Exam 4 Flashcards
(182 cards)
1
Q
more NON differentiated cells = (characteristic of the canceR)
A
more aggressive cancer
2
Q
problems r/t cancer can be caused by (3)
A
- cancer itself
- treatment
- both
3
Q
management / goals for cancer:
A
- cure
- control
- minimize SE of treatment
4
Q
main nursing priorities r/t cancer + related concerns
A
BM suppression….
- neutropenia –>infection
- anemia –> fatigue/oxygenation
- thrombocytopenia –> bleeding
5
Q
severe neutropenia is defined as what?
A
ANC <1000 cells
6
Q
most infections r/t neutropenia are what type?
A
opportunistic (suppressed immune system)
7
Q
name some ways to prevent infections with neutropenic patients
A
handwashing, educate patients to be their own advocates, no fresh flowers or raw foods, avoid sick people, monitor VS (fever!), no cat litter
8
Q
how do we treat patients if develop opportunistic infections r/t cancer? (general pharm)
KNOW
A
anti infectives
9
Q
re: neutropenia and cancer, what changes should be reported to provider? (4)
A
- changes in skin + mucous membranes
- fever
- cough
- s+s of infection at central line
10
Q
when should neutropenic precautions be started?
A
ANC <1000 w/fever
OR
ANC <500
11
Q
name some elements of neutropenic precautions
A
no fresh flowers or raw foods no shared supplies private room + no sick visitors no stagnant water no indwelling catheters wear masks regular hygiene ASSESS often!
12
Q
what are nurse-led protocols re: ABX with neutropenic patients?
A
ABX stewardship: get cultures, monitor for s+s of infection, get the right ABX on board + quickly!!
13
Q
<50,000 platelets =
<20,000 platelets =
A
50k = prolonged bleeding
20k = spontaneous
14
Q
what complication are we most concerned with re: platelets <20,000? + what specific assessment should occur?
A
spontaneous bleeding –> hemorrhagic stroke
FREQUENT NEURO CHECKS
15
Q
what should you be assessing for if patient has thrombocytopenia?
A
bleeding:
- petichiae
- prolonged bleeding
- large flank bruise (sign of internal bleeding)
- blood in urine or stool
- tachycardia
- hypotension
16
Q
what interventions should be introduced for patients with thrombocytopenia? (4)
A
- neuro assessments
- fall precautions
- bleeding precautions
- platelet administration
17
Q
what should be avoided in patient with thrombocytopenia?
A
anything that could cause injury + bleeding: rectal tubes, rectal meds, unnecessary tube inserts
18
Q
name some elements of bleeding precautions (7)
A
- limit venipunctures + IM injections
- lift sheet
- electric razor
- soft toothbrush, no floss
- ABD girth measurement
- no nose blowing
- assess IV sites
19
Q
what interventions should be implemented for fatigue r/t anemia / cancer? (3)
A
- find exercise that feels good (can even be a walk to the bathroom)
- treat underlying cause if possible
- energy conservation + manage activities
20
Q
why does chemo have such an effect on the GI cells?
A
chemo attacks rapidly dividing cells and GI cells fall into this category
21
Q
what interventions should be implemented for cachexia? (2)
A
- protein + CHO - rich foods
2. small, frequent meals
22
Q
interventions for mucositis + stomatitis r/t chemo or cancer
A
- cryotherapy
- mouth rinses (bicarbonate / magic mouthwash)
- soft toothbrush + no floss
- non-irritating cleansers
- hygiene
- ASSESS often!
23
Q
N/V r/t cancer + therapy, what types can you have?
A
acute, anticipatory, breakthrough
24
Q
motor + sensory deficits seen with cancer are related to what?
