CD final

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  1. Alopecia & cancer
    • Hair loss from tx
    • Pt needs education about potential side effect of treatment.
    • Chemo causes alopecia, radiation only causes it when it's on head
    • Pt needs to identify pos and neg feelings and threats to self-image.
  2. nursing interventions for alopecia
    • Educate:
    • Avoid hair dryers, curlers and other stresses on hair
    • Wear hat or scarf especially in sun
    • Take steps to deal with possible hair loss before it occurs...purchase wig or hairpiece if desired
    • Pt realizes hair loss and use of wig/head covering are temporary
  3. Allogeneic BMT
    • Bone marrow transplant from someone other than the pt
    • Could be related or matched from unrelated donor through registry
  4. Autologous BMT
    Bone Marrow Transplant from self
  5. Syngeneic BMT
    Bone Marrow Transplant from identical twin
  6. BMT priority
    • Until engraftment of the new marrow occurs, pt is high risk for death from sepsis and bleeding
    • Important to teach family to stay away when sick, hand washing, etc.
  7. GVHD
    Graft vs host disease - major cause of morbidity, occurs when donor lymphocytes initiate an immune response against recipient's tissues
  8. Clinical manifestations of acute GVHD
    • Diffuse rash progressing to blistering and desquamation similar to 2nd degree burns
    • mucosal inflammation of eyes and GI tract with diarrhea possibility exceeding 2L/day
    • Abd pain, hepatomegaly & elevated liver enzymes leading to obstructive jaundice
  9. Big 6 chemo side effects
    • Fatigue
    • N/V (GI distress)
    • Pain
    • Body image
    • Spiritual distress
    • suppression of immune system (myelosuppression)
  10. Fatigue care
    • Educate will be worse with chemo
    • Don't make big plans
    • Stay active but plan rest periods
    • Will affect ADL's, so it's ok to ask for help
    • Increase protein and calories to help body fight cancer
    • Make sure they have good sleep habits
  11. Immunosuppression priority
    • prevent infection!
    • Strict hand washing
    • no fresh fruits or veggies (unless natural covering like bananas)
    • Avoid groups of people
    • Aseptic technique
  12. IV complications
    • infection
    • bleeding
  13. Leukemia
    • An unregulated accumulation of immature, functionless leukocytes in the marrow and blood leaving little room for normal cell production
    • Commonly classified according to the stem cell line involved, either lymphoid or myeloid
    • Also classified as either acute or chronic based on time it takes for symptoms to evolve and phase of cell development that's halted
  14. Lymphoid leukemias
    • refers to stem cells that produce lymphocytes:
    • Acute Lymphocytic Leukemia (ALL)
    • Chronic Lymphocytic Leukemia (CLL)
  15. Myeloid Leukemias
    • refers to stem cells that produce nonlymphoid blood cells:
    • Acute Myelogenous leukemia
    • Chronic Myelogenous leukemia
  16. Leukemia - nursing interventions for physical care and symptom management
    Physical care: assess for infection and bleeding; central line cath care

    Symptom management: Myelosuppression, DIC, and cerebellar toxicity from Ara-C (drug)
  17. Leukemia education
    • teach infection and bleeding prevention
    • Manage mucositis
    • ensure adequate nutrition
    • Take antiemetic for nausea
    • Avoid uncooked food and those w/o peelable skin
    • Ease pain/discomfort
    • Manage anxiety and grief
    • Encourage spiritual well-being
    • *Death usually occurs from infection or bleeding.
  18. Leukemia labs
    • Will closely monitor CBC w diff
    • Bone marrow analysis - will show excess of immature blast cells (immature leukocytes) which is hallmark for dx
    • monitor fluid and electrolyte balance
  19. Leukemia patho
    • neoplastic proliferation of one particular cell type
    • Defect originates in hematopoietic stem cells, myeloid or lymphoid stem cell.
