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S3 1538 > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

ADHD diagnosing

A

symptoms last more than 6 months

symptoms begin before 7 years old

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2
Q

To diagnose ADHD before 17, pt must have

A

6 or more of ADHD characteristics

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3
Q

Stimulant drugs for ADHD

A

Dextroamphetamine - stimulant, loss of appetite, sleep problems, headaches

Atomoxetine - decreased appetite, N/V, sleep disturbance

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4
Q

Nonstimulant ADHD meds

A

Norepinephrine reuptake inhibitors

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5
Q

ADHD meds should be given to kids _ food

A

AFTER

so they eat

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6
Q

Monitor ADHD kids for…

Give meds early so they can _

A

weight loss

sleep

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7
Q

Therapeutic play for ADHD

A

Promotes communication

Increases understanding of thoughts and feelings

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8
Q

ADHD drugs should be stored safely to prevent

A

accidents or abuse

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9
Q

Behavioral therapy for ADHD

A

Positive reinforcement

Age appropriate consequences

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10
Q

Refer ADHD fam to

A

local support groups

national ADHD support groups

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11
Q

3 types of hyperactivity

A

Impulsive
Inattentive

combined

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12
Q

When is autism IDd

A

between 12 months and 36 months

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13
Q

Autism characteristics

A 
little eye contact 
few facial expressions
difficulty building relationships 
low emotional affect 
lack spontaneous enjoyment
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14
Q

Warning signs of autism

A

no babbling by 12m
no pointing or gesturing by 12m
no words by 16m
no 2-word utterances by 24m

LOSS or Regression of skills

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15
Q

Therapies for autism

A

behavioral and communication

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16
Q

Autism patients respond well to _ education

A

structured

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17
Q

Autism stereotyped motor behavior

A

Hand flapping
Body twisting
Head banging

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18
Q

Autism screenings

A

MchatR
SCQ Social communication questionnaire
PDDST pDevelopmental disorder screening test

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19
Q

Interventions for autism

A

emotional support
guidance and edu
Routine

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20
Q

Controversial treatment for menopause

A

HRT

Hormone replacement therapy

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21
Q

If a menopause woman still has her uterus her HRT will have

A

Both estrogen AND progestin

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22
Q

Dosing for HRT

A

Lowest effective

Shortest duration

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23
Q

HRT contraindications

A 
Hist of breast cancer
Uterine cancer
Vascular thrombosis
Impaired liver function
Undiagnosed uterine bleeding
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24
Q

HRT patients need to understand they are taking

A

HORMONES

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25
Q

S/S of DVT

HRT risk

A

leg redness and pain/tenderness

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26
Q

S/S of PE

HRT risk

A

chest pain and SOB

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27
Q

Patient maintenance for HRT therapy

A

Weight bearing exercises
v in smoking/alcohol
Annual mammogram
Take calcium and vit D

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28
Q

Does intellect decline with age

A

NO

just get a little slower

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29
Q

Is depression normal in older adults

A

NO

Neither is loneliness

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30
Q

Aging and heart

A

HF

Atherosclerosis

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31
Q

Aging had lungs

A

Loss of elasticity

Difficulty breathing

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32
Q

Aging and GU

A

Incomplete emptying, creates need to pee

Leads to fall risk and infection

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33
Q

Aging and GI

A

v metabolism

constipation

+fiber

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34
Q

Aging and senses

A

Vision Hearing Taste and Smell

ALL DECREASE

PT will add salt

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35
Q

TB spread is

A

Airborn

N95

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36
Q

Tuberculosis 101

A

airborne

multiply in alveoli and get transported via blood and lymph

as infected cells die they accumulate in lung causing bronchopneumonia

Can recur

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37
Q

TB infection occurs to weeks after exposure

A

2 to 10

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38
Q

S/S of EARLY TB

insidious

A

Low fever

cough

sweats

fatigue

weight loss

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39
Q

As TB progresses S/S includes

A

Mucopurulent sputum expectorate

Hemoptysis - blood in cough

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40
Q

Elder TB patients have _ pronounced symptoms

A

Less

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41
Q

If pt presents with positive skin, blood or sputum, for TB

A

Do history, physical exam, Chest xray.

Drug susceptibility testing.

