NRSG 102: Test 2- cancer, infection, immunity, mobility
NRSG 102: Test 2- cancer, infection, immunity, mobility NRSG 102
Ivy Tech Community College Bloomington
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This 51 page Study Guide was uploaded by Lucy Notetaker on Tuesday October 11, 2016. The Study Guide belongs to NRSG 102 at Ivy Tech Community College Bloomington taught by Cassie Mann in Fall 2016. Since its upload, it has received 10 views. For similar materials see Med Surg in Nursing Registered Assoc. Deg at Ivy Tech Community College Bloomington.
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Date Created: 10/11/16
Chapter 14- Cancer Cancer- a group of complex diseases characterized by uncontrolled growth and spread of abnormal cells Abnormal growth of cells Does not act or function like normal cells or cells of a specific area Does not die, replicates and reproduces at a rapid pace nd 2 most common cause of death o Lung cancer remains leading cause of all cancer deaths in both men and women, accounting for 27% of all cancer deaths African Americans and Asians have the most burden Oncology- the study of cancer Greek root “oncoma” meaning “root” Incidence and Mortality o Risk Factors Genetics and heredity Genetics- study of genes Human Genome- totality of human genes Genomincs- study of all the genes in the human genome together, including the genes’ interactions with each other, the environment, and the influence of other psychosocial and cultural factors Heredity- how genes are passed from generation to generation o Recurring patterns of cancer within the family are a risk factor for heredity, not necessarily genetics Breast cancer genes BRCA-1 and BRCA-2 Familial cancers generally occur during old age, whereas heredity cancers usually happen at younger ages Hereditary genes are at younger ages Age More than 75% of cancers diagnosed after age 55 Decreased immune system Longer exposure to risk factors/promotional agents Free radicals (molecules resulting from the body’s metabolic and oxidative processes) tend to accumulate in the cells over time. Cells increase in oxidant and inflammatory compounds and decrease in antioxidant defense causing cellular damage Hormonal changes that occur with aging can be associated with cancer o Postmenopausal women receiving estrogen- ↑ risk for breast cancer o Men break down testosterone into carcinogens- ↑ risk for prostate cancer Stress associated with increased age , death of a spouse and family/friends, loss of position in society, decline in physical abilities Elderly with cancer often die from secondary issues not necessarily the cancer itself Cultural (Blue Box pg. 336) Hispanics- higher rates of cancers associated with infectious agents o Uterine, cervix, liver, and stomach cancers o Hispanic women in US have 60% higher cervical cancer incidence than non-Hispanic white women o Incidence of liver cancer is almost twice as high in Hispanics compared to non-Hispanic whites African Americans are more likely to develop cancer than any other ethnic group in the US for MOST cancers- highest death rate and shortest survival of any ethnic group o African Americans have highest incidence and mortality for colorectal and lung cancers o Breast cancer is 10% lower in African Americans BUT mortality rate is 40% higher if they do get it than compared to Caucasian o African American men are 59% more likely for prostate cancer than men of any ethnic or racial group Native Americans are the lowest incidence in cancer and mortality Gender Breast cancer is the most frequently diagnosed cancer in women Prostate cancer is the most frequently diagnosed cancer in men Bladder cancer is 4x more likely in men than in women Thyroid cancer is more common in women Poverty Worse prognosis d/t lack of follow through with treatment Lack of health insurance Less access to health care o Especially screenings and/or counseling Stress Hormones such as epinephrine and cortisol can result in systemic fatigue and impaired immunologic surveillance General adaptation syndrome in relation to increased adrenal hormones Diet High in red meat and saturated fat ↑ risk for cancer High fat and low fiber foods (common American diet) show ↑ risk for colon, breast, and sex hormone dependent tumors Occupation- exposure to solar radiation, ionizing radiation, carcinogenic substances, asbestos Table 14-1 page 337 o Polycyclic hydrocarbons (smoke, soot, tobacco, smoked foods), benzopyrene- miners, coal/gas workers, chimney sweeps, migrant workers, smoke filled rooms o Arsenic- pesticide manufacturers o Vinyl chloride polymers- plastics workers, artists o Methylaminobenzine- fabric, rubber, glue workers o Asbestos- construction, rundown buildings, insulation makers o Wood and leather dust- woodworkers, carpenters, leather toolers o Chemotherapy drugs- drug manufacturers, pharmacists, nurses Infection Hep B (chronic Hepatitis) and Hep C (drug and alcohol use)- liver cancer Epstein Barr- lymphomas HIV- Kaposis Sarcoma (lung cancer) H. Pylori- stomach cancer and mucosal lining cancers HPV- cervical and anal cancers Tobacco use Smoking related diseases remain the world’s most preventable cause of death 3400 nonsmoking individuals dying from cancer related