final Flashcards
(288 cards)
1
Q
components of peripheral vascular assessment
A
Colour, temperature, capillary refill, edema, pulses
2
Q
components of a peripheral neurological assessment
A
Pain, sensation, motor function
3
Q
Purpose of neurovascular assessment
A
Early detection of impaired blood flow or damaged nerves
Essential in preventing permanent deficits, loss of a limb & even death
4
Q
What are the 6 p’s of compartment syndrome?
A
Pain
Pallour
Paralysis
Pulselessness
Paresthesia
Pressure
5
Q
What is osteoporosis
A
A chronic, metabolic bone disease wherein there low bone mass, and structural deterioration of bone tissue occur
Predisposes patients to increased risk of fracture at hip, wrist and spine
6
Q
What may cause osteoporosis?
A
Hereditary
Nutrition
Exercise
Hormones
7
Q
How does Osteoporosis manifest?
A
Back pain
Loss of height
Spinal deformation
8
Q
Pathophysiology osteoporosis
A
Bone resorption exceeds bone deposition
9
Q
Which gender is at greater risk for developing osteoporosis & why?
A
Women
- (1) women tend to have lower calcium intake;
- (2) women have less bone mass because of their generally smaller frame;
- (3) bone resorption begins at an earlier age in women and is accelerated at menopause;
- (4) pregnancy and breastfeeding deplete a woman’s skeletal reserve unless calcium intake is adequate; and
- (5) longevity increases the likelihood of osteoporosis, and women live longer than men
10
Q
Diagnostics osteoporosis
A
History & physical exam, serum calcium, phosphorous, and alkaline phosphate levels, bone mineral density, dual-energy X-ray absorptiometry (DEXA), quantitative ultrasound, radiology only detect when 25-40% lost, FRAX = 10yr risk hip fracture & 10yr risk for major osteoporosis fracture
11
Q
Medical Management osteoporosis
A
Estrogen replacement therapy, bisphosphonates, selective estrogen receptor modulator, teriparatide, salmon calcitonin
12
Q
Nursing Managementosteoporosis
A
Proper nutrition (high diet with calcium), calcium supplementation, vitamin D supplements, exercise, prevention of fractures, medications, education about smoking
13
Q
What is a fracture?
A
A fracture is a disruption of normal bone continuity occurring following an elevated level of stress being placed on bone tissue beyond that which it may otherwise manage
14
Q
What are some examples of bone fractures?
A
Closed fracture
Open fracture
Transverse fracture
Spiral fracture
Greenstick fracture
Comminuted fracture
Oblique fracture
Pathologic fracture
Stress fracture
15
Q
What is an open fracture?
A
broken bone that penetrates the skin
16
Q
Complete or incomplete fracture
A
Complete = break completely through bone
Incomplete = fracture occurs partly across bone shaft but bone still in 1 piece
17
Q
Displaced or non-displaced fracture
A
displaced: ends of the bone have come out of alignment
non-displaced: bone typically stays aligned in an acceptable position for healing
18
Q
What are the clinical manifestations of bone fractures?
A
Deformity
Edema, swelling
Muscle spasm
Pain, tenderness
Ecchymosis
Loss of normal function
Inability to bear weight on or use affected part, guards & protects extremity against movement
19
Q
What is fracture reduction?
A
restoration of the fracture fragments to anatomic alignment and positioning
20
Q
What is a closed reduction?
A
-manual realignment of the bones
-no surgery
-cast/splint
21
Q
What is an open reduction
A
Fracture realigned with surgery with various internal devices
22
Q
Medical management: Immobilization
A
External (cast, splints) or internal fixations
Casting or splinting, external fixation, internal fixation, prophylactic antibiotic therapy, surgical debridement & irrigation, tetanus & diphtheria immunization
23
Q
Nursing Management fractures
A
Neurovascular status, elevate limb, ice therapy, increase vitamin D, education
Neurovascular assessment
Drug therapy
Nutritional therapy
Preoperative and postoperative
Cast care
Ambulation and assistive devices
24
Q
What is a cast?
A
temporary immobilization device
25
What is external fixation?
Devices consist of pins that are placed through the skin into the fractured bone and connected to external frame
26
What is internal fixation?
Devices, pins and screws surgically inserted at time of realignment
27
Delayed union:
healing progresses more slowly than expected but eventually occurs
28
Nonunion:
fails to heal properly despite treatment
29
Malunion:
heals in expected time but in unsatisfactory position, possibly resulting in deformity or dysfunction
30
Angulation:
heals in abnormal position in relation to midline of structure (type of malunion)
31
Pseudoarthosis:
type of nonunion occurring at fracture site in which a false joint is formed with abnormal movement
32
Refracture
new fracture occurs at original site
33
Myositis ossificans:
deposition of calcium in muscle tissue at site of significant blunt muscle trauma or repeated muscle injury
34
Care of patients in a cast
Neurovascular assessment (bit of a running theme)
Pain assessment
Cast care teaching
Assessment for complications (compartment syndrome, infection)
35
What is an intracapsular fracture in the hip?
A fracture within the joint capsule
36
What is an extracapsular fracture in the hip?
A fracture not within the joint capsule
37
Clinical manifestations of hip fractures
* External rotation
* Muscle spasm
* Shortening of affected leg
* Severe pain and tenderness
38
Medical management of hip fractures
- medical (traction or casting); not ideal
- surgical (open reduction (move bones back into place & internal fixation (screws, pins), pre-op); common
39
Preoperative management of fractures
Preoperative check list
Consent
Pain management (muscle relaxation, analgesia)
Patient education
(Exercise for unaffected leg and both arms, weight bearing status)
40
Postoperative management of fractures
Vital signs
Pain management
Neurovascular assessment (it's a pattern)
Position / mobility
Maybe put in fall protections (hip protectors)
41
What is Osteoarthritis?
A chronic, progressive process where new tissue is formed in response to cartilage destruction
Noninflammatory disorder of the synovial joints
42
Osteoarthritis clinical manifestations
Worsening joint pain
Limitation of movement
Crepitus (bone rattling)
Stiffness
Deformity
43
causes osteoarthritis
Known event or condition that directly damages cartilage or causes joint instability
Decrease estrogen, obesity, inflammation
44
patho osteoarthritis
Cartilage damage that triggers a metabolic response at the level of the chondrocytes, causing the articular cartilage to become dull, yellow, and granular causing it to become less functional
45
diagnostics for osteoarthritis
History & physical exam, radiological studies of involved joints (CT scans, MRI, bone scan), synovial fluid analysis
46
Medical Management osteoarthritis
Acetaminophen, nonsteroidal anti-inflammatory drugs, antibiotics, intra-articular hyaluronic acid, opioids, reconstructive joint surgery, rest, joint protection
47
Nursing Management osteoarthritis
Nutrition & weight management, rest & use of assistive devices, therapeutic exercise, heat & cold application, herb therapy (glucosamine), yoga
48
Arthroplasty
reconstruction or replacement of a joint
49
What is Bipolar I disorder?
Characterized by one or more manic episodes generally with a major depressive occurrence.
Manic behaviour must last at least 1 week.
The mood disturbance is severe enough to cause marked impairment
Not otherwise explained by different drugs / conditions
50
What is Bipolar II disorder?
At least 1 episode of hypomania
One or more depressive episodes
Never had a manic episode
Usually begins with a depressive episode
51
What is hypomania?
