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NCLEX Saunders > Onco > Flashcards

Onco Flashcards

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1
Q

classic s/s bladder ca

A

painless hematuria

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2
Q

causes of bladder ca

A
  1. tobacco/cigarette smoking
  2. occupational chemical exposure
  3. ⬆️ fat intake
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3
Q

live virus immunization

A

not allowed and also their household contacts

measles, mumps, rubella, polio
varicella
shingles & some flu virus like H1N1

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4
Q

polio vaccine alternative

A

Salk vaccine (inactivated)

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5
Q

eliminate in child’s room

A

raw fruits & vegetables
fresh flowers & live plants
standing water

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6
Q

given to stimulate bone marrow to produce white blood cell

A

(Granulocyte Colony Stimulating Factor)
G CSF / Filgrastim (Neupogen)

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7
Q

air flow in rooms

A

(high efficiency particulate air)
HEPA Filter
or
laminar air flow system

  • sucks air and thru a filtration, removes pollen, dust, mold, bacteria, airborne particles
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8
Q

pedia bleeding prec

A

-measure abdominal girth
-soft toothbrush
-cool to warm soft foods
-avoid injections, if possible
-apply firm and gentle pressure to a needle-stick site for at least 10 minutes
-pad side rails and sharp corners -avoid constrictive or tight clothing. -avoid blowing nose
-avoid the use of rectal suppositories, enemas, and rectal thermometers
-count the number of pads or tampons used if the adolescent girl is menstruating
-avoid NSAIDs and aspirin

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9
Q

Late Signs of ⬆️ ICP

A

▪ Bradycardia
▪ Decreased motor response to command
▪ Decreased sensory response to painful stimuli
▪ Alterations in pupil size and reaction
▪ Decerebrate (extension) or decorticate (flexion) posturing
▪ Cheyne-Stokes respirations
▪ Papilledema
▪ Decreased consciousness
▪ Coma

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10
Q

early signs of ⬆️ ICP for infants

A
  • tense bulgung fontanel
  • irritability
  • high pitched cry
  • poor feeding
  • setting sun sign / sunset eyes
  • Macewen’s sign (cracked pot sound after percussion)
  • increased head circumference
  • distended scalp veins
  • separated cranial sutures
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11
Q

early signs of ⬆️ ICP for children

A

▪ forceful vomiting, nausea
▪ headache
▪ Seizures
▪ Diplopia; blurred vision

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12
Q

⬆️ ICP personality & behavior signs

A

▪ Irritability, restlessness
▪ Indifference, drowsiness
▪ Decline in school performance
▪ Diminished physical activity and motor performance
▪ Increased sleeping
▪ Inability to follow simple commands
▪ Lethargy

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13
Q

Leukemia

A

malignant increase of immature WBC in the bone marrow resulting in:
💀neutropenia - risk for infection
💀anemia -tired, SOB, weak
💀thrombocytopenia - risk for bleeding
common in boys than in girls

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14
Q

most frequent type of cancer in children

A

acute lymphocytic leukemka

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15
Q

phases of chemotherapy for leukemia

A
  1. induction - complete remission or disappearance of leukemic cells
  2. intensification or consolidation - decreases the tumor burden further
  3. central nervous system prophylactic therapy - prevents leukemic cells from invading the central nervous system
  4. maintenance - maintain remission phase
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16
Q

confirmatory for leukemia

A

+ bone marrow biopsy of blast cells

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17
Q

hair loss may occur from chemotherapy

A

hair regrows in about 3 to 6 months and may be a slightly different color or texture

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18
Q

Hodgkins Lymphoma

A

malignancy of the lymph nodes
painless/non tender, firm, enlarged, movable lymph nodes

supraclavicular
or
sentinal node in children

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19
Q

confirmatory of hodgkins lymphoma

A

+ Lymph node biopsy of Reed-Sternberg cells

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20
Q

nephroblastoma

A

Wilms’ Tumor
peaks at 3y.o.
intraabdominal and kidney tumor
DO NOT PALPATE ABDOMEN
measure abdominal girth daily
➕hypertension (⬆️renin bec tumor)

