Patient Care: Symptom Management Flashcards
1
Q
Anorexia: definition
A
lack or loss of appetite inability to eat resulting weight loss
2
Q
Anorexia: early stages
A
usually can be resolved, and any weight loss can be replaced with increased intake
3
Q
Anorexia: unchecked
A
leads to protein-calorie malnutrition (PCM) loss of fat tissue and lean muscle mass
4
Q
Anorexia: patients
A
advanced cancer, especially related to digestive system AIDS
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
6
Q
Cachexia: definition
A
Greek “bad condition” a state of general ill health and malnutrition producing marked weakness and emaciation
7
Q
Cachexia: occurance
A
in most patients with cancer; main cause of death > 20% AIDS CHF severe sepsis tuberculosis any debilitating chronic illness
8
Q
Anorexia and Cachexia
A
Anorexia can contribute to the development of cachexia
9
Q
Cachexia: loss
A
is an equal loss of fat and muscle as well as a marked loss of bone mineral content
10
Q
Cachexia: nutrition and increased intake
A
does not respond to nutritional supplements or increased intake
11
Q
Cachexia: development
A
develops from systemic inflammatory response and metabolic imbalance in the presence of pro-inflammatory cytokines
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.
13
Q
Spinal cord compression: primary symtom
A
back pain pain that increases when lying flat and improves when standing
14
Q
Spinal cord compression: symptoms
A
back pain bowel or bladder changes leg weakness or “funny feeling in legs”
15
Q
Spinal cord compression: treatment of symptoms
A
need to be recognized and treated immediately to prevent paralysis
16
Q
Spinal cord compression: pain
A
pain may be present long before any neurological dysfunction is detected
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
18
Q
Spinal cord compression: cancer
A
back pain is presumed to be cord compression until proven otherwise treated as medical emergency
19
Q
Spinal cord compression: medical emergency
A
treated as such may help to prevent permanent loss of function
20
Q
Spinal cord compression: treatment to decrease pain and preserve functoin
A
steroids surgical decompression hormone therapy radiation therapy
21
Q
Spinal cord compression: steroids
A
alone may decrease pain and preserve function for those in last stages of life
22
Q
Chemotherapy: palliative care
A
may be used to enhance comfort,well-being and symptom control for enhanced quality of life
23
Q
Chemotherapy: is not
A
expected to provide a cure not given to maintain false hope
24
Q
Chemotherapy: expectatoin
A
prolonged survival control of cancer related symptoms
25
Chemotherapy:decisions
based on clinical indicators patient's wishes
26
Chemotherapy: consider
benefit and cost ratios of treatment
27
Chemotherapy: usefulness
tumor response to treatment metastasis other disease specific factors
28
Chemotherapy: commitment
repeated travel hospitalizations invasive procedures and assessments
29
Pressure Ulcer: Stage I desciption
area of intact kin that is deep pink, red, or mottled does not blanch
30
Pressure Ulcer: Stage I intervention
pressure relief increased circulation to area
31
Pressure Ulcer: Stage II description
loss of partial thickness of skin can involve epidermis, dermis or both skin blistered, cracked, or torn
32
Pressure Ulcer: Stage II intervention
area must be relieved of pressure apply protective dressing
33
Pressure Ulcer: Stage III description
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
34
Pressure Ulcer: Stage III intervention
treated with irrigation and debridement
35
Pressure Ulcer: Stage IV description
full-thickness skin loss with extensive destruction necrosis is deep and extends through all tissue layers damage to muscle, bone, or other supporting structures
36
Pressure Ulcer: Stage IV intervention
wet/dry packed dressings when drainage is present surgical repair
37
Dyspnea: defintion
subjective sensation of breathlessness inability to obtain the needed amount of air
38
Dyspnea: occurance
will occur in the majority of advanced cancer patients
39
Dyspnea: intervention
high Fowler's position leaning forward with arms supported on table cool moving air relaxation techniques pursed-lip breathing oxygen opioids, tranquilizers, and anxioytics
40
Cachexia: major metabolic decreases
glucose tolerance insulin resistance lipoprotein lipase activity negative nitrogen balance skeletal and lean muscle mass loss
41
Cachexia: changes
metabolic changes, in response to inflammation and cytokine production, are common in cancer and AIDS patients represent initiating event for cachexia
42
Cachexia: other metabolic increased
glucose production and turnover protein synthesis fatty acid oxidation serum lipid and triglyceride
43
Cachexia: accompanying decreased
body glycogen mass body lipid mass fat synthesis
44
Cachexia: motor activity and energy stores
voluntary motor activity and ernergy stores and balance are quickly depleted during this wasting process
45
Cachexia: unchanged
serum glucose and insulin levels nitrogen excretion
46
Alginate Dressing: uses
best for wounds with heavy drainage controls secretions and reduces bacterial contamination
47
Alginate Dressing: Pain
is reduced softening the surrounding tissues reducing pressure caused by excessive exudates
48
Alginate Dressing: description
non-adherent easily removed
49
Enzymatic Dressing: uses
aids in loosening necrotic tissue
50
Enzymatic Dressing: treatment
for patients in long term care unable to sustain surgical/sharp debridement
51
Enzymatic Dressing: dressing changes
do not tend to cause addiitional discomfort
52
Semipermeable film: uses
not absorbent can't be used when drainage is present
53
Semipermeable film: protects
protects against early damage assists with healing
54
Semipermeable film: pain
minimizes pain by covering exposed nerve endings adhere to skin and wound bed, removal can be painful
55
Hydrocolloid dressings: uses
absorbs small amounts of exudates mild debridement keeps wound bed moist to promote granulation
56
Hydrocolloid dressings: pain
minimizing exposure of wound to air proper removal required to decrease pain
57
Hydrocolloid dressing: attachment
some designed for difficult sacral area
58
Dysphagia: definition
difficultly swallowing any substance affects airway protection and patient safety
59
Dysphagia: food
may become caught in upper digestive tract diverted to trachea causing aspiration, choking and possible asphyxiation
60
Dysphagia: emotion
frightening and discouraging to patient
61
Dysphagia: posture
tucking in the chin tilting head promote food movement along upper digestive tract
62
Dysphagia: food
changes to texture and consistency of food to promote food movement
63
Dysphagia: make swallowing easier
artificial saliva
64
Dysphagia: bypass digestive tract
introduce nutrients as gastronomy or jejunostomy tube feedings
65
Dehydration: dying process
normal part of dying process loss of normal body water
66
Dehydration: causes
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
67
Dehydration: not treating
decreased cough and congestion decrease edema and ascites decrease nausea and vomiting decrease in frequency of urination
68
Dehydration: decrease in urination
can improve quality of life by reducing irritation and infection related to elimination treatments
69
Dehydratoin: aggravates
confusion and restlessness
70
Dehydration: thirst
patients at end of life do not commonly experience thirst due to dehydration
71
Dehydration: treatment
can actually increase discomfort
72
Dehydration: symptom
dry mouth managed with comfort measures
73
Xerostomia: definition
sensation of a dry mouth
74
Xerostomia: secretions
may be experienced with or without decreased oral secretions
75
Xerostomia: description
as a burning or soreness of the oral tissues
76
Xerostomia: cause
common nature so difficult to pinpoint
77
Xerostomia: related to
interactions of multiple drugs head and neck surgeries chemotherapy and radiation infection inflammation disease processes: mouth and throat immunocompromised conditions dehydration psychological factors: anxiety
78
Xerostomia: medications causing it
antihistamines anticholinergics
79
Xerostomia: complications
dental caries soft tissue irritations, lesions and infections bad breath changes in taste speech and swallowing difficulties
80
Anxiety: definition
marked by feelings of excessive worry, irritability, restlessness, intense feelings of danger and agitation
81
Anxiety : source
unknown or vague
82
Anxiety: general symptoms
Patients have trouble falling or staying asleep experience interference with other nromal activities in daily lives
83
Anxiety: physical symptoms
frequent crying spells headaches muscle tension stomach and intestinal distress palpitations shortness of breath anorexia or overeating
84
Anxiety: psychologically
patient vulnerable to unrealistic fears obsessions with harmful ideas and complulsions
85
Anxiety: patients may attempt
self--medicate with multiple chemicals or substances in attempt to alleviate symptoms
86
Anxiety disorder: identified
by persistence of symptoms over a period of 6 months or more
87
N/V: effect
negative effect on all aspects of patient's well-being
88
N/V: causes
nutritional loss resulting in fluid and electrolyte imbalance fatigue reduced ability to care for self
89
N/V: stress resulting in
distress anxiety fear loss of happiness and enjoymnet
90
N/V: lives and relationships
interrupted with decrease in affection or sexual function increased dependence on caregiver
91
N/V: caregiver and patient relationship
increased burden and stress
92
N/V: increased stress
increase patient's fears r/t illness and suffering it causes spiritual meaning of illness as punishment for past deeds
93
Fatigue: categories
personal factors disease related treatment related
94
Fatigue personal factors
