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NURSING 110 JUST US!!!!! > exam 3 > Flashcards

exam 3 Flashcards

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1
Q

Changes in elderly that increase risk for infection?

A

Respiratory changes
Genitourinary changes
Gastrointestinal changes
Skin and subcutaneous tissue changes
Immune changes
Other factors

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2
Q

pediatric considerations that increase risk for infection?

A

Age < 1 month
Serious injury
(e.g., major trauma, burns, or penetrating wounds)
Chronic debilitating medical condition

Host immunosuppression

Large surgical incisions

Indwelling vascular catheters
Urinary tract abnormalities with frequent infection

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3
Q

airborne precautions for …

A

chicken pox, TB, measles, COVID

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4
Q

droplet precautions for ….

A

pneumonia, strep, flu

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5
Q

contact precautions for …

A

MRSA, VRE, Noro

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6
Q

prevention for nosocomial infections

A

Prevention is key!
Meticulous handwashing
Minimize invasive procedures
Strict medical and surgical asepsis
Oral care
Critical thinking, Agency policies
Hand hygiene for clients, nurse and family
Resources- WHO, CDC

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7
Q

What is sepsis and septic shock?

A

A life-threatening organ dysfunction cause by a dysregulation of the host body’s response to infection; Sepsis is an unregulated, uncontrolled, intravascular inflammation

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8
Q

what happens in septic immune response to infection?

A

mismatch of proinflammatory and anti-inflammatory mediators followed by leakage of inflammatory mediators into blood causing a systemic response

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9
Q

stages of sepsis

A

precipating event - vasodilation - activation of inflammatory response - maldistribution of intravascular volume - decreased venous return - decreased CO - decreased tissue perfusion

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10
Q

criteria for SIRS (systemic inflammatory response syndrome)

A

Temperature >38.3 or <36
Tachycardia
Tachypnea
WBC >12,000 or <4000 or > 10% immature cells
Must have 2 criteria present
to be identified with SIRS
not specific to sepsis

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11
Q

SIRS caused by ….?

A

ischemia, trauma, infection

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12
Q

What does SOFA score stand for?

A

sequential organ failure score

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13
Q

QSOFA criteria?

A

hypotension (systolic bp less than 100), altered mental status, tachypnea (RR above 22)

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14
Q

what is QSOFA?

A

quick sequential organ failure assessment- quick patient screening without labs

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15
Q

what is MEWS score?

A

modified early warning system

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16
Q

what is observed for MEWS?

A

RR, HR, systolic BP, conscious level (UPVA), temp, hourly urine for 2 hours

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17
Q

what is PEWS?

A

pediatric early warning signs

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18
Q

sepsis diagnosis criteria?

A

Suspected or known infection
Meeting MEWS or qSofa criteria
Increase of 2 or more on the SOFA scale

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19
Q

presentation of initial stage of sepsis?

A

Warm flushed skin
Bounding pulse
Normal blood pressure
Fever
Normal to decreased urinary output

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20
Q

tx of initial stages of sepsis?

A

Identify and treat underlying cause
Antibiotic administration
Fever control
Maintain hydration
Prevent progression to severe sepsis

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21
Q

early (warm) sepsis presentation?

A

B/P: normal to hypotension
↑ pulse
Rapid & deep respirations
Warm, flushed skin
Alert, oriented, anxious
Normal UOP
↑temp, chills, N/V/D
Weakness

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22
Q

late (cold) sepsis presentation

A

Hypotension
Tachycardia, arrhythmias
Rapid, shallow resp
Dyspnea
Pale, cool skin
Edematous
Lethargic to comatose
Oliguria to anuria
Norm to decreased temp

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23
Q

severe sepsis criteria?

A

Suspected or known infection
Sepsis induced organ dysfunction (increase of 2 or more points on SOFA criteria) or tissue hypoxia

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24
Q

severe sepsis presentation

A

Warm flushed skin (core)
Pale cool skin (periphery)
Fever
Bounding pulse, tachycardia
Hypotension
Elevated respiratory rate
Decreased urinary output, elevated creatinine
Nausea, vomiting, diarrhea, slow GI motility
Altered mental status
Increased bilirubin
Increased lactic acid level
Increased procalcitonin

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25
Q

severe sepsis tx?

A

Identify and treat underlying cause
Antibiotic administration
Fluid resuscitation
Fever control
Prevent progression to septic Shock

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26
Q

septic shock criteria?

