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Fundamentals SEM2 > WEEK 4 + 5 > Flashcards

WEEK 4 + 5 Flashcards

Cancer notes from class; End of Life notes (adults) from ATI; peds end of life

1
Q

cancer

A

caused by genetic changes that impact how cells operate

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2
Q

how are genetic changes caused for cancer

A

may be inherited, resulting from an error during cell division, or triggered by an environmental factor, such as tobacco or ultraviolet light exposure

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3
Q

normally, what can the body do to damaged cells (why is this an issue with old clients?)

A

Normally, the body can remove damaged cells before they become cancerous

with age, the body is less able to remove damaged cells, which is why cancer occurs more frequently in older individuals.

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4
Q

metastasis

A

cancers may start in one location but then spread

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5
Q

primary tumor vs secondary tumor

A

first place cancer arises: primary tumor
subsequent sites: secondary tumors

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6
Q

cell changes that undergo before becoming malignant

A

order:
hyperplasia
dysplasia
carcinoma in situ

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7
Q

hyperplasia

A

first cell change
There is an increased number of cells, though they appear normal.

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8
Q

dysplasia

A

second cell change
There are abnormal cells present; ranges in severity from mild to severe based on the degree of abnormality and how much of the body part is affected.

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9
Q

carcinoma in situ

A

A group of abnormal cells that stay in one location without spreading.

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10
Q

malignant cells

A

cancerous
Mutated and changed; replicated much faster than healthy cells; they don’t undergo apoptosis; as they grow they can spread to more areas; create their own blood supply

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11
Q

apoptosis

A

Programmed cell death.

malignant cells don’t do this, so there isn’t room for new healthy cells and the cancerous cells spread

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12
Q

angiogenesis

A

The process by which cancers create their own blood supply.

helps the cancer to survive and grow by providing nourishment and clearing waste

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13
Q

what is the risk factor that is a risk for virtually every cancer

A

smoking

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14
Q

potentially modifiable common risk factors to many cancers

A

Smoking
Alcohol consumption
Excess body weight
Sedentary lifestyle
Dietary habits

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15
Q

can viruses cause cancer

A

yes, viruses can cause some cancers. for example, HPV can cause cervical cancer. these viruses that can cause cancer can sometimes be prevented with vaccination or treatment

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16
Q

five most common cancers in the US for women

A

breast
lung
colorectal
uterine
melanoma

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17
Q

five most common cancers in the US for men

A

prostate
lung
colorectal
bladder
melanoma

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18
Q

pain for cancers

A

regional: site of tumor
can be from surgery, procedures, treatments like radiation or chemo

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19
Q

what does in situ mean

A

in the same spot

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20
Q

what can pain increase in cancer patients

A

depression, asking for medical aid in dying, persistent pain may need interprofessional approach

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21
Q

things to do to prevent cancer

A

scan for genes to know if you carry the gene
mammogram
healthy weight
breastfeeding can lower risk

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22
Q

infections with cancer

A

Clients who have cancer commonly experience an increased risk of infection related to treatment

chemo kills WBCs so you have lower WBC and neutropenia can develop

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23
Q

neutropenia

A

Abnormally low levels of neutrophils, one of the white blood cells.
increased risk for infection

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24
Q

what can a minor infection lead to

A

sepsis

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25
Q

Strategies for infection prevention

A

using proper hand hygiene, avoiding crowds, staying up to date with immunizations, and staying away from people who are contagious.