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
95
Fatigue: disease related
presence of metastases anemia uncontrolled pain sleep changes and interruptions changes in bowel and bladder habits cachexia dyspnea
96
Fatigue: treatment related
radiation chemotherapy medication permanent physiologic consequences
97
Nausea: pharmacological self care: air
provide fresh air with a fan or open window but limit sights, sounds and noxious smells
98
Nausea: pharmacological self care: avoid
consuming sweet, salty, fatty, and spicy foods
99
Nausea: pharmacological self care: food
should be bland served at room temperature or cold
100
Nausea: pharmacological self care: clothing
instruct to wear loose-fitting clothes during meal times
101
Nausea: pharmacological self care: fluids
consumption with meals should be restricted to just the amount needed to ease passage of food
102
Nausea: pharmacological self care: quantity of food
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
103
Nausea: pharmacological self care: cloth
application of cool damp cloth to forehead, neck and wrists may help
104
Vomiting occurance
reinforce need for oral care after each episode relief of unpleasant sensory s/e and for general oral health
105
Pureed diet: purpose
foods processed in blender to add liquid and change consistency to smooth
106
Pureed diet: intention
to reduce tongue function and the need for chewing
107
Pureed diet:type of food
applesauce yogurt mashed potatoes puddings
108
Mechanically altered diet:purpose
ground or finely chopped foods
109
Mechanically altered diet: intention
form small masses that require some, though minimal, chewing and tongue control
110
Mechanically altered diet: type of food
pasta scrambled eggs cottage cheese ground meats
111
Soft diet: purpose
foods are not mechanically altered but chosen for their naturally soft qualities
112
Soft diet: intention
foods still require some chewing when presented in small pieces, but they also allow for reduced endurance and attention span
113
Soft diet: foods
soft meats canned fruits baked fish
114
Prepared diet: avoid
raw vegetables bread tough meats
115
Swallowing disorder: general early s/s
become impulsive in regard to eating show inattention "playing" with food refuse to eat in presence of others avoid certain previously enjoyed food/drink
116
Swallowing disorder: changes early s/s
meal times and postures while eating may change
117
Swallowing disorder: solids early s/s
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
118
Swallowing disorder: weight loss early s/s
unexplained weight loss may occur
119
Swallowing disorder: oral-pharyngeal dysfunction
speech may become slurred and imprecise voice may sound "wet"
120
Swallowing disorder: assessment may show
dry mouth with thick secretions coating tongue and palate residual food may be present secretion drooling or leakage of liquids
121
Swallowing disorder: advanced s/s
coughing and choking while attempting to eat nasal regurgitation aspiration
122
Depression: tendency
Patients experiencing depression have a greater tendency toward medical illnesses and vice versa
123
Depression: risk factor for cardiac disease
cardiovascular disease CHF arrhythmia heart attacks
124
Depression:CNS patients at risk for
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
125
Depression: other causes
rheumatoid arthritis thyroid disease diabetes Cushing disease Addison disease anemia lupus liver disease syphilis encephalitis alcoholism general malnutriton
126
Hiccups: multiple treatments
respiratory nasal and pharyngeal stimulation stimulant inhalation stimulation of vagal nerve gastric distention psychiatric treatments misc
127
Hiccups: respiratory intervention
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
128
Hiccups: nasal and pharyngeal stimulation
drinking from far side of glass eating a spoonful of sugar holding the nose and applying pressure
129
Hiccups: stimulant inhalatoin
tongue traction eating soft bread drinking peppermint water to soothe esophagus stimulating palate with bitters such as cotton-tipped applicators soaked in lemon
130
Hiccups: stimulation of vagal nerve
ocular compression digital rectal massage careful carotid massage
131
Hiccups: gastric distension
fasting placement of a NG tube to relieve abdominal distention lavage vomiting
132
Hiccups: psychiatric treatments
distraction and behavior modification
133
Hiccups: misc treatments
bilateral radial artery compression acupuncture
134
Cancer related diarrhea: avoid foods
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
135
Cancer related diarrhea: high fiber or gas causing foods
legumes raw vegetables whole-grains popcorn
136
Cancer related diarrhea: caffeine, carbonated and high sugar or sorbitol drinks
coffee colas prune juice pear juice cherry juice peach juice apple juice orange juice
137
Cancer related diarrhea: high risk foods
sushi food from street vendors buffets
138
Cancer related diarrhea: medications causing
antibiotics laxatives medications with magnesium motility agents stool softeners
139
Cancer related diarrhea: herbs causing
milk thistle aloe cayenne saw palmetto Siberian ginseng
140
Internal stimulants: herbs
milk thistle aloe cayenne saw palmetto Siberian ginseng
141
Delirium: definition
acute or subacute, reversible state of confusion
142
Delirium: time frame
time frame foronsest is short, over a period of hours or days, and resolving over days or weeks
143
Delirium: severity
fluctuates with the time of day, becoming worse at night
144
Delirium: thinking
thinking is impaired and clouded can fluctuate rapidly in terms of awareness of surrounding environment
145
Delirium: s/s
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
146
Delirium: common
delusions hallucinations
147
Delirium: delusions and hallucinations
usually fleeting poorly organized commonly become multisensory
148
Delirium: speech
becomes uncharacteristic for patient loud, rapid or slow
149
Delirium: psychomotor activity
increased or reduced becomes unpredictable
150
Delirium: sleep cycles
often disturbed become reversed
151
Anxiety: chemically induced
introduction of substance withdrawal of substance
152
Chemically induced anxiety: everyday substance which increase
caffeine decongestants antihistamines
153
Chemically induced anxiety: physical addictions
alcohol nicotine
154
Chemically induced anxiety: physical addictions: withdrawal
vague feelings of unease,discomfort,dread
155
Chemically induced anxiety: causes
alcohol nicotine hypnotics
156
Chemically induced anxiety: hypnotics
benzodiazepines
157
Chemically induced anxiety: medication causes
thyroid replacement formulas neuroleptics corticosteroids bronchodilators epinephrine antihypertensives antiparkinsonian medications oral contraceptives anticholinergics anesthetics analgesicsl
158
Chemically induced anxiety:: toxins and digitalis
toxins and digitalis toxicity can cause anxiety
159
Chemically induced anxiety:marijuana and cocaine
cause chemically induced anxiety when withdrawan
160
Dementia: definition
progressive, irreversible state of decline in mental function
161
Dementia: time frame
chronic and irreversible
162
Dementia: onset
quiet and slow
163
Dementia: s/s
do not change over the course of the day
164
Dementia: mental clarity
remains intact until the later stages, but may be complicated by delirium
165
Dementia: short-term memory
may be affect early on, but attention span generally remains intact until later stages
166
Dementia: orientatoin
to person, place and things remain unaltered until later stages when person mya have difficulty recognizing familiar and common objects
167
Dementia: anomia
when person has difficulty recognizing familiar and common objects
168
Dementia: agnosia
when person has difficulty recognizing familiar people
169
Dementia: aphasia
difficulty finding appropriate words and expressing thoughts clearly
170
Dementia: hallucinations and delusions
most often absent
171
Dementia: psychomotor activity
generally unaffected, but patient may exhibit signs of apraxia
172
Dementia: apraxia
difficulty initiating purposeful movement
173
Dementia: sleep and wake cycles
become fragmented
174
Seizures: assessment
careful assessment multiple causes all patients: in order to prevent
175
Seizures: may be
preexisting new in onset
176
Seizures: causes
primary or metastatic cancer to brain medications withdrawal of medications other additives in chemical formulas disease process
177
Seizures: causes: medications
phenothiazines butyrophenones tricyclic antidepressants metabolites: normeperidine
178
Seizures: causes: medication withdrawal
benzodiazepines preservatives, antioxidants additives in chemical formulas
179
Seizures: causes: disease process
HIV infection metabolic disorders stroke hemorrhage oxygen deprivation rare paraneoplastic disorders
180
Hyponatremia dehydration: sodium level
\< 135 mEq/L
181
Hyponatremia dehydration: definition
sodium deficiency in relation to amount ow water in body body fluids are diluted and cells swell from decreased extra cellular fluid osmolaltiy
182
Hyponatremia dehydration: general S/S
volume depletion anorexia weight loss nausea and vomiting taste alteration
183
Hyponatremia dehydration: skin turgor
is decreased
184
Hyponatremia dehydration: mucus membranes
dry
185
Hyponatremia dehydration: sweating
reduced
186
Hyponatremia dehydration: may result in
orthostatic hypotension lethargy restlessness delirium seizures confusion stupor coma
187
Hyponatremia dehydration: Lab results
azotemia: increased nitrogenous waste disproportionate blood urea nitrogen creatinine hyponatremia hemoconcnetration urine osmolarity high sodium concentration
188
Hyponatremia: fluid movement
when serum osmolality decreases because of decreased sodium concentration fluid moves by osmosis from extracellualr area to intracellular area
189
Hypernatremic dehydration: sodium level
