Study guide adult health test 2.docx

Study guide adult health test 2 chapters 53,13,14,15,16 Cancer patient with a low neutrophil count is at risk of what and what do we do to prevent that? Risk: Infection due to neutropenia caused by disease or treatment. Prevention: Implement neutropenic precautions, such as rigorous hand hygiene, av...

Study guide adult health test 2 chapters 53,13,14,15,16 Cancer patient with a low neutrophil count is at risk of what and what do we do to prevent that? Risk: Infection due to neutropenia caused by disease or treatment. Prevention: Implement neutropenic precautions, such as rigorous hand hygiene, avoiding crowds or sick individuals, and potentially using prophylactic antibiotics. What is a normal neutrophil count? Answer: Approximately 2,500 to 6,000 neutrophils per microliter of blood. What is considered a concerning fever for a neutropenic patient? Answer: A fever ≥ 38.0°C (100.4°F) is concerning and warrants immediate medical evaluation. Risk of doxorubicin if it infiltrates and what do we do about it? Risk: Severe local tissue damage (necrosis) if it infiltrates. Action: Stop the infusion immediately, notify a physician, and follow the institution's protocol for managing extravasation, which may include applying cold packs, elevating the affected limb, and administering antidotes. Main side effects of chemotherapy? Answer: Nausea, vomiting, alopecia (hair loss), fatigue, mucositis (mouth sores), and myelosuppression (reduced blood cell production leading to increased risk of infection and bleeding). What is thrombocytopenia and what should we watch for? Definition: A condition characterized by a low platelet count. What to watch for: Signs of bleeding, such as bruising, petechiae, nosebleeds, and bleeding gums. Administering chemo- what do we do to protect ourselves and others? Protection Measures: Use personal protective equipment (PPE) such as gloves, gowns, and eye protection; follow proper disposal procedures for chemotherapy waste; and employ safe handling techniques. Most dangerous complication for a pt with a stem cell transplant- how do we protect them? Complication: Graft-versus-host disease (GVHD). Happens when an immune deficient person is transfused or transplanted with immunocompetent cells It happens in blood transfusions, bone marrow or thymus transplants Donor t-cells attack the host cells- usually in skin, liver, and GI tract The competent graft cells attack the incompetent host cells- Protection: Use prophylactic medications to prevent GVHD and monitor closely for signs and symptoms to manage promptly. Difficult to treat, often fatal- usually try steroids and immunosuppressive drugs Care of skin post radiation therapy? Care Instructions: Keep the area clean and dry, avoid applying heat or cold directly, use mild soaps, avoid rubbing or scratching the treated area, and protect the skin from sun exposure. Avoid constricting garments, harsh chemicals, and deodorants. What should be consulted for a dying cancer patient to provide care? Consultation: Palliative care team or hospice care services to manage pain and symptoms and provide support for the patient and family. Surgery for cancer can be done for what reasons- and examples of what they would help? Reasons: Diagnostic (biopsy), curative (removal of tumor), prophylactic (remove at-risk tissue), supportive/palliative (relieve symptoms), and reconstructive/rehabilitative (restore appearance or function). Examples: Prophylactic: Removal of non-vital organs is successful treatment for certain malignancies. Usual sites of regional spread may be removed. Like Lumpectomy, Mastectomy, Thyroidectomy Supportive/palliative: Preserving quality of life with gastric feeding tube, Creation of a colostomy, Suprapubic cystostomy. Placement of venous access device, Debulking of tumor or radiation therapy to relieve pain or pressure. Colostomy for relief of bowel obstruction, Laminectomy for relief of spinal cord compression Rehabilitative: Creation of a bladder reservoir, Breast reconstruction, Creation of ostomies End stage complications of chest cancers and symptoms of that? Complications: Pleural effusion, dyspnea, cough, pain, superior vena cava syndrome (includes facial edema, periorbital edema, Distention of veins of head, neck, and chest. Headache, seizures.) Symptoms: Shortness of breath, chronic cough, chest pain, swelling of the face and arms. Care of a patient with a radioactive implant and how do we keep caregivers and others safe? Care: Limit time spent near the patient, maintain distance, and possibly use shielding. Ensure that caregivers follow specific safety guidelines to minimize exposure. Difference between normal cells and cancer cells that is recognizable by the immune system? Answer: Cancer cells may exhibit changes in the expression of surface molecules or antigens, which can be recognized by the immune system. These changes include the presence of tumor-associated antigens (TAAs) or neoantigens