Symptoms are the same as mania but last only 4 days
No impairment in social or occupational functioning
Hypomanic episode is a distinctive change in functioning not otherwise seen when asymptomatic
If psychosis is present, it's mania
52
Bipolar impact on health
Medications used to treat disorder have some important side effects
Bipolar behaviour may include dangerous activities such as reckless driving, unsafe sex
53
bipolar impact on economic decisions & well being
High risk behaviour during mania may cause reckless spending, gambling
Friends and family may feel guilt, grief or worry
Family roles change during periods of illness
54
schizoaffective
Meets diagnostic criteria for schizophrenia (need 2 of these) = Delusions, Hallucinations, Disorganized speech, Grossly disorganized or catatonic behaviour, Negative symptoms
mood component = bipolar type (mania & depression), depressive type
Delusions or hallucinations for 2 or more weeks in the absence of a major mood disturbance
Long interrupted time of illness
55
What is mania?
a mood disorder marked by a hyperactive, wildly optimistic state with 3 of:
- Inflated self-esteem - grandiosity
- Decreased need for sleep
- Talkativeness
- Flight of ideas
- Distractibility
- purposeless non goal-directed activity
56
MSE focus with mania:
Appearance / Behaviour
Mood affect
Speech
Thought form / content
Perceptual Disturbances
57
What types of medications are used for mania?
Mood stabilizers
Antipsychotics
Benzodiazepines
58
Lithium toxicity: Early
Polyuria
Ataxia
Blurred vision
Diarrhea
extreme thirst
59
Lithium toxicity: Severe
Confusion/disorientation, memory impairment, seizures, nystagmus
60
Priorities of care for bipolar med adherence
May initially require IMs
Monitor for side effects
Concerns:
Sedation, CNS depression, substance use, EPS, lithium toxicity, anticholinergic effects, blood work, weight gain (important), dependence, tolerance, benzo & other drugs, cardiovascular effects (prolonged QT waves), agranulocytosis, endocrine effects (hyperprolactinemia = producing breast milk) thyroid problems, dermatological effects = acne, steven johnson syndrome = rash, changes in urination, diabetics, osteoporosis
61
priorities of care safety bipolar
(not just about suicide, homicide; need to safe from others, financial, sexual, vulnerability, social media, risky behaviour)
Redirection / distraction
Limit setting
Timeouts
Quiet/low stimulus environment
Private room
Seclusion room (last resort)
62
complicaitons after fracture infection
Assess = Early detection, warmth, redness, pus, swelling, increase in pain
Treat = Nutrition, rest, antibiotics, wound care, pain management
Prevent = Sterile techniques, prophylactic antibiotics, standard precautions
63
complicaitons after fracture compartment syndrome
Prevent = Early detection, assessing, neurovascular checks
Assess = Neurovascular, 7 Ps
Treat = Fasiostomy, open cast, loosing dressing, bivalving
64
complicaitons after fracture fat embolism syndrome (FES)
manifest as acute respiratory distress
Prevent = Careful mobilization
Assess = ARDS (acute respiratory distress syndrome)
Treat = Supportive treatment for presenting symptoms
65
complications of fractures venous thromboembolism
Prevent = Compression stockings/devices, enoxaparin/heparin, mobilize, range of motion exercises
Assess = Redness, swelling, pain, parasthesias, DDIMER, WBC
Treat = Aimed at preventing further blood clots
66
Cast care teaching
Don't = Get wet, Remove padding or insert objects, Bear weight x 48hrs, Cover cast with plastic for prolonged periods
Do = Report signs of possible problem, Apply ice over fracture site to reduce edema, Relieve itchiness: blowdryer on cool setting, elevate it, tapping, Move joints above & below regularly, Elevate higher than heart for 24-48hr
67
What is Electroconvulsive therapy (ECT)
a treatment that involves inducing a brief seizure by delivering an electrical shock to the brain
A safe and effective treatment for a variety of psych conditions
68
ECT indications for use
Acute suicidality
Psychotic features
History of poor response to medications
History of good response to ECT
Risk of standard antidepressants treatment outweighing risk of ECT
Mania
Schizophrenia
69
ECT contraindications
Unstable/severe cardiovascular conditions
Aneurysm or vascular malformation
Increased intracranial pressure
Recent cerebral infarction
Pulmonary conditions (COPD, asthma, pneumonia)
Pace maker
70
Psychotropic medications during ECT
Usually you continue them. Special attention must be paid to mood stabilizers and Benzos due to the anti-seizure effects of these medications
71
Frequency of treatment ECT
2-3 ECT treatments/week (Mon, Wed, Fri)
6-12 treatments
above is used early in treatment course when a rapid response is important (i.e. mania, catatonia, high suicide risk)
continuation phase: 1st 6 months
especially vulnerable time for re-emergence of symptoms
72
day before ECT
Assess pt’s physical and mental status
Begin ECT/pre-op checklist
Encourage & assist patient with personal hygiene if needed
Encourage expression of concerns & anxiety related to ECT
Maintain NPO from midnight
Weight them for anaesthia dosing
73
Patient Preparation
Be NPO,
Remove jewelry, hair accessories, contact lens, glasses, hearing aids, glasses, dentures
Pre-ECT medications (if ordered) and most routine medications 1 hour prior with sips of water
Void
Pre ECT Vital Signs
74
Pre ECT
Assess the education required
Implement education
Document education provided
Ensure chart forms are on pt’s chart including (Consent form/form 5, Checklists, Record of anesthesia, Record of ECT)
75
ECT morning
Complete ECT pre checklist
Confirm NPO has been maintained
Encourage pt to void immediately before transport
Assess anxiety
Provide reassurance & support
76
Post ECT
Assess pt’s physical & mental status (DOCUMENT)
VS within 5 mins of their return to unit
Assess frequency of observation required based on assessments and LOC
Assess safety of environment and pt’s ability to ambulate & swallow to take held morning medications & breakfast
Assess & document above & any side effects
Side effects include = Nausea, headache, muscle pain (acetaminophen), Acute confusion (resolves on own & orientate)
77
What is anaesthesia?
A state wherein there was a loss of sensation by depressing the CNS or PNS
78
Anaesthetic agents
Can decrease the level of consciousness, stimulate muscle relaxation and or cause a loss of response to stimuli
79
Types of Anaesthesia
Local and general anaesthesia
80
Local anaesthesia
occurs when sensation is lost to a limited part of the body without loss of consciousness
Loss of pain to specific area, no effect on respiratory function
81
General Anaesthesia
Causes loss of sensation to the entire body, usually resulting in loss of consciousness
Paralysis of respiratory function a worry
82
Local anaesthesia (LA) route types
Peripheral:
Skin (topical)
Nerve block
Infiltration (direct injection such as dental freeze)
Central:
Spinal or intraspinal anaesthesia- injected into the area near the spinal cord within the vertebral column; intrathecal and epidural
83
LA - Mechanism of action
Interfere with nerve transmission in specific areas of the body by blocking both the generation & conduction of nerve impulses by blocking the movement of sodium, potassium, calcium ions
Known as membrane stabilizing as decreases nerve cell permeability
84
LA s/e
Adverse effects are uncommon, and allergy is rare (may occur preservatives)
Resulting symptoms may be restlessness, anxiety, hypotension or dysrhythmias
Signs of CNS toxicity are excitement leading to irritability & confusion
85
examples of LA
Lidocaine most commonly used
Side effects =
Inadvertent IV injection occurs
Excessive dose or rate of injection is given
Slow metabolic breakdown
Inject into highly vascular tissue
86
general anesthesia (GA)
The goal of a GA is to provide a rapid and complete loss of sensation.
