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CHPN Exam > Patient Care: Symptom Management > Flashcards

Patient Care: Symptom Management Flashcards

1
Q

Anorexia: definition

A

lack or loss of appetite inability to eat resulting weight loss

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2
Q

Anorexia: early stages

A

usually can be resolved, and any weight loss can be replaced with increased intake

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3
Q

Anorexia: unchecked

A

leads to protein-calorie malnutrition (PCM) loss of fat tissue and lean muscle mass

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4
Q

Anorexia: patients

A

advanced cancer, especially related to digestive system AIDS

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5
Q

Anorexia: Causes

A

pain loss of or change in taste changed sensitivity ofodors loss of sense of smell changes in sight gastric dysfunction or malabsorption nausea and vomiting diarrhea constipation or obstruction infection fever change in metabolic rate difficulty or loss of swallowing breathing restrictions alcoholism or chemical dependency

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6
Q

Cachexia: definition

A

Greek “bad condition” a state of general ill health and malnutrition producing marked weakness and emaciation

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7
Q

Cachexia: occurance

A

in most patients with cancer; main cause of death > 20% AIDS CHF severe sepsis tuberculosis any debilitating chronic illness

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8
Q

Anorexia and Cachexia

A

Anorexia can contribute to the development of cachexia

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9
Q

Cachexia: loss

A

is an equal loss of fat and muscle as well as a marked loss of bone mineral content

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10
Q

Cachexia: nutrition and increased intake

A

does not respond to nutritional supplements or increased intake

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11
Q

Cachexia: development

A

develops from systemic inflammatory response and metabolic imbalance in the presence of pro-inflammatory cytokines

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12
Q

Cachexia: catabolic state

A

becomes self-reinforcing and continues to degrade the patient’s quality of life muscle tissue and essential fat deposits found within the body become depleted.

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13
Q

Spinal cord compression: primary symtom

A

back pain pain that increases when lying flat and improves when standing

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14
Q

Spinal cord compression: symptoms

A

back pain bowel or bladder changes leg weakness or “funny feeling in legs”

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15
Q

Spinal cord compression: treatment of symptoms

A

need to be recognized and treated immediately to prevent paralysis

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16
Q

Spinal cord compression: pain

A

pain may be present long before any neurological dysfunction is detected

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17
Q

Spinal cord compression: localized back pain

A

with normal neurological exam patients may still be experiencing as much as 75% spinal cord compression

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18
Q

Spinal cord compression: cancer

A

back pain is presumed to be cord compression until proven otherwise treated as medical emergency

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19
Q

Spinal cord compression: medical emergency

A

treated as such may help to prevent permanent loss of function

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20
Q

Spinal cord compression: treatment to decrease pain and preserve functoin

A

steroids surgical decompression hormone therapy radiation therapy

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21
Q

Spinal cord compression: steroids

A

alone may decrease pain and preserve function for those in last stages of life

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22
Q

Chemotherapy: palliative care

A

may be used to enhance comfort,well-being and symptom control for enhanced quality of life

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23
Q

Chemotherapy: is not

A

expected to provide a cure not given to maintain false hope

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24
Q

Chemotherapy: expectatoin

A

prolonged survival control of cancer related symptoms

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25
Q

Chemotherapy:decisions

A

based on clinical indicators patient’s wishes

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26
Q

Chemotherapy: consider

A

benefit and cost ratios of treatment

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27
Q

Chemotherapy: usefulness

A

tumor response to treatment metastasis other disease specific factors

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28
Q

Chemotherapy: commitment

A

repeated travel hospitalizations invasive procedures and assessments

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29
Q

Pressure Ulcer: Stage I desciption

A

area of intact kin that is deep pink, red, or mottled does not blanch

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30
Q

Pressure Ulcer: Stage I intervention

A

pressure relief increased circulation to area

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31
Q

Pressure Ulcer: Stage II description

A

loss of partial thickness of skin can involve epidermis, dermis or both skin blistered, cracked, or torn

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32
Q

Pressure Ulcer: Stage II intervention

A

area must be relieved of pressure apply protective dressing

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33
Q

Pressure Ulcer: Stage III description

A

involves full-thickness of skin obvious opening or hole into tissues subcutaneous tissue is necrotic damage may extend down to but not through the fascia

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34
Q

Pressure Ulcer: Stage III intervention

A

treated with irrigation and debridement

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35
Q

Pressure Ulcer: Stage IV description

A

full-thickness skin loss with extensive destruction necrosis is deep and extends through all tissue layers damage to muscle, bone, or other supporting structures

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36
Q

Pressure Ulcer: Stage IV intervention

A

wet/dry packed dressings when drainage is present surgical repair

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37
Q

Dyspnea: defintion

A

subjective sensation of breathlessness inability to obtain the needed amount of air

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38
Q

Dyspnea: occurance

A

will occur in the majority of advanced cancer patients

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39
Q

Dyspnea: intervention

A

high Fowler’s position leaning forward with arms supported on table cool moving air relaxation techniques pursed-lip breathing oxygen opioids, tranquilizers, and anxioytics

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40
Q

Cachexia: major metabolic decreases

A

glucose tolerance insulin resistance lipoprotein lipase activity negative nitrogen balance skeletal and lean muscle mass loss

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41
Q

Cachexia: changes

A

metabolic changes, in response to inflammation and cytokine production, are common in cancer and AIDS patients represent initiating event for cachexia

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42
Q

Cachexia: other metabolic increased

A

glucose production and turnover protein synthesis fatty acid oxidation serum lipid and triglyceride

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43
Q

Cachexia: accompanying decreased

A

body glycogen mass body lipid mass fat synthesis

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44
Q

Cachexia: motor activity and energy stores

A

voluntary motor activity and ernergy stores and balance are quickly depleted during this wasting process

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45
Q

Cachexia: unchanged

A

serum glucose and insulin levels nitrogen excretion

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46
Q

Alginate Dressing: uses

A

best for wounds with heavy drainage controls secretions and reduces bacterial contamination

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47
Q

Alginate Dressing: Pain

A

is reduced softening the surrounding tissues reducing pressure caused by excessive exudates

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48
Q

Alginate Dressing: description

A

non-adherent easily removed

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49
Q

Enzymatic Dressing: uses

A

aids in loosening necrotic tissue

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50
Q

Enzymatic Dressing: treatment

A

for patients in long term care unable to sustain surgical/sharp debridement

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51
Q

Enzymatic Dressing: dressing changes

A

do not tend to cause addiitional discomfort

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52
Q

Semipermeable film: uses

A

not absorbent can’t be used when drainage is present

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53
Q

Semipermeable film: protects

A

protects against early damage assists with healing

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54
Q

Semipermeable film: pain

A

minimizes pain by covering exposed nerve endings adhere to skin and wound bed, removal can be painful

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55
Q

Hydrocolloid dressings: uses

A

absorbs small amounts of exudates mild debridement keeps wound bed moist to promote granulation

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56
Q

Hydrocolloid dressings: pain

A

minimizing exposure of wound to air proper removal required to decrease pain

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57
Q

Hydrocolloid dressing: attachment

A

some designed for difficult sacral area

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58
Q

Dysphagia: definition

A

difficultly swallowing any substance affects airway protection and patient safety

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59
Q

Dysphagia: food

A

may become caught in upper digestive tract diverted to trachea causing aspiration, choking and possible asphyxiation

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60
Q

Dysphagia: emotion

A

frightening and discouraging to patient

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61
Q

Dysphagia: posture

A

tucking in the chin tilting head promote food movement along upper digestive tract

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62
Q

Dysphagia: food

A

changes to texture and consistency of food to promote food movement

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63
Q

Dysphagia: make swallowing easier

A

artificial saliva

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64
Q

Dysphagia: bypass digestive tract

A

introduce nutrients as gastronomy or jejunostomy tube feedings

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65
Q

Dehydration: dying process

A

normal part of dying process loss of normal body water

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66
Q

Dehydration: causes

A

vomiting diarrhea decreased food and fluid intake loss of thirst sensation fever or increased metabolic needs medications: diuretics; promote fluid loss renal complications: no clearance of excess liquid and electrolytes

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67
Q

Dehydration: not treating

A

decreased cough and congestion decrease edema and ascites decrease nausea and vomiting decrease in frequency of urination

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68
Q

Dehydration: decrease in urination

A

can improve quality of life by reducing irritation and infection related to elimination treatments

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69
Q

Dehydratoin: aggravates

A

confusion and restlessness

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70
Q

Dehydration: thirst

A

patients at end of life do not commonly experience thirst due to dehydration

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71
Q

Dehydration: treatment

A

can actually increase discomfort

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72
Q

Dehydration: symptom

A

dry mouth managed with comfort measures

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73
Q

Xerostomia: definition

A

sensation of a dry mouth

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74
Q

Xerostomia: secretions

A

may be experienced with or without decreased oral secretions

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75
Q

Xerostomia: description

A

as a burning or soreness of the oral tissues

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76
Q

Xerostomia: cause

A

common nature so difficult to pinpoint

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77
Q

Xerostomia: related to

A

interactions of multiple drugs head and neck surgeries chemotherapy and radiation infection inflammation disease processes: mouth and throat immunocompromised conditions dehydration psychological factors: anxiety

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78
Q

Xerostomia: medications causing it

A

antihistamines anticholinergics

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79
Q

Xerostomia: complications

A

dental caries soft tissue irritations, lesions and infections bad breath changes in taste speech and swallowing difficulties

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80
Q

Anxiety: definition

A

marked by feelings of excessive worry, irritability, restlessness, intense feelings of danger and agitation

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81
Q

Anxiety : source

A

unknown or vague

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82
Q

Anxiety: general symptoms

A

Patients have trouble falling or staying asleep experience interference with other nromal activities in daily lives

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83
Q

Anxiety: physical symptoms

A

frequent crying spells headaches muscle tension stomach and intestinal distress palpitations shortness of breath anorexia or overeating

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84
Q

Anxiety: psychologically

A

patient vulnerable to unrealistic fears obsessions with harmful ideas and complulsions

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85
Q

Anxiety: patients may attempt

A

self–medicate with multiple chemicals or substances in attempt to alleviate symptoms

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86
Q

Anxiety disorder: identified

A

by persistence of symptoms over a period of 6 months or more

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87
Q

N/V: effect

A

negative effect on all aspects of patient’s well-being

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88
Q

N/V: causes

A

nutritional loss resulting in fluid and electrolyte imbalance fatigue reduced ability to care for self

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89
Q

N/V: stress resulting in

A

distress anxiety fear loss of happiness and enjoymnet

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90
Q

N/V: lives and relationships

A

interrupted with decrease in affection or sexual function increased dependence on caregiver

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91
Q

N/V: caregiver and patient relationship

A

increased burden and stress

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92
Q

N/V: increased stress

A

increase patient’s fears r/t illness and suffering it causes spiritual meaning of illness as punishment for past deeds

