exam #2 nur 256

Education about STDs and the spread of infection

Communicating with sexual partners Treatment for suspected co-infection Avoid all sexual contact until issue is resolved

A nurse who provides care on an acute medical unit has observed that health care providers are frequently reluctant to refer clients to hospice care. What are contributing factors that are known to underlie this tendency? Select all that apply.

Financial pressures on health care providers Client reluctance to accept this type of care Advances in "curative" treatment in late-stage illness

wound dehiscence and evisceration

For patients that underwent open gastric surgery, what are examples of complications that they are at risk for post-op? s/s: wound- dressing soaked w/ serosanguinous fluid, gush of fluid, "wound feels wet", "feels something gave way", organ profusion

hypersensitivity reactions of chemo

HSRs subgroup of adverse drug reactions that are unexpected and associated with mild or progressively worsening s/s such as rash, urticaria,fever,hypotension, cardiac instability, dyspnea, wheezing, throat tightness, syncope. Start within 5 minutes to 6 hours of an infusion, STOP INFUSION IS THE NECESSARY FIRST STEP IF THE REACTION OCCURS

Septic Shock S/S with cancer patient

High or Low Temperature Tachycardia Tachypnea Hypotension There's a reason to suspect infection Altered Mental Status (worsening)

RECONSTRUCTIVE SURGERY FOR CANCER

INDICATED FOR BREAST, HEAD, NECK AND SKIN CANCERS

. The nurse is performing a preoperative assessment on a client going to surgery. The client reports to the nurse drinking approximately two bottles of wine each day for the last several years. What postoperative difficulties should the nurse anticipate for this client?

Increased risk for postoperative complications

Carcinogenesis three step

Initiation promotion progression

NURSING CARE OF PATIENT WITH CANCER

MAINTAINING TISSUE ITEGRITY stomatitis- rinse mouth with NaCI q 4hrs while awake, after meals or oral medication

A patient newly diagnosed with cancer is scheduled to begin chemotherapy treatment and the nurse is providing anticipatory guidance about potential adverse effects. When addressing the most common adverse effect, what should the nurse describe.

NAUSEA/VOMITING

Diabetes management has five components:

Nutritional therapy - including weight control. Exercise - including weight control. Monitoring - insulin levels, and by diabetes educator Pharmacologic therapy Education - including with a diabetes educator, include family/support persons.

Nursing Care of the Patient Undergoing Radiation Therapy

PRIVATE ROOM NOTICES ON DOORS ABOUT RADIATION SAFETY WEAR DOSIMETER BADGES(NO PREGNANT STAFF) LIMITING 30MINUTES VISITS 6 FT DISTANCE MONITOR FOR/ MANAGE TOXICITES AND SYSTEMIC EFFECTS SUCH AS FATIGUE AND WEAKNESS

physiological changes end of life

Pain dyspnea impaired secretions anorexia and cachexia anxiety and depression delirium

NCare- Radiation associated impairment of skin integrity.

Radiodermatitis - S/S- pain irriation, pruritus, burning , skin sloughing with drainage or with drainage and diminished quality of life

manifestation of std's

Rashes/lesions/chancre on genitalia, perianal area, mouth and throat, swollen inguinal lymph nodes to Pain, discharge, urinary symptoms are often what bring people in for evaluation.

Main goal is to normalize insulin activity and blood glucose levels to reduce the development of complications.

Retinopathy, nephropathy, neuropathy Hypoglycemia

Microvascular complications of diabetes

Retinopathy, nephropathy, neuropathy (sensory, autonomic dysfunction, sexual dysfunction and gastroparesis)

Sites of infection

Skin and mucosal lining of urethra, cervix, vagina, rectum, oropharynx

While a patient is receiving IV doxorubicin hydrochloride for the treatment of cancer, the nurse observes swelling and pain at the IV site. The nurse should prioritize what action

Stopping the administration of the drug immediately

Most common infectious disease in the United States

Syphilis, Chlamydia trachomatis, Neisseria gonorrhea, and human immune deficiency virus (HIV)

MANIFESTATIONS OF DIABETES

THREE P's ARE PRESENT POLYURINA POLYDIPSIA (ketones spill, take electrolytes ,lead to thirst) POLYPHAGIA (from protein and fat breakdown) fatigue, weakness, vision changes, tingling or numbness in hands or feet, dry skin, skin lesions or wounds that are slow to heal recurrent infections.

The hospice nurse is caring for a 45-year-old parent of three young children in the client's home. During the most recent visit, the nurse has observed that the client has a new onset of altered mental status, likely resulting from recently diagnosed brain metastases. Which goal of nursing interventions should the nurse identify?

