Med surg test 1 Flashcards
1
Q
How do certain stressors come up in our lives?
A
Latent viruses
2
Q
Stress is a risk factor for _____ cancer….
A
breast
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
4
Q
What neurohormone prepares the body for action?
A
Cortisol; increases mental alertness
5
Q
What is “a response of the body to any demand made on it”?
A
Stress
6
Q
What is “anything that induces stress, physical, emotional, psychological, etc.”?
A
Stressors
7
Q
Who developed the GAS theory?
A
Hans Seyle
8
Q
What is the first stage in the GAS theory?
A
Alarm
9
Q
What happens during the Alarm stage?
A
Fight or flight
10
Q
What is the second stage of the GAS theory?
A
Resistance
11
Q
What does the body try to do during the resistance stage?
A
adapt/ conquer
12
Q
What is the last stage of the GAS theory?
A
Exhaustion
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
14
Q
What stage happens in response to stress or activation of the sympathetic nervous system?
A
Alarm
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
16
Q
What are the three “stasis” that Dr. Clarke discussed?
A
Stasis of mucus
Stasis of blood
Stasis of urine
17
Q
What can happen with a stasis of mucus
A
HAI pneumonia
18
Q
What can happen with a stasis of blood?
A
HAI DVT
19
Q
What can happen with a stasis of urine?
A
HAI UTI
20
Q
What is the stage that discusses the resistance determined by the physical state, number of stressors, and coping abilities?
A
Resistance
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
22
Q
What includes comprehensibility, manageability, and meaningfulness?
A
A sense of coherence
23
Q
What term is associated with the thought that things happen for a reason?
A
Comprehensibility
24
Q
What term is associated with the concept that resources are available?
A
Manageability
25
What is the term that is associated with the thinking that things are work doing and taking on?
Meaningfulness
26
What term deals with one's problem-solving and flexibility?
Resilence
27
What is the "I can attitude"
Optimism/ Good attitude.
28
What are a few physiologic things that happen under stressors?
Lowering of the NKC, lymphocytes, decreasing phagocytosis, and issues with cytokines
29
What is the study of blood, and blood forming tissues includng blood cells and marrow
Hematology
30
What is the soft center of the bone that creates stem cells?
Bone marrow
31
What are the two most common sites for bone marrow aspirate?
Iliac crest and sternum
32
Normal value for erythrocytes for men?
4-6
33
Normal value for erythrocytes for females?
4-5
34
What lab value is the combination of heme (iron) and globin (protein) and represents the O2 carrying capacity of RBCs
Hemoglobin
35
Normal HGB value for men?
13-17
36
Normal HGB value for women?
12-16
37
What lab value is the % of RBCS compared to whole blood and is the quickest way to tell about the persons' blood value/loss?
Hematocrit
38
Normal HCT value for men?
30%-50%
39
Normal HCT value for women?
35%-47%
40
What is the lab value that is the measure of RBC size?
Mean Corpuscular Volume
41
Normal MCV value?
80-100
42
What is the lab value that is looking at the weight of the cell?
Mean Corpuscular Hemeglobin
43
Normal MCH
value?
27-34
44
What is the lab value that looks at the average concentration and percentage of hemoglobin withing a SINGLE RBC?
Mean Corpuscular Hemoglobin Concentration
45
What is a lay mans term for MCHC?
Looking at the wonky RBCs even though the rest could be normal
46
Normal value for WBCs?
5000-10000
47
Normal value for Neutrophils?
2500-8000 (under 8k)
48
WBCS work together so typically, if WBCs are elevated, then Neutrophils would _____
Be increased
49
Hematocrit and hemoglobin are ______ related
Directly
50
When WBCs are above 10,000 and very immature it is a ______ shift.
Left
51
When WBCs are less than 5,000 and very mature, it is a _______ shift
Right
52
What does a left shift mean?
Active infection in the immune system
53
What does a right shift mean?
Immunocompromised or chronic condition
54
What is the disorder when WBCs are less than 4,000 and neutrophils are less than 1,000
Leukopenia and neutropenia
55
What are some clinical considerations for leukopenia and neutropenia?
Neutropenic precaution
Handwashing
Private room
No fresh flowers or garden veggies
Screen visitors
Frequent vitals (Q2)
56
Normal value for platelets?
150,000-400,000
57
What are critical values for platelets?
Less than 10,000 and more than 1 million
58
Platelets are activated by _________
Intersistial collagen
59
What happens if there are too many platelets?
