WEEK 4 + 5 Flashcards
Cancer notes from class; End of Life notes (adults) from ATI; peds end of life
1
Q
cancer
A
caused by genetic changes that impact how cells operate
2
Q
how are genetic changes caused for cancer
A
may be inherited, resulting from an error during cell division, or triggered by an environmental factor, such as tobacco or ultraviolet light exposure
3
Q
normally, what can the body do to damaged cells (why is this an issue with old clients?)
A
Normally, the body can remove damaged cells before they become cancerous
with age, the body is less able to remove damaged cells, which is why cancer occurs more frequently in older individuals.
4
Q
metastasis
A
cancers may start in one location but then spread
5
Q
primary tumor vs secondary tumor
A
first place cancer arises: primary tumor
subsequent sites: secondary tumors
6
Q
cell changes that undergo before becoming malignant
A
order:
hyperplasia
dysplasia
carcinoma in situ
7
Q
hyperplasia
A
first cell change
There is an increased number of cells, though they appear normal.
8
Q
dysplasia
A
second cell change
There are abnormal cells present; ranges in severity from mild to severe based on the degree of abnormality and how much of the body part is affected.
9
Q
carcinoma in situ
A
A group of abnormal cells that stay in one location without spreading.
10
Q
malignant cells
A
cancerous
Mutated and changed; replicated much faster than healthy cells; they don’t undergo apoptosis; as they grow they can spread to more areas; create their own blood supply
11
Q
apoptosis
A
Programmed cell death.
malignant cells don’t do this, so there isn’t room for new healthy cells and the cancerous cells spread
12
Q
angiogenesis
A
The process by which cancers create their own blood supply.
helps the cancer to survive and grow by providing nourishment and clearing waste
13
Q
what is the risk factor that is a risk for virtually every cancer
A
smoking
14
Q
potentially modifiable common risk factors to many cancers
A
Smoking
Alcohol consumption
Excess body weight
Sedentary lifestyle
Dietary habits
15
Q
can viruses cause cancer
A
yes, viruses can cause some cancers. for example, HPV can cause cervical cancer. these viruses that can cause cancer can sometimes be prevented with vaccination or treatment
16
Q
five most common cancers in the US for women
A
breast
lung
colorectal
uterine
melanoma
17
Q
five most common cancers in the US for men
A
prostate
lung
colorectal
bladder
melanoma
18
Q
pain for cancers
A
regional: site of tumor
can be from surgery, procedures, treatments like radiation or chemo
19
Q
what does in situ mean
A
in the same spot
20
Q
what can pain increase in cancer patients
A
depression, asking for medical aid in dying, persistent pain may need interprofessional approach
21
Q
things to do to prevent cancer
A
scan for genes to know if you carry the gene
mammogram
healthy weight
breastfeeding can lower risk
22
Q
infections with cancer
A
Clients who have cancer commonly experience an increased risk of infection related to treatment
chemo kills WBCs so you have lower WBC and neutropenia can develop
23
Q
neutropenia
A
Abnormally low levels of neutrophils, one of the white blood cells.
increased risk for infection
24
Q
what can a minor infection lead to
A
sepsis
25
Strategies for infection prevention
using proper hand hygiene, avoiding crowds, staying up to date with immunizations, and staying away from people who are contagious.
