Exam 2 Flashcards

Question

Cardiac Catherization

Answer 1

Right-sided: Vein Left-sided: Artery - Views heart, chambers, O2 status and chamber pressures - Involves insertion of a catheter and injection of contrast media and possible placement of stent - Coronary angiogram – dye injected into coronary arteries to evaluate condition/blood flow

Answer 2

Check for Allergies- shellfish - pre-medicate - baseline pulse assessment - NPO 6-16 hrs prior

Answer 3

pt may be awake - feeling warmth sensation - maybe asked to cough as dye is passed -may feel fluttering sensation

Answer 4

CV assessment - cath site care/pressure dressing - observe for complications - fluids - flat ( if possible) bed rest 2-6 hrs

Answer 5

- Smoking and nicotine cessation - Diet - Exercise - Weight control - Monitor BP, Cholesterol levels, -Blood glucose

Answer 6

- identify high risk patients - blood pressure screen - lipid screening

Answer 7

- Nutrition: heart healthy diet - Activity/Exercise - Smoking Cessation

Answer 8

- Vasodilators - Vasopressors - Diuretics - Antidysrhythmics - Cardioglycosides - Anticoagulants - Antiplatelets - Thrombolytics - Lipid Lowering Agents

Answer 9

- Issue: poor perfusion and oxygenation - Atherosclerosis is the leading cause in majority of cases - Causes narrowing of the lumen, obstruction by thrombosis, plaque ulceration, aneurysm, rupture

Answer 10

-Intermittent Claudication -Thin, shiny, taut skin -Loss of hair on the lower legs -Diminished or absent pulses -Skin changes related to color or temperature “Dependent rubor” “Elevation pallor” -Ulcers (usually on toes or near toes, +pain, neurologic deficits present) -Pain at rest -Occurs in the foot or toes -Aggravated by limb elevation

Answer 11

- Position affected part below heart level - If edema is present, position slightly elevated but not above the heart - Walking (Isotonic) exercises to promote circulation and development of collateral circulation

Answer 12

-Risk of stroke Manifestation: depends on size of obstruction Diagnostic: Carotid duplex ultrasound, MRI, CT ( with contrast) ``` Carotid Endarterectomy (CEA) -opening the carotid artery and removing the obstructing plaque ``` Nursing care- monitor vitals, neuro status, pulses and bleeding

Answer 13

Operation with autogenous Vein to carry blood around the lesion or occlusion Nursing care: -important to asses for occlusion ( pulses, temp, cap refill, etc.) -report of pain ( type of pain) - bedrest for 18-24 hours - check BP - Notify surgeon immediately of abnormal findings

Answer 14

extreme sensitivity to Cold, aggravated by nicotine, emotion, chilling - limited to hands and feet - treatment and education related to preventing vasoconstriction

Answer 15

- non-arthrosclerotic - recurrent inflammatory vaso-occlusive disorder resulting in microscopic occlusion (thrombi) of distal vessels of upper and lower extremeties - caused by history of tobacco/marijuana use

Answer 16

Spectrum of pathology from DVT to PE -watch for signs of pulmonary embolism -what medications can a nurse anticipate? -

Answer 17

- Venous stasis - Damage of endothelium - Hypercoagulability of blood -Pain, warmth, redness, and edema

Answer 18

formation of a thrombus in association with inflammation of the vein superficial vein thrombosis(SVT) - formation of thrombus in superficial vein - generally benign Deep Vein Thrombosis(DVT) - formation of thrombosis in deep vein - most commonly iliac and femoral veins involved

Answer 19

- Results of prolonged venous hypertension that stretches the vein and damages the valves - Difficulty eliminating waste - Builds up in the tissues resulting in stasis, ulcers, edema, cellulitis, brownish “brawny” appearance - Prominence of superficial veins -Ulcers Usually ankle area, +pulses, no claudication, no neurologic deficits

Answer 20

- Avoid sitting/standing for long periods - Avoid trauma to limbs - Elevate legs above level of heart to reduce edema - Compression therapy - Proper nutrition - Exercise - Collaborate with Wound Care specialist Varicose veins - VNUS procedure - Laser - Adhesive