TOO MUCH CLOTTING
60
What are the treatment options for too many platelets (thrombocythemia)
Dialysis and Heparin
61
Which organ filters old RBCs, stores RBCs, store lymphocytes and monocytes and SEQUESTERS 30% of the body's platlets?
The spleen
62
After a splenectomy, what is the nursing priority infection prevention or bleeding?
Infection
63
Stem cell production drops after ____ and again after _____.
30; 65
64
Hemoglobin drops after _______ age
Middle
65
Lab value that looks ate the rate at which RBCs settle in saline over a specific time frame?
Erythrocyte Sedimentation Rate
66
ESR is __________
NONSPECIFIC
67
Normal ESR value?
Less than 30; women's are higher than men's
68
What iron studies looks at what iron is combined with protein?
Serum iron
69
What iron studies looks at the protein available to bind with proteins?
TIBC
70
Which iron studies are inversely related ?
TIBC and serum iron
71
Which iron studies looks at the major iron storage protein?
Ferratin
72
Which iron studies looks at the largest protein; has a low affinity to iron and is the last to bind?
Transferrin
73
Which iron studies are directly related. "They do the dance together"
Transferrin and TIBC
Ferratin and Serum iron
74
A PT test is an assessment of clotting time for patient's on ___________
Warfarin
75
Universal test; transfers from hospital to hospital for patient's on Warfarin
International Normalized ratio
76
A PTT test is an assessment of clotting time for patient's on _________
Heparin
77
Therapeutic range for INR
2-3.5
78
Normal range for INR
0.5-1.2
79
Normal range for PTT
25-35
80
Therapeutic range for PTT
60-70
81
Normal range for PT
11-16; therapeutic should be higher
82
Normal level for serum iron?
50-175
83
Normal level for TIBC
250-425
84
Normal level for Ferratin?
10-250
85
Normal level for Transferrin?
190-380
86
What is a hereditary bleeding disorder due to deficient clotting factor?
Hemophilia
87
Classic hemophilia; factor 8
Type A
88
Christmas disease; factor 9
Type B
89
Disease that involves a congenitally acquired deficiency of the Von Willebrand coagulation protein?
Won Willebrand
90
Treatments for Hemophilia?
Replacement factor as needed
During crisis and before a procedure
Assess for blood born infection
Monitor for joint bleeds
91
What is a deficiency in the number of erythrocytes, HGB, and or the volume of packed red blood cells (HCT)?
Anemia
92
What two values are key in diagnosing anemia?
H&H
93
low MCV?
Microcytic
94
normal MCV?
Normocytic
95
high MCV?
Macrocytic
96
What is the most common anemia, and the causes are poor absorption, GI bleeding, and menstration?
Iron deficiency anemia
97
What are the signs and symptoms of Iron deficiency anemia?
Pallor
glossitis
tongue burning
cheilitis
headache
paresthesia
98
How do you diagnose iron deficiency anemia?
Full panel
99
Treatment for iron deficiency anemia?
treat the underlying cause and iron replacement
100
What is a genetic condition where there is a chromosomal issue that causes a inadequate production of hemoglobin?
Thalassemia
101
What are some predisposed communities to thalassemia?
Mediterranean, Asian, Middle eastern, African Americans
102
What are some of the signs and symptoms of thalassemia?
thickening of the cranium, maxillary growth, retardation, and likely death
103
Treatment for Thalassemia?
Palliative; Treatment with IV Desferal or Ferripox
104
Goal for HGB levels in a patient with thalessemia?
9-10 (do not let is get to 12 bc then the body will stop producing it altogether)
105
What is an anemia that has an insufficient amount of intrinsic factor?
Cobalamin deficiency (Pernicious anemia)
106
Normal B12 levels?
190-950
107
What are some reasons for a Cobalamin deficiency?
Pernicious anemia
Alcoholism
GI surgery
Chrons disease
Ileitis
Diverticulitis
108
What populations are at risk for a Cobalamin deficiency?
Scandinavian and African American
109
Signs and symptoms of Cobalamin deficiency?
Cobalamin=COCO
(Neurosymptoms)
Paranesthesia, ataxia, weakness, confusion, dementia
110
What is the treatment of Cobalamin deficiency?
1000 ug Vitamin B 12 IM every day for two weeks, then weekly til their Hct is normal. Then monthly for LIFE
111
What is a type of amenia that stems from a poor diet, malabsorption, birth control, antiseizure drugs, alcoholic abuse, hemodialysis
Folic Acid Deficiency
112
Normal levels of folic acid?
