CPA 1
what you would do for an anaphylactic reaction
1. Ensure patent airway 2. Remove insect stinger 3. Establish IV access 4. Epi 5. Give high flow O2 (8-10 l/m) through mask 6. Nebulized albuterol for bronchospasm 7. Diphenhydramine IV for urticaria and itching 8. Corticosteroids
Hypotension:
1. Place recumbent and elevate legs 2. IV normal saline rapid bolus 1-2 liters 3. Maintain BP with fluids, volume expanders, vasopressors
autosomal recessive
25% have a chance of being effected and 50% chance of being carriers
What is special about stem cells
Adult stem cells can be used for skin grafting Adult stem cells are undifferentiated and can become specific cells Some embryonic stem cells are undifferentiated and can make any cells
Things to consider for genetic testing
Advocate for clients realize importance Recognize own values
A man was adopted, what health information related to his biologic parents and family will be most useful to him when he gets married
Ages of family members diagnosed with diseases Age and cause of death in deceased family members
The nurse is counseling a client on a diagnosis of a autosomal dominant disorder
All of the clients children will have a 50 chance of getting it Expressions in the past could be variable male and female will be effected equally
Which medications treat allergic rhinitis
Antihistamines Nasal Corticosteroids
The mom of a child with cystic fibrosis is asking the nurse about the impact on future children
Autosomal recessive so all children have a 50 chance of being carriers Autosomal recessive so that all children have a 25 chance of developing Autosomal so the parents may have not been effected
Which of the following is the infection that is the leading cause of death in the older adult
Bacterial Pneumonia
Transmission of HCV
Blood needles and sex
CAUTION
C - change in bowel or bladder A - any sore that does not heal U - unusual bleeding/discharge T - thickening in breast I - indigestion O- obvious change in wart N - nagging cough or hoarseness
Ribavirin
Causes birth defects - do not let a prego mother take it
Grade 4
Cells are immature and primitive (anaplasia) and undifferentiated; cell of origin is difficult to determine (high grade)
Grade 2
Cells are more abnormal (moderate dysplasia) and moderately differentiated (intermediate grade)
What is the nurses first assessment of a patient that is presenting with anaphylactic shock?
Check Airway
Carcinogens are
Chemical Viral Radiation
autosomal dominant
Children will have a 50% chance of being effected
Which transplant rejection in associated with the poorest prognosis
Chronic rejection
What is the biggest risk factor associated with pancreatic cancer
Cigarette smoking
The nurse understands that her clients acute hepatitis will effect
Coagulation Bile Production Blood glucose
Type 4 hypersensitivity
Delayed type hypersensitivity reactions. T-cell and Macrophage mediated. Ex: Tuberculosis LATEX ALLERGY CONTACT DERMITITS
Tacrolimus and cyclosporine
Do not drink grape fruit juice with this metabolizes slower and makes it stronger
24 hours post cholecystectomy. The T tube has drained 750 ml green brown drainage. What is the next best intervention
Document findings
The new parents of an infant born with down syndrome ask the nurse what happened to cause the chromosomal abnormality, what is the best response
During cell division of the reproductive cells there is an error causing abnormal number of chromosomes
Sudden change in LOC with cirrhosis
Exploded varices
Hemodialysis Patients are at the same risk for developing HBV as everyone else
False
You should wait to medicate your acute cholecystitis patient for pain until they rate the pain an 8/10
False
Acute care interventions for cholecystitis includes
Gastric decompression Assess for s/s of obstruction Turn Cough and deep breathe
GINA
Genetic Information Nondiscrimination Act
The nurse is counseling a client who ask why his warfarin dose is being decreased after undergoing genetic testing
Genetic testing shows that the client metabolized slower
Client presents to the clinic with abdominal pain what assessment finding indicate chronic pancreatitis
He reports unintended weight loss Metformin does not keep blood sugar under control Abdominal pain is not relieved
Which of the following are at high risk for latex allergy
Health Care workers Those who work in a rubber factory People who have had multiple surgeries
The nurse is counseling the mom of a child with hemophilia. The she asked how this occurred neither parent or child is effects
Hemophilia is X linked recessive so a female family member can be a carrier
Your client has undergone genetic testing for the BRCA 1 gene and express understanding test results with she says
I need to discuss a possible mastectomy with my husband and physician
Your seeing a client in the clinic recently diagnosed with HCV. He shows understanding of HCV when saying
I think I can get free clean needles from the clinic
which immunoglobin crosses the placenta to provide a newborn infant with innate immunity
IgG
Type 1 IgE mediated
Immediate onset (mins): ingestion, injection, or direct contact IgE formation: histamine and leukotriene release Anaphylactic reactions, allergic rhinitis, asthma, atopic dermatitis, urticaria, angioedema Antigen: pollen, food, drugs, dust Skin test: wheal and flare
innate immunity
Immunity that is present before exposure and effective from birth.
