
* No cost associated
* Doesn't require special/additional training
* Easily done @ home
53
What response am I in the inflammatory response?
* Brief moment of vasoconstriction followed by release histamine and other chemical mediators → leading to vasodilation.
* Increased capillary permeability caused by chemical mediators lead to movement of fluid from capillaries into tissue spaces
A. Vascular
B. Cellular
A: Vascular
54
In the vascular response of the inflammatory response, what releases chemical mediators and what is the body's response?
* _Injured cells release chemical mediators, triggering the vascular response_
* Responsible for many of the signs of inflammation
* Redness
* Heat
* Swelling @ site of injury and surround area
55
What response am I in the inflammatory response?
Neutrophils and monocytes migrate to the site of injury to engulf bacteria and breakdown inflammatory debris
A. Vascular
B. Cellular
B. Cellular
56
Which type of WBC am I?
* First WBC to arrive (usually 6 to 12 hrs)
* Role: engulf bacteria, foreign material, damaged cells
* Accumulation leads to pus due to short life span
Neutrophils
57
Immature neutrophils released by bone marrow to keep up with demand are known as what?
Bands
58
When there is an increased level of bands, this is known as what?
A shift to the left
59
A shift to the left is most commonly seen in what?
**_ACUTE_** bacterial infections
60
What type of WBC am I?
* Arrive to injury site 3-7 days after initial injury
* Can stay days to weeks
* Transform into macrophages once in tissue space and breakdown inflammatory debris
61
A patient's WBC count shows elevated neutrophils. What information can this provide about the infection?
It is relatively new
62
In an older infection, we expect to see what type of WBC elevated?
Monocytes
63
Chemical mediators: Prostaglandins
* Produced when cells are activated by injury
* Potent vasodilator: contribute to increased blood flow and edema formation
* Have significant pain receptors → arousal by stimuli that would normally be painless
64
Chemical mediators: Histamine
* Increases vasodilation
* Increases vascular permeability
65
Chemical mediators: Thromboxane
* Powerful vasoconstrictor, promotes clot formation
66
Chemical mediators: Leukotrienes
* Promotes chemotaxis
* Forms slow-reacting substance of anaphylaxis
67
Labs associated with inflammation
* **WBC**: 5,000-10,000
* **WBC w/ differentia**l
* Neutrophils: 2,500-8,000 (50%-70%)
* Monocytes: 100-800 (2-8%)
* Bands: 0-800 (0-8%)
* Lymphocytes: 1,000-4,000 (20-40%)
* **C-reactive protein**: measures protein made by liver, will be elevated if protein present _(normal is less than 1mg/L)_
* **Fibrinogen**: protein produced by liver to help w/ clotting. → will be elevated w/ in inflammation b/c clotting is present to capture foreign material
* Erythrocyte Sedimentation Rate (Sed-Rate): detects RBC clumping as result of increased Fibrinogen levels. (normal: men → 0-22mm/hr, women: 0-29mm/hr)
* Levels increase often above 100mm/hr with inflammation
68
What are some clinical manifestations of _local_ inflammation?
* Heat: increased metabolism @ injury site
* Loss of function: swelling & pain
* Pain: nerve stimulation by chemicals, pressure from fluid exudate
* Redness: excess blood from vasodilation
* Swelling: fluid shift to interstitial space
69
What are some clinical manifestations of systemic inflammation?
* Increased WBC w/ a shift to the left
* Malaise
* Nausea & anorexia
* Increased pulse, r/r
* Fever
70
What are the three types of wound healing?
* **_Primary intention_**: wound margins are neatly approximated
* **_Secondary intention_**: gaping wound edges, wound left open to heal from bottom up
* **_Tertiary intention_**: delayed suturing of a wound due to infection.
* Wound is sutured once infection is controlled
71
This is an example of what type of healing?
Primary intention
72
This is an example of what type of healing?
Secondary intention
73
This is an example of what type of healing?
Tertiary intention
74
What are the three stages of wound healing?
1. Initial Phase
2. Granulation Phase
3. Maturation Phase
75
Phases of wound healing: Initial
**Also known as inflammatory phase**
* Begins when wound develops, last 4-6 days
* Marked by edema, erythema, inflammation, and pain
* Blood clots form and platelets release growth factors to begin healing
* Immune system works to prevent microbial colonization
76
Phases of wound healing: granulation
**Also known as proliferative**
* Granulation tissue fills wound bed
* Pink in color, risk for dishesience, resistance to infection
* Fibroblasts strengthen granulation tissue w/ collagen
* Wound edges begin to contract
77
Phases of wound healing: Maturation
* Begins 7 days after injury, can last several months or years
* Granular tissue becomes more scar-like
* Color is more pale / skin tone
78
Promotion of wound healing: Diet
* High fluid intake
* High protein
* Increased carbohydrates
* Moderate fats
* Vitamin A
* Vitamin B
* Vitamin C
79
Why is increased fluid intake important for wound healing?