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26
Q

gastrointestinal manifestations for cancer patients

A

malnutrition and elimination
nausea and vomiting
dehydration, metabolic abnormalities, esophageal tears, wound dehiscence, and inability to continue treatment

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27
Q

neutropenic isolation precautions

A

mask, gown, shoe covers, hat
prevent the client from infection
interventions:
no fresh food (cooked/steamed)
no flowers
no raw meats
no sick visitors
no children
vaccinations
peds note:
no live vaccines like MMR when on chemo/radiation

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28
Q

meds for nausea and vomitting

A

Compazene
Zofine
diarrhea: Amodean

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29
Q

interventions for malnutrition for cancer patients

A

bland meals
small, frequent meals
no spicy
cold foods are better

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30
Q

early sign of cancer

A

unintentional weight loss

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31
Q

most common cause of fatigue for cancer patients

A

chemo-related anemia

also:
depression
anxiety
sleep disorders
inflammation
hormone response

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32
Q

oncologic complications: hypercalcemia
Who is most common in and define it

A

common in clients with multiple myeloma and breast cancer

too much calcium

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33
Q

manifestations of hypercalcemia

A

mental status changes, dehydration, weakness, nausea, vomiting, decreased appetite, and constipation

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34
Q

sign of spinal cord invasion or compression (and Tx)

A

pain
numbness
random falling
incontience

treatment: high dose steriods

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35
Q

treatments for hypercalcium

A

IV hydration and med to lower calcium levels

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36
Q

superior vena cava syndrome (define, common sign, tx, other manifestations)

A

tumor pressing on the SVC
SVC compressed, leads to lower blood flow
FACIAL EDEMA is common sign of this.
steriods, stent placement, chemo, radiation
swelling, hoarse voice, shoulder pain, etc

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37
Q

signs of right atrium overfilling

A

facial edema
upper extremities swelling

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38
Q

malignant pericardial effusion

A

fluid around the sac of the heart
shortness of breath
chest pain
palpitations
put drain in to drain the fluid, chemo later
think of grey’s anatomy stab chest to relieve fluid

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39
Q

tumor lysis syndrome

A

triggered by treatment
medical emergency/metabolic emergency
cancer cells leak their intracelluar content into bloodstream
cardiac arrythemias
IV hydration is primary treatment

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40
Q

lab abnormalities seen with tumor lysis syndrome

A

low calcium
elevated phosphorus, potassium, uric acid level, creatinine
may experience cardiac arrhythmias
IV hydration is a primary treatment

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41
Q

Syndrome of inappropriate antidiuretic hormone (SIADH)

A

common with small cell cancers
result from treatment
hyponatremia (ANTIdieuritic-holding fluid so sodium will drop because there is a lot of fluid)
Tx: correct sodium levels and treat primary cancer
manifestations: N+V, off balance, dizzy, coma, behavior changes, etc

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42
Q

hyponatremia (define, what can it cause, common Sx)

A

low sodium
can cause brain swelling!
less than 135 mEq/L
symptoms:
nausea, vomiting, blurred vision, impaired balance, headache, SEIZURES

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43
Q

treatment for hyponatremia

A

treat with 3% IV saline
Lasix’s to pull off that fluid

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44
Q

Cancer treatments may need to be adjusted for what based on age

A

dose or intensity to treat older adults safely

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45
Q

general manifestations for cancer

A

Unexplained weight loss
Fatigue
Palpable masses
Swelling
Pain
Skin changes

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46
Q

BRCA1 and BCRA2

A

breast cancer genes that repair damaged DNA

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47
Q

education for cancer patients

A

Resource: oncology website

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48
Q

safe amount of radiation we can be around

A

ALARA: as low as reasonably achievable

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49
Q

oral care

A

chemo related mouth ulcers
good oral hygiene and mouthwash

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50
Q

hospice care

A

care for client who has a diagnosis of less than 6 months to live

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51
Q

palliative care

A

improve quality of life
may or may not receive treatment

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52
Q

code status

A

A client’s cardiopulmonary resuscitation (CPR) preferences.

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53
Q

how is death defined

A

cessation of both breathing and the heartbeat

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54
Q

stages of dying

A

early
middle
late

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55
Q

early stage of dying (four things!)

