Exam 1 (4/21) Flashcards
(147 cards)
1
Q
Care or tx focusing on reducing severity of symptoms
* Emotional support of Pt/family/sig. other during terminal time
* Improves quality of life, decreases costs, & eases caregivers
Begins during curative or restorative healthcare
Berevement care follows death
Not the same as hospice
A
Palliative care
2
Q
Care provides compassion, concern, & support for people in last phases of terminal illness
* Life expectancy 6 months or less
2 criterias needed for admission
* Common dx are CA & heart disease
Reffer ASAP to facillitate care
Lack of info & population barriers to acess
Pain control, symptom management, spiritual assessment, assessment/management of family monitored by nurse
A
Hospice care
3
Q
List goals of palliative care:
A
Provide relief from pain and other physical symptoms
Maximize quality of life
Provide psychosocial and spiritual care
Help patients & their family determine goal of care
Neither hasten nor postpone death; recognize dying as natural process
Provide support to the family & caregivers during the patients illness & in bereavement
Recognize & respect cultural values & beliefs of patient & family
4
Q
Irriversible loss of brain function including brain stem
Cerebral cortex stops functioning or destroyed (no activity)
2 doctors to approve - 1 must be neurologist
Clinical Dx include:
* Coma
* Unresponsiveness
* Absence of brainstem reflexes
* Apnea
A
Brain dead
5
Q
Period when patient copes w/ declining health from terminal illness or from frailties associated w/ advanced age, even death is not imminent
Term used for issues & services related to death and dying
Goal:
* Provide support/ comfort during dying process
* Improve quality of remaining life
* Help ensure dignified death
* Provide emotional support to family
A
End of Life Care
6
Q
Occurs when all vital organs & body symptoms cease to function
Irriversible cessation of cardiovascular, resp, & brain function
A
Death
7
Q
What are some physical S/s a nurse may notice at the end of a life?
A
-
Cardiovascular:
* Increase HR, slowing & weaknening pulse
* Decreased BP
GI:
* Hypoactive bowel sounds, constipation, abd. distention, loss of sphincter control
* Anorexia
Musc.skeletal:
* Difficulty swallowing/speaking, loss of gag reflex
* Difficulty maintaining body positioning/ alignment
Nervous:
* Increased confusion/delirium, hallucinations, impaired cognition
* Temp changes (Hypothermia/ fever)
Resp:
* Irregular breathing, cheyne-stokes, apnea, rapid breaths
* Inability to cough/clear secretions resulting in grunting, gurgling, or noisy/congested breathing (death rattle)
Sensory:
* Hearing last to go, blurred vision
* Decrased taste/smell
* Decreased sensation/ response to tactile stimuli
* skin breakdown, mottling of skin, cold/clammy/waxlike skin
Urinary:
* Decreased urin O/p, Inability to urinate
* Incontinence
8
Q
What are some psychosocial S/s a nurse may notice at the end of a life?
A
Dealing w/ change & redefining self:
* Acceptance of mortality, engage in planning for death, peacefulness
* Denial, defensiveness, maladaptive coping
* Frustration & anger about situation
Impact of illness on finding meaning & hope:
* Worry about burdening others
* Enhanced meaning of life, ability to talk about future/death
* Deep expressions of loss, depression
Relationships w/ loved ones:
* Poor communication, unresolved conflicts, estrangement
* Engagement of loved ones, able to say goodbye, give/receive forgiveness
* Expressions of love
Prepping for death:
* Legacy work & life review
* Reconciling unfinished business/ incomplete life tasks
* Developmental issues expressed as anger, sorrow, grief/sadness
9
Q
Normal reaction to loss:
* Real or possible
* Current or future
* Psychologic or physiologic responses
Priority intervention: provide for Pt/family to express feelings
3 Types:
* Anticipatory: Experienced for caregiver or family of Pt w/ severe illness often beginning long before actual death
* Adaptive: Helps accept reality of death in a positive way (ex: Ability to see good from death & positive memories)
* Prolonged//complicated: Lengthy/intense morning; can include recurrent/severe distressing emotions/intrusive thoughts/denial for longer than 6 months
A
Grief
10
Q
What are the 5 Kubler-Ross stages of grief?
A
Denial: Denies loss, feeling defensive/withdrawn
* “Im doing fine”
* “The results are wrong”
Anger: Emotional response as realization of severity of illness increases; May be direct to objects, friends, family, or dying/dead loved one
* “Why me”
* “This is not fair. How could this happen”
Bargaining: Normal reaction to feeling helpless & vulerable; Associated w/ feelings of guilt
* “If I could trade their life for mine”
* “I promise to quit smoking”
Depression: Feelings of sadness,despar, & regret as mortality approches; Pt/family may be quiet, isolated, or mournful
* “Im dying, so whats the point”
* “Im so sad, why bother w/ anything”
Acceptance: Embracing mortality & death; Able to engage in life review & feel at peace
* “Im ok with it all”
* “Its going to be ok”
11
Q
What 2 things could cultural beliefs affect?
A
Understanding & reaction to death/loss
Tx decisions
12
Q
Written documentation that states information about the Pt’s future health care decisions/ choices
* Guides families/HCP/caregivers on Pt’s goals & wishes
* POA, Code status, ect
Takes various Forms
Adheres to guidlines in state of residence
A
Advanced directives
13
Q
Acknowledges Pt’s wish to avoid agressive measures
* May be associated w/ dignity & comfort
* Preferred term for DNR order
May be colled “Do-Not-Attempt-Resuscitation” (DNAR) in some states/ agencies
A
Allow Natural Death (AND)
14
Q
Written order reflecting Pt’s wish to avoid or not attempt CPR
* Signed by physician or NP (in some states)
Records that discussion was held
A
Do-Not-Resusitate (DNR)
15
Q
Lay terms for a written legal document that describes Pt’s preferences about future health care choices
Must identify specific tx that person wants/doesn’t want during end of life (EOL)
A
Living Will
16
Q
Code statuse that allows for resuscitation attempts w/ CPR, defib, intubation, vasopressors, and other life saving measures
A
Full Code
17
Q
A Physicians order for resusitation should specifically include what 2 things
A
Code status
Distinctions
18
Q
Deliberate act of hastening death
ANA states “RN should not participate in”
Not the same as pallitave care
A
Euthanasia
19
Q
Giving medications to relieve distressing symptoms a EOL
Relieve unmanageable pain & suffering
A
Palliative Sedation
20
Q
What is the RNs role in palliative & EOL care?
