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NUR 171 Test 4
NUR 171 block 2 test 4 study
| Question | Answer |
|---|---|
| pancreatic enzymes | Prescribed when the pancreas does not produce enough enzymes to break down food, common in cases of Pancreatic cancer. Also for management of cystic fibrosis to replace pancreatic insufficiency. |
| Pathogenic organisms | Organisms that cause disease and the resulting s/s that develop in response to the invasion. |
| Opportunistic organisms | Organisms such as bacteria, viruses or funguses that usually don’t cause problems until the host’s immune system is compromised. |
| RBC induces (Normal Values) | MCV=size of RBC’s- 82-98 fl Low= micrcytosis, High- macrocytosis MCH= weight of Hb/RBC’s 27-33 pg Low=microcytosis, hypochromia High=macrocytosis MCHC=RBC saturation with Hb 32-36% (.032-0.36) Low= hypochromia High=evident in spherocytosis |
| GI diet | Low in fats, high in fiber, lots of whole grains, veggies, fruits, moderate to high protein. |
| How is HIV spread? | Through exchange of body fluids: blood, semen, vaginal secretions, breast milk How-sexual contact, blood transfusions, sharing needles, childbirth, breast feeding |
| WBC Differential values | Neutrophils 50%-70% (0.50-0.70) Eosinophils 2%-4% (0.02-0.04) Basophils 0%-2% (0-0.02) Lymphocytes 20%-40% (0.20-0.40) Monocytes 4%-8% (0.04-0.08) |
| How do CD4+ count and viral load relate to one another. (HIV in plasma) | In early HIV infection the body is able to create more CD4+T cells for many years. Eventually, the ablility of HIV to destroy CD4+ T cells exceeds the body’s ability to replace them. (Higher viral load= more destruction of CD4+T cells |
| What are immunoglobulins? | Immunoglobulins are antibodies with specific jobs |
| IgG | 76% located in plasma Only IG that crosses placenta. Responsible for secondary immune response |
| IgA | 15% body secretions, tears, saliva, breast milk. Lines the mucous membranes & protects body surfaces |
| IgM | 8% Plasma. Responsible for primary Immune response. Forms andtibodies to ABO blood antigens |
| IgD | 1% Plasma. Is present on lymphocyte surface. Assists in differentiation of B lymphocytes |
| IgE | 0.002% Plasma. Causes symtoms of allergic reaction. Fixes to mast cells and basophils. Assists in defense against parasitic infections |
| Peritinitis | Inflammation process of the peritoneum in reaction to blood borne organisms entering the peritoneal cavity. |
| What emergency does rebound tenderness indicate? | Peritinitis |
| Parental nutrition | Administration of nutrients via the blood stream. It’s a hypertonic solution of glucose, amino acids, fat emulsion, minerals, and vitamins in a central venous rout. Used when GI tract has issues with injestion, digestion and absorption. |
| Tube Feedings | Nutritionally balanced liquefied food through a tube inserted into the stomach, duodenum or jejunum. This is used when a pt has a functioning GI tract but is unable to take any or enough oral nourishment |
| Menorrhagia | excessive menstrual bleeding |
| Assessment data for a pt who has menorrhagia? | History and physical focus on likely causes. Amt of bleeding, # of pads or tampons, degree of saturation. Fatigue level, BP, Pulse for anemia and hypovolemia. |
| How does Epoetin work? | Epoetin works by causing the bone marrow to make more red blood cells. |
| Normal CD4+ | 800-1200 CD4+ cells per µl of blood. |
| CD4+ levels of concern | Immune problems arise when < 500 CD4+ Tcells/µl and severe problems develop when < 200 CD4+ Tcells/µl. |
| 3 NANDAs for pt with polycythemia vera. | 1) Ineffective tissue perfusion, 2) disturbed sensory perception, 3) risk for injury |
| Stool characteristics for ascending, transverse, and desending colostomy | Ileostomy- Liquid stool to semi-liquid Ascending- Semi-liquid Transverse- Semi-liquid to semi-formed Desending- formed stool |
| S/S of Peritonitis | Tenderness over the involved area. Rebound tenderness, muscular rigidity, and spasm are major signs of irritation of the peritoneum. |
| Why is there bone pain with epoetin(Epogen) | It causes progenitor cells in bone marrow to manufacture large numbers of immature RBC's and to speed up maturation. This RBS growth take place in the bone marrow so one can feel bone pain, usually at the beginning of therapy. |
| When is a person’s stool clay colored and dark urine? | These are S/S of obstruction of the bile ducts by stones. Also Jaundice, foamy urine, steatorrhea (excess fat in feces), fever and increased WBC count. |
| Describe s/s one might see with internal bleeding | hypotension, abdominal pain due to tissue distension, weakness, fainting, dizziness, tachycardia, organ displacement, nerve compression. low H & H. |
| In what disease process will high ammonia be a problem? | Liver function diseases |
| What can be prescribed for elevated ammonia and how does it work to lower ammonia? | Lactulose is given to reduce ammonia. It traps the ammonia in the gut, and the laxative effect of the drug expels the ammonia from the colon. |
| In a “shift to the left” is there more segmented neutrophils or bands? | Bands |
