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Final review 3 Flashcards

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1
Q

preventing refeeding - check for what? (refeed the electrolytes)

A

Identify individuals at risk (just check elctrolytes before starting)
Correct depleted electrolytes before refeeding

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2
Q

enteral complications = Gastrostomy or jejunostomy tubes

A

Gastrostomy or jejunostomy tubes
Skin irritation around tube
Skin assessment and care
Tube dislodgement
Teach patient/family about feeding administration, tube care, and complications
Fistulas -entero-cutaneous
Infections: skin, fasciitis, peritonitis
Abdominal wall or intraperitoneal bleeding and bowel perforation
Obstruction or erosion of gastric wall
Gastric mucosa hypertrophy

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3
Q

Parenteral Nutrition - indications (when it’s needed) (Parents need IVs if they’re vomiting, gi problems, malnurished, panceatitis)

A

Indications:
Chronic or intractable diarrhea and vomiting
Complicated surgery or trauma
Post GI surgery
GI obstruction
GI tract anomalies and fistulae
Sepsis
Severe malnutrition
Malabsorption
Pancreatitis

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4
Q

Parenteral Nutrition - composition (parents are composed of everything but carbs)

A

Composition
Base solutions contain dextrose and protein in the form of amino acids
Prescribed electrolytes, vitamins, and trace elements are added to customize patient need
IV fat emulsion is added to complete the nutrients

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5
Q

Central Parenteral Nutrition: what is it made of? (the central parent says no more than 25% dextrose on halloween)

A

very concentrated sugar
Base Solution 20-25% dextrose

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6
Q

Peripheral Parenteral Nutrition: what is the base solution? (Perry is less than 20% dextrose)

A

Base solution must be < 20% dextrose
Through peripherally inserted catheter

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7
Q

Parenteral Nutrition: Complications (parents get hyper and hypo lips)

A

Hyperglycemia and hypoglycemia
Fluid, electrolyte, and acid base imbalances
Hyperlipidemia when lipids used
Phlebitis
Infection and bacteremia

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8
Q

nursing management/care - vital signs, weight, glucose, how often to check? parenteral

A

Vital signs every 4 to 8 hours
Daily weights
Regular blood glucose monitoring
Check initially every 4 to 6 hours

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9
Q

Parenteral Nutrition: Nursing
 Management/Care - assess for what and how often to change dressing? (change parents every week)

A

Assess central access site
Site assessment for phlebitis
Dressing change every 7 days or as needed
Use sterile technique with dressing changes

Infusion pump must be used

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10
Q

Parenteral - Pan culture when (and what culture) (parents dip)

A

infection is suspected
Perform DTTP blood cultures when systemic infection is suspected

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11
Q

starvation - liver (liver loses pap, fluid shifts, bye Na!)

A

Liver function impaired
Protein synthesis diminished
Low albumin leads to ↓ plasma oncotic pressure
Fluid shifts from vascular space into interstitial space
Na+/K+ pump fails due to deficiency in calories and proteins

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12
Q

Malnutrition: Nursing Management of Imbalanced Nutrition < Body Requirements = not eating enough. Just eat small meals w/ weed

A

Daily calorie count
High-protein, high-calorie foods or feedings
Multiple, small feedings
Supplements
Appetite stimulants such as Megace and Marinol (weed)

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13
Q

diabetes leading cause of (blind me with kidney disease and amputation)

A

Leading cause of
Adult blindness
End-stage kidney disease
Nontraumatic lower limb amputations

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14
Q

oral hypoglycemics - hold when? and monitor what labs?

A

Hold med if patient is undergoing surgery or radiologic procedure with contrast medium
24-48 before procedure and at least 48 hours after
Monitor serum creatinine
Contraindications
Renal, liver, cardiac disease
Excessive alcohol intake

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15
Q

nutritional therapy DM - when is meal consistency important?

A

Meal plan is based on individual’s usual food intake and is balanced with insulin and exercise patterns
Day-to-day consistency important for patients using conventional, fixed insulin regimens

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16
Q

When 60% of caloric needs met orally, then***

A

you can discontinue PN or EN nutrition

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17
Q

albumin helps keep (al loves water)

A

fluid in cells. Once this protein is gone, fluid starts leaking into interstitial fluid.