A
possible bone mets + compressed nerves
25
motor + sensory deficits r/t cancer put a person at risk for what? what interventions should we implement?
pain, injuries + falls
--> fall precautions, assess ability, offer assistance
26
peripheral nerve fxn r/t cancer puts a person at risk for what? what interventions should we implement?
pain, injuries, loss of balance + falls
--> fall precautions, assess for sensation + wounds
27
reduced oxygenation r/t anemia with cancer can lead to what? what interventions should we implement?
hypoxia + poor tissue perfusion
--> raise HOB + administer O2
28
interventions for pain r/t cancer should be _______
MULTIMODAL + patient specific <3
29
interventions for hair loss r/t cancer + chemo
protect scalp, wear hat, keep warm, address psychosocial aspect <3
30
"chemo brain" / cognitive changes can be from what?
cancer itself, brain mets, treatment or both
31
goals of radiation
cure, control + palliate
minimize destruction of normal tissue
32
exposure vs dose?
exposure: amt delivered
dose: amt absorbed
33
differences between teletherapy + brachytherapy? what are the 2 types of brachytherapy?
teletherapy: external
brachytherapy: internal
34
what are the 2 types of brachytherapy? + describe them
sealed: only patients emit radiation (not body fluids)
unsealed: bodily fluids are radioactive + patient
35
precautions for patients w/brachytherapy? (5)
1. private room w/sign
2. lead apron + limited time inside
3. visitors 6 feet away + limited time (30 mins)
4. no pregnant caregivers
5. keep all linens in room until discharge
36
SE of teletherapy (remember, it's localized) (6)
1. hair loss @ site
2. erythema
3. inflammation
4. fatigue
5. secondary malignancies
6. CV disease
37
what are the 3 categories for breast cancer?
1. noninvasive
2. invasive
3. metastasis
38
describe ductal carcinoma in SITU
early noninvasive --> can become invasive if untreated
39
describe lobal carcinoma in SITU (4 things) + what is treatment?
1. begins in lobules
2. not true cancer
3. cannot spread
4. increases chance of developing breast cancer later
tx: OBSERVATION
40
describe infiltrating ductal carcinoma
INVASIVE: starts in ducts --> epithelial cells lining the ducts --> grows into tissue
41
re: infiltrating ductal carcinoma, fibrosis, dimpling + peau d'orange indicates what?
late disease
42
inflammatory breast cancer
INVASIVE, highly aggressive + usually diagnosed later in disease
*no palpable lump + might not show up on mammogram*
43
s+s of inflammatory breast cancer (3)
swelling, pain, redness
44
triple negative breast cancer
HIGHLY AGGRESSIVE
| lacks typical receptors (locks), so medication (keys) to treat cancer will have no effect
45
triple negative breast cancer is common with what populations? (3)
BRCA positive + pre-menopausal females + black women
46
risk factors for breast cancer
gender, age, genetics, breast density, early menstruation, hormone replacement therapy, ETOH, obesity, oral contraceptives, null parity
47
re: screening for breast cancer, what are protocols for normal risk + high risk?
normal risk: annual mammogram from 40-45 yrs old
high risk: annual mammogram + annual MRI + clinical breast exams
48
what is a diagnostic mammogram? what is screening mammogram?
diagnostic: mammogram + ultrasound (if someone has lump)
screening: mammogram only
49
what s+s (r/t skin) might you see with more progressed breast cancer
1. peau d'orange
2. nipple changes (retractions)
3. ulceration
50
describe these surgery options for breast cancer:
```
lumpectomy
partial mastectomy
total mastectomy
radical mastectomy
neoadjuvant
```
lumpectomy: lump removal
partial mastectomy: remove part of breast tissue
total mastectomy: all breast tissue removed
radical mastectomy: all breast tissue + lymph node removed
neoadjuvant: chemo before surgery to reduce lump size
51
postop care after surgery for breast cancer
1. no BP readings or venipuncture on affected side
2. VS q15
3. monitor drains
4. educate patient on what to report (s+s of infection
5. semi fowlers
52
when can patient start arm exercises post surgery for breast cancer? what can they do?
one week --> start active ROM
- squeeze ball
- arm raises
- elbow extension
*if they have pain? STOP!*
53
home care for patient after having surgery for breast cancer
1. no commercial lotion
2. no deodorant
3. monitor for lymphedema + report
54
how can we prevent lymphedema?
don't take BP on affected side, even if it's been years!!
55
s+s of lymphedema (5) + what should you do?
1. heaviness
2. aching
3. numbness
4. swelling
5. tingling
**CONTACT PROVIDER ASAP**
56
what is nurse role for chemo?
