Process Final Exam Flashcards
What causes respiratory acidosis? What is pCo2?
COPD, Resp. Depression (Drugs, CNA trauma), or pneumonia. PCo2 is 35-45
What causes metabolic acidosis? What is normal HCo3?
Diabetes, shock, renal failure. 22-26
HPV, Genetic/Familial Factors, Radiation, EBV, Abstestos, H pylor,
Match to cause to the cancer: Hormones, HepB, Hereditary cancer syndrome, Tobacco, Lifestyle, Immunosuppresants, Genetic/familal
Cervical, leukemia, nasopharyngeal, liver, bladder, breast, thyroid
Multiple Myeloma, Head/neck, uterine, Bonde, prostate, pharyngeal
Cervical/head & neck, leukemia/childhood cancer, (2 malign/leukemia/bone/thyroid/mm/breast/lung, nasopharyngeal, lung, gastric,endogenous/exogenous-bc;uterine/breast/prostrate,liver, 2 1 degree relatives have it, phayrngeal/baldder, transplant/aids, leukemia
What teaching to provide patients for cancer prevention? What is the difference between primary, secondary, and teriary cancer prevention?
Limit alcohol, diet/exercise/wt, get all vaccinations (HPV/Hep B), Sunscreen; 1) limit RF/edu, 2) screening/detection of precancerous lesions 3) monitoring and preventing secondary malignacies
List seondary cancer prevention strategies for the following: colorectal, cervix, breast, lung, prostrate
Age: 50 get FIT/hemooccult; Stool Dna/colonscopy, 21> pap smear; 40 Mammograms, 55-74 with 30 + pack yr hx: CT, PSA>50/DRE as a shared decision
Tests to diagnose cancer
2 types; Interventions
To evaluate the extent of cancer and metastasis; A Punch biopsy is like hole cutter (prostate); PET SCAN Interventions: No Alcohol, exercise, tobacco, or caffeine 24 hours before, 4-6 hours NPO, Empty bladder, Diabetics: glucose 70-199, Last meal should be high protein/low carb, needs IV access; Glucose is a carrier for radioisotopes; Post procedure need to drink lots of water for excretion
Is grading and staging of cancer similar?
Describe both types
What is To, N1/N2, M1/M2; T2N1Mo vs T1N2M2
What are the goals of cancer treatment
?
No; TNM staging: extent of tumor, metastasis, and lymph node involvement. Grading: type 1 is similar to tissue of orgin; grade 4 looks completely diff; They are combined into antamonic groups
To is no tumor; T1 is small; N is node involvement-N1 is local; T2N1Mo
N2 is distant; M1 is nearby organs; M2 is distant; cure, control, and pallitation
Colectomy, Mammectomy, Lobectomy, Polyp removal, skin/head/neck recons,
Surgical treatment for cancer
Biopsy vs Removal;
Core needle,pallative, Wide excision, prophylactic,incisional,Excisional, fine needle, reconstructive, local removal
1) excisional: small & accessible (GI)
2) Incisional (too large; radiation 1st)
3) Fine needle bipsy (only cells-false negative)
4) Core needle (Wider and can take tissue-high risk for bleeding)
5) Local removal: small
6) Wide excision: Primary removal+lymph node+Surrounding tissue (lobectomy)
7) Prophylatic: Non-vital tissue removed due to genetic predisp (Colectomy/Mastecomy/Oophorectomy)
8) Pallative: relieve symptoms-debulking tumor to relieve p (drains/shunts); Pleural drain/brain
9) Resconstructive (Skin/head and neck Breast surgery)
What is standard perioperative care
3 things pre and post op
1) Educate the patient on POC/other treatment methods/make sure they have informed consent
2) Get informed consent; mark surgical site
3) Promote atelectasis prevention using Incentive Spirometer
Post Surgery
4) SCDs for VTE prophylaxis
5) Infection prevention (monitor surgical site and perform wound care)
6) Pain management
COPD includes what two diseases? What shoud SPO2 be kept at?
Dx criteria & what they are
Chronic bronchitis: 3 months each over 2 consecutive years; mucus in airways; Emphysema: overinflated alveoli/air trapping; Unable to exchange gas; 88-92%
Characteristics of Chronic Bronchitis
Bigand blue; Longterm cough & sputnum; Unsual lung sounds-stridor and wheezing; Edema; Acidosis
Overweight, hypoxemia/clubbing
Emphysema characterisitcs
Pink skin and pursed lip; Increased barrel chest; No cough; Keep tripoding
Worseing dyspnea; Alkalosis, cachezia/muscle wasting, dimished breath so
Overinflated lungs; Hyperventilation
COPD Symptoms
Sputnum and chronic cough; muscle wasting; barrel chest; tripoding; rectraction/accessory muscles; Acidosis/Alkalosis (Metabolic syndrome)
Hypercapnia and high hemoglobin (polycythemia)
Difference between type 1 and type 2 diabetes; Common symptoms
What is Latenet autoimmune diabetes of adults?
Type1 shld check ketones if sugar>240 or if flu
Type 1 has ketones (genetic/autoI) in urine and weight loss. Both have 3 P’s. Polyuria, Polydipsia, and polyphagia. In type 1 the pancrease is damaged and no insulin is produce. In type 2, the insulin doesn’t act on cells or the pancreas is overworked. Symptoms: slow wound healing, vision changes, frequent infections, tingling/numbness, fatigue
Slow destruction of beta cells (autoimmune);
They typically don’t need insulin 6 months after onset
What are risk factors for diabetes type 2?