Signs of a GA include:
*Total analgesia
*Loss of consciousness
*Loss of memory
*Loss of body movement (muscle relaxation and reflex reduction)
*Procedural Sedation*
87
Is general anaesthesia achieved by a single drug?
Not frequently, no.
Multiple are usually used to rapidly induce unconsciousness, relax muscles and maintain anaesthesia
Balanced anaesthesia is safer as less anaesthetic is used
88
Does ECT require a balanced approach?
YES
89
How is GA usually administered
IV or by inhalation
IV meds such as Propofol are given as they act within a few seconds
Inhalation meds such as halothane and Nitrous oxide are used to sustain anaestheisa
90
General Anaesthetic mechanism of action
Exact mechanisms unknown
Varies according to agent used
Lipid solubility of anaesthetic agents determines its potency
Nerve cell membranes & blood brain barrier have a high lipid content, allowing for anaesthetic agents to concentrate in cell membranes
91
What is thiopental sodium?
barb = It induces anaesthesia in like 30 seconds and lasts 10-30 minutes
Can be used alone for procedures less than 15mins, ECT meets this specification often involving anaesthesia for about 10 mins
92
What are the most commonly used GA agents?
Propofol is the most common though Etomidate and Methohexital are also used
93
What other agents may be used in adjunct to major GA agents? (Not common)
Benzos (Though they are NOT used for ECT due to anti-seizure effects)
Opioids (fentanyl)
Ketamine (The choice of little green gremlins everywhere. Also more often used as an animal tranquilizer)
94
What is succinylcholine?
depolarizing neuromusclar junction blocker
95
What does succinylcholine do?
Depolazing: occupiers acetylcholine receptors creating muscle paralysis
Often used to reduce the amount of anaesthetic used
96
What are some succinylcholine indications?
During ECT to prevent damage to musculo-skeletal system
The jaw is the only muscle not totally relaxed, thus indicating the need for bite-blockers
Mechanical ventilation will ALSO need to be used.
97
Side effects of SUCCylcholine
*Respiratory depression*
*Hypotension
*Tachycardia
*Urinary retention
*Dysrhythmias
*Delirium - hallucinations, confusion, excitability.
Malignant hyperthermia (rare)
98
What is malignant hyperthermia?
*Occurs during or after succinylcholine
*Sudden elevation in body temperature (40°C)
*Muscle rigidity or unexplained aches
*Dark brown urine
*Bleeding
*This is a life threatening emergency
99
Additional medications used with ECT
Atropine
Ranitidine
Metoclopramide
Tylenol
100
What is Atropine?
*An anticholinergic
*Indicated during ECT for clients who have excessive secretions.
*Inhibits the action of acetylcholine at postganglionic sites located in the secretory glands
*Low doses decrease sweating, salivation and respiratory secretion.
101
Why do we use Atropine?
It's an antidote for NMBA (Neuromuscular blocking agent) that we use in SMALL amountsto prevent bradycardia, hypotension, and secretions
102
What is Ranitidine?
*An antihistamine -histamine H2 antagonist
*Indicated during ECT for clients at risk for heartburn, acid reflux (gastric hypersecretory states).
*Inhibits the action of histamine at the H2 receptor site in the gastric parietal cells, leading to decreased gastric secretions.
103
What is metoclopramide?
*An antiemetic
*Indicated during ECT for clients who are at risk for or experience postoperative nausea and vomiting.
*Stimulates motility of the upper GI tract and accelerates gastric emptying, by blocking dopamine receptors.
104
metoclopramide side effects
Drowsiness, extrapyramidal reactions, restlessness, neuroleptic malignant syndrome
105
nursing process anathesia
Assess past history of surgeries & response to anaesthesia
Assess allergies to medications
Pre-op (Medical history, full physical exam, lab tests, substance use)
Post-op (Type of anaesthesia used, monitor LOC, airway, respiratory depression, cardiovascular depression)
Implement safety measures during recovery
Reorient client to surroundings
Provide preoperative teaching as necessary
106
Osteoarthritis
Cartilage begins to get destroyed between the joints
Chronic progressive process where new tissue is formed in response to cartilage destruction
Non inflammatory disorder of synovial joints (as progresses may be inflammation due to the bone on bone not the actual pathophysiology)
107
Diagnostics osteoarthritis
Bone scan, Xray, MRI, CT
Goal: confirm disease and stage progression of joint damage and slow it down
108
clinical manifestations osteoarthritis
Worsening joint pain
Limitation of movement
Crepitus
Stiffness
Deformity
109
medical management osteoarthritis
Rest and joint protection
Heat and cold therapy
Nutritional therapy & exercise
Complementary & alternative therapies
Drug therapy (pain management = nonopioids (acetaminophen)
110
osteoarthritis risk
Genetic links
Menopause
Increased weight
Strenuous exercise
Occupational
111
surgical management osteoarthritis
management
Hip = total hip arthroplasty
Knee = total knee arthroplasty
Goal = restore joint motion by replacing arthritic bone
112
What is anxiety?
A normal response to stress
Consists of three parts:
Psychological arousal (fight, flight response)
Cognitive Process
Coping strategies
Anxiety becomes abnormal when it impacts life negatively / causes interference in life
113
Causes of anxiety disorders
Genetics
Increases by 5 if someone on your family has
Temperament
Persons nature (low stress tolerance)
Neurotransmitters
Low serotonin levels = anxiety???
Norepinephrine = physical symptoms of anxiety (GI upset, tachycardia)
GABA
Life experiences
Trauma, financal, relationship, physical health concerns
114
Anxiety levels
mild, moderate, severe, panic
115
What is generalized anxiety disorder?
Characterized by persistent and excessive anxiety and worry about occupational/social/interpersonal situations
Affects daily functioning
Has physical symptoms
GAD can be debilitating disorder with a serious negative impact on quality of life
Often associated with other disorders
116
DSM5 criteria anxiety disorders
Excessive anxiety and worry, occurring more days than not for at least 6 months.
Difficult to control the worry.
The anxiety, worry or physical symptoms cause clinically significant distress or impairment in functioning
Anxiety is associated with 3 or more of the following symptoms:
*Restlessness or feeling keyed up or on edge
*Being easily fatigued
*Difficulty concentrating or mind going blank
*Irritability
*Muscle tension
Sleep disturbance
117
severe anxiety
Significant decrease in perceptual field
Focuses on specific detail
Impaired cognition
Much direction is needed to focus elsewhere
May be paralyzing causing inaction
May feel like everything is falling apart/impending doom
Increased somatic symptoms (headache, pounding heart)
Dilated pupils, urinary frequency, rigid muscles, decreased hearing
Learning and problem solving not possible
All or nothing thinking
“If I don’t do well on this test I'm going to fail out of nursing”
Emotional reasoning???
