mcgrath study guide 1 Flashcards
General concepts and care of older adults
- proper discharge teaching (FOLLOW UP CARE)
- we want a person with chronic illness to be able to transition from the hospital or wherever they are to their home
- patient can manage their own symptoms (disease management) cus we dont want patients with chronic illness to keep coming in and out the hospital
WATCH OUT FOR CONFUSION AND DEMENTIA BUT THEY ARE NOT NROMAL EFFECTS OF AGING
what does chronic illness require
- people learn to live with symptoms and disabilities
- come to terms with identity change
- manage regimens necessary to keep symptoms under control
cause is unknown and unpredictable
Approaches by the nurse for chronically ill patient
- explain to the patient the characteristics of their chronic illness
- want them to be able to adjust to their chronic illness
- WE WANT THEM TO MANAGE THEIR DISEASE
- be aware of FATIGUE AND DEPRESSION
Medication issues for the elderly
Sometimes error happens cus
- decreased vision
- forgetfulness
- using other peoples medications
- use of over the counter meds OTC
- ASK other than your OTC medication, what other meds are you taking
- we want them to take the medication slowly, right dose
- use pill box
- lack of money to buy meds
- side effects
- dont comprehend the instructions (take by day or night)
pretrajectory phases
they just at risk for it but they dont have it
stable phase of chronic illness
NO SYMPTOMS
symptoms and disability are managed
unstable phase (CRISIS) of chronic illness
- look at the blood pressure (HIGH? LOW, KEEP CHANGING??)
- look at the blood sugar
- exacerbation of symptoms
- development of complications
- reactivation of illness in remission (flareup)
What are the medicare criteria for Home care?
MARY HANSON IS UGLY RUDE CUNT
○ doctor orders (Mary ○ homebound status (Hanson ○ intermittent skilled nursing care (catherization etc) (Is ○ unstable condition (Ugly ○ reasonable and measurable goals (Rude ○ certified agency (Cunt
role of the nurse is not to be doing ADLs with the patient. that can be done by companion or nurse aide
Home Care discharge planning
- can it be managed at home?
- may need physical therapy (PT)
- may need occupational therapy (OT)
- how many visits can they get
- is their illness unstable, but manageable, not requiring hospital admission
how we know if the patient is ready to be discharged from home care?
look at their condition
- if the patient is still unstable? = YOU CAN GET THEM MORE VISITS BASED ON THEIR DOCUMENTATION
THEIR CONDITION IS WHAT CAN GET THEM MORE VISITS
Assessment of home care patient
- safe for the patient, family, attending nurse
- INFECTION CONTROL
- DISASTER PLANNING
- CONFIDENTIALITY
teaching a patient in homecare
- are they ready
- are they motivated
- how much do they know about their diagnosis
wanna know where you starting from
- can you tell me about your diabeties? cus you want to know what else needs to be taught to the patient
home care bag Technique
- Keep it sanitary (not on floor, tripping hazard)
- YOURE A GUES IN THEIR HOME. ASK BEFORE YOU DO ANYTHING
- needles are secured
- can i sit? can i put my bag on the table? where can i wash my hands
BIGGEST FEAR OF HOME CARE FOR NURSES
- transmission of organisms to the patient
Primary emphasis of rehab
- make sure the patient is motivated
- plan with patient and SMART GOALS
- physical therapy, occupational therapy
FOCUS MAIN ABILITIES
- focus on the functional parts ESPECIALLY IF A PATIENT HAS A RIGHT SIDE PARALYSIS, FOCUS ON THE LEFT SIDE CUS WE WANT TO MAKE THE LEFT SIDE STRONGER!!
Interventions for hospice patient who has difficulty breathing (SLOW DOWN THEIR BREATHING)
- MAK SURE THEY ARE NOT FLAT!
