Final Flashcards

1
Q

What is cultural competence?

A

An attitude of openness, respect for, and curiosity about different cultures, values, and traditions

Involves consideration and critical analysis of health disparities an attempt to make nursing adequate among all cultures

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2
Q

What is cross-cultural or transcultural nursing?

A

Any encounter a nurse has with a patient from a different culture

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3
Q

What is institutional, cultural competence?

A

When a company has the capacity to:
Value diversity
Conduct self-assessment
Manage dynamics
Acquire knowledge
Adapt to diversity

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4
Q

What is cultural humility?

A

Acknowledging that everyone’s views are culturally influenced

And that our own personal beliefs are not better than others

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5
Q

What is cultural safety?

A

Culturally appropriate health services to disadvantaged groups

While maintaining dignity and avoiding institutional racism, assimilationist and repressive practices

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6
Q

What is ethnocentrism?

A

And assumptions that everyone shares your cultural views, and/or you believe your culture is superior to others

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7
Q

What is subculture?

A

Group, sharing some practices, language, or other characteristics in common within a larger society that does not share those characteristics

Example: high school is the larger society, subculture would be the different clicks: goth, athletes, theater, etc

Example 2: race - it is a social construct, not a biologic entity

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8
Q

What is a health disparity?

A

Significant gap and health status between overall American population and people of specific ethnic backgrounds

Examples are people of different, ethnic backgrounds are more prone to comorbidities, such as cancer, heart disease, diabetes, HIV, AIDS, etc

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9
Q

What does Leininger’s theory include regarding transcultural nursing?

A

-culture care accommodation
-culture care restructuring
-Acculturation
-Cultural blindness
-Cultural imposition
-Cultural taboos

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10
Q

What are legislative issues regarding end of life?

A

DNR orders
Advanced directives
Assisted suicide legislation
Living will
Proxy directive
Durable power of attorney

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11
Q

What are the different awareness context regarding death and dying?

A

Closed - patient is unaware of the terminal state, but others are aware

Suspended - patient suspects what others know, and attempts to find out details about their condition

Mutual pretense - patient, family and healthcare professionals are aware the patient is dying, but pretend otherwise

Open - patient family and healthcare professionals are aware the patient is dying and open the acknowledge the reality

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12
Q

Where are the different settings that palliative care can take place?

A

Hospital
Skilled nursing facility
Outpatient

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13
Q

What is hospice care?

A

Group of professional caregivers and coordinated programs to help take care of patients with serious progressive illnesses with no cure

Hospice care is anticipated for no more than six months

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14
Q

What is managed her in hospice care?

A

Pain management
Patient support
Family support
Home care of dying
Bereavement
Research and education
Spiritual
Services
Supplies (bed, wheelchair, Walker, air tank, etc)

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15
Q

Where can hospice services be provided?

A

Home
Hospital
Nursing home
Hospice home setting
Assisted living

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16
Q

What are the four levels of hospice care?

A

1) routine home care
2) inpatient respite care (caregiver break)
3) continuous care
4) general and patient care

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17
Q

What is an advance directive?

A

Written document that allows competent people to document their preference regarding:

-use of medical treatment at end of life
-Specifically their preferred setting for care
-Communicate other valuable insight into their values and beliefs

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18
Q

What are proxy directives?

A

Appointment and authorization of another person, to make medical decisions on behalf of the person who created the advance directive when he or she can no longer speak for him or herself.

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19
Q

What is the death vigil?

(Signs death is coming)

A

Withdrawal
Sleeping longer
Somnolent
Increased intervals between respirations
Decrease blood pressure
Mottling of the skin

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20
Q

What is grief?

A

Personal feelings that accompany an anticipated or actual loss

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21
Q

What is mourning?

A

Individual, family, group, and culture expression of grief and associated behaviors

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22
Q

What is bereavement?

A

Period of time during which morning of a loss takes place

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23
Q

What are nursing interventions when death is imminent

A

-Decisions about level of care
-Comfort measures only
-Advance directives
-Artificial nutrition and hydration
-CPR?
-euthanasia and physician assisted suicide?

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24
Q

Will a dying patient go through all of the grieving steps in order?

