Cancer/Final Exam Flashcards
(207 cards)
1
Q
Pathophysiology of Cancer
A
When the cell is dividing DNA malfunctions. The abnormal cells do not die and continue to reproduce. Overgrowth of cells.
Oncogene is activated as result of DNA mutation > tumor suppression is disabled by cancer, the cell keeps dividing (in normal circumstances in inhibits cell division when there is an abnormal cell) > cellular mutation (DNA)
2
Q
Stages of cancer development
A
Initiation: irreversable mutation to DNA
Promotion: mutated cells stimulated to divide
Progression: increased growth (speed and invasiveness)
3
Q
Normal Cells Vs. Cancer Cells
A
Normal cells: contact inhibition, develop differentiation, contribute to homeostasis
Cancer Cells: no contact inhibition, poorly differentiated (anaplastic - divide rapidly), do not contribute to homeostasis.
4
Q
Benign Tumor
A
Local (does not spread) Well defined borders pushes other tissue out of the way slow growth encapsulated easily removed does not tend to recur
5
Q
Malignant Tumor
A
invasive doesn't stop at tissue border (spreads) invades and destroys surrounding tissue rapid growth metastasizes to distant sites not always easy to remove can recur
6
Q
How can tumors be classified?
A
I. origin
II. specific type of tissue it originates
III. grade
IV. stage - according to TNM system
7
Q
carcinoma definition
A
cancer of epithelial tissue - most common
8
Q
Sarcoma definition
A
cancer of connective and supportive tissue (bone, cartilege)
9
Q
myeloma definition
A
plasma cells cancer (bone marrow)
10
Q
leukemia definition
A
blood (aka liquid cancer)
11
Q
lymphoma definition
A
lymph node cancer (AKA solid cancer)
12
Q
Grading of cancer
A
higher the grade (grade 4) worse prognosis
13
Q
Classification by stage
A
T: size of tumor (1-4)
N: lymph nodes (0-3)
M: metastases (0 or 1)
14
Q
Calcium normal value
A
8.5-10
15
Q
metabolic cancer complications
A
Humoral Hypercalcemia of Malignancy (HHM)
- increased calcium levels D/T bone resorption
Symptom of Inappropriate Antidiuretic Syndrome
- impaired h2o excretion. Increased absorption of urine, pt. .cannot urinate. Edema, low sodium
Tumor Lysis Syndrome
- rapid release of intracellular content into blood (h2o, protein)
- rapid shrinkage of tumor D/T treatment
- excess thirst, muscle weakness, cramps
16
Q
Hematologic Cancer Complications
A
Febrile Neutropenia
- decreased neutrophils, WBC low
- patient can get infection easily
Hyperviscosity Syndrome
- increased blood viscosity leading to decreased blood flow
- D/T tumor or treatment
- @ risk for DVT, PE, clot
17
Q
Structural Cancer Complications
A
Superior Vena Cava Syndrome
- compromised venous drainage D/T obstruction
- dypnea, chest pain
- raise HOB
Malignant Epidural Spinal Cord Compression
- when cancer metastasize to spine
- neuropathy, numbness
Malignant Pericardial Effusions
- extra fluid collects inside sac around heart D/T cancer in pericardia, lungs
18
Q
Diet to avoid cancer
A
- avoid processed food
- increase fiber
eat balanced diet
19
Q
Prevention of Cancer
A
- healthy diet
- smoking cessation
- sunscreen
- physically active
- limit alcohol
- regular screening
- vaccinate against Hep B and HPV
20
Q
Cancer Treatment Goals
A
- cure
- palliation
- control
21
Q
Chemotherapy Overview
A
- treatment of choice for malignancies
- systemic or local
- cytotoxic drugs
- interfere with DNA synthesis and mitosis
22
Q
Chemotherapy Administration
A
Oral, injection, infusion
Central catheter or port, no infusion on reg. IV D/T necrotizing tissue if infiltrated
Extravaasation, vesicant
Special PPE, must be certified to admin Chemo, 48-72 hours patient has hazardous waste
23
Q
Chemotherapy Side Effects
A
Immunosuppression - most significant. Monitor neutrophil/WBC
Neurological symptoms (confusion, brain fog)
GI symptoms (N/V)
Alopecia
Weight loss
Reproductive organs impacted - early menopause
24
Q
N/V Nursing Management
A
Most common side effect of chemo
Give antiemetics (ondansetron, metoclopramide, dexamethasone)