to SHS Increased risk for oropharyngeal, esophageal, laryngeal, gastric, pancreatic, and bladder cancers 7000 chemicals in cigarettes, of these 69 are known carcinogens Carcinogens in tobacco are NOT genotoxic, therefore stopping smoking can reverse chances of lung cancer Other substances in tobacco are promotional so the longer the dose = higher risk Significantly less chance for former smokers compared to current smokers Alcohol use Enhances the contact between carcinogens in tobacco and the stem cells that line the oral cavity, larynx, and esophagus Recreational Drug Use Decreased nutrition Decreased immune system Marijuana demonstrated to cancer but not implicated (not proven) o Marijuana smoke is more destructive to lung tissue than tobacco smoke because marijuana changes at the chromosomal level and changes the DNA Obesity Cause of 14-20% of all cancer related mortality in the US (BMI>30) Excessive body fat has been linked to an increased risk of hormone dependent cancers o Breast, bowel, ovary, endometrium, and prostate Visceral fat- body sending blood to fat instead of sending oxygen and nutrients to other organs Sun Exposure Thinning ozone layer Older adults with decreased pigment are at a higher risk, even those with darker skin EVERYONE needs to take caution o Prevention Methods Sunscreen Low Fat Diet High Fiber Diet Smoking Cessation (also helps prevent cancers from SHS) Breastfeeding Routine Physical Activity Screening Early detection is THE BEST prevention method Pathophysiology o Normal Cell Growth o Cell Cycle o Differentiation- normal process occurring over many cell cycles that allows cells to specialize in certain tasks Hyperplasia Increase in the number or density of normal cells In response to stress, increased metabolic needs, or elevated hormone levels Under DNA control o Ex: hyperplasia of myocardial cells in response to prolonged increase in body’s demand for O₂ o Ex: hyperplasia of uterine cells in response to rising levels of estrogen during pregnancy Metaplasia Change in normal pattern of differentiation- dividing cells differentiate into cell types not normally found in that location in the body o Ex: House S4:E10. Lady has breast tissue behind her knee Normal cell for its particular type BUT not in normal location Protective response to adverse conditions Under normal DNA control and reversible Dysplasia Cells show abnormal variation in size, shape, appearance, and disturbance in usual arrangement Loss of DNA control o Ex: dysplastic cells in cervix in response to HPV o Ex: leukoplakia in mucous membranes in response to irritation found in smokers Anaplasia Regression of cell to immature state of undifferentiated cell type No longer under DNA control Occurs when damaging or transforming event occurs while cell is still dividing No useful function KNOW Hyperplasia Metaplasia Often reverse after irritating factor is eliminated but can Dysplasia lead to malignancy. Anaplasia is NOT reversible o Degree of anaplasia determines the risk for cancer o Theories of Carcinogenesis Carcinogenesis- process by which normal cells are transformed into cancer cells Can be 10+ years between exposure/mutations and detectable cancer Can be EXTERNAL: o Chemicals o Radiation o Viruses Can be INTERNAL: o Hormones o Immune conditions o Inherited mutations Two concepts about etiology of cancer: o Damaged DNA Sets up the necessary initial step for cancer to occur Whether inherited or from external sources o Impairment of the human immune system Lessens ability to destroy abnormal cells From whatever cause Cellular mutation Carcinogens- certain agents that cause mutations in cellular DNA and transform cells into cancer cells Three Stages: o Initiation- exposure Involves permanent damage to cellular DNA Ex: radiation or chemicals o Promotion- acts repeatedly on damaged cells May last for years Ex: smoking or alcohol use o Progression- further inherited changes acquired during cell replication develop into cancer Oncogenes- abnormal genes that promote cell proliferation and are capable of triggering cancerous characteristics Ex: Philadelphia Chromosome o BCR-ABL fusion protein, results from translocation between chromosomes 9 and 22 Found in patients with chronic myelogenous leukemia and other leukemia’s. Classified according to their overall function Proto-oncogenes- normal genes that promote cell growth and repair Occur during times of stress or in response to certain carcinogens Ex: patients with AIDS who have lower T-helper lymphocytes have a much higher incidence of certain cancers including non-Hodgkin’s Lymphoma and Kaposi’s Sarcoma Tumor suppressor genes Block cell growth by suppressing oncogenes Become inactive by deletion or mutation Ex: inherited mutations in the p53 gene are associated with sarcomas, breast cancer, leukemia, and renal tumors o Known Carcinogens Genotoxic carcinogens- directly alter DNA and cause mutations Promoter substances- cause other adverse biologic effects BUT DO NOT cause cancer in absence of previous cell damage Cytotoxicity Hormonal Imbalances Altered Immunity Chronic Tissue Damage Viruses- vaccinations may prevent the viruses which lead to cancers HIV- impairs protection of lymphoma and Kaposi’s Sarcoma Hep