26
gastrointestinal manifestations for cancer patients
malnutrition and elimination
nausea and vomiting
dehydration, metabolic abnormalities, esophageal tears, wound dehiscence, and inability to continue treatment
27
neutropenic isolation precautions
mask, gown, shoe covers, hat
prevent the client from infection
interventions:
no fresh food (cooked/steamed)
no flowers
no raw meats
no sick visitors
no children
vaccinations
peds note:
no live vaccines like MMR when on chemo/radiation
28
meds for nausea and vomitting
Compazene
Zofine
diarrhea: Amodean
29
interventions for malnutrition for cancer patients
bland meals
small, frequent meals
no spicy
cold foods are better
30
early sign of cancer
unintentional weight loss
31
most common cause of fatigue for cancer patients
chemo-related anemia
also:
depression
anxiety
sleep disorders
inflammation
hormone response
32
oncologic complications: hypercalcemia
Who is most common in and define it
common in clients with multiple myeloma and breast cancer
too much calcium
33
manifestations of hypercalcemia
mental status changes, dehydration, weakness, nausea, vomiting, decreased appetite, and constipation
34
sign of spinal cord invasion or compression (and Tx)
pain
numbness
random falling
incontience
treatment: high dose steriods
35
treatments for hypercalcium
IV hydration and med to lower calcium levels
36
superior vena cava syndrome (define, common sign, tx, other manifestations)
tumor pressing on the SVC
SVC compressed, leads to lower blood flow
FACIAL EDEMA is common sign of this.
steriods, stent placement, chemo, radiation
swelling, hoarse voice, shoulder pain, etc
37
signs of right atrium overfilling
facial edema
upper extremities swelling
38
malignant pericardial effusion
fluid around the sac of the heart
shortness of breath
chest pain
palpitations
put drain in to drain the fluid, chemo later
think of grey's anatomy stab chest to relieve fluid
39
tumor lysis syndrome
triggered by treatment
medical emergency/metabolic emergency
cancer cells leak their intracelluar content into bloodstream
cardiac arrythemias
IV hydration is primary treatment
40
lab abnormalities seen with tumor lysis syndrome
low calcium
elevated phosphorus, potassium, uric acid level, creatinine
may experience cardiac arrhythmias
IV hydration is a primary treatment
41
Syndrome of inappropriate antidiuretic hormone (SIADH)
common with small cell cancers
result from treatment
hyponatremia (ANTIdieuritic-holding fluid so sodium will drop because there is a lot of fluid)
Tx: correct sodium levels and treat primary cancer
manifestations: N+V, off balance, dizzy, coma, behavior changes, etc
42
hyponatremia (define, what can it cause, common Sx)
low sodium
can cause brain swelling!
less than 135 mEq/L
symptoms:
nausea, vomiting, blurred vision, impaired balance, headache, SEIZURES
43
treatment for hyponatremia
treat with 3% IV saline
Lasix's to pull off that fluid
44
Cancer treatments may need to be adjusted for what based on age
dose or intensity to treat older adults safely
45
general manifestations for cancer
Unexplained weight loss
Fatigue
Palpable masses
Swelling
Pain
Skin changes
46
BRCA1 and BCRA2
breast cancer genes that repair damaged DNA
47
education for cancer patients
Resource: oncology website
48
safe amount of radiation we can be around
ALARA: as low as reasonably achievable
49
oral care
chemo related mouth ulcers
good oral hygiene and mouthwash
50
hospice care
care for client who has a diagnosis of less than 6 months to live
51
palliative care
improve quality of life
may or may not receive treatment
52
code status
A client’s cardiopulmonary resuscitation (CPR) preferences.
53
how is death defined
cessation of both breathing and the heartbeat
54
stages of dying
early
middle
late
55
early stage of dying (four things!)
loss of mobility
decrease in the ability or desire to eat or drink
delirium
increased sleeping
56
middle stage of dying
continued decline in mental status
noisy respirations due to the pooling of mucus and saliva in the back of the throat and upper airways when the client is too weak to cough (DEATH RATTLE)
57
at what stage is the death rattle
middle stage of dying
58
late stage of dying (3 things!)
fever
periods of apnea
mottling of the skin (due to loss of peripheral circulation)
59
how long do the stages of death take
Clients will proceed through these stages at different rates, from 24 hr to over 14 days
60
“Good deaths” are typically considered
to be pain and distress-free
61
clinical death
the heart and lungs have ceased functioning, but the brain is still viable
function possibly restored with CPR
irreversible brain damage after 4 mins with no oxygen
62
when does irreversible brain damage occur
starts after just 4 min without oxygen, and death can occur as early as 4 to 6 min later
63
biological death
aka brain death
Occurs when heart and lung function has stopped permanently.