Decrease food order, give small amount of bland food/fluids
Encourage high protein, high carb diet, SFF
medications to stimulate appetite
25
Mucositis (stomatitis) Nursing Actions
Encourage fluids and nonstimulant foods, avoid extremely hot/cold foods
Oral care- soft toothbrush
Oral cryotherapy - ice cube in mouth 30 min prior to chemo
26
Constipation Nursing Actions
High fiber diet
Encourage fluids
ambulate
stool softener as ordered
27
Diarrhea Nursing Actions
Low residue diet - small meals
encourage fluids
anti-diarrheal meds as ordered, probiotics containing lactobacillus
maintain good skin care
28
Anemia/Fatigue Nursing Actions
teach pt to avoid over exhaustion, conserve energy, rest
remain active
encourage adequate nutrition
O2 as ordered
colony stimulating factors as ordered - epoetin alfa (epogen, procrit)
29
Leukopenia Nursing Action
Assess absolute neutrophil count
good handwashing and hygene of patient
private room, no fresh flowers
was fruits and veggies, no raw eggs or meat
avoid crowds/sick people
good room ventilation
colony stimulating factors (filgrastrim (Neupogen), argramostim (Leukine))
30
Thrombocytopenia Nursing Actions
```
Observe for bleeding
Apply pressure at venipuncture sites for 5 mins
avoid IM or subQ injections
Avoid sharp objects
avoid use of NSAIDS
platelets as ordered
```
31
Alopecia Nursing Management
Tell patient ahead of time
suggest scarves, hats, wigs
remind hair loss is temporary
32
Radiation Overview
Localized
- internal, external, systemic
Sealed Sources
- placed inside body
External Beam
- outside body
Stay away 6 ft. Thicker PPE
33
BPH
not cancer yet.
Prostrate enlargement
Decrease outflow of urine D/T urethra obstruction
Nodules in prostrate gland, hyperplasia of stromal/epithelial cells
bladder wall becomes thickend D/T incrased pressure of urine remaining in the bladder
androgen levels decreased with age
increased estrogen possible cause
34
BPH Risk Factors
- age (old age)
- diabetes
- overweight (d/t hormones stored in fat, increased intraabdominal pressure)
- erectile dysfunction (not cause BPH, BPH cause this)
- family hx
35
S&S of BPH
- weak urine stream
- frequent urination
- dribbling after urinating
- urge to urinate
- leakeage of urine
- nocturia
36
BPH Precautions
- reduce alcohol ( it contricts bladder)
- decrease salt (causes retention, UTI)
- do not allow bladder to get full
- perform kegal
- avoid use of androgens if sex steroid therapy
37
BPH Diagnostics
```
DRE (digital rectal exam)
PSA
Uroflow
Bladder Scan
Cystoscopy
Prostate ultrasound
```
38
Pharmacology BPH
Alpha-Adrenergic Blockers
- Tamsulosin (flomax) - relax bladder muscle
- Terazosin (Hytrin) - relax BV
Alpha-Reductase inhibitors
- Finasteride (Proscar) - decrease size of prostrate
39
Surgery BPH
-Transurethral Needle Ablation (TUNA)
Shrinks prostrate, allows urine to flow
Foley for up to 4 weeks
may suffer from retrograde ejaculation
- Transurethral Resection of the prostate (TURP)
a lot of trauma/blood
continuous bladder irrigation
removal of prostate gland through penis
may suffer from retrograde ejaculation
TURP syndrome - excessive absorption of electrolyte-free irrigation fluids. Low Na. Life threatening
40
Postoperative Nursing Care
```
Avoid heavy lifting
Avoid NSAID
Void as soon as urge
Drink 2000-3000 mL fluids/day
avoid alcohol, caffeine, spicy foods
```
41
Prostate Cancer
Most common cancer in men
Adenocarcinoma
Prostate makes fluid for semen
metastasis common to lymph node/bones
42
Prostate Cancer Risk Factor
Age (D/T decreased androgen)
Race (african american, carribean)
family hx
obesitiy (high level of insulin like hormone)
smoking
environmental exposure (fertilizer, smoke)
diet (high dairy, processed meat)
43
Prostate Cancer Manifestation
```
asymptomatic early
dysuria
polyuria
nocturia
hematura/hematospermia
discomfort/pain while sitting
ED
```
44
Prostate Cancer Diagnostic
```
PSA
DRE
Early Prostate Cancer Antigen-2 (look for increased protein)
Gleason Scale (higher # worse prognosis)