| TSE (Testicular Self Exam) | Warm shower, use both hand to feel testie, roll between thumb and three fingers over entire surface and palpate. Note structures as to understand when there is an irregularity. Choose same day every month and notify HCP if anything is abnormal. |
| Why is high ammonia level dangerous? | When large amounts of ammonia remain in the systemic circulation ammonia crosses the blood brain barrier and produces neurologic toxic manifestations. (hepatic encephalopathy) |
| 3 NANDA's for someone with primary polycythemia vera | 1)imbalanced nutrition, less than body requirements. 2) Risk for imbalanced fluid volume. 3) impaired physical mobility R/T hospitalization. |
| “segmented neutrophils” | Segmented- are mature neutrophils. They are segmented because the nucleus is segmented into 2 to 5 lobes connected by strands. |
| “band neutrophils” | Band- are immature neutrophils released by bone marrow in response to infection. Their nucleus has the appearance of a band. |
| What is hypersensitivity reaction? What is the cause and what is the effect? | Immune response over reactive against foreign antigens or fails to maintain self tolerance, results in tissue damage. This is hypersensitivity reaction as happens when the body fails to recognize self proteins and reacts against them. Autoimmune disease. |
| Why is lovenox often preferred over heparin for anticoagulation. | Low molecular weight heparin has higher degree of bioavailability and longer elimination half life than reg heparin. Laboratory monitoring is not needed with Lovenox allowing pt discharge. |
| Chronic Renal Insufficiency (CRI) acidosis or alkalosis | Metabolic Acidosis results from the impaired ability of the kidneys to excrete the acid load (primarily ammonia) and from defective re-absorption and regeneration of bicarbonate. |
| S/S of Anemia | Pallor, hyperpigmentation, hair loss, nail dystrophy, pale mucus membranes, fatigue, blurred vision, palpitations, dyspnea, diaphoresis, glossitis, dizzy , HA, tachycardia |
| Dietary needs and restrictions following a cholecystectomy. | Small frequent meal (6 small per day), low in carbs, restrict refined sugar, moderate amounts of protein and fat (low-fat at first).Fluid in between meals, rest in recombent position 30 min after meals. |
| Irritable bowel syndrom (IBS) care. | focuse on symptoms, diet and episodes of stress. +20g/ daily fiber. Eliminate gas producing foods (broccoli, cabbage), rule out lactose intolerance. Antispasmodics (Bentyl) before meals for pain. Imodium for diarrhea. Relaxation and stress management |
| Why is ELISA test viral load coded as “non-detected” instead of “negative”? | HIV viral loads reported as real numbers or as undetectable. “Undetectable” indicates a viral load lower than test can report. “Undetectable” does not mean the individual no longer has virus or can no longer spread the virus. |
| Na | 135-145 |
| K | 3.5-5.0 |
| Cl | 95-108 |
| P | 2.5-4.5 |
| Mg | 1.5-2.5 |
| PaCo2 | 35-45 |
| HCO3 | 22-28 |
| pH | 7.35-7.45 |
| BUN | 8-25 |
| Creatinine | 0.2-1.0 |
| Albumin | 3.5-4.8 |
| AST | 7-40 U/L (0.12-067ukat/L) |
| ALT | 5-36U/L (0.08-0.6 ukat/L) |
| Innate immunity | Natural or native immunity consists of defenses in place before infection and exists without prior contact to antigen. |
| Passive aquired immunity | Passive acquired immunity implies that the host recieves antibodies to an antigen rather then making them. |
| Active aquired immunity | Active acquired immunirty results from the invasion of the body by forgein substances such as microorganisms and subsequent development of antibodies and sensitized lympocytes. |
| Adaptive immunity | AKA acquired or specific immunity. Able to recognize and react to a large number of microbes and nonmicrobial substances. In addition, are able to distinguish among the different, but closely related substances. |
| Crohns disease | Inflammation involves all layers of the bowel wall and occurs anywhere in the GI tract from mouth to the anus but mostly in the terminal ileum to the anus. Ulcerations are deep and longitudinal and penetrate edematous mucosa make cobblestone appearance. |
| Ulcertive Colitis | Usually starts in the rectum and moves in a continual fashion toward the cecum. This is a terminal disease of the colon and rectum. |
| S/S ulcerative colitis and Crohns diseases | S/S same- diarrhea, bloody stools, weight loss, ab pain, fever fatigue. Inflammation pattern is different between two. |
| How would you care for a client with thrombocytopenia? | Goal during acute episode of thrombocytopenia- prevent or control hemorrhage. No OTC drugs, especially ASA. If injection is unavoidable use a small needle, apply direct pressure 5-10 min. May administer the platelet transfusion. |
| Antigen | Substance that elicits an immune response. All of the bodys cells have antigens on their surface that are unique so that the body can recognize itself. |
| Antibodies | Immunoglobulin molecules that have antigen-specific amino acid sequences |