that arise from mutations specific to cancer cells. Such differences allow the immune system to detect and potentially target cancer cells for destruction. However, cancer cells can also develop mechanisms to evade immune detection, contributing to their growth and spread. Understand acquired immunity- active and passive, and innate. Acquired Immunity: Active: Developed after exposure to an antigen or vaccination. Passive: Transferred from another source, such as maternal antibodies or immunoglobulin injections. Innate Immunity: Non-specific first line of defense, including physical barriers (skin, mucous membranes) and immune cells (phagocytes, natural killer cells). Altered number of T-cells or function of causes what potential complications? Complications: Increased susceptibility to infections, autoimmune diseases, and impaired tumor surveillance. First cells to arrive at an injury? Answer: Neutrophils, followed by macrophages. Removal of what organ puts patients at risk for severe sepsis? Answer: The spleen (splenectomy increases risk for overwhelming post-splenectomy infection (OPSI)). What is phagocytosis and what cells do it? Phagocytosis: The process by which cells engulf and digest microorganisms and cellular debris. Cells: Macrophages and neutrophils. What immunoglobulins and what cells are part of the allergic response and are elevated? Immunoglobulins: IgE is elevated in allergic responses. Cells: Mast cells and basophils are involved in the allergic response. What does histamine do in an allergic reaction? Function: Histamine increases vascular permeability and causes vasodilation, leading to symptoms such as swelling, redness, and itching. Name the types of hypersensitivity reactions and what would be examples of them. Type I: Immediate hypersensitivity (e.g., anaphylaxis, allergic rhinitis). Type II: Antibody-dependent cytotoxicity (e.g., hemolytic anemia, Goodpasture's syndrome). Type III: Immune complex-mediated (e.g., systemic lupus erythematosus, rheumatoid arthritis). Type IV: Delayed-type hypersensitivity (e.g., contact dermatitis, tuberculosis skin test reaction). What is the order of action when someone is having anaphylaxis? Order of Action: Immediately administer epinephrine, call for emergency medical help, provide supportive care (oxygen, IV fluids), and administer additional medications as needed (antihistamines, corticosteroids). What does positive urine ketones mean in diabetes? Meaning: Indicates that the body is using fat for energy due to a lack of insulin or inability to use glucose properly, leading to ketoacidosis, a potentially life-threatening condition. What are the percentage by calorie of food types a diabetic should eat- protein, carb, fat? Guideline: The American Diabetes Association suggests a balanced diet that includes about 45-65% of calories from carbohydrates, 15-20% from protein, and 20-35% from fat, though individual recommendations may vary. What is the peak, onset, and relationship to food for a diabetic for Humalog and regular insulin? Humalog (Insulin Lispro): Onset: About 15 minutes Peak: 1-2 hours Relation to food: Should be taken immediately before or after meals. Regular Insulin: Onset: 30 minutes to 1 hour Peak: 2-4 hours Relation to food: Should be taken 30 minutes before meals. How should a type 1 diabetic take care of themselves when they are sick? Care During Illness: Continue taking insulin, monitor blood glucose levels more frequently, stay hydrated, and have a plan for when to contact a healthcare provider if ketones are present or if glucose levels are too high or low. What are macro VS microvascular complication in diabetes and examples? Macrovascular: Complications affecting large blood vessels, such as cardiovascular disease, stroke, and peripheral artery disease. Microvascular: Complications affecting small blood vessels, including retinopathy, nephropathy, and neuropathy. Definition and cause of type 1 diabetes? Definition: An autoimmune condition where the immune system destroys insulin-producing beta cells in the pancreas. Cause: The exact cause is unknown, but it's thought to be a combination of genetic predisposition and environmental factors. Treatment steps in order of hyperosmolar hyperglycemic syndrome and who gets it? Treatment Steps: Initial fluid replacement, insulin therapy, and electrolyte management. Who Gets It: More common in type 2 diabetics, especially the elderly or those with compromised fluid intake. Laboratory values will show a Blood glucose >400 mg/dl. Increase in serum osmolality. Absent or minimal ketone bodies. Cause of gestational diabetes? Cause: Hormonal changes during pregnancy that lead to insulin resistance. How does stress affect diabetes? Effect: Stress can increase blood glucose levels by triggering the release of stress hormones such as cortisol and increases in sympathetic system, which can increase insulin resistance. What are the need-to-know teaching points for a new diabetic and how best do we