Obesity, BMI>30, HTN, Triglycerides>250, Hx of gestational diabetes or baby is >9 lbs, HDl<35
How is diabetes diagnosed?
Fasting plasma glucose, random, post-prandial, A1c
Fasting plasma glucose (8 hrs NPO)>126
Random (anytime)>200 & with symptoms
Post-prandial (2 hrs after eating)>200
A1c (% in blood): Normal is less than 5.7%; Prediabetes: until 6.4%; >6.5%
Only one test needs to be postive for diagnosis
Diabetes education
Exercise, meals, older afults, don’t exercise if what, what do they need on them?
-Don’t exercise when glucose>250 or ketones in urine; patients on insulin should have 15 g snack before (apple, 6 crackers, 1/2 raisin box), eat & monitor bs after exercise (if extensive b4,duri/after), medical alert bracelet, older adults: physical therapy
Exercise guideline For DB
Frquency, specific to db2, precautions before; why does it help? When?
3 times a week with no more than 2 consecutive days w/o; Db2: RT2xwk; If >30 and have 2 RF for heart disease->take exercise stress test b4; It helps lower bs (incr uptake and usage);hyperlipidemia- cholestrol & triglycerides, blood pressure, and helps with weight loss); Care with retinopathy/high BP; 1-3 hours after eating
Avoid extreme T’s, wear proper shoes/inspect feet; stretch b4; start slo
How do you diagnose copd? Complications?
Spirometry,
If pulmon. fxn returns after brondil use, the ____
Spirometry: FEV1/FVC; Tells u disease severity
ABG
Alpha antitrypsin
CXR; Pneumonia, Resp. Failure, Atelectasis, Pneumothroax, Cor Pulmonale (RV dysfunction)
COPD is reversibel
Medical management of COPD
Indication for oxygen, treatments
1) Get the flu and pneumonia vaccine (after 65)-every 10 yrs;
2) Managing exacerbation/ risk factors: Alt. activity with rest periods; encourage hydration 64-94 oz & nutrition (meal planning), smoking cessation;
3)Cough/deep breathing, Supplemental O2-change in Loc or respiratory rate (Low flow is less precise but more oxygen concentrated; high flow is opposite-venturi),
4) Tx: MDI; Pulmonary rehab, and surgery
All 3 nursing dx apply
COPD Medications
Mild, Grade 2-3, Grades 3-4 (severe to very sever)
Mild: Albuterol/SABA
Moderate/Severe: SABA + LABA (Albuterol and salmetrol)
Severe: SABA+LABA+Corticosteroids (Beclamethasone)
Advair (Fluticasone +Salmetrol) & Albulterol
(Duoneb-Salmetrol and ipratropium); Anticholinergics/Muscarinic: Ipratro
Mucolytics, Abx, anti-tussives only if bothering at night
Asthma is caused by what? What is the process of using the stepwise model?
Symptoms are what; complications, Dx is like what
Medications: Quick and Long; Severant, Singulair, pulmincort, atrovent
Wheezing/chest tightness/Dyspnea/Cough;
Quick: Beta agonist (albuterol); Muscarinic/anticholinergic agents (Ipratropium-atrovent);
Long acting (Salmetrol); Corticosteroids (Inhaled-budesonide-pulmicort) Beta agonist (Salmetrol-Severant), Leukotrienes-montelukast (Singulair)
Assess the pt (See if envt can b modified), modify med, and then review response. If patient is unadherant or it is poorly controlled move to the next step. If patient has no exacerbations for 3 months, u can move down.
Abrupt and increase; Status Asthmaticus, like COPD
How do you manage asthma?
Assess, labs, administer, and communicati;What does a silent chest mean?
1) Ausculate the lungs, SpO2, Peak flow, Vs, Dyspnea
2) ABG (Alkalosis if status asthmaticus->Acidic)
3) Admin. O2 and fluids
4) Approach the patient in a calm manner
Resp. failure
Patient teaching of Asthma
Peak flow monitoring classess
Identify triggers (Air filter, mattress, cleaning agents)
Wash mouth after using corticosteroids
SABA: tachycardiac and jittery
How to use MDI: prime (spray it), shake, close mouth around it, spray and take slow breath in for 10 s, hold, and exhale
Peak flow meter prevents asthma episodes/predicts exacerbations
gren (80-100 personal best), yelow: Symptomatic (60-80-use rescue & cal)
Red (Chest tightness;pain; noctural coughing; wheezing; dyspnea;sob;-60%); call 911/doc & use rescue
Cystic Fibrosis
Type of inheritance
Cause of mortality, prob with abx
Thick mucus everywhere due to problems in cl transport-lungs/pancreas/intestines/liver/reproductive, foul stool, repeated resp. inf, poor growth, constipation
Tx: neb: abx, pulmozyme,hypertonic saline, vest physiotherapy between meals to prevent aspiration, pancreatic enzymes, CFTR modulators (Trikfakta), pain meds, Double lung transplant
Management: O2, high calorie/protein diet
Encourage Independence, Contact Isolation
Males: lack vas deferens; females: thick cervical mucus
Genetic counseling/End of Life
Autosomal recessive; Rsp. inf, resistance