| B- cells | Differentiate into plasma cells when activated. Plasma cells produce antibodies (immunoglobulins.) |
| T-Cells | Responsible for immunity to intracellular viruses, tumor cells, and fungi. T cells live from a few months to the life span of an individual for long-term immunity. (2 types T Cytotoxic and T Helper Cells) |
| T Cytotoxic Cells | Involved in attacking antigens on the cell membrane of foreign pathogens and releasing cytolytic substances that destroy the pathogen. They have antigen specificity and and sensitized by exposure to the antigen. |
| T Helper Cells | (CD4) cells are involved in the regulation of cell mediated immunity and the humoral antibody response. T helper cells differentiate into subsets of cells that produce distinct types of cytokines. |
| What teaching is important with Iron supplements? | Iron rich foods (liver, muscle meats, eggs, dried fruits, legumes, darkgreen leafy veggies, whole grain, potatoes) Orange juice helps absorption, 1 hour before meals, black stools possible, drink through straw to avoid staining teeth. |
| Vesicles and erosions appear with which STD? | Genital Herpes, multiple small vesicular lesions appear which contain large amount of infectious viral particles. The lesions rupture and form shallow moist ulcerations, then crusting and eplithelialization of the erosions occurs. |
| Paralytic ileus | Lack of intestinal peristalsis and the presence of no bowel sounds, common after surgery. |
| What causes Paralytic ileus | Common post surgery. |
| How do we address Paralytic ileus | Assess= abdominal distention, presence of flatus or stool, bowel sounds, nausea and vomiting. • Maintain nothing-by-mouth (NPO) status until peristalsis returns and ensure patency of nasogastric tube to prevent vomiting and abdominal distention |
| Dysuria, vaginal discharge, and urethritis occurs with which STD? | Gonorrhea |
| Why are men on ED med cautioned about nitrate medications? | These drugs can potentiate the hypotensive effects of nitrates. ED drugs cause vasodilation, and smooth muscle relaxation. When ED meds mix with nitrates, they can lower bp and make you dizzy, lightheaded, or faint. In some cases, patients have died |
| Why and for whom are phosphate binders administered to? | For Chronic Renal Failure. Given as part of conservative therapy for pts with chronic kidney disease, these pts haven’t yet begun maintenance dialysis. They are given with each meal, constipation is often a side effect of the binders. |
| Gammaglutamyltranspeptidase (GGTP) | Elevated in hepatitis and alcoholic liver disease more sensitive for liver dysfunction than ALP. |
| H2 blockers | Block the action of histamine on the H2 receptors and reduce the HCl acid secretion. This decreases the conversion of pepsinogen to pepsin which allows of a quicker recovery. |
| PPI (proton pump inhibitor) | Block the APTase enzyme that is important for the secretion of HCl acid. More effective than H2 blockers in reducing gastric acid secretion and improving recovery. |
| What is an ESR? | ESR is the erythrocyte sedimentation rate which measures the settling of RBC’s used as a nonspecific measure for many diseases but more so indicates inflammatory conditions. |
| What does an elevated ESR indicate? | Common in inflammatory conditions both chronic and acute in which the destruction of the cells are increased. It may also indicate and MI, malignancy, or end-stage renal disease. |
| Why are hospitalized patients prescribed H2 blockers and PPI? | Surgery or trauma cause physiologic stress ulcers, they are highly prevalent and have a high morbidity rate-all pts are put on prophylaxis H2 blockers and PPI’s. H2 blockers and PPI reduce the amount of HCl secreted by the stomach. |
| What lab values support the physician order for epoetin (epogen), filgrastim (neupogen) oprelvkin? | Lab Value of low RBC count. Normal is 4.5 - 5.3. low WBC count and low platelet. Epoetin alfa is used to treat anemia that is associated w/end-stage renal diseae, HIV , & Cancer. |
| In what disease process is gamma glutamyl transferase (GGTP) most often elevated? | GGTP is a protein molecule that is produced in the bile duct. Elevated levels common with systemic lupus, hyperthyroidism and cirrhosis of the liver, mononucleosis,carcinoma of the pancreas, and Alcoholism. |
| Labs elevated with pancreatitis | Serum Amylase, Serum Lipase and urinary Amylase. These are digestive enzymes that are released into systemic circulation. |
| Explain to your patient what a hiatal hernia is. | A herniation of a portion of the stomach into the esophagus through an opening in the diaphragm called a hiatus. |
| Why does liver disease affect clotting factors? | Coagulation problems occur because the liver is unable to produce prothrombin and other factors essential for blood clotting. |
| Urinary retention is a post surgical complication. What is it, what causes it and how can we prevent it? | B/C anesthesia depresses the nervous system. Anticholinergic &/or opioid drugs interfere with the ability to initiate voiding or empty the bladder completely. Pain may also alter perception and interfere with the pts awareness of bladder filling. |
