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NURS 302/ Med-Surg 2 > Test 3 > Flashcards

Test 3 Flashcards

1
Q

What is an injury to the ligament structures surrounding a joint?

A

Sprain

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2
Q

How is a sprain normally caused?

A

Wrenching or a twisting motion

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3
Q

What is a first degree sprain?

A

tearing of a few fibers

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4
Q

What is a second degree?

A

Partial tear/more swelling and tenderness

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5
Q

What is a third degree sprain?

A

Complete tearing of a ligament

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6
Q

What is the presentation for a sprain?

A

Extreme pain
Palpate gap in joint
Ankle and wrist are common

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7
Q

What is the excessive stretching of a muscle and the facial sheath….. TENDON?

A

Strain

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8
Q

What is a first degree strain?

A

Mild to moderate pulled muscle

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9
Q

What is a second degree strain?

A

Moderately torn muscle

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10
Q

What is the third degree strain?

A

Severely ruptured or torn muscle

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11
Q

What is the presentation of a strain?

A

Pain
Edema
Decreased ability to function
Bruising

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12
Q

What is the complication that involves a ligament pulling loose from a fragment of bone?

A

Avulsion Fracture

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13
Q

What is the bleeding into the joint cavities

A

Hemoarthrosis

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14
Q

__________ joint can disocate

A

UNSTABLE

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15
Q

Sprains and _______ are usually self-limiting with full function returning in - weeks

A

Strains; 3-6 weeks

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16
Q

What are the acute care considerations for strains and sprains

A

RICE and analgesia

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17
Q

What are nursing care considerations for 48 hours after a strain or sprain

A

Heat
Limited use
Analgesia

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18
Q

What is a severe injury of the ligament structures that surround a joint and results in the complete displacement or separation of the articular surfaces of the joint.

A

Dislocation

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19
Q

What is a partial or incomplete displacement of the joint surface

A

Subluxation

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20
Q

What are the common dislocation sites

A

Thumb, elbow, shoulder, hip, and patella

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21
Q

______________ injuries are orthopedic emergencies

A

Dislocations

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22
Q

What is the treatment for dislocations

A

Closed or Open Reduction

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23
Q

What are two common complications from dislocation injuries?

A

Avascular Necrosis
Compartment Syndrome

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24
Q

What is the nursing care after a joint reduction

A

Immobilize
Pain management
Rehab to prevent contractures

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25
Q

What is the compression of the midean nerve

A

Carpal Tunnel Syndrome

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26
Q

What are common causes for Carpal Tunnel Syndrome

A

Tendonitis
Mass
Rheumatoid disease
Repititive motions

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27
Q

What are clinical manifestations for Carpal Tunnel Syndrome

A

Weakness
Burning
Impaired sensation
Atrophy with hand dysfunction

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28
Q

What are the 2 tests for Carpal Tunnel

A

Phalen’s sign
Tinel’s sign

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29
Q

Treatment options for Carpal tunnel

A

Pain alleviation
Remove cause
Stop aggravating motion
Remove mass
Corticosteroids
Srugery

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30
Q

Nursing Care for Carpal Tunnel

A

Splints to dorsiflex and relieve pressure
Avoid extreme temp. post steroid injection
Rehab for 7 weeks post op

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31
Q

What are the 4 muscles in the rotator cuff?

A

Supraspinatus
Infraspinatus
Teres Minor
Subscapularis

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32
Q

What injury is caused when there is a tear in the rotator cuff and humeral head is no longer stabalized?

A

Rotator Cuff Injury

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33
Q

What are common causes of rotator cuff injuries?

A

Aging
Stress
Trauma

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34
Q

What is the presentation of a Rotator Cuff Injury?

A

Shoulder Weakness
Pain
Decreased ROM

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35
Q

What is the treatment of Rotator Cuff Injuries?

A

NSAIDS
Corticosteroids
PT

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36
Q

What are possible complication after a rotator cuff injury?

A

Scar tissue
Athrofibrosis after surgery

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37
Q

What is the damage of the shearing of the Menisci?

A

A knee injury

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38
Q

What are causes of menisci injuries?

A

Rotational stress with knee and foot fixed
Blow to Knee

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39
Q

Manifestations of a Meniscus injury?

