Nursing_Skills 2

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ilikepinkeverything
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Nursing_Skills 2
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2012-02-08 21:01:25
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  1. General Disease-related consequences of Cancer
    • Impaired immune and blood-producing function
    • Altered GI structure and function
    • Motor and sensory deficits
    • Decreased respiratory function
  2. Untreated cancer leads to....
    death
  3. Oldest form of Cancer treatment
    Surgery
  4. Types of surgery used for Cancer treatment
    • Prophylaxis
    • Diagnosis
    • Cure
    • Control
    • Palliation
    • Second-look Surgery
    • Renconstruction or rehabilitation
  5. Type of surgery used as a preventative measure in cancer treatment
    Prophylaxis
  6. Type of surgery used for testing in cancer treatment
    Diagnosis
  7. Type of Surgery where removal is used in cancer treatment
    Cure
  8. Surgery used in cancer treatment to help slow progress of cancer, not cure it
    Control

    Part may be removed
  9. Surgery used to improve the quality of life of a cancer patient, in cancer treatment
    Palliation
  10. Type of surgery used to check the status of a cancer
    Second-look surgery
  11. Purpose of Radiation Therapy for cancer
    to destory cancer cells with minimal exposure of the normal cells to the damaging actions of radiation
  12. Teletherapy
    • radiation
    • distant treatment- source external to patient
    • pt is not radioactive and is not a hazord to others
  13. Brachytherapy
    • radiation
    • internal-in the patient and amit radiation
  14. unsealed Brachytherapy
    isotopes are eliminated in waste products with are radioactive and should not be touched, once isotope is eliminated (w/i 48) pt and waste no longer radioactive
  15. Sealed Brachytherapy
    pt emits radiation while implant is in place but are not radioactive and are not a hazard to anyone
  16. Side effects of Radiation Therapy
    • vary according to the site
    • Local skin changes
    • Permanent hair loss (depending on dose)
    • Altered taste sensations
    • Fatigue related to increased energy demands
    • inflammatory responses that cause tissue fibrosis and scarring
  17. Nursing Care of Patients undergoing Radiation Therapy
    • Teach accurate objective facts to help patient cope
    • Do not remove markings
    • Administer skin care
    • Do not use lotions or ointments
    • Avoid direct exposure of the skin to the sun
    • Care for xerostomia
    • Bone exposed to radiation is more vulnerable to fracture
  18. What is Xerostomia
    dry mouth
  19. Chemotherapy
    • Treating cancer w/ chemical agents
    • major role in cancer therapy
    • used to cure and increase survival time
    • some selectivity for killing cancer cells over normal cells
  20. Normal cells most affects by chemotherapy
    • skin
    • hair
    • intestinal tissues
    • spermatocytes
    • blood forming cells
  21. Cause of most chemotherapy side effects
    affected normal cells
  22. Chemotherapy drugs
    • Antimetabolics
    • Antitumor antibodies
    • Antimitotic agents
    • alkylating agents
    • Topoisomerase inhibitors
    • Miscellaneous chemotherapeutic agents
    • Combination chemotherapy
  23. Side effects of Chemotherapy
    • Anemia, neutropenia, thrombocytopenia
    • Temporary alopecia or hair loss
    • nausea or vomiting
    • Musocitis in the entire GI tract
    • Skin changes
    • Anxiety, sleep disturbance
    • altered bowel elimination
    • Changes in cognitive function
  24. Neutropenia
    a condition of an abnormally low number of neutrophils (white blood cells)
  25. Thrombocytopenia
    is any disorder in which there is an abnormally low amount of platelets
  26. A drug that interferes with a cell's growth or ability to multiply.
    Antimetabolite
  27. a new class of anticancer agents with a mechanism of action aimed at interrupting DNA replication in cancer cells, the result of which is cell death.
    Topoisomerase I inhibitors are
  28. A natural product that interferes with deoxyribonucleic acid in such a way as to prevent its further replication and the transcription of ribonucleic acid
    antitumor antibodies
  29. a group of specialized drugs used primarily to treat cancer
    Antineoplastic agents
  30. painful inflammation and ulceration of the mucous membranes
    Mucositis
  31. Nursing Care for Chemotherapy Patients
    • Infection risk (reverse isolation when WBC low)
    • CIN-Chemotherapy induced nausea and vomiting (antimetics)
    • Mucositis (Swish and spit, no alcohol)
    • Alopecia (help w/ body image disturbance)
    • Changes in cognitive function (reorienate them-Safety)
    • Peripheral Neuropathy (refer pain management-Safety)
  32. Hormonal Manipulation
    • not as common
    • not cure, increases survival time

