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Medsurg > Test 3 > Flashcards

Test 3 Flashcards

1
Q

The seven warning signs of cancer

A 
Changes in bowel or bladder habits 
A sore that does not heal 
Unusual bleeding or discharge 
Thickening or lump in the breast or elsewhere 
Indigestion or difficulty swallowing 
Obvious change in a wart or mole 
Nagging cough or hoarseness
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2
Q

Common sites of metastasis for different cancer types

A

Breast cancer: bone* lung* liver brain
Lung cancer: brain*, bone, liver, lymph nodes, pancreas
Colorectal cancer: liver * lymph nodes, adjacent structures
Prostate cancer: bone(especially spine, legs) pelvic nodes
Melanoma: gi tract, lymph nodes, lung, brain
Primary central brain cancer: central nervous system

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3
Q

Benign

A

Harmless, does not usually require intervention

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4
Q

Malignant

A

Indicates cancer, serious and lead to death without intervention.
Abnormal, serve no useful function and harmful to normal body tissues.

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5
Q

Cancer

A

Over 1.8 million people are newly diagnosed with cancer each year.
Two reason for the increase are the longer life expectancy of people in more affluent countries and increased exposure to substance hat cause cancer. Cancer will occur in about 1 in 3 people

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6
Q

Growth

A

The growth that is well controlled through cellular regulation, ensuing t hat the right number of cell is always present in any tissue or organ.
Hypertrophy: growth that cause tissue to increase in size by enlarging each cell
Hyperplasia: growth that causes tissue to increase in size by increasing the number of cells

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7
Q

Neoplasia

A

Any new or continued cell growth not needed for normal development or replacement of dead and damaged tissue

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8
Q

Specific morphology

A

The feature in which each normal cell type has a distinct and recognizable appearance, size, and shape

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9
Q

Smaller nuclear to cytoplasmic ratio

A

Means that the nucleus of a normal cell does not take up much space inside the cell

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10
Q

Differentiated function

A

Means that every normal cell has at least one function it performs to contribute to whole body function

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11
Q

Tight adherence

A

Occurs because normal cells make proteins that protrude from the members, allowing cells to bind closely and tightly together

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12
Q

Nonmigratory

A

Tha normal cells do not wander throughout the body except for blood cells

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13
Q

Orderly and well regulated growth or cellular regulation

A

Very important feature of norma cells

They divide to develop normal tissue and to replace lost or damaged normal tissue

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14
Q

Features of cancer cells

A 
Anaplasia
A large nuclear- cytoplasmic ratio 
Specific function lost
Loose adherence 
Migration (metastasis)
No contact inhibition 
Rapid or continuous cell division 
Abnormal chromosomes (aneuploidy)
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15
Q

Anaplasia

A

Is the cancer cells loss of the specific appearance of their parent cells. The more malignant he smaller and rounded the cell gets

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16
Q

A larger nuclear-cytoplasmic ratio

A

Occurs because the cancer cell nucleus is larger than that of a normal cell and the cancer and the cancer cell is smaller than a normal cell

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17
Q

Specific functions

A

Are lost partial or completely in cancer cells.

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18
Q

Loose adherence

A

Is typical for cancer cells because they do not make fibronectin, as a result cancer cells easily break off from the main tumor

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19
Q

Migration

A

Occurs because cancer cells do not bind tightly together and have many enzymes on their cell surfaces. The ability to spread metastasize is unique to cancer cells and a major cause of death

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20
Q

Contact inhibition

A

Does no occur in cancer cells because of lost cellular regulation when when all sides of these cells are in continuos contact with the surfaces of other cells

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21
Q

Rapid or continuous cell division

A

Occurs in many types of cancer cells because they re-enter the cell cycle for mitosis almost continuously because cellular regulation is lost
Cancer cells do not respond to apoptotic signal and have an unlimited life span

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22
Q

Abnormal chromosomes (aneuploidy)

A

Are common in cancer cells as they become more malignant

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23
Q

Cancer development

A

Carcinogenesis and oncogenesis are other names for cancer development. He process of changing a norma cell into a cancer cell is called a malignant transformation, occurring through loss of cellular regulation leading to the steps of initiation, promotion, progression and metastasis.

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24
Q

Carcinogens

A

Substances that change the activity of a cells genes so treat the cell becomes a cancer cell. May be chemical, physical agents or viruses.

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25
Q

Initiation first step of carsinogenesis

A

Is a change in gene expression caused by anything that can penetrate a cell, get into the nucleus and mutate the DNA leading to loss of cellular regulation

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26
Q

Promotion step 2 in carcinogenesis

A

The enhanced growth of an initiated cell by substances known as promoters.