A
Provide communication w/ Physicians, Pt, family/significant other, life connections, ect
Relieve suffering
Adjust to “norms”
Clarify misunderstandings about use of pain meds
* Addiction is not a concern when providing comfort care for terminally ill
21
Q
If your patient w/ a terminal illness is A&O, but needs an assessment done, how could the RN perform this task?
A
Minimal assessments
Focus on discomfort, pain, dyspnea, & N/
Stability determins frequency of assessment
22
Q
What challenges can occur w/ nurse-teacher effectiveness?
A
Lack of time
Own feelings as a teacher
Nurse-patient differences in learning goals
Rapid or early discharge from facility
23
Q
What do the letters stand for in the joint commission’s SPEAK UP initiative?
A
S: Speak up if you have questions or concerns. If you still don’t understand, ask again. You have the right to know
P: Pay attention to care you get. Always make sure you are getting right medication/ Tx. Never assume
E: Educate self about illness. Learn about tests & Tx plans
A: Ask trusted friend/family member to be advocate
K: Know what meds you take & why. Med errors are most common mistake
U: Use hospital, clinic, surg. center, or other types of health care organization
P: Participate in all decisions about your treatment. You are center of health care team
24
Q
What are some physical factors that could lead to a patient not understanding what education is being taught?
A
Sensory problems
* Hearing/vision loss
Nervous system
* Stroke
* Head trauma
* Impaired cognition
Liver problems
HF
Pain
Fatigue
Certain drugs
* Opioids
* Sedatives
25
What *physical assessment questions* would a RN ask themselves in order to finds out *how* *affective teaching* would be in a patient?
**Age?**
Acutely ill?
Any fatigue or pain?
**Primary Dx?**
**Other medical problems?**
**Current mental status**
Hearing, visual, & motor ability?
*What drugs are being taken?*
26
What *Psychological assessment questions* would a RN ask themselves in order to finds out *how* *affective teaching* would be in a patient?
*Does the patient appear anxious, afraid, depressed, or defensive?*
Is Patient in state of denial?
What is patients level of motivation or self-efficacy?
27
What *Sociocultural assessment questions* would a RN ask themselves in order to finds out *how* *affective teaching* would be in a patient?
**What are beliefs about illness or Tx?**
Is proposed teaching consistent w/ patients cultural values?
**What is patients educational experience, reading ability, & primary language?**
*Present or past occupation?*
Financial status?
*Living arrangements?*
Any family or close friends?
28
What *Learner assessment questions* would a RN ask themselves in order to finds out *how* *affective teaching* would be in a patient?
**What does the patient know about problem?**
*What does patient think is most important to learn?*
What prior learning experiences could be a frame of reference for current learning needs?
*Is patient ready to learn? Changed behavior?*
**How does patient learn best?** *(Reading, listening, pictures, doing, playing games)*
What learning enviornment would be better? *(Computer/web-based setting, informal setting, home, alone or w/ group)*
**In what way should caregivers be involved in teaching?**
29
What are some *psychological factors* that could affect a patients understanding of what education is being taught?
**Anxiety, depression, anger**
Hopelessness, powerlessness, life meaninglessness
Loneliness, abandonment
*Denial, rationalization*
Pain, *dyspnea*
Humor, fear
Self-efficacy
30
A person can *obtain & understand basic health information* needed to make the appropriate health decisions
**Patients w/ low levels have trouble understanding & acting on health information placing them at higher risk for readmission, frequent ER trips, higher mortality rate, & less likely to follow Tx plan**
* Must identify
Health Literacy
31
List & describe the 3 learning styles?
**Visual:** Reading, pictures
**Auditory:** Listening
**Physical:** Doing things
32
What do *clinical problems for Pt & caregiver relating to teaching* include?
Deficiency knowledge
Literacy problem
33
What 3 factors influence the choice of teaching strategies?
**Patient characteristics**
* Learning styles
* Educational background
* Culture/language skills
**Subject matter**
**Avalible resources**
34
A teaching strategy whose purpose is to **exchange points of view about a topic or to arrive to a decision or conclusion**
* Done w/ Pt, caregiver, and group
* *Ex: Weight loss*
Advantages:
* *Allows for active exchange of information & experiences among participants*
* **Good when Pt's have experience w/ subject** & have information to share
* Nonthreatening format
May need more time depending on topic and number of participants
**Disscussion ("Teach back")** - Teaching strategy
35
**Purpose is to teach Pt
& caregiver to perform a skill**
* Return demostration
* *Ex: Dressing changes, Injections*
Advantages:
* **Provides learning & practice of skills**
* Dividing skills into smaller steps helps master & provides reinforcements
May need more time to practice/master skill
* Pt's w/ limited manual dexterity may have difficulty
Demonstration/ Return demonstration ("Show back") - Teaching strategy
36
What are some ways to provide eduaction to a patient w/ *hearing loss*?
**Sit in front of patient at eye level w/ light shining in RN face**
Use assisted listening devices
**Speak slow & clear using short, simple sentences**
Create quiet atmosphere w/ **minimal noise**
*Leave room for hand usage if using sign language*
* Can use **interpreter**
Face patient, maintain eye level, speak in normal rhythem & tone, **if lip reading**
* Use good lighting & facial expressions to **ensure lips can be seen**
37
What are some ways to provide eduaction to a patient w/ *mild cognition impairment*?
**Explain procedure**
* 1 instruction at a time
* Be patient
*Use simple words*
**Ask yes/no questions**
* Avoid open-ended questions
Answer repeated questions
* Reinforce instructions often
Create *quiet enviornment & minimal distractions*
38
What are some ways to provide eduaction to a patient w/ *vision loss*?