| Construct a renal plan. | Limit protein intake. No contrast dye. Good medication regimen. Ace-inhibitors (although contraindicated in end stage). No NSAIDS. |
| If milk makes an ulcer feel “better” why is it not a prescribed treatment? | Milk and milk products should be avoided b/c they increase gastric acid secretion therefore making ulcer worse rather than better. |
| Gastric ulcers | Women than men and >50. Likely to result in hemorrhage, perforation and obstruction. Characterized by normal to low acid secretion, H. pylori is present in 60-80% of cases. NSAID’s and alcohol can cause acute or chronic ulcers. |
| Duodenal ulcers | More in men ages 35-45, caused by high secretion of HCl acid. Risk for duodenal ulcer is increased in COPD, cirrhosis of the liver, chronic pancreatitis, hyperparathyroidism, chronic kidney disease, and the Zollinger-Ellison syndrome. H. pylori also. |
| Gastric and duodenal ulcers treatment regimens | Generally the same for both types. Rest, antacids, H2 blockers, and PPI’s are all given and an ABX may be given in pts with H. pylori infections. |
| Differentiate between gastric and duodenal ulcers | Gastric ulcers are located in the stomach, predominantly in the antrum, and are characterized by a normal to low secretion of gastric acid. Duodenal ulcers are located in the first 1-2 cm of duodenum, and are associated with a high HCl acid secretion. |
| 27. Compare and contrast dietary needs of a person in acute diverticulitis and chronic diverticulitis. | Acute-allow the colon to rest, pt kept NPO and bed rest and is given parenteral fluids. May also be given broad spectrum ABX. Chronic- high-fiber diet, decreased intake of fat and red meat. |
| Pathophysiology of jaundice? | Excess production, decreased hepatic uptake or impaired conjugation of bilirubin. When this occurs normal bilirubin metabolism or flow into the hepatic or biliary duct system altered. It causes +levels in the blood to become abnormally increased. |
| How does s/e of aluminum and magnesium antacids differ? | Aluminum: Constipation, phosphorus depletion with chronic use. Magnesium: diarrhea, hpermagnesemia. |
| Warts appear with which STD? | Human papillomavirus (HPV). Genital warts are discrete single or multiple papillary growths that are white to gray and pink-flesh colored. |
| How high is the HOB with a person with a tube feeding ? | 30-45 degrees either sitting or lying down to prevent aspiration. It should remain elevated for 30-60 mins after the feeding. |
| Fistula | uses pts own vein and artery , providing arterial blood flow through the vein. Have a decreased risk of complications like infection and thrombosis formation. Not as common require 3 months before it can be used for HD. |
| Graft | synthetic material creates a “bridge” between the artery and a vein. Increased risk of thrombosis formation, distal ischemia, and increased risk of infection. Requires only 2-4 weeks for healing and can be accessed sooner than an AVF. |
| Name 3 functions of the immune response. | 1. Defense 2. Homeostasis 3. Surveillance |
| Why, in the prevention of allergies, does one wash their pillows in hot water often? The answer is NOT pollen. | Bacteria from the skin and hair can cause mold, fungus, and bacteria to grow on the pillow case. |
| What information is recorded on a medic bracelet? | An allergy or specific medical condition |
| What patient history would warrant the need for a medical alert bracelet? | People who wear these bracelets include people with diabetes, drug allergies, diabetes, asthma, epilepsy, or Alzheimer's Disease. |
| Lifestyle modifications prescribed for GERD, PUD, and HH | Small frequent meals. Eliminate aggravating foods (client specific). Sit up while eating and remain in upright position for at least 1 hour after eating. Stop eating 3 hours before bed. Teach common meds (H2 blockers, antacids) |
| What cross sensitivities should be looked for w/ a person who has allergies to tape, bananas, avocados, tree nuts, or tomatoes? | LATEX, kiwi, water chestnuts, guava, hazelnuts, potatoes, peaches, grapes, apricots |
| Differentiate between benign and malignant cancers | Malignant is cancerous. Malignant tumors can invade and destroy nearby tissue and spread to other parts of the body. Benign is not cancerous. Benign tumors may grow larger but do not spread to other parts of the body. |
| Our #1 priority w/anaphylaxis is… | AIRWAY!! |
| Describe the s/s of early and late latex allergic reactions. | Signs can be as simple as redness, itching, and swelling and go all the way to anaphylactic reaction including closing of the airway. |
| What precautions would medical staff take w/persons who are latex allergic? | Signs outside door, non latex gloves, bandages etc. |
| If a person is exposed to Hep B s/he receives gamma globulin instead of immunization, why? | They have already been exposed therefore gamma globulin contains antibodies to HBV and confers temporary passive immunity |
