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Med-surgII exam 3

respiratory, oral cancer, hematology, oncology emergencies, hepatic disorders

QuestionAnswer
Upper airway disorders -respiratory infections/ larynx cancer - can be minor/life threatening - patient teaching is very important
Respiratory infection - Health HX: smoker, environmental,cough -S/S: headache, cough, hoarseness, fever, stuffiness, fatigue Assessment: nose,neck,throat,lymph nodes
Larynx cancer (voice box) - Head/neck CA has a high death rate due to ignoring symptoms and smoking - Categories of larynx CA: - Supraglottic (false cords, above) - Glottic (true vocal cords) - Subglottic (below vocal cords)
Symptoms and risk factors of larynx cancer Risk factors: carcinogens, voice strain, chronic laryngitis, alcohol, nutritional: riboflavin diet(no milk,eggs or greens) -S/S: hoarseness >2 weeks, cough, lump, sore/ burning throat pain, wt loss, ear pain
Diagnosis/treatment of larynx cancer Diagnosis- health HX, exam, larynscopic, biopsy Treatments: Radiation- teach about diet, bland foods no spice, try ensure/ thicken foods Chemo- 5fu/ cisplatin -watch airway/ carotid artery weakness
Laryngectomy Types: - Partial: used for smaller cancers in ealier stages, only one vocal cord removed. voice may be horse but no swallowing problems noted -Total- complete removal of cords and two rings of the trachea, no voice, needs permanent trach
Laryngectomy care Speech/communication therapy, Nutritional assessment Laryngeal tube- shorter than a trach tube but all air flows through the tube. must keep patent airway Complications: resp distress, hemorraging, infections, aspiration raise HOB, check GI tube residu
Chest/ Lower resp tract disorders Atelectasis, pleural conditions, lung cancer
Atelectasis collapse of the alveoli caused by bronchial obstructions by secretions due to impaired lung expansion -causes: hypo-ventilation, airway obstruction/compression, post op patient -S/S: productive cough, fever, resp distress, decreased breath sounds
Pleural conditions Pleurisy, Pleural effusion, Empyema
Pleurisy inflammation of both layers and pleura causing sharp rubbing pain
Pleural effusion fluid collection in the pleural space >10 ml Causes: secondary to DX- heart failure, TB, pnemonia, pulm infection, PE, tumor diagnostics: chest xray,CT,trachea deviation, fluid analysis MGMT:treat DX, chest tube, thoracentesis,shunt
Lung cancer Spreads very easy, #1 killer a/w CA 2 categories: small cell/NSCLC Small cell- spreads fast, arises in major bronchi/ infiltrates bronchi wall NSCLS- squamous cell, large carcinoma Staging- based on tumor size,location and lymph involvement
Lung CA symptoms/risks/treatments Risks:smoking, environmental, genetics, underlying dx (copd/TB) S/S: cough-chronic to prodcutive, SOB, hemoptysis, chest/should pain, fever Diagnosis: chst xray,CT,MRI,needle aspiration TX:chemo, radiation,surgery
Lung cancer surgeries Lung resections- recommended for NSCLC -lobectomy- small cell cancer (remove lobe) -pneumoectomy- remove entire lung -segmentectomy- remove segment of lobe
Trachestomy bypasses upper airway obstructions
Lung cancer #1 killer a/w cancer, spreads easily 2 categories: small cell/ NSCLC Small cell- spreads fast in major bronchi infiltrating bronchial walls NSCLC:arises in lrge carcincoma/squamous cell Staging: depends on tumor size, location, lymph involvement
Lung cancer risks/treatments/diagnosis Risks: smoking, environmental,gender, genestics, underlying dx (copd/TB) Symptoms: cough devolps into productive, SOB, hemoptysis, chest/shoulder pain, fever Diagnosis: chest xray,PET,need aspiration Treatment:chemo/radiation/surgery