    • Some hormones make hormone sensitive tumor frow more rapidly
    • Some tumors actually require specific hormones to divide-decreasing the amount of these hormones to hormone-sensitive tumors can slow the cancer growth rate
  33. Side effects of Hormone Therapy
    • Androgens and antiestrogen receptor drugs cause masculinizing effects in women (chest, facial hair, no mentstral, lack breast)
    • for men and women receiving androgens, acne may dvelop, hypercalcemia is common and liver dysfunction may occur with prolonged therapy
    • feminine manifestation in men who take estrogen, progestins or antiandrogen receptor drugs
    • gynecomastia
  34. Gynecomastia
    Breast development in males
  35. Gene Therapy
    • Experimental as a cancer treatment
    • renders cancer cells more susceptible to damage or death by other treatments
    • inj into tumor cells, enabling the immune system to better recognize cancer cells and kill them
  36. Oncologic emergencies include...
    • Sepsis and disseminated intravascular coagulation
    • Hypercalcemia
    • Tumor lysis syndrome
  37. Management of Sepsis and disseminated intravascular coagulation include
    • prevention (the best measure)
    • IV antibiotic therapy
    • Anticoagulants, cryoprecipitated factors
  38. Management of Hypercalcemia
    • Oral hydration
    • Normal Saline IV
    • Drug Therapy
    • Dialysis
  39. Management of Tumor lysis syndrome
    • Prevention-through hydration
    • Hydration- dilute serum potassium and increase kidney filtration
    • Drug therapy-to treat specific high levels
  40. Hypercalcemia
    occurs most often in patients with bone metastasis

    s/s Fatigue, loss of appetite, nausea and vomiting, constipation, polyuria, severe muscle weakness, loss of deep tendon reflexes, paralytic ileus, dehydration, electrocardiographic changes
  41. Tumor Lysis Syndrome
    Large number of tumor cells are destroyed rapidly, resulting in intracellular conrents being released into the bloodstream faster than the body can eliminate them
  42. Accronym CANCER
    • C=comfort
    • A= altered body image
    • N=Nutrition
    • C=Chemotherapy
    • E=Evaluate Response to Meds
    • R= Respite for Caretakers
  43. Any microorganism capable of producing disease
    Pathogen
  44. infection transmitted from person to person
    Communicable
  45. The ability to cause disease
    pathogenicity
  46. Virulence
    the degree of communicability (strength)
  47. Normal Flora
    characteristic bacteria of a body location, often competes with other microorganisms to prevent infections
  48. Colonization
    the micoorganism present in tissue but not yet causing symptomatic disease
  49. Surveilance
    the tracking and reporting of infections

    CDC
  50. Chain of infection
    • Reservoirs (where its being held ex. soil, animal, water)
    • Pathogens (Toxins, Endotoxins)
    • Host Defenses (Susceptibility-risk)
  51. Immunity
    resistance to infection is usually associated with the presence of antibodies or cells acting on specific microorganisms
  52. Passive Immunity
    • short duration, either naturally by placental transfer or artificially by injection of antibodies
    • ex-mother to child
  53. Active Immunity
    last for years and occurs naturally by infection or artificially by stimulation (vaccine) of immune defenses
  54. Portal Of Entry Sites for infection
    • Respiratory Sites (breathing)
    • GI tract (eating)
    • Genitourinary tract (cathater)
    • Skin/mucos membranes
    • Bloodstream (Cuts)
  55. Mode of Transmission
    • Contact transmission-direct or indirect contact
    • Droplet transmission- i.e. influenza
    • Airborne transmission- tuberculosis
    • Contaminated food or water- covleria
    • Vector-borne transmission (insect or animal carriers)- Lyme disease
  56. Physiologic Defenses Against infection
    • Body Tissues(skin, mucous membranes, flushing urine, tears)
    • Phagocytosis ( neutrophils engolf and kill, digest)
    • Inflammation (Histamine realease bring neutrophils)
    • Immune Systems (antibody mediated, cell mediated)
  57. Infection Control in Inpatient Health Care
    • Health care associated Infection
    • Endogenous Infection
    • Exogenous Infection
  58. Health care-associated Infection
    is acquired in the inpatient setting, not present at admission
  59. Endogenous Infection
    from a patients flora
  60. Exogenous Infection
    is from outside the patient, often from the hands of health care workers
  61. Methods of Infection Control, in Inpatient Health care
    • Practice hand hygiene and proper handwashing
    • Personal protective equipment (mask, gloves, gown, hairnet)
  62. Infection Control in inpatient health care
    • Adequate staffing-have time to be safe
    • Sterilization- sterlizing equipment, cohoarding pts
    • Disinfection
    • Patient placement
    • Patient Transportation- wear mask
  63. Cohoarding
    putting patients with same illness in same room
  64. CDC and Prevention Transmission Based Guidelines
    • Standard Precautions
    • Respiratory hygiene/cough etiquette (RH/CE)
    • Safe Injection Practices (1 needle, 1 syringe per patient)
  65. Transmission based precautions
    • Airborne Precautions- Negitive Airflow room (TB, rubeola, chickenpox)
    • Droplet Precautions- (Flu, whopping cough)
    • Contact Precautions-(MRSA, VRE, CDIFF, Lice)
  66. Methicillin-Resistant Staphylococcus Aureus (MRSA)
    • Treated with Vancomycin, Linezolid (Zyvox)
    • the best way to decrease the incidence of this growing problem is health teaching
  67. Multi-drug Resistant Organisms (MDROs)
    • Vancomycin-resistant Enterococcus (VRE)
    • Multidrug resistant Tuberculosis
    • Gonorrhea
    • Vancomycin-intermediate Staphylococcus aureus (VISA)
    • Vancomycin-resistatn S. aureus (VRSA)
  68. Collaborative care for patients with infections
    History (MRSA, immunosupprese, age, meds, travel, family, nutrition, sexual )