Answer 21

sustained elevation of BP Normal - <120/<80 systolic/diastolic Pre-hypertension 120-139/ 80-89

Answer 22

Force exerted by blood against walls of blood vessels BP= CO x SVR SVR- arteries' resistance to blood flow

Answer 23

force of blood on arterial wall as heart contracts

Answer 24

Force as the heart relaxes to allow blood to flow into the heart

Answer 25

-95 % of all HTN -usually >60 y.o. -unknown cause -examine contributing factors ( smoking, diet, stress, exercise)

Answer 26

- 5 % of all cases - elevated BP with specific cause that can be identified and corrected - suspected in persons <20 or >50 with sudden onset

Answer 27

SBP >140 with average DBP <90 - increases with aging - DBP decreases with aging after 55 years - related to arteriosclerosis, valve disease

Answer 28

Patients with sustain BP higher that 140/90 are considered to have hypertension and are candidates for drug therapy diagnosis is based on elevated readings at least 3 times over a period of a week or more

Answer 29

develops over hours to days BP 220/120 evidence of acute target organ damage (encephalopathy, ICH/SAH, MI, renal failure, retinopathy)

Answer 30

Develops over days/weeks -BP severely elevated but no evidence of target organ damage -can be due to non-compliance of medications, Crack Cocaine use, tumor of adrenal medulla

Answer 31

Asymptomatic in itself However: presents as effects on target organs as - CAD (coronary artery disease) - CVA - PVD ( peripheral vascular disease) - Retinal damage - renal failure - TIA ( Transient ischemic attack), stroke - heart failure - LVH -left ventricular hypertrophy

Answer 32

Check BP in both arms- then use arm with highest reading - follow up for high BP is to take it twice, 5 minutes apart - BP evaluation should be assessed carefully before initiating RX-correct technique ABPM( ambulatory bp monitoring- r/o "white coat syndrome"

Answer 33

``` feet flat on the floor legs uncrossed support back empty bladder support arm at heart level BP cuff on bare arm no talking ```

Answer 34

-Dash Diet ( See table 31-6) Medications ( see table 31-5) -encourage compliance Side effect mgmt. : Gum & hard candy for dry mouth Slow position changes for orthostatic hypotension Discussion R/T sexual dysfunction Schedule diuretics to avoid nocturia

Answer 35

Abnormal clinical syndrome involving impaired cardiac pumping and/or filling which leads to lower-than normal cardiac output CO= HR x SV - dominant feature: Increased intravascular volume - manifestations depend on extent of failure and which ventricle is affected

Answer 36

inability of heart to pump blood effectively - hallmark= decrease in Left Ventricle ejection fraction = decreased Cardiac output

Answer 37

inability of ventricles to relax and fill during diastole= stiff ventricles= decrease CO -normale ejection fraction

Answer 38

Dysfunction in both systolic and diastolic

Answer 39

the left and right ventricles can fail separately left ventricle usually fails first

Answer 40

manifest as acute pulmonary edema -increase in pulmonary venous pressure caused by decreased efficiency of the LV= pulmonary engorgement LIFE THREATENING

Answer 41

- paroxysmal nocturnal dyspnea - elevated pulmonary capillary wedge pressure - pulmonary congestion ( crackles, cough, wheezes, blood-tinged sputum, tachypnea) - restlessness - confusion - orthopnea - tachycardia - exertional dyspnea - fatigue - cyanosis

Answer 42

- fatigue - increase peripheral venous pressure - ascites - enlarged liver and spleen - may be secondary to chronic pulmonary problems - distended jugular veins - anorexia and complaints of GI distress - weight gain - dependent edema ** R side makes you [R]etain water***

Answer 43

Diet - Sodium restriction, DASH diet Fluid management – weigh daily 1kg = 1 liter of fluid Weight gain: Call Provider 3 lbs. over 2 days up to 5 lbs. over 1 week Possible fluid restriction –(ice chips, hard candy to deal with thirst) Activity - energy-efficient behavior and rest Medications (table 30-8) - Diuretics - ACE or ARB’s - Beta Blockers - Inotropic Drugs

Answer 44

FACES: ``` [F]atigue [A]ctivity limitations [C]ongestion/Cough [E]dema [S]hortness of Breath ```

Answer 45

chronic illness that can't be cured and won't disappear -need basic lifestyle changs to promote recovery or health

Answer 46

chest pain temporary and reversible

Answer 47

not immediately reversible

Answer 48

Severe ischemia with cell damage Pain: -Severe, immobilizing chest pain not relieved by rest, position change, or nitrate administration - Heaviness, pressure, tightness, burning, constriction, crushing - Substernal, retrosternal, epigastric - More common in AM - Atypical in women, elderly - No pain if cardiac neuropathy (diabetes) Other SXS: Nausea/Vomiting Fever -Catecholamine release – SNS Stimulation Cardiovascular Manifestations: Initially, ↑ HR and BP, then ↓ BP (secondary to ↓ in CO) crackles, JVD

Answer 49

