EXAM 6 MEDSURGE Flashcards
1
Q
develop from a mutation in a single cell and grows without the control of a normal cell. (they do not listen) They divide rapidly and are extremely aggressive.
A
Cancer cells
2
Q
well-differentiated,
resembling normal cells from which they originated;
expands at a slow rate;
does not invade or infiltrate surrounding tissues;
usually does not cause tissue damage or death.
A
benign cells
3
Q
undifferentiated,
look nothing like the cells from which they originated;
grow on the periphery of the tumor;
the less they resemble cells of origin,
the quicker they grow and replicate;
gain access to other areas of the body;
results in death if not detected and controlled.
A
malignant cells
4
Q
Process by which malignant cells obtain nutrients and oxygen
A
angiogenesis
5
Q
host tissue produces its own?
A
growth hormone (VEGF)
6
Q
What causes cancer?
A
Viruses
Overexposed cells
Environment
(physical and chemical agents)
Diet
Genetics
Hormones
Immune system
(surveillance)
7
Q
ALL cancers involve the malfunction of genes that control…..
A
cell growth and division.
8
Q
The cells transformation from normal to cancerous is called
A
carcinogenesis!
9
Q
American Cancer Society Guidelines
A
Achieve and maintain a healthy weight
Adopt a Physically Active
Lifestyle
Consume a Healthy plant-based diet
Limit alcohol consumption
Involvement of Community
10
Q
75% of cancers in the US are related to
A
environmental and lifestyle factors.
11
Q
primary prevention
A
Avoid carcinogens
Dietary changes
Weight management
Reduction in alcohol consumption
Smoking cessation
Preventive medications
12
Q
secondary prevention of CA
A
screening & early detection
PSA screening
Breast self-examination
mammography
colonoscopy
pap test
cancer-related check-ups
13
Q
Tertiary Prevention
A
Monitoring for and prevention of recurrence
14
Q
7 signs of CA acronym
A
CAUTION
15
Q
C
A
change in bowel or bladder habits
16
Q
A
A
a sore throat that does not heal
17
Q
U
A
unusual bleeding or discharge from any body orifice
18
Q
T
A
thickening or lump in the breast or elsewhere
19
Q
O
A
obvious change in wart or mole
20
Q
N
A
nagging cough or hoarseness
21
Q
Epithelial tissues lining
A
(carcinomas)
22
Q
Glandular tissues
A
(adenocarcinomas)
23
Q
Connective, muscle, and bone tissues
A
sarcomas
24
Q
Tissue of the brain and spinal cord
A
gliomas
25
Pigment cells
(melanomas)
26
Plasma cells
(myelomas)
27
Lymphatic tissue
(lymphomas)
28
Leukocytes
(leukemia)
29
Erythrocytes
(erythroleukemia)
30
The tumor is classified by
the appearance of the cells and the degree of differentiation
31
Grade 1:
mild dysplasia
32
Grade 2:
moderate dysplasia
33
Grade 3:
severe dysplasia
34
Grade 4:
anaplasia
35
Determines the extent of the disease process:
clinical staging
36
Stage 0:
cancer in situ
37
Stage 1:
tumor limited to tissue of origin
38
Stage 2:
limited local spread
39
Stage 3:
extensive local/regional spread
40
Stage 4:
metastasis
41
TNM Classification System
tumor size
lymph nodes
metastasis
42
how to measure tumor size
0=no tumor
| 4= large tumor and other tissue involvement
43
how to measure degree of lymph node involvement
0= no lymph node involvement
3= regional lymph nodes involved-metastasis expected
44
how to measure metastasis
```
0= none
3= significant metastasis
```
45
Diagnostic studies are done to determine the extent of the disease:
bone and liver scans,
ultrasonography,
computed tomography,
MRI,
PET imaging, and
tumor markers
46
Interventions to manage cancer
surgery
chemo
radiation
47
complementary therapies
naturopathic medicine
nutritional therapy
physical rehabilitation
mind-body medicine
spiritual support
48
conventional therapies
surgery
chemo
immunotherapy
radiation
stem cell transplant
49
ND for patients with cancer
impaired oral MM
impaired tissue integrity: alopecia
imbalanced nutrition
fatigue
50
is a model of care that improves the quality of life of patients and their families facing problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and treatment of pain and other distressing symptoms (physical, psychosocial, and spiritual).
palliative care
51
Factors Affecting Responses to Loss
Age
Social Support
Families
Culture and Spiritual
Practices
Spiritual Beliefs
Rituals of Mourning
Nurses Response to Loss of
Patient
52
states that “each person has the right to be cared for by caring, sensitive, knowledgeable people who will attempt to understand my needs and be able to gain some satisfaction in helping me fact my death.”
the dying person's bill of rights
53
the process of dying
preparation for death
death
after death
54
phase 1: preparation for death
```
Coolness
Lethargy
Decrease in intake
Incontinence
Congestion
Breathing pattern change
Disorientation
Restlessness
Withdrawal
Visual hallucinations
Letting go, saying goodbye
Generalized edema
```
55
phase 2: death
```
Asystole
Release of bowel and bladder
No response
Eyelids slightly open
Pupils enlarged
Fixed eyes, no blinking
Jaw relaxed
Mouth slightly open
Mottled extremities
```
56
phase 3: after death
Family decisions (organ donation, cremation, burial)
Post death rituals (funerals)
Postmortem care
Organ harvesting
Healthcare workers attend funeral?