    Physical assessment and clinical manifestions (Fever, swollon lymphnodes, GI problems, pain, swelling, heat)

    Psychosocial assessment( How do you feel? Social stigmas)
  69. Laboratory Assessment for infections
    • Culture and antibiotic testing
    • complete blood count (with diff, include 5 tyoes WBC)
    • Erythrocye sedimentation rate (increase ESR=inflammation)
    • serologic testing (identifies antibody)
    • imaging assessment (X-rays)
  70. Shift to the Left
    in increase in inmuture white blood cells (Bands)
  71. associated with antibiotics esp. with older adults
    CDIFF
  72. Neutropenic Precautions
    protect patient from others aka reverse isolation

    • No flowers, fruit, childeren
    • No people with fevers, vacinations, sick
  73. Mono causes neutraphils to....
    decrease
  74. How is HIV spread?
    through blood or sex, not salvia (unless bloody)or urine (unless bloody)
  75. Immunodeficiency
    Failure of immune mechanisms of self defense

    Primary (congenital) immunodeficienc-born with

    Secondary (acquired) immunodeficiency-caused by another illness (cancer,infection) More common
  76. Altered immunologic response to antigen that
    results in disease or damage to host
    hypersensitivity
  77. 4 Types of Hypersensitivity
    • Type I: IgE mediated ex. Immediate
    • Type II: Tissue-specific reactions
    • Type III: Immmune complex mediated
    • Type IV: Cell Mediated
  78. Seasonal allergic rhinitis and asthma are
    examples of:
    • Type 1 hypersensitivies
    • IgE mediated reaction
    • Rate of development-Immediate
    • Antibody involved-IgE
  79. Autoimmune thrombocytopenic purpura, Graves
    disease, autoimmune hemolytic anemia, Erythroblastosis Fetalis, blood incompatabilities are examples of:
    • Type 2 hypersensitivies
    • Tissue specific reaction-cytotoxic
    • Rate of development-Immediate
    • Antibody involved- IgG and IgM
  80. , Serum sickness, arthus reaction-local reaction, Acute glomerulonephritis that follows strept infection is an example of:
    • Type 3 hypersensitivies
    • Immune complex mediated reaction
    • Rate of development-Immediate
    • Antibody involved-IgG and IgM
  81. Graft rejection, Skin test for TB, Allergic contact dermatitis- poison ivy and metals are examples of:
    • Type 4 hypersensitivies
    • Cell-mediated reaction
    • Rate of development-Delayed
    • Antibody involved-None
    • Effector cells involved-lymphocytes and macrophages
  82. Autoimmunity
    attack on host cell

    ex- Systemic lupu erythematosus (SLE), Rheumatoid arthritis (RA), chronic fatigue syndrome
  83. To meet the CDC definition for AIDs a client must...
    • be HIV positive and
    • have a CD4 count less than 200/mm3
    • or
    • Have any of the health problems (OI's) listed under clinical category C, regardless of CH4 count
  84. Opportunistic infections
    Organisms produce infection in persons w/impaired immune function
  85. Desired Test results for someone with HIV
    • want viral load low
    • want CD4 cound high
    • Reverse transcriptase low
  86. CDC Clinical CD4 cell Categories for HIV infection and AIDs case
    • 1= >500
    • 2= 200-499
    • 3= <200
  87. CDC Clinical Categories A for HIV infection and AIDs case
    • HIV positive, asymptomatic
    • or Persistent generalized lymphadenopathy
    • or Acute (primary) HIV infection with accompanying illness or history of acute infection as the only manifestations