``` Chronic Stable Angina Pectoris Silent Ischemia Nocturnal Angina and Angina Decubitus Prinzmetal’s Angina Microvascular Angina Unstable Angina (falls under the umbrella of Acute Coronary Syndrome ACS) ```

Answer 50

ABCDEF ``` [A]ntiplatelets/Anticoagulants/Anti-anginals/ACE-I/ARB [B]eta adrenergic blocker/blood pressure [C]igarette smoking/CCB/Cholesterol [D]iet/Diabetes [E]xercise/Education [F]lu vaccination ```

Answer 51

``` Initial interventions 12-lead ECG Blood Studies Semi-fowler’s position IV access ```

Answer 52

M-O-N-A Morphine Oxygen Nitroglycerin (SL) ASA (chewable) or plavix

Answer 53

In a healthy heart, the constant blood flow does not allow any bacteria to stay and colonize -If an individual has a defect of the inner lining, or heart valve – then any microorganism in the blood stream has a risk of developing endocarditis Infective endocarditis (IE) is an infection of the valves and endothelial surface of the heart caused by direct invasion by bacteria or other organisms and leading to deformity of the valve leaflets SXS: -General manifestations (chills, fever, malaise, fatigue, anorexia) - Micro-embolization in various organs - Arthralgias, abdominal pain, back pain (pain caused by obstruction of blood flow to tissues needing oxygen and nutrients) - Vascular Signs (Osler’s nodes, Janeway’s lesions, Roth’s spots) - Can lead to heart failure TREATMENT: -Eradicate the invading organism -4 to 6 weeks of IV antibiotics -Possible surgical valve replacement - Adequate rest - Home care – IV antibiotics, monitor temp, etc. - Prompt treatment of minor symptoms ( fatigue, chills, etc.) - Prophylactic Antibiotics to prevent IE and good oral hygiene

Answer 54

Inflammation of the pericardial sac Causes: infection noninfectious autoimmune SXS: -restriction of heart motion and pain with breathing -Chest pain: worse when lying flat and with deep inspiration ( sharp, stabbing) -Dyspnea -Pericardial friction rub ``` Complications: Pleural Effusion (increased fluid within pericardial sac) ``` Cardiac Tamponade: compression of the heart by accumulation of fluid in the pericardial sac sxs: JVD, muffled or distant heart sounds, low BP

Answer 55

- Treat underlying problem - Bed rest - Increase HOB 45 degrees Drug Therapy: Anti-inflammatory agents, Antibiotics -Manage Pain and Anxiety -Pericardiocentesis (guided by echocardi0gram)

Answer 56

Three Phases 1. Acute illness to discharge from hospital - promote rest and limited mobility - monitor HR ad BP with activities 2. Begins after discharge and continues through convalescence at home 3. long term maintenance program

Answer 57

Three Phases 1. Acute illness to discharge from hospital - promote rest and limited mobility - monitor HR ad BP with activities 2. Begins after discharge and continues through convalescence at home 3. long term maintenance program Recovery takes time: - Resuming physical activity is slow and gradual - Accept choices of patient: “what must be cut back”, “what should be cut back” and “what will be cut back” ``` Teaching – consider… Family learning needs Timing and family Emotional stage of family (grieving, shock, etc.) Anticipatory guidance ``` Physical Activity: Levels are measured through MET (metabolic equivalents units) 1 MET is the amount of oxygen needed by the body at rest (3.5 ml of Oxygen per kilogram per minute) Activity is gradual increased as tolerated By discharge goal for patient able - tolerate at least 3 MET

Answer 58