A

loss of mobility
decrease in the ability or desire to eat or drink
delirium
increased sleeping

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56
Q

middle stage of dying

A

continued decline in mental status
noisy respirations due to the pooling of mucus and saliva in the back of the throat and upper airways when the client is too weak to cough (DEATH RATTLE)

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57
Q

at what stage is the death rattle

A

middle stage of dying

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58
Q

late stage of dying (3 things!)

A

fever
periods of apnea
mottling of the skin (due to loss of peripheral circulation)

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59
Q

how long do the stages of death take

A

Clients will proceed through these stages at different rates, from 24 hr to over 14 days

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60
Q

“Good deaths” are typically considered

A

to be pain and distress-free

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61
Q

clinical death

A

the heart and lungs have ceased functioning, but the brain is still viable

function possibly restored with CPR

irreversible brain damage after 4 mins with no oxygen

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62
Q

when does irreversible brain damage occur

A

starts after just 4 min without oxygen, and death can occur as early as 4 to 6 min later

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63
Q

biological death

A

aka brain death

Occurs when heart and lung function has stopped permanently.

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64
Q

diagnosis of biological death

A

must have…

apnea
lack of brainstem reflexes
be in a coma for a known cause

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65
Q

what can biological death be a result from

A

intracranial or extracranial cause

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66
Q

most common intracranial cause of biological death

A

subarachnoid hemorrhage or traumatic brain injury (TBI)

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67
Q

most common extracranial cause of biological death

A

Cardiopulmonary arrest and inadequate CPR

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68
Q

Additional causes of biologic death include

A

head injury from blunt trauma or gunshot wounds, hanging, drowning, drug overdose, stroke, or aneurysm

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69
Q

pathophysiology of biologic death

A

decrease oxygen to brain (increase in edema in the brain) which then increases fluid to increase intracranial pressure and then leads to cerebral perfusion and subsequent herniation

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70
Q

herniation

A

Complete cessation of blood flow to the brain that causes death of brain tissue.

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71
Q

However, even as brain function is lost

A

lung and cardiac function can be prolonged through mechanical means

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72
Q

Clients must be declared brain dead to be eligible to be

A

vital organ donors

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73
Q

palliative care

A

receive medical care to improve the client’s quality of life by controlling significant manifestations of the disease while choosing not to receive curative, or traditional, treatments

Clients may also receive palliative care for manifestation management while continuing to receive curative medical care

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74
Q

two most common manifestations clients have that need palliative care

A

dyspnea and pain

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75
Q

hospice care

A

Hospice is used when the client cannot be cured or chooses not to be treated

doesn’t receive treatment, it is COMFORT CARE ONLY

usually started when the client has less than 6 months to live but is extended as long as needed

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76
Q

respite care

A

client to be admitted to facility to give their caregiver a break that can last hours to weeks

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77
Q

comfort care

A

any interventions to soothe and relieve suffering while respecting the client’s final wishes

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78
Q

comfort care interventions

A

manage SOB
administering meds for pain, nausea, anxiety or constipation
limiting med testing
ensuring emotional and spiritual support

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79
Q

palliative sedation

A

used when there are distressing manifestations in clients who are terminally ill or actively dying

indicated to provide relief from…

pain
agitation
anxiety

this cause of sedation is not to kill client or shorten lifespan

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80
Q

palliative sedation: medications

A

used to relieve the client’s respiratory distress, anxiety, and agitation

opiates
benzodiazepines
antipsychotics

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81
Q

what can meds from palliative sedation increase the risk of

A

this type of sedation can increase the risk of respiratory depression, aspiration, and possibly increased agitation from delirium.

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82
Q

manifestations of spiritual distress

A

depressed
scared
worried
fear of being alone

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83
Q

Causes of spiritual distress in clients during end of life

A

loss of identity and independence

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84
Q

HOPE

A

Hope
Organized religion
Personal spirituality and practices
Effects on medical care and end-of-life issues

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85
Q

advanced directive

A

Legal document used when clients are incapacitated and unable to voice their wishes.