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42
Q

5mm or greater on TB test

When is test read

Will it be elevated

A

Positive

48-72h

Yes

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43
Q

Blood tests for TB

A

QuantiFERON Gold

T-Spot

rules out Active and Latent infections

Good for BCG vaccinated people

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44
Q

TB meds

A

Anti-TB agents

INH, Rifampin, Pyrazinamide, Ethambutol

Given for 6 to 12 months

Prolong treatment to ensure eradication

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45
Q

TB drug resistance

A

Primary - resistance to ONE drug in people who have not had previous treatment

Secondary - resistance to ONE OR MORE in people undergoing therapy

Multi - resistance to TWO agents

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46
Q

TB treatment phases

A

phase 1: all drugs + Vit B6 for 8 weeks

phase 2: INH and rifampin for 4 to 7 months

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47
Q

Nursing priorities with TB

A

Airway clearance

Adherence to meds

^ Activity and nutrition

Prevent transmission

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48
Q

Airway clearance with TB interventions

A

^ fluid intake

Postural drainage

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49
Q

Adherence to meds with TB

A

Take meds on empty stomach or 1h before meal

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50
Q

Food that messes with TB meds

A

Tuna

Aged cheese

Red wine

Soy sauce

Yeast extract

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51
Q

Rifampin makes what meds less effective

A

Warfarin

digoxin

corticosteroids

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52
Q

Contact lenses and rifampin

A

Will be discolored

switch to glasses

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53
Q

Side effects of antiTB meds

A

Liver/Kidney problems (BUN, creatinine, enzymes)

Hearing loss

Rash

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54
Q

Prevent transmission with TB

A

Cover mouth

dispose of tissues

Hand hygiene

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55
Q

Do you report TB to the health department

A

YES

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56
Q

RA patho

A

Immune system attacks joints causing effusion, pain and edema

After triggering event, pain subsides pannus (extra growth) occurs

Destruction of joint cartilage and bone

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57
Q

Pannus

A

Proliferation of new synovial joint tissue WITH inflammatory cells already formed

occurs due to RA

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58
Q

RA is autoimmune

A

body attack self

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59
Q

S/S of RA

A

PAIN

joint swelling

limited movement

stiffness

weakness

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60
Q

Diagnosing RA

A 
RF rheumatoid factor
ACPA
ESR erythrocyte sedimentation rate
C reactive protein CRP
Radiology
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61
Q

Rx management of RA

A

salicylates (aspirin)

NSAIDs

DMARDs (work on autoimmune response)

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62
Q

None Rx management of RA

A

Heat/Paraffin baths 20 min max

Therapeutic exercises

Braces, splints, assistive devices (canes)

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63
Q

Treatment goals for RA

A

v inflammation

control pain

^ mobility

^ PT knowledge

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64
Q

RA exercise and activity

A

Physical/occupation therapy

TENS

relaxation techniques

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65
Q

Sleep with RA can be aided by

A

Low dose antidepressants

Amitriptyline

Good sleep hygiene (cold room, no tv, no eating in bed, etc.)

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66
Q

What joints are affected first by RA

A

fingers

wrists

toes

small joints first

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67
Q

clues for RA problems in elderly

A

Gait pattern change

Guarding

Joint flexion

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68
Q

3 Distinct characteristics of RA

A

Inflammation
Autoimmunity
Degeneration of cartilage

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69
Q

RA

Swan neck

Boutonniere

A

finger appearance ^v-

finger appearance ^-

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70
Q

Caution with biologic DMARDS

Disease modifying antirheumatic drugs

A

Suppress autoimmune response

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71
Q

RA joint deformities can result in

A

loss of use

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72
Q

Contractures

A

muscles bones joints get stuck due to joint destruction RA

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73
Q

When in they day is the pain worse

A

MORNING

ON TEST

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74
Q

RA foot deformities

A

Major bunion

Toes going in different directions

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75
Q

Why do joint deformities happen

A

destruction and recalcification of tissue

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76
Q

Biggest difference between lupus and RA

A

Degeneration and destruction of tissue with RA

ON TEST

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77
Q

NSAIDS CORTICOSTEROIDS DMARDS

with RA

A

STAY AWAY FROM PEOPLE

HIGH INFECTION RISK

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78
Q

DMARDs

A

stop progression but can not fix damaged joints

does not work indefinitely

Nonbiologic - take longer to work then biologic

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79
Q

Infliximab DMARD

A

Works to improve the immune system

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80
Q

Anaphylaxis

A

Type I hypersensitivity

Rapid release of IgE

severe life-threatening reaction

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81
Q

Common causes of anaphylaxis

A

Antibiotics and radiocontrast agents

Penicillin most common culprit

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82
Q

The faster the onset of anaphylaxis

A

The more severe the reaction

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83
Q

Mild anaphylaxis S/S

A

tingling and warmth

fullness in mouth and throat

nasal and periorbital swelling

sneezing and tearing of eyes

onset is first 2h of exposure

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84
Q

Moderate anaphylaxis S/S

A

flushing/warmth/itching

Anxiety

Bronchospasms

edema or airways

cough/wheezing

onset within first 2h

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85
Q

Severe anaphylaxis S/S

A

Abrupt onset

severe dyspnea

cyanosis

hypotension

V/D

seizures

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86
Q

Treatment for anaphylaxis

A

Strict avoidance

Epinephrine (EpiPen Auvi-Q)

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87
Q

Med management of anaphylaxis

A

O2

Epi

Antihistamines

Corticosteroids

IV fluids

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88
Q

After treatment for anaphylaxis watch for rebound reaction which happens…

A

4 to 8 h after

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89
Q

Nursing management of anaphylaxis

A

Check airway breathing and vitals

Notify providers

Instructions after recovery, like what to avoid and getting an epipen

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90
Q

Emergency nursing measures for anaphylaxis

A

Intubating

Admin emergency meds

IV lines + fluids

O2 admin

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91
Q

Anaphylactoid reaction

A

Not same as anaphylaxis

NON IgE

No sensitization

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92
Q

Fluids with Anaphylaxis

A

Increased permeability of capillaries

Fill up with fluid in lungs

N/V/D etc.

