NUR 209 Exam 1 Concept Map January 2025 PDF

**Cancer** **ABCDEs of Melanoma** - **A**: Asymmetry -- One half of the lesion does not match the other half. - **B**: Border -- Edges are irregular, ragged, or blurred. - **C**: Color -- Varies from one area to another (e.g., shades of tan, brown, black, white, red, or blue). -...

**Cancer** **ABCDEs of Melanoma** - **A**: Asymmetry -- One half of the lesion does not match the other half. - **B**: Border -- Edges are irregular, ragged, or blurred. - **C**: Color -- Varies from one area to another (e.g., shades of tan, brown, black, white, red, or blue). - **D**: Diameter -- Larger than 6 mm (size of a pencil eraser). - **E**: Evolving -- Changes in size, shape, color, or symptoms (itching, tenderness, bleeding). **TNM Classification** - **T (Tumor)**: Describes the size/extent of the primary tumor. - T0: No evidence of primary tumor. - T1-T4: Increasing size and/or extent of the tumor. - **N (Node)**: Indicates whether cancer has spread to lymph nodes. - N0: No lymph node involvement. - N1-N3: Increasing involvement of lymph nodes. - **M (Metastasis)**: Presence of distant metastasis. - M0: No metastasis. - M1: Presence of metastasis. **Chemotherapy Effects on Stem Cells and Bone Marrow** - **Impact**: Bone marrow suppression (myelosuppression) results in reduced production of RBCs, WBCs, and platelets. - **Complications**: Anemia, neutropenia, and thrombocytopenia. - **Assessment**: Monitor CBC, signs of infection, bleeding, and fatigue. **Neutropenia: Assessment Findings to Report** - Fever (even low-grade, ≥100.4°F or 38°C). - Chills or sweating. - Signs of infection (sore throat, cough, redness, swelling, or pain). - Decreased or absent WBC count (absolute neutrophil count \[ANC\] \50 years. - Family history of prostate cancer. - African American ethnicity. - High-fat diet and obesity. **Skin Cancer Risk Factors and Characteristics** - Risk factors: Fair skin, excessive UV exposure, family history, history of sunburns. - Characteristics: Persistent non-healing sores, pearly/waxy bumps (basal cell), or scaly patches. **Fluid, Electrolyte, and Acid-Base Imbalances** **Interventions to Delegate to a UAP** - Measuring intake/output. - Obtaining vital signs. - Assisting with ambulation or hygiene. - Reporting abnormal findings to the nurse. **Giving Hypotonic Solution Interventions** - Monitor for fluid shifts and cerebral edema. - Assess for signs of overhydration (e.g., confusion, lethargy). - Use cautiously in patients with head injuries or increased ICP. **Lasix (Furosemide) Interventions** - Monitor electrolytes (especially potassium). - Assess for signs of hypovolemia (e.g., dizziness, hypotension). - Encourage potassium-rich foods or supplementation. **Interpreting ABGs** - **Metabolic Acidosis**: pH \< 7.35, HCO₃⁻ \< 22 mEq/L. - **Metabolic Alkalosis**: pH \> 7.45, HCO₃⁻ \> 26 mEq/L. - **Respiratory Acidosis**: pH \< 7.35, PaCO₂ \> 45 mmHg. - **Respiratory Alkalosis**: pH \> 7.45, PaCO₂ \< 35 mmHg. **Electrolyte Replacement for DKA** - Replace potassium once levels fall below normal. - Administer IV fluids (0.9% NS or 0.45% NS). - Administer insulin to lower blood glucose. **Fluid Replacement for Diarrhea** - Use isotonic fluids (0.9% NS or LR). - Replace electrolytes (oral rehydration solutions or IV). - Monitor for signs of dehydration (e.g., poor skin turgor). **Lab Values and Interventions** - Potassium: 3.5-5.0 mEq/L. Hypokalemia: administer potassium cautiously IV or orally. - Sodium: 135-145 mEq/L. Monitor for signs of hyper/hyponatremia. - Calcium: 8.5-10.5 mg/dL. Monitor for tetany in hypocalcemia. **Integumentary Problems** **Appearance of Atypical Nevi** - Irregular borders, uneven pigmentation, or larger than normal moles. - May be raised or flat with mixed colors (brown, tan, pink, black). **Appearance of Melanoma** - Dark brown/black patches or nodules with irregular edges. - Rapid growth or changes in an existing mole (ABCDE criteria). - Possible bleeding, itching, or ulceration. **Appearance of Actinic Keratosis** - Rough, scaly patches or plaques on sun-exposed areas (e.g., face, hands). - Lesions are often pink, red, or brown. - Considered precancerous (may develop into squamous cell carcinoma). **Appearance of Basal Cell Carcinoma** - Pearly, waxy bump or flat lesion with a rolled edge. - May have visible blood vessels (telangiectasia). - Slow-growing and often appears on sun-exposed areas. **Risk Factors for Melanoma** - Fair skin, freckles, and light-colored eyes. - Family history of melanoma. - History