Exam 2 Flashcards
1
Q
ADHD diagnosing
A
symptoms last more than 6 months
symptoms begin before 7 years old
2
Q
To diagnose ADHD before 17, pt must have
A
6 or more of ADHD characteristics
3
Q
Stimulant drugs for ADHD
A
Dextroamphetamine - stimulant, loss of appetite, sleep problems, headaches
Atomoxetine - decreased appetite, N/V, sleep disturbance
4
Q
Nonstimulant ADHD meds
A
Norepinephrine reuptake inhibitors
5
Q
ADHD meds should be given to kids _ food
A
AFTER
so they eat
6
Q
Monitor ADHD kids for…
Give meds early so they can _
A
weight loss
sleep
7
Q
Therapeutic play for ADHD
A
Promotes communication
Increases understanding of thoughts and feelings
8
Q
ADHD drugs should be stored safely to prevent
A
accidents or abuse
9
Q
Behavioral therapy for ADHD
A
Positive reinforcement
Age appropriate consequences
10
Q
Refer ADHD fam to
A
local support groups
national ADHD support groups
11
Q
3 types of hyperactivity
A
Impulsive
Inattentive
combined
12
Q
When is autism IDd
A
between 12 months and 36 months
13
Q
Autism characteristics
A
little eye contact few facial expressions difficulty building relationships low emotional affect lack spontaneous enjoyment
14
Q
Warning signs of autism
A
no babbling by 12m
no pointing or gesturing by 12m
no words by 16m
no 2-word utterances by 24m
LOSS or Regression of skills
15
Q
Therapies for autism
A
behavioral and communication
16
Q
Autism patients respond well to _ education
A
structured
17
Q
Autism stereotyped motor behavior
A
Hand flapping
Body twisting
Head banging
18
Q
Autism screenings
A
MchatR
SCQ Social communication questionnaire
PDDST pDevelopmental disorder screening test
19
Q
Interventions for autism
A
emotional support
guidance and edu
Routine
20
Q
Controversial treatment for menopause
A
HRT
Hormone replacement therapy
21
Q
If a menopause woman still has her uterus her HRT will have
A
Both estrogen AND progestin
22
Q
Dosing for HRT
A
Lowest effective
Shortest duration
23
Q
HRT contraindications
A
Hist of breast cancer Uterine cancer Vascular thrombosis Impaired liver function Undiagnosed uterine bleeding
24
Q
HRT patients need to understand they are taking
A
HORMONES
25
S/S of DVT
| HRT risk
leg redness and pain/tenderness
26
S/S of PE
| HRT risk
chest pain and SOB
27
Patient maintenance for HRT therapy
Weight bearing exercises
v in smoking/alcohol
Annual mammogram
Take calcium and vit D
28
Does intellect decline with age
NO
| just get a little slower
29
Is depression normal in older adults
NO
| Neither is loneliness
30
Aging and heart
HF
Atherosclerosis
31
Aging had lungs
Loss of elasticity
Difficulty breathing
32
Aging and GU
Incomplete emptying, creates need to pee
Leads to fall risk and infection
33
Aging and GI
v metabolism
constipation
+fiber
34
Aging and senses
Vision Hearing Taste and Smell
ALL DECREASE
PT will add salt
35
TB spread is
Airborn
N95
36
Tuberculosis 101
airborne
multiply in alveoli and get transported via blood and lymph
as infected cells die they accumulate in lung causing bronchopneumonia
Can recur
37
TB infection occurs to weeks after exposure
2 to 10
38
S/S of EARLY TB
insidious
Low fever
cough
sweats
fatigue
weight loss
39
As TB progresses S/S includes
Mucopurulent sputum expectorate
Hemoptysis - blood in cough
40
Elder TB patients have _ pronounced symptoms
Less
41
If pt presents with positive skin, blood or sputum, for TB
Do history, physical exam, Chest xray.
Drug susceptibility testing.