trans rectal ultrasound
```
45
Pharmacology Treatment Prostate Cancer
- Hormone Therapy (most common)
- Androgen Suppression/deprivation therapy
- leuprolide acetate, degarelix
Anti-Androgens; androgen receptor blocker
- flutamide
46
Colon Cancer
most in rectum, sigmoid
| adenomatous polyps develop into adenocarcinoma
47
Colon Cancer Risk Factor
```
IBD
Family hx
genetics (familial adeonmatous polyposis, lynch syndrome)
lifestyle (sedentary)
diet (high fat, low fiber)
obesity
alcohol/tobacco
```
48
Colon Cancer S&S
rectal bleeding
weight loss
changes in bowel habits
cramping, pain, anemia
49
Colon Cancer Treatment
Chemotherapy - leucovorin with fluorouricil
radiation - in combination with chemo
targeted therapy
immunotherapy - pembrolizumab
palliative care
50
Vascular Endothelial Growth Factor (vegf)
Targeted therapy
protein that helps tumor form new blood vessels - targeted drugs will stop)
Epidermal Growth Factor (EGFR)
protein that helps cancer cells grow - targeted drugs will block receptors
51
Endoscopic Mucosal Resection
for polyps > 10 mm (1 cm)
52
Health Screening Colon
sigmoidoscopy every 5 years or colonoscopy every 5-10 at age 50.
screenings start at age 45
53
Lung Cancer
leading cause of cancer death
mutation of damaged bronchial epithelial cells into neoplastic cells
chronic irritation - hyperplasia of goblet cells - cilia less effective
if irritation continuous basal cells proliferate
54
Risk Factors for Lung Cancer
```
smoking
2nd hand smoke
radon
environmental factors
radiation therapy
diet
```
55
S&S of lung cancer
```
persistant cough
SOB
coughing up blood
weight loss
repeated resp infections
shoulder, arm, chest, back pain
```
lung cancer metasizes to spine
56
Lung Cancer Treatment
targeted drugs
immunotherapy - pembrolizumab
chemotherapy - methotrexate, cisplatin, paclitaxel
radiation
sx: lobectomy, pnumoectomy, wedge resection, segmental resection
57
Breast Cancer
most common cancer in women
| overgrowth of cells cause tumor
58
noninvasive breast cancer
not yet spread into blood or lymphatic system
ductal carcinoma in situ - milk duct
lobular carcinoma in situ - milk gland
59
invasive breast cancer
spread to sorrounding breast tissue
invasive ductal carcinoma more common
invasive lobular carcinoma less common
60
risk factors breast cancer
```
gender
age (40 +)
hormones
environmental
family hx BRCA 1 BRCA 2
```
61
modifiable risk factors breast cancer
```
alcohol
smoking
sedentary
oral contraception
use of chemical hair products
```
62
manifestations of breast cancer
hard, immobile, irregular lump common on upper outer quaderant
abnormal nipple discharge/ rash
dimpling
nipple pain, ulceration, retraction
63
screening breast cancer
self exam
mammogram screening 40-44
annual 45-54
every other year 55+
64
Breast Cancer Pharmacotherapy
hormone therapy - selective estrogen receptor modulator
- tamoxifen citrate
targeted drugs - tratuzmab
chemotherapy - doxorubicin
radiation
65
postoperative care breast cancer
```
elevate effected arm
prevent fluid accumulation
pain med schedule
promote lymphatic drainage
ROM
```
66
Curative Care
purpose is to cure a disease
| cure is acheivable
67
Palliative Care
comfort care
goal is to focus on quality of life for pt and family
includes prevention, relief, reduction
could transition to hospice
68
Hospice Care
care, comfort, quality of life with person with serious illness approaching end of life
six months or less left to live
final phase of palliative care
69
Self Determination Act 1990
law requiring health care to inform patient about advanced directive especially with terminal illness
done with social worker
required upon admission to health care institution by federal law
right to accept or refuse medical care
70
advanced directive
legal document
2 witness and notary required
planning for future care based on pt. values, belief, and preferences
no expiration under Ohio law
takes effect when patient permanently unconscious
71
medical power of attorney
legal document
