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2021 Care and Management of Adults > Unit 1 > Flashcards

Unit 1 Flashcards

1
Q

characteristics of normal cells

A
  • apoptosis
  • specialized
  • no invasion
  • no evasion
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2
Q

characteristics of cancer cells

A
  • no apoptosis
  • invasion
  • less specialized
  • evasion
  • angiogenesis
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3
Q

neoplasia

A

abnormal cell growth

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4
Q

neoplasm

A
  • cluster of abnormal cells
  • tumor, mass
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5
Q

malignant

A
  • harmful
  • cancerous
  • invasive
  • metastasizing
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6
Q

benign

A
  • no metastasis
  • no invasion
  • noncancerous
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7
Q

oncogenesis

A

tumor formation and development

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8
Q

carcinogenesis

A
  • normal cells → cancer cells
  • often d/t chemical, viral, or radioactive damage to genes
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9
Q

angiogenesis

A

formation of new blood vessels

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10
Q

hyperplasia

A
  • ↑ normal cells in organ or tissue
  • may or may not become cancer
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11
Q

dysplasia

A
  • abnormal, noncancerous cells
  • may or may not become cancer
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12
Q

cancer types

A
  • carcinoma
  • adenocarcinoma
  • sarcoma
  • leukemia
  • lymphoma
  • myeloma
  • melanoma
  • brain and spinal cord
  • germ cell
  • neuroendocrine
  • carcinoid
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13
Q

carcinoma origin

A

epithelial tissue

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14
Q

adenocarcinoma origin

A
  • glandular tissues/organs
  • examples
    • lung
    • prostate
    • pancreatic
    • esophageal
    • endometrial
    • colorectal
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15
Q

types of carcinomas

A
  • adenocarcinomas (glandular origin)
  • basal cell
  • squamous cell
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16
Q

sarcoma origin

A
  • mesenchymal (connective) tissue
    • bone
    • adipose
    • tendons
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17
Q

leukemia origin

A

blood-forming cells

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18
Q

lymphoma origin

A

lymph tissue

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19
Q

myeloma origin

A

plasma cells

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20
Q

melanoma origin

A

skin

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21
Q

plasma cells

A

type of WBC that secretes ↑ antibodies

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22
Q

germ cell tumor origin

A

ovaries, testes

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23
Q

carcinoid tumor origin

A
  • neuroendocrine cells of
    • intestinal tract
    • bile ducts
    • pancreas
    • bronchus
    • ovary
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24
Q

neuroendocrine tumor origin

A

cells of endocrine and nervous systems

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25
Q

cancer risk factors

A
  • age
  • ETOH
  • carcinogen exposure
  • chronic inflammation
  • diet
  • hormones
  • immunosuppression
  • infections
  • obesity
  • radiation
  • sunlight
  • tobacco
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26
Q

diet changes to ↓ CA risk

A
  • ↓ animal fats, nitrites, red meat
  • ↑
    • bran, cruciferous vegetables
    • vitamins A and C
  • limit ETOH: 1-2 drinks/day
  • breastfeed exclusively for ≥ 6 mo
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27
Q

behavior modifications to ↓ CA risk

A
  • no smoking
  • limit
    • sun exposure
    • sexual partners
  • avoid
    • known carcinogens
    • tanning beds
    • sharing needles
    • unprotected sex
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28
Q

at-risk tissues to remove to ↓ CA risk

A
  • moles
  • colon polyps
  • uterine polyps
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29
Q

chemoprevention

A

drugs, chemicals, nutrients to reverse gene damage

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30
Q

ASA + celecoxib ↓ risk for …

A

colon cancer

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31
Q

vitamin D + tamoxifen ↓ risk of …

A

breast cancer

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32
Q

lycopene ↓ risk of …

A

prostate cancer

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33
Q

only vaccine for CA prevention

A

HPV

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34
Q

benefit of CA screening and early detection

A

↓ deaths

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35
Q

Cancer screening changes with _____ and differs among _____.

A
  • with evidence
  • differs among experts
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36
Q

breast CA screening

A
  • clinical breast exam
  • mammogram
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37
Q

colorectal CA screening

A
  • fecal occult blood test
  • colonoscopy
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38
Q

prostate CA screening

A

DRE

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39
Q

cervical cancer screening

A

Pap smear

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40
Q

7 warning signs of cancer (CAUTION)

A
  • change in bowel or bladder habits
  • a sore that doesn’t heal
  • unusual bleeding or discharge
  • thickening or lump in breast or elsewhere
  • indigestion or dysphagia
  • obvious changes in warts or moles
  • nagging cough or hoarseness
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41
Q

PSA

A

prostate specific antigen

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42
Q

imaging for CA Dx and follow-up

A
  • X-ray
  • CT
  • MRI
  • PET
  • PET-CT
  • SPECT
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43
Q

DRE

A
  • digital rectal exam
  • screening for prostate cancer
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44
Q

shave Bx

A
  • for basal or squamous cell skin CAs
  • removes shallow layer of skin
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45
Q

punch Bx

A
  • for deeper skin lesions
  • removes tissue with hollow, round cutting tool
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46
Q

bone marrow Bx/aspiration

A

for leukemias

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47
Q

endoscopic Bx

A

for joints, respiratory system, body cavities, hollow organs

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48
Q

bronchoscopy

A

scope of respiratory system

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49
Q

arthroscopy

A

scope of joints

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50
Q

mediastinoscopy

A

scope into mediastinum

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51
Q

thoracoscopy

A

scope into thoracic cavity

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52
Q

enteroscopy

A

scope of small intestine

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53
Q

sigmoidoscopy

A

scope of sigmoid colon

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54
Q

endoscopy

A

scope of GI tract

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55
Q

needle Bx

A
  • for many soft-tissue tumors and skin
  • types
    • fine needle aspiration
    • core needle aspiration: takes larger sample, some tissue
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56
Q

open Bx

A
  • surgical Bx
  • types
    • incisional removes part
    • excisional removes all
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57
Q

sentinel lymph node Bx

A
  • removal of nodes near tumor to look for metastasis
  • dye used to map lymph nodes fed by tumor
  • sentinel node studied
    • negative → others assumed negative
    • positive → dissection
  • video
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58
Q

sentinel lymph node

A

first node fed by tumor

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59
Q

lymph node dissection

A

suspect lymph nodes removed, and sample viewed under microscope

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60
Q

RN responsibilities before Bx

A
  • answer questions
  • ensure signed consent
  • NPO
  • baseline VS
  • labs as ordered
    • PT
    • Plt
    • renal fxn
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61
Q

RN duties during Bx

A
  • instruct pt on positioning
  • talk pt through process
  • meds as ordered for
    • moderate sedation
    • pain
    • anxiety
  • monitor VS
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62
Q

RN responsibilities after Bx

A
  • post-op recovery
  • monitor
    • for bleeding
    • wound closure/dressing
  • teach
    • wound care
    • activity restrictions
  • when, why to follow up
  • urgent, emergent S/Sx
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63
Q

cancer grading

A

GX-G4

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64
Q

GX

A

grade cannot be determined

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65
Q

G1

A
  • cells well-differentiated
  • malignant, but slow-growing
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66
Q

G2

A
  • intermediate
  • moderately differentiated
  • more malignant characteristics
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67
Q

G3

A
  • high
  • poorly differentiated
  • few normal cell characteristics
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68
Q

G4

A
  • high
  • poorly differentiated
  • determining origin is difficult or impossible
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69
Q

high-grade tumors labels

A

G3-G4

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70
Q

intermediate tumor label

A

G2

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71
Q

low-grade tumor label

A

G1

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72
Q

cancer stage

A
  • extent of growth and spread
  • tumor size
  • spread to lymph nodes, other tissues
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73
Q

purpose of cancer staging

A
  • understanding severity and chance of survival
  • Tx planning
  • ID of appropriate clinical trials
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74
Q

Cancer is referred to by stage at _____, regardless of later _____ or _____.

A
  • stage at diagnosis
  • regardless of metastasis or growth
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75
Q

TNM

A
  • commonly used cancer staging system
  • stands for
    • tumor size and extent
    • nearby lymph node involvement
    • metastasis
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76
Q

TNM staging system components

A
  • TX-T4
  • NX-N3
  • MX-M1
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77
Q

TX-T4 interpretation

A
  • TX: cannot be measured
  • T0: cannot be found
  • T1-T4: size/extent of tumor ↑ with number
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78
Q

TNM lymph node interpretation

A
  • NX: cannot be measured
  • N0: no CA in nearby lymph nodes
  • N1-N3: number/site of lymph nodes w/ CA
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79
Q

TNM system metastasis interpretation

A
  • MX: cannot be measured
  • M0: none
  • M1: metastasis present
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80
Q

0-IV CA staging

A
  • Stage 0
    • abnormal cells, no spread
    • AKA carcinoma in situ (CIS)
    • could become cancer
  • Stages I-III
    • CA present
    • ↑ number = bigger tumor, more invasion
  • Stage IV: cancer has spread
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81
Q

other cancer staging

A
  • in situ: abnormal cells, no CA or spread
  • localized: no spread
  • regional: spread to nearby structures
  • distant: spread to distant structures
  • unknown: not enough info to stage
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82
Q

cachexia

A

dramatic wt loss, muscle wasting

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83
Q

general S/Sx in cancer pts

A
  • anorexia
  • cachexia
  • fatigue
  • lethargy
  • weakness
  • pain
  • massess
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84
Q

S/Sx with metastasis

A
  • discomfort elsewhere
  • lymphadenopathy
  • distant masses
  • abd swelling
  • bone pain or Fx
  • confusion or personality change
  • incontinence
  • vision changes
  • loss of balance
  • HA
  • Sz
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85
Q

cancer Tx options

A
  • chemo
  • radiation
  • surgery
  • stem cell/bone marrow transplant
  • biological therapy
  • photodynamic therapy
  • complementary alternative medicine (CAM)
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86
Q

chemo therapy indication

A

CA spread beyond localized area

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87
Q

chemotherapy selectivity

A

has some, but damages healthy cells, too

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88
Q

chemo MOA

A

damages DNA, stopping or slowing fast-growing cells

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89
Q

Chemo is most successful as part of _____ therapy.

A

combination

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90
Q

Most chemo agents are _____ and _____.

