Exam 5 New Content Review

Secondary Gout

"hyperuricemia" caused by another disease or factor - renal insufficiency - diuretic therapy - "crash diets" - some carcinomas and chemo agents

Types of chemotherapy administration

- IV - intrathecal (in the spine) - intraperitoneal - intravesicular (IV, bladder [catheter]) - topical - intra-arterial (in artery) - oral

Risk factors for Breast cancer

- Increases with age - first child after age 30 - family history (esp. mother or sister) - personal hx of BC or atypical hyperplasia on previous breast biopsy - known BRCA carrier

Cervical Cancer intervention

- LEEP (loop electrosurgical excision procedure) - laser surgery - cryosurgery - conization - radical trachelectomy (removal of the cervix and upper vagina, uterus body is left intact) - total hysterectomy

Acute Complications of fractures

- VTE (DVT and PE) - bone or soft tissue infection - acute compartment syndrome - fate embolism syndrome

Spinal cord compression in cancer

- a tumor directly enters the spinal cord spinal column or vertebral collapse from tumor degradation of bone - thoracic spine most commonly affected

S&S of uterine leiomyomas

- abdominal pain - abnormal heavy vaginal bleeding - backache - constipation - urinary frequency - dyspareunia (painful intercourse) - pelvic pressure

Osteoarthritis nodes

Heberden's nodes - the most distal joint of fingers Bouchard's nodes - the second most distal joint of fingers

Stage 1 of bone healing

Hematoma formation within 24-72 hours after injury at fracture site

Angioedema

Localized areas of swelling beneath the skin, often around the eyes and lips, but it can also involve other body areas as well. - deep-tissue problem of IgE mediated release of inflammatory proteins, especially bradykinin (not histamine) - corticosteroids and epinephrine

Superior Vena Cava syndrome in cancer

Superior vena cava compressed or obstructed by tumor growth

Type IV Delayed hypersensitivity

T-lymphocytes (T-cells) are activated immune system component triggering the excessive responses (occurs hours to days after exposure) - edema, induration, ischemia, tissue damage at site of exposure - NOT HISTAMINE or IgE reaction!!! - use corticosteroid to help resolve the reaction not antihistamines like diphenhydramine

Dupuytren's contracture

Thickening and shrinking of the fascia of the palm with fingers being drawn into a flexed position

functional erectile dysfunction

This type of ED is a result of a psychological cause such as high stress

Surgical Management for benign prostatic hyperplasia

Transurethral resection of the prostate (TURP) Rransurethral incision of the prostate (TUIP)

Knee injuries

Trauma can cause cartilage, ligament, and tendon injury RICE" mnemonic •Rest •Ice •Compression •Elevate

Types of Hypersensitivity Reactions

Type I: rapid hypersensitivity Type II: cytotoxic Type III: immune Complex - Mediated Type IV: delayed

toxic shock syndrome (TSS)

a severe illness characterized by high fever, rash, vomiting, diarrhea, and myalgia, followed by hypotension and, in severe cases, shock and death; usually affects menstruating women using tampons; caused by Staphylococcus aureus and Streptococcus pyogenes

amputation

a surgical removal of all or part of a limb

Gouty Arthritis

a systemic disease in which urate crystals deposit in the joints and other body tissues, causing inflammation

Type I (Rapid Hypersensitivity)

aka: atopic allergy - most common type - results from increased production of immunoglobulin E (IgE) - acute inflammation occurs when IgE responds to an antigen, such a pollen, and causes the release of histamine and other vasoactive amines - fust have a first exposure

Radiation Dose

amount of radiation absorbed

Exposure in radiation

amount of radiation delivered

Examples of disorders with an Autoimmune Basis

- diabetes type 1 - glomerulonephritis - graves disease - hashimoto thyroiditis - IBS - psoriasis - rheumatoid arthritis - systemic lupus erythematosus

Types of surgeries for cancer treatment

- prophylaxis (prevent) - diagnosis - cure - debulking - palliation - reconstruction or restorative

Testicular Cancer

- rare cancer affecting men usually between 20-35 years of age - 95% cure rate with early detection - primary testicular cancers: - germ cell tumors (arising from sperm-producing cells [most common]) - non-germ cell tumors (arising from cells that produce testosterone)

Management of Osteoarthritis

- regenerative therapies - position joints int heir functional position - rest balance with exercise - application of heat or cold (icy hot) - weight loss - complementary and integrative health - topical capsaicin (hot peppers) - glucosamine and chondroitin - medical marijuana - total joint arthroplasty - total joint replacement