\> 145 mEq/L
190
Hypernatremic dehydration: definition
excess of sodium relative to amoutn of water in body
191
Hypernatremic dehydration: fluid movement
body tries to maintain balance by shifting fluid from the inside of cells to the outside
192
Hypernatremic dehydration: s/s
thirst fever fatigue muscle weakness mental status changes
193
Isotonic dehydration: definition
different than hyponatremia or hypernatremia
194
Isotonic dehydration: s/s: psychological
morose aggression apathy demoralization
195
Isotonic dehydration: s/s: coordination
general lack of coordination
196
Isotonic dehydration: lab values
few or no laboratory abnormalities
197
Anxiety: physical roots
cardiovascular endocrine metabolic neoplasms neurological respiratory
198
Anxiety: physical roots: cardiovascular
hypovolemia myocardial infarction (MI) paroxysmal atrial tachycardia (PAT) angina congestive heart failure mitral valve prolapse
199
Anxiety: physical roots: endocrine
thyroid dysfunction low or high blood sugar Cushing disease carcinoid syndrome ( excess secretion of serotonin, bradykinin, and other vasoactive chemicals)
200
Anxiety: physical roots: metabolic
high potassium high or low sodium levels hyperthermia anemia low blood sugar (hypoglycemia)
201
Anxiety: physical roots: neurological
seizure disorders vertigo massive lesions postconcussion syndrome encephalopthy generalized brain function general restlessness
202
Anxiety: physical roots: respiratory
hypoxia asthma chronic obstructive pulmonary disease pneumonia pulmonary edema or embolus respiratory distress
203
Artificial hydration: routes
IV peripheral IV central hypodermoclysis
204
Artificial hydration: IV peripheral
should be monitored every few hours for: pain infiltration infection phlebitis
205
Artificial hydration: IV peripheral: usefulness
limited to a short duration
206
Artificial hydration: IV central: usefulness
treatment duration is longer than IV peripheral
207
Artificial hydration: IV central: risks
sepsis hemothorax or pneumonthorax thrombosis from: central vein catheter vein, catheter fragment air embolus brachial plexus injury arterial laceration
208
Artificial hydration: hypodermoclysis: definition
injecting fluid into the subcutaneous space
209
Artificial hydration: hypodermoclysis: usefullness
short term option use when oral or IV hydration cannot be achieved
210
Artificial hydration: hypodermoclysis: risks
pain infection volume overload third spacing tissue sloughing localized bleeding electrolyte disturbances
211
Urinary incontinence: causes
D = delirium I = infection A = atrophic urethritis P = pharmacy E = excessive urine production R = restricted mobility S = stool impaction
212
Urinary incontinence: D
delirium acute delirium and related confusion
213
Urinary incontinence: I
infection UTI can cause or worsen incontinence
214
Urinary incontinence: A
atrophic urethritis creates irritative voiding symptoms and stress incontinence
215
Urinary incontinence: P
pharmacy medications can reduce contractility and increase urinary retention, overflow and stress incontinence
216
Urinary incontinence: P: medications
opioids sedatives antidepressants anti-psychotics antiparkinsonian
217
Urinary incontinence: E
excessive urine production chronic disease states cause polyuria and affect smooth muscle and nerve involvement
218
Urinary incontinence: E: disease
diabetes cause excessive urine production
219
Urinary incontinence: R
restricted mobility immobility and restricted accesses to appropriate toileting facilities lead to urinary incontinenece
220
Urinary incontinence: S
stool impaction can result in urinary retention, urinary tract infection and incontinence
221
Enteral support: complications
aspiration diarrhea constipation dumping syndrome
222
Enteral support: aspiration: cause
use of a large-bore tube introducing formula too quickly or in too large of an amount
223
Enteral support: aspiration: s/s
fever cough
224
Enteral support: diarrhea: cause
(watery stools) hyperosmotic solution infusion rate that is too rapid lactose intolerance
225
Enteral support: constipation: cause
(hard infrequent stools) inadequate supplemental fluid intake inadequate fiber
226
Enteral support: dumping syndrome: cause
use of high-volume feeding boluses hyperosmotic fluids
227
Enteral support: dumping syndrome: s/s
weakness dizziness nausea palpitations syncope diarrhea
228
Edema: definition
result of excess fluid gathering within the tissues (interstitially) Capillary filtration exceed lymph drainage, creating a fluid imbalance
229
Edema: results in
swelling decreased skin mobility tightness tingling decreased strength and mobility discomfort ranging from aching to severe pain
230
Edema: pitting scale: +1
fluid build up is barely detectable
231
Edema: pitting scale: +2
slight indentation when pressed upon
232
Edema: pitting scale: +3
deep indentation for 5-30 seconds when pressure is applied
233
Edema: pitting scale: +4
creates a depression that is 1.5 to 2 x greater than normal
234
Edema treatment
good results when addressed in timely manner left untreated can transition to lymphedema
235
Pressure ulcers: result from
tissue compression restricted blood flow
236
Pressure ulcers: tissue breakdown and necrosis
happens when combined with moisture shearing forces friction
237
Pressure ulcers: general sites
over areas with bony prominences first points of contact when pressure is applied to certain body area
238
Pressure ulcers: common sites
sacrum greater trochanters (upper end of femur) heels or calcaneus lateral and medial malleolus (protrusions around ankle bone)
239
Pressure ulcers: other sites
back of head scapula area ischial tuberosities and hip ribs and vertebrae coccyx
240
Lymphedema: results from
untreated or incurable edema
241
Lymphedema: marked by
chronic condition marked by swelling and accumulated fluids within the tissue
242
Lymphedema: fluid accumulation
is result of: lymphatic drainage failure inadequate lymph transport capacity increased lymph production combination of above
243
Lymphedema: primary disease
result of inadequately developed lymphatic pathways
244
Lymphedema: secondary disease
due to damage outside of pathways
245
Lymphedema: process
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
246
Lymphedema: skin
skin and tissue thicken and change in color, texture,tone and temperature begins to blister and produce hyperkeratosis, warts, papillomatosis and elephantiasis
247
Lymphedema:risks
infection further complications
248
Lymphedema: hyperkeratosis
a thickening of the outer layer of the skin. this outer layer contains a tough, protective protein called keratin.
249
Lymphedema: papillomatosis
skin surface elevation caused by hyperplasia and enlargement of contiguous dermal papillae
250
Complementary and alternative medicine: reasons for
focus on ways to improve overall health reduce side effects of medical treatments improve quality of life
251
Complementary and alternative medicine: benefits
patients feel more in control than medical treatments interventions can help alleviate feelings of helplessness or hopelessness
252
Complementary and alternative medicine: allows patients to feel
they are taking an active role in their care
253
Complementary and alternative medicine: exploration
evolve from suggestions from friends and family philosophical and cultural factors may also come into play
254
Complementary and alternative medicine: desire
"tried everything" hoping to alter course of disease progression
255
Complementary and alternative medicine: mistrust
mistrust or lack of faith in traditional medical treatments
256
Complementary and alternative medicine: desire
to treat disease in more "natural" ways
257
Complementary and alternative medicine: costs
patient may feel: less expensive more accessible
258
Stomatitis: definition
inflammation of oral cavity lips tongue mucous membrances
259
Stomatitis: inflammation common cause
viral infections chemical irradiation chemotherapy radiation therapy mouth breathing medication s/e paralysis of nerves supplying oral cavity
260
Stomatitis: inflammation irritation or trauma causes
sun damage irritation from foreign bodies
261
Stomatitis: inflammation caused by tubes
nasal catheters used for oxygen and nutritional therapies endobronchial tubes inserted for surgery
262
Stomatitis: inflammation dental appliances
ill fitting dental appliances can also cuse irritation
263
Stomatitis: s/s: patient's complaints
oral pain with eating or drinking difficulty swallowing
264
Stomatitis: s/s: physical
bad breath oral lesions or ulcers swollen cervical lymph nodes possible fever mucous membranes that are easily damaged
265
Stomatitis: treatment
depends on identifying and treating the underlying cause as well as comfor measures for symptomatic complaints
266
Stomatitis: treatment:mucous membranes
need to be kept moist and clear from secretoins
267
Stomatitis: treatment: oral care
careful oral care, including flossing and ongoing assessments for areas of damage, needs to be provided
268
Stomatitis: treatment: irritating items
should be removed or carefully maintained
269
Stomatitis: treatment:analgesics
systemic and topical analgesics can be used
270
Intractable hiccups: cause
phrenic nerve or diaphragmatic irritation distention of stomach chest or abdominal surgery metabolic disorder: hyponatremia intracerebral lesions
271
Intractable hiccups: defintion
spasmodic closure of the glottis at varying intervals results in intermittent lowering of diaphragm which causes sharp inspiration and a correspoinding sound
272
Intractable hiccups: medication
chlorpromazine
273
Intractable hiccups: chlorpromazine dose
25 mg PO or rectum 1 tab, 3 x day
274
Intractable hiccups: irritation causes
chemical mechanical neruological
275
Intractable hiccups: anesthetization
in extreme cases anesthetization of phrenic nerve may be needed
