Test 1 Flashcards
1
Q
Hematopoietic stem cell transplant (HSCT) types
A
autologous, syngeneic, allogenic
2
Q
autologous HSCT
A
donating own stem cells
3
Q
syngeneic HSCT
A
identical twin donates stem cells
4
Q
allogenic HSCT
A
make a match from non-related donor for stem cell transplant that’s
5
Q
hemrarthrosis management
A
- during bleeding episodes, elevate and immobilize the joint
- ice
- analgesics
- range-of-motion exercises after the bleeding stops will help to prevent contractures
- physical therapy
- avoid obesity to minimize joint stress
6
Q
Hemophilia A: etiology and pathogenesis
A
- etiology: x-linked recessive gene
- pathogenesis: factor 8 deficiency (90%), defective factor 8 (10%)
7
Q
Four types of sickle cell anemia crises
A
- vasoocclusive: obstruction, vasospasm, thrombosis, & infarction
- sequestration: large amounts of blood pool in liver and spleen (children)
- aplastic: profound anemia d/t diminished erythropoesis
- hyperhemolytic: unusual, occurs with certain drugs or infections
8
Q
5 factors associated with sickling
A
- exposure to cold
- infection
- stress
- dehydration
- acidosis
9
Q
idiopathic thrombocytopenia purpura has platelet count of less than
A
less than 100,000 platelet count, can be drug induced
10
Q
aplastic anemia 3 differentiating assessment findings
A
- infection of skin/mucous membranes
- bleeding from gums, nose, vagina, rectum
- retinal hemorrhage
11
Q
immune mediated atrophic gastritis–> destruction of parietal cells–> decreased production of intrinsic factors and binding of intrinsic factors B12–>decreased absorption in the ileum–>large, flimsy RBC’s
A
pernicious anemia pathogenisis
12
Q
- low serum iron and ferritin
- elevated total iron binding capacity (TIBC)
- complete blood count: decreased RBC’s
- low HGB & HCT
A
diagnosis of iron deficiency anemia
13
Q
2 types of hemoglobin
A
0-6 months of age: Hemoglobin F
6 months of age and up: Hemoglobin A
14
Q
implement bleeding precautions if platelet count is…
A
-platelet count less than 50,000
15
Q
spontaneous hemorrhage occurs when platelet count is less than…
A
-platelet count less than 20,000
16
Q
types of radiation therapy
A
- external ration or “teletherapy”
- internal radiation or “brachytherapy”
17
Q
brachytherapy radiation source
A
direct radiation source in continuous contact with tumor tissues for a specific time
18
Q
- binds to target antigens (often specific cell surface membrane proteins)
- prevents protein from functioning, prevents cell division
- ex: Rituximab (Rituxan)
A
monoclonal antibodies
19
Q
Target mammalian target of rapamycin (mTOR)
-ex: Torisel
A
Angiogenesis inhibitors
20
Q
Prevent formation of a large complex of proteins into cells
-Bortezomib (Velcade)
A
Proteasome inhibitors
21
Q
Inhibit activity of specific kinases in cancer cells and tumor blood vessels
-Sunitib (Sutent)
A
Multikinase inhibitors (MKI’s)
22
Q
Bind to vascular endothelial growth factor (VEGF), prevent binding of VEGF with its receptors on surfaces of endothelial cells present in blood vessels
-ex: Bevacizumab (Avastin)
A
Vascular endothelial growth factor receptor inhibitors
23
Q
Block epidermal growth factor from binding to cell surface receptor
-Trastuzumab (Herceptin)
A
Epidermal growth factor/receptor inhibitors
24
Q
TNM staging classification TO, Tis, T1, T2, T3, T4
A
TO: no evidence
TIS: tumor insitu
T1, T2, T3, T4: ascending degrees of tumor size and involvement
25
TNM staging classification N0, N1, N2, N3, N4
N0: no abnormal lymph nodes
| N1, N2, N3, N4: progressively more involvement
26
TNM staging classification
```
T= tumor
N= lymph node involvement
M= metastasis
```
27
TNM staging classification M0, M1, M2, M3
M0= no evidence
| M1, M2, M3,= distant metastasis present
28
Tumor Marker: Cancer antigen CA 125
Ovarian, pancreas, breast, colon, lung, liver
29
Tumor Marker: Prostate-Specific antigen (PSA)
prostate
30
Tumor Marker: Carcinoembryonic antigen (CEA)
lung, GI, Breas, Pancreas
31
Tumor Marker: Alpha-fetoprotein (AFP)
testicular, choriocarcinoma, pancreas, colon, lung, stomach, liver
32
Tumor Marker: Bence Jones Protein
multiple myeloma
33
Tumor Markers
protein molecules that we can detect in serum or other body fluids. Can derive from tumor or immune response
34
4 stages of infection
incubation: pathogenesis is reproducing
without recognizeable symptoms
Prodromal: develops vague symptoms
Acute: lots of proliferation and disemination
of pathogen. Specific symptoms occur
& are more pronounced. Cell lysis,
response
Convalescent: Containment of pathogen
& ultimate elimination. Damaged tissues
undergoing repair. Resolution of
symptoms.