B- hepatocellular carcinoma (liver) Papilloma Viruses- cause planter, common, and flat warts associated with malignant melanoma and cervical, penile, and laryngeal cancers Drugs and Hormones Estrogen containing or chemotherapy agents Chemical Agents Benzopyrene- cigarette smoke Arsenic- pesticides Bile Acids- in high fat diet Sugar substitutes Bilirubin in babies/Jaundice o Excess can lead to brain damage Physical Agents Radon Nuclear Weapons Solar Radiation o Types of Neoplasms (Tumors) Table 14-2 Page 341 Benign Characteristics o Local o Cohesive o Well Defined Borders o Pushes Other Tissue Out of the Way o Slow Growth o Encapsulated o Easily Removed o Does Not Recur o Stops at Tissue Border Malignant o Invasive o Non-cohesive o Does NOT Stop at Tissue Border o Invades and Destroys Surrounding Tissue o Rapid Growth o Metastasizes to Distant Sites (Most Destructive Trait) o Not Always Easy to Remove o Can Recur o Cause Bleeding o Cause Inflammation o Cause Necrosis of Surrounding Tissue o Does NOT Respond to Body’s Homeostatic Controls o Characteristics of Malignant Cells Loss of regulation of the rate of mitosis Loss of specialization and differentiation Loss of contact inhibition Progressive acquisition of a cancerous phenotype Irreversibility Altered cell structure Simplified metabolic activities Transplantability Ability to promote their own survival o Tumor invasion and Metastasis (Page 342 understand invasion and metastasis process) Only 1 in 1000 cancer cells become cancer cells The rest are destroyed by the body Chemotaxis- cancer cells send out a chemical agent calling all other cancer cells in the body to unite and form a tumor AKA Autocrine Motility Factor Most common sites for metastasis Lymph nodes Liver Lungs Bone Brain Metastasize via blood or lymph and escape detection because they travel via “normal system” Lung cancer frequently metastasizes to adrenal glands Breast cancer frequently metastasizes to bone Malignant cells may break through walls of organ shedding cells into the nearby body cavity leaving opportunity for new cells to freely establish Ex: cells from a colon cancer can seed into the peritoneal cavity and establish a new tumor in the mesenteric epithelium Invasion Ability to cause pressure atrophy Ability to disrupt the basement membrane of normal cells Motility Response to chemical signals Metastasis steps Intravasation of malignant cells through the blood or lymphatic vessel walls and into the circulation Survival of the malignant cells in the blood Extravasation from the circulation and implantation in a new tissue o Table 14-3 Page 343 Bronchogenic (lung) Spinal cord Brain Liver Bone Breast Brain Liver Bone Lung Vertebrae Regional Lymph Nodes Colon Brain Liver Bone Lung Ovary Prostate Liver Bone (especially vertebrae) Bladder Malignant Melanoma Liver Brain Lung Spleen Regional Lymph Nodes Physiologic and Psychologic Effects of Cancer o Blue Box Page 343 Ascites Obstruction to the portal vein in liver, which can cause portal hypertension, resulting in the backup of fluid Malaise/Fatigue Effect of inflammatory mediators such as interleukins and tumor necrosis factor-α (TNF-α) on the central nervous system Anorexia, N/V Effect of inflammatory mediators and endotoxins on the vomiting center in the medulla Pain Stretching and compression of body tissues by the tumor Activation of nociceptors by chemicals released by ischemic tissues or tumor metabolites and toxins Disruption of Function Hematologic Alterations Infection Hemorrhage Anorexia-Cachexia Syndrome o Cachexia- wasted appearance of cancer patients Cancer robs its host of nutrients and increases body catabolism of fat and muscle to meet metabolic needs Ex: Figure 14-4 on Page 344 o Can be due to pain, infection, or depression o Side effect of chemotherapy and radiation o Early in the disease- altered glucose metabolism leads to increased glucose equaling loss of appetite o Tumor secretes substances altering taste and smell, producing early satiety, pain, infection, and depression o Causes food aversions to meats, coffee, or chocolate Paraneoplastic Syndromes- indirect effects of cancer o Endocrine Cancers set up ectopic sites of hormone production o Neurologic Cancer damages the nervous system o Hematologic abnormalities o Nephrotic o Cutaneous o Other neurologic syndromes Pain o Types of cancer pain Acute Pain Chronic Pain o Causes of cancer pain Direct tumor involvement is the PRIMARY CAUSE Side effects or toxic effects of cancer therapies Physical Stress- body tries to destroy neoplasm using all resources which is a physical strain o Fatigue o Weight Loss Weight is not an indicator for nutrition o Anemia o Dehydration o Altered Blood Chemistries Table 14-8 Page 349-350 Albumin: 3.5-5.0 o ↓ in malnutrition o ↓ is indicative of liver cancer Blood Urea Nitrogen (BUN): 5-25 o ↓ in malnutrition o ↓ is indicative of renal cancer Calcium (Ca): 4.5-5.5 o ↑ in bone cancer o ↑ in ectopic parathyroid hormone production Chloride (Cl): 95-105 o ↓ in vomiting and diarrhea o ↓ in syndrome of inappropriate antidiuretic hormone (SIADH) Creatinine: 0.5-1.5 o ↓ in malnutrition o ↑ in MOST cancers Fasting Blood Sugar (Glucose): 70-110 o ↓ in malnutrition o ↓ in stomach, liver, and lung cancers