Test 1 Flashcards
Most common malignant bone cancer
Osteosarcoma
S/s of osteosarcoma
Swelling, femur is usually affected, tibia, humorous and metastasizes (spread)
Fire Precautions
R.A.C.E
Stands for?
Rescue
Alarm
Contain/confine
Extinguish
Osteosarcoma Pathophysiology
Osteosarcoma Pathophysiology
Bone tumor that can occur in any bone, but usually occurs in the long bones near metaphyseal growth plates. The most common bones are femur, tibia, humerus, skull/jaw, and pelvis.
Osteosarcoma Signs and Symptoms
Pain - Pain in affected bone, worse at night, increases with activity
Swelling - May start weeks after pain develops. May feel like a lump or mass
Bone fractures - Osteosarcoma can weaken the bone it develops in and can cause fractures
How to diagnose Osteosarcoma
Only one for sure way-
Imaging tests - X-ray, MRI, CT, Bone scan, PET
Biopsy - Only certain way to diagnose osteosarcoma. Needle biopsy or surgical biopsy.
Lab tests - Pathology for biopsy
Blood tests - Helpful after diagnosis if disease is more advanced than appears
Osteosarcoma Medications/tx
Surgery: amputation, bone grafting, wide local excision),
Chemotherapy: methotrexate, carboplatin, cisplatin, doxorubicin, and ifosfamide
Radiation Therapy
Osteosarcoma Teaching
Client teaching will include:
when to seek medical attention for a possible advancement in your disease.
If you experience any complications you will need to contact your physician immediately
Osteosarcoma Complications
Bone fractures Limited range of motion Limping from pain and discomfort Swelling, Tenderness and Redness at the site Limb Removal Spread of Cancer to Lungs Side Effects related to Chemotherapy
Paget’s Disease Treatment
Surgery: Total knee or hip replacement Help fractures heal Replace joints damaged by severe arthritis Realign deformed bones Reduce pressure on nerves
People with Paget diseases have what high risk during an operation ?
Paget’s disease of bone often causes the body to produce too many blood vessels in the affected bones, increasing the risk of serious blood loss during an operation.
Psychological changes of the older adult
Losses, decrease social activities , tb shot q ten years, health promotion, illness prevention
Cardiovascular issues
systolic blood pressure increases-aorta is less flexable
hypertension due to artieries losing elasticity
Pulmonary
decreased gas exchange
-intercoastal muscles weaken which cause CO2 retention
-greater risk to respiratory infection
integumentary
- vascular supply to skin dimishes
- increased wrinkling due to subcutaneous tissue in arms and legs
- atrophy of sweat glands
musculoskeletal
- muscle fibers start to be replaced by fatty tissues
- size of the joints appear larger due to muscle atrophy
- bones are more porus due to decalcification
- gradual collapes of the vertebral comlum due to disk thinning
- osteoarthritis
- overall weakness
- possible increase in fractures
- bone healing is poor
- diminished muscle strength
gastrointestinal & nutrition calorie needs are decreased nutrient needs remain unchanged difficultly preparing meals tooth loss or wear difficultly chewing food bone and gums may shrink periodontal disease is very common plaque accumulates more rapidly food enters and leaves the stomch slowly difficulty in digesting foods secretion of acids and enzymes are diminished intestines no changes occur possible constipation
endocrine
pituitary glannd- activity may dimish but usually functions fine
-thyroid gland- activity is decreased so basic metabolic rate is decreased
- pancreas- produces less insulin, so incidence of type 2, non-insulin-dependant diabetes rises
- trypsin decreases
genitourinary- renal decreased number of glomeruli reduced filtrstion rate decreased number of nephrons bladder tone and capsity are reduced sphincter control ma reduce -in men- prostates enlarge causing frequency -total body fluid decreases causes greater risk of dehydration
genitourinary-genitalia
sexual interest not diminished
MALES- penis gets smaller and testicles hang lower
after 70 pubic hairs turn grey
decrease in testerone after 60
takes longer to achieve erection and climax
FEMALES- decreased hormones, lubercation,elasticity of vagina
pubic turns grey and thins
continued atrophy of the vagina, uterus, and breast
neurological react and move more slowly risk for falls grip decreases but remains strong pain perception responce to painful stimuli fine motor ability ability to regulate temp
sensory-vision
decreases visual acuity, color sensitivity, after age 70
decreased pupil size, depth perception, production of tears
lens continues to increase in size causing glaucoma more likely
lens thickens and yellows
cateracts are common
hearing
loss severe enough to impair communication- effects 30% of elderly
sensitivity to high pitched sounds is lost
men worse than women
Presbycusis- hearing loss due to age
outer ear- external meatus my atrophy
delayed processing- speak slowly
sleep pattern
almost total absense of deep sleep
stage 1 sleep-lightest awareness of sleep
frequently awakening
S/s associated with immobility and complications
Skin breakdown, clots (swelling, edema, redness), constipation
Incomplete bladder emptying, dehydration, UTI, Renal calculi
Pressure ulcers-Skin breakdown
Decreased cardiac contraction
Decreased contractibility, blood pooling in distal areas; monitor vitals, promote activity, elevate the feet, turn patient onto left side, use TED hose, SCD’s
Orthostatic hypotension
Get up slowly, sit before standing, increase fluids
Bronchial secretions
Bronchial stasis, atelectasis; educate the client, use incentive spirometer, deep breathing technique and coughing exercises/hold cough
Decreased muscle mass and strength:
ROM is decreased, atrophy & contractures
To prevent, do ROM exercises, turning, bring in PT and nutrition
DVT formation- do not massage or elevate - Homans sign
GI system
Decreased motility/peristalsis: constipation
Psychological effects of immobility
monitor for signs of depression, promote activity, create achievement goals, encourage support groups, validate their feelings
Immobility of the Respiratory System
Decreased respiratory movement resulting in atelectasis, hypostatic pneumonia, and decreased cough response.
