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Med Surg > Exam 3 > Flashcards

Exam 3 Flashcards

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1
Q

cell functions

A

create fuel for the body

manufacture proteins

transport

disposal of waste

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2
Q

benign vs malignant

A

abnormal growth
abnormal functions
metastasis

benign: BPH, fibroma, lipoma, Meningioma/Brain tumor, Nevi, gastric polyps

malignant: breast, prostate, colon, lung, brain, leukemia, lymphoma, sarcoma

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3
Q

cell cancer mutation risk factors

A

certain populations (black/african american, latino/hisbpanic, alaska native, american indian, gay/lesbian, less educated/lower socioeconomic status)
age
gender
tobacco use
infections
genetics
radiation
carcinogens
nutrition
physical activity

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4
Q

Cancer Assessment Diagnosis

A

Visualization (lumps, bumps, bruising, malnourished)

Imaging (xrays, ultrasounds, cat scan, PET scan)

Lab tests (electrolytes, hemogloblin, hematocrit, platelet)

Biopsy (aspirate cells and put under microscope)

Pathology (what kind of cancer cells, start grading and staging)

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5
Q

Cancer Assessment Grading/Staging

A

size, location, metastasis
TNM method - solid tumors (size, nodes, metastasis)
1 early
2 nearby tissues
3 spread to lymph nodes
4 advanced, distant tissue

Grading:
Gx - can not be assessed
G1 - well differentiated (low grade)
G2 moderate
G3 poor differentiated
G4 undifferentiated (high grade)

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6
Q

Clinical management (treatment) for cancers

A

surgery
radiation
chemotherapy
hormonal therapy
targeted therapy
biologics
bone marrow/stem cell transplants

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7
Q

cancer treatment side effects

A

bone marrow suppression (neutropenia, anemia, throbocytopenia)

organ disfunction

fatigue

GI

Mucositis/stomatitis

anorexia

skin reactions

alopecia

mental health changes

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8
Q

neutropenic precautions

A

strict handwashing
private room
no sick visitors/staff
no live vaccines
avoid procedures
no fresh fruits / vegetables or flowers

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9
Q

leukemia

A

cancer of blood-forming tissues (bone marrow and lymphatic system) hindering normal function

acute (the worst form, takes over in weeks) vs chronic (years, multiply slowly)
myelogenous vs lymphocytic

Acute Lymphocytic Leukemia (ALL) - children/teens
Acute Myelogenous Leukemia (AML) - adults
Chronic Lymphocytic Leukemia (CLL) - adults
Chronic Myelogenous Leukemia (CML) - older adults

symptoms: fatigue, fever, infections, SOB, weight loss, bone/joint paint, swollen lymph nodes, bruising/bleeding

diagnosis: bone marrow biopsy/cell examination

nursing and interprofessional management: chemo, biologics, targeted therapy, radiation, transplant, CAR T-Cell Therapy

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10
Q

Hodgkin vs Non-Hodgkin Lymphomas

A

cancer of the lymphatic system, originates from white blood cells

diagnos with PET scan, lymphnode biopsy

stages 1-4

Hodgkin: more rare, less subtypes
Fatigue, fever, wight loss, itching & pain (chest & belly, upper body)
Age: 29-39 or 65 and older
Presence of Reed-Sternberg lymphocytes (oversized WBCs)
More common in upper body

Non-Hodgkin: more common, 70 subtypes
Swollen nodes, pain, cough, dyspnea, fatigue, fever, weight loss, & fullness in stomach
Age: older population
Can occur anywhere in the body

Treatment mostly the same (but surveillance in NON Hodgkin early stages, watch and wait), chemo, targeted therapy, biologics, radiation & transplants

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11
Q

sarcomas

A

cancer of the bone and connective/soft tissue (fat, muscle, vessels, nerves & tissues around joints and bones)

more common in lower extremities, more common in male at birth, black and hispanic populations

symptoms: lumps, pain, movement issues, weight loss

age: bone child/teen or 65 and older, soft tissue adults

diagnosis: imaging and biopsy

staging: TNM

treatment: surgery (limb salvage), radiation, chemo, targeted therapy, biologics, thermal ablation (chryotherapy)