A

Suspected or known infection
*Sepsis induced organ dysfunction or tissue hypoxia
*Hypotension despite adequate fluid resuscitation
Subset of sepsis causing increased mortality due to abnormalities in circulation and cellular function

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27
Q

septic shock presentation

A

Critically ill
Hypotensive
Tachycardia
Altered level of consciousness
Respiratory distress or failure
Minimal to no urine output
Hypoactive bowel sounds

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28
Q

septic shock tx?

A

Antibiotic administration
Adequate fluid resuscitation
Vasopressor medications
Prevent progression to MODS

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29
Q

lab tests for sepsis?

A

CBC
Chemistries
LFTs
Lactate
Procalcitonin
Coagulation studies
CSF
Cultures- blood, urine, sputum

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30
Q

radiology testing for sepsis?

A

CXR, CT, US

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31
Q

lactic acid levels

A

<2 mmol/L Normal
2-4 mmol/L Lactic acidosis
>4 mmol/L Sever Lactic Acidosis

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32
Q

cause of lactic acid elevation?

A

Poor tissue perfusion
Cells begin anaerobic metabolism for energy
Anaerobic metabolism produces byproduct of lactic acid

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33
Q

effects and tx of high lactate levels?

A

Anaerobic metabolism
Makes cells swell
Causes membrane permeability
Lactate ½ life about 20 minutes
Consistently elevated lactate equals continue anaerobic metabolism
Lactic acid level > 4.0
27% increased mortality rate
Fluid resuscitation to improve perfusion
Vasopressor medications
Hypotension despite fluid resuscitation to improve perfusion

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34
Q

what is procalcitonin?

A

A protein produced by many cells in the body
Increased production in the presence of bacterial infections
½ life is about 28-30 hours

-cells release procal when exposed to bacterial toxins, used to determine the level of inflammation and degree of bacterial infection

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35
Q

interpretation of procal levels?

A

Normal 0.15ng/ml
0.15-2ng/ml
Localized mild to moderate bacterial infection
Noninfectious SIR
Untreated end-stage renal failure
>2ng/ml
Bacterial sepsis
Severe localized bacterial infection
Severe noninfectious inflammatory stimuli

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36
Q

Sepsis tx

A

Glycemic control
Nutrition
DVT prophylaxis
Temperature control
Fluid resuscitation
Medications
Vasopressor medications
Antibiotics

Insulin therapy keep blood sugar <180
Initiation of enteral feedings tolerated
Heparin or Lovenox
Tylenol or Motrin
IV fluids
30ml/kg adult
40ml/kg pediatric > 1 year
Up to 60ml/kg pediatric

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37
Q

What is the sepsis 6?

A

take 3 (blood cultures, blood tests including lactate, measure urine output), give 3 (O2 to keep sats >92, IV fluids, IV antibiotics as per local guidelines)

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38
Q

alpha 1 adrenergic receptors

A

Located in the vasculature
Global vasoconstriction
Increase BP
Strong Alpha 1 stimulation causes end organ damage due to decreased blood supply r/t vasoconstriction

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39
Q

beta 1 adrenergic receptors

A

Located in the heart
+ inotropic,
Increased heart rate (cardio stimulant)
Increase CO
Increase blood flow

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40
Q

beta 2 adrenergic receptors

A

Located in lungs and blood vessels
Vasodilation
Smooth muscle relaxant
Decrease blood pressure

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41
Q

what is norepinephrine (levophed)?

A

vasopressor- first line pressor for sepsis; start if hypotension remains despite fluids

1st for Adult septic shock
Alpha 1 Stimulation
Mild stimulation
Beta 1 & Beta 2 receptors
Global vasoconstriction
Minimal increase in CO

42
Q

what is high dose dopamine?

A

vasopressor;
1st line pediatric septic shock
Beta 1 stimulation
Alpha 1 receptors (some)
Minimal Beta 2 receptors
Increased HR
+ Inotropic effect
Some vasoconstriction

43
Q

what is epinephrine?

A

vasopressor;

1st or 2nd pediatric septic shock
Strong Alpha 1 & Beta 1 stimulation
Minimal Beta 2 stimulation
Global vasoconstriction
Increased HR,
+ Inotropic effects

may see increase in lactic acid

44
Q

what is vasopressin (ADH)?

