Exam 1 - Study Material Flashcards

Question

What causes Type 1 Diabetes?

Answer 1

* Peak age of diagnosis = 12 years * Autoimmune loss of β cells * Gene-environment trigger cell-mediated destruction of pancreatic cells * Slowly progressive, T-cell-mediated Lymphocyte & macrophage infiltration → inflammation → β cell death * Autoantibodies produced against islet cells, insulin, other cytoplasmic proteins  T helper lymphocytes → IL-4 → B lymphocyte proliferation & antibody production, IL-2 → T cytotoxic (CD8) cells, and IFNγ → macrophage activation * Altered β & α cells → excess glucagon → hyperglycemia * Non-immune is a secondary result of other diseases (pancreatitis)

Answer 2

* Acute onset of “3Ps” (polydipsia, polyuria, polyphagia ) * Weight loss * fatigue * glucosuria (excessive glucose in urine) * hyperglycemia * thirst

Answer 3

* Dehydration * Diabetic ketoacidosis (DKA) (fruity odor to breath, * Failure to thrive in small children/infants

Answer 4

* Insulin * diet * exercise * Blood Gas monitoring, * Islet cell/pancreas transplant

Answer 5

* Genetic-environmental interaction * Metabolic syndrome: central obesity (strongest factor) * Dyslipidemia * High blood pressure * Inactivity * Gestational DM + insulin during pregnancy, baby \> 9 lb birthweight, maternal postpartum obesity

Answer 6

1. insulin resistance (relative insulin deficiency) → pancreatic β cell dysfunction → absolute insulin deficiency 2. insulin secretory defect with insulin resistance

Answer 7

* Fasting blood glucose 100 \> 126 mg/dL = prediabetes * Oral Glucose Tolerence Test 140 \> 200 mg/dL = prediabetes * Non-fasting blood glucose \> 200 mg/dL + polyuria, polydipsia = You have diabetes * Glycosylated( glucose-bound) Hgb HBA1c * Normally between 4-6%, it is increased with hyperglycemia * Blood glucose control over 2 – 4 mo

Answer 8

A measure of the total hemoglobin over 3 months; this value reflects the average glucose level over those 3 months.

Answer 9

* 4-6% = Glucose level 60-120 * 7% = Glucose of 150 * 8% = Glucose 180, fair * 9% = Glucose \> 210, poor results

Answer 10

HbA1c \< 7%

Answer 11

* Beta cells of islets of Langenhans * ↑ blood glucose →↑ insulin release * 2-3 hr after meal, then basal rate occurs * Insulin levels low between meals * Insulin binding * Binds to insulin receptors to ↑ glucose transporter molecules; used for energy or stored as glycogen; negative feedback (↓ glucose & ↓ insulin release) * ANS effects * PNS ↑, SNS ↓

Answer 12

* Asymptomatic or vague (e.g., fatigue) * Visual changes * Nephropathy * Coronary artery disease (CAD) * Peripheral vascular disease (PVD) * Recurrent infections * Neuropathy (paresthesias, weakness)

Answer 13

oral hypoglycemics, diet, exercise

Answer 14

* Decreasing insulin resistance and increasing insulin sensitization (ie, metoformin) * Interfering with the digestion and absorption of dietary carbohydrates (ie, acarbose) * Augmenting insulin secretion and action (ie, sulfonylureas) **Diet, exercise, oral agents should be used first before resorting to insulin.**

Answer 15

* Hypoglycemia * Diabetic ketoacidosis (DKA) * Hyperosmolar hyperglycemic nonketotic syndrome (HHNKS) * Somogyi effect * Blood glucose fluctuations: hypoglycemia → rebound hyperglycemia * Common in children with DM Type 1 * Dawn phenomenon * Early AM rise in blood glucose * Related to nocturnal elevations of GH?

Answer 16

* sulfonylureas * meglitinides * beta blockers * alcohol

Answer 17

* thiazide diuretics * glucocorticoids * sympathomimetics

Answer 18

* Beta blockers * (tachycardia, palpitations) & also cause further hypoglycemia by blocking glycogenolysis.

Answer 19

* insulin overdose * reduced intake of food * vomiting/diarrhea * excess alcohol * unaccustomed exercise * childbirth

Answer 20

\< 60 mg/dl

Answer 21

* activation of the sympathetic nervous system leading to --\> * tachycardia, palpitations, sweating, nervousness

Answer 22

HA, confusion, drowsiness & fatigue

Answer 23

* Take fast acting sugar * glucose tablets, OJ, sugar cubes, honey, corn syrup, non diet soda * If pt has severe hypoglycemia IV glucose is preferred

Answer 24

* Glucagon is produced by alpha cells in the pancreas. * ↑ plasma levels of glucose & relaxes smooth muscle in the GI tract. * ↑ blood glucose levels following insulin overdose. * It promotes breakdown of glycogen, ↓ glycogen synthesis & stimulates biosynthesis of glucose.

Answer 25

IM, SQ & IV

Answer 26

Stimulates the release of insulin from pancreas depending on how much glucose there is (insulin sensitivity) --\> can lead to hypoglycemia

Answer 27

* Only works in type 2 diabetes * Can be used alone or in combo * Avoid during pregnancy/nursing mothers

Answer 28

* Hypoglycemia (fatigue, excessive hunger, profuse sweating, palpitations) * Weight gain

Answer 29

* Alcohol (disulfuram rxn) * Drugs that intensify hypoglycemia: NSAIDS’s, sufonamide antibiotics, ranitidine & cimetidine * Beta blockers – beta rec promote insulin release & mask S/Sx of hypoglycemia

Answer 30

* Tolbut**amide** * Acetohe**amide** * Tolaz**amide** * Chlorop**amide**

Answer 31

Glipizide Glyburide Glime

Answer 32

* Repa**glinide** (Prandin) * nate**glinide** (Starlix)

Answer 33

* Stimulates the release of insulin from pancreas depending on how much glucose there is (insulin sensitivity) --\> can lead to hypoglycemia * It is glucose dependant (if no glucose no insulin is produced) pt **MUST eat no longer than 30 min after drug intake** * **_Works exactly the same as Sulfonylureas_**

Answer 34

* Only approved for type 2 * **If no response with sulfonylureas there will be no response with metglitinides** * Approved for monotx or combo with metformin or a glitazone * Use this drug if pt. has allergic reaction to sulfonlureas

Answer 35

* Side effects: * Hypoglycemia (Less than with sulfonylureas), weight gain * Drug interactions * Gemfibrizol (causes hypoglycemia)

Answer 36

Metformin (Glucophage, Fortamet, Glumetza, Riomet)

Answer 37

* Dec glucose production in the liver & enhances glucose uptake & utilization by muscle. * Does NOT promote insulin release * Dec LDL and triglyceride levels.

Answer 38

* Because of MOA could possibly use it in pts with type 1 also * Can be used alone or with sulfonylureas or Exenatide * Absorbed slowly from small intestine and excreted unchanged in the kidneys (Check renal fxn, creatine cl)

Answer 39

* Males with creatine clearance \> 1.5 * Females with creatine clearance \> 1.4 * Liver dz, alcohol excess or pt. with shock (cause hypoxemia), alcohol use * Heart Failure * Severe infection (stop metformin, start temporary insulin)

Answer 40

* Weight loss, Dec appetite, nausea, **diarrhea**, dec absorption of vit B12 & folic acid * can cause lactic acidosis (rare, but mortality rate of 50%) S/Sx are: hyperventilation, myalgia, malaise & unusual somnolence

Answer 41

* Dec insulin resistance by inc insulin sensitivity of skeletal muscle, liver & adipose tissue (cellular response to insulin inc). * Insulin must be present for drug to work.

