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Med Surg2 > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

What is the GOAL of CA treatment?

A

Curative
Control
Palliative

Surgery can be done for all 3 reasons

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2
Q

Factors that determine cancer therapy choice

A

Tumor histology & staging

Pts physiologic status (comorbidities)

Personal desires

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3
Q

Types of Cancer therapy

A

Surgery
Chemo
Radiation (external & internal)
Hormone therapy growth factors
Stem cell transplant
Gene therapy

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4
Q

Common side effects of chemotherapy & Radiation

A

🦴marrow suppression
Fatigue 😴
GI issues
Skin & mucosal issues
Pulmonary concerns 🫁
Cardiovascular effects 🫀
Neuro effects 🧠
Reproductive effects 👶🏼

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5
Q

🦴marrow suppression can cause

A

Causes neutropenia
- ⬆️🦠
- hemorrhage 🩸
- thrombocytopenia
- anemia

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6
Q

When taking chemo & radiation, what causes fatigue? 😴

A

Anemia 🩸
Toxic substances
Lack of sleep 😴
Steroids 💊

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7
Q

GI issues due to radiation & chemo

A

Internal mucosa is sensitive to chemo
Mucocitis 🕳️
N/V/D 🤮💩
Anorexia

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8
Q

Skin and Mucosal issues due to chemo & radiation

A

Mucocitis 👄🕳️
Loss of taste 👅
Wound care 🩹🤕to cite of ☢️
Alopecia 🧑‍🦲, 🧢👒,
🧴 sunscreen ☀️

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9
Q

Pulmonary concerns from ☢️& chemo therapy

A

Irreversible 🫁damage
Cough
Dyspnea
Pneumonitis
Fever 🤒
Night sweats 🌜😥
Pulmonary fibrosis 🍇
Pulmonary edema 🌊

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10
Q

Cardiovascular 🫀effects from chemo & radiation ☢️

A

Pericardial effusions
Pericarditis ❤️‍🔥
EKG changes 📈(LV function)

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11
Q

Neuro 🧠effects from chemo & radiation ☢️

A

Chemo brain ☢️🧠
Slight memory loss 🤔

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12
Q

Reproductive 👶🏻effects from chemo & radiation ☢️

A

Infertility 🚫🪺🥚

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13
Q

How does immunotherapy work?

A
  1. Boosts immune system
    Creates environment🌋 bad for CA cells to grow
  2. Attack 🔨CA cells directly

(Cytokines, vaccines, monoclonal antibodies)

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14
Q

How does 🎯targeted therapy work?

A

🚦Interferes w/CA growth by 🎯specific cell receptors & pathways important in tumor 🪨growth

⬇️damage on nl cells than chemo

🎯therapy is personalized 👩🏽‍🦳tx based on the biology 🧬 of the tumor

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15
Q

Side effects of Immunotherapy & Targeted 🎯 therapy

A

Effects are acute & resolve when therapy is over 😅

Capillary leak syndrome (💦shift🔂)
Pulmonary edema 🫁💦
🦴marrow suppression (⬇️than chemo, neutropenic)
Fatigue 😴
Flu like symptoms

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16
Q

What medications 💊 help control chills 🥶 or rigors associated w/ receiving IL-2?

A

Acetaminophen & IV Demerol 💊

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17
Q

Malnutrition is a complication of CA & treatments. What RN managements should you take?

A

Calorie counts 🍩
Daily weights ⚖️
⬆️ protein 🍗
💊 for N/V/D 🤮
Flavor foods that are bland 🍓

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18
Q

Infection🦠 is a complication of CA & treatments. What RN managements should you take?

A

Foley care 💛
Oral hygiene 🪥 😬
Overall hygiene 🛁🧼
Wash hands 🙌🏽
Wear masks 😷
Monitor guests 👀
🚫visits from sick people 🗣️
🚫fresh 💐 or 🍓🍇

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19
Q

Pain😖 is a complication of CA & treatments. What RN managements should you take?

