test 2 Flashcards
1
Q
chemotherapy
A
-narrow therapeutic index
-combination drugs
-doses carefully calculated
2
Q
chemotherapy toxicities
A
-adverse effects are major drawbacks
-rapidly dividing cells such as hair, GI cells and bone marrow
3
Q
emetic potential
A
the likelihood that a drug will produce vomiting
4
Q
tumor lysis syndrome
A
-chemo destroys good and bad cells
-uric acid in blood following lysis- causes joint pain and neuropathy
-use gout meds like allopurinol
5
Q
antineoplastic meds
A
cell cycle specific drugs
-treat solid or circulating tumors
-there are different classes
6
Q
antimetabolites
A
neoplastic med
-CCS analogues antagonize actions of metabolites
-trick cancer cells into using their drug and not what they need
-work in S Phase
-folate, purine and pyrimidine antagonists
7
Q
folate antagonists
A
inhibits the conversion of folic acid to folate which is needed for DNA synthesis
8
Q
purine antagonists
A
purine bases inhibits synthesis of DNA and rna
9
Q
pyrimidine antagonists
A
pyrimidine bases inhibits synthesis of DNA and rna
10
Q
antimetabolites indications
A
-low dose matinence and palliative cancer therapy
-psoriasis ad RA
11
Q
mitotic inhibitors
A
antimetabolites
natural products obtained from the periwinkle or mandrake plant
-work in various phases of the cycle
-kaposi sarcome, lung cancers
12
Q
alkaloid topoisomerase 2 inhibitors
A
antimetabolites drug
-treat small cell lung cancer and testicular
-significant toxicities so not used much
-etoposide
13
Q
topoisomerase 1 inhibitors
A
-treat ovarian and colorectal cancer
-derived from Chinese shrub
14
Q
antineoplastic enzymes
A
-synthesized using cultures of bacteria and dna technology
-resulting in enzyme production
-ex: asparaginase
-treat acute lymph leukemia
adverse: pancreatic, dermatologic, hepatic and cardio effects
15
Q
cell cycle non-specific drugs
A
-alkylating drugs
-cytotoxic antibiotics
16
Q
alkylating drugs
A
-prevent cancer cells from reproducing
-alter dna
-use combo drugs to treat cancer
side effects: ototoxicity, peripheral neuropathy
-ex: cisplatin (solid tumors)
17
Q
cytotoxic antibodies
A
-produced by streptomyces
-block dna synthesis
-bone marrow suppression
-bleomycin, daunorubicin, doxorubicin
-treats solid tumors
18
Q
bevacizumab
A
blocks blood supply to the growing tumor
nephrotoxicity
19
Q
hydroxyurea
A
-action similar to antimetabolites
-treat squamous cell carcinoma and leukemia
-nephrotoxic
20
Q
hormonal drugs
A
treat variety go neoplasms in men and women
block the boys sex hormone receptors
used as adjuvant and palliative therapy
20
Q
nursing implementations
A
-assess baseline blood counts before antineoplastic drugs
-monitor for myelosuppression (all blood stuff)
21
Q
oncologic emergencies
A
-infections
-pulmonary toxicity
-allergic reactions
-stomatitis with severe ulcerations
-bleeding
-metabolic aberrations
-bowel irritability with diarrhea
-renal, liver and cardiac toxicity
22
Q
hematopoietic drugs
A
decrease the duration of chemotherapy-induced anemia, neutropenia, and thrombocytopenia
23
Q
protooncogenes
A
normal genes that regulate cell processes. carcinogens cause them to function as oncogenes. (good until cancer gets it)
24
tumor suppressor genes
suppress cell growth. carcinogen can make them inactive
25
initiation stage of cancer
first stage
mutation of cells genetic structure
-if damaged cell docent die or repair before entering cycle, it will be replaced with same alteration
26
promotion stage of cancer
reversible proliferation of altered cells
activities that are reversible are- obesity, smoking, drinking, etc.