- elevated atleast 30 degree
- if alert and oriented, do some relaxation techniques
- ADMINISTER PALLIATIVE SEDATION ( can calm down their breathing )
- that can cause respiratory
patient breathing quickly then they stop breating. On and off pattern = CHEYNE STOKE
- CHEYNE STOKES & DEATH RATTLE = go over transition, oral thrush (nystatin flush), kennedy ulcer- nonblanchable CLOSED SORE
Patient concerns in hospice
- want them to die with COMFORT DIGNITY AND RESPECT
advantages of a Central Venous Access Device (VAD) rather than a peripheral line
- immediate access
- reduced venipunctures
- decreased risk of extravasation ( from vein to tissue)
disadvantages of a Central Venous Access Device (VAD)
- increased risk of systemic infection because its a central line goin to the heart
- INVASIVE PROCEDURE
complications of a Central Venous Access Device (VAD)
- occlusion of the catheter =
- embolism/clot = entry of air, catheter breaks, disloged thrombus
- infection
- pneumothorax
what happens when they inserting a Central VAD and the patient starts to complain of chest pain and shortness of breath
- check (ausculate) their lungs to see whats happen? maybe you punctured their lung?
burns to face and neck
very serious why?
- gonna have difficulty breathing
- they gonna have edema
- DONT LIE THEM FLAT. we want them to be able to
- 100% oxygen (non rebreather mask)
clothes on? REMOVE THEM!!
patient has a burn and need a dressing change, what do we do?
- give them pain medications
- hydropmorphone, dilaudid, morphine
Fluid resuscitation of burn. what do we monitor the patient for
- vital signs and I&O
TYPICALLY OUTPUT!!!
USE CHAMBER CUS YOU WANNA RECORD
what if a patient has respiratory distress from a burn. what assessments?
- sputum black
- dry cough
- singed nasal hair
- hoarseness
- painful swallowing
- darkened and nasal membrane (SHOULD BE PINK)
Rule of nines
- burn percentage to worry about = 30 and higher
- problem they get when its 30 and up is fluid problems EDEMA and prone to other complications
- anasarca = TOTAL BODY EDEMA from another condition maybe kidney?
Donor tissue typing
- do cross match. theres positive and negative
- we want the crossmatch to be negative
POSITIVE CROSSMATCH = NOT A GOOD THING!! = indicates the recipient has cytotoxic antibodies
- HIV and severe infection
blood thinners/ anticoagulant before transplant
They cannot take blood thinners before transplants. IT HAS TO BE STOPPED ONE WEEK
Appropriate roommate before transplant
they can share a room but not with someone who can give them an infection
- someone with wound drainage
Acute rejection to transplant
still have to give them the immunosuppresant anyways.
immunosupprement medication for organ transplant
TACROLIMUS/PROGRAF.
take it for lifetime
Can they take more than 1 immunosuppresant drug? YES
difference between vesicant and irritant
irritants causes irritation, redness
Vesicants causes extravasions.
What to do when patient has extravasions?
- First stop the infusion on the pump
- Supply cool or warm on the site
- Surgery to debride
Neutropenia ( WBC less than 1000 ) precautions
- no things in the rectum
- no thermometers
- no enemas
- no fresh flowers and plants
- fresh fruit & vegetables, raw meats & fish, natural cheeses, raw eggs, frozen/dried fruit,
anything carrying bacteria
DONT WAIT TILL 100.5 or higher CALL DOCTOR IN CANCER PATIENTS
AMERICAN CANCER SOCIETY warning signs FOR CANCER: CAUTION
- Change in bowel/bladder habits
- A sore that doesn’t heal
- Unusual bleeding/discharge
- Thickening or lump in breast/elsewhere
- Indigestion/difficulty swallowing
- Obvious change in mole/wart
- Nagging cough/hoarseness
Biological Response Modifiers
boosts up a persons immune system
- includes INTERFERON, INTERLEUKIN-2
what do you monitor a person taking interfeorn and interleukin 2 for?
monitor for flu like symptoms
- fatigue
- anorexia
- weight loss, nausea and vomiting
side effect of chemo agents
- FATIGUE #1
- cytoxan and leukerin = NEPHROTOXIC
- Methotrexate and Fluorouracil = NEUROTOXIC
ADRIAMYCIN - cardiotoxic
- vincristine, vinblastine= INSTERSRINAL OBSTRUCTION and neurotoxic
FLUSH IV OUT!!