118
panic
Everything is blown totally out of proportion
Sense of dread or terror
Loss of control
Unable to do things even with direction
Disorganization
Psychomotor activity increases
Perceptions are distorted
Rational thoughts decrease
Delusional thinking
Physical symptoms
Sense of dread, shaky, feel faint, choking, rapid heart beat, wobbly legs
119
GAD
Characterized by persistent and excessive anxiety and worry about occupational/social/interpersonal situations
Affects daily functioning
Has physical symptoms
Can be debilitating disorder with a serious negative impact on quality of life
Often associated with other disorders
Depression or substances
120
Social anxiety
Involves intense fear of social situations in which the individual feels scrutinized and negatively evaluated by others
Appear to be highly sensitive to disapproval or criticism, tend to evaluate themselves negatively, and have poor self-esteem and a distorted view of their personal strengths and weaknesses
Onset early in adolescence
121
Generalized social phobia
Occurs when an individual experiences fears related to most social situations
Public performances and social interactions
122
Specific social phobia
Occurs when an individual fear and avoid only one or 2 social situations
Eating, writing, or speaking in public or using public washrooms
123
Panic disorder
Sudden short periods of intense fear or discomfort that are accompanied by significant physical nad cognitive symptoms
Mimic symptoms of a heart attack
Restricted perceptual field, feeling disconnected
124
DSM 5 panic disorder
Palpitations, pounding heart, increase HR
Sweating
Trembling or shaking
Sensations or SOB
Feelings of choking
Chest pain or discomfort
Nausea or abdominal distress
Feeling dizzy, unsteady, light-headed, faint
Chills or heat sensations
Numbness or tingling
Derealization or depersonalization
Fear of losing control or going crazy
Fear of dying
125
nursing interventions for panic disorder
Stay with patient
Allow pacing & walk with pt
Do not touch pt
Give clear, concise directions, using short sentences
Listen
Provide reassurance
Suicide assessment
PRN meds
Afterwards help with pt to identify what the trigger was so they can develop management strategies to help prevent it from reoccurring
126
OCD
Characterized by presence of obsessions and compulsions
Obsessions are recurrent, persistent unwanted thoughts that increase anxiety
Compulsions are repetitive acts that the person does in hopes to relieve anxiety
Most common reason that people with OCD seek help is for relationship problems, GAD, drug & ETOH use, depression
127
DSM 5 OCD
Recurrent and persistent thoughts or urges, that are intrustive and unwanted, and that cause anxiety & stress
Individual attempts to ignore or suppress such thoughts or urges with some other thought or action (compulsion)
Obsessions or compulsions are time-consuming or cause clinically significant distress or impairment in social or occupational functioning
128
Hoarding disorder
Excessive acquisition of, and inability to discard, material possessions
Accumulated possessions become a barrier to ADLs
Impairment in social, occupational, and family functioning
129
Agoraphobia
Fear of open spaces
Panic attacks can lead to the development of phobias
Exposure to a situation produces anxiety
Intensity of anxiety related to
Proximity of the object
Degree to which escape is possible
130
Somatic system disorders
Presence of physical symptoms without a medical explanation
Characterized by emotional distress
Disruption of daily living caused by preoccupation of 1 or more physical symptoms
Form of social or emotional communication – the bodily symptoms express emotion that cannot be verbalized
1 or more significant somatic concerns that may involve may body parts
GI (nausea, vomiting, diarrhea)
Neurological (headache)
Musculoskeletal (aching)
Physical symptoms may be intermittent or always present
Symptoms present for at least 6 months or longer
Perceive themselves as “sicker than sick”
Often can’t work or take part in ADLs
No medical explanation for symptoms
Seek out medical opinions from many different doctors but usually avoid mental health
More prevalent in females than males
Often there is a history of sexual abuse
Often concurrent depression/anxiety/substance abuse
131
somatization
Unexplained physical symptoms that occur in the presence of psychological distress
132
nrusing interventions somatic system disorder
Develop trusting relationships
Shift focus from somatic concerns to feelings
Build self-esteem
See only 1 health care provider at regularly scheduled times
Limited focus on physical symptoms
Conservative treatment of physical complaints
CBT most effective treatment
Antidepressants
Self awareness of nurse
133
Conversion disorder
Pseudo-neurological symptoms
Paralysis, blindness, movement disorder, numbness, loss of hearing, episodes resembling
134
Illness anxiety disorder
Preoccuption with fear about developing an illness
135
Factious disorder
Intentionally cause an illness or injury to receive attention from health care providers, relieves emotional stress
Munschsan by proxy
136
Malingering
Same as factious disorder but for different reasons
Forensic field
not criminally responsible d/t insanity
137
nursing interventions anxiety
Management of physical symptoms
GI problems
Headache – triggers/stress
Body aches/stiffness - exercise
Sleep – sleep hygiene
Relaxation techniques
Relationships
138
Treatment options anxiety
Identifying triggers
Diet
Exercise
Breathing control
Distraction
Positive self talk
Progessive muscle relazation
Meditation
Mindfulness
139
psychotherapies for anxiety
1. CBT
Based on individual’s interpretation of experiences, not event itself
Encourages realistic and flexible thinking
Highly effective for treating GAD, panic, SAD
Focuses on events & situations in the “here and now”
Encourages self-awareness
2. Exposure therapy/systematic desensitization
Repeated exposure to anxiety-provoking situations
Treatment for phobias
140
medications anxiety
Antidepressants
SSRI/NSRI
Benzo
Quick onset of anxiolytic effect
Careful of potential for dependence, rebound anxiety, sleep disturbances
Other
Propranolol relieves physical symptoms on anxiety but doesn’t change mood
141
TX options PTSD
CBT
Exposure therapy
Cognitive restructuring
Eye movement desensitization and reprocessing
142
PTSD
Exposure to traumas such as a serious accident, a natural disaster, or criminal assault can result in PTSD
143
symptoms PTSD
Re-experiencing the event: intrusive thoughts and recollections (flashbacks) or recurrent dreams/nightmares
Avoidance behaviour: avoiding activities, situations and people associated with the trauma, feelings of guilt
General numbness and loss of interest in surroundings
Hypersensitivity: inability to sleep, anxious feelings, overactive startle response, hypervigilance, irritability, angry outbursts
144
Immunity
Bodies ability to defend against foreign substances
145
3 primary functions of immunity
Defense, homeostasis, surveillance
146
types of immunity
innate
accquired
active accquired
passive accquired
147
innate
Exists without prior contact with an antigen
Involves nonspecific response
148
Acquired
Development of immunity either actively or passively
149
Active acquired
Invasion of body by foregin substances leads to the development of antibodies and sensitized lympthocytes
150
active natural
Contact with antigen through clinical infections (disease, recovery chicken pox)
151
active artifical
Immunization with antigen (immunization with live or killed vaccine)
152
Passive acquired
Host receives, rather than synthesizes, antibodies to an antigen
153
passive natural
Transplacental and colostrum mediated transfer from mother to infant (maternal immunoglobulins in neonate)
154
passive artifical
Injection of serum from immune human (injection of human y-globulin)
155
Immunity Defense Mechanisms
*Acquired Immunity
*Humoral Immunity
*Cell-Mediated Immunity
156
What is humoral immunity?
antibody-mediated immunity
Mediated by B cells
Protects against bacteria, extracellular viruses, respiratory and GI pathogens
Five classes of antibodies including IgG, IgA, IgM, IgD, IgE
157
When does the primary immune response occur in humoral immunity?