27
latent period
amount of time on the initiation and promotion stage
28
main sites of metastasis
brain, lung, liver, bones
29
sentinel lymph node
the lymph node that is closest to the tumor that must be cut out for biopsy
30
cytotoxic T cells
kills tumor directly
produce cytokines that stimulate all other cells
31
natural killer cells and activated macrophages
can lyse tumor cells
32
B cells
make antibodies that bind to tumor cells
33
oncofetal antigens
type of TAA that are present when the tumor cell has shifted back to a more immature differentiation, serves as a tumor marker
34
encapsulated?
benign- usually
malignant- rarely
35
differentiated?
benign- normally
malignant- poorly
36
metastasis?
benign- absent
malignant- capable
37
recurrence?
benign- rare
malignant- possible
38
vascularity?
benign- slight
malignant- moderate to marked
39
mode of growth?
benign- expansive
malignant- infiltrative and expansive
40
cell characteristics?
benign- fairly normal, like parent cells
malignant- calls abnormal, become more unlike parent cells
41
carcinomas
originate from skin, glands (ectoderm)
42
sarcomas
originate from connective tissue, muscle, bone and fat (mesoderm)
43
lymphomas and leukemia
originate from hematopoietic system
44
grade 1 classification
cells differ slightly from normal cells (mild dysplasia) and are well differentiated (low grade)
45
grade 2 classification
cells are more abnormal (moderate dysplasia) and moderately differentiated (intermediate grade)
46
grade 3 classification
cells are very abnormal (severe dysplasia) and poorly differentiated (high grade)
47
grade 4 classification
cells are immature, primitive (anaplasia) and undifferentiated, cell of origin is hard to determine (high grade)
48
TNM classification system
-tumor size and invasiveness
-spread of lymph nodes
-metastasis
49
stage 0 cancer
cancer in situ
50
stage 1 cancer
tumor limited to tissue origin, localized tumor growth
51
stage 2 cancer
limited local spread
52
stage 3 cancer
extensive local and regional spread
53
stage 4 cancer
metastasis
54
cancer diagnostic studies
-radiographic studies
-radioisotope scans
-PET scan
-tumor markers
-genetic markers
-cytology studies
-chest x-ray
-CBC
-liver function studies
-endoscopic examination
55
7 warning signs of cancer
C- change in bowel or bladder habits
A- a sore that won't heal
U- unusual bleeding or discharge
T- thickening or lump
I- indigestion or difficulty swallowing
O- obvious change in wart or mole
N- nagging cough or hoarseness
56
what is the only way to diagnose cancer?
pathologic evaluation of a tissue
57
oncologic emergencies
-super vena cava syndrome
-spinal cord compression
-third space syndrome
-hypercalcemia
-syndrome of inappropriate anti-diuretic hormone
-tumor lysis syndrome
-cardiac tamponade
-carotid artery rupture
58
UVA
tanning
59
UVB
burning
60
non melanoma skin cancers
-actinic keratosis
-basal cell carcinoma
-squamous cell carcinoma
61
actinic keratosis
-most common precancerous skin lesions
-older whites
-impossible to tell from squamous cell cancer
-rough adherent scale on red base, which returns when removed
-topical fluorouracil
62
basal cell carcinoma
-most common skin cancer
-least deadly
-sun exposed areas
-pearly, ulceration, depressed center, red and elevated
-fluorouracil
-slowest growing cancer
63
squamous cell carcinoma
-aggressive and can metastasize
-sun exposure and immunosuppression after organ transplant
-scaly, plaque, lesion with horn
64
melanoma
-causes most skin cancer deaths
-metastasize to brain and heart
-sentinel lymph node evaluation
65
malignant melanoma diagnosis
-dermoscopy
-excisional biopsy
-tumor thickness
66
atypical/ dysplastic nevus
-larger than usual- irregular boarders, different colors
-increased risk of developing melanoma
-should be looked at immediately
67
bacterial infections
staphylococcus aureus, impetigo, cellulitis, furuncles
68
viral infections
herpes simplex, herpes zoster, warts
69
infestations and insect bites
ticks and scabies
70
fungal infections
candidiasis, tinea
71
cutaneous drug reactions
-SJS
toxic epidermal necrolysis
-occur 4-21 days after use of drug( antibiotics, NSAIDS, seizure and retroviral drugs)
72
seborrheic keratosis
benign, familial tendency
brown moleish things
73
nevi
moles
74
acrochordons
skin tags
75
inter professional care for derma problems
-phototherapy uv light
-radiation therapy
-laser technology
-drug therapy
76
topical dermatological drugs
-antimicrobial
-antiinflammatory
-intineoplastic
-antipruritic
-burn drugs
77
Candida albicans
yeastlike opportunistic fungus present in normal flora of mouth, vagina and intestinal tract
78
dermatophytes
tinea or ringworm infections
79
topical antipruritic drugs
-antihistamines
-corticosteroids
adverse: acne, allergic dermatitis, burn, dry, atrophy skin, swollen face, alopecia, etc.