acquired immunity
Immunity that is present only after exposure and is highly specific.
Older people will have decreased cognitive function but not show a fever, what could it be
Infection
Contact precautions:
MRSA, VRSA, VRE and C DIFF. Gown and gloves
____ are more likely to develop cancer
Men
If something is carried on the X Chromosome how does it effect Men and Woman of the family
Men are more effected because they only have one X chromosome Woman have another X chromosome to compensate for the mutation
Type 2 cytotoxic and cytolytic reactions:
Min to hours Hemolytic transfusion reaction Goodpastures syndrome cell surface of RBC
The nurse is counseling twins. One of which has developed heart diseases the other did not why
Multifactorial
Interprofessional care for acute pancreatitis will include which of the following
NPO IV opioids
Does a poorly differentiated cancer cell have a really good prognosis?
No
Mycophenolate mofetil
ONLY Reconstitute in D5W DO not give as a bolus only over 2 hours
Acute Rejection
Occurs in the first 6 months due to cell immated response by lymphocytes
Which of the following clinical manifestations supports a diagnosis of acute episode of cholecystitis
Pain in the upper right quadrant after meals Fever Complaints of indigestion
Client presents to the ED with abdominal pain x 4 days which complaints below would indicate acute pancreatitis
Pain is in the upper left quadrant You notice a yellow discoloration of her sclera bruised look surrounding her umbilics
New onset nausea and vomiting in a patient with acute pancreatitis could indicate with complication
Pseudocyst
What is the first study un pancreatic cancer that reversals metastasis and vascular involvement
Spiral CT
allergy skin testing or immunotherapy
Subcutaneous immunotherapy: injection of titrated amounts of allergen extracts biweekly or weekly. Nursing management: never leave patient alone, if reaction occurs, remove patch( if they are using patch) and apply anti inflammatory cream, might need subq injection of epi, You cant do skin test on druggie patients, it suppresses the histamine response or have food Allergies Always give away from joint so you can apply a tourniquet for a sever reaction. Skin type: Scratch or prick: 5-10min Intradermal: 5-10 min Patch: 48-72 hours Usually on arms or back and you will see a flare and wheal response if positive
Chronic rejection
T-cell, antibody mediated vascular damage. Months to years after. Irreversible.
Airborne precautions:
TB, rubeola, measles, chicken pox- N95 or higher level respirators. small particles in the air
Impact of aging on immune system
Thymic shrinkage Decreased cell mediated immunity Decreased delayed hypersensitivity reactions Decreased IL1 and IL2 synthesis Decreased expression of IL2 receptors Decreased proliferative response of T and B cells Decreased primary and secondary antibody responses Increased autoantibodies
type 3 immune complex
Tissue damage in immune complex reactions occur secondary to antigen antibody complexes. Antigens combine with IgG and IgM to form complexes that are too small to be removed by mononuclear phagocyte system. They deposit in tissue or small blood vessels. Can be local or systemic and immediate or delayed. Manifestations depend on number of complexes and location in the body. Common deposit sites are kidney, skin, joints, blood vessels, and lungs. Severe type 3 reactions are associated with autoimmune disorders like systemic lupus erythematosus, acute glomerulonephritis, and rheumatic arthritis.Fi
In a type one hypersensitivity reaction the body creates antibodies that bind to mast cells and basophils
True
Malnutrition in cancer is not likely to be overcome through increased intake
True
Stage 2
Tumor limited to tissue of organ
What are the recommended measures to prevent the transmission of healthcare associated infections
Use of PPE Wash hands or use alcohol based sanitizer
Transmission of HEV
Water asia Africa Mexico developing country
Your client is a 23 yo infected with HCV and 6 months pregnant. She understands the risk to her baby when she says
When will we be able to test my baby for infection
passive acquired immunity
a form of immunity where the fetus receives antibodies made by the mother through breast milk
Antihistamines for
allergic rhinitis and urticaria (type1 )
Y linked
an affected father transmits the disorder to all his sons. Only men are affected.
