MedSurge Unit 1 Review

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MedSurge Unit 1 Review
2012-01-30 23:11:00
MedSurge Unit Review

MedSurge Unit 1 Review
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  1. Nursing care for stomatitis and nursing diagnoses
    • Stomatitis - inflammation and ulcers of the oral mucosa
    • Oral mucositis - damage to submucosa caused by chemotherapy or radiation therapy

    • Nursing Care:
    • +regular mouth care - brushing and flossing
    • +pt on antibiotics should have yogurn or buttermilk unless contraindicated
    • + pt on chemo or radiaiton should aviod use of alcohol and tobacco

    • Nursing Dx:
    • Impaired Oral Mucous Membrane
    • -assess oral mucous membranes & lesions q 4-8 hrs
    • -mouth care after meals, at bedtime, q 2-4 hrs while awake - saline or sodium bicarb rinse - no mouthwash (alcohol)
    • -Teach about condition, mouth care and treatments - instruct to avoid tobacco, alcohol, and spicy foods

    • Impalanced Nutrition: Less than body Requirements
    • -Assess food intake and pt ability to chew and swallow. Daily weight. Provide straws or feeding syringes as needed
    • -Encourage high-calorie, high-protein diet considerate of food preferences. Soft foods as needed, eggnog, milk shakes, ensure, popsicles, pudding, etc
    • -provide analgesics for pain as needed
  2. Care for alopecia
    -Discuss the pattern and timing of hair loss

    -Encourage wearing cheerful, brightly colored head coverings; assist in color coordinating them with usual clothing

    -Refer to a good wig shop before hair loss is experienced

    - Refer to support groups "Look good....Feel Better"

    - Reassure that hair will grow back after chemotherapy is discontinues - but color and texture of new hair may be different
  3. Ways to prevent cancer/ Modifiable Risk Factors
    • Poverty?
    • Stress?
    • Diet
    • Occupation?
    • Toacco use
    • Alcohol use
    • Recreational Drug Use
    • Obesity
    • Sun Exposure

    • Diet:
    • Avoid obesity
    • cut down on fat intake
    • include variety of fruits & vegs daily
    • Eat more high-fiber foods - whole grain cerals and breads, vegs, fruits
    • Limit alcohol
    • limit salt-cured, smoked, and nitrate-cured foods
  4. 5 Types of Antineoplastic drugs
    • Alkylating agents
    • Mitotic Inhibitors
    • Antimetabolic agents
    • Antineoplastic antibiotics
    • Hormones and hormone
  5. Alkylating Agents
    • Non- phase specific
    • Alkylating Agents - kills cancer cells by alterig the shape of the DNA double helix in a way that prevents DNA from duplicating

    • Nitrogen Mustards -Cyclophosphamide
    • nitrosoureas
    • platinum compounts

    Side Effects - headache, alopecia, nausea, vomiting, stomatitis, anorexia, fluid retention, bone marrow suppression, neurotoxicity, ototoxicity, pumonary toxicity, anaphylaxis
  6. Antimetabolites
    Antimetabolite Agents- interferes with metabolic processes (usually) in the S phase causing cell death. Mimick nutrients that the cell uses to synthesize DNA, RNA, and proteins. When antimetabolites are used they dont function properly causing disruption of cell function.

    • Folic Acid analogs -Methotrexate,
    • Purine analogs
    • Pyrimidine analogs - 5-fluorouracil

    Side Effects: Nausea, vomiting, stomatitis, anorexia, rash, alopecia, headache, bone marrow supression, diarrhea, mucositis, hepatotoxicity, pulmonary toxicity, neurotoxicity, anaphylaxis
  7. Antitumor Antibiotics
    • non phase specific
    • Antibiotic Antineoplastic Agents - contain substances obtained from bacteria that have the ability to kill cancer cells - bind to DNA & changes its shape like alkylating agents but must be administered IV into the body orgna or cavity - very cytotoxic so only used for specific cancers

