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concepts 3 > final > Flashcards

final Flashcards

1
Q

components of peripheral vascular assessment

A

Colour, temperature, capillary refill, edema, pulses

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2
Q

components of a peripheral neurological assessment

A

Pain, sensation, motor function

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3
Q

Purpose of neurovascular assessment

A

Early detection of impaired blood flow or damaged nerves

Essential in preventing permanent deficits, loss of a limb & even death

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4
Q

What are the 6 p’s of compartment syndrome?

A

Pain
Pallour
Paralysis
Pulselessness
Paresthesia
Pressure

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5
Q

What is osteoporosis

A

A chronic, metabolic bone disease wherein there low bone mass, and structural deterioration of bone tissue occur

Predisposes patients to increased risk of fracture at hip, wrist and spine

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6
Q

What may cause osteoporosis?

A

Hereditary
Nutrition
Exercise
Hormones

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7
Q

How does Osteoporosis manifest?

A

Back pain

Loss of height

Spinal deformation

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8
Q

Pathophysiology osteoporosis

A

Bone resorption exceeds bone deposition

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9
Q

Which gender is at greater risk for developing osteoporosis & why?

A

Women
- (1) women tend to have lower calcium intake;
- (2) women have less bone mass because of their generally smaller frame;
- (3) bone resorption begins at an earlier age in women and is accelerated at menopause;
- (4) pregnancy and breastfeeding deplete a woman’s skeletal reserve unless calcium intake is adequate; and
- (5) longevity increases the likelihood of osteoporosis, and women live longer than men

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10
Q

Diagnostics osteoporosis

A

History & physical exam, serum calcium, phosphorous, and alkaline phosphate levels, bone mineral density, dual-energy X-ray absorptiometry (DEXA), quantitative ultrasound, radiology only detect when 25-40% lost, FRAX = 10yr risk hip fracture & 10yr risk for major osteoporosis fracture

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11
Q

Medical Management osteoporosis

A

Estrogen replacement therapy, bisphosphonates, selective estrogen receptor modulator, teriparatide, salmon calcitonin

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12
Q

Nursing Managementosteoporosis

A

Proper nutrition (high diet with calcium), calcium supplementation, vitamin D supplements, exercise, prevention of fractures, medications, education about smoking

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13
Q

What is a fracture?

A

A fracture is a disruption of normal bone continuity occurring following an elevated level of stress being placed on bone tissue beyond that which it may otherwise manage

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14
Q

What are some examples of bone fractures?

A

Closed fracture

Open fracture

Transverse fracture

Spiral fracture

Greenstick fracture

Comminuted fracture

Oblique fracture

Pathologic fracture

Stress fracture

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15
Q

What is an open fracture?

A

broken bone that penetrates the skin

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16
Q

Complete or incomplete fracture

A

Complete = break completely through bone

Incomplete = fracture occurs partly across bone shaft but bone still in 1 piece

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17
Q

Displaced or non-displaced fracture

A

displaced: ends of the bone have come out of alignment

non-displaced: bone typically stays aligned in an acceptable position for healing

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18
Q

What are the clinical manifestations of bone fractures?

A

Deformity

Edema, swelling

Muscle spasm

Pain, tenderness

Ecchymosis

Loss of normal function

Inability to bear weight on or use affected part, guards & protects extremity against movement

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19
Q

What is fracture reduction?

A

restoration of the fracture fragments to anatomic alignment and positioning

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20
Q

What is a closed reduction?

A

-manual realignment of the bones
-no surgery
-cast/splint

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21
Q

What is an open reduction

A

Fracture realigned with surgery with various internal devices

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22
Q

Medical management: Immobilization

A

External (cast, splints) or internal fixations

Casting or splinting, external fixation, internal fixation, prophylactic antibiotic therapy, surgical debridement & irrigation, tetanus & diphtheria immunization

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23
Q

Nursing Management fractures

A

Neurovascular status, elevate limb, ice therapy, increase vitamin D, education

Neurovascular assessment
Drug therapy
Nutritional therapy
Preoperative and postoperative
Cast care
Ambulation and assistive devices

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24
Q

What is a cast?

A

temporary immobilization device

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25
Q

What is external fixation?

A

Devices consist of pins that are placed through the skin into the fractured bone and connected to external frame

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26
Q

What is internal fixation?

A

Devices, pins and screws surgically inserted at time of realignment

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27
Q

Delayed union:

A

healing progresses more slowly than expected but eventually occurs

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28
Q

Nonunion:

A

fails to heal properly despite treatment

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29
Q

Malunion:

A

heals in expected time but in unsatisfactory position, possibly resulting in deformity or dysfunction

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30
Q

Angulation:

A

heals in abnormal position in relation to midline of structure (type of malunion)

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31
Q

Pseudoarthosis:

A

type of nonunion occurring at fracture site in which a false joint is formed with abnormal movement

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32
Q

Refracture

A

new fracture occurs at original site

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33
Q

Myositis ossificans:

A

deposition of calcium in muscle tissue at site of significant blunt muscle trauma or repeated muscle injury

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34
Q

Care of patients in a cast

A

Neurovascular assessment (bit of a running theme)
Pain assessment
Cast care teaching
Assessment for complications (compartment syndrome, infection)

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35
Q

What is an intracapsular fracture in the hip?

A

A fracture within the joint capsule

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36
Q

What is an extracapsular fracture in the hip?

A

A fracture not within the joint capsule

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37
Q

Clinical manifestations of hip fractures

A
  • External rotation
  • Muscle spasm
  • Shortening of affected leg
  • Severe pain and tenderness
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38
Q

Medical management of hip fractures

A
  • medical (traction or casting); not ideal
  • surgical (open reduction (move bones back into place & internal fixation (screws, pins), pre-op); common
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39
Q

Preoperative management of fractures

A

Preoperative check list
Consent
Pain management (muscle relaxation, analgesia)
Patient education
(Exercise for unaffected leg and both arms, weight bearing status)

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40
Q

Postoperative management of fractures

A

Vital signs

Pain management

Neurovascular assessment (it’s a pattern)

Position / mobility

Maybe put in fall protections (hip protectors)

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41
Q

What is Osteoarthritis?

A

A chronic, progressive process where new tissue is formed in response to cartilage destruction

Noninflammatory disorder of the synovial joints

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42
Q

Osteoarthritis clinical manifestations

A

Worsening joint pain
Limitation of movement
Crepitus (bone rattling)
Stiffness
Deformity

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43
Q

causes osteoarthritis

A

Known event or condition that directly damages cartilage or causes joint instability

Decrease estrogen, obesity, inflammation

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44
Q

patho osteoarthritis

A

Cartilage damage that triggers a metabolic response at the level of the chondrocytes, causing the articular cartilage to become dull, yellow, and granular causing it to become less functional

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45
Q

diagnostics for osteoarthritis

A

History & physical exam, radiological studies of involved joints (CT scans, MRI, bone scan), synovial fluid analysis

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46
Q

Medical Management osteoarthritis

A

Acetaminophen, nonsteroidal anti-inflammatory drugs, antibiotics, intra-articular hyaluronic acid, opioids, reconstructive joint surgery, rest, joint protection

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47
Q

Nursing Management osteoarthritis

A

Nutrition & weight management, rest & use of assistive devices, therapeutic exercise, heat & cold application, herb therapy (glucosamine), yoga

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48
Q

Arthroplasty

A

reconstruction or replacement of a joint

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49
Q

What is Bipolar I disorder?

A

Characterized by one or more manic episodes generally with a major depressive occurrence.

Manic behaviour must last at least 1 week.

The mood disturbance is severe enough to cause marked impairment

Not otherwise explained by different drugs / conditions

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50
Q

What is Bipolar II disorder?

A

At least 1 episode of hypomania

One or more depressive episodes

Never had a manic episode

Usually begins with a depressive episode

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51
Q

What is hypomania?

