Med-Surg Exam 3

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mel26704
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153796
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Med-Surg Exam 3
Updated:
2012-05-14 18:24:43
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exam med surg death dying oncology
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Death and Dying/Oncology Ch. 25 & 25
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  1. Type of clinical death that is defined as a reversible cessation of CP functions
    Cardiopulmonary death
  2. Type of clinical death that is defined as irreversible cessation of brain function, including brain stem
    Brain death
  3. Most common pre-arrest heart rhythm
    V-fib (ventricular fibrillation)
  4. Four main indicators that must be present to define death:
    • lack of receptivity/responsiveness
    • lack of breathing/movement
    • lack of reflexes
    • flat EEG
  5. Clinical signs of impending death: Vital Signs
    • increase body temp
    • c/o feeling hot, but skin feels cool
    • changes in pulse (weak, irregular) & decreased BP
  6. Clinical signs of impending death: Pupils
    • fixed; eyes stare
    • no response to light
  7. Clinical signs of impending death: CNS
    • change in LOC
    • confusion/disorientation
    • lethargy
    • drowsiness/coma
  8. Clinical signs of impending death: Reflexes
    • decreased blinking, gag, and cough reflexes
    • involuntary movements
  9. Clinical signs of impending death: Respirations
    • irregular/dyspnea
    • stridor
    • apnea/Cheyne-Stokes respirations
    • noisy/congested/"death rattle"
  10. Clinical signs of impending death: Elimination
    • incontinence
    • decreased urinary output
    • dark, concentrated urine
    • constipation/decreased peristalsis
  11. Clinical signs of impending death: Nutrition
    • dysphagia
    • anorexia/nausea
  12. Clinical signs of impending death: Extremities
    • CMS changes
    • cool
    • puleses weak/thready
  13. Clinical signs of impending death: Skin
    • facial pallor
    • mottling/cyanosis
    • edema
    • fragile
    • cool/clammy
  14. Focus of Nursing Care:
    • promote physical comfort
    • maintain independence
    • prevent loneliness/isolation
    • promote spiritual comfort
  15. Holistic care includings meeting pt/s needs such as:
    • physical
    • psychological
    • emotional
    • spiritual
  16. Rigidity and contracture of bodily muscles (head to toe) due to chemical changes (ATP decrease and acid buildup)
    Rigor mortis
  17. Rigor mortis begins ___ to ___ hours after death; peaks at ___ hours; and may continue for ___ to ___ hours.
    • 1 to 2 hours
    • 12 hours
    • 24-48 hours
  18. Vasoconstrition and cooling of body temperature after death is defined as:
    Algor mortis
  19. RBCs break down; bruising/mottling occurs, especially in most dependent tissues; positioning and handling affect this
    Livor mortis
  20. Kubler-Ross' stages of dying:
    • denial
    • anger
    • bargaining
    • depression
    • acceptance
  21. Stages of dying are NOT
    fixed or rigid; loose boudaries; may move back and forth between stages
  22. Stages of grieving
    • shock
    • anger
    • acceptance
    • reorganization
  23. Organ donation act that established comprehensive, uniform laws regarding organ donation in all 50 states
    Uniform Anatomical Gift Act of 1968
  24. Organ donation act that developed "Required Request" laws requiring that a designated HCW approach issue of organ/tissue donation within an agency
    National Organ Transplant Act of 1984
  25. Organ donation policy when the donor is on life support:
    Patient taken off life support, declared dead, then back on support to maintain circluation to organs
  26. Chemical "preservation"
    embalming
  27. After death care includes:
    • pronounced dead
    • notify people/departments: physician, family, supervisor, admitting office, organ donation facility, medical examiner