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27
Q

Progression step 3 in carcinogenesis

A

Is the continued change of a cancer, making it more malignant over time. The tumor must firs develop its own blood supply.

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28
Q

Metastasis step 4 in carcinogenesis

A

Occurs when cancer cells move from the primary location by breaking off fro the original group and establishing remote colonies.

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29
Q

Steps 1 of metastasis malignant transformation

A

Malignant transformation, some normal cuboidal cells have undergone malignant transformation and have divided enough times to form a timorous area within the cuboidal epithelium

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30
Q

Step 2 in metastasis Tumor vasculation

A

cancer cell secrete vascular endothelial growth factor stimulation to bud and for new channels that grow in the tumor.

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31
Q

Step 3 metastasis blood vessel penetration

A

penetration cancer cells have broken off from the main tumor, enzymes on the surface of the tumor cells make holes in the blood vessels allowing cancer cells to enter blood vessels and travel around the body

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32
Q

Step 4 in metastasis arrest and invasion

A

cancer cells clump up in blood vessel calls and invade new tissue areas. If the new tissue areas have the right conditions to support continued growth of cancer cells new tumors will form at this site.

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33
Q

Cancer classification

A

Grading of the tumor classifies cellular aspects of the cancer
Ploidy classifies tumor chromosomes as normal or abnormal
Staging classifies clinical aspects of the cancer, determines the exact location of the cancer and its degree of metastasis at diagnosis
Euploidy the normal diploid number
Aneuploidy some cancer cells gain or lose whole chromosomes and may have structural abnormalities of the remaining chromosomes

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34
Q

Grading of malignant tumors

A

Gx- grade can not be determined
G1- tumor cells are well differentiated and closely resemble he normal cells from which they arose. This grade is considered a low grade of malignant change. These tumors are malignant but are relatively slow growing.
G2- tumor cells are modestly differentiated, they still retain some of the characteristics of normal cells but also have more malignant characteristics than do G1 tumor cells
G3- tumor cells are poorly differentiated by the tissue of origin can usually be established. The cells have a few normal cell characteristics.
G4- tumor cells are poorly differentiated and retain no normal cell characteristics. Determination of the tissue of origin is difficult and perhaps impossible.

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35
Q

Staging (T)

A 
Primary Tumor (T)
Tx- primary tumor cannot be assessed 
T0- no evidence of primary tumor 
Tis- carcinoma in situ 
T1,T2,T3,T4- Increasing size and or local extent of the primary tumor
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36
Q

Staging (N)

A

Regional lymph Nodes (N)
Nx- regional lymph nodes cannot be assessed
No- no regional lymph node metastasis
N1,N2,N3- increasing involvement off regional nodes

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37
Q

Staging (M)

A

Distant metastasis (M)
Mx- presence of distant metastasis cannot be assessed
Mo- no distant metastasis
M1- distant metastasis

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38
Q

Doubling time

A

Tumor growth is assessed in terms of doubling time (the amount of time it takes for a tumor to double in size)

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39
Q

Mitotic index

A

The percentage of actively dividing cells within a tumor

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40
Q

Oncogenes

A

Are not abnormal genes but are part of every cells normal makeup. Become a problem only if they are over expressed as a result of exposure o carcinogenic agents or evens with loss of cellular regulation

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41
Q

External factors

A

Including environment exposure are responsible for about 80% of cancer in north America

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42
Q

Chemical carcinogenesis

A

Can occur from exposure to many known chemical, drugs, and other products used in everyday life

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43
Q

Physical carcinogenesis

A

From physical agents or events also causes cancer by DNA damage. Two physical agents that are known to cause cancer are radiation and chronic irritation- burn scars or skin injury

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44
Q

Viral carcinogenesis

A

Occurs when viruses infect body cells and break DNA strands. Viruses that cause cancer oncoviruses

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45
Q

Dietary factors

A

Dietary factors include low fiber intake and a high intake of red meat or animal fat.preservatives preparation methods and additives(days, flavoring, sweeteners) may have cancer promoting effects

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46
Q

Personal factors

A

Immune function, age, and genetic risk also affect.immune function protects the body from foreign invaders and non-self cells
Cancer incidence increases among immunosuppressed people.
Advancing age is the single most important risk factor for cancer, as a person ages, immune protection decreases and external exposure to carcinogens accumulate

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47
Q

Primary prevention

A

Is the use of strategies to prevent the actual occurrence of cancer.
Avoidance of known or potential carcinogens is an effective prevention strategy when a cause of cancer is known and avoidance is easily accomplished
Sun screen, don’t smoke, pipe, diet low in fiber with colon, breast, and ovarian, multiple sexual partners or protection. HPV gardasil and cervarix