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93
Q

Fatigue: categories

A

personal factors disease related treatment related

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94
Q

Fatigue personal factors

A

age household and personal demands hormonal changes outside disease depression anxiety spirituality conflicts unmet goals culture and ethnicity income and its stability living environment patient’s relationships with support/caregiver

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95
Q

Fatigue: disease related

A

presence of metastases anemia uncontrolled pain sleep changes and interruptions changes in bowel and bladder habits cachexia dyspnea

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96
Q

Fatigue: treatment related

A

radiation chemotherapy medication permanent physiologic consequences

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97
Q

Nausea: pharmacological self care: air

A

provide fresh air with a fan or open window but limit sights, sounds and noxious smells

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98
Q

Nausea: pharmacological self care: avoid

A

consuming sweet, salty, fatty, and spicy foods

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99
Q

Nausea: pharmacological self care: food

A

should be bland served at room temperature or cold

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100
Q

Nausea: pharmacological self care: clothing

A

instruct to wear loose-fitting clothes during meal times

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101
Q

Nausea: pharmacological self care: fluids

A

consumption with meals should be restricted to just the amount needed to ease passage of food

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102
Q

Nausea: pharmacological self care: quantity of food

A

reduce the quantity of food consumed at one time by eating smaller, more fequent meals and lying down for up to 2 hours after eating

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103
Q

Nausea: pharmacological self care: cloth

A

application of cool damp cloth to forehead, neck and wrists may help

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104
Q

Vomiting occurance

A

reinforce need for oral care after each episode relief of unpleasant sensory s/e and for general oral health

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105
Q

Pureed diet: purpose

A

foods processed in blender to add liquid and change consistency to smooth

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106
Q

Pureed diet: intention

A

to reduce tongue function and the need for chewing

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107
Q

Pureed diet:type of food

A

applesauce yogurt mashed potatoes puddings

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108
Q

Mechanically altered diet:purpose

A

ground or finely chopped foods

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109
Q

Mechanically altered diet: intention

A

form small masses that require some, though minimal, chewing and tongue control

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110
Q

Mechanically altered diet: type of food

A

pasta scrambled eggs cottage cheese ground meats

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111
Q

Soft diet: purpose

A

foods are not mechanically altered but chosen for their naturally soft qualities

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112
Q

Soft diet: intention

A

foods still require some chewing when presented in small pieces, but they also allow for reduced endurance and attention span

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113
Q

Soft diet: foods

A

soft meats canned fruits baked fish

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114
Q

Prepared diet: avoid

A

raw vegetables bread tough meats

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115
Q

Swallowing disorder: general early s/s

A

become impulsive in regard to eating show inattention “playing” with food refuse to eat in presence of others avoid certain previously enjoyed food/drink

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116
Q

Swallowing disorder: changes early s/s

A

meal times and postures while eating may change

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117
Q

Swallowing disorder: solids early s/s

A

patient may begin using large amounts of fluid to wash down solids begin taking smaller bites or laboriously chewing them and then take several swallows following each bite with frequent throat clearing

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118
Q

Swallowing disorder: weight loss early s/s

A

unexplained weight loss may occur

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119
Q

Swallowing disorder: oral-pharyngeal dysfunction

A

speech may become slurred and imprecise voice may sound “wet”

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120
Q

Swallowing disorder: assessment may show

A

dry mouth with thick secretions coating tongue and palate residual food may be present secretion drooling or leakage of liquids

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121
Q

Swallowing disorder: advanced s/s

A

coughing and choking while attempting to eat nasal regurgitation aspiration

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122
Q

Depression: tendency

A

Patients experiencing depression have a greater tendency toward medical illnesses and vice versa

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123
Q

Depression: risk factor for cardiac disease

A

cardiovascular disease CHF arrhythmia heart attacks

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124
Q

Depression:CNS patients at risk for

A

cerebral anoxia cerebrovascular accident Huntington disease subdural hematoma Alzheimer disease and dementia HIV infection carotid stenosis, temporal lobe epilepsy multiple sclerosis postconcussion syndrome myasthenia gravis narcolepsy subarachnoid hemorrhage

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125
Q

Depression: other causes

A

rheumatoid arthritis thyroid disease diabetes Cushing disease Addison disease anemia lupus liver disease syphilis encephalitis alcoholism general malnutriton

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126
Q

Hiccups: multiple treatments

A

respiratory nasal and pharyngeal stimulation stimulant inhalation stimulation of vagal nerve gastric distention psychiatric treatments misc

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127
Q

Hiccups: respiratory intervention

A

classic method of breath holding re-breathing into a paper bag providing diaphragm compression stimulating sneeze or cough reflex with spice ice may be placed in mouth

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128
Q

Hiccups: nasal and pharyngeal stimulation

A

drinking from far side of glass eating a spoonful of sugar holding the nose and applying pressure

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129
Q

Hiccups: stimulant inhalatoin

A

tongue traction eating soft bread drinking peppermint water to soothe esophagus stimulating palate with bitters such as cotton-tipped applicators soaked in lemon

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130
Q

Hiccups: stimulation of vagal nerve

A

ocular compression digital rectal massage careful carotid massage

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131
Q

Hiccups: gastric distension

A

fasting placement of a NG tube to relieve abdominal distention lavage vomiting

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132
Q

Hiccups: psychiatric treatments

A

distraction and behavior modification

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133
Q

Hiccups: misc treatments

A

bilateral radial artery compression acupuncture

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134
Q

Cancer related diarrhea: avoid foods

A

high fiber or gas causing products high fat foods heavily spiced foods milk and dairy products caffeine or carbonated high sugar or sorbitol drinks high risk foods

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135
Q

Cancer related diarrhea: high fiber or gas causing foods

A

legumes raw vegetables whole-grains popcorn

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136
Q

Cancer related diarrhea: caffeine, carbonated and high sugar or sorbitol drinks

A

coffee colas prune juice pear juice cherry juice peach juice apple juice orange juice

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137
Q

Cancer related diarrhea: high risk foods

A

sushi food from street vendors buffets

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138
Q

Cancer related diarrhea: medications causing

A

antibiotics laxatives medications with magnesium motility agents stool softeners

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139
Q

Cancer related diarrhea: herbs causing

A

milk thistle aloe cayenne saw palmetto Siberian ginseng

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140
Q

Internal stimulants: herbs

A

milk thistle aloe cayenne saw palmetto Siberian ginseng

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141
Q

Delirium: definition

A

acute or subacute, reversible state of confusion

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142
Q

Delirium: time frame

A

time frame foronsest is short, over a period of hours or days, and resolving over days or weeks

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143
Q

Delirium: severity

A

fluctuates with the time of day, becoming worse at night

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144
Q

Delirium: thinking

A

thinking is impaired and clouded can fluctuate rapidly in terms of awareness of surrounding environment

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145
Q

Delirium: s/s

A

impaired short-term memory poor attention span inability to focus and sustain attention disoriented to time and place delusions and hallucinations speech becomes uncharacteristic psychomotor activity; increased or reduced sleep cycles disturbed

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146
Q

Delirium: common

A

delusions hallucinations

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147
Q

Delirium: delusions and hallucinations

A

usually fleeting poorly organized commonly become multisensory

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148
Q

Delirium: speech

A

becomes uncharacteristic for patient loud, rapid or slow

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149
Q

Delirium: psychomotor activity

A

increased or reduced becomes unpredictable

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150
Q

Delirium: sleep cycles

A

often disturbed become reversed

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151
Q

Anxiety: chemically induced

A

introduction of substance withdrawal of substance

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152
Q

Chemically induced anxiety: everyday substance which increase

A

caffeine decongestants antihistamines

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153
Q

Chemically induced anxiety: physical addictions

A

alcohol nicotine

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154
Q

Chemically induced anxiety: physical addictions: withdrawal

A

vague feelings of unease,discomfort,dread

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155
Q

Chemically induced anxiety: causes

A

alcohol nicotine hypnotics

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156
Q

Chemically induced anxiety: hypnotics

A

benzodiazepines

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157
Q

Chemically induced anxiety: medication causes

A

thyroid replacement formulas neuroleptics corticosteroids bronchodilators epinephrine antihypertensives antiparkinsonian medications oral contraceptives anticholinergics anesthetics analgesicsl

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158
Q

Chemically induced anxiety:: toxins and digitalis

A

toxins and digitalis toxicity can cause anxiety

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159
Q

Chemically induced anxiety:marijuana and cocaine

A

cause chemically induced anxiety when withdrawan

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160
Q

Dementia: definition

A

progressive, irreversible state of decline in mental function

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161
Q

Dementia: time frame

A

chronic and irreversible

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162
Q

Dementia: onset

A

quiet and slow

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163
Q

Dementia: s/s

A

do not change over the course of the day

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164
Q

Dementia: mental clarity

A

remains intact until the later stages, but may be complicated by delirium

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165
Q

Dementia: short-term memory

A

may be affect early on, but attention span generally remains intact until later stages

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166
Q

Dementia: orientatoin

A

to person, place and things remain unaltered until later stages when person mya have difficulty recognizing familiar and common objects

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167
Q

Dementia: anomia

A

when person has difficulty recognizing familiar and common objects

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168
Q

Dementia: agnosia

A

when person has difficulty recognizing familiar people

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169
Q

Dementia: aphasia

A

difficulty finding appropriate words and expressing thoughts clearly

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170
Q

Dementia: hallucinations and delusions

A

most often absent

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171
Q

Dementia: psychomotor activity

A

generally unaffected, but patient may exhibit signs of apraxia

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172
Q

Dementia: apraxia

A

difficulty initiating purposeful movement

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173
Q

Dementia: sleep and wake cycles

A

become fragmented

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174
Q

Seizures: assessment

A

careful assessment multiple causes all patients: in order to prevent

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175
Q

Seizures: may be

A

preexisting new in onset

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176
Q

Seizures: causes

A

primary or metastatic cancer to brain medications withdrawal of medications other additives in chemical formulas disease process

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177
Q

Seizures: causes: medications

A

phenothiazines butyrophenones tricyclic antidepressants metabolites: normeperidine

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178
Q

Seizures: causes: medication withdrawal

A

benzodiazepines preservatives, antioxidants additives in chemical formulas

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179
Q

Seizures: causes: disease process

A

HIV infection metabolic disorders stroke hemorrhage oxygen deprivation rare paraneoplastic disorders

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180
Q

Hyponatremia dehydration: sodium level

A

< 135 mEq/L

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181
Q

Hyponatremia dehydration: definition

A

sodium deficiency in relation to amount ow water in body body fluids are diluted and cells swell from decreased extra cellular fluid osmolaltiy

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182
Q

Hyponatremia dehydration: general S/S

A

volume depletion anorexia weight loss nausea and vomiting taste alteration

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183
Q

Hyponatremia dehydration: skin turgor

A

is decreased

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184
Q

Hyponatremia dehydration: mucus membranes

A

dry

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185
Q

Hyponatremia dehydration: sweating

A

reduced

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186
Q

Hyponatremia dehydration: may result in

A

orthostatic hypotension lethargy restlessness delirium seizures confusion stupor coma

