Process Final Exam

Question 1

What causes respiratory acidosis? What is pCo2?

Answer 1

COPD, Resp. Depression (Drugs, CNA trauma), or pneumonia. PCo2 is 35-45

Question 2

What causes metabolic acidosis? What is normal HCo3?

Answer 2

Diabetes, shock, renal failure. 22-26

Question 3

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

Answer 3

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

Question 4

What teaching to provide patients for cancer prevention? What is the difference between primary, secondary, and teriary cancer prevention?

Answer 4

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

Question 5

List seondary cancer prevention strategies for the following: colorectal, cervix, breast, lung, prostrate

Answer 5

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

Question 6

Tests to diagnose cancer

2 types; Interventions

Answer 6

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

Question 7

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
?

Answer 7

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

Question 8

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

Answer 8

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)

Question 9

What is standard perioperative care

3 things pre and post op

Answer 9

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

Question 10

COPD includes what two diseases? What shoud SPO2 be kept at?

Dx criteria & what they are

Answer 10

Chronic bronchitis: 3 months each over 2 consecutive years; mucus in airways; Emphysema: overinflated alveoli/air trapping; Unable to exchange gas; 88-92%

Question 11

Characteristics of Chronic Bronchitis

Answer 11

Bigand blue; Longterm cough & sputnum; Unsual lung sounds-stridor and wheezing; Edema; Acidosis

Overweight, hypoxemia/clubbing

Question 12

Emphysema characterisitcs

Answer 12

Pink skin and pursed lip; Increased barrel chest; No cough; Keep tripoding

Worseing dyspnea; Alkalosis, cachezia/muscle wasting, dimished breath so

Overinflated lungs; Hyperventilation

Question 13

COPD Symptoms

Answer 13

Sputnum and chronic cough; muscle wasting; barrel chest; tripoding; rectraction/accessory muscles; Acidosis/Alkalosis (Metabolic syndrome)

Hypercapnia and high hemoglobin (polycythemia)

Question 14

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

Answer 14

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

Question 15

What are risk factors for diabetes type 2?

Answer 15

Obesity, BMI>30, HTN, Triglycerides>250, Hx of gestational diabetes or baby is >9 lbs, HDl<35

Question 16

How is diabetes diagnosed?

Fasting plasma glucose, random, post-prandial, A1c

Answer 16

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

Question 17

Diabetes education

Exercise, meals, older afults, don’t exercise if what, what do they need on them?

Answer 17

-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

Question 18

Exercise guideline For DB

Frquency, specific to db2, precautions before; why does it help? When?

Answer 18

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

Question 19

How do you diagnose copd? Complications?

Spirometry,

If pulmon. fxn returns after brondil use, the ____

Answer 19

Spirometry: FEV1/FVC; Tells u disease severity
ABG
Alpha antitrypsin
CXR; Pneumonia, Resp. Failure, Atelectasis, Pneumothroax, Cor Pulmonale (RV dysfunction)

COPD is reversibel

Question 20

Medical management of COPD

Indication for oxygen, treatments

Answer 20

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

Question 21

COPD Medications

Mild, Grade 2-3, Grades 3-4 (severe to very sever)

Answer 21

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

Question 22

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

Answer 22

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

Question 23

How do you manage asthma?

Assess, labs, administer, and communicati;What does a silent chest mean?

Answer 23

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

Question 24

Patient teaching of Asthma

Peak flow monitoring classess

Answer 24

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

Question 25

Cystic Fibrosis

Type of inheritance

Cause of mortality, prob with abx

Answer 25

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