64
diagnosis of biological death
must have...
apnea
lack of brainstem reflexes
be in a coma for a known cause
65
what can biological death be a result from
intracranial or extracranial cause
66
most common intracranial cause of biological death
subarachnoid hemorrhage or traumatic brain injury (TBI)
67
most common extracranial cause of biological death
Cardiopulmonary arrest and inadequate CPR
68
Additional causes of biologic death include
head injury from blunt trauma or gunshot wounds, hanging, drowning, drug overdose, stroke, or aneurysm
69
pathophysiology of biologic death
decrease oxygen to brain (increase in edema in the brain) which then increases fluid to increase intracranial pressure and then leads to cerebral perfusion and subsequent herniation
70
herniation
Complete cessation of blood flow to the brain that causes death of brain tissue.
71
However, even as brain function is lost
lung and cardiac function can be prolonged through mechanical means
72
Clients must be declared brain dead to be eligible to be
vital organ donors
73
palliative care
receive medical care to improve the client’s quality of life by controlling significant manifestations of the disease while choosing not to receive curative, or traditional, treatments
Clients may also receive palliative care for manifestation management while continuing to receive curative medical care
74
two most common manifestations clients have that need palliative care
dyspnea and pain
75
hospice care
Hospice is used when the client cannot be cured or chooses not to be treated
doesn't receive treatment, it is COMFORT CARE ONLY
usually started when the client has less than 6 months to live but is extended as long as needed
76
respite care
client to be admitted to facility to give their caregiver a break that can last hours to weeks
77
comfort care
any interventions to soothe and relieve suffering while respecting the client’s final wishes
78
comfort care interventions
manage SOB
administering meds for pain, nausea, anxiety or constipation
limiting med testing
ensuring emotional and spiritual support
79
palliative sedation
used when there are distressing manifestations in clients who are terminally ill or actively dying
indicated to provide relief from...
pain
agitation
anxiety
this cause of sedation is not to kill client or shorten lifespan
80
palliative sedation: medications
used to relieve the client’s respiratory distress, anxiety, and agitation
opiates
benzodiazepines
antipsychotics
81
what can meds from palliative sedation increase the risk of
this type of sedation can increase the risk of respiratory depression, aspiration, and possibly increased agitation from delirium.
82
manifestations of spiritual distress
depressed
scared
worried
fear of being alone
83
Causes of spiritual distress in clients during end of life
loss of identity and independence
84
HOPE
Hope
Organized religion
Personal spirituality and practices
Effects on medical care and end-of-life issues
85
advanced directive
Legal document used when clients are incapacitated and unable to voice their wishes.
86
There are several ethical principles applicable to end-of-life care
justice
nonmaleficence
beneficence
fidelity
autonomy
87
limitation of autonomy
client cannot make decision that will cause them harm
The provider cannot provide care requested by the client that will in fact harm the client.
88
terminal sedation
The purpose of terminal sedation is to relieve pain not responding to other interventions.
89
requirements for terminal sedation
must have terminal illness
must have severe, intolerable manifestations that are not responding to treatment
death is imminent
client has a DNR code status
90
medical aid in dying
client req provider to prescribe medication that causes client's death
respect for autonomy and relief of suffering
91
Currently, no state allows MAiD in clients under
18 years old
92
requirements for MAiD
must live in state it is legal in
term illness expected to result in natural death in less than 6 months
make a request verbally more than once and written witnessed by a non-relative
capable of making own decisions
can self admin the medication prescribed
93
two types of advanced directives
living will
durable power of attorney
94
living will
document that informs health care providers what treatments the client desires if they are dying or if regaining consciousness is unlikely
allows the client to make their wishes known when they are unable to make their own decisions about available emergency treatment
95
In the living will, the client typically documents if they would
allow or deny the use of a ventilator, CPR, dialysis, artificial hydration and nutrition, or comfort care measures
96
durable power of attorney for health care
legal document used to designate a person as a health care proxy
This person is then legally able to make medical decisions for the client when the client is unable to or incapacitated
97
Advance directives are legal documents, not...