    • Cause is not fully understood, but there is some evidence of genetic and viral influences
  20. Lymphoma
    • neoplasms of lymphoid tissue, more mature cells compared to leukemia
    • Originate in lymph node, skin, GI tract, or other lymphatic structure
    • Hodgkin's or non-hodgkin's
    • 5th most common type of cancer
    • 4 stages
  21. Hodgkins lymphoma
    • Usually begins as enlargement of one or more lymph nodes on side of neck, painless and firm (but not hard)
    • Mild anemia is most common hematologic finding
    • Will have reed-sternberg cells
    • Leukocyte count can be elevated or decreased
    • Rare malignancy, but high cure rate
  22. Hodgkin's dx
    To diagnose, they excise lymph node and biopsy to find Reed-Sternberg cells
  23. Hodgkins patho
    • Involved B lymphocytes, localized to regional
    • Unlike other lymphomas, it initiates in a single node.
    • Can have familial pattern
    • Seen in pts receiving chronic immunosuppressive therapy (ex: transplants), military veterans exposed to Agent Orange
  24. Treatment for Hodgkins
    • Combo chemotherapy, such as ABVD
    • Most pt's are cured or experience prolonged remissions
  25. Non-Hodgkin's lymphoma
    • Involves malignant B lymphocytes AND T lymphocytes
    • Lymphoid tissue involved are largely infiltrated with malignant cells
    • Multiple sites may be infiltrated, even outside lymphatic system
    • NOT LOCALIZED - so it is a disseminated disease meaning it extends beyond it's origin
    • Generally found in older adults, worse outcome than Hodgkins
  26. Stage 1 lymphoma
    Involvement of a single lymph node or one extranodal site
  27. Stage 2 Lymphoma
    Involvement of 2 or more lymph nodes regions or extranodal site on same side of the diaphragm
  28. Stage 3 Lymphoma
    Involvement of lymph node regions and/or one extranodal site on BOTH sides of diaphragm
  29. Stage 4 Lymphoma
    Diffuse or disseminated disease of one or more extralymphatic organs or tissues
  30. Non-Hodgkin's Lymphoma tx
    • Determined by classification, stage of disease, any prior tx, and pt ability to tolerate therapy
    • Tolerance is largely dictated by organ function tests, comorbidities, functional status, and age. 
    • Non aggressive types may only need radiation
    • Aggressive uses combination of chemo drugs such as R-CHOP
  31. Nursing interventions for lymphoma
    • Educate on s/s of poss complication of disease & tx
    • Explain complex diagnosis and therapeutic methods
    • Symptom management based on assessment: nutrition, fatigue, pain
    • Support psychosocial such as stage & curability, fear of relapse, facilitate coping mech.
  32. Mucositis care
    • Educate to avoid spicy/hot foods
    • Avoid alcohol rinses
    • Use soft brushes
    • Pain control & ice chips
  33. Multiple myeloma
    • Malignant disease of the most mature form of B lymphocyte - the plasma cell
    • The malignant plasma cells produce increased amt of immunoglobulin (antibodies) which are nonfunctional (M protein)
  34. M protein
    • found in blood or urine
    • blood test marker for multiple myeloma diagnosis
    • They stimulate osteoclasts → bone breakdown → Ca lost in bone
    • Bence Jones is marker in urine
  35. Multiple myeloma priority problem
    • Infection is #1 cause of death
    • Focus on neutropenic guidelines
  36. Multiple myeloma signs and symptoms
    Classic presenting symptom is bone pain

    • Hypercalcemia (due to Ca from bone breakdown)
    • Osteoporosis = pathological bone fractures
    • Renal Failure
    • Anemia (less space in the marrow)
    • Spinal cord compression

    Hyperviscosity (syndrome - group of symptoms triggered by increase in viscosity of blood) which leads to thromboembolic events
  37. Multiple Myeloma memory aid
    • CRAB
    • C: hypercalcemia
    • R: Renal failure
    • A: anemia
    • B: Brittle bone
  38. Neutropenia diet
    • *abnormally low level of neutrophils
    • Avoid fresh fruits and veggies, unless they have own cover (bananas)
    • Low microbe diet, thoroughly cook food
  39. Supportive care for multiple myeloma
    • Pain management - opioids and nonopioids
    • Supports and braces
    • Heat and/or cold
    • Massage
    • neurological assessment
    • GI assessment (N/V, constipation)
    • I's & O's
  40. Thrombocytopenia
    • decrease in circulating platelet count
    • most common cause of bleeding in pt with cancer
    • defined as platelet count less than 100,000
  41. Thrombocytopenia assessment
    • petechiae, ecchymoses, bruising
    • decrease in Hbg or hct (indicates blood loss)
  42. thrombocytopenia education
    • educate of ways to minimize bleeding: 
    • soft toothbrush
    • avoid alcohol mouthwashes
    • electric razors
    • safe environment like padding on side rails
    • fall prevention
    • prevent constipation
  43. enteral feedings
    • Nutrition delivered directly to stomach, duodenum, or jejunum
    • PEG & J tubes: give food, fluids & meds
    • NG tubes: remove fluids (decompress) and gas of upper resp.