Hematocrit (Hct): M:40-54% F: 36-46% 1:3/Hgb:Hct o ↓in anemia, leukemia, Hodgkin’s lymphoma, lymphosarcoma, multiple myeloma, and malnutrition o ↓ is a side effect of chemotherapy Hemoglobin (Hgb): M: 13.5-18 F: 12-15 1:3/Hgb:Hct o ↓ in anemia, many cancers, Hodgkin’s Lymphoma, leukemia, and malnutrition o ↓ is a side effect of chemotherapy Occult Blood: Negative o + in gastric and colon cancers Platelet (thrombocyte) Count: 150K-400K o ↓ in bone, gastric, and brain cancers o ↓ in leukemia o ↓ is a side effect of chemotherapy Potassium (K): 3.5-5.3 o ↓ in vomiting, diarrhea, and malnutrition Red Blood Cells (RBCs): M: 4.6-6.0 F: 4.0-5.0 o ↓ in anemia, leukemia, infection, multiple myeloma Sodium (Na):135-145 o ↓ in SIADH, and vomiting o ↑ in dehydration Total Leukocytes: 4.5-10K o ↑ in acute infection, leukemia, and tissue necrosis o ↓ is a side effect of chemotherapy Psychologic stress o Guilt o Fear o Grief o Anger o Powerlessness o Hopelessness o Body Image Concerns Interprofessional Care o Diagnosis X-rays, CT, ultrasonography, and MRI can locate tumors Classification Cell type and structural difference from parent cell- tissue samples acquired through biopsy, shed cells, or collection of secretions Grading and Staging Grading- “aggressiveness” o Evaluates the amount of differentiation (level of functional maturity) of the cell and estimates the rate of growth based on mitotic rate Staging- used to classify solid tumors and refers the relative size of the tumor and extent of the disease o T- relative tumor size, depth of invasion, and surface spread o N- presence and extent of lymph node involvement o M- presence or absence of distant metastases Table 14-6 Page 347 Cytologic examination- how specimens are collected Exfoliation from an epithelial surface o Scraping cells from the cervix (Pap smear) or bronchial washings Aspiration of fluid from body cavities or blood o WBCs for evaluation of hematopoietic cancers, pleural fluid, and cerebrospinal fluid Needle aspiration of solid tumors o Includes breast, lung, or prostate Tumor markers Protein molecule detectable in serum or other body fluids Used for early diagnosis and for tracking responses to therapy High levels are considered suspicious Include o Antigens o Hormones o Proteins o Enzymes Oncologic Imaging X-Ray Imaging o Method of choice for screening o Can see tumor 1 cm in size o Used especially for breast, lung, and bone Computed Tomography (CT) o Allows visualization of cross sections of the anatomy o Greater accuracy than X-Ray o Used for renal cell and GI tumors o Evaluate lymph node involvement Magnetic Resonance Imaging (MRI) o Placed in strong magnetic field with pulsed radio waves directed at patient o Computer analyzes characteristics based on transmitted signals o Positron Emission Tomography (PET) scan o Single Photon Emission Computed Tomography (SPECT) scan o MRI is the diagnostic tool of choice for cranial and head/neck tumors Ultrasonography o Measures sound waves as they bounce off various body structures o Prostate cancer is found using ultrasound o Used to guide needle biopsy Nuclear Imaging o Use of special scanner in conjunction with the ingestion or injection of specific radioactive isotopes o Used for bone or other metastases o Invasive but safe diagnostic method for identifying tumors Angiography o Used when precise location of tumor cannot be identified or when need to visualize the tumors extent prior to surgery Direct Visualization Invasive but do not required radiography Sigmoidoscopy o Sigmoid colon Cystoscopy o Urethra and bladder Endoscopy o GI tract Bronchoscopy o Lungs These methods permit biopsy Lab Tests Used to rule out nutritional disorders and other noncancerous conditions that may be causing patient’s symptoms Table 14-8 Page 349 Psychologic Support During Diagnosis o Cancer Treatment Goals Eliminate tumor Prevent metastasis Reduce cellular growth and the tumor burden Promote functional abilities Provide pain relief Surgery Surgical resection is used for diagnosis and staging of more than 90% of all cancers and for primary treatment of more than 60% of cancers Prophylactic- remove tissues or organs more likely to develop cancer o Ex: breast Radiation may be done prior to surgery to shrink size of tumor when extensive Chemotherapy o Know safety precautions when administering o Care with excretory products o VADS- risk of infection, catheter obstruction, and extravasation (leakage), and infiltration o Monitor lab values that indicate organ toxicity o Infection control d/t decreased immune response Classes of Chemotherapy Drugs o Alkylating Agents o Antimetabolites o Antitumor Antibiotics o Mitotic Inhibitors o Hormones and Hormone Antagonists o Miscellaneous Agents o Effects of Chemotherapeutic Drugs Mucous membranes May result in anorexia Loss of taste Aversion to food Painful ulcerations Nausea and vomiting Diarrhea Alopecia Bone marrow depression affecting RBC Impaired ability to respond to infection Diminished ability to clot blood Severe anemia Organs such as heart, lungs, bladder, and kidneys Cardiac toxicity Pneumonitis Reproductive organs- ability or fetus Physiologic issues Need to plan activities around chemotherapy Weight loss Alopecia Feelings