medical orders
Advance directives state preferences for CPR but are not the same as code status orders such as Do-Not-Intubate (DNI) or Do-Not-Resuscitate (DNR) orders
98
types of code status
full code
DNR
DNI
99
full code
indicates that if a client’s heart stops beating or their respirations stop, the health care team will use full resuscitation measures to restore a heart rhythm and respiration
includes intubation, chest compressions, and defibrillation
assumed status unless otherwise stated
100
DNR status is typically chosen by clients who
have multiple chronic diseases
101
A DNI order does allow
basic CPR, meds, defibrillation, external pacemaker, and chest compressions
102
DNI indications
no intubation or placed on ventilator
103
withdrawal of MANH
Withdrawing or withholding nutrition or hydration.
104
general changes in clients who are near death
weak and fatigue
drowsy and increased sleeping
disorientation
talking to dead people
105
foods and fluids during impending death
client often begins to show a decrease in interest in food or fluids
weight loss and dehydration noted
difficulty swallowing (choking or coughing)
106
urinary function during impending death
urinary output will decrease
may develop urinary incontinence
urine=dark and concentrated (from decreased fluid intake)
107
skin changes in impending death
mottling (purple or dark pink webbed pattern, brown on darker skin)
pressure injuries from laying in bed
assess for breakdown/redness/etc.
108
cardiac and circulation changes during impending death
decrease in cerebral perfusion (decreased LOC, delirium, etc)
decreased perfusion (mottling)
cyanosis in upper extremities
decrease in CO (leads to hypotension, tachycardia, and peripheral cooling of body)
109
vitals during impending death (HR, BP, temp)
tachycardia
hypotension
low temp
110
respiratory changes with impending death
secretions in pharynx and upper resp tract
death rattle
weak or absent cough
Cheyne-Stokes respirations
111
Cheyne-Stokes respirations
Type of breathing pattern with cyclical hyperventilation and apnea.
shallow/rapid/apnea
112
A nurse is caring for a client who is actively dying. Which of the following manifestations should the nurse expect?
decreased urinary output
confusion
mottling of skin
113
management of manifestations: pain control (nonpharm vs pharm)
Nopharm: music therapy, massage, heat and cold therapy
pharm: admin of pain meds (morphine, ibuprofen), antidepressants, corticosteroids (methylprednisolone)
114
end of life pain: morphine adverse effects
hypotension, confusion, bradycardia, constipation, respiratory depression, nausea and vomiting, hallucinations, and urinary retention.
slow to stand: can cause orthostatic hypotension
115
end of life pain: ibuprofen adverse effects
headache, constipation, dyspepsia, nausea, vomiting, and prolonged bleeding time
HEMATURIA
116
education with ibuprofen end of life pain
take ibuprofen with a full eight-ounce glass of water as tolerated and sit in an upright position for 30 min following administration
med can cause dizziness and drowsiness
117
end of life care pain: methylprednisolone adverse effects
corticosteroid
pheochromocytomas, depression, euphoria, hypertension, decreased wound healing, hirsutism, adrenal suppression, hyperglycemia, leukocytosis, thromboembolism, osteoporosis, and cushingoid appearance
ELEVATED WBC COUNT
118
opioid safety (monitor what & admin what for respiratory distress?)
Monitor clients who have received opioids for respiratory depression. Monitor oxygen saturation, respiratory rate, and effort frequently. Administer Narcan for respiratory distress
119
treatment for dyspnea
opioids and bronchodilators
O2 therapy 2-3 liters
raise head of bed
use fan to circulate air in the room
120
If the client develops anorexia
offer small amounts of a favorite food, if desired and tolerated
121
anorexia
Decreased appetite.
part of dying process
122
GI manifestations of impending death
anorexia and constipation
123
constipation treatment
provide meds (stool softeners)
hydration
increase fiber
more mobility
124
causes of fatigue in dying patients
depression
anemia
dehydration
infection
125
Immediate changes to the body after death
absence of respirations, heart rate, responsiveness, voluntary movement, muscle relaxation, and nervous system functions
Algor mortis, rigor mortis, and livor mortis are usually noted 30 min to 3 hr following death.