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18
Q

Renal diet (Renal needs a low pump)

A

(low K and Na diet)
NPO vs strict NPO

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19
Q

what labs to assess during a nurtritonal assessment? (PLAITHs are my labs)

A

Nutritional lab studies: albumin, prealbumin, transferrin, Hg, Fe, blood glucose, lipid panel

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20
Q

For patients with nutritional deficit: oral feeding

A

High-calorie supplements
Milkshakes
Ensure, Glucerna for DM patients, Nepro for renal failure patients
Consult dietician

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21
Q

residual hold order

A

Depending on order: usual residual with hold order is >250- 400mL

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22
Q

how often to change enteral bags? (change the entry every12-24 hour life)

A

changed every 12-24h
Wear gloves when hanging feeding

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23
Q

how is parenteral different than crystalloid? (krystal doesn’t like vitamins)

A

*Different from crystalloid solutions in that crystalloids do not contain amino acids or vitamins

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24
Q

where is central parenteral infused? (central access central line)

A

May only be infused via central access due to the risk of thrombophlebitis caused by hypertonic solution of TPN

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25
when are PICCs used? (only long haul use piccs)
Peripherally inserted central catheters (PICCs) - For longer term nutrition support
26
what labs to check for parenteral feeding? (Electra is a parent?)
Check labs: Electrolytes, BUN, Creatinine, CBC, liver function enzymes
27
parenteral feeding? how often to replace solution? (parents need to be fed every 24 hrs)
MUST replace solution and tubing every 24 hours even if bag hanging is not empty
28
if parenteral feeding bag is not available?
If solution is not available, hang D10W to prevent hypoglycemia Tubing with filter is required for TPN Do not abruptly discontinue TPN (total parenteral nutrition) Decrease rate by half for one hr then stop. Check blood sugar in an hr.
29
Hallmark of refeeding syndrome (refeeding makes me lose phosphate)
Hypophosphatemia
30
enteral feeding complications - Diarrhea (diarrhea at 4 and 8) How much can you hang at once?
Do not hang more than 4° (4 hours) worth of modular formula and 8° (8 hours) vol of pre-packaged formula; change system Q 12-24°
31
enteral - Intermittent - how much is usually given to patient? (intermittently 500)
by gravity or syringe Vol usually 200 to 500 mL per feeding Remember to flush with 30mL water before after feeding so tube does not clog
32
when to use peripheral parenteral nutrition? (PPN perry is a short parent)
Short-term When lower protein and calorie content is required
33
parenteral pan culture - differential (the difference in infection from the catheter or the blood)
Differential time to positivity Differentiates infection likely source from catheter or blood
34
parenteral - Systemic Infection (s/s)
High risk associated with TPN Fever, chills Nausea/vomiting Malaise
35
parenteral pan culture - Samples must be drawn when? (peter pan in 15 min)
no more than 15 min apart and collect same amount of blood for each sample
36
parenteral pan culture - If the sample from catheter grows bacteria < 2hrs before peripheral sample, then
the likely source of infection is from catheter
37
refeeding - how to initiate? (I was refed at 25 for 3 days in the morning)
Initiate nutrition support at approximately 25% of the estimated goal and advance over 3-5 days to the goal rate Serum electrolytes and vital signs monitored carefully after initiation
38
parental nutrition causes what? (only parents have issues with gallbladder, liver, and blood clots)
Gallbladder and liver disease Thrombosis
39
indications for enteral (enter the burn victim with deficiencies in vitamins and brains, and psycho on chemo)
Burn victims Nutritional deficiencies Neurologic conditions Psychiatric conditions Chemotherapy
40
central parenteral nutrition - where is the catheter? (central downtown is in the jugular)
Tip of catheter lies in superior vena cava where vesicant and irritant solutions are safe to be administered Central catheter to internal jugular vein to superior vena cava
41
what types of insulin have the most flexibility with diet?
rapid-acting insulin, multiple daily injections, or insulin pump
42
Intraoperative Phase: (nurse intra-operating room)
ntraoperative Phase: Role of the scrub nurse and circulating nurse; anesthetics
43
pre op - allergies (LISBA)`
latex, iodine, shellfish, bannana, avacado (all from same tree family) antibiotics (and find out what the exact reaction is), tape allergies,
44
pre op - Geriatric Considerations
cognitive decline so have family there, decreased kidney functions, confusion, not following direction
45
pre op - prescreening (prescreen for a walker)