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12
Q

cancer patients have decreased immune response and are susceptible to ______

A

sepsis

symptoms: fever, tachycardia, tachypnea, confusion, hypotension and decreased urine output

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13
Q

Upper GI dysfunctions

A

GERD, gastritis, Peptic Ulcer Disease

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14
Q

Liver dysfunctions

A

Hepatitis A/B/C, Cirrhosis

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15
Q

GastroEsophageal Reflux Disease (GERD)

A

chronic symptom of mucosal damage caused by reflux of stomach acid into the lower esophagus

dysfunction of the Lower Esophageal Sphincter (LES), acts like a valve, keeping stomach contents in the stomach

risk factors: obesity, pregnancy (increased abdominal pressure), smoking, hiatal hernia (stomach pushes up through diaphragm), spicy foods, fatty meals, caffine, alcohol

clinical manifestations: heartburn (mimics heart attach), regurgiation, dysphagia, chronic cough, chest pain

complications: Barrett’s esophagus (pre-cancerous condition), esophageal strictures (narrowing due to buildup of scar tissue), reflux pneumonia

treatment/nursing interventions: lifestyle modifications- weight loss, avoid trigger foods, eating smaller meals, elevate HOB

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16
Q

gastritis

A

inflammation of the stomach lining (gastric mucosa)

acute (rapid onset) or chronic (H. Pylori infection, ongoing exposure)

risk factors: prolonged NSAIDs use, alcohol, poor diet, high stress, autoimmune conditions, bile reflux, advanced age, previous stomach surguries

clinical manifestations: epigastric pain, N/V, anorexia, fullness, hematemisis/melena

complications: peptic ulcers, GI bleed, pernicious anemia (trouble absorbing B12), gastric cancer

treatment: lifestyle mod, avoid alcohol/smoking/irritaitng foods, meds: PPI, antacids, endoscopy

nursing interventions: education, dietary guidance, monitor and assess, stress management, follow up care

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17
Q

Peptic Ulcer Disease

A

erosion of the GI mucosa from the digestive action of HCI acid and pepsin

most common are gastric and duadnum

excess acid production overwhelms defense mechanisms

risk factors: H Pylori, NSAIDs long term use, stress, smoking, alcohol, coffee, genetics, Ellilson’s syndrome (incrased acid)

clinical manifestations: epigastric pain, N/V, bloating, burping, weight loss
gastric - pain worsens with eating
duadenal - pain better while eating and worse after

complications: bleeding, perforation (peritinitis), obstruction

treatment: lifestyle mod: alcohol, smoking, trigger foods, meds, surgery

nursing interventions: education, monitor & assess, dietary guidance, stress reduction, follow up care

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18
Q

hepatitis

A

inflammation of the liver

presents as flu-like signs and symptoms

most common are a, b, c

A & E are usually though food/water contamination

B & C usually resulting in chronic disease

B, C, D usually by body fluids

vaccines for hep A & B

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19
Q

hepatitis A

A

causes: fecal/oral, contaminated food/water, crowded conditions, poor hygiene

prevention: hand hygiene, vaccination

can spread 1-2 weeks before symptoms appear

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20
Q

hepatitis B

A

spread through sexual contact with infected person, sharing needles (accidental needle sticks in a healthcare workplace) OR from infected mother to fetus

causes: unsafe sex, contaminated needles, mom to baby, exposure to bodily fluids

prevention: vaccine, prevention education

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21
Q

hepatitis C

A

primarily spread blood to blood

NO VACCINE

causes: drug use, high risk sexual behavior, untested blood products

prevention: education

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22
Q

cirrhosis

A

end stage liver disease characterized by extensive degeneration and destruction of liver cells

stages leading to cirrhosis: healthy, fatty, fibrosis (scared liver tissue), cirrhosis

risk factors: alcoholism, chronic hepatitis C, overweight, excessive drug use (tylenol)

mimic flu-like signs and symptoms early on

moderate complications: jaundice, pruritis (severe itching), spider angioma (blood vessles), fector hepaticus, bruising and bleeding more easily with impaired clotting

major complications: portal HTN (increased pressure in veins), esophageal varices, ascites, neurologic