A
  • cytotoxic
  • teratogenic
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91
Q

AE of chemo: anemia

A
  • lab values
    • RBC < 3.8 million/μL
    • Hgb < 11.5 g/dL
    • Hct < 34%
  • S/Sx
    • extreme fatigue
    • pallor
    • dizziness
    • SOB
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92
Q

pt education for anemia

A
  • schedule rest periods
  • energy-saving measures
  • possible Tx
    • O2 therapy
    • erythropoietic meds
    • antianemic meds
    • transfusion (pRBCs)
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93
Q

AE of chemo: immunosuppression/neutropenia

A
  • normal ANC: 1500-8000/μL
  • normal WBC: 3,000-12,000/μL
  • main concern: infection
  • may not have fever; even slight fever is big problem
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94
Q

AE of chemo: thrombocytopenia

A
  • normal Plt: 150,000-450,000/μL
  • main concerns
    • bleeding
    • hemorrhagic cystitis
  • interventions
    • fall precautions
    • bleeding precautions
    • Plt transfusion
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95
Q

bleeding precautions

A
  • electric shaver
  • no ASA
  • needles
    • small guage
    • ↓ sticks
  • protect from injury
  • soft toothbrush
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96
Q

pancytopenia

A

low RBCs, WBCs, and Plt

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97
Q

nadir

A
  • lowest point
  • in chemo
    • onset: 7-12 days after Tx
    • HIGHEST RISK OF INFECTION
    • duration: 5-7 days
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98
Q

alopecia

A
  • hair thinning or loss
  • in chemo
    • onset: 7-10 days after first Tx
    • regrowth ~ 1 mo after last Tx
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99
Q

AE of chemo: mucositis

A
  • inflammation of mucous membranes from mouth to stomach
  • includes stomatitis (mouth)
  • interventions
    • mouthwashes
      • anesthetic, antifungal, coating
      • saline rinse
    • lubricants for xerostomia
    • soft toothbrush
    • rinse AC and PC
    • soft, bland foods
  • avoid
    • ETOH
    • tobacco
    • glycerin
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100
Q

CINV

A

chemo-induced nausea and vomiting

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101
Q

AE of chemo: CINV and anorexia

A
  • meds
    • ondansetron: serotonin blocker
    • in combo with
      • corticosteroids
      • phenothiazines (compazine, phenergan)
      • diphenhydramine
  • interventions
    • mouth care to ↑ appetite
    • small meals
    • cold foods
    • uncover meal away from pt
    • assess for dehydration
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102
Q

AE of chemo: peripheral neuropathy

A
  • early S/Sx: symmetrical, distal to proximal
    • burning
    • tingling/pins-and-needles
    • numbness
    • redness
    • sensitivity to extreme temps
    • difficulty w/ fine motor skills
  • later S/Sx
    • loss of taste
    • orthostatic hypotension
    • constipation
  • can → sensory or motor dysfunction
  • cause: nerve damage
  • pt education: protect skin, avoid falls/injuries
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103
Q

chemo nursing interventions

A
  • meds for pain, CINV, infection, etc.
  • monitor for SE
  • intervene PRN
  • regular med reconciliation
  • address psychosocial needs
  • pt and family education
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104
Q

teletherapy

A

external radiation therapy

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105
Q

brachytherapy

A
  • internal radiation therapy
  • radiation source in direct contact with tumor
  • placed in vagina, prostate, abdomen, etc.
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106
Q

teletherapy regimen

A
  • daily doses for set period
  • skin marked for guidance
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107
Q

AE of teletherapy

A
  • extreme fatigue
  • dysgeusia
  • injury to skin, mucous membranes
  • hair loss
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108
Q

interventions for extreme fatigue

A
  • schedule rest
  • gentle exercise
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109
Q

interventions/pt education for dysgeusia

A
  • avoid red meat, other distasteful foods
  • gum, mints
  • try new flavors
  • plastic utensils
  • drink w/ meals
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110
Q

dysgeusia

A

altered taste

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111
Q

interventions for injury to skin

A
  • wash w/ mild soap and water and pat dry
  • wear soft clothing
  • avoid sun, heat
  • only use prescribed creams/ointments
  • no powders
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112
Q

interventions for radiation injury to mucous membranes

A
  • mucositis/stomatitis
    • prescribed mouthwashes
    • avoid ETOH, tobacco
    • bland, soft, smooth foods
    • small bites/meals
    • high-calorie and -protein
  • gastroenteritis
    • meds
      • abx
      • antidiarrheals
      • steroids
      • opioids
    • bland, lactose-free, low-fat diet
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113
Q

pt education for brachytherapy

A

body wastes are radioactive until isotope is eliminated

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114
Q

nursing considerations for brachytherapy

A
  • private room
  • door sign
  • visitors
    • ≤ 30 min
    • ≥ 6 ft from pt
    • restrict: PG or < 18 yo
  • wear lead apron
  • face pt
  • have lead container, tongs for devices that could fall out
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115
Q

types of surgeries for CA

A
  • prophylactic
  • diagnostic
  • curative
  • cytoreductive (debulking)
  • palliative
  • second-look
  • reconstructive/rehabilitative
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116
Q

purpose of stem cell/bone marrow transplant

A

to replace bone marrow destroyed by CA or chemo/radiation

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117
Q

allogeneic stem cell/bone marrow transplant considerations

A
  • at risk for GvHD
  • rejection can occur anywhere in the body
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118
Q

nursing care for stem cell/bone marrow transplant

A
  • anti-rejection meds
  • protection from infection
  • monitor for SE/complications
    • GvHD
    • graft failure
    • infection
    • hepatic veno-occlusive dz (VOD)
    • interstitial pneumonitis
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119
Q

GvHD

A

graft-versus-host dz

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120
Q

VOD

A
  • hepatic veno-occlusive dz
  • possible complication of stem cell/bone marrow transplant
  • AKA sinusoidal obstruction syndrome (SOS)
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121
Q

biological therapy

A
  • modify pt’s biological response to tumor cells
  • types
    • antitumor
    • improved immune fxn
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122
Q

biological therapy: interleukins

A
  • seek and destroy
  • SE
    • chills
    • fever
    • fatigue
    • confusion
    • NVD
    • ↓ BP
    • rare
      • arrhythmias
      • CP
  • ↑ dose must be given in hospital
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123
Q

biological therapy: interferons

A
  • slow cell division, boost immune attack on CA cells
  • SE
    • chills
    • fever
    • fatigue
    • HA
    • ↓ appetite
    • N/V
    • ↓ WBC
    • skin rash
    • thinning hair
    • rare: PNS/CNS damage
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124
Q

mAbs

A

monoclonal antibodies

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125
Q

biological therapy: mAbs

A
  • lab-produced antibodies
  • mimic immune system
  • SE
    • fever
    • chills
    • weakness
    • HA
    • NVD
    • ↓ BP
    • rashes
    • allergic rxn
  • ↑ dose must be given in hospital
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126
Q

biological therapy: molecularly targeted therapy

A
  • targets molecules involved in growth and spread of CA
  • SE
    • rash
    • dry skin
    • nail changes
    • hair depigmentation
    • impaired
      • clotting
      • wound healing
    • ↑ BP
    • rare: GI perforation
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127
Q

nursing care for biological therapies

A
  • ↑ dose should be in ICU
  • monitor for SE, allergic rxn
  • promote comfort
  • identify neuro and psychosocial manifestations early
  • no topical steroids
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128
Q

skin care for pts on biological therapy

A
  • unscented moisturizers (if allowed)
  • mild soap
  • sun protection
  • no
    • swimming
    • topical steroids
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129
Q

hormonal manipulation (androgens/antiestrogens) SE

A
  • chest/facial hair growth
  • menstruation stops
  • breasts shrink
  • fluid retenion
  • acne
  • hypercalcemia
  • liver dysfunction
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130
Q

hormonal manipulation (estrogen/progestin) SE

A
  • men
    • thinning facial hair
    • smoother facial skin
    • body fat moves
    • gynecomastia
    • testicular/penile atrophy
    • bone loss
  • women
    • irregular menstruation
    • fluid retention
    • breast tenderness
  • both
    • bone loss
    • ↑ risk for clotting
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131
Q

photodynamic therapy

A
  • photosensitizing agent + special light = cell death
  • photosensitizers and wavelengths specific to body area
  • process
    • photosensitizer injected
    • tumor exposed to light 24-72 hr after injection
    • photosensitizer absorbs light → chemical rxn
    • rxn destroys CA cells
  • usually outpatient
  • can be repeated or used in combo
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132
Q

complementary and alternative medicine for CA

A
  • alternative medical systems
    • ayurveda
    • homeopathy
    • traditional Chinese medicine
  • biological
    • diet
    • herbs
    • vitamins
  • manipulative
    • massage
    • osteopathic
    • chiropractic
  • mind-body
    • yoga
    • imagery
    • meditation
    • spirituality
  • energy
    • reiki
    • biolfields
    • magnets
    • qigong
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133
Q

CAM

A

complementary and alternative medicine

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134
Q

oncologic complications/emergencies

A
  • sepsis
  • DIC
  • SIADH
  • spinal cord compression
  • hypercalcemia
  • sueprior vena cava syndrome
  • tumor lysis syndrome
  • cardiac tamponade
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135
Q

DIC

A

disseminated intravascular coagulation

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136
Q

SIADH

A

syndrome of inappropriate antidiuretic hormone

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137
Q

SIRS

A

systemic inflammatory response syndrome

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138
Q

sepsis starts with …

A

SIRS

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139
Q

systemic inflammatory response syndrome

A
  • must have ≥ 2 of the following
    • T > 38C or < 36C
    • HR > 90
    • RR > 20
    • acute AMS
    • WBC > 12,000 or < 4,000
    • hyperglycemia in absence of DM
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140
Q

sepsis Dx

A

2+ SIRS criteria + presence or suspicion of infection

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141
Q

septic shock Dx

A

sepsis + hypotension not reversed w/ ↑ volume

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142
Q

common DIC cause

A

gram-negative sepsis in pts w/ CA

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143
Q

consequences of DIC

A
  • bleeding
  • organ failure via microvascular thrombosis
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144
Q

syndrome of inappropriate antidiuretic hormone

A
  • abnormal production of ADH
  • diluted serum Na+
    • usually ≤ 115-120 mEq/L
    • ↓ UOP
    • weakness
    • muscle cramps
    • ↓ appetite
    • fatigue
    • wt gain (fluid retention)
    • → pulmonary edema and HF
  • Tx: hypertonic saline
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145
Q

spinal cord compression

A
  • S/Sx
    • pain
    • weakness
    • loss of sensation
    • tingling
    • incontinence
    • constipation
    • foot drop
    • unsteady gait
  • Tx/interventions
    • ↑ dose corticosteroids (↓ swelling)
    • back brace
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146
Q

hypercalcemia

A
  • serum Ca > 10.5 mg/dL (critical: > 14 mg/dL)
  • S/Sx
    • excessive thirst
    • frequent urination
    • stomach upset, N/V, constipation
    • bone and muscle pain
    • weakness
    • confusion
    • lethargy, fatigue
    • depression
    • rare
      • palpitations
      • fainting
      • arrhythmia
  • Tx: fluid intake, bisphosphonates, furosemide, calcitonin, pamidronate
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147
Q

superior vena cava syndrome

A
  • compression/obstruction of SVC → ↑ pressure → edema
  • S/Sx
    • facial, upper estremity edema
    • SOB
    • HA
    • CP
    • facial plethora
    • NVD
    • chest vein distension
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148
Q

facial plethora

A

facial fullness

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149
Q

tumor lysis syndrome

A
  • S/Sx
    • hyperkalemia
    • hyperuricemia
    • hyperphosphatemia
    • hypocalcemia
    • → heart, kidney damage
  • prevention: hydration, 3-4 L/day as tolerated
  • Tx
    • kayexolate
    • allopurinol, rasburicase
    • calcium carbonate
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150
Q

cardiac tamponade

A
  • buildup of blood or other fluid in pericardial sac
  • S/Sx
    • → cardiogenic shock
    • dyspnea
    • tachycardia
    • tachypnea
    • pallor
    • cold extremities
    • hypotension
    • NVD
    • possible: pericardial friction rub, muffled heart sounds
  • Tx: pericardiocentesis
  • Dx: echo, CBC, ECG, CXR, CT, ABGs,
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151
Q

Professional nursing practice is the practice of _____ and delivery of _____ to meet the needs of _____.

—Academy of Medical-Surgical Nurses

A
  • practice of nursing
  • delivery of care
  • meet the needs of society
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152
Q

Professional nursing practice implies more than a _____ level of _____ in the professional role.