| It has been said that the person w/HIV-AIDS is at greater risk from getting infection from you than you are of getting HIV from them. Defend this statement. | The HIV/AIDS pt is highly immunocompromised therefore at risk of getting all bacteria and viruses around them. Any of these could kill the HIV/AIDS patient. There would need to be an exchange of bodily fluids in order to get HIV. |
| What is a RAST test used to dx | (radioallergosorbent test) is an invitro diagnostic test for IgG antibodies specific to antigens. Helpful in confirming reactivity to various foods or drugs in individuals w/ a history of severe anaphylactic reactions. |
| Explain pathophysiology of autoimmune disease. | Autoimmunity is an immune response against self. In a sense your immune system sense that the body is the enemy and attacks it. The immune system develops auto antibodies and auto-sensitized T cells to causes pathophysiologic tissue damage |
| 1st stage of HIV | Stage one-Flu-like symptoms that last 3-12 weeks |
| 4th stage of HIV | Stage four (AIDS)-10% body weight lost, chronic diarrhea, fever, night sweats, thrush, 1 or more opportunistic infections, rare cancers, personality changes, memory loss, lypodystrophy, CD4 count <200 and viral load climbing |
| 2nd stage of HIV | Stage two-Replication stage with no outward symptoms |
| 3rd stage of HIV | Stage three-Symptoms begin such as swollen glands, fever, weight loss, night sweats, n/v, CNS symptoms, diarrhea |
| What is the goal of anti-retroviral replication? | Keep T cells up and viral load “undetectable” and stop HIV from replicating |
| What is HARRT therapy for HIV? | Highly active antiretroviral treatment. Goal is to reduce viral loads and reverse clinical progression of HIV, usually taking 3 different antiretroviral drugs from at least 2 different drug classes also to decrease the risk of developing resistance. |
| Rationalize health promotion with the HIV positive person. | Prevention is crucial for control of the epidemic, it also encourages early detection of disease so that if primary prevention failed, early intervention can be implemented. How?? Safe sex, HIV testing, etc. |
| Differentiate between benign and malignant cancers. | Malignant is cancerous. Malignant tumors can invade and destroy nearby tissue and spread to other parts of the body. Benign is not cancerous. Benign tumors may grow larger but do not spread to other parts of the body. |
| Is it a person’s legal responsibility to disclose +HIV diagnosis? | NO a person does not have to disclose. State agencies will be notified however. |
| How do allergies decompensate to an anaphylactic emergency? | Allergic reactions cause vasodilation, which cause fluid to leak from vessels, which cause edema and swelling. This swelling closes airways and a person cannot breath - if the person's airways are not opened death will occur. |
| List 7 warning signs of cancer | CAUTION = Change in bowel/bladder habbits, A sore that doesnt heal, Unusaual bleeding/ discharge, Thickening or a lump in the breast or somewhere else, Indigestion or difficulty in swallowing, Obvious change in a wart or mole, Nagging cough or hoarseness. |
| Apply Elizabeth Kubler Ross's 5 stages of grief to the cancer patient. Do all people reach stage 5, why or why not? | Denial (this isn't happening to me!) Anger (why is this happening to me?) Bargaining (I promise I'll be a better person if...) Depression (I don't care anymore) Acceptance (I'm ready for whatever comes) Not all will hit all stages. |
| How do nursing interventions change if a person's goal of cancer treatment is cure? | Cure= nurses should know the goals of the treatment plan to appropriately communicate with, educate, and support the patient. Curative thearapy differs according to the cancer being treated. |
| How do nursing interventions change if a person’s goal of cancer treatment is Control? | Control=many cancers cannot be eradicated so anticancer therapies and are maintained for long periods of time. pt has inital course of treatment then maintenance therapy. Patients are followed closely for s/s of recurrence/ progression. |
| How do nursing interventions change if a person’s goal of cancer treatment is Palliative? | Palliative= relief or control of symptoms and the maintainance of a satisfactory quality of life are primary goals rather than cure or control of disease process. |
| What part does smoking play in the development of cancer. | Smoking is a leading cause of cancer and death from cancer. It causes cancers of the lung, esophagus, larynx, mouth, throat, kidney, bladder, pancreas, stomach, and cervix, as well as acute myeloid leukemia. |
| Goal of chemo: | Chemo can cure some cancers, control some cancers for long periods of time, and in some cases offer palliative relief of symptoms. |
| How does chemo effect normal tissue? | Chemo cannot distinguish between cancerous and non-cancerous cells and will affect all body systems. |
| What will you do to make your pt more comfortable? | Treat the pain and side effects. There are acute (n&v), delayed (alopecia, rashes, etc), or chronic effects (damage to organs) |