42
5mm or greater on TB test
When is test read
Will it be elevated
Positive
48-72h
Yes
43
Blood tests for TB
QuantiFERON Gold
T-Spot
rules out Active and Latent infections
Good for BCG vaccinated people
44
TB meds
Anti-TB agents
INH, Rifampin, Pyrazinamide, Ethambutol
Given for 6 to 12 months
Prolong treatment to ensure eradication
45
TB drug resistance
Primary - resistance to ONE drug in people who have not had previous treatment
Secondary - resistance to ONE OR MORE in people undergoing therapy
Multi - resistance to TWO agents
46
TB treatment phases
phase 1: all drugs + Vit B6 for 8 weeks
phase 2: INH and rifampin for 4 to 7 months
47
Nursing priorities with TB
Airway clearance
Adherence to meds
^ Activity and nutrition
Prevent transmission
48
Airway clearance with TB interventions
^ fluid intake
Postural drainage
49
Adherence to meds with TB
Take meds on empty stomach or 1h before meal
50
Food that messes with TB meds
Tuna
Aged cheese
Red wine
Soy sauce
Yeast extract
51
Rifampin makes what meds less effective
Warfarin
digoxin
corticosteroids
52
Contact lenses and rifampin
Will be discolored
switch to glasses
53
Side effects of antiTB meds
Liver/Kidney problems (BUN, creatinine, enzymes)
Hearing loss
Rash
54
Prevent transmission with TB
Cover mouth
dispose of tissues
Hand hygiene
55
Do you report TB to the health department
YES
56
RA patho
Immune system attacks joints causing effusion, pain and edema
After triggering event, pain subsides pannus (extra growth) occurs
Destruction of joint cartilage and bone
57
Pannus
Proliferation of new synovial joint tissue WITH inflammatory cells already formed
occurs due to RA
58
RA is autoimmune
body attack self
59
S/S of RA
PAIN
joint swelling
limited movement
stiffness
weakness
60
Diagnosing RA
```
RF rheumatoid factor
ACPA
ESR erythrocyte sedimentation rate
C reactive protein CRP
Radiology
```
61
Rx management of RA
salicylates (aspirin)
NSAIDs
DMARDs (work on autoimmune response)
62
None Rx management of RA
Heat/Paraffin baths 20 min max
Therapeutic exercises
Braces, splints, assistive devices (canes)
63
Treatment goals for RA
v inflammation
control pain
^ mobility
^ PT knowledge
64
RA exercise and activity
Physical/occupation therapy
TENS
relaxation techniques
65
Sleep with RA can be aided by
Low dose antidepressants
Amitriptyline
Good sleep hygiene (cold room, no tv, no eating in bed, etc.)
66
What joints are affected first by RA
fingers
wrists
toes
small joints first
67
clues for RA problems in elderly
Gait pattern change
Guarding
Joint flexion
68
3 Distinct characteristics of RA
Inflammation
Autoimmunity
Degeneration of cartilage
69
RA
Swan neck
Boutonniere
finger appearance ^v-
finger appearance ^-
70
Caution with biologic DMARDS
| Disease modifying antirheumatic drugs
Suppress autoimmune response
71
RA joint deformities can result in
loss of use
72
Contractures
muscles bones joints get stuck due to joint destruction RA
73
When in they day is the pain worse
MORNING
ON TEST
74
RA foot deformities
Major bunion
Toes going in different directions
75
Why do joint deformities happen
destruction and recalcification of tissue
76
Biggest difference between lupus and RA
Degeneration and destruction of tissue with RA
ON TEST
77
NSAIDS CORTICOSTEROIDS DMARDS
| with RA
STAY AWAY FROM PEOPLE
| HIGH INFECTION RISK
78
DMARDs
stop progression but can not fix damaged joints
does not work indefinitely
Nonbiologic - take longer to work then biologic
79
Infliximab DMARD
Works to improve the immune system
80
Anaphylaxis
Type I hypersensitivity
Rapid release of IgE
severe life-threatening reaction
81
Common causes of anaphylaxis
Antibiotics and radiocontrast agents
Penicillin most common culprit
82
The faster the onset of anaphylaxis
The more severe the reaction
83
Mild anaphylaxis S/S
tingling and warmth
fullness in mouth and throat
nasal and periorbital swelling
sneezing and tearing of eyes
onset is first 2h of exposure
84
Moderate anaphylaxis S/S
flushing/warmth/itching
Anxiety
Bronchospasms
edema or airways
cough/wheezing
onset within first 2h
85
Severe anaphylaxis S/S
Abrupt onset
severe dyspnea
cyanosis
hypotension
V/D
seizures
86
Treatment for anaphylaxis
Strict avoidance
Epinephrine (EpiPen Auvi-Q)
87
Med management of anaphylaxis
O2
Epi
Antihistamines
Corticosteroids
IV fluids
88
After treatment for anaphylaxis watch for rebound reaction which happens…
4 to 8 h after
89
Nursing management of anaphylaxis
Check airway breathing and vitals
Notify providers
Instructions after recovery, like what to avoid and getting an epipen
90
Emergency nursing measures for anaphylaxis
Intubating
Admin emergency meds
IV lines + fluids
O2 admin
91
Anaphylactoid reaction
Not same as anaphylaxis
NON IgE
No sensitization
92
Fluids with Anaphylaxis
Increased permeability of capillaries
Fill up with fluid in lungs
N/V/D etc.