Fluid is loss from perspiration, exudate formation, and increased metabolic rate
80
This food is known as the “building blocks for healing”
Protein
* Gives energy for increased metabolic rate and synthesis of immune factors
81
Why are carbohydrates needed for wound healing?
Provide energy to meet increased metabolic energy required for healing
* Body breaks down protein for needed for Carbs not available
82
This vitamin is needed for capillary synthesis and collagen production by fibroblasts
Vitamin C
83
This vitamin aides in collagen synthesis and wound healing strength?
Vitamin A
84
The provider recommends the patient increases _protein_ to aid in wound healing. What kinds of food would the nurse promote?
* Lean meats (beef, pork)
* Poultry
* Seafood
* Eggs
85
The provider recommends the patient increases carbs to aid in wound healing. What kinds of food would the nurse promote?
* Spaghetti
* Bread
* Beans
* Potatoes
86
The provider recommends the patient increases _fats_ to aid in wound healing. What kinds of food would the nurse promote?
* Avocados
* Cheese
* Nuts
* Tofu
* Chia seeds
* Flaxseed
87
The provider recommends the patient increases _Vitamin C_ to aid in wound healing. What kinds of food would the nurse promote?
* Tomatoes
* Bell peppers
* Oranges
* Strawberries
* Cauliflower
88
The provider recommends the patient increases _Vitamin B_ to aid in wound healing. What kinds of food would the nurse promote?
* Broccoli
* Brussel sprouts
* Kale
* Spinach
* Cabbage
89
The provider recommends the patient increases _Vitamin A_ to aid in wound healing. What kinds of food would the nurse promote?
* Milk
* Eggs
* Cantaloupe
* Mange
* Red bell peppers
* Carrots
* Sweet potatoes
* Tomatoes
* Kale
* Spinach
90
What can a nurse promote to aid wound healing?
* Keep wound clean w/ dry and intact dressing
* Limit infection risk: i.e, proper hand hygiene
* Educate on importance of no smoking / limit smoking
* Promote well-balanced diet
* Monitor lab values to prevent or catch infection early
* Promote adequate sleep
91
What factors can delay wound healing?
* Nutritional deficiencies
* Advanced age
* Anemia
* Certain medications
* Medical conditions
* Infection
* Smoking
* Poor general health
92
Factors delaying wound healing, nutritional deficiencies: Vitamin C
Delays formation of collagen fibers and capillary development
93
Factors delaying wound healing, nutritional deficiencies: Protein
Decreases supply of amino acids for tissue repair
94
How can anemia delay wound healing?
Supplies less oxygen at tissue level
95
How can certain infection delay wound healing?
Increases inflammatory response and tissue destruction
96
How does obesity delay wound healing?
Decreases blood supply in fatty tissue
97
How does poor general health delay wound healing?
Causes generalized absence of factors necessary to promote wound healing
98
How does smoking delay wound healing?
**Vasoconstrictor:** impedes blood flow to healing areas
99
Persons at risk for wound healing problems are those with what?
* Obesity
* Nutritional decencies
* Smoking
* Low oxygen
* Age: very old and very young
* Certain conditions (diabetes, cancer)
* How injury happened: clean vs dirty environment
* Race: certain complications prone to race
100
What types of patients are at an increased risk for pressure ulcers?
Patients who:
* Are immobile
* Incontinent
* Have low BP
* Experience shear
* Have difficulty communicating
* Have advanced age
* Spend longer periods of time in positions that place pressure on areas prone to ulcers
* Have inadequate diet
101
Within the first 7-10 days of an injury, the wound is most at risk for what?
* Infection
* Hemorrhage
* Dehiscence
* Evisceration
102
Bands of scar tissue that forms between or around organs are known as what?
Adhesions
* Join two internal body surfaces that are not normally connected
* **Not seen externally**
103
Shortening of muscle or scar tissue, especially over joints, that results from excessive fibrous tissue formation is called what?
Contractions
104
Seperation and disruption of perviously joined wound edges is called what?
* Dishiscence
* Usually occurs when primary healing site bursts open because granulation tissue not strong enough to withstand forces
105
When wound edges separate to the extent that intestines protrude, _____ has occurred.
Evisceration
## Footnote
**Needs immediate surgical treatment. Cover it immediately with sterile gauze/saline (use sterile gloves) and then call provider**
106
When excess granulation tissue protrudes above the surface of the healing wound, ____ has occurred
Excess granulation tissue ("proud flesh")
* Cut off, cauterize tissue, will continue to heal in normal manner
107
A _____ is abnormal passage between organs or a hollow organ and skin
Fistula
* Abdominal or perianal fistula common
108
Abnormal internal or external blood loss is called what?