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93
Q

If you have Mild anaphylaxis now

A

DOT NOT mean will have Mild anaphylaxis next time

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94
Q

Solution to push IV for anaphylaxis

A

Isotonic

LR
NS

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95
Q

Nursing management basics for anaphylaxis

A

Stop allergen

Give epi FIRST, IV, O2

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96
Q

If you have allergy

awareness

A

wear bracelet

Inform school nurse/teachers

ask for return demonstration when showing how to use

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97
Q

Hold epipen in injection place for

A

FULL 10 SECONDS

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98
Q

Crohn’s disease 101

A

Chronic inflammation of GI

Most common in distal ileum and ascending colon

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99
Q

Crohn patho

A

small lesions that expand and thicken becoming fibrotic

intestinal lumen narrows

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100
Q

S/S of crohn

A

prominent right lower quadrant pain

unrelieved diarrhea

pain occurs after meals

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101
Q

Secondary complications of crohns

A

weight loss

malnutrition

anemia

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102
Q

stretorrhea and chron

A

fat in feces

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103
Q

Assessment for crohns

A

CT and MRI

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104
Q

Crohn bowl complications

A

obstruction

structural problems

perianal disease

Enterocutaneous fistula - opening between small bowels and skin

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105
Q

Enterocutaneous fistula

A

opening between small bowels and skin

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106
Q

Ulcerative colitis 101

A

ulcerative inflammatory disease of mucosal and submucosal layers of colon and rectum