35
Gram (+) vs. Gram (-) bacteria
```
Gram (+): do NOT retain violet dye
-many medically relevant bacilli
& cocci
-endotoxin/lipopolysacharide walls
Gram (-): DO retain violet dye in gram
staining
-staph, strep, enteroccocus
```
36
prions
protein particles with NO DNA or RNA
| ex: mad cow disease
37
viruses
- tend to be intracellular pathogens
- require living cell to replicate
- ex: HIV
38
bacteria
- large groups of unicellular procaryotes
- no nucleus
- have both RNA & DNA
39
Rickettsiae & Chlamydiaceac
- intracellular pathogens
| - need direct conatct
40
Fungi
-yeast, mold, mushrooms
41
parasites
- protozoa etc.
| - organisms requiring host
42
apoptosis
programmed cell death
43
physiological apoptosis
development of body tissue in normal embryonic development
44
pathologic apoptosis
result of intracellular events or disease
45
lipid peroxidation
destruction of lipids leading to membrane damage & increased permeability. Caused by free radicals.
46
electrically uncharged atom or groups of atoms that has an unpaired electron
free radicals
47
tissue hypoxia or chemical injury--> decreased cellular intracellular ATP--->Na+ K+ ATPAse pump failure---> altered cell permeability---> sets up inflammatory response, cell fluids leak out causing edema, interferes with cell functioning and causes cell to die
depletion of ATP sequence
48
metaplasia vs. displasia
```
metaplasia= reversible
displasia= potentially reversible
```
49
-persistant paint that serves no useful
function.
-predominance of C fiber stimulation
-neural changes: increased sensitivity--->
decreased threshold
-loss of inhibition at the spinal column
-reorganization of nociceptors at the
dorsal root ganglion
chronic pain
50
unrelieved pain---> activation of the autonomic nervous system
acute pain
51
cutaneous somatic pain
skin, sub Q, localized
52
deep somatic pain
bone, muscles, tendons, joints, blood vessels, locally diffuse
53
pain pathways 1st order
periphery--> spinal cord
54
pain pathways 2nd order
spinal cord--->thalamus
55
pain pathways 3rd order
thalamus--->primary sensory cortex
56
noxious stimuli (chemical, mechanical, orthermal)--->nociceptor stimulation--->type A and C fibers--->neospinothalamic tract (A), paleospinalthalamic tract (C)--->somatosensory cortex
pain mechanism
57
fibroblast synthesis and lysis of collagen---> increased tissue strength
maturation phase
58
excess scar tissue
Keloid formation
59
keloid formation occurs during which phase?
maturation phase
60
- macrophages release:
- transforming growth factor beta (TGFB)
- angiogenesis factor (VEGF)
- matrix metalloproteinases (MMPs)
- granulation tissue
- wound contraction
reconstructive phase
61
epithelialization, fibroblast and collagen
granulation tissue
62
myofibroblasts
wound contraction
63
3 components of plasma protein synthesis complement system
opsonins, chemotatic factors, anaphylatoxins
64
3 components of plasma protein synthesis pathway to activation
classical, lectin, alternative
65
immediate release of histamine and chemotatic factors
mast cell degranulation
66
later release of leukotienes, prostoglandins, and platelet activating factor
mast cell synthesis
67
4 cardinal signs of vascular response/stage
erythema, warmth, edema, pain
68
includes vascular response, cellular mediators, plasma protein system
acute inflammation
69
5 cardinal manifestations of inflammation
warmth, redness, swelling, pain, decreased function
70
who discharges the patient from pacu?
anesthesiologist
71
Requires:
- no IV narcotic for last 30 min.
- minimal nausea & vomiting
- voided
- able to ambulate
- responsible adult present to accompany pt.