Hemorrhage
* Can be caused by:
* Suture failure
* Clotting abnormalities
* Dislodged clot
* Infection
* Erosion of blood vessel by foreign objection (tube, drain)
109
Hypertrophic scars are characterized by what?
Inappropriately large, raised red and hard scars
* Over abundance of collagen is made during healing
110
A great protrusion of scar tissue that extends beyond wound edges and may form tumor-like masses of scar tissue are called what?
Keloids
111
A superficial wound involves only what layer of the skin?
Epidermis
112
When a wound has partial thickness, that means it has extended into what?
The dermis
113
A full-thickness wound occurs when….
There is deepest layer destruction:
* Subcutaneous involvement
* May extend into fascia and underlying structures: muscle, tendon, bone
114
A stage one pressure ulcer can be defined as what?
* Intact skin with localized area of non-blanchable erythema
* Blanchable erythema or changes in sensation, temperature or firmness may precede visual changes
115
A patient who has been confined to her bed and is incontinent has an ulcer located on her buttock. After assessing the wound, the RN determines the dermis is exposed and a serum-filled blister is present but adipose tissue and deeper tissues are not visible. What stage should the RN document this pressure ulcer as?
Stage Two:
* Partial-Thickness Skin Loss
* Loss of skin with **exposed dermis**
* Wound bed pink or red, moist
* Blisters may be present
* Adipose tissue and deeper tissues aren't visible
116
While assessing a pressure ulcer on the sacrum, adipose tissue is clearly present as well as tunneling. What stage would be appropriate to document?
Stage Three: Full Thickness
* Adipose visible
* Granulation tissue w/ rolled edges
* Slough and/or eschar may be visible
* Undermining and tunneling may occur
117
A pressure ulcer as exposed fascia, muscle, and tendon. What stage is this?
Four: Full Thickness
* Exposed and directly palpable fascia, muscle, tendon, cartilage, bone
* Slough and/or eschar may be present
* Rolled edges, undermining, and tunneling may be present
118
When an ulcer cannot be confirmed because it's obscured by slough or eschar, it's staged as what?
Unstageable
119
What are the ways in which a genetic disorder can be inherited?
1. Autosomal dominant
2. Autosomal recessive
3. X-linked
4. Y-linked
120
Which genetic inheritance pattern is this:
“Caused by mutation of single gene pair, meaning you **_need one abnormal_** autosome to get the disorder”
Autosomal dominant
121
Which genetic inheritance pattern is this?
“Caused by mutations of 2 gene pairs, meaning you **_need both abnormal_** autosomes to get the disorder"
Autosomal recessive
122
Which genetic inheritance pattern tend to affect men more often and why?
X-linked
* Women have 2 X chromosomes, so they have another chromosomes to compensate for the mutation while men only have 1 X chromosome
123
This type of genetic inheritance pattern **_only_** impacts men
Y-linked
124
Which genetic inheritance pattern is generally carried by females by commonly expressed in males?
X-linked
125
When a genetic disorder is caused by changes in **_one_** particular gene, this disorder can be classified as what?
Single gene
* Relatively rare
* Run in families and show the same inherited characteristics
126
Complex diseases that result from inherited variations in genes acting acting together with environmental factors are known as what?
Multifactorial Inherited Conditions
* Run in families but don't show the same inherited characteristics
* Ex: heart disease, diabetes, cancer
127
What is the nurse's role in genetics?
* Remain up to date and competent about genetics
* Support patients, educate and assist patients in making decisions about genetic issues
* Provide accurate information about genetics and genetic disorders
* Inheritance patterns, what the results of means, etc.
128
What are some benefits of genetic testing?
* Relief of stress, anxiety, etc. that can come from uncertainty
* Results can help in development of tx or prevention plan
* Provides information to help make informed medical decisions
* Provides greater understanding of one's health risks
129
What are some risks of genetic testing?
* May lead to feelings of anger, guilt, depression, anxiety, etc. if test is positive
* Genetic testing may uncover information that may affect family members that weren't tested
* May show biologic relationships weren't as thought
* Test results may not be private and provides potential for discrimination
130
What are some reasons for genetic testing?
* Diagnostic purposes: determine if disorder is present - what type? (single gene)
* Determine whether person is a carrier for particular gene mutation / if increased risk is present for developing disorder GENETICALLY
* Determine risk of passing disease onto children
* Provide treatment direction
131
A patient has a positive genetic test. What can the RN say to the patient about this?