A

No, they may go through one or all, may go out of order, and may return to one in a later time

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25
What is palliative care?
Focus on the relief of suffering for clients with serious illness Best possible quality of life not only for clients, but for their family as well. Giving them their dignity Can before for: a cute, serious, life-threatening, illnesses, or progressive chronic illnesses
26
What is the focus of palliative care?
Controlling symptoms Coordinating care Reducing unnecessary tests and futile interventions Ongoing conversations with patient and family
27
What services are included for hospice care?
Physician Nursing Physical therapy Occupational therapy Speech/language pathology Medical social services Hospice aide services Homemaker services Medical supplies (drugs, biologic, and Medical appliances) Counseling (diet, bereavement, spiritual) Short term and patient care for respite care, pain control, and symptom management
28
What does “ staging?” Mean regarding cancer
Has it spread? TNM: tumor, nose, metastasize T = extent of the primary tumor N = absence or presents and extent of regional lymph node metastasis M = absence, or presence of distant metastasis
29
What does “ grading” mean regarding cancer?
Classification of the tumor cells -To what extent to the cells resemble the original tissue -Grade 1- through four 1: closely resembles the tissue of origin 4: do not resemble the tissue of origin
30
What is a biopsy?
Obtaining a tissue sample of a cell that is expected to be malignant
31
What are the different types of biopsy
Excisional - surgical removal of the tumor (done when tumor is easily accessed; skin, breast, GI, respiratory tract) Incisional - performed if tumor is too large to be removed Needle - for masses easily accessible (Breast, thyroid, long, liver, kidney)
32
What surgeries can be completed as a prophylaxis for cancer
Colectomy Mastectomy Oophorectomy
33
What is radiation regarding cancer?
It is used to cure localized cancers, and can be used in combination with other therapies Can be used in a positive way to try and shrink the tumor
34
What is a lethal tumor dose?
Well eradicate 95% of the tumor, but preserve normal tissue
35
What is fractionated radiation regarding cancer?
Doses of radiation, delivered overtime until total doses delivered
36
What is teletherapy radiation regarding cancer?
External beam of radiation This is most commonly used It’s targeted
37
What is Brachytherapy radiation regarding cancer
Implanted seeds, beads, or Catheters Delivers a high dose of radiation
38
What are some radiation complications
Toxicity Alopecia Stomatitis Thrombocytopenia
39
What do nurses need to assess during radiation therapy?
Skin Oropharyngeal mucosa Nutritional status General well-being
40
What are safety precautions regarding brachytherapy radiation?
Private room Posting signs Dosimeter badge No pregnant staff members / visitors No children Limit visits to 30 minutes per day Visitors maintain 6 feet away
41
What is chemotherapy?
Used to attempt to destroy tumor cells by interfering with the cells functioning (their ability to replicate)
42
What are alkylating agents (regarding chemo)
Alters DNA structure by miss reading the DNA code
43
What are Nitrosoureana agents (regarding chemo) ?
Similar to alkylating, but they cross the blood brain barrier
44
What are topoisomerace I inhibitor agents (regarding chemo) ?
Induce breaks in the DNA strand by binding to enzyme and prevent the cells from dividing
45
What are antimerabolite agents (regarding chemo) ?
Interfere with a bio synthesis of metabolites or nucleic acids necessary for RNA and DNA synthesis
46
What are antitumor antibiotics (regarding chemo) ?
Interfere with DNA synthesis by binding DNA and prevent RNA synthesis
47
What are mitosis spindle poisons (regarding chemo) ?
Arrest metaphase by inhibiting mitotic tubular formation, and inhibiting, DNA and proteins synthesis
48
What are hormonal agents (regarding chemo) ?
Binding two hormone receptor sites that alter cellular growth
49
What do nurses need to do during chemotherapy?
-assess fluid and electrolyte balance -Modify risk for infection and bleeding -Administer chemotherapy -Protect caregivers
50
What are the different types of bone marrow transplant?
-Allogeneic: related donor other than patient, donor may be related donor or matched unrelated donor -autologous: from the patient himself /herself -Syngenic: from identical twin
51
What are nursing interventions pre-bone marrow transplants?