*Primary immune response is evident by 4-8 days after initial exposure to antigen
158
Is the secondary immune response stronger and faster in humoral immunity?
Yes, it's faster, longer, harder and various other innuendos.
159
What is cell-mediated immunity?
*Immune response that is initiated through specific antigen recognition by T cells
160
What cells are involved in cell-mediated immunity?
Involves T cells, macrophages, and NK cells
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What does cell-mediated immunity protect against
Protects against fungus, intracellular, viruses, chronic infectious agents and tumor cells
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Effects of aging on immunity
Effectiveness in immunity is reduced with age
Older adults have more malignancies and are therefore more susceptible to infection
Bacterial pneumonia is the leading cause of death for older adults
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What is a hypersensitivity reaction
An overreactive immune response against foreign antigens
Or
Failure to maintain self-tolerance that can result in tissue damage
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What is an immediate reaction
An immediate (antigen-antibody) reaction is one that occurs within the first few minutes of exposure to that allergen
165
What are the three types of immediate reaction?
Type I: Anaphylactic Reactions
Type II: Cytotoxic & Cytolytic reactions
Type III: Immune complex reactions
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What is a delayed reaction?
Wherein there is a prolonged response to the initial allergen
T-cells - Delayed inflammatory response occurring with 2-8 hours after mast cells are activated
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What is the one type of delayed reaction?
Type IV: Delayed hypersensitivity reaction
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Medical management of hypersensitivity reactions
Identify allergen
Avoid allergen
Stress management
Control environment
Administer medications
Immunotherapy
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What is a Hypersensitivity I reaction?
IgE antibodies produced in response to allergens
Anaphylaxis, asthma, allergic rhinitis
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What is a Hypersensitivity II reaction?
IgG or IgM bind to antigen Hemolytic transfusion reactions
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What is a Hypersensitivity III reaction?
Local/systemic Immediate/delayed SLE, rheumatoid arthritis
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What is a hypersensitivity IV reaction?
Sensitized T-cells attack antigens Contact dermatitis, transplant rejection Delayed reaction (cell-mediated)
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Nursing interventions for immune difficulties?
Anapyhlaxis management
Chronic allergy management
*Medications
*Environmental control
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\What steps do you take to manage anaphylaxis?
Recognize clinical manifestations
Maintain ABC
Administer medication
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What medications are used for immune responses?
Antihistamines
Beta 2 agonists
Corticosteroids
Anticholinergics
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What is a vaccination
a biological preparation that provides active acquired immunity to a particular disease
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What is a vaccine made from?
a weakened or dead form of a pathogen
178
What is an immunization schedule?
Designed to yield the best lvls of immunity Ideally, primary immunization begins at 2 mo of age
Dosages must not be alternated
Doses shall not be repeated/the sched restarted regardless of prolonged time since prev dose
Doses given at less than the recommended interval may result in less than optimal antibody response & should not be counted as part of a primary series
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How do How Vaccines Work against viruses?
1 - A vaccine introduces safe forms/fragments of pathogens, called immunogens, to mimic the actual pathogen & trigger the body to generate immune responses
2 - Immune cells (B-cells & T-cells) circulating in the blood/mucous membranes are activated by these immunogens
3 - B-cells recognize immunogens soon after they have entered the body & produce antibodies which bind to & possible neutralize foreign particles in the body & mark them for destruction
4 - "helper" "CD4" T-cells, once activated by a pathogen, divide rapidly & secrete cytokines that reg or "help" the immune response coordinates the activities of a set of "killer" cells called CD8+ T-cells. CD8+ T-cells
5 - A small group of "memory" B-cells & T-cells remain in the body & can very quickly start a strong immune response. When the body is exposed to a virus w the same immunogens as the vaccine, it can mount an effective response in days, thus preventing infection & illness.
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What is personality?
Persistent patterns of thinking, feeling or behaving across time
181
What is temperament?
*A recognizable and distinctive pattern of behaviour evident during the first few months of life.
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What is the difference between disorder and trait?
Disorder - Impaired function, interpersonal conflict and emotional dysregulation for prolonged periods of time
Trait - Feelings, behaviours with intermittent dysregulation, conflict and function but not for prolonged periods of time
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Causes of personality disturbances
Early life experiences (Biological)
Learned behaviours (psychological)
Social environment (abuse, trauma)
Biological makeup / genetics
Impaired regulation of the brain circuits
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Common features and diagnostic criteria personaliy
Cognitive schemas = Pattern of thought that determines how a person interprets events & Friendly gesture can be interpreted as suspicious (example)
Emotions
Impaired self-identity and interpersonal function = Behaviour and ideas of relationships and how the world works is impaired
Impulse control = Negative consequences when engaging in impulsive behaviours
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What are the Cluster A personality types
paranoid, schizoid, schizotypal
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What is paranoid personality disorder?
A pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent, beginning by early adulthood and present in a variety of contexts
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Treatment modalities for paranoid personality
*Goal is to create trust / empathy
*Do not talk them 'out' of the persecutions
*Often "agree to disagree" approach.
*SSRI helpful diminish obsessional thoughts.
*CBT to develop trust, increase coping skills (how they handle anxiety)
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What is schizoid personality disorder?
A. A pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings, beginning by early adulthood and present in a variety of context
1. neither desires or enjoys close relationships, including being part of a family
2. almost always chooses solitary activities
3. has little, if any, interest in having a sexual experience with another person
4. takes pleasure in few activities
5. lacks close friends or confidants other than first-degree relatives
6. appears indifferent to the praise or criticism of others
7. shows emotional coldness, detachment, or flattened affect
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Treatment modalities: Schizoid
*Medications may target "negative" sx.
