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Med surg > Med surg test 1 > Flashcards

Med surg test 1 Flashcards

1
Q

How do certain stressors come up in our lives?

A

Latent viruses

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2
Q

Stress is a risk factor for _____ cancer….

A

breast

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3
Q

What are some other things that have a tendency to flare up when an individual is stressed?

A

IBS
gastric pain
ulcers
Chrons disease

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4
Q

What neurohormone prepares the body for action?

A

Cortisol; increases mental alertness

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5
Q

What is “a response of the body to any demand made on it”?

A

Stress

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6
Q

What is “anything that induces stress, physical, emotional, psychological, etc.”?

A

Stressors

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7
Q

Who developed the GAS theory?

A

Hans Seyle

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8
Q

What is the first stage in the GAS theory?

A

Alarm

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9
Q

What happens during the Alarm stage?

A

Fight or flight

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10
Q

What is the second stage of the GAS theory?

A

Resistance

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11
Q

What does the body try to do during the resistance stage?

A

adapt/ conquer

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12
Q

What is the last stage of the GAS theory?

A

Exhaustion

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13
Q

What happens during the exhaustion part?

A

Terminal normally. The body has used all of its power to get better but ultimately cannot beat whatever it is

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14
Q

What stage happens in response to stress or activation of the sympathetic nervous system?

A

Alarm

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15
Q

What are some of the physiological things that happen during the fight of flight?

A

pupils dilate
Increased HR and CO
Myocardium pumps more efficiently
RR deepens
GI motility decreases
Urinary system does work as hard
Glucagon makes more blood sugar
Increased EPI and NOREPI

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16
Q

What are the three “stasis” that Dr. Clarke discussed?

A

Stasis of mucus
Stasis of blood
Stasis of urine

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17
Q

What can happen with a stasis of mucus

A

HAI pneumonia

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18
Q

What can happen with a stasis of blood?

A

HAI DVT

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19
Q

What can happen with a stasis of urine?

A

HAI UTI

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20
Q

What is the stage that discusses the resistance determined by the physical state, number of stressors, and coping abilities?

A

Resistance

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21
Q

What is the stage that all the energy for adaptation is exhausted and may return to the alarm phase or be fatal

A

Exhaustion stage

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22
Q

What includes comprehensibility, manageability, and meaningfulness?

A

A sense of coherence

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23
Q

What term is associated with the thought that things happen for a reason?

A

Comprehensibility

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24
Q

What term is associated with the concept that resources are available?

A

Manageability

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25
Q

What is the term that is associated with the thinking that things are work doing and taking on?

A

Meaningfulness

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26
Q

What term deals with one’s problem-solving and flexibility?

A

Resilence

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27
Q

What is the “I can attitude”

A

Optimism/ Good attitude.

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28
Q

What are a few physiologic things that happen under stressors?

A

Lowering of the NKC, lymphocytes, decreasing phagocytosis, and issues with cytokines

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29
Q

What is the study of blood, and blood forming tissues includng blood cells and marrow

A

Hematology

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30
Q

What is the soft center of the bone that creates stem cells?

A

Bone marrow

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31
Q

What are the two most common sites for bone marrow aspirate?

A

Iliac crest and sternum

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32
Q

Normal value for erythrocytes for men?

A

4-6

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33
Q

Normal value for erythrocytes for females?

A

4-5

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34
Q

What lab value is the combination of heme (iron) and globin (protein) and represents the O2 carrying capacity of RBCs

A

Hemoglobin

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35
Q

Normal HGB value for men?

A

13-17

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36
Q

Normal HGB value for women?

A

12-16

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37
Q

What lab value is the % of RBCS compared to whole blood and is the quickest way to tell about the persons’ blood value/loss?

A

Hematocrit

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38
Q

Normal HCT value for men?

A

30%-50%

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39
Q

Normal HCT value for women?

A

35%-47%

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40
Q

What is the lab value that is the measure of RBC size?

A

Mean Corpuscular Volume

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41
Q

Normal MCV value?

A

80-100

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42
Q

What is the lab value that is looking at the weight of the cell?

A

Mean Corpuscular Hemeglobin

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43
Q

Normal MCH
value?

A

27-34

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44
Q

What is the lab value that looks at the average concentration and percentage of hemoglobin withing a SINGLE RBC?