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23
Q

_____ can slow cirrhosis in chronic hep C patients

A

antivirals

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24
Q

cirrhosis damage is _______

A

irreversible

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25
jaundice
yellowing of skin, mucous membrains and eyes caused by buildup of bilirubin (when RBC break down but not well excreted by the impaired liver) in the blood nursing interventions: monitor labs (liver panel - AST/ALT, bilirubin, ammonia, and PT/NR), encourage hydration, emotional support
26
pruritis
severe itching caused by the buildup of toxins and bile salt intense at night, lacks visible rashes nursing interventions: comfort measures (cold bath, moisturizes, antihistimines/colestrimines, loose soft clothing), monitor labs, avoid irritants, promote skin integrity, patient education
27
spider angioma
small dilated blood vessels that appear close to the skin's surface, central red spot with thin radiating lines outward (press red spot and lines dissapear) increased estrogen nursing interventions: assessment, monitor labs (liver panels), patient education, emotional support
28
fetor hepaticus
distinct musty odor on the breath, not related to oral care, but a buildup of dimethalsulphide being breathed out associated with hepatic encephalopathy look for changes in mental status/confusion nursing interventions: monitor labs (ammonia levels), promote oral hygiene, medication-lactulose, monitor for other symptoms (neurological), emotional support
29
portal hypertension
increased pressure in the portal venous system, which carries blood from the digestive organs to the liver scaring and liver fibrosis obstructs blood flow, in response the body tries to make backup pathways: collateral circulation (bypass the liver) leading to various complications: spienomegaly (enlarged spleed from blood backup), ascites, varices, caput medusae (enlarged visible veins on abdomen), hemoroids nursing interventions: monitor for bleeding, medications, monitor ascites, shunt (TIPS, lowers portal pressure), monitor labs (platelets/INR, albumin), patient education (avoid heavy lifting or straining during bowel movements, low sodium diets for fluid retention)
30
esophageal varices
enlarged swollen veins due to elevated pressure in the portal vein system EMERGENCY asymptomatic until they rupture, but after they rupture s/s are vomiting blood, black tarry stools, shock symptoms: low bp, rapid hr, confusion equipment needed: suction, intubation, oxygen delivery, IV access (2 large, placed immediately), and have blood readily available for transfusion nursing interventions: IV access, monitor breathing, airway management, blood products, monitor for bleeding, medications (bb lower pressure and bleeding), endoscopy, banding, TIPS, monitor labs and VS, patient education
31
ascites
accumulation of fluid in the peritoneal or abdominal cavity causing abdominal distension taught shiny skin nursing intervetions: daily weights and abdominal measurements, monitor for hypotension, labs liver/electrolytes, medications diuretics, NA restricted diet/fluid restriction, paracentesis (relieve discomfort and test fluids), patient education
32
hepatic encephalopathy
neurological complication - mild: confusion, forgetfullness, difficulty concentrating, moderate: lethargy, disorentation, worsening confusion, severe: somulance/inable to stay awake/coma hand flap/asterixis peripheral neuropathy - tingling/numbness in hands and feet reversible decline in brain function caused by swelling in the brain from buildup of ammonia nursing interventions: neuro assessment (orientation, loc), medications (lactulose to reduce ammonia, but diarrheah can lead to dehydration), dietary management (vitamin deficiencies, low protiene), patient safety, patient education
33
normal Na
135-145
34
normal K
3.5-5
35
normal Ca
9-10.5
36
normal PO4
3-4.5
37
normal BUN (blood urea nitrogen)
5-25
38
normal creatinine
0.5-1.2
39
normal hemoglobin
12-18
40
normal hematocrit
37%-52%
41
normal parathyroid hormone
4-19
42
normal glomurular filtration rate (GFR)
125 mL/min
43
_____ are good indicators of kidney function
creatinine and GFR
44
as kidney function declines, GFR _______
decreases
45
normal urine pH
4.0-8.0
46
normal urine WBC
0-5
47
urine should not have