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21
Q

neuroblastoma

A

poor prognosis
peaks before 10y.o.
⬆️immature neuroblast cells forming tumor in adrenal gland or retroperitoneal

+ in urine: vanillylmandelic acid, homovanillic acid, dopamine, and norepinephrine

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22
Q

Osteosarcoma

A

osteogenic sarcoma
most common bone cancer in children, peaks 10-25yo
tumor in metaphysis of long bones, mostly in femur
earliest sign: extremity injury or normal growing pains relieved by a flexed position
-limping during weight bearing
-pathological fractures

treatment: limb salvage/limb resection procedure

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23
Q

brain tumors

A

-headache severe at waking up & improves within the day
-vomiting
-ataxia
-diplopia
-facial weakness
-clumsiness

no trendelenburg/supine
no to operative side
-infratentorial:flat on either side
-supratentorial: above heart level
monitor temperature!
monitor CSF leakage:
-colorless drainage in the dressing or from ears/nose
-dipstick for +glucose = CSF

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24
Q

opisthotonus

A

backward arching of the spine bec of meningitis

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25
Q

nadir

A

the time where bone marrow activity & wbc counts are at lowest

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26
Q

types of biopsy

A
  1. needle
  2. incisional - part/wedge
  3. excisional - whole
  4. staging - multiple needle & incisional
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27
Q

types of oncological surgeries

A
  1. prophylactic - premalignant
  2. curative - affected organ only
  3. controlled (cytoreductive/controlling) - affected organ & adjacent
  4. palliative - alleviate symptoms
  5. reconstructive/rehabilitative - for altered body image
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28
Q

external beam radiation

A

teletherapy

patient NOT RADIOACTIVE

-wash gently each day with warm water alone or with mild soap and water
-use hand rather than a washcloth
-rinse soap thoroughly
-do not to remove the markings
-dry with patting motions rather than rubbing motions; use a clean, soft towel or cloth
-no powders, ointments, lotions, or creams
-wear soft clothing over the skin
-avoid wearing belts, buckles, straps, or any type of clothing that binds or rubs the skin
-avoid exposure to heat and the sun

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29
Q

internal radiation

A

brachytherapy

patient RADIOACTIVE

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30
Q

unsealed radiation source

A

a type of brachytherapy

patient RADIOACTIVE for 48hrs until excreted

given PO or IV into body cavities
thus body fluids are radioactive
excreta is also radioactive

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31
Q

sealed radiation source

A

a temporary or permanent implant, implanted in the target tumor

patient RADIOACTIVE
excreta NON RADIOACTIVE

patient becomes NON RADIOACTIVE after implant removal

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32
Q

dislodged sealed radiation implant

A

lie still
long handled forceps
deposit in a lead container
contact oncologist
document

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33
Q

types of donor stem cells

A

autologous - self sourced
syngeneic - twin
allogeneic - relative or non relative

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34
Q

BMT harvest

A

bone marrow transplantation harvest
-multiple aspirations of stem cells from the iliac crest
-allogeneic or syngeneic marrow, transferred immediately
-autologous marrow, filtered for cancer cells and are frozen (cryopreservation)

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35
Q

PBSCT Harvest

A

peripheral blood stem cell transplantation harvest

-like a dialysis machine, for 4 to 6hrs, blood removed thru central venous catheter and thru apharesis or leukapharesis, removes stem cells and returns the rest of the blood to the blood stream

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36
Q

conditioning

A

done after harvesting
immunosuppresion therapy eradicating all malignant cells creating space in bone marrow for engraftment

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37
Q

transplantation (stem cell)

A

given iv or iv push thru central line like a blood transfusion

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38
Q

engraftment

A

blood cell counts begin to rise
process takes 2 to 5 weeks

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39
Q

post transplantation (stem cell)