—Academy of Medical-Surgical Nurses

A

more than a competent level of performance

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153
Q

Many [7] activities are included in professional nursing practice relative to the _____ of _____, including ….

—Academy of Medical-Surgical Nurses

A
  • quality of care
    • performance appraisal
    • collegiality w/ others in the profession
    • ethics
    • research and EBP
    • collaboration
    • education
    • resource management
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154
Q

professional responsibility

A

obligation nurses have to every pt

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155
Q

Professional responsibility requires nurses to be knowledgeable in what 10 areas?

A
  • advance directives
  • advocacy
  • confidentiality
  • disruptive behavior
  • ethical practice
  • information security
  • information technology
  • informed consent
  • legal practice
  • pt rights
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156
Q

nursing role in pt rights

A
  • ensure pt understands his or her rights
  • protect those rights during nursing care
  • advocate for pt
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157
Q

5 pt rights

A
  • be informed about ALL aspects of care
  • take active role in decision-making
  • accept, refuse, or request modification to plan of care
  • receive competent care
  • be treated with respect
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158
Q

nursing role in advocacy

A
  • ensure
    • pts know rights
    • pts have adequate info
    • orders are appropriate for care
  • assist with decision-making
  • mediate when others’ actions aren’t in pt’s best interest
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159
Q

When assisting w/ pts’ decision-making, a nursing should not _____ or _____.

A

control or direct

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160
Q

situations for advocacy

A
  • end-of-life decisions (advance directives)
  • access to health care
  • protection of privacy
  • informed consent
  • substandard practice
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161
Q

nursing role in informed consent

A
  • ensure
    • provider gave adquate info
    • provider answers/clarifies all questions
    • pt understanding
    • signed consent form present before pt is taken for procedure
  • witness pt signature
    • provider is to have pt sign consent form
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162
Q

legal practice principles/aspects

A
  • providing safe and competent care
  • advocating for pt rights
  • providing care in your scope of practice
  • discerning responsibilities of nursing in relation to those of other staff members
  • providing care consistent w/ current standards
  • shielding yourself from liability
  • KNOW YOUR NURSE PRACTICE ACT
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163
Q

mandated reporting

A
  • impaired coworkers
  • abuse
  • communicable dz
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164
Q

disruptive behavior

A
  • incivility
  • lateral violence
  • bullying
  • cyberbullying
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165
Q

principles of ethical practice

A
  • autonomy
  • beneficence
  • fidelity
  • justice
  • nonmaleficence
  • veracity
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166
Q

autonomy

A

ability of pt to make their own decision

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167
Q

beneficence

A

care in best interest of pt

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168
Q

fidelity

A

doing what you say you will

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169
Q

justice

A

fair treatment

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170
Q

nonmaleficence

A

obligation to cause no harm

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171
Q

veracity

A

duty to tell the truth

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172
Q

accountability

A

having an obligation to pts and being responsible for your actions

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173
Q

By going to work and accepting a patient assignment, you accept _____ for the pts.

A

responsibility

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174
Q

delegation

A
  • transferring authority and responsibility to another team member to complete a task
  • you retain accountability for completion, outcome, and timeliness
  • requires supervision
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175
Q

assigning

A

transferring authority, accountability, and responsibility of pt care to another staff member

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176
Q

responsibilities of delegation

A
  • clear directions
  • reassessment
  • evaluation of outcome
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177
Q

Who can RNs delegate to?

A
  • other RNs
  • LPNs
  • UAPs
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178
Q

Who can LPNs delegate to?

A
  • other LPNs
  • UAPs
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179
Q

Delegation allows for the most _____ use of everyone’s time and _____.

A
  • most efficient
  • time and skills
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180
Q

6 considerations when delegating

A
  • predictability of outcome
  • potential benefit vs. harm to pt
  • complexity of care required
  • extent of problem-solving involved
  • appropriateness of task for delegatee
  • extent of interaction
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181
Q

components of delegation

A
  • delegator
  • delegatee
  • acceptance of delegated task
    • ability
    • willingness
  • supervision, follow-up, and reassessment/evaluation
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182
Q

5 rights of delegation

A
  • right task
  • right circumstance
  • right person
  • right direction and communication
  • right supervision and evaluation
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183
Q

right task

A
  • should require little supervision
  • should be relatively noninvasive
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184
Q

right circumstance

A
  • complexity of care should match delegatee’s skill set
  • consider delegatee’s workload
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185
Q

right person

A
  • delegatee should be competent to complete task
  • task should be in delegatee’s scope of practice
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186
Q

right direction and communication

A
  • what data to collect
  • how to report it
  • specific task to be performed
  • expected results, timelines, and expectations for follow-up reporting
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187
Q

right supervision and evaluation of care

A
  • delegator must supervise (directly or not)
  • monitor performance
  • provide feedback
  • intervene if necessary
  • evaluate pt and determine if goals are met
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188
Q

obstacles to delegation

A
  • personal qualities and experience
  • resources
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189
Q

personal qualities and experience that can become obstacles to delegation

A
  • poor communication
  • poor interpersonal skills
  • poor time management
  • lack of trust and confidence
  • insecurity
  • inexperience in delegation
  • inadequate organizational skills
  • belief that others are incapable
  • belief that you are indispensable
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190
Q

How can resources create obstacles to delegation?

A
  • no one to delegate to
  • span of control
  • finances
  • educational resources
  • time
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191
Q

overdelegating

A
  • burdens delegatees: don’t overdelegate just because an employee is exceptional
  • can be a result of someone’s insecurity to complete a task
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192
Q

delegation errors

A
  • overdelegating
  • underdelegating
  • reverse delegation
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193
Q

underdelegating

A
  • can be result of insecurity by manager
  • control freak/micromanager
  • lack of experience in delegation
  • difficulty assuming manager role
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194
Q

reverse delegation

A
  • common form of ineffective delegation
  • occurs when someone w/ lower rank delegates to one w/ more authority
  • often happens w/ individuals who are new to job
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195
Q

What causes resistance to delegation?

A
  • delegatee is overwhelmed: tasks from multiple sources
  • delegatee believes self to be incapable of task
  • inherent resistance to authority
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196
Q

what cannot be delegated

A
  • nursing process
  • pt education
  • tasks that require nursing judgment
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197
Q

what can be delegated

A

tasks appropriate to skill and education of delegate

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198
Q

tasks to delegate to LPN

A
  • reinforcement of teaching
  • trach care
  • suctioning
  • NGT patency check
  • administration of meds, enteral feeds
  • insertion of foley
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199
Q

tasks that can be delegated to UAP

A
  • ADLs
  • baths
  • toileting
  • ambulation
  • PO feeding
  • positioning
  • specimen collection
  • I&O
  • VS
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200
Q

nursing process

A
  • way of thinking about, strategizing about, and implementing solutions to improve pt status/outcomes
  • parallels scientific process
  • contains 5 steps
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201
Q

5 steps of nursing process

A
  • assessment
  • diagnosis
  • planning
  • implementation
  • evaluation
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202
Q

purpose of the nursing process

A

framework to apply knowledge, skills, judgment, and experience to formulate a nursing plan of care

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203
Q

ADPIE

A

acronym for steps of nursing process

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204
Q

assessment

A

collecting data, subjective and objective

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205
Q

diagnosis

A
  • clustering data
  • discriminating relevant from irrelevant data
  • identifying pt needs/problems
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206
Q

planning

A
  • setting priorities
  • establishing goals (SMART)
  • identifying desired outcomes
  • determining interventions to meet goals
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207
Q

implementation

A

performing interventions identified in planning stage

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208
Q

evaluation

A
  • determining if goals and outcomes
    • were met with planned interventions
    • are feasible
    • need more time
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209
Q

parts of assessment/data collection

A
  • thorough physical assessment
  • pt Hx
  • labs/imaging
  • pt reports
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210
Q

purpose of nursing plan of care

A
  • guides nursing care
  • documents pt care
    • accountability
    • quality assurance
    • liability
  • substantiates care provided for
    • payers
    • legal entities
    • accreditors
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211
Q

SMART

A
  • acronym for guidelines setting goals in care planning
    • specific
    • measurable
    • attainable
    • relevant
    • timed
  • “The patient will do something specific in a measurable way that is attainable and relevant by specific timeframe.”
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212
Q

aspects of planning in the nursing process

A
  • separating actual from potential problems
  • prioritizing problems/needs
  • identifying goals
  • identifying nursing, provider, and other interventions to help meet goals
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213
Q

types of care planning

A
  • comprehensive
  • ongoing
  • discharge
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214
Q

comprehensive planning

A

based on full head-to-toe assessment and pt interview (usually admission data)

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215
Q

ongoing planning

A
  • new info w/ each shift or as available
  • update, modify, and individualize care plan
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216
Q

discharge planning

A
  • learning and anticipating pt’s and family’s needs after discharge
  • should begin during admission
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217
Q

prioritizing

A

separating actual from potential problems/needs

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218
Q

Maslow’s hierarchy of needs

A
  1. physiological
  2. safety and security
  3. love and belonging
  4. self-esteem
  5. self-actualization
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219
Q

ABC framework

A
  • airway
  • breathing
  • circulation
  • disability
  • exposure
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220
Q

airway priority

A
  • necessary for breathing
  • look for blockage/obstruction
  • listen for stridor/wheezing
  • consider exposure (smoke inhalation)
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221
Q

breathing priority

A
  • necessary for oxygenation of blood
  • auscultate breath sounds for crackles, wheezing, rhonchi
  • check SpO2
  • common problems: COPD, asthma, pulmonary edema
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222
Q

circulation priority

A
  • monitor BP
  • consider volume, pressure changes
    • IVF
    • vasopressors
    • diuretics
    • dialysis
    • trauma
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223
Q

physiological needs beyond ABC

A
  • order depends on number and severity, but generally:
  1. food/fluid
  2. neurosensory
  3. elimination
  4. rest/activity
  5. pain/discomfort
  6. hygiene
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224
Q

goal time frames and their purposes

A
  • short-term: end of clinical day; baby steps toward long-term goal
  • long-term: by discharge; aimed at functionality outside hospital
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225
Q

nursing interventions

A
  • nurse-initiated/independent
  • don’t need provider order
  • e.g. turn Q2H
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226
Q

provider interventions

A
  • dependent interventions
  • by order or facility protocol
  • e.g. meds, blood products, treatments, etc.
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227
Q

collaborative interventions

A
  • done in collaboration w/ other health professionals
  • e.g. wound care, PT, OT, speech therapy, etc.
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228
Q

teaching interventions

A

instruction or education of pt and family

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229
Q

Interventions should be _____, include _____ to meet the goals, and be done on a _____.

A
  • be specific
  • include actions
  • on a schedule
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230
Q

using priorities during a shift

A
  • develop a plan
  • complete highest priority tasks first
  • finish one task before beginning another
  • reprioritize throughout shift based on new info
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231
Q

prioritization principles

_____ before local

actual before _____

consider pt/family _____

recognize and respond to _____

differentiate _____ from expected

know procedural _____

A
  • systemic
  • potential
  • priorities
  • trends
  • emergent
  • standards
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232
Q

other frameworks

A
  • risk reduction
    • assess safety risks
    • eliminate greatest risks first
  • survival potential
    • mass casualty, disaster triage
    • priority: pts w/ reasonable chance for survival with prompt intervention
  • least restrictive
    • implement least restrictive/invasive interventions first
    • move to more restrictive/invasive PRN
  • acute vs. chronic
  • urgent vs. nonurgent
  • stable vs. unstable
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233
Q

Evaluate priorities _____, remain _____, and don’t fall into _____ to the “squeaky wheel.”