126
algor mortis
pale skin
loss of turgor
body cooling
127
rigor mortis
muscle rigidity is noted
128
livor mortis
discoloration in the dependent or lower areas of the body
129
qualify as an organ donor
client must be brain dead
to confirm brain dead...
apena
coma of known cause
absent brainstem reflexes
130
Types of Organs and Tissues Eligible for Donation
organs (kidneys, liver, lungs, heart, pancreas, intestines)
corneas
tissues (middle ear, heart valves, bone, veins, ligaments, tendons, cartilage, skin)
hands and face
Bone marrow, cord blood, blood stem cells
Blood and platelets
Live organ donation (One kidney, one lung, part of the liver, part of the pancreas, part of the intestine)
131
Priorities for the donor’s care include
preserving a patent airway, normal body temperature, and adequate organ and tissue oxygenation and perfusion while also maintaining fluid and electrolyte balance and preventing complications.
132
resources for grief in losing a child
support groups
written educational materials about grief and loss
referrals to therapists and grief counseling
133
therapeutic communication with losing a child
listening to parents
allow enough time to process information
using simple terminology
134
nonverbal factors at play in cross-cultural communication that the nurses may not be aware of
facial expressions, posture, body language, gestures, concepts of time and personal space, tone of voice, and eye contact.
135
What is the nurse’s responsibility for facilitating communication with clients who are not fluent English speakers?
The nurse must ensure the presence of a medical interpreter when clients and the nurse do not speak the same language.
136
Work-related stress is described as
one of the most serious occupational hazards
137
personal traits that influence grief
moodiness, emotionality, guilt, and anxiety
138
difference in palliative care between adult and peds
peds: parents are making the decision most likely and not the client themselves
139
primary goal of pallative care is to
improve the client's quality of life
140
initiation of hospice care
when a client has a terminal illness and is not expected to live more than 6 months
141
concurrent care
hospice services are provided to address the client’s comfort and the family’s need for education and support while potentially curative therapies remain underway
142
when children receive hospice or palliative care...
they are more likely to die at home than in the hospital
143
pain assessment for neonates
N-PASS
Neonatal Pain and Sedation Scale
144
Wong-Baker Pain Rating Scale
use for children as young as 3 and IDEAL for those 6 and older
145
rFLACC scale
observe 1-5 mins while awake and at least 5 mins while asleep
146
ped pain therapies (non pharm)
dance
art
music
massage
guided imagery
progressive relaxation
147
ped pharm therapies for pain
least invasive route should be used
Parents should be screened for any history of substance use disorder if client is going home
148
opiates to mainstay pain in pallative care in peds
start at lowest dose and adjust as needed
Depending on the source of the pain, corticosteroids, nonsteroidal anti-inflammatory medications, topical anesthetics, ketamine, and antiepileptic medications may also be used
149
what should not be used in pain management regiments in children
aspirin and codeine
150
what medications to look over for pain management in palliative care in children?
hydromorphone
morphine
fentanyl
ibuprofen
ketorolac
naproxen
prednisolone
prednisone
dexamethasone
151
common side effect of opioids
constipation
152
other common side effects of opioids include
sedation
N+V
sweating
pruritus
dry mouth
other possible:
muscle twitching, hallucinations, urinary retention, depressed mood, and respiratory depression
153
pruritus
itchiness
154
Which of the following categories of medication should be initiated with an opiate regimen for management of adverse effects?
stool softeners
because constipation is a very common side effect of opiates!
155
If the child has been receiving opiates and has developed tolerance
ketamine may be an effective adjunct medication for pain (Hauer, 2023).
156
manifestations of the dying process
(Psychological and neurological) (all can use what Tx?)
agitation
anxiety
seizures
all of which are treated with benzodiazepines
157
Phenothiazines such as promethazine, prochlorperazine, and chlorpromazine produce
extrapyramidal effects
Dyskinesias and Parkinson-like manifestations resulting from the blockage of dopamine.