Answer 42

* Only approved for type 2 DM * Approved for monotx & for combo with metformin, sulfonylurea or insulin (carefully b/c insulin & glitizones cz edema).

Answer 43

* Fluid retention (edema & wt gain), inc HDL, LDL and triglycerides * Contraindicated in Class III or IV heart failure or hepatoxicity

Answer 44

* Before breakfast, lunch, & dinner, and before bedtime snack * 1-2 hours after a meal * Periods of stress, illness, or surgery * Pregnancy; changes in treatment plan * When suspect low blood sugar

Answer 45

* Test blood sugar before & after exercise * **Do not exercise if blood glucose 100 \< or \> 240 and there are ketones in urine**

Answer 46

A problem that occurs in people when the body cannot use glucose as a fuel source because there is no insulin or not enough insulin; Fat is used for fuel instead producing ketones which build up in the body.

Answer 47

* Precipitated by intercurrent illness or inadequate insulin Rx * Insulin deficiency → ↓ glucose uptake, ↑ fat mobilization with release of fatty acids, ↑ gluconeogenesis, ↑ ketogenesis * Hepatic overproduction of acids → metabolic acidosis

Answer 48

* polyuria & dehydration (osmotic diuresis from hyperglycemia) * ketonuria * hyperkalemia (shift of K+ out of cell in exchange for H+) * metabolic acidosis * Kussmaul respirations * postural dizziness, * ↓ LOC, nausea, * thirst * glycosuria * BG \> 250 mg/dL

Answer 49

* insulin (↓ hyperglycemia & hyperkalemia by transport of glucose & K+ into cell), * **fluids (correct dehydration) --\> 0.9% NS at 500 ml/hr for 1st hr**

Answer 50

A serious condition most frequently seen in older persons in which blood sugar levels rise, and your body tries to get rid of the excess sugar by passing it into your urine

Answer 51

* Precipitated by stress, noncompliance with meds * More common in type 2 DM * Relative insulin deficiency → hyperglycemia → solute diuresis → dehydration → hyperosmolality

Answer 52

* glycosuria * polyuria * thirst * polydipsia, * ↓ BP, ↑ HR, * weakness, * N & V, * stupor, * seizures, * coma, * **Blood Glucose \> 600 mg/dL, pH \> 7.30** * **serum osmolarity \> 320 mOsm/L,** * **↓ K+**

Answer 53

* insulin * **rapid fluid replacement** * K+ replacement

Answer 54

* Microvascular disease * Macrovascular disease * Infection

Answer 55

* Hyperglycemia → capillary basement membrane thickening with endothelial cell hyperplasia → ↓ tissue * Pathology related to ↑ blood glucose level & duration of disease * Sequelae: retinopathy → blindness, nephropathy → ESRD, & neuropathies

Answer 56

* Fibrous plaques associated with proliferation of subendothelial smooth muscle in arterial wall * Contributions to premature atherosclerosis: hyperglycemia, ↑ triglycerides, ↑ LDL, ↓ HDL, * Sequelae: coronary artery disease (CAD), stroke, & peripheral vascular disease (PVD)

Answer 57

* Monitor VS and pulse oximetry, provide supplemental oxygen as needed * Monitor for potential complications * Blood or blood product transfusions * Drug therapy * Dietary and lifestyle changes * Patient teaching * Nutrition intake * Compliance with drug therapy * Balance physical activity, exercise & rest

Answer 58

Anemia resulting from decreased erythropoiesis in individuals with conditions of chronic systemic disease or inflammation.

Answer 59

This type of anemia results from: 1. ↓ erythrocyte life space 1. from ↑ destruction of RBC's 2. ↑ lactoferrin binding → ↑ iron storage → ↓ avaliablity of iron for blood 2. Suppressed production of erythropoietin 3. Ineffective bone marrow eryhroid progenitor response to erythropoietin 4. Altered iron metabolism and iron sequestration in macrophages

Answer 60

* Tachycardia, murmurs, orthostatic hypotension, Dyspnea, tachypnea * Headache, fatigue, lightheadedness, pallor, intermittent claudication * Low levels of circulating iron ( * Very high lvls of total body iron storage * Normal to high serum ferritin levels

Answer 61

Treat the underlying cause: 1. Arthritis 2. Malignancies 3. AIDS 4. Chronic kidney disease

Answer 62

Anemia caused by pancytopenia (a reduction or absence of all 3 blood cell types) from failure or suppression of bone marrow to produce adequate amounts of blood cells.

Answer 63

* Caused by a bone marrow dysfunction which is hereditary or acquired (autoimmune, cancer, vitamin deficiency, etc) * This results in T-cells attacking hemopoietic stem cells lead to their apoptosis which in turn causes pancytopenia (↓ RBCs, ↓ WBCs, ↓ platelets).

Answer 64

* Hypoxemia (low blood oxygen) * Pallor (paleness) * Fatigue, fever, dyspnea (difficulty in breathing) * Hemorrhaging due to ↓ platelets * ↓ platelets also leads to easy bruising * GI bleeding * Prolonged bleeding * ↓ leukocyte production leads to more frequent and prolonged infections * Ulcerations in mouth

Answer 65

A deficiency in folate causes this anemia, and leads to the RBC's becoming Macrocytic (larger than normal) & normochromic (w/ normal hemoglobin)

Answer 66

* A diet deficient in folate (young women, malnutrition, alcoholics) * Diets low in vegtables

Answer 67

* Tongue ulcerations * **stomatitis (inflammation of the mouth)** * **flatulence, ** * **watery diarrhea** * ↓ Hgb * ↑ MCV \> 98 * MCHC WNL * **Serum folate \< 5 ng/mL ** * ↑ risk fetal malformations, * CVD in adults

Answer 68

* folic acid supplements * blood transfusion if severe

Answer 69

A premature accelearted destruction of erythrocytes either episodically or continually

Answer 70

* Genetic defect (in erythrocytes) * Idiopathic * Severe burn or infection, DIC, hemodialysis * Exposure to incompatible blood, drug, or toxin * Malaria * Newborn hemolytic disease * Transfusion reaction * Sickle cell anemia, thalassemia (defective Hgb)

Answer 71

* Jaundice - Occurs when heme destruction exceeds liver ability to conjuagte an excrete bilirubin * Splenomegaly * thromboembolism formation -- Especially pulmonary embolisms * Erythroid hyperplasia - Abnomrally increased numbers of erythrocyte stem cells in bone marrow

Answer 72

1. Hepten model - Cessation of administration of the antibiotic (penicillin, cephalosporins, hydrocortisone) results in rapid resolution of the anemia. 2. Immune complex formation - Treated by removing the cause or treating the underlying disorder 3. Autoimmune model - Treated by removing the cause or treating the underlying disorder Corticosteroids and or Rituximab (an antibody that supresses B cells) can be used to help less the effects of autoimmune responses

Answer 73

A life-threatening Immune-mediated destruction of ABO antigens on blood because of incompatible blood types.

