Final Flashcards
What is cultural competence?
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
What is cross-cultural or transcultural nursing?
Any encounter a nurse has with a patient from a different culture
What is institutional, cultural competence?
When a company has the capacity to:
Value diversity
Conduct self-assessment
Manage dynamics
Acquire knowledge
Adapt to diversity
What is cultural humility?
Acknowledging that everyone’s views are culturally influenced
And that our own personal beliefs are not better than others
What is cultural safety?
Culturally appropriate health services to disadvantaged groups
While maintaining dignity and avoiding institutional racism, assimilationist and repressive practices
What is ethnocentrism?
And assumptions that everyone shares your cultural views, and/or you believe your culture is superior to others
What is subculture?
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
What is a health disparity?
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
What does Leininger’s theory include regarding transcultural nursing?
-culture care accommodation
-culture care restructuring
-Acculturation
-Cultural blindness
-Cultural imposition
-Cultural taboos
What are legislative issues regarding end of life?
DNR orders
Advanced directives
Assisted suicide legislation
Living will
Proxy directive
Durable power of attorney
What are the different awareness context regarding death and dying?
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
Where are the different settings that palliative care can take place?
Hospital
Skilled nursing facility
Outpatient
What is hospice care?
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
What is managed her in hospice care?
Pain management
Patient support
Family support
Home care of dying
Bereavement
Research and education
Spiritual
Services
Supplies (bed, wheelchair, Walker, air tank, etc)
Where can hospice services be provided?
Home
Hospital
Nursing home
Hospice home setting
Assisted living
What are the four levels of hospice care?
1) routine home care
2) inpatient respite care (caregiver break)
3) continuous care
4) general and patient care
What is an advance directive?
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
What are proxy directives?
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.
What is the death vigil?
(Signs death is coming)
Withdrawal
Sleeping longer
Somnolent
Increased intervals between respirations
Decrease blood pressure
Mottling of the skin
What is grief?
Personal feelings that accompany an anticipated or actual loss
What is mourning?
Individual, family, group, and culture expression of grief and associated behaviors
What is bereavement?
Period of time during which morning of a loss takes place
What are nursing interventions when death is imminent
-Decisions about level of care
-Comfort measures only
-Advance directives
-Artificial nutrition and hydration
-CPR?
-euthanasia and physician assisted suicide?
Will a dying patient go through all of the grieving steps in order?
No, they may go through one or all, may go out of order, and may return to one in a later time
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
What is the focus of palliative care?
Controlling symptoms
Coordinating care
Reducing unnecessary tests and futile interventions
Ongoing conversations with patient and family
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
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
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
What is a biopsy?
Obtaining a tissue sample of a cell that is expected to be malignant
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)
What surgeries can be completed as a prophylaxis for cancer
Colectomy
Mastectomy
Oophorectomy
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
What is a lethal tumor dose?
Well eradicate 95% of the tumor, but preserve normal tissue
What is fractionated radiation regarding cancer?
Doses of radiation, delivered overtime until total doses delivered
What is teletherapy radiation regarding cancer?
External beam of radiation
This is most commonly used
It’s targeted
What is Brachytherapy radiation regarding cancer
Implanted seeds, beads, or Catheters
Delivers a high dose of radiation
What are some radiation complications
Toxicity
Alopecia
Stomatitis
Thrombocytopenia
What do nurses need to assess during radiation therapy?
Skin
Oropharyngeal mucosa
Nutritional status
General well-being
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
What is chemotherapy?
Used to attempt to destroy tumor cells by interfering with the cells functioning (their ability to replicate)
What are alkylating agents (regarding chemo)
Alters DNA structure by miss reading the DNA code
What are Nitrosoureana agents (regarding chemo) ?
Similar to alkylating, but they cross the blood brain barrier
What are topoisomerace I inhibitor agents (regarding chemo) ?
Induce breaks in the DNA strand by binding to enzyme and prevent the cells from dividing
What are antimerabolite agents (regarding chemo) ?
Interfere with a bio synthesis of metabolites or nucleic acids necessary for RNA and DNA synthesis
What are antitumor antibiotics (regarding chemo) ?
Interfere with DNA synthesis by binding DNA and prevent RNA synthesis
What are mitosis spindle poisons (regarding chemo) ?
Arrest metaphase by inhibiting mitotic tubular formation, and inhibiting, DNA and proteins synthesis
What are hormonal agents (regarding chemo) ?
Binding two hormone receptor sites that alter cellular growth
What do nurses need to do during chemotherapy?
-assess fluid and electrolyte balance
-Modify risk for infection and bleeding
-Administer chemotherapy
-Protect caregivers
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
What are nursing interventions pre-bone marrow transplants?
Pre-transplantation:
-nutritional assessment
-Extensive physical exam
-Organ function test
-psychological evaluation
-patient support system 
What are nursing interventions during bone marrow transplants?
-Vital signs
-Pain
-Comfort
What are nursing interventions post- bone marrow transplants?
Ongoing assessment for several weeks
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
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
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
How do you diagnose breast cancer?
Mammogram
Biopsy
Estrogen/progesterone receptor assay
Lab test
Bone scan/CT/PET scan
What are surgical interventions for breast cancer?
Lumpectomy
Mastectomy
Mammoplasty
Bone marrow transplant
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
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
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
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
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
What is medical management options for prostate cancer?
Surgery: prostatectomy
Radiation
Androgen deprivation therapy
Chemotherapy
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
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
What are risk factors for colorectal cancer’s?