- discharge instructions given and understood
ambulatory surgery criteria for discharge
72
On the aldrete score ___ or more points are required for confired recovery
9 or more points are required for confirmed recovery
73
Aldrete score categories
activity, respirations, circulation, conciousness, 02 saturation
74
nursing PACU interventions for HTN (4)
analegsics, assistance w/ voiding, correction of respiratory problems, antihypertensives
75
nursing PACU interventions for hypotension (3)
administer oxygen, IV bolus fluids, antiarrhythmics
76
classification of surgery
risk factor, urgency, purpose, setting
77
poor understanding of right and wrong
newborn/infant values and beliefs
78
punishment and reward guides behaviors
toddlers/preschooler's values and beliefs
79
moral judgements that are situation specific leading to a choice or decisions. Question faith and challenge religion
adolescent's values and beliefs
80
values and morals developed. Are at high level with autonomous devisions, moral reasoning, spirituality evolves and is applied, health and spiritual harmony
adults/older adults values and beliefs
81
stable physical structure, maturation complete, peak efficiency, peak reproductive function
young adults 21-40 years old physical development
82
rapid growth, puberty, growth spurts
11-18 years adolescent physical development
83
search for identity, independence, challenge value systems
11-18 years adolescent psychological development
84
taller and thinner, 2-3 inches per year, 6.5 lbs per year, redistribution of fat and muscle, facial changes, loose/gain four teeth per year, large and small muscle activities
school age physical development, 6-11 years
85
friendships very intense, start to master skills, vocab increases dramatically, can classify and order objects, concept of time
school age psychological development, 6-11 years
86
school failure, lack of friends, social isolation, aggressive behavior
school age 6-11 years red flags for development
87
inability to perform self-care tasks, lack socialization, unable to play with other children, unable to follow directions
preschool red flags for development
88
mini adult form, permanent teeth begin, attend to ADL's, visual acuity 20/20
3-6 years preschoolers physical development
89
associative play, like to question things, can think in the past as well as the present (not future), lots of make-believe play, talk constantly, count, colors, follow three step directions, read simple print
3-6 years psychological development
90
large heads, pot bellied, slower growth rate, all deciduous teeth present, visual acuity 20/30
toddler 1-3 years physical development
91
separation anxiety is highest during this period, can express fear, parallel playing, developing preferences
toddler 1-3 years psychological development
92
copy circle and cross, build using small clocks
fine motor 3 years
93
use scissors, color within borders
fine motor 4 years
94
write some letters and draw a person with body parts
5 years fine motor skills
95
developmental assessment domains (5)
cognitive, motor, language, social/behavioral, adaptive
96
stages of development across the lifespan
- infancy: neonate (0-1 month)
- early childhood: toddler (1m to 1 yr)
- preschool: (3-6 yrs)
- middle childhood: (7-12)
- late childhood: adolescent (13-19)
97
onlooker play
child just watching
98
solitary play
child entertains themselves
99
parallel playing
playing in the same room next to each other but not engaging with one another
100
associative playing
play interacting with one another
101
cooperative play
can share, have a common goal in play
102
sociological activity theory
-psychological and social fitness is maintained by social activity. Based on one's self concept is affirmed through activities associated with various socially derived roles. Loss of roles in old age negatively affects life satisfaction
103
sociologic disengagement theory
social equilibrium is achieved by a process of withdrawal between society and the older person. Mutually beneficial, reciprocal, governed by society's needs, not individuals needs or desires
104
endocrine theory
hormones control the rate of aging
105
immunity theory
functioning of the immune system diminishes with age. Fewer defenses against foreign organisms.
106
cross-linkage theory
cross linking agent attaches to DNo, damage results and accumulates due to failure of defense and repair mechanisms
107
spiritual development stages
- stage 0: undifferentiated
- stage 1: intuitive-projective
- stage 2: mythical-literal
- stage 3: synthetic-convention
- stage 4: Individuating-reflexive
108
rapid periods of growth
infancy and puberty
109
slow periods of growth
preschool-puberty, post puberty is slow decelleration
110
barely able to lift head
newborn
111
easily lifts head, chest, and upper abdomen and can bear weight on arms
6 month old
112
ambulation milestones
- 9 months: crawl
- 1 year: stand independently from crawl position
- 13 months: walk and toddle quickly
- 15 months: can run
113
BAER test
done at birth for hearing
114
normal lab values for potassium
3.5-5
115
preop-med, decreases probability of emesis and aspiration
-ex: metoclopramide HCL (reglan), and
ondansetron (Zofran)
anti-emetics
116
* DANGER STAGE*
- Begins with depression of vital functions and ends with respiratory failure, cardiac arrest, and possible death
- respiration muscles are paralyzed and apnea occurs
- pupils are fixed and dilated
stage 4 general anesthesia
117
* Surgical Anesthesia*
- begins with generalized muscle relaxation and ends with loss of reflexes and depression of vital functions
- jaw is relaxes and there is quiet, regular breathing
- client cannot hear
- sensations are lost
stage 3 general anesthesia
118
* Excitement, Delirium*
- begins with loss of consciousness and with relaxation, regular breathing, and loss of eyelid reflex