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86
Q

There are several ethical principles applicable to end-of-life care

A

justice
nonmaleficence
beneficence
fidelity
autonomy

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87
Q

limitation of autonomy

A

client cannot make decision that will cause them harm

The provider cannot provide care requested by the client that will in fact harm the client.

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88
Q

terminal sedation

A

The purpose of terminal sedation is to relieve pain not responding to other interventions.

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89
Q

requirements for terminal sedation

A

must have terminal illness

must have severe, intolerable manifestations that are not responding to treatment

death is imminent

client has a DNR code status

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90
Q

medical aid in dying

A

client req provider to prescribe medication that causes client’s death

respect for autonomy and relief of suffering

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91
Q

Currently, no state allows MAiD in clients under

A

18 years old

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92
Q

requirements for MAiD

A

must live in state it is legal in
term illness expected to result in natural death in less than 6 months
make a request verbally more than once and written witnessed by a non-relative
capable of making own decisions
can self admin the medication prescribed

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93
Q

two types of advanced directives

A

living will
durable power of attorney

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94
Q

living will

A

document that informs health care providers what treatments the client desires if they are dying or if regaining consciousness is unlikely

allows the client to make their wishes known when they are unable to make their own decisions about available emergency treatment

95
Q

In the living will, the client typically documents if they would

A

allow or deny the use of a ventilator, CPR, dialysis, artificial hydration and nutrition, or comfort care measures

96
Q

durable power of attorney for health care

A

legal document used to designate a person as a health care proxy

This person is then legally able to make medical decisions for the client when the client is unable to or incapacitated

97
Q

Advance directives are legal documents, not…

A

medical orders

Advance directives state preferences for CPR but are not the same as code status orders such as Do-Not-Intubate (DNI) or Do-Not-Resuscitate (DNR) orders

98
Q

types of code status

A

full code
DNR
DNI

99
Q

full code

A

indicates that if a client’s heart stops beating or their respirations stop, the health care team will use full resuscitation measures to restore a heart rhythm and respiration

includes intubation, chest compressions, and defibrillation

assumed status unless otherwise stated

100
Q

DNR status is typically chosen by clients who

A

have multiple chronic diseases

101
Q

A DNI order does allow

A

basic CPR, meds, defibrillation, external pacemaker, and chest compressions

102
Q

DNI indications

A

no intubation or placed on ventilator

103
Q

withdrawal of MANH

A

Withdrawing or withholding nutrition or hydration.

104
Q

general changes in clients who are near death

A

weak and fatigue
drowsy and increased sleeping
disorientation
talking to dead people

105
Q

foods and fluids during impending death

A

client often begins to show a decrease in interest in food or fluids

weight loss and dehydration noted
difficulty swallowing (choking or coughing)

106
Q

urinary function during impending death

A

urinary output will decrease
may develop urinary incontinence
urine=dark and concentrated (from decreased fluid intake)

107
Q

skin changes in impending death

A

mottling (purple or dark pink webbed pattern, brown on darker skin)

pressure injuries from laying in bed

assess for breakdown/redness/etc.

108
Q

cardiac and circulation changes during impending death

A

decrease in cerebral perfusion (decreased LOC, delirium, etc)

decreased perfusion (mottling)

cyanosis in upper extremities

decrease in CO (leads to hypotension, tachycardia, and peripheral cooling of body)

109
Q

vitals during impending death (HR, BP, temp)

A

tachycardia
hypotension
low temp

110
Q

respiratory changes with impending death

A

secretions in pharynx and upper resp tract
death rattle
weak or absent cough
Cheyne-Stokes respirations

111
Q

Cheyne-Stokes respirations

A

Type of breathing pattern with cyclical hyperventilation and apnea.

shallow/rapid/apnea

112
Q

A nurse is caring for a client who is actively dying. Which of the following manifestations should the nurse expect?