A

Symptoms are the same as mania but last only 4 days

No impairment in social or occupational functioning

Hypomanic episode is a distinctive change in functioning not otherwise seen when asymptomatic

If psychosis is present, it’s mania

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52
Q

Bipolar impact on health

A

Medications used to treat disorder have some important side effects

Bipolar behaviour may include dangerous activities such as reckless driving, unsafe sex

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53
Q

bipolar impact on economic decisions & well being

A

High risk behaviour during mania may cause reckless spending, gambling

Friends and family may feel guilt, grief or worry

Family roles change during periods of illness

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54
Q

schizoaffective

A

Meets diagnostic criteria for schizophrenia (need 2 of these) = Delusions, Hallucinations, Disorganized speech, Grossly disorganized or catatonic behaviour, Negative symptoms

mood component = bipolar type (mania & depression), depressive type

Delusions or hallucinations for 2 or more weeks in the absence of a major mood disturbance

Long interrupted time of illness

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55
Q

What is mania?

A

a mood disorder marked by a hyperactive, wildly optimistic state with 3 of:

  • Inflated self-esteem - grandiosity
  • Decreased need for sleep
  • Talkativeness
  • Flight of ideas
  • Distractibility
  • purposeless non goal-directed activity
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56
Q

MSE focus with mania:

A

Appearance / Behaviour
Mood affect
Speech
Thought form / content
Perceptual Disturbances

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57
Q

What types of medications are used for mania?

A

Mood stabilizers
Antipsychotics
Benzodiazepines

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58
Q

Lithium toxicity: Early

A

Polyuria
Ataxia
Blurred vision
Diarrhea
extreme thirst

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59
Q

Lithium toxicity: Severe

A

Confusion/disorientation, memory impairment, seizures, nystagmus

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60
Q

Priorities of care for bipolar med adherence

A

May initially require IMs

Monitor for side effects

Concerns:

Sedation, CNS depression, substance use, EPS, lithium toxicity, anticholinergic effects, blood work, weight gain (important), dependence, tolerance, benzo & other drugs, cardiovascular effects (prolonged QT waves), agranulocytosis, endocrine effects (hyperprolactinemia = producing breast milk) thyroid problems, dermatological effects = acne, steven johnson syndrome = rash, changes in urination, diabetics, osteoporosis

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61
Q

priorities of care safety bipolar

A

(not just about suicide, homicide; need to safe from others, financial, sexual, vulnerability, social media, risky behaviour)

Redirection / distraction

Limit setting

Timeouts

Quiet/low stimulus environment

Private room

Seclusion room (last resort)

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62
Q

complicaitons after fracture infection

A

Assess = Early detection, warmth, redness, pus, swelling, increase in pain

Treat = Nutrition, rest, antibiotics, wound care, pain management

Prevent = Sterile techniques, prophylactic antibiotics, standard precautions

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63
Q

complicaitons after fracture compartment syndrome

A

Prevent = Early detection, assessing, neurovascular checks

Assess = Neurovascular, 7 Ps

Treat = Fasiostomy, open cast, loosing dressing, bivalving

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64
Q

complicaitons after fracture fat embolism syndrome (FES)

A

manifest as acute respiratory distress

Prevent = Careful mobilization

Assess = ARDS (acute respiratory distress syndrome)

Treat = Supportive treatment for presenting symptoms

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65
Q

complications of fractures venous thromboembolism

A

Prevent = Compression stockings/devices, enoxaparin/heparin, mobilize, range of motion exercises

Assess = Redness, swelling, pain, parasthesias, DDIMER, WBC

Treat = Aimed at preventing further blood clots

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66
Q

Cast care teaching

A

Don’t = Get wet, Remove padding or insert objects, Bear weight x 48hrs, Cover cast with plastic for prolonged periods

Do = Report signs of possible problem, Apply ice over fracture site to reduce edema, Relieve itchiness: blowdryer on cool setting, elevate it, tapping, Move joints above & below regularly, Elevate higher than heart for 24-48hr

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67
Q

What is Electroconvulsive therapy (ECT)

A

a treatment that involves inducing a brief seizure by delivering an electrical shock to the brain

A safe and effective treatment for a variety of psych conditions

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68
Q

ECT indications for use

A

Acute suicidality
Psychotic features
History of poor response to medications
History of good response to ECT
Risk of standard antidepressants treatment outweighing risk of ECT
Mania
Schizophrenia

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69
Q

ECT contraindications

A

Unstable/severe cardiovascular conditions

Aneurysm or vascular malformation

Increased intracranial pressure

Recent cerebral infarction

Pulmonary conditions (COPD, asthma, pneumonia)

Pace maker

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70
Q

Psychotropic medications during ECT

A

Usually you continue them. Special attention must be paid to mood stabilizers and Benzos due to the anti-seizure effects of these medications

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71
Q

Frequency of treatment ECT

A

2-3 ECT treatments/week (Mon, Wed, Fri)
6-12 treatments

above is used early in treatment course when a rapid response is important (i.e. mania, catatonia, high suicide risk)

continuation phase: 1st 6 months

especially vulnerable time for re-emergence of symptoms

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72
Q

day before ECT

A

Assess pt’s physical and mental status

Begin ECT/pre-op checklist

Encourage & assist patient with personal hygiene if needed

Encourage expression of concerns & anxiety related to ECT

Maintain NPO from midnight

Weight them for anaesthia dosing

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73
Q

Patient Preparation

A

Be NPO,

Remove jewelry, hair accessories, contact lens, glasses, hearing aids, glasses, dentures

Pre-ECT medications (if ordered) and most routine medications 1 hour prior with sips of water

Void

Pre ECT Vital Signs

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74
Q

Pre ECT

A

Assess the education required

Implement education

Document education provided

Ensure chart forms are on pt’s chart including (Consent form/form 5, Checklists, Record of anesthesia, Record of ECT)

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75
Q

ECT morning

A

Complete ECT pre checklist

Confirm NPO has been maintained

Encourage pt to void immediately before transport

Assess anxiety

Provide reassurance & support

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76
Q

Post ECT

A

Assess pt’s physical & mental status (DOCUMENT)

VS within 5 mins of their return to unit

Assess frequency of observation required based on assessments and LOC

Assess safety of environment and pt’s ability to ambulate & swallow to take held morning medications & breakfast

Assess & document above & any side effects

Side effects include = Nausea, headache, muscle pain (acetaminophen), Acute confusion (resolves on own & orientate)

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77
Q

What is anaesthesia?

A

A state wherein there was a loss of sensation by depressing the CNS or PNS

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78
Q

Anaesthetic agents

A

Can decrease the level of consciousness, stimulate muscle relaxation and or cause a loss of response to stimuli

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79
Q

Types of Anaesthesia

A

Local and general anaesthesia

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80
Q

Local anaesthesia

A

occurs when sensation is lost to a limited part of the body without loss of consciousness

Loss of pain to specific area, no effect on respiratory function

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81
Q

General Anaesthesia

A

Causes loss of sensation to the entire body, usually resulting in loss of consciousness

Paralysis of respiratory function a worry

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82
Q

Local anaesthesia (LA) route types

A

Peripheral:
Skin (topical)
Nerve block
Infiltration (direct injection such as dental freeze)

Central:
Spinal or intraspinal anaesthesia- injected into the area near the spinal cord within the vertebral column; intrathecal and epidural

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83
Q

LA - Mechanism of action

A

Interfere with nerve transmission in specific areas of the body by blocking both the generation & conduction of nerve impulses by blocking the movement of sodium, potassium, calcium ions

Known as membrane stabilizing as decreases nerve cell permeability

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84
Q

LA s/e

A

Adverse effects are uncommon, and allergy is rare (may occur preservatives)

Resulting symptoms may be restlessness, anxiety, hypotension or dysrhythmias

Signs of CNS toxicity are excitement leading to irritability & confusion

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85
Q

examples of LA

A

Lidocaine most commonly used

Side effects =

Inadvertent IV injection occurs

Excessive dose or rate of injection is given

Slow metabolic breakdown

Inject into highly vascular tissue

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86
Q

general anesthesia (GA)

A

The goal of a GA is to provide a rapid and complete loss of sensation.