A

most critical period
patient at risk for bleeding, infection until engraftment

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40
Q

complications of stem cell transplantation

A
  1. failure to graft
  2. graft vs host disease - esp in allogeneic, managed thru immunosuppressive agents
  3. hepatic veno-occlusive disease - occlusion bec of thrombosis / phlebitis
    s&s
    right upper quadrant abdominal pain
    jaundice
    ascites
    weight gain
    hepatomegaly
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41
Q

leukamia pts to avoid doing

A

changing litter box
working w/ house plants/garden
going to crowds

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42
Q

adult bleeding prec

A

same w/ pedia

-for injection, press for 5mins or more instead of 10 mins
-count tampons/pads for menstruating
-use of electric razor
-soft toothbrush and NO dental floss
-avoid blowing nose

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43
Q

remission

A

-adiminutionof theseriousnessor intensity of disease or pain;
-a temporary recovery

44
Q

forms of blood cancer

A

leukemia, lymphoma, myeloma

45
Q

multiple myeloma

A

-increasing abnormal plasma cells in bone marrow
-decreases production of immunoglobulins and antibodies
-produces an abnormal antibody (myeloma protein or bence jones protein) found in blood and urine (proteinuria)
-⬆️ uric acid (hyperuricemia, gout) and calcium (hypercalcemia) ➡️ Renal failure
-➕osteoporosis & pathological fractures

46
Q

bisphosphonate medications

A

as prescribed to slow bone damage and reduce pain and risk of fractures

47
Q

testicular ca

A

-predisposing fx: cryptorchidism (undescended testes)
-early detection: monthly testicular self exam
➕ painless testicular swelling
dragging or pulling sensation

op:
unilateral or radical orchiectomy
retroperitoneal lymph node dissection
💀 avoid heavy lifting
offer: sperm storage, donor insemination or adoption
&
monthly testicular self exam for the remaining testes

48
Q

cervical ca

A

predisposing: HPV virus, cigarette smoking, early first intercourse <17yo., multiple partners

pap smear

-painless vaginal postmenstrual & postcoital bleeding
-foul smelling/ serosanguinous dischargr

49
Q

cervical ca

A

predisposing: HPV virus, cigarette smoking, early first intercourse <17yo., multiple partners

pap smear

-painless vaginal postmenstrual & postcoital bleeding
-foul smelling/ serosanguinous dischargr

50
Q

cervical ca: laser therapy

A

slight vaginal bleeding expected
heals at 6 to 12 weeks

51
Q

cervical ca: cryosurgery

A

-avoid sexual intercourse
-use tampons

expected:
-cramps during procedure
-heavy water discharge for several weeks post procedure

52
Q

cervical ca: conization

A

-remove cone shape area of cervix
-reproductive capacity unharmed
-💀 preterm labor for future pregnancies
-💀 long term ff/u

53
Q

cervical ca: hysterectomy

A

(radical hysterectomy with bilateral lymph node dissection)
removal of uterus & cervix if childbearing is not desired

1month post op
-avoid stairs
-no weight bearing/lifting (>20lbs/9kg)
-no prolonged sitting/ long drive
-no bath tubs
-no sexual intercouse 3-6 weeks

💀 bleeding
>1 saturated pad per hour

54
Q

cervical ca: pelvic exenteration

A

-remove pelvic contents including bowel, vagina, bladder
-performed ONLY for recurring CA with NO TUMOR outside pelvis and NO lymph node involvement

RIGHT SIDE: for urine/ bladder:
placement of ileal conduit

LEFT SIDE: for feces:
placement of colostomy

-interventions: almost similar to hysterectomy
-sexual counseling: no more sexual intercourse
-perineal opening may drain for several months
-avoid strenuous activity for 6months
-perineal irrigations and sitz baths

55
Q

ovarian ca

A

aysmptomatic in early stage & fast growing
thus highest mortality rate
north american / european descent

diagnosing: exploratory laparotomy
(TVS/Transvaginal UTZ not definitive but can be done)

elevated tumor marker CA 125

op: Total abdominal hysterectomy and bilateral salpingooophorectomy with tumor debulking