276
Ascites: types
central mixed types both associated with renal sodium and water retention
277
Ascites; associated with
renal sodium and water retention
278
Ascites: treatment of fluid retention
restricted sodium and fluid intake diuretics
279
Ascites: diuretics
spironolactone (preferred) furosemide
280
Ascites: spironolactone
100 - 400 mg/day
281
Ascites: furosemide
40 - 80 mg/day be careful not to remove more fluid than is beneficial
282
Ascites: furosemide: dehydration
can lead to : electrolyte imbalances hepatic encephalopthy prerenal failure
283
Ascites: mixed type: dietary changes
decreased fat intake increased medium-chain triglycerides sorter fatty acid chains may be easier to digest
284
Ascites: refractory
those with shortened life expectancy can benefit from use of paracentesis
285
Ascites: tense ascites
associated with cirrhosis or nonmalignant ascites paracentesis may be helpful a
286
Ascites: paracentesis: fluid removal
4-6 liters per day has been deemed safe and effetive
287
Ascites: paracentesis: albumin infusion
to prevent hypovolemia and renal impairment
288
Ascites: peritoneovenous shunts
Denver or LeVeen helpful for 75% to 85 5 of paitents with nonmalignant ascites
289
Ascites: nursing interventions: comfort
pillow supports loose clothing
290
Ascites: nursing interventions
fluid and sodium restrictions may help reduce severity
291
Ascites: nursing interventions: education
diet parameters expected outcomes for improved quality of life
292
Ascites: patient's difficult cycle
thirst, hydration, and increased discomfort
293
Ascites:nursing skills
good assessments skin care to monitor and prevent skin breakdown
294
Ascites: recurring
may require repeated paracentesis
295
Ascites: paracentesis: risk
help patient recognizethe risk and benefit ratio of repeated paracentesis may become necessary
296
Depression: s/s
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
297
Depression: severity
assigned by presence of an expressed intent with a plan and means to carry out a suicide attempt, as well as previous attempts
298
Depression: hallmark s/s
changes in appetite and sleep decreased energy and concentration
299
Depression: physical illness
s/s can be masked or created by disease process or its treatments
300
Depression with preexisting illness: predictable s/s
fearfulness depressed or changed appearance social withdrawal brooding self-pity and pessimism depressed mood or affect that can't be changed or lifted
301
Status epilepticus: definition
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
302
Status epilepticus: considered to be
neuro-oncological emergency
303
Status epilepticus: treatment
maintaining a clear airway protecting patient from eminent harm administering medication to resolve episode
304
Status epilepticus: assess
for adequate patient perfusion
305
Status epilepticus: give
flucose solutoin
306
Status epilepticus: evaluate
electrolytes
307
Status epilepticus: administer
IV benzodiazepines followed by IV phenytoin
308
Status epilepticus: 1st choice medication
lorazepam
309
Status epilepticus: 2nd choice medication
phenytoin ( Dilantin) ] fosphenytoin (Cerebyx)
310
Status epilepticus: extreme medication to control seizure activity
barbiturates anesthesia neuromuscular blocks propofol
311
Active seizure: medications
diazepam lorazepam midazolam phenytoin phenobarbital
312
Active seizure: first line of defense
lorazepam, prn
313
Active seizure: lorazepam: route
IV in solution of intensol sublingually
314
Active seizure: medication chosen based on
drug availability practitioner knowledge and comfort base delivery routes available with patient
315
Active seizure: IM medication
diazepam (Valium) phenobarbital (Luminal)
316
Active seizure: diazepam route
IM rectal gel
317
Active seizure: phenobarbital: route
IM parenteral solution oral and rectal administration
318
Active seizure: fosphenytoin: route
subcutaneous has greater cost
319
Active seizure: phenytoin IV: complications
"purple glove syndrome" edema discoloration pain
320
Purple glove syndrome: s/s
edema discoloration pain
321
Purple glove syndrome: medication
IV phenytoin
322
Dyspnea: risk factors
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
Dyspnea: structural deviations
decrease in skeletal muscle barrel chest increased anteroposterior chest wall diameter with decreased chest wall elasticity decrease in alveoli elasticity
324
Dyspnea: fever
risk factor fever with a reduced immune and febrile response
325
Dyspnea: surgery
risk factor stomach pelvic chest
326
Dyspnea: structural deviations: breathing
Increase work of breathing while decreasing the maximum volume expiration and vital capacity
327
Agitation; non-pharmacological intervention: most effective
maintain or creating a calm, familiar environment with restricted stimulation
328
Agitation; non-pharmacological intervention: furnishing and decroations
should be minimal and soothing in nature
329
Agitation; non-pharmacological intervention: reorient and calm with
supportive listening composed affect calm, gentle, respectful tone of voice
330
Agitation; non-pharmacological intervention: calming effect
consistent reorientation to patent's surroundings well-established routines
331
Agitation; non-pharmacological intervention: music
offered in soft soothing tones
332
Agitation; non-pharmacological intervention: family member
presence of a calming, familiar and respected family member can provide for agitation reduction
333
Agitation; non-pharmacological interventions
calm familiar environment furnishings and decorations minimal supportive listening composed affect respectful tone of voice music family member
334
Ileus: definition
cessation of peristalsis
335
Ileus: pain
ileus itself is generally painless
336
Ileus: loss of forward motion results in
intestinal obstruction abdominal cramps constipation fecal vomiting abdominal distention atrophy or collapse of surrounding intestines
337
Ileus: causes
operative anesthesia medications for pain control
338
Ileus: postoperative ileus prevention
early ambulation and other activity use of non-opioids to control pain encourage oral intake
339
Ileus: postoperative: oral intake
should be encouraged even prior to presence of bowel sounds
340
Ileus: postoperative: resolve
may resolve itself withing 2-3 days with activity and oral intake
341
Ileus: postoperative: monitor
fluid and electrolyte imbalances blood pressure changes changes in abdominal firth
342
Ileus: postoperative: decompression
colonoscopy or rectal tube may aid in decompression
343
Elderly: delirium: causes
age-related changes within brain visual changes hearing loss prolonged immobility Foley catheters, IV infections metabolism changes polypharmacy malnutrition disease
344
Elderly: delirium: age-related changes within brain
atrophy plaque formation disorders in hippocampus, amygdala or thalamus Alzheimer's cerebrovascular disease
345
Elderly: delirium: Infections
pulmonary urinary tract
346
Elderly: delirium: metabolism changes
chemical buildup reduction of protein binding of drugs enhanced effects of opioids reduced ability to eliminate drugs
347
Elderly: delirium: malnutrition
decreased vitamin or folate deficiencies reduced thirst with fluid and electrolyte imbalances and hypovolemia
348
Elderly: delirium: diseases
cancer cardiovascular pulmonary renal hepatic endocrine
349
BREATHES
B = bronchospasm R = rales/crackles E = effusion A = airway obstruction T = tachypnea and breathlessness H = hemoglobin E = Education S = secretions
350
BREATHES: bronchospasm
consider use of albuterol nebulizers and/or steroids
351
BREATHES: : rales/crackles
fluid intake should be reduced by fluid restriction and D/C IV therapy furosemide 20-40 mg/day spironolactone 100 mg/day
352
BREATHES: effusion
determine presence of pleural effusion by physical examination and chest x-ray Tx: thoracentesis or chest tube
353
BREATHES: airway obstruction
assess for aspiration risk provide preventative measures such as pureed meals, thickened liquids, and keeping patient upright during and after meals
354
BREATHES: tachypnea and breathlessness
opioid use may reduce respiratory rate and create feelings of breathlessness and anxiety assess medications frequently treat anxiety provide cool, moving air
355
BREATHES: hemoglobin
if low, consider blood transfusion
356
BREATHES: education
educate and support the patient and family
357
BREATHES: secretions
if secretions are copious, provide pharmacological treatment
358
haloperidol (Haldol): classification
anti-psychotic antiemetic
359
haloperidol (Haldol): action
blocks post-synaptic dopamine receptors in brain
360
haloperidol (Haldol): most appropriate
drug for agitation associated with physical harm by the patient to self or others and/or psychotic tendencies
361
haloperidol (Haldol): nausea
useful for opioid induced, chemical and mechanical sources of nausea especially anxiety when aggravating symptoms
362
haloperidol (Haldol): used with corticosteriods
helpful for chemotherapy induced nausea and vomiting
363
haloperidol (Haldol): oral dose
0.5 - 5 mg PO q 6-24 hours
364
haloperidol (Haldol): IM dose
5 mg q 3-4 hours
365
haloperidol (Haldol): IV dose
0.5 - 2 mg q 3-4 hours
366
haloperidol (Haldol): elderly patients
require lower initial dose more gradual dose titration
367
haloperidol (Haldol): S/E
prolonged and involuntary contraction of muscles restricted ability to control muscle movement actual loss of muscle movement
368
haloperidol (Haldol): S/E: minimized
by use of low dose
369
haloperidol (Haldol): additive effect
when combined with other CNS depressants
370
Artificial hydration: starting vs. ending
decision to begin is easier than to stop
371
Artificial hydration: termination
problematic and emotional decision must be reached without patients's direct input
372
Artificial hydration: initiate