Pre-transplantation: -nutritional assessment -Extensive physical exam -Organ function test -psychological evaluation -patient support system 
52
What are nursing interventions during bone marrow transplants?
-Vital signs -Pain -Comfort
53
What are nursing interventions post- bone marrow transplants?
Ongoing assessment for several weeks
54
What are gene targeted therapies regarding cancer?
Tumor directed therapy: introduction of a therapeutic gene (suicide gene) into tumor cells and attempt to destroy them Active immunotherapy : administration of genes that will invoke the antitumor responses of the immune system Adoptive immunotherapy : administration of genetically altered lymphocytes at a program to cause tumor destruction
55
what are risk factors for breast cancer?
Gender (being a woman) Age (greater than 40) Nulliparity Having your first child after 30 Early menarche Late menopause Long term estrogen replacement 90% are NOT related to heredity However, risk doubles with 1st degree family member
56
How do you assess for breast cancer?
-Firm lump or thickness in breast (typically painless) -spontaneous nipple discharge (can be bloody, clear, or serous) -asymmetry of breast -Nipple retraction -Nipple scaliness -Enlargement of auxiliary or super clavicular lymph nodes
57
How do you diagnose breast cancer?
Mammogram Biopsy Estrogen/progesterone receptor assay Lab test Bone scan/CT/PET scan
58
What are surgical interventions for breast cancer?
Lumpectomy Mastectomy Mammoplasty Bone marrow transplant
59
What are nursing interventions for breast cancer?
-Monitor for adverse effects of radiation therapy such as: fatigue, sore throat, dry, cough, nausea, anorexia -Monitor for adverse effects of chemotherapy such as: bone marrow suppression, nausea, vomiting, alopecia, weight gain/loss, fatigue, stomatitis, anxiety, depression -provide psychological support -Involve patient and planning -describe surgical procedures to alleviate fear -Prepare patient -Administer anti-emetics -Administer IV fluids -Help patient identify support person -Suggest to patient the psychological interventions may be necessary for anxiety, depression, or sexual problems -Teach all women the recommended cancer screening procedures
60
What are patient teachings regarding breast cancer?
Dressing changes/wound drainage management Bathing Medication instructions Teach precautions to prevent lymphedema No BP or blood draws on affected arm No carry backpacks, handbags, or luggage with affected arm Protect hand and arm from cuts sticks and burns
61
What is prostate cancer?
Most common cancer, and second most common cancer that causes death on my males Malignant tumor that originates in a prostate
62
What are risk factors for prostate cancer?
Advanced age Family history Alcohol abuse Obesity High animal, fat, low fiber diet Long-term exposure to radiation Certain chemicals, such as benzene and toluene
63
What are the symptoms of prostate cancer?
No symptoms in the early stages Difficulty urinating Difficulty with ejaculation Hematuria Hip/lower back pain Weight loss
64
What is medical management options for prostate cancer?
Surgery: prostatectomy Radiation Androgen deprivation therapy Chemotherapy
65
What are nursing management options for prostate cancer?
Encourage patient to Express fears and concern Pain management Check dressing and drainage Monitor S/S of infection Maintain adequate fluid and take Meds as prescribed Encourage pernil exercises (24 to 48 hours post surgery) Meticulous catheter care Monitor for urinary retention or complications Monitor for signs of urethral stricture
66
What is colorectal cancer?
Cancer that begins in the colon is called cancer Cancel that begins in. The rectum is called rectal cancer. Most colon and rectal cancels are type of tumor called adenocarcinoma
67
What are risk factors for colorectal cancer’s?
Age Diet Polyps Personal history Family history Genetic factors IBD
68
Signs and symptoms of colorectal cancer
Change in bowel habits (diarrhea constipation feeling bowel does not empty) Bright, red or very dark blood in stool Stools that look narrower or thinner than normal Discomfort in abdomen Weight loss with no known explanation Constant, tiredness, or fatigue Unexplained, iron deficiency anemia
69
What are surgical management options for colorectal cancer?
Local excision : removing cancer without cutting through the abdominal wall (using a tube through rectum into colon) Anastomosis: part of the colon containing the cancer and nearby healthy tissue is removed, then the cut ends are joined Colostomy : part of colon is removed along with healthy nearby tissue (a stoma is created and colostomy bad is attached) Radiation Chemo
