lp 7- immune / hemtology Flashcards

(159 cards)

1
Q

what is blood made up from

A

plasma,

solutes,

RBCs,

WBCs,

platelets

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2
Q

Hematopoietic

bone marrow function
originate

A

bone marrow tissues (where blood cells are formed)

-all cells originate in bone marrow

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3
Q

lymphoid tissues

what does

A

white blood cells mature & circulate)

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4
Q

Red blood cells

aka

shape

what does shape do

A

AKA erythrocytes- most common

biconcave disks

  • allows cells to pass through small capillaries without disrupting cell membrane
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5
Q

Duty of RBCs & Hemoglobin

transport

excretion

A

Transport O2 to body tissues

Carbon dioxide excretion

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6
Q

normal levels of RBC/hemoglobin

in women/men

A

Normal levels are Hemoglobin-

(12-16 Women)

(13.5-18-men)

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7
Q

Anemia

A

low Blood cell count

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8
Q

Polycythemia

A

–High blood cell count

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9
Q

Erythropoiesis

production starts/end where

how long does it take

A

RBC production

Production starts in bone marrow

ends in blood/spleen

takes 3-5 days

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10
Q

What stimulates RBC production

when that occurs…

___ stimulates

A

tissue hypoxia

When this occurs, Kidneys release erythropoietin

erythropoietin stimulates bone marrow to produce RBC’

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11
Q

lifespan of rbc

A

Lifespan of 120 days

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12
Q

hemolysis-what is it

converted/ what is it/ where goes

A

Old damaged RBCs are lysed (damaged) by phagocytes

Lysed RBCs are converted into bilirubin

bilirubin( orange/yellow pigment that bilirubin is removed by liver

which is then excreted out

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13
Q

If someone has impaired liver function/disease process

causes
means
causes

A

, this causes increases hemolysis,

which means bilirubin will be accumulated into serum

causes jaundice

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14
Q

WBC

AKA
where come from
what is duty

A

leukocytes

Come from stem cells in bone marrow

Duty?- Defense against microorganisms

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15
Q

normal levels of WBC

A

(4000-11,000

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16
Q

Leukopenia

A

lower WBc count

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17
Q

Leukocytosis

A

higher WBc count

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18
Q

Granular Leukocytes

what are they
3 types

A

Mature fully in bone marrow, then release into blood stream

neutrophils
eosinophils
basophils

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19
Q

Neutrophils

active
first
increases
immature
lifespan

A

active phagocyte-

first cell to arrive to site of injury-

increases during inflammation-

immature forms will be released during inflammation/infection-

10 hr lifespan

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20
Q

Eosinophils

found
increase

A

found in large numbers of mucosa of intestines and lungs-

increase during allergic reaction or parasitic infestations

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21
Q

Basophils

contain
which do what

A

contain inflammatory mediators

which increase during allergic or inflammatory reactions.