93
If you have Mild anaphylaxis now
DOT NOT mean will have Mild anaphylaxis next time
94
Solution to push IV for anaphylaxis
Isotonic
LR
NS
95
Nursing management basics for anaphylaxis
Stop allergen
Give epi FIRST, IV, O2
96
If you have allergy
awareness
wear bracelet
Inform school nurse/teachers
ask for return demonstration when showing how to use
97
Hold epipen in injection place for
FULL 10 SECONDS
98
Crohn's disease 101
Chronic inflammation of GI
Most common in distal ileum and ascending colon
99
Crohn patho
small lesions that expand and thicken becoming fibrotic
intestinal lumen narrows
100
S/S of crohn
prominent right lower quadrant pain
unrelieved diarrhea
pain occurs after meals
101
Secondary complications of crohns
weight loss
malnutrition
anemia
102
stretorrhea and chron
fat in feces
103
Assessment for crohns
CT and MRI
104
Crohn bowl complications
obstruction
structural problems
perianal disease
Enterocutaneous fistula - opening between small bowels and skin
105
Enterocutaneous fistula
opening between small bowels and skin
106
Ulcerative colitis 101
ulcerative inflammatory disease of mucosal and submucosal layers of colon and rectum
107
Characteristics of Ulcerative colitis
Abdominal cramps
Bloody/purulent diarrhea
LEFT lower quadrant pain
Weight loss
six or more liquid stools a day
108
Patho of ulcerative colitis
mucosa become edematous and inflamed
colonic epithelium sheds
Eventually the bowel narrows, shortens and thickens
109
Assessment for ulcerative colitis
abdominal x ray
colonoscopy
110
Ulcerative colitis may lead to toxic mega colon this is treated with
NG suction
IV fluids
Lytes
Corticosteroids
Antibiotics
SURGERY
111
Diet for ulcerative colitis
Oral fluids
Low residue
High protein, high calorie diet
Supplemental vitamins, iron
112
Food to avoid with ulcerative colitis
cold food
milk
113
Rx or ulcerative colitis
sedatives antidiarrheals antiperistalitics for diarrhea
Aminosalicilates to reduce inflammation
Corticosteroids to reduce swelling
Immunomodulators to treat underlying cause
114
Partial or complete obstruction or bowels =
surgery
115
Colectomy and ileostomy
removal of colon and stoma for drainage
used in IBD problems
116
Normal elimination nursing interventions
food diary
give meds
increase fluid intake
record frequency and consistency of stool
117
Pain nursing interventions for IBD
Analgesics
Position changes
Heat
118
When doing parenteral nutrition for IBD patients monitor
glucose q6h
119
Mental health and ulcerative colitis
Promote rest
Reduce anxiety
Enhance coping measures
120
With bedridden IBD patients monitor for
skin breakdown
121
2 types of TB
Active- showing symptoms, neutrophils and macrophages fight infection
Latent- NOT active but carrier of encapsulated bacteria
122
Most obvious TB S/S
Cough lasting more than 3 weeks
low grade fever
blood in sputum
123
if PPD test is greater than 10mm
POSITIVE
Induration (raised) MUST be present
124
PPD test is considered
SCREENING not diagnostic
TB GOLD, Chest xray and Acid fast are diagnostic
ACID FAST CULTURE IS THE GOLD STANDARD OF TB TESTING
125
Standard number of meds to take for TB
4
isoniazide
Rifampin
Pyrazinamide
Ethambutol
126
All TB meds are toxic to
LIVER
do enzyme tests
127
For tb take B6
take meds 1 h _ meals
when to take
to prevent neuropathy
before
SAME TIME QDAY
128
When is a TB patient not contagious
after 2-3 weeks
AND
3 negative sputum cultures
AND
Med compliant
129
when are sputum samples done for TB
Q2-4W
Helps track progress
130
S/S or hepatotoxicity
S/S nerutoxicity
Jaundice, Right upper quadrant pain, Fever
Numbness, tingling
131
for alergic reactions do you shut the med off first or give epi
SHUT THE MED OFF
132
Ulcerative colitis only affects