70
How can a patient reduce the risk for colorectal cancer?
Exercise Eat healthy Don’t smoke Drink in moderation Lose weight Take occasional aspirin Avoid red meat Get enough calcium and vitamin D Genetic counseling
71
What are risk factors for kidney renal and pelvis cancer
Genetics (men) Tobacco Exposure Obesity Estrogen therapy Polycystic kidney disease Regular use of NSAIDs Faulty genes Family history Dialysis Hep c
72
S/s of kidney renal and pelvis cancer
Hematuria Pain Mass in flank Dull back pain Unexplained weight loss Increased weakness Anemia Colicky pain
73
What are management options for kidney renal and pelvis cancer?
Surgery: radical NephrEctomy Radiation Hormonal therapy Chemotherapy Immuno therapy Nephron, sparing surgery
74
What is bladder cancer ?
Rapid, uncontrolled growth of abnormal cells in the bladder Starts in the lighting and spreads into the muscular wall From there it can spread to the lymph nodes, other organs in the pelvis, or other organs like the liver and lungs
75
What are risk factors for bladder cancer?
Smoking Environmental carcinogens Recurrent/chronic infection Bladder stones High urinary pH High chol Pelvic radiation therapy Prostate colon rectal cancer
76
What is the most common cause of bladder cancer?
Smoking
77
What are signs and symptoms of bladder cancer?
Hematuria UTI Urinary frequency Urinary urgency Dysuria Changes with voiding Abnormal back and pelvis pain with meta-stasis
78
management options for bladder cancer
Surgery: transurethral resection or cystectomy Chemotherapy Radiation Gene therapy
79
What are complications for bladder cancer?
Regional metastasis Generalized metastasis
80
What are nursing interventions for bladder cancer?
Manage urinary elimination Controlling pain Relieving anxiety Patient teaching
81
What are risk factors for ovarian cancer?
Genetics Reproductive history -Birth control pills, fertility drugs, nullparity Age (older)
82
What are manifestations of ovarian cancer?
Pain and pelvis and lower abdomen Back pain Indigestion/heartburn More frequent or urgent urination Pain during sex Changes in bowel habits Nausea Weight loss SOB Tiredness Loss of appetite
83
What are management options for ovarian cancer?
Salpingo-oophorectomy Hysterectomy Lymph node dissection Cytoreductive surgery Chemo Hormone Radiation
84
What are preop nursing interventions for ovarian cancer?
Explain side effects of radiation and chemo Explain physical preparation and procedures Administer analgesics Advise to avoid heavy, lifting, exercise, or intercourse Encourage small, frequent bland meals
85
What are post operative nursing interventions for ovarian cancer?
Observe for signs of shock Check wounds Check wound drainage (amount and type) Understand hemorrhage can occur within the first 24 hours Give analgesics as prescribed Encourage frequent position changes Activity decreases pain Monitor stool Restrict oral fluid and food until peristalsis resumes
86
What is uterine and endometrial cancer
That could be several different types of cancer that occur in the uterus Endometrial : glands of the endometrium Cervical : transformation zone of the service and lower portion of the service
87
Causes/risk factors for uterine/endometrial cancer
Causes unknown Estrogen Endometrial hyperplasia Obesity High fat diet Diabetes Age Family history Personal history History of pelvic radiation therapy Race: Caucasian
88
What are manifestations of uterine/endometrial cancer?
Asymptomatic Abnormal vaginal bleeding Any vaginal bleeding after menopause Prolonged periods/leading between periods Abnormal discharge Dysuria Pelvic pain Anorexia Weight loss Changes in bowel or bladder habits Dyspareunia 
89
What is management of uterine/endometrial cancer?
Hysterectomy Radiation Chemo Hormone therapy
90
Pre-op nursing interventions interventions for uterine/endometrial cancer
Same as ovarian cancer
91
Post op, nursing interventions for uterine/endometrial cancer
Same as ovarian cancer
92
How to reduce the risk for uterine/endometrial cancer
No unopposed estrogen Progesterone recommended with estrogen Birth control pills reduce the risk Maintain healthy weight Exercise
93
What is cervical cancer?
Abnormal cell growth of the uterine cervix Occurs in the transition zone Caused by exposure to HPV
94
Risk factors for cervical cancer
