Common 2

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  1. cancer prevention
    • Primary prevention:
    • Reduce risks through health promotion & risk reduction
    • Avoid known carcinogens
    • Some meds to reduce risk (ASA for colon, Tamoxifen for breast)
    • Secondary prevention
    • Screenings and early detection activities
    • Tertiary prevention
    • Monitoring for and preventing recurrence of primary cancer
    • Screening for development of second malignancies in cancer survivors
  2. Chemotherapy administration procedures
    • Wear PPE
    • Long sleeve, disposable gowns made of polyethylene coated polypropylene
    • double layer pwdr free gloves designed for chemo
    • Wash hands soap & water
    • Spill kits
    • Equip disposed of in closed, puncture and leak proof container labeled "hazardeous: chemo waste" (may be yellow)
  3. chemotherapy SE
    • Extravasation
    • pH of irritant agents induce inflammation
    • can cause tissue damage & necrosis
    • only admin by those w established competency
    • NEVER in peripheral veins w hand or wrist
    • Hypersensitivity-chemo pose higher risks & are life-threatening
    • First thing to do... STOP DRUG!
  4. Chemo toxicity
    • Cells w rapid growth rates very susceptible to damage (gut, skin, bone marrow)
    • N/V most common SE
    • Renal issues (SIADH, decreased renal perfusion, nephritis)
    • Cardiac toxicity
    • Testicular and ovarian function can be affected = sterility
    • Neurotoxicity
  5. SIADH
    • Syndrome of inappropriate antidiuretic hormone (ADH) secretion (SIADH)
    • the hyponatremia and hypo-osmolality resulting from inappropriate, continued secretion or action of the hormone despite normal or increased plasma volume, which results in impaired water excretion.
    • The hyponatremia results from an excess of water rather than a deficiency of sodium.
  6. Hospice care criteria
    • Have less than 6 months to live
    • Must have 2 physician's document
  7. Hospice principles
    • Focuses on:
    • Quality of life
    • Palliation of symptoms
    • Physical, psychosocial and spiritual support
  8. IV administration procedures in oncology
    • Never in peripheral veins involving the hand or wrist.  
    • Stop the med immediately if extravasation is suspected.
  9. Mastectomy nursing care
    • No BP, IV's, labs or venous pokes on arm the same side as mastectomy 
    • This is because all the lymph nodes have been taken
  10. Metastasis pathophysiology
    • Dissemination or spread of malignant cells from the primary tumor
    • Lymph and blood are key mechanisms for cancer cells to spread
    • Lymphatic spread is most common type
  11. Myelosuppression
    • side effect of some cancer treatments
    • 3 types:
    • Anemia (RBC)
    • Thrombocytopenia (platelets- blood clotting)
    • Leukopenia (WBC)
  12. Treating anemia
    • ID and treat underlying cause
    • Help manage Sx
    • PRBC (packed RBC)
    • Measure erythropoietin (hormone that tells bone marrow to make more)
    • Relaxation 
    • Adequate protein and calories
    • Journaling fatigue patterns
  13. Thrombocytopenia care
    • Monitor platelet count
    • Assess for bleeding
    • Education to minimize bleeding
    • Measures to minimize bleeding
  14. In thrombocytopenia, how to assess for bleeding
    • NO CONTACT SPORTS!
    • Petechiae or ecchymosis
    • Hgb/hct
    • Prolonged bleeding
    • Frank or occult blood (in vomit, feces, urine) 
    • Altered mental status
  15. In thrombocytopenia, how to education to minimize bleeding
    • Soft toothbrush
    • Avoid commercial mouthwashes
    • Use electric razor
    • Emery board for nail care
    • Avoid foods difficult to chew
  16. In thrombocytopenia, measures to minimize bleeding
    • No Im injections
    • No rectal temps
    • No suppositories
    • direct pressure to venipuncture sites for 5 min
    • lubricate lips
    • avoid bladder cath
    • stool softeners
    • avoid ASA (ASPIRIN)
  17. Leukopenia nursing care
    • Assess pt for evidence of infection
    • V.S. every 4 hrs
    • WBC w differential
    • Inspect IV sites, wounds, skin folds, bony prominences, perineum and oral cavity
    • Report fever
    • Need private room
    • avoid people w recent infect or vaccination
    • Handwashing
    • Avoid rectal or vaginal procedures
    • stool softners
    • Education about safe food handling (Can't eat fruits can't be washed well)
    • Avoid urinary cath
  18. Myelosuppression S/S
    • *nearly all chemo leads to bone marrow supr.
    • Anemia:  fatigue, paleness, increased heart rate, tiring easily with exertion, dizziness, SOB
    • Leukopenia: Weak immune system
    • Thrombo: Easy bruising, nosebleeds, bleeding of mouth/gums, occult blood, petechiae
  19. Radiation SE
    • *Altered skin integrity most common! (Burns) skin care important after radiation
    • Body tissues most affected are those that proliferate rapidly (Skin, GI, bone marrow)
    • Stomatitis (canker sores)
    • Xerostomia
    • loss of taste
    • Mucositis
    • Systemic affects: fatigue, alaise, anorexia
    • Impaired wound healing
  20. Radiation teaching
    • Avoid soaps, cosmetics, perfumes, powders, lotions and ointments
    • Use lukewarm water to bathe the area
    • Avoid rubbing, scratching, shaving, hot water bottles, heating pads, ice, sunlight, cold or tight clothes
    • Pay close attention to rashes
  21. Stem cell transplant teaching
    • For hematologic malignancies
    • Is high dose chemo and total body irradiation 
    • Much higher Risk for anemia,leukopenia, thrombocytopenia.
    • Patients are highly immunocompromised so limit visitors and take precautions for infection prevention.
  22. Bladder scanning nursing care
    *For ultrasonography (which is initial dx procedure), bladder needs to be full 