  44. nursing care for enteral feedings
    • HOB 30-45 degrees
    • check all tubing before admin feeding or meds
    • Reg. oral & nasal hygiene
    • Coughing during feedings/meds could mean tube is malpositioned
    • monitor for aspiration
    • Assess tubes for kinks
  45. Enteral feedings residual volumes
    • check gastric residual volumes before each feeding
    • return aspirate to stomach to assess color and volume of contents
    • With continuous feedings, check Q 4hrs.
    • If residual is greater than 500mL, 50% or more than previous bolus feeding, notify MD & withhold feedings until residuals decrease
  46. NG placement assessment
    • Ways to ensure placement:
    • Measure tube length & mark to make sure it goes low enough
    • Xray 
    • visual assessment of aspirate color & volume
    • pH measurement test
    • air auscultation
  47. NG tube - GI complications
    • constipation - opioids, low fiber or fluid intake
    • diarrhea
    • N/V - change in formula, inadequate gastric emptying
    • Gas/bloating/cramping - air in tube, excess fiber
  48. NG tube complications - mechanical
    • Aspiration - due to flat HOB or improper placement
    • Tube displacement: excessive coughing/vomiting
    • Tube obstruction: inadequate flushing/formula rate or crushing of meds
    • Nasopharyngeal irritation: tube position/improper taping, large tubes
  49. NG tube complications: metabolic
    • Hyperglycemia - high carb, glucose intolerance
    • Dehydration and azotemia: hyperosmolar feedings w low fluid intake
  50. TPN complications
    • Pneumothorax- improper IV placement and puncture of pleura
    • Embolism: disconnected tubing, no cap on port, of blocked segment
    • Clotted line: inadequate/infrequent saline/heparin flushes
    • Catheter displacement: excessive movement
    • Sepsis: contaminated dressing, infection & insertion site, unsterile dressing changes
    • Hyperglycemia: glucose intolerance 
    • fluid overload: fluid infusing too fast
    • Rebound hypoglyc: feeding stopped too quickly w/out dextrose solution running to help wean off
  51. TPN infection source
    • skin and catheter hub
    • unsterile dressing and tube changes
    • High fat and sugar content of TPN makes them ideal for bacterial and fungal growth
    • CDC recommends changing dressings no more than 7 days unless damp, bloody, loose, or soiled
  52. TPN nursing priority
    • inspect TPN solution for separation, oily appearance or any precipitate (white crystals) if present, don't use
    • Listen to lungs for fluid overload
    • Watch for s/s of infection
    • Pt should be weaned on/off feedings
    • Monitor labs & response to feedings
  53. ALS
    • (amyotrophic lateral sclerosis)
    • Also called Lou Gehrig's Disease
    • A progressive neurodegenerative disease that affects nerve cells in the brain and spinal cord
    • Loss of motor neurons
    • Unknown cause
    • **Ice bucket challenge - "ALS weakens ADL's"
  54. ALS assessment
    • Begins with muscle twitching, weakness in limbs that spreads to other body parts
    • Slurred speech & hard to swallow, breathe, chew
    • Excessive salivation
    • Eventually effects muscles that move, speak, eat, breathe--then fatal.