| Why do we type and screen and cross match prior to blood administration | To make sure that the pt and blood products are compatible. |
| Explain antigen-antibody response. | After an exposure body makes antibodies specific to antigen from pathogen. These antibodies are attached to mast cells. Upon rexpsure the pathogen (antigen)is bound to the antibody on the mast cell which triggers the release of chemical mediators. |
| List lifestyle, genetic, and environmental factors that contribute to the incidence of cancer. | Exposure to known carcinogens tobacco & sun exposure, radiation, lack of exercise, poor diet, Lack of healthcare examinations, stress, lack of sleep, no self-examinations, Family Hx growing older. It’s also higher in African Americans and men. |
| Which is more dangerous a malignant or benign brain tumor. | The distinction between benign and malignant can be ambiguous. Some benign tumors can be as dangerous as malignant ones if in a dangerous or inaccessible location, such as the brain stem. Conversely, some malignant tumors can be successfully treated. |
| Explain the classifications of cancers; anatomic site | Anatomic classification of tumors= identified by the tissue of origin (the anatomic site), and the behavior of the tumor (ie benign or malignant) |
| Explain the classifications of cancers; histology | Histologic classification= appearance of cells and degree of differentiation. Four grades used to evaluate abnormal cells based on degree or resemblence to original tissue. Tumors poorly differentiated (undifferentiated) have a worse prognosis. |
| Explain the classifications of cancers: staging | staging= based on descripton of extent of disease rather than cell appearance. Stage 0= cancer in situ Stage 1= tumor limited to tissue of origin, localized. Stage 2= limited local spread. Stage 3= extensive spread. Stage 4= metastasis. |
| Cancer Staging | The tumor, node, metastases (TNM) system classifies cancer by tumor size (T), the degree of regional spread or node involvement (N), and distant metastasis (M). |
| How to biologic response modifiers (BMR) work in the care of cancer? | biologic response modifier consists of agents that modify the relationship btwn the host and the tumor by altering the biologic response of the host to the tumor cells. |
| List 4 cancer treatments used today | Surgical, chemotherapy, radiation, Biologic and Targeted Therapy |
| Surgical Therapy | Oldest form of local cancer treatment. when the tumor is localized and relatively small. can be used as preventative measure to reduce risk of cancer e.g. genetic mutations of BRCA-1 or BRCA-2 in woman - may opt to have a prophylactic mastectomy. |
| Chemotherapy | now the mainstay of cancer treatment used in treatment of most solid mass tumors and hematologic malignancies. Chemotherapy can offer cure for certain cancers, control for others and in some instances palliative relief of symptoms. |
| Radiation Therapy | used to treat a carefully defined area of the body to achieve local control. Only has an affect on tissues wihtin the treatment field - it is not appropriate for patients with systemic disease. |
| Biologic and targeted therapy | biologic response modifier consists of agents that modify the relationship btwn the host and the tumor by altering the biologic response of the host to the tumor cells. Targeted interfers with cancer growth. |
| Explain the body’s response to cellular destruction caused by chemo and radiation. | Myelosuppression, fatigue, GI, n&v, diarrhea, mucositis (inflammation of the oral mucosa, anorexia. Skin reactions such as wet or dry desquamation, erythema, hyperpigmentation, PPE, and Alopecia. Pulmonary, cardiovascular and reproductive effects |
| Describe the vision and mission of Hospice. | Hospice is a type of care and a philosophy of care that focuses on the palliation of a terminally ill patient's symptoms. These symptoms can be physical, emotional, spiritual or social in nature. Both patient and family and surrounding people |
| How is cancer pain addressed? | pain management diary, nsaids, opiods,adjuvant pain medications. Analgesics on schedule with breakthrough coverage. Apropriate opiod dose is whatever necessary to control the pain using least to avoid SE. Nonpharmacologic interventions as well. |
| List specific labs and diagnostics for specific cancers. | Cytology studies (study of cells), Pap test, bronchial washings, tissue biopsy, CXR, CBC/ Chem panel, Sigmoidoscopy/ colonoscopy, Radiologic, CT, PET, tumor markers, bone marrow. |
| What is the diagnostic considered “definitive” when making a cancer diagnosis? | Biopsy |
| Devise a teaching plan for a 17 year old in the prevention of pregnancy and STD | proper condom use, peri- area hygiene, and careful partner screening are important. For pregnancy prevention, use condoms, birth control pills or devices but stress that these pills and devices are not prevention against contracting STD’s |
| What is normal CD4+ cell count? | Normal adults have between 800-1200 CD4+ per microliter of blood. (aka t helper cells, CD4 cells, or T lymphocytes). |