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187
Q

Hyponatremia dehydration: Lab results

A

azotemia: increased nitrogenous waste disproportionate blood urea nitrogen creatinine hyponatremia hemoconcnetration urine osmolarity high sodium concentration

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188
Q

Hyponatremia: fluid movement

A

when serum osmolality decreases because of decreased sodium concentration fluid moves by osmosis from extracellualr area to intracellular area

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189
Q

Hypernatremic dehydration: sodium level

A

> 145 mEq/L

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190
Q

Hypernatremic dehydration: definition

A

excess of sodium relative to amoutn of water in body

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191
Q

Hypernatremic dehydration: fluid movement

A

body tries to maintain balance by shifting fluid from the inside of cells to the outside

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192
Q

Hypernatremic dehydration: s/s

A

thirst fever fatigue muscle weakness mental status changes

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193
Q

Isotonic dehydration: definition

A

different than hyponatremia or hypernatremia

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194
Q

Isotonic dehydration: s/s: psychological

A

morose aggression apathy demoralization

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195
Q

Isotonic dehydration: s/s: coordination

A

general lack of coordination

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196
Q

Isotonic dehydration: lab values

A

few or no laboratory abnormalities

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197
Q

Anxiety: physical roots

A

cardiovascular endocrine metabolic neoplasms neurological respiratory

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198
Q

Anxiety: physical roots: cardiovascular

A

hypovolemia myocardial infarction (MI) paroxysmal atrial tachycardia (PAT) angina congestive heart failure mitral valve prolapse

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199
Q

Anxiety: physical roots: endocrine

A

thyroid dysfunction low or high blood sugar Cushing disease carcinoid syndrome ( excess secretion of serotonin, bradykinin, and other vasoactive chemicals)

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200
Q

Anxiety: physical roots: metabolic

A

high potassium high or low sodium levels hyperthermia anemia low blood sugar (hypoglycemia)

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201
Q

Anxiety: physical roots: neurological

A

seizure disorders vertigo massive lesions postconcussion syndrome encephalopthy generalized brain function general restlessness

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202
Q

Anxiety: physical roots: respiratory

A

hypoxia asthma chronic obstructive pulmonary disease pneumonia pulmonary edema or embolus respiratory distress

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203
Q

Artificial hydration: routes

A

IV peripheral IV central hypodermoclysis

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204
Q

Artificial hydration: IV peripheral

A

should be monitored every few hours for: pain infiltration infection phlebitis

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205
Q

Artificial hydration: IV peripheral: usefulness

A

limited to a short duration

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206
Q

Artificial hydration: IV central: usefulness

A

treatment duration is longer than IV peripheral

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207
Q

Artificial hydration: IV central: risks

A

sepsis hemothorax or pneumonthorax thrombosis from: central vein catheter vein, catheter fragment air embolus brachial plexus injury arterial laceration

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208
Q

Artificial hydration: hypodermoclysis: definition

A

injecting fluid into the subcutaneous space

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209
Q

Artificial hydration: hypodermoclysis: usefullness

A

short term option use when oral or IV hydration cannot be achieved

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210
Q

Artificial hydration: hypodermoclysis: risks

A

pain infection volume overload third spacing tissue sloughing localized bleeding electrolyte disturbances

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211
Q

Urinary incontinence: causes

A

D = delirium I = infection A = atrophic urethritis P = pharmacy E = excessive urine production R = restricted mobility S = stool impaction

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212
Q

Urinary incontinence: D

A

delirium acute delirium and related confusion

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213
Q

Urinary incontinence: I

A

infection UTI can cause or worsen incontinence

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214
Q

Urinary incontinence: A

A

atrophic urethritis creates irritative voiding symptoms and stress incontinence

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215
Q

Urinary incontinence: P

A

pharmacy medications can reduce contractility and increase urinary retention, overflow and stress incontinence

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216
Q

Urinary incontinence: P: medications

A

opioids sedatives antidepressants anti-psychotics antiparkinsonian

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217
Q

Urinary incontinence: E

A

excessive urine production chronic disease states cause polyuria and affect smooth muscle and nerve involvement

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218
Q

Urinary incontinence: E: disease

A

diabetes cause excessive urine production

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219
Q

Urinary incontinence: R

A

restricted mobility immobility and restricted accesses to appropriate toileting facilities lead to urinary incontinenece

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220
Q

Urinary incontinence: S

A

stool impaction can result in urinary retention, urinary tract infection and incontinence

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221
Q

Enteral support: complications

A

aspiration diarrhea constipation dumping syndrome

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222
Q

Enteral support: aspiration: cause

A

use of a large-bore tube introducing formula too quickly or in too large of an amount

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223
Q

Enteral support: aspiration: s/s

A

fever cough

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224
Q

Enteral support: diarrhea: cause

A

(watery stools) hyperosmotic solution infusion rate that is too rapid lactose intolerance

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225
Q

Enteral support: constipation: cause

A

(hard infrequent stools) inadequate supplemental fluid intake inadequate fiber

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226
Q

Enteral support: dumping syndrome: cause

A

use of high-volume feeding boluses hyperosmotic fluids

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227
Q

Enteral support: dumping syndrome: s/s

A

weakness dizziness nausea palpitations syncope diarrhea

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228
Q

Edema: definition

A

result of excess fluid gathering within the tissues (interstitially) Capillary filtration exceed lymph drainage, creating a fluid imbalance

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229
Q

Edema: results in

A

swelling decreased skin mobility tightness tingling decreased strength and mobility discomfort ranging from aching to severe pain

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230
Q

Edema: pitting scale: +1

A

fluid build up is barely detectable

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231
Q

Edema: pitting scale: +2

A

slight indentation when pressed upon

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232
Q

Edema: pitting scale: +3

A

deep indentation for 5-30 seconds when pressure is applied

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233
Q

Edema: pitting scale: +4

A

creates a depression that is 1.5 to 2 x greater than normal

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234
Q

Edema treatment

A

good results when addressed in timely manner left untreated can transition to lymphedema

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235
Q

Pressure ulcers: result from

A

tissue compression restricted blood flow

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236
Q

Pressure ulcers: tissue breakdown and necrosis

A

happens when combined with moisture shearing forces friction

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237
Q

Pressure ulcers: general sites

A

over areas with bony prominences first points of contact when pressure is applied to certain body area

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238
Q

Pressure ulcers: common sites

A

sacrum greater trochanters (upper end of femur) heels or calcaneus lateral and medial malleolus (protrusions around ankle bone)

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239
Q

Pressure ulcers: other sites

A

back of head scapula area ischial tuberosities and hip ribs and vertebrae coccyx

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240
Q

Lymphedema: results from

A

untreated or incurable edema

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241
Q

Lymphedema: marked by

A

chronic condition marked by swelling and accumulated fluids within the tissue

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242
Q

Lymphedema: fluid accumulation

A

is result of: lymphatic drainage failure inadequate lymph transport capacity increased lymph production combination of above

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243
Q

Lymphedema: primary disease

A

result of inadequately developed lymphatic pathways

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244
Q

Lymphedema: secondary disease

A

due to damage outside of pathways

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245
Q

Lymphedema: process

A

worsened and complicated as macrophages are released to control inflammation caused by increased release of fibroblasts and keratinocytes gradual increase in adipose tissue and leakage of lymph through the skin

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246
Q

Lymphedema: skin

A

skin and tissue thicken and change in color, texture,tone and temperature begins to blister and produce hyperkeratosis, warts, papillomatosis and elephantiasis

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247
Q

Lymphedema:risks

A

infection further complications

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248
Q

Lymphedema: hyperkeratosis

A

a thickening of the outer layer of the skin. this outer layer contains a tough, protective protein called keratin.

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249
Q

Lymphedema: papillomatosis

A

skin surface elevation caused by hyperplasia and enlargement of contiguous dermal papillae

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250
Q

Complementary and alternative medicine: reasons for

A

focus on ways to improve overall health reduce side effects of medical treatments improve quality of life

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251
Q

Complementary and alternative medicine: benefits

A

patients feel more in control than medical treatments interventions can help alleviate feelings of helplessness or hopelessness

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252
Q

Complementary and alternative medicine: allows patients to feel

A

they are taking an active role in their care

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253
Q

Complementary and alternative medicine: exploration

A

evolve from suggestions from friends and family philosophical and cultural factors may also come into play

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254
Q

Complementary and alternative medicine: desire

A

“tried everything” hoping to alter course of disease progression

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255
Q

Complementary and alternative medicine: mistrust

A

mistrust or lack of faith in traditional medical treatments

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256
Q

Complementary and alternative medicine: desire

A

to treat disease in more “natural” ways

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257
Q

Complementary and alternative medicine: costs

A

patient may feel: less expensive more accessible

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258
Q

Stomatitis: definition

A

inflammation of oral cavity lips tongue mucous membrances

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259
Q

Stomatitis: inflammation common cause

A

viral infections chemical irradiation chemotherapy radiation therapy mouth breathing medication s/e paralysis of nerves supplying oral cavity

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260
Q

Stomatitis: inflammation irritation or trauma causes

A

sun damage irritation from foreign bodies

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261
Q

Stomatitis: inflammation caused by tubes

A

nasal catheters used for oxygen and nutritional therapies endobronchial tubes inserted for surgery

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262
Q

Stomatitis: inflammation dental appliances

A

ill fitting dental appliances can also cuse irritation

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263
Q

Stomatitis: s/s: patient’s complaints

A

oral pain with eating or drinking difficulty swallowing

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264
Q

Stomatitis: s/s: physical

A

bad breath oral lesions or ulcers swollen cervical lymph nodes possible fever mucous membranes that are easily damaged

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265
Q

Stomatitis: treatment

A

depends on identifying and treating the underlying cause as well as comfor measures for symptomatic complaints

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266
Q

Stomatitis: treatment:mucous membranes

A

need to be kept moist and clear from secretoins

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267
Q

Stomatitis: treatment: oral care

A

careful oral care, including flossing and ongoing assessments for areas of damage, needs to be provided

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268
Q

Stomatitis: treatment: irritating items

A

should be removed or carefully maintained

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269
Q

Stomatitis: treatment:analgesics

A

systemic and topical analgesics can be used

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270
Q

Intractable hiccups: cause

A

phrenic nerve or diaphragmatic irritation distention of stomach chest or abdominal surgery metabolic disorder: hyponatremia intracerebral lesions

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271
Q

Intractable hiccups: defintion

A

spasmodic closure of the glottis at varying intervals results in intermittent lowering of diaphragm which causes sharp inspiration and a correspoinding sound