    In bladder training, scan bladder immediately after voiding
  23. catheter nursing care
    • Prevent backflow
    • empty cath every 8 hrs
    • bag below bladder level
  24. cystoscopy nursing care
    • *urologic endoscopic procedure to visualize urethra and bladder
    • may cause trauma to mucous membranes
    • warm heat may help
  25. Dialysis indications
    • Start at Stage 5 renal failure
    • When GFR is <15%
  26. ESRD risk factors
    • *End Stage Renal Disease
    • DM
    • HTN
    • Proteinuria
    • Family history
    • Increase age
  27. GFR and kidney disease staging
    • Stage 1: >90%
    • Stage 2: 60-89%
    • Stage 3: 30-59%
    • Stage 4: 15-29%
    • Stage 5: <15%

    *GFR estimates how much blood passes through the glomeruli per minute
  28. Kidney disease nursing assessment
    • daily weights 1 liter = 1 kg
    • Costovertebral angle discomfort
    • I & O (<500 mL/day is oliguria)
    • skin turgor, edema, JVD (fluid overload)
    • VS
  29. Kidney disease assessment - lab values
    • Biopsy - used to dx or eval extent of kidney disease
    • Lab values:
    • Creatinine clearance 24 hr urine specimen (will check serum creatinine 1/2 through)
    • BMP
    • GFR

    UA: Specific gravity, proteinuria, glycosuria
  30. Kidney stone nursing care priotiry
    PAIN!!
  31. Kidney stone priority
    • If stone is in uretero pelvic junction, needs immediate attention!!!
    • Don't want stone to get into kidney
  32. Kidney's role in acid base balance
    Excretes H+ into urine, reabsorbs HCO(bicarb)