A
  • evaluate constantly
  • remain flexible
  • responding to the “squeaky wheel”
234
Q

antigen

A

toxin or other foreign substance that induces an immune response, esp. production of antibodies

235
Q

antibody

A

blood protein produced in response to and counteracting a specific antigen

236
Q

autoimmunity

A

process whereby a person develops an inappropriate immune response to healthy, normal tissues

237
Q

ANA test

A

identifies if antinuclear antibodies are present in blood, which could indicate autoimmune d/o

238
Q

ANA

A

antinuclear antibodies

239
Q

In addition to protection, immunity plays a role in _____ of _____ tissues.

A

repair of damaged tissues

240
Q

immunity

A
  • protection from illness or dz
  • maintained by body’s physiologic defense mechanisms
241
Q

leukocytes

A
  • WBCs
  • stimulate inflammatory response and protect against various infections and foreign antigens
242
Q

types of leukocytes

A
  • neutrophils
  • lymphocytes
  • monocytes
  • eosinophils
  • basophils
243
Q

differential

A

percentages of types of total circulating WBCs

244
Q

WBC expected reference range

A

5,000-10,000/mm3

245
Q

leukopenia

A
  • total WBC < 4,000/mm3
  • causes
    • drug toxicity
    • autoimmune dz
    • bone marrow failure
    • overwhelming infection
246
Q

leukocytosis

A
  • total WBC > 10,000/mm3
  • causes
    • inflammation
    • infection
    • some malignancies
    • trauma
    • dehydration
    • stress
    • steroids
    • thyroid storm
247
Q

Someone may have persistently high _____ count after splenectomy.

A

WBC count

248
Q

neutropenia

A
  • ANC < 2,000/mm3
    • < 1,000/mm3 = neutropenic precautions are essential
  • ↑ risk of infection
  • causes
    • viral infections
    • overwhelming bacterial infections
    • radiation and chemotherapy
249
Q

ANC

A

absolute neutrophil count

250
Q

neutropenic precautions

A
  • no visitors
  • no live plants
  • no fresh fruits and veggies
  • avoid contamination from pt’s own bacterial flora
    • no rectal temp
    • no IM injections
251
Q

left shift

A
  • increase in immature neutrophils (bands or stabs) that occure in acute infection
  • immature cells incapable of phagocytosis
252
Q

viral infections that commonly lead to neutropenia

A
  • Epstein-Barr
  • CMV
  • hep A and B
  • parvovirus
  • flu
  • measles
253
Q

segmented neutrophils

A

mature neutrophils

254
Q

banded neutrophils

A

immature neutrophils

255
Q

immunocompetence

A
  • ability of the body’s immune system to respond to pathogenic organisms and tissue damage
  • inflammation response + cell-mediated + antibody-mediated processes
256
Q

body structures involved in immunity

A
  • mucous membranes
  • tonsils
  • lymph system: vessels, nodes, spleen
  • thymus
  • skin
  • bone marrow
257
Q

All parts of the immune system involve _____.

A

WBCs

258
Q

self vs. non-self

A

immune system uses proteins on cell surface (human leukocyte antigens) to determine whether a cell is foreign or not

259
Q

human leukocyte antigens

A

protein sequence on cell surface determined by DNA and unique to each person

260
Q

bone marrow purpose

A

site for formation of all blood cells and majority of immune cells

261
Q

pluripotent

A
  • having multiple functions
  • as in stem cell, giving rise to multiple types of cells
262
Q

innate/natural immunity

A
  • barrier: skin, mucous membranes
  • inflammation
263
Q

adaptive immunity

A
  • antibody-mediated immunity
  • cell-mediated immunity
264
Q

inflammatory response

A
  • immediate, but short-term immune response
  • no lasting immunity to repeat exposure
265
Q

risk factors for changes in immunity

A
  • genetic risk for ↑ or ↓ immunity
  • OA
  • low socioeconomic status
  • nonimmunized
  • chronic illnesses that weaknes immunity
  • chronic drug therapy
  • substance abuse d/o
266
Q

SCID

A
  • severe combined immunodeficiency
  • congenital
  • missing important WBCs
267
Q

meds that can weaken immunity

A
  • steroids
  • chemo
  • other CA drugs
  • anti-rejection meds
268
Q

environmental factors that can weaken immune system

A
  • ETOH
  • smoking
  • poor nutrition
269
Q

viruses that can weaken the immune system

A
  • HIV
  • flu
  • mono
  • measles
270
Q

The immune system is healthiest in what age groups?

A

20s and 30s

271
Q

consequences of and pt education for decreased immune response

A
  • sucsceptible to multiple types of infections
  • avoid large crowds; wash hands
272
Q

consequences of excessive immune response

A
  • allergies: hypersensitivity rxn
  • autoimmune rxn or dz: remission vs. cure
273
Q

conditions caused by overactive immune system

A
  • asthma
  • eczema
  • allergic rhinitis
274
Q

eczema

A

allergen → atopic dermatitis

275
Q

asthma

A

immune rxn in lungs → wheezing, coughing, trouble breathing

276
Q

asthma triggers

A
  • allergens: mold, pollen
  • irritants: smoke
277
Q

allergic rhinitis

A
  • indoor or outdoor allergens evoke immune response in upper airway
  • sneezing, runny nose, sniffling, swelling of nasal passages
278
Q

inflammation

A
  • immediate, short-term immune response
  • does not result in future immunity to same organism/injury
  • response varies by injury
  • cardinal signs: edema, erythema, warmth, pain, ↓ fxn
279
Q

major cells involved in inflammatory response

A
  • Plt
  • mast cells
  • neutrophils
  • macrophages
  • monocytes
  • basophils
  • eosinophils
280
Q

Plt fxn in inflammatory response

A
  • initial response to stop bleeding
  • release messengers to attract other immune system cells
281
Q

mast cell fxn in inflammatory response

A
  • hang out near possible pathogen entry points
  • immediately open and release contents on contact w/ pathogens
  • bring other cells to site of entry
282
Q

neutrophil fxn in inflammatory response

A
  • short lifespan, high number
  • kill pathogens via phagocytosis
283
Q

macrophage fxn in inflammatory response

A
  • phagocytosis
  • secretion of cytokines to recruit specific immunity cells to site
284
Q

monocyte fxn in inflammatory response

A
  • monocyte = immature macrophage
  • migrate from bone marrow to site of pathogen when signaled
285
Q

basophil fxn in inflammatory response

A
  • release histamine
  • cause manifestations of inflammation
286
Q

eosinophil fxn in inflammatory response

A
  • release amines during allergic rxn
  • some phagocytic properties
  • major role in destruction of parasites
287
Q

stages of acute inflammation

A
  • Stage I: vascular
  • Stage II: cellular exudate
  • Stage III: tissue repair/replacement
288
Q

vascular stage of acute inflammation

A
  • histamine and kinin release
    • → constriction of veins, dilation of arterioles
    • purpose: ↑ blood flow to area
  • capillaries become leaky
    • → inflammatory cells, mediators to injury site
    • → edema
  • macrophages start phagocytosis and send cytokines
    • → more WBCs and neutrophils come to site
289
Q

cellular exudate stage of acute inflammation

A
  • neutrophils arrive
  • exudate (purulent drainage) forms from debris
  • most protection from phagocytosis
  • more monocytes produced, send signals to continue response
  • production of neutrophils continues
290
Q

tissue repair/replacement stage of acute inflammation

A
  • body begins to fill in gaps in injured tissue
  • may →
    • scar tissue
    • ↓ fxn of tissue
291
Q

chronic inflammation

A
  • self-perpetuating
  • duration: wks, mos, yrs
  • often
    • asymptomatic
    • switches away from neutrophil involvement
  • can → DNA damage, certain types of CA
  • common causes: irritants
    • foreign bodies: viruses (e.g. HPV), fungi
    • obesity: production of a cytokine used in inflammation
292
Q

Chronic inflammatory dz are the most significant cause of _____ in the world.

A

death

293
Q

3 diseases that can be caused by chronic inflammation

A
  • heart dz
  • DM
  • CA
294
Q

humoral immunity

A

antibody-mediated immunity

295
Q

antibody-mediated immunity

A
  • process: B cells
    • are sensitized/imprinted by contact w/ specific antigen
    • produce antibodies
    • divide and make memory B cells for future immunity
296
Q

Total population of lymphocytes in immunocompetent person can be in the _____.

A

millions

297
Q

B and T cells

A

lymphocytes

298
Q

B cells

A
  • lymphocytes that begin as stem cells in bone marrow
  • enter blood circulation and mature in
    • spleen
    • lymph nodes
    • tonsils
    • mucosa of GI tract
299
Q

B cells attack invaders _____ cells.

A

outside cells

300
Q

T cells attack _____ cells.

A

infected cells

301
Q

process of specific immunity development

A
  • (B cells)
  • exposure
  • antigen recognition
  • sensitization
  • antibody production/release
  • antibody-antigen binding
  • inactivation of organism w/ antigen
  • sustained immunity
302
Q

steps in inactivation of organism w/ antigen by B cells

A
  • allutination
  • lysis
  • complement activation and fixation
  • precipitation
  • inactivation
303
Q

antibody types

A
  • IgG
  • IgA
  • IgM
  • IgE
  • IgD
304
Q

immunoglobulin

A

antibody

305
Q

Ab

A

antibody

306
Q

IgG

A

most abundant and involved Ab

307
Q

IgA

A

found in blood, body secretions

308
Q

IgM

A
  • largest
  • first Ab produced during primary response
309
Q

IgE

A
  • mediator in allergic responses
  • defends against parasites
310
Q

IgD

A
  • low serum concentration
  • found mostly on surface of developing B cells
311
Q

cell-mediated immunity

A
  • major cells
    • T lymphocytes
    • natural killer (NK) cells
    • dendritic cells
  • hang out in secondary lymph organs and wait for exposure to antigens
312
Q

classes of T cells

A
  • helper (Th, T4)
  • suppressor (Ts, T8)
  • cytotoxic (Tc)
313
Q

Th cell fxn

A

activate macrophages, Tc cells, and B cells

314
Q

Ts/T8 cell fxn

A

control immune response to protect host

315
Q

Tc cell fxn

A

kill cells with antigen they’ve been exposed to

316
Q

T cell origin

A

thymus

317
Q

NK

A

natural killer (cells)

318
Q

natural killer cell fxn

A

direct cytotoxic effects on some non-self cells without prior sensitization

319
Q

DCs

A

dendritic cells

320
Q

dendritic cell fxn

A

process antigen material and present it on cell surface to T cells of immune system

321
Q

cytokines

A
  • small hormones produced by WBCs
    • WBCs → monokines
    • T cells → lymphokines
  • regulate action of immune system
  • may have multiple roles or single role
322
Q

antigen-presenting cells

A
  • APCs
  • cells that process antigen material and present it on cell surface to Th cells
  • mostly done by
    • B cells
    • DCs
    • macrophages
323
Q

cell-mediated immunity process

A
  • APCs present to Th cells
  • Th cells recruit
    • Th1 cells activate macrophages and Tc cells
    • Th2 cells activate B cells
  • T memory cells formed for future immunity
324
Q

CMI protects by differentiating _____ from _____, and most easily recognizes _____.

A
  • self from non-self
  • recognizes CA
325
Q

CMI

A

cell-mediated immunity

326
Q

CMI can also recognize some _____ self cells.

