Adult Health II Exam #1 Content Guide PDF

Content Guide Adult Health II Exam #1 Oncology 7 Warning Signs of Cancer ​ Changes in bowel/bladder habits ​ A sore that does not heal ​ Unusual bleeding or discharge ​ Thickening/lump in the breast or e...

Content Guide Adult Health II Exam #1 Oncology 7 Warning Signs of Cancer ​ Changes in bowel/bladder habits ​ A sore that does not heal ​ Unusual bleeding or discharge ​ Thickening/lump in the breast or elsewhere ​ Indigestion or difficulty swallowing ​ Obvious change in a wart or mole ​ Nagging cough or hoarseness Common signs of Cancer – Malignancy Malignant neoplasms display aggressive characteristics, can invade and destroy adjacent tissues, have a high rate of proliferation and metastasize to distant sites Risk factors for colon cancer modifiable risk factors ​ overweight or obese ​ smoking ​ alcohol use ​ consumption of red meat Non modifiable ​ male ​ hx of polyps ​ family hx ​ IBD ​ race ( african american ashkenazi jewish) Differentiate between Hospice and Palliative care Palliative Care: Control of symptoms throughout an illness including bereavement care for family, psychosocial care, spiritual support. (Aggressive symptom management) Hospice Care: Life expectancy of ≤ 6 months (having a terminal illness alone does not qualify for Hospice). Side effects of chemotherapeutic agents and interventions to help reduce effects ​ Nausea and vomiting – most common side effects ​ Alopecia (temporary) ​ Mucositis/Stomatitis  Content Guide Adult Health II Exam #1 ​ Skin changes ​ Anxiety, sleep disturbance ​ Altered bowel elimination ​ Nephrotoxic, hemorrhagic cystitis ​ Cardiopulmonary toxicity Interventions to reduce side effects ​ Antiemetics and benadryl given BEFORE chemotherapy- premedicate ​ Mucositis/Stomatitis or yeast infection - mouth assessment and oral hygiene (brushing, rinsing, flossing at least once daily & dental care). Use soft bristled toothbrushes or disposable mouth sponges. Rinse mouth with plain water or NS. Avoid mouthwashes containing alcohol. Avoid irritating foods. Use water-based lip moisturizers. Bland diet; neutral temperature ​ Alopecia – prevent injury to the scalp and assist the patient in coping with body image change ​ Pain – pharmacological and nonpharmacological approaches ​ Changes in cognitive function – support the patient ​ Chemotherapy-induced peripheral neuropathy – teach the patient to prevent injury What does extravasation mean and how is it treated? Definition: leakage of chemotherapy drug into extravascular space (tissue) ​ Most important nursing intervention is prevention (Vincristine, Vinblastine, Bleomyosin) ​ Vesicant chemotherapy agents should never be administered in peripheral veins involving the hand or wrist. ​ for frequent or prolonged administration of antineoplastic vesicants, use PICCs or implanted venous access devices. Indications of extravasation ​ Absence of blood return from the IV catheter ​ Resistance to flow of IV fluid ​ Burning or pain, swelling or redness at the site ​ Management Initial action -- Discontinue the infusion ​ aspirate remaining drug from site ​ cold or warm compress What is Tumor Lysis Syndrome and what are interventions and treatments? ​ Tumor Lysis Syndrome (TLS) – a positive sign that cancer treatment is effective.Occurs when cancer cells are killed and spill into the bloodstream.  Content Guide Adult Health II Exam #1 However Hyperkalemia and hyperuricemia can have life-threatening end-organ effects on the myocardium, kidneys & CNS. ​ Drink at least 3 L of fluid daily or admin IV fluids ​ Drug therapy – diuretics, allopurinol, sodium polystyrene sulfonate PO or IV, glucose and insulin IV insulin pushes potassium into cell ​ Dialysis Interventions for Immunocompromised patients ​ Private patient room. Avoid fresh flowers, potted plants in the pt’s room. ​ no fresh fruits, salads, raw fish ​ Strict aseptic technique. Avoid indwelling catheters ​ Perform head-to-toe patient assessment every 8 hours; Teach PCA’s the importance of personal hygiene/oral care – must be performed at least every 12 hours. (Clean armpits; genitals) ​ Administer blood/products as ordered/follow labs Care of the patient undergoing BM biopsy Priority is to prevent and monitor for bleeding and infection; ​ Cover the site with a sterile dressing after bleeding is controlled with manual pressure for several minutes ​ Elevate the biopsy site. Monitor VS q4 for 24 hrs ​ Mild analgesic. Must be aspirin free; ​ Ice packs can be used to limit bruising; ​ Can return to normal activities after the procedure, avoid contact sports or activity that might result in trauma for 48 hours Care of the patient with leukemia A type of cancer with uncontrolled production of immature WBCs in the bone marrow.