*Overlap of depression. Anti-depressants
*CBT but 'difficult' due to entrenched thoughts (part of the personality)
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Cluster B
Antisocial PD
Borderline PD
Histrionic PD
Narcissistic PD
Dysregulation of emotion and behaviour
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Cluster C
Avoidant PD
Dependent PD
Obsessive-compulsive PD
Sense of fearfulness
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Paranoid personality disorder diagnostic criteria DSM
Pervasive distrust & suspiciousness of others such that their motives are interpreted as malevolent, beginning by early adulthood & present in a variety of contexts, as indicated by 4 or more:
1. suspects, without sufficient basis, that others are exploiting, harming, or deceiving
2. preoccupied with unjustified doubts about the loyalty or trustworthiness friends or associates
3. Reluctant to confide in others because of unwarranted fear that the info will be used maliciously against them
4. reads hidden demeaning or threatening meanings into benign remarks or events
5. persistently bears grudges
6. perceives attacks on their character or reputation that are not apparent to others and is quick to react angrily or to counterattack
7. has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner
Does not occur exclusively during the course of schizophrenia, bipolar disorder or depressive disorder with psychotic features, or another psychotic disorder and is not attributable to the physiological effect of other medical conditions
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Treatment modalities – paranoid personality
Goal is to create trust / empathy
CBT to develop trust, increase coping skills (how they handle anxiety)
SSRI helpful diminish obsessional thoughts, although no medications have been found to be specifically effective in treating PPD
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Schizoid personality disorder diagnostic criteria
pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings, beginning by early adulthood and present in a variety of contexts, as indicated by 4 or more
1. neither desires or enjoys close relationships, including being part of a family
2. almost always chooses solitary activities
3. has little, if any, interest in having a sexual experience with another person
4. takes pleasure in few activities
5. lacks close friends or confidants other than first-degree relatives
6. appears indifferent to the praise or criticism of others
7. shows emotional coldness, detachment, or flattened affect
b. does not occur during course of schizophrenia, bipolar disorder, depressive disorder with psychotic features or medical condition
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Treatment modalities – schizoid PD
Because persons with SPD typically shy away from interactions in general establishing a therapeutic relationship can be challenging
Treatment goals are to enhance the experience of pleasure, prevent social isolation, and increase emotional responsiveness to others
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Schizotypal personality disorder – diagnostic criteria
Pervasive pattern of social and interpersonal deficits marked by acute discomfort with and reduced capacity for, close relationships as well as by cognitive or perceptual distortions and eccentricities of behaviour, beginning by early adulthood and present in a variety of contexts as indicated by 5 or more
1. ideas of reference (excluding delusions of reference)
2. odd beliefs or magical thinking that influences behaviour and is inconsistent with subculture norms
3. unusual perceptual experiences, including bodily illusions
4. odd thinking and speech
5. suspiciousness or paranoid ideation
6. inappropriate or constricted affect
7. behaviour or appearance that is odd, eccentric, or peculiar
8. lack of close friends or confidants other than 1st degree relatives
9. excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgements about self
b. does not occur exclusively during the course of schizophrenia, bipolar disorder or depressive disorder with psychotic features, or another psychotic disorder, autism spectrum
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Treatment modalities – schizotypal PD
Medications mainstay treatment for psychosis
SSRI reduce depression and intensity
CBT to deal with cognitive distortions of emotional reasoning, and personalization (believing they are responsible for something or reading minds)
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Antisocial personality disorder
Disregard for others needs or feelings
Persistent lying, stealing, using aliases, conning others
Recurring problems with law
Repeated violation of rights of others
Aggressive, often violent behaviour
Disregard for the safety of self or others
Impulsive behaviour
Consistently irresponsible
Lack of remorse for behaviour
Individual is at least 18 years old
Evidence of conduct disorder with onset before age 15
Occurrence of antisocial behaviour is not exclusively during the course of schizophrenia and bipolar disorder
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Psychoeducation checklist: antisocial personality disorder
Positive health care practices, including substance abuse control
Effective communication and interaction skills
Impulse control
Anger management
Group experience to help develop self-awareness and impact of behaviour on others
Analysing an issue from the other person’s viewpoint
Maintenance of employment
Interpersonal relationships and social interactions
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Borderline personality disorder – diagnostic criteria
pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity, beginning by early adulthood and present in a variety of contexts, as indicated by 5 or more
1. frantic efforts to avoid real or imagined abandonment
2. pattern of unstable and intense interpersonal relationships characterized by alternating b/w extremes of idealization and devaluation
3. identity disturbances: markedly and persistently unstable self-image or sense of self
4. impulsivity in at least 2 areas that are potentially self-damaging (spending, sex, substance abuse, reckless driving, binge eating)
5. recurrent suicidal behaviour, gestures, or threats, or self-mutilating behaviour
6. affective instability due to a marked reactivity of mood (intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)
7. Chronic feelings of emptiness
8. inappropriate, intense anger or difficulty controlling anger
9. transient, stress-related paranoid ideation or severe dissociative symptoms
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BPD care planning
Emotional regulation and stability
Helping pt with personality disorder develop skills to manage intense emotions and achieve emotional stability
Interpersonal relationships and social functioning
Addressing difficulties in establishing and maintaining healthy relationships and improving social interactions
Self-identity and self-esteem
Assisting individuals with personality disorders in developing a positive sense of self and improving self-esteem
Impulse control and self-destructive behaviours
Supporting pt in managing impulsive behaviours, self-harm tendencies, and reducing the risk of self-destructive actions
Cognitive distortions and maladaptive thinking patterns
Working with pt to identify and challenge negative thoughts, distorted beliefs, and maladaptive thinking patterns that contribute to their difficulties in functioning and adapting to different situations
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Histrionic personality disorder
Feel underappreciated or depressed when they’re not the centre of attention.
Be dramatic and extremely emotionally expressive, even to the point of embarrassing friends and family in public.
Have a “larger than life” presence.
Be persistently charming and flirtatious.
Be overly concerned with their physical appearance.
Use their physical appearance to draw attention to themselves by wearing bright-coloured clothing or revealing clothing.
Act inappropriately sexual with most of the people they meet, even when they’re not sexually attracted to them.
Think that their relationships with others are closer than they usually are.
Have difficulty maintaining relationships, often seeming fake or shallow in their interactions with others.
Need instant gratification and become bored or frustrated very easily.
Constantly seek reassurance or approval.
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Narcissistic personality disorder
Overinflated sense of self-importance
Constant thoughts about being more successful, powerful, smart, loved or attractive than others
Feelings of superiority and desire to only associate with high-status people
Need for excessive admiration
Sense of entitlement
Willingness to take advantage of others to achieve goals
Lack of understanding and consideration for other people’s feelings and needs
Arrogant or snobby behaviours and attitudes
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What is the difference between narcissistic and antisocial
Narcissistic Personality Disorder is characterized by grandiosity, the constant need for admiration and a lack of empathy for others. They regularly brag about themselves and their achievements
NO SOCIAL GRACES (no insight)
Underneath all these characteristics is an individual who is quite fragile
Antisocial Personality Disorder
on the other hand, are very self-destructive, seem to have no awareness of consequences and repeat the same destructive patterns of behavior. They lack any remorse for the harm they have caused others
They are not fragile, and quite dangerous (often not detectable)
OFTEN HAVE (GOOD) SOCIAL GRACES
‘grooming’ make you feel good about yourself – for gain
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Treatment personality disorders
Difficult to “treat” a personality (a way of thinking and believing)
Insight
Medications cannot “cure” personality but can help treat other conditions that often accompany such as depression, impulsivity, and anxiety
Do they want help?
Counselling and skills to manage emotions / behaviours
CBT & DBT
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Avoidant personality disorder
Avoidance of activities at work that involve interpersonal contact due to fear of criticism or rejection
Unwillingness to interact with others unless certain they will receive a positive response
Hesitancy in intimate relationships due to fear of shame
Preoccupation with criticism in social situations
Feeling inadequate and being inhibited in new social situations
Perception of self as inept, unappealing, and inferior
Reluctance to take risks or engage in activities that might result in embarrassment
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What is the difference between avoidant and schizoid PD
Patients with Avoidant personality disorder desire companionship but are extremely shy (fear rejection)
Whereas patients with Schizoid personality disorder have no desire for companionship
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Dependent personality disorder
Essential feature is a pervasive and excessive need to be taken care of
Leads to submissive and clinging behaviour and fears or separation
Regression is often seen in people with DPD, this is defined as going back to a younger age of maturity
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Obsessive compulsive personality disorder
pts must have a persistent pattern of preoccupation with order, perfectionism, and control of self, others, and situations
This pattern is shown by the presence of 4 or more
* Preoccupation with details, rules, schedules, organization, and lists
A striving to do something perfectly that interferes with completion of the task
Excessive devotion to work and productivity (not due to financial necessity), resulting in neglect of leisure activities and friends
Excessive conscientiousness, fastidiousness, and inflexibility regarding ethical and moral issues and values
Unwillingness to throw out worn-out or worthless objects, even those with no sentimental value
Reluctance to delegate or work with other people unless those people agree to do things exactly as the patients want
A miserly approach to spending for themselves and others because they see money as something to be saved for future disasters
Rigidity and stubbornness
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Treatment modalities of cluster C
SSRI reduce depression and anxiety
CBT to deal with cognitive distortions of emotional reasoning, and personalization
Groups also can be effective
Ineffective coping, and impaired social interaction
Develop skills (dependency into autonomy)
Sleep
Work on self-esteem, and improve relations
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What is cancer?