A

infected

327
Q

hypersensitivity

A
  • essentially an overreaction to an antigen
  • four major types that can occur alone or with one or more others
328
Q

types of hypersensitivity rxns

A
  • Type I: rapid/immediate
  • Type II: cytotoxic
  • Type III: immune complex
  • Type IV: delayed
329
Q

Type I hypersensitivity rxn

A
  • rapid/immediate
  • ↑ production of IgE in response to antigen
  • excessive release of histamine from basophils, eosinophils →
    • anaphylaxis
    • allergic asthma
    • conjunctivitis
    • rhinitis
    • pruritis
    • edema
    • rash
    • urticaria
    • angioedema
  • methods of exposure
    • inhalation
    • ingestion
    • injection
    • contact
330
Q

5 common primary allergens and their cross-reactant allergens

A
  • pollen: apple, hazelnut, carrot, kiwi, apricots, peaches
  • mites: crustaceans
  • latex: exotic fruits such as banana, avocado, kiwi
  • bird dander: egg yolk
  • cat dander: pork
331
Q

Type II hypersensitivity rxn

A
  • Ab directed against foreign antigen on self cell
  • usually attacks a specific tissue type
  • mainly IgG or IgM
  • play a role in several autoimmune diseases
332
Q

examples of Type II hypersensitivity rxn

A
  • autoimmune hemolytic anemia
  • hemolytic dz of the newborn (Rh dz)
  • blood transfusion rxn
  • myasthenia gravis (acetylcholine receptor)
333
Q

AIHA

A

autoimmune hemolytic anemia

334
Q

Type III hypersensitivity rxn

A
  • immune complex rxn
  • process
    • excess antigens → formation of immune complexes in blood
    • immune complexes precipitate, wedge into vessels in organs → inflammation and damage
  • types/conditions
    • serum sickness
    • SLE
    • RA
335
Q

SLE

A

systemic lupus erythematosis

336
Q

RA

A

rheumatoid arthritis

337
Q

Type IV hypersensitivity rxn

A
  • delayed
  • T cells recruit macrophages to attack hrs or days after exposure
  • examples
    • poison ivy
    • latex
    • graft rejection
    • positive TB skin test
    • sarcoidosis
    • IV drug rxn (e.g. abx)
338
Q

autoimmunity

A
  • condition in which immune system recognizes proteins on self cells as foreign
  • body attacks self cells w/ that protein
  • can be Ab- and/or cell-mediated
  • no cure
339
Q

mechanisms of autoimmunity

A
  • genetics: certain HLAs are more susceptible
  • infections
    • various viruses and bacteria can contribute
    • viruses or bacteria share epitope w/ host cells
    • adaptive immune system forms response to antigen w/ T and B cells
    • immune system attacks all cells w/ that epitope
340
Q

rheumatoid arthritis

A
  • systemic AID affecting mostly synovial joints
  • → damage to joint and cartilage
  • also affects
    • blood vessels
    • pleurae
    • pericardium
    • iris and sclerae
  • typically affects upper joints first
341
Q

pathophysiology of RA

A
  • body makes Abs that attack synovium, articular cartilage, joint capsule, ligaments, and tendons
  • thought to be initiated by CD4 cells
    • CD4s recruit mediators that attack synovial membrane
    • also involves B cells
  • process
    • synovium thickens
    • fluid accumulates
    • pannus forms
    • more blood vessels form in synovial membrane → perpetuation of inflammatory response
  • result: permanent damage to bone
  • early Dx and Tx can prevent damage
342
Q

risk factors for RA

A
  • female gender
  • age: 20-50, then OA
  • genetics
  • exposure to Epstein-Barr
  • possible other environmental factors: smoke, silica, insecticides
  • exacerbations linked to stress
343
Q

early manifestations of RA

A
  • generalized weakness, fatigue
  • anorexia, wt loss
  • persistent low-grade fever
  • joints: stiff, red, painful, tender, swollen, warm
  • usually in hands first
  • pain at rest and with movement
344
Q

late manifestations of RA

A
  • progressive inflammation
  • ↑ pain
  • morning stiffness (gel phenomenon) lasting 45 min to several hrs
  • joints feel soft, look puffy (synovitis and effusions)
  • joint deformity, lack of fxn
    • ulnar deviation
    • swan neck
    • boutonniere
345
Q

labs for RA

A
  • RF: Abs present in connective tissue dz (IgG, IgM)
  • ANA: Abs targeted at host DNA
  • anti-CCP antibodies: specific to RA, + for most RA pts
  • ESR: measure of general inflammation; repeated w/ Tx
  • CRP: possible sub for ESR
  • serum complement proteins: lower in RA, other AIDs
  • HLA tissue typing (HLA-B27 antigen)
  • CBC: ↑ WBCs during exacerbation; anemia (iron unavailable)
346
Q

RF

A

rheumatoid factor

347
Q

anti-CCP antibodies

A

anti-cyclic citrullinated peptide antibodies

348
Q

ESR

A

erythrocyte sedimentation rate

349
Q

diagnostics for RA

A
  • X-ray
  • CT
  • MRI
  • arthrocentesis
  • bone scan
350
Q

skeletal scintigraphy

A

bone scan

351
Q

expected findings in arthrocentesis for RA

A

↑ WBCs and RF

352
Q

pharm Tx for RA, in order of use

A
  1. NSAIDS
  2. Cox-2 inhibitor
  3. corticosteroids
  4. DMARDs
353
Q

NSAIDs for RA

A
  • first-line med
  • pain and fever relief, anti-inflammatory
  • often w/ H2 blocker to protect GI; monitor for bleed
  • experimentation w/ types usually needed
354
Q

Cox-2 inhibitor for RA

A
  • celecoxib
  • ↓ GI Sx
  • ↑ cardiac dz risk
355
Q

corticosteroids for RA

A
  • prednisone
    • fast anti-inflammatory
    • often used in high dose for flares
    • not for long-term
  • SE
    • immunosuppression
    • osteoporosis
    • hyperglycemia
    • cataracts
356
Q

DMARDs for RA

A
  • antimalarial: hydroxychloroquine
  • abx w/ anti-inflammatory properties: minocycline
  • sulfonamide: sulfasalazine
  • biological response modifiers
    • etanercept
    • infliximab
    • adalimumab
  • cytotoxic meds
    • methotrexate
    • leflunomide
    • azathioprine
    • cyclophosphamide
357
Q

hydroxychloroquine for RA

A
  • ↓ pain
  • used with mild dz
358
Q

minocycline for RA

A
  • anti-inflammatory properties
  • used for mild RA
359
Q

sulfasalazine for RA

A
  • ↓ pain and swelling
  • prevent damage
  • ↓ risk of long-term disability
360
Q

biological response modifiers for RA

A
  • slows progression
  • typically given w/ methotrexate
  • risk of immunosuppression
  • bing w/ part of inflammatory process to ↓ response
  • must rule out TB and MS (can cause flare)
  • lab monitoring: TB, hep B, LFTs, CBC, hCG
361
Q

methotrexate for RA

A
  • folic acid antagonist
  • blocks several enzymes in immune response
  • 1x/wk
  • relatively inexpensive
  • onset: 4-6 wks
  • avoid PG
362
Q

leflunomide for RA

A
  • ↑ mobility
  • ↓ joint swelling
  • severe SEs
    • alopecia
    • diarrhea
    • ↓ WBCs, Plt
    • liver damage
363
Q

MTX

A

methotrexate

364
Q

azathioprine or cyclophosphamide for RA

A
  • immunosuppressants
  • interrupt immune process
  • ↓ inflammation
  • slow joint damage
365
Q

skin cancer pathophysiology

A
  • uncontrolled growth of abnormal cells in specific epithelial cells of skin
  • types
    • squamous
    • basal
    • melanocytes
366
Q

skin cancer risk factors

A
  1. exposure to UV rays
  • fair complexion
  • age
  • being male
  • family Hx
  • chemical exposure
  • radiation exposure
  • living in upper elevations or near equator
  • presence of many moles
367
Q

skin cancer prevention

A
  • primary
    • ↓ sun exposure
    • no tanning beds
  • secondary/screening
    • early detection
    • body spot map
    • frequent skin checks (self and/or provider)
368
Q

basal cell carcinoma

A
  • most common skin CA
  • growth
    • slow
    • rarely metastasizes
    • can cause local tissue destruction
  • presentation
    • generally painless
    • usually in sun-exposed areas (head, face, neck)
    • nodular lesion most common
369
Q

squamous cell carcinoma

A
  • second most common skin CA
  • appearance: firm, crusty, or ullcerated
  • vulnerable areas
    • sun-exposed areas (head, neck lower lip)
    • (chronic irritation) scars, irradiated skin, ulcers
  • growth
    • rapid invasion
    • metastasis in 10%
    • larger tumors more likely to metastasize
370
Q

malignant melanoma

A
  • deadliest form of skin cancer
  • growth: metastasizes
  • presentation
    • irregular red, blue, white, or dark-colored lesions
    • almost always a change in a skin lesion over months
  • vulerable areas: all
    • upper back
    • lower legs
    • soles of feet
    • palms
371
Q

skin CA assessment

A
  • Hx
    • skin injury
    • sunburns/exposures
    • mole or other lesion removals
  • assess all areas of skin, including in hair
  • ABCDE
    • asymmetry
    • borders
    • color
    • diameter
    • evolving
372
Q

ABCDE for skin CA

A
  • asymmetry
  • borders
  • color
  • diameter
  • evolving
373
Q

asymmetry

A

when half the mole doesn’t match the other

374
Q

border

A

when the border of the mole is ragged or irregular

375
Q

color

A

when color of mole varies throughout

376
Q

diameter

A

if the mole’s diameter is larger than a pencil eraser

377
Q

evolving

A

the appearance of the mole changes over time

378
Q

skin CA labs and Dx

A
  • no blood tests
  • Bx is gold standard
379
Q

types of Bx for skin CA

A
  • shave
  • punch
  • incisional
  • excisional
380
Q

incisional Bx

A

part of tumor is removed for testing

381
Q

excisional Bx

A

all of tumor is removed, then tested

382
Q

nonsurgical management of skin CA

A
  • cryosurgery
  • topical chemo
  • radiation
383
Q

surgical management of skin CA

A
  • curettage and electrodessication (video)
  • excision
    • gold standard: Mohs excision
    • removal of nearby lymph nodes and tissue (sentinel node Bx)
384
Q