Bone marrow transplant complications
- bleeding
- infection
- graft VRS host disease
who can get it? anybody who cancer has spread to the bone marrow can get it
cytoxan and leukeran CANCER MED SIDE EFFECTS
NEPHROTOXIC
Methotrexate and Fluorouracil CANCER MED SIDE EFFECTS
neurotoxic
Factors when ordering of chemo
type of cancer
- stage
- location
- general health of the patient. IF THEY HAVE KIDNEY PORBLEMS, AVOID THE NEPHROTOXIC CHEMO AGENTS
Dose: thats when you look at the age and weight NOT FOR CHEMO
BEST WAY TO DO CHEMO: look at height and weight = TOTAL BODY SURFACE AREA
Superior Vena Cava Syndrome
- clot or TUMOR pressing down the superior vena cava causing an obstruction of blood flow
Superior Vena Cava Syndrome manifestations
- dismental
- headaches
- cough
- chest pain
- nasal stuffiness
hoarsness - swelling of the face NECK AND ARM
what is the difference between staging and grading
GRADING classifications of the tumor cell type, how closely they resemble a normal cell
STAGING: looks at the tumor itself and if theres any mestasis
TNM = tumor, node, metasis
What to expect with External radiation
most common symptom of radiation and even chemo = FATIGUE
can they have visitors: THEY CAN HAVE VISITORS
INTERNAL RADIATION (what to worry as a nurse): gonna be in private room, time, distance issue. * dosimeter *
Do’s and dont’s of external radiation
- get plenty of rest, eat right
- AVOID wearing tight fitting clothes
- no soaps, lotions, powders on radiation site
- no adhesive tape, use electric shaver, protect area from sun
- DONT CLEAN ANY MARKER TATTOS
when a person is on a radiation, when does their symptoms usually occur
usually 10-14 days into the treatment
2 weeks later
Breast cancer risk factors
- family history
- smoking
- early or late menopause
- obesity
- smoking
- environmental factors
what is lymphedema
lymph nodes have been removed
- amount of lymph nodes removed will determine the amount of lymphemeda
- can be mild moderate, severe, gigantic
what would the patient feel that they have lymphedema.
- tightness and heaviness in their arms
Cervical cancer treatments
- internal radiation
- intravenous = cisplatin, topotecan, paclitaxel, isofamide, 5FU
VERY HARD TO DO EXTERNAL RADIATION ON CERVIX
what sign and symptoms should the nurse be on the look out for in a patient getting radiation for cervical cancer
- nausea
- vomiting
- diarrhea
- vagina dryness and stenosis (narrow)
- menopause
bladder cancer risk factors
- smoking
- increasing age
- smell
- hair dye
in - bladder infections
ovarian cancer sign and symptoms ASSESSMENT
- pelvic abdmonial back pain
- bloating
- gas
- urinary frequency
pelvic/ab/back pain
- bloating, indigestion, gas, nausea, heartburn, urinary urgency/freq
- alternating constipation/diarrhea
- difficulty eating/feel full fast
- vaginal bleeding
Lung Cancer: Tumor markers
- CEA
- CA 125
- NSE
laryngeal has no tumor markers
Prostate cancer diagnosis
- DRE and PSA most common ones
- blood test
- ultrasound
PAP MRI
Prostate cancer late sign
dribbling, nocturia, retention, interruption of urinary stream, can’t pee
Prostate cancer sign and symptoms
may have no symptoms or LUTS (lower urinary tract symptoms)
similar to BPH (urgency, hematuria
Skin cancer: Assessment
- fair
- freckled skin
- coal tar
- sun tanning salons
- radiation
HOW OFTEN SHOULD YOU CHECK YOUR SKIN? ONCE A MONTH
Lymphoma: Signs & Symptoms
- fever
- pruritus or itching
- night sweats
- large lymph nodes (usually painless)
- fatigue and decreased appetite
Leukemia: Risk factors
- smoking
- chemical exposure
- chromosomal abnormalities
- radiation
- alkaloid agent
- HLV 1 AND 2
- HIV
Larynx cancer: Medications
- caphosol = treat dry mouth
- viscose xylocain= gel used for pain
- appetite stimulant = megace
- Moisture Mouthkot (mimic saliva)
Colon cancer: Diagnostics, main tests
- colonoscopy
- biopsy (scope, lesions)
polyps immediately removed there
Treatment Multiple Myeloma
- chemO
- radiation = ONLY FOR PALLIATION, treatment of pain. NOT FOR CURE
- bone marrow transplant