nitrates, glucose, ketones, blood, bilirubin, casts/crystals or culture
48
if you just placed a catheter, urine may have
RBCs
49
urinary tract infection (UTI) manifestations of lower vs upper
Lower: hesitancy, frequency, urgency, dribbling, retention, dysuria, incontinence, notcturia Upper: fever, chills, flank pain uremia, hematuria
50
UTI diagnosis
urinalysis, culture, ultrasound, CT scan
51
UTI treatment/intervention
antibiotics, education (hygiene)
52
renal calculi / kidney stones
manifestations: pain, renal colic, kidney stone dance, dysuria, fever/chills, shock diagnosis: Urinalysis, 24-hr urine test, CT, labs, history treatment: monitor, treat the cause, pain control meds, lithotripsy, surgery, education
53
urinary incontinence
involuntary loss of bladder control
54
3 types of incontinence
overflow - urtethral blockage, bladder unable to empty normally stress - relaxed pelvic floor, increased abdominal pressure urge - bladder oversensitivity from infectoin, neurological disorders
55
external incontinence devices
condom cath/purewick brief
56
urinary retention
the inability to fully empty the bladder, leading to discomfort and complications acute or chronic, often results from underlying condition
57
Benign Prostatic Hyperplasia (BPH)
noncancerous enlargement of prostate gland effects 50% of aging men compresses urethra, leading to potential urinary retention manifestations: straining to void, reduction/weakness in stream, frequency (nocturia), incontinence, retention diagnosis: rectal exam treatment/intervention: watch and wait, meds, bladder scan, straight cath, voiding shedule, balloon dilation, TURP (surgery, removes excesive prostate tissue), education
58
spastic bladder
overactive
59
flacid bladder
underactive
60
neurogenic bladder
brain is not communicating with bladder manifestations: high bp, low hr, flushed, headach, sweating, goosebumps, nausea, CAN LEAD TO AUTONOMIC DYSRELEXIA (emergency, life-threatening, painful irritating stimulus leads to uncontrolled sympathetic nervous system action) diagnosis: history, MRI treatment/intervention: education
61
post-surgical retention
the bladder may need more time to wake up from anesthesia, contractions are inhibited feeling the urge but unable to void is typical manifestations: spasms, pain, distention, inability to void, hesitancy diagnosis: history of recent surgery treatment/intervention: bladder scan, straight cath, bladder training, fill and spill (stimulate bladder stretch receptors)
62
bladder cancer often shows with
painless hematuria
63
acute kidney diease/injury (AKI)
a sudden and often reversible decline in kidney function, occurs over hours to days if caught early, kidney function can often be restored, but with out intervention AKI can lead to long term compliclations or CKD prerenal AKI - lack of blood flow to kidneys (dehydration, hf, hypotension) intrinsic AKI - direct kidney damage (meds, infection, rabdomylosis) post renal AKI - due to obstruction in urinary tract (kidneys stones, bph, tumors) manifestations: straining to void, reduction in stream, frequency, incontinence, retention diagnosis: lab work, urinalysis, ultrasound treatment/intervention: assessment, treat the cause manage electrolyte imbalance, medications
64
prerenal AKI
acute, lack of blood flow to kidneys (dehydration, hf, hypotension)
65
intrinsic AKI
acute, direct kidney damage (meds, infection, rabdomylosis)
66
post renal AKI
acute, due to obstruction in urinary tract (kidneys stones, bph, tumors)
67
chronic kidney disease (CKD)
stage based on GFR, less than 15 is end stage renal (stage 5) manifestations: urinary system, cardiovasuclar system, respiratory, GI, endocrine, hematology, neurological, integumentary, pychological management: drug therapy, nutrition, kidney transplant, dialysis
68
3 kidney treatment options
transplant - living or deceased donor, lifelong immunosuppresents to prevent rejection, healthy lifestyle management hemodialysis - a machine filters waste products out of the blood, done at a facility, 3 times a week for 3-5 hours peritoneal dialysis (PD) - part of the abdomen (peritoneum) is used to filter waste out of the blood internally, alternative to hemodialysis to manage treatment at home, 4-5 times a day for 20-30 minutes

Med Surg (11 decks)

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