Treatment Flashcards
EBRT (radiation) - what is it and how often is tx?
Radiation beams from different angles externally
Daily tx over few days - few weeks
What is brachytherapy?
Internal radiation tx inside little seeds placed on or next to tumor
Precautions to protect caregivers during radiation tx / brachytherapy
Private room
Signage
No pregnant staff or visitors
No children visitors
30 minute visit
6 foot distance
What is HSCT (stem cell therapy) used for?
Myeloma
Leukemia
Lymphoma
Precautions to protect caregivers during chemo
Manage spills
Proper disposal
Double glove
Cover toilet and double flush
Infection prevention with chemo patients
VS q4h
Private room
Hand hygiene
Stool softeners
Change water daily
No urinary catheters
Nursing for hand and foot surgery
Neuro vascular checked q1h first 24 hours post
Meds, elevation, ice
Wound and pin care
Weight bearing restrictions
Methods to prevent dislocation post hip replacement
Correct positioning with splint, wedge, or pillows
Keep hip abducted when turning
Keep hip adducted when transferring
Limit hip flexion
Stay less than 90 degrees in bed
Hip replacement nursing/education
Begin ambulating within 1 day post op with walker or crutches
Remove drain in 24-48 hours to prevent infection
Prevent infection and VTE
Osteoporosis prevention
Ca and vitamin D
Vitamin C with Ca supplements
Weight bearing exercise 20-30 minutes a day
Nursing for osteoporosis vertebral fracture
Short rest periods
Supportive mattress
Heat and back rubs
Improve bowel elimination with fiber, liquids, and stool softeners
Strengthen muscles with exercise
Osteomalacia mgmt
Sunlight (along with pharm and coping and pain mgmt)
Osteomyelitis nursing
Immobilize affected part
Elevation
Analgesics and abx (monitor for superinfection)
Activity restriction
Gentle ROM above and below affected part
Hydrate, vitamins, protein
Septic arthritis
Aspiration of joint
Immobilization of joint
Pain relief
Abx
Metastatic secondary bone tumor nursing
Palliative
Soft tissue injury mgmt
RICE = rest ice compress elevation
And immobilize
Emergency management of fracture
Immobilize
Splint areas distal and proximal
Neuro vascular checks before and after splint
If open fracture: cover with sterile dressing, don’t attempt to reduce
Medical mgmt fracture
Reduction back into alignment
Traction with closed
Fixation with opened
Immobilize
Factors that affect bone healing
Inadequate immobilization
Inadequate blood supply
Multiple trauma
Extensive blood loss
Infection
Poor adherence to restrictions
Malignancy
Steroids
Older
Comorbidities
Clavicle fracture
Sling
Exercise elbow, wrist, fingers ASAP
Don’t elevate arm 6 weeks
(Also strap to immobilize)
Humerus fracture
Sling and brace
Activity limitations
Monitor for Volkmann
Elbow fracture
Monitor for Volkmann contracture from humerus fracture, neuro vascular compromise, and compartment syndrome
Active exercise and ROM after healing (6 weeks cast, 1 week fixation)
Radial, ulnar, wrist, hand fractures
Early rehabilitation exercises
ROM fingers and shoulder
Pelvic fractures
Bed rest few days if stable fracture
Early mobilization
Hip fracture
Surgery to reduce and fixate
Similar to hip replacement patients (i.e. preventing overstretching the hip)
Femoral fractures
Lower leg, foot, hip exercises to preserve muscle function and improve circulation
PT, ambulation, weight bearing
Knee exercises ASAP
Edu and mgmt for patient in cast, brace, or splint
Cast takes 24-72 hours to dry
Don’t cover or stick things in cast
Assess 5 Ps (pain, pallor, pulse, paresthesia, paralysis) in neuro vascular check (to ID compartment syndrome)
Tx pain with analgesic, elevation, ice
Monitor for compartment syndrome, pressure injuries, disuse syndrome (atrophy)
Principles of traction
Counterforce
Continuous
Unobstructed
Knots and footplate can’t touch foot of bed
Nursing for skin traction
Skin assessment TID
Palpate tape for tenderness
5 Ps
Temp, cap refill
Assess for DVT
Nursing for skeletal traction
Maintain body alignment
Report pain promptly
Trapeze
Assess for pressure injury q8h
Position change
Pressure reducing mattress
Foot and leg exercises q1h
Embolism prevention
Pin care
Prevention of sports injuries
Proper training
Gear
Nutrition
Hydration
Stretching
Amputation nursing
Relieve pain with analgesics, position, sandbag, alternative measures
Psychological support
Self care
Frequent turning
ROM
Assistive devices
Muscle strengthening exercises
Proper bandaging
Elevate first 24 hours
Fall prevention and home modification
Guidelines for early detection of breast cancer
MRI and yearly mammogram for high risk