Answer 74

* Fever/chills * flank pain * hematuria * facial flushing * chest/low back/abdominal pain * N & V * renal failure * ↓ BP * ↑ HR * dyspnea * shock * death

Answer 75

* Prevention! * Verify correct patient, correct blood * Patient assessment * Immediately stop transfusion * ↑ fluids to flush kidneys * Support ABC * Antihistamine & steroid for anaphylaxis

Answer 76

* **Stop transfusion** If acute transfusion reaction occurs ( flushing, itching, difficulty breathing, hives or other rashes) * **Maintain a patent IV line with NS** * **Notify blood bank and physician immediately ** * **Monitor VS and urine output** * Treat symptom as per physician’s order * Save blood bag and tubings & send to blood bank * Complete transfusion reaction reports * Document on transfusion reaction form and chart

Answer 77

Anemia as a result of inadequate dietary intake of iron or a result of excessive blood loss

Answer 78

* deficient diet * chronic blood loss * malabsorption disorder * A ↓ in RBC's causes the bone marrow to produce small Hgb-deficient RBC's

Answer 79

* Slowly develops * Most common wordwide * **RBC's are Microcytic (smaller than normal), hypochromic (paler than normal)** * ↑ risk: pregnant/menstruating women, toddlers, GI/renal/liver disease, chronic blood donation, vegetarian diet, ↓ SES

Answer 80

* DOE * cold intolerance * HA * brittle/thin/concave nails * maybe mouth sores, * pica & leg cramps if severe * cognitive impairment * burning mouth/glossitis * dysphagia

Answer 81

* **Dietary teaching- Iron rich foods** (beans,, organ meat-liver, red meat, leafy green veggies, raisins & molasses) and increase fiber * Avoid dairy or antacids with iron intake Supplemental iron (PO iron should be taken 1 hour before meals or 2 hours after). * **Vitamin C (ascorbic acid) enhances iron absorption** * Discuss diagnostic studies to identify cause * Emphasize compliance with dietary & drug therapy * Lifelong iron supplementation for some patients * **Stools may become black**

Answer 82

* Hgb \< 8 gm/dL – systemic signs; \< 5 gm/dL – heart failure, death * ↓ Hgb, Hct, serum iron, ferritin (diagnostic), transferrin; ↑ TIBC

Answer 83

* iron supplementation (ferrous better absorbed), take w/ vitamin C because it will enhance absorption * Take supplements on an empty stomach, use straw if liquid iron * ↑ Iron in diet * Fix underlying disease * **It takes 6-12 months to see change** * caution with IV iron dextran (anaphylaxis)

Answer 84

An overload of iron in the body, can occur from too much iron supplementation.

Answer 85

Anemia characterized lack of intrinsic factor that results in macrocytic (larger than normal) and normochromic (normal hemoglobin lvls) RBC's.

Answer 86

* Congenital or autoimmune deficiency of intrinsic factor that impairs absorption of Vitamin B12 → ↑ abnormal RBC production * Defective DNA synthesis caused by Vitamin B12 deficiency * Deficient gastric hormone needed for absorption * Deficient dietary intake

Answer 87

* Infections * weakness * fatigue * distal paresthesias/distal neuropathies (stocking-glove – irreversible nerve demyelination) * ataxia * sallow skin * memory loss * **beefy/sore red tongue** * loss of appetite, hepatomegaly * ↓ Hgb, ↓ Hct, ↓ retic, ↑ ferritin * serum B12 \< 100 pg/mL, achlorhydria (gastric biopsy)

Answer 88

* Rx: IM or s. q. Vitamin B12 (long-term) * **Increase amount of animal produces eaten (they contain vitamin b12)** * Follow up with reticulocyte count

Answer 89

* ↑ WBCs * Occurs from as a normal inflammatory/infection response * **A significant cause of persistent leukocytosis is hematologic maligancy -- Leukemia** * ↑ eosinophils with asthma, allergic response * ↑ blasts (acute leukemia) * Left shift * ↑ immature neutrophils (bands)

Answer 90

* ↓ WBCs (any or all) **\< 2000** * Due to: Prolonged stress, viral infection, bone marrow disease, radiation, chemotherapy, SLE, thyroid disease, Cushing syndrome, drugs (e.g., NSAID, antibiotics, etc.) * This ↑ infection risk * **Generally defined as “immunocompromised” when neutrophil count is \< 500 / mm3**

Answer 91

* WNL = 140,000 – 340,000/mm3 * Thrombocytopenia = \< 100,000/mm3 * Spontaneous bleeding = \< 20,000 * ↑ thrombosis – thrombocytosis

Answer 92

↓ in # of circulating platelets

Answer 93

**1. Decreased platelet production in bone marrow:** * Bone marrow deficiency * Drugs (Aspirin, chemo, alcohol, sulfa, Methotrexate) * Toxins / Infectious agents * Malignancy (Leukemias) **2. Increased platelet consumption:** * Disseminated intravascular coagulation (DIC) **3. Increased platelet destruction:** * Due to antibodies * **Immune (Idiopathic) thrombocytopenic purpura (ITP)- most common cause** * Lupus Erythematosus * Malignant Lymphoma * Chronic Lymphocytic Leukemia –CLL * Medications- Heparin-induced --HIT **4. Due to infections:** * Bacteremia * Post viral infection * Sequestration of platelet in an enlarged spleen

Answer 94

* ↑bleeding risk * Petechiae (small, sq bleeds) * Purpura (large, sq bleeds) * Ecchymosis (bruising)

Answer 95

The appearance of red or purple discolorations on the skin that do not blanch on applying pressure. * They are caused by bleeding underneath the skin usually secondary to vasculitis or dietary deficiency of vitamin C (scurvy). * Purpura measure 0.3–1 cm (3–10 mm), whereas petechiae measure less than 3 mm, and ecchymoses greater than 1 cm.[2]

Answer 96

* Care is based on the etiology * **If it is an immunologic cause,** such as Immune Thrombocytopenic Purpura (ITP), the patient will: * receive Corticosteroids * have a Splenectomy (surgery) * Intravenous Immunoglobulin -Immunosuppressives (Rituxan, Cyclosporine) * have a Platelet transfusion * **If it is drug induced,** such as with heparin-inducted thrombocytopenia, then: * Discontinue heparin, don't give warfarin * **Give Protamine sulfate to treat heparin overdose** * If it is a physiologic cause then give platlet transfusions (but they generally are not that sucessful)

Answer 97

* Risk for bleeding * Risk for injury * Knowledge deficit * Ineffective tissue perfusion

Answer 98

**Health promotion** * Avoidance of excessive use of OTC drugs (ASA) * Seek medical care for bleeding tendencies * Monitor pts receiving chemo **Bleeding precautions** - Avoid IM’s, indwelling catheters, enemas, suctioning, shaving razors. **Use stool softeners, soft-bristled toothbrushes, no flossing**. Apply pressure to puncture sites. **Pad rails….prevent falls.**

Answer 99

An Abnormal increase in number of circulating platelets (\> 600,000)

Answer 100

**Manifestations** * Bruising or bleeding from various sites (nose, mouth, gums, stomach and intestinal tract) * Headache * TIA & diplopia **Complications** * Stroke * Heart attack * clot in the blood vessels

Answer 101

* Treat the underlying cause * Low dose Aspirin * Hydroxyurea or Anagrelide - to suppress platelet production by the bone marrow * Interferon-alfa-2b –lower platelet counts * Severe life-threatening thrombocytosis - platelet pheresis to lower the platelet count to safer levels

Answer 102

Hereditary coagulation disorders (defective or deficient coagulation factor) that is sexually transmitted

Answer 103

* Cancer of one WBC type in bone marrow due to ↑ proliferation at expense of other cell types * Malignant Leukemic cells predominate in bone marrow → ↓ circulating levels of non-leukemic cells → generalized clinical manifestations

Answer 104

* **Genetic predisposition + mutating event** * radiation exposure * chemotherapy * pesticide exposure * PMH of hematopoiesis disease (e.g., Hodgkin lymphoma, multiple myeloma, polycythemia vera, sideroblastic anemia) * **Philadelphia chromosome**