A

Locational Pain
Knee clicks or pops
Pain with abduction and adduction
Quad atrophy

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40
Q

What is the treatment of Meniscus Injury?

A

Immobilize, Ice, and crutches
Surgical repair
Pain management
PT, ROM, exercises, knee immobilizer
Education r/t pre-activity warm up and stretches.

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41
Q

What is a disruption or break in the continuity of the structure of the bone?

A

Fracture

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42
Q

What is a fracture that involves tendons pulling off part of the bone

A

Avusion

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43
Q

What is a fracture when there is more than two fragments within the smaller pieces appearing to be floating?

A

Comminuted

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44
Q

What is a fracture that involves one piece of the bone displaced to the side of the other?

A

Displaced

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45
Q

What fracture that is not all the way through?

A

Greenstick

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46
Q

What fracture is comminuted with more that 2 fragments driven into each other?

A

Impacted

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47
Q

What fracture extends to the articular surface of the bone?

A

Interarticular

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48
Q

What is the incomplete fracture that runs longitudinally?

A

Longitudinal

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49
Q

What is the line of the fracture extends in an oblique direction?

A

Oblique

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50
Q

What is the spontaneous fracture at the sight of bone disease?

A

Pathological

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51
Q

What fracture extends in a spiral direction along the bone?

A

Spiral

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52
Q

What fracture may occur in normal or diseased bone after repeated stress?

A

Stress

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53
Q

What is a fracture line that extends across the bone?

A

Transverse

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54
Q

What is stages of bone healing

A

Fracture hematoma
Organization into fibrous network
Invasion of Osteoblasts
Callus Form
Remodeling

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55
Q

What is the bleeding and edema surrounding bone fragments?

A

Fracture Hematoma

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56
Q

When does a fracture hematoma initiatie?

A

72 hours after injury

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57
Q

What is the local necrosis and when the clot turns into a granulated tissue?

A

Granulation stage and occurs a few days after injury

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58
Q

What is the formation of bone network and appears after the second week of injury?

A

Callus formation

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59
Q

What is it called when the callus is hardened and can start to have some mobility?

A

Ossification and occurs 3-6 weeks after the injury

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60
Q

Over time, bone fragments move closer into proximity, this is called?

A

Consolidation

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61
Q

What is it when excessive tissue is absorbed and there is gradual shaping of the bone?

A

Remodeling

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62
Q

What is the Non-surgical, manual realignment of bone fragments to their previous anatomic positions.

A

Closed reduction

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63
Q

What is the correction of the bone alignment through surgical incision.

A

Open Reduction

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64
Q

What is the application of pulling force to an injured or diseased part of the body while counter traction pulls in the opposite direction.

A

Traction

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65
Q

What is the purpose of traction?

A
  • Prevent or reduce muscle spasms
  • Immobilize a joint or part of the body
  • Reduce a fracture or dislocation
  • Treat a pathological joint condition
  • Prevent soft tissue damage
  • Expand a joint space before major joint reconstruction or during arthroscopic procedures
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66
Q

How long is skin traction allowed?

A

48-72 hours

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67
Q

What is the taping, booting, or splinting attached to the skin until skeletal traction is available?

A

Skin Traction

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68
Q

What is the purpose of skin traction?

A

Maintain alignment
Assists with reduction
Decreases muscles spasms

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69
Q

What is the weight limit for skin traction

A

5-10 lbs

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70
Q

What are other nursing care of skin traction

A

Asses Q4
Neuro checks
Assess for vascular impingment

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71
Q

What is traction is used to align injured bones and joints or to treat joint contractures and congenital hip dysplasia.

A

Skeletal traction

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72
Q

Weight for skeletal traction

A

5-45 lbs.

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73
Q

Never disrupt ________ traction unless life threatening emergency!

A

Skeletal

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74
Q

Nursing Care for Skeletal Traction

A

Cap refill
Sensation and motor function
Assess pin sites
Check Q4 hours

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75
Q

What is a temporary circumferential immobilization device?

A

Cast

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76
Q

A _____ is commonly used after closed reduction

A

Cast

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77
Q

Casts normally incorporate the joint ________ the affected bone

A

ABOVE

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78
Q

A body jacket cast is used for what kind of fractures?

A

Thoracic and Lumbar

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79
Q

What is the nursing care of a body jacket cast?