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48
Q

Secondary prevention

A

Regular screening.
Yearly mammography for women older than 40 years
Yearly clinical breast examination for women older than 40 years
Every 3 years for women 20-39
Colonoscopy at age 50 years and tha every 10 years
Yearly fecal occult blood for all ages
Digital rectal examination for men older than 50
BRCA1 gene increase the risk for both breast and ovarian
BRCA2 gene ris for breast and mutations in the APC, MLH1, mlh2 in crease for colon

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49
Q

Cancer associated with tobacco

A 
Lung.                    Uterine 
Oral                        Kidney 
Pharynx.                Bladder
Larynx.                   Liver
Esophagus.           Stomach 
Pancreas.               Myeloid leukemia
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50
Q

Viral origin

A

Epstein-barr virus- Burkett she lymphoma, bell lymphoma, nasopharyngeal carcinoma
Hepatitis b virus-primary liver carcinoma
Hep c virus- primary liver carcinoma, possibly b-cell lymphomas
Hpv- cervical carcinoma, vulvar carcinoma, penile carcinoma and other anogenital carcinomas
Human lymphotrophic virus 1- adult t cell leukemia
Human lymphotrophic virus 2-hairy cell leukemia

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51
Q

Leading sites of new cancer

A 
New cases 
Male.             Female 
Prostate.       Breast
Lung.             Lung 
Colon.           Colon 
Urinary.         Uterine
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52
Q

Estimated death

A 
Male                    Female 
Lung.                   Lung
Prostate.             Breast
Colon.                 Colon
Pancreas.            Pancreas
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53
Q

General

A

Cancer can develop in any organ or tissue and destroys normal tissue, which decreases function of that tissue or organ.

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54
Q

Advance cancer can

A

Reduce immunity and blood producing functions
Altered gi structure and function
Motor and sensory deficient
Decreased respiratory function

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55
Q

Reduced immunity and blood producing functions

A

Impaired immune and blood producing function occur most often in patient with leukemia and lymphoma but can also occur with any cancer that invades the bone marrow.
Can cause anemia by decreasing the number of RBC’s and causes thrombocytopenia by decreasing the number of platelets

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56
Q

Altered gi structure and function

A

Abdominal tumors may obstruct or compress structures anywhere in the GI tract, reducing the ability to absorb nutrients and eliminate wastes.
Anorexia, cachexia, diet in high protein and carbs

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57
Q

Motor and sensory

A

When cancer invade bone or the brain or compress nerves.

Causes pain, fractures, spinal cord compression and hypercalcemia

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58
Q

Reduce gas exchange

A

Cancer can disrupt oxygenation in several way and often results in death. Tumors in the airway cause obstruction

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59
Q

Cancer management

A

The purpose of cancer management is to prolong survival time and improve quality of life.

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60
Q

Surgery

A

The earliest known treatment for cancer and continues to be a cornerstone of therapy.

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61
Q

Prophylactic surgery

A

Removes at risk tissue to prevent cancer development

62
Q

Diagnostic surgery

A

Biopsy is the removal of all or part of a suspected lesion for examination and testing.

63
Q

Curative surgery

A

Removes all cancer tissue. About 30 % cure rate when all visible and microscopic tumor is removed and destroyed

64
Q

Cancer control or cytoreductive surgery

A

Removes part of but not the entire tumor. Also known as debulking

65
Q

Palliative surgery

A

Focuses on improving the quality of life during the survival time not on cure.
Removing tumor that is causing pain etc

66
Q

Second-look surgery

A

Is a repeat examination after treatment to assess the disease status in patient who have been treated and haven no symptoms of remaining tumor

67
Q

Reconstructive or rehabilitative surgery

A

Increases function enhances appearance or both

68
Q

Side effects of radiation therapy

A

Acute and long term site specific changes
Skin changes and hair loss are local but are often permanent depending on the total absorbed dose
Altered tastes sensations and fatigue are two common systemic side effects
Fatigue sone marrow suppression
Damage to normal tissue can start inflammatory responses that lead to tissue fibrosis and scaring may appear years after treatment
Increases the risk for 2nd malignancies

69
Q

Patient centered care

A

Provide accurate information to help parents cope
Skin care needs during radiation therapy
Do not remove temporary ink markings
Avoid skin irritations
Follow radiation-oncology departments policy for skin care products use
Avoid sun for up to 1 year after treatment is complete
Regular dental visit
Exercise and sleep

70
Q

Care a patient with sealed implants

A

Assign to private room with caution sign
Portable shields used place between patient and door
Keep door closed as much as possible
Wear dosimeters at all times
Lead apron
If pregnant or attempting do not perform direct care
Limit each visit to one-half four, visitors stay 6 feet away
Never touch with bare hands, use forceps and place in lead containers
Save all dressing and bed linens in patients room until after radioactive source is removed