56
Q

endometrial (uterine) ca

A

slow growing usually in menopausal years

predisposing: estrogen use, nulliparity, pcos, late menopause, obesity, hypertension, DM, family hx of uterine ca & colorectal ca

sign: abN° bleeding postmenopause

for estrogen-dependent tumors:
-progesterone & antiestrogen

op: Total abdominal hysterectomy and bilateral salpingo-oophorectomy

57
Q

breast ca

A

-predisposing: family hx of breast ca, nulliparity, late first birth, early menarche, late menopause, previous ca of breast uterus/ovaries, obesity, high radiation exposure

early detection: bse

-painless, fixed, irregular, nonencapsulated mass
-peau d orange

58
Q

for human epidermal growth factor receptor 2–positive (HER-2 +)
breast ca

A

Monoclonal antibodies such as trastuzumab

59
Q

breast ca: lymphedema

A

-pressure sleeve (looks like a compression stockings but for arms)
-diuretics
-low salt diet

60
Q

breast ca: mastectomy

A

immediate postop:
semi-Fowler’s position, turn from the back to the unaffected side, with the affected arm elevated above the level of the heart

❌no IVs, no injections, no blood pressure measurements, and no venipunctures should be done in the arm on the side of the mastectomy

61
Q

esophageal ca

A

squamous cell carcinoma or adenocarcinoma

predisposing: smoking, alcohol, chronic reflux, Barrett’s esophagus, and vitamin deficiencies

➕ dysphagia, odynophagia (painful swallowing)

62
Q

gastric ca

A

predisposing: H. Pylori, diet of smoked, highly salted, processed, or spiced foods, smoking, alcohol and nitrate ingestion, and a history of gastric ulcers

63
Q

gastric ca complication

A

dumping syndrome: rapid gastric emptying

64
Q

gastric ca: gastrectomy

A

postop
-fowlers position
-NPO status as prescribed for 1 to 3 days until peristalsis returns
-assess for bowel sounds
-Monitor nasogastric suction. -drainage from the nasogastric tube is normally bloody for 24 hours postoperatively, changes to brown-tinged, and is then yellow or clear
-‼️Do not irrigate or remove the nasogastric tube
-Advance the diet from NPO to sips of clear water to 6 small bland meals a day, as prescribed

65
Q

pancreatic ca

A

highly malignant, rapidly growing adenocarcinoma

predisposing: hx of pancreatitis, high fat intake, smoking, DM, alcohol, exposure to chemicals

diagnosing: ERCP Endoscopic retrograde cholangiopancreatography

signs: clay colored stools, jaundice

op: Whipple procedure, which involves a pancreaticoduodenectomy with removal of the distal third of the stomach, pancreaticojejunostomy, gastrojejunostomy, and choledochojejunostomy

post op:
pancreatitis mgt
and gastrectomy mgt

‼️check for blood glucose

66
Q

colorectal ca

A

predisposing:
family hx of colorectal ca
familial polyposis
colorectal polyps
chronic inflammatory bowel ds
hx of breast, endometrial & gastric ca

-blood in stool (feccal occult, sigmoido- & colonoscopy
-abN° stool
1. ascending colon tumor: diarrhea
2. descending colon tumor: constipation or for partial obstruction: diarrhea, or flat, ribbon-like stool
3. Rectal tumor: Alternating constipation and diarrhea

late sign:
-cachexia - (skeleton like muscle wasting)
-guarding, abd distention or mass

67
Q

colorectal ca

A

predisposing:
family hx of colorectal ca
familial polyposis
colorectal polyps
chronic inflammatory bowel ds
hx of breast, endometrial & gastric ca

-blood in stool (feccal occult, sigmoido- & colonoscopy
-abN° stool
1. ascending colon tumor: diarrhea
2. descending colon tumor: constipation or for partial obstruction: diarrhea, or flat, ribbon-like stool
3. Rectal tumor: Alternating constipation and diarrhea

late sign:
-cachexia - (skeleton like muscle wasting)
-guarding, abd distention or mass