Emerging infection:
an infectious disease that has recently increased in incidence or that threatens to increase the immediate future. Example: H. pylori, Hep C and E, zika virus, west nile virus
Latex food:
banana, avocado, chestnut, kiwi, tomato, water chestnut, guava, hazelnut, potato, peach, grape and apricot.
Which of the following allergens can cause anaphylactic shock
bee stings nuts penicillin
Transplant rejection the
body attacks the organ
Which of the following is a teaching related to epinephrine injectors
can be injected through clothing Hold in place 2-3 seconds Inject at a 90 degree angle
Initiation: :
cancer cells arise from normal cells because of changes in genes. This involves a mutation in the cells genetic structure.
Stage 0
cancer in situ
Grade 3
cells are very abnormal (severe dysplasia) and poorly differentiated (high grade)
Grade 5
cells cannot be assessed
grade 1
cells differ slightly from normal cells and are well differentiated (mild dysphagia)
Transmission of HAV
contaminated food / water, fecal oral / Gay Men
active acquired immunity
develops following direct exposure to the pathogenic agent, VACCINE
Anaplaxis reaction needs what kind of medication
epi
Stage 3
extensive local and regional spread
Graft vs host the
graft attacks the host
Reemerging infection:
illnesses like measles and pertussis have had sporadic recurrences. Example: diptheria, pertussis, TB, measles
Hyperacute rejection
immediately after transplantation due to preexisting antibodies against the transplanted organ
Droplet precautions:
influezna, pertussis, bacterial meningitis surgical mask
Progression:
last stage in the natural history of a cancer. This is characterized by increased growth rate of the tumor, increased invasiveness, and metastasis.
Pharmacogenomics:
looks at how drugs affect and interact with the genome and output expression. It allows for the identifications of variations in multiple genes that affect drug response. helping develop personalized medicine based on genetics (warfarin dosing - some are most sensitive/ less sensitive to it which was discovered through genetic testing)
Stage 4
metastasized
Why should you not take leftover antibiotics
not enough may not have bacteria may not be appropriate antibiotics lose potency over time
If they have Huntington's recommend
recommend genetic testing, maybe recommend not to have kids.
Promotion:
reversable proliferations of the altered cells. An increase in alter cell population further increases the likelihood for more mutations. The activity of the promotors are reversible. This includes dietary fat, obesity, cigarette smoking, and alcohol use. Changing ur lifestyle can help reduce the risk of cancer development.
Cholecystitis
risk, manifestations, what you do - know that surgery is an option ^ pain meds, anticholinergics, antispasmodics, we would cut down on fat they consume so maybe cut down fat soluble vitamins, bile salts, smaller more frequent meals low in fat high in fiber and calcium, how do you take care of them in acute care setting
Transmission of HDV
same as HBV
Transmission of HBV
sex, perinatal contaminated blood, shared needles, Healthcare workers at risk. Carrier for life
Single Gene Disorders:
single gene mutation. Ex: cystic fibrosis, sickle cell, etc. Can be autosomal dominant, recessive, or x linked.
What are some examples of promotion in the development of cancer
smokes cigarettes A diet high in fat 3 glasses of wine at dinner
Antibiotics are effective against
strep
A Whipple procedure
the head of the pancreas, the first part of the small intestine (duodenum), the gallbladder and the bile duct. The remaining organs are reattached to allow you to digest food normally after surgery
Pharmacogenetics:
the study of variable drug responses including adverse events from differences in inheritable genes.
Antipruritic drugs:
topically applied for relief from itching when skin is intact (calamine lotion)
Stage 1
tumor limited to the tissue of origin; localized tumor growth
The nurse suspects cancer of the pancreatic head with the client presents with
unintentional weight loss abdominal pain jaundice