made ahead of perceived crisis
373
Artificial hydration: declining to initiate
psychological weight of death is not as pronounced
374
Artificial hydration: religious view
no difference between withholding and withdrawal of hydration measures as it affects individual's life and impending death
375
Artificial hydration: cristeria
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
Artificial hydration: limitations
consider hydration limitations on: patient's well-being mobility interactions stress levels finances
377
Pneumocystis carinii pneumonia: definition
opportunistic infection common cause of pulmonary disease in patients with HIV infection
378
Pneumocystis carinii pneumonia:: treatment
trimethoprim-sulfamethoxazole (TMP-SMX)
379
Pneumocystis carinii pneumonia: combination medication
trimethoprim-sulfamethoxazole and corticosteroids survival rate and treatment outcomes greatly improved
380
Pneumocystis carinii pneumonia: second line therapy medications
pentamidine clindamycin
381
trimethoprim-sulfamethoxazole (TMP-SMX)
initial therapy of Pneumocystis carinii pneumonia used with corticosteroids used prophylaxis for patients with AIDS
382
trimethoprim-sulfamethoxazole (TMP-SMX): prophylaxis treatment
can begin in presence of a CD 4 + count of less than 200 or oropharyngeal candidiasis
383
Angiogenesis: definition
normal physiological process in which new blood vessels grow from preexisting vessels
384
Angiogenesis: wound healing
normal part of wound healing
385
Angiogenesis: tumors
key component in creating tumors that mutate from a benign state to a malignant state
386
Angiogenesis: types
sprouting intussusceptive therapeutic
387
Angiogenesis: sprouting
sends proliferating endothelial cells out from the tumor, acting like roots, trying to capture new areas for cell growth
388
Angiogenesis: intussesceptive
identified as "splitting" original capillary walls split into two, forming new, separate cells
389
Angiogenesis: therapeutic
body's natural defenses in order to help combat disease or tissue repair
390
Angiogenesis: tumors use for
to expand and spread in the process of metastasis
391
Angiogenesis: research
expects to identify ways to inhibit this process in the tumor cells
392
Chemotherapy: symptoms
not every patient will experience every symptom, or in same degree S/E can vary greatly some can be controlled with medications
393
Chemotherapy: S/E due to
effects of chemotherapy on cells which have a rapid mitotic rate and rapid turn over bone marrow hair gastrointestinal
394
Chemotherapy: common S/E: bone marrow
bone marrow suppression anemia infection increased bruising and bleeding
395
Chemotherapy: common S/E: gastrointestinal
mouth ulcers sore throat and gums heartburn nausea and vomiting loss of apetite loss of weight anorexia cachexia
396
Chemotherapy: common S/E: other
nerve and muscle problems dry or discolored skin bladder irritation fatigue i
397
Chemotherapy: common S/E: sexual function
can also be affected possible infertility
398
Azotemia: sign of
renal failure
399
Azotemia: definition
represents abnormal levels of nitrogen-based compounds such as urea, and creatinine within the blood
400
Azotemia: build up
caused by insufficient filtering through the kidneys
401
Azotemia: prerenal
results from a lack of blood flow to the kidneys for filtering
402
Azotemia: postrenal
results from obstructed urinary flow
403
Azotemia: diseases which cause
CHF shock severe burns extensive vomiting and diarrhea liver failure trauma to kidneys
404
Azotemia: medications which cause
antiviral medications
405
Azotemia: s/s
decreased urine output fatigue confusion or decreased awareness pale skin rapid pulse dry mouth c/o thirst edema orthostatic blood pressure
406
Azotemia: treatments
hemodialysis peritoneal dialysis
407
CHF: definition
inability of heart to function properly right ventricle, left ventricle or both
408
CHF: most common cause
coronary artery disease
409
CHF: s/s
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
CHF: auscultation of heart
heart murmurs extra heart sounds
411
CHF: auscultation of lungs
crackles in lungs decreased breath sounds
412
CHF: liver
enlarged liver
413
CHF: disease process
may be silent
414
CHF: manifest during times of
infection with high fever anemia arrhythmias hyperthyroidism kidney disease
415
Neutropenia: defintion
small number of neutrophils (most common type of WBC) in blood
416
Neutropenia: lab number
identified as a polymorphonuclear neutrophil count equal to or less than 500/ml
417
Neutropenia: chronic
is a sustained condition of minimal neutrophils lasting 3 months or more
418
Neutropenia: cause
chemotherapy or radiation therapy autoimmune disease
419
Neutropenia: silent
but dangerous
420
Neutropenia: results in
no neutrophils to fight any threat of infection
421
Neutropenia: neutrophils
make up as much as 70% of WBC circulating in bloos
422
Neutropenia: complications
septic situation, life threatening
423
Neutropenia: neutropenic state
up to 70% of patients experiencing a fever will die within 48 hours if not treated aggressively
424
Anti-emetics: 10 classes of medication
butyrophenones prokinetic agents cannabinoids phenothiazines antihistamines anticholinergics steroids benzodiazepines 5-HT 3 receptor antagonists somatostatin
425
Anti-emetics: butyrophenones medications
haloperidol droperidol
426
Anti-emetics: butyrophenones: used for
nausea induced by opioid chemical mechanical
427
Anti-emetics: prokinetic agents: medications
metoclopramide domperidone
428
Anti-emetics: prokinetic agents; used for
gastric stasis and ileus
429
Anti-emetics: cannabinoids: medications
dronabinol
430
Anti-emetics: cannabinoids: used for
second defense anti-emetics that are more effective in young adults
431
Anti-emetics: phenothiazines: medications
prochlorperazine thiethylperazine trimethobenzamide
432
Anti-emetics: phenothiazines: used for
generally used for nausea and vomiting
433
Anti-emetics: antihistamines
diphenhydramine cyclizine dimenhydrinate
434
Anti-emetics: antihistamines: diphenhydramine and cyclinzine:used for
intestinal obstruction peritoneal irritation increased secretions increased ICP
435
Anti-emetics: anticholinergics: medication
scopolamine
436
Anti-emetics: anticholinergics: used for
intestinal obstruction peritoneal irritation increased secretions increased ICP
437
Anti-emetics: steroids: medications
dexamethasone
438
Anti-emetics: steroids: used for
can be used alone or as an adjuvant therapy
439
Anti-emetics: benzodiazepines: medications
lorazepam
440
Anti-emetics: benzodiazepines: used for
nausea and vomiting associated with anxiety
441
Anti-emetics: 5 HT 3 receptors: medication
ondansetron granisetron
442
Anti-emetics: 5 T 3: receptors: used for
chemotherapy radiation therapy postoperative nausea and vomiting
443
Anti-emetics: somatostatin: medication
octreotide acetate
444
Anti-emetics: somatostatin: used for
intestinal obstruction
445
Anti-emetics: antihistamine: dimenhydrinate: used for
used for nausea and vomiting associated with dizziness and motion sickness
446
Sickle cell disease: prevelance
most common genetic diseases in US
447
Sickle cell disease: affects
African Middle Eastern Mediterranean Indian
448
Sickle cell disease: identified by
abnormal globulin gene that allows hemoglobin S to form a "sickle" shape rather than round
449
Sickle cell disease: "sickle" shape
shortens lifespan of hemoglobin, causing chronic anemic state
450
Sickle cell disease: s/s
pallor jaundice weakness fatigue
451
Sickle cell disease: crisis occurs
when cells clump together
452
Sickle cell disease: crisis: causes
thrombi vascular occlusions hypoxia myocardial infarction
453
Sickle cell disease: associated with
multiple acute pain events
454
Sickle cell disease: pain episodes
individualized vary in frequency and severity
455
Sickle cell disease: pain episodes: s/s
pale lips,m tongue, palms or nail beds lethargy and difficulty awakening listlessness irritability severe pain high fever for at least 2 days
456
Sickle cell disease: patient at risk for
bacterial infections
457
Sickle cell disease: children
generally hospitalized less than 6 times a year
458
Sickle cell disease:patient \> 20 years
hospitalized more than 3 times a year may be an indication of impending death
459
Asthenia: etymology
from Greek "athenes", without strength
460
Asthenia: medical term
for debilitating feeling of weakness without an actual loss of muscle strength
461
Asthenia: weakness
may be muscle-group specific or affect entire body
462
Asthenia: vs. actual muscle weakness
distinguishing between can sometimes be difficult asthenia progresses towards muscle weakness in presence of chronic disease
463
Asthenia: most common among patients with
chronic fatigue syndrome sleep disorders chronic heart disease chronic lung disease chronic adrenal disease chronic kidney disease cancer anemia
464
Asthenia: cause
Addison disease anemia anxiety chemotherapy chronic pain dehydration and electrolyte imbalances depression diabetes heart disease infections medications, including narcotics paraneoplastic syndrome
465
Cystic Fibrosis: definition
genetic disease eventually fatal
466
Cystic Fibrosis: child
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
Cystic Fibrosis: symptoms: body locations
lungs pancreas urogenital skeleton skin
468
Cystic Fibrosis: lungs
COPD lung infections
469
Cystic Fibrosis: pancreas
deficient pancreatic enzymes
470
Cystic Fibrosis: skeleton
osteoporosis
471
Cystic Fibrosis: skin
sweat that shows a high electrolyte concentration
472
Cystic Fibrosis: complications: respiratory
nasal polyposis (multiple polyps) bronchiectasis (chronic dilation of bronchus) bronchitis pneumonia respiratory failure
473
Cystic Fibrosis: complications: GI
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
Cystic Fibrosis: complications: children
delayed puberty