* Lab found a change in a particular gene, chromosome, or protein that was being tested
* Does **_NOT_** mean a disorder will develop
132
What can a genetic test **_NOT_** tell a patient?
* Whether a genetic disorder will develop / timeline of development
* Predict the course of severity of a condition
133
A patient had a genetic test that came back negative. What does this mean?
* Lab did not find an altered form of gene, chromosome, or protein that is under consideration
* Does not necessarily mean disease won't develop in other ways (i.e, multifactorial)
* Patient does have decreased / diminished risk of developing disease through genetic connection
134
What are some assessments a nurse should perform associated with genetic testing?
* Obtain family history:
* Pedigree best for this. Increased risk for genetic disorder if family has:
* Disease in one or more close relatives
* Disease that doesn't usually affect a certain gender
* Disease that occurs at an earlier age than expected
* Certain combos of diseases within a family (breast cancer + ovarian)
* Obtain what genetic testing means to patient
* What results will mean to patient
* What patients knows about genetic testing
* Explain inheritance pattern of disorder being tested
135
What are some of the uses of NGs/Enteral feedings?
* Decompress stomach - contents removed to relieve stomach and intestine pressure caused by accumulation of GI air and fluid
* Remove gas & fluid
* Lavage stomach to remove ingested toxins other than poison
* Determine problems w/ GI motility and other disorders
* Treat an obstruction
* Administer feedings & medications
* Aspirate contents for analysis
136
What are some complications that can come from NG placement?
* Aspiration
* Mucosal injury
* Decreased VS
* Chronic irritation causing rhinitis, sinusitis
* Coughing, gagging, vomiting (can lead to displacement)
* Fluid, electrolyte imbalance
137
What is residual and why do you check for residual?
* Amount of gastric contents left in stomach between feedings
* Check it to ensure stomach is emptying properly
138
If the residual is about 250mL, what should you do?
Not continue the feeding and contact provider
139
If gastric content is coffee colored, what could this be a sign of?
Hemorrhage
* Need to do occult blood test
140
What are some important thins to know _prior_ to NG tube placement?
* Physician's order
* Type of tube for purpose
* Purpose of the tube for the patient
* Patient hx/risk for aspiration
* Type of feedings and the delivery of feeding
141
What are some important assessments / interventions associated with NG tube placements?
* Review patient’s hx → also confirm with patient for hx of facial trauma or surgery, anticoagulant therapy, etc.
* Assess nares patency: any polyps, irritated mucosa, other signs that could complicate insertion
* Test clients gag reflex to ensure adequate swallowing → helps determine risk for aspiration
* Place patient in high-fowlers position
* Measuring tube: nose to tip of ear, then to xiphoid process
* Add to 20-30cm if duodenal jejunal (14-18 French)
* Assess for kinks @ back of throat w/ pen light
* pH testing: 0 to 5.5 is indicative of being in the stomach (STILL NEED TO XRAY BEFORE USING)
142
What is the appearance of a normal stoma?
Shiny, pink/red, moist
143
What does an abnormal stoma look like?
dark red, purple, or even black in color
144
What type of discharge is normal in a stoma?
**Mucus-discharge is a common part of having any type of stoma.**
* Mucus is produced by the lining of the bowel to help with the passage of stools.
* The lining of the bowel will continue to produce mucus after stoma surgery, even if it is not needed anymore.
145
What is an open drain? How does it differ from a closed drain?
* _Open drains_ drain fluid onto a gauze pad or into a stoma bag → likely to increase risk of infection. **Penrose drain**
* _Closed drains_ use compression and suction to remove drainage and collect it in a reservoir → reduced risk of infection & more accurate way to measure drainage.
146
What are the first signs of **_infection_**
* Redness (not normal after 72hrs after injury)
* Warmth
* Swelling (not normal after 72 hrs following injury)
* Drainage (white/green/yellow/gray/smell)
* Pain
147
What are some reasons for an ostomy?
* Cancer-Trauma
* Colon cancer (obstruction)
* Abdominal Trauma
* IBS, Crohns (bowels rest)
* Bladder cancer-urostomy
148
An ostomy is put in the _descending colon._ Will this allow for the patient to be continent or incontinent
continent
149
An ostomy is put in the ascending _colon._ Will this result in the patient being continent or incontinent
incontinent
150
Serous fluid can be defined as what?
Clear, thin, and watery fluid
* Normal, not be alarmed about
151
Discharge that is thin and watery with a light red or pink hue is known as what?
Serosanguinous
* Surgical site drainage → to be expected
152
Discharge that is bright red can be defined as what?
Sanguineous
153
Discharge that is thick, yellow/green, and odorous is known as what?
Purulent (pus)
* Indicative of _infection_
* Consists of WBCs, microorganisms (dead and alive), liquefied dead cells, and other debris