80
meds for psoriasis
begins with topical corticosteroids
-tar-containing products were first meds to be used
81
ectoparasites
lice
82
what health problems lead to acid base imbalances
-diabetes mellitus
-COPD
-kidney disease
83
what is pH
the measure of H+ ion concentration in the blood
84
acid base regulatory mechanisms
-buffers
-respiratory system
-renal system
85
respiratory system regulation
-medulla controls breathing
-increased breathing= increase CO2
86
renal system regulation
conserves bicarbonate and excretes acid
87
three mechanisms for acid elimination
-secrete free hydrogen
-combine H+ with ammonia
-excrete weak acids
88
what happenes when CO2 rises?
the kidneys retain HCO3 to compensate
89
arterial blood gas values provide information about
-acid-base status
-underlying cause of imbalance
-bodys ability to regulate pH
-overall oxygen status
90
what happens when HCO3 falls?
CO2 falls to compensate
91
interpretation of AB
-look at each of the values
-evaluate pH
-analyze PaCO2
-analyze HCO3
-determine if patient is compensating
-assess the PaO2 and O2 saturation
92
saO2 and paO2
both on a blood gas
saO2- bound to hemoglobin
paO2- unbound in bloodstream, avaliable to tissues
93
carbonic acid excess caused by?
-hypoventilation
-respiratory failure
94
respiratory acidosis
-hypoventilation, hyperkalemia
carbonic acid excess
95
respiratory alkalosis
carbonic acid deficit by hyperventilation
-hypokalemia, tingling of extremities
96
metabolic acidosis
excess carbonic acid or base bicarbonate deficit
-ketoacidosis, lactic acid, diarrhea and kidney disease
-kussmaul respirations (deep and rapid)
cool clammy skin
97
metabolic alkalosis
base bicarbonate excess by vomiting or gastric suction
-tremors, confusion, restlessness, hypokalemia
98
maintenance of homeostasis
-fluids constantly moving:oxygen, CO2, nutrients
-electrolytes control movement of muscles
-disease processes can alter fluid and electrolyte balance
99
intracellular fluid
2/3 body water is in the cell
100
extracellular fluid
interstitial fluid- in spaces between cells
intravascular- liquid part of blood
lymph- fluid in lymph
transcellular- cif, gi tract, joints, etc
101
ICF electrolyte composition
cation is K+
anion is PO4 3-
102
ECF electrolyte composition
cation is Na+
anion is Cl-
103
diffusion
-movement from high to low concentration
-no energy
104
facilitated diffusion
uses carrier to move molecules from high to low
-no energy
105
active transport
-molecules move agains concentration gradient
-atp is required
106
osmosis
movement of water down
-low to high
semipermeable membrane
107
osmotic pressure
amount of pressure required to stop osmotic flow of water- the higher, the stronger
108
osmolarity
measures the total milliosmoles/L of solution
109
osmolality
measures the number of milliosmoles/kg of water
110
isotonic
fluids with the same osmolality as the surrounding cells
111
hypotonic
solutions that are less concentrated than in the cells
112
hypertonic
fluids that are more concentrated than in the cells
113
hydrostatic pressure
the force of a fluid in a compartment pushing against a cell membrane or vessel wall
114
oncotic pressure
osmotic pressure caused by plasma proteins. plasma proteins attract water and keep it in the vascular space
115
first fluid spacing
normal distribution
116
second fluid spacing
abnormal accumulation of fluid within the interstitial compartments that can be exchanged between compartments