of sunburns or tanning bed use. - Excessive UV radiation exposure. **Burns** **Rule of Nines** - Head and Neck: 9% - Each Arm: 9% (4.5% front, 4.5% back) - Each Leg: 18% (9% front, 9% back) - Anterior Trunk: 18% - Posterior Trunk: 18% - Perineum: 1% **Classification of Burns** - **Superficial**: Red, painful, dry (e.g., sunburn). - **Partial-thickness**: Blisters, red and moist skin, painful. - **Full-thickness**: White, charred, or leathery skin; painless due to nerve damage. **Priority Nursing Interventions for Burns** - Airway management: Assess for smoke inhalation and respiratory distress. - Fluid resuscitation: Use the **Parkland formula**. - Wound care: Prevent infection with aseptic techniques. - Pain control: Administer IV opioids as needed. **Interventions for Electrical Burns** - Cardiac monitoring for arrhythmias. - Assess entry and exit wounds. - Monitor for compartment syndrome and kidney function (rhabdomyolysis). **Emergency Interventions for Burns** - Remove the patient from the source of the burn. - Cool the burn with lukewarm water (not ice). - Cover with a clean, dry cloth to prevent infection. - Assess for airway and circulation. **Complications of Burns** - Infection/sepsis. - Hypovolemic shock. - Contractures and scarring. - Electrolyte imbalances (e.g., hyperkalemia). **Parkland Formula for Burns** - Formula: **4 mL × % TBSA × weight (kg)**. - Half the fluid is given in the first 8 hours. - The other half is given over the next 16 hours. **Hormone Alterations in Burns** - Increased cortisol and catecholamines (stress response). - ADH secretion leading to fluid retention. - Insulin resistance and hyperglycemia. **Diabetes Mellitus** **Type 1 Diabetes Signs and Symptoms** - Polyuria, polydipsia, polyphagia. - Weight loss, fatigue, blurred vision. - Ketoacidosis symptoms (nausea, abdominal pain). **Type 2 Diabetes Signs and Symptoms** - Polyuria, polydipsia, polyphagia (less common than Type 1). - Fatigue, recurrent infections, poor wound healing. - Gradual onset of symptoms. **Familial History of Diabetes and Pregnancy Interventions** - Screen for gestational diabetes (OGTT). - Provide dietary counseling and education. - Monitor fetal growth and maternal blood glucose. **Interventions for Type 1 Diabetic Patients After Insulin Administration** - Monitor for signs of hypoglycemia (sweating, shakiness, confusion). - Ensure the patient consumes a meal within 15-30 minutes after rapid-acting insulin. **Hyperglycemia Signs and Symptoms** - Polyuria, polydipsia, dry mouth. - Fatigue, nausea, blurred vision. - Fruity breath (in DKA). **Somogyi Phenomenon** - Nocturnal hypoglycemia leading to rebound hyperglycemia in the morning. - Intervention: Adjust evening insulin or provide a bedtime snack. **Dietary Patient Teaching for New Diabetic Patients** - Carbohydrate counting and balanced meals. - Avoid sugary beverages and processed carbs. - Include high-fiber foods to stabilize blood glucose. **Diabetic Patients and Contrast Administration** - Hold metformin 24-48 hours before and after contrast use. - Monitor renal function (BUN, creatinine). - Ensure adequate hydration. **DKA Interventions** - Fluid replacement with 0.9% or 0.45% NS. - Administer insulin drip and monitor glucose hourly. - Correct electrolyte imbalances (e.g., potassium). **Patient Education for Type 2 Diabetes** - Encourage physical activity and weight loss. - Teach self-monitoring of blood glucose (SMBG). - Stress the importance of medication adherence. **Endocrine Problems** **Hypopituitarism Findings** - Fatigue, weight gain, infertility. - Hypotension, low libido, cold intolerance. **SIADH Interventions** - Fluid restriction (500-1000 mL/day). - Administer diuretics and hypertonic saline if severe. - Monitor for signs of hyponatremia (e.g., confusion). **Diabetes Insipidus Lab Values to Monitor** - Low urine osmolality (\295 mOsm/kg). - Hypernatremia (Na \>145 mEq/L). **Assessing Medication Effectiveness for Hypothyroidism** - TSH levels normalize (decrease if elevated). - Improvement in symptoms (e.g., fatigue, cold intolerance). **Addison's Disease Interventions in Times of Stress** - Increase glucocorticoid dosing as prescribed. - Monitor for hypotension and electrolyte imbalances. - Administer IV hydrocortisone if necessary. **Cushing Syndrome Laboratory Tests to Monitor** - Increased cortisol levels (24-hour urine cortisol test). - Hyperglycemia, hypokalemia. **Acromegaly Assessment** - Enlarged hands, feet, and facial features. - Joint pain, thickened skin. - Sleep apnea and hypertension.