158
meds to look over for treating nausea in children
Promethazine
Prochlorperazine
Chlopromazine
Diphenhydramine
Ondansetron
159
manifestations of the dying process
anorexia
decrease LOC
changes in rate, rhythm, and character of breathing
mottling of skin
irregularity in heartbeat
incontinence
160
Nursing responsibilities for dying expected manifestations
swabbing and moisturizing the client’s mouth, reassuring the family about comfort measures being done for specific manifestations of the disease process, positioning the client to promote drainage of oral secretions, and regular changes of linen and absorbent padding
161
If the child was under hospice care at the time of death,
hospice standards mandate that bereavement services be offered to the family for at least 13 months, including developmentally appropriate services for siblings
162
caring for client with malignant neoplasm of the right breast. where should the nurse put port
on the opposite side of the primary site of the cancer
163
ABCDE of melanoma
Asymmetrical
Borders uneven
Color (dark brown and varies, might be blue)
Diameter: greater than 6mm
Evolution: changed from primary notice
164
where does BCC originate
basal layer of the epidermis
165
where does melanoma originate
melanocytes
166
which skin cancer is most likely to metastasize to other cancers
melanoma
167
is squamous cell carcinoma a small cell or non-small cell lung cancer
is it a non-small cell lung cancer
mostly likely originates in one the large central airways
most often caused by smoking
168
which test to do to follow up and monitor treatment of someone with colorectal cancer
carcinoembryonic antigen (CEA) test
169
common manifestations of spinal cord cancer
loss of coordination
bladder and bowel control issues
numbness in the limbs
generalized weakness
170
stage 0 colorectal cancer
innermost layer of GI tract
just the mucosa layer
171
actinic keratosis
precancerous
can lead to squamous cell carcinoma!
172
a client who is diagnosed with Crohn's disease is at higher risk for what cancer
colorectal cancer
173
The client who has experienced biologic death has
apnea, lacks brainstem reflexes, and is in a coma.
174
according to birth, who is more at risk
nulliparous
175
what is the brain divided into
two hemispheres and five lobes
two glands
176
what are the five lobes of the brain
frontal
parietal
occipital
temporal
insula
177
what are the brain's two glands
pineal
pituitary gland
178
spinal cord
housed within the vertebrae
has 31 segments
each segment is a pair of spinal nerves
179
meninges
cerebrospinal fluid and connective tissue membranes surround components of the CNS
meninges havce three layers
180
three layes of the meninges
dura mater
arachnoid
pia mater
181
dura mater layer of the meninges
the outer layer
made of sturdy connective tissue
182
arachnoid layer of the meninges
middle layer
thin, cobweb like layer that attaches to the middle layer
183
pia mater layer of the meninges
inner layer
thin membrane that is securely attached to the brain and spinal cord
184
patho of brain cancer
cell damaged (inherited or environmental)
185
common brain tumors include (that we need to know)
meningioma
pituitary tumor
186
meningioma
a brain and CNS tumor that arises from the meninges
187
pituitary tumor
tumor that occurs in the pituitary gland
188
do primary CNS tumors usually metastasize
no
189
risk factors for CNS tumors
few links with risk factors but...
vinyl chloride exposure
smoking
some dx like ( neurofibromatosis, tuberous sclerosis, and Li-Fraumeni syndrome)
190
are most brain tumors benign or malignant
most are benign, about 29% are malignant
191
common manifestations of brain tumors
onset seizure (common)
N/V
visual changes
balance problems
behavior changes
drowsiness
coma
hearing loss
weakness
numbness
difficulty swallowing
192
spinal cord tumors manifestations
coordination problems
bladder and bowel issues
weakness
numbness
193
do males or females have a higher mortality rate with CNS cancers
males
194
spinal vs brain tumor manifestations
know that bladder and bowel are for spinal!