of powerlessness Depression o Preparation and Administration o Management of Patients Receiving Chemotherapy Assessment and monitoring of toxic effects or side effects of drugs Organ toxicities reported immediately Teach how to care for access sites and dispose of used equipment and excretions Teach to increase fluid intake, rest, identify major complications Know when to call for physician Limit exposure to others Radiation Therapy Consists of delivering ionizing radiations of gamma and x- rays Used to kill the tumor, reduce its size, decrease pain, or relieve obstruction External radiation (teletherapy) o Relatively uniform dosage from a source at a distance from the patient o Side effects Skin changes such as blanching, erythema, desquamation, sloughing, hemorrhage Ulcerations of mucous membranes Decreased oral secretions Increased infection and cavities GI- nausea, vomiting, diarrhea, bleeding Lungs- interstitial exudate called radiation pneumonia Internal radiation (brachytherapy) o Given inside the body o Radioactive material is placed directly into or adjacent to the tumor Can be dangerous for those living with, taking care of, or treating the patient Decision to use made by risk- benefit analysis BOX 14-5 – understand safety precautions that must be used during radiation, especially for those undergoing internal radiation Biotherapy Modifies the biologic processes that result in malignant cells o Enhances the patient’s own immune response Used for both hematologic malignancies (lymphoma, hairy cell leukemia) and renal, lung, and melanoma Tumor associated antigens can be isolated from serum and used for diagnosis and tx Development of monoclonal antibodies- tumor antigen placed in animal and recovered antibodies given to human Natural killer cells Cytokines such as interferon alpha or interleukin 2 in combo with chemo agents can treat renal cell, malignant myeloma, and lung cancer Photodynamic Therapy Used for superficial tumors of bladders, peritoneal cavity, chest wall, pleura, bronchus, head and neck MUST HAVE photoprotection Bone Marrow and Peripheral Blood Stem Cell Transplantations Complementary Therapies- BOX 14-6 Botanical agents o Echinacea o Essiac o Ginseng o Green tear o Pau d’ arco o Hoxsey Nutritional supplements o Vitamins o Minerals o Enzymes o Amino acids o Essential fatty acids o Proteins Promote health and help cure cancer Dietary regimens o Ingestion of only natural substances to purify the body and slow growth of cancer Mind & Body o Relaxation o Meditation o Imagery Energy Healing o Therapeutic touch o Healing touch Spiritual approaches o Faith based healing Miscellaneous o Aromatherapy o Music o Art o Humor o Pain Management Categories of pain syndromes in cancer patients Pain associated with direct tumor involvement Pain associated with treatment Pain from a cause not related to either cancer or therapy Goals Promote health and help cure cancer Provide relief that allows patient to function Die relatively free from pain Other Therapies Injection of anesthetic drugs into spinal cord or nerve plexuses Surgical severing of nerves Radiation to reduce tumor size and pressure Behavioral approaches Drugs and pain management Morphine sulfate and transdermal fentanyl are the most commonly used drugs for relief of cancer pain Fentanyl can be given as a patech Primary narcotic administered intramuscularly, subQ, or rectally on intermittent schedule Nonopiods o Tylenol o Ibuprofen o Toradol o Relafen o Daypro Opiods o Morphine o Oxycodone o Dilaudid o Fentanyl Coanalgesics o NSAIDS o Antispasmatics o Muscle relaxers Pain management steps o Conduct initial and ongoing assessment of pain o Evaluate the patient’s functional goals o Establish a plan with combinations of non-narcotic drugs with adjuvants o Evaluate the degree of pain relief o Progress to stronger drugs as needed o Continue to try cominations and escalate dosages until maximal pain relief balances with patient’s need to function is achieved Nursing Care Health Promotion Assessment o Physical Assessment Diagnoses, Outcomes, and Interventions o Anxiety o Disturbed Body Image o Grieving o Risk for Infection o Risk for Injury o Imbalanced Nutrition Less than Body Requirements o Impaired Tissue Integrity Nursing Interventions for Oncologic Emergencies o Pericardial Effusion and Cardiac Tamponade Accumulation of excess fluid in the pericardial sac that compresses the heart, restricts heart movement, and results in cardiac tamponade Decreased cardiac output and impaired cardiac function Signs and Symptoms (s/s) Hypotension Tachycardia Tachypnea Dyspnea Cyanosis Increased central venous pressure Anxiety Restlessness Impaired consciousness Interventions Oxygen Intravenous catheter Monitor v/s Vasopressor drugs Emergency cart to bedside Assist physician with pericariocentesis o Superior Vena Cava Syndrome Can be compressed by mediastinal tumors or adjacent thoracic tumors Most common cause is small cell or squamous cell lung cancers Other cause could be a thrombus around a central venous catheter Results in obstruction and backup of the blood flow Signs and Symptoms Facial, periorbital, and arm edema are early signs Respiratory distress Dyspnea Cyanosis Tachypnea Altered consciousness