(neutrophils) ​ Pain management ​ Energy conservation ​ Monitor labs/monitor for bleeding/Fluid and electrolyte management ​ Colony-stimulating growth factors ​ Signs of infection: urine, respiratory, vitals ​ Oral care  Content Guide Adult Health II Exam #1 ​ Nutrition: high calorie, high vitamin, frequent meals, soft texture, assess caloric intake ​ Antiemetic's prn What is the ANC, and what happens when it is low? ☆If ANC is too low it may cause chemotherapy treatments to be temporarily paused until number increases below 500mhold ​ Neutropenia, an abnormally low ANC, is associated with an increased risk of infection. The risk of infection rises as the ANC decreases. ​ For some patients, an absolute neutrophil count (ANC; a calculation of the number of circulating neutrophils, derived from the total WBCs and the percentage of neutrophils counted in a microscope’s visual field) of zero is not uncommon during chemotherapy Differentiate symptoms of Hodgkin’s vs Non-Hodgkin’s Lymphoma ​ Hodgkin's Lymphoma: Lymph nodes contain Reed-Sternberg cells. Usually presents with one unilateral supraclavicular node ​ Non-Hodgkin’s Lymphoma: All lymphoid cancers that do not contain Reed-Sternberg cells. Can be lymph nodes anywhere in the body Symptoms overlap ​ Enlarged lymph nodes in the armpits, neck or groin ​ Fever and/or night sweats ​ Unexplained weight loss ​ Severe itching ​ Ongoing fatigue BRCA 1 & 2 positive patient – what are treatment options Medical management ​ Radiation, chemotherapy, hormone or targeted therapy Surgical management  Content Guide Adult Health II Exam #1 ​ lumpectomy, lumpectomy with lymph node dissection, simple mastectomy, modified radical mastectomy, breast reconstruction Who is at risk for Superior Vena Cava Syndrome and what are their signs & symptoms? Potassium imbalance + hypercalcemia : monitor EKG ☆Painful and life-threatening emergency Most commonly seen with patients with lung , , head and neck cancer but can be seen in patients with metastases to the lung ie breast cancer ​ Superior Vena Cava (SVC) Syndrome – occurs when the SVC is compressed or obstructed by tumor growth or by clots in the vessel. ​ Early manifestations include facial edema especially around eyes, periorbital. As compression worsens blood vessels become engorged, JVD occurs, edema of upper body,dyspnea, erythema and epistaxis(nose bleed). pneumonectomy: Radiation Therapies Safety concerns to consider and teach about related to sealed radiation treatments ​ Sealed radiation source (implants) – the patient is radioactive but not excreting Safety factors regarding radioactive implants non-sealed and what to do if it becomes displaced or is out of the placed location ​ taken orally ie thyroid: If dislodged, use long-handled forceps to retrieve the source and deposit it in the lead container in the pt’s room immediately. Never touch the radioactive source with bare hands. Brachytherapy – who can and can't care for the patients; guidelines with care? Internal radiation (brachytherapy) - patient is radioactive for a period of time. oSystematic administration of radionuclide (e.g. IV isotopes, iodine-131) – excreta are radioactive & should not be directly touched by others. Take precaution & Do not share a toilet with others. ​ Assign the patient to a private room with a private bath. Place a caution sign on the door of the pt’s room. Keep the door closed. ​ Wear a dosimeter badge when caring for the patient. ​ Wear a lead apron while providing care.  