Lung cancer surgeries -Lung resection- recommended for NSCLC -Lobectomy- small cell, remove a lobe -Pneumoectomy- remove the entire lung -Segmentectomy- remove a segment on the lobe
Trach care trach-bypasses the upper airway obstructions Avioding complications: suctioning, dressing/tape change, asses lung sounds, monitor s/s of infection, admin O2, have ambu bag within reach
Oral Cancer Causes: tobacco, alcohol, HPV,>40/black Symptoms:PAINLESS sore or more > 2 weeks later signs= impaired chewing, enlarged lymph nodes, blood tinged sputum MGMT: raidiation,chemo,surgery -avoid spicy/hot foods, oral care to prevent infection, gentle br
Oral Cancer surgeries Hemiglossectomy- removal of half the tongue Total glossectomy- tongue removal
Radical neck dissection worry about carotids/ trachea -post op- monitor airway, pain, bleeding - complications: hemorraging, chyle fistula- constantly draining, nerve injury-clavical/matoid -place pt in fowlers, sunction, liquid/soft diet, puree foods
Bone marrow site of hematopresis(blood cell formation) -stems cells:premature bone marrow cells that differeniate into myeloid,lymphoid and mature stem cells -myeloid:RBCS,WBCS,Platlets -Lymphoid: T/B cells
RBC(erythrocytes) Transport O2 between tissues/lungs -Mature RBCs= hemoglobin -Produced by the liver if marrow fails
WBC(leukocytes) - need FOLIC ACID for WBC development-eledry should take folic acid replacement 2 types of WBCS::lymphoids/granucytes to fight infection Lymphyctes:T/B cells- T cells react to forgein agent and B cells create antibodies and trigger T cells
Platelets(thromocytes) stored and released in the SPLEEN Functions: clotting, bleeding control, aggregation, release fibrin to stabilize clot
Spleen antibody synthesis/ hematopesis/phagcytosis
Liver RBC production is imparied bone marrow BLOOD COAGULANT Proteins-albumin/globulins
Lymphatic filtration/ lymphocyte differentaition
Hemostatsis stop bleeding - blood vessels allow blood to injury -platlets aggregate site -plasma coagulate and stabilize clot with fibrin -plasma proteins- albumins, fibrogen, globulins -albumin maintain fluid balance
Bone marrow transplant graft vs host DX: can occur in first 100 days, give immunosurpressants immunosupressants- blisters, rash, abd pain MGMT during infusion: vitals, O2,fevers,chills,SOB,aniexty,taste changes Watch for infection- varicella, eyes, liver, skin, plum abnorm
Coagulpathies bleeding and clotting disorders:DIC,anemia,Thrombocytopenia ,Myeloproliferative,thrombocytosis
DIC(disseminated intravascular coagulation) Acute complications of SEPSIS, liver dx,transfusions Phase 1: little clots devolp throu circulation Phase 2: inability to clot- hemmorage Cause- sepsis causes overproduction of fibrin S/S: decreased platlets, increased FSP/d-dimer, depends on phase 1/
Anemia S/S a/w hypoxia
Thrombocytopenia decrease in platlets 3 Types:ITP.TTP,HIT TX: steriods,transfusion, immunosurpessants, splenectomy(platlet destruction
ITP(idopathic) - ITP:common in kids/woman, acute a/w with kids post virus 6months self limiting, chronic- may be triggered by lupus S/S: petiachie,easy brusing, decreased platlets TX: infusion/immunosurpressants
TTP caused by a large thrombus collecting platlets
HIT(heparin induced) give argatroban (safe anticoagulant)
Myeloproliferative disorders Increased number of cells -polychemiavera