and headache and vision changes etc are for brain tumors
195
The imaging modalities used most frequently to diagnose brain and spinal cord tumors are
CT and MRI scans
196
Because lung cancer often metastasizes to the brain
a chest x-ray is necessary to assess for a lung mass that could be the primary cancer
197
biopsies for brain cancer
worried about cancer calls in the cerebrospinal fluid (CSF) so a lumbar puncture can be obtained
198
myelogram
uses an injectable dye to better visualize the spinal cord on an x-ray
199
chemo meds for brain and CNS tumors
IV
PO
directly into the brain
200
side effects of radiation for brain tumors
headaches, alopecia, nausea, vomiting, fatigue, hearing loss, skin and scalp changes, difficulty with memory and speech, seizures, brain swelling, memory loss, and stroke-like manifestations
201
preop education for brain surgery
stop blood thinners and antiplatelet agents
202
Brain and CNS cancer treatment options include
active surveillance, surgery, chemotherapy, radiation, and targeted therapy
203
active surveillance for brain tumors
tumors are slow growing and not causing problematic sx
204
surgery for brain and CNS tumors
remove a tumor partially or fully, especially when it is necessary to decrease pressure on the brain caused by the tumor (
205
chemo for brain and CNS tumors
when chemo can cause the blood-brain barrier, IV chemo is used
chemo wafer is used (med directly into the tumor site)
206
admin what meds for brain and CNS tumors
meds to lower intracranial pressure
207
what meds decrease intracranial pressure for brain and CNS tumors
diuretics (reducing fluid volume in the brain)
corticosteroids (decreased swelling)
antiseizure meds (levetiracetam and phenytoin)
208
imminent brain death
score of three of the Glasgo Coma Scale and the absence of a minimum of three brain stem reflexes (corneal reflex, cough and gag, pupil to light, and pain response)
209
when should organ donation begin
only when the client has died! do not bring it up until client has died
210
what do anxiolytics treat
anxiety
211
medicaid covers how long in children who are dying
6 months
212
cardiac function may be present in
neurological death
213
neurological death vs cardiac death
neurological- irreversible (lack of brainstem reflex but cardiac function may still be available)
cardiac- all circulatory and respiratory functions have stopped and it is ALSO irreversible
214
two types of HIV
both types can cause AIDS
215
patho of HIV
virus enters...
monocytes
macrophages
and CD4 lymphocytes
basically causes immunosuppression.
216
how does almost all HIV infections in infants develop
through vertical transmission (Transmission of a pathogen from a mother to a baby during the period immediately before and after birth)
217
average lifespan of a child with HIV
is about 10 years
218
most HIV related deaths in infants and children result from
immune system dysfunction
high risk for...
opportunistic infections (Pneumocystis pneumonia and Candida esophagitis)
219
Pneumocystis pneumonia and Candida esophagitis.
use of antiretroviral medications can lead to...
hyperbilirubinemia
anemia
overall decreased WBCs
high blood sugar
220
A nurse is caring for a pregnant client who has HIV. Which of the following is most important for this client?
Prevention of vertical transmission
221
what race is most likely affected by anancephaly?
Hispanic
222
type l lissenecephaly
the cerberal cortex has four layers INSTEAD of the expected six layers
223
type ll lissencephaly
have disorders of the muscles and eyes
224
90% of clients with lissencephaly will develop what
epilepsy
225
what do seizures from lissencephaly require
multiple anticonvulsants
226
how are most inborn errors of metabolism identified?
through the manifestation of neurological anomalies
227
what will most people with inborn errors of metabolism experience
developmental delays and seizures
228
common manifestation of CF
salty skin
229
a common theme among clinicians with death of a ped pt
they might think of their client when interacting with their own children and put themselves in the position of the families they care for
230
personal and individual characteristics that make staff more vulnerable to burnout, including...
younger age
fewer years of experience
lower education level
anxiety
working nights
231
palliative sedation meds
opiates
benzodiazepines
antipsychotics
232
what can palliative sedation lead to
increase risk for...
respiratory depression
aspiration
agitation and delrium
233
hisutism
excessive hair growth in women
234
dyspepsia
indigestion
