Exam 4 Study Guide PDF

**Chapter 15 -- HIV** 1. Risk factor: a. Male b. Homosexual c. Healthcare workers d. Pregnancy i. Mom passes to baby through vaginal birth 2. Viral -- Retrovirus e. Needs host f. RNA to DNA g. CD4 cells attacked - ii. By billions every...

**Chapter 15 -- HIV** 1. Risk factor: a. Male b. Homosexual c. Healthcare workers d. Pregnancy i. Mom passes to baby through vaginal birth 2. Viral -- Retrovirus e. Needs host f. RNA to DNA g. CD4 cells attacked - ii. By billions every day h. Once virus is into cell; DNA; replicates 3. S/S i. 2-4 wks. after transmission -flu- like symptoms iii. Fever iv. Sweats v. malaise vi. Swollen nodes j. Progression of HIV s/s vii. Diarrhea viii. Flush in mouth -- immunosuppressed makes way for more cooties ix. Flare up of shingles x. Kaposi Sarcoma; lesions on skin xi. CD4 goes down 1. Worry about [pneumonia ] xii. Wasting syndrome -- loss of weight 4. Development of pneumonia (CARE) k. Fluid intake: 3000ml/ day xiii. Loosen up sputum l. Raise HOB -- 45 degrees xiv. Lung expansion m. Incentive spirometer / Cough/ Deep breath n. Sputum Culture xv. For abx o. Vital signs 5. Diagnostic p. CD4 cells -- 400 to 800 (normal value) xvi. Between 400 to 200 -- HIV stage xvii. Below 200 -- AIDS q. ELISA -- only if antigens are present xviii. Let's you know if they were exposed to HIV r. Western blot \*← xix. Definitive test for HIV; how its confirmed xx. Weeks until test comes back xxi. No cure for HIV 6. Treatment: focus on progression s. Antiretrovirals xxii. E.g. -vir drugs t. Patients that have AIDS xxiii. Teach prevention xxiv. Flu-like symptoms xxv. Prep for sex 2. Prophylactic meds, e.g. PREP xxvi. Needle users 3. New needles 4. Don't share xxvii. Lifelong meds; must remain 7. Emotional support for HIV u. Talk to patients but WEAR GOWN for: xxviii. Suctioning xxix. Diaper changes xxx. Speaking with patient **Chapter 14 - Organ Transplants** 1. Type of donors: LIVE a. Tissue typing: Same blood type, not necessary the RH type i. Loved ones b. Transplant rejection: ii. Hyperacute -- within 24 hrs. of recveing organ 1. Body creates antigens and rejects organ 2. Must remove immediately iii. Acute -- with 6 mos. after transplant 3. Recipient lymphocytes attack the organ 4. TX: Placed on steroids and immunosuppressants a. Watch for infection: i. Safe food handling ii. High protein/High caloric meals iii. May be NPO in hospital for a few days iv. Liver failure: 5. AST, ALT elevated 6. Jaundice v. Kidney 7. Weight gain 8. Oliguria 9. Elevated BUN/Creatinine c. Chronic -- within a few years; irreversible vi. May see scarring 2. Immunosuppressant therapy: Life-long d. Corticosteroids added w/ immunosuppressants vii. Monitor for s/s of corticosteroids e. Tacrolimus / Myfortics viii. No grapefruit juice 3. Graft vs Host f. The organ rejects the recipient ix. Donors T-cells attacks the recipient 10. Liver, GI transplants x. Typically happens 30 days after transplant g. s/s: itching, rash, marks and sores on palms and soles of feet, elevated WBCs h. TX: xi. Immunosuppressant therapy **Chapter 10 -- Palliative and End of Life Care** 1. Palliative care -- the active holistic care of a person w/ serious health -- related suffering from a severe illness. 2. Ask the family their preferences for end-of-life care 3. Nurses give emotional support to patient a. Hold their hand b. Talk to them c. Give them foods they like d. Ask if they want DNR i. If they say yes, inform HP to write an order or telephone order e. Discuss final wishes ii. Encourage them to talk "final wishes" with their family 4. 