Polycemia vera increased RBCs, hypercellular bone marrow, S/S: increased blood volume/viscosity, enlarged spleen, itching, increased H&H for a substained time, headache,HTN 3 cardnal signs: increased RBC mass, norm O2, enlarged spleen TX: remove 500 ml 1-2xwk,antico
Thrombocytosis stem cell disorder in bone marrow,increased platlets, unknown causes, hemmoraging/vascular occulision can occur S/S: burning,pain,warmth,headache,petichie Risks: >60, thrombolitic events
Hematologic maligances myelomas:mulitple/waldenstorms Lymphomas:hodgskins/non-hodgkins Leukemias:ALL,CLL,HCL,AML,CNL
ALL(acute lymphatic leukemia) a/w YOUNG KIDS, over production of immature white cell B cell, very curable, 4-5 yr olds and eledry 405 cure rate S/S: fatigue, fever,infection,bleed/bruise joint and bone pain, elarged lymphs/spleen TX: chemo/local raidation/BMT for long term survival
CLL CLL(chronic lymphaotic leukemia) common in eledry pts,mature leukemia cells S/S: asyptomatic- enlarged lymph nodes, DRENCHING NIGHT SWEATS,fever, wt loss
AML(acute myeloid leukemia) effects all ages, 5 yr survival rate that decreases with age, decreased cell production S/S: fever, infections from neutropenia, very weak, pain from enlarged liver/spleen, bleeding complications: bleeding/infection- two causes of death
CML(chronic myeloid leukemia) myeloid stem cell mutation,uncontrolled cell growth,BMT=cure S/S: tierd, increased WBCs, anorexia,SOB, pain, enlarged liver/spleen- tenderness
Lymphomas tumors usually start in the lymph nodes
Hodgkins M>W, early 20s/>50 unknown causes/a/w viral and pts on immunosuressants, reed sternberg cell S/S: PAINLESS enlraged lymph nodes, all organs can be invaded DX: increased nodes, reed sternberg, pet scan, Xray
Non-hodgskins lymphoid tissues are infiltrated by CA cells in multi sites, delayed DX because no S/S S/S: DRENCHED NIGHT SWEATS,fever, nausea, wt loss DX: cat scan, pet scan, BM biospy Classification- eledry, age, blood levels,risk for failure
Mulitple Myelomas increased # of immuglobins (M.protein) classic sign= bone pain(back/ribs), bone injury, increased M protein No cure, spreads to other organs/longbones Two markers: increased albumin/beta 2 mircoglobin 5 yr survival rate
Blood transfusion acute blood loss
Reactions to blood transfusions Acute hemolytic: error with blood, chest/back pain, fever, chills Allergy- hives/itching Fibrile: reaction to WBCs- S/S MGMT Delayed hemolotic- 14 days after- signs- fever, increased billirubin, anemia TRALI: transfusion related lung jury, 1-2 hrs pos
Oncology emergencies SVC,hypercalemia,DIC,spincal cord compression
Suprerior vena cave syndrome compression/invasion of SVC by tumor/lymph/thrombus -a/w lung/breast CA S/S: SOB,cough,hoarseness,chest pain, FACIAL EDEMA, decreased swallowing, increased ICP, JVD, decreased LOC -MGMT:radiation,chemo,stents,anticoagulants, corticosteriods, dierectics
Hypercalcemia increased calicum is released from the bones and kidneys cant excrete it S/S: fatigue, confusion, decreased LOC, dehydration, N/V, dyshythmias MGMT: increase fluids, increase molbilty, antiemetics, pt edu of S/S
DIC coagulation disorder that results in thrombus/bleeding Phase1=excessive cloting (chronic) phase2- hemmoraging (acute) MGMT: chemo/raidation/SX- treat underlying DX first-sepsis, blood transfusion, anticoagulants
Spinal cord compression a/w tumor, lymphomas,decreased nerve supply, breast/lung/kidney/prostate CA S/S: local inflamm, decreased blood supply, increased pain with movement, decreased ROM, MGMT: raidation to decrease tumor, corticosteriods, SX,chemo
Hepatic disorders Liver Dx, cirrhosis, encephalaphy, hepatis