    and A1, A2, A3
  88. CDC Clinical Categories B for HIV infection and AIDs case
    • Bacterial endocarditis, meningitis, pneumonia, sepsis, Vulvovaginal Candidiasis, Oropharyngeal Candidiasis (thrush), Severe cervical dysplasia or carcinoma, Fever, diarrhea >1 month, Oral hairy leukoplakia, Herpes Zoster
    • Idiopathic thrombocytopenia purpura, Listeriosis, Pulmonary Mycobacterium tuberculosis, Nocardiosis
    • Pelvic inflammatory disease, Peripheral neuropathy,

    and B1, B2, B3
  89. CDC Clinical Categories C for HIV infection and AIDs case
    Bronchial, tracheal, pulmonary, esophageal candidiasis, Invasive cervical cancer, Disseminated or extrapulmonary coccidioidomycosis, Chronic intestinal cryptosporidiosis, cytomegalovirus, encephalopathy, Herpes Simplex, Disseminated or extrapulmonary histoplasmosis, Chronic intestinal isosporiasis, Kaposi's sarcoma, Lymphoma, Extra pulmonary M. Tuberculosis, Pneumocystis jiroveci pneumonia, leukoencephalopathy, Salmonelle septicemia, Toxoplasmosis, Wasting Syndrome
  90. and C1, C2, C3
  91. Patient history of skin (chart 26-2)
    Usual skin condition and changes that have occurred

    When did this problem start/how long has it been there.

    Is the problem associated with anything?

    What is nutritional status

    Does anything help or make worse?

    Assess family hx, meds, allergies, social history and travel
  92. What to assess for re:skin
    Table 26-2
    Color-erythema, pallor, cyanosis, jaundice

    Temperature

    Moisture-Dry, moist, oily

    Elasticity, turgor, edema-assess turgor of back of hand, sternum

    Texture-soft, smooth, rough, scarred

    Vascular changes-petechia, ecchymosis, birthmarks
  93. Ingestion of _____________ causes redness to skin
    Alcohol
  94. How to assess dark colored patients
    Mucousa and Nailbeds
  95. What should I assess for with skin
    Thickness-callus, scarring, keloids, skin changes with aging

    Odor-draining lesions which should be cultured.

    Hair and Nails-alopecia, hirsutisim, infestionation of nits, capillary refill, clubbing (table 26-5, 26-6)

    Skin lesions Fig. 26-13

    Skin changes related to aging Chart 26-1

    Assessing changes in dark skin:Chart 26-3
  96. Role of skin and human need for protection
    Skin problems can reduce protection

    Minor skin irritations-priority is increasing pt comfort and preventing skin injury

    • Xerosis-Dry
    • Pruritis-Itching
    • Uticaria-Hives

    Review p480-481
  97. What are the 6 assessment variables of Braden Scale?
    • 1.Sensory perception-ability to respond to pressure related discomfort
    • 2. Moisture-degree to which skin exposed to moisture
    • 3. Activity
    • 4. Mobility
    • 5. Nutrition
    • 6.Friction and shear
  98. Labs important to assess pressure ulcers
    Swab cultures helpful only inidentifying types of bacteria present on ulcer and may be misleading when trying to identify or quantify bacteria in deep tissue.

    Wound biopsies allow # of bacteria to be analyzed but are time consuming, costly and unavailable in many labs.

    Therefore clinical findings of size , depth, change to quantity and quality of exudate and systemic signs of bacteria (fever, Elevated WBC)are used
  99. Prevention of Pressure ulcers

    chart 27-2 pt 485
    Positioning

    Nurtrition-2 to 3K mL/day

    Skin Care

    Skin Cleaning
  100. Stages of PU (chart 27-5) p.497
  101. Concept Map PU (p.492)
  102. Break down of Braden Scale
    23-High skin integrity

    16-Mild

    11-Severe

    Higher the score-less risk involved
  103. General PU care
    (chart 27-4) p.493
    • 1.Describe characteristics including size, location, exudate, granulation/necrotic, epithelialization at regular intervals
    • 2.Monitor color, tem,edema, moisture, and appearance
    • 3.Keep moist to aid in healing
    • 4. clean w/mild soap and water
    • 5. debride as needed
    • 6.apply dressings prn
    • 7.adequate dietary intake and nutritional status
    • 8.teach
    • 9. initiate consult with CWS-certified wound specialist
    • 10. position q1-2 hr
  104. Dressings for PU
    Table 27-5 p.494
    • Alginate
    • Biologic
    • Cotton Gauze
    • Foam
    • Hydrocollodial
    • Hydrogel
    • Adhesive Transparent film
  105. New technologies of PU intervention
    Electrical stimulation-CWS, 1 hr/day 5-7 days/wk-contraindicated for pacermaker pt or near heart