  55. Medical care for Lou Gehrig's
    • no cure exists
    • Live exp is 3-5 yrs
    • Drugs used to prevent decrease in function
  56. Nursing Care
    • main focus is to maintain or improve function, well being, and quality of life
    • Help pt remain comfortable and prepare family and pt for end of life
  57. Nursing dx for ALS
    • Ineffective breathing pattern
    • Risk for imbalanced nutrition
    • Less than body requirements
    • Impaired verbal communication
    • Impaired physical mobility
  58. Guillain Barre
    • Acute inflammatory demyelination (inflammation of nerves) in which immune system attacks nerves
    • Autoimmune disease caused/triggered by bacterial/viral infection
    • If you don't get tx fast, wont recover
    • Usually can get full function back
    • Getting sick will trigger it, can happen after a simple cold
    • **BOTTOMS UP... kid mooning, cause starts at feet and moves up
  59. S/S of Guillain Barre
    • Initial: numbness, pain, paresthesia, weakness, paralysis in legs.
    • Starts in legs and progresses upward
    • SEVERE! Respiratory depression
    • *May have sudden onset and or last long time
  60. Guillain Barre assessment
    • Assess for resp failure, cardiac dysrhythmias, DVT's
    • Monitor for changes in vital capacity & inspiratory force
    • Assess VS frequently
    • Continuous EKG
  61. clinical manefestations
    • Prickling "pins & needles" of fingers, toes, ankles, wrists
    • Unsteady gait
    • Difficulty w facial movements
    • Severe or achy pain, worse @ night
    • Difficult bladder/bowel control
    • Tachycardia
    • Difficulty breathing = medical emergency
  62. Guillain Barre prioritizing
    • reposition Q 2hrs
    • Passive ROM exercises
    • Fall risks
    • Maintain patent airway, may need intubation
    • Watch for skin breakdown
    • Keep HOB up to prevent aspiration
    • Neuro checks
    • Need alot of nutrition - may need TPN
  63. Guillain Barre Tx
    • No cure, but most recover - takes few months to fully recover
    • Tx: Plasmapheresis - helps by getting rid of antibodies in plasma attacking nerves
    • Immunoglobulin therapy: IV infusion of antibodies from blood donors
    • Pain meds, anticoags, PT, assistive devices
  64. Huntington's disease
    • Inherited disease which causes progressive breakdown of nerve cells in brain
    • Sure diagnosis with genetic testing
    • 50% chance of getting it if one parent has it
  65. Huntington's diet
    • higher caloric needs due to physical exertion
    • May need more than 3 meals/day
    • Nurtrient dense foods
    • Feeding tube in later stages
  66. Huntington's swallowing difficulties
    • Aspiration risk
    • Remove distractions during meals
    • Eat foods easy to eat & swallow
    • Special utensils that help pt w diminished fine motor skills
  67. MS
    • muscular dystrophy
    • degeneration of muscle fibers that's
    • replaced by connective tissue
    • Missing genes that prevents making proteins needed for muscle building
    • Incurable disorder which causes progressive weakening/wasting of skeletal/voluntary muscle
  68. MS education
    • Avoid stress, which can exacerbate it
    • Maintain room temp
    • Use assistive devices
