Nursing Health & Illness Module II Exam PDF

**[Nursing Health & Illness Module II Exam]** [Chapter 11: Care of the Client with Cancer (12 questions)] - Neoplasm: tumor (comparison chart: pg 144, table 11.1) - Benign: abnormal cluster of cells that are noncancerous; SLOW GROWTH - Malignant: disorganized tumors in body...

**[Nursing Health & Illness Module II Exam]** [Chapter 11: Care of the Client with Cancer (12 questions)] - Neoplasm: tumor (comparison chart: pg 144, table 11.1) - Benign: abnormal cluster of cells that are noncancerous; SLOW GROWTH - Malignant: disorganized tumors in body; cause harm if not treated; FAST GROWTH - Metastasis: when malignant cells invade blood or lymph vessels - Mechanical movement: something is "pushing" it - Makes home in new location - Most common sites: lungs, liver, bones, brain - In situ cancer: remain localized; difficult to detect which is why they are identified though microscopic cell; removed and rarely need further treatment - Cancer pathophysiology - Many diseases with different causes (why it's hard to find cure) - Mutated cellular genes that lead to abnormal growth - No cell division limit - Lack of contact inhibition; cells don't die (why there is different forms of treatment) - Cancer etiology - Carcinogens: substances or agents that increase risk of cancer development - Three step process of growth and reproduction - Initiation: altered DNA - Promotion: tumor growth due to mutated cells (formation of tumor) - Progression: growth and metastasis - Cancer risk factors - Oncoviruses: HPV virus (if males get vaccine, it protects the female); Epstein Barr, HIV - Radiation: sun, tanning beds, xray, CT scans, MRIs - Chemicals and irritants: smoke - Genetics - Diet: high fat/low fiber can lead to colon cancer; fatty foods can lead to prostate cancer - Hormones: long term use of estrogen hormone; diabetes - Immunity: chronic illnesses, stress, HIV, immunosuppressive meds after transplants - Cancer types - Carcinoma: skin, glands, digestive, urinary tract, respiratory tract (most common) - Sarcoma: connective tissue, bone and muscle - Leukemia: blood, plasma cells, bone marrow - Lymphoma: lymph tissue, spleen - Melanoma: skin cells - Cancer prevention - Early detection (remember "CAUTION" acronym) - C- change in bowel or bladder habits - A- a sore that won't heal - U- unusual bleeding - T- thickening or lump - I- indigestion or difficult swallowing - O- obvious change in a mole - N- nagging cough or hoarseness - Regular screenings: mammograms, pap smears (baseline at age 21; if normal then every 5 years until 65), prostate/lung cancer screening - Genetic tests - Healthy lifestyle: smoking cessation - Protectant foods: folate, fruits, veggies - 2 ½ cups of fruits and veggies each day - Limit red meat - Decrease alcohol intake - 150-300 minutes per week doing moderate to intense activity - Limit sedentary activity - Vaccines: hepatitis B vaccine protects against infection that increases susceptibility to liver cancer - Diagnostic tests - Biopsy: only accurate way to identify cancer - VIA endoscope, surgical incision, or small needle inserted into site to get a sample of tissue or fluid - Done in outpatient surgery or HCP office - Radiological studies: detects cancer of bones or hollow organs, helps with staging - Barium is given PO to visualize esophagus and stomach, can be given rectally to see colon, or can be pushed IV to see vessels, urinary tract, or fallopian tubes - X rays, CT scans, mammography - Can be outpatient or inpatient - Nuclear imagining: detects sites of abnormal cell growth - PET scans: provide cellular function; useful with brain imagining and detecting cancer spread - Ultrasounds: detects tumors of pelvis, abdomen, heart, and breast; helps distinguish between benign and malignant - Magnetic resonance imaging (MRI): locates and stages malignant tumors in CNS, spine, head, breast, or musculoskeletal system - Endoscopic procedures: direct visualization of body cavity or opening; helps surgeon with biopsy; detects lesions of throat, lungs, esophagus, stomach, colon - Lab tests: tests via blood, serum, urine, etc; tumor markers help confirm a cancer diagnosis, detect origin, monitor effects, and help determine remission - An increased WBC count without infection raises questions about leukemia - Bone marrow aspiration: most common diagnosis of leukemia; learns numbers, shapes, and size of RBCs, WBCs, and platelets - Cytological studies: studies formation, structures, and