usually done in dr. office. may need walker, etc.
46
Preoperative Phase
Teaching
incentive spirometer - teach in preoperative, need to see patient do it.
47
pre op skin prep
showering the day before with chlorahexadine, advise John not get chloro on face and not put on lotion.
48
bowel prep
whatever comes out should be clear.
49
preop checklist checked...(check my tests, meds, and VS)
twice, Form that lists requirements to be ascertained before patient goes to OR Documents diagnostic tests complete Documents pre-op medication given Documents VS
50
operating room (intraoperative phase)
Role of Surgical Nurse Scrub Nurse/Techćician RN Circulator (problem-solver and advocate - make sure everything is ready, equipment) Patient Advocacy Nurse legally responsible for correct counts! (count - keep track of what is going to surgeon, ie sponges, to make sure that everything is accounted for)
51
post op meds - antidotes
Flumazenil used to reverse effects of benzodiazepines Narcan used to reverse effects of opioids
52
post op assessment (ABCs)
Adequacy of airway: Immediate priority assessment Vital Signs CV/peripheral perfusion Status: LOC
53
safety post op
side rails up and call light near
54
potential complications (I'm shocked during surgery by the thumb, emboly and pneumonia)
Shock: Inadequate tissue perfusion (First sign may be decreased urine output) Hemorrhage Thrombophlebitis Pulmonary Embolus Pneumonia
55
degree of risk assigned by...
anesthesialogist
56
who gives post op report?
anestheseologist bc they carried out all of the interventions. can be supplemented by nurse.
57
Irreversible (abnormal to ana is irreversible)
Anaplasia
58
Proto-oncogenes (onco lock)
Genetic locks that keep cells functioning normally
59
External Risk Factors - (CCRD is external to the office) and ex.
Chemicals - formaldeyhde Radiation - sunlight Chronic Irritation - acid reflux, smoking Dietary Influences - nitrates
60
Physical Activity (physical for 120 minutes)
Physical Activity - Engage in at least 150 minutes of moderate intensity or 75 min of vigorous intensity physical activity each week, or equivalent combination - Children engage in 60 min moderate- vigorous activity each day with vigorous activity at least 3x week.
61
7 warning signs of cancer (CAUTION) (bowel, throat, bleeding, lump, indigestion, mole. cough)
Change in bladder or bowel habits A sore throat that does not heal Unusual bleeding or discharge Thickening or lump Indigestion or difficulty swallowing Obvious change in wart or mole Nagging cough or hoarseness
62
diagnostic tests (diagnose my cyte, is it a genetic tumor or bone marrow?)
Cytology studies (just one cell type - needle aspiration) Tumor Markers Genetic Markers Bone Marrow Exam
63
classification of cancer - Histologic (study tissue under a microscope) classification
Appearance of cells and degree of differentiation are evaluated to determine how closely cells resemble tissue of origin.
64
histological grade (how is history looking?)
Evaluation of appearance of cells and degree of differentiation
65
staging
TNM classification for a 4cm lung cancer with 3 involved lymph nodes and metastasis would be as follows: T2N2M1(bone).
66
clinical staging (get situated in staging)
Stage O Stage I Stage II Stage III Stage IV
67
radiation internal (aka brachytherapy)
Requires less dosage*** Implant place directly in tumor or in close proximity Will emit radiation when implant in place
68
radiation safety - limit visiting time to what? And under what age?
Safety Precautions (ALARA: As low as reasonably achievable) Principles of time, distance, shielding Limit visitors to 30 min No children under 16, pregnant women
69
radiation systemic affects - what areas of the body impacted? (radiation affects my bones, mucus, and skin)
Usually localized to region being irradiated Affects rapidly proliferating cells bone marrow gastrointestinal mucosa skin
70
radiation late effects (late radiation scars me and causes other cancers)
radiation late effects (late radiation scars me and causes other cancers)
71
chemo systemic effects - affects which cells? (just rapid)
Affects cells with rapid growth rates
72
chemo nursing interventions - nutrition (hard candy, no oj, avoid what?)
Minimize effects of altered taste sensations (ex metallic taste)Ii.e. Hard candies Mechanical soft, avoid citrus with stomatitis*** Anorexia - small frequent meals, liquid supplements High calorie, high protein foods: examples? nuts, ensure, yogurt. try to avoid carbs.
73
chemo biologic therapy - May affect host-tumor response in three ways: (biology is direct, to the immune system, and may mess with CA)
Direct antitumor effects Restore, augment, or modulate host immune system mechanisms Have other biologic effects, such as interfering with CA cells’ ability to metastasize or differentiate
74
types of chemo biotherapy - interferon (interferon is biology, and it's a killer)
interferon - Alters cellular metabolism in normal & CA cells - Inhibits function of several oncogenes - Can activate NK cells