teach them? Teaching Points: Blood glucose monitoring, insulin administration (if applicable), recognizing signs of hypoglycemia and hyperglycemia, diet and exercise recommendations. How to Teach: Use a combination of verbal instructions, written materials, demonstrations, and hands-on practice; tailor the education to the individual's learning style and literacy level. Priority in DKA treatment and in what order do you do them? Priorities: Fluid replacement to address dehydration, electrolyte management to correct imbalance, and then insulin therapy to reduce blood glucose levels. STEPS: Correct fluid/electrolyte imbalance. IV 1 L over 30 min 0.45% or 0.9% NaCl. Repeat x 3 or more if U/O or BP is low. Raise SBP to > 90. Correct K, Phos, and Mag. K+> 3.3 first before insulin drip started. Every 4 hours labs- BMP, Phos, acetone. Pt needs to be on a cardiac monitor. Signs and symptoms (S&S) of neuropathy? S&S: Tingling, numbness, pain, or weakness in the feet and hands. Labs and symptoms in DKA? Labs: Blood Glucose: Generally >300 mg/dL, but can be much higher. Blood pH: Less than 7.30 (indicating acidosis). Bicarbonate (HCO3): Less than 15 mEq/L (sign of metabolic acidosis). Ketones: Positive in blood and urine. Anion Gap: >12 mEq/L, indicating a gap acidosis due to the accumulation of ketoacids. Symptoms: Polyuria, polydipsia (increased thirst), nausea, vomiting, abdominal pain, deep and rapid breathing, confusion, and possibly coma. Recessive genetic disorders-what is the potential for a child to get it if one parent has the disorder and the other one doesn’t, or if both are carriers? One Parent Affected, One Not: The child will not have the disorder but will be a carrier. Both Parents Carriers: Each child has a 25% chance of having the disorder, a 50% chance of being a carrier, and a 25% chance of neither having the disorder nor being a carrier. Risk of taking beta-blockers for a type one diabetic- what do beta blockers end in? Risk: Masking symptoms of hypoglycemia. Beta Blockers End in: "-olol" (e.g., metoprolol, atenolol). Insulin and meal planning related to exercise? Guidance: Monitor blood glucose levels before, during, and after exercise. Adjust insulin doses and carbohydrate intake based on activity level to prevent hypoglycemia. Somogyi effect and dawn phenomenon- how do we tell which is happening? Somogyi Effect: Rebound hyperglycemia from insulin-induced hypoglycemia during the night. Check blood sugar levels at night to confirm. Dawn Phenomenon: Natural early morning increase in blood sugar without preceding hypoglycemia. Check fasting early morning (2am-4am) glucose levels to distinguish. Treatment of hypoglycemia? Treatment: Consume 15-20 grams of rapid-acting carbohydrates (e.g., glucose tablets, juice), recheck blood glucose in 15 minutes, and repeat if necessary until blood glucose is within normal range. What does the T,N,M mean- what are the 0s and 1s for each? T (Tumor): Size and extent of the primary tumor. T0 indicates no evidence of primary tumor, T1 indicates a small tumor. N (Nodes): Number of nearby lymph nodes involved. N0 indicates no lymph node involvement, N1 indicates involvement of nearby lymph nodes. M (Metastasis): Presence of distant metastasis. M0 indicates no distant metastasis, M1 indicates distant metastasis is present. Care of a patient on Neutropenia precautions? Care: Implement strict infection control measures, including hand hygiene, limiting exposure to potential sources of infection, and possibly using protective isolation. Severe allergy respiratory assessment? Assessment: Monitor for signs of respiratory distress, such as wheezing, shortness of breath, decreased oxygen saturation, and use of accessory muscles for breathing. Potential complications of a cancer patient and concerning symptoms? Complications: Infection, bleeding, kidney or liver dysfunction, and metabolic imbalances. Concerning Symptoms: Fever, uncontrolled pain, sudden shortness of breath, and changes in mental status. Adverse effects of cyclophosphamide? Adverse Effects: Myelosuppression, hemorrhagic cystitis, alopecia, nausea, and vomiting. Dangerous potential complications of patients with HIV? Complications: Opportunistic infections, AIDS-related cancers, and medication-related side effects. Most common method of transmission of HIV- teaching to prevent that? Method: Sexual contact, sharing needles, mother-to-child transmission. Prevention Teaching: Use condoms, do not share needles, and pregnant women with HIV should receive treatment during pregnancy. Cannot spread the virus via saliva, urine, sputum, sweat, or feces. Reasons to start antiretroviral HIV meds and reasons to wait to start? Reasons to Start: To reduce the viral load, improve immune function, and prevent transmission. Reasons to Wait: Historically, some guidelines recommended waiting until a certain CD4 count threshold, but current recommendations advocate starting antiretroviral therapy (ART) as soon as possible after diagnosis.