Use low-vision aids
* Magnifiers, high-powered reading glasses, telescopes
Screen-readers that can read texts
Electronics w/ adjustable text sizes
Large prints
Good lighting, minimal distractions & background noise
**Verbal & tactile instructions instead of written**
39
Inability to cope w/ percieved demands/ threats to mental, emotional, or spiritual-wellbeing
Described as:
* **Internal**: Stress on body *(Ex: Disease/ Illness)*
* **External**: Outside of body *(Ex: Flat tire, marriage)*
2 types:
* **Acute:** *Alarm system/ puts you on alert*, Sudden onset
* **Chronic:** *Bodies defence cant keep up w/ demands, can lead to or progress illnesses*, Long termed/ drawn out
Stress
40
What *internal* factors could affect a response to stress?
**Age**
Attitude
**Genetic background**
Hardiness
**Health & nutritional status**
Optimistic outlook
*Personality characteristics*
**Previous experience w/ stressors**
Resilience
Sleep status
41
What *external* factors could affect a response to stress?
**Cultural & ethnic influences**
**Number of stressors present**
**Religious or spiritual influences**
Socioeconomic status
*Social support*
Timing of stressors
42
What 3 body systems are involved in stress response?
Nervous system *(cerebral cortex, limbic system, reticular formation, hypothalmus)*
Endocrine system
Immune system
43
In what 4 ways can stress affect immune function?
1) Decreasing number & function of natural killer cells
2) Decreasing lymphocyte proliferation
3) Altering production of cytokinesis
* Solubles factors secreted by WBCs & other cells
4) Decreasing phagocytosis by neutrophils & monocytes
44
Involves the relationship & interconnectedness among the parts that make up a person
* Important in life & determining who you are
Mind-Body-Spirit connection
45
Which of the following is linked to leading cause of death, including cancer, accidents, & suicide
A) Anxiety
B) Depression
C) Stress
D) Acute pain
C) Stress
46
**The protective end caps on chromosomes**
* **Chronic stress can alter DNA & change how fast cells age**
* Diminishing size is sign of age
Highly susceptible to stress
* Shorter in people w/ stress
Telomeres
47
A person's effort to manage stressors
* Develope strategies to help deal with stress
* Can be positive or negative
Divided into 2 categories:
* **Emotion-focused**
* **Problem-focused**
Coping
48
What is the difference between Emotion-focused coping & Problem-focused coping?
**Emotion-focused:**
* **Managing emotions felt during stressful time**
* May become predominate when situation is unchangeable or uncontrollable
* **Primary purpose is to help decrease neagtive emotions & create a feeling of wellbeing**
* *Ex: Going for a run, expressing feelings*
**Problem-focused:**
* Involves attempts to resolve the problem causing the stress
* **Most helpful if situation can be changed or controlled**
* Allows person to address the problem & reduce stress
* *Ex: Obtaining a tutior, follow ups*
49
What is the basic tech. for relaxation breathing?
1) Inhale slowly & deeply pushing abd. out
2) Exhale slowly, letting abd. come in & all muscle relax
3) Repeat 10 times w/o interruptions
* Stop for 30 sec if light-headed, then start again
50
**Helps become more aware of involunatry body responses**
* Breathing
* HR
* Muscle activity
**Gives person the power to use thoughts to control the body**
* Allows person to control their responses
* Often to improve condition or physical performance
**Electrodes attached to skin or hand held sensorys measure** process and display on a monitor
Biofeedback
51
What is the first step in managing stress?
**Becoming aware of its presence**
* Identify stressor(s) & response to them
* Identify prior experiences w/ similar demands
* Beware of situations that could result
52
What are some behavior, work related, & cognitive responses to stress?
**Behavior:**
* *Inability to concentrate*
* *Accident proneness*
* Impaired speech
* Anxiety, crying, irritability, frustration
**Work related:**
* *Absenteeism or tardiness*
* Decreased productivity
* Job dissatisfaction
**Cognitive:**
* Self reports about inability to make decisions
* Forgetfulness
53
What are some stressors to assess for in a caregiver?
Patients physical health
Job responsibilities
Finances
Children
54
How could you teach a patient about stress management?
**Learn relaxation breathing (easiest)**
*Practice* teaching relaxation breathing w/ peers, family, or friends
Choose **positive coping strategy** that is appropriate
Take advantage on teaching coping & relaxation skill to Pt
If setback, think about what went wrong. *Do not quit*
Attend seminars & stress managment workshops for more info
55
gWhile palliative care can be started at any time, optimal benefits occur when it starts following Dx of serious illnesses such as...
Neurodegenerative diseases
Cancer
*HF*, COPD
Dementia
ESRD
*DM*
56
Solution equal in concentration
* Cell stays the same
* Ideal to replace ECF volume deficit
**Use:**
* *Increased ECF*
* *Blood loss*
* *Dehydration*
* *Surg, burns*
**Types:**
* **0.9% NS**
* **5% Dextrose (D5W)**
* 5% Dextrose in .225% NS
* **LR**
**REMEMBER - DEXTROSE IS SUGAR**
**REMEMBER - LR HAS POTASSIUM (K)**
Isotonic Solutions
57
Type of isotonic solution that contains *sugar*
* **Do not give to hyperglycemic Pt's**
* **Irritating to veins, use central/mid/picc line**
**Use:**
* Fluid loss and dehydration
* *Hypernatremia*
* **Prevent ketosis (lacking sufficient carbohydrates for energy, starts burning fat for fuel)**
*Solution becomes Hypotonic when metabolized in the body*
Do not use for resuscitation
**Use cautiously in renal, cardiac and diabetic patients**
**5% Dextrose in water (D5W)** - Isotonic
58
A type of isotonic solution
**Use:**
* Shock
* **Resuscitation**
* *Fluid challenges (Preferred fluid for immediate response)*
* **Blood transfusions**
* *Metabolic alkalosis, DKA*
* *Hyponatremia*
**Use with caution in patients with heart failure, edema, or hypernatremia**
**Can lead to fluid overload**
No free water, calories or electrolytes
Expands IV volume
**Compatible with most medications**
Normal Saline (NS) - Isotonic
59