A

Repositiion Q2-3 hours to let cast dry
Watch for cast syndrome

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80
Q

What is the compressing of the mesenteric artery?

A

Cast syndrome

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81
Q

What is the presentation of cast syndrome?

A

Abd. pain
Increased Abd. pressure
Nausea and vomitting
Bowel sounds

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82
Q

What is the treatment for cast syndrome?

A

NG to suction- relives pressure
Remove splint or cast- releases pressure
Monitor RR, bowel, bladder and pressure

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83
Q

What casts are used for pediatric patients with femoral fractures?

A

Hip Spica

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84
Q

What is the nursing care for a hip spica cast?

A

Do not lie on abdomen while the cast is drying
Support with pillows
Never use space bar to turn a patient who has a hip spica cast
Skin care under cast edge

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85
Q

A fiberglass cast is full strength in minutes and is _______ resistant

A

water

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86
Q

A plaster cast is less costly and is more compliant to molding. But you cannot bear weight for 24-__ hours and must turn Q2

A

72; Sets within 15 minutes but no weight for 2-3 days

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87
Q

What are some nursing care for casts

A

Handle a new cast with palm of hands
Once dry, smooth rough edges
Put ice on the cast for the first 24 hours

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88
Q

What are the 5 P’s

A

Pain- unrelieved pain = compartment
Pulses
Pallor
Paresthesia
Paralysis

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89
Q

Complication of Immobilization?

A

Kidney stones
Constipation
Skin breakdown
Orthostatic Hypotension

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90
Q

If a patient gets an infection after an open reduction, what would the nursing care be?

A

Surgical debridement
Wound management
IV ABX 7-10 days

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91
Q

What are complications r/t a bone infection?

A

Contaminated tissue
Osteomyelitis

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92
Q

What is a condition in which elevated intra-compartmental pressure within a confined myofascial compartment compromises the neurovascular function of tissues within that space.

A

Compartment Syndrome

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93
Q

What are the causes of compartment syndrome?

A

tight cast
edema

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94
Q

Types of injuries that can lead to compartment syndrome?

A

Soft tissue damage
Crush of an extremity
Forearm and lower leg injuries
Severe burns
Venomous bites
Revascularization procedures

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95
Q

two most common sites for compartment syndrome?

A

Upper Arm and Lower Leg

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96
Q

Compartment syndrome in the upper arm is called

A

Volkman’s Ischemic Contracture

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97
Q

Compartment syndrome in the lower leg is called

A

Anterior tibial compartment syndrome

98
Q

Manifestations of CS?

A

Increased pressure on tissues
Venous occlusion which increases edema
Arterial obstruction and ischemia
Destruction of muscle and nerve cells
Fibrotic tissue replaces normal tissues
Potential for Myoglobinuria
Contractures and loss of function
The 5 + Pressure around the compartment

99
Q

Treatment for compartment syndrome?

A
  • Early detection
  • Remove cast
  • No RICE
  • Fasciotomy
100
Q

What is the nursing care after a fasciotomy?

A

Leave open for a few days
Infection
Amputation

101
Q

What is the etiology of DVT?

A

Inappropriate cast or traction
Pressure to a vein
Inactivity

102
Q

What is the nursing care for a DVT?

A

SCD
TED stockings
Heparin
Wiggle toes and fingers of affected extremities.

103
Q

What is the presence fat globules from fractures that are distributed into tissues and organs after a traumatic skeletal injury.

A

Fat Embolism Syndrome

104
Q

Where is FES most common?

A

Long bones like the tibia, ribs, and pelvis

105
Q

What is the clinical manifestation of FES?

A

12-72 hours after injury
ARDS
Chest pain, high HR, cyanosis, dyspnea, apprehension, high RR, low O2

106
Q

What are more s/sx of FES?

A

Memory loss
Confusion
Restlessness
Elevated temperature
Headache
Continued change in LOC
Feeling of impending doom
Skin change from pale to cyanosis
Petechiae located around the neck, anterior chest,
axilla, buccal membrane and conjunctiva of the eyes

107
Q

Labs to look for in suspected FES?