Starts at
Mucosal and Submucosal layers
Low part of rectum and works its way up
133
Crohn's disease affects
All layers of intestine from mouth to butt but not continuously
here and there
134
movement number
Ulcerative colitis UC pain will start at
15 to 20 bowel movements
Left lower side
Bleeding
135
movement number
CD pain
5 stool movements
pain in right lower quadrant
136
UC complications
Loss of Haustra - smooths out intestine, these parts can absorb nutrients
Toxic megacolon - colon dilates, inflammation. Unable to contract, distends, becomes paralyzed
137
Cobblestone intestine is related to
CD
138
IBS labs
Albumin will be LOW malnutrition
ESR, C reactive protein - inflammation
Stool sample
CBC
Chem panel
139
IBS diagnostics
MRE - magnetic resonance enterography
MRI/CT
Sigmoidoscopy
Colonoscope
Endoscopy
140
With IBS diet avoid
FIBER - will make you shit more
POPCORN - will get stuck and infected
RED MEAT - slow digestion
Peal fruit and veg
141
IBS treatments side effects
5 Aminosalicylic acid - nausea fever rash, kidney toxicity
Steroids and immunosuppressants - avoid getting sick
142
Surgery for IBS
Always give
Ileostomy, Colectomy, Proctocolectomy
ANTIBIOTICS
143
IBS diet
Low fiber
High protein
High calorie
144
Toxic megacolon treatment
NPO
bowel suction
TPN
if not resolved by 3 days, surgery
145
Before applying a valve sticker to the colostomy use
barrier cream, prevents skin breakdown
146
Teach parent about ADHD
Support groups
Routines
Reward systems
Monitor weight
147
Comms with ADHD parents to support therapy
Your child is not bad
Have appropriate reward and punishment systems
Keep child on track
148
TB isolation
negative pressure room
| put sign on door
149
TB evaluation best
Sputum
150
With RA safety
Avoid large crowds
Check temp
Avoid sick people
151
RA stiffens is _
bilateral
152
When would you not give RA PTs DMARDS
TB
| Immune compromise
153
How to give epi
Thigh
10 sec
through clothing
154
On top of epi give
Antihistamines
155
Response to EPI meds
If pt still breathing bad, has rash or other symptoms
| still needs med
156
With IBS assess bleeding in stool
Drop in BP increase in HR
| CBC
157
Complications of steroid therapy
Low Immunity
Hyperglycemia
Osteoporosis - Bone scans, weight bearing exercise, Calcium Vid D
158
IBS serious complications
Toxic Megacolon ON TEST
S/S
unalleviated pain
abdominal distention
inflammation to the muscular wall
rest, NPO, TPN
If no response to med management in 72h = surgery
159
MS manifestations
Visual problems
Cognitive problems
Speech/swallowing problems
160
Lupus manifestations
Fever
Fatigue
Anorexia
Joint pain
Butterfly rash
161
Lupus and blood
Kidney function
BUN value ?
Creatinine value ?
162
Diagnosing lupus
?
163
Breast cancer meds
Tamoxifen
Chemo - N/V, alopecia, loss of appetite
Radiation - skin irritation, keep distance especially if imbedded ratiation
164
Tamoxifen
Preventative
| given if pt has potential
165
Gold standard of breast cancer treatment
Surgery
166
Prostate cancer S/S
?
167
Surgery for prostate cancer
TURP
Irrigation of bladder
Progression of color like lochia
168
Brachytherapy safety
Maintain distance
stay away from pregnant people
elderly and children
169
Gold standard of colon cancer
Colonoscopy
Starts at 50
Then every 10 years
170
Colonoscopy
Camera looking for growth and dollops
Can take a sample
Gold standard of Colon cancer testing
171
Before colon surgery give
ANTIBIOTICS
teaching for end result like a bag or tube
172
With Chemo
blood
Anemia
Thrombocytopenia
Low WBC
173
Radiation is too much
blistering
bleeding
puss
174
Leukemia interventions and assistance
Stop if lab too low
| May give blood or other supplements
175
ABCDE of skin cancer
?