Signs of a GA include:
*Total analgesia
*Loss of consciousness
*Loss of memory
*Loss of body movement (muscle relaxation and reflex reduction)
Procedural Sedation

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87
Q

Is general anaesthesia achieved by a single drug?

A

Not frequently, no.

Multiple are usually used to rapidly induce unconsciousness, relax muscles and maintain anaesthesia

Balanced anaesthesia is safer as less anaesthetic is used

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88
Q

Does ECT require a balanced approach?

A

YES

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89
Q

How is GA usually administered

A

IV or by inhalation

IV meds such as Propofol are given as they act within a few seconds

Inhalation meds such as halothane and Nitrous oxide are used to sustain anaestheisa

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90
Q

General Anaesthetic mechanism of action

A

Exact mechanisms unknown

Varies according to agent used

Lipid solubility of anaesthetic agents determines its potency

Nerve cell membranes & blood brain barrier have a high lipid content, allowing for anaesthetic agents to concentrate in cell membranes

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91
Q

What is thiopental sodium?

A

barb = It induces anaesthesia in like 30 seconds and lasts 10-30 minutes

Can be used alone for procedures less than 15mins, ECT meets this specification often involving anaesthesia for about 10 mins

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92
Q

What are the most commonly used GA agents?

A

Propofol is the most common though Etomidate and Methohexital are also used

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93
Q

What other agents may be used in adjunct to major GA agents? (Not common)

A

Benzos (Though they are NOT used for ECT due to anti-seizure effects)

Opioids (fentanyl)

Ketamine (The choice of little green gremlins everywhere. Also more often used as an animal tranquilizer)

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94
Q

What is succinylcholine?

A

depolarizing neuromusclar junction blocker

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95
Q

What does succinylcholine do?

A

Depolazing: occupiers acetylcholine receptors creating muscle paralysis

Often used to reduce the amount of anaesthetic used

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96
Q

What are some succinylcholine indications?

A

During ECT to prevent damage to musculo-skeletal system

The jaw is the only muscle not totally relaxed, thus indicating the need for bite-blockers

Mechanical ventilation will ALSO need to be used.

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97
Q

Side effects of SUCCylcholine

A

Respiratory depression
*Hypotension
*Tachycardia
*Urinary retention
*Dysrhythmias
*Delirium - hallucinations, confusion, excitability.
Malignant hyperthermia (rare)

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98
Q

What is malignant hyperthermia?

A

*Occurs during or after succinylcholine
*Sudden elevation in body temperature (40°C)
*Muscle rigidity or unexplained aches
*Dark brown urine
*Bleeding
*This is a life threatening emergency

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99
Q

Additional medications used with ECT

A

Atropine
Ranitidine
Metoclopramide
Tylenol

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100
Q

What is Atropine?

A

*An anticholinergic
*Indicated during ECT for clients who have excessive secretions.
*Inhibits the action of acetylcholine at postganglionic sites located in the secretory glands
*Low doses decrease sweating, salivation and respiratory secretion.

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101
Q

Why do we use Atropine?

A

It’s an antidote for NMBA (Neuromuscular blocking agent) that we use in SMALL amountsto prevent bradycardia, hypotension, and secretions

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102
Q

What is Ranitidine?

A

*An antihistamine -histamine H2 antagonist

*Indicated during ECT for clients at risk for heartburn, acid reflux (gastric hypersecretory states).

*Inhibits the action of histamine at the H2 receptor site in the gastric parietal cells, leading to decreased gastric secretions.

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103
Q

What is metoclopramide?

A

*An antiemetic

*Indicated during ECT for clients who are at risk for or experience postoperative nausea and vomiting.

*Stimulates motility of the upper GI tract and accelerates gastric emptying, by blocking dopamine receptors.

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104
Q

metoclopramide side effects

A

Drowsiness, extrapyramidal reactions, restlessness, neuroleptic malignant syndrome

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105
Q

nursing process anathesia

A

Assess past history of surgeries & response to anaesthesia

Assess allergies to medications

Pre-op (Medical history, full physical exam, lab tests, substance use)

Post-op (Type of anaesthesia used, monitor LOC, airway, respiratory depression, cardiovascular depression)

Implement safety measures during recovery

Reorient client to surroundings

Provide preoperative teaching as necessary

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106
Q

Osteoarthritis

A

Cartilage begins to get destroyed between the joints

Chronic progressive process where new tissue is formed in response to cartilage destruction

Non inflammatory disorder of synovial joints (as progresses may be inflammation due to the bone on bone not the actual pathophysiology)

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107
Q

Diagnostics osteoarthritis

A

Bone scan, Xray, MRI, CT

Goal: confirm disease and stage progression of joint damage and slow it down

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108
Q

clinical manifestations osteoarthritis

A

Worsening joint pain

Limitation of movement

Crepitus

Stiffness

Deformity

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109
Q

medical management osteoarthritis

A

Rest and joint protection

Heat and cold therapy

Nutritional therapy & exercise

Complementary & alternative therapies

Drug therapy (pain management = nonopioids (acetaminophen)

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110
Q

osteoarthritis risk

A

Genetic links

Menopause

Increased weight

Strenuous exercise

Occupational

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111
Q

surgical management osteoarthritis

A

management

Hip = total hip arthroplasty

Knee = total knee arthroplasty

Goal = restore joint motion by replacing arthritic bone

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112
Q

What is anxiety?

A

A normal response to stress

Consists of three parts:
Psychological arousal (fight, flight response)
Cognitive Process
Coping strategies

Anxiety becomes abnormal when it impacts life negatively / causes interference in life

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113
Q

Causes of anxiety disorders

A

Genetics

Increases by 5 if someone on your family has

Temperament

Persons nature (low stress tolerance)

Neurotransmitters

Low serotonin levels = anxiety???

Norepinephrine = physical symptoms of anxiety (GI upset, tachycardia)

GABA

Life experiences

Trauma, financal, relationship, physical health concerns

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114
Q

Anxiety levels

A

mild, moderate, severe, panic

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115
Q

What is generalized anxiety disorder?

A

Characterized by persistent and excessive anxiety and worry about occupational/social/interpersonal situations

Affects daily functioning

Has physical symptoms

GAD can be debilitating disorder with a serious negative impact on quality of life

Often associated with other disorders

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116
Q

DSM5 criteria anxiety disorders

A

Excessive anxiety and worry, occurring more days than not for at least 6 months.

Difficult to control the worry.
The anxiety, worry or physical symptoms cause clinically significant distress or impairment in functioning
Anxiety is associated with 3 or more of the following symptoms:

*Restlessness or feeling keyed up or on edge
*Being easily fatigued
*Difficulty concentrating or mind going blank
*Irritability
*Muscle tension
Sleep disturbance

117
Q

severe anxiety

A

Significant decrease in perceptual field

Focuses on specific detail

Impaired cognition

Much direction is needed to focus elsewhere

May be paralyzing causing inaction

May feel like everything is falling apart/impending doom

Increased somatic symptoms (headache, pounding heart)

Dilated pupils, urinary frequency, rigid muscles, decreased hearing

Learning and problem solving not possible

All or nothing thinking

“If I don’t do well on this test I’m going to fail out of nursing”

Emotional reasoning???