Infection by HPV Early sexual activity Smoking Birth control pills Irregular screening Nutritional deficiency (folate, carotene, but C) Obesity Poor immune system (hiv) Nullipara Age 21-35
95
What are signs and symptoms of cervical cancer?
Abnormal vaginal bleeding Increased vaginal discharge Pelvic pain Pain during sex Foul smelling discharge
96
How can you diagnose cervical cancer?
Pap Colposcopy w/ biopsy Cervical biopsy Endocervical curettage Imaging studies CT scan MRI X-ray
97
How is cervical cancer managed?
Surgery: radical tracheotomy, total hysterectomy, radical hysterectomy (removal of cervix, and some tissue, along with a uterus and part of the vagina), salpingo-oophorectomy, lymph nodes Radiation Chemo Crysurgery
98
What are complications to cervical cancer?
Low blood count Uterine pain due to pyelitis and pyelonephritis Vesicovaginal fistula Menorrhagia Post-menopausal PV bleed Infection and sepsis Hemorrhage severe pain shock
99
Nursing management for preop for cervical cancer
-Assess patient condition -Give careful attention to postop bleeding -provide close monitoring for the first 2 to 3 days -Ambulate early -Close monitoring for hemorrhage and hypothermia -Instructed patient to follow up visit
100
Nursing management post operative for cervical cancer
-Assess patient condition -Give careful attention to postop bleeding -provide close monitoring for the first 2 to 3 days -Ambulate early -Close monitoring for hemorrhage and hypothermia -Instructed patient to follow up visit
101
What is the first step and transcultural nursing?
Becoming self-aware
102
What is your innate immunity ?
Provides broad defense against infection You have this from birth, and it is present before any exposure to pathogen Example: skin, mucous membranes, stomach acid, lysozymes
103
What is nonspecific resistance examples regarding innate immunity?
Fever Inflammation Phagocytosis cells
104
What is adaptive (acquired) immune response?
Body’s reaction to pathogen. Used B&T lymphocytes Lag time for first exposure Protects against pathogens and cancer cells
105
How does specific resistance (acquired immunity) work?
1) antigen is detected 2) T cells activate 3) T cells secrete interleukin 2 4) interleukin 2 stimulates cytotoxic T cells and B cells 5) cytotoxic T cells attack & B cells make antibodies (memory) so they can fight it off again
106
What are the 3 major types of T cells?
Cytotoxic - secrete cytotoxin which poke holes in the pathogens plasma membrane Helper - recruit more cells to help fight the pathogen Memory - remain dormant after the initial exposure to an antigen. If the antigen comes back, the memory cells convert into T cells to help fight
107
What are antibodies!?
Also called immunoglobulins The body has millions of an cells and each are able to respond to a specific antigen
108
What are the three types of immunizations?
Live, attenuated vaccines (viruses: contain a weak versions (MMR & Varicella) Inactivated vaccines (virus) : “killed” version of the pathogen (polio) Toxoid (bacteria) : uses the toxins produced by bacteria to stimulate the immune response (DTap)
109
What are allergies?
An immune reaction to a foreign substance The immune system overreacts and produces antibodies called immunoglobulin E *these travel to cells that release chemicals to create a reaction
110
What is anaphylaxis?
Histamines cause blood vessels to expand : which drops blood pressure. Blood vessels become leaky, and the fluid can go into the lungs and cause swelling (pulmonary edema)
111
What are the three major types of skin cancer?
1) basal cell carcinoma 2) squamous cell carcinoma 3) malignant melanoma
112
What are risk factors for skin cancer?
Too much sun Tanning beds Genetics Skin tone Exposure to toxic chemicals History of sunburns
113
What does basal cell carcinoma look like?
“Pearly” glossy, shiny, waxy, appearance. Raised edges with depressed center Very slow growing and rarely metastasizes
114
What does squamous cell carcinoma look like?
“Crusty” hard- covering, scaly, pink, or reddish and raised lesion
115
What is actinic keratosis
It is precancerous and can turn into SCC
116
How do you assess skin cancer?
A - asymmetry B - boarders C - color D - diameter >5mm E - evolving (in shape, size, or color)
117
What is malignant melanoma?
The most deadly form of skin cancer Can form anywhere on the body (even in the eyes)
118
What is MOHS surgery?
Used for skin cancer that has a high risk of returning Removes all of cancer while preserving as much healthy tissue as possible Removed a thin layer at a time until nothing else is detected
119
What is HIV and how does it work?