475
Cystic Fibrosis: complications: disease process
diabetes failure to thrive arthritis
476
Cystic Fibrosis: medical research
continues to make progress extending life of children into 20s, 30s, and occasionaly into 40s
477
Cystic Fibrosis: treatments
control and prevention of infection excessive secretions pulmonary complications dietary monitoring
478
megestrol acetate: definition
progestin and antineoplastic
479
megestrol acetate: route
tablets oral suspension
480
megestrol acetate: used for
breast and endometrial cancers appetite stimulant
481
megestrol acetate: breast cancer dose
40 mg PO 1 tab 4 x day
482
megestrol acetate: endometrial cancer
up to 320 mg PO in evenly divided doses
483
megestrol acetate: weight loss
400 mg P 1 tab 2 x day
484
megestrol acetate: highest level given
800 mg per day
485
megestrol acetate: S/E
increased appetite fluid retention occasionally nausea
486
megestrol acetate: nausea
will resolve itself within the first few weeks of taking the medication
487
megestrol acetate: rare allergic reactions
jaundice elevated blood pressure
488
Bates-Jensen wound assessment tool: rates
various aspects of wound on a scale
489
Bates-Jensen wound assessment: higher score
more severe the nature of the wound
490
Bates-Jensen wound assessment: size
measured in centimeters multiplying length by width
491
Bates-Jensen wound assessment: depth
1 - 5 1 = noting tissue damage with intact skin covering 5 = involving supporting structures such as tendon and joint capsule
492
Bates-Jensen wound assessment: edges
indistinct attached not attached rolled under hyperkeratosis (callous-like) fibrotic
493
Bates-Jensen wound assessment: measures
size depth edges undermining necrotic tissue type necrotic tissue amount exudate exudate amount color of surrounding tissue presence of edema and pitting epithelialization
494
Bates-Jensen wound assessment: undermining
tip of cotton applicator around edges of wound to identify how far the wound extends under the visible edges
495
Bates-Jensen wound assessment: necrotic tissue type
white/gray nonviable non-adherent yellow slough loosely adherent yellow slough adherent soft black eschar firmly adherent hard/black eschar
496
Bates-Jensen wound assessment: amount of necrotic tissue
1 = none visible to 5 = 75% to %100 of wound covered
497
Bates-Jensen wound assessment: exudate type
bloody serosanguineous serous purulent foul purulent
498
Bates-Jensen wound assessment: exudate amount
none scant small moderate large
499
Bates-Jensen wound assessment: color of surrounding tissue
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
Bates-Jensen wound assessment: peripheral tissue edema and pitting
none to crepitus and/or pitting edema extends \> 4 com around wound
501
Bates-Jensen wound assessment: epithelialization
100% wound covered, surface intact to \<25% wound covered
502
Bates-Jensen wound assessment: granulation
skin intact or partial thickness wound to no granulation tissue present
503
Most common infection in hospice patients
pneumonia patients are greatly hindered in physical activity by disease process
504
Pneumonia: immune systems
compromised
505
Pneumonia: complication of AIDS
pneumocystis carinii 85% of AIDS patients will develop
506
Pneumonia: pneumocystis: treatment
trimethoprim-sulfamethoxazole
507
Pneumonia: trimethoprim-sulfamethoxazole
used prophylactically first drug of choice
508
Pneumonia: s/s
fever dyspnea cough
509
Pneumonia: vaccination
recommended for palliative care patients
510
Fever: common causes: minor
constipation dehydration
511
Fever: common causes: immunosuppressed patient
fresh fruits vegetables spices flowers tobacco
512
Fever: common causes: cancers
Hodgkin and non-Hodgkin lymphoma hypernephroma carcinoma of liver leukemia multiple myeloma Ewing sarcoma adrenal carcinoma obstructive tumors
513
Fever: common causes: obstructive tumors
thermoregulatory gastrointestinal genitourinary respiratory
514
Fever: common causes: misc
neutropenia immunosuppression chemotherapeutic agents blood products infections inflammatory processes autoimmune allergic responses environmental agents
515
Fever: common causes: inflammatory process
thrombophlebitis trauma necrosis pulmonary embolism ulcerative colitis
516
Fever: common causes: auotimmune
lupus rheumatoid arthritis AIDS medication based
517
Chemotherapy: concern
infection because of the decreased numbe rof neutrophils in patient's system
518
Chemotherapy: neutropenia
silent but dangerous leaving no neutrophils to fight the threat ofinfections
519
Chemotherapy: neutropenia: causes
septic situation, which can be life-threatneing
520
Chemotherapy: anemia
may result in need for blood transfusion
521
Chemotherapy: neurological damage
mild alterations in taste or smell peripheral neuropathy mental status changes seizures
522
Chemotherapy: heart damage
some anticancer drugs can cause heart damage
523
Chemotherapy: kidney
anticancer drugs may cause: kidney damage increasing risk of drug toxicity from decreased renal function
524
Chemotherapy: eye damage
cataracts retina damage
525
Chemotherapy: complications
neutropenia anemia neurological damage heart damage kidney damage eye damage
526
Chemotherapeutic agents
alkylating agents nitrosoureas antimetabolites anti-tumor antibiotics plant (vinca) alkaloids steroid hormones
527
Chemotherapeutic agents: alkylating agents:MOA
work directly by acting the DNA of cancers
528
Chemotherapeutic agents: alkylating agents: used for
chronic leukemia Hodgkin disease lymphomas lung breast prostate ovary
529
Chemotherapeutic agents: nitrosoureas: MOA
inhibit repair in damaged DNA able to cross blood brain barrier
530
Chemotherapeutic agents: nitrosoureas: used for
brain tumor lymphomas multiple myeloma malignant melanoma
531
Chemotherapeutic agents: antimetabolites:MOA
block cell growth
532
Chemotherapeutic agents: antimetabolites: used for
leukemia choriocarcinoma (rare, uterus, ectopic) gastrointestinal breast ovary
533
Chemotherapeutic agents: anti-tumor: MOA
bind to DNA and prevent RNA synthesis
534
Chemotherapeutic agents: anti-tumor: used for
wide variety of concers
535
Chemotherapeutic agents: plant (vinca) alkaloids: MOA
extracted from plants and blockcell division
536
Chemotherapeutic agents: plant (vinca) alkaloids: used for
acute lymphobastic leukemia Hodgkin and non-Hodgkin lymphomas neuroblastomas Wilms tumor lung breast testes
537
Chemotherapeutic agents: steroid hormones: MOA
unclear action
538
Chemotherapeutic agents: steroid hormones: used for
hormone-dependent cancers ovary breast
539
expressive aphasia: known as
Broca aphasia
540
expressive aphasia: definition
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
expressive aphasia: example
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
expressive aphasia: therapeutic comminication
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
expressive aphasia: helpful tool
communication board
544
expressive aphasia: eye blinking
eye blinking responses to simple yes/no types of questions used when patient maintains comprehension, but has extremely limited neuromuscular function
545
Cancer: patient top two complaints
fatigue anorexia and cachexia
546
Cancer: common complaints
fatigue anorexia nausea constipation states of delirium dyspnea
547
Cancer: fatigue: s/s
tiredness lack of energy not related to amount of rest diminished mental capacity weakness
548
Cancer: fatigue: complications
interfere with ability to perform ADLs often undiagnosed or downplayed
549
Cancer: anorexia and cachexia: treatment
careful nutritional management
550
Cancer: nausea and constipation: treatment
easily treated if assessed and planned for
551
Cancer: altered mental states and dyspnea
easily treated if assessed and planned for
552
Chemotherapy: routes
orally intramuscular subcutaneously IV intra-arterially intralesionally (directly into tumor) intraperitoneally intrathecally (arachnoid membrane which covers the brain and spinal cord) topically
553
Chemotherapy: oral
easiest and often used in home
554
Chemotherapy: IV
most common route
555
Chemotherapy: IM
may have more lasting effects
556
Chemotherapy: intra-arterial
goal is to introduce agent directly into blood supply feeding tumor or affected organ
557
Chemotherapy: intraperitoneal
used for ovarian cancer with tumors greater than 2 centimeters in diameter
558
Chemotherapy: intrathecal
used for acute lymphocytic leukemia
559
Chemotherapy: intralesional
used for melanoma and Kaposi sarcoma
560
Chemotherapy: topical
used for skin cancer
561
Dementia: patients should have
minimal stimulation simple and consistent routines
562
Dementia: communication
straightforward uncomplicated words and explanations
563
Dementia: high priority
patient safety
564
Dementia: patient clothing and foot wear
well fitting
565
Dementia: environment
uncluttered unchanging free from hazards
566
Dementia: environmental hazards
dimly lit areas open flames sharp corners loose area rugs
567
Dementia: supervision
requires close supervision
568
Dementia: sleeping
discouraged from sleeping during daytime hours to avoid time disorientation and to maximize nighttime restfulness and safety
569
Dementia: medications
donepezil tacrine ginkgo biloba
570
Dementia: interventions
well-fitting clothing and footwear safe environment close supervision sleeping medications
571
Depression: chemically induced: results from
introduction of substance withdrawal from substance
572
Depression: chemically induced: worsening
preexisting depression can be worsened in presence of these substances
573
Depression: chemically induced: everyday substances
alcohol and analgesics are known to increase depression
574
Depression: chemically induced: withdrawal from alochol
associated with: vague feelings of unease discomfort dread associated with depression and anxiety
575