``` Increases CO Decreases blood lipids Decreases BP Increases blood flow through the coronary arteries Increases muscle mass and flexibility Assists in weight loss Improves the psychological state ```

Answer 59

- should be limited - increases HR and BP Rapidly - lifting, carrying, pushing heavy objects - involves straining muscles against other muscles

Answer 60

- Walking, jogging, bike riding - Puts a safe steady load on the heart - Improves circulation to many organs

Answer 61

initiating and discussing this topic with patients. Sexual dysfunction after MI is common and that dysfunction usually disappears after several attempts Chest pain can occur during intercourse Medications for erectile dysfunction are avoid when patient taking Nitrates Can generally be resumed about 1 week after an uncomplicated MI The energy expended during sexual activity is similar to walking briskly up two flights of stairs Avoid sex after a full meal Positioning is a matter of individual choice Provide pamphlets on sexual activity after an MI

Answer 62

Responsible for variation in traits- each individual has two 'versions' of these factors (genes)

Answer 63

when two plants express different forms ( alleles) of the trait are crossed, only one form can be expressed Recessive will be masked Dominant will be expressed

Answer 64

is the combination of alleles

Answer 65

the physical characteristics that are expressed

Answer 66

alleles are the same ex ( TT)

Answer 67

alleles differ Ex (Tt)

Answer 68

only one copy ( genes on the X chromosome in males)

Answer 69

trait or disorder is express in the heterozygote (Dd)

Answer 70

trait is expressed in the homozygote (dd)

Answer 71

trait expressed on genes on chromosome 1-22

Answer 72

trait is expressed genes on the X ( or Y) chromosomes

Answer 73

- Carried on the autosome - male to male transmission CAN occur - each off spring has a 50% chance of inheriting the mutant allele - does not skip generations, off spring can pass on only the recessive gene - occurs equally in males and females ``` Examples: Huntington's disease Familial Hypercholesterolemia Marfan syndrome polydactyl ```

Answer 74

- 25% chance of having the disease - 50% chance of being a carrier ( inherited one allele) - must have both alleles from disease ( one from each parent) - males and females affected - affected males and females can transmit the gene, unless it causes death before reproductive age - trait can skip generations - parent of an affected individual are heterozygous or have the disease Examples: cystic fibrosis phenylketonuria sickle cell disease

Answer 75

- Genes carried on X chromosome are X linked - Genes carried on Y chromosome are Y linked Y-linked traits are rare because the chromosome has few genes and many have counterparts on the X chromosome Y-linked are passed male to male

Answer 76

- females are carriers ( 50% chance of transmitting dominant mutant gene to offspring) - Mutant allele is on the X chromosome - expressed more severely in males ( has no other allele to balance it) - high rate of miscarriages in males due to early lethality in males - affected males had a mother who IS a carrier - an unaffected females with an affected brother has 50% chance of being a carrier - affected female has an affected father and and affected/carrier mother Examples: Hemophilia muscular dystrophy Menkes Disease

Answer 77

- expressed in females in one copy - much more sever in effects in males - HIGH rate of miscarriages - no male-male transmission - sons can only be effected by mothers - daughters can be effected from either parent Examples: incontinentia pigmenti hypertrichosis

Answer 78

mitochondria are structures inside the cell that convert energy form food into the form that the cell can use. - most DNA is packaged in chromosomes within the nucleus, mitochondria also have a small amount of their own DNA Alterations in mitochondrial DNA has been linked to many cancers ( leukemia, breast, etc.) Transmitted via the maternal gene ONLY -affected males do NOT pass the gene Examples: leigh syndrome ( shows up in infancy/childhood; usually fatal) Lebers hereditary optic neuropathy- rapid central visin loss, tremors in teens and young adults Common mtDNA related disorders include: migraines, thyroid disease, diabetes, heart failure, pancytopenia

Answer 79

Exceptions to mendels laws: - More than two alleles (normally a person has two alleles for any autosomal gene) - different allele combination can produce different variation in phenotype ex: different types of CF, PKU, eye color