Clinical breast exams twice a year starting at 25 yo
Prophylactic tx breast CA
Mastectomy
Tamoxifen and raloxifene
Breast CA tx
Surg: modified radical, total, breast conservation, sentinel node biopsy and axillary node dissection
Radiation, chemotherapy, hormonal, targeted
Cast edu
Will feel warm first 30 minutes
Don’t cover
Don’t rest on hard surface while drying
24 - 72 hours to dry
Don’t stick stuff in there
Isometric exercises
Interventions to maintain airway with altered LOC
HOB 30
Lateral or semi prone
Suction
Oral hygiene
CPT
Interventions to maintain tissue and structural integrity with altered LOC
Frequent turning
Splints, boots, rolls for body alignment
Passive ROM
Protect cornea with drops, cotton balls with saline, tape, patch
Frequent oral care
Pre op mgmt for cranial surgery
Imaging and baseline neuro
Anti convulsants
Steroids and abx
Fluid restriction, Mannitol, diuretics
Diazepam for anxiety
Post op mgmt cranial surgery
Reduce edema, pain, seizures
Neuro assessment
Might be intubated and have lines
Resp and ABG assessments
Assess dressing for blood and CSF
VS and LOC
Fluid and labs (IO and weights, BG, electrolyte, osm and specific gravity)
HOB 30, straight neck, avoid laying on side of tumor removal
Pack nose if transsphenoidal
Avoid increasing ICP
Edu for cranial surgery
No cough/sneeze/nose blow etc to avoid CSF leakage
Self care
Seizure mgmt
Side lie
Suction
Padding
Stroke prevention
No smoke
40 minutes a day 3-4 x/week exercise
DASH and Mediterranean
Daily low dose aspirin
Anticoagulants for a fib, antiplatelets
Statins, BP meds
Carotid endarterectomy for carotid stenosis
Acute stroke mgmt
TPA thrombolytic within 3 - 4.5 hours (monitor for bleeding adverse effect)
Elevate HOB
Airway, hemodynamic, neuro
Bowel and bladder
Skin, confusion, mobility
Swallow eval within 24 hours (NPO til then)
Hemorrhagic: lumbar puncture to confirm SAH, prevent bleeding, bed rest with sedation, O2, tx of: vasospasm, HTN, ICP, seizure
Epidural hematoma
Reduce ICP
Remove clot
Burr holes / craniotomy to stop bleeding
Support of vitals and respiratory
Acute subdural hematoma
Craniotomy to reduce ICP
Also: remove clot
Chronic subdural hematoma
Remove clot
Concussion
Monitor LOC
Arouse and assess frequently
Encephalitis
Acyclovir
Amphotericin
MS nursing
Control ss: spams, fatigue, ataxia, bowel and bladder control
GBS assessment (fatal complications)
Look for early ss respiratory failure, dysrhythmia, DVT
ECG
Head injury mgmt
Assume SCI
Cervical collar
CV and resp maintenance
Control bleeding
Maintaining ABG
Surg
Monitor ICP
Drain CSF
Seizure precautions
NGT
F and lyte
Pain and anxiety mgmt
Nutrition
TBI nursing
Airway
GCS
VS
IO and weights
Labs (BG, lytes, osm)
Nutrition therapy
Assess oxygenation, bowel and bladder, dressing and cast constriction
Padded side rails and mittens
Nursing for SCI includes…
Secretion
Pulse ox and ABG
Humidification
Skin
Urinary catheter
NGT for distention, paralytic ileus and prevent aspiration
Diet: high calorie, high protein, high fiber
Stool softeners
Traction pin care
Meningitis prevention
Meningococcal vax
Iso with droplet precautions
Meningitis tx
IV abx
Dexamethasone
Tx for pain, seizures, complications associated with immobility
Brain abscess mgmt
Control ICP / drain
Abx, roids
Nursing for MS includes
Comfortable temperature
Memory aids
Speech therapy
Voiding schedule
Bell’s Palsy mgmt
Roids
Protect eye
Facial exercises and massage
Nursing for brain tumor includes
Oral hygiene before meals
Supplements
Try to serve them meals that are to their liking
Record intake and weight
Parkinson’s
Levodopa-carbidopa
Daily exercise and ROM
Postural exercises
Frequent rest
Proper shoes and assistive devices
Self care and support groups
Mgmt lumbar disc disease
Muscle relaxants
NSAIDS
Roids
Lose weight
TENS
Surg
Avoid heavy work 2-3 months
Strengthen core and back muscles
Proper lifting techniques
Mgmt osteoarthritis
Decrease pain and stiffness
Exercise - CV, leg day
Lose weight
OT and PT
Pharm and non pharm pain mgmt
Nursing mgmt with HSCT
Care for patient and recipient
Nursing mgmt for traction (mostly r/t bed rest)
Monitor for:
PNA and ATE
Constipation
Anorexia
Urine status
Infection
VTE
(Also skin)
Ischemic stroke nursing
Splint affected extremity to avoid flexion
Pillow under arm to prevent shoulder adduction
Turn and ROM
Avoid pully to prevent shoulder pain
Sling for flaccid arm
Thick liquid and puréed
(Or tube feeding - depends on condition)
High fiber and fluids for constipation
Toileting schedule, straight cath
Skin care and other bed bound considerations (pulmonary, VTE)