A

Mean Corpuscular Hemoglobin Concentration

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45
Q

What is a lay mans term for MCHC?

A

Looking at the wonky RBCs even though the rest could be normal

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46
Q

Normal value for WBCs?

A

5000-10000

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47
Q

Normal value for Neutrophils?

A

2500-8000 (under 8k)

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48
Q

WBCS work together so typically, if WBCs are elevated, then Neutrophils would _____

A

Be increased

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49
Q

Hematocrit and hemoglobin are ______ related

A

Directly

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50
Q

When WBCs are above 10,000 and very immature it is a ______ shift.

A

Left

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51
Q

When WBCs are less than 5,000 and very mature, it is a _______ shift

A

Right

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52
Q

What does a left shift mean?

A

Active infection in the immune system

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53
Q

What does a right shift mean?

A

Immunocompromised or chronic condition

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54
Q

What is the disorder when WBCs are less than 4,000 and neutrophils are less than 1,000

A

Leukopenia and neutropenia

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55
Q

What are some clinical considerations for leukopenia and neutropenia?

A

Neutropenic precaution
Handwashing
Private room
No fresh flowers or garden veggies
Screen visitors
Frequent vitals (Q2)

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56
Q

Normal value for platelets?

A

150,000-400,000

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57
Q

What are critical values for platelets?

A

Less than 10,000 and more than 1 million

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58
Q

Platelets are activated by _________

A

Intersistial collagen

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59
Q

What happens if there are too many platelets?

A

TOO MUCH CLOTTING

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60
Q

What are the treatment options for too many platelets (thrombocythemia)

A

Dialysis and Heparin

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61
Q

Which organ filters old RBCs, stores RBCs, store lymphocytes and monocytes and SEQUESTERS 30% of the body’s platlets?

A

The spleen

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62
Q

After a splenectomy, what is the nursing priority infection prevention or bleeding?

A

Infection

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63
Q

Stem cell production drops after ____ and again after _____.

A

30; 65

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64
Q

Hemoglobin drops after _______ age

A

Middle

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65
Q

Lab value that looks ate the rate at which RBCs settle in saline over a specific time frame?

A

Erythrocyte Sedimentation Rate

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66
Q

ESR is __________

A

NONSPECIFIC

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67
Q

Normal ESR value?

A

Less than 30; women’s are higher than men’s

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68
Q

What iron studies looks at what iron is combined with protein?

A

Serum iron

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69
Q

What iron studies looks at the protein available to bind with proteins?

A

TIBC

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70
Q

Which iron studies are inversely related ?

A

TIBC and serum iron

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71
Q

Which iron studies looks at the major iron storage protein?

A

Ferratin

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72
Q

Which iron studies looks at the largest protein; has a low affinity to iron and is the last to bind?

A

Transferrin

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73
Q

Which iron studies are directly related. “They do the dance together”

A

Transferrin and TIBC
Ferratin and Serum iron

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74
Q

A PT test is an assessment of clotting time for patient’s on ___________

A

Warfarin

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75
Q

Universal test; transfers from hospital to hospital for patient’s on Warfarin

A

International Normalized ratio

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76
Q

A PTT test is an assessment of clotting time for patient’s on _________

A

Heparin

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77
Q

Therapeutic range for INR

A

2-3.5

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78
Q

Normal range for INR

A

0.5-1.2

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79
Q

Normal range for PTT

A

25-35

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80
Q

Therapeutic range for PTT

A

60-70

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81
Q

Normal range for PT

A

11-16; therapeutic should be higher

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82
Q

Normal level for serum iron?

A

50-175

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83
Q

Normal level for TIBC

A

250-425

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84
Q

Normal level for Ferratin?

A

10-250

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85
Q

Normal level for Transferrin?

A

190-380

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86
Q

What is a hereditary bleeding disorder due to deficient clotting factor?

A

Hemophilia

87
Q

Classic hemophilia; factor 8

A

Type A

88
Q

Christmas disease; factor 9

A

Type B

89
Q

Disease that involves a congenitally acquired deficiency of the Von Willebrand coagulation protein?

A

Won Willebrand

90
Q

Treatments for Hemophilia?

A

Replacement factor as needed
During crisis and before a procedure
Assess for blood born infection
Monitor for joint bleeds

91
Q

What is a deficiency in the number of erythrocytes, HGB, and or the volume of packed red blood cells (HCT)?