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107
Q

Characteristics of Ulcerative colitis

A

Abdominal cramps

Bloody/purulent diarrhea

LEFT lower quadrant pain

Weight loss

six or more liquid stools a day

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108
Q

Patho of ulcerative colitis

A

mucosa become edematous and inflamed

colonic epithelium sheds

Eventually the bowel narrows, shortens and thickens

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109
Q

Assessment for ulcerative colitis

A

abdominal x ray

colonoscopy

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110
Q

Ulcerative colitis may lead to toxic mega colon this is treated with

A

NG suction

IV fluids

Lytes

Corticosteroids

Antibiotics

SURGERY

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111
Q

Diet for ulcerative colitis

A

Oral fluids

Low residue

High protein, high calorie diet

Supplemental vitamins, iron

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112
Q

Food to avoid with ulcerative colitis

A

cold food

milk

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113
Q

Rx or ulcerative colitis

A

sedatives antidiarrheals antiperistalitics for diarrhea

Aminosalicilates to reduce inflammation

Corticosteroids to reduce swelling

Immunomodulators to treat underlying cause

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114
Q

Partial or complete obstruction or bowels =

A

surgery

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115
Q

Colectomy and ileostomy

A

removal of colon and stoma for drainage

used in IBD problems

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116
Q

Normal elimination nursing interventions

A

food diary

give meds

increase fluid intake

record frequency and consistency of stool

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117
Q

Pain nursing interventions for IBD

A

Analgesics

Position changes

Heat

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118
Q

When doing parenteral nutrition for IBD patients monitor

A

glucose q6h

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119
Q

Mental health and ulcerative colitis

A

Promote rest

Reduce anxiety

Enhance coping measures

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120
Q

With bedridden IBD patients monitor for

A

skin breakdown

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121
Q

2 types of TB

A

Active- showing symptoms, neutrophils and macrophages fight infection

Latent- NOT active but carrier of encapsulated bacteria

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122
Q

Most obvious TB S/S

A

Cough lasting more than 3 weeks

low grade fever

blood in sputum

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123
Q

if PPD test is greater than 10mm

A

POSITIVE

Induration (raised) MUST be present

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124
Q

PPD test is considered

A

SCREENING not diagnostic

TB GOLD, Chest xray and Acid fast are diagnostic

ACID FAST CULTURE IS THE GOLD STANDARD OF TB TESTING

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125
Q

Standard number of meds to take for TB

A

4

isoniazide

Rifampin

Pyrazinamide

Ethambutol

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126
Q

All TB meds are toxic to

A

LIVER

do enzyme tests

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127
Q

For tb take B6

take meds 1 h _ meals

when to take

A

to prevent neuropathy

before

SAME TIME QDAY

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128
Q

When is a TB patient not contagious

A

after 2-3 weeks

AND
3 negative sputum cultures

AND

Med compliant

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129
Q

when are sputum samples done for TB

A

Q2-4W

Helps track progress

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130
Q

S/S or hepatotoxicity

S/S nerutoxicity

A

Jaundice, Right upper quadrant pain, Fever

Numbness, tingling

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131
Q

for alergic reactions do you shut the med off first or give epi

A

SHUT THE MED OFF

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132
Q

Ulcerative colitis only affects

Starts at

A

Mucosal and Submucosal layers

Low part of rectum and works its way up

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133
Q

Crohn’s disease affects

A

All layers of intestine from mouth to butt but not continuously

here and there

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134
Q

movement number

Ulcerative colitis UC pain will start at

A

15 to 20 bowel movements

Left lower side

Bleeding

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135
Q

movement number

CD pain

A

5 stool movements

pain in right lower quadrant

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136
Q

UC complications

A

Loss of Haustra - smooths out intestine, these parts can absorb nutrients

Toxic megacolon - colon dilates, inflammation. Unable to contract, distends, becomes paralyzed

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137
Q

Cobblestone intestine is related to

A

CD

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138
Q

IBS labs

A

Albumin will be LOW malnutrition

ESR, C reactive protein - inflammation

Stool sample

CBC

Chem panel

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139
Q

IBS diagnostics

A

MRE - magnetic resonance enterography

MRI/CT

Sigmoidoscopy

Colonoscope

Endoscopy

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140
Q

With IBS diet avoid

A

FIBER - will make you shit more

POPCORN - will get stuck and infected

RED MEAT - slow digestion

Peal fruit and veg

141
Q

IBS treatments side effects

A

5 Aminosalicylic acid - nausea fever rash, kidney toxicity

Steroids and immunosuppressants - avoid getting sick

142
Q

Surgery for IBS

Always give

A

Ileostomy, Colectomy, Proctocolectomy

ANTIBIOTICS

143
Q

IBS diet

A

Low fiber

High protein

High calorie

144
Q

Toxic megacolon treatment

A

NPO

bowel suction

TPN

if not resolved by 3 days, surgery

145
Q

Before applying a valve sticker to the colostomy use

A

barrier cream, prevents skin breakdown

146
Q

Teach parent about ADHD

A

Support groups
Routines
Reward systems

Monitor weight

147
Q

Comms with ADHD parents to support therapy

A

Your child is not bad
Have appropriate reward and punishment systems
Keep child on track

148
Q

TB isolation

A

negative pressure room

put sign on door

149
Q

TB evaluation best

A

Sputum

150
Q

With RA safety

A

Avoid large crowds
Check temp
Avoid sick people

151
Q

RA stiffens is _

A

bilateral

152
Q

When would you not give RA PTs DMARDS

A

TB

Immune compromise

153
Q

How to give epi

A

Thigh
10 sec
through clothing

154
Q

On top of epi give

A

Antihistamines

155
Q

Response to EPI meds

A

If pt still breathing bad, has rash or other symptoms

still needs med

156
Q

With IBS assess bleeding in stool

A

Drop in BP increase in HR

CBC

157
Q

Complications of steroid therapy

A

Low Immunity
Hyperglycemia

Osteoporosis - Bone scans, weight bearing exercise, Calcium Vid D

158
Q

IBS serious complications

A

Toxic Megacolon ON TEST
S/S

unalleviated pain
abdominal distention
inflammation to the muscular wall

rest, NPO, TPN

If no response to med management in 72h = surgery

159
Q

MS manifestations

A

Visual problems
Cognitive problems
Speech/swallowing problems

160
Q

Lupus manifestations

A

Fever
Fatigue
Anorexia
Joint pain

Butterfly rash

161
Q

Lupus and blood

A

Kidney function

BUN value ?
Creatinine value ?

162
Q

Diagnosing lupus

A

?

163
Q

Breast cancer meds

A

Tamoxifen
Chemo - N/V, alopecia, loss of appetite
Radiation - skin irritation, keep distance especially if imbedded ratiation

164
Q

Tamoxifen

A

Preventative

given if pt has potential

165
Q

Gold standard of breast cancer treatment

A

Surgery

166
Q

Prostate cancer S/S

A

?

167
Q

Surgery for prostate cancer

A

TURP

Irrigation of bladder
Progression of color like lochia

168
Q

Brachytherapy safety

A

Maintain distance

stay away from pregnant people
elderly and children

169
Q

Gold standard of colon cancer

A

Colonoscopy

Starts at 50
Then every 10 years

170
Q

Colonoscopy

A

Camera looking for growth and dollops
Can take a sample

Gold standard of Colon cancer testing

171
Q

Before colon surgery give

A

ANTIBIOTICS

teaching for end result like a bag or tube

172
Q

With Chemo

blood

A

Anemia
Thrombocytopenia
Low WBC

173
Q

Radiation is too much

A

blistering
bleeding
puss

174
Q

Leukemia interventions and assistance

A

Stop if lab too low

May give blood or other supplements

175
Q

ABCDE of skin cancer

A

?

176
Q

Clinical manifestation of Hodgkins

A

B Symptoms ?