Content Guide Adult Health II Exam #1 ​ Limit time to 30 minutes per care provider per shift. ​ Pregnant staff members should not be assigned to the patient’s care. ​ Do not allow pregnant women or children < 16 to visit. ​ Visitors should stay at least 6 feet away from the source. Limit visitors to 30 minutes per day. Adverse effects of radiation therapy (external beam) Vary according to the site ​ Local altered skin integrity : radiation dermatitis ​ Alopecia (permanent) associated with whole brain radiation. Radiation of other body parts does not lead to hair loss. ​ Stomatitis, xerostomia, mucositis , altered taste sensations ​ Fatigue, malaise, anorexia ​ Inflammatory responses leading tissue fibrosis and scarring Hematology Differentiate between anemias discussed (microcytic vs macrocytic), including signs and symptoms and what may cause these, and how each is treated Megaloblastic anemia: B12 and folate deficiency : High mcv and mcH: bone marrow makes red blood cells that are larger than normal.This is a problem because they are too large to leave the marrow to enter the bloodstream. Treatment of megaloblastic anemia may include taking vitamin B12 and folate supplements and increasing your dietary intake of these vitamins. (meat, dairy, fish) Megaloblastic anemia symptoms are similar to symptoms of other types of anemia ​ fatigue ​ weakness ​ pallor ​ and notably tingling or paresthesia in the extremities specific to b12 Microcytic anemia: iron deficiency and thalassemia: red blood cells don’t have enough hemoglobin, so they are smaller than normal. Treat with iron and vitamin C supplements. Iron rich foods; beef, chicken, lentils, dark leafy green vegetables  Content Guide Adult Health II Exam #1 ​ Fatigue ​ dizziness ​ easy bruising ​ dry skin Sickle Cell Crisis – Prevention, Causes of Crisis, Treatments ​ Sickle cell crises – triggered by conditions that cause local or systemic hypoxemia ​ Education: Avoid sick contacts, extremity of temperature, maintain hydration, altitudes, stress, immunizations ​ High risk for splenic infarct ​ treatment: O2, hydroxyurea, morphine, IV fluids, blood transfusion Autoimmune hemolytic anemias – common treatment regimens the nurse would expect ​ occurs when your immune system mistakes red blood cells as unwanted substances. As a result, your body produces antibodies that destroy red blood cells, which can lead to a low amount of red blood cells (known as anemia). ​ treatment: first line is corticosteroids, last resort is splenectomy immune thrombocytic purpura: something alters their immune system we need to g Thrombocytopenia – causes, signs & symptoms, platelet count? Nursing Interventions and Patient Education ​ Etiology: < 150K platelets; inherited or acquired; may be caused by some foods or meds (chemo, anti-seizure) ​ Autoimmune disease (after viral illness): Immune thrombocytopenia purpura (ITP) ​ S&S: petechiae, purpura, ecchymosis, prolonged bleeds, nosebleeds, other anemia like symptoms. (non-blanching) ​ Nursing: Follow labs, IV immunoglobulin, Corticosteroids, plasma infusion ​ Education: avoid Valsalva (cough, sneeze) Gentle nose blow, report new symptoms why? Because it cause clot to break off ​ What is therapeutic phlebotomy and why would it be done? ​ Bloodletting, taking off 1-2L of blood ​ done if they have chronic conditions like polycythemia vera or highIron. excess iron can damage the liver and cause cirrhosis  Content Guide Adult Health II Exam #1 Blood Transfusions – procedure, nursing responsibilities, reaction types and interventions to carry out Nursing care- during transfusion ​ Remain with the patient for the first 15-30 minutes. ​ Assess vital signs 15 minutes after starting the transfusion, then at least every hour throughout the transfusion. ​ Infuse the blood product at the prescribed rate. ​ Ask the patient to report any unusual sensations. ​ Flush line with normal saline after transfusion Febrile transfusion reactions (most common transfusion reaction) – caused by anti-WBC antibodies. -​ Chills, tachycardia, fever, hypotension, tachypnea. Bacterial transfusion reactions – infusion of contaminated blood products. -​ Tachycardia, hypotension, fever, chills and shock. circulatory overload – blood product infused too quickly. -​ Hypertension, bounding pulse, DJV, dyspnea, restlessness, confusion Hemolytic transfusion