    Wound vac complications-failure of VAC is d/t inability to maintain adequate and consistent dressing seal

    Hyperbaric Oxygen(HBO)-100% Oxygen for 60-90 min time

    Topical growth factors (PRP, PDGF)

    Skin substitutes (apligraf, dermograf, biobrane, oasis) manufactured skin
  106. Post op surgical debridment of pressure ulcer
    P. 496
    Graft sites immobilized with bulky cotton pressure dressing for 3-5 days to allow "take" of newly grafted skin.

    Do not disturb dressing and encourage elevation and complete rest of area

    After dressing removed, monitor for failure to vascularize, nonadherence to wound or graft necrosis
  107. Preventing infection and monitoring of wound
    P. 497
    • Discharge
    • odor
    • color
    • size depth
    • pain
  108. Diagnostic tests for skin infection
    Potassium Hydroxide-identifies fungal

    Tzanck smear-viral like herpes zoster

    • Culture-Gram stain and culture and sensitivity
    • Common skin infection staph and MRSA

    Skin biopsy-examine lesion to differentiate benign from skin ca

    Wood's Light-aids in diagnosis of fungal infections of scalp and body (color noted in dar room)
  109. Superficial infection involving only upper portion of follicle and caused by staph. Rash is raised and red and usually shows small pustules
    Folliculitis
  110. Also caused by staph but infection muche deeper in follicle. Larger, sore looking raised bum may or may not have pustular head
    Furuncle

    Carbuncle-more than one infected follicle
  111. Generalized infection with staph or strep and involves deeper connective tissue
    cellulitis
  112. Increasingly common skin problem that can range from mild folliculitis to extensive furuncles. Easily spread to other body aread and to others by direct contact with infected skin, clothing, bed linens, towels and other objects
    MRSA-methicillin resistant stahylococcus aureus
  113. 2 types of MRSA
    hospital associated

    Community associated

    Dx:drainage or blood culture
  114. Antibiotics used to treat community MRSA
    • Bactrim
    • clindamycin
    • Minocycline
    • Doxycycline
  115. Antibiotics used for Hospital assoc MRSA
    More severe cases

    • Vancomycin
    • Zyvox
    • Synercide
  116. Teaching involved with MRSA
    • Hand hygiene
    • good nutrition
    • Not sharing personal items
    • Do not squeeze or try to open pimple or boil
    • Take full course of ATB
    • ATB teaching (chart 27-9)
    • Preventing spread of MRSA(chart 27-8)
  117. Herpes Zoster
    Viral

    • Assessment:
    • Hx of chickenpox,declined immune
    • Vesicular lesions in linear patter along dermatone
    • Macules, vesicles, crusting
    • malaise, fever, itching
    • Postherpetic neuralgia

    DX:Tzanck smear and viral culture
  118. Herpes Zoster Management
    Anitvirals:Acyclovir (Zovirax), valacyclovir (valtrex)

    Analgesics, topical antipruritics, corticosteriods (lyrica and lidoderm patches)

    Loose clothing

    Avoid exposure to susceptible persons

    Pain management for post herpetic neuralgia
  119. Who should not care for shingles pts?
    • Pregnant women
    • Children
    • Those not exposed to chickenpox
  120. Teaching of Herpes Zoster
    Prevent spread of infection

    Trim nails, hands clean, don't scratch

    Care of lesions
  121. Is there a vaccine for shingles?
    Yes-Zostavax for 60 yrs and older

    SQ injection
  122. Tinea
    • Fungal
    • Feet-pedis
    • Body-corporis
    • hands-manus
    • head-capitis
    • groin-cruris
  123. s/s of tinea
    Red raised borders, pruritis and erythema

    circular patches with raised red border, painful fissures in toe webs

    Warm moist environments

    Microscopic exam using KOH or wood's light
  124. Management of tinea
    Antifungals: Oral, topical

    Drugs:Nystatin, clotrimazole, ketoconazole (nizoral) systemic
  125. Teaching of tinea
    • For tx regimen
    • Keep affected areas clean and dry
    • Dry all skin folds, assess daily
    • Wear cotton socks and underclothing
  126. Pediculosis
    • (lice)
    • Parasitic