57
the study of blood and blood forming tissues.
hematology
58
blood consists of?
55% plasma
45% formed elements
59
Formed elements include
erythrocytes, leukocytes, and thrombocytes.
60
bone marrow produces how many RBCs per day
175 billion
61
hemoglobin level
13.5-17.5
62
hematocrit levels
41-53
63
what to RBCs look like
non-nucleated
biconcave
disk-shape cell
64
Mature erythrocytes consist primarily of ?
hemoglobin.
65
Principle function of RBCs is to
transport oxygen between the lungs and the tissue
66
life span of RBCs
120 days
67
leukocytes
WBCs
68
WBC count
4,000-11,000
69
granulocytes
eosinophils
basophils
neutrophils
70
hypersensitivity reactions
eosinophils
71
produce and store histamine
basophils
72
ingestion and digestion of bacteria
neutrophils
73
agranulocytes
monocytes
lymphocytes
74
phagocytize bacteria within the tissues
monocytes
75
principle cells of the immune system; produce antibodies
lymphocytes
76
Involved in fighting infection, combatting allergic reactions, and immune responses.
leukocytes
77
Not technically cells. Granular fragments from giant cells in the bone marrow.
thrombocytes
78
normal range for thrombocytes
130,000-400,000
79
normal life span of thrombocytes
7-10 days
80
Active role in coagulation and maintaining hemostasis.
thrombocytes
81
A complex process the body uses to stop bleeding.
Blood Clotting
82
CBC
Erythrocytes
Leukocytes
Platelets
Hemoglobin
Hematocrit
RBC
MCV (Ch. 33)
MCHC (Ch. 33)
83
(percentage of total blood volume consisting of RBCs)
hematocrit
84
(iron-containing protein of the RBC)
hemoglobin
85
The number, appearance and development of the various blood cell types are analyzed to diagnose hemolytic blood disorders.
Bone Marrow Aspiration
and Biopsy
86
Aspirate is typically obtained from the ?
posterior superior iliac crest (Biopsy), anterior iliac crest, or sternum.
87
The Nurse’s Role in Bone Marrow Aspirate and Biopsy
Honest explanation of the procedure by physician and nurse
Signed Informed Consents
Positioning is based on the site where aspirate/biopsy will be obtained from
Aseptic cleansing, anesthetizing of the site, aspiration (generally 5 mLs), pressure applied to the site, covered with sterile dressing
88
part of the lymphatic system
Role is to filter the blood, produce lymphocytes and store blood and platelets
spleen
89
Hemoglobin concentration is lower than normal or the number of circulating RBCs is decreased
anemia
90
anemia is caused by?
impaired RBC formation
excessive loss or destruction of RBCs
hemorrhage
chronic bleeding
Nutritional problems that interfere with the body’s ability to form RBCs
91
3 classifications of anemia
defect in their production
by their destruction
by their loss
92
bya defect in their production
hypoproliferative anemia
93
by their destruction
hemolytic anemia
94
by their loss
bleeding
95
Catagorizes the RBCs by size (Normocytic, Microcytic, Macrocytic)
MCV (Mean corpuscular volume)
96
Average concentration of Hemoglobin which is reflective in its color (Normochromic, Hypochromic)
MCHC (mean corpuscular hemoglobin concentration)
97
hypoproliferative anemia have def. in ?
iron
B12
folate
98
An inadequate supply of iron for RBC formation
Most common type of anemia
Body can not make hemoglobin without iron
Deficiency leads to fewer RBCs, smaller RBCs (microcytic) and pale RBCs (hypochromic)
iron deficiency anemia
99
the usual cause of iron def. anemia
iron loss due to bleeding
100
What are typical sources of bleeding in Adults?