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272
Q

Intractable hiccups: medication

A

chlorpromazine

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273
Q

Intractable hiccups: chlorpromazine dose

A

25 mg PO or rectum 1 tab, 3 x day

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274
Q

Intractable hiccups: irritation causes

A

chemical mechanical neruological

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275
Q

Intractable hiccups: anesthetization

A

in extreme cases anesthetization of phrenic nerve may be needed

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276
Q

Ascites: types

A

central mixed types both associated with renal sodium and water retention

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277
Q

Ascites; associated with

A

renal sodium and water retention

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278
Q

Ascites: treatment of fluid retention

A

restricted sodium and fluid intake diuretics

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279
Q

Ascites: diuretics

A

spironolactone (preferred) furosemide

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280
Q

Ascites: spironolactone

A

100 - 400 mg/day

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281
Q

Ascites: furosemide

A

40 - 80 mg/day be careful not to remove more fluid than is beneficial

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282
Q

Ascites: furosemide: dehydration

A

can lead to : electrolyte imbalances hepatic encephalopthy prerenal failure

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283
Q

Ascites: mixed type: dietary changes

A

decreased fat intake increased medium-chain triglycerides sorter fatty acid chains may be easier to digest

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284
Q

Ascites: refractory

A

those with shortened life expectancy can benefit from use of paracentesis

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285
Q

Ascites: tense ascites

A

associated with cirrhosis or nonmalignant ascites paracentesis may be helpful a

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286
Q

Ascites: paracentesis: fluid removal

A

4-6 liters per day has been deemed safe and effetive

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287
Q

Ascites: paracentesis: albumin infusion

A

to prevent hypovolemia and renal impairment

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288
Q

Ascites: peritoneovenous shunts

A

Denver or LeVeen helpful for 75% to 85 5 of paitents with nonmalignant ascites

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289
Q

Ascites: nursing interventions: comfort

A

pillow supports loose clothing

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290
Q

Ascites: nursing interventions

A

fluid and sodium restrictions may help reduce severity

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291
Q

Ascites: nursing interventions: education

A

diet parameters expected outcomes for improved quality of life

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292
Q

Ascites: patient’s difficult cycle

A

thirst, hydration, and increased discomfort

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293
Q

Ascites:nursing skills

A

good assessments skin care to monitor and prevent skin breakdown

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294
Q

Ascites: recurring

A

may require repeated paracentesis

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295
Q

Ascites: paracentesis: risk

A

help patient recognizethe risk and benefit ratio of repeated paracentesis may become necessary

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296
Q

Depression: s/s

A

depressed mood insomnia or hypersomnia absence of pleasure in previously enjoyed activities psychomotor retardation fatigue feelings or worthlessness and guilt inability to concentrate, make decisions, or remember important information unexplained weight loss or gain thoughts of death or suicide

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297
Q

Depression: severity

A

assigned by presence of an expressed intent with a plan and means to carry out a suicide attempt, as well as previous attempts

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298
Q

Depression: hallmark s/s

A

changes in appetite and sleep decreased energy and concentration

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299
Q

Depression: physical illness

A

s/s can be masked or created by disease process or its treatments

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300
Q

Depression with preexisting illness: predictable s/s

A

fearfulness depressed or changed appearance social withdrawal brooding self-pity and pessimism depressed mood or affect that can’t be changed or lifted

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301
Q

Status epilepticus: definition

A

seizure lasting longer than 5 minutes state or repeated seizures without subsequent return to consciousness or return of normal brain function between each separate episode

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302
Q

Status epilepticus: considered to be

A

neuro-oncological emergency

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303
Q

Status epilepticus: treatment

A

maintaining a clear airway protecting patient from eminent harm administering medication to resolve episode

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304
Q

Status epilepticus: assess

A

for adequate patient perfusion

305
Q

Status epilepticus: give

A

flucose solutoin

306
Q

Status epilepticus: evaluate

A

electrolytes

307
Q

Status epilepticus: administer

A

IV benzodiazepines followed by IV phenytoin

308
Q

Status epilepticus: 1st choice medication

A

lorazepam

309
Q

Status epilepticus: 2nd choice medication

A

phenytoin ( Dilantin) ] fosphenytoin (Cerebyx)

310
Q

Status epilepticus: extreme medication to control seizure activity

A

barbiturates anesthesia neuromuscular blocks propofol

311
Q

Active seizure: medications

A

diazepam lorazepam midazolam phenytoin phenobarbital

312
Q

Active seizure: first line of defense

A

lorazepam, prn

313
Q

Active seizure: lorazepam: route

A

IV in solution of intensol sublingually

314
Q

Active seizure: medication chosen based on

A

drug availability practitioner knowledge and comfort base delivery routes available with patient

315
Q

Active seizure: IM medication

A

diazepam (Valium) phenobarbital (Luminal)

316
Q

Active seizure: diazepam route

A

IM rectal gel

317
Q

Active seizure: phenobarbital: route

A

IM parenteral solution oral and rectal administration

318
Q

Active seizure: fosphenytoin: route

A

subcutaneous has greater cost

319
Q

Active seizure: phenytoin IV: complications

A

“purple glove syndrome” edema discoloration pain

320
Q

Purple glove syndrome: s/s

A

edema discoloration pain

321
Q

Purple glove syndrome: medication

A

IV phenytoin

322
Q

Dyspnea: risk factors

A

structural deviations anemia cachexia dehydration dry mucous membranes thick secretions causing mucus plugs ascites fever heart failure immobility obesity surgery lung disease aspiration deep vein thrombosis pulmonary embolism

323
Q

Dyspnea: structural deviations

A

decrease in skeletal muscle barrel chest increased anteroposterior chest wall diameter with decreased chest wall elasticity decrease in alveoli elasticity

324
Q

Dyspnea: fever

A

risk factor fever with a reduced immune and febrile response

325
Q

Dyspnea: surgery

A

risk factor stomach pelvic chest

326
Q

Dyspnea: structural deviations: breathing

A

Increase work of breathing while decreasing the maximum volume expiration and vital capacity

327
Q

Agitation; non-pharmacological intervention: most effective

A

maintain or creating a calm, familiar environment with restricted stimulation

328
Q

Agitation; non-pharmacological intervention: furnishing and decroations

A

should be minimal and soothing in nature

329
Q

Agitation; non-pharmacological intervention: reorient and calm with

A

supportive listening composed affect calm, gentle, respectful tone of voice

330
Q

Agitation; non-pharmacological intervention: calming effect

A

consistent reorientation to patent’s surroundings well-established routines

331
Q

Agitation; non-pharmacological intervention: music

A

offered in soft soothing tones

332
Q

Agitation; non-pharmacological intervention: family member

A

presence of a calming, familiar and respected family member can provide for agitation reduction

333
Q

Agitation; non-pharmacological interventions

A

calm familiar environment furnishings and decorations minimal supportive listening composed affect respectful tone of voice music family member

334
Q

Ileus: definition

A

cessation of peristalsis

335
Q

Ileus: pain

A

ileus itself is generally painless

336
Q

Ileus: loss of forward motion results in

A

intestinal obstruction abdominal cramps constipation fecal vomiting abdominal distention atrophy or collapse of surrounding intestines

337
Q

Ileus: causes

A

operative anesthesia medications for pain control

338
Q

Ileus: postoperative ileus prevention

A

early ambulation and other activity use of non-opioids to control pain encourage oral intake

339
Q

Ileus: postoperative: oral intake

A

should be encouraged even prior to presence of bowel sounds

340
Q

Ileus: postoperative: resolve

A

may resolve itself withing 2-3 days with activity and oral intake

341
Q

Ileus: postoperative: monitor

A

fluid and electrolyte imbalances blood pressure changes changes in abdominal firth

342
Q

Ileus: postoperative: decompression

A

colonoscopy or rectal tube may aid in decompression

343
Q

Elderly: delirium: causes

A

age-related changes within brain visual changes hearing loss prolonged immobility Foley catheters, IV infections metabolism changes polypharmacy malnutrition disease

344
Q

Elderly: delirium: age-related changes within brain

A

atrophy plaque formation disorders in hippocampus, amygdala or thalamus Alzheimer’s cerebrovascular disease

345
Q

Elderly: delirium: Infections

A

pulmonary urinary tract

346
Q

Elderly: delirium: metabolism changes

A

chemical buildup reduction of protein binding of drugs enhanced effects of opioids reduced ability to eliminate drugs

347
Q

Elderly: delirium: malnutrition

A

decreased vitamin or folate deficiencies reduced thirst with fluid and electrolyte imbalances and hypovolemia

348
Q

Elderly: delirium: diseases

A

cancer cardiovascular pulmonary renal hepatic endocrine

349
Q

BREATHES

A

B = bronchospasm R = rales/crackles E = effusion A = airway obstruction T = tachypnea and breathlessness H = hemoglobin E = Education S = secretions

350
Q

BREATHES: bronchospasm

A

consider use of albuterol nebulizers and/or steroids

351
Q

BREATHES: : rales/crackles

A

fluid intake should be reduced by fluid restriction and D/C IV therapy furosemide 20-40 mg/day spironolactone 100 mg/day

352
Q

BREATHES: effusion

A

determine presence of pleural effusion by physical examination and chest x-ray Tx: thoracentesis or chest tube

353
Q

BREATHES: airway obstruction

A

assess for aspiration risk provide preventative measures such as pureed meals, thickened liquids, and keeping patient upright during and after meals

354
Q

BREATHES: tachypnea and breathlessness

A

opioid use may reduce respiratory rate and create feelings of breathlessness and anxiety assess medications frequently treat anxiety provide cool, moving air

355
Q

BREATHES: hemoglobin

A

if low, consider blood transfusion

356
Q

BREATHES: education

A

educate and support the patient and family

357
Q

BREATHES: secretions

A

if secretions are copious, provide pharmacological treatment

358
Q

haloperidol (Haldol): classification

A

anti-psychotic antiemetic

359
Q

haloperidol (Haldol): action

A

blocks post-synaptic dopamine receptors in brain

360
Q

haloperidol (Haldol): most appropriate

A

drug for agitation associated with physical harm by the patient to self or others and/or psychotic tendencies

361
Q

haloperidol (Haldol): nausea

A

useful for opioid induced, chemical and mechanical sources of nausea especially anxiety when aggravating symptoms

362
Q

haloperidol (Haldol): used with corticosteriods

A

helpful for chemotherapy induced nausea and vomiting

363
Q

haloperidol (Haldol): oral dose

A

0.5 - 5 mg PO q 6-24 hours

364
Q

haloperidol (Haldol): IM dose

A

5 mg q 3-4 hours

365
Q

haloperidol (Haldol): IV dose

A

0.5 - 2 mg q 3-4 hours

366
Q

haloperidol (Haldol): elderly patients

A

require lower initial dose more gradual dose titration

367
Q

haloperidol (Haldol): S/E

A

prolonged and involuntary contraction of muscles restricted ability to control muscle movement actual loss of muscle movement

368
Q

haloperidol (Haldol): S/E: minimized

A

by use of low dose

369
Q

haloperidol (Haldol): additive effect

A

when combined with other CNS depressants

370
Q

Artificial hydration: starting vs. ending

A

decision to begin is easier than to stop

371
Q

Artificial hydration: termination

A

problematic and emotional decision must be reached without patients’s direct input

372
Q

Artificial hydration: initiate

A

made ahead of perceived crisis

373
Q

Artificial hydration: declining to initiate

A

psychological weight of death is not as pronounced

374
Q

Artificial hydration: religious view

A

no difference between withholding and withdrawal of hydration measures as it affects individual’s life and impending death

