mid term 2 Flashcards
Breast Cancer Risk Factors
Body weight Personal cancer history Physical activity Family cancer history and genetics Alcohol use Early menstruation and late menopause Smoking Breast density Exposure to hormones: the Pill, IVF, and HRT Breast conditions Pregnancy and breastfeeding Radiation exposure
diagnosis of breast cancer
- self exam
- clinical exam
- breast awareness
- mamogram
- ultrasound
- fine-needle biopsy
- core biopsy
self exam
performed monthly after period
clinical exam
annual check up
breast awareness
aware of changes in breast; dimpling, drooping, puckering, pain, redness, change in shape
ultrasound
used to determine lump present and to locate lump for needle biopsy
needle biopsy
removes cells from breast lump
syringe aspirates cells to be analysed, cannot determine if cancer is invasive
Core biopsy
removes a sample of affected cells and tissue surrounding the lump, is able to determine if cancer invasive
Surgical biopsy
an operation that removes breast tissue and may remove the lump with some surrounding tissue
situ breast cancer
noninvasive breast cancer that remains in milk ducts or lobules of breast
invasive breast cancer
starts in milk ducts and breaks thru to surrounding breast tissue
inflammatory breast cancer
rare, s/s = red, swollen, warm, pitted, orange-like texture, may become hard, itchy, tender
Staging
TNM = tumour (size), Nodes (# and size affected), Metastasis (any)
tumor
T1= 0-2cm
T2= 2-5cm
T3=>5cm
T4= ulcerating or fixed
Nodes
N-0= nodes test negative N-1 = nodes are positive N-3= nodes are large N-4= nodes are near collarbone
metastasis
M-0=none
M-1= any
Stage 1
small tumour with no nodes and no mets
Stage 2
tumour size less than 5cm with +nodes
Stage 3 (no metastasis)
any tumour with large nodes, nodes near collarbone and no mets. or >5cm tumour with + nodes, no mets,
Stage 4 (mets)
anysize tumour with mets
treatments
surgery= lumpectomy, mastectomy, radical mastectomy
radiation therapy, chemo therapy, hormone therapy
• Sodium
135 to 145 mmol/L
Hypernatremia < 135(low body sodium) symptoms: hypotension, irritability, confusion, tachycardia, dry mucous membranes, weight loss.
Causes:
• Excessive water intake
• Diarrhea, vomiting, burns
Hypernatremia >145 can be life threatening hypovolemic= symptoms: intense thirst, hypotension
• Sweating , diabetes insipidus, impaired thirst/or restricted water intake
Potassium
3.5-5 mmol/L
Hyperkalemia (high)= acute renal failure, Addison’s disease, dehydration, diabetic ketoacidosis, excessive dietary/IV intake, massive tissue destruction either trauma or metabolic dying cells lyse releasing potassium into the blood stream (burns)
Symptoms; anxiety, diarrhea, weakness, paresthesia (prickling, tingling of skin), irregular pulse, cardiac arrest if sudden or severe.
Hypokalemia: Cushing’s disease, severe diarrhea, deficient dietary, starvation, vomiting.
Symptoms: leg cramps, fatigue, soft flabby muscles, weak irregular pulse, hyperglycemia, polyuria.
Chloride
95-105 mmol/L
It helps keep the amount of fluid inside and outside of your cells in balance. It also helps maintain proper blood volume, blood pressure, and pH of your body fluids.
High level Causes:
• Loss of fluids due to vomiting, diarrhea, sweating (dehydration)
• Kidney failure, diabetes insipidus, corticosteroids, diuretics
Symptoms: dizziness, diabetics may have high sugar levels.
Low level causes: Addison’s disease, diarrhea, over hydration, vomiting Drugs - bicarbonate, corticosteroids, diuretics, laxatives
Creatinine
43-133 mcmol/L
Chemical waste
Increased levels represent renal failure, reliable indicator of kidney function. Raised creatinine level indicates the kidneys unable to poor elimination/clearance.