    • Assess
    • Head, body, pubic
    • Mite and Nits (eggs)
    • papules and pruritus
    • Person to person contact
    • hats, brushes, combs, clothing

    Dx-Inspection and microscopic exam
  127. Scabies
    parasitic

    • Assess
    • Skin to skin contact
    • small red/brn some with vesicles pruritic lesions
    • Brn lines on webs b/t fingers,wrists, axilla, waist
    • Intense itching at night

    Dx:scraping under microscope
  128. Lice and scabies management
    permethrin (NIX, Elimite, Acticin)

    Malathion (ovide)

    Lindane (kwell)-for scabies lotion entire body neck down and leave 12 hrs then shower

    Oral antihistamines or steriods for itching

    Antibiotics for secondary infection

    Treat close contacts
  129. Lice and scabies teaching
    Educated to prevent spread and use direction for prescribed tx

    Soak combs and brushes

    Wash cloths and linens in hot water and dry

    Items that cannot be laundered placed in plastic bags for several weeks
  130. Contact dermatitis
    Inflammatory-dyes, metals, poison ivy

    Assessment-erythema, vesicles, swelling, pruritus, burning

    Diagnosis:symptoms, scratch, patch or intradermal tests

    management-antipruritics, antihistamines, oral or topical steroids

    Teaching-avoid contact with allergan, follow instructions with meds-how to apply topical preps, if oral steroids-how to taper, antihistamines cause drowsiness
  131. Psoriasis
    Inflammatory/autoimmune

    • Assessment-scaling, erythema, pruritus
    • Papules, plaques, silvery, white scale
    • Scalp, elbows, knees
    • Exacerbations and remissions

    Dx: Clinical s/s or skin bx
  132. Psoriasis management
    Methotrexate-chemo dx used for RA and psoriasis, MABS, etanercept (enbrel)

    corticosteriods

    Dovonex (vit D)

    Tazarotene (Tazorac)

    Uv light therapy

    Photochemotherapy
  133. Teaching for psoriasis
    Follow up with tx

    Discuss body image issues

    Discuss chronic nature

    Guidelines for apply topical meds
  134. Benign Tumors
    Seborrheic keratoses-common in older adults

    Keloids-overgrowth of scar, common in dark skinned

    Nevi-mole
  135. Skin Cancer (Table 27-6)
    Actinic keratosis-Premalignant lesions. Common in chronic sun-damaged skin, can progress to squamous cell carcinoma if untreated.

    Basal cell carcinoma-metastatsis rare, but invasive and may cause destruction of underlying tissue. Genetic predisposition. UV exposure most common cause

    Squamous cell carcinoma-invade locally but potentially metastatic. Often on lip, ear, face.
  136. Malignant melanoma Risk Factors
    • Genetic predisposition
    • previous melanoma
    • Presence of one or more precursor lesions that resemble unusual moles
    • Fair complexion
    • Hx of blistering sunburns
    • Excessive exposure to uv light
    • immunosuppressive drugs
  137. Health promotion and maintenance and client education
    Prevention of skin cancer (chart 27-11)

    Total skin self exam (TSSE) on month basis

    ABCDE of skin lesions

    if had skin cx, schedule reg f/u's q 3mo first 2 yrs

    utilize resources(ACS, Skin cancer foundation)
  138. Surgical procedures for skin cancer
    Surg excision-most common way of managing-often done with local

    • Curettage and electrodesiccation-small lesions non melanoma
    • -scraping/scooping out of lesion
    • -electric current used to remove tissue and bleeding

    • Cryosurgery
    • -rapid freezing
    • swelling, increased tenderness and blistering common
  139. Non surgical management of skin cancer
    Drug therapy-5 FU cream (efudex) and immunotherapy(aldara)

    Biotherapy-interferon for malignant melanoma

    Radiation-older pt with deep invasive BCC, or poor risk of surgery. Does not work on malignant melanoma
  140. Dermatologic surgery instructions
    Don't disrupt scab if forms, keep dry.