A

Anemia

92
Q

What two values are key in diagnosing anemia?

A

H&H

93
Q

low MCV?

A

Microcytic

94
Q

normal MCV?

A

Normocytic

95
Q

high MCV?

A

Macrocytic

96
Q

What is the most common anemia, and the causes are poor absorption, GI bleeding, and menstration?

A

Iron deficiency anemia

97
Q

What are the signs and symptoms of Iron deficiency anemia?

A

Pallor
glossitis
tongue burning
cheilitis
headache
paresthesia

98
Q

How do you diagnose iron deficiency anemia?

A

Full panel

99
Q

Treatment for iron deficiency anemia?

A

treat the underlying cause and iron replacement

100
Q

What is a genetic condition where there is a chromosomal issue that causes a inadequate production of hemoglobin?

A

Thalassemia

101
Q

What are some predisposed communities to thalassemia?

A

Mediterranean, Asian, Middle eastern, African Americans

102
Q

What are some of the signs and symptoms of thalassemia?

A

thickening of the cranium, maxillary growth, retardation, and likely death

103
Q

Treatment for Thalassemia?

A

Palliative; Treatment with IV Desferal or Ferripox

104
Q

Goal for HGB levels in a patient with thalessemia?

A

9-10 (do not let is get to 12 bc then the body will stop producing it altogether)

105
Q

What is an anemia that has an insufficient amount of intrinsic factor?

A

Cobalamin deficiency (Pernicious anemia)

106
Q

Normal B12 levels?

A

190-950

107
Q

What are some reasons for a Cobalamin deficiency?

A

Pernicious anemia
Alcoholism
GI surgery
Chrons disease
Ileitis
Diverticulitis

108
Q

What populations are at risk for a Cobalamin deficiency?

A

Scandinavian and African American

109
Q

Signs and symptoms of Cobalamin deficiency?

Cobalamin=COCO
(Neurosymptoms)

A

Paranesthesia, ataxia, weakness, confusion, dementia

110
Q

What is the treatment of Cobalamin deficiency?

A

1000 ug Vitamin B 12 IM every day for two weeks, then weekly til their Hct is normal. Then monthly for LIFE

111
Q

What is a type of amenia that stems from a poor diet, malabsorption, birth control, antiseizure drugs, alcoholic abuse, hemodialysis

A

Folic Acid Deficiency

112
Q

Normal levels of folic acid?

A

5-25

113
Q

Treatment for folic acid anemia?

A

Replacement 1-5 mg daily

114
Q

What can anemia of chronic disease come from?

A

Inflammatory disease, AI, infections, and malignant disease

115
Q

Treatment for anemia of chronic disease?

A

Treat the underlying condition

116
Q

Patient’s with good _______ heal faster?

A

PERFUSION

117
Q

What is an anemia that comes from a stem cell disorder resulting pancytopenia?

A

Aplastic amenia. Can be congenital or acquired

118
Q

What is an anemia that is a genetic disorder that is fatal by middle age?

A

Sickle cell anemia

119
Q

Sickle cell anemia is like chronic anemia until _________

A

a crisis

120
Q

Pain in sickle cell anemia is caused by an _____

A

Occlusion

121
Q

The two pain priorities for sickle cell anemia are?

A

Not enough oxygen
Pain (Morphine)

122
Q

Things that can help with sickle cell anemia?

A

Avoiding high altitudes, drinking lots of the water, avoiding infection breeding grounds, getting the penumovax vaccine and H flu vaccine.

123
Q

All tissues have ___

A

stem cells

124
Q

Stems cells activate and form new cells when?

A
  1. Cells are damaged or die
  2. When the body needs more (like WBCs)
125
Q

Normal cell division results in ________-

A

identical daughter cells

126
Q

What is the initial stage of cancer development?

A

Initiation

127
Q

What are some thing that enhance the presence of initiation of cancer cells?

A

Carcinogens, genetic predisposal, and promotors

128
Q

The initiation phase cannot be ______

A

reversed or undone

129
Q

What is the second phase of cancer development?

A

The promotion phase

130
Q

The presence of _____ agents creates the correct environment for cancer cell development

A

promoting

131
Q

Promoting factors are ____

A

reversible

132
Q

What is the phase in the promotion period in which deals with the timeframe from mutation until actual clinical evidence of the disease (1-40 years)?