8 Key Domains of Palliative Care: f. Care structure of processes g. Physical aspects of care: h. Psychologic and Psychiatric aspect: i. Social: j. Spiritual/religious/Existential: k. Cultural: l. Care nearing the end of life: m. Ethical/Legal: 5. Death: n. Nurses can call death if pt has DNR iii. Take stethoscope if you hear no heart sounds iv. Look at watch and note time v. Document, your observations for calling death 1. No lung, heart sounds o. What will you see: vi. Patients may start to hallucinate vii. Patient has spurt of energy viii. Cheyne- Stoke breathing 2. Normal ix. Bereavement/ Grief 3. How people mourn 4. People grieve in different ways a. Feels: i. Anger, relief, guilt, sad, anxiety b. Keep grief as adaptive -- healthy c. If grief is longer, feeling suicide, depression -- maladaptive; unhealthy ii. Acting like person is not dead, in denial x. Physical: 5. Lungs don't work 6. Heart don't work 7. Bowels release 8. Rigor mortis will set in d. Flatten bed when patient passes away e. Close eyes as soon as possible f. Fix hair 9. If autopsy needs to be performed: don't touch anything on the body g. Died within 24 hrs. of reaching hospital 10. After patient dies: h. Call life gift: for organ donations iii. Document that you have spoken to life gift **Chapter 16 -- Cancer**: *a group of diseases characterized by uncontrolled and unregulated call growth* 1. Anatomic Site- Review Table 16.4 2. Most common per gender: a. Men: Prostate cancer () b. Women: Breast cancer (highest incidence) 3. 5 Grades: c. Grade 1 d. Grade 2 e. Grade 3 f. Garde 4 g. Grade 5 4. Stages: h. Stage 0 -- Cancer in situ -- right where it started, no invasion. i. Stage 1 -- Tumor limited to the tissue of origin, localized tumor growth j. Stage 2 -- Limited local spread k. Stage 3 -- Extensive local and regional spread l. Stage 4 -- Metastasis -- cancer spread all throughout body 5. TNM -- Tumor, Lymph nodes, Metastasis m. T -- invasiveness n. N -- Regional spread o. M -- Metastasis 6. Prevention/ Early Detection: p. Self examination i. Men -- look at scrotum for testicular cancer/ prostated cancer 1. Testicular cancer: unilateral, genetics, check prostate around age 50 ii. Women -- look for lumps in breast, get cervical checks ; mammograms at 40, unless it runs in family -- 35. q. Prevention: iii. Limit alcohol iv. Excerecise -- moderate, 30 mins or more v. Regular physical exams (annually) vi. Obtain regular colorectum exams vii. Stop smoking viii. Regular mammograms/ pap smears ix. 6-8 hrs of sleep x. Sunscreen (pf 50 or higher) 2. Avoid tanning beds xi. Reduce stress xii. Well balanced diet 3. Whole foods and grains 4. Reduce fat/ processed foods 5. Stay away from foods high in nitrates a. Smoked and cured meats 7. Warning signs: r. C -- Change in bowel and bladder habits s. A -- A sore that doesn't heal t. U -- Unusual bleeding or discharge u. T -- Thickening or a lump v. I -- Indigestion or difficulty swallowing w. O -- Obvious changes in warts or moles x. N -- Nagging cough or hoarseness 8. Diagnostics: y. Chest x-ray z. Cytology a. CBC b. LFT c. Endoscopic radiologic studies d. PET scan e. Tumor markers f. Biopsy 9. Treatment: g. Chemotherapy xiii. Cell cycle nonspecicfic xiv. Cell cycle specific xv. Preparation 6. Diluate with NS xvi. Affects of chemo 7. Kills rapid going cells 8. Kills all rapid going cells b. Hair -- hair lose i. When it grows back it can be different texture/color c. Lining of stomach -- nausea xvii. If patient goes home on chemo: 9. Make sure family member uses a diffenet toilet than atient 10. When flushing toilet: d. Put down lid and then flush 11. Put toothbrush in drawer not on counter 12. Wear double gloves if dealing with bodily fluid from patent 13. Wash laundry separate xviii. Patient on chemo in the hospital: 14. Place at the end of hallway 15. Private room h. Radiation -- kills all cancer xix. Low-energy beam 16. Very effective; surface based e. Eg. Skin cancer ii. High risk: Caucasian, Old folks, works in the sun: construction workers iii. S/S: redness and