A

adjunct med to vasopressor- use when hypotension persists despite fluids and pressors

Used with norepinephrine (Hence the BFF)
Not commonly used alone
Increased SVR and BP
Increases retention of water
Vasoconstriction
Synthetic ADH

45
Q

when do you start antibiotics for sepsis?

A

within 1-3hrs of identification

46
Q

Sepsis complications

A

Acute Kidney Injury
Hyperglycemia
GI complications
Disseminated Intervascular Coagulation
Acute Respiratory Distress Syndrome
Multi Organ Dysfunction Syndrome

47
Q

what is MODS?

A

Alteration in organ function requiring medical treatment to continue organ function
Organ damage occurs at cellular level
PREVENTION of tissue hypo-perfusion important
Supporting organ function only treatment
High mortality associated

48
Q

sx of mild systemic anaphylactic reaction?

A

Peripheral tingling
Warmth
Possible full feeling in mouth or throat
Nasal congestion
Periorbital swelling
Begins within 2 hours of exposure

49
Q

sx of moderate systemic anaphylactic reaction?

A

Nasal congestion
Periorbital swelling
Flushing
Warmth
Anxiety
Itching
Possible bronchospasm
Possible airway swelling
Begins within 2 hours of exposure

50
Q

first med given for anaphylaxis?

A

epinephrine

51
Q

second med given for anaphylaxis?

A

diphenhydramine - benadryl

52
Q

how long does epi last?

A

30-45 minutes

53
Q

what is the dosing for epipen and epipen jr?

A

0.3mg adult; 0.15mg JR

54
Q

What are the 3rd and 4th meds given for anaphylaxis?

A

histamine 2 blockers, methylprednisone (solumedrol)

55
Q

nursing interventions for anaphylaxis?

A

meds (epi, benadryl, histamin 2 blockers, solumedrol), duoneb, monitor ABCs, monitor vitals, support pt and family, education for pt and family, MONITOR pt for rebound sx

56
Q

pathophys of malignant cells?

A

rapid cell division, no useful funtion, adhere loosely, able to migrate, grow by invasion

57
Q

what are factors that are associated with the development of cancer?

A

environmental exposure
genetic predisposition
immune function

58
Q

risk factors for developing cancer?

A

Heredity
*Age
*Gender
*Poverty
*Stress
* Diet
*Occupation
* Infection
*Tobacco use
*Alcohol
*Obesity

59
Q

what is CAUTION? (cancer)

A

– Changes in bowel/bladder habits
– A sore that does not heal
– Unusual bleeding/discharge
– Thickening or lump in the breast/elsewhere
– Indigestion
– Obvious change in wart or mole
– Nagging cough or hoarseness

60
Q

primary prevention for Ca

A

 Dietary habits to
reduce cancer risk
Weight control
 Tobacco use
 Alcohol use
 Sun exposure

61
Q

secondary prevention for Ca

A

ACS recommendations for early detection in
asymptomatic people:
* Sigmoidoscopy
* Fecal occult
* Digital rectal exam
* Prostate, testicular
* Pap smear
* Mammography
* Breast exam

62
Q

What are the types of biopsies?

A
  • Removal of tissue for pathologic review for definitive
    diagnosis
  • Needle
  • Incisional
  • Excisional
  • Results identified, classified and graded
63
Q

what is Tumor TNM classification staging?

A
  • T The extent of the primary tumor
  • N The absence or presence and extent of
    regional lymph node metastasis
  • M The absence or presence of distant
    metastasis
  • The use of numerical subsets of the TNM
    components indicates the progressive
    extent of the malignant disease.
64
Q

things to know about primary tumor (T) in TNM

A
  • Tx Primary tumor cannot be assessed
  • T0 No evidence of primary tumor
  • Tis Carcinoma in situ
  • T1, T2, T3, T4 Increasing size and/or local
    extent of the primary tumor
65
Q

things to know about regional lymph nodes (N) in TNM staging?

A
  • Nx Regional lymph nodes cannot be
    assessed
  • N0 No regional lymph node metastasis
  • N1, N2, N3 Increasing involvement of
    regional lymph nodes
66
Q

things to know about distant metastasis (M) in TNM staging?

A
  • Mx Distant metastasis cannot be assessed
  • M0 No distant metastasis
  • M1 Distant metastasis
67
Q

GX grading

A

grade cannot be assessed (undetermined)

68
Q

G1 grading

A

well differentiated (low grade)

69
Q

G2 grading

A

moderately differentiated (intermediate grade)

70
Q

G3 grading

A

poorly differentiated (high grade)

71
Q

G4 grading

A

undifferentiated (high grade)

72
Q

how does cancer metastasize?