375
Q

Artificial hydration: cristeria

A

overall effect on quality of life patient’s wish and goal for end of life discomforting s/s that may be aggravated by hydration effects of hydration on patient’s LOC

376
Q

Artificial hydration: limitations

A

consider hydration limitations on: patient’s well-being mobility interactions stress levels finances

377
Q

Pneumocystis carinii pneumonia: definition

A

opportunistic infection common cause of pulmonary disease in patients with HIV infection

378
Q

Pneumocystis carinii pneumonia:: treatment

A

trimethoprim-sulfamethoxazole (TMP-SMX)

379
Q

Pneumocystis carinii pneumonia: combination medication

A

trimethoprim-sulfamethoxazole and corticosteroids survival rate and treatment outcomes greatly improved

380
Q

Pneumocystis carinii pneumonia: second line therapy medications

A

pentamidine clindamycin

381
Q

trimethoprim-sulfamethoxazole (TMP-SMX)

A

initial therapy of Pneumocystis carinii pneumonia used with corticosteroids used prophylaxis for patients with AIDS

382
Q

trimethoprim-sulfamethoxazole (TMP-SMX): prophylaxis treatment

A

can begin in presence of a CD 4 + count of less than 200 or oropharyngeal candidiasis

383
Q

Angiogenesis: definition

A

normal physiological process in which new blood vessels grow from preexisting vessels

384
Q

Angiogenesis: wound healing

A

normal part of wound healing

385
Q

Angiogenesis: tumors

A

key component in creating tumors that mutate from a benign state to a malignant state

386
Q

Angiogenesis: types

A

sprouting intussusceptive therapeutic

387
Q

Angiogenesis: sprouting

A

sends proliferating endothelial cells out from the tumor, acting like roots, trying to capture new areas for cell growth

388
Q

Angiogenesis: intussesceptive

A

identified as “splitting” original capillary walls split into two, forming new, separate cells

389
Q

Angiogenesis: therapeutic

A

body’s natural defenses in order to help combat disease or tissue repair

390
Q

Angiogenesis: tumors use for

A

to expand and spread in the process of metastasis

391
Q

Angiogenesis: research

A

expects to identify ways to inhibit this process in the tumor cells

392
Q

Chemotherapy: symptoms

A

not every patient will experience every symptom, or in same degree S/E can vary greatly some can be controlled with medications

393
Q

Chemotherapy: S/E due to

A

effects of chemotherapy on cells which have a rapid mitotic rate and rapid turn over bone marrow hair gastrointestinal

394
Q

Chemotherapy: common S/E: bone marrow

A

bone marrow suppression anemia infection increased bruising and bleeding

395
Q

Chemotherapy: common S/E: gastrointestinal

A

mouth ulcers sore throat and gums heartburn nausea and vomiting loss of apetite loss of weight anorexia cachexia

396
Q

Chemotherapy: common S/E: other

A

nerve and muscle problems dry or discolored skin bladder irritation fatigue i

397
Q

Chemotherapy: common S/E: sexual function

A

can also be affected possible infertility

398
Q

Azotemia: sign of

A

renal failure

399
Q

Azotemia: definition

A

represents abnormal levels of nitrogen-based compounds such as urea, and creatinine within the blood

400
Q

Azotemia: build up

A

caused by insufficient filtering through the kidneys

401
Q

Azotemia: prerenal

A

results from a lack of blood flow to the kidneys for filtering

402
Q

Azotemia: postrenal

A

results from obstructed urinary flow

403
Q

Azotemia: diseases which cause

A

CHF shock severe burns extensive vomiting and diarrhea liver failure trauma to kidneys

404
Q

Azotemia: medications which cause

A

antiviral medications

405
Q

Azotemia: s/s

A

decreased urine output fatigue confusion or decreased awareness pale skin rapid pulse dry mouth c/o thirst edema orthostatic blood pressure

406
Q

Azotemia: treatments

A

hemodialysis peritoneal dialysis

407
Q

CHF: definition

A

inability of heart to function properly right ventricle, left ventricle or both

408
Q

CHF: most common cause

A

coronary artery disease

409
Q

CHF: s/s

A

weight gain peripheral edema in feet and ankles nocturia decreased urine output shortness of breath & nocturnal dyspnea wheezing cough distended neck veins heart palpitations or irregular heart beat anxiety restlessness cyanosis or pallor fatigue weakness fainting

410
Q

CHF: auscultation of heart

A

heart murmurs extra heart sounds

411
Q

CHF: auscultation of lungs

A

crackles in lungs decreased breath sounds

412
Q

CHF: liver

A

enlarged liver

413
Q

CHF: disease process

A

may be silent

414
Q

CHF: manifest during times of

A

infection with high fever anemia arrhythmias hyperthyroidism kidney disease

415
Q

Neutropenia: defintion

A

small number of neutrophils (most common type of WBC) in blood

416
Q

Neutropenia: lab number

A

identified as a polymorphonuclear neutrophil count equal to or less than 500/ml

417
Q

Neutropenia: chronic

A

is a sustained condition of minimal neutrophils lasting 3 months or more

418
Q

Neutropenia: cause

A

chemotherapy or radiation therapy autoimmune disease

419
Q

Neutropenia: silent

A

but dangerous

420
Q

Neutropenia: results in

A

no neutrophils to fight any threat of infection

421
Q

Neutropenia: neutrophils

A

make up as much as 70% of WBC circulating in bloos

422
Q

Neutropenia: complications

A

septic situation, life threatening

423
Q

Neutropenia: neutropenic state

A

up to 70% of patients experiencing a fever will die within 48 hours if not treated aggressively

424
Q

Anti-emetics: 10 classes of medication

A

butyrophenones prokinetic agents cannabinoids phenothiazines antihistamines anticholinergics steroids benzodiazepines 5-HT 3 receptor antagonists somatostatin

425
Q

Anti-emetics: butyrophenones medications

A

haloperidol droperidol

426
Q

Anti-emetics: butyrophenones: used for

A

nausea induced by opioid chemical mechanical

427
Q

Anti-emetics: prokinetic agents: medications

A

metoclopramide domperidone

428
Q

Anti-emetics: prokinetic agents; used for

A

gastric stasis and ileus

429
Q

Anti-emetics: cannabinoids: medications

A

dronabinol

430
Q

Anti-emetics: cannabinoids: used for

A

second defense anti-emetics that are more effective in young adults

431
Q

Anti-emetics: phenothiazines: medications

A

prochlorperazine thiethylperazine trimethobenzamide

432
Q

Anti-emetics: phenothiazines: used for

A

generally used for nausea and vomiting

433
Q

Anti-emetics: antihistamines

A

diphenhydramine cyclizine dimenhydrinate

434
Q

Anti-emetics: antihistamines: diphenhydramine and cyclinzine:used for

A

intestinal obstruction peritoneal irritation increased secretions increased ICP

435
Q

Anti-emetics: anticholinergics: medication

A

scopolamine

436
Q

Anti-emetics: anticholinergics: used for

A

intestinal obstruction peritoneal irritation increased secretions increased ICP

437
Q

Anti-emetics: steroids: medications

A

dexamethasone

438
Q

Anti-emetics: steroids: used for

A

can be used alone or as an adjuvant therapy

439
Q

Anti-emetics: benzodiazepines: medications

A

lorazepam

440
Q

Anti-emetics: benzodiazepines: used for

A

nausea and vomiting associated with anxiety

441
Q

Anti-emetics: 5 HT 3 receptors: medication

A

ondansetron granisetron

442
Q

Anti-emetics: 5 T 3: receptors: used for

A

chemotherapy radiation therapy postoperative nausea and vomiting

443
Q

Anti-emetics: somatostatin: medication

A

octreotide acetate

444
Q

Anti-emetics: somatostatin: used for

A

intestinal obstruction

445
Q

Anti-emetics: antihistamine: dimenhydrinate: used for

A

used for nausea and vomiting associated with dizziness and motion sickness

446
Q

Sickle cell disease: prevelance

A

most common genetic diseases in US

447
Q

Sickle cell disease: affects

A

African Middle Eastern Mediterranean Indian

448
Q

Sickle cell disease: identified by

A

abnormal globulin gene that allows hemoglobin S to form a “sickle” shape rather than round

449
Q

Sickle cell disease: “sickle” shape

A

shortens lifespan of hemoglobin, causing chronic anemic state

450
Q

Sickle cell disease: s/s

A

pallor jaundice weakness fatigue

451
Q

Sickle cell disease: crisis occurs

A

when cells clump together

452
Q

Sickle cell disease: crisis: causes

A

thrombi vascular occlusions hypoxia myocardial infarction

453
Q

Sickle cell disease: associated with

A

multiple acute pain events

454
Q

Sickle cell disease: pain episodes

A

individualized vary in frequency and severity

455
Q

Sickle cell disease: pain episodes: s/s

A

pale lips,m tongue, palms or nail beds lethargy and difficulty awakening listlessness irritability severe pain high fever for at least 2 days

456
Q

Sickle cell disease: patient at risk for

A

bacterial infections

457
Q

Sickle cell disease: children

A

generally hospitalized less than 6 times a year

458
Q

Sickle cell disease:patient > 20 years

A

hospitalized more than 3 times a year may be an indication of impending death

459
Q

Asthenia: etymology

A

from Greek “athenes”, without strength

460
Q

Asthenia: medical term

A

for debilitating feeling of weakness without an actual loss of muscle strength

461
Q

Asthenia: weakness

A

may be muscle-group specific or affect entire body

462
Q

Asthenia: vs. actual muscle weakness

A

distinguishing between can sometimes be difficult asthenia progresses towards muscle weakness in presence of chronic disease

463
Q

Asthenia: most common among patients with

A

chronic fatigue syndrome sleep disorders chronic heart disease chronic lung disease chronic adrenal disease chronic kidney disease cancer anemia

464
Q

Asthenia: cause

A

Addison disease anemia anxiety chemotherapy chronic pain dehydration and electrolyte imbalances depression diabetes heart disease infections medications, including narcotics paraneoplastic syndrome

465
Q

Cystic Fibrosis: definition

A

genetic disease eventually fatal

466
Q

Cystic Fibrosis: child

A

care during lifetime of child is focused on preventative measures to avoid disease complications therapeutic care for lung disease progression and palliative care for symtom management are provdied

467
Q

Cystic Fibrosis: symptoms: body locations

A

lungs pancreas urogenital skeleton skin

468
Q

Cystic Fibrosis: lungs

A

COPD lung infections

469
Q

Cystic Fibrosis: pancreas

A

deficient pancreatic enzymes

470
Q

Cystic Fibrosis: skeleton

A

osteoporosis

471
Q

Cystic Fibrosis: skin

A

sweat that shows a high electrolyte concentration

472
Q

Cystic Fibrosis: complications: respiratory

A

nasal polyposis (multiple polyps) bronchiectasis (chronic dilation of bronchus) bronchitis pneumonia respiratory failure