5-25
113
Treatment for folic acid anemia?
Replacement 1-5 mg daily
114
What can anemia of chronic disease come from?
Inflammatory disease, AI, infections, and malignant disease
115
Treatment for anemia of chronic disease?
Treat the underlying condition
116
Patient's with good _______ heal faster?
PERFUSION
117
What is an anemia that comes from a stem cell disorder resulting pancytopenia?
Aplastic amenia. Can be congenital or acquired
118
What is an anemia that is a genetic disorder that is fatal by middle age?
Sickle cell anemia
119
Sickle cell anemia is like chronic anemia until _________
a crisis
120
Pain in sickle cell anemia is caused by an _____
Occlusion
121
The two pain priorities for sickle cell anemia are?
Not enough oxygen
Pain (Morphine)
122
Things that can help with sickle cell anemia?
Avoiding high altitudes, drinking lots of the water, avoiding infection breeding grounds, getting the penumovax vaccine and H flu vaccine.
123
All tissues have ___
stem cells
124
Stems cells activate and form new cells when?
1. Cells are damaged or die
2. When the body needs more (like WBCs)
125
Normal cell division results in ________-
identical daughter cells
126
What is the initial stage of cancer development?
Initiation
127
What are some thing that enhance the presence of initiation of cancer cells?
Carcinogens, genetic predisposal, and promotors
128
The initiation phase cannot be ______
reversed or undone
129
What is the second phase of cancer development?
The promotion phase
130
The presence of _____ agents creates the correct environment for cancer cell development
promoting
131
Promoting factors are ____
reversible
132
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)?
Latent phase
133
The length of latent phase is based on cellular __________ rate and environmental factors
division
134
What is it called when cancer cells are detectable (1cm to palpate and 1 billion cells) (0.5 on MRI)?
Critical mass
135
What is immunological escape?
Most cancer cells are caught and phagocytocized.
136
What are used to mark and track a tumor presence and development?
Oncofetal antigens
137
What is the third phase of cancer development?
The progression phase
138
The progression phase include m_______ and g_____
metastasis and growth
139
What are the organs where metastasis typically occurs?
brain, bone, liver, lung, adrenals
140
How are tumors spread?
by blood or lymph
141
each cell type has its own typical pattern of ____and sites of colonization
mets
142
Grade I, II, III, IV, X are _______
Histological grading
143
Which grade is well differentiated (mature) and the cells are still pretty normal?
Grade I
144
Which grade is it when cells are moderately differentiated with moderate dysplasia
Grade II
145
Which grade has poorly differentiated cells, severe dysplasia, and super abnormal cells
Grade III
146
Which grade has undifferentiated cells, anaplasia, immature, primitive cells.
Grade IV
147
Which grade is difficult to determine the cells of origin; most difficult to treat and poorest response rate
Grade IV
148
Which grade CANNOT be assessed?
Grade X
149
Clinical staging is detemining....
How spread or local the cancer is
150
What clinical staging means that the cancer is in situ (self-contained)
0
151
Which clinical staging means the cancer is limited to tissues of origin?
1
152
Which clinical staging means that the cancer has limited local spread
2
153
Which clinical staging means that the cancer has extensive local spread as well as regional spread?
3
154
Which clinical staging includes metastasis?
4
155
Which classification is looking at malignancy?
TNM classification
156
Which TNM classification has no evidence of a primary tumor?
T0
157
Which TNM classification says the cancer is in situ?
Tis
158
Which TNM classification has ascending degrees of tumor sizes and involvement (based on size and spread)
T1-T4
159
the N in TNM classification is looking at what involvement?
nodular
160
Which TNM classification indicates there is no nodular involvement?
N0
161
Which TNM classification rates it based on how many nodes are involved?
N1-N4
162
Which TNM classification says that the nodes cannot be accesses clinically?
NX
163
The M in TNM looks at _______
the distant metastasis
164
Which TNM classification means theres no evidence of mets?
M0
165
Which TNM classification has ascending degrees of distant mets?
M1-M4
166
What are the CAUTIONS of cancer
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
What are some of the goals of cancer treatment?
Cure
Control
Pallation
168
What are some cancer treatment options?
chemo, surgery, radiation, biological and targeted therapy
169
What is the use of chemicals as systemic therapy for cancer?
chemotherapy
170
The goal is chemo is to reduce the number of _____________ in the tumor site
malignant cells
171
Chemo is a good choice for what two kinds of cancer
tumors and hematologic cancer
172
What are some factors that effect chemo?
mitotic rate of tissue, size, age, location of tumor, and presence of resistant tumor cells
173
What are some routes you can give chemo?