reactions (most dangerous transfusion reaction) – caused by blood type or Rh incompatibility. -​ Fever, chills, apprehension, headache, chest pain, low back pain (flank pain), impending doom Allergic transfusion reactions – seen in patients with a history of allergy. -​ Urticaria, itching, bronchospasm, or anaphylaxis. Renal Function Understand which labs are utilized to monitor renal function ​ Specific gravity: dilution/ ​ 24 hour urine test: after the void ​ Serum: Creatinine levels  Content Guide Adult Health II Exam #1 ​ Serum: Urea nitrogen blood (BUN) ​ BUN: Cr ratio ​ GFR (next slide) Used in staging chronic kidney disease. normal is greater than 90 ml a minute ​ Normal blood flow is about = 1200 mL/min ​ Blood flows into the glomerulus from afferent arterioles where filtration occurs. ​ The filtered fluid then enters the renal tubules where it is processed Diabetics should have micro albumin tests every year because they show the first signs of renal failure ACES are renal protective! low doses can reverse the damage Process for collection of 24-hour urine ​ First void is discarded Client with UTI – signs/symptoms (what might you see in elderly different than others?) education regarding treatment and prevention and discharge instructions, considerations to teach patient about urinary analgesic Pyridium ☆Presence of nitrates: gram negative bacteria present in urine like e coli Factors contributing to UTIs: ​ inability to empty bladder, MS, spinal cord issues ​ urinary flow obstruction; stones contractures ​ iatrogenic factors: catheterization Symptoms include pain and burning upon urination; frequency; nocturia; incontinence; suprapubic, pelvic, or back pain; hematuria; or change in urine or urinary pattern. Some patients may be asymptomatic. Shift to the left an increase in Neutrophils prevention ​ Personal hygiene: wipe front to back ​ Medications as prescribed: antibiotics, analgesics, and antispasmodics ​ Application of heat to the perineum to relieve pain and spasm ​ Increased fluid intake ​ Avoidance of urinary tract irritants such as coffee, tea, citrus, spices, cola, and alcohol ​ Frequent voiding ( every 2-3 hrs)  Content Guide Adult Health II Exam #1 ​ Patient education female: pee after sex, cotton underwear, dry clothes ☆With elderly patients you may see confusion without typical UTI symptoms ! ​ perfectly fine yesterday but now suddenly confused ​ May be colonized ​ at risk bc: enlarged prostate, women Complicated vs Uncomplicated complicated: Immunocompromised, pregnant, alteration in urinary tract, male uncomplicated: all other UTIs Medications ​ Analgesics: phenazopyridine – urine will turn red or orange, food reduces GI disturbances. When it reach the bladder it numb the bladder and urethra ​ Antibiotics: short (3 day), high dose course of trimethoprim/ sulfamethoxazole or fluoroquinolone is first line treatment; fluoroquinolone (e.g. Ciprofloxacin, Levofloxacin, Norfloxacin) is contraindicated during pregnancy ​ education: complete all prescribed course of drugs Epididymitis – treatments, nursing care An infection of the epididymis, which usually spreads from an infected urethra, bladder or prostate. Can be a complication of an STD. ​ S/S low grade fever, chills, swelling in scrotum, heaviness in testicles ​ Selection of antibiotics depends on the causative organism. If the infection is STD in origin, the pt’s sexual partner should also receive antibiotics. ​ Bed rest with scrotum elevated with a scrotal bridge or folded towel to prevent traction. ​ Supportive interventions include reduction in physical activity, scrotal support and elevation, ice packs, NSAIDs, analgesics, sitz bath. Avoid straining and catheters. TURP – Nursing care of the post-op patient  Content Guide Adult Health II Exam #1 Transurethral Resection of the Prostate (TURP) : replaced largely b y cyberknife TURP involves prostate resection ​ Assess the patient’s physical and psychological condition. ​ Monitor clotting function, correct clotting defects, anticoagulants withheld ​ Postoperative care ​ IDC in place ​ Monitor urine output, check the drainage tubing frequently forexternal (e.g. kinks) and internal (e.g. blood clots) obstructions especially