Answer 105

* **Manifestations are Fewer with chronic leukemia until advanced** * Pallor, fatigue (anemia), **Pancytopenia** * **Frequent infections (↓ WBC)** * Bleeding/bruising (thrombocytopenia) * Progressive bone pain (pressure of cell accumulation in bone marrow) * Weight loss * Lymphadenopathy, hepatomegaly, splenomegaly (leukemic cell infiltration of lymphoid organs)

Answer 106

**Management:** * Goal is to attain remission * Prognosis is directly related to ability to maintain a remission * Chemotherapeutic treatment Radiation therapy * Stem Cell transplantation **Precautions:** * Strict hand washing * Single patient room & visitor restrictions to protect pt from others who may have conditions that may increase the probability of transmitting infections

Answer 107

* **Risk for infection** * Imbalanced nutrition * Fatigue and activity intolerance * Self-care deficit * Deficient knowledge * **Ineffective Protection** * Impaired mucous membrane * Anxiety Disturbed body image Potential for spiritual distress

Answer 108

* Bleeding precautions if platelets are low * Teachings (meds, disease process, complications) * Mucositis -- Frequent, gentle oral hygiene Soft toothbrush, or if counts are low, sponge-tipped applicators * Improving Nutrition: * Oral care before and after meals * Administer analgesics before meals * Appropriate treatment of nausea (induced from chemo)

Answer 109

1. Lymphocytic -- immature lymphocytes 2. Myelocytic -- pluripotent myeloid stem cells

Answer 110

1. Acute Lymphocytic Leukemia (ALL) 2. Chronic Lymphocytic Leukemia (CLL) 3. Acute Myelocytic Leukemia (AML) 4. Chronic Myelocytic Leukemia (CML)

Answer 111

* Progression = Rapid * Adult vs Child = Most common in children * Survival rate = 91% * Primary cell involved = Greater than 30% lymphoblasts and B cells

Answer 112

* Progression = slow * Adult vs Child = Most common in adults * Survival rate = 85% * Primary cell involved = Monoclonal B

Answer 113

* Progression = rapid * Adult vs Child = Most common adult form * Survival rate = 24% * Primary cell involved = Precursor myeloid cells

Answer 114

* Progression = Slow * Adult vs Child = Found mostly in adults * Survival rate = NO CURE * Primary cell involved = Neutrophilic or eosinophilic or clonal; arise from a hematopoietic stem cell

Answer 115

* Cancer of **single group** of lymphoid tissue **(localized nodal involvement**) * Clonal disorder of B cell, T cell, or monocyte

Answer 116

* Nodal involvement = Localized to single axial group of nodes (e.g., cervical, mediastinal, para-aortic) * Extranodal involvement = Rare * Spread = Orderly spread * Fever, night sweats, weight loss = common * Reed Sternberg cells = Present * Extent of disease = Often localized * Common in young adults & 60s * **Reed-Sternberg cells – large, atypical cells (diagnosis is based on the presence of these cells**

Answer 117

* unknown – evidence of ↓ T-cell-mediated immunity during disease & remission * May be Genetic * May be due to the Herpes virus, **Epstein-Barr virus** * **Seen commonly in patients receiving immunosuppressive therapy (renal transplant)**

Answer 118

* **Painless lymph node enlargement above level of diaphragm:** * **cervical, supraclavicular, mediastinal, axiliary, or inguinal lymph nodes** * Nodes remain moveable and nontender * Cough, dyspnea, chest discomfort (mediastinal masses) * Night fever & sweats with pruritis (B symptoms) * Weight loss in advanced stages

Answer 119

Treatment depends on the nature and extent of the disease: * Multidrug chemotherapy (ABVD—adria, bleo, vinblastine, dacarbazine) * Radiation therapy * Bone marrow transplant * Targeted biological (e.g., receptor-specific antibodies) therapy

Answer 120

* Manage their pain * Physical, psychosocial, spiritual needs must be addressed * Long-term evaluation of patient * Consequences may not be apparent for many years * Decrease risk of 2nd cancers (smoking, alcohol, exposure to environmental carcinogens and excessive sunlight

Answer 121

Diffuse cancer of lymph tissue primarily B cell lymphocyte **(involves multiple peripheral nodes).** It is a progressive clonal expansion of B cells, T cells, or NK cells

Answer 122

* Cause unknown – viral? * There is damage to proto-oncogenes or tumor-suppressor genes resulting in cell immortalization which results in malignant cells. * Lymphomas most likely originate from mutations in cellular genes.

Answer 123

* More common in elderly * Poorer prognosis than Hodgkin, but variable

Answer 124

* **Nodal involvement = Multiple peripheral nodes** * **Extranodal involvement = Common** * Spread = Noncontiguous * Fever, night sweats, weight loss = Uncommon * Reed Sternberg cells = Not Present * Extent of disease = Rarely localized * **Painless lymphadenopathy, splenomegaly** * Back & neck pain

Answer 125

* Treatment is determined by type & stage of the disease (Interferon, chemotherapy and/or radiation therapy) * More aggressive lymphomas are more responsive to treatment * Patients are Asymptomatic with advanced disease

Answer 126

* Clonal plasma cell cancer disorder with slow proliferation of B lymphocyte & plasma cells * They disperse throughout circulation & deposit in bones usually resulting in destruction of the bone.

Answer 127

* Chromosomal translocations (breakpoints) in plasma cells is responsible for development of myeloma in most individuals. * A progression of further secondary genetic alterations causes development to an aggressive multiple myeloma

Answer 128

* Plasma cells produce abnormally large amounts of one class of immunoglobulin, usually IgG (which is defective). (Bence-Jones proteins) * Myeloma cells in the bone marrow secrete hepatocyte growth factor and parathyroid homrone-related peptide that stimulate osteoclasts to reabsorb bone, resulting in bone lesions and hyper calcemia. * This is because the malignant plasma cells multiply and crowd out normal blood cells, and it is this that ultimately causes the breakdown of bone. * **High mortality -- No cure**

Answer 129

* Bone pain & fractures (from the break down of bone) * Weight loss, fatigue * Neurologic impairment from hypercalcemia (bone breakdown) * Proteinuria (Bence-Jones proteins from excessive defective IgG's being produced) * Infection from ↓ B-cell function * Hypercalcemia

Answer 130

* An aquired clinical syndrome that prevents a person's blood from clotting normally. * It characterized by the widespread activation of coagulation, resulting in fibrin clots in medium and small vessels throughout the body. * **This can result in consumption of platlets and clotting factors leading to severe bleeding**

Answer 131

* Platelet consumption → hemorrhage * Complication of shock, sepsis, major burn, cancer * Hypoxemia & acidemia → damaged vascular endothelial cells → extensive activation of platelets & intrinsic coagulation pathway → vascular microthrombi * Tissue damage → ↑ thromboplastin → activates extrinsic coagulation pathway → extensive clotting → ↑ fibrinolysis → release of anticoagulation enzymes into circulation → vicious cycle of simultaneous clotting & bleeding

Answer 132

* Highly variable: acute vs. chronic (covert) * Hemorrhage, hypotension, shock, hematuria * ↓ LOC, neurologic deficits * Cyanosis, respiratory distress, ischemia, multiple organ failure * ↓ platelets, ↑ FDP, ↓ fibrinogen, prolonged clotting, ↓ levels of anticoagulant measures * High mortality with acute