patient designates individual to make all healthcare decisions
takes effect when patient can no longer make informed healthcare decisions
attending physician must certify patient is unable to make own decision
72
living will
"wishes"
legal document
states treatment preferences when patient unable to make decision/choices on own
describes under what conditions an attempt to prolong life should be started or stopped
73
DNR CC
person receive any care to alleviate suffering but no resuscitative measures to sustain life
74
DNR CC - Arrest
patient receive care until the time he/she experiences cardiac or respiratory arrest
abscense of palpable pulse
absence of spontaneous respiration
75
Assisted Suicide
end of life options act - california
physician can decline d/t moral, religious views
76
uniform determination of death act
defines death
irreversable cessation of circulatory and respiratory functions - clinical death
irreverseable cessation of all functions of brain including brain stem - biological death
77
Bereavement
Experience of losing a loved one
78
Grief
intense physical and psychological distress
avoidance (MOST Common)
confrontation - reality sinking in
restoration: restore balance
79
Coping
```
permission to feel loss
accept social support
be realistic about course of greiving
remeber the deceased
when ready, invest in new activities
```
80
Role of the nurse during end of life
6 C's
```
care
control
composure
communication
continuity
closure
```
81
Grief Reactions
```
denail/isolation
anger
bargaining
depression
acceptance
```
82
Caring For Client
effective communication
avoid too strict of a routine
encourge communication
explore with family ways to communicate with pt
83
Family Care
```
give little information at a time
allow family to assist in non technical aspects of care
encourge rest
show acceptance of grief
prepare family for changes
```
84
signs of imminent death
altered LOC (most common)
vitals decrease
changes in breathing (dyspnea, chyne stokes, death rattle)
skin changes (cyanosis, motling, xerostomia)
sensory changes - illusions, hallucination,dealusions of grandeur
near death awareness
give atropine/scopolamine for death rattle
85
Ethics definition
system of moral principles that attempt to determine what is right and wrong
86
morals definition
basic standards for what is considered right or wrong
defined by larger group or society
authority comes from outside individual
law reflects moral values of society
personal/private standards of right/wrong
87
values definition
personal beliefs about truth and worth that form our morals
values conflict: when we must choose between two things, both of which are important to use
88
values clarification definition
process of identifying, examining, developing invidual values
ongoing
89
ethical dilemma
when an individual must choose between two equally unfavorable alternatives
90
beneficence definition
obligation to do good, not harm
91
nonmaleficence definition
prohibition of intentional harm
92
justice definition
fairness, obligation to treat like cases similarly
93
fidelity definition
obligation to be faithful
| keep promises
94
veracity definition
tell the truth, don't intentionally mislead patient
95
Futility definition
do not have a potential for creating a positve outcome
96
deontology
morality of an action is based on the intention behind the decision rather than the outcome that results
97
utilitarianism
supports what is best for most people. The greater good. medicare. disaster triage
98
ANA Code of Ethics
statement of ethical obligation and duties of a nurse
non-negotiable ethical standards
guides the behavior of professional nurse
99
Provision 1
practice with compassion and respect
100
Provision 2
primary commitment is to the patient
101
Provision 3
nurse promotes and advocates for the rights of patient
102
Provision 4
responsibility and accountability for each nurse's action belong to the nurse
103
Provision 5
maintain competence
104
Provision 6
responsible for ethical environment