    • ensure privacy
    • documentation
  28. Leading cause of death today:
    Heart disease
  29. Serve persons with end-stage illness (life expectancy < or = to 6 months)
    Hospice
  30. Hospice focuses on what type of care?
    Palliative
  31. Palliative care
    relieves symptoms; does not cure cause of disease
  32. Curative care
    Directed towards healing or curing a disease
  33. Patient may "leave hospice care" at any time to see more agressive, __________ care.
    Curative
  34. Abnormal growth of cells:
    Tumor
  35. Benign:
    noncancerous
  36. Malignant:
    cancerous
  37. Carcinogenesis stages:
    • initiation
    • promotion
    • progression
  38. Large group of diseases characterized by uncontrolled growth and spread of abnormal cells
    Cancer
  39. Most common skin cancer OVERALL
    skin cancer
  40. Most common cancer in MALES
    prostate, lung
  41. Most common cancer in FEMALES
    breast, lung
  42. 3 primary layers of embryo
    • ectoderm (outer)
    • mesoderm (middle)
    • endoderm (inner)
  43. Embryo layer that forms the skin, nervous system and glands:
    ectoderm EXAMPLE: Malignant melanoma
  44. Embryo layer that forms some organs, connective tissue, bones, blood, carilage, fat, firous tissue, muscle, and blood/lymph vessels:
    mesoderm EXAMPLE: sarcoma
  45. Embryo layer that forms some organs, epithelial tissues, digestive/respiratory tract linings, bladder, and urethra:
    endoderm EXAMPLE: carcinoma
  46. Malignant tumor that contains components from all three embryo layers:
    teratoma
  47. Bone marrow tumor
    myeloma
  48. Connective tissue tumor
    sarcoma
  49. Epithelial tissue tumor
    carcinoma
  50. Fibrous tissue tumor
    fibroma
  51. Fatty tissue tumor
    lipoma
  52. Muscle tissue tumor
    myoma or leiomyoma
  53. Skin tissue tumor
    melanoma
  54. ABCDEs of skin cancer assessment:
    • Asymmetry: one half of the mole/lesion doesn't match the other
    • Border: irregular
    • Color: different shades of brown
    • Diameter: larger than 6 mm (size of pencil eraser)
    • Elevation: rased above skin with unever surface
  55. TNM system
    • Tumor
    • Node
    • Metastasis
  56. Stage of cancer when the cancer is in one place:
    Stage 0
  57. Stage of cancer when the cancer is a tumor limited to tissue of origin; localized tumor growth:
    Stage I
  58. Stage of cancer when the cancer is cancer limited; local spread:
    Stage II
  59. Stage of cancer when the cancer is extensive local and regional spread:
    Stage III
  60. Stage of cancer when the cancer is metastasis:
    Stage IV
  61. The movement of malignant cancer cells from one part of the body to another:
    metastasis
  62. Common sites of metastasis:
    • lymph nodes
    • lung
    • bone
    • liver
    • brain
  63. Three levels of prevention:
    • primary
    • secondary
    • tertiary
  64. Primary prevention:
    • true prevention
    • health education; good eating habits, no smoking
  65. Secondary prevention:
    screening, early detection, prompt treatment
  66. Tertiary prevention:
    • minimizing the effects of disease and disability; preventing recurrence/complications
    • rehabilitation
  67. Used to screen for colorectal cancer:
    Fecal occult blood test
  68. Used to screen for prostate cancer:
    digital rectal examination and prostate-specific antigen test
  69. Uses high-energy ionizing radiation to break down the strands of the DNA inside the CA cells and kill them; normal cells are also affected, but they are better able to repair the DNA damage
    Radiotherapy
  70. Does the patient emit radiation to others when external radiation therapy is used?
    No
  71. Simulation sessions are required for:
    External radiation therapy
  72. Radiation therapy that uses radioactive isotopes:
    internal radiation therapy
  73. Internal radiation therapy/brachytherapy can be _______ or_______.
    • sealed: placed into body cavity or tissue
    • unsealed: taked PO, IV, or directly instilled
  74. Does the patient emit radiation to otheres when internal radiation therapy is used?
    Yes!
  75. Side effects from XRT:
    • fatigue
    • anorexia/stomatitis/gastritis/N/V/D
    • bone marrow suppression/melosuppression
    • skin/mucosal reactions
    • alopecia
  76. Use of chemical agents to destroy cancer cells:
    Chemotherapy

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