68
Q

colorectal ca

A

predisposing:
family hx of colorectal ca
familial polyposis
colorectal polyps
chronic inflammatory bowel ds
hx of breast, endometrial & gastric ca

-blood in stool (feccal occult, sigmoido- & colonoscopy
-abN° stool
1. ascending colon tumor: diarrhea
2. descending colon tumor: constipation or for partial obstruction: diarrhea, or flat, ribbon-like stool
3. Rectal tumor: Alternating constipation and diarrhea

late sign:
-cachexia - (skeleton like muscle wasting)
-guarding, abd distention or mass

69
Q

colorectal ca

A

predisposing:
family hx of colorectal ca
familial polyposis
colorectal polyps
chronic inflammatory bowel ds
hx of breast, endometrial & gastric ca

-blood in stool (feccal occult, sigmoido- & colonoscopy
-abN° stool
1. ascending colon tumor: diarrhea
2. descending colon tumor: constipation or for partial obstruction: diarrhea, or flat, ribbon-like stool
3. Rectal tumor: Alternating constipation and diarrhea

late sign:
-cachexia - (skeleton like muscle wasting)
-guarding, abd distention or mass

70
Q

colorectal ca

A

predisposing:
family hx of colorectal ca
familial polyposis
colorectal polyps
chronic inflammatory bowel ds
hx of breast, endometrial & gastric ca

-blood in stool (feccal occult, sigmoido- & colonoscopy
-abN° stool
1. ascending colon tumor: diarrhea
2. descending colon tumor: constipation or for partial obstruction: diarrhea, or flat, ribbon-like stool
3. Rectal tumor: Alternating constipation and diarrhea

late sign:
-cachexia - (skeleton like muscle wasting)
-guarding, abd distention or mass

op: Bowel resection, local lymph node resection, and a colostomy or ileostomy

71
Q

colorectal ca: complications

A

bowel perforation w/ peritonitis, abscess or fistula formation
intestinal obstruction
hemorrhage (shock)

72
Q

signs of intenstinal obstruction

A

early sign:
increased peristalsis
increased bowel sounds

vomiting (maybe fecal contents)
pain
constipation
abdominal distention
hypoactive bowel sounds

73
Q

ostomy care

A

-assess stoma for size, unusual bleeding, color changes, or necrotic tissue
-normal stoma color is red or pink
-Fecal matter should not be allowed to remain on the skin
-instruct the client to avoid foods that cause excessive gas formation and odor
-Instruct the client in stoma care and irrigations
-check for proper fit
-cover with a dry sterile dressing until pouch is placed

74
Q

colostomy stool differences

A

-Expect that stool will be liquid postoperatively but will become more solid, depending on the area of the colostomy:

a. ascending colon: liquid stool
b. transverse colon: loose to semiformed stool
c. descending colon:close to normal stool from a colostomy

75
Q

ileostomy stool characteristics

A

Postoperative drainage will be dark green and progress to yellow as the client begins to eat

Stool is liquid

bec it is in the small intestine, risk for dehydration and electrolyte imbalance exists

76
Q

lung ca: op

A
  1. Laser therapy: To relieve endobronchial obstruction
  2. Thoracentesis and pleurodesis: To remove pleural fluid and relieve hypoxia
  3. Thoracotomy with pneumonectomy: removal of 1 entire lung
  4. Thoracotomy with lobectomy: removal of 1 lobe
  5. Thoracotomy with segmental resection:removal of a lobe segment
77
Q

special for pneumonectomy

A

no closed chest drainage

78
Q

laryngeal ca

A

predisposing: smoking, alcohol, asbestos, wood dust

painless neck mass, change in voice quality, dysphagia

nutritional support via parenteral nutrition, nasogastric tube feedings, or gastrostomy or jejunostomy tube

79
Q

laryngeal ca: op

A

cordal stripping
cordectomy
partial laryngectomy
total laryngectomy
➡️tracheostomy is performed with a total laryngectomy; this airway opening is permanent and is referred to as a laryngectomy stoma