Lumps

177
Q

Who is most at risk for ALL

A

Kids

178
Q

MS

Multiple sclerosis 101

A

progressive demyelinating disease of the CNS

Impaired transmission of nerve impulses

onset at 25 to 35 y

179
Q

MS Patho

A

T and B cells demyelinate nerve cells in CNS

plaque appears on demyelinated nerves further interrupting connections

axon begin to degenerate resulting in permanent damage

180
Q

MS S/S

A

Fatigue

Depression

Weakness

Numbness

Bad coordination

181
Q

Vision with MS

A

Diplopia (double)

Blurred

may cover affected eye

182
Q

MS and pain

MS and spasticity

MS and ataxia

A

pain - social isolation

spasticity - messes with motor pathways

ataxia - impaired movement

183
Q

MS assessment and diagnosis

A

Plaque in CNS observed via MRI

184
Q

Common symptoms of MS that require interventions

A

Ataxia

Bladder dysfunction

Depression

Fatigue

Spasticity

185
Q

Disease-modifying therapies for MS

A

reduce frequency or relapse

reduce duration of relapse

reduce number and size of plaques

186
Q

Disease modifying meds MS

A

Interferon beta 1a - flu like symptoms

Glatiramer acetate - takes 6m

IV methylprednisolone - key agent in treatment, no long term benefits

Mitoxantrone - cardiac toxicity

187
Q

Symptoms management meds MS

A

Baclofen and benzos - spasticity

anticholinergics - bladder issues

Ascorbic acid for UTIs

188
Q

Nursing interventions for MS

A

Exercises

Minimizing spasticity and contractures

Nutrition

Minimize immobility

189
Q

Nursing treatment of MS for walking

A

Assistive devices

Gait training

190
Q

Nursing treatment for bladder/bowels MS

A

Training to control and respond in time

self cath

191
Q

Nursing treatment and sallowing MS

A

Speech/language pathologist to assist with dysphagia

192
Q

MS and home living

A

assistive eating devices

raised toilet seats

bathing aids

phone modifications

long-handled comb

193
Q

DMARDs

A

stop progression but can not fix damaged joints

does not work indefinitely

Nonbiologic - take longer to work then biologic

194
Q

Can you get myelination back with MS

A

NO

195
Q

Diagnosing MS

A

MRI

CSF spinal tap

EMG - assesses nerve response

Neuro exam

196
Q

MS meds are immunosuppressive so

A

Wear masks

Stay away from crowds

Take steps to not get sick

197
Q

DMARDs decrease

A

Frequency and duration of relapse

Can decrease plaque in brain

WILL BE ON TEST

198
Q

Main focus of nursing care for MS

A

Safety first

assistive devices

Bladder/bowel care

Cognitive function

Meds

199
Q

SLE

Systemic lupus erythematosus

A

Inflammatory autoimmune disorder

Affects body organs

200
Q

Factors that contribute to lupus

A

Genetic

Immunologic

Hormonal

Environmental

201
Q

SLE Lupus manifestations

A

Fever, malaise, weight loss, anorexia

202
Q

Most commonly affected system by SLE

A

Gastrointestinal tract

Liver

Ocular system

203
Q

Skin manifestations of lupus

A

Rash on nose bridge and cheeks

204
Q

With SLE, skin lesions are worsened by

A

sunlight

ultraviolet light

205
Q

Earliest symptoms of SLE

A

Joint problems

Arthralgia (joint stiffness)

206
Q

Heart symptoms with SLE

A

Pericarditis

Hypertension

Dysrhythmias

Valve problems

207
Q

Kidneys and SLE

A

Nephritis

Serum creatinine for screening

208
Q

Normal BUN

A

6 to 24

209
Q

Normal Creatinine

A

0.7-1.3

210
Q

CNS and SLE

A

cognitive impairment

seizure

strokes

central and peripheral neuropathy

211
Q

Diagnosing SLE

A

History

Physical

Blood tests

212
Q

Erythematous rash

Erythematous plaque with scale

A

Sign of lupus

213
Q

Scalp with SLE

Mouth with SLE

A

Alopecia

Ulcerations

214
Q

SLE has 11 criteria

if _ are present, lupus is diagnosed

A

4

215
Q

Blood work for lupus

A

Anti-DNA

Anti-ds DNA

Anti-Sm

216
Q

Mainstay of SLE management

A

Pain

Immunosuppression

217
Q

Meds for SLE

A

Monoclonal antibodies

Corticosteroids

Antimalaria agents

NSAIDS

Immunosuppressive agents

218
Q

Belimumab

A

Approved by FDA for SLE

Monoclonal antibody that renders BLyS inactive

219
Q

BLyS

A

Produced by body during lupus

Attacks organs

220
Q

Risk factor for corticosteroids and SLE

A

Osteoporosis

221
Q

Nursing management focus with SLE

A

Fatigue

Impaired skin integrity

Body image disturbance

Deficit in knowledge

222
Q

SLE patients need to increase

A

screenings

health promoting activities

have good diet

223
Q

Immunosuppressants and corticosteroid side effects with lupus

A

increased risk for infection

Increased risk for osteoporosis

224
Q

Most common sign of lupus

A

Low grade fever

joint pain

MALAR RASH ON TEST (the nose cheekbone thing)