Menstrual cycle in females
Chronic blood loss from ulcers
Hemorrhoids
Cancer
101
Required for RBC formation and maturation
Vitamin B12 Deficiency (Pernicious) Anemia
102
usual cause of Vitamin B12 Deficiency (Pernicious) Anemia is?
impaired absorption from the GI tract
103
secreted by the gastric mucosa, binds with dietary B12 so it can be absorbed in the body
intrinsic factor
104
Lack of B12 results in release of
immature, megaloblastic RBCs that are fragile and incapable of carrying oxygen in adequate amounts
105
Required for normal production and maturation of RBCs
Absorbed from the intestines
Found in green leafy vegetables, fruits, fortified cereals and meats
folic acid
106
Folic Acid Deficiency Anemia is characterized by what type of RBCs
fragile
immature
megaoloblastic
107
Folic Acid Deficiency Anemia is more common among people who are?
chronically malnourished
on TPN
PG
108
Characterized by the premature destruction of RBCs. May be destroyed due to improperly formed cells (intrinsic) or damage by an outside source (acquired)
hemolytic anemia
109
ex of hemolytic anemia
altered erythropoiesis
hypersplenism
drug-induced anemia
autoimmune anemia
mechanical heart valve-related anemia
110
Genetically transmitted, autosomal recessive trait (both parents)
Usually affects those of African American descent
sickle cell anemia
111
sickle cell anemia is characterized by abnormal ___ in the RBCs
hemoglobin S
112
when do cells sickle?
when blood O2 falls
113
what do cells do when they sickle?
clump together and obstruct small blood vessels
114
when does shape return to normal for sickle cells?
when O2 levels are restored
115
what can damage overtime in sickle cell anemia?
membranes
116
____ occurs in sickle cell which leads to anemia
hemolysis
117
Sx of sickle cell anemia
abrupt onset of INTENSE PAIN in abd, chest, back, and/or joints
118
the obstruction of BVs in sickle cell anemia can cause?
tissue ischemia
119
in sickle cell anemia you may see ____ due to release of bilirubin
jaundice
120
when will sickle cell anemia occur?
chronic
unpredictable
recurrent
121
Entrapment of erythrocytes and leukocytes in the microcirculation causing hypoxia, inflammation, and necrosis
seen in sickle cell pts.
acute-vaso-occlusive crisis
122
what to educate pts on with acute-vaso-occlusive crisis
Educate on ways to minimize precipitating events; alert the patient to signs and symptoms of tissue hypoxia, infection, neurological deficits, respiratory and cardiovascular dysfunction.
123
what do you treat with acute-vaso-occlusive crisis
TX THE PAIN
124
EVENTS Leading to CRISIS
Fever
Emotional or physical stress or events
Fatigue
Low oxygen- high altitude settings
Poorly pressurized planes
Hypoventilation
Vasoconstriction when cold
Dehydration
Vomiting
Acidosis
Alcohol consumption
Pregnancy
125
Sickled cells can resume a normal shape when
rehydrated and reoxygenated.
126
what to focus on in pts with sickle cell?
PAIN CONTROL
rehydrate
oxygenate
127
Also referred to as Erythrocytosis (abnormally high red blood cell count with high hematocrit)
polycythemia
128
Hematocrit of greater than ___% in females and ___% in males-blood becomes more viscous (sticky)
50; 55
129
is most common form-result of chronic hypoxia/excess production of erythropoietin
Secondary Polycythemia
130
what can cause polycythemia
high altitudes
smoking
chronic lung dx
131
how to tx polycythemia
tx of the contributing factor
132
A decrease in the number of circulating neutrophils either my decreased production or increased destruction
neutropenia
133
Decreased neutrophil count greatly increases the risk of ?
infection
134
First indication of deficiency of neutrophils is usually an ?
infection
135
Platelet count of less than 100,000 /mL of blood
thrombocytopenia
136
thrombocytopenia is the most common cause of?
abnormal bleeding
137
if the platelet number falls below 20,000 what is likely?
spontaneous bleeding (internal & external)
petechiae
138
thrombocytopenia can result from?
decreased platelet production
increase destruction of platelets
increased consumption of platelets (clotting process)
139
sx of thrombocytopenia
Ecchymosis
Petichiae
Epistaxis
Menorrhagia
Hematuria
Gastrointestinal bleeding
Gingival bleeding
140
Simultaneous blood clotting and hemorrhage
Tissue damage activates an abnormal activation of the body’s clotting mechanisms.
Widespread, continuous clot formation which consumes all of the clotting factors, resulting in generalized bleeding.
Disseminated Intravascular Coagulation (DIC)
141
DIC is due to an underlying condition such as?
sepsis
shock
trauma
CA
abruptio placenta
toxins
allergic rxns
142
what kind of temp in DIC
decreased
143
increased ___ in extremities in DIC
cyanosis
144
what kind of pain in DIC
increased
145
what kind of bleeding in DIC
internally or from all orifices
146
what kind of pulses in DIC
decreased
147
what kind of cap refill in DIC
increased time
148
where is the pain in DIC
gastric & chest