117
third fluid spacing
fluid is trapped where it is difficult or impossible for it to move back into cells or blood vessels
118
hypothalamic-pituitary regulation of water balance
-osmoreceptors in hypothalamus sense fluid deficit or increase
-deficit stimulates thirst and antidiuretic hormone release from posterior pituitary
-decreased plasma osmolality suppresses ADH release
119
renal regulation of water balance
-primary organs for regulating fluid and electrolyte balance
-average person absorbs 99% of kidney filtrate
120
adrenal cortical regulation of water balance
-releases hormones to regulate water and electrolytes
-glucocorticoids and mineralocorticoids
121
cardiac regulation of water balance
-peptides are antagonists
-produced by cardiomyocytes in response to increased arterial pressure
122
GI regulation of water balance
-oral intake for most water
-small amount of water eliminated from feces
-vomiting and diarrhea are big water loss
123
gerontologic considerations
kidney structure changes decrease ability to conserve water
hormonal changes and loss of sub q tissue
124
fluid and electrolyte imbalances
-directly caused by illness or disease
-result of therapeutic measures (colonoscopy, diuretics)
-more than one imbalance at a time
125
sodium imbalances
-parallel changes in osmolality
-plays a role in ECF volume, nerve impulses, muscles, and acid base balance
126
hypernatremia
-inadequate water intake or excess water loss or sodium gain
-causes hyperosmololity
-causes thirst
-effecrs brain and mental status
127
hypernatremia management
water deficit- replace fluids
excess sodium- dilute and promote excretion with diuretics
128
hyponatremia
-sodium loss or water excess
-CNS symptoms, confusion, vomiting, NVD, come, seizures
129
hyponatremia management
-fluid restrictions
-loop diuretics
-give IV hypertonic saline solution 3%
-block vasosuppression
-sodium containing solution
130
potassium imbalances
-major ICF cation: 98%
-conduction of nerve impulses
-cell growth
-maintenance of cardiac rhythms
-acidbase balance
when K is high, urine potassium increases
131
hyperkalemia
-impaired renal excretion and ICF-ECF shift
-beta blockers can impair K entry into cells, heparin and others can reduce ability to excrete K
-common in renal failure!!!
132
hyperkalemia manifestations
-cardiac dysrhythmias
-peak T waves, v fib ,death, more wave stuff
-cramp in leg
133
hyperkalemia management
-sodium polystyrene sulfate
-insulin and glucose, b-adrenergic agonist or sodium bicarbonate
-calcium gluconate
134
hypokalemia
-increased loss of K in kidney or GI
-ecf-icf shift increase
-lethargy, cardiac serious, flat wave, muscle weakness, rest. arrest
135
hypokalemia management
-NEVER give KCl by iv push
-shouldnt exceed 10 mEq/hr
-use pump
-digoxin toxicity
136
calcium
-form teeth and bones
-blood clotting
-nerve impulses
-myocardial and muscle contractions
-need vitamin D to absorb
-free, ionized and protein bound forms
-balance controlled by: parathyroid hormone, calcitonin
137
hypercalcemia
-caused by hyperparathyroidism and malignancy!!
-fatigueness, nephtolothiasis (kidney stones)
138
hypercalcemia management
-loop diuretic
-mobilization
-bisphosphonates for hyper as result of malignancy
-IM or SC calcitonin
-dialysis
139
hypocalcemia
-decreased PTH, blood transfusions, alkalosis
-positive trousseaus or chovsteks sign!!!!!