71
Q

Skin protecting during radiation

A

Wash the Irradiated are gently each day with water or mild soap
Use your hand
Rinse soap throughly from our skin
Take care not to remove the ink
Dry are with a patting motion
Use only prescribed ointment on site
Wear clothing over site
Avoid wearing belts or anything that irritates the site
Avoid exposed of the site to the sun
Go outdoors early in the am or late in the pm hottest 10-7pm
Avoid heat exposure

72
Q

Chemotherapy

A

The treatment of cancer it’s chemical agents is used to cure and it increase survival time.
Drugs used for chemo usually are given systemically and exert their sell-damaging (cytotoxic) effects against healthy cells as well as cancer cells.
The normal cells most affected are those that divide rapidly including hair, skin, intestinal tissue,spermatocytes and blood forming cells

73
Q

Chemo drug categories

A 
Ankylating agents 
Anteimetabolites
Antimitotic agents
Antitumor antibiotics 
Topoisomerase inhibitors 
Miscellaneous
74
Q

Alkylation agents

A

cross-link DNA, making the DNA strands bind tightly together. This action prevents proper DNA and RNA synthesis which inhibits cell division.

75
Q

Anteimetabolites

A

similar to normal metabolites needed for vital cell processes. They fool cancer cells into using antimetabolites in cellular reactions. Because they cannot function as proper metabolites their presence impairs cell division

76
Q

Antimitotic agents

A

Interfer with the formation and actions of micro tumbles so cells cannot complete mitosis during cell division. As a results the cancer cell does not resolve at all or only divides once

77
Q

Antitumor antibiotics

A

Damage the cells DNA and interrupt DNA or RNA synthesis. Exactly how the interruptions occur varies with each agent

78
Q

Topoisomerase inhibitors

A

Disrupt an enzyme topoismerase essential for DNA synthesis and cell division. When drugs disrupt the enzyme proper DNA maintenance is prevented leasing to DNA breakage and cell death

79
Q

Miscellaneous

A

Chemo dugs are those with mechanism of action that are wither unknown or do not fit those of other drug categories

80
Q

Chemo drugs

A

Are given on a regular basis and are tidied it maximize cancer cell kill and minimize damage to normal cells. The intent is to allow normal cells time to recover from any injury but not allow adequate time for the cancer cells to recover

81
Q

Extravasation

A

A serious complication key is prevention. Pain, infection and tissue lost. Anyone preparing, giving, or disposing of chemotherapy drugs or handling excreta from patient within 48 hours of receiving IV chemo must use extreme caution and wear PPE . Eye protection, masks, double gloves or chemo gloves and gown

82
Q

Side effects of chemo

A

Temporary and permanent damage can occur to normal tissue from chemo because it is systemic and excerpts its effects on all cells. Problems include hemorrhagic cystitis, cardiac muscle damage and loss of bone density.
Common distressing side effects N/V, alopecia, mucositis, skin changes, anxiety, sleep disturbance, altered bowel elimination and cognitive. CIPN

83
Q

Bone marrow suppression

A

Chemo destroys circulating blood cells and reduces replacement of these cells by suppressing bone marrow function

84
Q

Chemo therapy induced neutropenia

A

Older people are at great risk because of age-related changes in bone marrow function
Protect from infection
Patient assessment

85
Q

Care

A

Instruct patient to report pimple, sore, rash, or open skin area, south, burning upon urination, pain around venous access site or drainage from any area.

86
Q

Prevention of infection

A 
Avoid crowds 
Do not share bath daily 
Clean your tooth brush at least weekly 
Wash your hands throughly 
Wash dishes with hot water 
Do not drink liquids that have been standing 
Do not reuse cups 
Do not change pet litters 
Take temp at least once a day 
Report signs of infection 
Temp grater than 100, cough, pus drainage, boil,cloudy urine
Take all meds
Condom and clean gloves under gardening gloves
87
Q

CINV

A

Anticipatory- before receiving the chemo, often triggered by thoughts, sights, sounds r/t anticipated chemo
Acute-within the first 24 hours
Delayed-after 24 hours
Breakthrough- occurring intermittently during therapy
Antiemetics, give before chemo and as needed

88
Q

Side effect teaching

A

Mucositis-important hygiene, including teeth and mouth rinsing, soft toothbrush, gentle flossing, rinse mouth with plain water or saline, avoid mouth washes with alcohol
Alopecia- temporary, may come back different color, texture and thickness. Hairless scalp is at risk for injury avoid direct sunlight, do not ware anything that can irritate head.
Cognitive function- chemo brain most often in women with breast cancer
CIPN- loss of sensory motor function of peripheral nerves associated with exposure to anti cancer drugs loss of sensation of hands and feet, orth hypotention, erectile dysfunction and constipation. Teach to prevent injury . Injury is very high.