Mohs excision

A
  • gold standard for skin CA excision
  • surgeon removes visible CA and small margin of surrounding healthy tissue
  • allows surgeon to verify all CA cells are removed at time of surgery
385
Q

skin CA nursing implications

A
  • interventions based on AE of Tx
    • surgical site care
    • monitor for complications
  • pt education
    • tests
    • Tx and AE
    • meds
    • ways to ↓ UV exposure
386
Q

lung CA

A
  • among most common forms of CA
  • most common cell types
    • non-small cell
    • small cell
  • survival
    • 5-year: 16%
    • w/ early detection, small tumor: 52%
    • most detected late
    • generally poor prognosis
387
Q

lung CA patho

A
  • most are bronchogenic
    • bronchial tumor → obstruction of bronchus
    • lung tumor → obstruction of alveoli, nerves, blood vessels, lymph vessels
  • can metastasize to surrounding tissue, blood, lymph system
388
Q

lung CA risk factors

A
  • tobacco smoke
    • smoking: 85% of deaths
    • second-hand smoke exposure
  • radiation exposure
  • environmental exposure → chronic inflammation
    • pollutants
    • irritants
389
Q

lung CA primary prevention

A
  • no smoking
  • use appropriate mask to minimize exposure to pollutants/irritants
390
Q

secondary prevention for lung CA

A

annual CT for those at high risk

391
Q

clinical manifestations of lung CA

A
  • Sx
    • chronic cough
    • chronic dyspnea
    • fatigue
    • chest wall pain
  • signs
    • hoarseness
    • chest wall masses
    • fingernail clubbing
    • low SpO2
    • visible massess or fluid on imaging
    • late
      • wt loss, anorexia, cachexia
      • hemoptysis
392
Q

lung CA labs and diagnostics

A
  • CXR
  • chest CT
  • PET
  • pulmonary fxn test
  • cytology
    • sputum culture
    • thoracentesis (for pleural effusion)
  • ABGs
  • Bx
    • bronchoscopy
    • CT-guided
393
Q

nonsurgical Tx for lung CA

A
  • chemo
  • radiation
  • targeted therapy
  • photodynamic therapy
  • radiofrequency ablation
394
Q

chemo for lung CA

A

mostly for SCLC

395
Q

purpose of radiation in lung CA

A
  • shrink tumor → assist w/ Tx or palliate
  • primary Tx for high-risk pts
396
Q

photodynamic therapy for lung CA

A
  • used in bronchial tumors via scope
  • for small, easily accessed tumors
397
Q

radiofrequency ablation for lung CA

A

electric current delivered directly to tumor via CT-guided needle

398
Q

surgical Tx for lung CA

A
  • wedge resection
  • segmental resection
  • lobectomy
  • pneumonectomy
399
Q

wedge resection for lung CA

A

very small area of tumor near surface of lung is removed

400
Q

segmental resection for lung CA

A

removal of one or more lung segments w/ attached bronchiole and alveoli

401
Q

lobectomy

A

removal of entire lobe of lung

402
Q

pneumonectomy

A

removal of entire lung

403
Q

post-op care for lung CA pts

A
  • monitor respiratory status
    • tracheal deviation
    • dyspnea
    • SpO2
    • coloration
  • maintain chest tube/drain
    • patency/adequate drainage
    • monitor drainage color, amount
    • insertion site
    • empty container
  • incisional site care
  • encourage
    • ambulation
    • incentive spirometry
    • T, C, DB exercises w/ splinting
404
Q

nursing implications for lung CA Tx

A
  • care of SE r/t Tx
  • maintain airway, suction PRN
  • high Fowler’s
  • O2 therapy
  • bronchodilators, steroids
  • fluids
  • anxiety ↓
  • support
  • palliative care
405
Q

leukemia

A
  • cancer of bone marrow
  • most common malignancy in children and young adults
406
Q

leukemia patho

A
  • uncontrolled proliferation of immature WBCs
  • CA cells replace normal cells in marrow → ↓ healthy WBCs, RBCs, and Plts
407
Q

leukemia classifications

A
  • speed of progression
    • acute
    • chronic
  • type of blood cells affected
    • lymphocytic/lymphoblastic
    • myelogenous
408
Q

leukemia risk factors

A
  • (exact cause unknown)
  • genetics
  • previous chemo
  • ionizing radiation
  • certain chemicals
  • immunodeficiency
  • smoking
409
Q

leukemia clinical menifestations

A
  • fever/chills
  • persistent fatigue, weakness
  • frequent or severe infection
  • wt loss w/o trying
  • lymph node swelling
  • enlarged liver or spleen
  • easy bleeding/bruising
  • recurrent epistaxis
  • petechiae
  • excessive sweating, esp. at night
  • bone pain or tenderness
410
Q

leukemia labs, diagnostics

A
  • bone marrow aspiration and Bx
    • ↑ immature leukemic blast cells
    • determines cell type involvement
  • CBC
    • WBC: ↑, ↓, or WNL
    • ↓ H&H
    • ↓ Plt
  • INR, aPTT: ↑ w/ acute types
  • CXR, CT, PET, bone scan to check for metastasis
411
Q

leukemia Tx

A
  • chemo
    • three phases
      • induction
      • consolidation
      • maintenance
    • may require re-induction
  • biologic response modifier (filgrastim) after chemo
  • bone marrow/stem cell transplant
412
Q

induction therapy

A
  • aggressive chemo Tx for leukemia
  • 4-6 wks in hospital
  • usually continuous chemo infusion
413
Q

consolidation therapy

A
  • second phase of leukemia chemo Tx
  • lower dosage
  • possibly different meds
  • about 6 mo
414
Q

maintenance therapy

A
  • third phase of leukemia chemo Tx
  • even lower doses
  • months to years to prevent relapse
415
Q

bone marrow/stem cell transplant for leukemia

A
  • bone marrow destroyed using full-body radiation or chemo
  • marrow replaced with healthy cells via infusion
  • pt at high risk for infection and bleeding until transplanted cells start working
416
Q

nursing implications for leukemia pts

A
  • pancytopenia
  • interventions based on AE
  • monitor for complications (GvHD)
  • pt education
    • tests
    • Tx
    • AE
    • meds
417
Q

lymphoma types

A
  • Hodgkin’s (HL)
  • non-Hodgkin’s (NHL)
418
Q

HL

A

Hodgkin’s lymphoma

419
Q

NHL

A

non-Hodgkin’s lymphoma

420
Q

Hodgkin’s lymphoma

A
  • contains Reed-Sternberg cells
  • population: teens and young adults, 50s-60s
  • progression
    • single node or chain of nodes
    • predictable metastasis, starting w/ closest nodes
421
Q

non-Hodgkin’s lymphoma

A
  • no Reed-Sterberg cells
  • more common in men, OA
  • > 65 subtypes
  • complicated Dx and classification
  • metastasis unpredictable
422
Q

risk factors: HL

A
  • mostly unknown
  • possibly viral infections or exposure to certain chemicals
423
Q

risk factors: NHL

A
  • gene damage
  • viral infections
  • radiation
  • AID
  • chemicals: ↑ incidence w/ exposure to pesticides, insecticides, dust
424
Q

lymphoma S/Sx

A
  • often asymptomatic
  • large, painless swelling of lymph node
    • NHL: multiple nodes
    • HL: usually starts in neck
  • may c/o
    • fevers > 101.5
    • night sweats
    • wt loss
    • infections
  • general malaise
425
Q

lymphoma labs and diagnostics

A
  • extensive testing required; difficult to classify
  • gold standard: lymph node Bx
  • CBC
    • r/o similar conditions
    • check for met to bone marrow (pancytopenia)
  • bone marrow Bx
  • staging, mapping, metastasis: CT, CXR, PET, bone scan
426
Q

lymphoma Tx

A
  • chemo
  • radiation
  • immunotherapy
  • NHL only: targeted therapy
427
Q

nursing implications for lymphoma pts

A
  • intervene based on AE of Tx
  • monitor for complications
  • pt education: tests, Tx, meds, AE
428
Q

multiple myeloma

A
  • cancer of plasma cells
  • accumulates in bone marrow, crowds out healthy cells
429
Q

multiple myeloma patho

A
  • cancerous plasma cells
  • create abnormal Abs (myeloma proteins)
430
Q

M protein

A
  • myeloma protein
  • abnormal Ab made by cancerous plasma cells
431
Q

MM

A

multiple myeloma

432
Q

MM risk factors

A
  • OA: Dx usually ≥ 65 yo
  • male sex
  • African-American race (2x as common as caucasian)
  • Fm Hx
  • obesity
  • personal Hx of other plasma cell dz
    • monoclonal gammopathy of undetermined significance (MGUS)
    • solitary plasmacytoma
433
Q

MM clinical manifestation

A
  • varies and may be asymptomatic
  • bone pain, esp. spine or chest
  • weakness, numbness in legs
  • GI
    • nausea
    • constipation
    • loss of appetite
    • wt loss
    • abd pain
  • mental fog, confusion
  • fatigue
  • infections
  • GU
    • excessive thirst
    • renal dz/failure
    • polyuria
434
Q

MM labs and diagnostics

A
  • CBC
    • usually anemia
    • thrombocytopenia, leukopenia possible
  • chemistry
    • Cr to test kidney fxn
    • albumin: ↓ in MM
    • Ca: ↑ in advanced MM
    • lactic dehydrogenase: ↑ in advanced, poor prognosis
  • urine: M protein
  • bone marrow Bx
  • CT, PET, bone scan, MRI
435
Q

Tx for MM

A
436
Q

nursing implications for MM

A
  • interventions for AE of Tx
  • monitor for complications
  • pt education: tests, Tx, AE, meds
437
Q

bone cancer

A
  • sarcomas starting in osteoblasts or osteoclasts
  • common types
    • osteosarcoma
    • chondrosarcoma
    • Ewing’s sarcoma
438
Q

osteosarcoma

A
  • most common
  • starts in bone cells
  • population
    • 10-30 yo or 60-70 yo
    • rare: middle age
    • male > female
  • usually in arms, legs, or pelvis
439
Q

chondrosarcoma

A
  • second most common bone CA
  • sites: starts in any cartilage cells
    • trachea
    • larynx
    • chest wall
    • scapula
    • ribs
    • skull
  • population
    • rare: < 20 yo
    • more common: 20-75 yo
    • men = women
440
Q

Ewing’s sarcoma of bone

A
  • third most common bone CA
  • population
    • rare in adults > 30 yo
    • most common in whites
    • rare in African- and Asian-Americans
  • sites
    • pelvis
    • chest wall
    • long bones of arms, legs
441
Q

bone CA risk factors

A
  • retinoblastoma ↑ risk
  • possible genetic tendency
  • multiple enchodromatosis ↑ risk for chondrosarcomas
  • Paget dz
  • radiation
442
Q

enchondromatosis

A

cartilaginous bumps on bones

443
Q

Paget dz

A
  • pre-cancerous condition
  • → formation of abnormal bone tissue
  • affected bones become heavy, thick, brittle, and weak
444
Q

bone CA clinical manifestations

A
  • pain in affected bone (most common)
  • swelling of area around bone
  • Fx
  • numbness, tingling
  • wt loss
  • fatigue
445
Q

bone CA labs and diagnostics

A
  • Ca may be ↑ in blood, urine
  • CBC
  • ↑ alkaline phosphatas, lactate dehydrogenase
  • imaging
    • X-ray
    • bone scan
    • CT
    • MRI
    • PET
  • Bx: definitive
446
Q

bone CA Tx

A
  • surgery
  • radiation
  • chemo
447
Q

surgery for bone CA

A
  • type of surgery depends on type and severity
  • ranges from curettage with cryotherapy to amputation
448
Q

radiation for bone CA

A
  • most types not killed easily
  • requires high doses
  • used when
    • cannot be completely removed w/ surgery
    • positive margins found after excision
449
Q

chemo for bone CA

A

usually for Ewing’s sarcoma of bone, osteosarcoma, or metastatic bone CA

450
Q

nursing implications for bone CA Tx

A
  • interventions based on AE of Tx
  • peri-op care
  • monitor for complications
  • pt education: testing, Tx, AE, meds
451
Q

colorectal CA patho

A
  • most start as polyps, but not all polyps become cancer
  • adenomatous polyps: pre-cancerous
  • hyperplastic, inflammatory polyps mostly not cancerous
  • could become cancer if
    • > 1 cm
    • > 2 polyps
    • dysplasia present (abnormal, but not cancerous cells)
452
Q

colorectal CA patho

A
  • polyp → cancerous → grows into wall of colon/rectum
  • innermost layer → outer layer
  • 95% are adenocarcinoma
  • site: anywhere in colon or rectum
    • proximal: ascending, transverse
    • distal: descending, sigmoid
    • most common: rectosigmoid
453
Q

colorectal CA risk factors

A
  • colorectal: women > men
  • rectal: men > women
  • adenomatous polyps
  • age > 50
  • African-American descent
  • ulcerative colitis, Crohn’s dz
  • diet ↑ fat and red meat, ↓ fiber
  • smoking
  • ETOH abuse
  • inactivity
  • HPV
  • family Hx
454
Q

colorectal CA manifestations

A
  • change in stool consistency
  • pencil-thin stools
  • blood in stool
    • hematochezia
    • melena
    • occult
  • cramps
  • mass
  • wt loss
  • fatigue
  • vomiting
  • abd fullness, distention, pain
455
Q

hematochezia

A

bright red blood in stool

456
Q

melena

A

black, tarry stool

457
Q

colon CA labs and diagnostics

A
  • CBC: ↓ H&H
  • carcinoembryonic antigen (CEA): +
  • fecal occult blood test
  • colonscopy, sigmoidoscopy w/ Bx (Bx definitive)
  • CT, MRI
  • barium enema
458
Q