    Report signs of infection

    If dressing, give instructions to care for and changing

    Avoid aspirin products and other anticoagulant drugs for 7 days before and after surgery
  141. HIV positive, asymptomatic
    Persistent enlarged lymph nodes (PGL)
    Flu like symptoms
    Clinical Category A
  142. Are clinical category A defined as AIDS?
    No-not in less their CD4 counts drop below 200/mm3 (when they have A3)
  143. HIV positive
    Have one or more of problems in category B such as Thrush, diarrhea more than 1 mo, PID, peripheral neuropathy, shingles
    Clinical category B
  144. HIV positive
    Any of health problems listed under category C such as invasive cervical CA, CMV, Kaposi's, PJP

    See tbl 21-1
    Clinical category C
  145. Which problems in category C meet CDC definition of AIDS?
    All of them do
  146. HIV progression depends on:
    • How HIV was acquired
    • Personal factors-reexposure, stress, nutritional
    • Interventions/early tx
  147. Antibodies to virus usually made within 3 wks to 3 mo after initial infection
    Seroconversion
  148. Period b/t contraction of virus and antibody formation
    Window Period
  149. Type of testing that is:
    Inexpensive and accurate test
    False positives may occur
    Enzyme-Linked Immunosorbent Assey (ELISA aka EIA)

    99.5% accuracy after 13 wks

    Always retest on ELISA with Western Blot
  150. More sophisticated and expensive testing that relies on production of antibodies
    Western Blot

    99.9% accuracy

    +ELISA confirmed with Western blot
  151. Device or pad placed b/t gum and cheek for 2 minutes and results in 20 min. confirm with blood test
    Rapid Tests
  152. Healthy Adult CD4 cell counts
    800-1000
  153. AIDS dx if CD4 drops to:
    <200

    With progression of AIDS, CD4 drops
  154. Presence of HIV genetic material (RNA) in pt's blood

    Measures amount of virus in person's serum
    Viral Load (viral burden testing)

    Used to assess disease progression

    • Monitor effectiveness of antiretroviral therapy
    • Levels of 5000-10000 need therapy
  155. Other Quantitative RNA assays
    Non antibody tests

    RT-PCR - reverse transcriptase test and want low

    p24 antigen-Detects p24 protein of AIDS
  156. Goals of pharmacologic management of clients with HIV/AIDS
    • 1. Suppress infection, prolong life
    • 2. Prevent opportunistic infections (OI)
    • 3. Stimulate hematopoetic response
    • 4. Treat OI and malignancies
  157. Highly Active Antiretroviral Therapy (HAART)
    Does not eradicate HIV infection (only inhibits replication)

    Combines multiple antiretroviral drugs to reduce incidence of drug resistance

    Expensive

    Meds cause adverse S/E

    Adherence to regimen imperative

    Classes of HIV drugs: NRTIs, NNRTIs, PI, Fusion inhibitors, and integrase inhibitors (p 376-378)
  158. What factors contribute to development of drug resistance to HAART?
    Compliance

    Delaying dose or skipping

    Reducing dosage to save $$
  159. Post Exposure Prophalyxis (PEP)

    Charts 21-2 and 21-3
    Basic:2 drugs for low risk exposures

    Expanded:3 or more drug for high risk exposures

    28 day recommended course of tx

    Best to start asap of exposure (no later than 72 hrs) Best if started 2-3 hrs after.
  160. Assessment Findings for AIDS

    p. 371 Chart 21-6
    • H/A
    • Fever
    • Involuntary wt loss
    • Fatigue
    • Night sweats
    • Lymphadenopathy-PGL does not go away
    • Rashes/skin lesions
    • Diarrhea
    • Dehydration/ FVD-metabolic acidosis
    • Electrolyte imbalance
    • Acid/base imbalance
    • Mental changes
    • Appearance of OI and malignancies
  161. Community based care
    Guidelines for safer sex practices (ABC) chart 21-1

    Maintain nutrition, rest, exercise

    Teach infection transmission and prevention

    Identifying S/S of OI

    Medication regimen, adverse effects, and FU

    Community resources (support groups, hospice, respite care)
  162. ABC's of Safe sex practices
    Abstinence

    Be Faithful

    Condoms
  163. Mycobacterium Avium Complex (MAC)
    An OI

    Bacterial

    Dx:Blood Culture

    Tx:Combination ATB therapy
  164. Symptoms of MAC-mycobacterium avium complex
    Affects resp and GI

    • High fever
    • malaise
    • wt loss
    • Diarrhea-#1
    • Respiratory symptoms
  165. What are two toxicities to watch for with aminoglycoside class of antibiotics
    Neprotoxicity

    Ototoxicity
  166. Mycobacterium Tuberculosis symptoms
    • Fever, chills
    • night sweats
    • productive cough
    • chest pain
    • dyspnea
    • hemoptysis
    • +skin test
  167. Potential nsg dx for mycobacterium tuberculosis
    Ineffective airway clearance
  168. Potential nsg dx for Mycobacterium Avium Complex
    Imbalanced Nutrition:LBR
  169. Treatment of Myco Tuberculosis
    Support resp system, comb drug therapy