■All diseases involving the cell in which normal mechanisms for control of growth and proliferation have been altered.
■It spreads directly to surrounding tissues and to new sites in the body.
Process of Cancer
■Defects in cellular proliferation
■Defects in cellular differentiation
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What is a neoplasm?
a new and abnormal growth of tissue in some part of the body, especially as a characteristic of cancer.
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Classification of Neoplasms
■Anatomical Site Classification
■Histological Analysis Classification
-Grading
■Extent of Disease Classification
-Staging
-TNM Classification System
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Neoplasm 4 grades
■Grade I - cells differ slightly from normal cells, well differentiated
■Grade II - cells more abnormal, moderately differentiated
■Grade III - cells very abnormal, poorly differentiated
■Grade IV - cells immature & primitive, cell of origin difficult to determine
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Neoplasm staging
■Stage O - cancer in situ
■Stage I - tumor limited to tissue of origin, localized growth
■Stage II - limited to local spread
■Stage III - extensive local & regional spread
Stage IV - metastasis
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Diagnostic Evaluation for cancer
■Blood tests
■X-rays & scopes
■CT, MRI, and/or PET scans
■Ultrasound
■Biopsy
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Treatment Modalities for cancer
-Surgery
-Radiation Therapy
-Chemotherapy
-Biotherapy
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What is the TNM classification system?
T= tumor; N= lymph node involvement; M= metastasis. This is a form of staging that classifies the tumor according to size, invasiveness, and spread.
219
Cancer surgery
Diagnosis & treatment (biopsy)
Supportive care
Rehabilitation
Palliation of symptoms
Prevention
220
221
How does radiation treatment for cancer work?
Use of high energy ionizing radiation to treat a variety of cancer
Destroys a cell’s ability to reproduce by damaging its DNA, delaying repair of DNA, or inducing apoptosis
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What are the two types of radiation therapy
External radiation (teletherapy)
- Localized to that area
Internal radiation (brachytherapy)
- Implant radioactive beads into the tumour
- Prostate cancer common
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What is chemotherapy in cancer treatment?
A systemic intervention that directly/indirectly disrupts reproduction of cells by alt essential biochemical processes Combination chemotherapy far superior to single agent therapy
224
Chemotherapy uses
Used for (1) widespread disease, (2) risk of undetectable disease is high, & (3) tumor cannot be resected and resistant to XRT
225
What is biological therapy in cancer treatment
■The use of biological agents such as interferons and growth factors to modify the relationship between the host and tumor
226
Nursing Management:Radiation Therapy & Chemotherapy: Fatigue
Increased metabolic rate
Mgmt - advise pt that fatigue is an expected adverse effect of therapy - sleep/hygiene, moderate exercise, pace activities as tol can help - encourage pt to rest/maintain routine
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Nursing Management:Radiation Therapy & Chemotherapy: Anorexia
Lack or loss of appetite for food
Certain immune factors that are released to fight cancer have certain immune suppressing appetizing effects
Loss of weight,
Mgmt monitor weight encourage pt to eat small meals inc in protein intake meal replacement drinks
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Nursing Management:Radiation Therapy & Chemotherapy: Bone marrows suppression
Dec RBC - fatigue, anemia, paleness of skin, increased HR
Dec WBC - fever & chills, diarrhea, infection
Dec platelets - easy bruising, bleeding,
avoid strenuous activities monitor lab values keep wounds clean & covered drink plenty of fluids, assess for infection
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Nursing Management:Radiation Therapy & Chemotherapy: Oral, Oropharyngeal, & Esophageal Reactions
Throat hurts, teeth rot, it's bad.
Give them fluids, encourage hydration and mouth care, assist oral care as needed.
Don't give them extreme hot or cold foods
230
Nursing Management:Radiation Therapy & Chemotherapy: Pulmonary effects
There will be inflammation and fibrosis
We treat it with bronchodilators, repositioning, cortidosteroids.
Provide education about oxygenation
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Nursing Management:Radiation Therapy & Chemotherapy: GI effects
Nausea, vomiting, diarrhea, abdominal pain.
Assess pain / discomfort. Provide patient education as needed. Monitor BM's
Give ondansetron for nausea
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Nursing Management:Radiation Therapy & Chemotherapy: Skin reactions
Chemo rash - small pimples & puss filled, itchiness, pain Dermatitis
Redness & Irritation
Dry, Flaking, Peeling (for radiation)
colour to skin veins & hair (discoloured/darker)
change to fingernails & toenails (yellow, cracked, darkened, brittle)
Alopecia (no hair)
Photo sensitivity
Wash in cool water
Moisturize
No scratching
Change sheets / towels regularly
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Nursing Management:Radiation Therapy & Chemotherapy: Reproductive effects
Infertility, miscarriages, sperm count and egg reduction.
Early menopause may occur
Utilize TR skills, assess for depression, suicide, sexual therapist
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What is a malignant tumor?
A mass of cancer cells that can spread.
It grows rapidly and spreads to other tissues.
235
What is a benign tumor
A mass of cells that grows out of control but remains at the site of origin
236
What is a neoplasm
a new and abnormal growth of tissue in some part of the body, especially as a characteristic of cancer.
237
What is cell differentiation?
The process in which cells become specialized.
238
What is cell proliferation
process of increasing cell numbers by mitotic division
239
What is biotherapy?
biotherapy involves the use of immunotherapy and biologic response modifiers as a means of changing the person's immune response to cancer
The major mechanisms by which biotherapy exerts its effects are modification of host responses (immunotherapy) and modification of tumor cell biology (biologic response modifiers)
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What is active acquired immunity
Immunity gained wherein there is intentional introduction of a foreign substance to cause the body to say "what the F" and become sensitized to future invasions.
241
What is Passive acquired immunity
The host receives rather than synthesizes antibodies to an antigen
Breastfeeding
242
What is teletherapy?
external radiation
243
What is Chemotherapy
the use of drugs to treat a disease
244
What is aggression?
A term used to describe hostile, unpleasant, or unacceptable behaviour
245
What may cause aggression?
Any * neurocognitive impairment
Developmental deficits such as anoxia, malnutrition, toxins, trauma to brain (birth).
Brain injury (e.g. poor impulse control)
Cognitive Neuroassociation
Neurobiological
Deficits or damage
Neurotransmitter dysregulation
Psychosis, substance misuse (exacerbate anger response)
246
Sociocultural factors for aggression
Learned/ Family/Culture
Culture might mean a culture of aggressive nursing
practices, or aggressive sales, or an unsafe work environment.
Social Experiences have multiple determinants.
Gender (risk factors for violence)
247
Environmental factors for aggression
*Decreased Education
*Unemployment
*Poverty
*Family instability
*Poor Housing
*Crowding
248
What is lateral violence?
Aggressive and destructive behavior or psychological harassment of colleagues against each other.