    • Plan activity/exercise with periods of rest/relaxation
    • Aspiration precautions
  69. MS s/s
    • fatigue
    • weakness & numbness
    • coordination difficulties
    • Loss of balance
    • pain
    • visual disturbances
    • muscle spasms
    • bowel and bladder problems
  70. MS tx meds
    • interferon beta-1A & beta 1B
    • Copaxone
    • IV methylprednisolone
    • *Symptom management: tx bowel/bladder probs
    • muscle spasms
    • fatigue ataxia (loss of full control of body movements)
  71. Myasthenia gravis
    • Autoimmune disease which attach acetylcholine receptors
    • Body produces antibodies that block/destroy muscles receptors
    • Results in voluntary muscle weakness
  72. Myasthenia gravis s/s
    • Drooping eyelids
    • Diplopia (double vision)
    • Facial weakness
    • Diff swallowing, probs chewing
  73. Parkinson's aspiration prevention
    • Do swallow tests
    • At meals, sit upright 90 degrees
    • remain sitting/standing 15-20 mins after eating
    • Eat slow, cut up food
    • drink plenty of fluids
    • puree foods
  74. Parkinson's assessment
    • tremor, rigidity
    • bradykinesia (slow movements)
    • Nurse needs to assess how disease has affected ability for ADL's
    • Assess med response
  75. Sinemet side effects
    • Levodopa
    • drug to treat parkinson's (basically dopamine)
    • N/V, dizzy, loss of appetite, HA
    • Med will go through periods when it is and isn't effective
  76. Tensilon test
    • test used to diagnose myasthenia gravis
    • The drug tensilon (edrophonium) is injected
    • If muscles get stronger after injection, have myasthenia Gravis
    • After 30 secs, they improve for about 5 mins
  77. Basilar skull fracture s/s
    • Raccoon eyes
    • Battle sign (bruising behind ears)
    • persistent localized pain
    • hemorrhage from nose, pharynx, or ears
    • blood under conjunctiva
    • CSF from ears and nose
    • meningeal infections can occur
  78. Cerebral edema med interventions
    • surgery
    • diuretics
    • maintain O2
  79. Cerebral perfusion pressure
    • Should be 80 mmHg
    • Tx for over 100 is surgery to evacuate blood clots, debredement and elevation of depressed fractures
    • Maintain adequate o2
    • Decrease metabolic needs and blood volume with diuretics (manitol)
  80. Nursing care for cerebral perfusion pressure
    • prevent 2ndary injury
    • monitor ICp
    • maintain O2 and nutrition
    • elevate HOB 30 degrees
  81. Concussion teaching
    • can go to sleep, but need to awaken to test LOC frequently
    • Go to ER if: altered LOC, seizures, worsening HA, dizziness, blurred vision, repeated vomiting, slurred speech, weakness
  82. Traumatic diabetes insipidus
    • Results from decreased secretion and action of anti-diuretic hormone (ADH)
    • Caused by traumatic brain injury with compression on hypothalamic or pituitary OR inadequate blood supply
  83. S/S of diabetes insipidus
    • First sign is POLYURIA, 4-6 L urine a day
    • Hypernatremia - losing water so Na in body increases, less fluid to dilute
    • Thirst, polydipsia
    • dehydration & shock
  84. Tx of diabetes insipidus
    • Goal is to prevent circulatory failure and brain swelling due to imbalance in electrolytes. 