A

Around the 🕦pain medications
(On time ⏰)

💊for break through pain 😖

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20
Q

You should administer what 💊 when beginning chemotherapy?

A

Antiemetics 💊

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21
Q

When should you administer APAP when treating with interferons?

A

Tylenol before treatment &
Every 4 hours ⏰ after treatment

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22
Q

What is Hemophilia? 🩸

A

🩸Deficient in a coagulation factor:

Hemophilia A- factor 8
(✔️More common)

Hemophilia B- factor 9

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23
Q

What is Von Wilebrand disease? 🩸

A

Deficiency in the VW factor

(Protein in the clotting cascade)

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24
Q

What disease results in 🩸in mucous membranes and skin?

A

Von Willebrand Disease

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25
Q

What disease causes 🩸 in the lining of the 👃🏽, intestines, uterus 👛, and vagina?

A

Von Willibrand Disease

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26
Q

What disease results in 🩸 in the deep⬇️ tissue?

A

Hemophilia

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27
Q

What disease is caused by a ⬇️deficiency in the Von Willibrand Factor?

A

Von Willibrand disease

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28
Q

What disease consists of symptoms that are more likely to include 🩸 in joints 💪🏽& within muscles?

A

Hemophilia 🩸

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29
Q

What disease is caused by the deficiency of factor VIII or IX?

A

Hemophilia 🩸

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30
Q

What disease is more prominent in men than women?

A

Hemophilia 🩸

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31
Q

Nursing management for 🩸 disorders

A

Neuro checks 🧠
Fall precautions
Skin checks
Bleeding precautions
Soft 🪥
🚫contact sports 🏈
Electric shaver
Fibrin 🩹🤕
Pain inhibits sleep (📞call Dr- possible🩸)

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32
Q

What are labs for hemophilia?

A

⬆️ PTT due to low clotting factor

Can have normal platelets & PT

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33
Q

Minor 🩸should be treated for?

A

At least 72 hours ⏱️

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34
Q

Nursing management for joint 💪🏽bleeds

A

Replacement factors
RICE 🧊🛋️
analgesics - no ASA
Ambulating 💃🏻
Avoid weight bearing 🩼until swelling resolves

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35
Q

Immediate treatment/attention is needed if?

A

Severe pain 😖or swelling of a muscle or joint that restricts movement or inhibits sleep

Head injury:
Swelling in neck, mouth👄 , abd pain, hematuria, melena🩸, & skin wounds needing suturing 🪡

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36
Q

Immediate treatment/attention is needed if?

A

Severe pain 😖or swelling of a muscle or joint that restricts movement or inhibits sleep

Head injury:
Swelling in neck, mouth👄 , abd pain, hematuria, melena🩸, & skin wounds needing suturing 🪡

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37
Q

Oral CA facts 👅

A

Consists of oral cavity, pharynx, and larynx
Common after 35yrs
Average Dx is 65yrs

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38
Q

Risk factors for Oral CA 👅

A

Tobacco use 🚬💨
Frequent ETOH use 🥃🍸
Prolonged exposure to ☀️
Occupation to chemicals 🧑‍🔬💨
Oral HPV

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39
Q

S&S of oral CA 👄

A

🫦or mouth sores that 🩸easy & don’t heal w/in two weeks

Crusty areas on 🫦, gums, or inside mouth

Numb/pain on face, neck, or mouth occurring w/out cause

Difficulty chewing, swallowing, speaking, or moving jaw or 👅

Weight loss, 👂🏼pain, chronic bad breath

40
Q

S&S of oral CA 👄

A

🫦or mouth sores that 🩸easy & don’t heal w/in two weeks

Crusty areas on 🫦, gums, or inside mouth

Numb/pain on face, neck, or mouth occurring w/out cause

Difficulty chewing, swallowing, speaking, or moving jaw or 👅

Weight loss, 👂🏼pain, chronic bad breath

41
Q

Types of therapies for Oral CA

A

Surgical- partial removal of mandible, tongue 👅

Nonsurgical- ☢️ radiation, chemo, palliative

Nutritions- PEG, parental nutrition

42
Q

Oral👄 CA nursing management

A

Airway, ability to communicate, nutrition, possible trache care

🚫smoking 🚬💨
Oral hygiene 🪥
Pre-op education
Emotional support
Peg tube

43
Q

Esophageal CA risk factors

A

Smoking 🚬💨 doubles risk
Age 65-70
Barrett’s esophagus (irritation to mucosal cells from GERD)
Esophageal injury
Excess ETOH use 🍸🥃
Obesity 🤰🏻
Occupational exposure to asbestos or dust 💨