    • Anthrocyclines - Adriamycin
    • Nonanthracyclines - Bleomycin

    Side Effects - nausea, vomiting, stomatitis, anorexia, headache, rash, alopecia, bone marrow suppression, mucositis, pulmonary toxicity, cardiac toxicity, anaphylaxis
  8. Hormones and Hormone Antagonists
    Hormones - only effecive on hormone dependent cancers such as breast and prostate cancer - block hormones that are essential for tumor growth - not cytotoxic


    Side Effects Hormones: Weight gain, abdominal distension, sweating, flushing, diarrhea, nervousness, hirsutism, thrombophlebitis, muscle wasting, osteoporosis, hepatotoxicity

    Side Effects Hormone antagonists - hot blashes, insomnia, breast enlargement or pain, headache, diarrhea, nausea, CHF, sexual dysfunction, ocular toxicity
  9. Mitotic Inhibitors
    • • Mitotic Inhibitors - Interferes in the M phase and inhibits cell division by blocking mitosis. Binds to tubulin and interferes with mitotic spindle Slows or stops the disease process.
    • vinca alkaloids - Vincristine

    Side Effects: Nausea, vomiting, stomatitis, anorexia, rash, alopecia, loss of energy and strength, bone marrow suppression, pulmonary or cardiac toxicity, nephrotoxicity, neurotoxicity, anaphylaxis
  10. Interventions for Chemo-related nausea
    • administer antiemetic drugs
    • encourage small, frequent, low-fat meals with dry foods such as crachers and toast
    • avoid liquids with meals
    • sit upright for an hour after eating
  11. Purposes of surgery for cancer
    • Cure- primary treatment (60%)
    • Diagnostic (90%)
    • Prophylaxis
    • Debulking procedure
    • Palliation
    • Body image disturbance - reconstruction
  12. Early warning signs of cancer and screening/ testing (mammogram, PSA, occult blood)
    • • C Change in bowel or bladder
    • • A A lesion that does not heal
    • • U Unusual discharge from any orifice
    • • T Thickening lump in breast or elsewhere
    • • I Indigestion or difficultyswallowing/dysphagia
    • • O Obvious change in a wart or mole
    • • N Nagging cough or persistent hoarseness

    • Pain in later stages
    • • Fatigue
    • • Cachexia
    • • Anemia
    • • Infection/leukopeniaWBC’s < 4,000 (Normal 5,000-10,000)
    • • Bleeding/thrombocytopeniaPlatelets < 150,000 (Normal 150,000-400,000 uL)
  13. Needle biopsy & limitiations
    Fine needle biopsy - use of a very thin needle to aspirate a small amount of tissue from the tumors

    Needle core biopsy - use of a slightly larger needle than that used for a fine-needle biopsey to extract a small amount of tissue from tumors that cannot be aspirated by fine-needle aspiration
  14. Side Effects of vascualr access devices
    • risk for infection
    • catheter obstruction
    • extravasation

    teach to observe for redness, swelling, pain, or exudate at site
  15. Mastectomy postop exercises
  16. Cancer pain management
    • 1. ongoing assessment of pain
    • 2. Evaluate patients functional goals
    • 3. Est a plan with combinations of nonnarcotic drugs with adjuvants (corticosteroids, antidepressants)
    • 4. Eval degreee of pain relief
    • 5. Progress to stronger drugs as needed
    • 6. Try combinations and escalate dosages until maximal pain relief balanced with patients need to funciton is anchieved
  17. Mastectomy complicaitons and care
  18. Radiation treatment and care
    Radiation therapy - delivering ionizing radiations of gamma and x-rays

    External radiation - teletherapy - from outside the patient - delivers relatively uniform dosage

    • Internal radiation - brachytherapy - seed planted in the tissue
    • - keep pt in private room
    • -dispost of body fluids in special containers
    • -limit visitation
  19. Ways cancer spreads/ metastasizes
    -embolism in the blood/ lymph