118
Q

panic

A

Everything is blown totally out of proportion

Sense of dread or terror

Loss of control

Unable to do things even with direction

Disorganization

Psychomotor activity increases

Perceptions are distorted

Rational thoughts decrease

Delusional thinking

Physical symptoms

Sense of dread, shaky, feel faint, choking, rapid heart beat, wobbly legs

119
Q

GAD

A

Characterized by persistent and excessive anxiety and worry about occupational/social/interpersonal situations

Affects daily functioning

Has physical symptoms

Can be debilitating disorder with a serious negative impact on quality of life

Often associated with other disorders

Depression or substances

120
Q

Social anxiety

A

Involves intense fear of social situations in which the individual feels scrutinized and negatively evaluated by others

Appear to be highly sensitive to disapproval or criticism, tend to evaluate themselves negatively, and have poor self-esteem and a distorted view of their personal strengths and weaknesses

Onset early in adolescence

121
Q

Generalized social phobia

A

Occurs when an individual experiences fears related to most social situations

Public performances and social interactions

122
Q

Specific social phobia

A

Occurs when an individual fear and avoid only one or 2 social situations

Eating, writing, or speaking in public or using public washrooms

123
Q

Panic disorder

A

Sudden short periods of intense fear or discomfort that are accompanied by significant physical nad cognitive symptoms

Mimic symptoms of a heart attack

Restricted perceptual field, feeling disconnected

124
Q

DSM 5 panic disorder

A

Palpitations, pounding heart, increase HR

Sweating

Trembling or shaking

Sensations or SOB

Feelings of choking

Chest pain or discomfort

Nausea or abdominal distress

Feeling dizzy, unsteady, light-headed, faint

Chills or heat sensations

Numbness or tingling

Derealization or depersonalization

Fear of losing control or going crazy

Fear of dying

125
Q

nursing interventions for panic disorder

A

Stay with patient

Allow pacing & walk with pt

Do not touch pt

Give clear, concise directions, using short sentences

Listen

Provide reassurance

Suicide assessment

PRN meds

Afterwards help with pt to identify what the trigger was so they can develop management strategies to help prevent it from reoccurring

126
Q

OCD

A

Characterized by presence of obsessions and compulsions

Obsessions are recurrent, persistent unwanted thoughts that increase anxiety

Compulsions are repetitive acts that the person does in hopes to relieve anxiety

Most common reason that people with OCD seek help is for relationship problems, GAD, drug & ETOH use, depression

127
Q

DSM 5 OCD

A

Recurrent and persistent thoughts or urges, that are intrustive and unwanted, and that cause anxiety & stress

Individual attempts to ignore or suppress such thoughts or urges with some other thought or action (compulsion)

Obsessions or compulsions are time-consuming or cause clinically significant distress or impairment in social or occupational functioning

128
Q

Hoarding disorder

A

Excessive acquisition of, and inability to discard, material possessions

Accumulated possessions become a barrier to ADLs

Impairment in social, occupational, and family functioning

129
Q

Agoraphobia

A

Fear of open spaces

Panic attacks can lead to the development of phobias

Exposure to a situation produces anxiety

Intensity of anxiety related to

Proximity of the object

Degree to which escape is possible

130
Q

Somatic system disorders

A

Presence of physical symptoms without a medical explanation

Characterized by emotional distress

Disruption of daily living caused by preoccupation of 1 or more physical symptoms

Form of social or emotional communication – the bodily symptoms express emotion that cannot be verbalized

1 or more significant somatic concerns that may involve may body parts

GI (nausea, vomiting, diarrhea)

Neurological (headache)

Musculoskeletal (aching)

Physical symptoms may be intermittent or always present

Symptoms present for at least 6 months or longer

Perceive themselves as “sicker than sick”

Often can’t work or take part in ADLs

No medical explanation for symptoms

Seek out medical opinions from many different doctors but usually avoid mental health

More prevalent in females than males

Often there is a history of sexual abuse

Often concurrent depression/anxiety/substance abuse

131
Q

somatization

A

Unexplained physical symptoms that occur in the presence of psychological distress

132
Q

nrusing interventions somatic system disorder

A

Develop trusting relationships

Shift focus from somatic concerns to feelings

Build self-esteem

See only 1 health care provider at regularly scheduled times

Limited focus on physical symptoms

Conservative treatment of physical complaints

CBT most effective treatment

Antidepressants

Self awareness of nurse

133
Q

Conversion disorder

A

Pseudo-neurological symptoms

Paralysis, blindness, movement disorder, numbness, loss of hearing, episodes resembling

134
Q

Illness anxiety disorder

A

Preoccuption with fear about developing an illness

135
Q

Factious disorder

A

Intentionally cause an illness or injury to receive attention from health care providers, relieves emotional stress

Munschsan by proxy

136
Q

Malingering

A

Same as factious disorder but for different reasons

Forensic field

not criminally responsible d/t insanity

137
Q

nursing interventions anxiety

A

Management of physical symptoms

GI problems

Headache – triggers/stress

Body aches/stiffness - exercise

Sleep – sleep hygiene

Relaxation techniques

Relationships

138
Q

Treatment options anxiety

A

Identifying triggers

Diet

Exercise

Breathing control

Distraction

Positive self talk

Progessive muscle relazation

Meditation

Mindfulness

139
Q

psychotherapies for anxiety

A
  1. CBT

Based on individual’s interpretation of experiences, not event itself

Encourages realistic and flexible thinking

Highly effective for treating GAD, panic, SAD

Focuses on events & situations in the “here and now”

Encourages self-awareness

  1. Exposure therapy/systematic desensitization

Repeated exposure to anxiety-provoking situations

Treatment for phobias

140
Q

medications anxiety

A

Antidepressants

SSRI/NSRI

Benzo

Quick onset of anxiolytic effect

Careful of potential for dependence, rebound anxiety, sleep disturbances

Other

Propranolol relieves physical symptoms on anxiety but doesn’t change mood

141
Q

TX options PTSD

A

CBT

Exposure therapy

Cognitive restructuring

Eye movement desensitization and reprocessing

142
Q

PTSD

A

Exposure to traumas such as a serious accident, a natural disaster, or criminal assault can result in PTSD

143
Q

symptoms PTSD

A

Re-experiencing the event: intrusive thoughts and recollections (flashbacks) or recurrent dreams/nightmares

Avoidance behaviour: avoiding activities, situations and people associated with the trauma, feelings of guilt

General numbness and loss of interest in surroundings

Hypersensitivity: inability to sleep, anxious feelings, overactive startle response, hypervigilance, irritability, angry outbursts

144
Q

Immunity

A

Bodies ability to defend against foreign substances

145
Q

3 primary functions of immunity

A

Defense, homeostasis, surveillance

146
Q

types of immunity

A

innate

accquired

active accquired

passive accquired

147
Q

innate

A

Exists without prior contact with an antigen

Involves nonspecific response

148
Q

Acquired

A

Development of immunity either actively or passively

149
Q

Active acquired

A

Invasion of body by foregin substances leads to the development of antibodies and sensitized lympthocytes

150
Q

active natural

A

Contact with antigen through clinical infections (disease, recovery chicken pox)

151
Q

active artifical

A

Immunization with antigen (immunization with live or killed vaccine)

152
Q

Passive acquired

A

Host receives, rather than synthesizes, antibodies to an antigen

153
Q

passive natural

A

Transplacental and colostrum mediated transfer from mother to infant (maternal immunoglobulins in neonate)

154
Q

passive artifical

A

Injection of serum from immune human (injection of human y-globulin)

155
Q

Immunity Defense Mechanisms

A

*Acquired Immunity
*Humoral Immunity
*Cell-Mediated Immunity

156
Q

What is humoral immunity?

A

antibody-mediated immunity

Mediated by B cells

Protects against bacteria, extracellular viruses, respiratory and GI pathogens

Five classes of antibodies including IgG, IgA, IgM, IgD, IgE

157
Q

When does the primary immune response occur in humoral immunity?