89
Q

CIPN teaching

A 
Protect feet and other body areas 
Shoes big enough
Long breaks for shoes and buy evening
Avoid pointed toes 
Avoid extreme temps 
Test water
Use pot holders when cooking 
Gloves 
So not eat steaming hot foods 
Eat foods high in fiber , drink 2-3 liters of fluid 
Falls prevention 
Avoid using rugs, floors free of clutter, use handrails.
90
Q

BRMs

Biological response modifiers

A

Modify the patients biological responses to tumor cells
Can improve immune function and enhance the body’s ability to repair or replace cells damaged
Can interfere with cancer cell differentiation, transformation, metastasis

91
Q

Targeted therapies

A

Block the growth and spread of cancer by interfering with specific signals or molecules involved in he growth and progression of cancer cells

92
Q

Hormonal manipulation

A 
Involves changing usual hormone responses 
Masculinizing effects in women 
Feminist groups effects in men 
Fluid rentention
Acne 
Hypercalcemia 
Liver dysfunction 
Venous thromboembolism
93
Q

Sepsis DIC

A

Organism enter the bloodstream
DIC is a problem with clotting process, triggered by many sever illness, including cancer. Can be viral or bacterial
Prevention is the key, use strict adherence to aseptic technique during invasive procedure and during contact with nonintact skin

94
Q

SIADH

A

Induce ADH sevreation when not needed by the body
Water is reabsorbed in excess by the kidneys and put into systemic circulation. Retained water dilutes blood sodium levels. Mild manifestations include weakness, muscle cramps, loss of appetitive s and fatigue.
Manage by treating the condition ad cause. Restore normal fluid balance and provide support. Fluid restriction, increase sodium and drug therapy.

95
Q

Tumor lysis syndrome

A

Large numbers of tumor cells are destroyed rapidly
Severe or untested can cause tissue damage and acute kidney injury hydration prevents and manages TLS by diluting the serum potassium level and increasing he kidney flow rates. 3000ml of fluid day before day of and 3 days after

96
Q

Bone marrow

A

Responsible for blood formation
Produces RBC’s, WBC’s, platelets
Also involved in the immune system

97
Q

Bone marrow aspiration

Helps evaluate the patients hematologic status when other test show abnormal findings that indicate a possible problem in blood cells or maturation

A

Are invasive procedures
Cells and fluids are suctioned from the bone marrow
Signed consent before
By physician, PA, APN, at bedside sterile technique
Provide accurate information and support , explain the procedure and reassure you will say. Anesthetics will feel like a stinging or burning
Will feel heavy sensation of pressure and pushing while the needle is being inserted, will feel painful pulling take 5-15 minutes
Follow up is prevention of excessive bleeding
Cover with dressing, observe for 24 hours, mild aspirin, ice, avoid contact sports for 48 hours

98
Q

Bone marrow biopsy

A

Solid tissues and cells are obtained by coring four an area of bone marrow with a large bore needle
Signed conscientious before

99
Q

3 major types of plasma proteins

A

Albumin- maintains he osmotic pressure of the blood, preventing the plasma from leaking into the tissues.
Globulins-have many functions such as transporting other substances and as antibodies protecting the body against infection
Fibrinogen- is activated to form fibrin which is critical in the blood clotting process

100
Q

Blood cells

A

RBC- largest portion of blood cells, number varies with age normal 4,200,000-6,100,00 have a life span of 120 days. They produce Hgb
WBC- formed in the bone marrow provide protection though inflammation and immunity
Platelets- are the third type of blood cells, they are the smallest formed in the bone marrow from megakaryocyte precursor. When activated platelets stick to injured blood vessel walls and form platelet plugs that can stop the flow of blood at the injured site.help keeps small vessels intact by initiating repair after damage

101
Q

Accessory organs

A

The spleen and he liver are important accessory organs for blood production. They help regulate the growth of blood cells and form factors that ensure proper blood clotting

102
Q

Assessment methods

A

Age and gender are important to consider when assessing the patients hematologist status.bone marrow function and immune activity decrease with age.
Liver function, hematologist disorders, drug use and diet ad socioeconomic are important . Occupation and hobbies.