Answer 80

When someone with a particular genotype do no have associated Phenotype

Answer 81

a genotype is associated with a phenotype of varying intensity ( polydactyly)

Answer 82

the heterozygous phenotype is intermediate b/w either homozygote Ex. Flower (snapdragon) with red (dominant) crosses with a white (recessive) results in pink flowers

Answer 83

Different alleles are both expressed in a heterozygote - blood typing (ABO) - a child's blood types doesn't have to match parents

Answer 84

deadly - usually causes death before and individual can reproduce - usually results in spontaneous abortion or miscarriages

Answer 85

occur as a results of structural rearrangement within or between chromosomes -arrangement is 'balanced' if chromosome set appears to contain all the correct material but arranged in unusual way unbalance when there is additional or missing chromosome material such as depletion or duplication of a chromosome - when normal balance is disturbed, mental or physical development is altered - person who carries a rearrangement does not have any disabilities

Answer 86

loss of a portion of the chromosome 22q11.2 deletion syndrome (syndrome with heart defects, immune problems, cleft palate, low calcium)

Answer 87

- A circular structure that occurs when a chromosome breaks in two places and its broken ends fuse together - Variety of conditions depending on chromosome involved

Answer 88

- Breaks in a single chromosome - Piece reinserted - Balanced - May not see any visible changes Some noticeable anomalies include polydactyly, club foot, cardiac and GI conditions

Answer 89

-Down syndrome (Trisomy 21) sxs range from mild to severe; increased risk of thyroid disease, leukemia, sleep apnea and dementia - Turner Syndrome (X0) (females sexually undeveloped) - Klienefelter syndrome (XXY)(males sexually undeveloped, large hands and feet, may develop breast tissue) - Trisomy 18(Edward’s Syndrome) mental and physical disabilities,

Answer 90

- Many birth defects as well as adult diseases have a multifactorial cause. - Result from gene variations and environmental influences that work together - Conditions cluster in families but do not demonstrate the characteristic pattern of inheritance seen with single gene disorders Examples: - Neural Tube Disorders (Spina Bifida) – taking folic acid has decreased the incidents - Congenital Heart Defects - Diabetes - Heart Disease

Answer 91

Complete Blood Panel 1. Red blood cells ( 4.1 - 5.3 ), which carry oxygen 2. White blood cells ( 4500-11,000), which fight infection 3. Hemoglobin (Men- 13.2 - 17.3) (females 11.7- 15.5), the oxygen-carrying protein in red blood cells 4. Hematocrit (male: 43-49%) (females: 38-44%), the proportion of red blood cells to the fluid component, or plasma, in your blood 5. Platelets ( 150,000- 450,000), which help with blood clotting

Answer 92

Erythocyte sedimentation Rates "sed rate" -reflects inflammation or infection < 30mm

Answer 93

3-8 minutes | temporary clot

Answer 94

PT - 11- 12.5 seconds -extrinsic PTT - 40 secs -Intrinsic INR - 1 sec

Answer 95

Radiological Studies: CT MRI Biopsies(only definitive cancer diagnostic tool): bone marrow lymph node

Answer 96

patient prep anxiety/pain med education - what to expect/feel position- prone or side lying Procedure : last 5-10 minutes sedation ( local or monitored anesthesia care, MAC) Sterile procedure Post care: - Prevent bleeding- put patient on side for 30 -60 minutes (to maintain pressure) - check for infection - pain relief soreness for 3-4 days - wear bandage for 24 hours- report any soaking, reinforce, do not remove for 24 hours - no tub baths or shower for 24 hours - avoid contact sports

Answer 97

develops when damage occurs to your bone marrow, slowing or shutting down the production of new blood cells Manifestations- Similar to anemia ( pancytopenia) : decrease RBCs, Decrease WBCs, Decrease platelets ) EVERYTHING IS LOW Collaborative mgmt: Prevent complications - hypoxia - infection - hemorrhage Nursing Care - neuro assessment - good hand washing - oral care - screen visitors for infection/exposure to illness - avoid invasive procedures - prevent problems with immobility - protective isolation - bleed precautions - Increase fluid & fiber intake - increase head of the bed - no fresh flowers or fruit - avoid over inflation of BP cuff - may need an arterial line