A

Decreased PaO2 < 60
Fat cells in the blood, urine or sputum
Prolonged PTT
ST segment changes on EKG
CXR (pulmonary infiltrate or consolidation)
Decreased platelets and Hematocrit

108
Q

How is FES prevented?

A

Careful immobilization of a long bone fracture is the most important factor in the prevention of fat embolism.

109
Q

Nursing Care for FES

A

Management is symptom related
O2 for hypoxia
Coughing / Deep breathing
Hydration to prevent hypovolemic shock
Correct Acidosis
Replacement of blood loss
Intubate if needed – positive pressure

110
Q

An open book pelvic fracture is caused by what?

A

External force pulling the pelvis apart?

111
Q

An closed book fracture is caused by what?

A

lateral force compression

112
Q

What are complication from a pelvic fracture?

A

Hemorrhage
Paralytic Ileus
Laceration of the bladder, colon, urethra
FES/DVT/Sepsis

113
Q

Upon assessment a pelvic fracture would look like what?

A

Local swelling
Tenderness
Unusual pelvic movement
Eccymosis

114
Q

Treatment for a pelvic fracture

A

Bed rest from a few days to 6 weeks
May not be full weight bearing up to 3 months
Casts, External Fixator, IF with screws/wires/plates
Move only on physician order – move with caution
Monitor bowel, bladder and distal neurovascular function

115
Q

Clinical Manifestations for a hip fracture?

A

EXTERNAL rotation
Muscle spasms
Shortening of an extremity
Severe Pain

116
Q

Nursing Care of Hip (PREOP)

A

Stabilize other health conditions
Muscle relaxants and pain meds for spasms
Pre-op teaching

117
Q

Nursing Care of Hip (POSTOP)

A

VS, I&O, respiratory status
Pain meds
Observe dressing for bleeding, sight for infection
Monitor for signs of dislocation (Pain, Lumb on buttock, limb shortening, and external rotation)

118
Q

HIP DO NOTS POST OP

A

DO NOT force hip >90 degrees flexion
DO NOT force hip into adduction
DO NOT force hip into internal rotation
DO NOT CROSS LEGS
DO NOT put on own shoes or stockings
DO NOT sit on chairs without arms or stand without assistance

119
Q

Hip DOS for at least 6 weeks

A

Use bedside toilet
Sit in shower chair while bathing
Keep hip in neutral straight position when walking, sitting or lying
Use pillows between knees when lying on “good” side
Notify surgeon of severe pain or visible deformity
Prophylactic ABX before dental surgery
Prevent both external and internal rotation with pillows between legs and lateral to effected leg

120
Q

What is when a movement is not likely to cause damage to the spinal cord?

A

Stable Vertebral Fractures

121
Q

All vertebral fractures are considered _______ until proven other wise

A

UNSTABLE

122
Q

Other Nursing Considerations for Stable Vertebral Fractures?

A

Support / Heat/ Traction
Maintain good alignment until healed
May use halo vest and or body jacket cast
Use log rolling
Pain management
Common treatment includes either vertebroplasty or kyphoplasty

123
Q

Facial fractures always assume cervical trauma,,,,

A

Until proven otherwise

124
Q

Nursing Considerations for Facial Fractures?

A

Have suction ready to use
Airway – Keep wire cutters taped to head of bed!
Oral HYGEINE
Communication
Pain Management
Nutrition

125
Q

Amputation in the young is normally r/t ________

A

Trauma

126
Q

Amputation in the middle to older age is r/t ________

A

Peripheral Vascular Disease

127
Q

Reasons for amputation

A

PVD
Trauma
Thermal Injuries
Malignant tumors
Uncontrolled Infections

128
Q

Pre-op amputation care

A

Warn about phantom limb sensation
Type of prosthesis to be used

129
Q

Post-op for amputation

A

Surgical tourniquets must be available to emergency use.

130
Q

Discharge info for Amputation

A

Residual limb care
Ambulation
Exercises
Stop using prosthesis if irritation develops
Lie on abdomen for 30 minutes 3-4 times per day

131
Q

What is the chronic progressive loss of bone mass

A

Osteoporosis

132
Q

_____ and _______ increases bone loss

A

ETOH and smoking

133
Q

Preg, breastfeeding, menopause all _______ the risk of osteoporosis

A

INCREASE

134
Q

Treatment options for osteoporosis

A

Good nutrition
Ca and Vit. D supplements
1200 Ca daily for pt. > 51
Low impact exercise
Calcitonin
Bisphosponates

135
Q

What is severe infection of the bone, bone marrow and surrounding soft tissue either through direct or indirect entry.