A type of isotonic solution that is closer to the bodies pH
* Similar in composition to plasma except contains no magnesium
**Use:**
* *Dehydration*
* **Burns**
* **GI tract fluid loss**
* Acute blood loss
* *Hypovolemia*
**Contains Potassium**
* *Can cause hyperkalemia* in renal patients
**Lactate is converted into bicarbonate by liver**
* *Do not give to patients with liver disease because they cannot metabolize lactate*
*Good for preg. moms*
No free water or calories
Lactated Ringers (LR) - Isotonic
60
A type of solution that **causes the cell to swell**
* *Decreases concentration* of solute in solution
**Types:**
* *0.45% NS (1/2 NS)*
* *0.225% NS (1/4 NS)*
* *0.33% NS (1/3 NS)*
**Use:**
* **Rehydrate cells**
* *Dehydration*
* *DKA, HHS*
**NOT used for ICP, burns, or trauma**
Watch for depletion of circulatory system
**Give slowly to prevent cellular edema**
**Risk of hypovolemia, tachy, decreased BP, & cellular edema/damage**
Hypotonic Solution (Low)
61
A type of solution that expands and raises the osmolality of ECF
* **Pulls fluids out of the cells** and into ECF **causing cell to shrink**
**Require frequent monitoring of:**
* Blood pressure
* Lung sounds
* Serum sodium levels
**Types:**
* *3% NS*
* *5% NS*
* **10% Dextrose**
* *5% Dextrose in 0.9% NS*
* *5% Dextrose in 0.45% NS*
* *5% Dextrose in LR*
**Use:**
* **Hypovolemia**
* **Hyponatremia**
* *Cerebral edema*
*Give slowly*
* Very **hard on vein**
* **Give via central line**
**Watch for FVO, bounding pulses, JVD, crackles, & edema**
Hypertonic Solution (High)
62
Provides 340 kcal/L
**Hypertonic glucose solution**
Provides free water but no electrolytes
Limit of dextrose concentration may be infused peripherally
10% Dextrose in water (D10W) - Hypertonic
63
Contain large molecules that increase oncotic pressure & **pull fluid into blood vessels/stream**
* **Always Hypertonic**
* AKA " Volume expanders" or **"Plasma expander"**
Used if crystalloids do not improve blood volume
**Watch for increased BP, Dyspnea, and bounding pulse**
Include human plasma products *(albumin, FFP, blood)* & semisynthetic solutions *(Dextran, startches, hespan)*
Colloids
64
What is the difference between fluid intake & fluid output?
**Fluid intake:**
* Regulated through thirst drive
* **Rising blood osmolarity**
* **Decreasing blood volume**
**Fluid Output:**
* **Insensible loss**
* *Uncontrolled water loss from skin, lungs and stool*
* Normal loss is about 500 to 1000mL/day
65
Adjustable and dependent on the amount of fluid intake and the body's need to conserve fluid
**Minimum amount of urine needed per day to excrete waste is 400 to 600 mL** (Obligatory urine loss)
* *Minimun urine output per hour is 30 mL*
Kidneys
66
**Secreted by adrenal cortex whenever sodium levels are low**
* Prevents water and sodium loss
**Triggers the kidneys (nephrons) to reabsorb sodium and water from the urine back into the blood**
Increases blood osmolarity and blood volume
Prevents excessive kidney excretion of Na
Aldosterone
67
**Produced in the brain and stored in the posterior pituitary gland**
*Release is controlled by the hypothalamus* in response to changes in blood osmolarity
**Acts directly on the kidneys tubules and collecting ducts making them more permeable to water**
* *More water reabsorbed by the tubules and returned to the blood decreasing blood osmolarity* and making it more dilut
Antidiuretic Hormone (ADH)
68
What is the difference between first, second, & third spacing?
**First spacing:** Normal distribution
**Second spacing:** Abnormal (edema)
**Third spacing:** Fluid is trapped where it is difficult or impossible for it to move back into cells or blood vessels
* Ascites (abnormal buildup of fluid in the abdominal cavity)
* Burn edema
69
Directly caused by illness or disease
* Burns or heart failure
Result of therapeutic measures
* colonoscopy preparation, diuretic
Fluid & electrolyte imbalances
70
**pH: 7.35 - 7.45**
* pH below 7.4 is Acidosis
* pH above 7.4 is Alkolosis
**Paco2: 34 - 45 mm HG**
**HCO3: 22 - 26 mEq/L**
*PaO2: 80 - 100 mm Hg*
*Respiratory conditions:*
* **Resp. Alkolosis:** pH increased, PaCo2 decreased
* **Resp. Acidosis:** pH decreased, PaCO2 Increased
*Metabolic Conditions:*
* **Metabolic Alkolosis:** pH, HCO3, & PaCO2 increase or normal
* **Metabolic Acidosis:** pH, HCO3, & PaCO2 decrease or normal
**ROME:**
* **R**esp. **O**pposite
* **M**etobolic **E**qual
Arterial Blood Gas (ABG)
71
What are important subjective information regarding health data about electrolyte/acid-based imbalances is needed when obtaining a Pt's health Hx?
**Past medical Hx involving:**
* Kidneys
* Heart, lungs
* GI/GU
**Specific diseases:**
* DM, endocrine problems
* Renal failure, liver disease
* COPD
* Cancer
**Medications (Current or past):**
* Over-the-counter drugs are hidden sources of NA, K, Ca, Mg, & other electrolytes
* Diuretic, steroids, & electrolyte supplements can cause electrolyte imbalances
**Surg. or other Tx:**
* Ask about past/present dialysis, kidney surg, or bowel surg. resulting in temporary or permanent external collecting system (Illeostomy, colostomy)
72
What are some physical assesment findings regarding electrolyte/acid-based imbalances?
**BP:**
* **Hypotension w/ FVD, low Ca, & high Mg**
* **HTN w/ FVO, high Ca, & low Mg**
**Muscular:**
* **Chvosteks sign w/ low Ca***& low Mg*
* **Muscle cramps w/ high K, low Ca**, & low Mg
* *Muscle weakness w/ High/low K*, high Ca, High Mg
* **Trousseau sign w/ low Ca**, & low Mg
**Neurologic:**
* **Confusion w/ FVO, High/ low Na/K/Ca/Mg**
* **Decreased LOC w/ FVD or FVO**, High or low Na
* Fatigue w/ FVD, low K, & high Ca
* **Seizures w/ high Na, low K**, & low Mg
**Resp:**
* Crackles w/ FVO
* Dyspnea w/ FVO
* Rapid RR w/ FVD
* Restricted airway w/ low Ca
**Pulse:**
* **Bounding w/ FVO**
* **Rapid, weak, thready pulse w/ FVD**
* Weak, irregular, rapid pulse w/ severe low K, & low Mg
* Weak, irregular, slow pulse w/ severe high K & high Mg
**Skin:**
* Cold, clammy skin w/ FVD & low Na
* Fushed, dry skin w/ high Na, & high Mg
* Pitting edema w/ FVO
* Poor skin turgor w/ FVD
73
What are some nursing interventions for electrolyes & acid-base imbalances?