Answer 98

Primary polycythemia/polycythemia vera -Chronic myeloproliferative disorder arising from chromosomal mutation in stem cell ↑RBC ↑ WBC ↑ platelets (cells are often impaired) ↑ blood viscosity ↑ blood volume, congestion of organs/tissues with blood -Hypercoagulopathies = predisposed to clotting Secondary polycythemia (CAUSED by Hypoxia) Hypoxia stimulates erythropoietin in kidneys ↑ RBC production Complications Stroke (secondary to thrombosis) ``` SXS: headache dizziness angina intermittent claudification general pruritus (increase in RBCs prompt the immune sxs to release histamine= itchiness) flushing of face left upper abdominal pain/fullness ``` WDYD: - Hydration therapy - aspirin if Primary - Small frequent meals - Avoid iron supplements - Avoid tight-fitting clothing - Avoid citrus with meals- (because citrus ↑absorption of iron) - Reduce blood volume and viscosity ( hydration, severe, transfuse blood out) - Anti-platelets (ASA) - Reduce bone marrow activity with myelosuppressant agents - Ambulate to decrease thrombus formation - Avoid extreme temp changes ( because of vaso-dilation/constriction )

Answer 99

Low platelets <150,000 He GONNA DIE: < 20,000 platelets -pt at risk for spontaneous bleed ( inside or out) ``` WDYD: -assess vitals ( worrisome vitals = HR: initial increases (Tachycardia) RR: increased BP: decreased mental status change cold, pale skin ``` - monitor for signs of bleeding - Health promotion- ID bands for pt.s at risk - monitor labs - patent teaching

Answer 100

-Normal leukocyte (WBC) count: 4,500-11,000/µL Diagnostic tests: 1. ANC ( Absolute Neutrophil Count)- determined by multiplying the total WBC count by % of neutrophils ANC < 1000/µL = neutropenia – at risk for bacterial infection ANC 500-1000/µL – moderate risk for bacterial infection ANC < 500/µL – severe risk for bacterial infection 2. Peripheral blood smear - assesses for immature cells 3. bone marrow aspiration and biopsy WHAT IS NEUTROPENIA - Neutrophils are one type of WBC – primary phagocytic cell - Reduction in the number of neutrophils - Clinical consequence which occurs with a variety of conditions/diseases Most common cause = iatrogenic Widespread use of chemotherapy/immunotherapy in treatment of malignancies & autoimmune diseases Classic signs of infection/inflammation (redness, heat, swelling) may not occur WDYD: - Patient teaching - Alert for minor complaints that may indicate infection -Sore throat, diarrhea, low grade fever, etc. Neutropenic fever (>100.4°F) and ANC < 500/µL is a medical emergency - Blood cultures and antibiotics - Strict hand-washing - Private room (Laminar air flow rooms if needed) - Avoidance of fresh fruits and vegetables (or may wash before eating)

Answer 101

- strict hand washing - private room with closed room- negative air - FULL precautions - gown and gloves - no fresh fruit o flowers - no visitors

Answer 102

Accumulation of dysfunctional (immature) cells due to loss of regulation in cell division Pathophysiology: - No single causative agent - Combination of genetic and environmental influences - Associated with - Chemical agents - Chemotherapeutic agents - Viruses - Radiation - Immunologic deficiencies SXS: -Clinical manifestations are varied but usually related to bone marrow failure - Overcrowding by abnormal cells - Inadequate production of normal marrow elements - Anemia - Thrombocytopenia - ↓ Number and function of mature WBCs Nursing diagnoses: related to anemia, thrombocytopenia, neutropenia Nursing care: acute intervention -administer medications and monitor side effects (chemo, anti-emetics) Ambulatory home care -refer patients and family to survivor networks