cell function; based on cell abnormality; significant cell changes could indicate and increase in cancerous activity - Smeared cells that shed from mucous membranes are examined (cervical, oral, anal, or vaginal) - Cancer staging (TNM is most common system) - Tumor - Well differentiated: neoplastic tumor resembling normal tissue; easy to treat - Poorly differentiated: malignant neoplasm that contains mostly abnormal cells - TX: primary tumor cannot be evaluated - T0: no evidence of primary tumor - Tis: carcinoma in situ (no spread yet) - T1-T4: size and extent of primary tumor - Nodes - NX: regional lymph nodes cannot be evaluated - N0: no regional lymph node involvement - N1-N3: involvement of regional lymph nodes - Metastasis - M0: no distant metastasis - M1: distant metastasis - Surgery: either done to cure or for comfort measures - Radiation - Side effects - Fatigue (encourage naps and prioritize activities) - N/V and anorexia - Mucositis: inflammation of mucous membranes - Xerostomia: dry mouth - Desquamation: peeling skin (encourage to keep skin dry and irritant free) - Bone marrow depression: low blood cells (possible blood administration) - Hair loss - Safety - Time (work effectively/efficiently) - Distance (remember radiation isotopes) - Shielding (use barrier such as lead apron) - Chemotherapy - Action: cytotoxic meds (psychological age plays a huge role) - Routes of admin: depends on size of patient and risk of toxicity; usually through port - Vesicant drug: by IV into large vein (can cause necrosis if infiltration occurs) - If noticed, STOP infusion, leave catheter in place, and leave catheter in place, then notify RN and HCP - Oral an IV chemo has same potency - Combo therapy (timing is important for drugs to work properly)- BITES accronym - B- bleeding (suggests low platelet count) - I- infection (suggests low WBC count) - T- tiredness (suggest anemia) - E- emesis (altered nutrition and electrolyte imbalance) - S- skin changes (radiation reaction or skin breakdown) - Side effects - Bone marrow suppression at nadir (when cell counts are at its lowest; pts are most at risk for complications - Leukopenia: low WBC count - Thrombocytopenia: lack of clotting factor (monitor for bleeding, protect from injury, report bruising) - Anemia: blood loss - N/V/D - Stomatitis: mouth inflammation - Alopecia: hair loss - Reproductive complications: infertility due to damage of sperm and ova - Neurotoxicity: nerve damage, confusion - Colony-stimulating factors (medications) - Granulocyte colony stimulating factor (G-CSF): stimulates proliferation of stem cells into granulocytes (neutrophils) - Erythropoietin: proliferation of stem cells into RBCs - Interleukin-Two - Nursing Diagnoses (more on pg 158-160) - Ineffective coping: assess coping mechanisms, hopelessness, suicide risk - Risk for infection: monitor temperature Q4H, WBC count daily, potential respiratory depression, limit visitors, keep fresh flowers and fruits out of room - Oncological emergencies - Superior vena cava syndrome: tumor or enlarged lymph nodes block circulation - Results in edema, SOB, cough, chest pain, facial flushing, swollen neck veins - Interventions: elevate HOB, remove rings and restrictive clothing, avoid taking BP and venipunctures - Spinal cord compression: when malignant growth presses on spinal cord - Potential motor loss, myelogram or bone scan to diagnose - Hypercalcemia: exceeds 11 mg/dL and is common with bone metastasis from breast cancer - Interventions: monitor heart, pulse, and rhythm, I/Os, pain control, administer IV meds and hydration [Chapter 27: Hematologic & Lymphatic System Function, Assessment, & Therapies (10 questions)] +-----------------------------------+-----------------------------------+ | **Red blood cells (RBCs)** | **Significance of findings** | +===================================+===================================+ | RBCs | Increased in chronic hypoxia | | | | | | Decreased in anemia or blood loss | +-----------------------------------+-----------------------------------+ | Hematocrit (Hct)- cellular | Increased in dehydration or | | portion of blood | chronic hypoxia | | | | | Hemoglobin (Hgb)- oxygen carrying | Decreased in anemia or blood loss | | capacity | | +-----------------------------------+-----------------------------------+ | Reticulocytes- number of immature | Increased in hypoxia or anemia | | RBCs | | | | Decreased in RBC maturation | | | defect | +-----------------------------------+-----------------------------------+ | **White blood cells (WBCs)** | **Significance of findings** | +-----------------------------------+-----------------------------------+ | WBCs | Increased in infections | +-----------------------------------+-----------------------------------+ | Neutrophils | Increased in bacterial | | | infections, inflammation, and | | | some leukemias | +-----------------------------------+-----------------------------------+ | Eosinophils | Increased in allergic response, | | | some leukemias | | | | | | Decreased in infections | +-----------------------------------+-----------------------------------+ | Basophils | Increased in hyperthyroidism, | | | some bone marrow disorders, and | | | some leukemias | +-----------------------------------+-----------------------------------+ | Lymphocytes | Increased in viral infections, | | | chronic bacterial infections, and | | | some leukemias | +-----------------------------------+-----------------------------------+ | monocytes | Increased in chronic inflammatory | | | disorders and some leukemias | +-----------------------------------+-----------------------------------+ - Hematological system: bone marrow and blood/blood components - Lymphatic system: lymph nodes, nodules, lymph vessels, spleen, thymus - Functions: returning tissue fluid to maintain blood volume, protect body against pathogens and other foreign materials - Function of spleen specifically: stores platelets, removes of RBCs from circulation; contains lymphocytes and macrophages (found in LUQ; not necessary for life because other organs compensate) - Lymph nodes: tightly bound fibers that filters our blood - General functions of blood: transportation, regulation of body temp, pH, and fluid balance, and overall body protection - Human body contains 4-6 L of blood (45% is formed elements; remainder is plasma) - Consists of plasma, RBCs (lifespan of 130 days), WBCs, platelets - Platelets are formed by megakaryocytes - Normal WBC count: 4,500-11,000 - Blood types: A, B, AB, O - Effects of aging on the hematologic and lymphatic system - Less efficient immune response (risk for infection - Iron deficiency & slowed erythrocyte production (risk for anemia) - Reduced plasma volume (risk for dehydration) - Formation of blood clot - Damaged blood vessel triggers the release of clotting factors- prothrombin, thrombin, fibrinogen (soluble), and fibrin (insoluble) - Formation of platelet plug- vasoconstriction limits blood flow and platelets form a sticky plug - Clot development- fibrin strands adhere to the plug to form an insoluble clot - Diagnostic tests that evaluate hematological and lymphatic systems - Blood tests - Coagulation tests - Bone marrow biopsy (extremely painful) - Lymphangiography - Lymph node biopsy - Therapeutic measures for blood disorders - Packed RBCs - Frozen RBCs - Platelets - Albumin - Fresh frozen plasma - Cryoprecipitates - Transfusion safety tips - Assessment - Identification - Use only normal saline - Filtering - Washing - Warming - Transfusion complications - Febrile reaction: fever; most common; why it's important to get baseline vitals - If temp rises greater than 1 degree Fahrenheit, notify HCP - Acetaminophen may be ordered - Urticarial reaction: hives - Stop transfusion and notify HCP immediately - Diphenhydramine will be ordered - If restarted, make sure 4-hour administration rule is not violated - Hemolytic reaction: deadliest reaction due to incompatible blood; hemolysis occurs (destruction of RBCs) - Reports of back pain, SOB, chest pain, chills, fever, N/V, impending doom - Signs of shock, hypotension, oliguria, decreased consciousness - Late sign: disseminated intravascular coagulation (uncontrollable bleeding from many different sites at the same time) - Immediately stop and notify HCP and the blood bank; keep vein open with normal saline - High doses of diuretics may be ordered to wash out kidneys and promote urine flow - Anaphylactic reaction: not common; due to sensitization to immunoglobulins passed through donor blood - Stop infusion and stay with them; have someone else call RN and HCP - CPR may be initiated until rapid response team or code team arrives - After emergency has passes, pt may need transfusion from frozen deglycerolized blood cells - Circulatory reaction: due to rapid infusion in short amount of time; more common in older or debilitated patients; - Patient will have chest pain, cough, frothy sputum, distended neck veins, crackles and wheezes in lung