A

*Primary immune response is evident by 4-8 days after initial exposure to antigen

158
Q

Is the secondary immune response stronger and faster in humoral immunity?

A

Yes, it’s faster, longer, harder and various other innuendos.

159
Q

What is cell-mediated immunity?

A

*Immune response that is initiated through specific antigen recognition by T cells

160
Q

What cells are involved in cell-mediated immunity?

A

Involves T cells, macrophages, and NK cells

161
Q

What does cell-mediated immunity protect against

A

Protects against fungus, intracellular, viruses, chronic infectious agents and tumor cells

162
Q

Effects of aging on immunity

A

Effectiveness in immunity is reduced with age

Older adults have more malignancies and are therefore more susceptible to infection

Bacterial pneumonia is the leading cause of death for older adults

163
Q

What is a hypersensitivity reaction

A

An overreactive immune response against foreign antigens

Or

Failure to maintain self-tolerance that can result in tissue damage

164
Q

What is an immediate reaction

A

An immediate (antigen-antibody) reaction is one that occurs within the first few minutes of exposure to that allergen

165
Q

What are the three types of immediate reaction?

A

Type I: Anaphylactic Reactions
Type II: Cytotoxic & Cytolytic reactions
Type III: Immune complex reactions

166
Q

What is a delayed reaction?

A

Wherein there is a prolonged response to the initial allergen
T-cells - Delayed inflammatory response occurring with 2-8 hours after mast cells are activated

167
Q

What is the one type of delayed reaction?

A

Type IV: Delayed hypersensitivity reaction

168
Q

Medical management of hypersensitivity reactions

A

Identify allergen
Avoid allergen
Stress management
Control environment
Administer medications
Immunotherapy

169
Q

What is a Hypersensitivity I reaction?

A

IgE antibodies produced in response to allergens

Anaphylaxis, asthma, allergic rhinitis

170
Q

What is a Hypersensitivity II reaction?

A

IgG or IgM bind to antigen Hemolytic transfusion reactions

171
Q

What is a Hypersensitivity III reaction?

A

Local/systemic Immediate/delayed SLE, rheumatoid arthritis

172
Q

What is a hypersensitivity IV reaction?

A

Sensitized T-cells attack antigens Contact dermatitis, transplant rejection Delayed reaction (cell-mediated)

173
Q

Nursing interventions for immune difficulties?

A

Anapyhlaxis management
Chronic allergy management
*Medications
*Environmental control

174
Q

\What steps do you take to manage anaphylaxis?

A

Recognize clinical manifestations

Maintain ABC

Administer medication

175
Q

What medications are used for immune responses?

A

Antihistamines
Beta 2 agonists
Corticosteroids
Anticholinergics

176
Q

What is a vaccination

A

a biological preparation that provides active acquired immunity to a particular disease

177
Q

What is a vaccine made from?

A

a weakened or dead form of a pathogen

178
Q

What is an immunization schedule?

A

Designed to yield the best lvls of immunity Ideally, primary immunization begins at 2 mo of age

Dosages must not be alternated

Doses shall not be repeated/the sched restarted regardless of prolonged time since prev dose

Doses given at less than the recommended interval may result in less than optimal antibody response & should not be counted as part of a primary series

179
Q

How do How Vaccines Work against viruses?

A

1 - A vaccine introduces safe forms/fragments of pathogens, called immunogens, to mimic the actual pathogen & trigger the body to generate immune responses

2 - Immune cells (B-cells & T-cells) circulating in the blood/mucous membranes are activated by these immunogens

3 - B-cells recognize immunogens soon after they have entered the body & produce antibodies which bind to & possible neutralize foreign particles in the body & mark them for destruction

4 - “helper” “CD4” T-cells, once activated by a pathogen, divide rapidly & secrete cytokines that reg or “help” the immune response coordinates the activities of a set of “killer” cells called CD8+ T-cells. CD8+ T-cells

5 - A small group of “memory” B-cells & T-cells remain in the body & can very quickly start a strong immune response. When the body is exposed to a virus w the same immunogens as the vaccine, it can mount an effective response in days, thus preventing infection & illness.

180
Q

What is personality?

A

Persistent patterns of thinking, feeling or behaving across time

181
Q

What is temperament?

A

*A recognizable and distinctive pattern of behaviour evident during the first few months of life.

182
Q

What is the difference between disorder and trait?

A

Disorder - Impaired function, interpersonal conflict and emotional dysregulation for prolonged periods of time

Trait - Feelings, behaviours with intermittent dysregulation, conflict and function but not for prolonged periods of time

183
Q

Causes of personality disturbances

A

Early life experiences (Biological)
Learned behaviours (psychological)
Social environment (abuse, trauma)
Biological makeup / genetics
Impaired regulation of the brain circuits

184
Q

Common features and diagnostic criteria personaliy

A

Cognitive schemas = Pattern of thought that determines how a person interprets events & Friendly gesture can be interpreted as suspicious (example)

Emotions

Impaired self-identity and interpersonal function = Behaviour and ideas of relationships and how the world works is impaired

Impulse control = Negative consequences when engaging in impulsive behaviours

185
Q

What are the Cluster A personality types

A

paranoid, schizoid, schizotypal

186
Q

What is paranoid personality disorder?

A

A pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent, beginning by early adulthood and present in a variety of contexts

187
Q

Treatment modalities for paranoid personality

A

*Goal is to create trust / empathy
*Do not talk them ‘out’ of the persecutions
*Often “agree to disagree” approach.
*SSRI helpful diminish obsessional thoughts.
*CBT to develop trust, increase coping skills (how they handle anxiety)

188
Q

What is schizoid personality disorder?

A

A. A pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings, beginning by early adulthood and present in a variety of context

  1. neither desires or enjoys close relationships, including being part of a family
  2. almost always chooses solitary activities
  3. has little, if any, interest in having a sexual experience with another person
  4. takes pleasure in few activities
  5. lacks close friends or confidants other than first-degree relatives
  6. appears indifferent to the praise or criticism of others
  7. shows emotional coldness, detachment, or flattened affect
189
Q

Treatment modalities: Schizoid

A

*Medications may target “negative” sx.
*Overlap of depression. Anti-depressants
*CBT but ‘difficult’ due to entrenched thoughts (part of the personality)

190
Q

Cluster B

A

Antisocial PD

Borderline PD

Histrionic PD

Narcissistic PD

Dysregulation of emotion and behaviour

191
Q

Cluster C

A

Avoidant PD

Dependent PD

Obsessive-compulsive PD

Sense of fearfulness

192
Q

Paranoid personality disorder diagnostic criteria DSM

A

Pervasive distrust & suspiciousness of others such that their motives are interpreted as malevolent, beginning by early adulthood & present in a variety of contexts, as indicated by 4 or more:

  1. suspects, without sufficient basis, that others are exploiting, harming, or deceiving
  2. preoccupied with unjustified doubts about the loyalty or trustworthiness friends or associates
  3. Reluctant to confide in others because of unwarranted fear that the info will be used maliciously against them
  4. reads hidden demeaning or threatening meanings into benign remarks or events
  5. persistently bears grudges
  6. perceives attacks on their character or reputation that are not apparent to others and is quick to react angrily or to counterattack
  7. has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner

Does not occur exclusively during the course of schizophrenia, bipolar disorder or depressive disorder with psychotic features, or another psychotic disorder and is not attributable to the physiological effect of other medical conditions

193
Q

Treatment modalities – paranoid personality

A

Goal is to create trust / empathy

CBT to develop trust, increase coping skills (how they handle anxiety)

SSRI helpful diminish obsessional thoughts, although no medications have been found to be specifically effective in treating PPD

194
Q

Schizoid personality disorder diagnostic criteria

A

pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings, beginning by early adulthood and present in a variety of contexts, as indicated by 4 or more