*Determin cause & risks of imbalance*
**Prep resp. supplies & resuscitation protocols**
Give IV fluid & meds as prescribed
*Treat dysrhythmias according to policy*
Prescribe approp. diet
**Obtain labs for electrolytes & ABG**
Prioritizie activities
74
What are some nursing interventions for IV therapy?
Assess for S/s of fluid & electrolyte imbalance
Determine if IV order is approp.
Choose & insert approp IV catheters & infusion devices
Give IV fluids & meds
Monitor for adverse reaction to IV fluids or meds
Assess for FVO or hypovolemia & initiate approp. IV fluid changes
Evaluate if IV therapies are addressing fluid & electrolyte needs
Collaborate w/ Pharmacist to:
* Determine appropriateness of IV therapy & dose adjustments
* Prep IV infusions & meds
* Screen for potential problems
* Monitor response therapy
75
Acute inflammation of the walls of small, cannulated veins (veins w/ IV)
**S/s:**
* **Pain**
* **Tenderness**
* Warmth
* Swelling
* **Redness**
* **Palpable cord**
Risk factors:
* **Irritation from IV**
* Infusion of irritating drug
* Iv cath. at area of flexion (wrist, Ac)
*Avoid IV insertion in areas w/ symptoms*
*If edema present:*
* **Elevate extremity**
* **Apply warm, moist cloth over area**
* Give oral NSAIDS (Ibuprofen) topical NSAIDS (Diclofenac gel) to relieve pain
Phlebitis
76
**Narcotic**
* Can become addicted & go through withdrawl (use as prescribed)
* Used to treat severe pain
* *Acts on CNS to relieve pain*
* Let prescriber know if you are on any other medication
* **Antidote: Naloxone (Narcan)**
**S/s:**
* Darkening of the skin, skin rash (adrenal gland)
* Depression (adrenal gland)
* Tiredness, weakness (adrenal gland)
* Dizziness, fainting (adrenal gland)
* **sleep apnea, sleep-related hypoxemia**
* Rash, itching **(anaphylaxis)**
* Hoarseness, **trouble breathing or swallowing (anaphylaxis)**
* **Swelling of your hands, face, or mouth (anaphylaxis)**
**Can cause severe constipation:**
* Take laxatives, drink a lot of fluids,
* Increase the amount of fiber in your diet.
**Watch for signs of an overdose:**
* seizures
* **Difficulty or irregular breathing**
* *Cyanosis of lips, fingernails, or skin*
* **Pinpoint pupils of the eyes**
* Increased thirst
Morphine
77
**Opioid analgesic** used in anesthesia, cancer pain, or other pain management
* *Route: IV, IM, PO, sublingual*, nasal spray
* Schedule 2 narcotic
* *Risk of addiction & withdrawl; should not mix w/ alcohol, or benzos*
* **Antidote: Naloxone (Narcan)**
**Watch for signs of an overdose:**
* seizures
* **Difficulty or irregular breathing**
* *Cyanosis of lips, fingernails, or skin*
* **Pinpoint pupils of the eyes**
* Increased thirst
Fentanyl
78
**Classification: Anticonvulsant, benzodiazepine**
* *Used for anxiety & seziures* (via injection)
* Affects CNS
* Can cause addiction & withdrawl
**S/s:**
* Impaired motor function
* **Breathing problems**
* **Tachycardia**
* Swollen lymph nodes
* *swelling of face, lips, mouth, tongue, ot throat*
* **SI**
* Seizures
Do not take if you have glaucoma
Ativan (Lorazepam)
79
**Classification: anticholinergic**, antispasmodic
**Used for:**
* *Peptic ulcer disease, diverticulitis, IBS*
* *Cystitis*
* Stiffness, tremor
* Renal colic from kidney stones
* Biliary coloc from gallstones
**Blocks the action of neurotransmitter called acetylcholine**
* *Can help relax specific muscles, affect CNS*, and affect specific glands in your body that secrete sweat, saliva, milk, and stomach fluids
S/s:
* Dry mouth
* Tachycardia
* Dilated pupils
* **Breathing problems**
* *Swollen lymph nodes*
* *Swelling of the face, lips, mouth, tongue, or throat*
* Joint pain
* Hallucinations
Hyoscyne (Hyoscyamine)
80
**Classification: Anticholinergic**, Antispasmodic
**Used to treat bradycardia**, reduce salivation & bronchial secretions before surgery
* Antidote for overdose of cholinergic drugs or mushroom poisoning
**S/s:**
* Dry mouth
* Blurred vision
* *Hypersensitivity (skin rash)*
* **Tachycardia, palpitations**
* *Dilated puils*
* *Pyloric obstruction*
Atropine
81
**Classification: Corticosteroid**
* *Route: PO*
**Used for a variety of inflammatory, autoimmune, and hormonal conditions**
* Works by suppressing the immune response & reducing inflammation
S/s:
* **HTN**
* Abd. distention
* Blurred vision
* **Tendon rupture**
* **Tachycardia**, *circulatory collapse*
* *Embolism*
* Poor wound healing
* **Buffalo hump, moon face, rapid weight gain, excess sweating (cushings syndrom)**
**Do not stop abruptly - Adrenal crisis**
**Wear medica ID band w/ prescriber information**
Monitor for hyperglycemia & hypokalemia
Prednisolone (Orapred)
82
**Classification: Corticosteroids**
* Route: PO, IV, IM
**Treats asthma, allergic reactions, arthritis, inflammatory bowel diseases, and adrenal, blood or bone marrow conditions**
* It decreases inflammation by slowing down an overactive immune system or replacing cortisol made in your body
**S/s:**
* **Embolism**
* **GI hemorrhage**
* Tachycardia
* *Circulatory collapse*
* HTN
* Flushing
* **Buffalo hump, moon face, rapid weight gain, excess sweating (cushings syndrom)**
**Do not use w/ grapefruit/ grapefruit juice**
**Do not stop abruptly - Adrenal crisis**
**Wear medica ID band w/ prescriber information**
Monitor for hyperglycemia & hypokalemia
Methylprednisolone (Medrol)