225
Q

Discoid lesions

A

Scaly

very clear

cause alopecia

Sign of LUPUS

226
Q

Lupus related arthritis

A

Swelling of joints due to lupus

BILATERAL AND SEMETRICK

227
Q

Lupus meds

S/S of nephritis

A

Cloudiness blood or puss in urine

Pain at kidneys

BUN Creatinine urinalysis labs

228
Q

Indicative test for lupus

A

ANA

History of symptoms

229
Q

Why are kidneys stressed during lupus

A

Kidneys are our filters

NEED EM

230
Q

Meds for lupus

A

hydroxychloroquine

corticosteroids

Methotrexate and azathioprine (immunosuppressants)

NEED TO BE SAFE BECAUSE THESE MEDS WILL DISTROY IMMUNITY

231
Q

As nurses helping with lupus

A

Manage pain

Rest

MONITOR KIDNEYS

V/S, edema, breath sounds

Monitor Mental status

232
Q

for alergic reactions do you shut the med off first or give epi

A

SHUT THE MED OFF

233
Q

Mutation in BRCA 1 or BRCA 2 indicates

A

increased risk for breast cancer

234
Q

Chemopreventives for breast cancer

A

tamoxifen

raloxifene

235
Q

Prophylactic mastectomy

A

Total mastectomy of a breast at risk

Reasons to get

Fam history, BRCA, LCIS, previous cancer

236
Q

Breast cancer is usually found in the

A

upper outer quadrant

237
Q

S/S of breast cancer

A

nontender fixed hard mass

skin dimpling, nipple retraction, skin ulceration

238
Q

BC prognosis is based on

A

size

spread to other areas

239
Q

Preoperative nursing interventions Breast cancer

A

Know difference between ALND (axillary lymph node dysection) and SLNB (sentinel lymph node biopsy) and treatment options

Emotional support

promote decision making

240
Q

Postoperative nursing interventions Breast cancer

A

Pain and discomfort relief THERAPY

Promote positive body image

Promote coping

improve sexual function

Monitor for complications LYMPHEDEMA

241
Q

When are post surgery drains removed

A

When drain output is less than 30ml in 24h

242
Q

Complications of breast surgery

A

Lymphedema

Hematoma/Seroma

Infection

243
Q

Range of motion exercises should be performed at what rate

A

3 times a day

20 min session

244
Q

Brachytherapy

A

radiation delivered via internal device

given over 4 to 5 days as opposed to regular radiation

which is 5 to 6 weeks

245
Q

Nursing management for radiation therapy

A

Used mild soap and minimal rubbing

No perfumes/deodorants

Hydrophilic lotions

Antipruritic soap

Avoid tight cloths

246
Q

To minimize chemo side effects pts may be given

A

hematopoietic growth factors

granulocyte colony stimulants

247
Q

Trastuzumab

A

Binds specifically to HER-3 protein preventing cancer

248
Q

How often after 40 are mamograms and clinical breast exams done

A

every year

249
Q

Well differentiated is

Undifferentiated is

A

tumor look line normal cell GOOD

no similarity BAD

250
Q

To admin chemo you need

can you crush chemo drugs

A

special certs

double checking by 2 nurses

NO

251
Q

Types of tumor excisions

A

surgery and biopsy

252
Q

Genes associated with prostate cancer

A

HPC 1 BRCA 1 BRCA 2

253
Q

S/S of pros cancer

A

urinary obstruction

blood in urine or semen

painful ejaculation

254
Q

Symptoms of metastases of prostate cancer

A

backache

hip pin

perineal and rectal pain

255
Q

Assessment for pros cancer

A

DRE

serum PSA

ultrasound guided TRUS

256
Q

Score to determine treatment for pros cancer

A

gleason

257
Q

pros cancer and vaccines

A

therapeutic vaccines kill existing cancer cells

provide future immunit

258
Q

Surge management of pros cancer

A

radical prostatectomy

may have impotence

259
Q

radiation for pros cancer

A

brachytherapy - radiation

260
Q

ADT

A

androgen deprivation therapy - castration - increases morbidity

hormone therapy

261
Q

Hormone therapy for pros cancer

A

LHRH agonists

Antiandrogen receptor agonists

262
Q

Other pros cancer therapies

A

cryosurgery

TURP

Pain management

263
Q

Prostate cancer is so slow that treatment can be delayed for up to

this can also lead to under monitoring

A

10 year

264
Q

Prostate cancer is also linked with what mutation

A

BRCA

265
Q

Early prostate cancer s/s

A

Hesitancy

weak stream

urgency

frequency

nocturia

266
Q

prostate cancer likes to spread to

A

BONE

the lymph nodes

will hur

267
Q

PSA

A

prostate specific antigen

elevated is more than 4

do this BEFORE Digital rectal exam

268
Q

EPCA =

A

prostate cancer

best indicator

269
Q

Androgen deprivation therapy

A

hormonal therapy for prostate cancer

270
Q

post prostate surgery procedure

A

CBI

continuous bladder irrigation

monitor color for progression

1000ml in should = 1000ml out

271
Q

Most significant risk factor for colorectal cancer

A

old age

272
Q

S/S of colorectal cancer

A

change is bowel habits

blood in or on stool

anemia anorexia

weight loss or gain

273
Q

Dull abdominal pain and melena(dark stool)