75
targeted therapy (tyrone targets cats)
Tyrosine kinase inhibitors Monoclonal antibodies Angiogenesis inhibitors Proteasome inhibitors
76
during surgery, primary staging is...(primary is TNT - and what it stands for)
TNM determine prognosis, treatment, and to report to registry for statistics T - tumor size N - lypmph nodes M - matastesties
77
dry desquamation (dry and red)
red raw skin from radiation
78
Targeted therapy
Targeted therapy Aims at a cancer’s specific genes or proteins that contribute to cancer growth and survival Biopsy can help determine whether a tumor has the specific target
79
biologic therapy - Toxic and Side Effects (think interferon and the flu - you used to know this) and what about the heart?
Systemic immune and inflammatory response Rash Flu like symptoms (rakers - sever shivering - same with hep C) Symptoms decrease over time Tachycardia, orthostatic hypotension
80
Gerontologic Considerations - what about the dose?
maybe a lower dose
81
Kubler-Ross: focuses on behavior & includes 5 stages (I DABDA in kubla)
Denial Anger Bargaining Depression Acceptance
82
reversible disorders with cell growth (MAHH, hypertrophy is reversible)
atrophy hypertrophy hyperplasia metaplasia
83
viral carcinogens (HHHE is viral - think pap)
The are anko! epstein-barr - burkitt's lymphma HIV - Kaposi sarcoma Hep B - Hepatocellular carcinoma Human pap - squamous cell carcinoma
84
promotion is reversible or not? (tony the promoter can be stopped)
reversible. if cell goes on to develop more cells.
85
cigs have both
initiating and promoting factors
86
progression - reversible or not? (you can't reverse the progression of life)
cluster of cells, evidence of disease. Irrereversible
87
when proto-oncogenes become mutated....
they alter their expression can activate them to function as oncogenes, causing unrestrained growth (cancer)
88
ex of tumor suppressor genes (please suppress the B52s and Braca)
P53 supressor gene - mutation could be a risk of colon cancer. Braca 1 or 2 - breast and ovarian cancer.
89
Types of Biopsies: Only definitive means of dx (NIE biopsies)
1. Needle Bx 2. Incisional Bx (portion of mass taken out) 3. Excisional Bx (remove entire mass and boarders)
90
Stage O (zero situations)
Stage O - Carcinoma In Situ (hasn't spread)
91
Stage I (one is the origin)
Stage I - tumor limited to tissue of origin
92
Stage II (limited 2 locals only)
Stage II - limited local spread
93
Stage III (mom)
Stage III - extensive local and regional spread
94
Stage IV
Stage IV - metastasis
95
where is internal radiation used? (HNG the P internally)
Commonly used in head, neck and gynecologic tumors, prostate
96
systemic effects - chemo - epithelium
Affects cells with rapid growth rates i.e. Epithelium, bone marrow, hair follicles, sperm Integumentary System (hair loss)
97
systemic effects - chemo GI
GI (esophagitis, diarrhea, N/V)
98
systemic effects - chemo - Hematopoietic System
Hematopoietic System (bone marrow - WBC, RBC, bleeding)
99
systemic effects - chemo - renal
Renal System (dead cells can accumulate in kidneys) Cardiopulmonary System
100
systemic effects - chemo - Reproductive System
birth control up to 2 years after therapy. have genetic counseling if you're having kids
101
chemo nursing interventions - injections?
AVOID IM, SQ injections Tissue Integrity (especially with radiation, surgery)
102
chemo nursing interventions - ice or heat?
No ice or heat on radiation sites Susceptible to breakdown, pressure ulcers May require wound care
103
biggest danger of biologic therapy? (biology is killing my capillaries)
***Capillary Leakage Syndrome - biggest danger - inflammation and leaking
104
oncologic emergencies - (THC_D for oncology)
Hypercalcemia Tumor Lysis Syndrome- large number of cancer cells die within a short period, releasing their contents in to the blood Disseminated Intravascular Coagulation (DIC) Cardiac Tamponade Syndrome - fluid sac around your heart fills with blood or other fluid, putting pressure on your heart.
105
atrophy ex. (reversible)
atrophy (brain, muscle cells),
106
hypertrophy ex. (reversible)
hypertrophy (muscle cells, cardiac muscle)
107
hyperplasia ex. (reversible) (hyper amount of cells)
increase in # of cells, tissue regeneration, hormonal
108
metaplasia ex. (reversible) (replace GERD trude at the met)
metaplasia (replace one cell for another - chemical insult - GERD - collumnar for squamous cells)
109
dysplasia ex. (the abnormal are displaced)
abnormal tissue. connection to cancer growth
110
histological grades (history grades for ana)
Grade I mild dysplasia Grade II moderate dysplasia Grade III severe dysplasia Grade IV anaplasia -
111
early signs of radiation
desquimation, fatigue, esophagitis, cough, pain
112
s/s of capillary leakage syndrome (biology) (think too much fluid) and lungs???
tachycardia, ortho hypo, crackles on lungs, edema - urgent action needed

XIO (400 decks)

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