44
Q

Esophageal CA patho

A

Tumors appear as ulcers, often advanced

Metastasis to liver & 🫁

45
Q

Esophageal achalasia

(Delayed emptying of lower esophagus squamous cell)

A

Early stage- tapering of lower esophagus

Advanced stage- showing dilated, tortuous esophagus

46
Q

Clinical manifestations of esophageal Cancer

A

*Progressive dysphagia
(most common early sign)
Occurs w/🥩, soft foods, then liquids

Pain- radiates to neck, jaws,👂🏼, shoulders, sore throat, choking, hoarseness

Weight loss ⚖️
Regurgitation d/t stenosis➡️ aspiration
Possible hemorrhage
Possible fistula in 🫁or trachea

47
Q

Esophageal CA treatment

A

Poor prognosis
Surgical therapies
Endoscopic ablation
Chemo
Radiation ☢️
palliative
Targeted therapies 🎯

Nutritional- IVF, J-tube, swallow study
small bland meals, 🪑during feeds,
👀 aspiration & 🦠

48
Q

Esophageal CA assessment

A

History of GERD, hiatal hernial, Barrett’s esophagus, 🚬& 🍸🥃 use

Progressive dysphagia, pain assessments

49
Q

Esophageal CA Education 📚

A

Oral hygiene 🪥
Managing GERD
Barrett’s Esophagus or HH
Healthy dietary choices
⬆️protein, ⬆️calorie
G-tube?

50
Q

Esophageal CA nursing management

A

Possible chest tube, NG tube, central line, feeding tube

Cough & deep breathe (pneumonia)

51
Q

Esophageal CA nursing management

A

Possible chest tube, NG tube, central line, feeding tube

Cough & deep breathe (pneumonia)

52
Q

Post op for Esophageal CA

A

🦠, dysrhythmias
anastomic leaks
fistula,
🫁edema, respiratory distress,
assess drainage from NG tube, monitor chest tube
cough & deep breathe
incentive spirometer
aspiration precautions

53
Q

Acute gastritis symptoms

A

Sx for several hours➡️a few days
Epigastric tenderness
A/N/V 🤮
Mucosal inflammation➡️hemorrhage
GI bleeding 🩸

54
Q

Chronic gastritis symptoms

A

Similar to acute
Asymptomatic
Pernicious Anemia (⬇️B12)

55
Q

Risk factors for gastritis

A

NSAIDS 💊
Steroids
ETOH 🍸
Spicey foods 🫑🌶️
H pylori 🦠
Viral/bacterial infections 🧫

56
Q

Acute gastritis nursing management

A

NPO 🚫
IVF
Antiemetics
👀for dehydration
Possible NG tube
👀 for 🩸
Clear liquids➡️ gradual solids
PPIs💊
VS🩺, H&H🩸

57
Q

Nursing management for chronic gastritis

A

Combination abx 💊if Hoylori 🦠
Educate 📚on pernicious anemia
Possible B12 💉
Small frequent meals 🥪
Follow up cares

58
Q

Hematemesis

A

Bloody emesis 🩸🤮

Fresh, bright red or ☕️grounds
Coming from the stomach 🫄

59
Q

Melena

A

Black🖤, tarry stools💩 (has iron)

A slow 🩸from upper GI

60
Q

Occult bleeding

A

Small 🩸in gastric secretions, not apparent to 👀

61
Q

Massive hemorrhage from a UGI 🩸is determined by?