249
What constitutes workplace violence?
Direct or indirect threats delivered in person or through letters, phone calls, or electronic mail.
Intimidating or frightening gestures.
Throwing or striking objects.
Stalking
Wielding a weapon, or carrying a concealed weapon for the purpose of threatening or injuring a person.
Assault
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ASSESSMENT:Tetrad of Lethality (Shea, 2017)
1)Patients presenting with a recent violent episode.
2)Patients presenting with a dangerous psychotic process.
3)Indication from the interview that the patient intends to engage in violence.
4)The patient is lying and collaborative evidence suggests intended violence.
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What is the prostate
*The prostate is part of the male reproductive system that adds nutrients and fluid to sperm
*It is located in front of the rectum, just below the bladder, and surrounds the urethra
252
What is benign prostatic hyperplasia?
*A nonmalignant overgrowth of cells in the prostate gland that results in constriction of the urethra
*Occurs in aging males that have normal testicular function
*Prostate hyperplasia and hypertrophy à prostate enlargement à obstruction of urethra & bladder outlet
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Clinical Manifestations: BPH
Obstructive Symptoms
*Decrease in urinary stream, difficulty initiating voiding, intermittency, dribbling at end of urination
Irritative Symptoms
*Urinary frequency, urgency, dysuria, bladder pain, nocturia, incontinence, retention
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Diagnostic Tests for BPH
*Digital rectal exam (DRE)
*Urinalysis & urine culture
*Kidney function tests (Cr, gfr, BUN)
*Prostate specific antigen (PSA) levels
*Transrectal ultrasonography (TRUS)
*Postvoid residual & uroflowmetry
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Medical Management for BPH
*Active Surveillance
*Limiting fluid intake
*Avoiding medications/food that will cause urinary retention
*Timed voiding schedule
*Drug Therapy
*Alpha-Adrenergic Receptor Blockers
*5 Alpha-Reductase Inhibitors
256
Surgical Management for BPH
*Transurethral Resection of the Prostate (TURP)
Surgical procedure where a resectoscope inserted in the urethra to scrape out enlarged portion of the prostate gland
257
What is prostate cancer?
*Prostate cancer is a malignant tumor of the prostate gland
*Tumor becomes clinically relevant when local invasion or distant metastasis interrupts function of urinary tract or other organs
258
What are some clinical manifestations of prostate cancer
Irritative Symptoms Frequency Urgency Nocturia
Obstructive Symptoms Hesitancy/Straining Incomplete emptying Intermittency Weak stream
259
Diagnostic Tests for prostate cancer
*DRE & PSA
*TRUS
*Biopsy
*Bone scan
*MRI
CT
260
Treatment for prostate cancer
Conservative Therapy "Watchful Waiting"
*PSA & DRE to monitor progress of disease
Surgical Therapy
*Radical Prostatectomy
*Cryosurgery
*Nerve-sparing Procedure
*Orchiectomy
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What is radical prostaectomy?
Entire removal of prostate
262
What is cryotherapy?
Use of extreme cold to freeze & remove abnormal tissue
263
What is laproscopic surgery?
Type of radical (prostate removed using small incisions w/ special tools) less invasive & more common
264
What is Orchiectomy
Surgical of one or both testicles
265
Clinical manifestations of tesitcular cancer
*Painless lump in scrotum
*Lump usually non-tender and very firm
*Scrotal swelling
*Scrotal heaviness
*Dull ache/heavy sensation in lower abdomen, perianal area, or scrotum
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What are the types of breast cancer?
*Noninvasive Breast Cancer
*Ductal carcinoma in situ (DCIS)
*Lobular carcinoma in situ (LCIS)
*Infiltrating Lobular Carcinoma
*Infiltrating Ductal Carcinoma
*Paget's Disease
*Inflammatory Breast Cancer
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What is breast cancer?
*A lump or mammographic abnormality in the breast that often occurs in the upper outer quadrant of the breast.
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What is ductal carcinoma in situ?
Noninvasive form of cancer
Inside milk duct in breast - Earliest form of breast cancer Can progress if not treated Unilateral (generally)
269
What is lobular carcinoma in situ (LCIS)
Malignant proliferation of cells in lobules with no invasion of the basement membrane
270
What is Infiltrating Lobular Carcinoma?
Begins at the glands of the breast & breaks through the walls of the lobule then invades the breast -can spread everywhere else
271
What is Infiltrating Ductal Carcinoma
Arise from the epithelium of large or intermediate sized ducts and infiltrate the breast parenchyma
272
What is Paget's disease of the breast?
Scaling rash/dermatitis of the nipple caused by invasion of skin by cells from a ductal carcinoma
273
What is inflammatory breast cancer?
Rare + v aggressive - cells block lymph vessels in the skin of the breast
274
Diagnostic screening breast cancer
*Breast Self Examination
*Mammogram
*Breast Ultrasound
*Breast Magnetic Resonance Imaging (MRI)
*Biopsy
275
Medical treatment for breast cancer
*Surgery
*Breast conserving (lumpectomy)
*Modified radical mastectomy
*Axillary lymph node dissection (ALND)/Sentinel lymph node dissection (SLND)
*Radiation Therapy
*Chemotherapy
*Hormonal Therapy
*Biological & Targeted Therapy
276
Nursing Management for breast cancer
*Turning, coughing & deep breathing exercises
*Postoperative arm & shoulder exercises
*Pain management
*Drain management
*Lymphedema management
*Psychological care
277
What is cervical cancer?
*A malignant tumor that starts in the cells of the cervix.
*Infection with HPV is the most significant risk factor.
*A Pap Test should be performed every 1 to 3 years.
278
Cervical Cancer Clinical Manifestations
*intermenstrual discharge
*unusually long or heavy periods
*bleeding after sex
*bleeding after menopause
*pain during sex
*increased or foul smelling discharge from vagina
279
What is uterine cancer?
*Cancer arising from the cells of the uterus.
*Grows slowly & metastasizes late.
*Common metastatic sites are the lung, bone, liver, and brain.
280
Uterine CancerClinical Manifestations
*Abnormal vaginal bleeding
*Unusual vaginal discharge
*Pain during intercourse
*Pelvic pain/pressure
*Pain during urination/BM, difficult urination/BM or blood in urine/BM
*Ascites or lymphedema in legs
281
What is Ovarian cancer?
*A malignant neoplasm of the ovaries
*Can metastasize directly by shedding malignant cells and by lymphatic spread.
*No screening tests exist for ovarian cancer
282
inflammatory response
biological response to cell injury that
- neutralizes inflammatory agents
- removes necrotic cells
- promotes healing/repair of damaged cells
283
4 inflammatory response stages
1. vascular response
2. cellular response
3. exudate formation
4. healing
284
local/systemic inflammation symptoms
Redness.
Heat.
Swelling.
Pain.
Loss of function.
285
inflammatory markers
CRP (<10mg/L)
ESR (M=0-10, F=0-20)
WBC
286
nursing management inflammation
- health promotion
- VS
- wound assessment
- fever managment
- medicaiton
- RICE
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what does RICE stand for
rest, ice, compression, elevation
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HCP contribute to development of antibiotic resistance by
- admin ABX for viral infection
- prescribing unnecessary ABX
- using inadeqaute drug regimens to treat infections
- using broad spectrum or combo agents for infections that should be treated with 1st line medications