Answer 133

* Treat underlying cause * Give heparin, if no CNS bleeding (prevent conversion of fibrinogen → fibrin) * Selected indications only * Controversial * Low-molecular-weight heparin (↓ new thrombi formation) * Volume replacement (to replace loss of blood) * Fresh frozen plasma (FFP), cryoprecipitate, & platelet transfusions * Antithrombin drugs (activated protein C)? * Inhibit adhesion of neutrophils to endothelium * Degrade activated clotting factors (e.g., APC)

Answer 134

An inherited incurable disease that leads causes abnormal an abnormal form of hemoglobin in the RBC which causes the RBC to stiffen and elongate

Answer 135

* Blood loss * Hypoxia or deoxygenation caused by: * Viral or bacterial infection **(most common precipitating factor)** * High altitude * Emotional/physical stress * Surgery

Answer 136

* Typical patient is anemia, and is asymptomatic except during sickling episodes * Symptoms result from chronic hemolysis or thrombosis & can be * pain and swelling * Pallor of mucous membranes (skin ashen/grayish) * Hemolytic jaundice & prone to gall stones (cholelithiasis) * Fatigue & ↓ exercise tolerance * Dehydration * **Vasoocclusion - Hallmark symptom**

Answer 137

Pain as a result of tissue ischemia (back, chest, abdomen & extremities), stroke, priapism (painful, prolonged erection)

Answer 138

* No specific treatment for SCD * Alleviate symptoms of disease complications * **Minimize end-organ damage ** * **O2 for hypoxia and to control sickling** * **Manage pain with: ASA, NSAIDS, Morphine**

Answer 139

Avoid high altitudes, maintain fluid intake, seek treatment for respiratory infections promptly, control pain

Answer 140

* Folic acid daily supplements * Blood transfusions in crisis * Hydroxyurea:Antisickling agent * Arginine: Antisickling agent * Peripheral Blood Stem Cell Transplant

Answer 141

* Acute pain R/T tissue hypoxia * Knowledge deficit * Fluid volume deficit * Coping, ineffective/ Powerlessness * Risk for Infection * Activity intolerance * Tissue perfusion, altered * Gas exchange, impaired

Answer 142

* Review patient history * Perform patient teaching and obtain informed consent * **Equipment:** IV (use at least a 20-gauge needle (18 or 16G for rapid transfusion) and appropriate tubing, normal saline * **ALWAYS use** special blood tubing (Y type for Normal Saline and the other arm for the blood product) with a special filter (microaggregate filter) * **When Flushing** - verify IV line patency before requesting blood product from blood bank *

Answer 143

* **take baseline VS before transfusion. If fever, notify MD** * Pre-medication- (Tylenol & Benadryl) * **Begin blood transfusion slowly (2cc/min) and stay in room for the 1st 15 minutes or 50 cc of blood transfusion (reactions may occur at this time).** Blood Transfusion should not take \> 4 hours. Platelets can be transfused over 15 to 30 minutes * Monitor vital signs –after 1st 15 minutes, retake VS and follow hospital policy * **Cross-check- Need 2 licensed nurses to check patient ID and blood product ID data including expiration date**

Answer 144

A malignant disease characterized by: * A series of cellular, genetic aberrations that cause abnormal cell proliferation. * Unchecked local growth and invasion of surrounding tissue.

Answer 145

* Grade 0 - normal tissue * Grade 1 - well-differentiated * Grade 2 - moderately differentiated * Grade 3 - poorly differentiated * Grade 4 - very anaplastic

Answer 146

1. Stage 0 - in situ 2. Stage I - local 3. Stage II - limited local spread 4. Stage III - extensive local/regional spread 5. Stage IV - metastasis

Answer 147

* To find the cancer at an early stage when it is less likely to have spread and is **easier to treat.** * Early detection can: * identify cancers at a treatable stage * decrease treatment time * improve quality of life improve chances of survival

Answer 148

* The early detection of disease by use of tests, examinations, or other procedures prior to the development of symptoms * Assumptions: * early detection=favorable prognosis * cost effective * widely available * acceptable to population * adequate sensitivity, specificity

Answer 149

1. Change in bowel or bladder 2. Unusual bleeding or discharge 3. Sore that does not heal 4. Obvious change in wart or mole 5. Thickening or lump 6. Nagging cough or hoarseness 7. Indigestion or difficulty swallowing

Answer 150

* Women in 20s-30s, recommended that CBE be part of their periodic health exam at least every 3 years. * Asymptomatic women \> 40 – receive CBE annually

Answer 151

* Who: Women aged \> 40 years * Begin annual mammography at age 40 years

Answer 152

* **Who:** Women aged \> 18 years * Begin approximately 3 years after a woman begins having vaginal intercourse, but no later than 21 years of age

Answer 153

**Who & when:** Men and women aged 50 **What:** * A fecal occult blood test (FOBT) every year * A flexible sigmoidoscopy (FSIG) every five years * Annual fecal occult blood test and flexible sigmoidoscopy every five years * A double-contrast barium enema every five years * A colonoscopy every ten years

Answer 154

* Begin testing at age 45 * African-American men are at high risk for this patient

Answer 155

1. **Cure -** eradication of cancer cells in the body. 2. **Control -** containment of the growth of cancer cells without complete eradication. 3. **Palliation -** comfort and relief of symptoms when the possibility of cure is hopeless.

Answer 156

* Anxiety * Fear * Denial * Knowledge deficit * Decisional conflict * Role strain

Answer 157

* Oldest method of cancer treatment * **Best chance for cure** * 55% of all cancer pts * Often the initial form of cancer treatment * Aims: removal of all tumor with negative margins (surgen will keep removing tissue until there isn’t anymore) – removal of surrounding tissues/organs

Answer 158

* Increased age * Cancer * Obesity * Diabetes * Immune suppressed * Malnutrition

Answer 159

* Emergent surgery * Surgery lasting \>2 hours * Multiple procedures * Abdominal pelvic surgery

Answer 160

* Pain * Altered nutrition * Altered mobility * Altered fluid volume * Altered urinary/bowel elimination * Altered protection * High risk for infection

Answer 161

* Risk for injury RT increased risk of infection & lymphedema 2nd axillary node dissection * Treat it with: * Exercise * Elevation * Compression * Prevention * S/S of infection * Wearing a compression sleeve

Answer 162

* Avoid burns while cooking or smoking * Avoid sunburns * Have all injections, vaccinations, blood samples, & blood pressure tests done on the unaffected arm when possible * Use an electric razor with a narrow head for underarm shaving to reduce the risk of nicks or scratches * Carry heavy packages or handbags with the other arm * Wash cuts promptly, treat them with antibacterial medication, & cover with a sterile dressing; check often for redness, soreness or other signs of infection

Answer 163

* Begins after postoperative period (Day 1 & 2) * Encourage patient to focus on the elbow, wrist, & hand of the affected side. * Have them: * active elbow flexion & extension * Gently squeezes a soft rubber ball * Does deep breathing to facilitate lymph flow * Shoulder shrugs & active ROM, including flexion & abduction – 2nd day postop * Use unaffected arm * Do not abduct the arm, raise the arm or elbow above the shoulder height until the drains are removed. * Exercises are important to prevent muscle shortening

Answer 164

Is the accumulation of excessive proteins, edema, chronic inflammation, & fibrosis secondary to the impairment of the lymph vessels.