if sudden decrease of urine output. ​ Monitor vital signs including pain. ​ Monitor for postoperative bleeding. ​ Continuous bladder irrigation. ​ Teach the patient it is normal to feel the urge to void with IDC in place. Complications Related to CBI ​ TUR syndrome: severe hyponatremia ​ Water intoxication ​ Excessive absorption of bladder irrigation during surgery Signs & Symptoms ​ MS changes/confusion ​ Bradycardia ​ hypertension Pyelonephritis-Risk Factors, Signs/Symptoms, treatment  Content Guide Adult Health II Exam #1 An upper UTI, bacterial infection in the kidney Acute pyelonephritis – resulted from active bacterial infection. ​ Chronic pyelonephritis – resulted from structural deformities or obstruction with reflux. ​ Risk factors: recurrent UTIs, pregnancy, enlarged prostate ​ immunosuppression, DM or kidney stones. ​ Occurs most frequently young women or older men ​ +CVA tenderness chronic s/s ​ Fatigue, headache, poor appetite, polyuria, excessive thirst, weight loss. ​ Hypertension --- end-stage kidney disease ​ Inability to conserve sodium ​ Nocturia ​ Tendency to develop hyperkalemia and acidosis ​ Risk for abscess and scarring Assessment ​ urinalysis ​ urine culture ​ CRP. ESR Managing pain ​ Drug therapy – 2-week course of oral antibiotics for outpatients. For inpatients, IV broad spectrum antibiotics initially, then more specific antibiotics after culture sensitivity results available, urinary antiseptic drug (nitrofurantoin) ​ Nutrition therapy – adequate calories, fluid intake at 3-4 L/day ​ Emptying bladder regularly, perineal hygiene ​ Surgical interventions to remove the source of infection Chronic Prostatitis – treatment, signs/symptoms ​ Chronic infectious prostatitis is usually bladder infections> 3 months. ​ Acute bacterial prostatitis: fever, chills, dysuria, frequency, urgency, hesitancy, nocturia, urethral discharge, a boggy, tender prostate, nausea, vomiting  Content Guide Adult Health II Exam #1 ​ Treatment: Anti-inflammatory drugs along with warm sitz baths, analgesics, antibiotics ​ Acute: 14 days antibiotics ​ Chronic : 4-12 weeks antibiotics ​ Non infectious Prostatitis Tx: Hytrin and Cardura ( alpha blockers) Diagnostic Testing – Contrast dye considerations, metformin considerations Nephrolithiasis – Risk Factors, Signs/Symptoms, Treatments, Nursing Considerations Calculi (stones) in the urinary tract or kidney Causes: may be unknown Risk factors ​ family history ​ dehydration ​ obesity ​ high protein diet Manifestations: Depend upon location and presence of obstruction or infection ​ Pain and hematuria Diagnosis: x-ray, blood chemistries, and stone analysis; strain all urine and save stones prevention ​ Hydrate!!!!!!! ​ Drink 2 glasses of water at bedtime and an additional glass at each nighttime awakening to prevent urine from becoming too concentrated during the night ​ Contact HCP at first sign of UTI ​ Avoid offending foods when possible. Caution with avoiding calcium = osteoporosis Ileal conduit if bladder is removed Oldest and most common urinary diversion Nursing management ​ Monitoring urine output ​ Providing stoma and skin care: a healthy stoma is pink or red. ​ Testing urine and caring for the ostomy  Content Guide Adult Health II Exam #1 Diagnostics Intravenous urography: allergies to iodine or seafood Patient preparation – assess history of allergies especially to iodine, shellfish, seafood, eggs, milk or chocolate, obtain medical & medication Hx, NPO status, bowel preparation, precaution for contrast-induced kidney failure, discontinue metformin 24 hours before the procedure and at least 48 hours after the procedure due to the risk for lactic acidosis. Procedure – IV dye contrast injected and X-rays taken. Pt may experience a temporary feeling of warmth, face flushing, unusual flavor in the mouth when contrast is injected Follow-up care – adequate hydration, ​ monitor kidney function changes DYE USED MAY BE NEPHROTOXIC! Need Pre-procedure BUN/Cr/GFR Cystitis: inflammation of the lining of the bladder Prostate: smooth= enlarged BPH Prostate: nodules or hard lump = cancer symptoms will have uneven stream, frequent urination, changes in voiding pattern Content Guide Adult Health II Exam #1