NG308 Exam #1

What is expected with external radiation?

#1 symptom - fatigue -can have visitors -documeter used for pts with internal radiation -don't wash off markings for external radiation -check lotion or powder with provider -Symptoms occur 10-14 days into treatment

What are the three most important interventions for burn patients?

-Don't put patient flat (breathing will be difficult especially if burns are on face or neck) -Loosen clothing -Administer oxygen (normally 100% nonbreather)

What are risks for Breast Cancer?

-Family history -Early Menarche -Late menopause -Dense breast -Female -Sedentary lifestyle -Smoking -Dietary fat intake -Obesity -Excess weight gain during adulthood -Alcohol intake -Environmental factors - radiation exposure

What are two treatment types for Cervical Cancer?

-Internal radiation -IV Chemotherapy

What are other risk factors for bladder cancer?

-Occupational exposure - certain chemicals linked. -Occupations include - hairdresser, machinist, painter, printer, truck driver. -Diabetic meds: Pioglitazone (Actos) -Arsenic in drinking water -More Men -Caucasins more likely than AA -increasing age. 68-69 years -Chronic bladder infections -History of bladder cancer -birth defects involving bladder -pelvic radiation -Low fluid intake (can't flush out chemicals) -Did they have radiation?

What are the four complications of bone marrow transplants?

Bleeding Infection Vasoocclusive crisis (sickle cell/moon shaped cells) Graft vs host disease (reject the transplant)

What type of medication should be stopped a week before organ transplant surgery?

Blood thinners

A nurse is caring for a client with prostate cancer and assesses bleeding gums and hematuria. What serum indicator should the nurse relate the bleeding?

Platelet count of 60,000/mm3

What are the skin changes with external radiation?

Moist desquamation (peeling skin). Enoxaparin powder or guaze combined to prevent skin friction.

What are the three pain medications for burn patients?

Morphine, Codeine, and Hydromorphone. *key to give pain meds before dressing change.

As a client approaches death, respirations become noisy. This is the result of which type physical event?

Musculoskeletal change

What is the SE of Cytoxan and Leukeran?

Nephrotoxic

What is the most likely side effect from chemo agent

Nephrotoxicity (kidney)

What is the SE of Methotrexate & SFU (flurouracil)

Neurotoxic

What is the SE of Vincristine & Vinblastine?

Neurotoxic & intestinal obstruction

A nurse is caring for a patient in the emergent/resuscitative phase of burn injury. During this phase, the nurse should monitor for evidence of what alteration in laboratory values?

Sodium deficit

What do you worry about when your body has more than 30% of TBSA burns?

Systematic Issues

What is the name of the immunosuppressant drug used for a lifetime for organ transplant recipients?

Tacrolimus/Prograf

What is ansarca?

Total body edema

What is TNM

Tumor - location Node -whether tumor has spread to its neighboring lymph nodes Metastasis - has it metasized?

What does IV fluid resuscitation accomplish?

1. Restore circulating volume 2. preserve vital organs 3. Increase tissue perfusion

What are the rules for a patient with neutropenia?

1. Sign on door 2. NO fresh flowers/live plants/fresh fruit/vegetables/uncooked food 3. avoid anything by rectum/vaginal to avoid damage of mucosal membrane and bleeding risk 4. 100.5 or higher call doctor due to high risk of sepsis.

What are two components of Prostate Cancer?

1. Slow growing 2. Androgen dependent

What to do in case of suspected extravision?

1. Stop infusion 2. apply cool or warm compress 3. administer antidote 4. surgical intervention

What are the clinical manifestations for cervical cancer?

-pain, weight loss, anemia, cachexia, discharge bleeding (key question - when is it occurring? post-coitally can be an indication.

What are the four signs of Ovarian Cancer?

1. Ab/Back pain 2. Bloating/gas 3. Urinary frequency 4. Swollen abdomen

What are four Colon Cancer diagnostics?

1. Biopsy done through a scope. *must be cleared out. 2. Surgery 3. Targeted Therapy 4. Chemotherapy

Name the four medications that can be used for Larynx cancer.