  1. neither desires or enjoys close relationships, including being part of a family
  2. almost always chooses solitary activities
  3. has little, if any, interest in having a sexual experience with another person
  4. takes pleasure in few activities
  5. lacks close friends or confidants other than first-degree relatives
  6. appears indifferent to the praise or criticism of others
  7. shows emotional coldness, detachment, or flattened affect

b. does not occur during course of schizophrenia, bipolar disorder, depressive disorder with psychotic features or medical condition

195
Q

Treatment modalities – schizoid PD

A

Because persons with SPD typically shy away from interactions in general establishing a therapeutic relationship can be challenging

Treatment goals are to enhance the experience of pleasure, prevent social isolation, and increase emotional responsiveness to others

196
Q

Schizotypal personality disorder – diagnostic criteria

A

Pervasive pattern of social and interpersonal deficits marked by acute discomfort with and reduced capacity for, close relationships as well as by cognitive or perceptual distortions and eccentricities of behaviour, beginning by early adulthood and present in a variety of contexts as indicated by 5 or more

  1. ideas of reference (excluding delusions of reference)
  2. odd beliefs or magical thinking that influences behaviour and is inconsistent with subculture norms
  3. unusual perceptual experiences, including bodily illusions
  4. odd thinking and speech
  5. suspiciousness or paranoid ideation
  6. inappropriate or constricted affect
  7. behaviour or appearance that is odd, eccentric, or peculiar
  8. lack of close friends or confidants other than 1st degree relatives
  9. excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgements about self

b. does not occur exclusively during the course of schizophrenia, bipolar disorder or depressive disorder with psychotic features, or another psychotic disorder, autism spectrum

197
Q

Treatment modalities – schizotypal PD

A

Medications mainstay treatment for psychosis

SSRI reduce depression and intensity

CBT to deal with cognitive distortions of emotional reasoning, and personalization (believing they are responsible for something or reading minds)

198
Q

Antisocial personality disorder

A

Disregard for others needs or feelings

Persistent lying, stealing, using aliases, conning others

Recurring problems with law

Repeated violation of rights of others

Aggressive, often violent behaviour

Disregard for the safety of self or others

Impulsive behaviour

Consistently irresponsible

Lack of remorse for behaviour

Individual is at least 18 years old

Evidence of conduct disorder with onset before age 15

Occurrence of antisocial behaviour is not exclusively during the course of schizophrenia and bipolar disorder

199
Q

Psychoeducation checklist: antisocial personality disorder

A

Positive health care practices, including substance abuse control

Effective communication and interaction skills

Impulse control

Anger management

Group experience to help develop self-awareness and impact of behaviour on others

Analysing an issue from the other person’s viewpoint

Maintenance of employment

Interpersonal relationships and social interactions

200
Q

Borderline personality disorder – diagnostic criteria

A

pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity, beginning by early adulthood and present in a variety of contexts, as indicated by 5 or more

  1. frantic efforts to avoid real or imagined abandonment
  2. pattern of unstable and intense interpersonal relationships characterized by alternating b/w extremes of idealization and devaluation
  3. identity disturbances: markedly and persistently unstable self-image or sense of self
  4. impulsivity in at least 2 areas that are potentially self-damaging (spending, sex, substance abuse, reckless driving, binge eating)
  5. recurrent suicidal behaviour, gestures, or threats, or self-mutilating behaviour
  6. affective instability due to a marked reactivity of mood (intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)
  7. Chronic feelings of emptiness
  8. inappropriate, intense anger or difficulty controlling anger
  9. transient, stress-related paranoid ideation or severe dissociative symptoms
201
Q

BPD care planning

A

Emotional regulation and stability

Helping pt with personality disorder develop skills to manage intense emotions and achieve emotional stability

Interpersonal relationships and social functioning

Addressing difficulties in establishing and maintaining healthy relationships and improving social interactions

Self-identity and self-esteem

Assisting individuals with personality disorders in developing a positive sense of self and improving self-esteem

Impulse control and self-destructive behaviours

Supporting pt in managing impulsive behaviours, self-harm tendencies, and reducing the risk of self-destructive actions

Cognitive distortions and maladaptive thinking patterns

Working with pt to identify and challenge negative thoughts, distorted beliefs, and maladaptive thinking patterns that contribute to their difficulties in functioning and adapting to different situations

202
Q

Histrionic personality disorder

A

Feel underappreciated or depressed when they’re not the centre of attention.

Be dramatic and extremely emotionally expressive, even to the point of embarrassing friends and family in public.

Have a “larger than life” presence.

Be persistently charming and flirtatious.

Be overly concerned with their physical appearance.

Use their physical appearance to draw attention to themselves by wearing bright-coloured clothing or revealing clothing.

Act inappropriately sexual with most of the people they meet, even when they’re not sexually attracted to them.

Think that their relationships with others are closer than they usually are.

Have difficulty maintaining relationships, often seeming fake or shallow in their interactions with others.

Need instant gratification and become bored or frustrated very easily.

Constantly seek reassurance or approval.

203
Q

Narcissistic personality disorder

A

Overinflated sense of self-importance

Constant thoughts about being more successful, powerful, smart, loved or attractive than others

Feelings of superiority and desire to only associate with high-status people

Need for excessive admiration

Sense of entitlement

Willingness to take advantage of others to achieve goals

Lack of understanding and consideration for other people’s feelings and needs

Arrogant or snobby behaviours and attitudes

204
Q

What is the difference between narcissistic and antisocial

A

Narcissistic Personality Disorder is characterized by grandiosity, the constant need for admiration and a lack of empathy for others. They regularly brag about themselves and their achievements

NO SOCIAL GRACES (no insight)

Underneath all these characteristics is an individual who is quite fragile

Antisocial Personality Disorder

on the other hand, are very self-destructive, seem to have no awareness of consequences and repeat the same destructive patterns of behavior. They lack any remorse for the harm they have caused others

They are not fragile, and quite dangerous (often not detectable)

OFTEN HAVE (GOOD) SOCIAL GRACES

‘grooming’ make you feel good about yourself – for gain

205
Q

Treatment personality disorders

A

Difficult to “treat” a personality (a way of thinking and believing)

Insight

Medications cannot “cure” personality but can help treat other conditions that often accompany such as depression, impulsivity, and anxiety

Do they want help?

Counselling and skills to manage emotions / behaviours

CBT & DBT

206
Q

Avoidant personality disorder

A

Avoidance of activities at work that involve interpersonal contact due to fear of criticism or rejection

Unwillingness to interact with others unless certain they will receive a positive response

Hesitancy in intimate relationships due to fear of shame

Preoccupation with criticism in social situations

Feeling inadequate and being inhibited in new social situations

Perception of self as inept, unappealing, and inferior

Reluctance to take risks or engage in activities that might result in embarrassment

207
Q

What is the difference between avoidant and schizoid PD

A

Patients with Avoidant personality disorder desire companionship but are extremely shy (fear rejection)

Whereas patients with Schizoid personality disorder have no desire for companionship

208
Q

Dependent personality disorder

A

Essential feature is a pervasive and excessive need to be taken care of

Leads to submissive and clinging behaviour and fears or separation

Regression is often seen in people with DPD, this is defined as going back to a younger age of maturity

209
Q

Obsessive compulsive personality disorder

A

pts must have a persistent pattern of preoccupation with order, perfectionism, and control of self, others, and situations

This pattern is shown by the presence of 4 or more

  • Preoccupation with details, rules, schedules, organization, and lists

A striving to do something perfectly that interferes with completion of the task

Excessive devotion to work and productivity (not due to financial necessity), resulting in neglect of leisure activities and friends

Excessive conscientiousness, fastidiousness, and inflexibility regarding ethical and moral issues and values

Unwillingness to throw out worn-out or worthless objects, even those with no sentimental value

Reluctance to delegate or work with other people unless those people agree to do things exactly as the patients want

A miserly approach to spending for themselves and others because they see money as something to be saved for future disasters

Rigidity and stubbornness

210
Q

Treatment modalities of cluster C

A

SSRI reduce depression and anxiety

CBT to deal with cognitive distortions of emotional reasoning, and personalization

Groups also can be effective

Ineffective coping, and impaired social interaction

Develop skills (dependency into autonomy)

Sleep

Work on self-esteem, and improve relations

211
Q

What is cancer?