Depression: chemically induced: medications which cause
hypoglycemic agents steroids chemotherapy antimicrobial L-dopa antihypertensives antiparkinsonian oral contraceptives estrogen and progesterone therapy benzodiazepines phenothiazines amphetamines lithium carbonate heavy metals cimetidine
576
Cancer related fatigue: cause
physiologic psychological
577
Cancer related fatigue: may be related to
depression pain anemia r/t iron deficiency sleeping disorders fluid and electrolyte imbalances hypocalcemia hypothyroidism hypoxia infection overmedicating
578
Cancer related fatigue: disorders
metabolic neurological
579
Cancer related fatigue: mood disorders
unresolved anxiety or fears concerning disease process or treatments
580
Cancer related fatigue: stress
overall change and increase in amount of stress experienced can lead to fatiguein
581
Cancer related fatigue: impaired thinking
can cause confusion around timing of the day and need for active rest
582
Cancer related fatigue: treatment strategies
focus on finding and resolving the underlying cause for fatigue
583
Fatigue: medications
methylprednisolone methylphenidate modafinil hydrocortisone erythropoietin alpha (epoetin alfa) antidepressants dextroamphetamines
584
Fatigue: medications: methylprednisolone
increases patient activity
585
Fatigue: medications: methylphenidate: improves in cancer patients
pain relief somnolence
586
Fatigue: medications: methylphenidate: reduces and increases
fatigue and increases cognitive function when combined with exercise
587
Fatigue: medications: methylphenidate: staminia
increases stamina and energy
588
Fatigue: medications: methylphenidate: therapeutic effects
for major depressive disorders and improves overall mood
589
Fatigue: medications: modafinil
can be used with MS to reduce fatigue
590
Fatigue: medications: MS
modafinil histamine phosphate/caffeine citrate transdermal patch
591
Cancer related fatigue: treatment strategies
focus on finding and resolving the underlying cause for fatigue
592
Fatigue: medications
methylprednisolone methylphenidate modafinil hydrocortisone erythropoietin alpha (epoetin alfa) antidepressants dextroamphetamines
593
Fatigue: medications: methylprednisolone
increases patient activity
594
Fatigue: medications: methylphenidate: improves in cancer patients
pain relief somnolence
595
Fatigue: medications: methylphenidate: reduces and increases
fatigue and increases cognitive function when combined with exercise
596
Fatigue: medications: methylphenidate: staminia
increases stamina and energy
597
Fatigue: medications: methylphenidate: therapeutic effects
for major depressive disorders and improves overall mood
598
Fatigue: medications: modafinil
can be used with MS to reduce fatigue
599
Fatigue: medications: MS
modafinil histamine phosphate/caffeine citrate transdermal patch
600
Fatigue: medications: hydrocortisone
use cautiously can enhance mood and improve fatigue for a short time in patients experiencing chronic fatigue syndrome
601
Fatigue: medications: chronic fatigue syndrome
hydrocortisone
602
Fatigue: medications: erythropoietin alpha
may treat anemia-based fatigue by working to increase the base hemoglobin levels
603
Fatigue: medications: anemia-based fatigue
erythropoietin alpha
604
erythropoietin alpha: antidepressants
nortriptyline amitriptyline
605
Fatigue: medications: dextroamphetamines
CNS stimulants may be used cautiously
606
Bowel strangulation: s/s
severe steady pain, rather than cramping
607
Bowel strangulation: severe steady pain
indicates blood supply has been completely cut off to an area of intestines where there is an obstruction
608
Bowel strangulation: considered
medical emergency
609
Large bowel obstruction: s/s
cramping pains in lower abdomen bloating diarrhea or constipation
610
Large bowel obstruction: cramping pain
lower abdomen, below navel increases over time
611
Large bowel obstruction: bloating
feeling of bloating in lower stomach and pelvic area
612
Large bowel obstruction: vomiting
not common
613
Small bowel obstruction: s/s
cramping, colicky pain vomiting constipation and inability to pass gas bloating high pitched stomach noises
614
Small bowel obstruction: cramping, colicky pain
come in waves middle to upper abdomen relieved with vomiting
615
Small bowel obstruction: emesis
green in color
616
Small bowel obstruction: untreated pain
pain may become lessened over time as bowel stops contracting
617
Small bowel obstruction: most common
constipation inabiliity to pass gas
618
Small bowel obstruction: partial bowel obstruction
diarrhea faltulence
619
Small bowel obstruction: bloating
patients will complain of feeling bloated
620
Small bowel obstruction: high pitched stomach noises
will decrease and stop as bowel slows down
621
Disease processes with highest risk of fatigue
cancer coronary artery disease chronic fatigue syndrome chronic obstructive pulmonary disease end-stage renal disease HIV/AIDS MS Parkinson
622
High risk for fatigue: cancer
most distressing symptom to experience S/E of treatment
623
High risk for fatigue: coronary artery disease
affects 13 million people leading cause of death significant fatigue
624
High risk for fatigue: chronic fatigue syndrome
most common among women
625
High risk for fatigue: COPD
fatigue is second most prevalent s/s most prevalent is shortness of breath
626
High risk for fatigue: End-stage renal disease
hemodialysis, fatigue rates are 100% peritoneal dialysis, fatigue rates are 80%
627
High risk for fatigue: HIV/AIDS
fatigue presenting symptom before diagnosis
628
High risk for fatigue: MS
most common and disabling symptom no widely accepted pharmacological treatment
629
High risk for fatigue: Parkinson disease
studies lacking for exact information rates most agree rates are extremely high
630
Fatigue assessment
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
Fatigue assessment: body
where in body is fatigue experienced extremities mental faculties total body
632
Fatigue assessment: severity
what is severity
633
Fatigue assessment: ADLs
does fatigue interfere with patient's daily activities
634
Fatigue assessment: aggravate
what factors seem to aggravate the symptoms of fatigue
635
Fatigue assessment: alleviate
what methods seem to help alleviate fatigue
636
Fatigue assessment: medications
any of patient's current medications a contributing factor
637
Fatigue assessment: physical exam and general appearance
present evidence of medically based reasons for, or resulting harm related to,fatigue
638
Fatigue assessment: muscle strength and nerve responses
what are patient's muscle strenght and nerve responses
639
Fatigue assessment: vital signs
low blood pressure low pulse irregular heart rate fever
640
Fatigue assessment: oxygenated
is patient oxgenated
641
Fatigue assessment: balanced
hormone levels fluid electrolytes
642
Cancer related fatigue: nursing interventions
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
Cancer related fatigue: best tool
education
644
Cancer related fatigue: explanations
disease process nutrition treatments presence of infection and fever all increase body's demand for rest
645
Cancer related fatigue: routine and schedule
changes in routine and schedule increase fatigue
646
Cancer related fatigue: worry and anxiety
increase fatigue
647
Cancer related fatigue: be prepared
for all procedures, activities, and routines to help reduce energy demands
648
Cancer related fatigue: sleep cycle
reduce disruptions to sleep cycle by establishing routines for bedtime and awakening provide longest sleep and rest times possible
649
Cancer related fatigue: nurtition
encourage foods that will help maintain energy levels with minimal energy output to eat and digest small frequent meals
650
Cancer related fatigue: foods
protein minimal energy to eat and digest
651
Cancer related fatigue: assessments
treat other symptoms which may be interfering with ability to rest pain depression nausea and vomiting
652
Cancer related fatigue: distracting and restorative activities
music time with nature time with family and friends
653
Cancer related fatigue: prioritize
help patient determine what expenditures of energy are most important and which can be removed
654
Cancer related fatigue: routines
mild exercise leisure activities physical therapy
655
Non-pharmacological for N/V
self-hypnosis relaxation biofeedback imagery distraction desensitization acupressure music therapy
656
Non-pharmacological for N/V: self-hypnosis
involves invoking an altered state of consciousness in anticipation of N/V espisodes to decrease frequency, severity, amount, and druation of uncomfortable episodes
657
Non-pharmacological for N/V: relaxation
progressive relaxation of muscle groups often involving imagery helpful in conjunction with chemotherapy induced N/V
658
Non-pharmacological for N/V: biofeedback
electromyographic or skin temperature controlled responses to changes within the body May be used with relaxation during chemotherapy
659
Non-pharmacological for N/V: imagery
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
Non-pharmacological for N/V: distraction
diverting attention to other activities such as video games, puzzles or humor
661
Non-pharmacological for N/V: desensitization
involves relaxation and visualization to decrease perceptions of N/V
662
Non-pharmacological for N/V: acupressure
a form of massage to increase energy flow and improve emotion
663
Non-pharmacological for N/V: music therapy
often used with other therapies to influence physiological psychological, and emotional states during and after N/V episodes
664
Constipation: causes
bowel or pelvic cancer disease processes hypercalcemia decreased fluid intake weakness and inactivity confusion depression changes in toileting medications
665
Constipation: causes: cancers
primary or metastasized bowel or pelvic area cause intestinal obstruction or adhesion