A

More than 1500ml of 🩸 or
25% of intravascular 🩸volume

62
Q

Abdominal distention, guarding & peristalsis can be a sign of?

A

Pancreatitis

63
Q

During a UGI 🩸, vitals should be taken?

A

Immediately 👇🏽& q 15-30min

64
Q

Nursing management/intervention for UGI 🩸

A

-Identify ⬆️risk
(gastritis, cirrhosis, PUD)
-🩸That are likely to reoccur
-NG tube (skin✔️)
-Med✔️ (🚫steroids, NSAIDS)
-Good💊= PPI, H2 receptor blocker (famotadine/Pepcid) take with 🌮
Avoid irritants 🌶️🧂🍔🍹🚬

65
Q

🚨 Emergency management for an UGI 🩸

A

Assess for shock 😱
(Tachy, weak pulse, hypotension, 🥶🧊extremities, prolonged cap RF)
Insert Foley 💛 q hr assessments
VS 🩺
Possible central line 🩸
Oxygen if low H&H
GI assessment (☑️for peritonitis)
Volume replacement
(Crystalloids, PRBC, FFP)
2L 🩸loss= surgery 🔪
Telemetry 📈

66
Q

The pancreas makes?

A

enzymes to break ⬇️sugar, fat, and starch

67
Q

The pancreas secretes these enzymes into the GI tract?

A

Amylase: breaks⬇️ carbohydrates

Protease: breaks⬇️ proteins

Lipase: breaks⬇️ fats

68
Q

The pancreas secretes these hormones into the 🩸stream

A

Insulin: to ⬇️ 🩸glucose

Glucagon: to ⬆️ 🩸glucose

69
Q

Risk factors for acute pancreatitis

A

Prolonged 🍹🍻consumption

Gallstones 🪨

Biliary tract disease

🦠 infection

Less common: ⬆️triglycerides

70
Q

S&S of Acute Pancreatitis

A

LUQ and pain radiating to back w/sudden onset (worse with 🌮& not relieved with 🤮)

N/V, low🤒, leukocytosis, hypotension, tachy, jaundice 💁‍♂️

⬇️or absent 💩sounds, paralytic ileus

Crackles 🫁

💚💛🤎discoloration of abd wall
💙echymosis of flank
💙Periumbillical area

Shock 😱, toxemia💃🏻🤰🏻, hypovolemia

71
Q

Acute pancreatitis complications

A

Pseudocysts: fluid & exudate

🦠pseudocysts: abscess resulting in necrosis 🖤 to pancreas (🔪drainage to prevent sepsis)

Hypotension from 💦shifting & 🦠

Pleural effusions💦, atelectasis

Tetany 🤌🏽from hypocalcemia

Abd 🤰🏻Compartment syndrome

72
Q

Pancreatitis Diagnostics 🔬👩‍🔬

A

Amylase: ⬆️in early stages and stays ⬆️for 24-72 hours (other disorsers can cause ⬆️)

Serum Lipase: 🚨 lab indicator

Other labs: ⬆️ LFTs, Triglycerides, glucose, bilirubin, & ⬇️Calcium

CT 🚨 best image of pancreas

73
Q

Amylase lab level

A

60-120

74
Q

Lipase lab level

A

0-160

75
Q

With Chronic pancreatitis, the pancreas is destroyed 💣due to

A

Fibrotic 🍇tissue leading to strictures and calcifications

76
Q

Chronic pancreatitis can be caused by?

A

Obstructing pancreatitis: obstructing gall🪨, tumors, trauma🥊,
pseudocysyt, disease & inflamm.

Non obstructing: Chronic 🍷🥃🍹🍻

77
Q

Chronic pancreatitis S&S

A

And pain:
Heavy, gnawing, cramping, 🚫relief with 🌮 or antacids

Pancreatic insufficiency:
Weight⬇️, constipation, steatorrhea

Pseudocysts, duodenal and bile duct obstruction, ascities, CA, effusion

78
Q

Diet for chronic pancreatitis

A

Small frequent meals

No carbonated beverages 🥤🍻

🚫🍷🚬

79
Q

Risk factors for Pancreatic CA

A

⬆️ fat diet 🐖
Chronic pancreatitis
DM 💉
Age 👵🏽👴🏼& 🚬
Black Americans 👩🏾

80
Q

Manifestations of pancreatic CA

A

Abdominal pain 😖
Jaundice 🧔‍♂️
Rapid weight ⬇️

81
Q

Parental Nutrition for pancreatic CA is?