Answer 103

Hodgkins disease (H is better): A malignant condition caused by proliferation of abnormal, giant, multi-nucleated cells (Reed-Sternberg cells) located in the lymph nodes SXS - enlarged cervical, axillary or inguinal nodes - fever - fatigue - night sweats - weight loss - chills Non-hodgkins disease: A malignant neoplasms of the immune system (B & T cells) SXS: -painless lymph node enlargement with s/s dependent on area of disease Diagnostic/staging studies for Lymphoma - nodes biopsies ( only definitive diagnosis) - staged 1- size matastasize level of organ involvement Treatment: - localized radiation - combination chemotherapy with local radiation - high dose combo therapy with radiation - surgery - stem-cell replacement: depends on the aggressiveness of the disease

Answer 104

- Neoplastic plasma cells infiltrate bone marrow and destroy bone - Neoplastic cells produce excess amount of immunoglobulins (myeloma protein) and cytokines which play a role in bone destruction Cause unknown: -possible radiation, chemical exposure as well as viral or genetic influence ``` SXS: -Skeletal pain is most common Symptoms develop slowly -Fatigue -Easy bruising -Bone degeneration/Fractures -hypercalcemia ``` WDYD: - Maintain adequate hydration( to flush out calcium) - Move patient carefully - Ambulation as tolerated ( to put calcium back in bone) - Pain management Teach patient and family about remissions and exacerbations, and need for hospitalization during acute episodes TX: - Chemotherapy - Immunotherapy - Corticosteroids - Biophosphanates (medicine that prevents the loss of bone density) - Stem cell transplantation

Answer 105

all functions carried out within a cell to maintain homeostasis, including its responses to extracellular signals ( such as hormones, cytokines and neurotransmitters) and the way each cell produces an intracellular response

Answer 106

CAUTION ``` [C]hange in bowel habits [A] sore that wont heal [U]nusual bleeding or discharge [T]hickening or a lump in breast or elsewhere [I]ndigestion or difficulty swallowing [O] bvious change in mole or wart [N]agging cough or hoarsness ```

Answer 107

Prevention is KEY! Modifiable: - alcohol - tobacco - diet - sun exposure - infectious disease - chemicals - radiation - Vaccinations Non-Modifiable: - age - sex - race - family medical history

Answer 108

Benign tumors: - non cancerous - can often be removed - usually do not reoccur - cells do not spread outside of the tumor example: lipoma Malignant Tumor: - cancerous - can invade other areas- matastasize examples: 1. carcinoma ( skin and tissues lining internal organs) 2. sarcoma ( bone, connective tissue or supportive tissue) 3. leukemia ( starts in blood) 4. lymphoma and myeloma (immune system) 5. CNS ( brain and spinal cord)

Answer 109

ABCD [A] assymetry [B] borders [C] color [D] Diameter more that 6mm E- elevated E-evolving F - firmness

Answer 110

-Destroys cancer cells Types: - external (teletherapy) delivery of radiation from a source placed at some distance from target -internal ( Brachytherapy) involves placement of specially prepared radioisotopes directly into or near the tumor itself or close proximity (interstitial seeds)

Answer 111

Sealed-source Internal Radioactive Implants - Patients require private room & bath - Rooms at ends of halls - Rooms with lead-shielded walls - Sign on door: “Caution: Radioactive Material” - Turn patient away from door and keep door closed as much as possible - Nurse wears dosimeter film badge - No pregnant staff or children less than 16 - visitors remain 6 feet away and max 30 min/day Leaded shields at doorway to wear; lead container and pair of long-handled forceps in case implant comes out of place Ensure proper handling of bed linens/clothing Call radiation therapist & radiation officer immediately to retrieve and secure source

Answer 112

- Don’t wash treatment area until instructed to do so - Wash treated skin gently with mild soap, rinse well, pat dry - Use warm or cool water - Use hands for bathing in place of washcloths - Don’t remove tattoo marks - Avoid powders, lotions, creams, alcohol, & deodorants on treated skin - Loose-fitting clothing to avoid friction over treatment field - No tape/dressings on site - No direct sunlight, chlorinated swimming pools, or temperature extremes

Answer 113

- Can cure disease - Increases mean survival time - Decreases the risk for specific life-threatening complications - Combination therapy usually more successful than the use of a single medication Chemotherapy can be an irritant or a vesicant!!!! Irritant: Damages intima of vein Vesicant: Can cause severe local tissue breakdown and necrosis Extravasation: fluid from IV leak into tissues - Pain - Swelling - Redness - Presence of vesicles on the skin Requires antidote or chemo-protective agent; may require skin grafts for closure Stop the infusion immediately!!!!!!