A

Latent phase

133
Q

The length of latent phase is based on cellular __________ rate and environmental factors

A

division

134
Q

What is it called when cancer cells are detectable (1cm to palpate and 1 billion cells) (0.5 on MRI)?

A

Critical mass

135
Q

What is immunological escape?

A

Most cancer cells are caught and phagocytocized.

136
Q

What are used to mark and track a tumor presence and development?

A

Oncofetal antigens

137
Q

What is the third phase of cancer development?

A

The progression phase

138
Q

The progression phase include m_______ and g_____

A

metastasis and growth

139
Q

What are the organs where metastasis typically occurs?

A

brain, bone, liver, lung, adrenals

140
Q

How are tumors spread?

A

by blood or lymph

141
Q

each cell type has its own typical pattern of ____and sites of colonization

A

mets

142
Q

Grade I, II, III, IV, X are _______

A

Histological grading

143
Q

Which grade is well differentiated (mature) and the cells are still pretty normal?

A

Grade I

144
Q

Which grade is it when cells are moderately differentiated with moderate dysplasia

A

Grade II

145
Q

Which grade has poorly differentiated cells, severe dysplasia, and super abnormal cells

A

Grade III

146
Q

Which grade has undifferentiated cells, anaplasia, immature, primitive cells.

A

Grade IV

147
Q

Which grade is difficult to determine the cells of origin; most difficult to treat and poorest response rate

A

Grade IV

148
Q

Which grade CANNOT be assessed?

A

Grade X

149
Q

Clinical staging is detemining….

A

How spread or local the cancer is

150
Q

What clinical staging means that the cancer is in situ (self-contained)

A

0

151
Q

Which clinical staging means the cancer is limited to tissues of origin?

A

1

152
Q

Which clinical staging means that the cancer has limited local spread

A

2

153
Q

Which clinical staging means that the cancer has extensive local spread as well as regional spread?

A

3

154
Q

Which clinical staging includes metastasis?

A

4

155
Q

Which classification is looking at malignancy?

A

TNM classification

156
Q

Which TNM classification has no evidence of a primary tumor?

A

T0

157
Q

Which TNM classification says the cancer is in situ?

A

Tis

158
Q

Which TNM classification has ascending degrees of tumor sizes and involvement (based on size and spread)

A

T1-T4

159
Q

the N in TNM classification is looking at what involvement?

A

nodular

160
Q

Which TNM classification indicates there is no nodular involvement?

A

N0

161
Q

Which TNM classification rates it based on how many nodes are involved?

A

N1-N4

162
Q

Which TNM classification says that the nodes cannot be accesses clinically?

A

NX

163
Q

The M in TNM looks at _______

A

the distant metastasis

164
Q

Which TNM classification means theres no evidence of mets?

A

M0

165
Q

Which TNM classification has ascending degrees of distant mets?

A

M1-M4

166
Q

What are the CAUTIONS of cancer

A

C:hange in bowl or bladder habits
A: sore that does not heal
U:nusual bleeding or discharge
T:hickening of lump in breasts
I:ndigestion and difficulty swallowing
O:bvious changes in warts or nevi
N:agging cough and hoarseness

167
Q

What are some of the goals of cancer treatment?

A

Cure
Control
Pallation

168
Q

What are some cancer treatment options?

A

chemo, surgery, radiation, biological and targeted therapy

169
Q

What is the use of chemicals as systemic therapy for cancer?

A

chemotherapy

170
Q

The goal is chemo is to reduce the number of _____________ in the tumor site

A

malignant cells

171
Q

Chemo is a good choice for what two kinds of cancer

A

tumors and hematologic cancer

172
Q

What are some factors that effect chemo?

A

mitotic rate of tissue, size, age, location of tumor, and presence of resistant tumor cells

173
Q

What are some routes you can give chemo?

A

PO, IM, IV, Intracavitary, Intrathecal, Intra-arterial, perfusion, Continuous infusion, SUBQ, topical and central line

174
Q

Give an antiemetic _____ chemo

A

BEFORE

175
Q

what is hair loss caused by cancer?

A

alopecia

176
Q

Watch for __________ in chemo patients

A

leuko/neutropenia

177
Q

Monitor chemo patient’s IV for ______

A

extravasation

178
Q

What is a treatment option that accomplishes local treatment modality by the emission of energy thru space or material medium

A

Radiation

179
Q

What are special considerations with radiation patients?