fields, and tachycardia - Stop infusion and notify HCP - Diuretics will be ordered to help get rid of fluid - Transfusion may be restarted at a slower rate [Chapter 28: Care of the Client with Hematologic and Lymphatic Disorders (26 questions)] - Anemia - Patho: deficient number of RBCs, Hgb, or both (impaired production, increased production, blood loss) - Leads to a reduced capacity to carry oxygen to tissues - Etiology: diet, hemolysis, hereditary disorders - S/s: pallor, tachycardia, tachypnea, irritability, fatigue, dyspnea - Pernicious anemia: numb hands or feet, sore tongue - Iron deficiency: mouth fissures, glossitis (inflammation of the tongue), spoon-shaped nails - Diagnostic tests: CBC with microscopic exam, bone marrow analysis, tests to determine source of bleeding - Check stool and urine color - Interventions: eliminate cause, dietary change (choose foods with iron), supplements, transfusions, possible administration of oxygen - Foods with iron: leafy greens, ice, liver or red meat - Nursing diagnoses - Activity intolerance: help patient conserve energy - Imbalanced nutrition: educate about healthy foods - Impaired oral mucous membrane integrity: - Aplastic Anemia - Patho: bone marrow cannot produce adequate RBCs because it's fatty - Always fatal if untreated - Etiology: congenital, toxin exposure, chemotherapy - S/s: weakness, fatigue, pallor, dyspnea, headache, ecchymoses, petechiae, frank bleeding (injection site oozing), infection, death - Diagnostic tests: CBC, bone marrow biopsy, total iron-biding capacity (TIBC), serum iron - Treatment: treat the cause, colony stimulating factors, steroids, bone marrow transplant - Interventions: place on bleeding precautions, avoid use of drugs that interfere with platelet formation, minimize risk of infection (neutropenic precautions) - Sickle Cell Anemia - Patho: inherited autosomal recessive disorder - Etiology: must have gene mutation form both mom and dad - Crisis prevention: avoid risk of lowered O2 (cold exposure, infection, exercise), low dose-penicillin, frequent transfusions, hydroxyurea (drug that reduced crisis risk but can cause serious life-threatening effects) - Dianostic tests: sickle Dex test, hgb electrophoresis, CBC, erythrocyte sedimentation rate (ESR) - Crisis treatment: antibiotics (at risk for infection), pain management (opioids, PCA pump), transfusions, fluids, oxygen therapy - S/s - Brain: thrombosis, hemorrhage, stroke - Heart: failure - Abdomen: hepatomegaly, gallstones, splenic enlargement, splenic infarction - Bones and joints: hand and foot syndrome - Eye: retinal or conjunctival hemorrhage, blindness - Lungs: atelectasis, infarction, pneumonia - Kidney: diluted urine, diuresis, hematuria - Penis: priapism - Skin: stasis ulcers - Nursing diagnoses - Risk for ineffective tissue perfusion: remove constrictive clothing, avoid alcohol, cold exposure, smoking, avoid strenuous exercise, infections, unpressurized aircraft, administer oxygen, warm compress, avoid cold compress, IV fluids - Acute pain: PCA pump, Tylenol for fever, avoid aspirin, encourage bedrest due to increased need for oxygenation - Polycythemia - Patho: overabundance of RBCs, Hgb \55%, blood is too thick - Etiology - Primary polycythemia: specific gene mutation - Secondary polycythemia: due to long-term hypoxia - S/s: HTN, headache, vision changes, vertigo, dizziness, tinnitus - Von Willebrand: acquired bleeding disorder (retinal hemorrhaging, bloody gums, and nosebleeds), chest pain, external dyspnea, dark/flushed skin, itching (due to excess mast cells) - Diagnostic tests: CBC, bone marrow aspiration - Treatment: Phlebotomy, low dose aspirin, chemo and radiation - Interventions: ROM exercises, increased fluids, avoid tight clothing, elevate feet, educate about reporting signs and symptoms of iron deficiency and bleeding - Disseminated intravascular coagulation - Patho: accelerated clotting, clotting factors become depleted, leads to excess bleeding (severe hemorrhaging); can lead to necrosis - Acute onset; high mortality rate - Etiology: major trauma or obstetric complications - S/s: abnormal bleeding without cause, joint pain, N/V, organ failure, convulsions, shock/coma, death - Diagnostic tests: prothrombin time (PT), partial prothrombin time (PPT), platelet count, Hgb, BUN, creatinine levels, D-dimer test - Interventions: administer blood, fresh frozen plasma, platelets, cryoprecipitates, IV heparin, O2, fluids, blood, monitor vitals, and watch for bleeding - Bleeding s/s: easy bruising, petechiae, bloody urine, black/tarry stool, gum bleeding, nosebleeds, new onset of painful joints - Idiopathic Thrombocytopenic Purpura (ITP)- also known as "immune" - Patho: platelet destruction by immune system which leads to bleeding risk - Etiology: acute viral illness, drug reaction, immune system dysfunction - S/s: bleeding (GI, nose, mouth), petechiae, ecchymoses - Diagnostic tests: platelets, bleeding times, bone marrow aspiration - Treatment: steroids (to decrease immune activity), immunoglobulins, chemotherapy, vitamin K (anecdote for thin blood), splenectomy (when all other measures don't work), platelets - Nursing interventions: prevent bleeding (electric razor, soft-bristled toothbrush, avoid invasive procedures, avoid blood draw, maintain pressure on puncture sites for 5 minutes, prevent bumps and bruises, avoid aspirin and NSAIDs, prevent straining during bowel movements, blow nose gently (pg 467, box 28.1) - Hemophilia - Patho: missing clotting factors; only platelet plugs form but there isn't enough fibrin to form a lasting clot - Hemophilia A: missing factor VIII (classic) - Hemophilia B: missing factor IX (christmas) - Etiology: hereditary - S/s: bleeding into joints, muscles, subcutaneous tissue, and brain - Bleeding in joints (hemoarthrosis) leads to acute pain and can cause deformities and decreases ROM - Death can occur if untreated, due to bleeding out which can cause hypovolemic shock - Diagnostic tests: PTT and factor levels - Treatments: desmopressin (helps body release missing factors; given before dental procedures or sporting events), clotting factors, fibrin sealants, blood transfusions - Nursing diagnoses - Acute pain: RICE (rest, ice, compress, elevate), acetaminophen, analgesics - Risk for bleeding: desmopressin, prevent bruising, be gentle - Leukemia - Patho: immature WBCs causing the body not able to fight off infections; bone marrow produces useless cells and normal cells cannot be produced - Etiology: viruses, genetics, radiation and chemo - S/s: fever, infection, pallor, weakness, tachycardia, palpitations, dyspnea, abdominal pain, malaise, sternal/rib pain, CNS changes, bleeding - Diagnostic tests: CBS, bone marrow aspiration, lumbar puncture, genetic analysis - Treatment: chemo and radiation, bone marrow transplant, blood stem cell transplant through the IV (autologous transplant) - Nursing diagnoses - Risk for injury (infection, bleeding): monitor vitals, swelling, drainage, tarry stools, protect from injury - Fatigue: help them focus on main ADLs, encourage balanced diet, allow for rest, ensure adequate sleep schedule - Impaired oral mucous membrane integrity: inspect mouth for redness and lesions, encourage adequate nutrition, use a soft-bristled brush, avoid lemon-glycerin swabs, obtain order for diphenhydramine mouthwash, teach about smoking cessation and alcohol - Multiple Myeloma - Patho: cancer of plasma cells in bone marrow which leads to sepsis; tumors devour bone tissue and can invade organs; abnormal useless antibodies are created, and osteoclasts speed up done destruction - Etiology: family history, radiation exposure - S/s: skeletal/bone pain, fever/malaise, spinal cord compression, pathological fractures, hypercalcemia, infection - Spinal cord compression can lead to peripheral neuropathy, loss of bladder and bowl function - Diagnostic tests: CBC, blood calcium levels, bone xrays, urine sample (testing for bence-jones proteins), bone marrow biopsy - Treatment: steroids, chemo, serum calcium control, radiation, stem cell transplant, IV pamidronate (Aredia) - Nursing diagnoses - Risk for infection: - Risk for injury (fractures, immobility, hypercalcemia): keep patient mobile to help stimulate calcium reabsorption, reduce fall risk, reposition bedridden patients, provide passive ROM exercises, administer fluids, educate about good hydration - Make sure urine output is never \55 Age \>50 Reed-sternberg cells NO reed-sternberg cells Good prognosis Poorer prognosis Alcohol induced pain Not affected by alcohol - Splenectomy: surgical removal of spleen - Preoperative care: baseline labs and vitals, blood transfusion, if necessary, Vitamin k (incase blood cannot clot), teach about coughing and deep breathing - Postoperative care: monitor for bleeding, assess vitals, administer narcotics for pain, deep breathing and ambulation - Possible complications: bleeding, pneumonia, atelectasis, infection, overwhelming post-splenectomy infection \*\*\*2 dosage calcs\*\*\*