Answer 165

* Reduction in volume of the edema * Restoration of ROM * Assistance with restoring the normal external appearance * Reduce pain & coping skills * Improve QOL * Enhance person’s self-esteem

Answer 166

* Assess oral cavity * Assess nutritional status * **Assess ETOH use (CAGE)** * May need to provide nutritional supplementation prior to surgery * May need dental work before surgery (to prevent infection) * **WATCH FOR ASPIRATION -- GIVE SUCTIONING & MANAGE SECRETIONS** * **Prevent infection by checking dressing and wound!**

Answer 167

* Begin with soft or semi soft foods. * Stay with a nurse or swallowing specialist during meals until you have mastered the technique of swallowing without choking. * Tell patient to: 1. Take a deep breath 2. Bear down to close the vocal cords 3. Place food into your mouth 4. Swallow 5. Cough to rid the closed cord of accumulated food particles 6. Swallow 7. Cough Breath

Answer 168

**Alteration in airway** * Laryngectomy tube * Humidity * **HOB 45 degrees, DO NOT LIE FLAT !** * **Suction** **Alterations in nutrition** * Enteral feeding for 7-10 days **Impaired Communication** * Writing * Artificial larynx * Esophageal speech –Day 5 – will begin to cork the tracheostomy tube to begin the weaning process

Answer 169

* not to lift objects heavier than 10 lbs for 4 months after surgery. * Avoid water sports –can’t protect airway * Take special precautions when gardening, etc not to get dust, dirt into stoma * Management of drain * Stoma bib * Takes up to 3 months to fully recover from surgery

Answer 170

To Administer the largest dose possible, to kill the largest number of cancer cells, while inducing reversible and tolerable "therapeutic index"

Answer 171

* Kills all cells which are dividing rapidly * Mucous membranes, bone marrow, and hair follicles most acutely affected * Stomatitis, esophagitis, enteritis * Neutropenia * Alopecia – hair loss * Nausea & vomiting (also chemically-mediated) * Skin changes , sperm * **Increased potential for infection**

Answer 172

* It reflects the patients risk for infection * Chemotherapy is frequently held if the WBC’s are between 1000-3000/mm3 or if the ANC is below 1500 cells/mm3. * Not significant ANC 1500-2000 * Minimal ANC 1000-1500 * Moderate ANC 500-1000 * Severe ANC \< 500

Answer 173

Low levels of neutrophils, \< 500 -1000. **A neutropenic patient can not mount an adequate inflammatory response to an infecting organism.**

Answer 174

* NO signs of heat, swelling, redness, exudate formation * **Fever is the only indicator of an infection** * Progression from localized infection to life-threatening sepsis is so rapid * fatality rate is 18% to 40% in the first 48 hours.

Answer 175

* Mucous membranes * Lungs * Skin * Venipuncture sites * Catheter sites * Perineal area * Perirectal area

Answer 176

* Check pt. history * ANC * Vital signs * Comprehensive physical exam * Skin integrity * Assess for redness, pain, discoloration, swelling. Examine skin folds, wound sites , suspicious lesions

Answer 177

* Check if Pt has Hx. of Dysphagia, diminished gag reflex, tobacco use, exposures. * RR, effort, pattern, and depth of respiration, use of accessory muscles * Auscultate chest * Check for any recent changes in pylmonary status

Answer 178

* Check pt. hx for Chemotherapy, radiation to head/neck, tobacco, ETOH use, periodontal disease, hydration, nutritional status. * Assess Oral cavity - color, moisture, lesions, ulcerations, amount and character of saliva * Patients routine for oral hygiene

Answer 179

* Check pt. hx for diet, sexual practices, medications, chemotherapy, HIV status, change in bowel habits * Assess for erythema, ulceration, hemorrhoids, bleeding * Assess character, frequency of bowel movements

Answer 180

* Check pt hx for Benign prostatic hypertrophy, HIV status, bladder -**_toxic chemotherapy_**, symptom of GU infection (dysurina, urinary frequency, urgency, hematuria, pruritis, vaginal/penile discharge) * Examine: genitilia - lesions, ulcerations, discharge * Assess Characteristics of urine - color, turbidity, odor

Answer 181

* Assess for Subtle changes in neurologic function can signify either the onset of an infection or progression of a malignancy. * Assess for Headache, fever, meningismus, personality changes, focal neurological signs, nuchal rigidity, altered mental status, seizures

Answer 182

* **–Vital signs including temperature for fever.** * –Prophylactic pulmonary hygiene measures especially for B cell deficiencies * –Monitor CBC with differential * –Meticulously clean sources where bacteria live * **–No fresh cut flowers or live plants in room** * –Encourage regular personal hygiene (include oral care) –Protect from other persons with infections * –Assign only healthy HCP to care for patient * –Avoid injections

Answer 183

* Platelet count \< 100,000/mm3 * Risk for bleeding high if \< 25,000/mm3 * Patient teaching * avoid aspirin, NSAIDs nprevent constipation nD/C use of razors nsoft tooth brushes abstain from sexual * assess their fall risk

Answer 184

* 2-3 X more often in hematologic malignancies; 75% BMT patients * Direct effect (cytotoxic) or indirect (related to myelosuppression) * Dose-related, common with antimetabolites & some antibiotics * Risk factors: elderly, pre-existing oral disease, local irritants, poor oral hygiene, myelosuppression

Answer 185

* After each meal and at HS at least * Lubrication of lips; saliva substitutes * Soft toothbrush & unwaxed floss if platelet ct ok and no lesions * Daily flouride if xerostomia

Answer 186

* Experienced by over 50% of all patients receiving chemotherapy * **Decreased Quality Of Life** * lmost feared side effect * worsens throughout the treatment * can lead to non-compliance * **Physiological** * ldehydration * fluid and electrolyte imbalance * esophageal tears

Answer 187

* Age * Previous emetic control * Sex * Course number * History of motion sickness * **History heavy alcohol use - will cause less N/V** * **Anxiety - will cause more**

Answer 188

* extreme tiredness or weariness resulting from physical or mental activity that is Not relieved by rest * Causative factors in absence of anemia unknown; most often with cytokines * **DECREASES Quality of life** * Interventions: * –energy conservation * –setting priorities * –nutrition, * physical activity within limits

Answer 189

the HIV virus targets cells with CD4 receptors, which are expressed on the surface of T lymphocytes, monocytes dendritic cells & brain microglia.

Answer 190

* Having sex (anal, vaginal, or oral) with someone who is HIV + * Sharing needles or injection equipment with a user who is HIV + * HIV+ women to their babies during pregnancy, during birth or through breastfeeding * Occupational exposure * (rare) Blood transfusion/organ transplant * **NOT through casual contact, insect bites, toilet seats**

Answer 191

* Blood * Semen * Pre-seminal fluid * Breast milk * Vaginal fluids * Rectal (anal) mucous * Amniotic fluid * Cerebrospinal fluid * Synovial fluid

Answer 192

* Nasal fluid * saliva * sweat * tears * feces * urine * vomit

Answer 193

* Viral load * Lack of circumcision * Sexual risk * Presence of ulcerative sexually transmitted diseases * Nitrate inhalant use * Host factors * Genetic factors

Answer 194

* Routinely using barriers (such as gloves and/or goggles) when anticipating contact with blood or body fluids. * Immediately washing hands and other skin surfaces after contact with blood or body fluids. * Carefully handling and disposing of sharp instruments during and after use.