103
Q

Anticoagulant drugs

A

Interfering with one or more steps involved in the blood clotting cascade. These agents prevent new clots from forming and limit or prevent extension of formed clots. Do not break down existing clots.classified as direct thrombin inhibitors and vitamin k

104
Q

Indirect thrombin inhibitors

A

the drugs cause anticoagulation by binding to and increasing the activity of antithrombin III
Heparin
(Parin)

105
Q

Vitamin k antagonist

A

Decreas the synthesis of vitamin k in the intestinal tract which then reduces the production of vitamin k dependent clotting factors. Most common are warfarin

106
Q

Fibrinolytic drugs

A

Thrombolytic clot busters brea down fibrin threads present in formed blood clots.
Anistreplase
Retaplase

107
Q

Platelet inhibitors

A

Antiplatelet drugs prevent either platelet activation or aggression clumping most wide used drug is aspirin which inhibits the production of substances that activate platelets such as thromboxane

108
Q

Nutritional status

A

Diet can alter cell quality and affect clotting.
Diets high in vitamin k found in leafy greens veggies may increase the rate of blood clotting.
Diets high in fat and carbs and low in protein,iron and vitamins can cause anemia

109
Q

Family history and genetic risk

A

Ask weather anyone has hemophilia, frequent nosebleeds, postpartum, excessive bleeding after tooth excratation, heavy brushing.

110
Q

Physical assessment

A

Skin- pallor or jaundice, gums, petechiae
Head and neck- pallor or ulceration of the oral mucosa, Smooth and beefy red tongue
Respiratory- lungs work harder o make adjustments that maintain tissue perfusion
Cardiovascular- heart works harder to make adjustments pulses may become weak and threads, observe for distended neck veins, edema, phlebitis
Kidney- bleeding problems may cause gross or occult hematuria
Musculoskeletal-
Abdominal-palpating the edge of the liver in the right upper quadrant of the abdomen can detect enlargement
Cns

111
Q

Diagnostic test

A

Reticulocyte- helpful in determine bone marrow function. An elevated count usually indicates health problems such as polycythemia vera
Platelet count (thrombocytopenia) number of platelets in circulation normal range 150,000-400,000 when low higher risk for bleeding because platelets are critical for blood clotting 40,000-80,000 prolonged bleeding. Below 20,000 spontaneous bleeding difficult to stop
Hemoglobin-detects abnormal forms of hemoglobin such as s in sickle cell
LAP- is an enzyme produced by normal neutrophils, elevated occur during stress
Serum ferritin (TIBC) measure iron levels.

112
Q

Anemia

A

A reduction in either the nu,bear of RBC’s, the amount of hemoglobin, or the hematocrit can result from dietary problems, genetic disorders, bone marrow disease or excessive bleeding. Gi bleeding is the most common reason for anemia in adults

113
Q

Sickle cell disease

A

Genetic disorder that results in chronic anemia, pain, disability, organ damage, increased risk for infection and early death.

114
Q

Conditions that cause sickling

A

Hypoxia, dehydration, infections, venous status, pregnancy, alcohol, high altitudes, low or high environment or body temp, acidosis, strenuous excerise, environmental stress and anesthia

115
Q

Sickle cell genetic risk

A

Genetic disorder with an autosomal recessive pattern of inheritance.
If patient has children each child will inherit one or two abnormal gene alleles and at least have sickle cell trait
Sickle cell trait occurs when one normal gene allele and one abnormal gene for hgb are inherited and only half of hgb chains are abnormal
Most common among AfricanAmericans 1-500

116
Q

Physical assessment of sickle cell

A

Pain is the most common.
Cardio vascular changes including the risk for high output, hf,occur because of anemia
Priapism prolonged erection
Pallor or cyanosis ulcers in lower leg
Abdominal changes and kidney and urinary chnages

117
Q

Laboratory assessments of SCD

A

Percentage of hemoglobin s on electrophoresis.
Has 80-100% of hbs, number of RBC’s with permanent sickling 90%
WBC is high

118
Q

Care of patient with sickle cell crisis

A 
Administer o2
Pain meds
Hydrate with ns and beverage of choice no caffeine 
Remove constricting clothing 
Keep extremities extended
Do not raise knee position 
Elevate HOB no more than 30
Keep room 72 
Avoid taking bp 
Check circulation pulse finger toes,cap, peripheral, tow temp
119
Q

Therapy for SCD

A

Morphine and dilaudid are given iv on routine

Droxia may reduce the number of sickling and pain episodes by stimulating fetal hemoglobin production

120
Q

Prevention of sickle cell crisis

A 
Drink at least 3-4 liters a day
Avoid alcohol
Avoid smoking
Contact health provider at the first sign of infection
Get flu-shot
Pna vaccine 
Avoid temp hot and cold
Ware sock and gloves
Avoid planes
Avoid travel to high altitude 
Consider genetic consulting 
Avoid strenuous activity 
Mild exercise 3 times a week
121
Q