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22
Q

Non-Granular Leukocytes

enter

active part

2 types

A

Enter bloodstream before fully mature

Active part in: inflammatory & Immune responses

2 types-monocytes, lymphocytes

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23
Q

platelets

aka
formed
live for how long

A

AKA Thrombocytes

Formed in bone marrow-

live for 10 days

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24
Q

duty of platelets

release
produce

A

Release mediators required for CLOTTING

Produce ATP

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25
normal levels of platelets
Normal levels are 150,000-400,000
26
Thrombocytosis
excessive amountof platelets
27
Thrombocytopenia risk
deficient amount risk for injury dt bleeding, petechiae, ecchymosis
28
Anemia
abnormally low RBC count/ low hemoglobin concentration
29
Duty of RBCs & Hemoglobin anemia --leads to
Transport O2 to body tissues & Carbon dioxide excretion Anemia- reduces the oxygen carrying capacity of the blood-leads to hypoxia
30
Body can compensate and be asymptomatic; if not and symptoms do arise symtoms anemia
Pallor; skin, mucous membranes, nail beds Heart and resp rate increases Tissue hypoxia; angina, fatigue, dyspnea on exertion Bone pain
31
Blood Loss Anemia caused from circulating bv->
Anemia caused from acute/chronic blood loss Circulating blood volume decrease  cardiac output falls
32
Compensatory mechanisms for blood loss anemia
heart rate increases, blood vessels constricts, fluid shift from interstical space to vascular space to help maintain fluid volume
33
Acute blood loss-when return to normal
Return to normal 3-4 weeks
34
Chronic blood loss- iron store microcytic hypochromic
- iron store eventually depleted; RBCs -> microcytic(small rbc) & hypochromic ( pale RBC)
35
what are nutritional keys to RBC development
Iron Protein, vitamins, minerals B 12 and folate specifically Vit C & Vit E
36
what are Nutrient Deficits causes
inadequate diet, malabsorption, increase need for nutrients
37
Iron- Deficiency Anemia most increases cause by
Most common type of anemia Risk factors increase with age, Cause developed when supply of iron is inadequate for optimal rbc formation
38
iron deficiency anemia may result from defiecneies decreased increased loss/excessive chronic
Dietary deficiencies Decreased absorption Increased metabolic requirements Blood loss /excessive bleeding Chronic hemoglobinuria
39
manifestations for iron defunct anemia
Brittle spoon shaped nails, sore tongue, cheilosis-cracked mouth pica-unusual taste
40
Treatment: iron deficiency anemia
High iron diet-chicken, beef, egg yolk, brown rice dietary supplements causes an increase in H&H
41
Vitamin B 12 Deficiency Anemia occurs failure lack of
Occurs when B 12 is not consumed or absorbed Failure to absorb  is called Pernicious anemia Lack of intrinsic factor needed for absorption
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Who is at risk for vitamin b12 anemia
pts who have had stomach resection. , chronic gastritis
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manifestations of vitamin b 12 Deficiency anemia
Pallor, smooth sore beefy red tongue, neurologic symptoms- paresthesia; numbness & tingling/pain of extremities
44
Treatment -Vitamin B 12 Deficiency Anemia dietary sources treatment b12 found where
Dietary sources of B-12- Eggs, liver, milk, shrimp, cheese Treatment B-12 injection B12 is almost exclusively found in food derived from animals
45
Folic Acid Deficiency Anemia folicacid is needed for found in
Needed for normal maturation of RBCs found in Inadequate dietary intake, increased metabolic needs, malabsorption, impaired metabolism
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who is at risk Folic acid deficiency anemia
__older adults, drug/alcohol issues, pregnancy, children dt increased metabolic needs/meds
47
Folic Acid Deficiency Anemia Manifestations similar difference
Similar to anemia, and B 12- (pallor SOB, heart palpations) - >difference though? Is folic acid does not have neurologic symptoms
48
Folic Acid Deficiency Anemia Strongly associated with
Neural Tube Defects; spina bifida- Prenatal vitamin
49
Folic acid anemia treatment nutrition
supplemental folic acid nutrition- broccoli, Brussel sprouts, citrus, ceralacche, peas, beans, green veggies
50
Hemolytic Anemias characterized by
Characterized by premature destruction of RBCs
51
Hemolytic Anemias causes causes can be
Causes: RBC cell membrane defect , HgB structure defects (Thalassemia, sickle cell), Mechanical damage, drugs/chemicals, bacteria and other infections Causes can be intrinsic(disorder within rbc) or extrinsic(disorder outside of rbc
52
Thalassemia inherited leads to causing