83
**Classification: Antineoplastic (Anticancer/chemo)**
* *Route: PO*
**Used to treat early hormone receptor-positive breast cancer, metastatic (cancer that has spread) breast cancer**
* *Used only in postmenopausal women*
**S/s:**
* HTN
* **Thrombophlebitis**
* Hot flashed
* Angioedema
* **SJS**
* **Anaphylaxis**
Repost vag. bleeding ASAP
*Assess bone mineral density, cholestorol, & lipid panel periodically*
Anastrozole (Armidex)
84
**Classification: Antineoplastic (Anticancer/chemo)**
* *Route: PO*
* *Hormone therapy*
**Used to block estrogen receptors in breast cancer & reduces the risk of cancer recurrence**
**S/s:**
* Altered menses
* Decreased visual acutity
* **PE**
* *SOB*, leg cramps, weakness
* **DVT**
* **Stroke**
Teach to repost decreased visual acuity ASAP (may become irriversible)
Assess CBC, differentials, & platelet count baseline
**BBW:**
* Bleeding
* uterine malignancies
* Thrombolitic disease
* Endometrial cancer
Tamoxifin (Soltamox)
85
**Classification: Antineoplastic (Anticancer/chemo)**
* *Route: PO*
* *Hormone therapy*
**Used to treat certain types of breast cancer, & breast cancer in women after menopause**
* **Prevents estrogen production**
S/s:
* Lethargy, joint/muscle pain
* *Fractures, osteoporosis*
* Night sweats
* **MI, CVA**
* HTN
* Angioedema
* **Anaphylaxis**, Pruritus (itching)
Teach to report vag. bleeding & chest/bone pain
Assess baseline pain
**Monitor hepatic studies before/after therapy (Bilirubin, AST, ALT, LDH)**
Letrozole (Femera)
86
**Classification: Corticosteroids**
* Route: PO, IV, IM
**Used to treat inflammation, autoimmune, or hormonal conditions**
* *Works to regulate the body’s metabolism and immune response*
S/s:
* Hyperglycemia
* **Vomiting**
* **HTN**
* Tendon rupture
* Myopathy
* **Peptic ulcertaion**
* **Buffalo hump, moon face, rapid weight gain, excess sweating (cushings syndrom)**
**Do not stop abruptly - Adrenal crisis**
Dexamethasone (Decadron)
87
**Classification: Cannabinoid (schedule 3)**
* *Route: PO*
**Used to treat N/V from chemotherapy, & anorexia associated w/ weight loss in AIDS patients**
S/s:
* Mood changes
* Tachycardia, anxiety
* **Slurred speech**
* Fainting
* **Seizures**
* **Change in senses**
Avoid if substance abuse - Educate on S/s of withdrawl
*Avoid driving or doing tasks that require alertness*
*Educate to rise slowly*
*Do not smoke or use other forms of cannabis w/o talking to HCP*
Dronabinol (Marinol)
88
**Classification: Antineoplastic (Anticancer/chemo)**
* *Route: IM*
**Used for synthetic hormone treats symptoms of prostate cancer, early-onset puberty and other hormone-related conditions**
S/s:
* *Seizures (Increased risk w/ SSRI)*
* **MI**
* Dyspnea
* **PE**
* Bone pain
* **GI bleeding**
**Educate on how to prepare & give medication:**
* Rotate site
* Store at room temp if open
* Store in fridge if unopen
**Monitor for QT prolongation, Anaphylaxix, & hepatic studies (Bilirubin, AST, ALT, LDH)**
Leuprolide (Lupron)
89
**Classification: Antineoplastic (Anticancer/chemo), *antimetabolite***
* *Route: PO, IV, IM*
* Vesicant
**Used to treat:**
* **Rheumatoid arthritis** *by decreasing the activity of your immune system*
* **Cancer** *by slowing the growth of cancer cells*
Inhibits enzymes that reduce folic acid
* Immunosuppressive
S/s:
* **Encephalopathy**
* *Seizure*
* **Sudden death**
* Renal failure, hepatotoxicity
* **GI hemorrhage**
* Blurred vision
*Do not use w/ proton pump inhibitors*
**Educate on s/s of hepatotoxicity**
* Dark urine, jaundice, clay stool, abd. pain
**Report black tarry stool, chills, sore throat, bleeding/brusing, SOB, hematuria, seizure, ect.**
*Monitor BUN, electrolytes, & urine o/p*
*Monitor for S/s of infection & abnormal bleeding*
Methotreaxte (Rheumatrex)
90
Encompassess all functions carried out in cells to **maintain homeostasis**
* Includes response to extracellular signals **(hormones,cytokines & neurotransmitters)**
Cellular regulation
91
The production of new cells through cell growth & division
**Growth of a cell**
Proliferation
92
The aquisition of a speific cell function
* Less specialized cell becomes more specialized
**Cell maturity**
Differentiation
93
New but abnormal growth of tissue growth that is uncontrolled & progressive
**Categorizes as benign (not matastisized) or malignant (matastisized)**
* Cancerous
Neoplasm
94
What is the difference between a benign neoplasm & a malignant neoplasm?
**Benign neoplasm:**
* *Usually encapsulated*
* Normally differentiated
* **Absent metastasis**
* Rare recurrence
* Slight vascularity
* Expansive mode of growth
* **Fairly normal** - similar to parent cells
**Malignant neoplasm:**
* *Rarely encapsulated*
* Porrly differentiated
* **Capable metastasis**
* Possible recurrence
* Moderate vascularity
* **Expansive & infiltrative mode of growth**
* **Abnormal** - Unlike parent cells
95
5,000 - 10,000
WBC
96
12-18
Hemoglobin (Hgb)
97
Males: 42-52%
Females: 37-47%
Hematocrit (Hct)
98
150,000 - 400,000
Platelets
99
4.0 - 6.0
RBC
100
8.5 - 10
Calcium (Ca)
101
Characterized by uncontrolled & unregulated growth of cells
**2 major dysfunctions in process of cancer development:**
* Defective cell *proliferation (growth)*
* Defective cell *differeation (process of maturing)*
Cancer
102
What are some risk factor that could lead to a cancer Dx?