Polycythemia vera

A

The number of red blood cells in the blood is greater than normal blood is hyperviscous (thicker)
A disease with a sustained increase in blood hemoglobin levels to 18 and RBC count 6 million or hct 55% or greater

122
Q

Polycythemia vera manifestation

A

Facial skin and mucous membranes have a dark, purple or cyanotic, flushed (plethoric) appearance with discolored veins. Itching, hypertention

123
Q

Patient care for polycythemia

A 
A malignant disease that progresses severely over time if left untreated few people live longer than 2 years after diagnosis 
Drink at least 3 liters each day 
Avoid tight clothing 
Ware gloves
Keep appointments
Contact hp first sign of infection
Take anticoagulants 
Ware support hose or stocking while awake
Elevate feet when seated 
Exercise slowly 
Stop activity at first sign of pain
Use electric razor
Soft tooth brush
Do not floss
124
Q

Hereditary hemochromatosis

A

Is an autosomal recessive disorder in which mutation in both allele of the HFE gene cause increased intestinal absorption of dietary iron
More common in men and manifestations appear later because the loss of menstraul blood before menopause helps remove excess iron

125
Q

Hereditary manifestations

A

Abdominal pain, liver enlargement, hyperglycemia, and a gradual darkening of the skin. Later problems include diabetes, liver cirrhosis, endocrine glad failure , heart disease, and death.
Desired outcome is to reduce blood ferritin levels to less than 9-50 mcg per liter.

126
Q

Immunohemolytic anemai

A

Most common types of hemolytic anemia in north america
Antibodies attack a persons own RBC’s
Two types
Warm antibody anemia- igG antibody excess are most active in 98.6 and may be triggered by drugs, chemical or autoimmune problems
Cold antibody anemia- complete protein fixation on igm and occurs most at 86 occurs with raynauds-like response in which there arteries in the hands and feet constrict profoundly in response to cold temp or stress.

127
Q

Iron deficiency aneami

A

Most common world wide especially among women, older adults, and people with poor diets . Can result from blood loss,poor gi absorption of iron and inadequate diet
Symptoms- weakness, parlor, fatigue, reduced activity tolerance fissures around mouth. Serum ferritin values less than 10ng/ml
(Normal 12-300)
Give iron fish food or supplemts (red meat, organ meat, egg yolks, kidney beans, leafy green veggie,raisins.

128
Q

B12 aneamia

A

Failure to activate the enzyme that moves folic acid into precursor rbc cells so that cell division and growth functional rbc can occur.
Causes vegan diets or diets lacking dairy, small bowel resection, chronic diarrhea, tapeworm or overgrowth of intestinal bacteria
Symptoms: pallor, jaundice, glossitis (smooth, beefy red tongue)
Treat: animal protein,fish, eggs, nuts, dairy, dried beans, citrus fruit, leafy genes.
With pernicious anemia b-12 shots

129
Q

Folic acid aneamia

A

Similar to b-12

Slow, from poor nutrition, drugs and malabsorption

130
Q

Acute transfusion reactions

A

Febrile, hemolytic, allergic, or bacterial reactions, circulatory overload, transfusion-associated graft-versus-host-disease

131
Q

Febrile transfusion

A

Occur most often in patient with anti-wbc antibodies

Chills tachycardia, fever, hypotention an tachypnea

132
Q

Hemolytic transfusion

A 
Reactions are caused by blood type pr RH incompatibility
Apprehension 
Headache
Chest pain 
Low back pain 
Tachycardia 
Tachypnea 
Hypotension
Hemoglobinuria
A sense of impending doom
Are immediate
133
Q

Allergic reaction

A

Urticaria, itching, brocnchospasm, anaphylaxia, onset occurs surging or up to first 24 hours after transfusion

134
Q

Bacterial transfusion

A

Occur from infusion or contaminated products especially gram-negative organism
Tachycardia, hypotention, fever, chills, shock

135
Q

Circulatory overload

A 
When blood product is infused to quickly especially in older adults 
Hypertension
Bounding pulse
Dissented jugular veins 
Dyspnea 
Restlessness
Confusion 
Monitor I&O, infuse slow, give diuretic
136
Q

Blood admin

A

Determine clients -allergies, previous reactions
Check cross match record with TWO nurses, abo group, rh type, name, hospital number, expiration date
Administer within 30 min of receiving form blood bank
Never add ANY meds
Do NOT warm unless risk of hypothermic response THEN only by specific blood warming equipment
Infuse each unit over 2-4 hours BUT no longer than 4 hours
KEY POINTS
VERIFY CLIENTS ID
CHECK DR ORDER
CHECK LABELS ON BLOOF BAG & BLOOD BANK RECORD
BASELINE VITALS
#18 GAUGE NEEDLE
NS IV SOLUTION
BLOOD ADMIN SET WITH FILTER
SEVERE REACTIONS MOST LIKELY FIRST 15 MIN & FIRST 50cc