    • Replace volume deficit and ongoing loss
    • Replace ADH & electrolytes
    • Treat brain injury (surgery if needed) and maintain ICP
  85. SIADH
    clinical condition involving an excess of ADH secretion 

    • Pt is hyponatremic with low serum osmolality
    • Retains water, diluting electrolytes
  86. S/S of SIADH
    • low urine output in absence of hypovolemia
    • Hyponatremia
    • N/V
    • mental status changes
  87. SIADH tx
    • Normalize sodium over 24 to 48 hrs
    • Restrict fluids 800 mL/day
    • loop diuretics
  88. Epidural hematoma tx
    May require emergency craniotomy... Burr holes and pressure drains may also be used

    • Serious, fast arterial bleeding usually from blunt force that tears dura mater away from skull
    • Loss of consciousness - lucid - LOC rapidly declines
    • HA, vomiting, fixed dilated pupil on same side as hematoma, seizures
  89. Glasgow coma score
    • Assesses LOC
    • Max score is 15, unless intubated (10)
    • Min score 3 (2 if intubated)
  90. Eye scores for glascow
    • 4 - spontaneous
    • 3 - Speech
    • 2- Pain
    • 1- None
  91. Verbal responses for glasgow
    • 5 - oriented
    • 4 - confused conversation
    • 3 - words inappropriate
    • 2 - sounds incomprehensible
    • 1 - None
  92. Best motor response for glasgow
    • 6 - Obey commands
    • 5 - Localized pain
    • 4 - flexion - normal
    • 3 - flexion - abnormal
    • 2 - extend 
    • 1 - none
  93. Herniation
    • Increased ICP from any cause decreases cerebral perfusion, stimulating swelling (edema) and may shift brain tissue, resulting in herniation
    • The brain's ability to autoregulate become ineffective and decompensation (ischemia and infarction) begins
  94. Herniation s/s
    • *Cushing's triad: bradycardia, hypertension, bradypnea
    • Pt also exhibits significant changes in mental status and VS
  95. Increased ICP early signs
    • Change in LOC
    • Restlessness
    • confusion
    • disorientation
    • slow speech
  96. Intracranial surgery priority nursing
    • Monitor body temp
    • Prevent DVT's, stem herniation
    • Monitor ICP closely
    • Maintain adequate O2
    • Elevate HOB at least 30
    • Maintain normal BP
    • Avoid extreme head rotation
  97. Therapeutic hypothermia
    • deliberate reduction of core body temp
    • Pt is at risk for infection d/t lowered immune response, aspiration from sedation, skin breakdown from vasoconstriction
  98. Autonomic dysreflexia
    • an acute life-threatening emergency that occurs as a result of exaggerated autonomic responses 
    • Occurs after spinal shock has resolved
    • Occurs among pt with cord lesions above T6
  99. Clinical manifestation of autonomic dysreflexia
    • characterized by severe, pounding HA w paroxysmal hypertension, profuse diaphoresis, Nausea, bradycardia
    • sudden increase in BP may cause rupture or cerebral blood vessels or increased ICP
  100. s/s of autonomic dyreflexia
    • Stimuli which may trigger this reflex:
    • distended bladder most common
  101. Morbidity & mortality of SCI
    • Most common cause is MVA, falls, violence, sports
    • Leading cause of death is infection
    • Higher spinal injures, vented pt and advanced age have higher death rate
  102. Neurogenic shock
    • shock state resulting from loss of sympathetic tone causing relative hypovolemia
    • Sympathetic stimulation causes vascular smooth muscle to constrict
  103. Causes of neurogenic shock
    • Spinal cord injury
    • spinal anesthesia
    • other nervous system damage
  104. S/S of neurogenic shock
    • Hypovolemia d/t vessel dilation
    • Bradycardia
    • Hypotension
    • Warm dry skin
  105. Nursing management of neurogenic shock
    • HOB >30 
    • Prevent DVT's
    • Monitor signs of bleeding (pt with SCI may not be able to feel pain)
  106. Priority care for SCI
    • Prevent secondary injury
    • Maintain airway
    • Maintain BP and CO
  107. Respiratory control w SCI
    • vent/trach if injury is high enuf to affect diaphragm
    • Encourage deep breathing, coughing

    • *Respiratory dysfunction is related to level of injury. Muscles contributing to respiration are T1 to T11. and diaphragm C4. 
    • High cervical injury can result in lost of diaphragm function
  108. Spinal shock s/s
    • decreased BP and HR
    • decrease CO
    • venous pooling
    • peripheral vasodilation
    • increase in temp
  109. spinal shock tx
    • methylprednisolone steroid
    • can occur from abrupt them changes
    • Main prob is SNS is blocked so heart can't beat fast enough to supply O2 to organs
  110. Ischemic attack
    • Also known as CVA
    • A sudden loss of function resulting from disruption of blood supply to a part of brain
    • Only have a 3 hr window for thrombolytic therapy
  111. S/S of ischemic stroke
    • Numbness or weakness of face, arm, leg especially on one side of body
    • Confusion & mental status change
    • trouble speaking & understanding
    • difficulty walking & balance
  112. Hemorrhagic stroke
    • Strokes caused by bleeding into the brain tissue, the ventricles, or subarachnoid space
    • Primarily caused by intracranial or subarachnoid hemorrhage, also cerebral aneurysm or arteriovenous malformation
  113. S/S of hemorrhagic stroke
    • Exploding HA
    • Decreased level of consciousness
    • Have poor prognosis
  114. Cerebral aneurysm nursing care
    • Airway priority!