A

decreased urinary output
confusion
mottling of skin

113
Q

management of manifestations: pain control (nonpharm vs pharm)

A

Nopharm: music therapy, massage, heat and cold therapy

pharm: admin of pain meds (morphine, ibuprofen), antidepressants, corticosteroids (methylprednisolone)

114
Q

end of life pain: morphine adverse effects

A

hypotension, confusion, bradycardia, constipation, respiratory depression, nausea and vomiting, hallucinations, and urinary retention.

slow to stand: can cause orthostatic hypotension

115
Q

end of life pain: ibuprofen adverse effects

A

headache, constipation, dyspepsia, nausea, vomiting, and prolonged bleeding time

HEMATURIA

116
Q

education with ibuprofen end of life pain

A

take ibuprofen with a full eight-ounce glass of water as tolerated and sit in an upright position for 30 min following administration

med can cause dizziness and drowsiness

117
Q

end of life care pain: methylprednisolone adverse effects

A

corticosteroid

pheochromocytomas, depression, euphoria, hypertension, decreased wound healing, hirsutism, adrenal suppression, hyperglycemia, leukocytosis, thromboembolism, osteoporosis, and cushingoid appearance

ELEVATED WBC COUNT

118
Q

opioid safety (monitor what & admin what for respiratory distress?)

A

Monitor clients who have received opioids for respiratory depression. Monitor oxygen saturation, respiratory rate, and effort frequently. Administer Narcan for respiratory distress

119
Q

treatment for dyspnea

A

opioids and bronchodilators
O2 therapy 2-3 liters
raise head of bed
use fan to circulate air in the room

120
Q

If the client develops anorexia

A

offer small amounts of a favorite food, if desired and tolerated

121
Q

anorexia

A

Decreased appetite.

part of dying process

122
Q

GI manifestations of impending death

A

anorexia and constipation

123
Q

constipation treatment

A

provide meds (stool softeners)
hydration
increase fiber
more mobility

124
Q

causes of fatigue in dying patients

A

depression
anemia
dehydration
infection

125
Q

Immediate changes to the body after death

A

absence of respirations, heart rate, responsiveness, voluntary movement, muscle relaxation, and nervous system functions

Algor mortis, rigor mortis, and livor mortis are usually noted 30 min to 3 hr following death.

126
Q

algor mortis

A

pale skin
loss of turgor
body cooling

127
Q

rigor mortis

A

muscle rigidity is noted

128
Q

livor mortis

A

discoloration in the dependent or lower areas of the body

129
Q

qualify as an organ donor

A

client must be brain dead

to confirm brain dead…
apena
coma of known cause
absent brainstem reflexes

130
Q

Types of Organs and Tissues Eligible for Donation

A

organs (kidneys, liver, lungs, heart, pancreas, intestines)

corneas

tissues (middle ear, heart valves, bone, veins, ligaments, tendons, cartilage, skin)

hands and face

Bone marrow, cord blood, blood stem cells

Blood and platelets

Live organ donation (One kidney, one lung, part of the liver, part of the pancreas, part of the intestine)

131
Q

Priorities for the donor’s care include

A

preserving a patent airway, normal body temperature, and adequate organ and tissue oxygenation and perfusion while also maintaining fluid and electrolyte balance and preventing complications.

132
Q

resources for grief in losing a child

A

support groups
written educational materials about grief and loss
referrals to therapists and grief counseling

133
Q

therapeutic communication with losing a child

A

listening to parents
allow enough time to process information
using simple terminology

134
Q

nonverbal factors at play in cross-cultural communication that the nurses may not be aware of

A

facial expressions, posture, body language, gestures, concepts of time and personal space, tone of voice, and eye contact.

135
Q

What is the nurse’s responsibility for facilitating communication with clients who are not fluent English speakers?

A

The nurse must ensure the presence of a ​​​​medical interpreter when clients and the nurse do not speak the same language.