A

Osteomyelitis

136
Q

Clinical Manifestations of Osteomyelitis

A

Fever / Chills / Night sweats
Restlessness
Nausea
Malaise
Constant bone pain that is unrelieved with rest and worsens with activity
Swelling, tenderness and warmth at the site
Restricted movement of affected part

137
Q

Chronic osteomyelitis lasts for more than

A

One month

138
Q

Treatment options for osteomyelitis

A

Aggressive IV ABX therapy
Immobilization of affected limb
Surgical removal of dead tissue/bone with chronic
Pain management
Negative pressure wound VAC
Hyperbaric oxygen therapy

139
Q

Complications for osteomyeltis

A

Septicemia
Septic Arthritis
Pathologic Fractures
Amyloidosis

140
Q

Benign Bone Tumors

A

Osteocondroma, Osteoclastoma & Endocroma

141
Q

Malignant Bone Tumors

A

Osteosarcoma, Chondrosarcoma & Ewing’s Sarcoma

142
Q

Osteosarcoma and Ewing’s Sarcoma require ___________ treatment modalities (surgery, chemo & radiation)

A

Multiple

143
Q

Chondrosarcoma requires wide _________ resection; typically responds poorly to chemo or radaition

A

Surgical

144
Q

What is a primary bone tumor that is extremely aggressive and can metastasize quickly

A

Osteogenic sarcoma

145
Q

sign of Osteogenic sarcoma?

A

Gradual onset of pain and swelling in kids and young people

146
Q

How is osteogenic sarcoma diagnosed

A

Alkaline phosphate and Ca levels
X-ray, CT, MRI, PET
Tissue biopsy

147
Q

Treatment for Osteogenic Sarcoma

A

Pre surgical chemotherapy
Limb salvage if 6-7 cm margin around lesion
Amputation if major neurovascular involvement, pathologic fracture, infection or extensive muscle involvement
Chemo + amputation = 5 year survivability rate

148
Q

What is a primary bone tumor that can occur any time during childhood and young adulthood, but usually develops during puberty. It can cause early metastasis to lungs and other bones (approx 1/3 of diagnosed will have metastasis)

A

Ewing’s Sarcome

149
Q

What are treatment options for Ewing’s Sarcoma?

A

Aggressive chemo
Surgical resection
Radiation

150
Q

What is the most common arthritis, with slow progressive non-inflammatory disease of the synovial joints?

A

Osteoarthritis

151
Q

What are some manifestations of OA?

A

Localized pain with activity
Stiffness after rest – usually resolves with movement
May develop HEBERDEN’s Nodes in hands
Crepitation if cartilage integrity is lost
DX – CT, MRI, X-Rays

152
Q

What are treatment options for OA?

A

Balance rest and activity
Application of heat and cold
Healthy weight
NSAIDS , Acetaminophen, Ointments…

153
Q

What is an important education point for a patient with OA?

A

Rest, Ice, Compression, and Elevate
THEY SHOULD NOT WORK THRU THEIR PAIN

154
Q

What is chronic, systemic autoimmune disease with periods of exacerbation and remission

A

Rheumatoid Arthritis

155
Q

What is an important education point for patient’s with RA?

A

They NEED to work thru their pain for flexibility

156
Q

What are some systemic effects of RA?

A

Sjogren’s syndrome
Rheumatoid nodules
Felty syndrome

157
Q

What are diagnostic factors for RA?

A

+ RF
High ESR and ANA
XR changes and physical assessment

158
Q

What are some treatment considerations for RA?

A

DMARDs, immunotherapy, corticosteroid injection, NSAIDs, balanced diet, alternating rest and activity to minimize stiffness and fatigue .
Joint protection, heat/cold therapy, ROM exercises, relaxation techniques, biofeedback, TENS​

159
Q

What is the increase in uric acid production or under excretion of uric acid in the kidney?

A

Gout

160
Q

Gout is common in what population?

A

Middle Aged Men

161
Q

What is the end product of purine catabolism and deposits uric acid crystals?