473
Q

Cystic Fibrosis: complications: GI

A

gallbladder disease intussusception (slipping of one part of an intestine into another part just below it) meconium ileus salt depletion nutritional malabsorption pancreatitis peptic ulcer rectal prolapse

474
Q

Cystic Fibrosis: complications: children

A

delayed puberty

475
Q

Cystic Fibrosis: complications: disease process

A

diabetes failure to thrive arthritis

476
Q

Cystic Fibrosis: medical research

A

continues to make progress extending life of children into 20s, 30s, and occasionaly into 40s

477
Q

Cystic Fibrosis: treatments

A

control and prevention of infection excessive secretions pulmonary complications dietary monitoring

478
Q

megestrol acetate: definition

A

progestin and antineoplastic

479
Q

megestrol acetate: route

A

tablets oral suspension

480
Q

megestrol acetate: used for

A

breast and endometrial cancers appetite stimulant

481
Q

megestrol acetate: breast cancer dose

A

40 mg PO 1 tab 4 x day

482
Q

megestrol acetate: endometrial cancer

A

up to 320 mg PO in evenly divided doses

483
Q

megestrol acetate: weight loss

A

400 mg P 1 tab 2 x day

484
Q

megestrol acetate: highest level given

A

800 mg per day

485
Q

megestrol acetate: S/E

A

increased appetite fluid retention occasionally nausea

486
Q

megestrol acetate: nausea

A

will resolve itself within the first few weeks of taking the medication

487
Q

megestrol acetate: rare allergic reactions

A

jaundice elevated blood pressure

488
Q

Bates-Jensen wound assessment tool: rates

A

various aspects of wound on a scale

489
Q

Bates-Jensen wound assessment: higher score

A

more severe the nature of the wound

490
Q

Bates-Jensen wound assessment: size

A

measured in centimeters multiplying length by width

491
Q

Bates-Jensen wound assessment: depth

A

1 - 5 1 = noting tissue damage with intact skin covering 5 = involving supporting structures such as tendon and joint capsule

492
Q

Bates-Jensen wound assessment: edges

A

indistinct attached not attached rolled under hyperkeratosis (callous-like) fibrotic

493
Q

Bates-Jensen wound assessment: measures

A

size depth edges undermining necrotic tissue type necrotic tissue amount exudate exudate amount color of surrounding tissue presence of edema and pitting epithelialization

494
Q

Bates-Jensen wound assessment: undermining

A

tip of cotton applicator around edges of wound to identify how far the wound extends under the visible edges

495
Q

Bates-Jensen wound assessment: necrotic tissue type

A

white/gray nonviable non-adherent yellow slough loosely adherent yellow slough adherent soft black eschar firmly adherent hard/black eschar

496
Q

Bates-Jensen wound assessment: amount of necrotic tissue

A

1 = none visible to 5 = 75% to %100 of wound covered

497
Q

Bates-Jensen wound assessment: exudate type

A

bloody serosanguineous serous purulent foul purulent

498
Q

Bates-Jensen wound assessment: exudate amount

A

none scant small moderate large

499
Q

Bates-Jensen wound assessment: color of surrounding tissue

A

pink or normal for ethnic group bright red and/or blanches to touch white or grey pallor or hypo-pigmented dark red or purple and /or non-blanchable black or hyperpigmented

500
Q

Bates-Jensen wound assessment: peripheral tissue edema and pitting

A

none to crepitus and/or pitting edema extends > 4 com around wound

501
Q

Bates-Jensen wound assessment: epithelialization

A

100% wound covered, surface intact to <25% wound covered

502
Q

Bates-Jensen wound assessment: granulation

A

skin intact or partial thickness wound to no granulation tissue present

503
Q

Most common infection in hospice patients

A

pneumonia patients are greatly hindered in physical activity by disease process

504
Q

Pneumonia: immune systems

A

compromised

505
Q

Pneumonia: complication of AIDS

A

pneumocystis carinii 85% of AIDS patients will develop

506
Q

Pneumonia: pneumocystis: treatment

A

trimethoprim-sulfamethoxazole

507
Q

Pneumonia: trimethoprim-sulfamethoxazole

A

used prophylactically first drug of choice

508
Q

Pneumonia: s/s

A

fever dyspnea cough

509
Q

Pneumonia: vaccination

A

recommended for palliative care patients

510
Q

Fever: common causes: minor

A

constipation dehydration

511
Q

Fever: common causes: immunosuppressed patient

A

fresh fruits vegetables spices flowers tobacco

512
Q

Fever: common causes: cancers

A

Hodgkin and non-Hodgkin lymphoma hypernephroma carcinoma of liver leukemia multiple myeloma Ewing sarcoma adrenal carcinoma obstructive tumors

513
Q

Fever: common causes: obstructive tumors

A

thermoregulatory gastrointestinal genitourinary respiratory

514
Q

Fever: common causes: misc

A

neutropenia immunosuppression chemotherapeutic agents blood products infections inflammatory processes autoimmune allergic responses environmental agents

515
Q

Fever: common causes: inflammatory process

A

thrombophlebitis trauma necrosis pulmonary embolism ulcerative colitis

516
Q

Fever: common causes: auotimmune

A

lupus rheumatoid arthritis AIDS medication based

517
Q

Chemotherapy: concern

A

infection because of the decreased numbe rof neutrophils in patient’s system

518
Q

Chemotherapy: neutropenia

A

silent but dangerous leaving no neutrophils to fight the threat ofinfections

519
Q

Chemotherapy: neutropenia: causes

A

septic situation, which can be life-threatneing

520
Q

Chemotherapy: anemia

A

may result in need for blood transfusion

521
Q

Chemotherapy: neurological damage

A

mild alterations in taste or smell peripheral neuropathy mental status changes seizures

522
Q

Chemotherapy: heart damage

A

some anticancer drugs can cause heart damage

523
Q

Chemotherapy: kidney

A

anticancer drugs may cause: kidney damage increasing risk of drug toxicity from decreased renal function

524
Q

Chemotherapy: eye damage

A

cataracts retina damage

525
Q

Chemotherapy: complications

A

neutropenia anemia neurological damage heart damage kidney damage eye damage

526
Q

Chemotherapeutic agents

A

alkylating agents nitrosoureas antimetabolites anti-tumor antibiotics plant (vinca) alkaloids steroid hormones

527
Q

Chemotherapeutic agents: alkylating agents:MOA

A

work directly by acting the DNA of cancers

528
Q

Chemotherapeutic agents: alkylating agents: used for

A

chronic leukemia Hodgkin disease lymphomas lung breast prostate ovary

529
Q

Chemotherapeutic agents: nitrosoureas: MOA

A

inhibit repair in damaged DNA able to cross blood brain barrier

530
Q

Chemotherapeutic agents: nitrosoureas: used for

A

brain tumor lymphomas multiple myeloma malignant melanoma

531
Q

Chemotherapeutic agents: antimetabolites:MOA

A

block cell growth

532
Q

Chemotherapeutic agents: antimetabolites: used for

A

leukemia choriocarcinoma (rare, uterus, ectopic) gastrointestinal breast ovary

533
Q

Chemotherapeutic agents: anti-tumor: MOA

A

bind to DNA and prevent RNA synthesis

534
Q

Chemotherapeutic agents: anti-tumor: used for

A

wide variety of concers

535
Q

Chemotherapeutic agents: plant (vinca) alkaloids: MOA

A

extracted from plants and blockcell division

536
Q

Chemotherapeutic agents: plant (vinca) alkaloids: used for

A

acute lymphobastic leukemia Hodgkin and non-Hodgkin lymphomas neuroblastomas Wilms tumor lung breast testes

537
Q

Chemotherapeutic agents: steroid hormones: MOA

A

unclear action

538
Q

Chemotherapeutic agents: steroid hormones: used for

A

hormone-dependent cancers ovary breast

539
Q

expressive aphasia: known as

A

Broca aphasia

540
Q

expressive aphasia: definition

A

patients able to understand what is being said to them and know what they want to say, but are unable or limited in ability to speak

541
Q

expressive aphasia: example

A

Yes… ah… Monday… er… Dad and Peter H… (his own name), and Dad…. er… hospital… and ah… Wednesday… Wednesday, nine o’clock… and oh… Thursday… ten o’clock, ah doctors… two… an’ doctors… and er… teeth… yah

542
Q

expressive aphasia: therapeutic comminication

A

provide an unhurried and attentive atmosphere remove distractions and external stimulus speak in normal tone using simple, direct phrasing communication board allow patients to show thoughts, rather than speak eye blinking

543
Q

expressive aphasia: helpful tool

A

communication board

544
Q

expressive aphasia: eye blinking

A

eye blinking responses to simple yes/no types of questions used when patient maintains comprehension, but has extremely limited neuromuscular function

545
Q

Cancer: patient top two complaints

A

fatigue anorexia and cachexia

546
Q

Cancer: common complaints

A

fatigue anorexia nausea constipation states of delirium dyspnea

547
Q

Cancer: fatigue: s/s

A

tiredness lack of energy not related to amount of rest diminished mental capacity weakness

548
Q

Cancer: fatigue: complications

A

interfere with ability to perform ADLs often undiagnosed or downplayed

549
Q

Cancer: anorexia and cachexia: treatment

A

careful nutritional management

550
Q

Cancer: nausea and constipation: treatment

A

easily treated if assessed and planned for

551
Q

Cancer: altered mental states and dyspnea

A

easily treated if assessed and planned for

552
Q

Chemotherapy: routes

A

orally intramuscular subcutaneously IV intra-arterially intralesionally (directly into tumor) intraperitoneally intrathecally (arachnoid membrane which covers the brain and spinal cord) topically

553
Q

Chemotherapy: oral

A

easiest and often used in home

554
Q

Chemotherapy: IV

A

most common route

555
Q

Chemotherapy: IM

A

may have more lasting effects

556
Q

Chemotherapy: intra-arterial

A

goal is to introduce agent directly into blood supply feeding tumor or affected organ

557
Q

Chemotherapy: intraperitoneal

A

used for ovarian cancer with tumors greater than 2 centimeters in diameter

558
Q

Chemotherapy: intrathecal

A

used for acute lymphocytic leukemia

559
Q

Chemotherapy: intralesional

A

used for melanoma and Kaposi sarcoma

560
Q

Chemotherapy: topical

A

used for skin cancer

561
Q

Dementia: patients should have

A

minimal stimulation simple and consistent routines

562
Q

Dementia: communication

A

straightforward uncomplicated words and explanations

563
Q

Dementia: high priority

A

patient safety

564
Q

Dementia: patient clothing and foot wear

A

well fitting

565
Q

Dementia: environment

A

uncluttered unchanging free from hazards

566
Q

Dementia: environmental hazards

A

dimly lit areas open flames sharp corners loose area rugs

567
Q

Dementia: supervision

A

requires close supervision

568
Q

Dementia: sleeping

A

discouraged from sleeping during daytime hours to avoid time disorientation and to maximize nighttime restfulness and safety