ulceration iv. Prevention: Wear sunscreen ; SPF 50 \^ xx. Hi-energy beam 17. Penetrate deeper f. Eg. Bone cancer; TX: hemopoetic stem-sells v. Isolation for 2-4 weeks vi. Can be done in the room vii. Very painful xxi. External 18. Can cause dysphagia, dysnea 19. Head/ neck: dry mouth g. Teach oral care h. Don' t use hydrogen paroxide i. Soft brushes j. No alcohol based rinses e.g Listerine xxii. Internal xxiii. Limit exposure to patient: group nursing tasks xxiv. Wound healing diet: high protein diet xxv. Teach importance of chemo/radiation and it's survival rate xxvi. Leukemia 20. Receptive to chemo 21. Often goes into remission 10. Nurse Management: i. Hyperurecemia xxvii. TX: Allopurinol, Increase fluids j. Cardiotoxicity xxviii. TX: EKG k. Damage near by tissues: xxix. Pericarditis, Myocarditis l. Fatigue m. Anorexia xxx. TX: Small high protein/ caloric meals n. Bowel changes xxxi. Nausea 22. TX: antiemetic: Zofran \\ can cause HA xxxii. Diarreha 23. TX: antidiarreha: Imodium xxxiii. Stomitis -- chemo can destroy lining 24. No spicy foods or hot foods k. Bland food l. If giving coffee viii. Cold xxxiv. Thrombopenia and Leukopenia 25. Stay away from crowds -- leukopenia 26. Look for bleeding/ bruising -- thrombocytopenia xxxv. No sick visitors xxxvi. Give bottled water xxxvii. No fresh fruits and vegatables after chemo 27. Canned xxxviii. No sushi, no runny eggs, no ice, no flowers 11. Skin care: o. Radiation: skin can get damaged xxxix. Use soft soaps -- dove xl. Tepid water (shower/bathe) xli. Dry softly xlii. No perfumes, lotions, creams xliii. Sensitive detergents for laundry xliv. No tight fititing clothing xlv. No swimming in chlorine pools 28. Burn skin xlvi. Stay out the sun 29. If you do go in direct sunlight: wear SPF 50 or higher 12. Complications: p. Nutrional issues xlvii. Lose weight 30. Pancreatic cancer (high wasting) xlviii. Muscle wasting xlix. Food can taste bitter/ metallic l. Sensitive to smell li. Food: soft foods 31. Milk shakes 32. Fish m. Rich in Omega-3 : good fr prostate health 33. Chopped meat 34. Cottage cheese 35. Vitamin Saw Palmeto -- prostate health q. Infections: lii. Neutropenic isolation liii. Silverware cleaned 36. Dishwaher liv. Protective precaution 37. Any type of dental work -- let dentish know about chemo/radiation lv. No public transportation r. Cancer pain lvi. Give pain medication around the clock Exam Review -- 75 Questions HIV and how transmitted High risk for HIV CD4 cells -- how it's destroyed Manifestations -- when first contracted HIV Difference/ Similarities of HIV and Aids How they go from HIV to AIDS HIV -- dx that test for HIV Treatment for HIV ; drug classes Concerns for pt getting organ transplant What will you see when organ begins to fail: depending on organ TX for immunosuppresent therapy ; contraindications Know diff between transplant reaction: hyperacute, acute, chronic and graft vs host disease If they develop graft vs host: Manifestations will you see Pallative care and hopice care -- GOALs Physical and psychological side of death ; what do you see? What do you do when the pt is nearing death DNR Grieving process -- adaptive and maladaptive grieving Define cancer Stages of cancer (extent of disease) Detection Pap smears/ self examination Prevention Warning signs= CAUTION Treatment for cancer -- Chemo/ Radiation Surgical -- remove tumor Administer chemo -- HOW Stem cells, bone marrow Skin cancer ; whos at higher risk -- lighter skin Radiation ; damage tissue ; other s/s that develop Leukemia -- receptive to chemo, goes into remission Nursing management : what you will see ? what to do e.g cardiotoxicity Skin care -- what you need to teach patient Diet: prostate -- vitamin saw , nauseous what kind of meal? , neutropenic precautions -- what do you do? Pain management -- bone = deep