1. monitor central line
2. manage symptoms
3. give chemo
57
name some effects of chemotherapy? (4)
**KNOW**
1. myelosuppression --> low WBCs, RBCs, platelets **KNOW**
2. fatigue
3. GI effects
4. nerve + motor involvement
58
Hormonal therapy for cancer can only be used for which type of cancer
w/hormone receptors
NOT triple-negative - wouldn't be effective
59
what is colorectal cancer?
cancer of large bowel: large intestine + rectum
60
where are most colorectal cancers found? + what type are most of them?
rectosigmoid region
most are adenocarcinoma (starting in mucous producing cells)
61
precancerous cells of colorectal cancer =
polyps
| visualized on colonoscopy
62
metastasis of colorectal cancer can happen via which 3 routes?
1. blood
2. lymph
3. through intestinal wall to surrounding organs
63
what is "seeding" r/t colorectal cancer surgery?
cancer cells that are dropped into new places, spreading cancer
64
what are some complications of colorectal cancer? (5)
1. obstruction
2. perforation
3. fistula
4. abscess
5. bleeding
65
re: colorectal cancer, where are obstructions most common?
transverse + descending colon
66
what are s+s of obstruction? (3)
1. gas pains
2. cramping
3. incomplete evacuation
67
what are s+s of partial bowel obstruction? (3)
1. PAIN
2. visible peristalsis
3. tinkling/high pitched bowel sounds
68
what are s+s of complete bowel obstruction? (2)
1. PAIN
| 2. absent bowel sounds
69
what are risk factors for colorectal cancer? (8)
1. ULCERATIVE COLITIS
2. age
3. genetics
4. ETOH + smoking
5. sedentary lifestyle
6. high fat diet + low fiber
7. Crohn's disease
8. obesity
70
what is gold standard for screening for colorectal cancer?
colonoscopy
71
what is the "con" to fecal occult blood test?
positive? need colonoscopy
negative? can't rule out cancer
= VERY LIMITED
72
screening recommendations for colorectal cancer:
- average
- high risk
- close relative or strong hx
average: colonoscopy 45 years
high risk: colonoscopy before 45 years
close relative or strong hx: genetic testing
73
most common s+s of colorectal cancer (3)
+ name some others...
1. changes in stool
2. changes in bowel habits
3. bleeding
fatigue, weight loss, pain, distention, fullness, palpable mass
74
re: CRC, mahogany blood =
further up in colon
75
re: CRC, bright red blood =
+ most likely which location
lower in colon
| probably rectosigmoid
76
what is our BEST tool to diagnose CRC? why?
colonoscopy - can visualize entire colon
77
what lab tends to be low with CRC?
H+H
normal per Messer 11-17 Hgb
78
surgical intervention options for CRC (2)
1. colon resection
| 2. colectomy
79
what is colostomy?
piece of colon diverted through ABD wall to bypass part of colon --> stoma formed
80
ileoanal pullthrough =
entire colon removed + j pouch formed
81
name some components of wound management after surgery for CRC (4)
1. monitor for s+s of infection
2. manage drains
3. pain management (incl. phantom pain)
4. comfort (physical + psychosocial)
82
postoperative care after surgery for CRC (3) *think orders*
1. NG tube
2. NPO
3. colostomy care w/WOCN
83
assessment findings for stoma ◡̈
1. beefy red
2. budding + protruding from skin 3/4"
3. intact peristomal skin
84
after colostomy, what should drainage look like and progress towards?
start: sanguineous --> serosanguineous --> "working" in 2-3 days (stool)
85
what would excoriated skin around stoma indicate?
wafer not cut properly + skin exposed to stool
86
how should wafer be cut for stoma?
1/8-1/16 larger than stoma
87
stool findings if colostomy formed in:
- ascending colon:
- transverse colon:
- descending colon:
-ileostomy:
ascending colon: liquid
transverse colon: pasty
descending colon: solid
ileostomy: liquid
88
what is most common upper GI disorder?