*Advanced age*
**Smoking / second hand smoke**
Poor nutrition
Infectious agent
Weight gain
**Sedentary lifestyle**
**Exposure to carcinogens**
* Sunlight, radiation, pollutants, soil, water, food
**Genetics**
103
What are the 7 warnings of cancer?
**C.A.U.T.I.O.N**
**C:** **C**hange in bowel or bladder
**A:** **A** sore that doesnt heal
**U:** **U**nusual bleeding / discharge
**T:** **T**hickening / lump on breast or elsewhere
**I:** **I**ndigestion / diff. swallowing
**O:** **O**bvious change in wart / mole
**N:** **N**agging cough/ hoarsness
104
What should the nurse do when assessing a Pt w/ cancer?
Gather health Hx
Gather objective & subjective data
Perform physical assessment:
* Duration
* Location
* Characteristics
* PQRST
105
What Dx studies can be done for a Pt w/ cancer?
**Radiography (MRI, CT, XR)**
Mammogram
**Lab tests**
Direct visualization
Pathology
Genetic testing
106
**Cancer causing agent capable of producing alterations**
* Detoxified by protective enzymes & are harmlessly excreted
**Failure of protective mech. allows them to enter a cells nucleus & alter DNA**
*May be from chemicals, radiation (higher in bone & skin cancer) or viral*
Carcinogen
107
What are the 3 stages of cancer development?
**Initation:** Target cell goes to carcinogen
* *First exposure*
**Promotion:** Continuing activities that increase risk
* Reversible
* *Ex: Smoking or drinking*
**Progession:** Increases w/ invasive matastisis
* *Last stage*
108
Tumor must reach critical mass that can be detected
Cell dormat / undetected until 1cm (1 billion cancer cells)
Latent period
109
Where are the main sites of metastasis?
Brain & CSF
Lungs
Liver
Adrenal glands
Bones
110
**Rejects / destroyes cancer cells**
* May be inadequate as cancer cells arise from normal human cells
Some cancer cells change on surface antigens
* *Tumor-associated antigen (TAAs)*
Immune system
111
What are the 2 types of cancer classifications?
**Anatomic Classification:** Tumor identified by tissue of orgin, the anatomic site & behavior of tumor
* *Benign or malignant*
**Histologic Classification:** Grading - appearence of cells & degrees of differentiation are evaluated to determine how closely cells resemble tissue of orgin *(Grade I-V)*
* **Extent of disease**
* **Clinical staging classifies extent & spread**
112
Describe the cancer stages listed below:
0
1
2
3
4
**0:** Cancer in situ
**1:** Tumor limited to tissue of orgin (localized)
**2:** Limited to local spread
**3:** Extensive local & regional spread
**4:** Metastasis
113
What are some primary prevention tips for cancer?
Regular **physical activity**
**Smoking Cessation**
*Avoidance of extensive exposure to sunlight*
Prophylactic surgery
**Healthy diet**
114
What are some Secondary prevention tips for cancer?
Mammogram
Prostate-specific antigen
**Colonoscopy**
**Guaiac test for occult blood**
115
**Antineoplastic therapy**
* *Route: PO, IV, IM, SUBQ, Topical*
**Use of chemicals given as systemic therapy for cancer**
* Doesnt always cross blood brain barrier
**Cannot distinguish between normal cells & cancer cells**
Side effects are result of destruction of normal cells
**Body fluid precaution (Standard)**
**Monitor for extravasation**
* *Use central venous access device (central line or CVC)*
Chemotherapy
116
Emission of energy from a source & travels through space or material
**Used to treat cancer**
* not primary Tx for systemic disease
*Use by self or in combination w/ chemo* or surgery
* **Treats primary tumors**
* For palliation of metastic lesions
**4 types:**
* Low-energy beams
* High-energy beams
* External beam radiation (External radiation)
* Internal radiation (Brachy therapy)
Radiation therapy
117
Describe the 4 types of radiation beams listed below:
Low-energy beams
High-energy beams
External beam radiation (External radiation)
Internal radiation (Brachy therapy)
**Low-energy beams:**
* Expand enery quickly
* *Penetrate short distances*
* *Useful for skin lesions*
**High-energy beams:**
* Greater debth of penetration
* *Suitable for optimal dosing* of internal target while sparing skin
**External beam radiation (External radiation):**
* Exposed to megavolt machine
* Gamma knife technology - Cobalt
* Cyclotron - Neutrons or protrons
* Linear acceleration - ionizing radiation
**Internal radiation (Brachy therapy):**
* Radioactive materials inserted into or close to tumor
* Minimal exposure to healthy tissue
* Commonly used w/ external radiation
118
What are common side effects of chemo/radiation?
Bone marrow suppression *(myelosuppression)*
* Leukopenia, Neutropenia, Thrombocytopenia
* Anemia
Fatigue
GI disturbance (Fluid balance)
Integumentary & mucosal reactions
Any system can show problem
* Depents on Tx
119
**Arise from mutated epithelial cells**
* **Tumor development promoted by epidermal growth factor**
* Leading cause of cancer related death
**Occur in primary segmental bronchi & upper lobes**
**Smokers & non-smokers can develop**
* Tobacco contains 60 carcinogens
* *Causes change in bronchial epithelium (Exposure)*
* Quitting reduces risk
**Side stream (Smoke in air) smoke contains same carcinogens as mainstream smoke (smoke inhaled)**
Lung cancer
120
What are some carcinogens that pose a risk for developong lung cancer?
Pollution
Radiation/Radon
Asbestos
Industrial agents
* Nickle, uranium, chromiuum, formaldehyde, arsenic
121
Describe the 2 types of lung cancers listed below:
Non-small lung cancer (NSLC)
Small cell lung cancer (SCLC)
**Non-small lung cancer (NSLC):**
* *Most common* (85-90%)
* *Arise in outer region of lung*
* Looks like pneumonia on CXR
* More common in women
**Small cell lung cancer (SCLC):**
* *Least common* (10-15%)
* **Most aggresive**
* *Rapidly growing at many sites w/in body*
* Strongly related to cigarette smoking
122
What are S/s of lung cancer?