176
Clinical manifestation of Hodgkins
B Symptoms ?
| Lumps
177
Who is most at risk for ALL
Kids
178
MS
| Multiple sclerosis 101
progressive demyelinating disease of the CNS
Impaired transmission of nerve impulses
onset at 25 to 35 y
179
MS Patho
T and B cells demyelinate nerve cells in CNS
plaque appears on demyelinated nerves further interrupting connections
axon begin to degenerate resulting in permanent damage
180
MS S/S
Fatigue
Depression
Weakness
Numbness
Bad coordination
181
Vision with MS
Diplopia (double)
Blurred
may cover affected eye
182
MS and pain
MS and spasticity
MS and ataxia
pain - social isolation
spasticity - messes with motor pathways
ataxia - impaired movement
183
MS assessment and diagnosis
Plaque in CNS observed via MRI
184
Common symptoms of MS that require interventions
Ataxia
Bladder dysfunction
Depression
Fatigue
Spasticity
185
Disease-modifying therapies for MS
reduce frequency or relapse
reduce duration of relapse
reduce number and size of plaques
186
Disease modifying meds MS
Interferon beta 1a - flu like symptoms
Glatiramer acetate - takes 6m
IV methylprednisolone - key agent in treatment, no long term benefits
Mitoxantrone - cardiac toxicity
187
Symptoms management meds MS
Baclofen and benzos - spasticity
anticholinergics - bladder issues
Ascorbic acid for UTIs
188
Nursing interventions for MS
Exercises
Minimizing spasticity and contractures
Nutrition
Minimize immobility
189
Nursing treatment of MS for walking
Assistive devices
Gait training
190
Nursing treatment for bladder/bowels MS
Training to control and respond in time
self cath
191
Nursing treatment and sallowing MS
Speech/language pathologist to assist with dysphagia
192
MS and home living
assistive eating devices
raised toilet seats
bathing aids
phone modifications
long-handled comb
193
DMARDs
stop progression but can not fix damaged joints
does not work indefinitely
Nonbiologic - take longer to work then biologic
194
Can you get myelination back with MS
NO
195
Diagnosing MS
MRI
CSF spinal tap
EMG - assesses nerve response
Neuro exam
196
MS meds are immunosuppressive so
Wear masks
Stay away from crowds
Take steps to not get sick
197
DMARDs decrease
Frequency and duration of relapse
Can decrease plaque in brain
WILL BE ON TEST
198
Main focus of nursing care for MS
Safety first
assistive devices
Bladder/bowel care
Cognitive function
Meds
199
SLE
Systemic lupus erythematosus
Inflammatory autoimmune disorder
Affects body organs
200
Factors that contribute to lupus
Genetic
Immunologic
Hormonal
Environmental
201
SLE Lupus manifestations
Fever, malaise, weight loss, anorexia
202
Most commonly affected system by SLE
Gastrointestinal tract
Liver
Ocular system
203
Skin manifestations of lupus
Rash on nose bridge and cheeks
204
With SLE, skin lesions are worsened by
sunlight
ultraviolet light
205
Earliest symptoms of SLE
Joint problems
Arthralgia (joint stiffness)
206
Heart symptoms with SLE
Pericarditis
Hypertension
Dysrhythmias
Valve problems
207
Kidneys and SLE
Nephritis
Serum creatinine for screening
208
Normal BUN
6 to 24
209
Normal Creatinine
0.7-1.3
210
CNS and SLE
cognitive impairment
seizure
strokes
central and peripheral neuropathy
211
Diagnosing SLE
History
Physical
Blood tests
212
Erythematous rash
Erythematous plaque with scale
Sign of lupus
213
Scalp with SLE
Mouth with SLE
Alopecia
Ulcerations
214
SLE has 11 criteria
if _ are present, lupus is diagnosed
4
215
Blood work for lupus
Anti-DNA
Anti-ds DNA
Anti-Sm
216
Mainstay of SLE management
Pain
Immunosuppression
217
Meds for SLE
Monoclonal antibodies
Corticosteroids
Antimalaria agents
NSAIDS
Immunosuppressive agents
218
Belimumab
Approved by FDA for SLE
Monoclonal antibody that renders BLyS inactive
219
BLyS
Produced by body during lupus
| Attacks organs
220
Risk factor for corticosteroids and SLE
Osteoporosis
221
Nursing management focus with SLE
Fatigue
Impaired skin integrity
Body image disturbance
Deficit in knowledge
222
SLE patients need to increase
screenings
health promoting activities
have good diet
223
Immunosuppressants and corticosteroid side effects with lupus
increased risk for infection
Increased risk for osteoporosis