569
Q

Dementia: medications

A

donepezil tacrine ginkgo biloba

570
Q

Dementia: interventions

A

well-fitting clothing and footwear safe environment close supervision sleeping medications

571
Q

Depression: chemically induced: results from

A

introduction of substance withdrawal from substance

572
Q

Depression: chemically induced: worsening

A

preexisting depression can be worsened in presence of these substances

573
Q

Depression: chemically induced: everyday substances

A

alcohol and analgesics are known to increase depression

574
Q

Depression: chemically induced: withdrawal from alochol

A

associated with: vague feelings of unease discomfort dread associated with depression and anxiety

575
Q

Depression: chemically induced: medications which cause

A

hypoglycemic agents steroids chemotherapy antimicrobial L-dopa antihypertensives antiparkinsonian oral contraceptives estrogen and progesterone therapy benzodiazepines phenothiazines amphetamines lithium carbonate heavy metals cimetidine

576
Q

Cancer related fatigue: cause

A

physiologic psychological

577
Q

Cancer related fatigue: may be related to

A

depression pain anemia r/t iron deficiency sleeping disorders fluid and electrolyte imbalances hypocalcemia hypothyroidism hypoxia infection overmedicating

578
Q

Cancer related fatigue: disorders

A

metabolic neurological

579
Q

Cancer related fatigue: mood disorders

A

unresolved anxiety or fears concerning disease process or treatments

580
Q

Cancer related fatigue: stress

A

overall change and increase in amount of stress experienced can lead to fatiguein

581
Q

Cancer related fatigue: impaired thinking

A

can cause confusion around timing of the day and need for active rest

582
Q

Cancer related fatigue: treatment strategies

A

focus on finding and resolving the underlying cause for fatigue

583
Q

Fatigue: medications

A

methylprednisolone methylphenidate modafinil hydrocortisone erythropoietin alpha (epoetin alfa) antidepressants dextroamphetamines

584
Q

Fatigue: medications: methylprednisolone

A

increases patient activity

585
Q

Fatigue: medications: methylphenidate: improves in cancer patients

A

pain relief somnolence

586
Q

Fatigue: medications: methylphenidate: reduces and increases

A

fatigue and increases cognitive function when combined with exercise

587
Q

Fatigue: medications: methylphenidate: staminia

A

increases stamina and energy

588
Q

Fatigue: medications: methylphenidate: therapeutic effects

A

for major depressive disorders and improves overall mood

589
Q

Fatigue: medications: modafinil

A

can be used with MS to reduce fatigue

590
Q

Fatigue: medications: MS

A

modafinil histamine phosphate/caffeine citrate transdermal patch

591
Q

Cancer related fatigue: treatment strategies

A

focus on finding and resolving the underlying cause for fatigue

592
Q

Fatigue: medications

A

methylprednisolone methylphenidate modafinil hydrocortisone erythropoietin alpha (epoetin alfa) antidepressants dextroamphetamines

593
Q

Fatigue: medications: methylprednisolone

A

increases patient activity

594
Q

Fatigue: medications: methylphenidate: improves in cancer patients

A

pain relief somnolence

595
Q

Fatigue: medications: methylphenidate: reduces and increases

A

fatigue and increases cognitive function when combined with exercise

596
Q

Fatigue: medications: methylphenidate: staminia

A

increases stamina and energy

597
Q

Fatigue: medications: methylphenidate: therapeutic effects

A

for major depressive disorders and improves overall mood

598
Q

Fatigue: medications: modafinil

A

can be used with MS to reduce fatigue

599
Q

Fatigue: medications: MS

A

modafinil histamine phosphate/caffeine citrate transdermal patch

600
Q

Fatigue: medications: hydrocortisone

A

use cautiously can enhance mood and improve fatigue for a short time in patients experiencing chronic fatigue syndrome

601
Q

Fatigue: medications: chronic fatigue syndrome

A

hydrocortisone

602
Q

Fatigue: medications: erythropoietin alpha

A

may treat anemia-based fatigue by working to increase the base hemoglobin levels

603
Q

Fatigue: medications: anemia-based fatigue

A

erythropoietin alpha

604
Q

erythropoietin alpha: antidepressants

A

nortriptyline amitriptyline

605
Q

Fatigue: medications: dextroamphetamines

A

CNS stimulants may be used cautiously

606
Q

Bowel strangulation: s/s

A

severe steady pain, rather than cramping

607
Q

Bowel strangulation: severe steady pain

A

indicates blood supply has been completely cut off to an area of intestines where there is an obstruction

608
Q

Bowel strangulation: considered

A

medical emergency

609
Q

Large bowel obstruction: s/s

A

cramping pains in lower abdomen bloating diarrhea or constipation

610
Q

Large bowel obstruction: cramping pain

A

lower abdomen, below navel increases over time

611
Q

Large bowel obstruction: bloating

A

feeling of bloating in lower stomach and pelvic area

612
Q

Large bowel obstruction: vomiting

A

not common

613
Q

Small bowel obstruction: s/s

A

cramping, colicky pain vomiting constipation and inability to pass gas bloating high pitched stomach noises

614
Q

Small bowel obstruction: cramping, colicky pain

A

come in waves middle to upper abdomen relieved with vomiting

615
Q

Small bowel obstruction: emesis

A

green in color

616
Q

Small bowel obstruction: untreated pain

A

pain may become lessened over time as bowel stops contracting

617
Q

Small bowel obstruction: most common

A

constipation inabiliity to pass gas

618
Q

Small bowel obstruction: partial bowel obstruction

A

diarrhea faltulence

619
Q

Small bowel obstruction: bloating

A

patients will complain of feeling bloated

620
Q

Small bowel obstruction: high pitched stomach noises

A

will decrease and stop as bowel slows down

621
Q

Disease processes with highest risk of fatigue

A

cancer coronary artery disease chronic fatigue syndrome chronic obstructive pulmonary disease end-stage renal disease HIV/AIDS MS Parkinson

622
Q

High risk for fatigue: cancer

A

most distressing symptom to experience S/E of treatment

623
Q

High risk for fatigue: coronary artery disease

A

affects 13 million people leading cause of death significant fatigue

624
Q

High risk for fatigue: chronic fatigue syndrome

A

most common among women

625
Q

High risk for fatigue: COPD

A

fatigue is second most prevalent s/s most prevalent is shortness of breath

626
Q

High risk for fatigue: End-stage renal disease

A

hemodialysis, fatigue rates are 100% peritoneal dialysis, fatigue rates are 80%

627
Q

High risk for fatigue: HIV/AIDS

A

fatigue presenting symptom before diagnosis

628
Q

High risk for fatigue: MS

A

most common and disabling symptom no widely accepted pharmacological treatment

629
Q

High risk for fatigue: Parkinson disease

A

studies lacking for exact information rates most agree rates are extremely high

630
Q

Fatigue assessment

A

body severity factors which aggravate what alleviate medications physical exam and general appearance muscle strength and nerve responses vital signs oxygenated balance in hormone, fluid and electrolytes mood and activity changed from previous states

631
Q

Fatigue assessment: body

A

where in body is fatigue experienced extremities mental faculties total body

632
Q

Fatigue assessment: severity

A

what is severity

633
Q

Fatigue assessment: ADLs

A

does fatigue interfere with patient’s daily activities

634
Q

Fatigue assessment: aggravate

A

what factors seem to aggravate the symptoms of fatigue

635
Q

Fatigue assessment: alleviate

A

what methods seem to help alleviate fatigue

636
Q

Fatigue assessment: medications

A

any of patient’s current medications a contributing factor

637
Q

Fatigue assessment: physical exam and general appearance

A

present evidence of medically based reasons for, or resulting harm related to,fatigue

638
Q

Fatigue assessment: muscle strength and nerve responses

A

what are patient’s muscle strenght and nerve responses

639
Q

Fatigue assessment: vital signs

A

low blood pressure low pulse irregular heart rate fever

640
Q

Fatigue assessment: oxygenated

A

is patient oxgenated

641
Q

Fatigue assessment: balanced

A

hormone levels fluid electrolytes

642
Q

Cancer related fatigue: nursing interventions

A

education explanations changes in routine increased worry and anxiety sleep cycle nutrition nursing assessments to treat other s/s activities which distract and restore energy expenditures (prioritize) enjoyable activities

643
Q

Cancer related fatigue: best tool

A

education

644
Q

Cancer related fatigue: explanations

A

disease process nutrition treatments presence of infection and fever all increase body’s demand for rest

645
Q

Cancer related fatigue: routine and schedule

A

changes in routine and schedule increase fatigue

646
Q

Cancer related fatigue: worry and anxiety

A

increase fatigue

647
Q

Cancer related fatigue: be prepared

A

for all procedures, activities, and routines to help reduce energy demands

648
Q

Cancer related fatigue: sleep cycle

A

reduce disruptions to sleep cycle by establishing routines for bedtime and awakening provide longest sleep and rest times possible

649
Q

Cancer related fatigue: nurtition

A

encourage foods that will help maintain energy levels with minimal energy output to eat and digest small frequent meals

650
Q

Cancer related fatigue: foods

A

protein minimal energy to eat and digest

651
Q

Cancer related fatigue: assessments

A

treat other symptoms which may be interfering with ability to rest pain depression nausea and vomiting

652
Q

Cancer related fatigue: distracting and restorative activities

A

music time with nature time with family and friends

653
Q

Cancer related fatigue: prioritize

A

help patient determine what expenditures of energy are most important and which can be removed

654
Q

Cancer related fatigue: routines

A

mild exercise leisure activities physical therapy

655
Q

Non-pharmacological for N/V

A

self-hypnosis relaxation biofeedback imagery distraction desensitization acupressure music therapy

656
Q

Non-pharmacological for N/V: self-hypnosis

A

involves invoking an altered state of consciousness in anticipation of N/V espisodes to decrease frequency, severity, amount, and druation of uncomfortable episodes

657
Q

Non-pharmacological for N/V: relaxation

A

progressive relaxation of muscle groups often involving imagery helpful in conjunction with chemotherapy induced N/V

658
Q

Non-pharmacological for N/V: biofeedback

A

electromyographic or skin temperature controlled responses to changes within the body May be used with relaxation during chemotherapy

659
Q

Non-pharmacological for N/V: imagery

A

mentally removing the focus from unpleasant S/E and refocusing the mind on other images increases self-control while decreasing length and perceptions of N/V episodes

660
Q

Non-pharmacological for N/V: distraction

A

diverting attention to other activities such as video games, puzzles or humor

661
Q

Non-pharmacological for N/V: desensitization

A

involves relaxation and visualization to decrease perceptions of N/V

662
Q

Non-pharmacological for N/V: acupressure

A

a form of massage to increase energy flow and improve emotion

663
Q

Non-pharmacological for N/V: music therapy

A

often used with other therapies to influence physiological psychological, and emotional states during and after N/V episodes

664
Q

Constipation: causes

A

bowel or pelvic cancer disease processes hypercalcemia decreased fluid intake weakness and inactivity confusion depression changes in toileting medications