Answer 195

* EIA (Enzyme immunoassay)(aka ELISA, enzyme-linked immunosorbent assay) * Western blot * Orasure * Home Access HIV-1 Test System * Oraquick Rapid HIV-1 Antibody Test

Answer 196

1. Viral transmission 2. Primary infection (acute HIV infection or acute seroconversion syndrome) 3. HIV asymptomatic (clinical latent period) 4. HIV symptomatic (AIDS-related complex) 5. AIDS (CD4 count less than 200) 6. Advanced HIV infection (CD4 count less than 50)

Answer 197

**Characteristics:** * lack of HIV antibodies * Period of rapid viral replication and dissemination through the body * **Viral set point: balance between amount of HIV and the immune response- steady state infection** **Symptoms:** * Acute retroviral syndrome: fever (38-40C), lymphadenopathy, sore throat, rash, myalgia/arthralgia, & headache plus mucocutaneous ulcers & prolonged duration suggestive of HIV

Answer 198

**Characteristics:** * More than 500 CD4+ T lymphpocytes/mm3 * Upon reaching the viral set point, chronic asymptomatic state begins * **_Body has sufficient immune response to defend against pathogens_** * **Usually 8-10 years before major complication **

Answer 199

**Characteristics:** * 200–499 CD4+ lymphocytes/mm3 * CD4 T cells gradually fall. * The patient develops symptoms or conditions related to the HIV infection, which are not classified as category C conditions * Patients who are once treated for a category B condition are considered category B * Category B conditions include: candidiasis (oropharyngeal or vulvovaginal), herpes zoster, oral hairy leukoplakia, ITP, PID, peripheral neuropathy

Answer 200

conditions caused by the HIV infection or a defect in cellular immunity OR considered to have a clinical course or require management that is complicated by HIV infection

Answer 201

* CDC category C * Less than 200 CD4+ lymphocytes/mm3 * As levels drop below 100 cell/mm3 the immune system is significantly impaired * Development of listed conditions

Answer 202

* Maximal & durable suppression of viral load * Restoration and/or preservation of immunologic function * Improvement of QOL * Reduction of HIV-related morbidity and mortality

Answer 203

* Maximize adherence to the antiretroviral regimen * Rational sequencing of drugs * Preservation of future treatment options * Use of resistance testing in selected clinical settings.

Answer 204

* Rash * Erythema multiforme * Liver toxicity * Headache

Answer 205

* Lipodystrophy especially fat atrophy * Peripheral neuropathy with ddI, d4T, * Life threatening (rare) lactic acidosis with hepatic steatosis

Answer 206

* Hyperglycemia * Hyperlipidemia * Lipodystrophy * GI- diarrhea, nausea, abdominal pain, dyspepsia * Serious liver problems possible * Skin rash * Fever

Answer 207

* Pneumocystic carini pneumonia (PCP): * Most common infection * Initial symptoms may be nonspecific and may include nonproductive cough, fever chills, dyspnea, and chest pain * If untreated, progresses to pulmonary impairment and respiratory failure Treatment: TMP-SMZ or pentamidine, prophylactic TMP-SMZ * Mycobacterium avium complex (MAC) * Tuberculosis * Without prophylactic treatment, 80% of all people infected with TB will develop PCP

Answer 208

* Loss of appetite * Nausea & vomiting * **Oral candidiasis** * May progress to esophagus and stomach if untreated * **Treatment with Mycelex troches or nystatin,** ketoconazole * Diarrhea related to HIV infection or enteric pathogens * Octretide acetate for severe chronic diarrhea * Wasting syndrome

Answer 209

* 10% weight loss and chronic diarrhea or chronic weakness and fever with absence of other cause * Protein energy malnutrition * Anorexia, diarrhea, GI malabsorption, and lack of nutrition may contribute

Answer 210

* Kaposi's sarcoma * Cutaneous lesions, but may involve multiple organ systems * Lesions cause discomfort, disfigurement, ulceration, and potential for infection * B-cell lymphomas * Invasive cervical cancer

Answer 211

* HIV encephalopathy * Progressive cognitive, behavioral, and motor decline * Probably directly related to the HIV infection * Cryptococcus neoformans * Peripheral neuropathy * Other neurologic disorders * **_Depression!!_**

Answer 212

* **Assess physical and psychosocial status -** ID potential risk factors, including hx risky sexual behavior or IV/injection drug use * **Identify potential risk factors** - IV drug abuse, risky sexual practices * Immune system function * **Nutritional status -** obtain diet hx, ID factors that may interfere with oral intake- anorexia, nausea, vomiting, oral pain, difficulty swallowing. * **Skin integrity - **membranes:daily inspect for breakdown, ulceration or infection. Oral cavity for redness, ulcerations, candidasis. Perianal area for excoriation or infection. Wound cultures to ID infectious organisms * **Respiratory status - **monitor pt for cough, sputum production (TB), SOB, orthopnea, tachypnea, chest pain. Assess breath sounds. Other modalities: CXR, ABG, pulse ox, PFTs * **Neurologic status - **LOC, orientation (person, place, time), memory lapses. Sensory deficits (visual changes, headache, numbness/tingling in extremities), motor involvement (gait, paresis or paralysis), seizures? * **Fluid and electrolyte balance -** examine skin & mucous membranes for turgor & dryness. Assess for decreased mental status, muscle twitching, muscle cramps, irregular pulse, N&V, shallow respirations. * **Knowledge level -** about the disease & modes of disease transmission, treatment, family & friends level as well. Support resources also ID’d

Answer 213

* Impaired skin integrity r/t immunological deficit, diarrhea * Grieving: individual r/t loss of physical & psychosocial well-being * Diarrhea r/t inflammatory bowel changes * Risk for infection r/t inadequate immune system * Fatigue r/t disease process, stress, decreased nutritional intake * Chronic pain r/t tissue inflammation & destruction * Imbalanced nutrition: less than body requirements * Social isolation r/t self-concept disturbance, therapeutic isolation

Answer 214

* Assess for s/sx skin breakdown, dehydration * Labs: O&P x 3, chemistry, stool cultures * Assess bowel pattern and factors that may exacerbate diarrhea * Administer medications (antidiarrheals) as prescribed, may be ATC (kaopectate or Sandostatin) * Dietary counseling: Avoid foods that act as bowel irritants, such as raw fruits and vegetables, carbonated beverages, spicy foods, and foods of extreme temperatures * Small, frequent meals, calorie dense * Adequate fluid intake especially between meals * Food safety: discard expired food, wash hands, clean countertops * Perineal care daily & prn (see bowel incontinence car plan)

Answer 215

* Nutritional assessment at each visit * Monitor food intake (I & O); calorie counts * Monitor weight at least weekly. **•Note labs: serum albumin, prealbumin, total protein, ferritin, transferrin, hemoglobin, hematocrit & elecgtrolytes** * **Serum albumin** * Referral to dietician * Recognize that clients with chronic disease related malnutrition may need calories to maintain nutritional status * Provide small, frequent meals and snacks, high in protein & calories. * Consider offering 30ml of nutritional supplement q hour if anorexic * Use antiemetics if needed. * Provide meticulous mouth care before each meal * Medications that stimulate appetite •

Answer 216

* Assess/perform comprehensive pain assessment (location, quality, onset/duration, temporal profile, intensity, aggravating & alleviating factors, effects on function & QOL) * Ask client to ID pain level that will allow performance of desired activities & achieve acceptable QOL * Assess for burning or tingling in the extremities, severe headaches, tenderness in lymph nodes, diagnosis of malignancies, presence of lesions. * Identify the source of pain. * Manage chronic pain using a multimodal approach; administer medications as ordered for pain relief such as anticonvulsant, local anesthetic and opioid. * Non-pharm measures: * Ensure proper body alignment/positioning. * Relaxation techniques * Back rubs * Distraction * Guided imagery * Watch for signs of depression

Answer 217

* Nutritional assessment at each visit * Referral to dietician * Monitor I & O; calorie counts. * Provide meals & snacks with high protein and calories. * Provide small, frequent meals. * Monitor weight at least weekly. * Use antiemetics if needed. * Provide meticulous mouth care at least every 2 hr.. * Treat OIs affecting eating. * Medications that stimulate appetite * Low fat diet, lactose free