80
Q

laryngeal ca: health teaching

A

airway (tracheostomy care)
alternative methods of communication
suctioning
pain control methods
nutritional support
changes in body image and loss of voice

81
Q

prostate ca

A

slow growing

predisposing: after age 50, african american men, smoking, history of stds, heavy metal exposure

asymptomatic to painless hematuria

diagnosing: biopsy, prostate specific antigen level not a reliable screening test unless with DRE

82
Q

prostate ca: op

A

-orchiectomy (palliative) limit the production of testosterone
-prostatectomy: radical prostatectomy can be performed via:
a. retropubic - lower abdomen, not opening the bladder
b. perineal -between scrotum & anus
c. suprapubic -right through the bladder
*all can result to sterility; except perineal, all need cbi, and only perineal has higher risk for infection
-Cryosurgical ablation is a minimally invasive procedure that may be an alternative to radical prostatectomy; liquid nitrogen freezes the gland, and the dead cells are absorbed by the body

83
Q

prostate ca: post op

A

-continuous feeling of urge to void is n°
-avoid attempts to void around catheter: prevent bladder spasms
-

84
Q

turp complicxn

A

transurethral resection syndrome
water intoxication/ severe hyponatremia
-too much bladder irrigation absorption

confusion
altered mental status
bradycardia
increased blood pressure

85
Q

suprapubic prostatectomy catheter removal

A

dressing always saturated w/ urine and needs to be changed frequently

2 to 4 days post op
-clamp
-instruct to attempt to void
-unclamp
-check the residual urine
remove if
✓consistent bladder emptying
✓ residual urine 75ml or less

86
Q

bladder ca: complicxn of radiation

A

a. Abacterial cystitis
b. Proctitis -rectal lining inflmxn
c. Fistula formation
d. Ileitis or colitis - ileum & inner lining of the colon inflmxn
e. Bladder ulceration and hemorrhage

87
Q

bladder ca: chemotherapy

A

intravesical installation
-meds injected in the urethral catheter and placed for 2hrs
-pt rotated every 15 to 30mins starting with supine, to avoid full bladder
-after 2 hrs, increase fluids, void while sitting, urine is radioactive, send to radioisotope

-disinfect toilet for 6 hrs with household bleach

88
Q

bladder ca: op

A
  1. transurethral resection of bladder tumor (also palliative)
  2. partial cystectomy: bladder capacity gradually increases post op from 60ml to 200-400ml, suprapubic catheter removed after 2weeks
  3. radical cystectomy and urinary diversion - the latter can be performed w/o former and can also be performed weeks ahead of former
  4. ileal conduit/ureteroileostomy
  5. kock pouch-creates reservoir attached with ureters & nipple between ileum and ascending colon
  6. indiana pouch-same with kock pouch but between ascending colon and terminal ileum (other pouch: Mainz, Florida)
  7. neobladder-same with pouches but empties into pelvis thru urethra
  8. percutaneous nephrostomy/pyelostomy: nephrostomy tube for drainage
  9. ureterostomy: palliative, ureters attached to abdomen and drains w/o conduit
  10. vesicostomy: bladder attached to the abdomen creating stoma and drains
89
Q

oncological emergencies:
sepsis & DIC

A

gram negative bacteria causing sepsis
together w/ DIC

strict asepsis
Antibiotics & Anticoagulants

90
Q

oncological emergencies: SIADH

A

some tumors mimic ADH
Na: 115-120 ❗ water intoxication
Na< 110 ‼️seizure coma death
⬆️ Na intake
❌ fluid restriction
give ADH Antagonists