Inherited disorder hemoglobin synthesis is incomplete meaning it is missing a molecule Leads to deficient HgB production,-> causing fragile, microcytic, hypochromic characteristics to rbc
53
Hemolytic Anemias can be can cause manifestations
Can be asymptomatic Can cause Mild to moderate anemia Manifestations->splenomegaly, brown skin color, bone marrow hypoplasia
54
Hemolytic Anemias Accumulation of iron, following repeated transfusions...
leads to failure of major failure such as heart/liver
55
Hemolytic Anemias treatment
: Blood transfusions, folic acid supplements, splenectomy, genetic counseling
56
Sickle cell anemia what is characterized by can be
Hereditary Characterized by episodes of sickling where rBC become crescent shaped can be acute or chronic
57
sickle cell anemia patho
These will clump together and obstruct capillary blood flow, causing ischemia and possible infarction to surrounding tissue.
58
Symptoms of sickle cell
-pallor, fatigue, jaundice, irritability, and pain(when RBC clump together)
59
Aplastic Anemia- bone marrow leading to replaced will see develops
Bone marrow fails to produce all three types of blood cells leading to pancytopenia Normal bone marrow is replaced by fat Will see low count of RBC,WBC and platelets. Anemia develops as bone marrows fails to replace
60
Manifestations aplastic anemia
Vary with severity of pancytopenia Pallor, weakness, exertional dyspnea, headache…tachycardia, heart failure
61
anemia goal interventions treatment
Goal- Ensure adequate tissue oxygenation interventions- pace activités, encourage rest TDB- withdrawal of causative agent, blood transfusions, bone marrow transplant
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CBC- what looking for Anemia- Diagnosis
blood cell count, H&H, severity of anemia, shape, volume, and can help determine cause of anemia
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iron-why Anemia- Diagnosis
performed to detect iron deficiency anemia
64
Serum Ferritin- low due to reserves Anemia- Diagnosis
low due to total depletion iron reserves available for iron synthesis.
65
HgB electrophoresis- seperates used diagnosis Anemia- Diagnosis
separates normal hemoglobin from abnormal, used to evaluate hemolytic anemia , and to diagnose thalassemia
66
Schilling Test what is it helps determine Anemia- Diagnosis
- 24 hr urine sample to measure b12 absorption, before and after intrinsic administration . Helps determine between pernicious anemia and intestinal malabsorption of vitamin
67
Bone Marrow Examination- diagnoses if present then Anemia- Diagnosis
diagnose aplastic anemia. If this is present then normal levels are decreased as they are replaced by fat.
68
Iron Sources- anemia meds given how oral given w/ dont take w/ take w/ stools increase
Given orally, iv, im Oral is given with orange juice- helps enhance absorption-drink w/ straw to avoid teeth straining Don’t take iron w/ milk-decreased absorption If taken with food it'll help decrease gi upset Stools may be dark in color or black-can mask blood in stool Increase fluids and fiber to decrease constipation
69
Vitamin B 12-anemia meds given do not pts mat feel taken for life
Given orally, subq or im Do not expose medication to light, because it'll compromise medication Pts may feel burning sensation on administration -normal Pernicious anemia=taken for life
70
Folic Acid Sources-anemia meds given how large doses excessive do not
Iv, subq, oral Large doses causes urine to become darker Excessive alcohol intake increases need for folic acid Do not mix with other medications
71
Polycythemia- aka excess hematocrit
“Erythrocytosis” Excess amount of RBC’s – hematocrit higher then 55%
72
primary Polycythemia what is it cause
overproduction of rbcs Cause- unknown
73
primary Polycythemia Manifestations-
inc blood volume-> hypertension, dizziness , headache , inc blood viscosity, inc risk for thrombosis,
74
Treatment- Polycythemia
phlebotomy removing 300-500 mls of blood to keep blood volume/viscosity within normal limits. , chemo to suppress marrow production , prevent stasis-Thrombosis-> Elevate legs when sitting to prevent blood stasis
75
Secondary Polycythemia- cause manifestation treatment
Cause- response to excess erythropoietin, due to prolonged hypoxia Manifestations similar to primary Treatment- Phlebotomy, treatment underlying cause
76
Mononucleosis- invasion by affects mode of transmission incubation period
Invasion of B cells in oropharyngeal lymphoid tissue by the Epstein- Barr Virus Affects Young adults 15-30 Mode of transmission Saliva Incubation period 4-8 weeks
77
Mononucleosis- manifestations
headache, malaise, fever , fatigue, sore throat, enlarged lymph nodes
78
mononucleosis labs increased elevation low
Increased lymphocytes & monocytes, WBC elevation later, platelets low