CEA

A

cracinoembryonic antigen test

459
Q

surgical colon CA Tx

A
  • polypectomy: local excision during colonoscopy
  • abd-perineal resection: anus, rectum, and sigmoid colon removed
  • colectomy: all or part of colon and nearby lymph nodes removed
  • proctocolectomy: colon and rectum removed
  • reanastamosis: if not possible, will need ostomy:
    • colostomy
    • ileostomy
    • stoma: pink or red and moist
    • temporary or permanent
460
Q

non-surgical Tx of colon CA

A
  • chemo
  • adjuvant: extra chemo after surgery to ↓ risk of recurrence
  • targeted med therapy: monoclonal antibodies to inhibit growth
  • radiation
461
Q

nursing implications for colon CA Tx

A
  • interventions based on AE
  • peri-op care
  • monitor for complications
  • pt education
    • tests
    • Tx, AE
    • meds
    • ostomy care
462
Q

impact of CA

A
  • physical and psych health
  • quality of life
  • financial
  • family dynamics
463
Q

plasmapheresis

A

process that filters blood, removes harmful Abs

464
Q

therapeutic procedures for RA

A
  • plasmapheresis
  • synovectomy
  • total joint arthroplasty
465
Q

synovectomy

A
  • excision of synovial membrane
  • types
    • open: ↑ morbidity
    • arthoscopic: incomplete removal
466
Q

total joint arthroplasty

A

removal and replacement of articulating bone parts in joint

467
Q

clinical remission rate for RA

A

50%

468
Q

Within 10 yrs of definitive Dx and Tx, what percentage of RA pts are disabled?

A

30%

469
Q

other Tx for RA

A
  • ↓ pain and stiffness
    • rest
    • gentle, low-impact exercise when tolerated
    • ROM exercises (stiffness)
    • heat therapy
  • ice for ↓ edema
  • proper nutrition
  • CAM (usually anti-inflammatory)
    • fish oil
    • turmeric
    • glucosamine and chondroiton
470
Q

nursing care for RA

A
  • assist w/ ROM
  • heat for stiffness, pain
  • ice for edema
  • encourage gentle exercise
  • cluster care/activities to conserve energy
  • give meds properly
  • monitor lab values
471
Q

pt education for RA

A
  • S/Sx to report
    • fever
    • s/sx of infection
    • pain on inspiration
  • nutrition
    • high-protein
    • small, frequent meals
  • meds
    • SEs
    • importance of adherence
    • S/Sx of bleeding
472
Q

other conditions RA pts commonly develop

A
  • interstitial lung dz (ILD)
  • bronchiectasis
  • bronchiolitis obliterans
473
Q

ILD

A

interstitial lung dz

474
Q

interstitial lung dz

A
  • any of a large group of diseases w/ different causes but the same or similar clinical and pathological changes
  • cause: chronic, nonmalignant, noninfectious dz of lower respiratory tract w/ inflammation, disruption of alveolar walls
  • manifestations
    • limited O2 transfer from alveoli to capillaries
    • dyspneic
      • first w/ exercise
      • later, even at rest
  • risk factors
    • ↑ RF and anti-CCP
    • smoking
    • age
475
Q

bronchiectasis

A
  • chronic dilation of a bronchus or bronchi
  • usually in lower portions of lung
  • caused by damaging effects of long-standing infection
476
Q

bronchiolitis obliterans

A
  • inflammation of the bronchioles
  • bronchioles and sometimes smaller bronchi are partly or completely obliterated by nodular masses
  • massess contain granulation and fibrotic tissue
477
Q

complications of RA

A
  • Sjogren’s syndrome
  • secondary osteoporosis
  • vasculitis → organ ischemia
  • interstitial lung dz
478
Q

Sjogren’s syndrome

A
  • dz → ↓ production of tears, saliva, vaginal secretions
  • can result from RA
  • can →
    • light sensitivity
    • blurred vision
    • corneal damage
  • Tx: eye drops, artificial saliva, vaginal lubricants
479
Q

secondary osteoporosis

A
  • cause: long-term glucocorticoid use
  • encourage
    • weight-bearing exercise
    • Ca and vitamin D supplements
480
Q

vasculitis

A
  • →
    • organ ischemia
    • infarction and necrosis of tissue
  • usually involves smaller arteries in
    • skin
    • eyes
    • brain
  • inflammation of arteries 2/2 deposition of immune complexes
481
Q

SLE

A

systemic lupus erythematosus

482
Q

lupus erythematosus

A
  • vague early manifestations, many diagnostic challenges
  • series of remissions and exacerbations
  • still no definitive test
  • ANA usually +, but + is not exclusive to SLE
483
Q

classifications of LE

A
  • discoid (DLE)
  • systemic (SLE)
  • medication-induced
484
Q

DLE

A

discoid lupus erythematosus

485
Q

discoid lupus erythematosus

A
  • only affects skin
  • scaling, red, macular, pruritic rash
  • some pts have arthritis and/or arthralgia
486
Q

systemic lupus erythematosus

A
  • affects skin and connective tissue of multiple organs
  • → multi-organ inflammation
487
Q

medication-induced lupus erythematosus

A
  • temporary
  • induced by
    • procainamide
    • hydralazine
    • isoniazid
  • goes away w/ D/C of meds
488
Q

lupus patho

A
  • autoimmune w/ likely environmental factors
  • autoantibodies, mainly attacking cell nucleus
    • → buildup of immune complexes in serum and organs
    • → initiation of inflammatory process, damage of organs w/ possible vasculitis
489
Q

lupus risk factors

A
  • female > male: possibly linked to estrogen
  • 20-40 yo
  • minority race
  • genetics: some familial involvement
490
Q

clinical manifestations of SLE

A
  • fatigue
  • blurred vision
  • general pain
  • photosensitivity
  • joint pain
    • mostly small joints: hands, wrists, and knees
    • w/o deformity
  • anorexia
  • depression
  • fever
  • anemia
  • butterfly rash
  • alopecia
  • muscle atrophy
  • pleural effusion
  • pericarditis
  • hematuria
  • peripheral edema (lupus nephritis?)
  • CNS
    • sz
    • migraine
  • avascular necrosis of femur
  • tendon rupture
491
Q

lupus nephritis

A
  • inflammation (swelling or scarring) of small vessels that filter wastes in kidneys
  • can → peripheral edema
492
Q

labs for LE

A
  • CBC
  • BUN, creatinine
  • UA
  • immunologic
    • ANA
    • serum complement (C3, C4)
    • ESR
  • other labs for Abs
493
Q

diagnostics for LE

A
  • skin Bx for DLE
  • renal Bx
  • echo
  • other imaging based on affected organs/systems
494
Q

Tx for LE

A
  • NSAIDs
  • corticosteroids: topical and PO
  • hydroxychloroquine: ↓ absorption of UV light
  • immunosuppressants
495
Q

nursing care for LE

A
  • monitor
    • and treat pain
    • BP for HTN
    • renal fxn
    • respiratory status
  • provide small, frequent meals
  • pt education
496
Q

pt education for LE

A
  • avoid UV esposure, use sunscreen
  • avoid infection
  • S/Sx of renal failure
    • peripheral edema
    • SOB
    • ↑ fatigue
  • PG risk factors w/ lupus meds
497
Q

S/Sx of renal failure for lupus pt

A
  • hematuria
  • protein in urine (frothy/foamy)
  • edema
  • wt gain
  • ↑ BP
498
Q

LE complications

A
499
Q

scleroderma

A
  • “hardening of skin”
  • AKA systemic slerosis
  • uncommon
  • induration of various body parts
    • skin mainly, but can also affect other body systems
    • lungs and kidneys (primary COD)
    • SubQ tissue
    • muscles
    • other organs
  • manifestations vary greatly
500
Q

induration

A
  • ↑ of fibrous elements in tissue
  • associated w/ inflammation
  • marked by loss of elasticity, pliability
501
Q

scleroderma patho

A
  • involves humoral (Ab) and cell-mediated immune responses
  • immune attack on body structures → inflammatory process
    • affected areas become hardened and fibrotic
  • common presentation: skin or microvascular changes
  • exact etiology unknown
502
Q

3 processes that lead to scleroderma manifestations

A
  • severe fibroproliferative vascular lesions of small arteries, arterioles
  • excessive, often progressive deposition of collagen and other ECM macromolecules in skin and internal organs
  • alterations of humoral and cellular immunity
503
Q

ECM

A

extracellular matrix

504
Q

3 types of scleroderma

A
  • diffuse cutaneous systemic sclerosis
  • limited cutaneous systemic sclerosis (milder)
  • fulminant systemic sclerosis: rapid onset/progression
505
Q

diffuse cutaneous systemic sclerosis

A
  • over most of body
  • skin is thickened on trunk, face, and extremities
506
Q

limited cutaneous systemic sclerosis

A
  • milder form
  • limited to sites distal to elbows and knees
  • may involve face and neck
  • pts usually have CREST syndrome
507
Q

CREST syndrome

A
  • a variant of progressive systemic sclerosis
  • presence of
    • calcinosis
    • Raynaud phenomenon
    • esophageal dysfunction
    • sclerodactyly
    • telangiectasia
508
Q

calcinosis

A

condition marked by abnormal deposition of Ca salts in tissues

509
Q

Raynaud phenomenon

A
  • intermittent vasospastic attacks of small arteries and arterioles of fingers
  • pallor → cyanosis (numbness, cold) → erythema 2/2 hyperemia (throbbing, paresthesia)
  • triggered by cold temps or emotion
  • associated w/
    • scleroderma
    • SLE
    • Buerger dz
    • nerve entrapment
    • anorexia-bulimia
510
Q

sclerodactylia

A

induration of the skin on toes and fingers

511
Q

telangiectasia

A
  • AKA spider veins
  • vascular lesion formed by dilatation of a group of small blood vessels
  • usually on face or thighs
  • causes: sun exposure, birth mark, CREST syndrome, etc.
512
Q

dilatation

A

expansion of an organ or vessel beyond normal size

513
Q

systemic sclerosis risk factors

A
  • found in all races, all geographic areas
  • female 4-9x > male
  • age 25-55 yo
  • Hx of connective tissue dz
  • some chemical exposures
  • for more severe prognosis
    • younger age
    • African descent
    • rapid progression of skin Sx
    • involvement
      • ↑ skin
      • pulmonary
      • cardiac
      • renal
    • anemia
    • ↑ ESR
514
Q

clinical manifestations of scleroderma

A
  • joint pain and stiffness
  • LES incompetence + ↓ esophageal peristalsis →
    • GERD complaints
    • dysphagia
    • aspiration pneumonia
    • hoarseness
    • hiatal hernia
  • painless, symmetric pitting edema
    • fingers, hands, forearms
    • → carpal tunnel syndrome
  • loss of skin elasticity: tight and shiny
  • Raynaud’s phenomenon
  • fibrosis of myocardium and lung alveoli
  • stone face
  • malignant HTN (renal effect)
  • telangiectasia
515
Q

Raynaud phenomenon is present in initial presentation for ___ of pts w/ scleroderma, and ___ develop it.