Oncologic Emergencies

- sepsis - disseminated intravascular coagulation - syndrome of inappropriate antidiuretic hormone - spinal cord compression - hypercalcemia - superior vena cava syndrome tumor lysis syndrome

infiltrating ductal carcinoma

breaks out of duct and grows irregularly into surrounding tissue (irregular, poorly defined mass)

Extravasation

escape of fluid from a blood vessel into surrounding tissue

Nonproliferative Breast lesions

fibrocystic changes, cysts - caused by an imbalance in estrogen-to-progesterone ratio - does not increase chance of developing cancer

first exposure in type I hypersensitivity

first exposure to an antigen that provokes allergic sensitization (allergen) > antigen-specific IgE is formed and binds to basophils and mast cells - the pt is now sensitized to that allergen

Organic Erectile Dysfunction

gradual deterioration of function related to diabetes, hypertension, smoking, alcohol, surgery and other causes

Malignant Bone Tumors (metastatic)

greatly outnumber primary malignant bone tumors types of "bone seeking" cancers include: - prostate - breast - kidney - thyroid - lung

Proliferative breast lesions with atypia

growth of abnormal cells, but not considered cancer

Primary Gout

inborn error of purine metabolism > uric acid

Osteomyelitis

inflammation of bone and bone marrow

Mastitis

inflammation of the breast - most commonly occurs in women who are breastfeeding - treatment

Vulvovaginitis

inflammation of the vulva and vagina

sentinel lymph node biopsy

injection of blue dye and/or radioactive isotope used to identify the sentinel lymph nodes, the chemical will travel to locations of possible metastasis, tis helps locate how far the cancer has spread

Fractures of the chest and pelvis

internal damage is chief concern - assess airway, breathing, circulation first for any chest trauma

Brachytherapy

internal; radiation source in direct contact with tumor tissues for a specific amount of time

Fractures of the hip

intracapsular - within the joint capsule extracapsular - outside the joint capsule

Pathophysiology of Osteoarthritis

joint pain and loss of function characterized by progressive deterioration and loss of cartilage in one or more joints

Triple Negative Breast Cancer (TNBC)

lacks the expression of: (triple negative) - estrogen receptor (ER) - progesterone receptor (PR) - human epidermal growth factor receptor (HER2)

Tumor Lysis Syndrome (TLS)

large numbers of tumor cells destroyed rapidly, results in intracellular contents being released into bloodstream faster than the body can eliminate them

osteomalacia

loss of bone related to lack of vitamin D, which causes bone softening

Osteopenia

low bone mass, which occurs when osteoclastic (bone resorption) activity is greater than osteoblastic (bone-rebuilding) activity

Erectile Dysfunction (ED)

repeated inability to initiate or maintain an erection sufficient for sexual intercourse "impotence"

Generalized secondary osteoporosis

results from an associated medical condition such as hyperparathyroidism, long-term drug therapy (corticosteroids), long-term immobility.

Type III immune complex reaction hypersensitivity

results from excess antigens causing immune complexes to form in the blood (most autoimmune disorders are caused by the type of reaction) - Usual sites: - kidneys - skin - joints - small blood vessels

Examples of Type III Complex Reactions

rheumatoid arthritis systemic lupus erythematosus

Ganglion

round, benign cyst often found on a rist or foot joint or tendon - synovium surrounding the tendon degenerates, allowing the tendon sheath to become weak and distended

Fat embolism syndrome

serious complication in which fat globules are released from yellow bone marrow into bloodstream

acute compartment syndrome

serious condition in which increased pressure within one or more compartments reduces circulation to the area

Uterine Leiomyomas

(Fibroids) benign, slow-growing tumors of the myometrium - classified by the position in layers of the uterus - intramural - submucosal - subserosal - develop from excessive growth of smooth muscle cells - cause unknown

Stage 2 of bone healing

- 3 days to 2 weeks - granulation tissue begins to invade the hematoma - prompts the formation of fibrocartilage -foundation for bone healing

Stage 3 of bone healing

- 3 to 6 weeks - callus formation (new vascular tissue) - beginning of a nonbony union

Stage 4 of bone healing

- 3 to 8 weeks - callus gradually reabsorbed and transformed into bone

Stage 5 of bone healing

- 4 to 6 weeks or longer in older person - consolidation and remodeling of bone

Continuous Bladder Irrigation (CBI)

- A three-way (lumen) irrigation is used to decrease bleeding and to keep the bladder free from clots - traction via taping to pt's abdomen or thigh - uncomfortable urge to void continuously - antispasmodic medication *** at risk for bleeding (should not see bright red or ketchup-like bleeding with numerous clots)