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mononucleosis recovery can be fatigue lasts
can be in 2-3 weeks, fatigue can last up to 3 months
80
mononucleosis treatment
Bedrest pain control frequent rest periods
81
Thrombocytopenia- platelet count decline leads to
Platelet Count less than 100,000 Decline of less than 20,000/mL can lead to hemorrhage
82
Thrombocytopenia bleeding causes
Bleeding dt platelet deficiency occurs in small vessels Petechiae & purpura-rash
83
Causes Thrombocytopenia-\ immune-what happens micro-what happens drug-what happens
: immune response-body destroys platelets microcirculation issues- platelets clump together drug induced(heparin therapy)- abnormal response to heperin
84
Thrombocytopenia- Diagnosis
CBC, platelet, Bone marrow examination, history/ manifestations
85
Thrombocytopenia - treatment meds treatment surgery-
meds-glucocorticoids, immunosuppressive drugs, withdrawal of heparin therapy treatmentPlatelet transfusion surgery-Splenectomy
86
Splenectomy- spleen is site of what's altered pts need to be at caution
Spleen is site of Platelet destruction and antibody production Platelet destruction and immune function altered -pts need to be at caution for infection,
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Nursing Interventions to include: Thrombocytopenia- reduce risk risk promote assessing assessing
Reduce risk of bleeding, risk of injury dt bleeding tendencies, promote oral membrane health, -assessing mouth and encouraging soft toothbrush, assessing for evidence of peticular areas or bruising.
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Type a antigens antibodies
blood has a antigens has B antibodies
89
Type b antigens antibodies
has b antigens A antibodies
90
Type ab antigens antibodies universal
both a and b antigens no antibodies (Universal recipient
91
Type o antigens antibodies universal
no antigens Both antibodies (Universal Donor
92
antigen d if have if not have
If have antigen d then rH + If not have antigen d then rH -
93
Blood Transfusions- watch-if non reactions seen when
Watch for any agglutination, if non occurs then blood ins compatible Reactions- most likely to be seen within first 15 minutes of administration
94
Reactions to blood manifestations
Fever, chills, hives, flushing, lumbar pain nursing responsibilities-stop the blood, medicate and send blood to be analyzed.
95
Innate Immune Response aka first 3 barriers
AKA Natural immune response First line of defense against infection 3 barriers: Skin- Barrier protection Mucous membranes Barrier Body Fluids
96
Breach of these defenses -> what is it
Inflammation- response to injury, brings fluid and blood cells to area in which damage/invasion has occurred
97
Adaptive Immune Response- what is it when will develop 2 types
More specific immune response- when innate response is not enough and will develop over time 2 types- Antibody Mediated & Cell Mediated
98
Adaptive Immune Response- directed at specific response has what
Directed at materials recognized as foreign Specific- initiated and directed at specific antigens Response is systemic compared to localized Has memory- repeated exposure= more rapid response
99
Anti-body Mediated cells create produced by _ cells activated when in contact rapid response
cells create antibodies to fight against antigens Produced by B cells B Cells are activated by contact with an antigen When in contact; cell changes into antibody producing & memory cells Rapid response if antigen is encountered again
100
Cell-Mediated secretes antibodies initaited antigen T cells
–secretes cytokines, and antibodies will attack pathogen Initiated by T cells Antigen specific and that antigen must be present on another cells surface T cells then form antigen specific clones
101
Immunity-
protection of the body from disease
102
Active immunity
- Occurs when the body produces antibodies or develops immune lymphocytes against specific antigen
103
Active- artificial natural
Vaccines- provide artificial acquired immunity Infection with pathogen- Chickenpox (Natural)
104
Passive immunity
- Provides temporary protection against disease producing antigens
105
PassiveIMMUNITY artificial natural
Artificial- Acquired by admin of antibodies or antitoxins in immune globulin –glamalgobin injection following hep a exposure Natural- transfer of maternal antibodies via placenta, breastmilk
106
Diagnosis for immunity is used for what
Used to assess the patients immune status
107
Serum protein decreased/noted diagnosis immunity
decreased levels noted with immune deficiency.
108
Antibody Testing- Titer negative titer indicated diagnosis immunity
