healing and episode part 3.docx

Healing and Episode Part 3 **Inflammation and infection:** Cellular Response to Injury: - - - - - inflammatory response: coordinated events - - - Events in Inflammation (inflammatory response) - - - - - - - Types of Inflammatory Exudate - - - -...

Healing and Episode Part 3 **Inflammation and infection:** Cellular Response to Injury: - - - - - inflammatory response: coordinated events - - - Events in Inflammation (inflammatory response) - - - - - - - Types of Inflammatory Exudate - - - - Systemic Manifestations of Inflammation - - - - - - Types of Inflammation - - - - Healing process: Tissue repair 1. - - - - 2. - - - **Inflammation is (almost) always present with infection, BUT infection is not always present with inflammation!** Infection - - - - - The Chain of Infection 1. 2. 3. 4. 5. 6. Chain of Infection: Susceptible Host - - - - Client Susceptibility to Infections - - - - - - Chain of Infection: Infectious Agent/Pathogen - - - - - - - - - Infectious Process - - - 1. 2. 3. 4. 5. infectious Process -- Nursing Assessment - - - - - Signs and Symptoms of Infection (not exhaustive) - - - - - - - - - - - - Diagnostic tests - - - - - - - - - - - - - - Role of Infection Control - - - - - - - - Health Care Associated Infection (formerly called Nosocomial Infections) - - - Health Care Associated Infection (HAI) - - - - - - - - - - - - - - - Routine practices: - - - - - - - Infection Prevention Strategies - - - - - Immunization - - - - **Wound care** Types of wounds - - - - Phases of Wound Healing - - - Process of Wound Healing - - - - Types of Wounds - - - - - - - - - - - - - - - - Acute Surgical Wound Classifications - - - - Pressure Sores (Ulcers) - Causes of Pressure Ulcers - - - Identification of High-risk Clients - - - - - Pressure Ulcer Staging - - - - - Client Assessment - - - - - - - - - Assessment of the pressure ulcer & surrounding area - - - - - - - - - - - - - - - Wound Treatment Goals - - - - - - - - - - - - - - Making Dressing Choices - - - - Tipping the scales in your favor - - - - - - - - Moist Wound Healing - - - - - - - - RNAO Guidelines - - - - - - - - - The ideal dressing should: - - - - - - - Categories of Wound Care Products - - - - - - - - - - - - - - - - Managing Fragile Skin: Non Adherent dressings - - - - - - - - - Drying a wet wound - - - - - - - - Adding Moisture to a Dry Wound - Hydrocolloid Dressings - - - - - Charcoal Dressings - - - - - - - - Skin Sealants/Barriers - - - - - - Biologic Dressings - - - - Adjunctive Therapies - - - - - - VAC Therapy - - - - - Signs and Symptoms of Infection - - - - - - Treatments for infected wounds - - - - - - - - - Topical Treatment of Contaminated or Infected Wounds - - - - - - - Fistula - - - Sinus - - - **Cancer** Based on data from 2015 to 2017, 64% of Canadians diagnosed with cancer are expected to survive for 5 years or more after a cancer diagnosis. - - - - **Cancer:** Group of distinct diseases - - - - Etiology What Causes Cancer? - - - - - - - Secondary & Tertiary Prevention - - - **The process of carcinogenesis consists of three major steps:** 1. - 2. - 3. - Diagnosis - - - - - - - **Early Warning Signs of Cancer** C- Change in bowel or bladder habits A- A lesion that does not heal U- Unusual bleeding T- Thickening or lump I- Indigestion or trouble swallowing O- Obvious change in wart or mole N- Nagging cough or persistent hoarseness Is it Benign or Malignant?? **BENIGN** - - - **MALIGNANT** - - - How does it spread? - - **Invasion** - - Metastasis - - - Tumor Staging and Grading- prior to treatment, helps for treatment options and prognosis **Staging:** - - - - **Grading** - \- High Grade \- Barely resemble tissue from which they arose + are aggressive + metastasize rapidly Grade I to IV Individual Treatment Plans Based on: - - - - Canadian Cancer Society -- Sometimes, 2 people with the same cancer may be given very different treatments Treatment Goals - - - - - - - Management of Cancer - Multiple Modalities Commonly Used **Surgery** - - - - - - **Others** - - Treatment Plans **Primary Treatment** - **Combination of Treatment** - [- Adjuvant] \- Given after the primary therapy to control the cancer more effectively **Types of Treatment** [Local therapy \[Radiation + Surgery\]] - [Systemic