- client may have irregular breathing, increased muscle tone, and involuntary movement of extremities during this stage
- larygospasm and vomiting
- client susceptible to external stimuli
stage 2 general anesthesia
119
* analgesia and sedation relaxation*
- begins with induction and ends with loss of consciousness
- client feels drowsy and dizzy, has reduced sensation to pain, and is amnesic
- hearing exaggerated
stage 1 general anesthesia
120
malignant hyperthermia caused _________ and leads to __________
- causes: increased metabolism and calcium levels in muscle cells
- leads to: acidosis, high temps, dysrhythmias
121
hypnotics, opiod analgesics, neuromuscular blocking agents
adjuncts to general anesthesia agents
122
stages of general anesthesia
- stage 1: analgesia and sedation, relaxation
- stage 2: excitement, delirium
- stage 3: surgical anesthesia
- stage 4: danger *not expected stage to go through*
- emergence: recovery and wake up
123
definition of major risk classification in surgery
extended area of involvement with increased time in surgery and high degree of risk
124
definition of minor risk classification in surgery
limited to a body area with a short surgery time, minimal risk
125
attachment, interaction between them and caregiver
newborn/infant roles and relationships
126
sense of loss, separation anxiety and protest
toddlers and preschoolers roles and relationships
127
sexual development and pier group influence, less time with family
school age/adolescent roles and relationships
128
multiple roles, deferred parenting, multiple losses
adults/older adults roles and relationships
129
self perception stems from primary caregivers
newborn/infants
130
self perception is egocentric
toddlers/preschoolers
131
self perception in based on piers and positive groups
school age/adolescents
132
self perception is individualized, depression
adult, older adult
133
sensory stimulation, overstimulation, pain ID, physical sensory stimulation, environmental stimulation
cognition/perception newborn/infant
134
hearing and vision problems, play even with pain, pain face scale
toddlers/preschoolers cognition/perception
135
different with school, work, physiologic, emotional, environmental problems, drug use
school age/adolescent cognition/perception
136
declining sensory function, pain perception varies, confusion, dementia
adult/older adult cognition/perception
137
sleep/rest for newborn/infant
sleep thru night by 3-4 months
138
sleep/rest toddler/preschool
1-2 naps, majority sleep at night, nightmares
139
sleep/rest school age
continuation of nightmares and nighttime awakening, bed wetting
140
adolescent sleep/rest
increased need of sleep, teach time management activities
141
adult/older adult sleep/rest
stress related insomnia, sleep apnea, poor sleep habits
142
- decreased physiological systems functioning
- decreased stamina, strength, recovery time, elimination control
- degenerative change in bones
- sensory changes
60 years and older physical development
143
- redistribution of body tissue
- hair changes
- decreased vision, muscular strength, hormones
- increased fatigue
- empty nest syndrome
- maladaptive coping skills can be present
- death of a spouse
40-60 years, middle adult physical development
144
- buttoning clothing
- holding crayon/pencil
- building with small blocks
- using scissors
- playing a board game
- have child draw pic of self
3-6 year fine motor and cognitive abilities
145
stranger anxiety in toddlers should disappear by age___
should disappear at 3 years of age
146
temper tantrums in toddler should occur _____, peak at ____, and disappear by___
- occur: weekly
- peak: 18 months
- disappear: by age 3
147
sibling rivalry peaks_____
-peaks around 1-2 years of age
148
toilet training is accomplished by ____ years of age
-accomplished by age 3
149
- fast growth
- voluntary motor skills
- visual acuity
- motor ability increases
- pincer grasp
- eruption of deciduous teeth
1 month to 1 year development
150
birth to 1 month height and weight
7lb, 1oz, 19.3 inches
151
most widely used developmental screening tool
Denver II
152
interrelationship of personal competence and environment determine successful aging
person-environment fit theory
153
best way to predict how a person will adjust to being old is to examine how that person has adjusted to changes throughout life. Stability of personality is a rule rather than an exception.
continuity theory
154
- lifespan predetermines by genetic program/biological clock
- in humans, biological programming is about 100-110 years
- based on observation that human cells reproduce a set number of times
programmed theory
155
organisms are like machines and they eventually wear out, even with care and maintenance and replacement of parts
wear and tear theory
156
molecules capable of attacking other molecules because they posses an extra electron
-in aging, free radical production increases and/or protective mechanisms decrease
free radical theory
157
psychosexual, id, ego
Freud
158
sensitive periods
susceptibility is based on a positive or negative influence when interacting with the environment
159
progression of behavioral changes that involve cognitive, linguistic, and psychosocial skills
development
160
physiological development of a living being measured by body size
growth
161
diagnostic
to diagnose something, ex; removing mass to test
162
ablative
remove diseased item ex: tonsilectomy, appendectomy
163
constructive
restore function and or build tissue to connect something that's missing, ex: cleft lip
164
reconstructive
trying to rebuild something that has been damaged, ex: broken bone, skin grafts
165
palliative
relieve intensity of symptoms or reduce, NOT curative, ex: ascites, remove fluid
166
degree of risk in surgery is affected by
age, nutritional status, fluid and electrolyte status, general health, use of meds, mental attitude
167
who can sign for informed consent?