224
Most common sign of lupus
Low grade fever
joint pain
MALAR RASH ON TEST (the nose cheekbone thing)
225
Discoid lesions
Scaly
very clear
cause alopecia
Sign of LUPUS
226
Lupus related arthritis
Swelling of joints due to lupus
BILATERAL AND SEMETRICK
227
Lupus meds
| S/S of nephritis
Cloudiness blood or puss in urine
Pain at kidneys
BUN Creatinine urinalysis labs
228
Indicative test for lupus
ANA
History of symptoms
229
Why are kidneys stressed during lupus
Kidneys are our filters
NEED EM
230
Meds for lupus
hydroxychloroquine
corticosteroids
Methotrexate and azathioprine (immunosuppressants)
NEED TO BE SAFE BECAUSE THESE MEDS WILL DISTROY IMMUNITY
231
As nurses helping with lupus
Manage pain
Rest
MONITOR KIDNEYS
V/S, edema, breath sounds
Monitor Mental status
232
for alergic reactions do you shut the med off first or give epi
SHUT THE MED OFF
233
Mutation in BRCA 1 or BRCA 2 indicates
increased risk for breast cancer
234
Chemopreventives for breast cancer
tamoxifen
raloxifene
235
Prophylactic mastectomy
Total mastectomy of a breast at risk
Reasons to get
Fam history, BRCA, LCIS, previous cancer
236
Breast cancer is usually found in the
upper outer quadrant
237
S/S of breast cancer
nontender fixed hard mass
skin dimpling, nipple retraction, skin ulceration
238
BC prognosis is based on
size
spread to other areas
239
Preoperative nursing interventions Breast cancer
Know difference between ALND (axillary lymph node dysection) and SLNB (sentinel lymph node biopsy) and treatment options
Emotional support
promote decision making
240
Postoperative nursing interventions Breast cancer
Pain and discomfort relief THERAPY
Promote positive body image
Promote coping
improve sexual function
Monitor for complications LYMPHEDEMA
241
When are post surgery drains removed
When drain output is less than 30ml in 24h
242
Complications of breast surgery
Lymphedema
Hematoma/Seroma
Infection
243
Range of motion exercises should be performed at what rate
3 times a day
20 min session
244
Brachytherapy
radiation delivered via internal device
given over 4 to 5 days as opposed to regular radiation
which is 5 to 6 weeks
245
Nursing management for radiation therapy
Used mild soap and minimal rubbing
No perfumes/deodorants
Hydrophilic lotions
Antipruritic soap
Avoid tight cloths
246
To minimize chemo side effects pts may be given
hematopoietic growth factors
granulocyte colony stimulants
247
Trastuzumab
Binds specifically to HER-3 protein preventing cancer
248
How often after 40 are mamograms and clinical breast exams done
every year
249
Well differentiated is
Undifferentiated is
tumor look line normal cell GOOD
no similarity BAD
250
To admin chemo you need
can you crush chemo drugs
special certs
double checking by 2 nurses
NO
251
Types of tumor excisions
surgery and biopsy
252
Genes associated with prostate cancer
HPC 1 BRCA 1 BRCA 2
253
S/S of pros cancer
urinary obstruction
blood in urine or semen
painful ejaculation
254
Symptoms of metastases of prostate cancer
backache
hip pin
perineal and rectal pain
255
Assessment for pros cancer
DRE
serum PSA
ultrasound guided TRUS
256
Score to determine treatment for pros cancer
gleason
257
pros cancer and vaccines
therapeutic vaccines kill existing cancer cells
provide future immunit
258
Surge management of pros cancer
radical prostatectomy
may have impotence
259
radiation for pros cancer
brachytherapy - radiation
260
ADT
androgen deprivation therapy - castration - increases morbidity
hormone therapy
261
Hormone therapy for pros cancer
LHRH agonists
Antiandrogen receptor agonists
262
Other pros cancer therapies
cryosurgery
TURP
Pain management
263
Prostate cancer is so slow that treatment can be delayed for up to
this can also lead to under monitoring
10 year
264
Prostate cancer is also linked with what mutation
BRCA
265
Early prostate cancer s/s
Hesitancy
weak stream
urgency
frequency
nocturia
266
prostate cancer likes to spread to
BONE
the lymph nodes
will hur
267
PSA
prostate specific antigen
elevated is more than 4
do this BEFORE Digital rectal exam
268
EPCA =
prostate cancer
best indicator
269
Androgen deprivation therapy