therapy \[Chemo\]] - [Targeted therapy \[Example - Angiogenesis inhibitors\]] - **Chemotherapy: antineoplastic drugs** - - - - - - **Dosage: antineoplastic drugs** - - - - HCP -- need to protect self -- specific protocols in place Infection: all stages of cancer - - - WBC function impaired in Client with Cancer - - - - - Myelosuppression - bone marrow suppression - ★ Increased risk of infection and bleeding - Thrombocytopenia - decrease in number of circulating platelets - - - - - Side Effects of Chemotherapy & Nursing Care - **Gastrointestinal:** - - - - - - - - - Side Effects of Chemotherapy [Reproductive System] - - Sexuality Fatigue - - Renal System - - Side Effects of Chemotherapy & Nursing Assessments **Neurological System** - - - **Assess for:** Pain - - Psychosocial - - - Alopecia: hair loss - - - - - **Radiation Therapy** - - - - - - Used for: - - - - - **[External]** Radiation Therapy [\[External Beam Radiation Therapy\]] - - - - - **[Internal]** Radiation Therapy: [Brachytherapy] - - - - General Side Effects - - - - - - - - Skin Integrity Care - - - - - - - - - - Mouth Care \[Follow Mouth Care Program - Organization\] - - - - - - - - Nursing Priorities - - Other Treatments Hormone Manipulation - Can alter the rate of growth of some tumors Biologic Response Modifiers - Can enhance the effectiveness of the immune system and can be supportive therapy during cancer treatment Nursing Management - - - - - - Oncological Emergencies - - Role of the Interprofessional Team Emotional Care of the Client with Cancer - - - - - - - Palliative care includes skills used in any nursing encounter: - Cancer Survivorship - Components of survivorship care: - - - - **Cancer of the Breast- Early Detection = Better Survival** - - - Most Prevalent Risk Factors - - - - Other Risk Factors - - - - - - - - - - - - - - "Early Detection is your BREAST PROTECTION" [Ontario Breast Screen Program] - - [OBSP Eligibility for Mammograms] Women ages 50-74 are eligible for screening through the Ontario Breast Screening Program if they: - - - - - Family History of Breast Cancer - - - - Recommendations for Screening for High Risk - - **OBSP Criteria for High Risk Screening** **Less than 1% of the population** **Who is Eligible?** - - - - - Mammogram Screening - If found early, 5 yr. survival rate is 96% Early detection by screening for breast masses involves a three-pronged approach: 1. 2. 3. Fibrocystic Breast Changes - Most common breast problem in women - - - What should you look for? - Characteristics of Malignant Breast Tumors - - - Skin changes: - - - - - - Non Invasive Types: Ductal (DCIS) & Pleomorphic Lobular Carcinoma (PLCIS) in situ - - - - - Invasive Types of Breast Cancer 1. - - 2. - - Other Types of Breast Cancer - - Protective Factors - - - - - Nursing Diagnosis - - - - - - Diagnosis - - - - - - - **Staging Of Breast Cancer Tumors** Stage 0: Ductal or Lobular in situ Stage I: 0-2 cm Stage II: 2-5 cm Stage III: larger than 5cm + node involvement Stage IV: Metastatic disease \*\*\* Staging is much more complicated than this Breast Cancer Staging - Based on - - - Other factors for prognostic staging: - - Therapy Hormonal Chemotherapy Radiation Targeted Surgery \*\*\*Order of treatment will depend on many patient and tumour factors Breast Cancer Interventions \*\*\*Treatment is tailored specifically to each client **Hormonal Therapy** - Breast Cancer Interventions **Chemotherapy** - - - - Breast Cancer Medications - Chemotherapy Medications - - - - - - - - - - - - Breast Cancer Interventions **Targeted Therapy** - - Breast Cancer - Symptom Management Recommended Anti-emetics: Cancer Care Ontario One of the "trons": - - - - AND Possibly - - Breast Cancer Interventions - Radiation - - - - Breast Cancer Interventions Surgery - Breast Options: 1. 2. Axillary Options: 3. 