-18 and older
-legal parents/legal guardians
-emancipated minors
-minors living without parent or
guardian, providing own financial
support
-married
-pregnant
-active duty in US military
168
implied emergency consent
- immediate threat to life
- experts agree that an emergency exists
- client unable to consent
- legally authorized person cannot be reached
169
3 classifications of anesthesia
general, regional, concious
170
type of anesthesia?
- loss of consciousness
- amnesia
- analgesia
- loss of reflexes
- muscle relaxation
general anesthesia
171
- tachycardia
- skin mottling
- cyanosis
- myoglobinemia
- rise in end tidal CO2
- elevated temp
malignant hyperthermia clinical manifestations
172
briefly disrupts sensory nerve impulse transmission from specific body area/region
local anesthesia
173
regional anesthesia
analgesia, loss of reflexes, muscle relaxation
174
regional anesthesia classifications
- surface or topical
- local nerve infiltration
- nerve blocks
- epidural blocks
- spinal anesthesia
175
local or regional anesthesia complications
- anaphylaxis
- incorrect delivery technique
- systematic absorption
- overdose
- local complications
176
nursing interventions to manage respiratory functions in PACU
- side-lying position
- extend jaw
- administer 02 as needed
- assist client with turning, coughing, deep breathing every 30 minutes until fully awake
- monitor RR, breath sounds, pulse OX
- suction as necessary
177
PACU discharge criteria
- client awake
- vital signs stable
- no excess bleeding or drainage
- no respiratory depression
- O2 sat great than 90
- report called/given to post op until
178
1/4-1/3 usual dose of pain medication is given and might be prescribed every 10-15 minutes
PACU pain meds
179
Any natural protective feature of a person
| -ex: inflammation
innate (native) immunity
180
- Non-specific complex response
- protective process
- stimulates healing and prevents further damage
- types: acute and chronic
inflammation
181
immature undifferentiated cells produced by bone marrow
stem cells
182
protect body from effects of invasion by organisms
leukocytes (WBC's)
183
- macrophage and lymphocyte infiltration
- fibroblast proliferation
- greater scaring and deformity
chronic, non-specific inflammation
184
stitches (type of wound healing)
primary intention wound healing example
185
open sore on foot (type of wound healing)
second intention wound healing example
186
inflammatory, reconstructive, maturation
stages of wound healing
187
- nutritional state
- perfusion
- immune status
- infection
factors impacting wound healing
188
the point at which a stimulus is perceived as painful
pain threshold
189
- tachycardia
- increased stroke volume
- hypertension
- pupil dilation
- increased muscle tension
- dry mouth
- decreased gut motility
manifestations of prolonged unrelieved acute pain
190
- trigeminal neuralgia
- complex regional pain syndrome
- phantom limb pain
neuropathic pain syndromes
191
non-pharm. pain management of infants (4)
- containment
- non-nutrative sucking
- kangaroo care
- positioning
192
drug therapy for pain, 3 groups
- non-opiods: acetaminophen, NSAIDS
- opiods: morphine, oxycodone, methadone, codeine
- adjuvants: SSRI's, anti-epileptic drugs, muscle relaxants/antispasmotics, Alpha-2 adrenergics, local anesthetics/analgesics, NMDA antagonists, cannabinoids (cannabis extracts)
193
gerentological pain med considerations
- "start low, go slow"
| - initially no more than half of recommended dose
194
Level one WHO pain rating
1-3: non-opiods are recommended
195
Level 2 WHO pain rating
4-6 rating: weak opioid alone or with adjuvant drug recommended
196
Level 3 WHO pain rating
7-10: use strong opioids
197
nerve blocks and spinal cord stimulation are _____ techniques for ______
invasive techniques for chronic pain
198
Decrease in number or cell size
atrophy
199
atrophy causes
disuse, paralysis, hormonal changes, ischemia
200
cell increase in size, occurs frequently in cardiac and skeletal muscles
hypertrophy
201
what helps neutralize free radicals?