665
Q

Constipation: causes: cancers

A

primary or metastasized bowel or pelvic area cause intestinal obstruction or adhesion

666
Q

Constipation: causes: disease processes

A

diabetes hypothyroidism hypokalemia diverticulitis hemorrhoids colitis chronic neurological disease

667
Q

Constipation: causes: changes which cause slow motility

A

nutrition and appetite decreased fluid intake weakness and inactivity confusion depression toileting

668
Q

Constipation: causes: medications

A

opioids anticholinergics tricyclic antidepressants antiparkinsonian iron antihypertensives antihistamines antacids diuretics vinca alkaloid chemotherapy

669
Q

Constipation: causes: medications: opioids

A

suppress motility increase sphincter tone increase electrolyte and water absorption

670
Q

Constipation: causes: medications: vinca alkaloid chemotherapy

A

damages myenteric plexus of colon, causing increased contractions without increased movement

671
Q

Palliative nutrition: definition

A

patient should be permitted to eat whatever he or she dsires

672
Q

Palliative nutrition: calorie count

A

should not focus on calories or content

673
Q

Palliative nutrition: focus

A

on patient’s desires and preferences

674
Q

Palliative nutrition: major concern

A

fatigue

675
Q

Palliative nutrition: education

A

about importance of proper nutrition and adequate energy-providing foods

676
Q

Palliative nutrition: food

A

nutritious high protein nutrient dense

677
Q

Palliative nutrition: meals

A

small, frequent

678
Q

Palliative nutrition: encourage

A

adequate fluid intake frequent oral hygiene

679
Q

Palliative nutrition: supplements

A

use of protein supplements

680
Q

Diarrhea: assess

A

environment patient’s history physical evaluate stool

681
Q

Diarrhea: assess: environment

A

ease of care during episode of diarrhea

682
Q

Diarrhea: assess: patient’s history

A

duration and frequency fluid and fiver intake appetite presence of N/V surgical and radiation therapy presence of bacterial, protozoan, or viral disease states

683
Q

Diarrhea: assess: physical

A

perineum or ostomy site for skin breakdown fissures or hemorrhoids impaction abdomen for distention or palpable stool

684
Q

Diarrhea: assess: stool

A

evaluate stool for signs of bleeding and for dehydration

685
Q

Diarrhea: nursing interventions

A

perineum or stoma sitz baths nutrtion

686
Q

Diarrhea: nursing interventions: perineum or stoma

A

ensure area is cleaned gently and thoroughly after each movement

687
Q

Diarrhea: nursing interventions: sitz baths

A

offer sitz baths as appropriate

688
Q

Diarrhea: nursing interventions: meals

A

small, frequent, bland meals with increased fluid intake

689
Q

Diarrhea: nursing interventions: diet

A

low-residue diet with potassium-rich foods

690
Q

Diarrhea: nursing interventions: homeopathic methods

A

ginger tea glutamine (amino acid) peeled apples

691
Q

Hiccups: medications

A

simethicone metoclopramide baclofen midazolam gabapentin carbamazepine valproic acid haloperidol chlorpromazine phenytoin nefopam lidocaine quinidine nifedipine dexamethasone mephenesin amitriptyline methylphenidate sertraline

692
Q

Hiccups: medications: simethicone

A

15 - 30 ml

693
Q

Hiccups: medications: metoclopramide

A

10-20 mg

694
Q

Hiccups: medications: bacolfen

A

5-10 mg

695
Q

Hiccups: medications: gabapentin

A

300-600 mg

696
Q

Hiccups: medications: haloperidol

A

1-5 mg

697
Q

Hiccups: medications: reduce gastric distention

A

simethicone metoclopramide

698
Q

Hiccups: medications: muscle relaxants

A

baclofen midazolam

699
Q

Hiccups: medications: anti-convulsive agents

A

gabapentin carbamazepine valproic acid

700
Q

Hiccups: medications: dopamine agonists

A

haloperidol chlorpromazine

701
Q

Hiccups: medications: calcium channel blockers

A

phenytoin nefopam lidocaine quinidinenifedipine

702
Q

Hiccups: medications: other medications

A

dexamethasone mephenesin amitriptyline methylphenidate sertraline

703
Q

Hiccups: medications: midazolam

A

5-10 mg

704
Q

Hiccups: medications: carbamazepine

A

200 mg

705
Q

Hiccups: medications: valproic acid

A

5-15 mg

706
Q

Hiccups: medications: chlorpromazine

A

5-50 mg

707
Q

Hiccups: medications: phenytoin

A

200-300mg

708
Q

Hiccups: medications: nefopam

A

10 mg not in Davis Drug Guide

709
Q

Hiccups: medications: lidocaine

A

2 mg/min

710
Q

Hiccups: medications: nifedipine

A

10-80 mg

711
Q

Hiccups: medications: quinidine

A

200 mg

712
Q

Hiccups: medications: dexamethasone

A

40 mg

713
Q

Hiccups: medications: mephenesin

A

1000 mg not in Davis Drug Guide

714
Q

Hiccups: medications: amitriptyline

A

25-90 mg

715
Q

Hiccups: medications: methylphenidate

A

5-20 mg

716
Q

Hiccups: medications: sertraline

A

50 mg

717
Q

Cultural considerations: American Indian/ Alaskan natives

A

embarrassed to report N/V, constipation, diarrhea dyspnea = “heavy air” appearance of high activity levels despite fatigue depression/psychiatric problems = “heavy heart”

718
Q

Cultural considerations: Asian/Pacific Islanders

A

illness caused by imbalance “yin & yang” treat symptoms homeopathically mental illness hidden, not discussed

719
Q

Cultural considerations: Black population

A

willing to discuss symptoms unwilling to seek treatments, medication

720
Q

Cultural considerations: Hispanic

A

willing to discuss s/s may feel s/s beneficial or do not require treatment mental difficulties = weakness and embarrassement

721
Q

Actively dying: definition

A

physical signs and symptoms that indicate anticipation of death within hours or days

722
Q

Actively dying: s/s

A

weakness skin changes nutrition respiratory changes changes in mental status semi-comatose / fully comatose incontinence third-space fluids reabsorbed pupils fixed and dialated

723
Q

Actively dying: s/s: weakness

A

profound weakness, requiring complete care

724
Q

Actively dying: s/s: skin changes

A

gaunt and pale cool extremities

725
Q

Actively dying: s/s: nutrition

A

lack interest in food or drink difficulty swallowing significant decreases in intake

726
Q

Actively dying: s/s: respiratory changes

A

dyspnea changing to an easier, shallow respiration with decreased oxygen concentration gurgling or gravely sounds in the back of throat from excess secretoins

727
Q

Actively dying: s/s: changes in mental status

A

transient improvement in comfort, pain experiences overall state varying in: agitation, restlessness, delirium, confusion, increased pain, profound sleepiness, reduction in awareness, difficulty concentration, disorientation to time and place

728
Q

Actively dying: s/s: third space fluids

A

reabsorbed, decreasing the amount of swelling present

729
Q

Dyspnea: physiology:

A

vascular bed decrease impaired mechanical responses and ventilatory pump impairment

730
Q

Dyspnea: physiology: vascular bed decrease from

A

thromboemboli tumor emboli vascular obstruction radiation chemotherapy toxicity concomitant emphysema

731
Q

Dyspnea: physiology: vascular bed

A

the sum of the blood vessels supplying an organ or region

732
Q

Dyspnea: physiology: vascular bed decrease cause

A

dead space causes increased ventilation demands

733
Q

Dyspnea: physiology: increased ventilation demands results in

A

hypoxemia severe deconditioning metabolic acidosis alterations in carbon dioxide output and arterial partial pressure of carbon dioxide increased neural reflex activity, anxiety, depression

734
Q

Dyspnea: physiology: impaired mechanical responses and ventilatory pump impairment

A

inspiratory muscle weakness from cachexia electrolyte imbalances neuromuscular abnormalities and steroid use pleural or parenchymal disease reduced chest wall compliance airway obstruction

735
Q

Ethics: definition

A

branch of philosophy that focuses on moral life

736
Q

Ethics: method used to

A

understand and examine social customs, norms,and rules that help define right and wrong

737
Q

Ethics: not absolute

A

do not have clear answers

738
Q

Ethics: adjust

A

to cover ever-changing social and cultural contexts influenced by individual and cultural morals

739
Q

Ethics: clinical information

A

must incorporate information about the patient and family’s values and goals identification of key decision makers consideration of ethical principles that influence the situation

740
Q

Ethics: nurse should demonstrate

A

basic understanding of ethical principles concepts that influence health care knowledgeable about laws that govern ethical positions of profesoinal nursing organizations

741
Q

Ethics: problem solving

A

use of nursing process

742
Q

Ethics: resolution of ethical dilemmas

A

best choice is made based on all the information considered

743
Q

Ethics: legal system

A

ethical dilemmas can often be resolved without input from legal system

744
Q

End stage respiratory disease: original diagnosis

A

regardless of original underlying diagnosis, s/s as well as treatment will be the same by the end stages

745
Q

End stage respiratory disease: iimpacts

A

ADLs respiratory infection respiratory failure increased stress in lungs

746
Q

End stage respiratory disease: ADLs:

A

impacts with frequent exacerbation increasing use of emergency treatments

747
Q

End stage respiratory disease: infection

A

increased respiratory infection and failure rate as disease progress

748
Q

End stage respiratory disease: respiratory failure

A

results from decreased PO2 and increased PCO2 suppresses respiratory drive causes slow loss of consciousness until respiration stop

749
Q

End stage respiratory disease: increased stress in lungs

A

creates increased stress on heart lead to lower peripheral edema, pulmonary hypertension, right-sided heart failure

750
Q

End stage respiratory disease: complications

A

fatigue, limited tolerance for activity poor quality of life weight loss tachycardia tachypnea pneumonia pneumonthorax polycythemia (too much production of red blood cells)

751
Q

End stage respiratory disease: FEV1 (forced expiratory volume at 1 second)

A

less than 0.75 L have a 30% chance of dying within a year

752
Q

Tuberculosis: common among

A

immunosuppressed patients

753
Q

Tuberculosis: s/s

A

night sweats unexplained weight loss fatigue chronic cough with active sputum

754
Q

Tuberculosis: untreated

A

may spread to other organs causing neurological disease such as meningitis, bone infections, and urinary bleeding

755
Q

Tuberculosis: positive tuberculin skin test

A

signifies previous exposure to tuberculin organisms

756
Q

Tuberculosis: skin test can’t

A

pinpoint a recent change from a negative status unless the positive test is a follow-up to previous negative test results

757
Q

Tuberculosis: skin test: time of exposure

A

cannot accurately pinpoint time of exposure

758
Q

Tuberculosis: diagnosis for presence of active disease

A

obtained by finding acid-fast bacilli in stained smear samples from sputum or other body fluids

759
Q

Tuberculosis: bacteria

A

mycobacterium tuberculosis isolating on culture or rapid nucleic acid test probes

CHPN Exam (6 decks)

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