-breathe into bag, treat hyperventilation alkalosis
140
phosphate
-primary anion in ICF (calcium phosphate
-serum levels controlled by parathyroid hormone
-low calcium level= high h=phos level and vise versa
-if kidneys dont work- phos increases
141
hyperphosphatemia
-kidney injury, chemo, hypoparathyroidism
-neuromuscular irritability and tetany (hypocalcemia), calcified deposition
-no dairy, bind and secrete, correct hypocalcemia and hemodialysis
142
hypophosphatemia
-malnourishment/malabsorption
-CNS depression, muscle weakness, resp and heart fail
-use IV administration
143
magnesium
-coenzyme in metabolism of carbs, DNA and protein synthesis, glucose and BP, ATP production
-acts on myoneural junction- affect neuromuscular excitability and contractibility
-50-60% in bone
-excrete by kidneys
144
hypermagnesemia
-excess IV magnesium administration
-causes lethargy, kidney failure, impaired reflexes
-IV CaCl or calcium gluconate
-furosemide
145
hypomagnesemia
-prolonged fasting or starvation
-chronic alcoholism
-fluid loss
-prolonged parenteral nutrition
-diruetics
-cases corresponding hypocalcemia and hypokalemia
-increase dietary and IV-IM go mag.
146
crystalloids
-better for dehydration- distributes faster
-compensate for fluid loss, replace electrolyte loss, promote urinary flow
-clear iv fluids
147
colloids
-stay in vascular space and increase pressure
-albumin, FFP, blood, semisynthetic
-treat plasma volume expansion
148
hypotonic crystalloids
-more water than electro- pure water lyses RBC's
-ECF to ICF
-fluid out of vein into tissue and cells
-treat hypernatremia to maintain fluid but not replace
-monitor changes in mentation
ex- half normal saline, quarter saline, dextrose in water
149
hypotonic crystalloids contraindications
-pts who are risk for cerebral edema
- dont use if liver disease, trauma, burns
-monitor for changes in mentation
150
isotonic crystalloids
similar concentration of water and electrolytes to plasma
-expants ecf, ideal to replace ecf volume deficit
D5W
151
D5W
-isotonic
-free water without electrolytes
-170 cal/L
-replace water loss, hypernatremis and prevent ketosis
152
normal saline
-isotonic
-0.9%
-more NaCl than ecf
-compatable with meds
-only solution used with blood
153
lactated ringer
-isotonic
-similar to plasma nut no mag.
0has Na, Cl, K, Ca, and lactate
-treats burns, hypovolemia
-contra with hyperkalemia
154
hypertonic crystalloids
-raises osmolality of ECF
-monitor lung sounds and sodium levels
-3% NaCl, D10W
155
D5 1/2 NS
-hypertonic
-common maintenance fluid
-replaces fluid loss
-KCl added for maintenance
156
D10W
-hypertonic
-340 cal/L
-free water but no electrolytes
-limit of dextrose may be infused peripherally
157
colloids
-stay in vascular space and increase osmotic pressure
-treat shocks and burns
158
albumin
-naturally produces by liver
-generated 70% of COP
-pasteurized to destroy any contaminants
159
cryoprecipitate and plasma protein factors uses
management of acute bleeding
160
fresh frozen plasma uses
increase clotting factor levels
161
packed red blood cell uses
increase oxygen-carrying capacities in pt with anemia or substantial; hemoglobin deficits or lots of blood loss
162
whole blood uses
same as PRBC's but whole blood us beneficial in extreme blood loss bc of plasma
163
TRALI
transfusion related acute lung injury
164
TACO
transfusion associated circulatory overload
165
supplies for blood transfusion
-0.9% NS
-no other fluids
-Y type blood with filter
-IV pump
166
signs and symptoms of adverse reactions to blood transfusion
-temp rise 1C above
-urticaria
-chills
-pruritus
167
what do the kidneys do?