hormonal therapy for prostate cancer
270
post prostate surgery procedure
CBI
continuous bladder irrigation
monitor color for progression
1000ml in should = 1000ml out
271
Most significant risk factor for colorectal cancer
old age
272
S/S of colorectal cancer
change is bowel habits
blood in or on stool
anemia anorexia
weight loss or gain
273
Dull abdominal pain and melena(dark stool)
colorectal cancer
274
Screening for colorectal cancer
colonoscopy
275
Complications of butt cancer
obstruction
hemorrhange
276
Old butt cancer patients may report fatigue due too
low iron
277
med to prevent butt cancer
aspirin
278
Surgeries for butt cancer
segmental resection
perineal resection
Temp/permanent colostomy
Colonic j-pouch
279
With butt cancer, chemo usually starts at stage _
unless your is messed up at stage
3
MMR, 2
280
Butt cancer preop nursing care
Nutrition
Infection prevention
FV balance
281
Butt cancer postop nursing care
Nutrition
Wound care
Monitor for complications, Rectal bleed emergency - hemorrhage
282
When do colonoscopy's and fecal occult blood start
age 50 q10y
283
To admin chemo you need
can you crush chemo drugs
special certs
double checking by 2 nurses
NO
284
Chemo complications
immunosuppression
NV Anorexia
Alopecia
Oral effects - mucus lining thinning mucositis/stomatitis
Anemia/thrombocytopenia
285
Increase in chemo intensity =
increase in positive outcomes BUT ALSO increase in toxicity
286
How to chemo meds work in terms to cell life
they affect different life stages of cell procreation mitosis
287
chemo pain
tissue necrosis neuropathies
288
radiation pain
skin, tissue, organ inflammation
289
Radiation therapy lead to skin
Integrity issues
290
Brachytherapy
radiation delivered via internal device
given over 4 to 5 days as opposed to regular radiation
which is 5 to 6 weeks
291
Nursing management for radiation therapy
Used mild soap and minimal rubbing
No perfumes/deodorants
Hydrophilic lotions
Antipruritic soap
Avoid tight cloths
292
Radiation
ionizes and targets tissue cells
Skin will be Sun Burned - expected side effect
293
bad radiation side effects
Weeping
drainage
ulcers
294
Do you put lotions on radiation
how is radiation give
NO
fractions - given in centigrade of whole
if prescribed 500 centigrade, given 20 centigrade per a session
295
Protection with radiation
ware dosimeter and protective equipment as a nurse
let pt know to stay away from pregos and spouse
visiting times down to 30 min 6 foot distance
296
Internal radiation implant seeds will cause
radiation precaution to last longer
297
Leukemia
Hematopoietic malignancy of the a particular blood cell
can be granulocyte, lymphocyte, erythrocyte or megakaryocyte
298
Manifestations of AML
Acute myeloid leukemia
Neutropenia - fever and infection
Anemia - fatigue dyspnea pallor
Thrombocytopenia - petechia, ecchymoses, bleeding tendencies
299
AML and manifestations inorgans
Pain in liver or spleen from enlargement
Bone pain from marrow expansion
Hyperplasia (enlargement) of gums
Hyperplasia of synovial space of joints
300
Diagnostics of AML
CBC - v in erythrocytes and platelets
v in Leukocytes
Bone marrow analysis - 20% increase in immature leukocytes aka Blast Cells Hallmark of diagnosis
301
AML treatment
Aggressive chemo - induction therapy (hospitalization for weeks)
results in low ANC
Packed RBCs and Platelets for ANC
G-CSF or GM-CSF - promote granulocyte and macrophage growth
302
Absolute neutrophil count
precise calculation of the number of circulating neutrophils
DROPS in AML
303
Chronic Myeloid leukemia CML 101
Pain in Liver Spleen and Long bones - excessive leukocyte proliferation
SOB, confusion - due to too much leukocytes
304
Transformation phase CML S/S
bone pain, fever, weight loss
Spleen will enlarge
Anemia/Thrombocytopenia
305
Acceleration (blast crisis) phase CML S/S
Same as AML
Induction therapy
306
Nursing management of CML
PCR to detect levels of BCR-ABL molecules
Major molecular response Benchmark for determining efficacy
Biggest issue with taking tyrosine therapy is ADHERENCE, STRESS importance of taking meds
307
Skin cancer causes
UV exposure
308
skin Basal cell carcinoma S/S
small waxy nodule