Answer 114

Central line- most common PICC ( peripherally inserted catheter) - tip resides in superior vena cava, placed in ante-cubital fossa; low complication rates and less expensive -No BP/ blood draws from this extremity Implantable port - jugular vein Needle Regional chemo: - intraarterial - intraperitoneal - intrathecal - intravesical bladder chemotherapy Nursing/collaborative care - monitor blood panel - Monitor for weight loss (may also be indicative of depression) - hair loss- whole body, not everyone looses it, when lost its called alopecia, may come back different texture - Eat small, frequent, low fat meals - Avoid spicy foods - Take nutritional substances as prescribed - Encourage 2 to 3 liters of fluid per day if not contraindicated - Administer antiemetics prior to chemotherapy - Continue daily activities however, rest in between ``` Side effects: -Coping with therapy -Bone marrow suppression -Fatigue -Skin reactions -Nausea and vomiting -Mucositis, Stomatitis, and Xerostomia ( dry mouth, mucosal lesions, lip ulcers) -Diarrhea -Anorexia -Thrombocytopenia -Neutropenia -peripheral neuropathy ( pins and needles feeling) - cognitive dysfunction -urethral cystitis increase fluids) ```

Answer 115

Check the site of IV! Assessment – renal/cardiac function Monitor patient status (Wt, I/O, lab studies) Doctor’s orders - rate and solution Patient Safety - Be aware of “high alert” drugs (KCL) - Smart pump - Computerized physician order entry

Answer 116

check expiration of tubing and fluids, check for beak in sterile technique

Answer 117

IV piggy backs hung hire than straight gravity iv flow Factors that influence Flow rate of gravity pump - height of solution - patency of cannula - venous spasms - size of cannula - blood in tubing - presence of local complications

Answer 118

can deliver two or more solutions at the same time via separate pathways

Answer 119

tunneling or non-tunneling - X-Ray before starting fluids - Sterile dressing change - Observe site for S/S infection - Observe for IV systemic complications - Care depends on complication assessed

Answer 120

-no part of catheter is visible - venous system most common placement - accessed with a needle through the skin

Answer 121

-Medication Administration -Nutrition Blood samples/transfusions -Conditions (renal failure, burns etc.) Complications: - Catheter Occlusion - Embolism - Infection - Pneumothorax - Catheter Migration

Answer 122

(IO route - into bone marrow) - High infusion rates are possible - Pain meds may be required - Good for severely dehydrated or during cardio/resp. emergencies - Proximal humerus, proximal and distal tibia

Answer 123

CHECK THE SITES Local complications - infiltration - nerve damage - infection - phlebitis - thrombophlebitis - hematomas and ecchymosis Systemic complications: -Catheter related infection (pyrogenic or septic) - abrupt rise in temp, severe chillds, increaser HR and RR, headache -circulatory overload increased Bp, distended neck veins, SOB WDYD: increase head of bead, decrease drip rate

Answer 124

SXS: Decreased or absent breath sounds, respiratory distress, distended unilateral chest WDYD

Answer 125

SXS:Chest pain, SOB, decrease BP, increase HR, cyanosis, anxiety, confusion WDYD: put pt in L lateral, modified trandelenburg ( just raise feet), to trap air in R atrium

Answer 126

ISO: 0.9% NaCl (NS) 5% Dextrose in water (D5W) Lactated Ringers (LR) Hypotonic: 0.45% NaCl (1/2 NS) 0.33% NaCl 5% Dextrose and ¼ NS (D5 ¼) ``` Hypertonic: 3% NaCl 10% Dextrose in water (D10W) 5% Dextrose and ½ NS (D5 ½) 20% Dextrose in water (D20W) 5% Dextrose in lactated ringers (D5LR) Plasmalyte ```

Answer 127

- Enables the patient to self administer medication on prn. basis - Programmed according to medical orders (dosage, time intervals between doses, and lock-out intervals) - Can record the amount of medications received and the number of requests by the patient