| What is considered low and “compromised” CD4+ count? | CD4+ levels drop below 500 at which time immune system problems start to occur. Severe problems develop below 200 CD4+ cells per microliter. |
| What CD4+ level depicts AIDS | CDC guidelines for AIDS diagnosis = CD4 levels dropping below 200. |
| In report you learn your patient has implanted high dose radiation seeds. Anticipate cares and education needs. | Caregiver precautions include ALARA- as low as reasonably achievable, time, distance, and shielding. Limit the time in contact with patient while explaining reasons for precautions, other cautions relate to amount of dosage. |
| What assessment data suggests that the person who is HIV+ has converted to AIDS? | CD4+ levels below 200, One of the following opportunistic infections- FUNGAL, VIRAL, PROTOZOAL, BACTERIAL, CANCER, Also- wasting syndrome and aids dementia complex. |
| Bacterial STD’s | be cured and are treated with Antibiotics to get rid of the bacteria in the body. |
| Viral STD’s | Can not be cured. Is usually treated with Antiviral agents which inhibit herpetic viral replication. Not a cure but shortens the duration of viral shedding and the healing time of genital lesions & reduce outbreaks. |
| Uterine prolapse | the downward displacement of the uterus into the vaginal canal as a result of impaired pelvic support. |
| Cystocele | herniation or protrusion of the urinary bladder through the wall of the vagina, resulting from weakened connective tissue support between the vagina and bladder. |
| Rectocele | herniation or protrusion of the rectum through the wall of the vagina, resulting from weakened connective tissue support between the rectum and vagina. |
| Endometriosis | the presence of normal endometrial tissue in sites outside the endometrial cavity. Common sites include ovaries, uterosacral ligaments, and uterovesical peritoneum. |
| Uterine prolapse S/S | S/S feeling of something coming down, dyspareunia, backache, bowel problems, stress incontinence. |
| Cystocele S/S | complete emptying of the bladder can be difficult and can predispose a woman to bladder infections. |
| Rectocele S/S | can inhibit the complete emptying of the rectum requiring digital stool manipulation. |
| Endometriosis S/S | Mini-menstral cycles, secondary dysmenorrheal, infertility, pelvic pain, dyspareunia, and irregular bleeding, backache, painful bowel movements, dysuria. |
| Why are elderly more prone to dehydration than adults? | Elderly loose thirst response while ADH hormones remain same or become elevated. Nephrons become less able to conserve fluids. These issues are added to a decreasing tissue and skin area and a decline in lean tissue available for fluid storage. |
| Why are babies more prone to dehydration than adults? | Greater fluid turnover with higher metabolic rate. They loose more fluids through the kidneys since less able to conserve fluids than adult kidneys. Rapid infant respirations and larger proportional body surface area =insensible fluid losses. |
| How does one attempt to prevent uterine prolapse, Cystocele, and rectocele? | Kegel exercises are advised for all three conditions. Pessary devices are installed for uterine prolapse and Cystocele. All three conditions can be addressed surgically through Colporrhaphy. |
| What does a high specific gravity indicate? | Normal range 1.003-1.030. Higher indicates Albuminuria, dehydration, glycosuria. |
| Explain tell tale signs of peritonitis? | Abdominal pain, tenderness over involved area, rebound tenderness, muscular rigidity, and spasms, abdominal distention, ascites, fever, tachycardia, tachycardia, tachypnea, nausea, vomiting, and altered bowel habits. |
| What do cephalosporin’s and penicillin have in common? | They are both common sources of medication caused allergic reactions. They are both beta lactam antibiotics. |
| From what “normal” organisms is the immune deficient person at risk against? | Their own flora! Whether it be in their GI tract, skin, mouth, vagina…if theyre introduced into a normally sterile environment, it could cause an infection that the body cannot fight due to an immune deficiency (AIDS patients, cancer patients) |
| List the most common sites of metastasis with breast cancer. Why? | metastasis through lymphatic system spreading though lymph node involvement. first though the axilla region, when lymphatic system is fully involved, metastasis can reach distant sites skeletal, spinal cord, brain, pulmonary, liver, and bone marrow. |
| polycythemia | an abnormal condition with excessive levels of red blood cells. |
| Primary polycythemia (polycythemia Vera) | chronic disorder arising from chromosomal mutations in a single pluripotent stem cell. Not only RBC’s but WBC’s and platelets are involved. |
| Secondary polycythemia (not Vera) | hypoxia driven or hypoxia independent stimulation of the kidneys to stimulate erythropoietin production and therefore affects only RBC’s. |
| Differentiate between primary and secondary polycythemia Vera? | Polycythemia Vera affects all cells, secondary only effects RBC’s |