antioxidants: donate free electron to help neutralize them
202
- attack of critical proteins affecting ion pumps and transport mechanisms
- fragmenting DNA decreasing protein synthesis
- damage to mitochondria allowing influx of cellular calcium
damaging effects of free radicals
203
4 broad classifications of genetic disorders
- autosomal dominant disorders
- autosomal recessive disorders
- x-linked disorders
- chromosomal disorders
204
heterozygous vs. homozygous
heterozygous: 1 mutated gene in pain
homozygous: both genes in pair are mutated
205
- Ex: Huntington's disease
- 50% will have disease
- only 1 parent has to have dominant gene mutation
autosomal dominant disorders
206
- Ex: Cystic fibrosis, sickle cell anemia
- 50% of people will be carriers
- 25% will have disease
- 25% normal
- both parents must be carriers for the child to have the disease
autosomal recessive
207
- Ex: Duchenere's muscle dystrophy
- mothers are carriers and pass disease to their sons 50% of the time
- mothers are carriers and 50% girls can be carrier
- sex-linked recessive disorder
x-linked
208
Aneuploidy
abnormal number of chromosomes
209
monosomy
1 copy of chromosome only
| -ex: Turner syndrome
210
Trisomy
3 copies of chromosome
| -downs syndrome
211
endotoxins vs exotoxins
exotoxins: proteins/enzymes released during bacterial growth
- antitoxins: tetanus, diptheria, pertussis
- endotoxins: cell wall of gram-bacteria and released during lysis of the cell
212
4 portals of entry
-penetration, direct contact, ingestion, inhalation
213
symptomology (5)
* all cause the symptoms of infection/illness
- biological response mediators
- endotoxins
- exotoxins
- antigen-antibody complexes
- intracellular
214
malignant vs benign tumors (neoplasm)
benign: not cancer, only locally and cannot spread by invasion or metastasis, slow growing, cohesive
Malignant: cancer, cells invade neighboring tissues, enter clood vessels, and metastasize to different sites, relatively undifferentiated, grow rapidly, un-encapsulated
215
4 types of metastasis
- hematogenous: through the bloodstream
- lymphatic
- direct invasion: finger like projections that invade surrounding tissue
- surgical seeding: they undergo surgery, minute cells break off into body cavity
216
2d screening test
xray
217
3d screening test
CT
218
screening and follow up
MRI
219
detect abnormalities in structure, needle biopsies done with this
ultrasound
220
glucose and tissue metabolism
PET
221
detect metastases, especially to bones and other types of organ tissues
nuclear imaging
222
invasive diagnostic techniques in cancer
* give definitive diagnosis*
- biopsy: needle, incisional, excisional
- endoscopy: helps to provide direct visualization of the are of concern
223
used to diagnose, stage, and treat cancer
surgery
224
masculanizing effects in women
- feminizing effects in men
- risk for venous thromboembolism
- acne
- hypercalcemia
- liver dysfunction
- Bone loss
side effects of hormone therapy
225
- selective destruction of cancer of cancer cells via chemical reaction triggered by different types of laser light
* sensitive to light up to 12 weeks*
-photodynamic therapy
226
immunotherapy biological response modifiers (BRMs)
- modify patient's biological response to tumor cells
| - side effects: generalized, sometimes severe inflammatory response, peripheral neuropathy, skin rashes
227
tyrosine kinase inhibitors
- inhibit activation of tyrosine kinases
| - side effects: fluid retention, electrolyte imbalances, bone marrow suppression
228
-decreased WBCs, platelets, hemoglobin
bone marrow suppression
229
type or radiation when client does not pose risk for radiation exposure to others
external radiation
230
Brachytherapy
*internal therapy*
-radiation source is sealed in needle, seed, or wire, implanted for hours to several days
-client emits radiation while implant in place but excreta are not radioactive
-client remains hospitalized during treatment
*client does not pose risk for radiation
exposure to others*
-unsealed: by mouth or IV, client emits radiation, excreta ARE radioactive
*poses risk to others
231
re-growth of hair after chemo/radiation
chemo: hair grows back 1 month after completion. Texture/color different
- radiation to head: hair loss is permanent
232
neutropenic precautions for WBC less than?
WBC less than 2,000
233
HgbS and low oxygen tension (PO2 aggregation and polymerization of HgbS--->Change in shape and rigidity of RBCs--->Hemolysis of sickled cells vascular occlusion
sickle cell disease pathogenesis
234
3 sicle shape causes of RBCs
HgbS RBCs move through microcirculation more slowly
- more time for de-oxygenation
- adherence to the vascular endothelium further inhibiting blood flow
235
- usually fatal by middle age from renal and pulmonary failure
- prone to infection; pneumonia most common
- gradual involvement of all body systems
sickle cell complications
236
- increased blood volume and impaired tissue oxygenation