Age
Diet
Polyps
Personal history
Family history
Genetic factors
IBD
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
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
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
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
S/s of kidney renal and pelvis cancer
Hematuria
Pain
Mass in flank
Dull back pain
Unexplained weight loss
Increased weakness
Anemia
Colicky pain
What are management options for kidney renal and pelvis cancer?
Surgery: radical NephrEctomy
Radiation
Hormonal therapy
Chemotherapy
Immuno therapy
Nephron, sparing surgery
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
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
What is the most common cause of bladder cancer?
Smoking
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
management options for bladder cancer
Surgery: transurethral resection or cystectomy
Chemotherapy
Radiation
Gene therapy
What are complications for bladder cancer?
Regional metastasis
Generalized metastasis
What are nursing interventions for bladder cancer?
Manage urinary elimination
Controlling pain
Relieving anxiety
Patient teaching
What are risk factors for ovarian cancer?
Genetics
Reproductive history
-Birth control pills, fertility drugs, nullparity
Age (older)
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
What are management options for ovarian cancer?
Salpingo-oophorectomy
Hysterectomy
Lymph node dissection
Cytoreductive surgery
Chemo
Hormone
Radiation
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
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
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
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
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 
What is management of uterine/endometrial cancer?
Hysterectomy
Radiation
Chemo
Hormone therapy
Pre-op nursing interventions interventions for uterine/endometrial cancer
Same as ovarian cancer
Post op, nursing interventions for uterine/endometrial cancer
Same as ovarian cancer
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
What is cervical cancer?
Abnormal cell growth of the uterine cervix
Occurs in the transition zone
Caused by exposure to HPV
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
What are signs and symptoms of cervical cancer?
Abnormal vaginal bleeding
Increased vaginal discharge
Pelvic pain
Pain during sex
Foul smelling discharge
How can you diagnose cervical cancer?
Pap
Colposcopy w/ biopsy
Cervical biopsy
Endocervical curettage
Imaging studies
CT scan
MRI
X-ray
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
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
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
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
What is the first step and transcultural nursing?
Becoming self-aware
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
What is nonspecific resistance examples regarding innate immunity?
Fever
Inflammation
Phagocytosis cells
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
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
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
What are antibodies!?
Also called immunoglobulins
The body has millions of an cells and each are able to respond to a specific antigen
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)
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
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)
What are the three major types of skin cancer?
1) basal cell carcinoma
2) squamous cell carcinoma
3) malignant melanoma
What are risk factors for skin cancer?
Too much sun
Tanning beds
Genetics
Skin tone
Exposure to toxic chemicals
History of sunburns
What does basal cell carcinoma look like?
“Pearly” glossy, shiny, waxy, appearance.
Raised edges with depressed center
Very slow growing and rarely metastasizes
What does squamous cell carcinoma look like?
“Crusty” hard- covering, scaly, pink, or reddish and raised lesion
What is actinic keratosis
It is precancerous and can turn into SCC
How do you assess skin cancer?
A - asymmetry
B - boarders
C - color
D - diameter >5mm
E - evolving (in shape, size, or color)
What is malignant melanoma?
The most deadly form of skin cancer
Can form anywhere on the body (even in the eyes)
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
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
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
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
What is rheumatoid arthritis?
Auto immune disease that attacks the synovial joints, causing information, degeneration and pain
What are the causes of rheumatoid arthritis?
Genetics
Infectious agents
Female hormones
Environmental factors
Occupational exposure
What her clinical manifestations of rheumatoid arthritis
Joint pain
Swelling
Warm
Erythema
Lack of function
Deformities
Nodules
How to manage rheumatoid arthritis
Rest and exercise
Occupational therapy
Nutrition
Community agencies
Medication’s (NSAIDS, Cox 2, methotrexate, analgesic, immunosuppressant, anti-depressant)
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
What are the risk factors for lupus?
Genetics
Sun exposure
Infection
Hormones
Manifestations of lupus
Butterfly rash
Photosensitivity
Fatigue
ulcers
Pain
How to manage lupus
Steroids
NSAIDS
Hydroxychloroquine
Immunosuppressant
Biologics
What is gout?
Excess uric acid that forms crystals that settle in the joints
Usually big toe
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)
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
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)
Patient education for gout
Avoid purine rich foods
Maintain adequate hydration
Take medication as prescribed
Lose weight
Warm compresses
What is fibromyalgia?
A chronic disorder that causes pain and tenderness throughout the body with no known cause
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
Medication options for fibromyalgia
Anti-depressant
Muscle relaxer
Gabapentin
Lyrica
Physical therapy
What is psoriasis?
An autoimmune disorder where there is hypo proliferation of the skin, and inflammation, which leads to scaly patches on the skin
What are risk factors for psoriasis?
Genetics
Stress
Smoking and alcohol
Infection
Obesity
Cold, dry air
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)
management of psoriasis
MOISTURIZE
meds (methotrexate, biological therapy)
UV phototherapy
Education
-manage stress
-moisturize skin
-quit smoking and drinking
-get sun, but avoid sunburn
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)
Management of eczema
MOISTURIZE
corticosteroid creams
Biologics
Avoid triggers
Nursing interventions for radiation therapy
Maintain skin integrity (burns)
Can cause bone marrow suppression (drop in blood cells = anemia & infection)
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
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
What does a mammogram do?
Used to help diagnose breast cancer, but cannot be used by itself. Determines mass, then a biopsy is taken.