4. Mastectomy + axillary node dissection = modified radical mastectomy Pre-Operative Care - - - - Post-Operative Care - - - - Maintaining skin integrity - - - - - - - - - - - Reducing Stress & Improving Coping Skills - - - Engaging in sexual activity after surgery - - - **The Child with Cancer** \* More boys are diagnosed with cancer than girls \* The median age of a child diagnosed with cancer is 5 years Always Remember \... - - - - - - - - What is Leukemia? - - - - - - - What are signs & symptoms that are suspicious of a diagnosis of leukemia? **History:** - - - - - - - - **Physical Exam:** - - - - **[Note]**: Initial S & S often vague & non specific until bone marrow infiltration increases **CASE STUDY Ashlee -** 4 yr old preschooler - - - - - - - - - Ashlee blood work values **CBC & Diff (normal values for a 4 yr child)** - - - - - - - Ashlee is referred to the paediatric oncologist LP & Bone Marrow aspiration ordered and completed Deciding on Treatment Protocol - - - - - Deciding on Treatment Protocol **Leukemia --** - - - - **Cranial Radiation** - - - Target therapy Childhood Cancer Treatment for all has [commonalities] **Side effects of treatment the same** - - Treatment for Cancer/Leukemia **CHEMOTHERAPY PHASES** 1. 2. 3. CNS prophylaxis: **ongoing** throughout **each** phase - - Chemotherapy Administration: LHSC - "Cytotoxic Agents -- Safe Management" - - - - - **Central Venous Access Devices** - Induction Phase - Started as soon as diagnosed: - - - - Side Effects/Complications -- Start of Cancer Treatment **TUMOR LYSIS SYNDROME** - Renal failure, LOC, N&V ↓ - - - - **[Treatment]** **Life threatening!!!** - - - - - CNS Prophylaxis - Ongoing - - Intensification Phase **[Purpose]**: To eradicate residual leukemic cells - - Maintenance Phase **[Purpose]**: To preserve remission & lessen leuk. cells - - - - - If Relapse \... - - - - Bone Marrow Transplant - - - - - - - - - - - Side Effects \[Disease and/or Treatment\] **AMEMIA** - - - **THROMBOCYTOPENIA** - **Bone & Joint Pain** - Analgesics - - **INFECTION** - - - - - - - Infection **PREVENTION** - - - - - Fever Neutropenia Teach parents that f/n is **[expected]** post chemo -- notify oncologist of fever ASAP - - - - Infection: Nursing Care - - - - - - - Nausea & Vomiting - - → ondansetron → THC -- cannabis? - Nutrition - - - May need - - - - - - Oral Ulcers **"Stomatitis" "Mucositis"** - - - - - - - - Hemorrhagic Cystitis - - - - - - Alopecia - - - - - Other medications: Steroids - - - - - - - - - - - - Long Term effects - - - - - - Late Effects of Treatment Improved Long Term Remission rates BUT - After Care Clinics to monitor - - - - - - Supports for Families - - - - - - - - Paediatric Family Resource Centre - Pediatric Oncology Group of Ontairo (POGO) Pediatric Interlink Community Cancer Nurses - - **Prostate, Bladder and Testicular Cancer** THREE COMMON DISEASES OF THE PROSTATE 1. 2. 3. PROSTATITIS ▪ Symptoms: perineal discomfort, burning DIAGNOSIS OF PROSTATITIS ▪ Urine tests, including urinalysis, to check for bacteria and white blood cells in the urine ▪ Complete blood count (CBC) ▪ Prostate-specific antigen (PSA) test, but this test usually isn't done until the inflammation in the prostate has gone away ▪ Blood chemistry tests THE MOST COMMON PROSTATE DISEASE IS BENIGN PROSTATIC HYPERPLASIA (BPH) [S & S of an enlarged prostate:] - - - - - - DIAGNOSIS OF BPH ▪ DRE -- Digital rectal examination ▪ PSA -- Prostate specific antigen ▪ Creatinine blood test ▪ Cystoscopy ▪ Post void residual ▪ Ultrasound ▪ CT scan HEALTH PROMOTION - - - - - TREATMENT OF BPH Medications - - - - - Risk Factors: - - - Possible risk factors: - - - PROSTATE CANCER SCREENING - - - - - DIAGNOSIS - - - - - - Treatment of Prostate Cancer - - - - - - - - Tumor is Slow Growing - - - - Metastases - - Plan of Care: The Client with Prostate Cancer - - - - - - - - - Prostate Surgery - - - - Suprapubic Resection for Large Mass of Tissue - - - - Catheter Care and Continuous Bladder Irrigation (CBI) - - - - **Health teaching** - - **Urinary Incontinence** - - - - **COMPLICATIONS** - - - - - Follow up after Prostate Cancer Treatment - - - - - - - Patient Goals - - - - - **Testicular Cancer** - - - Signs and Symptoms - - RISK FACTORS - - - - **Health Promotion -- TSE** - **Radical Orchiectomy** - - - - **Fertility Concerns** - - - - - BLADDER CANCER - - - - **Signs and Symptoms** - - - - **Treatment and Other Considerations** - - - - - - **Conduits to Divert Urine** - - - - - **Living with Rheumatoid Arthritis and Juvenile - Idiopathic Arthritis** **Anatomy and Physiology of Joints** - 1. 2. 