136
Q

Work-related stress is described as

A

one of the most serious occupational hazards

137
Q

personal traits that influence grief

A

moodiness, emotionality, guilt, and anxiety

138
Q

difference in palliative care between adult and peds

A

peds: parents are making the decision most likely and not the client themselves

139
Q

primary goal of pallative care is to

A

improve the client’s quality of life

140
Q

initiation of hospice care

A

when a client has a terminal illness and is not expected to live more than 6 months

141
Q

concurrent care

A

hospice services are provided to address the client’s comfort and the family’s need for education and support while potentially curative therapies remain underway

142
Q

when children receive hospice or palliative care…

A

they are more likely to die at home than in the hospital

143
Q

pain assessment for neonates

A

N-PASS

Neonatal Pain and Sedation Scale

144
Q

Wong-Baker Pain Rating Scale

A

use for children as young as 3 and IDEAL for those 6 and older

145
Q

rFLACC scale

A

observe 1-5 mins while awake and at least 5 mins while asleep

146
Q

ped pain therapies (non pharm)

A

dance
art
music
massage
guided imagery
progressive relaxation

147
Q

ped pharm therapies for pain

A

least invasive route should be used
Parents should be screened for any history of substance use disorder if client is going home

148
Q

opiates to mainstay pain in pallative care in peds

A

start at lowest dose and adjust as needed

Depending on the source of the pain, corticosteroids, nonsteroidal anti-inflammatory medications, topical anesthetics, ketamine, and antiepileptic medications may also be used

149
Q

what should not be used in pain management regiments in children

A

aspirin and codeine

150
Q

what medications to look over for pain management in palliative care in children?

A

hydromorphone
morphine
fentanyl
ibuprofen
ketorolac
naproxen
prednisolone
prednisone
dexamethasone

151
Q

common side effect of opioids

A

constipation

152
Q

other common side effects of opioids include

A

sedation
N+V
sweating
pruritus
dry mouth

other possible:

muscle twitching, hallucinations, urinary retention, depressed mood, and respiratory depression

153
Q

pruritus

A

itchiness

154
Q

Which of the following categories of medication should be initiated with an opiate regimen for management of adverse effects?

A

stool softeners

because constipation is a very common side effect of opiates!

155
Q

If the child has been receiving opiates and has developed tolerance

A

ketamine may be an effective adjunct medication for pain (Hauer, 2023).

156
Q

manifestations of the dying process
(Psychological and neurological) (all can use what Tx?)

A

agitation
anxiety
seizures

all of which are treated with benzodiazepines

157
Q

Phenothiazines such as promethazine, prochlorperazine, and chlorpromazine produce

A

extrapyramidal effects

Dyskinesias and Parkinson-like manifestations resulting from the blockage of dopamine.

158
Q

meds to look over for treating nausea in children

A

Promethazine
Prochlorperazine
Chlopromazine
Diphenhydramine
Ondansetron

159
Q

manifestations of the dying process

A

anorexia
decrease LOC
changes in rate, rhythm, and character of breathing
mottling of skin
irregularity in heartbeat
incontinence

160
Q

Nursing responsibilities for dying expected manifestations

A

swabbing and moisturizing the client’s mouth, reassuring the family about comfort measures being done for specific manifestations of the disease process, positioning the client to promote drainage of oral secretions, and regular changes of linen and absorbent padding

161
Q

If the child was under hospice care at the time of death,

A

hospice standards mandate that bereavement services be offered to the family for at least 13 months, including developmentally appropriate services for siblings

162
Q

caring for client with malignant neoplasm of the right breast. where should the nurse put port

A

on the opposite side of the primary site of the cancer

163
Q

ABCDE of melanoma

A

Asymmetrical
Borders uneven
Color (dark brown and varies, might be blue)
Diameter: greater than 6mm
Evolution: changed from primary notice