Side effects of radiation therapy

- Acute and long-term side effects - vary according to radiation site - Radiation dermatitis - varies from redness > to desquamation - Altered taste - Fatigue - Bone marrow suppression - occurs regardless of treatment

Disorders of the foot

- Hallux valgus - bunion - hammertoe - plantar - inflammation of plantar facia in arch of the foot (use NSAIDS)

Chronic Complication of fractures

- avascular necrosis - delayed union - complex regional pain syndrome (CRPS)

Risk factors of uterine leiomyomas

- black woman - vitamin D deficiency - reproductive tract infection - early menarche - red meat, alcohol - hypertension

S/S of osteomyelitis

- bone pain - fever - erythema and heat in the area of the infected bone, edema - elevated WBC - ESR may raise later in the disease course

Drug Therapy for Osteoporosis

- calcium and vitamin D - give a third of daily dose at bedtime - drink lots of water to prevent kidney stones - Calcitonin (Miacalcin) - "keeps" calcium in the bone - Bisphosphonates - slow bone reabsorption - take on an empty stomach with a FULL glass of water, first thing in the morning, remain upright for 30 minutes after administration - Selective estrogen receptor modulators - increases bone mineral density, reduces bone resorption, reduces osteoporotic vertebral fractures - RANKL (receptor activator of nuclear factor kappa-B ligand) inhibitors - used when no other drug is effective - prevents the protein form activating its receptor, the drug decreases bone loss

Disseminated Intravascular Coagulation (DIC)

- common cause of death - widespread clotting in small blood vessels followed by depletion of clotting factors and extensive bleeding, damage to major body organs

Types of fractures

- complete or incomplete - open (compound) or closed (simple) -fragility (pathologic or spontaneous) - fatigue or stress - compression

anaphylaxis interventions

- establish airway - call RR - apply high flow oxygen - discontinue IV drug if pt is reacting to that drug - epinephrine; repeat as necessary - IV fluids - normal saline - inhaled beta-adrenergic agonist (albuterol) - corticosteroids, oral steroids

Examples of Type II cytotoxic hypersensitivity

- immune hemolytic anemias - immune thrombocytopenic purpura - transfusion reaction (wrong blood type given)

rheumatoid arthritis (RA)

- inflammatory - autoimmune - exacerbations/remission (commonly around stress) - bilateral - upper extremities, hands - systemic - elevated rheumatoid factor - elevated ESR - low grade fever - lateral deviation of fingers (ulnar) - NSAIDs - Methotrexate (chemo drug) - immunosuppressants - Hydroxychloroquine (risk for retinal damage) - Glucocorticoids (taper off if not > addison's disease)

Anaphylaxis: Recognize Cues

- initial symptoms may be subtle - apprehension, weakness, impending doom - generalized itching and hives - angioedema - congestion, rhinorrhea, dyspnea, wheezing, crackles, stridor, respiratory distress - hypotension - diaphoresis

Lower extremity fractures

- lower. 2/3 of femur - usually from trauma - tibia/fibula - ankle - foot or phalanges

Syndrome of Inappropriate Antidiuretic Hormone (SIADH)

- most commonly found in carcinoma of the lung - caused by an increased antidiuretic hormone from the pituitary - water is reabsorbed to excess by kidneys; put into system circulation - pts have fluid overload problems - monitor for pulmonary edema

side effects of chemotherapy therapy

- neutropenia (lack of neutrophils, a type of WBC, infection precaution) - thrombocytopenia (bleeding precautions) - alopecia (hair loss) - mucositis (inflammatory response leading to sores or ulcers of mucous membranes) - skin changes - anxiety - N/V (give zofran to prevent) - changes in cognitive function (chemo brain) - chemotherapy induced peripheral neuropathy

Osteoarthritis (OA)

- noninflammatory - aging (usually over 60 year), genetic, obesity (disease of "wear and tear") - degenerative with secondary inflammation - may be unilateral - weight-bearing joints (hips & knees) - non-systemic - slightly elevated ESR - Heberden's and Bouchard's nodes - NSAIDs - Acetaminophen

Hypercalcemia in cancer

- occurs with multiple myeloma and bone metastasis - some cancer secrete parathyroid hormone - fatigue, loss of appetite, N/V, constipation, polyuria, severe muscle weakness, loss of deep tendon reflexes, paralytic ileus, dehydration, ECG changes