A

■All diseases involving the cell in which normal mechanisms for control of growth and proliferation have been altered.

■It spreads directly to surrounding tissues and to new sites in the body.
Process of Cancer
■Defects in cellular proliferation

■Defects in cellular differentiation

212
Q

What is a neoplasm?

A

a new and abnormal growth of tissue in some part of the body, especially as a characteristic of cancer.

213
Q

Classification of Neoplasms

A

■Anatomical Site Classification

■Histological Analysis Classification
-Grading

■Extent of Disease Classification
-Staging
-TNM Classification System

214
Q

Neoplasm 4 grades

A

■Grade I - cells differ slightly from normal cells, well differentiated
■Grade II - cells more abnormal, moderately differentiated
■Grade III - cells very abnormal, poorly differentiated
■Grade IV - cells immature & primitive, cell of origin difficult to determine

215
Q

Neoplasm staging

A

■Stage O - cancer in situ
■Stage I - tumor limited to tissue of origin, localized growth
■Stage II - limited to local spread
■Stage III - extensive local & regional spread
Stage IV - metastasis

216
Q

Diagnostic Evaluation for cancer

A

■Blood tests

■X-rays & scopes

■CT, MRI, and/or PET scans

■Ultrasound

■Biopsy

217
Q

Treatment Modalities for cancer

A

-Surgery
-Radiation Therapy
-Chemotherapy
-Biotherapy

218
Q

What is the TNM classification system?

A

T= tumor; N= lymph node involvement; M= metastasis. This is a form of staging that classifies the tumor according to size, invasiveness, and spread.

219
Q

Cancer surgery

A

Diagnosis & treatment (biopsy)

Supportive care

Rehabilitation

Palliation of symptoms

Prevention

220
Q
A
221
Q

How does radiation treatment for cancer work?

A

Use of high energy ionizing radiation to treat a variety of cancer

Destroys a cell’s ability to reproduce by damaging its DNA, delaying repair of DNA, or inducing apoptosis

222
Q

What are the two types of radiation therapy

A

External radiation (teletherapy)
- Localized to that area

Internal radiation (brachytherapy)
- Implant radioactive beads into the tumour
- Prostate cancer common

223
Q

What is chemotherapy in cancer treatment?

A

A systemic intervention that directly/indirectly disrupts reproduction of cells by alt essential biochemical processes Combination chemotherapy far superior to single agent therapy

224
Q

Chemotherapy uses

A

Used for (1) widespread disease, (2) risk of undetectable disease is high, & (3) tumor cannot be resected and resistant to XRT

225
Q

What is biological therapy in cancer treatment

A

■The use of biological agents such as interferons and growth factors to modify the relationship between the host and tumor

226
Q

Nursing Management:Radiation Therapy & Chemotherapy: Fatigue

A

Increased metabolic rate

Mgmt - advise pt that fatigue is an expected adverse effect of therapy - sleep/hygiene, moderate exercise, pace activities as tol can help - encourage pt to rest/maintain routine

227
Q

Nursing Management:Radiation Therapy & Chemotherapy: Anorexia

A

Lack or loss of appetite for food
Certain immune factors that are released to fight cancer have certain immune suppressing appetizing effects
Loss of weight,
Mgmt monitor weight encourage pt to eat small meals inc in protein intake meal replacement drinks

228
Q

Nursing Management:Radiation Therapy & Chemotherapy: Bone marrows suppression

A

Dec RBC - fatigue, anemia, paleness of skin, increased HR

Dec WBC - fever & chills, diarrhea, infection

Dec platelets - easy bruising, bleeding,

avoid strenuous activities monitor lab values keep wounds clean & covered drink plenty of fluids, assess for infection

229
Q

Nursing Management:Radiation Therapy & Chemotherapy: Oral, Oropharyngeal, & Esophageal Reactions

A

Throat hurts, teeth rot, it’s bad.

Give them fluids, encourage hydration and mouth care, assist oral care as needed.

Don’t give them extreme hot or cold foods

230
Q

Nursing Management:Radiation Therapy & Chemotherapy: Pulmonary effects

A

There will be inflammation and fibrosis

We treat it with bronchodilators, repositioning, cortidosteroids.

Provide education about oxygenation

231
Q

Nursing Management:Radiation Therapy & Chemotherapy: GI effects

A

Nausea, vomiting, diarrhea, abdominal pain.

Assess pain / discomfort. Provide patient education as needed. Monitor BM’s

Give ondansetron for nausea

232
Q

Nursing Management:Radiation Therapy & Chemotherapy: Skin reactions

A

Chemo rash - small pimples & puss filled, itchiness, pain Dermatitis
Redness & Irritation
Dry, Flaking, Peeling (for radiation)
colour to skin veins & hair (discoloured/darker)
change to fingernails & toenails (yellow, cracked, darkened, brittle)
Alopecia (no hair)
Photo sensitivity

Wash in cool water

Moisturize

No scratching

Change sheets / towels regularly

233
Q

Nursing Management:Radiation Therapy & Chemotherapy: Reproductive effects

A

Infertility, miscarriages, sperm count and egg reduction.

Early menopause may occur

Utilize TR skills, assess for depression, suicide, sexual therapist

234
Q

What is a malignant tumor?

A

A mass of cancer cells that can spread.
It grows rapidly and spreads to other tissues.

235
Q

What is a benign tumor

A

A mass of cells that grows out of control but remains at the site of origin

236
Q

What is a neoplasm

A

a new and abnormal growth of tissue in some part of the body, especially as a characteristic of cancer.

237
Q

What is cell differentiation?

A

The process in which cells become specialized.

238
Q

What is cell proliferation

A

process of increasing cell numbers by mitotic division

239
Q

What is biotherapy?

A

biotherapy involves the use of immunotherapy and biologic response modifiers as a means of changing the person’s immune response to cancer

The major mechanisms by which biotherapy exerts its effects are modification of host responses (immunotherapy) and modification of tumor cell biology (biologic response modifiers)

240
Q

What is active acquired immunity

A

Immunity gained wherein there is intentional introduction of a foreign substance to cause the body to say “what the F” and become sensitized to future invasions.

241
Q

What is Passive acquired immunity

A

The host receives rather than synthesizes antibodies to an antigen

Breastfeeding

242
Q

What is teletherapy?

A

external radiation

243
Q

What is Chemotherapy

A

the use of drugs to treat a disease

244
Q

What is aggression?

A

A term used to describe hostile, unpleasant, or unacceptable behaviour

245
Q

What may cause aggression?

A

Any * neurocognitive impairment
Developmental deficits such as anoxia, malnutrition, toxins, trauma to brain (birth).
Brain injury (e.g. poor impulse control)
Cognitive Neuroassociation
Neurobiological
Deficits or damage
Neurotransmitter dysregulation
Psychosis, substance misuse (exacerbate anger response)

246
Q

Sociocultural factors for aggression

A

Learned/ Family/Culture
Culture might mean a culture of aggressive nursing
practices, or aggressive sales, or an unsafe work environment.

Social Experiences have multiple determinants.
Gender (risk factors for violence)

247
Q

Environmental factors for aggression

A

*Decreased Education
*Unemployment
*Poverty
*Family instability
*Poor Housing
*Crowding

248
Q

What is lateral violence?

A

Aggressive and destructive behavior or psychological harassment of colleagues against each other.

249
Q

What constitutes workplace violence?