A

A mix of proteins, carbohydrates, fats, electrolytes, vitamins, dextrose, and amino acids

82
Q

Parental Nutrition facts ✅

A

Refrigerate until 30min before IV
2 RN✅
1.2 micron filter for PN w/lipids
0.22 micron filter for PN w/out lipids
Change tubing, filter, clave, bag q 24hrs due to 🦠 from 🍬
Glucose ✅ q4-6 hrs

83
Q

Cholelithiasis

A

Stones 🪨in the gallbladder

84
Q

Cholecystitis

A

Inflammation of the gallbladder wall

Associated with gall🪨

85
Q

Gall🪨 are more common in

A

Female 💃🏻
Fat 🤰🏻
Fertile
Over Fourty 🥳

Oral contraceptive use

86
Q

Pain from cholelithiasis or cholecystitis can happen

A

3-6 hours after a ⬆️ fat meal or when the patient lies down 🛌

87
Q

S&S of gallbladder disease?

A

RUQ pain
R-Shoulder pain 😖
Fever 🤒 & 🥶
Billiary colic (pain comes & goes)

88
Q

Complications from gallbladder disease

A

Rupture of gallbladder➡️peritonitis ➡️sepsis➡️ ☠️💀🏴‍☠️

Jaundice 🧔‍♂️ (skin assess)
Biliary cirrhosis
Ascities 🫄(pain assess)
Necrotic tissue 🖤
Fistula 🕳️
Subphrenic abscess
Pancreatitis
Urine is dark (bilirubin)
Clay colored 💩

(Neuro ✅for hepatic encephalopathy)

89
Q

Conservative therapy for gallbladder disease

A

IV 💦
NG tube or NPO
Antiemetics
Analgesics
Antibiotics 🦠
ERCP (scope of biliary🌲)
Shock wave lithotripsy- pee out 🚽💛

90
Q

Surgical therapy for gallbladder disease

A

Laparoscopic cholecystectomy
(🕳️= ⬆️risk of 🩸)

Incisional 🔪🧵🪡

91
Q

Cirrhosis can be caused by?

A

ETOH use 🍷🍺🥃
Hep C 💉
Malnutrition 🦴
Genetic
Frequent use of APAP (Acute)

92
Q

Complications of cirrhosis

A

Portal HTN 🚨

⬇️liver fx➡️ 💦shift➡️ portal HTN➡️ protein shifts out of vascular into 🫄=ascities (Give Albumin)

⬆️Ammonia➡️ 🧠decline= give lactose (Titer💩)

Hypernatremic 🧂

Gynicomastia 🤦🏽‍♂️👙
Jaundice 🧔‍♂️
Flank pain
Varicies 🩸
Palmar Erythema (cut nails)
Urinary retention 🚽

93
Q

During a parasethesis, the fluid should be

A

Straw colored fluid

94
Q

During cirrhosis liver function labs🧑‍🔬…

A

Normal LFTs at first then….
⬆️LFTs

95
Q

Cares for Cirrhosis

A

⬆️calorie, ⬇️protein, ⬇️🧂 diet
2g sodium 🚫
F&E … tube feeds
🩸Assessments
Beta Blocker to ⬇️ portal HTN= varicies
Vasopressin to ⬇️🩸
Lactulose for Amonia
Dietetics for Anemia
Analgesics—- 🚫narcotics
Hydroxyzine- palmar erythema

HOB 💺for ascities
I&Os- urine output- bladder scans
Daily weights
🧠status
Asteristix- 👋🏼&🦶🏼shaking

Med Surg2 (5 decks)

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