105
Provision 7
advance nursing profession through research and scholarly inquiry
106
Provision 8
collaborates with others
107
Provision 9
maintain integrity of profession
108
Pneumonia Interventions
```
antibiotic, antifungal, antiviral
bronchodilators
mucolytics, expectorants
IV fluids
O2
diet high in protein
rest
chest physiotherapy
```
109
pneumonia manifestations
```
headache
mood swings
confusion
dyspnea
cough
crackles
sputum
hemoptosis
hypoxia
tachycardia
fever
chills
malaise
```
110
pneumonia pathophysiology
affects the parenchyma
caused by aspiration of particles through nasopharynx which get trapped in cilia and lead to aveolar edema. Causes hypoxia and dyspnea
111
Pneumonia Diagnostic Tests
```
CBC
sputum culture
urine test
PCR
CT scan
```
*look for neutrophils*
112
metabolic alkalosis causes
over use of antacids
diuretic therapy
loss of acid via GI tract
113
metabolic acidosis causes
```
diabetic ketoacidosis
hyperchloremic aciosis
kidney disease
lactic acidosis
aspirin poisoning
dehydration starvation
```
114
Respiratory alkalosis causes
hyperventiliation
stimulation of respiratory center
exhaling too much CO2
115
respiratory acidosis causes
airway obstruction
depression of respiratory center
chronic respiratory problems
116
Uncompensated vs. partially compensated vs. fully compensated
Uncompensated: pH abnormal, either HCO3 or CO2 normal, either HCO3 or CO2 abnormal
Partially Compensated: pH abnormal, both CO2 and HCO3 abnormal
Full Compensation: pH normal, both CO2 and HCO3 abnormal
117
HCO3 Normal Range
22-28
above 28 = alkalosis
below 22 = acidosis
changes in HCO3 indicate metabolic disturbances
118
PaCO2
normal 35-45
above 45 = acidosis
below 35 = alkalosis
move in opposite direction of pH
indicate respiratory
119
pH
normal 7.35-7.45
less than 7.4 acidosis
greater than 7.4 alkalosis
120
COPD diagnostic findings
```
- ABG - respiratory acidosis
CBC increased RBC
decreased FEV1
decrease FVC
increased RV
increased airway resistance
```
diagnosed as FEV1/FVC ratio of less than 70% in addition to manifestations
121
Bronchitis Symptoms COPD
- productive cough
- cough that lasts longer than 3 months
- fatigue
- dyspnea
- cyanosis
- rhonci
122
COPD patho
bronchitis: loss of cilia leads to hypertrophy/hyper secretion in goblet cells/mucous glands. Chronic inflammation occurs and obstructs airflow
emphysema: yperinflation of lungs, respiratory acidosis
breakdown of elastin in lung tissue leads to increased size of airspace. Increase of alveolar space causes loss of elastic recoil, air trapping, and imbalance of lung proteases. Diffuse airway narrowing.
123
emphysema symptoms
- Wheezing
- Cough
- use of accessory muscles
- increased respiratory rate with prolonged expiratory phase
- anorexia/weight loss
- wheezing
124
Increased Intacranial Pressure Manifestations
increased BP
decreased MAP
slow breathing
125
What is the Monroe-Kellie Hypothesis?
Cerebral spinal fluid, intravascular blood, and brain tissue must all exist in equilibrium. If there is a change in any of these, it will result in IIP.
126
normal ICP
5-15
127
normal MAP value
65-105
128
normal CPP
50-100
129
What causes IIP?
- intracranial mass lesions (tumors)
- cerebral edema
- increased CSF production
- decreased CSF absorption
- obstructive hydrocephalus
- obstruction of venous outflow
- idopathic ICH
130
Cushings Triad
- HTN
- bradycardia because of compression of vegas nerve
- bradypnea because of compression of brain stem
131
IIP Clinical Manifestations
ALOC - most sensitive indicator
-headache, drowsiness, pupillary changes, widening pulse pressure, purposeless movements, hyperthermia (late stage), posturing
132
Mannitol
used for IIP
Osmotic Diuretic, pulls h2O out of brain. It begins to lower ICP in 1-5 minutes. Measure I&O while on it - normal urine 30 mL/hour
Thins blood
Starting dose 1.5-2 g/kg IV infusion
133
What is the pathophysiology of a stroke?
blood flow to an area of the brain is cut off
134
What are some risk factors for a stroke?