164
Q

where does BCC originate

A

basal layer of the epidermis

165
Q

where does melanoma originate

A

melanocytes

166
Q

which skin cancer is most likely to metastasize to other cancers

A

melanoma

167
Q

is squamous cell carcinoma a small cell or non-small cell lung cancer

A

is it a non-small cell lung cancer
mostly likely originates in one the large central airways
most often caused by smoking

168
Q

which test to do to follow up and monitor treatment of someone with colorectal cancer

A

carcinoembryonic antigen (CEA) test

169
Q

common manifestations of spinal cord cancer

A

loss of coordination
bladder and bowel control issues
numbness in the limbs
generalized weakness

170
Q

stage 0 colorectal cancer

A

innermost layer of GI tract
just the mucosa layer

171
Q

actinic keratosis

A

precancerous
can lead to squamous cell carcinoma!

172
Q

a client who is diagnosed with Crohn’s disease is at higher risk for what cancer

A

colorectal cancer

173
Q

The client who has experienced biologic death has

A

apnea, lacks brainstem reflexes, and is in a coma.

174
Q

according to birth, who is more at risk

A

nulliparous

175
Q

what is the brain divided into

A

two hemispheres and five lobes
two glands

176
Q

what are the five lobes of the brain

A

frontal
parietal
occipital
temporal
insula

177
Q

what are the brain’s two glands

A

pineal
pituitary gland

178
Q

spinal cord

A

housed within the vertebrae
has 31 segments
each segment is a pair of spinal nerves

179
Q

meninges

A

cerebrospinal fluid and connective tissue membranes surround components of the CNS
meninges havce three layers

180
Q

three layes of the meninges

A

dura mater
arachnoid
pia mater

181
Q

dura mater layer of the meninges

A

the outer layer
made of sturdy connective tissue

182
Q

arachnoid layer of the meninges

A

middle layer
thin, cobweb like layer that attaches to the middle layer

183
Q

pia mater layer of the meninges

A

inner layer
thin membrane that is securely attached to the brain and spinal cord

184
Q

patho of brain cancer

A

cell damaged (inherited or environmental)

185
Q

common brain tumors include (that we need to know)

A

meningioma
pituitary tumor

186
Q

meningioma

A

a brain and CNS tumor that arises from the meninges

187
Q

pituitary tumor

A

tumor that occurs in the pituitary gland

188
Q

do primary CNS tumors usually metastasize

A

no

189
Q

risk factors for CNS tumors

A

few links with risk factors but…

vinyl chloride exposure
smoking
some dx like ( neurofibromatosis, tuberous sclerosis, and Li-Fraumeni syndrome)

190
Q

are most brain tumors benign or malignant

A

most are benign, about 29% are malignant

191
Q

common manifestations of brain tumors

A

onset seizure (common)
N/V
visual changes
balance problems
behavior changes
drowsiness
coma
hearing loss
weakness
numbness
difficulty swallowing

192
Q

spinal cord tumors manifestations

A

coordination problems
bladder and bowel issues
weakness
numbness

193
Q

do males or females have a higher mortality rate with CNS cancers

A

males

194
Q

spinal vs brain tumor manifestations

A

know that bladder and bowel are for spinal!
and headache and vision changes etc are for brain tumors

195
Q

The imaging modalities used most frequently to diagnose brain and spinal cord tumors are

A

CT and MRI scans

196
Q

Because lung cancer often metastasizes to the brain

A

a chest x-ray is necessary to assess for a lung mass that could be the primary cancer

197
Q

biopsies for brain cancer

A

worried about cancer calls in the cerebrospinal fluid (CSF) so a lumbar puncture can be obtained

198
Q

myelogram

A

uses an injectable dye to better visualize the spinal cord on an x-ray

199
Q

chemo meds for brain and CNS tumors

A

IV
PO
directly into the brain

200
Q

side effects of radiation for brain tumors

A

headaches, alopecia, nausea, vomiting, fatigue, hearing loss, skin and scalp changes, difficulty with memory and speech, seizures, brain swelling, memory loss, and stroke-like manifestations