Neurologic deficits Interventions Respiratory support with oxygen Tracheostomy Monitor v/s Administer corticosteroids to reduce edema Administer anticoagulants if due to a clot o Sepsis and Septic Shock Bacteria enters bloodstream Usually gram negative Caused by tissue necrosis, immune deficiency, antineoplastic therapy, malnutrition, and comorbid conditions Can result in multisystem failure Two phases Phase one- vasodilation with hypovolemia, high fever, peripheral edema, hypotension, tachycardia, hot flushed skin with creeping mottling on extremities Phase two- signs of shock such as hypotension, rapid thread pulse, respiratory distress, cyanosis, subnormal temp, cold clammy skin, decreased urinary output, and altered mentation o Spinal Cord Compression Occur d/t pressure from expanding tumors of breast, lung, or prostate; lymphoma; metastatic disease Can lead to irreversible paraplegia Signs and Symptoms Initially back pain, then leg pain Numbness Parethesias Coldness Bowel and bladder dysfunction Neurologic dysfunction Weakness Paralysis Tx Surgery Radiation o Obstructive Uropathy Occurs with intra-abdominal, retroperitoneal, pelvic malignancies Colorectal Prostate Cervical Bladder Obstructions of bladder neck and ureters Signs and Symptoms Urinary retention Flank pain Hematuria Persistent UTIs Often not evident until patient is in renal failure o Hypercalcemia Occurs d/t excessive ectopic production of parathyroid hormone Breast, lung, esophagus, thyroid, head, neck, multiple myeloma Signs and Symptoms Nonspecific symptoms such as fatigue Anorexia Nausea Polyuria Apathy Diminished reflexes Can progress to show alterations in mental status, psychotic behavior, cardiac arrhythmias, seizures, coma, and death o Hyperuricemia Complication of rapid necrosis of tumor cells after vigorous chemotherapy for leukemia and lymphomas Related to increased uric acid production or tumor lysis syndrome Caused by uric acid crystal deposits causing renal failure and uremia Signs and Symptoms Nausea Vomiting Lethargy Oliguria o Tumor Lysis Syndrome Life threatening Characterized by two or more metabolic emergencies Hyperuricemia Hyperphophatemia Hyperkalemia Hypocalcemia High incidence of TLS occurs in patients with high grade lymphomas and acute lymphocytic leukemia Main cause is chemo to tumors with a high proliferative rate, large tumor burden, high sensitivity to cytotoxic agents- massive and rapid cell death Signs and Symptoms Nausea and vomiting Lethargy Edema Fluid overload CGF Cardiac dysrhythmias Seizures Muscle cramps Tetany Syncope Sudden Death Allopurinol is administered to inhibit conversion of nucleic acid to uric acid Promote hydration and diuretic therapy to promote uric acid and phosphate excretion Administer oral phosphate binder Promote excretion of phosphate and sodium Hemodialysis may be necessary to manage electrolyte balance Health Education for the patient o Rehabilitation and Survival Continuity of Care- rehab centers, in home support, certified health aides, PT and OT o Teach wound care o Explain special diets, or refer patient to a dietitian before discharge o Hospice Care o Review physician’s instructions Medications Any other treatments When to see the doctor for follow-up care Complications of having cancer o Typically lower body weight but can increase as well o Pain o Increased fatigue- metabolic needs increasing need to fight cancer o Inability to digest or metabolize nutrients Adverse effects (of tx) o Chemo changes taste of food o n/v o diarrhea o satity- become full quickly o dry mouth- difficulty swallowing food o mucous membranes very fragile, bleeding ulcers of lining from mouth to rectum Nursing Interventions o Educate o Pain management o Biotene and other products o Monitor labs o Incorporate patient in meal planning o Protein shakes Chapter 12- Infections (Chapter 13- pages 1291-1307) Overview of Immune System Immune System Components o Leukocytes Granulocytes Monocytes, Macrophages, and Dendritic Cells Lymphocytes Antigens o Lymphoid System Innate Immune Response o Vascular Response o Cellular Response o Phagocytosis o Healing Adaptive Immune Response o Antibody-Mediated Immune Response o Cell-Mediated Immune Response Patient with Natural or Acquired Immunity o Pathophysiology *Interprofessional Care* Diagnosis Immunizations *Nursing Care* Health Promotion Assessment o Health History o Physical Assessment Priorities of Care Diagnosis, Outcomes, and Interventions o Readiness for Enhanced Immunization Status Continuity of Care Normal Immune Responses Patient with Tissue Inflammation o Pathophysiology and Manifestations Acute Inflammation Chronic Inflammation Granulomatous Inflammation Nonspecific Chronic Inflammation Complications *Interprofessional Care* Diagnosis Medications Nutrition *Nursing Care* Health Promotion Assessment Priorities of Care Diagnosis, Outcomes, and Interventions o Acute Pain o Impaired Tissue Integrity o Risk for Infection Delegating Nursing Care Activities Continuity of Care Normal Immune Responses Patient with an infection o Pathophysiology Pathogens Reservoir and Transmission Host Factors o Stages of the Infectious Process Incubation Period Prodromal Stage Acute Phase Convalescent Stage o Complications