A

Uric acid

162
Q

Acute gout effects how many joints?

A

1-4 joints

163
Q

Acute gout is normally triggered by what?

A

Trauma, ETOH, infection leading to sudden onset of pain

164
Q

Chronic gout is how many joints

A

More than 4 joints with visible deposits called tophi and can lead to renal disease

165
Q

What are precipitating factors for gout?

A

Too many calories
Too many purines in diet
ETOH and drugs

166
Q

What are medication considerations for Gout?

A

Colchicine, NSAIDS, steroids, ACTH during attacks and allopurinol for chronic

167
Q

Other treatment considerations for Gout?

A

Adequate fluid volume (2-3L)
Decrease foods high in purines

168
Q

What is the autoimmune inflammatory disease where there are chronic flare ups and remission

A

Systemic lupus Erythematosus (SLE)

169
Q

What are some triggers for SLE?

A

Onset of menarche
During/After pregnancy
Sun exposure and infections

170
Q

What are some common manifestations of SLE?

A

Butterfly rash
ANA
Anti-DNA antibodies

171
Q

What are medication considerations for SLE?

A

NSAIDS
Immunosuppressants
Steroid sparing drugs
Antimalarials and corticosteroids for flare ups

172
Q

What is the chronic musculoskeletal syndrome that is not understood

A

Fibromyalgia

173
Q

What are important considerations for Fibromyalgia

A

It is NONPROGRESSIVE
NON-DEGENERATOVE
NON- INFLAMMATORY

174
Q

What are some physical signs of Fibromyalgia

A

Widespread burning sensation, poor pain discrimination, non-restorative sleep/ fatigue, IBS, depression, and anxiety (constant pain = poor sleep​)

175
Q

What are some treatment considerations for fibromyalgia?

A

Rest, analgesics, heat, massage, stretching, biofeedback, stress management, antidepressants, Lyrica.
TREAT PAIN AND SLEEP  symptom diary on what triggers pain​

176
Q

What is an infection of Borrelia burgdorferi transmitted by a deer tic?

A

Lyme Disease

177
Q

What is the hallmark of Lyme Disease

A

BULLSEYE

178
Q

What are s/sx of Lyme Disease?

A

Fever
Chills
Stiff neck and HA
Swollen lymph nodes

179
Q

How is Lyme Disease diagnosed?

A

Assessment and serology

180
Q

How to remove a tic?

A

Remove with tweezers and wash site with an antiseptic

181
Q

What med is given for Lyme Disease and for how long?

A

Doxycycline for 20-30 days

182
Q

If Lyme disease is not treated, what can it lead to?

A

Bells Palsy
Poor motor coordination arthritis
Coagulation problems

183
Q

What kind of breast changes are benign and are the most common breast disorder?

A

Fibrocystic Conditions

184
Q

What is the basic patho of fibrocystic changes?

A

Excess fibrous tissue, hyperplasia of the epithelial lining of the ducts, and cyst formation

185
Q

Fibrocystic breast changes ________ and ______ with the menstrual cycle

A

Enlarge and shrink

186
Q

What is a common cause of benign masses due to increased estrogen sensitivity in a localized area of the breast?

A

Fibroadenoma

187
Q

What are the manifestations of a fibroadenoma

A

Small, painless mass, well delineated (circular), mobile, usually solid firm and rubbery (not hard), slow growth/ stops at 2-3 cm, and dramatic growth with pregnancy

188
Q

How is a fibroadenoma diagnosed?

A

Biopsy

189
Q

What is the treatment for a fibroadenoma?

A

Surgical Excision

190
Q

What is patient education for a fibroadenoma

A

Lower caffeine
Teach about herbals
Tumors can reoccur

191
Q

What is a benign wart like growth in the mammary ducts usually near the nipple?

A

Intraductal Papilloma

192
Q

What are some manifestations of Intraductal Papilloma?

A

Bloody nipple discharge
Palpable mass

193
Q

What is the treatment for intraductal papilloma?

A

Excision of the papilloma and the duct

194
Q

What is the benign disease involving the swelling of several bilateral ducts (affects peri/ post menopausal women​)

A

Ductal Ectasia

195
Q

What is the manifestations of ductal ectasia?