> 65, men, HTN, DM, smoking
135
ischemic vs hemorraghic stroke
ischemic: bloackage D/T tumor/clot
hemorrahic: bleeding into brain
136
What is a transient Ischemic attack?
a mini stroke. blood flow to the brain is blocked for only a short time. caused by blood clots. if not treated 10-15 % will have a major stroke within 3 months
137
What are some risk factors for a stroke?
lack of excercise, sleep apnea, heavy alcohol, smoking/drugs, diabetes, cardiovascular disease, high cholesterol, HBP, obesity
138
Stroke Pharmacology
Thrombolitics (TPA), blood thinners (anti-platelet, anticoagulants) - w/i 4 hours of stroke
BP lowering meds (ACE, ARB, B Blockers, Ca Channel blockers, diuretics)
Cholesterol lowering medications (fibrates, niacin, resins, statins)
139
What is TPA?
"clot buster" AKA alteplase. Gold standard for ISCHEMIC stroke, contraindicated for hemorrhagic.
Must lower SBP <185 and DBP <110
No major surgical procedures within 14 days
140
What is osteoporosis?
Chronic, progressive, metabolic bone disease resulting in decreased bone density. Bone reabsorption (osteoclast) exceeds bone deposition (osteoblast)
vitamin D an calcium deficient
141
Does osteoporosis have symptoms?
Yes, but it's usually a silent disease
| Symptoms are: height loss, dowager's hump, low back pain, fragility related fractures
142
What are risk factors for osteoprosis?
```
After 35
women
disease: DM, HTN, kidney disease
Lifestyle
Smoking
Excessive alcohol: slows osteoblast and liver dysfunction - liver imp. for activating Vit. D
Diet low in Ca
Excessive caffeine : increased urination of Ca and Vit D
```
143
What medications are a risk factor for osteoporosis
Corticosteroids - affect absorption of Ca and increase osteoclast
Antiseizure drugs
Aluminum coated antacids
Excessive thyroid hormotes
144
What medication would be prescribed for osteoporosis?
Bisphosphanates (fosamax)
calcitonin (miacalcin)
Calcium and vitamin D
145
What is a good diet for someone with osteoporosis?
dairy, spinach, canned salmon, sardines
146
What are some preventive measures someone with osteoporsis can take?
Exercise - 30 min/day
Heat therapy
smoking cessation
avoid alcohol
147
what is osteoarthritis?
alteration of bone remodeling process. cartilage that cushions ends of bones wears down. Hands and weight bearing joints are effected. Caused idiopathic or secondary
148
OA clinical manifestations
pain with joint movement, stiffness, crepitus, hypertrophied joints, heberden's node, bouchard's node,
149
OA risk factors
```
Over 55
BMP
Repetitive stress
Women
obesity
work related - poor posture
genetic influences
```
150
OA Diagnostic studies - Labratory
synovial fluid - remains clear/yellow
CRP increased
ESR increased
151
OA Pharmacology
Acetominophen: 4g/4000 mg /day
NSAID: watch for GI bleed
COX-2-Inhibitor: newer NSAID, antirheumatic
Corticosteroids: harmful effects on cartilege, only give 3-4 injections/year
Topical NSAID: Icy hot
Glucosimine, chondrotin: dietary supplement, decrease pain
152
Joint Surgery potential complications
```
DVT
Compartment Syndrome - very painful
Infection
Bleeding - monitor H&H
dislocation - position properly, proper transfer
```
153
What is Rheumatoid Arthritis?
Autoimmune disease
marked by periods of remission/exaceration
Effects small joints, synovial joint lining. Synovial fluid becomes inflammed
154
RA clinical manifestations
Early stage: paraesthesia, anorexia, night sweats, weakness, warm/swollen/painful joints, mild/moderate pain
Late stage: joint stiffness, atrophy, chronic pain, multiple organ involvement
155
RA Labratory Test
```
Rheumatoid Factor - increased
CBC- WBC increased
ANA: positive
Anti-CCP antibodies - positive
Synovial Fluid: cloudy
```
156
What is a good diet for someone with RA?
cardiac diet, low cholesterol, low sodium
157
RA pharmacology
NSAID, corticosteroids for acute exacerbation, DMARD
158
Politics definition
The way in which people in a society try to influence decision making and the allocation of resources (money, time, personnel)
159
Expert Power
possessing the knowledge/skill that someone else needs
160
legitimate power
power bestowed by a particular status or role
ex. RN license
161
referent power
gained by having others admiration/respect
162
reward power
anything desirable - promotion, award, etc.