regulate volume and composition of ECF, excrete waste, control BP, make erythropoietin, activate vitamin D, and regular acid-base balance
168
causes of UTI's
E. coli, Cath, fungal
169
classification of UTI
location- upper and lower
severity- uncomplicated and complicated
170
defense mechanisms to maintain sterility
-complete emptying with void
-peristalsis propels urine towards bladder
-acidic pH
-high urea concentration
171
risk factors for UTI
obstruction, retention, renal impairment, foreign bodies, anatomic factors, compromised immune response, functional disorders, other factors
172
causes of UTI
-organisms from perineum ascend urethera
-hematogenous transmission
-health care infections
173
lower urinary tract symptoms
-emptying symptoms
-storage symptoms
-hematuria and cloudy appearance
174
upper urinary tract symptoms
-flank pain, chills, fever
-fatigue, anorexia
-older: abdominal pain, cognitive impairment
175
diagnostic studies for UTI's
-dipstick urinalysis
-urine culture and sensitivity (clean catch)
176
bladder irritants
caffeine, alc, fruits, spicy food, tomatoes, carbonated drinks, chocolate
177
acute pyelonephritis
inflammation of renal parenchyma and collecting system
-urosepsis
178
pyelonephritis
initial colonization and infection of lower urinary tract from urethrea
causes: preexisting factors, cauti, pregnancy
179
clinical manifestations of pyelonephritis
fever,chilld, N/V/D, flank pain, dysuria, CVA, scarring and impaired kidney function
180
pyelonephritis diagnostic studies
urinalysis, urine cultures and sensitivities
-blood cultures
decreased kidney function tests
ultrasound
CT scan
181
urethritis
-inflammation of the urethra due to bacterial or viral infection
males- sexually transmitted
woman- no symptoms
182
glomerulonephritis
inflammation of the glomeruli
-vascular scarring and hardening, affects both kidneys
-ERSD
-nephrotoxic drugs, immune and systemic diseases
acute: sudden
chronic: slow, irreversible
183
chronic glomerulonephritis
-syndrome of permanent and progressive renal fibrosis can progress to ESRD
-symptoms develop slowly
184
nephrotic syndrome
low albumin, peripheral edema, massive proteinuria, foamy urine, hypercoaguability
185
most common type of stones
calcium oxalate and phosphate
186
lithotripsy
-procedure to eliminate stones from urinary tract
-high energy and disintegrate the stones
187
uretheral strictures
prolonged fibrosis or inflammation of uretheral lumen leads to narrowing and compromised opening and closing with bladder filling and voiding from trauma, etc
188
renal artery stenosis
partial occlusion of one or both renal arteries and major branches
-control the BP and restore perfusion
treat with renal angioplasty
189
indications for indwelling catheter
-releif of urinary retention
-bladder decomposition prep or postop
-facilitate surgery
-facilitate healing
-accurate I and o
-stage 3 or 4 pressure ulcer
-terminal illness
190
acute kidney injury
rapid loss of kidney function with rise in creatinine, elevated BUN, azotemia
its potentially reversible
191
dialysis
-movement of fluid/ molecules across membrane to correct imbalances and remove waste in kidneys
15mL/min.1.73m2
192
safety for AV fistulas and grafts
-never preform BP measures on same arm
-distal ischemia
-aneurysms
-prevent infection and clotting
193
hemodialysis complications
hypotension
muscle cramps
loss of blood
hepatitis
194
kidney transplant recipient selection contraindications
-advanced cancer
-refractory/ untreated heart disease
-chronic respiratory failure
-extensive vascular disease
-chronic infection
-unresolved physcosocial disorders
195
cholinergic meds
-stimulate the PNS by binding to the acetylcholine receptors and activate them
-stimulate intestine and bladder causing increased urine frequency
-pupil constriction
196
anticholinergic meds
-antagonize PNS by binding to the ace. receptors and mediating response
-decrease GI mobility, secretions, and decrease urine
197
Bethanechol
-cholinergic med
used to treat urinary retention
198
cholinergic meds SE
-bradycardia
-hypotension
SLUDGE
salvation, lacrimation, urinary incontinence, diarrhea, GI cramps, emesis
overdose could cause- circulatory collapse, hypotension, shock, arrest
199
oxybutynin
anticholinergic med
-used for overactive bladder, neurogenic bladder
200
tolterodine
anticholinergic med
treats incontinence
201
anticholinergic meds adverse effects
-low therapeutic index
tachycardia, restlessness, delirium, dilated pupils, decreased salvation, retention, no sweat
202
diuretic drugs
-accelerate the rate of urine formation
-result in removal of water and sodium
-treats hypertension
203