Virus that kills the T-cells of the body. It enters CD4+ T cells and replicates them
120
How does HIV manifest ?
Fever (more than 38.5) Diarrhea (exceeding a month) Wasting syndrome Opens Pt up to opportunistic infections, respiratory failure, impaired breathing, cachexia and wasting
121
Nursing interventions for HIV
Promote skin integrity Promote usual bowl patterns Prevent infection Improve activity intolerance Maintain thought processes Improve airway clearance Relieve pain and discomfort Improve nutritional status
122
What is rheumatoid arthritis?
Auto immune disease that attacks the synovial joints, causing information, degeneration and pain
123
What are the causes of rheumatoid arthritis?
Genetics Infectious agents Female hormones Environmental factors Occupational exposure
124
What her clinical manifestations of rheumatoid arthritis
Joint pain Swelling Warm Erythema Lack of function Deformities Nodules
125
How to manage rheumatoid arthritis
Rest and exercise Occupational therapy Nutrition Community agencies Medication’s (NSAIDS, Cox 2, methotrexate, analgesic, immunosuppressant, anti-depressant)
126
What is lupus?
An autoimmune condition that causes inflammation to organs, joints and tissues Has flareup in remission. SLE is the most common type Affects women more than men
127
What are the risk factors for lupus?
Genetics Sun exposure Infection Hormones
128
Manifestations of lupus
Butterfly rash Photosensitivity Fatigue ulcers Pain
129
How to manage lupus
Steroids NSAIDS Hydroxychloroquine Immunosuppressant Biologics
130
What is gout?
Excess uric acid that forms crystals that settle in the joints Usually big toe
131
What foods can increase uric acid?
Foods high in poutine Organ meats (liver, kidneys, sweet bread) Other red meat Alcohol (beer) Seafood (anchovies, sardines, scallops)
132
What are clinical manifestations of gout?
Joint pain and inflammation (typically in the big toe sometimes knees) Can increase kidney stones * approximately 10 to 15% of kidney stones are Uric acid
133
Causes that increase the risk of a gout to flare up
Purine rich foods High fructose corn syrup Alcohol Aspirin Cyclosporine Loop diuretic (causes dehydration)
134
Patient education for gout
Avoid purine rich foods Maintain adequate hydration Take medication as prescribed Lose weight Warm compresses
135
What is fibromyalgia?
A chronic disorder that causes pain and tenderness throughout the body with no known cause
136
Risk factors for fibromyalgia
Age (typically after 40 but can affect any age) Gender (more common in women) Stress/trauma Repetitive injuries Illness Family history Obesity
137
Medication options for fibromyalgia
Anti-depressant Muscle relaxer Gabapentin Lyrica Physical therapy
138
What is psoriasis?
An autoimmune disorder where there is hypo proliferation of the skin, and inflammation, which leads to scaly patches on the skin
139
What are risk factors for psoriasis?
Genetics Stress Smoking and alcohol Infection Obesity Cold, dry air
140
What are the different types of psoriasis?
Erythrodermic : red rash, like lesions * Rarei Guttate : pinkish / red spot (activated by upper respiratory infections) Inverse : located in the armpits, groin and skin folds (friction makes it worse) Plaque (most common) : patches are thick, red with white scales Pustular : puss filled, blisters and Red skin (activate of a chemical’s medication’s and infection)
141
management of psoriasis
MOISTURIZE meds (methotrexate, biological therapy) UV phototherapy Education -manage stress -moisturize skin -quit smoking and drinking -get sun, but avoid sunburn
142
What is atopic dermatitis (eczema)
-chronic inflammatory skin disease, more frequently in children, can affect adults Dry, scaly, itchy skin (typically in folds of skin)
143
Management of eczema
MOISTURIZE corticosteroid creams Biologics Avoid triggers
144
Nursing interventions for radiation therapy
Maintain skin integrity (burns) Can cause bone marrow suppression (drop in blood cells = anemia & infection)
145
Nursing interventions for brachytherapy
Make sure pt is in a private room No pregnant women or children People must stay 6 feet away Nurses must wear lead apron and dosimeter badge
146
Understand chemotherapy
Can cause thrombocytopenia (decreased platelets which can lead to excess bleeding) Stomatitis (soreness and mouth ulcers) Does not wipe out all cancer, 90-95% Fluid and electrolyte deficit due to vomiting and loss of fluids
147
What does a mammogram do?
Used to help diagnose breast cancer, but cannot be used by itself. Determines mass, then a biopsy is taken.