A

Multicolor, sticky nipple discharge, can be itching, burning, and painful around nipple, swelling around areola, discharge may present as bloody later on

196
Q

What is a treatment for ductal ectasia?

A

Surgical excision of the ducts

197
Q

What are risk factors for breast cancer?

A

Hereditary: history of breast ca (BRCA 1/2 genes autosomal dominant )
Hormonal involvement: is the tumor hormone sensitive (is it fed by estrogen)​
Inactivity​ and obesity
Smoking ​ and Alcohol ​
Environmental (chemical or radiation exposure)​
First full term pregnancy > 30 y/o or nulliparous (no children)​
Long menstrual history (<12 >55 y/o)​
>50 years old​

198
Q

What is the main risk for hormone replacement therapy?

A

Risk: hormonal regulation related to breast cancer development (mechanisms are poorly understood)

199
Q

Combines hormone therapy increases the risk of…..

A

Risk of breast CA
Increased tumor size at diagnosis
Increased tumor stage at diagnosis

200
Q

Breast CA usually arise from epithelial tissue of the _____

A

Ducts (Called ductal carcinoma)

201
Q

Prognosis of breast CA depend on what factors:

A
  • size of nodule​
  • axillary node involvement ( more nodes involved, worse prognosis)​
  • tumor differentiation (tumor board grades the tumor- TNM staging)​
  • estrogen, progesterone, HER2 receptor status (triple test – do NOT want a triple negative/ triple test: Estrogen-receptor (ER), Progesterone-receptor (PR), & HER2 ​
  • cell type has little impact once the tumor is invasive​
202
Q

Tamoxifen is used for _____ positive tumors

A

ER +

203
Q

Herceptin is used for _______ positive tumors

A

HER 2 +

204
Q

What are the two noninvasive breast cancers

A

Ductal Carcinoma IN SITU
Lobular Carcinoma IN SITU

205
Q

What is the treatment for non-invasive breast CAs

A

Lumpectomy
Bilateral masectomy

206
Q

What is an inflammatory process leading to intraductal?

A

Paget’s Disease

207
Q

What are the manifestations of Paget’s Disease

A

Rare, see persistent nipple/ areola lesion, may/ may not feel mass but have excoriation that won’t heal, itching/ burning/ bloody discharge, erosion that leads to ulceration ​

208
Q

What is the treatment of Paget’s Disease

A

Mastectomy

209
Q

What are the manifestations of Inflammatory breast cancer

A

Skin looks red and feels warmer
Orange peel looking
Hair follicles enlarge
Skin thickens

210
Q

What is the treatment for inflammatory breast cancer?

A

Radiation and Chemo

211
Q

What is the removal of tissue with the preservation of pectoralis muscle and axillary node dissection

A

Mastectomy

212
Q

What are pre-op teaching for a mastetomy

A

chest wall tightness, phantom breast sensation, arm swelling (lymphedema), sensory lost, Post-op exercises to strengthen arm, chest to decrease lymphedema​

213
Q

What is a lumpectomy?

A

Wide excision of a tumor, axillary node dissection, followed by radiation therapy

214
Q

What are some considerations for a lumpectomy?

A

There may be breast soreness and swelling, skin reactions to radiation, arm swelling, sensory changes in breast and arm, fatigue, discomfort

215
Q

Primary radiation therapy is for not a surgical candidate and lasts for how long?

A

5-7 weeks

216
Q

Palliative radiation is what?

A

Aimed at distant met sites to help shrink tumor and reduce pain

217
Q

What is internal radiation?

A

Brachytherapy (5 days)

218
Q

There are normally good results if there is a combo of ____

A

chemo

219
Q

What are some SE of chemo?

A

Anorexia
N/V
Weight loss
Hair loss
BMS

220
Q

Nursing care for Restoring arm function on affected side after mastectomy and axillary lymph node dissection is one of the most important goals

A
  • Place patient in semi-Fowler’s position with affected arm elevated on a pillow​
  • Flexing and extending fingers should begin in recovery room, and progressive increase in activity should be encouraged​
  • Postoperative arm and shoulder exercises are instituted gradually at surgeon’s direction​
  • Exercises are designed to prevent contractures and muscle shortening, maintain muscle tone, and improve lymph and blood circulation​

​

221
Q

Nursing care for acute lymphadema

A
  • Complete decongestive therapy (CDT) – massage ​
  • Elevation of arm (level with heart)​
  • Diuretics​
  • Isometric exercises​
  • Wearing a fitted compression sleeve during waking hours​
  • Lifelong protection s/p mastectomy side:​
    NO IV sticks, BP cuffs, injections on affected side.​

​

222
Q

Infection of the pelvis, fallopian tubes, ovaries, and peritoneum?