Healthcare-Associated Infections (HAIs) Antibiotic-Resistant Microorganisms *Interprofessional Care* Diagnosis Medications o Antibiotics o Antivirals o Antifungals o Antiparasitics Isolation Precautions Standard Precautions Transmission-Based Precautions *Nursing Care* Health Promotion Assessment Priorities of Care Diagnosis, Outcomes, and Interventions o Risk for Infection o Anxiety o Hyperthermia o Delegating Nursing Care Activities Continuity of Care Autoimmune and Inflammatory Disorders Patient with Rheumatoid Arthritis o Pathophysiology o Joint Manifestations o Extra-Articular Manifestations o Complications Rheumatoid Arthritis in the Older Adult *Interprofessional Care* Diagnosis Medications o Nonsteroidal Anti-inflammatory Drugs (NSAIDs) o Corticosteroids o Disease-Modifying Antirheumatic Drugs Nonbiologic DMARDS Biologic DMARDS Treatments o Rest and Exercise o Heat and Cold o Assistive Devices and Splints o Nutrition o Surgery *Nursing Care* Health Promotion Assessment Priorities of Care Diagnosis, Outcomes, and Interventions o Readiness for Enhance Self-Health Management o Chronic Pain o Fatigue o Ineffective Role Performance Delegating Nursing Care Activities Continuity of Care Autoimmune and Inflammatory Disorders Patient with Systemic Lupus Erythematosus o Pathophysiology o Manifestations *Interprofessional Care* Diagnosis Medications Treatments *Nursing Care* Diagnosis, Outcomes, and Interventions o Impaired Skin Integrity o Ineffective Protection o Readiness for Enhanced Self-Health Management Continuity of Care Chapter 38- Assessing the Musculoskeletal System Anatomy, Physiology, and Functions of the Musculoskeletal System Bones o Bone Structure o Bone Shapes o Bone Remodeling in Adults Cartilage Muscles Joints, Ligaments, and Tendons Assessing the Musculoskeletal System Diagnostic Tests Genetic Considerations Health Assessment Interview Physical Assessment Chapter 39- Musculoskeletal Trauma Traumatic Injuries of the Muscles, Ligaments, and the Joints Contusion, Strain, or Sprain o Pathophysiology and Manifestations o Interprofessional Care R I C E o Nursing Care Diagnosis, Outcomes, and Interventions Acute Pain Impaired Physical Mobility Joint Trauma o Pathophysiology and Manifestations Rotator Cuff Injuries Knee Injuries Joint Dislocation o Interprofessional Care Treatment o Nursing Care Assessment Priorities of Care Diagnosis, Outcomes, and Interventions Risk for Peripheral Neurovascular Dysfunction Acute Pain Impaired Physical Mobility Continuity of Care Repetitive Use Injury o Pathophysiology Carpal Tunnel Syndrome Bursitis Epicondylitis o Interprofessional Care Diagnosis Medications Treatments Conservative management Surgery o Nursing Care Diagnosis, Outcomes, and Interventions Acute Pain Impaired Physical Mobility Continuity of Care Traumatic Injuries of Bones Fracture o Pathophysiology o Fracture Healing o Manifestations o Complications Compartment Syndrome Fat Embolism Syndrome Deep Vein Thrombosis (DVT) Infection Delayed Union and Nonunion Complex Regional Pain Syndrome o Interprofessional Care Emergency care Diagnosis Medications Treaments Traction Casts Surgery Electrical Bone Stimulation o Fractures of Specific Bones or Bony Areas Skull Face Spine Clavicle Humerus Elbow Radius/Ulna Wrist/Hand Ribs Pelvis Hip Femoral Shaft Tibia/Fibula Ankle/Foot o Nursing Care Health promotion Assessment Priorities of Care Diagnosis, Outcomes, and Interventions Acute Pain Risk for Peripheral Neurovascular Dysfunction Risk for Infection Impaired Physical Mobility Continuity of Care Amputation o Causes of Amputation o Levels of Amputation o Types of Amputation o Amputation Site Healing o Complications Infection Delayed healing Chronic Stump pain Phantom Limb Pain Contractures o Interprofessional Care Diagnosis Medications Prosthesis o Nursing Care Health Promotion Assessment Priorities of Care Diagnosis, Planning, and Interventions Acute Pain Risk for Infection Risk for Impaired Skin Integrity Risk for Complicated Greiving Disturbed Body Image Impaired Physical Mobility Continuity of Care Chapter 40- Musculoskeletal Disorders Metabolic Disorders Osteoporosis o Risk Factors Nonmodifiable Risk Factors Modifiable Risk Factors A C C E S S o Pathophysiology o Manifestations o Complications o Interprofessional Care Diagnosis Medications o Nursing Care Health promotion Nutrition Exercise Assessment Priorities of Care Diagnosis, Outcomes, and Interventions readiness for Enhanced Self-Health Management Risk for Injury Readiness for Enhanced Nutrition Acute Pain Delegating Nursing Care Activities Continuity of Care Paget’s Disease of Bone o Pathophysiology o Manifestations o Complications o Interprofessional Care Diagnosis Medications Surgery o Nursing Care Priorities of Care Diagnosis, Outcomes, and Interventions Chronic Pain Impaired Physical Mobility Continuity of Care GOUT o Pathophysiology o Manifestations o Complications o Interprofessional Care Diagnosis Medications Acute Atttack Prophylactic Therapy Complementary and Alternative therapies Treatment Nutrition Rest o Nursing Care Diagnosis, Outcomes, and Interventions Acute Pain Continuity of Care Osteomalacia o Pathophysiology o Manifestations o Interprofessional Care Diagnosis Medications o Nursing