A
  • 70%
  • 95%
516
Q

labs for scleroderma

A
  • general AID labs like SLE
  • findings like SLE
  • ESR
    • almost always normal
    • if ↑, usually poor outcome
517
Q

diagnostics for scleroderma

A
  • dependent on organ involvement
  • CT, X-ray, echo, EGD, colonoscopy
  • upper and lower GI series common
518
Q

pharm Tx for scleroderma

A
  • to slow progression
  • often unsuccessful
  • ID organ involvement early and treat
  • meds
    • systemic steroids + ↑ dose immunosuppressants
    • bosentan (endothelium receptor antagonists) for pulmonary arterial HTN
    • H2 blockers + antacids for GERD
    • NSAIDs for inflammation/joint pain
    • future: tocilzumab (IL-6 antagonist)
519
Q

nursing care for scleroderma

A
  • monitor and treat pain
  • mild soap, skin care
  • keep pt warm
  • esophageal involvement: collaboration w/ speech therapy, dietitian
  • small, frequent meals
520
Q

pt education for scleroderma

A
  • S/Sx of organ involvement
  • how to avoid Raynaud’s
  • dietary: avoid foods that worsen GERD
  • meds
    • importance of adherence
    • take w/ food to avoid GI distress
  • avoid infection
  • stress, smoking can worsen Sx
521
Q

complications of scleroderma

A
  • fibrosis of
    • myocardium
    • lungs → pulmonary HTN
    • esophagus
    • intestines
  • renal failure
  • med-related
    • infection
    • cataracts
522
Q

Systemic sclerosis has the highest case-specific _____ among AIDs, with pulmonary _____ and _____ and _____ crisis being the most frequent CODs.

A
  • highest mortality
  • pulmonary HTN and fibrosis (ILD)
  • renal crisis
523
Q

HIV

A

human immunodeficiency virus

524
Q

AIDS

A

acquired immune deficiency syndrome

525
Q

HIV/AIDS

A
  • very deadly because of the way it attacks the body
  • HIV → AIDS
  • HIV: retrovirus w/ 3 stages
526
Q

HIV patho

A
  • enters body via blood, semen, or vaginal secretions
    • binds to CD4 molecule on surface to enter Th cells
    • hijacks replicative mechanisms of cell to produce billions of virus particles
    • new particles enter other Th cells and continue cycle
  • window period
    • undetectable for first 1-3 mo
    • can still infect others
  • loss of CD4+ Th cells →
    • opportunistic infections
    • neoplastic processes
527
Q

What viruses commonly co-infect w/ HIV?

A
  • hep B and C
  • human herpes virus 8
    • HHV8
    • AKA Kaposi sarcoma herpes virus (KSHV)
528
Q

3 stages of HIV infection

A
  • created by CDC
  • based on CD4+ cell counts
  • stages
    • I: acute infection
    • II: clinical latency
    • III: AIDS
529
Q

HIV Stage I

A
  • acute infection
  • 2-4 wks after infection
  • flu-like illness for a few wks
530
Q

HIV Stage II

A
  • clinical latency: inactivity or dormancy
  • asymptomatic/chronic
  • still active, but produces at low levels
531
Q

HIV Stage III

A
  • AIDS
  • most severe stage
  • opportunistic infections occur
532
Q

WHO divides HIV progression into ___ clinical stages, which are based more on _____ _____.

A
  • 4 clinical stages
  • based on clinical manifestations
533
Q

risk factors for HIV

A
  • unprotected sex
    • esp. receptive anal intercourse
    • ↑ rate of transmission w/ mucosal disruptions
  • multiple sex partners
  • exposure in workplace
  • fetal exposure
  • IV drug use, shared needles
  • blood transfusion before 1985 in U.S.
  • maternal HIV infection: birth, breastfeeding
534
Q

MTCT

A

mother-to-child transmission

535
Q

clinical manifestations of HIV

A
  • subjective
    • flu-like Sx
    • chills and/or night sweats
    • malaise
    • anorexia, nausea
    • weakness
    • fatigue
    • HA
  • objective
    • rash: flat and red
    • fever
    • cough/SOB
    • wasting syndrome, wt loss
    • enlarged lymph nodes
    • poor wound healing
    • opportunistic infections
536
Q

acute seroconversion

A

in HIV → flu-like illness: fever, malaise, rash

537
Q

HIV sequelae

A
  • AIDS-associated dementia/encephalopathy
  • wasting syndrome: chronic diarrhea and wt loss w/ no identifiable cause
  • fluid/electrolyte imbalance
538
Q

opportunistic infections common in HIV patients

A
  • fungal
  • TB
  • CMV
  • toxoplasmosis
  • herpes
  • HHV-8
  • Epstein-Barr
539
Q

HHV-8

A
  • human herpesvirus 8
  • → Kaposi’s sarcoma in HIV pts
540
Q

TB, CMV, toxoplasmosis and other opportunistic infections can lead to what problems in HIV pts?

A

adrenal dysfunction

541
Q

Epstein-Barr virus is associated w/ what Dx in HIV pts?

A

Hodgkin’s lymphoma

542
Q

HIV-associated lipodystrophy syndrome

A
  • side effect of protease inhibitor Tx
  • →
    • abnormal accumulations of body fat (upper back)
    • hypercholesterolemia
    • hyperglycemia/insulin resistence
    • hypertriglyceridemia
543
Q

labs for HIV

A
  • CBC
  • cell counts
    • CD4+ Th cells
    • CD8+ Ts cells
  • antigen/antibody
    • ELISA
    • Western blot assay
  • PCR
  • viral load
  • testing for other viruses
544
Q

PCR for HIV

A

can detect HIV RNA in blood earlier than antigen/antibody tests

545
Q

ELISA

A
  • enzyme-linked immunosorbent assay
  • test for antibodies and antigens in blood
546
Q

Western blot assay

A
  • previously used to confirm HIV-positive ELISA
  • test for antibodies in blood
547
Q

other infections routinely checked for in HIV pts

A
  • PPD
  • CMV
  • other STDs
  • hepatitis A, B, and C
548
Q

PPD

A
  • purified protein derivative
  • TB skin test
549
Q

diagnostics for HIV

A
  • none
  • imaging based on S/Sx indicating co-infection
550
Q

HAART

A

highly active antiretroviral therapy

551
Q

highly active antiretroviral therapy (HAART)

A
  • 3+ drugs working @ different stages of replication
  • 90% adherence required
552
Q

HAART goals

A
  • ↓ viral load
  • slow dz progression
  • prevent immune deterioration
553
Q

Once HIV progresses to AIDS, survival is usually < ___ yrs.

A

2 yrs

554
Q

mortality rate for untreated HIV

A

90%

555
Q

average time from HIV infection to death

A

8-10 yrs

556
Q

classes of anteretrovirals

A
  • nucleoside reverse transcriptase inhibitors (NRTIs)
  • nonnucleoside reverse transcriptase inhibitors (NNRTIs)
  • protease inhibitors (PIs)
  • fusion inhibitors
  • entry inhibitors
    • CD4-directed post-attachment inhibitors
    • CCR5 co-receptor antagonists
  • HIV integrase strand transfer inhibitors
557
Q

NRTI

A
  • nucleoside reverse transcriptase inhibitor
  • antiretroviral
558
Q

NNRTI

A
  • nonnucleoside reverse transcriptase inhibitor
  • antiretroviral
559
Q

PI

A
  • protease inhibitor
  • antiretroviral
560
Q

nucleoside reverse transcriptase inhibitors

A

antiretrovirals

  • abacavir
  • didanosine
  • emtricitabine
  • lamivudine
  • stavudine
  • tenofovir
  • zidovudine
561
Q

nonnucleoside reverse transcriptase inhibitors

A

antiretrovirals

  • delavirdine
  • efavirenz
  • etravirine
  • nevirapine
  • rilpivirine
562
Q

protease inhibitors

A

antiretrovirals

  • atazanavir
  • darunavir
  • fosamprenavir
  • indinavir
  • lopinavir/ritonavir
  • nelfinavir
  • saquinavir
  • tipranavir
563
Q

fusion inhibitor

A

antiretroviral

  • enfuvirtide
564
Q

CCR5 co-receptor antagonists

A

antiretrovirals, entry inhibitors

  • maravirac
565
Q

CD4-directed post-attachment inhibitors

A

antiretrovirals, entry inhibitors

  • ibalizumab
566
Q

WHO’s 4 stages of HIV infection

A
  • 1: asymptomatic
  • 2: mildly symptomatic
  • 3: moderately symptomatic
  • 4: severely symptomatic → AIDS
567
Q

HIV pre-exposure prophylaxis (PrEP)

A
  • antiretrovirals for prevention
  • for select, high-risk population
  • must be HIV–
  • labs
    • renal fxn
    • HIV
  • onset: 4 days’ consistent dosing
568
Q

PrEP

A

pre-exposure prophylaxis

569
Q

PrEP can ↓ risk of HIV infection via sex by ___%.

A

99%

570
Q

PrEP drugs

A
  • PO daily
    • Truvada (emtricitabine/tenofovir disoproxil fumarate)
    • Descovy (emtricitabine/tenofovir alafenamide)
  • IM monthly: Cabenuva (cabotegravir/rilpivirine)
571
Q

PrEP SEs

A
  • diarrhea
  • nausea
  • HA
  • fatigue
  • stomach pain
572
Q

nursing care for HIV

A
  • precautions
    • standard
    • immunocompromise
  • monitor
    • wt
    • I&O
    • labs
  • assess
    • skin and provide care PRN
    • respiratory fxn
573
Q

pt education for HIV

A
  • importance of
    • medication adherence
    • follow-ups
  • infection control principles
  • support groups
574
Q

Kaposi sarcoma

A
  • KS
  • malignancy in lining of blood and lymph vessels
  • lesions: painless, purplish
  • etiology: HHV-8
575
Q

KSHV

A
  • Kaposi sarcoma-associated herpesvirus
  • HHV-8
576
Q

Malignancies are named by _____ of _____.

A

area of origin

577
Q

carcinoid tumor secretions

A

serotonin and other vasoactive substances

578
Q

SPECT

A
  • imaging technique
  • single photon emission computerized tomography
579
Q

SOS

A

sinusoidal obstruction syndrome

580
Q

veno-occlusive dz

A
  • disruption in normal flow of venous blood from liver
  • complication of stem cell transplant, within 3 wks
  • S/Sx
    • hepatomegaly
    • RUQ pain
    • jaundice
    • ascites

2021 Care and Management of Adults (3 decks)

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