A

PID

223
Q

PID begins are ________ and moves upward

A

Cervicitis

224
Q

What is the common cause of PID?

A

Chlamydia and gonorrhea

225
Q

Who is at risk for PID?

A

Females < 24 y/o, multiple sex partners, new sex partners

226
Q

Clinical Manifestations for PID?

A
  • Lower abdominal pain
  • Walking and intercourse increase pain​
  • Spotting after intercourse and vaginal discharge​
  • Fever and chills​
  • bilateral adnexal tenderness (ovaries/ovarian ligaments) and pain on manipulation of cervix​
  • foul smelling/ green vaginal discharge
227
Q

Possible complications from PID?

A

Fitz-Hugh-Curtis Syndrome – PID causative agent spreads to liver causing acute peri-hepatitis (see RUQ pain but LFTS are normal with this.​)
- ovarian or tubular abscesses​
- adhesions and stricture of fallopian tubes​
- increased ectopic pregnancies / infertility​​

228
Q

Nursing Care for PID?

A

Nursing Care:​
- Education regarding decreasing STD risk​
- Allow expression of feelings (fear, regret, shame etc)​
- Monitor VS​
- Document color, amt, odor of vaginal discharge​
- Increase fluids​
- Semi-fowlers – facilitates drainage (HOB 30 degrees)​
- Assess abdomen to evaluate drug therapy​
- Heat to abd and sitz bath if ordered ( if no abscess)​
- Analgesics​
- Abx therapy, corticosteroids, no intercourse 3wks​
- Test partner for chlamydia/ gonorrhea.​

229
Q

What is the slow cell change over time and a change in hormones levels?

A

BPH

230
Q

What are clinical manifestations of BPH? early

A

narrowed stream, hesitancy initiating a stream, dribbling after voiding (urinary retention), feel as if not emptied, nocturia, urgency​

231
Q

What are clinical manifestations of BPH? LATE

A

bladder dysfunction, abnormally distended ureters, destruction of kidney tissue, pyelonephritis

232
Q

How is BPH diagnosed?

A
  • Abnormal physical findings (feels nodular, hard or boggy by DRE- all men after age 50)​
  • Signs of infection (WBC, hematuria, bacteria in urine)​
  • May see elevated BUN and serum creatinine if long standing problem​
  • PSA count ( prostate-specific antigens) can rise with BPH
233
Q

What medications can be used for BPH?

A

Proscar and Cardura

234
Q

What are non-surgical options for BPH treatment?

A

coil/ stent, prostatic balloon dilation, transurethral needle ablation ​

235
Q

What is Transurethral resection of the prostate?

A

TURP

236
Q

What are the basics of TURP?

A
  • no incision, excise and cauterize prostatic tissue​
  • 18-22 French 3-way catheter with a 30 cc balloon containing 30-60 cc sterile water inserted to apply pressure​
  • bladder irrigation for first 24 hours- strict I & Os.​
237
Q

What is nursing care for TURP?

A

For bladder spasms - opiate suppositories, push fluids to 2-3 liters per day, assess for hyponatremia and fluid excess, maintain patency of catheter, pain management, mobilize pt - roll side to side – worry about clots in bladder, may have order for continuous irrigation to prevent clot formation

238
Q

What is transurethral cutting/incision of the prostate?

A

TUI (for mild obstructions and high risk pts.)

239
Q

What procedure is used if there is an extremely large mass?

A

Suprapubic resection

240
Q

Post-op care for BPH?

A
  • Maintain patency of catheter ​
  • irrigate for clots - CBI​
  • analgesics​
  • watch VS etc for infection​
  • I&O​
  • avoid lifting > 10 lb or straining​
  • increase fiber, increase fluids, stool softeners​
  • Kegel exercises​
  • watch for hemorrhage​

NURS 302/ Med-Surg 2 (5 decks)

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