Immobility of the Metabolic/Endocrine System
- Decreased appetite and altered nutritional intake, - Decreased protein - muscle and weight loss
- Alterations in calcium/fluid/electrolytes,
Prevention of immobility
- Turning the client every 2 hours to prevent ulcers
- Use assistive devices to help them get out of bed and to move around
- Perform ROM
- Helping the client to use the bathroom
Aldrenodrate (Fosamax): Administration teaching points
For osteoporosis
-Take it 30 minutes before breakfast w/a full glass of water
For next 30 minutes
- Be sitting or standing (gets pill out of esophagus)
- Nothing by mouth (except for water)
Osteoarthritis teaching points
Maintaining weight Exercise Increase vitamin D and calcium Heat and cold for pain management Avoid repetitive bending and stress on joint Capsaicin or ota creams Assistive devices and taping joints
Common causes of falls?
How to prevent them?
Cognition, balance, gate, mobility, vision, peripheral neuropathy, awareness, medications, toddlers, elderly are mostly at risk above age of 80, hypotension, hx of falls,dizziness, pain, polypharmacy, arthritis
Bed to lowest position, only two guard rails left up, remove all rugs , remove clutter, orient to room, patient knows how to use canes, walker, crutches, call light within reach, prepare a fall assessment ,clean, dry floors , wet floor sign
Handrails I’m broom and stairs, child proof home, well lit, glasses up to date, hearing aids , footwear, medication teaching, fire alarms and carbon dioxide alarms are working, fire extinguisher, water and heat, children: keep heat, knifes, meds, chemicals, small objects, blinds, cords away. Know cpr
Common health issues in the older adult
PhysicAl limitations and mental impairments
Decreased nutrition and hydration and mobility
Stress
Loss
Accidents
Drug use
Cognitive changes
Substance use
Elder neglect and abuse ..
sight ,Taste and smell diminish
Reduce income
Chronic disease
Mva increase due to decrease in reactive time
Skin breakdown
Fatigue
Gout teachings - what to eat? What not to eat? Medications?
Diet- eat a diet low in purines is helpful to reduce serum Uric acid
May cause kidney stones , joint damage, limited ROM
Eat-refined cereals,white bread, pasta, flour, milk, sugar, sweets, gelatin, all fats, nuts and peanut butter, veggies, cream soups , fluids, ice
Avoid - high purine food, alcohol , anchovies, sardines, herring, codfish, lamb, trout, and haddock, mussels, scallops, and oysters, turkey, veal, venison, organic meats, bacon, (seafood, red meat, and alcohol)
Meds- NSAIDs, gout meds, corticosteroids, allopurinol- reduces uric acid but does not relieve acute attacks and may cause low bs, analgesics,colchicine (for acute attack within first 24 hours) , febuxostat (uloric)-newest with in 40 years
Do not take aspirin or diuretics, stress can make worse
*check kidney function
Electrical safety?
? Can occur in hospital environment Electrical outlets Cause fires Infants
Multiple outlets of separate circuits are required to avoid overloads that prevent short circuits and loss of power
Ensure it meets standards
Must be functional and properly working condition
Proper placement of grounding pads, inspection of device, avoid pt contact with metal components, other equipments or pooling preparation solutions prevent surgical burns
Prioritization?
?
ABCDE
Airway/cervical spine (low O2, SOB)
Breathing (crackles in lungs)
Circulation (bp, skin)
Disability (neurological)
Exposure
Goals for patients at risk for injuries and risk for falls?
?
Decrease falls and injuries