163
coercive power
based on the ability to punish
164
8 ways to influence political process
1. become informed
2. vote for those who reflect views
3. vote for officers
4. express opinion through letters/public forum
5. communicate directly with legislators
6. work for or contribute to nursing organization or political action committee
7. work for candidates who support your views
8. testify
165
Hypoglycemia
Low blood sugar
less than 45-60
consider any unconcious person hypoglycemic
166
Hypoglycemia S&S
```
sweating
pallor
irritability
hunger
lack of coordination
sleepiness
```
167
hypoglycemia management
15 g of fast acting carb - OJ, soda, milk, lifesavers, glucose tablet for MILD
for SEVERE glucagon, dextrose 50%
15/15 rule - check blood sugar, treat, wait 15 mins, recheck, repeat of <70
168
hyperglycemia
elevated blood glucose
180-200
DKA - greater than 250
HHS greater than 600
169
hyperglycemia S&S
```
dry mouth
increased thirst
weakness
headache
blurred vision
polyuria
```
170
hyperglycemia management
maintain airway/o2
decrease BS - insulin drip, monitor blood glucose every 1-2 hours
improve dehydration
171
CAD Risk Factors
Age, gender, race, ethnicity, family history, DM, hyperlipidemia, HTN, smoking, inactivity, obesity, unmanaged stress
172
CAD Treatment Goals
Relieve chest pain, reduce extent of myocardial damage, maintain cardiovascular stability, manage risk factors
173
Nitrates
Treat angina. Produce coronary artery and peripheral vasodilation. Take 3.
174
What is a good diet for somebody with HTN?
low cal., low fat, low sodium
175
HTN risk factors
age, ethnicity, smoking, high salt intake, health problems, inactive lifestyle, alcohol, high stress, obesity
176
Pharmacology for HTN
diuretics: first drug of choice. Thiazide
beta blockers: "LOL"
ACE Inhibitor: "pril" block angiotensin which causes BV to open
angiotensin 2 receptor blcoekrs: "tan"
calcium channel blockers: amlodipine, diltiazem
177
Left Sided Heart Failure
Prevents delivery of oxygenated blood. Main cause of right sided heart failure. There are 2 types: systolic heart failure, diastolic heart failure
178
Left sided heart failure symptoms
* paroxysmal nocturnal dyspnea (most common)
* cough,
* pulmonary congestion: cough, crackles, wheezes, blood tinged sputum, tachapnea
* restlessness
* confusion
* tachycardia
* exertional dyspnea
* fatigue
* cyanosis
179
Systolic Heart Failure
* pumping problem
* reduced ejection fraction
* inability of heart to contract enough to push blood foward
* stretch and thin chambers 0 heart gets bigger
* increased afterload
* impaired contrile ability
* incompetent valves
* cardiomyopathy
180
Diastolic Heart Failure
* filling problem
* preserved ejection fraction - it could remain normal
* inability of left ventricle to relax, resulting in fluid backing up into lungs
* increased preload
* left ventriclular hypertrophy
181
Right Sided Heart Failure
* Oxygen depleted blood
* heart loses ability to move o2 depleted blood into lungs
* Caused by left sided heart failure
182
Right sided heart failure symptoms
* edema
* ascites
* fatigue
* enlarged liver and spleen
* distended jugular vein
* anorexia and GI distress
* weight gain
183
Heart Failure Pharmacotherapy
ace inhibitors: "pril"
beta blockers: "LOL"
diuretics
vasodilators
184
6 P's of peripheral vascular disease
```
Pain
Paresthesia
poikilothermia
paralysis
pallor
pulselessness
```
185
Peripheral Artery Disease
Narrow, weak, blocked arteries
Result of build up of fat and cholesterol
Arterioslerosis
Atheroslecrosi