    P. 671 What do you remember about TB drugs

    • Isoniazid
    • Rifampin *liver failure possible w/both*
  170. What type of precautions will we use for pts with myco tuberculosis
    • Airborne precautions
    • Neg air flow room
  171. Pneumocycstis jiroveci pneumonia (PJP) symptoms
    • Dyspnea
    • persistent dry cough
    • intermittent fever
    • tachycardia
    • crackles
  172. Diagnosis and tx for PJP
    Dx:CXR, biopsy, sputum test, ABGs

    Tx:IV or oral TMP-SMX (bactrim)

    Pentamidine IV-for severe-can cause hypotension

    Corticosteriods- decrease inflammation of airways

    • Oxygen
    • Respiratory Care
  173. Most common OI of HIV pts
    PJP

    75-85%
  174. Cryptospordium (protozoal)
    1st OI typically to occur

    • Severe watery diarrhea (4Lt/day)
    • Wt loss
    • F & E imbalances

    Dx:stool culture

    Tx:Sandostatin (octreotide) must be refrigerated. given sq or iv
  175. Candidiasis (fungal)
    • White, curdlike patches of mouth and throat
    • erythema
    • dysphagia
    • rectal lesions
    • vaginal infections
  176. Potential Nsg Dx for Candidiasis
    Impaired skin integrity
  177. Dx and Tx of Candidiasis
    DX:S/S and oral scraping

    • TX:
    • Soft foods
    • soft toothbrush
    • Nystatin
    • Fluconazole (diflucan)
  178. CMV and Herpes:Viral
    CMV-inflammatory reactions in lungs, gi tract, and eyes causing blindness

    Herpes-painful vesicular lesions, genital or perianal, or shingles
  179. Dx and Tx of CMV (cytomeglovirus)
    Valcyte-oral

    Ganciclovir, Foscarnet IV

    • DX:S/S, antibodies in serum
    • TX:Avoid sources of infection
  180. Dx and Tx of Herpes
    Acyclovir (zovirax)

    Valacyclovir (valtrex)

    • DX:S/S, antibodies in serum
    • TX:Avoid sources of infection
  181. HIV related cancers
    Kaposi's Sarcoma-#1

    Lymphoma

    Invasive cervical cancer
  182. S/S of Kaposi's
    Purple, red papular lesions

    On skin, mouth, tongue, sclera, internal organs
  183. S/S of lymphoma
    Non Hodgkins

    Most common brain, GI and bone marrow
  184. DX of HIV cancers
    • Biopsy
    • PAP q 6 mo to assess for cerv CA
  185. Tx of HIV cancers
    Interferon (KS)

    Radiation therapy

    Surgery of local lesions/masses

    Chemo

    Brachytherapy-Short distance radiation
  186. Nursing interventions for Imbalanced nutrition :less than body requirements
    Monitor wt loss, decreased muscle tone, decreased energy, nausea, stomatitis

    Monitor labs-protein, albumin, H/H

    Antiemetics, meds to stimulate appetite

    Oral analgesics, antifungal drugs, mouth care

    Offer soft foods, assist with eating

    • High calorie, high protein diet-6 small mls and supplements
    • Pleasant environment for meals, encourage family to bring fav foods
  187. Nursing interventions for impaired skin integrity
    monitor skin

    lesions for s/s infection and impaired healing

    turn q2

    Pressure relieving devices

    skin clean/dry

    Dressings/lotions as ordered

    Avoid intense scratching
  188. Nursing interventions for deficit fluid volume
    monitor freq and consistency of stools and bowel sounds

    I&O

    Encourage oral fluids, maintain IV

    Monitor labs(Lytes)

    obtain stool cultures

    Assess for S/S dehydration

    Diet:low residue, lactose free, high K, high protein, high cal (BRAT)
  189. Nursing interventions for social isolation
    assist to recognize fear

    • reduce barriers to social contact
    • Assess social support network
    • Encourage pt to discuss their concerns with consistent, uninterrupted time and assign primary nurse

    Encourage involvement in decision making

    • Assess coping skills
    • community resources
  190. Nursing intervention for risk of infection
    assess signs of OIs

    V/S

    Monitor WBC

    Prevention of infection (chart 21-7)

    Care of hospitalized immunosuppressed pt (chart 21-8)
  191. Nursing interventions for ineffective protection
    • hand hygiene
    • assess s/s of infection
    • monitor labs
    • reverse/protective isolation
    • avoid contact crowds, children, recently vaccinated and infectious sources
    • addequate nutrition-no fresh fruits/vegs or flowers
    • avoid invasive lines
    • good mouth care
    • monitor adverse effects of meds

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