A

colorectal cancer

274
Q

Screening for colorectal cancer

A

colonoscopy

275
Q

Complications of butt cancer

A

obstruction

hemorrhange

276
Q

Old butt cancer patients may report fatigue due too

A

low iron

277
Q

med to prevent butt cancer

A

aspirin

278
Q

Surgeries for butt cancer

A

segmental resection

perineal resection

Temp/permanent colostomy

Colonic j-pouch

279
Q

With butt cancer, chemo usually starts at stage _

unless your is messed up at stage

A

3

MMR, 2

280
Q

Butt cancer preop nursing care

A

Nutrition

Infection prevention

FV balance

281
Q

Butt cancer postop nursing care

A

Nutrition

Wound care

Monitor for complications, Rectal bleed emergency - hemorrhage

282
Q

When do colonoscopy’s and fecal occult blood start

A

age 50 q10y

283
Q

To admin chemo you need

can you crush chemo drugs

A

special certs

double checking by 2 nurses

NO

284
Q

Chemo complications

A

immunosuppression

NV Anorexia

Alopecia

Oral effects - mucus lining thinning mucositis/stomatitis

Anemia/thrombocytopenia

285
Q

Increase in chemo intensity =

A

increase in positive outcomes BUT ALSO increase in toxicity

286
Q

How to chemo meds work in terms to cell life

A

they affect different life stages of cell procreation mitosis

287
Q

chemo pain

A

tissue necrosis neuropathies

288
Q

radiation pain

A

skin, tissue, organ inflammation

289
Q

Radiation therapy lead to skin

A

Integrity issues

290
Q

Brachytherapy

A

radiation delivered via internal device

given over 4 to 5 days as opposed to regular radiation

which is 5 to 6 weeks

291
Q

Nursing management for radiation therapy

A

Used mild soap and minimal rubbing

No perfumes/deodorants

Hydrophilic lotions

Antipruritic soap

Avoid tight cloths

292
Q

Radiation

A

ionizes and targets tissue cells

Skin will be Sun Burned - expected side effect

293
Q

bad radiation side effects

A

Weeping

drainage

ulcers

294
Q

Do you put lotions on radiation

how is radiation give

A

NO

fractions - given in centigrade of whole

if prescribed 500 centigrade, given 20 centigrade per a session

295
Q

Protection with radiation

A

ware dosimeter and protective equipment as a nurse

let pt know to stay away from pregos and spouse

visiting times down to 30 min 6 foot distance

296
Q

Internal radiation implant seeds will cause

A

radiation precaution to last longer

297
Q

Leukemia

A

Hematopoietic malignancy of the a particular blood cell

can be granulocyte, lymphocyte, erythrocyte or megakaryocyte

298
Q

Manifestations of AML

Acute myeloid leukemia

A

Neutropenia - fever and infection

Anemia - fatigue dyspnea pallor

Thrombocytopenia - petechia, ecchymoses, bleeding tendencies

299
Q

AML and manifestations inorgans

A

Pain in liver or spleen from enlargement

Bone pain from marrow expansion

Hyperplasia (enlargement) of gums

Hyperplasia of synovial space of joints

300
Q

Diagnostics of AML

A

CBC - v in erythrocytes and platelets

v in Leukocytes

Bone marrow analysis - 20% increase in immature leukocytes aka Blast Cells Hallmark of diagnosis

301
Q

AML treatment

A

Aggressive chemo - induction therapy (hospitalization for weeks)

results in low ANC

Packed RBCs and Platelets for ANC

G-CSF or GM-CSF - promote granulocyte and macrophage growth

302
Q

Absolute neutrophil count

A

precise calculation of the number of circulating neutrophils

DROPS in AML

303
Q

Chronic Myeloid leukemia CML 101

A

Pain in Liver Spleen and Long bones - excessive leukocyte proliferation

SOB, confusion - due to too much leukocytes

304
Q

Transformation phase CML S/S

A

bone pain, fever, weight loss

Spleen will enlarge

Anemia/Thrombocytopenia

305
Q

Acceleration (blast crisis) phase CML S/S

A

Same as AML

Induction therapy

306
Q

Nursing management of CML

A

PCR to detect levels of BCR-ABL molecules

Major molecular response Benchmark for determining efficacy

Biggest issue with taking tyrosine therapy is ADHERENCE, STRESS importance of taking meds