Examples of Type IV delayed hypersensitivity

- positive purified protein derivative (TB test) - contact dermatitis - poison Ivy skin rashes - local responses to insect stings - sarcoidosis (lung problems)

Interventions for Prostate Cancer

- preventing metastasis (active surveillance) - radiation therapy - hormone therapy - chemotherapy - surgical management - radical prostatectomy

Drug therapy for erectile dysfunction

- sildenafil (Viagra) - vardenafil (Levitra) - tadalafil (Cialis) - avoid alcohol before sexual intercourse - common side effects include: - heartburn - headaches - headaches - facial flushing - stuffy nose *** men who take nitrates should not take these drugs: profound hypotension and reduced blood flow to vital organs can result

Prostate Cancer

- slow-growing cancer that affects a large number of males after age 50 - first symptoms related to the bladder neck obstruction; difficulty in starting urination, urinary retention

angioedema interventions

- stop reaction - ensure an adequate airway - oxygen, possible intubation or tracheostomy, drug therapy - IV access - corticosteroids, epinephrine (drug therapy may need to continue for several hours after angioedema has initially resolved

Cancer Management

- surgery - radiation - chemotherapy (for metastasis) - immunotherapy - photodynamic therapy (light sensitive chemical that is hit by laxer to kill cells with chemicals) - hormone therapy

nutrition therapy for Gout

- teach pts to determine which foods precipitate acute attacks and avoid them - low purine diet - avoid shellfish, organ meats. oily fish with bones - avoid alcohol - avoid starvation "crash" diets - limit proteins - avoid aspirin and diuretics - drink plenty of fluids - prevent urinary stones

Cytotoxic Systemic Therapy (Chemotherapy)

- treatment of cancer with antineoplastic agents - kill cancer cells and disrupt their cellular regulation - places pt at high risk for infection, immunosuppression, complications - cytotoxic effects exerted on healthy cells and cancer cells - to kill metastisis as well as healthy cells

Histamine results in the five cardinal sings of inflammation:

- warmth - redness - swelling - pain - decreased function (caused by capillary leak, mucous secretion, itching, and erythema)

General Autoimmunity

-inappropriate immunity that develop in an adults tissue - body will form lymphocytes that will attack against body's own healthy tissue and normal cells - common, chronic, progressive, self-perpetuating, cannot be cured

Drug therapy for Benign prostatic hyperplasia

5-alpha reductase inhibitor (5-ARI) - finasteride (Proscar) - dutasteride (Avodart) - shrink enlarged prostate; need to take for 6 months before improvement is noticed Alpha-blocking agents - tamsulosin (Flomax) - doxazosin (Cardura) - increased urine flow by relaxing smooth muscles in the prostate; watch for orthostatic hypotension Complementary and Alternative Therapies

Osteoporosis Risk Factors (ACCESS)

A - alcohol Use C - corticosteroid Use C - calcium low E - estrogen low S - smoking S - sedentary lifestyle/s ACCESS leads to OSTEOPOROSIS

drug therapy for gout

Acute: - colchicine + NSAID to decrease inflammation Chronic: - Allopurinol (Zyloprim) - prevents production of uric acid - Probenecid - prevents excretion of excess uric acid Avoid aspirin as it inactivates the effects of these drugs

Type I (Rapid Hypersensitivity) emergency reactions

Anaphylaxis Angioedema

Ductal Ectasia

Benign breast problem of women approaching menopause caused by dilation and thickening of the collecting ducts in the subareolar area - mass that is hard with irregular borders, tender* - greenish brown nipple discharge, enlarged axillary nodes and edema over the site of the mass*

endometrial (uterine) cancer

Endometrial cancer is a cancer that starts in the endometrium, the inner lining of the uterus (womb). - adenocarcinoma is the most common type

Malignant Bone Tumors (primary)

Osteosarcoma - most common - more than 50% involves distal femur - commonly metastasizes Ewing's sarcoma - most malignant - usually occurs in children and young adults

Phalen's maneuver

Place back of the hand together & bend at both wrist & 80% who have carpel tunnel syndrome will have paresthesia within 60 seconds, a positive Phalen's maneuver

rectocele

Protrusion of the rectum into the posterior vagina

Rickets

Vitamin D deficiency in children

Crepitus

a crackling or grating sound usually of bones (caused by cartilage disintegration, bone and cartilage "float" into joint causing the crepitus)

Internal fixation

a fracture treatment in which a plate or pins are placed directly into the bone to hold the broken pieces in place

External fixation

a fracture treatment procedure in which pins are placed through the soft tissues and bone so that an external appliance can be used to hold the pieces of bone firmly in place during healing