| What role does iron play in the prevention of anemia? | Iron binds to globule proteins “transferrins” to create a single hemoglobin molecule. “heme”= iron. Iron deficiency anemia can develop from inadequate dietary intake, blood loss, or hemolysis. |
| Describe a healthy stoma | Red beefy appearance. |
| What clotting factor is not made in the liver? | Factor VIII (made by the vascular endothelium) and vonWillebrand's factor which is also made in the endothelium and acts as a carrier for factor VIII. |
| Construct a diabetic diet meal plan? | emphasis proper caloric intake to maintain healthy weight. Carbohydrates 45-65% of calories. Fats 25-30%. Proteins no more than 10%. Alcohol should be avoided. |
| diabetic diet meal plan? plate method | The plate method is ½ non-starchy vegetables, ¼ starch food, ¼ protein, with a glass of nonfat milk and small piece of fresh fruit. |
| Explain neutropenia | An abnormal reduction of the neutrophils count to <1000/. Normal levels are 4000-11000. Causes include drug induced (chemotherapy or immunosuppressant) hematological, autoimmune, infections. |
| diet guidelines for patient with dumping syndrome. | Six small meals, fluids 30-45 minutes before meals but none with meals, avoid concentrated sweets, increase protein and fats. |
| Dumping syndrome | Result of surgical removal of large portion of stomach and pyloric sphincter and is associated with meals having a hyperosmolar composition. The result is fluid being drawn into the bowel lumen causing distention of bowels and rapid intestinal transit. |
| Urine osmolality vs specific gravity? | Both are measures of solutes concentration in urine and are measures of fluid and electrolyte balance/ fluid balance. Osmolality is more exact measurement of concentration. |
| What is the function of albumin | Albumin is a protein produced by the liver. Increased levels indicate dehydration while decreased levels can indicate liver dysfunction, malnutrition, AIDS, severe burns, infection. |
| What is the normal levels of albumin | Normal levels = 3.5-5.0 g/dl or 3.5-4.8 |
| What solution does the nurse hang with blood? | Normal Saline ONLY. |
| Pap (papanicolaou) test | Microscopic study of exfoliated cells via special staining and fixation technique detects abnormal cells. Cells most commonly studied are those obtained directly from the endocervix and ectocervix. |
| What is the papanicolaou test used to diagnose? | Detects abnormal cells to screen for cancer. |
| When is the papanicolaou test performed? | Woman who are sexually active and who are over 18 should have test per American cancer guidelines. Once every 3 years beginning 3 years after first sexual intercourse but no later than age 21. |
| APTT (therapeutic) | Therapeutic 46-70 |
| INR (Therapeutic) | Therapeutic = 2-3 |
| PT (Therapeutic) | Therapeutic = 12-15 seconds |
| Goal of radiation therapy? | Goal of radiation therapy is to cure, control, or palliation. Radiation is used to treat a carefully defined area of the body to achieve local control of disease. |
| What will you do to make your radiation patient more comfortable? | Make the patient comfortable by helping them to deal with side effects and anxiety. Provide support, information, provide resources. |
| Most common cause of GERD? | “there is no one single cause of GERD” “One of the primary factors in GERD is an incompetent LES (lower esophageal sphincter)”. Other factors, smoking, obesity, pregnancy, hiatal hernia. |
| Explain the importance of Na and K with the renal patient. | In the renal patient, the regulation and reabsorption of Na and K are impaired leading quickly to complications. Hypervolemia, hyperkalemia, hypernatremia. |
| ED (erectile disfuntion) | inability to attain or maintain an erect penis that allows satisfactory sexual performance. |
| ED (erectile disfuntion) treatment | Treatment is based on treating the cause. Also, Viagra, levitra, cialis, vacuum device, intraurethral medication, intracavernosal injections, penile implants, sexual counseling. |
| ED (erectile disfuntion) Risk factors | physiological- large number of factors including DM, vascular disease, meds, surgery, trauma, chronic illness, decreased gonadal hormone secretion. Phychological- stress, relationship issues, depression, low self esteem. |
| Impotence | Impotence is term used in the past and commonly applied to the same factors of ED which is now the preferred term. |
| White “cottage cheese” appearing substance appears with which STD? | Chlamydia Can also appear with non STD's -Viral – Candida albicans, candidiasis (yeast infection) |
| Sterility | male is the inability to achieve a pregnancy in a fertile female; most often due to abnormalities in semen; low sperm count or defective swimmers |
| Why is ammonia elevated in liver disease? | Liver normally converts ammonia into urea. Impaired liver function can lead to elevated ammonia levels and hepatic encephalopathy as a result of liver cirrhosis. |
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918rider
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