A

Nausea and vomiting
Care of skin
Care of skin/tissue damage

180
Q

What are some common s/sx of chemo and radiation patients?

A

Bone marrow suppression
Fatigue
GI distress
Skin and mucous membrane reactions
Lung and repro effects

181
Q

What method uses medications to boost the immune system and attack cancer cells by utilizing immunization, cytokines, and antibodies?

A

Immunotherapy

182
Q

What method slows cancer growth by targeting specific cell receptors on the cell surface and is more selective then chemo?

A

TARGETED therapy

183
Q

What is AML

A

Acute myelogenous leukemia

184
Q

What is ALL

A

Acute lymphocytic leukemia

185
Q

What is CML

A

Chronic myelogenous leukemia

186
Q

What is CLL

A

Chronic lymphocytic leukemia

187
Q

AML affects people who are generally

A

60-70

188
Q

What are the clinical manifestations of AML?

A

Mouth sores
Anemia
Bleeding
HA
Lymphadenopathy
Fatigue and weakness
And sudden dramatic onset with infection and bleeding

189
Q

What are some Dx factors of AML?

A

LOW RBC, HCT, HGB and platelets

190
Q

How do you treat AML?

A

RAPID HARD AND FAST CHEMO

191
Q

ALL typically affects people

A

before age 14; primarily 2-9

192
Q

What are the clinical manifestations of ALL?

A

FEVER
pallor
bruising
weight loss
weight loss and abd. pain
CNS, hepato-splenomegaly
Leukemic meningitis

193
Q

What are some D/x considerations for ALL?

A

LOW RBC, HGB, HCT, Platelets. Low, normal, high WBC, transverse lines at ends of metaphysis of long bones, immature lymph cells

194
Q

CML primarily occurs in people between

A

25-60

195
Q

S/sx of CML

A

asymptomatic early on, develops fatigue, sternal pain, joint tenderness, bone pain, splenomegaly and sweating

196
Q

What are some Dx factors of CML?

A

Low RBC, HGB, HCT, High platelets then a drop and normal lymph count

197
Q

What is a major issue with CML?

A

It can turn to AML during a blastic crisis which is life threatening

198
Q

CLL primarily occurs in people who are

A

50-70 (more in men)

199
Q

What are some s/sx for CLL?

A

chornic fatihue, anorexia, splenomegaly, increased infection

200
Q

Dx considerations for CLL?

A

Mild anemia
Thrombocytopenia
Lymphocytes in the bone marrow

201
Q

Unclassified leukemias have __________ and _________-

A

mixed presentation and poor response

202
Q

What is the treatment for AML?

A

Stem cell and bone marrow transplant

203
Q

What is the treatment for ALL?

A

Cranial radiation, intrathecal Methoxtrexate and stem cell transplant

204
Q

What is a treatment for CML?

A

Total body radiation
bone marrow and stem cell transplant
alpha interferon and leukapheresis

205
Q

What is the treatment for CLL?

A

Radiation, splenectomy, alpha interferon , colony stimulating factors to stimulate cell formation and stem cell transplant

206
Q

What are cancers that originate in the bone marrow and lymphatic system resulting in proliferation of lymphocytes

A

Lymphomas

207
Q

What lymphoma is a malignant condition characterized by the proliferation of giant, multinucleated cells called Reed-Stenberg cell in the lymph nodes

A

Hodgkin’s

208
Q

What is a lymphoma that is unclassified and has malignant neoplasms?

A

Non Hodgkins

209
Q

Non-Hodgkin’s lymphoma is the most common ______- cancer and ______ leading cause in cancer death?

A

hematologic and 5th

210
Q

Non-Hodgkin’s does not have ___________________ cells

A

Reed-Sternberg cells

211
Q

What is a kind of cancer that in the plasma cell cancer

A

multiple myeloma

212
Q

What are the s/sx of multiple myeloma

A

Advanced; pain in ribs, spine and pelvis. Lesions and bone destruction common. Hypercalcemia can cause renal, GI, neurological changes

213
Q

Dx consideration for multiple myeloma?

A

Blood, urine, xrays and bone marrow biopsy

214
Q

What are some nursing considerations for multiple myelomas?

A

I&O- they need 3-4 L of fluid
Fracture precautions
Active and passive ROM
PAIN MANAGEMENT

Med surg (2 decks)

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