137
Q

Transfusion

A

RBC-given to replace cells lost form trauma
Platelet- given for low platelet counts, active bleeding, scheduled for invasive procedure
Plasma-given to replace blood volume and clothing factors
WBC- given rarely to neutropenia patients

138
Q

Febrile reactions

A

Child, fever, headache, flushing, tachycardia, increase anxiety

139
Q

Hemolytic reaction

A

Low back pain, hypotetnion, tachycardia, fever, chills

Chest pain, tachypnea, hemoglobinuria, may have immediate onset

140
Q

Allergic reaction

A

Mild- hives, purity, facial flushing

Sever- severe shortness of breath, bronchospasm, anxiety

141
Q

Pretransfusion

A

VERIFY rd with another RN
Test donors/recipients blood for compatibility
Verify patients id with another RN
Examine blood bag label, attached tag and requisition slip for ABO, RH compatibility with the patient with another RN
Check expiration date with another RN
Inspect blood for discoloration, gas bubbles, cloudiness

144
Q

Nursing implications for transfusion reaction

A 
Stop 
Change IV tubing
Treat symptoms-02, fluids, epinephrine as ordered 
Recheck crooks mach recor with unit
HEMOLYTIC
Obtain 2 blood sample dismal to infusion site
Obtain first us test
Monitor fluid/electrolyte balance
Evaluate serum calcium levels
146
Q

Anemias

A

Hypochromic-iron or vitamin deficiency
Pernicious-lack of intrinsic factor
Erythroblastosis fetalls- destruction by antibodies
Secondary- bleeding, leukemia, cancer or chronic kidney disease
Genetic factors-sickle cell, spheroidail
Aplastic- malfunctioning bone marrow

147
Q

Sickle cell anemai crisis

A

Cell clumping- obstruction produces vasocclusive crisis
Pain abdominal & long bone hand foot syndrome joint pain
Complications-infections stroke, URI, leg ulcer, spienomegaly
Treat: HOSPITAL (HOP TO IT)
Hydration
O2
Pain relief

148
Q

Whit blood cell count

A

First response combat group
Functional WBC count is 5,000-10200
YES SIR
We have the PMN’s team(polymophonucler Leukocytes made up of neutrophils, eosinophils and basophils
The other team ill be the ML’S (monocytes and lymphocytes) at first sign of infection or inflammation, they will join the battle

149
Q

Hemophilia

A

An x linked recessive trait women who are carries can pass gene without expressing bleeding problems 50% chance passing gene to daughters who than are carries and pass to their sons who have hemophilia
Hemophilia A affects most males, none who’s sons will have the gene and all of whose daughters will carrie
Regular scheduled infusion or synthetic factor VIII or the infusion of this substance only when injury or bleeding

150
Q

Heparin-induced thrombocytopenia

A

Serious immunity-mediated clotting disorder with unexplained drop in platelet count after heparin treatment

  1. Duration of heparin longer than 1 week
  2. exposure to unfracionated heparin
  3. Post surgical thromprophylaxis
  4. Being female
151
Q

Hemophilia inherited blood disorder

Factor VLL, classic or type A

A 
No cure 
Avoid injury and meds that promote bleeding
Good nutrition 
Good dental hygiene 
Iv admin of deficient clotting factors 
       Signs 
Intracranial hemorrhage 
Prolonged nosebleeds
Bruises easily 
Warm, painful, swollen joints with movement 
Gi hemorrhage 
Coffee ground eyes is, cola colored urine, tarry stools
155
Q

Transfusion responsibility

A

During: education
Assess vitals immediately and before sharing
Begin infusion slowly, stay with pt first 15-30 min
Ask pt to report unusual sensations, chill, shortness of breath, hives, itching
Administer blood per protocol
Assess for hyperkalemia

158
Q

Intervention for transfusion reactions

A

Stopping and removing blood tubing
Hemolytic and bacterial- return bag, label and tubing to blood bank.
Notify RRT- do not flush blood in tubing in patient
O2 and Benadryl iv

159
Q

Polycythemia vera education

A 
Drink at least 3 liters each day 
Avoid tight constrictive clothing
Ware gloves
Keep appointment
Contact hp at sign of infection 
Ware support hose 
Elevate feet when seated
Exercise slow 
Sop when chest pain
Electric razor
Soft tooth brush
Do not floss

Medsurg (4 decks)

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