BUN (Blood Urea Nitrogen)
3.6 - 7.1
Your liver produces ammonia — which contains nitrogen — after it breaks down proteins used by your body’s cells.
• The nitrogen combines with other elements, such as carbon, hydrogen, and oxygen, to form urea, which is a chemical waste product.
• The urea travels from your liver to your kidneys through your bloodstream.
• Healthy kidneys filter urea and remove other waste products from your blood.
BUN levels rise if kidneys are unable to remove urea.
Increased level Caused by:
• CHF/poor renal perfusion
• Impaired renal function
• Dehydration
• Shock
• Excessive protein intake or protein catabolism
Decreased BUN
• Liver failure (not breaking down protein)
• Malnutrition
• Anabolic steroid use
• Pregnancy due to increased plasma volume
Glucose
• 3.6-6 mmol/L
The pancreas releases insulin into the blood, based upon the blood sugar level. Insulin helps move glucose from digested food enter into cells.
Signs and symptoms of hyperglycemia would include: polyuria, polyphagia, and polydipsia, weight loss/gain with increased and longer lasting infections due to poor peripheral perfusion leading to neuropathies and blurred vision The signs/symptoms of hypoglycemia include; hunger, shakiness, slurred speech, diaphoresis, confusion, tachycardia, weakness, headache, blurry vision, irritability. In extreme cases coma or seizure can occur that can lead to death.
Pain OPQRST
- O=onset
- P=provocative
- Q=quality or quantitiy
- R=Region or radiation
- S=severity scale
- T=timing
- U=understanding perceptions
Pattern of pain
onset and duration
intensity= scale 0-10
characteristics = burning, cold, crushing, stabbing, sharp,
effects of pain on ADL
Drug therapy for pain
schedulced analgesics with focus on prevention and control
fast acting drugs for break thru pain. never play catch up with pain relief.
analgesic ladder
Mild Pain 1-3
NSAIDS, non-opioid analgesics (aspirin)
have ceiling= increased dose does not = increased pain relief
Mild to moderate pain 4-6
persists even with non-opioid analgesics
step 2 drugs = morphine like (codeine, oxycodone)
Moderate to severe 7-10
when step 2 drugs ineffective
no analgesic ceiling
morphine
Adjuvant analgesic therapy
increases pain relief when used with opioids and non-opioids by: enhancing effects of 1st drug, possess analgesic properties also, counteract side effects of 1st drug
Adjuvant analgesic therapy includes:
antidepressants, antiseizure, corticosteroids
Persistent pain results in
depression, sleep disturbances, decreased mobility, social role dysfunction
Age related considerations to pain management
metabolize drugs more slowly
risk of gi bleeds with NSAIDs
interactions due to x drugs
hyperosmolar= acute dehydration can lead to acute kidney failure.
high concentration of glucose in the blood, life threatening condition similar to DKA
both treated with insulin and fluid/electrolyte replacement.
Fast acting insulin
absorbed quickly and used to control spike in blood sugar during meals and snacks.
also used to treat elevated blood sugar
intermediate lasting insulin
absorbed more slowly,used to control blood sugar between meals and overnight
long acting insulin
absorbed slowly with minimal peak, plateau effect that lasts most of day, night or between meals
Acute Renal failure
rapid onset due to infection, injury,(uti infection), dehydration (excessive vomiting, diarrhea), diuretic therapy, heart failure, hypovolemia. treated with fluids.
monitor in and out of fluids
Chronic kidney disease
not likely to be reversed
manifests= electrolyte imbalance
Warning signs of kidney disease
diabetics, high blood pressure, relatives with disease
high blood pressure, puffiness of eyes, hands, feet, bloody, cloudy, tea colour urine, protein in urine, foaming of urine, frequent urination/ less urination output, difficulty urinating, fatigue.