666
Constipation: causes: disease processes
diabetes hypothyroidism hypokalemia diverticulitis hemorrhoids colitis chronic neurological disease
667
Constipation: causes: changes which cause slow motility
nutrition and appetite decreased fluid intake weakness and inactivity confusion depression toileting
668
Constipation: causes: medications
opioids anticholinergics tricyclic antidepressants antiparkinsonian iron antihypertensives antihistamines antacids diuretics vinca alkaloid chemotherapy
669
Constipation: causes: medications: opioids
suppress motility increase sphincter tone increase electrolyte and water absorption
670
Constipation: causes: medications: vinca alkaloid chemotherapy
damages myenteric plexus of colon, causing increased contractions without increased movement
671
Palliative nutrition: definition
patient should be permitted to eat whatever he or she dsires
672
Palliative nutrition: calorie count
should not focus on calories or content
673
Palliative nutrition: focus
on patient's desires and preferences
674
Palliative nutrition: major concern
fatigue
675
Palliative nutrition: education
about importance of proper nutrition and adequate energy-providing foods
676
Palliative nutrition: food
nutritious high protein nutrient dense
677
Palliative nutrition: meals
small, frequent
678
Palliative nutrition: encourage
adequate fluid intake frequent oral hygiene
679
Palliative nutrition: supplements
use of protein supplements
680
Diarrhea: assess
environment patient's history physical evaluate stool
681
Diarrhea: assess: environment
ease of care during episode of diarrhea
682
Diarrhea: assess: patient's history
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
Diarrhea: assess: physical
perineum or ostomy site for skin breakdown fissures or hemorrhoids impaction abdomen for distention or palpable stool
684
Diarrhea: assess: stool
evaluate stool for signs of bleeding and for dehydration
685
Diarrhea: nursing interventions
perineum or stoma sitz baths nutrtion
686
Diarrhea: nursing interventions: perineum or stoma
ensure area is cleaned gently and thoroughly after each movement
687
Diarrhea: nursing interventions: sitz baths
offer sitz baths as appropriate
688
Diarrhea: nursing interventions: meals
small, frequent, bland meals with increased fluid intake
689
Diarrhea: nursing interventions: diet
low-residue diet with potassium-rich foods
690
Diarrhea: nursing interventions: homeopathic methods
ginger tea glutamine (amino acid) peeled apples
691
Hiccups: medications
simethicone metoclopramide baclofen midazolam gabapentin carbamazepine valproic acid haloperidol chlorpromazine phenytoin nefopam lidocaine quinidine nifedipine dexamethasone mephenesin amitriptyline methylphenidate sertraline
692
Hiccups: medications: simethicone
15 - 30 ml
693
Hiccups: medications: metoclopramide
10-20 mg
694
Hiccups: medications: bacolfen
5-10 mg
695
Hiccups: medications: gabapentin
300-600 mg
696
Hiccups: medications: haloperidol
1-5 mg
697
Hiccups: medications: reduce gastric distention
simethicone metoclopramide
698
Hiccups: medications: muscle relaxants
baclofen midazolam
699
Hiccups: medications: anti-convulsive agents
gabapentin carbamazepine valproic acid
700
Hiccups: medications: dopamine agonists
haloperidol chlorpromazine
701
Hiccups: medications: calcium channel blockers
phenytoin nefopam lidocaine quinidinenifedipine
702
Hiccups: medications: other medications
dexamethasone mephenesin amitriptyline methylphenidate sertraline
703
Hiccups: medications: midazolam
5-10 mg
704
Hiccups: medications: carbamazepine
200 mg
705
Hiccups: medications: valproic acid
5-15 mg
706
Hiccups: medications: chlorpromazine
5-50 mg
707
Hiccups: medications: phenytoin
200-300mg
708
Hiccups: medications: nefopam
10 mg not in Davis Drug Guide
709
Hiccups: medications: lidocaine
2 mg/min
710
Hiccups: medications: nifedipine
10-80 mg
711
Hiccups: medications: quinidine
200 mg
712
Hiccups: medications: dexamethasone
40 mg
713
Hiccups: medications: mephenesin
1000 mg not in Davis Drug Guide
714
Hiccups: medications: amitriptyline
25-90 mg
715
Hiccups: medications: methylphenidate
5-20 mg
716
Hiccups: medications: sertraline
50 mg
717
Cultural considerations: American Indian/ Alaskan natives
embarrassed to report N/V, constipation, diarrhea dyspnea = "heavy air" appearance of high activity levels despite fatigue depression/psychiatric problems = "heavy heart"
718
Cultural considerations: Asian/Pacific Islanders
illness caused by imbalance "yin & yang" treat symptoms homeopathically mental illness hidden, not discussed
719
Cultural considerations: Black population
willing to discuss symptoms unwilling to seek treatments, medication
720
Cultural considerations: Hispanic
willing to discuss s/s may feel s/s beneficial or do not require treatment mental difficulties = weakness and embarrassement
721
Actively dying: definition
physical signs and symptoms that indicate anticipation of death within hours or days
722
Actively dying: s/s
weakness skin changes nutrition respiratory changes changes in mental status semi-comatose / fully comatose incontinence third-space fluids reabsorbed pupils fixed and dialated
723
Actively dying: s/s: weakness
profound weakness, requiring complete care
724
Actively dying: s/s: skin changes
gaunt and pale cool extremities
725
Actively dying: s/s: nutrition
lack interest in food or drink difficulty swallowing significant decreases in intake
726
Actively dying: s/s: respiratory changes
dyspnea changing to an easier, shallow respiration with decreased oxygen concentration gurgling or gravely sounds in the back of throat from excess secretoins
727
Actively dying: s/s: changes in mental status
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
Actively dying: s/s: third space fluids
reabsorbed, decreasing the amount of swelling present
729
Dyspnea: physiology:
vascular bed decrease impaired mechanical responses and ventilatory pump impairment
730
Dyspnea: physiology: vascular bed decrease from
thromboemboli tumor emboli vascular obstruction radiation chemotherapy toxicity concomitant emphysema
731
Dyspnea: physiology: vascular bed
the sum of the blood vessels supplying an organ or region
732
Dyspnea: physiology: vascular bed decrease cause
dead space causes increased ventilation demands
733
Dyspnea: physiology: increased ventilation demands results in
hypoxemia severe deconditioning metabolic acidosis alterations in carbon dioxide output and arterial partial pressure of carbon dioxide increased neural reflex activity, anxiety, depression
734
Dyspnea: physiology: impaired mechanical responses and ventilatory pump impairment
inspiratory muscle weakness from cachexia electrolyte imbalances neuromuscular abnormalities and steroid use pleural or parenchymal disease reduced chest wall compliance airway obstruction
735
Ethics: definition
branch of philosophy that focuses on moral life
736
Ethics: method used to
understand and examine social customs, norms,and rules that help define right and wrong
737
Ethics: not absolute
do not have clear answers
738
Ethics: adjust
to cover ever-changing social and cultural contexts influenced by individual and cultural morals
739
Ethics: clinical information
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
Ethics: nurse should demonstrate
basic understanding of ethical principles concepts that influence health care knowledgeable about laws that govern ethical positions of profesoinal nursing organizations
741
Ethics: problem solving
use of nursing process
742
Ethics: resolution of ethical dilemmas
best choice is made based on all the information considered
743
Ethics: legal system
ethical dilemmas can often be resolved without input from legal system
744
End stage respiratory disease: original diagnosis
regardless of original underlying diagnosis, s/s as well as treatment will be the same by the end stages
745
End stage respiratory disease: iimpacts
ADLs respiratory infection respiratory failure increased stress in lungs
746
End stage respiratory disease: ADLs:
impacts with frequent exacerbation increasing use of emergency treatments
747
End stage respiratory disease: infection
increased respiratory infection and failure rate as disease progress
748
End stage respiratory disease: respiratory failure
results from decreased PO2 and increased PCO2 suppresses respiratory drive causes slow loss of consciousness until respiration stop
749
End stage respiratory disease: increased stress in lungs
creates increased stress on heart lead to lower peripheral edema, pulmonary hypertension, right-sided heart failure
750
End stage respiratory disease: complications
fatigue, limited tolerance for activity poor quality of life weight loss tachycardia tachypnea pneumonia pneumonthorax polycythemia (too much production of red blood cells)
751
End stage respiratory disease: FEV1 (forced expiratory volume at 1 second)
less than 0.75 L have a 30% chance of dying within a year
752
Tuberculosis: common among
immunosuppressed patients
753
Tuberculosis: s/s
night sweats unexplained weight loss fatigue chronic cough with active sputum
754
Tuberculosis: untreated
may spread to other organs causing neurological disease such as meningitis, bone infections, and urinary bleeding
755
Tuberculosis: positive tuberculin skin test
signifies previous exposure to tuberculin organisms
756
Tuberculosis: skin test can't
pinpoint a recent change from a negative status unless the positive test is a follow-up to previous negative test results
757
Tuberculosis: skin test: time of exposure
cannot accurately pinpoint time of exposure
758
Tuberculosis: diagnosis for presence of active disease
obtained by finding acid-fast bacilli in stained smear samples from sputum or other body fluids
759
Tuberculosis: bacteria
mycobacterium tuberculosis isolating on culture or rapid nucleic acid test probes