Care Degenerative Disorders Osteoarthritis o Risk Factors o Pathophysiology o Manifestations o Interprofessional Care Diagnosis Medications Treatment o Surgery Arthroscopy Osteotomy Joint Arthroplasty Physical Therapy and Rehabilitation Complementary and Alternative Therapies o Nursing Care Health Promotion Assessment Priorities of Care Diagnosis, Outcomes, and Interventions Chronic Pain Impaired Physical Mobility Readiness for Enhanced Self-Care Delegating Nursing Care Activities Continuity of Care Muscular Dystrophy o Pathophysiology o Manifestations o Interprofessional Care o Nursing Care Diagnosis, Outcomes, and Interventions Self-Care Deficit Continuity of Care NCLEX Practice Questions Chapter 12 1. A patient receives gamma globulin after being exposed to hepatitis A. Which type of immunity should the nurse expect the patient to develop? a. Natural active b. Natural passive c. Acquired active d. Acquired passive 2. The nurse is caring for a patient with an infection. Which nursing action is a priority when providing the prescribed treatment? a. Administer prescribed anti-infective b. Obtain specimen for culture and sensitivity c. Assess for history of hypersensitivities and allergies d. Monitor for reaction to prescribed anti-infective 3. The nurse is providing medications to a patient with an inflammation. Which medication provided by the nurse will inhibit prostaglandin synthesis? a. Aspirin b. Penicillin c. Morphine Sulfate d. Warfarin (Coumadin) 4. While reviewing a patient’s recent complete blood count, the nurse notes a large percentage of banded neutrophils. What does this finding indicate to the nurse? a. Renal failure b. Acute infection c. Hyperthyroidism d. Autoimmune disorder 5. A patient is admitted with methicillin-resistant Staphylococcus Aureus cultured from a draining sacral wound. Which type of precaution should the nurse implement for this patient? a. Droplet b. Contact c. Airborne d. Protective 6. A patient with a systemic inflammation is resting in bed, periodically sleeping, and wants additional blankets. Which part of the immune system is responsible for this patient’s illness behavior? a. Interferons b. Phagocytes c. Complement system d. Inflammatory cytokines 7. A patient is diagnosed with neutrophilia. What does this finding indicate to the nurse? a. A decrease in total white blood cells b. A decrease in circulating neutrophils c. An increase in circulating neutrophils d. An expected average number of white blood cells 8. The nurse is preparing discharge instructions for a patient with an inflammation who is at risk for infection. What should the nurse include when teaching this patient? a. Limit daily intake of calories b. Apply heat for 20 minutes at a time c. Resume normal activities of daily living d. Take prescribed antibiotics until fever drops 9. The nurse is caring for an older patient recovering from an acute illness. Which interventions should the nurse implement to reduce the patient’s risk of developing a healthcare-associated infection? a. Teach the patient to restrict fluids throughout the day b. Coach the patient to deep breathe and cough frequently c. Recommend placement of an indwelling urinary catheter d. Wash hands with soap and water before entering the patient’s room 10. The nurse is instructing unlicensed assistive personnel (UAP) to use standard precautions when providing morning care to assigned patients. What should the nurse teach UAP to specifically do? a. Perform hand hygiene, wear masks, and recap needles b. Apply a mask and gown, and spray working surfaces with disinfectant c. Apply gloves, gown, and goggles if coming in contact with body fluids d. Wash hands with alcohol-based hand rub for visibly dirty or blood-contaminated hands Chapter 13 1. A nurse is caring for a patient experiencing a type I immediate hypersensitivity reaction. For which health problem is the nurse providing care to the patient? a. Anaphylaxis b. Graft rejection c. Hemolytic anemia d. Systemic lupus erythematosus 2. A patient received a liver transplant 1 day ago. If the patient were to develop an acute transplant rejection episode, when should the nurse expect to see the manifestations? a. Within the first 8 hours b. Within the first 24 hours c. Approximately 2 days after d. Approximately 4 days to 3 months after 3. The nurse notes a cough, shortness of breath, and tachypnea in a patient with AIDS. Which opportunistic infection is probably causing these manifestations a. Cytomegalovirus b. Toxoplasma gondii c. Pneumocystis jiroveci d. Cryptococcus neoformans 4. Which explanation should the nurse provide to a patient who has tested positive for HIV? a. “You have been diagnosed with AIDS.” b. “At this point, AIDS is not active in your blood.” c. “Antibodies to the AIDS virus are present in the blood.” d. “This means that you will not develop AIDS in the future.” 5. A patient is taking the nucleoside reverse transcriptase inhibitor zidovudine (Retrovir) for HIV. What should the nurse identify as an adverse reaction to this medication? a. Neutropenia b. Polycythemia c. Cardiotoxicity d. Nephrotoxicity 6. A patient is being scheduled for allergy testing. Which method shoul
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