- puritis
- erythromyalgia
- splenomegaly
- epitaxis, Gi bleeding
- CBC: increased RBCs, AGBs, HCT, WBCs, Platelets
polycythemia clinical manifestations
237
polycythemia nursing actions
- assist in therapeutic phlebotomy
| - prevent thrombotic events
238
- etiology: genetic, latent mutation, factor V
| - acquired: incresed platelet function, stasis of blood, hyperestrogenic states
hypercoagulability disorders
239
-increased estrogen levels---> increased synthesis of coagulation factors and decreased synthesis of antithrombin III
hyperestrogenic states
240
Clot location in artery or vein?: impaired perfusion, tissue ischemia
clot in artery
241
Clot location in artery or vein?: back up of blood behind clot, swelling
clot in vein
242
- decreased platelet function
- decreased platelets in circulation
- impaired coagulation
bleeding disorders manifestation
243
-decreased number of platelets (
thrombocytopenia
244
idiopathic thrombocytopenia purpura is what kind of disorder? And etiology
- autoimmune disorder
| - etiology: unknown, possible viral illness
245
- etiology: deficiency or defect in vWF, autosomal dominant disorder
patho: decreased platelet adherence, impaired clot formation
dx: low levels of vWF
Von Willebrands disease & dx
246
types of leukemia
- non-lymphocytic
- lymphocytic
- acute
- chronic
247
- uncontrolled production of immature WBC's in the bone marrow
etiology: unknown, ionizing radiation, certain chemicals and drugs, genetic factors, immunologic factors
leukemia
248
- 80% of adult leukemias
| - etiology: unknown, exposure to toxins, chromosome abnormalities ie: downs syndrome
acute non-lymphocytic leukemia (ANLL)
249
- all cell lines affected
- etiology: philielphia chromosome, formation of abnormal gene: BCR-ABL
- manifestation: NBC. 30,000, anemia, splenomegaly
chronic non-lymphocytic leukemia (CLL)
250
phases of CLL
chronic
accelerated
hypermetabolism
terminal: blastcrisis
251
-most common cancer among children ,15 years (Tcell, Bcell, Null)
Etiology: uknown
Patho: malignant transformation in lymphoblast line, CNS involvement
Presentation: CNS symptoms (headache, vomit, seizure, etc), lymphadenopathy, lethargy
acute lymphocytic leukemia presentation and etiology
252
- clotting factors, desmpopressin (DDAVP), transfusions (prompt intervention to decrese complications), exercise and physical therapy
* are all collaborative management for
hemophilia A collaborative management
253
-suppress autoimmune response
-corticosteroids, azathioprine (Imuran),
retuximab (Rituxan), immunoglobulins
-platelet growth factor (neumega)
*are all medications for ?
thrombocytopenia medications
254
- neuro changes
- kidney failure
- anemia
- menorrhagia, hematuria, GI bleeding
- epistaxis, gingival bleeding
- petechiae & purpura
* clinical manifestations for?*
thrombocytopenia clinical manifestations
255
drug induced cytopenia
- heparin, quinine, and sulfa based drugs
- clinical course/dx: decreased platelets 2-3 days after starting new drug. Resolution when drug is stopped. Antiplatelet antibodies
256
drug induced cytopenia "type" reaction
type 2 reaction
257
clinical manifestations that differentiates pernicious anemia
neurological symptoms: symmetrical parasthesias, loss of vibratory sense, loss of proprioception
258
refers to hemoglobin
chromic
259
refers to cell size
cytic
260
decreases with malnutrition and CA
hemoglobin
261
increases and decreases with chemo, increases with multiple cancers
WBC's
262
prolonged with leukemia and mets in liver
bleeding times
263
decreased with malnutrition and mets in liver
albumin
264
increased liver and gallbladder cancer
bilibrubin
265
increased with renal cancer
BUN and Creatinine
266
increased in mets cancer
CRP
267
positive gastric and colon cancer
occult blood
268
range for RBC's and hemoglobin Hct
```
RBC's:
-men: 4.2-5.4
-women: 3.6-5.0
Hbg:
-men: 13.4-17.6
-women: 12.0-15.4
Hct
-men: 42-53%
-women: 38-46%
```
269
- increase in size due to increase in the number of cells
- can be normal (ex: pregnancy, puberty) or abnormal
- when you take away the stimulus, it stops
hyperplasia
270
etiology: impingement of nerve root
| unilateral manifestations: facial tics/grimacing, excruciating stabbing, distribution along the trigeminal nerve
Trigeminal nueralgia
271
- pain along a single peripheral nerve
- etiology: peripheral nerve damage
- clinical manifestations: allodynia, hyperalgesia, burnign pain, (early) vasodilation and edema, (late) vasoconstriction, cyanosis, tissue edema
complex regional pain syndrome (reflex sympathetic dystrophy)
272
etiology: sensory nerve injury from trauma, DN, chronic alchohol use, neurotoxic drugs
Patho: degeneration, abnormal spontaneous discharge
Manifestation: burning, tingling, stabbing or shooting pain
neuropathic pain
273
- pain, histamine-like effects
| - factor xIIa, bradykinin
kinin system
274
fibrin vs. fibrinopeptides
Fibrin: clotting, factor X