Liver largest gland, RUQ, very vascular Storage: minerals, vitamins Protection: detox,RBCC destruction/bacteria, secretes bile/bilirubin,plasama proteins Metablizes:gluclose,ammonia,protein,fat, drugs
Cirrhosis of the liver types: alcoholic,postnercotic,billary causes:alcoholism a/w nutrition,infection, nuturtional defenicies S/S:jaundice,portal HTN, ascites, coma, edema, decreased LOC, spleen/liver enlarge complications:bleeding, hepatic encephalaophy, FVE
Jaundice yellow-green body tissues a/w increased bilirubin levels Types:hemolytic,hepatocelluar/obsrtuctive(liver Dx), hereitary -hepatocelluar S/S:appear ill, decreased appetite, nausea, fatigue, headache chills -obstructive:dark/orange urine, impaired fat dig
Portal HTN flow obstruction in liver leads to HTN which results in ascities in abd/peritoneal
Ascites increased fluid retention/decreased albumin synthesis Assesment:abd girth, daily wt, fluid wave TX: low Na diet, diurectics, paracenteis, bed rest
Hepatic encephalaphy/coma complication of liver Dx, accum of ammonia/toxins in the blood -assesment: EEG,decreased LOC/neuro checks, seizures, monitor electrolyes Asterxiz-flapping tremor, damage to brain cells MGMT: elmin cause of Dx, decreased ammonia levels,IV gluclose
Bleeding Esophagel varices a/w patients with cirrohsis -S/S: hemtatemesis, shock, deteroration - pt w/ cirrohsis should have endo q 2 yrs Tw: shock tx,O2,Iv fluids, blood, nitro, decrease HTN, portal shunts, ballon tamponade,
Hepatitis inflamm of the liver caused by a virus, bacteria or drugs Viral- systemic virus that causes necrosis/liver inflamm Non-viral:toxin/drug induced
Hep A(HAV) FECAL-ORAL transmission, spread by poor hyngine, hand to mouth, foods/fluids -incubuation 15-50 days/ lats 4-8 weeks -S/S: flu like, low fever, anorexia, jaundice, indigestion, epigastric pain, enlraged liver/spleen MGMT: good hygeine, vaccine,rest
Hep B(HBV) BLOOD TO BLOOD, salvia, sexually, mother to infant, major cause of cirrohsis/ liver CA - long incubation 1 to 6 months S/S: flu like, low fever,jaudice, indeigestion MGMT: vaccine, standard precuations, nutritonal support, meds: interferon, hepsera,Epi
Hep C BLOOD TO BLOOD, sexual,needles, blood borne infection -liver transplant is common -incubation varies S/S:mild MGMT: blood screening, prevent needle sticks, no alcohol, anti viral: riapfam/interferon
Hep D only people with HEP B can get HEP D, BLOOD TO BLOOD, sexual S/S: similar to B but deveolp liver Dx/ cirrohsis faster
Hep E FECAL-ORAL, resembles Hep A but is self limiting with abrupt onset, no chronic form 15-65 day incubation period
Pancreatis inflamm of exocrine tissues caused by digestive enzymes attacking the pancreas, can be very deadly Cardinal signs: abd pain, increased proteins, nausea/vomitting Causes:cholethasis,viral,alcohol,trauma, obesity, increased calcium/lipids,idoptthc
Acute Pancreatitis duct is obstructed and enzymes back up into the pancreas causing auto digest/infalmm S/S: serve abd pain, acutely ill, nausea/vomitting, fever, confusion,jaundice, eccymosis on flank/umblical, shock S/S Tx: pain MGMT,NGT,NPO,IVF,nausea control
Chronic pancreatitis progressive inflamm with pancreas destructions, cells are replaced by fibrous tissues and obstruct CBD S/S: recurrent serve upper abd/back pain, vommiting, wt loss, Complications: fluid/eletroye imbalance, nercosis of pancreas, DIC, organ dysfxn
NGT decompress stomach, monitor drainage, measure tube placement, check placement with 20-50ml air blous, irrigate every 4 hrs, watch for sudden change in drainage it could mean displacement
Created by: ndeluca08
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