GERD
89
what is GERD?
reflux of stomach contents into esophagus --> inflammation --> hyperemia
90
GERD can be caused by what? (3)
1. excessive relaxation of LES
2. increased ABD pressure
3. reduced stomach emptying
91
re: GERD, reduced stomach emptying can be caused by what?
gastric neuropathy from DM
92
risk factors for GERD (7)
1. ETOH + smoking
2. spicy foods
3. large portions
4. pregnancy
5. lying down after eating
6. obesity
7. tubes (NG tube)
93
complications of GERD
1. Barrett's epithelium (precancerous cells - cells changed to protect from acidic stomach contents in esophagus)
2. PNA
3. dental decay
4. cardiac disease
94
s+s of GERD (5)
1. indigestion (20 min - 2 hrs after eating)
2. pain
3. regurgitation + water brash
4. heartburn
5. morning hoarseness
95
what is definitive way we diagnose GERD? but how do we usually diagnose GERD?
pH exam
don't usually need this; we usually diagnose based on symptoms -- if we treat and it works? assume GERD
96
interventions for GERD (9)
*Emily's fav card ◡̈ *
1. small, frequent meals
2. sit upright after eating for 1 hour
3. avoid irritating foods + spicy foods
4. don't eat before bedtime
5. sleep on right side
6. weight loss
7. sleep apnea eval
8. ETOH + smoking cessation
9. meds to reduce acid (usually PPIs)
97
why would someone get nissen fundoplication surgery?
unrelenting GERD not improving with meds; to create a tighter LES
98
peptic ulcer + what is common cause?
mucosal lesion of stomach or duodenum
common cause: H. pylori
99
gastric ulcers are often caused by what?
DELAYED stomach emptying (food sitting in stomach too long --> causes lesions)
100
gastric ulcer pain is often felt where?
upper epigastrium and left
101
how long after eating would manifestations of a gastric ulcer be felt?
30-60 mins
102
if bleeding was present with gastric ulcers, what would you see?
hematemesis
103
duodenal ulcers are often caused by what?
INCREASED stomach emptying
104
duodenal ulcer pain is often felt where?
below epigastrium and right
105
how long after eating would manifestations of a duodenal ulcer be felt?
1.5-3 hrs after eating
106
if bleeding was present with duodenal ulcers, what would you see?
melena (blood in stool)
107
stress ulcers are often caused by what? (7) + what medical scenarios? (4)
H. pylori*, NSAIDs, corticosteroids, ETOH, smoking, caffeine, stress
+ often after medical crisis or trauma (burns, head injury, sepsis, NPO)
108
s+s of stress ulcer
1. indigestion
2. sharp, burning pain
3. fullness
4. tenderness
5. hyperactive bowel sounds EARLY
6. hypoactive bowel sounds LATE
7. N/V
109
what assessment is very important with stress ulcers? why?
VS - can give us cues about bleeding happening in the body
110
what is diagnostic for PUD?
what is diagnostic for H. pylori?
**KNOW**
PUD: EGD
H. pylori: urea breath test
111
interventions for PUD
reduce pain + complications + meds
112
re: PUD treatment, what is triple therapy? what is quadruple therapy?
triple: PPI + 2 ABX
quadruple: triple + Pepto-Bismol
113
what nutrition interventions should be implemented with PUD? (3)
BRAT diet (banana, rice, applesauce, toast)
no irritating foods
no bedtime snacks
114
what is a major complication of PUD?
hemorrhage
hematemesis: upper bleed
melena: dark, tarry stool
115
things to monitor for with hemorrhage r/t PUD? (4)
1. VS (tachycardia + BP trending down) **KNOW**
2. hemoccult test
3. H+H
4. s+s of bleeding
116
management of hemorrhage rt PUD (4)
**KNOW**
1. AIRWAY PROTECTION --> position on their side if vomiting **KNOW**
2. O2
3. fluids (volume replacement)
4. prepare patient for EGD
5. IV PPI
117
if patient is unstable with hemorrhage r/t PUD, what should you do?
**KNOW**
anticipate blood products + fluids.... GET IV!!!!
118
what could happen with perforation as complication of PUD?