    • Thrombolytic agents
    • Monitor for signs of bleeding
    • Frequent neuro checks
    • Monitor ICP
    • monitor cardiac funtion
  115. CVA discharge teaching
    • Self care, assistive devices
    • home modification
    • PT
    • Emotional changes and depression are common
    • Educate family & caregivers to take care of themselves too
    • Health promotion: diet, exercise, medication management
  116. Hemianopsia
    • Loss of half of field of vision
    • Pt will often neglect affected side
  117. Hemianopsia nursing care
    • Remind pt of side of body 
    • maintain alignment of extremities
    • If possible, place extremities where pt can see them
  118. Priority for hemorrhagic stroke
    • CT to determine type of stroke - don't give 
    • Airway!
    • Monitor ICP
    • Hypertension control - lower systolic to prevent hematoma enlargement
    • Elevate HOB to allow for drainage
  119. Risk factors and prevention for Stroke
    • Age, gender and race are well-known nonmodifiable risk fasters
    • Modifiable:
    • HTN
    • AFib
    • DM
    • Smoking
    • Obesity
    • Sleep apnea
    • Excessive alcohol
    • Periodontal disease
  120. Thrombolytic therapy contraindication
    • Hemorrhagic Stroke
    • Serious Head injury
    • Major surgery in last 14 days
    • Active bleeding
  121. ETOH withdrawal assessment
    • Sx of alcohol withdrawal can vary widely in severity. 
    • HA, N/V, tremors, hallucination & seizure
    • Benzodiazepines and carbamazepine can be used to treat physical symptoms
  122. Cerebellum function
    • responsible for balance and coordination
    • Test by Romberg, finger to nose, and heel to shin
  123. Meninges
    • fibrous connective tissues that cover the brain and spinal cord
    • provide protection, support, and nourishment
    • Dura Mater
    • Arachnoid
    • Pia Mater
  124. Dura Mater
    • outermost layer
    • cover brain and spinal cord
    • tough thick elastic fibrous and gray
  125. Arachnoid
    • middle membrane
    • extremely thin, delicate membrane that closely resembles a spider web
    • CSF in space below it known as subarachnoid space
  126. Pia mater
    the innermost thin, transparent layer that hugs the brain closely and extends into every fold of the brains surface
  127. Reflex documentation
    • deep tendon reflexes graded on scale of 0-4
    • 0-no response
    • 1+ - diminished (hypoactive)
    • 2+ - normal
    • 3+ -increased (may be interpreted as normal)
    • 4+ - hyperactive
  128. Which substance is released into the circulatory system in tumor lysis syndrome (TLS)
  129. Which type of malignancy is most likely to cause TLS
  130. Allopurinol is administered for TLS to
    inhibit uric acid
  131. Appropriate tx of hypercalcemia includes
  132. SIADH causes...
    excessive release of ADH
  133. Nursing interventions to consider for pt with SIADH might include
    implementing seizure precautions
  134. Pericardial effusion is mainly seen in pt..
    with primary tumors of the heart or metastatic lung or breast cancer
  135. New onset of back pain in a cancer pt that worsens with movement or lying down is suspicious of...
    • SVCS
    • Superior vena cava syndrome
  136. Which medication is initially given to reduce the pain and edema of spinal cord compression
  137. The initial tx to reduce tumor burden in spinal cord compression is...
    radiation therapy
  138. SVCS impairs circulatory drainage from the
    head and upper extremities
  139. What type of test is used for diagnosing SVCS
Card Set:
CD final
2016-12-12 04:41:56

Complex disorders final
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