A

Direct or indirect threats delivered in person or through letters, phone calls, or electronic mail.
Intimidating or frightening gestures.
Throwing or striking objects.
Stalking
Wielding a weapon, or carrying a concealed weapon for the purpose of threatening or injuring a person.
Assault

250
Q

ASSESSMENT:Tetrad of Lethality (Shea, 2017)

A

1)Patients presenting with a recent violent episode.
2)Patients presenting with a dangerous psychotic process.
3)Indication from the interview that the patient intends to engage in violence.
4)The patient is lying and collaborative evidence suggests intended violence.

251
Q

What is the prostate

A

*The prostate is part of the male reproductive system that adds nutrients and fluid to sperm

*It is located in front of the rectum, just below the bladder, and surrounds the urethra

252
Q

What is benign prostatic hyperplasia?

A

*A nonmalignant overgrowth of cells in the prostate gland that results in constriction of the urethra

*Occurs in aging males that have normal testicular function

*Prostate hyperplasia and hypertrophy à prostate enlargement à obstruction of urethra & bladder outlet

253
Q

Clinical Manifestations: BPH

A

Obstructive Symptoms
*Decrease in urinary stream, difficulty initiating voiding, intermittency, dribbling at end of urination

Irritative Symptoms
*Urinary frequency, urgency, dysuria, bladder pain, nocturia, incontinence, retention

254
Q

Diagnostic Tests for BPH

A

*Digital rectal exam (DRE)

*Urinalysis & urine culture

*Kidney function tests (Cr, gfr, BUN)

*Prostate specific antigen (PSA) levels

*Transrectal ultrasonography (TRUS)

*Postvoid residual & uroflowmetry

255
Q

Medical Management for BPH

A

*Active Surveillance
*Limiting fluid intake

*Avoiding medications/food that will cause urinary retention

*Timed voiding schedule

*Drug Therapy
*Alpha-Adrenergic Receptor Blockers
*5 Alpha-Reductase Inhibitors

256
Q

Surgical Management for BPH

A

*Transurethral Resection of the Prostate (TURP)
Surgical procedure where a resectoscope inserted in the urethra to scrape out enlarged portion of the prostate gland

257
Q

What is prostate cancer?

A

*Prostate cancer is a malignant tumor of the prostate gland

*Tumor becomes clinically relevant when local invasion or distant metastasis interrupts function of urinary tract or other organs

258
Q

What are some clinical manifestations of prostate cancer

A

Irritative Symptoms Frequency Urgency Nocturia

Obstructive Symptoms Hesitancy/Straining Incomplete emptying Intermittency Weak stream

259
Q

Diagnostic Tests for prostate cancer

A

*DRE & PSA
*TRUS
*Biopsy
*Bone scan
*MRI
CT

260
Q

Treatment for prostate cancer

A

Conservative Therapy “Watchful Waiting”
*PSA & DRE to monitor progress of disease

Surgical Therapy
*Radical Prostatectomy

*Cryosurgery

*Nerve-sparing Procedure

*Orchiectomy

261
Q

What is radical prostaectomy?

A

Entire removal of prostate

262
Q

What is cryotherapy?

A

Use of extreme cold to freeze & remove abnormal tissue

263
Q

What is laproscopic surgery?

A

Type of radical (prostate removed using small incisions w/ special tools) less invasive & more common

264
Q

What is Orchiectomy

A

Surgical of one or both testicles

265
Q

Clinical manifestations of tesitcular cancer

A

*Painless lump in scrotum

*Lump usually non-tender and very firm

*Scrotal swelling

*Scrotal heaviness

*Dull ache/heavy sensation in lower abdomen, perianal area, or scrotum

266
Q

What are the types of breast cancer?

A

*Noninvasive Breast Cancer
*Ductal carcinoma in situ (DCIS)
*Lobular carcinoma in situ (LCIS)

*Infiltrating Lobular Carcinoma

*Infiltrating Ductal Carcinoma
*Paget’s Disease
*Inflammatory Breast Cancer

267
Q

What is breast cancer?

A

*A lump or mammographic abnormality in the breast that often occurs in the upper outer quadrant of the breast.

268
Q

What is ductal carcinoma in situ?

A

Noninvasive form of cancer

Inside milk duct in breast - Earliest form of breast cancer Can progress if not treated Unilateral (generally)

269
Q

What is lobular carcinoma in situ (LCIS)

A

Malignant proliferation of cells in lobules with no invasion of the basement membrane

270
Q

What is Infiltrating Lobular Carcinoma?

A

Begins at the glands of the breast & breaks through the walls of the lobule then invades the breast -can spread everywhere else

271
Q

What is Infiltrating Ductal Carcinoma

A

Arise from the epithelium of large or intermediate sized ducts and infiltrate the breast parenchyma

272
Q

What is Paget’s disease of the breast?

A

Scaling rash/dermatitis of the nipple caused by invasion of skin by cells from a ductal carcinoma

273
Q

What is inflammatory breast cancer?

A

Rare + v aggressive - cells block lymph vessels in the skin of the breast

274
Q

Diagnostic screening breast cancer

A

*Breast Self Examination
*Mammogram
*Breast Ultrasound
*Breast Magnetic Resonance Imaging (MRI)
*Biopsy

275
Q

Medical treatment for breast cancer

A

*Surgery
*Breast conserving (lumpectomy)
*Modified radical mastectomy
*Axillary lymph node dissection (ALND)/Sentinel lymph node dissection (SLND)
*Radiation Therapy
*Chemotherapy
*Hormonal Therapy
*Biological & Targeted Therapy

276
Q

Nursing Management for breast cancer

A

*Turning, coughing & deep breathing exercises
*Postoperative arm & shoulder exercises
*Pain management
*Drain management
*Lymphedema management
*Psychological care

277
Q

What is cervical cancer?

A

*A malignant tumor that starts in the cells of the cervix.

*Infection with HPV is the most significant risk factor.

*A Pap Test should be performed every 1 to 3 years.

278
Q

Cervical Cancer Clinical Manifestations

A

*intermenstrual discharge
*unusually long or heavy periods
*bleeding after sex
*bleeding after menopause
*pain during sex
*increased or foul smelling discharge from vagina

279
Q

What is uterine cancer?

A

*Cancer arising from the cells of the uterus.

*Grows slowly & metastasizes late.

*Common metastatic sites are the lung, bone, liver, and brain.

280
Q

Uterine CancerClinical Manifestations

A

*Abnormal vaginal bleeding
*Unusual vaginal discharge
*Pain during intercourse
*Pelvic pain/pressure
*Pain during urination/BM, difficult urination/BM or blood in urine/BM
*Ascites or lymphedema in legs

281
Q

What is Ovarian cancer?

A

*A malignant neoplasm of the ovaries

*Can metastasize directly by shedding malignant cells and by lymphatic spread.

*No screening tests exist for ovarian cancer

282
Q

inflammatory response

A

biological response to cell injury that

  • neutralizes inflammatory agents
  • removes necrotic cells
  • promotes healing/repair of damaged cells
283
Q

4 inflammatory response stages

A
  1. vascular response
  2. cellular response
  3. exudate formation
  4. healing
284
Q

local/systemic inflammation symptoms

A

Redness.
Heat.
Swelling.
Pain.
Loss of function.

285
Q

inflammatory markers

A

CRP (<10mg/L)

ESR (M=0-10, F=0-20)

WBC

286
Q

nursing management inflammation

A
  • health promotion
  • VS
  • wound assessment
  • fever managment
  • medicaiton
  • RICE
287
Q

what does RICE stand for

A

rest, ice, compression, elevation

288
Q

HCP contribute to development of antibiotic resistance by

A
  • admin ABX for viral infection
  • prescribing unnecessary ABX
  • using inadeqaute drug regimens to treat infections
  • using broad spectrum or combo agents for infections that should be treated with 1st line medications

concepts 3 (2 decks)

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