1. Caphosol - used for xerostomoia/dry mouth 2. Mouthwash made from peroxide, salt water and baking soda 3. Viscous Xylocaine - for mouth pain 4. Moister Mouthkot - artificial saliva spray to reduce dryness from decreased salvia.

What are four signs of Lung Cancer?

1. Chronic Cough - if two plus weeks. Is there yellow or green sputum (infection) or bloody 2. Hemoptysis - coughing up blood 3. Pneumonitis - inflammation of lung tissue

Name the three main diagnostic tools for Prostate Cancer.

1. Digital rectal exam 2. Blood tests - PSA (glycoprotein produced by prostate gland) Prostate specific antigen 3. Biopsy following PSA levels that are continually elevated

Name three risks factors for Skin Cancer

1. Fair skinned 2. Tanning salons 3. Radiation for other cancers

What are six signs of Lymphoma?

1. Fever 2. Pruritus (itchy skin) 3. Night sweats 4. Enlarged Lymph Nodes 5. Fatigue 6. Decreased appetite

List four advantages of Venous Access Devices

1. Immediate Access 2. No need for frequent vein punctures 3. Decreased risk of extravasation 4. Allow for administration of vesicants

List Disadvantages of Venous Access Devices

1. Invasive procedure which can lead to problems. 2. Catheter that occludes 3. Embolism (air/blood) 4. Can have infection/pneumonthorax

Name three signs/symptoms of Prostate Cancer.

1. Mimic signs of BPH - prostate gland enlargement =Urine Issues: dribbling, nocturia, retention, interruption of stream 2. Bleeding - *late sign. Often no signs in early stages. 3. Once in spreads to bones pain is the major indicator

Rehab PT focuses on 1. _____________. Rehab OT focuses on 2. _____________ and 3. ___________.

1. Muscle strengthening 2. ADLs 3. Fine motor skills

What are the six risk factors of Leukemia?

1. Oncogenes (abnormal genes) 2. Smoking 3. Family clustering = genetic factors 4. Chromosomal abnormalities (eg: down syndrome) 5. Radiation 6. Chemical exposure to benzene, paint, dye

What are the three steps of diagnostics for Ovarian Cancer?

1. annual bimanual pelvic exam. *ovaries should not be palpable in postmenopausal women 2. Ab or transvaginal ultrasound 3. Exploratory laparotomy - establish diagnosis and stage of disease.

A public health nurse is participating in a campaign aimed at preventing cervical cancer. What strategies should the nurse include is this campaign? Select all that apply. A) Promotion of HPV immunization B) Encouraging young women to delay first intercourse C) Smoking cessation D) Vitamin D and calcium supplementation E) Using safer sex practices

A) Promotion of HPV immunization B) Encouraging young women to delay first intercourse C) Smoking cessation E) Using safer sex practices

How much to elevate the bed for a patient in hospice care?

30 degrees

What is the ABCDE of burn patients?

Airway, breathing, circulation, neurological deficit, examine (or exudate or evolution)

What drugs can cause leukemia?

Alkylating agents, chloramphenicols, and phenylbutazone

What is the drug used for Multiple Myeloma?

Allopurinoal - reduces uric acid

What normally causes Colon Cancer?

Adenomatous Polyps *Polyps greater than one cm in diameter are associated with a greater risk of cancer. If they are not removed they continue to grow and become cancerous.

An emergency department nurse has just received a patient with burn injuries brought in by ambulance. The paramedics have started a large-bore IV and covered the burn in cool towels. The burn is estimated as covering 24% of the patients body. How should the nurse best address the pathophysiologic changes resulting from major burns during the initial burn-shock period?

Administer IV fluids

What is the most definitive diagnostic test for skin cancer and how often?

Biopsy 20-40 every three years 40 years and older every year

What is a chemoprevention for cancer?

Aspirin

What does ABCDE of skin cancer mole assessment stand for?

Asymmetry - one half does not match the other half Borders - the edges are irregular Color - The mole is not evenly colored Diameter - spot is larger than 6 millimeters across Evolving - changing in size *Look at whole body not just face

The nurse is performing a comprehensive health history of a patient who is in her 50s. The nurse should identify what risk factor that may increase this patients risk for breast cancer? A) The patient breastfed each of her children. B) The patient gave birth to her first child at age 38. C) The patient experienced perimenopausal symptoms starting at age 46. D) The patient experienced menarche at age 13.