A

bloodborne or lymphatic

73
Q

diangostic tests and tumor markers?

A

CA 125- ovarian, breast
PSA- prostate specific antigen
ADH- brain
CEA- GI
alkaline phosphatase- bone, liver
AFP (alphafetoprotein)- liver, ovarian, testicular, pancreas

74
Q

diagnostic tests and labs?

A
  • CT scan
  • Bone Scan
  • PET scan
  • Chest x-ray
  • CBC with diff
  • BMP
75
Q

What happens with internal radiation?

A

implant placed into affected area and sealed in tubes, seeds, etc.
may be temporary or permanent
can be ingested, injected, or introduced to tumor via catheter
may transmit rays outside the body or excreted in body fluids

76
Q

external radiation nursing care?

A

▪ Monitor for adverse effects: skin changes, ulcerations of
mucous membranes; nausea and vomiting, diarrhea, or
gastrointestinal bleeding.
▪ Assess lungs for rales
▪ Identify and record any medications that the client will be
taking during the radiation treatment.
▪ Monitor WBC’s and platelet count

77
Q

patient and family teaching for radiation?

A
    • Wash the skin that is marked as the radiation site only
      with plain water, no soap; do not apply deodorant, lotions,
      medications, perfume, or talcum powder to the site during
      the treatment period. Take care not to wash off the
      treatment marks.
    • Do not rub, scratch, or scrub treated skin areas. If
      necessary, use only an electric razor to shave the treated
      area.
    • Apply neither heat nor cold (e.g., heating pad or ice
      pack) to the treatment site.
    • Inspect the skin for damage or serious changes, and
      report these to the radiologist or physician
  • Wear loose, soft clothing over the treated area.
  • Protect skin from sun exposure during treatment and for
    at least 1 year after radiation therapy is discontinued.
    Cover skin with protective clothing during treatment; once
    radiation is discontinued, use sun-blocking agents with a
    sun protection factor (SPF) of at least 15.
  • External radiation poses no risk to other people for
    radiation exposure, even with intimate physical contact.
  • Be sure to get plenty of rest and eat a balanced diet.
78
Q

common side effects with chemo?

A

Alopecia
* Nausea/vomiting
* Stomatitis
* Skin changes
* Hematopoietic effects: bone marrow suppression

79
Q

education for oral chemo

A

Medication calendar
* Do not chew/cut or crush meds
* Watch for s/e:
* Hand-foot syndrome
* Nausea/vomiting
* Flu-like symptoms
* Skin rash
* Elevated temp
* Hair loss and nail changes
* Mouth sores -

80
Q

chemo can cause ….?

A
  • Bone Marrow Suppression
  • Thrombocytopenia :< 100,000, severe <20,000
  • Hold chemo if <7500
  • Give thrombopoietin receptor agonist, transfuse platelets
  • Leukopenia/Neutropenia: <1,000 some say <3500
  • Give Neupogen (filgrastin)
  • Reverse precautions
  • Anemia: HCT (10-13)
  • Give epoetin
81
Q

what is nadir?

A
  • the period after chemo during which blood counts
    (particularly the WBC) are the lowest–generally 10-14 days after chemo bone marrow suppression
82
Q

paraneoplastic syndrome tx

A
  • Corticoid steroids
  • Antipsychotics & benzodiazapines
  • Opioids – oral, iv, systemic
  • Megace
  • Electrolyte replacement
  • Epoeitin Alfa
  • Tricyclic antidepressants
  • Anticonvulsants
  • Lidocaine patches
83
Q

risk factors for breast cancer

A
  • Family history of breast cancer
  • BRAC1 & BRAC2
  • Early menarche & late menopause
  • Previous cancer of the breast, uterus, or ovaries
  • Obesity, high-dose radiation exposure of chest
84
Q

breast cancer manifestations

A
  • Breast mass or thickening
  • Unusual lump in the underarm or above the collarbone
  • Persistent skin rash near the nipple area
  • Flaking or eruption near the nipple
  • Dimpling, pulling, or retraction in area of breast
  • Nipple discharge
  • Change in nipple position
  • Burning, stinging or pricking sensation
  • Peau d’orange
85
Q