GI contents leak into peritoneal cavity
119
s+s of perforation (2)
1. sudden, sharp mid epigastric pain --> radiates through ABD
2. tender, rigid, boardlike abdomen with rebound tenderness = peritonitis
120
gastritis
inflammation of mucosal lining of stomach
121
acute gastritis is usually _______
self-limiting (several days)
122
most common cause of acute gastritis
NSAIDs
123
acute gastritis symptoms usually occur when? what are they? (6)
AFTER MEALS
pain, cramping, indigestion, anorexia, N/V, bleeding
124
interventions for acute gastritis (2)
SUPPORT:
1. fluids
2. BRAT diet (banana, rice, applesauce, toast)
125
chronic gastritis
patchy, diffuse inflammation --> stomach wall things and atrophies
126
what is common cause of chronic gastritis?
H. pylori (burrows --> activate activates toxins --> inflammation)
127
what can chronic gastritis cause if not treated? what would this lead to?
pernicious anemia
(parietal cell fxn decreases --> less acid + less intrinsic factor)
= B12 injections needed!!
128
intervention for chronic gastritis
remove cause + PPI
129
prevention of chronic gastritis
1. diet (healthy foods + avoid irritating / spicy foods - caffeine, spicy, chocolate)
2. exercise
3. smoking cessation
4. limit ASA + NSAIDs
130
some patient education for UC + CD
1. medication adherence: continue even through remissions
2. food journal + BM journal
3. how to get adequate nutrition
4. check perineal area while maintaining dignity (Explain why you're doing what you're doing)
131
what is tenesmus?
urge to defecate
132
what is ulcerative colitis?
inflammation of rectum + sigmoid colon (starts at "end" and can move up the colon to involve all of it)
133
with ulcerative colitis, the intestinal mucosa is _______, _______ + ______.
(adjectives)
hyperemic, edematous + narrowed
134
re: UC, edema of the colon can cause ________, which can lead to ___________ (complication)
edema can cause THICKENING/NARROWING, which can lead to OBSTRUCTION
135
what is the main difference re: stool in Ulcerative Colitis + Crohn's Disease?
UC stool: diarrhea w/blood or pus
CD: steatorrhea (fatty stool)
136
what is the main difference re: stool in Ulcerative Colitis + Crohn's Disease?
UC stool: diarrhea w/blood or pus
CD: steatorrhea (fatty diarrhea)
137
what is toxic megacolon?
dilation of colon + ileus.... BIG ASS COLON on xray
138
what are the main (2) complications of UC?
1. malabsorption
| 2. GI bleed
139
1/3 of all deaths r/t ulcerative colitis are from what?
development of colorectal cancer
140
what psychosocial aspect of both UC + CD are very important to look for and care for?
anxiety + depression
*strong correlation*
141
what psychosocial aspect of both UC + CD are very important to look for and care for?
anxiety + depression
*strong correlation*
142
with both UC + CD, we can have manifestations involving nearly any organ system. what is this called? what are some systems affected?
extraintestinal symptoms
liver, lungs, kidney, eye, skin + joints
143
re: ulcerative colitis and nutrition, what would be something to assess with patient?
nutrition history: food diary + triggers
weight loss
144
re: ulcerative colitis, what aspects of bowel elimination should we be assessing?
color, characteristic, frequency, pain, pattern, blood
145
what medication class can cause an exacerbation of ulcerative colitis?
NSAIDs
| GI!!
146
why is it especially important to assess bowel elimination patterns with patients with UC or CD?
we can prepare them for BM + set them up for success!!
147
re: UC, fever + tachycardia could be sign of worsening complication.... what complication might this be?
dehydration / F+E imbalances
148
re: UC/CD and extraintestinal complications, what are some very important assessment pieces? (Harrell repeated this multiple times)
skin assessment + oral mucosa assessment
149
```
re: UC + CD, what might labs look like:
H+H:
WBC:
CRP + ESR:
electrolytes:
albumin:
```
```
H+H: low (r/t bleeding)
WBC: high (r/t inflammation + infection)
CRP+ ESR: high (r/t inflammation)
electrolytes: low (malabsorption + diarrhea)
albumin: low (loss of protein in stool)
```
150
what is gold standard for diagnosing Ulcerative Colitis + Crohn's disease?
MRI - can visualize bowel, bowel wall + surrounding organs
151
if you've had ulcerative colitis for > 10 years, how often should you get a colonoscopy?