201
Q

preop education for brain surgery

A

stop blood thinners and antiplatelet agents

202
Q

Brain and CNS cancer treatment options include

A

active surveillance, surgery, chemotherapy, radiation, and targeted therapy

203
Q

active surveillance for brain tumors

A

tumors are slow growing and not causing problematic sx

204
Q

surgery for brain and CNS tumors

A

remove a tumor partially or fully, especially when it is necessary to decrease pressure on the brain caused by the tumor (

205
Q

chemo for brain and CNS tumors

A

when chemo can cause the blood-brain barrier, IV chemo is used
chemo wafer is used (med directly into the tumor site)

206
Q

admin what meds for brain and CNS tumors

A

meds to lower intracranial pressure

207
Q

what meds decrease intracranial pressure for brain and CNS tumors

A

diuretics (reducing fluid volume in the brain)
corticosteroids (decreased swelling)
antiseizure meds (levetiracetam and phenytoin)

208
Q

imminent brain death

A

score of three of the Glasgo Coma Scale and the absence of a minimum of three brain stem reflexes (corneal reflex, cough and gag, pupil to light, and pain response)

209
Q

when should organ donation begin

A

only when the client has died! do not bring it up until client has died

210
Q

what do anxiolytics treat

A

anxiety

211
Q

medicaid covers how long in children who are dying

A

6 months

212
Q

cardiac function may be present in

A

neurological death

213
Q

neurological death vs cardiac death

A

neurological- irreversible (lack of brainstem reflex but cardiac function may still be available)

cardiac- all circulatory and respiratory functions have stopped and it is ALSO irreversible

214
Q

two types of HIV

A

both types can cause AIDS

215
Q

patho of HIV

A

virus enters…
monocytes
macrophages
and CD4 lymphocytes
basically causes immunosuppression.

216
Q

how does almost all HIV infections in infants develop

A

through vertical transmission (Transmission of a pathogen from a mother to a baby during the period immediately before and after birth)

217
Q

average lifespan of a child with HIV

A

is about 10 years

218
Q

most HIV related deaths in infants and children result from

A

immune system dysfunction
high risk for…
opportunistic infections (Pneumocystis pneumonia and Candida esophagitis)

219
Q

Pneumocystis pneumonia and Candida esophagitis.

A

use of antiretroviral medications can lead to…
hyperbilirubinemia
anemia
overall decreased WBCs
high blood sugar

220
Q

A nurse is caring for a pregnant client who has HIV. Which of the following is most important for this client?

A

Prevention of vertical transmission

221
Q

what race is most likely affected by anancephaly?

A

Hispanic

222
Q

type l lissenecephaly

A

the cerberal cortex has four layers INSTEAD of the expected six layers

223
Q

type ll lissencephaly

A

have disorders of the muscles and eyes

224
Q

90% of clients with lissencephaly will develop what

A

epilepsy

225
Q

what do seizures from lissencephaly require

A

multiple anticonvulsants

226
Q

how are most inborn errors of metabolism identified?

A

through the manifestation of neurological anomalies

227
Q

what will most people with inborn errors of metabolism experience

A

developmental delays and seizures

228
Q

common manifestation of CF

A

salty skin

229
Q

a common theme among clinicians with death of a ped pt

A

they might think of their client when interacting with their own children and put themselves in the position of the families they care for

230
Q

personal and individual characteristics that make staff more vulnerable to burnout, including…

A

younger age
fewer years of experience
lower education level
anxiety
working nights

231
Q

palliative sedation meds

A

opiates
benzodiazepines
antipsychotics

232
Q

what can palliative sedation lead to

A

increase risk for…

respiratory depression
aspiration
agitation and delrium

233
Q

hisutism

A

excessive hair growth in women

234
Q

dyspepsia

A

indigestion

Fundamentals SEM2 (7 decks)

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