3. - - - - - **Rheumatoid Arthritis** - - - - **Prevalence/Targets** - - - - - - **Physiological Perspective** - - - **Etiology & Pathophysiology** - - - **Pathogenesis (Stages)** 1. - - - 2. - - - **Clinical Manifestations: Joints** Possibly preceded by: - - Joint: - - - - **Clinical Manifestations: Joints** - - - - - - - - Small joints -- hands then feet Later larger joints affected **Extraarticular Manifestations** Every system in the body [Most common] - - - - - - - - **Assessment & Diagnostic Tests** +-----------------------------------+-----------------------------------+ | **History and Physical Exam** | **Radiologic Studies** | +===================================+===================================+ | **Labs** | **Synovial Fluid Analysis/ | | | Arthocentesis** | | - - - - - - | | +-----------------------------------+-----------------------------------+ **Challenges for the Client with RA** - - - - - **Collaborative Management** - - - - Drug Therapy - - - - - - - - **DMARDS** - - - - - - - **Biologics** - - - **Nutrition** - - - - **Nursing Priorities** - - - - - - - - - - - - **Protect your Joints** - - - - **Juvenile Idiopathic Arthritis** - - - - - **Warning Signs** - - - - - - **Classification** 1. 2. 3. 4. 5. Oligoarthritic Juvenile Arthritis - - - - - - Polyarticular Juvenile Arthritis - - - - - Systemic-Onset Juvenile Arthritis - - - - - - **Distinguishing Features from Adult RA** - - - - - - **Diagnosis of JIA** - - - - - - **Collaborative Care Goals** - - - - **Medications** - - - - - **Physical Management** - - - - - - - - - - **Plan of Care & Implementation** - - - - - **Test your Knowledge** **True or False** 1. 2. 3. 4. **Case Study** 5. 6. **In Reflection:** 7. 8. **Osteoarthritis and Orthopedic Surgery** - - - **Pathological Changes in Joints** - - - **Inflammatory Joint Disorders** - - **Non-Inflammatory Joint Disorders** **Osteoarthritis**: Main non-inflammatory disorder of the joints Also called degenerative joint disease **Types:** 1. 2. **Statistics** - - - - - - - - **PSYCHOSOCIAL IMPLICATIONS** - - - - **MUSCULOSKELETAL ASSESSMENT** **Health History:** - - - - **Physical Examination:** - - **Osteoarthritis** - - - - **PATHOPHYSIOLOGY OF OSTEOARTHRITIS** - - - Risk Factors - - - - - - - - **ASSESSMENT OF OSTEOARTHRITIS** **Clinical Manifestations:** - - - - - - - **NURSING IMPLICATIONS FOR OSTEOARTHRITIS** - - - - **Drug Therapy** - - - - - \- Viscosupplementation (hyaluronan injections) \- NeoVisc®, SynVisc®, SynVisc One®, Durolane®, Euflexxa® \- Cannabis **ORTHOPEDIC SURGERY** - - - **Arthroplasty** - - - - **Arthroplasty** - - - - **Arthroscopy and Osteotomy** - - - **ASSESSMENT FOR ORTHOPEDIC SURGERY** - - **NURSING IMPLICATIONS FOR ORTHOPEDIC SURGERY** - - - - - - - - **Postoperative Management** - - - - - - - **Peripheral Neurovascular Assessment** **Peripheral Vascular** - - - - - **Peripheral Neurological** - - - **Peripheral Pulses** - - - - **Minimally Invasive Anterior THA** - - - - - **Indications of possible hip dislocation\...\...\...\...\....** - - - - - - - If the nurse noticed any of the signs, what would be the appropriate action? - **Prevention of Venous Thrombus** - - - - - - **Anticoagulants** - - **INFECTION** **[Fracture]** - - - **[Replacement]** - - - **Discharge Teaching** - - - - - - - **Menopause and Osteoporosis** **True/False** 1. Calcium supplements should be taken with meals 2. After taking a bisphosphonate medication for management of osteoporosis, the patient should lie down for at least 30 minutes to facilitate drug Absorption 3. Osteoporosis frequently results in compression fractures of the thoracic and lumbar vertebrae 4. Primary osteoporosis in women occurs prior to Menopause Why is it called 'silent thief'? - Osteoporosis - Pathophysiology - - - - Joints most at risk: - - - Osteoporosis - - - - Human Costs - - - - - - Major Risk Factors for Fracture - - - - - - Minor Risk Factors for Fracture - - - - - - - - - Secondary Osteoporosis - - Osteoporosis -- Signs and Symptoms - - - - Osteoporosis - Diagnosis - - - - Osteoporosis -- Management and Treatment - - - - - - Medications - - - - - - - - Nursing Interventions - - - - - - Menopause - - - - - - Menopause - - - - - Perimenopause - - - - - - Post menopause - - - - - Menopause -- Care and Treatment - - - - - - Medications - - - - - - Menopause -- Care and Treatment -