rolled translucent pearly borders
309
skin Squamous cell carcinoma
from epidermis
Invasive and metastasizing
310
SCC S/S
rough thickened scaly tumor
may or may not bleed
311
Surgical skin cancer treatment
Mohs micrographic surgery - most accurate, removes layers
Electrosurgery - current burn it
Cryosurgery - deep freezing the tissue
312
Topical treatment for skin cancer
5 aminolevulinic acid + PDT
ALAPDT
313
Teaching for skin cancer
dressing changes and wound checking
monitor bleeding
emollient cream for dryness
follow up q3m for a year
314
Melanoma manifestation
dark red blue
irregular shape
1cm
itching ulcerations bleeding
rapid growth
315
2 phases of melanoma growth
1 wide
2 into skin
316
Diagnosing melanoma
Biopsy
317
Staging for melanomas
Tumor nodes metastasis system
318
Melanoma nursing intervnetions
Pain and discomfort
Reduce anxiety
Monitor complications
319
actinic keratosis
small red areas that grow scale and thick over time
Precursor to skin cancer
might be on test
320
3 types of skin cancer
scc - squamous, scaly lesions
bcc - basal, most skin cancer, small waxy nodules
melanoma - Most dangerous and spreading, Look like moles
321
ABCDE of melanomas
Asymmetry
Border irregularity
Color variation
Diameter over 6mm
Evolving
generally the more symmetry the better and vice versa
322
+5 sunburn =
double the skin cancer risk
323
Mohs surger
continuing to burn or freeze post melanoma cites until biopsy comes up negative
324
Hodgkin lymphoma 101
Rare, high cure rate
happens between 15y and 34y or over 60y
familial pattern
325
Hodgkin lymphoma patho
Single node origin
Reed-Sternberg Cell - huge immature lymphoid tumor cell, Core cell of the disease, all benign cells around it just support it.
326
S/S of hodgkin lymphoma
Enlargement of one or more lymph nodes on neck, Painless and firm
Cervical, Supraclavicular and mediastinal nodes most common
Mediastinal mass may be large enough to close trachea and cause dyspnea
327
Organ S/S of hodgin lymphoma
Organ compression
Pulmonary effusion
Jaundice
Abdominal pain
Bone pain
B symptoms
328
B symptoms
Fever
Drenching seats
Weight loss
329
Erythrocyte sedimentation rate
Rate of RBC settling - elevation indicates hodgkin lymphoma
330
Diagnosing hodgkin lymphoma
Lymph node biopsy
Finding of the Reed-Sternberg cell
331
Staging
| Assessing the extent of hogkins
like b symptoms
lymph node palpation
spleen and liver size
Xray and CT
PET positron emission tomography
332
Treatment for hodkins
Chemo plus meds
MoAb - attack's Reed Sternberg but also attacks T and B cells
333
Nursing management of hodkins
Check for secondary malignancy
Decrease tobacco, alcohol and exposure to carcinogens/excessive sunlight
334
Basic Nursing focus with leukemia
Infection and bleeding
Mucositis management
335
F/E and leukemia
Measure I&Os - dehydration and fluid overload
CBC BMP - lytes, BUN, creatinine, hematocrit
K and Mag are frequent IVs
336
Nutrition and Leukemia
Small frequent feedings
soft texture
moderate temperature
Daily body weight
337
Pain and leukemia
Tylenol
Sponging with cool water NO COLD
PCA (patient controlled analgesia)
338
Fatigue and leukemia
Stationary bike
Physicals therapy
Just sitting up during the day will improve tidal volume
339
With leukemia don't forget to manage
Hygiene
Anxiety and grief
Spiritual well-being
340
Kubler Ross
Stages of grief
test
```
Denial
Anger
Bargaining
Depression
Acceptance
```
341
Most important part of moving through grief stages
Be open and communicative
342
Are grief stages definite
NO
pt can spend different amounts of time and go back and forth between stages
343
Nursing interventions for grief
Understand process
Develop Therapeutic communication
Active listening
Be non-judgmental
344
3 Assessments of client
Perception
Support
Coping
345
Nursing with terminal illness
support family unit
encourage meaningful interactions
professional support (Chaplin, grief counselor)
346
Effective listening
Allow for silence
Ask if pt needs time
Assess understanding
347
Things to avoid with comms
Distractions
Impulse to give advice
Canner responses "I know how you feel"
348
Grief vs mourning
Feeling
expression of it