91
Q

oncological emergencies: hypercalcemia

A

late manifestation, sign of malignancy in bones

encourage ambulation & possible dialysis

92
Q

oncological emergencies: spinal cord compression

A

tumor reached the spine, early sign is back pain before neurological (tingling, numbness etc)

corticostreoid for swelling, neck or back braces

93
Q

oncological emergencies: superior vena cava syndrome

A

tumor growth from lymphomas or lung ca obstructing svc

early s/s: morning: edema of face, tightness of collar (stokes’ sign)

s/s: blockage of blood flow head neck and upper trunk (edema, epistaxis, erythema, swelling of the veins

semifowlers, corticosteroid, diuretics

94
Q

oncological emergencies: tumor lysis syndrome

A

ca cells destroyed rapidly resulting to rapid release of potassium & uric acid in the blood stream which is difficult to eliminate fast

yperkalemia, hyperphosphatemia with resultant hypocalcemia, and hyperuricemia occur; hyperuricemia can lead to acute kidney injury

oral & iv hydration
glucose & insulin: hyperkalemia
diuretics: general
allopurinol: purine
eventually, dialysis

95
Q

Warning Signs of Cancer—CAUTION

A

▪ Change in bowel or bladder habits
▪ Any sore that does not heal
▪ Unusual bleeding or discharge
▪ Thickening or lump in breast or elsewhere
▪ Indigestion
▪ Obvious change in wart or mole
▪ Nagging cough or hoarseness

96
Q

Care of the Client with a Sealed Radiation Implant

A

▪ Place the client in a private room with a private bath.
▪ Place a radiation precaution sign on the client’s door.
▪ Organize nursing tasks to minimize exposure to the radiation source.
▪ Nursing assignments to a client with a radiation implant should be rotated
▪ Limit time to 30 minutes per care provider per shift. ▪ Wear a dosimeter film badge to measure radiation exposure. ▪ Lead shielding may be used to reduce exposure to radiation. ▪ The nurse should never care for more than 1 client with a radiation implant at 1 time. ▪ Do not allow a pregnant nurse to care for the client. ▪ Do not allow children younger than 16 years or a pregnant woman to visit the client. ▪ Limit visitors to 30 minutes per day; visitors should be at least 6 feet from the source. ▪ Save bed linens and dressings until the source is removed; then dispose of the linens and dressings in the usual manner.

97
Q

bse

A

7 days after onset of menstruation

98
Q

post Radiation Therapy

A

▪ Wash the irradiated area gently each day with warm water alone or with mild soap and water.
▪ Use the hand rather than a washcloth to wash the area.
▪ Rinse soap thoroughly from the skin.
▪ Take care not to remove the markings that indicate exactly where the beam of radiation is to be focused.
▪ Dry the irradiated area with patting motions rather than rubbing motions; use a clean, soft towel or cloth.
▪ Use no powders, ointments, lotions, or creams on the skin at the radiation site unless they are prescribed by the radiologist.
▪ Wear soft clothing over the skin at the radiation site.
▪ Avoid wearing belts, buckles, straps, or any type of clothing that binds or rubs the skin at the radiation site.
▪ Avoid exposure of the irradiated area to the sun.
▪ Avoid heat exposure.

99
Q

tse

A

same day each month
after shower

100
Q

post mastectomy

A

▪ Avoid overuse of the arm during the first few months.
▪ To prevent lymphedema, keep the affected arm elevated;
▪ Provide incision care with an emollient as prescribed, to soften and prevent wound contracture.
▪ Encourage to perform breast self-examination on the remaining breast and surgical site once healed.
▪ Protect the affected hand and arm.
▪ Avoid strong sunlight on the affected arm.
▪ Do not let the affected arm hang dependent.
▪ Do not carry a pocketbook or anything heavy over the affected arm.
▪ Avoid trauma, cuts, bruises, or burns to the affected side.
▪ Avoid wearing constricting clothing or jewelry on the affected side.
▪ Wear gloves when gardening.
▪ Use thick oven mitts when cooking.
▪ Use a thimble when sewing.
▪ Apply hand cream several times daily.
▪ Use cream cuticle remover.
▪ Wear a MedicAlert bracelet stating which arm is at risk for lymphedema.