Titer: Example is Varicella Zoster (Chicken Pox) Negative Titer Indicates: there has never been an infection with Varicella Zoster virus and person is susceptible to chicken pox virus
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Skin Testing/prick testing antigen where site assessed for if you see__ means exposure diagnosis immunity
– antigen is injected intradermally site is assessed for induration, redness, swelling, If see induration/pruritic wheal/erythema this will indicate there has been exposure.
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Vaccines suspension given why? local reactions
Suspension that are treated to make them nonpathogenic Given why? To gain immunity Local reactions- redness, swelling, tenderness, muscle aches,
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Vaccines Health promotion/education nurse safety
Health Promotion education and reinforce importance of immunizations. Nurse safety – use dominant arm for administration, clean off site, and have epi pen for anaphylaxis/ allergic reaction
112
Immune System- Allergy hypersensitivity -> when environmental tissue response
Hypersensitivity- immune response that results in harm to patient When environmental this is called an allergy Tissue response mild to severe
113
Anaphylaxis manifestations begins when new meds-assess
- Tachycardia, Hypotension Begins within minutes of exposure to antigen New medication admin- watch for reactions-assess 30 minutes after administration of medications- always re
114
Latex Allergy simple always have
simple irritant that can cause dermatitis, Always have nonsterile, non latex gloves readily available
115
Allergy- Diagnosis & Treatment
Blood Testing – used to identify allergens/ hypersensitivity to allergens. Skin Testing –pin prick, intradermal antigen directly into skin, Food Allergy Testing –keep dietary log,
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Treatment- allergy meds
antihistamines, steroids for inflammatory response, epi pen
117
Subjective data collection: allergies
what's causing this, what medications are they on, treatments, OTC medications, when/time of year do allergies happen , other family members, have they had other allergies in the past
118
Treatment of allergic reaction avoid explain meds see
avoid scratching area,- wear long sleeve with neck to avoid scratching explain use of steroids topical relief medications see a alergist
119
Teaching allergies see who do what directions information
Allergist Dietary Epi Pen directions/instructions Hereditary information children with parents that have allergies are more prone to allergies
120
Cancer what is it incidence/mortality keys to treatment
Uncontrolled growth and spread of abnormal cells Incidence and mortality- causes 25% of deaths, second most common cause of death Prevention, early detection and treatment-key to treatments
121
Cancer- AD what is it essential hospice
Advance Directives Essential for individuals with poor prognosis Hospice- Not only for patient but also family
122
Cancer Risk Factors
Heredity Age—75% diagnosed after age 55 Gender Poverty Stress Diet Occupation Infection Tobacco Use Alcohol Use Recreational Drug Use Obesity Sun
123
Malignant neoplasm cancer i N no growth
Invasive Noncohesive No borders Rapid growth
124
Benign where is it defined removed reoccurrence
Localized Well defined- capsulated Easily removed, minimal reoccurrence
125
Metastasis definition common sites
Definition—malignant cells from primary tumor travel to other tissues and organs Common Sites bone, lymph , liver, brain
126
Cancer Consequences-Altered GI function o/c change in change in change in A
Obstruction/compression Change in metabolic rate Change in digestion Change in taste Anorexia
127
Cancer Consequences impaired infection
Impaired immune and hematopoietic function Leukopenia – Infection
128
Your patient is on neutropenic precautions….now what? no avoid perform stop
No fresh flowers in the room avoid eating unwashed fruits/vegetables Perform hand hygiene before touching stop visitors who appear ill
129
Anorexia/Cachexia no syndrome remove
No appetite, wasting syndrome Remove odors or anything that is unpleasent
130
Cancer- infection-avoid can cause(A/T/H)
Infection: avoid contact with infectious processes d/t compromised immune system can cause Anemia can cause Thrombocytopenia can cause Hemorrhage
131
Pain in cancer
Can be acute/ chronic
132
Motor and/or sensory deficits compression change invasion Cancer Consequences
Compression of nerves Change in cognitive function Invasion of bones
133
Physical and Psychological stress want get pt Cancer Consequences
Want pt to Express feelings, give lots of encouragement Get pt to open up with Open ended questions and , therapeutic communication
134
surgery-types Treatment of Cancers