Answer 218

* Rheumatoid arthritis (RA) is a long-term disease that leads to inflammation of the **synovial membranes** * **It involves symmetric joints** (if one joint is inflammed, the other one will be too). Other musculoskeletal illnesses invovle isolated or unilateral joints. * **RA pain is worse in the morning when arising.** * **RA stiffness occurs in the morning and after rest periods** * **Movement decreases pain**

Answer 219

* **Edema** * fatiuge * weakness * anorexia, * Weight loss, * low grade fever, * lymphadenopathy * Joint problems over time: * Occur symmetrically * Alteration in the wrist * Ulnar drift * Boutonniere deformity * Swan-neck deformity * Rheumatoid nodules ## Footnote **Stiffness after prolonged periods of inactivity**

Answer 220

**Diagnostic criteria: (1 to 4 different symptoms for at least 6 weeks)** 1. Morning stiffness 2. Swelling in at least 3 joints 3. Hand joint swelling 4. Symmetrical involvement 5. Subcutaneous nodules 6. Positive RF 7. Radiographic changes (decalcification)

Answer 221

* Characteristic symmetric joint swelling with stiffness, warmth, tenderness, and pain * Stiffness prominent in the AM and subsides during the day * Duration of stiffness an indicator of disease activity; may develop permanent deformities.

Answer 222

* NSAIDS + PPI * Methotrexate (MTX) * Glucocorticoids * Cyclooxygenase-2 (COX-2) inhibitor **Goals: Relieve pain, increase mobility/function & maintain life as usual (family & work)**

Answer 223

1. Arthroscopy (visualizing joint) 2. Arthodesis (bone fusion) 3. Arthroplasty (total joint replacement) ## Footnote **Can correct deformities, improve function, ease pain & increase self-esteem **

Answer 224

* Osteoarthritis (OA) is the most common joint disorder, which is due to aging and wear and tear on a joint. * **asymetric pain is localized and is worse usually later in the day** * **Movement increases pain** *

Answer 225

A decrease in skeletal bone mass occuring when rate of bone resorption is \> than that of bone formation

Answer 226

* age \> 50 * Family history ( eg Rheumatoid Arthritis) * Obesity * Joint abnormality * History of trauma

Answer 227

* age * Gender - Female * family history * estrogen deficiency * small stature * race -- Northern European descent * Heavy cigarette and/or ETOH use * Poor diet with low Ca intake * Periods of immobilization * Use of steroids * Sedentary lifestyle

Answer 228

The weakened bone state increases the risk for stress fractures: **especially at the hip, wrist, and verebrae.**

Answer 229

* More African-Americans- 3 times more than Caucasians * Usually younger women (18-45 years)

Answer 230

An autoimmune disorder in which Autoantibodies are created, ue to defect in T-suppressor cells (and NK cells are also suppressed), they circulate in blood, & deposit (usually) in kidneys, brain, or heart. ## Footnote **This is both a type 2 and type 3 hypersensitvity **

Answer 231

* Fever * Anorexia * Malaise * **Weight loss** * **Butterfly rash (\< 50%)** * **Discoid rash (40%)** * **Sensitivity to sunlight (photosensitivity) 40%** * Splenomegaly * Fingertip lesions (raynad's phenomena) * Periungal erythema * Splinter hemorrhages * Alopecia

Answer 232

* Mild symptoms: bedrest, midafternoon naps, avoidance of fatigue * Sun protection * Topical steroids for isolated skin lesions * NSAIDS for arthritis, arthralgias, fever * Hydroxycholoroquine for rashes or joint symptoms not responsive to NSAIDS * Glucocorticoids for life-threatening manifestations

Answer 233

**1. Serum ANA level (also elevated in RA, scleroderma, CA, TB, hepatitis) --\> ANA + 95% of patients** Antiphospholipid antibody + & arterial or venous clotting – patient will be on coumadin and INR needs to be \> 3 2. Serum C-reactive protein (CRP) & sedimentation rate (ESR) measures inflammation levels 3. Serum complement tests measures amount of proteins in antigen-antibody reaction 4. CXR, EKG, MRI- organ involvement

Answer 234

* maintenance of skin integrity * promotion of healthy lifestyle * reduction of stress * maintenance of proper nutrition * promotion of comfort * increase in self-dependence * maintenance of well-being

Answer 235

**Medications:** a. Corticosteroids b. Immunosuppressants c. Antimalarials d. NSAIDS e. **Meds for specific organ involvement** ** proteinuria – ACE inhibitor** ** hypertension – antihypertensive agents**

Answer 236

A autoimmune connective tissue disease that causes thickening & hardening of skin, blood vessels, & internal organs, and is more prominent in women (4:1 women to men)

Answer 237

* excessive collagen deposition * Microvascular injury * changes in humoral & cellular immunity

Answer 238

**C**alcium deposits beneath skin **R**aynaud’s phenomenon **E**sophageal motility decreased / GI problems **S**clerodactyly / swelling fingers & toes **T**elangiectasia (dilation of vessels) Sjogren’s Syndrome (salivary ducts) Heart, kidney, lung involvement\ **REMEMBER CREST**

Answer 239

**Primary medications:** a. Corticosteroids b. Immunosuppressants **Nursing care:** * skin care * pain management, * dietary changes

Answer 240

A progressive degenerative disease that affects the myelin sheath & conduction pathway of the CNS, slowing down the .

Answer 241

Especially affected: optic nerves, pyramidal tracts, posterior columns, brain stem nuclei, & the periventricular region of the brain?

Answer 242

* intention tremor * Positive Babinski’s reflex * Inc. or hyperactive DTRs * May report tinnitus, vertigo, hearing loss * may have facial weakness, dysphagia * Lhermitte's sign - an electrical sensation that runs down the back and into the limbs

Answer 243

* numbness, tingling, burning, crawling sensations. * Demyelination of spinal cord - may experience bowel & bladder dysfunction; dysfunction in sexuality

Answer 244

* Impaired Physical mobility RT to muscle weakness, awkward movements, fatigue & incoordination. * Sensory/perceptual alterations RT visual, motor, & sensory changes * Body image disturbances & altered role performance RT changes caused by the disease process * Self care deficit RT motor deficits, weakness, spasticity or fatigue * Sleep pattern disturbances RT muscle spasms & pain * Altered nutrition: less than body requirement RT dysphagia, & inability to feed oneself * Pain RT sensory changes, muscles spasms

Answer 245

**Sensory / perceptual:** * Visual changes - help pt. In developing compensatory strategies * An eye patch that is alternated from eye to eye every few hours helps relieve diplopia * Peripheral vision deficits - scanning techniques by having pt. Move head from side to side. * Visual acuity - corrective lesions may help **Safety:** * Avoid environmental clutter * avoid overexposure to heat & cold - use thermometer * shoes at all times.

Answer 246

**Acute exacerbations:** * Steroid therapy - watch for S/E of therapy **Long-term treatment:** * Novantrone (chemotherapeutic agent) * Beta Interferon * Watch for depression

Answer 247

* **baclofen (Lioresal)** * diazepam (Valium) * Dantrolene (Dantrium)

Answer 248

* Fluid intake at least 2000cc/hr * Void every three hours – may have to use intermittent catheterization * High-fiber, fluids - prevent constipation

Answer 249

* Maintain independence in all activities as coordination allows. * **Encourage pt. To ventilate feelings of frustration & anger.** * Work on strategies with family & pt. To minimize the impact of decreased mobility.

Exam 1 - Study Material Flashcards

(274 cards)