    Reabsorbs base, pees out acid
  33. Lithotripsy teaching
    • *shoots laser to break up stones
    • Call MD for fever, or cloudy/foul urine
    • Strain urine for gravel or sand
  34. Renal function nursing assessment
    • the most useful information is initially obtained from estimation of the glomerular filtration rate (GFR) and examination of the urinary sediment.
    • Other s/s impaired kidney function is hematuria, flank pain, or extrarenal symptoms (edema, hypertension, signs of uremia-(high levels of waste products in blood))
  35. What is used to figure GFR
    • creatine
    • weight
    • age
    • sex
    • race
  36. UI and aging
    • UI is NOT part of normal aging
    • Short term UI in older adults can be caused by UTI’s, vaginal  infections or irritations (estrogen vaginal cream can help), constipation, and some medication
    • Types of UIs: Stress, functional, urge, overflow (common with BPH)
  37. Urinalysis interpretation
    • With UTI, commonly contaminated with bacteria
    • >105 colonies/mL distinguishes true bacteria from contamination
  38. Urinary retention assessment
    • Dullness on percussion of suprapubic region
    • Bladder scan (In older adults, 50-100 mL residual is normal)
  39. UTI teaching
    • increase fluids,
    • pyridium may cause orange urine,
    • antibiotics may cause secondary infections
  40. Bariatric surgery complications
    • Dumping syndrome (when stomach rapidly and without regulation empties its contents into the small intestines)
    • cholelithiasis (gallstones)
    • pulmonary embolism and deep vein thrombosis
    • anastomotic leak (can be life-threatening), death (0.15% to 0.64%).

    *anastomotic leak refers to leak from two luminal structures , like connecting two segments of bowel
  41. Bariatric surgery teaching
    • can only have 600-800 cal per day
    • must have smaller, more frequent meals
    • no more than 1 cup
    • eat slow
    • 120 mL fluid btwn meals
    • vitamin education
    • need B12 injection (peri-anemia)
  42. Bowel obstruction priority
    • *tissue perfusion (could cut off vascular supply)
    • *electrolyte balance
    • *Pain management

    NPO, decompress bowel,  NG tube suction, rectal tube, monitor fluids/ electrolytes, surgery may be necessary.
  43. Bowel obstruction priority nursing dx
    Impaired Tissue perfusion and risk for fluid/ electrolyte imbalance
  44. Colon cancer risks
    • Older age,
    • history of polyps/ cancer,
    • UC and Crohn’s
    • family history
    • low- fiber and high fat diet, sedentary lifestyle/obesity
    • DM
    • smoking, alcohol abuse
  45. Constipation teaching
    • Increase fluids and fiber
    • exercise
    • laxative
    • target underlying cause
  46. Gastrectomy medical care
    • *partial or whole stomach surgically removed.
    • Teach about changes in GI function.
    • Need B12 injections to prevent pernicious anemia
    • risk for bowel obstruction
    • small meals <1 cup, 600-800 kcal/day
    • fluids between meals
    • increase protein, lower carbs
    • eat slowly
    • Raise head of bed
    • take vitamins
    • exercise
  47. Gastric surgery outcome
    • weight loss?
    • One study defined success as a loss of more than 50% of excess body weight and failure as a loss of less than 30% of excess body weight at one year after surgery.
    • The American Diabetes Association recommends that patients with a BMI of ≥35 kg/m2 &/or type 2 diabetes also be considered for bariatric surgery, especially if the diabetes has not been well controlled with lifestyle changes and pharmacotherapy.
  48. GERD medical care
    • antiacids
    • PPI 
    • Hblockers
    • Metoclopramide (Reglan) to increase peristalsis.
    • Possible surgery (nesin-fludo plycation)
  49. GERD nursing education
    • avoid caffeine, alcohol, milk, tobacco
    • avoid eating/drinking 2 hrs before bed
    • maintain normal weight
    • avoid tight fitting clothes
    • low fat diet
    • elevate HOB
  50. GERD pathophysiology
    frequent acid reflux caused by abnormal relaxation of esophageal sphincter.
  51. GI bleeding assessment
    • Black tarry stool or coffee ground vomit for upper GI bleed,
    • Blood in stool.
    • could come from Ulcers from gastritis.
  52. Inflammatory bowel disease nutrition
    • High protein & calorie
    • Low residue
    • Low fiber
  53. What is a low residue diet
    • A low residue diet is a diet designed to reduce the frequency and volume of stools while prolonging intestinal transit time.
    • Typically includes restrictions on foods that increase bowel activity, such as milk, milk products, and prune juice.
  54. Inflammatory bowel disease outcomes
    • decrease inflammation
    • suppress immune response
    • rest for bowel