Usually appear late
Chronic cough
Depending on primary cancer, location, & matastatic spead:
* Hemoptysis
* CP
* Dyspnea, wheezing
* Pneumonia
* **Persistant cough w/ sputum**
123
What are some Dx tests/studies for lung cancer?
**CXR (Initial Dx)**
*CT of brain, pelvis, abd. (location & extent of mass)*
**Lung biopsy (Definitive Dx)**
Bone scans
MRI, PET scan
**CBC w/ differentials**, chemisty panel
Liver, renal, & pulmonary function test
124
Describe the 4 stages of lung cancer:
**Stage 1:** One tumor less than 3cm
**Stage 2:** Lymph nodes involved (3-5cm)
* Local/regional
* *Spread in same lobe*
**Stage 3:** Lymph nodes in both lungs (greater than 5cm)
* Local spread in both lungs & bronchus
**Stage 4:** Matastisized lymph nodes / tumor on both lungs & liver
* distant movement of tumor
125
How does radiation therapy help treat lung cancer?
**Primary therapy from those unable to tolerate surgery**
Palliative to relieve dyspnea & pain
Reduces tumor mass
126
How does chemotherapy help treat lung cancer?
**Primary Tx for SCLS**
*Tx of nonreversible tumors or as adjuvant to surgery in NSCLC*
Usually used in combination with 2+ drugs
* Ex: Carboplatin, sysplatin, cycolophosphomide
127
**Medictions that block tumor growth & growth of new blood vessels**
Less toxic than chemo
Target therapy
128
Protein on T cells that decrease immune response
Target PD-1
129
What should you educate a patient to feel for when giving a breast self exam (BSE)?
Feel breast for any hard, irregular shaped, nonmobile & nontender masses
130
What are some hormonal regulations related to breast cancer development?
Combine hormone replacement therapy
* Estrogen + Proestrogen (estrogen alone may increase risk after 10 years)
Increased risk of breast cancer
Increased tumor size & stage at Dx
131
what genetic links might make a patient more prone to getting breat cancer?
Hx of ovarian cancer
Premenopausal
Bilateral breast cancer
First degree relative (Increases risk by 1.5-3x)
132
Tumor suppressing gene
If gene is mutated, risk for breat cancer increases
BRCA gene
(**BR**east **CA**ncer)
133
What are some breast cancer risks for men?
Hyperestrogenism
Family Hx
Radiation exposure
**Consider:**
* Thorough breast exam w/ physical exam
* Genetic testing in familys w/ BRCA mutation (BSE, CBE, mammograms, prostate screening)
134
What should a nursing assesment consist of with breast cancer?
Hx or breast disorder
Presence of nipple discharge
* Color & consistency
Pain (PQRST)
Rate of growth of lump
Breast asymmetry
Correlation w/ menstrual cycle
Enlarged lymph nodes
135
What are some complications of breast cancer?
Reoccurance
Metastases
* Local / regional (lymph nodes)
* Distant (bones, spinal cords, brain, liver, lungs, & bone marrow)
136
What are some radiography Dx studies for breast cancer?
Mammogram, Digital mammorgam, 3D mammogram
Ultrasound (US)
MRI
137
What are some biopsy Dx studies for breast cancer?
Fine-needle aspiration (FNA)
Stereoatctic or hand core biopsy
MRI guided biopsy
Vaccum-assisted biopsy
Surgical biopsy
138
What are the 5 standars Tx options for breast cancer?
Radiation / chemo
Surgery
* Breast conservation
* Lumpectomy
* Segmental mastectomy
* Mastectomy w/ or w/o reconstruction
* Prophylactic bilateral mastectomy w/ or w/o oophorectomy (BRCA)
Hormone therapy
Target therapy
139
**Accumulation of lymphs** in soft tissue
* *Fluid accumulates in arms, hands, or breasts*
Causes obstructive pressure on veins & venous return
**Compression bandaging / intermittent pneumatic compression sleeves**
* Worn during waking hours
Lymphedema
140
Chemotherapy is indicated for breast cancer when...
Evidence of node involvement exists
Large tumor present
Aggressive types of tumors Dx
141
What are some nutritional problems associated w/ cancer?
Malunutrition:
* Fat & muscle depletion
* protein & Calorie malnutrition
* Weight loss (5% notes)
Altered taste senation (dysgeusia)
* Teach to avoid foods they dislike & experiment with spices / seasonings
142
Wasting syndrom
S/s:
* *Anorexia or unintended loss of appetie or weight*
* General tissue wasting
* skeletal muscle atrophy
* *Immune dysfunction*
* *Metabolic abnormalities*
Cancer Cachexia
143
Primary cause of death in cancer patients
**Occurs d/t:**
* Ulceration
* Compressions of vital organs by tumor
* Neutropenia caused by disease or Tx
Usual sites of infections:
* **Lungs**
* **Genitourinary tract (GU)**
* *Peritoneal cavity*
* Mouth, rectum
* **Blood**
Cancer infections
144
Life threatening emergency that occurs as result of diseas or Tx
Ex:
* Obstructive
* Metabolic (hypercalcemia, septic shock)
* Infiltrative
Oncolgical emergencies
145
SVA compressed or obstructed by tumor or clot
Painful, life-threatening emergency
S/s:
* Facial edema (eyes, chest/trunk)
* Edema in hands & arms
* Dyspnea
* Collar of stokes signs
*Obstructive:* **Superior Vena Cava Syndrome**
146
Occurs more in Pt's w/ bone metastasis
S/s:
* Fatigue
* Anorexia, N/V/Constipation
* Poluria, *dehydration*
* *Severe muscle weakness*
* **Loss of deep tendon reflex**
* Paralytic Ileus
Managment:
* **Oral hydration**
* **NS via IV**
* Drug therapy
* *Dialysis*
Metabolic hypercalcemia ( > 12mg/dl)
147
How does cancer affect blacks, whites, & asians / hispanics?
**Blacks:**
* Higher incident of lung cancer
* More likely to die from lung cancer than other ethnic groups
* High rate of lung cancer among men
**Whites:**
* 2nd highest death rate
* High rate in women
**Asains/Hispanics:**
* Lowest death rates