surgical tx for breast cancer

A
  • Lumpectomy – excision of primary tumor & adjacent
    breast tissue f/b radiation therapy
  • Simple mastectomy- breast tissue & nipple are removed,
    lymph nodes are left intact
  • Modified radical mastectomy – breast tissue, nipple and
    lymph nodes are removed, muscles are left intact
  • Radical mastectomy – removal of entire affected breast,
    underlying chest muscles, and lymph nodes under the
    arms
  • Breast reconstruction – may be performed at time of
    mastectomy or any time after
86
Q

non-surgical breast cancer tx

A
  • Chemotherapy
  • Radiation therapy
  • NEW – intraoperative radiation therapy
  • Hormonal use of medications (eg, tamoxifen)
87
Q

risk factors for colon cancer

A

genetics and diet

88
Q

manifestations of colon cancer?

A
  • Blood in stool
  • Anorexia, vomiting,
  • Weight loss, malaise
  • Anemia abnormal
    stools
  • Guarding or
    abdominal distention
  • Abdominal mass (late
    sign)
  • Ascending colon
    tumor (diarrhea)
  • Descending colon
    tumor (constipation,
    some diarrhea, or flat,
    ribbon like stools)
  • Rectal tumor
    (alternating
    constipation &
    diarrhea)
89
Q

colon cancer tx

A
  • Hyperthermic intraperitoneal chemotherapy (HIPEC)
  • Targeted therapy
  • Immunotherapy
  • Surgery
90
Q

causes of lung cancer

A
  • Cigarette smoking
  • Exposure to
    environmental
    pollutants
  • Exposure to
    occupational pollutants
91
Q

sx of lung cancer

A
  • Cough, dyspnea,
    hoarseness,
    hemoptysis, chest
    pain, anorexia, weight
    loss
  • Weakness
  • FATIGUE FATIGUE
    FATIGUE
92
Q

lung cancer tx

A
  • Radiation therapy for
    palliation of
    hemoptysis,
    obstruction,
    dysphagia & pain
  • Chemo may be
    prescribed for TX of
    nonresectable tumors
    or as adjuvant
    therapy
  • Laser therapy
  • Thoracentesis &
    pleurodesis
  • Thoracotomy
  • Lobectomy
93
Q

causes of leukemias?

A
  • Exposure to radiation, certain chemicals
  • Retrovirus known as human T-lymphotropic virus
  • Malignant production of WBC’s actual cause of disease
94
Q

types of leukemias?

A
  • Acute myelogenous leukemia (AML)
  • Chronic myelogenous leukemia (CML)
  • Acute lymphocytic leukemia (ALL)
  • Chronic lymphocytic leukemia (CLL)
95
Q

major effects of leukemias?

A
  • Increased numbers of abnormal, immature leukocytes
  • Accumulations of cells within lymph nodes, spleen and
    other organs
  • Eventual infiltration of malignant cells t/o organs of body
96
Q

acute leukemia info

A
  • Sudden, rapid growth of
    immature blast or stem cells
  • Rapid progression of
    disease
  • Short survival if not treated
97
Q

chronic leukemia info

A

Gradual onset,
* Slower disease
progression
* Relatively longer survival
time
* CLL common in men over
50
* CML most common in
young & middle-aged
adults
* CML progresses to acute
form, death is common

98
Q

s/s of leukemia?

A
  • Fever
  • Malaise
  • Frequent or persistent infections
  • Swollen lymph nodes
  • Enlarged spleen
  • Bone pain
  • Weight loss
  • Easy bleeding or thrombosis
99
Q

what is graft v host diseases?

A
  • Graft-versus-host disease (GVHD) is a complication that
    can occur after a stem cell or bone marrow transplant
  • Newly transplanted donor cells attack the transplant
    recipient’s body
  • Treatment of chronic GVHD includes steroids and
    antibiotics
100
Q

risk factors for childhood leukemias?

A

Genetics
* Having a brother or sister with leukemia
* Environmental – chemicals - benzene
* Radiation & chemo exposure

101
Q

long term side effects of tx with childhood cancers?

A

Abnormal pulmonary function
* Hearing loss
* Endocrine or reproductive dysfunction
* Cardiac conditions
* Neurocognitive impairment
* Liver & kidney dysfunction
* Abnormal blood cell counts
* Osteoporosis
* 18% of survivors will have a second malignancy during
adulthood

102
Q

what is superior vena cava syndrome?

A

happens when the superior vena cava is partially blocked or compressed. Cancer is usually the main cause of SVCS.

NURSING 110 JUST US!!!!! (14 decks)

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