Pessary

appliance inserted into the vagina to support the uterus

Traction

application of a pulling force to a part of the body

benign prostatic hyperplasia (BPH)

benign growth of cells within the prostate gland

Vessicants

blistering agents

Type II Cytotoxic Hypersensitivity

body makes autoantibodies directed against self cells that have some form of foreign protein attached to them, the antibodies binds to self cell and forms an immune complex, the self cell is then destroyed, along with the attached protein

Ostephytes

bone spurs

Ductal Carcinoma in situ (DCIS)

cancer cells in the duct and have not invaded the surrounding fatty breast tissue

Lobular Carcinoma in situ (LCIS)

cells look like cancer cells and are contained in the lobule (milk-producing) glands

Complex Regional Pain Syndrome (CRPS)

characterized by an overactive sympathetic nervous system; typically follows an insult (no matter how minor) to a nerve

Systemic Lupus Erythematosus

chronic autoimmune inflammatory disease of collagen in skin, joints, and internal organs "called the great imitator" - commonly have a "butterfly rash" - serum complement levels for C3 and C4 are the inflammatory markers in lupus

Osteoporosis

chronic disease of cellular regulation, in which bone loss causes decreased density and possible fracture

carpal tunnel syndrome

compression of the median nerve as it passes between the ligament and the bones and tendons of the wrist

Trophi

deposits of sodium urate crystals that are visible as small white nodules under the skin

Cervical Cancer

malignant tumor of the cervix - most cases are caused by HPV - maybe asymptomatic - classic symptom is painless vaginal bleeding and bleeding after intercourse - pelvic or back pain - hematuria - hematochezia (blood in stool) - vaginal passage of stool or urine (in advanced disease)

Ovarian Cancer

malignant tumor of the ovary - vague abdominal and GI symptoms - diagnosis depends on surgical exploration and diagnostic testing

Proliferative breast lesions without atypia (Fibroadenoma)

mass of connective tissue that is unattached to the surrounding tissue (tumors are oval, freely mobile, rubbery, and vary in size)

T score for osteoporosis

measures a pt's bone density - normal is -1 to +4 - osteoporosis is -4 to -2.5

ulnar deviation

movement of fingers distaly

Compression fractures of the spine

occur when the vertebrae in the spine become weak and collapse under low stress - associated with osteoporosis or metastatic bone cancer

Paget's Disease

occurs in or around the nibble, scaly, red, irritated, may be associated with other types of breast cancer

Generalized primary osteoporosis

occurs most commonly in postmenopausal women & men (age 70-80) (loss of estrogen)

rotator cuff injuries

occurs usually as a result of fall, throwing, or heavy lifting - partial thickness tear - NSAIDs - Intermittent steroid injections - PT - activity limitations - full-thickness tear - surgical repair

regional osteoporosis

occurs when a limb is immobilized related to a fracture, injury, for paralysis for longer than 8-12 weeks.

Benign Bone Tumors

often asymptomatic and may be discovered on routine x-ray or as a cause of pathologic fracture Classifications: - Chondrogenic - from cartilage - Osteogenic - from bone - Fibrogenic - from fibrous tissue Osteochondroma (most common) - onset in childhood - most often in tibia and femur

phantom limb pain

pain in a limb (or extremity) that has been amputated

Ballottement test

presence of excess fluid in the knee

cystocele

protrusion of the bladder into the vagina

external beam radiation therapy (EBRT)

radiation source outside the pt

Inflammatory breast cancer (IBC)

rare but aggressive form of breast cancer in which the cancer cells block the lymphatic vessels in the skin of the breast - breast itching - peau d'orange - diffuse erythema

Hysterectomy

surgical removal of the uterus

Lymphedema

swelling due to an abnormal accumulation of lymph fluid within the tissues

Anaphylaxis

systemic, sometimes fatal reaction that involves airway obstruction and circulatory collapse

Lyme disease

systemptic infectious disease caused by the spirochete borrelia burgdorferi, resulting from the bite of an infected deer tick - bull's eye rash

urterine prolapse

the disention of the uterus through the pelvic floor

Nadir

the time when bone marrow activity and WBC counts are at their lowest - usually WBCs are affected first

Adjuvant Chemotherapy

used after surgery or radiation

Neoadjuvant Chemotherapy

used to shrink tumor before surgery or radiation

Radiation Therapy

uses high-energy radiation to kill cancer cells, with goal of having minimal damaging effects on surround normal tissue (localized treatment)

Immunotherapy in Cancer

using the body's own defense system to attack foreign cells