Prophylactic—removal of a breast based on genetic findings Diagnostic Primary treatment Reconstruction/rehabilitation Palliative
135
Treatment of cancers C-therapy R-therapy B-therapy P-therapy transplants
Chemotherapy Radiation Therapy Biotherapy Photodynamic Therapy Stem Cell Transplant
136
Mucous membranes monitor for oral pain complaints- Chemotherapy- Side Effects
Monitor Mucous membranes for stomatitis Oral pain complaints: Assess, evaluate, then treat, may need topical analgesic, teach to avoid alcohol bases mouthwashes
137
Hair Chemotherapy- Side Effects
- alopecia – loss of hair
138
Bone marrow suppression causes allow protect prevent Chemotherapy- Side Effects
(causes anemia, thrombocytopenia, neutropenia) allow lots of rest protect from illness- immunocompromised way from people with illness prevent too much activity
139
Fatigue & Anemia caused from promote activity intolerance Chemotherapy- Side Effects
Caused from : decrease of erythrocytes (rbc) Promote: rest, quiet activities, Activity Intolerance: pace activities to how they are tolerating
140
Nausea and Vomiting Nursing Interventions: diet liquids/food high low minimize Chemotherapy – Side effects
Bland diets, cold liquids/foods, high protein low volume substances, minimize odors Movement; avoid laying flat
141
Chemo- Pharmacological management non pharm
Pharm: give iv fluids Antiemetic before meals non pharm: Attention diversion –phone, tv , visitors, etc
142
Radiation local treatment s/e
Local treatment- Dosimetry, area marked w ink (instruct patient not to wash off markings) Side effects- Burns
143
Radiation internal implant __or__ radioactive material radioactive substance
Implant- radiation source implanted temporary or permanent Radioactive material is injected directly into tumor/body cavity radioactive substance may transmit outside of body or into body fluids
144
radiation internal Nursing Responsibilities room visitors sit instruct asses avoid
private room, limit visitors, sit away from pt, instruct visitors to sit away. Asses surrounding tissues, avoid contanct with pregnant women
145
radiation internal Patient and Family Teaching dispose avoid
dispose of urine in special containers, avoid close contanct
146
Radiation external what do site how often per week how long does it take for how long total
Marked; pinpoint site of radiation, treatment usually 5 days per week, 15-30 minutes , 2-7 weeks
147
Radiation external Nursing Responsibilities r/t to skin care looking for assess
looking for redness/peeling, - normal, assess skin changes and mucous membranes
148
Education for radiation risk for infection-wash with/no /dont want/ dont put care Education for patient and family
Risk for infection –washing skin that is red/peeling with plain water, no soaps or lotions, don’t want them to scrub or scratch it. Do not want heat/cold on areas. Skin care
149
3 Types of Pain - treatments of cancer and goals
tumor treatment noncancer pain Goals: establish what idea is prior to treatment
150
Medication Administration cancer acting careful administration ->
Long Acting/short acting Careful administration  metabolism (what do they have cancer of, where is medication metabolized
151
pain meds for cancer treatment meds can assess before
a lot of meds can decrease respiratory rate/drive – assess repository rate and sp02 before giving meds.
152
Cancer prevention avoid: carcinogen examples associated factor examples:
Avoid carcinogens SMOKING, industrial (asbestos), foundries, radiation Avoid associated factors Alcohol, obesity, lack of exercise
153
C CAUTION-seven warning signs of cancer
– Change in bowel or bladder habits. This is a common sign of colorectal cancer
154
A CAUTION-seven warning signs of cancer
– A sore that does not heal in a normal amount of time. If located on the skin or in the mouth, skin cancer or oral cancer could be the cause. Asymmetrical and irregular boarder lesion
155
U CAUTION-seven warning signs of cancer
Unusual bleeding or discharge. Any bleeding from the bladder, vagina, or rectum could mean prostate, cervical, or colorectal cancer, postmenopausal bleeding
156
T CAUTION-seven warning signs of cancer
Thickening of breast tissue or a lump. Any thickening of tissue or a lump on the breast can be a sign of cancer. A lump on a testicle can mean testicular cancer
157
I CAUTION-seven warning signs of cancer
Indigestion. Indigestion and/or difficulty swallowing can be a symptom of stomach, throat, esophagus, or mouth cancer.
158
O CAUTION-seven warning signs of cancer
Obvious changes to moles or warts. This is the most common sign of skin cancer. Asymmetrical and irregular boarders
159
N CAUTION-seven warning signs of cancer
– Nagging cough. A cough that lasts for four weeks or longer can be a symptom of lung and/or throat cancer.