***TEST QUESTION***
annually ◡̈
152
with ulcerative colitis management, what are goals? (3)
1. relieve symptoms
2. decrease inflammation
3. intestinal healing
153
re: nutrition therapy + UC and CD, is diet a major factor in the inflammatory process?
Harrell says NO.
154
re: nutrition and UC + CD, what would be a recommendation to the patient to track their food tolerances and how it impacts eliminiation?
food journal
+
BM journal
*very individualized*
155
re: UC + CD and management, what's one way we can relieve symptoms, decrease inflammation + promote healing?
bowel rest / NPO <3
156
name some potential food triggers for UC + CD (7)
1. high fiber foods
2. ETOH
3. caffeine
4. raw veggies
5. carbonated drinks
6. lactose
7. nuts + corn
= foods that increase GI motility
157
what is the GOLD STANDARD for surgical treatment of ulcerative colitis? (just the name)
restorative proctocolectomy w/ ileostomy pouch anal anastomosis
(phew)
158
what happens with a restorative proctocolectomy w/ ileostomy pouch anal anastomosis?
2 step procedure:
1. remove colon + most of rectum (leave anus and sphincter intact). create internal pouch (j pouch) and connect to anus --> temporary ileostomy so pouch can heal
2. reverse the ileostomy 1-2 months later
159
what happens with a total proctocolectomy?
removal of colon, rectum + anus.
surgical closure of anus.
permanent ileostomy
160
re: UC + ileostomy, what characteristics will the output have when ostomy is new and before adaptation has taken place? (4 things)
1. known as "effluent"
2. sweet smell
3. liquid green
4. very caustic to skin
161
re: UC + ileostomy, if we see >2000mL in 24 hours, this is known as what? what's our MAIN concern? what are some of our solutions? (4)
HIGH OUTPUT ILEOSTOMY
main concern: fluid loss + electrolyte imbalance
solutions:
1. TPN until regulated
2. benefiber to bulk up stool
3. gatorade (replace electrolytes)
4. opium tincture (slow things down)
162
re: UC and a new ileostomy, after time adaptation will occur. what is this? what will you see with the stool? (2)
small intestine adapt to take on functions of the colon --> stool volume decreases and becomes thicker / pasty --> stool is brown or yellow-green color
163
crohn's disease is what?
chronic inflammation of small intestine, colon or both
"gum to bum"
= can affect ENTIRE GI tract
164
crohn's disease most commonly affects what area of the GI tract?
terminal ileum
165
what is the hallmark sign of crohn's disease?
cobblestone appearance of the bowel
166
crohn's disease causes ______ + ________ which could lead to ________
causes EDEMA + NARROWING, which could lead to OBSTRUCTION
167
what risk increases with Crohn's disease? (complication)
fistulas
168
what is the main difference re: pain in Ulcerative Colitis + Crohn's Disease?
UC: rectum + abdominal
CD: abdominal (constant around umbilicus)
169
what manifestation is more common in Crohn's (VS)?
FEVER
common when pt has fistula, abscess or severe inflammation
170
which sign/symptom is much more SIGNIFICANT in CD compared to UC?
weight loss
| secondary to malabsorption
171
GI bleed more likely in Crohn's or UC?
UC
172
colon cancer and small bowel cancer more likely in Crohn's or UC?
UC
173
severe malabsorption + malnutrition more common in Crohn's or UC?
Crohn's
174
fistula formation more common in Crohn's or UC?
Crohn's
175
perirectal abscess more common in Crohn's or UC?
Crohn's
176
what would you hear re: bowel sounds in severe inflammation and/or obstruction?
decreased or absent
177
what would you hear re: bowel sounds over narrowing?
high pitched
178
what assessment is very important if abscess or fistula is present? (with UC or CD) + who should we consult?
skin assessment / perineal assessment
consult WOCN
179
neurological changes with UC or CD could indicate what complication?
electrolyte imbalances (Na)
180
re: CD, what would you expect labs for folic acid and vitamin B12 to look like?
decreased (r/t malabsorption)
181
re: fistula management with Crohn's disease, how many calories are needed per day for wound healing?
3000 cal/day
182
if an abscess forms from CD, what would you expect to give as a nurse?
ABX!