athermatous plaque formation in intima of vessel --> calcification of medial layer and loss of elasticity --> inadequate blood supply to tissues leads to tissue hypoxia
186
PAD manifestations
Claudation
rest pain
ulceration
gangrene
187
PAD Risk Factors
```
CAD/PAD
Diabetes
HTN
obesity
smoking
> 50
```
188
PAD Risk Factor Modifaction
```
Antiplatelet Therapy
Lipid lowering agents
glycemic control
BP control
smoking cessation
lifestyle modication heart healthy diet
Excercise
```
189
DVT
vein blockage or valve leakage in leg veins, blood flows back and pools in legs
hemdynamic changes/veno status --> endothelial injury/dysfunction --> hypercoagulability
190
DVT manifestions
edema, vericous veins, skin changes/discoloration, skin ulceration
191
DVT Risk Factors
```
> 50
obesity
smoking
family history
hormonal fluctuation
poor lyfestyle choices
```
192
DVT nursing management
```
avoid long periods of sitting or standing
elevate legs
exercise regularly
lose weight
hygiene
```
193
Pancreatitis
inflammation of pancreas - located LUQ behind stomach
autodigestion of pancreas, trypsin released too early
caused by:
Gallstone - most common - blocks bile duct
Alcoholism
194
Risk factors for pancreatitis
```
T: toxic - metabolic (alcohol)
I: idiopathic (unknown)
G: genetic
A: autoimmune
R: recurrent/sever acute pancreatitis
```
O: obstructive: gallstone, fat, tumor, duct scars
195
Pharmacotherapy Pancreatitis
NSAID (1st line), opioid analgesic, H2 Blockers, Proton Pump Inhibitor, Antibiotic (preventative), Pancreatic Enzymes
196
Nursing Management Pancreatitis
- Rest pancreas NPO
- NG tube, prevent intraabdominal pressure
- TPN
- high carb, high protein, low fat diet
- IV access
- Prevent hypovolemia (watch for fluid overload)
- assess I/O, skin turgor
- CIWA protocol
197
Peptic Ulcer Disease Patho
Disruption of the mucosal barrier of the stomach due to H Pylori or ulcer of the lining of the stomach, duodenum, lower esophagus
mucosal injury D/T increaed gastric acid HCL and Pepsin
198
etiology of PUD
- NSAID use (most common cause)
- alcohol, smoking, stress, antbiotic (docucycline, clindomycin)
- zollinger-ellison (tumor in pancrease which incrase hormone that stimulates stomach acid
199
Avoid with PUD
- chocolate
- coffee
- brined/fermented
- fatty
- spicy
- acidic
200
S&S of PUD
```
bloating, belching D/T distention
N/V
weight loss
anemia D/T bleeding
guaic positive ( check H&H)
```
201
Pharmacotherapy for PUD
antacids, H2 receptor agonist, PPI, cytoprotective agents, antibiotics
202
Complications of PUD
```
Pyloric Obstruction
- anorexia, N/V
Hemmorhage
- anemia
Perforation/Peritonitis (lethal!!!)
- rigid, board like abdomen
- rebound tenderness
- no bowel sounds
- hypotension, tachycardia, shallow respirations
```
203
Nursing Management of PUD
- V/S and I/O
- assess repirations and gastric status
- maintain NG tube
- observe for distention
- small, frequent meals
- minimize stress
204
IBD Patho
chronic inflammation of GI tract (autoimmune!!). Chrons or Ulcerative Colitis
205
Ulcerative Colitis S&S
```
Diarrhea, mucousy, bloody
LLQ pain
bloody stools
fever (rare)
anemia
weight loss
dehydration
```
206
Chron's S&S
- always diarrhea
- abdominal pain (RUQ)
- steatorrhea
- fever
- anemia
- weight loss
- skip lesions
207
Nursing Management IBD
Diet
- NPO w/ IVF during flare up
- small, frequent meals low residue, lactose free, elemental
- high protein, high vitamin, high carlorie
IV access for antibiotics, transfusion
monitor V/S, I/O, daily weight, stool for occult blood, lab values
Educate: NO alcohol, NO smoking, LOW stress