FP: chemotactic factor, vascular permiability, factor X
275
Piaget 4 stages
I: sensorimotor (0-2 yrs)
II: preoperational (2-7)
III: concrete operations (7-11)
IV: formal operations (11-adult)
276
Psychosocial 8 stages guy
| -ex: trust vs. mistrust
Erikson
277
- preceeds the development of fine motor skills
| - occurs in cephalocaudal fashion
gross motor skills
278
5 stages Cognitive developmental theory guy
Piaget
279
5 piaget stages
oral, anal, phallic, latency, genital
280
8 erikson stages
- stage 1: trust vs. mistrust (1yr)
- stage 2: autonomy vs. shame and doubt (1-3)
- stage 3: initiative vs. guilt (3-6)
- stage 4: industry vs. inferiority (6-11)
- stage 5: identity vs. role confusion (puberty)
- stage 6: intimacy vs. isolation (young adult)
- stage 7: generative vs. self absorption and stagnation (middle age)
- stage 8: integrity vs. dispair (old age)
281
transfer objects from hand to hand
fine motor 1 yr old
282
can hold crayon and color verticle strokes
fine motor 2 yr old
283
-unable to sit alone by __months
9 months, red flag for development
284
unable to transfer object from hand to hand by __
1 year, red flag for development
285
abnormal pincer at ___
15 months, red flag for development
286
unable to walk alone by ___
18 months, red flag for development
287
failure to speak recognizeable words by age ___
2 years, red flag for development
288
cooing milestone
1-2 months speech
289
laughs and squeals milestone
2-6 months speech milestone
290
babbles, mama/dada milestone
8-9 months speech milestone
291
20-30 words, 50% understood by strangers milestone
18-20 months speech milestone
292
2 word sentances, > 50 words, 75% understood by strangers milestone
22-24 months speech milestone
293
almost all speech understood by strangers
30-36 months speech milestone
294
palmer grasp age
6 months
295
pincer grasp age
9 months
296
needs assistance sitting up
2 months
297
can sit alone in tripod position
6 months
298
can sit w/o support and engage in play
8 months
299
* preop med
- reduces anxiety and induces sedation and amnesia
ex: idazolam (Versed), diazepam (Valium), Lorazepam (ativan)
benzodiazepines
300
* preop med
- reduces amount of anesthetic needed
- provides analgesia
- decrease anxiety
ex: morphine sulfate, fentanyl (Sublimaze)
Opiods
301
- reduce gastric acidity and decrease gastric volume
| ex: famotidine (pepcid), ranitidine (zantac)
H2 receptor antagonists
302
* preop med*
- decreased oral and respiratory secretions
ex: atropine sulfate, scopolamine (transderm-Scop)
anti-cholinergics
303
caution model
* american cancer society 7 warning signs*
- Change in bowel/bladder habits
- A sore that does not heal
- Unusual bleeding or discharge from any body oraface
- Thickening or lump in breast or elsewhere
- Indigestion or difficulty swallowing
- Obvious change in wart or mole
- Nagging cough or horseness
304
mechanisms of cell injury (3)
- Depletion of ATP
- Free radicals
- Impaired calcium homeostasis
305
- iron defieciency
- megaloblastic anemias
- aplastic anemias
deficiencies in production of RBC's
306
- weakness
- pallow
- fatigue
- dyspnea
- heart murmurs
- palpitations
- angina
- tachycardia
- epithelial atrophy
- overweight "milk baby"
clinical manifestations of iron deficiency anemia
307
RBC's assuming various shapes
polkilocytosis
308
RBC's assuming various sizes
anistocytosis
309
- production of large, oval shaped RBCs
etiology: folic acid or Vit. B12 deficiency
- Risk Factors: malnutrition, malabsorption, parasitic infestations (tapeworm)
megaloblastic anemia
310
etiology: hereditary atrophic gastritis, abscence of intrinsic factor
pernicious anemia
311
Vit B12 important for what 3 things related to anemia?
DNA synthesis, maturation of RBC's, facilitates metabolism of folic acid
312
a state of too many RBC's, can be primary or secondary
polycythemia
313
- hemolytic anemia
- autosomal recessive
- synthesis of HgbS
sickle cell disease
314
-decreased production of all 3 types of bone marrow elements
pancytopenia
315
- pancytopenia
- classification: autosomal recessive chromosomal defect (congenital) or radiation, chemo, viral infections, pregnancy (acquired)
aplastic anemia
316
polycythemia vera: too many RBC's, WBCs, Platelets
etiology: unknown
Patho: increased number of cells, increased blood viscocity
primary polycythemia
317
-an adaptive mechanism to chronic hypoxemia
Etiology: chronic heart and lung disease, living at high altitudes
Patho: increased erythropoeitin
secondary polycythemia
318
causes of increased platelet function
- atherosclerosis
- diabetes
- smoking
- malignancy and chronic inflammation
319
<200 cells
agranulocytosis
320
-<1500 cells
neutropenia
321
An increased band cell count, decreased WBC, and signs and symptoms of infection are signs of?
neutropenia
322
lymphoproliferative
-age >60, 2:1 male
-B cell line
Presentation: painless lymphadenopathy, splenomegaly
Chronic Lymphocytic Leukemia