PO, IM, IV, Intracavitary, Intrathecal, Intra-arterial, perfusion, Continuous infusion, SUBQ, topical and central line
174
Give an antiemetic _____ chemo
BEFORE
175
what is hair loss caused by cancer?
alopecia
176
Watch for __________ in chemo patients
leuko/neutropenia
177
Monitor chemo patient's IV for ______
extravasation
178
What is a treatment option that accomplishes local treatment modality by the emission of energy thru space or material medium
Radiation
179
What are special considerations with radiation patients?
Nausea and vomiting
Care of skin
Care of skin/tissue damage
180
What are some common s/sx of chemo and radiation patients?
Bone marrow suppression
Fatigue
GI distress
Skin and mucous membrane reactions
Lung and repro effects
181
What method uses medications to boost the immune system and attack cancer cells by utilizing immunization, cytokines, and antibodies?
Immunotherapy
182
What method slows cancer growth by targeting specific cell receptors on the cell surface and is more selective then chemo?
TARGETED therapy
183
What is AML
Acute myelogenous leukemia
184
What is ALL
Acute lymphocytic leukemia
185
What is CML
Chronic myelogenous leukemia
186
What is CLL
Chronic lymphocytic leukemia
187
AML affects people who are generally
60-70
188
What are the clinical manifestations of AML?
Mouth sores
Anemia
Bleeding
HA
Lymphadenopathy
Fatigue and weakness
And sudden dramatic onset with infection and bleeding
189
What are some Dx factors of AML?
LOW RBC, HCT, HGB and platelets
190
How do you treat AML?
RAPID HARD AND FAST CHEMO
191
ALL typically affects people
before age 14; primarily 2-9
192
What are the clinical manifestations of ALL?
FEVER
pallor
bruising
weight loss
weight loss and abd. pain
CNS, hepato-splenomegaly
Leukemic meningitis
193
What are some D/x considerations for ALL?
LOW RBC, HGB, HCT, Platelets. Low, normal, high WBC, transverse lines at ends of metaphysis of long bones, immature lymph cells
194
CML primarily occurs in people between
25-60
195
S/sx of CML
asymptomatic early on, develops fatigue, sternal pain, joint tenderness, bone pain, splenomegaly and sweating
196
What are some Dx factors of CML?
Low RBC, HGB, HCT, High platelets then a drop and normal lymph count
197
What is a major issue with CML?
It can turn to AML during a blastic crisis which is life threatening
198
CLL primarily occurs in people who are
50-70 (more in men)
199
What are some s/sx for CLL?
chornic fatihue, anorexia, splenomegaly, increased infection
200
Dx considerations for CLL?
Mild anemia
Thrombocytopenia
Lymphocytes in the bone marrow
201
Unclassified leukemias have __________ and _________-
mixed presentation and poor response
202
What is the treatment for AML?
Stem cell and bone marrow transplant
203
What is the treatment for ALL?
Cranial radiation, intrathecal Methoxtrexate and stem cell transplant
204
What is a treatment for CML?
Total body radiation
bone marrow and stem cell transplant
alpha interferon and leukapheresis
205
What is the treatment for CLL?
Radiation, splenectomy, alpha interferon , colony stimulating factors to stimulate cell formation and stem cell transplant
206
What are cancers that originate in the bone marrow and lymphatic system resulting in proliferation of lymphocytes
Lymphomas
207
What lymphoma is a malignant condition characterized by the proliferation of giant, multinucleated cells called Reed-Stenberg cell in the lymph nodes
Hodgkin's
208
What is a lymphoma that is unclassified and has malignant neoplasms?
Non Hodgkins
209
Non-Hodgkin's lymphoma is the most common ______- cancer and ______ leading cause in cancer death?
hematologic and 5th
210
Non-Hodgkin's does not have ___________________ cells
Reed-Sternberg cells
211
What is a kind of cancer that in the plasma cell cancer
multiple myeloma
212
What are the s/sx of multiple myeloma
Advanced; pain in ribs, spine and pelvis. Lesions and bone destruction common. Hypercalcemia can cause renal, GI, neurological changes
213
Dx consideration for multiple myeloma?
Blood, urine, xrays and bone marrow biopsy
214
What are some nursing considerations for multiple myelomas?
I&O- they need 3-4 L of fluid
Fracture precautions
Active and passive ROM
PAIN MANAGEMENT