B) The patient gave birth to her first child at age 38.

What are the three tumor markers of lung cancer?

CEA High AFP CEA-125 NSE

What is the SE of Adriamycin chemo drug?

Cardiotoxic

ACES Warning sign? CAUTION

Change in bowel/bladder habits A sore that does not heal Unusual bleeding or discharge Thickening or lump in the breast or elsewhere Indigestion or difficulty swallowing Obvious change in mole/wart Nagging cough or hoarseness

What are two treatments for Multiple Myeloma?

Chemotherapy Radiation

What is the preferred cleaning agent for Venous Access Devices?

Chlorhexidine

The three primary goals of hospice care are?

Comfort, dignity, and family support.

What factors are taken into consideration when ordering chemo

Dosage based on TBSA, type of cancer, location of cancer, overall health of patient.

What do you monitor for when dealing with biological modifiers?

Flu like symptoms (fatigue, anorexia, weight loss, nausea and vomiting)

What regions of the larynx can Larynx cancer develop in?

Glottis (vocal cords, suprglottis (above vocal cords), subglottis (connection b/n layrnx & trachea). *It can also spread anywhere.

What is the difference between grading and staging?

Grading - classification and type of cell Staging - tumor itself and has it metasized

What viruses can cause Leukemia?

HIV, HLV-1, and HLV-2

What vaccine can be preventive?

HPV

What are the three most common risk factor for cervical cancer?

HPV, Polyposis - common in the colon and down syndrome

What medication can you give for marked confusion in a hospice patient?

Haldol

What are the percentages for each body part in the rule of nines?

Head 9% - 4.5% front and back Arms 18% - 4.5% front and back of each arm Genitalia - 1% Chest 36% - 18% front and back Legs 36% - 9% front and back of each leg

What are the three types of organ transplant rejections?

Hyperacute - within 24 hours - take organ out Acute - within first six months. Generally vascular reaction. Chronic - occurs over years/lifetime. No definitive therapy

Which of the following is to be expected soon after a major burn?

Hypotension, tachycardia, and anxiety

What are the two biological response modifiers and what do they do?

Interferon and interleukin-2. They boost the immune system

The nurse is caring for a client undergoing an incisional biopsy. Which statement does the nurse understand to be true about an incisional biopsy?

It removes a wedge of tissue for diagnosis.

What is the preferred IV fluid for burn resuscitation?

Lactated Ringer

Which cancers are generally very responsive to chemo? and why?

Leukemia, lymphoma, small cell lung cancer. Cancers that spread through blood/lymph are responsive to chemo since its a treatment that is distributed through the blood/lymph.

What is lymphedema? What is the outcome?

Lymph occurs when lymph is not able to flow through the body the way that it should. It is the build-up of fluid in soft body tissues when the lymp system is damaged or blocked. Heaviness/tightness in the arms.

Name a medication used for appetite stimulation

Megace

Following a burn injury, the nurse determines which area is the priority for nursing assessment?

Pulmonary System

What is Cheynes-Stokes?

Rapid breathing with periods of apnea. Patient becomes very short of breath.

What are signs of respiratory distress from a burn patient?

Singed sputum, singed nasal hairs, dry cough, hoarseness, painful swallowing, darkened oral and nasal membranes (should be pink)

What is the greatest risk factor for Bladder cancer?

Smoking - Carcinogens enter blood and are concentrated in urine after kidney filtration. Chemicals in the urine damage the transitional cells that line the inside of the bladder, and increase the chance of cancer.

What is the difference between an irritant and a vesicants?

Vesicants cause extravision/tissue damage. Irritants cause redness, swelling, etc. Not as caustic as vesicants.

What are signs of imminent death?

death rattle (noisy congested breathing), inability to cough/clear secretions, decreased urine output, ecchymosis (discoloration of the skin resulting from bleeding underneath), mottling, kennedy ulcer (a dark sore that develops rapidly during the final stages of a person's life), restlessness, agitation , hallucinations, sedation.

What is an inappropriate roommate for an organ transplant recipient?

infectious patients, drainage patients