307
Q

Skin cancer causes

A

UV exposure

308
Q

skin Basal cell carcinoma S/S

A

small waxy nodule

rolled translucent pearly borders

309
Q

skin Squamous cell carcinoma

A

from epidermis

Invasive and metastasizing

310
Q

SCC S/S

A

rough thickened scaly tumor

may or may not bleed

311
Q

Surgical skin cancer treatment

A

Mohs micrographic surgery - most accurate, removes layers

Electrosurgery - current burn it

Cryosurgery - deep freezing the tissue

312
Q

Topical treatment for skin cancer

A

5 aminolevulinic acid + PDT

ALAPDT

313
Q

Teaching for skin cancer

A

dressing changes and wound checking

monitor bleeding

emollient cream for dryness

follow up q3m for a year

314
Q

Melanoma manifestation

A

dark red blue

irregular shape

1cm

itching ulcerations bleeding

rapid growth

315
Q

2 phases of melanoma growth

A

1 wide

2 into skin

316
Q

Diagnosing melanoma

A

Biopsy

317
Q

Staging for melanomas

A

Tumor nodes metastasis system

318
Q

Melanoma nursing intervnetions

A

Pain and discomfort

Reduce anxiety

Monitor complications

319
Q

actinic keratosis

A

small red areas that grow scale and thick over time

Precursor to skin cancer

might be on test

320
Q

3 types of skin cancer

A

scc - squamous, scaly lesions

bcc - basal, most skin cancer, small waxy nodules

melanoma - Most dangerous and spreading, Look like moles

321
Q

ABCDE of melanomas

A

Asymmetry

Border irregularity

Color variation

Diameter over 6mm

Evolving

generally the more symmetry the better and vice versa

322
Q

+5 sunburn =

A

double the skin cancer risk

323
Q

Mohs surger

A

continuing to burn or freeze post melanoma cites until biopsy comes up negative

324
Q

Hodgkin lymphoma 101

A

Rare, high cure rate

happens between 15y and 34y or over 60y

familial pattern

325
Q

Hodgkin lymphoma patho

A

Single node origin

Reed-Sternberg Cell - huge immature lymphoid tumor cell, Core cell of the disease, all benign cells around it just support it.

326
Q

S/S of hodgkin lymphoma

A

Enlargement of one or more lymph nodes on neck, Painless and firm

Cervical, Supraclavicular and mediastinal nodes most common

Mediastinal mass may be large enough to close trachea and cause dyspnea

327
Q

Organ S/S of hodgin lymphoma

A

Organ compression

Pulmonary effusion

Jaundice

Abdominal pain

Bone pain

B symptoms

328
Q

B symptoms

A

Fever

Drenching seats

Weight loss

329
Q

Erythrocyte sedimentation rate

A

Rate of RBC settling - elevation indicates hodgkin lymphoma

330
Q

Diagnosing hodgkin lymphoma

A

Lymph node biopsy

Finding of the Reed-Sternberg cell

331
Q

Staging

Assessing the extent of hogkins

A

like b symptoms

lymph node palpation

spleen and liver size

Xray and CT

PET positron emission tomography

332
Q

Treatment for hodkins

A

Chemo plus meds

MoAb - attack’s Reed Sternberg but also attacks T and B cells

333
Q

Nursing management of hodkins

A

Check for secondary malignancy

Decrease tobacco, alcohol and exposure to carcinogens/excessive sunlight

334
Q

Basic Nursing focus with leukemia

A

Infection and bleeding

Mucositis management

335
Q

F/E and leukemia

A

Measure I&Os - dehydration and fluid overload

CBC BMP - lytes, BUN, creatinine, hematocrit

K and Mag are frequent IVs

336
Q

Nutrition and Leukemia

A

Small frequent feedings

soft texture

moderate temperature

Daily body weight

337
Q

Pain and leukemia

A

Tylenol

Sponging with cool water NO COLD

PCA (patient controlled analgesia)

338
Q

Fatigue and leukemia

A

Stationary bike

Physicals therapy

Just sitting up during the day will improve tidal volume

339
Q

With leukemia don’t forget to manage

A

Hygiene

Anxiety and grief

Spiritual well-being

340
Q

Kubler Ross
Stages of grief

test

A 
Denial
Anger
Bargaining
Depression
Acceptance
341
Q

Most important part of moving through grief stages

A

Be open and communicative

342
Q

Are grief stages definite

A

NO

pt can spend different amounts of time and go back and forth between stages

343
Q

Nursing interventions for grief

A

Understand process

Develop Therapeutic communication

Active listening

Be non-judgmental

344
Q

3 Assessments of client

A

Perception
Support
Coping

345
Q

Nursing with terminal illness

A

support family unit

encourage meaningful interactions

professional support (Chaplin, grief counselor)

346
Q

Effective listening

A

Allow for silence
Ask if pt needs time
Assess understanding

347
Q

Things to avoid with comms

A

Distractions
Impulse to give advice
Canner responses “I know how you feel”

348
Q

Grief vs mourning

A

Feeling

expression of it

S3 1538 (15 decks)

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