    • Fluid/ electrolyte balance
    • no GI bleeding
    • no megacolon or cancer
  55. Inflammatory bowel disease tx
    • Antidiarrheal
    • Regulan?? antiperistaltic 
    • Sulfasalazine (Azulfidine)  is inflammatory.
    • Corticosteroids
    • Humera is immunomodulator
    • surgery
  56. Oral parotitis risk factors
    • *parotitis is inflammation of the gland that produces saliva
    • Xerostomia is greatest risk factor
    • poor oral hygiene
    • smoking
  57. PUD medical care
    • Eradicate H.Pylori & acidic
    • antibiotics
    • PPI
    • Bismuth
    • Stop smoking
    • Avoid extreme temp w/ food
    • Avoid alcohol, caffeine
    • 5 small meals daily
  58. PUD pathophysiology
    • H. Pylori #1 cause
    • also overuse of NSAIDs
    • Alcohol abuse/smoking
    • stress
    • gastritis
    • Can form in esophagus, stomach, or duodenum
  59. Wound Care assessment
    • ongoing pain
    • skin integrity
    • infection
    • drainage
  60. Dehiscence tx
    • cover with moist, sterile dressing
    • call dr.
    • keep pt calm
    • decrease HOB and elevate knees.
  61. Infection patho
    Inflammation, proliferation, maturation
  62. Infection s/s
    • redness, warmth, swelling, purulent discharge, increased WBC, fever, chills, increased HR, hypotensive, tachypnea,  odor.
    • Wound infection not usually noticeable until post-op day 5.
  63. Bariatric surgery may be contradicted for pt who have
    severe congestive heart failure
  64. RYGB
    Roux-en-Y gastric bypass.
  65. VSG
    Vertical sleeve gastrectomy
  66. BPD-DS
    Biliopancreatic diversion with duodenal switch
  67. AGB
    Adjustable gastric banding
  68. VBG
    • Vertical banded gastroplasty
    • "stomach stapling"
  69. The most commonly performed bariatric procedure in US
    RYGB
  70. The authors note that VSG significantly improves or resolves
    HTN
  71. In pt's who have undergone BPD-DS, digestive enzymes cannot mix with food until food reaches the
    distal ileum
  72. In a study, the remission rate for type 2 diabetes within 1 yr of BPD-DS surgery was
    100%
  73. What advantage is there with AGB
    The tightness of the silicone band can be adjusted
  74. Pt's who've undergone VBG tent to feel early satiety because
    stomach emptying is delayed
  75. Remission of type 2 diabetes after bariatric surgery is less likely in pt who
    have had diabetes for longer periods of time
  76. Remission rates for type 2 diabetes have been highest for patients who have undergone:
    BPD-DS
  77. One of the 2 comorbidities most predictive of postoperative complications after bariatric surgery is
    • sleep apnea
    • (guide also listed GERD)
  78. Symptoms of dumping syndrome may include
    abdominal cramping

    dizziness, N/V, bloating, and diarrhea
  79. In pts who have undergone bariatric surgery, cholelithiasis...
    is related to postoperative weight loss, rather than to the surgery (especially in women)
  80. Strategies to prevent postoperative PE and DVT include do not include
    administration of oral clopidogrel (Plavix)
  81. A swallowing study on postop days 1 or 2 may be done to detect
    an anastomotic leak
  82. One of the top 3 causes of dealth after bariatric surgery is
    sepsis  (is 3rd)

    • 1st: PE
    • 2nd: Cardiac Complications
  83. A study found that significant factors in successful weight loss do not include
    taking a higher dosage of antianxiety meds
  84. Abdominoplasty for excess skin removal has a complication rate as high as
    50%
  85. Which statement is true regarding nutritional issues after bariatric surgery
    Protein deficiency is common and protein shakes may be prescribed

Card Set Information

Author:
jskunz
ID:
316326
Filename:
Common 2
Updated:
2016-02-23 03:59:58
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common
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Description:
Common disorders test2
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