101
Q

gastrectomy types

A

Subtotal Gastrectomy
a. Billroth 1 gastroduodenostomy
b. Billroth 2 gastrojejunostomy
Total Gastrectomy
-esophagojejunostomy

102
Q

Stoma Care Following Laryngectomy

A

▪ Protect the neck from injury.
▪ Instruct in how to clean the incision and provide stoma care.
▪ Instruct to wear a stoma guard to shield the stoma.
▪ Demonstrate ways to prevent debris from entering the stoma.
▪ Advise to wear loose-fitting, high-collared clothing to cover the stoma.
▪ Avoid swimming, showering, and using aerosol sprays.
▪ Teach clean suctioning technique.
▪ Advise to increase humidity in the home.
▪ Increase fluid intake to 3000 mL/day.
▪ Avoid exposure to persons with infections.
▪ Alternate rest periods with activity.
▪ Instruct in range-of-motion exercises for the arms, shoulders, and neck.

103
Q

urinary stoma care

A

▪ Instruct to change the appliance in the morning, when urinary production is slowest.
▪ Collect equipment, remove collection bag, and use water or commercial solvent to loosen adhesive.
▪ Hold a rolled gauze pad against the stoma to collect and absorb urine during the procedure.
▪ Cleanse the skin around the stoma and under the drainage bag with mild nonresidue soap and water.
▪ Inspect the skin for excoriation, and instruct to prevent urine from coming into contact with the skin.
▪ After the skin is dry, apply skin adhesive around the appliance.
▪ Instruct to cut the stoma opening of the skin barrier just large enough to fit over the stoma (no more than 3 mm larger than the stoma).
▪ Instruct that the stoma will begin to shrink, requiring a smaller stoma opening on the skin barrier.
▪ Apply the skin barrier before attaching the pouch or face plate.
▪ Place the appliance over the stoma and secure in place.
▪ Encourage self-care; teach to use a mirror.
▪ Instruct that the pouch may be drained by a bedside bag or leg bag, especially at night.
▪ Instruct to empty the urinary collection bag when it is one-third full to prevent pulling of the appliance and leakage.
▪ Instruct to check the appliance seal if perspiring occurs.
▪ Instruct to leave the urinary pouch in place as long as it is not leaking and to change it every 5 to 7 days. ▪ During appliance changes, leave the skin open to air for as long as possible.
▪ Use a non–karaya product, because urine erodes karaya.
▪ To control odor, instruct to drink adequate fluids, wash the appliance thoroughly with soap and lukewarm water, and soak the collection pouch in dilute white vinegar for 20 to 30 minutes; a special deodorant tablet can also be placed into the pouch while it is being worn.
▪ Instruct who takes baths to keep the level of the water below the stoma and to avoid oily soaps.
▪ If plans to shower, instruct to direct the flow of water away from the stoma.

104
Q

self irrigation of stoma

A

▪ Instruct to wash hands and use clean technique.
▪ Instruct to use a catheter and syringe, instill 60 mL of normal saline or water into the reservoir, and aspirate gently or allow to drain.
▪ Instruct to irrigate until the drainage remains free of mucus but to be careful not to overirrigate.

105
Q

self catheterization of stoma

A

▪ Instruct to wash hands and use clean technique.
▪ Initially, instruct to insert a catheter every 2 to 3 hours to drain the reservoir; during each week thereafter, increase the interval by 1 hour until catheterization is done every 4 to 6 hours.
▪ Lubricate the catheter well with water-soluble lubricant, and instruct never to force the catheter into the reservoir.
▪ If resistance is met, instruct to pause, rotate the catheter, and apply gentle pressure to insert.
▪ Instruct to notify the surgeon if unable to insert the catheter.
▪ When urine has stopped, instruct to take several deep breaths and move the catheter in and out 2 to 3 inches (5 to 7.5 cm) to ensure that the pouch is empty.
▪ Instruct to withdraw the catheter slowly and pinch the catheter when withdrawn so that it does not leak urine.
▪ Instruct to carry catheterization supplies.

NCLEX Saunders (16 decks)

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