Teaching family members how to interact with, and ensure safety for, the client with impaired cognition

Hemovac drain

a closed drainage system in which a soft drain is attached to a springlike suction device

Penrose drain

a flat, thin, rubber tube inserted into a wound to allow for fluid to flow from the wound; it has an open end that drains onto a dressing.

Vesicants

agents from extravasation that cause inflammation .tissue damage, and possibly necrosis of tendons, muscles, nerves, and blood vessels if extravasation occurs

Carcinogenesis: Progression

altered cells exhibit malignant behavior. these cells acquire ability to stimulate angiogenesis (growth of new blood vessels) to invade adjacent tissues and metastasize.

bleeding, thrombocytopenia

avoid invasive procedures- foley , rectal temp) avoid razors

Chemotherapy Administration- dosage

based primarily on the patient total body surface area, weight previous exposure and response to chemotherapy or radiation therapy. determined to maximize cell kill while minimizing impact on healthy tissues and subsequent toxicities

alopecia( hair loss)

begins 1 to 3 wks after initiation of chemo and radiation regrowth 8wks after last treatment Nurse provide information about hair lose and support pt and family coping with the changes in body image

DKA WHAT KIND OF BREATH SMELL

characteristic fruity odor due to the presence of ketoacids.

Postoperative confusion and delirium of older patients

cognitive deficits, hallucinations, and fluctuating state of consciousness

long term complications of diabetes

damage to the heart, blood vessels, kidneys, eyes, and nervous system. Infections are more common in patients with diabetes, and amputations may be necessary.

Carcinogenesis

development of cancer

nephropathy

disease of the kidney

neropathy

disease of the nerves, marked by inflammation or degeneration

retinopathy

disease of the retina

PAD (physician aid in dying), medical aid in dying MAD , physician assisted dying

dr prescribles lethal dose of oral medication that the patient self administers for the purpose of ending someones life

alopecia

hair loss

Jackson-Pratt drain

hollow bulb-like device used to collect drainage

. The nurse admits a client to the postanesthesia care unit with a blood pressure of 132/90 mm Hg and a pulse of 68 beats per minute. After 30 minutes, the client's blood pressure is 94/47 mm Hg, and the pulse is 110. The nurse documents that the client's skin is cold, moist, and pale. This client is showing signs of what potential issue?

hypovolemic shock

The nurse is caring for a patient who is to begin receiving external radiation for a malignant tumor of the neck. While providing patient education, what potential adverse effects should the nurse discuss with the patient?

impaired nutritional

Anorexia end of life

inadequate nutritional intake :

when will a infection develop after surgery

increased pain, fever, white blood cell count may be atypical in geriatric population onset is typically 2 days or more after surgery

The nurse is creating the care plan for a 70-year-old obese client who has been admitted to the postsurgical unit following a colon resection. This client's age and body mass index increase the risk for what complication in the postoperative period?

infection

Carcinogenesis: Initiation

initial mutation occurs cigarette smoking asbestos ( carcinogen) causes mutations in the cellular dna

Carcinogenesis: Promotion

initiation of uncontrolled growth repeat exposure to promoting agents causes proliferation of initiated cells with increased expression. reverse if promoting substances is removed.

Extravasation

leakage from a vessel into the tissue STOP TREATMENT

nadir

lowest ANC following chemo or radioation therapy that suppresses bone marrow function

DKA seen more in T1DM or T2DM?

more commonly seen in T1DM due to absolute insulin deficiency Onset is predicable in days beforehand with increasing polyuria, polydipsia, nausea, vomiting, and fatigue with eventual stupor and coma if not treated.

Palliative surgery for cancer

no way to get rid of the cancer but remove the tumor for comfort reasons. ULCERATION,OBSTRUCTION,HEMORRAHAGE,PAIN AND MALIGNANT EFFUSIONS .

nephropathy

oCan lead to hypertension oManagement is prevention, avoidance of nephrotoxic medications, low sodium and low protein diet oMay require dialysis, transplant

vRetinopathy is leading cause of blindness

oManifests as blurry vision, floaters, cobwebs, spots, hazy vision oManagement is prevention (routine eye exam, more frequent prn), smoking cessation, argon laser photocoagulation, vitrectomy §Goal to restore useful, not full, vision

Time of death signs

obtunded nonresponsive hearing may be intact sweating tachy/brady cardiaa tachy/brady pnea hypotensive diaphoretic anuria mottling of extremities

Mucositis

painful inflammation of oral mucous membranes

Classic signs of hypovolemic shock

pallor; cool, moist skin; rapid breathing; cyanosis of the lips, gums, and tongue; rapid, weak, thready pulse; narrowing pulse pressure; low blood pressure; and concentrated urine.

Five P's": of assessment of std's

partners, prevention of pregnancy, protection from STIs, practices past history of STIs

collaborative problems

pulmonary infection/hypoxia deep vein thrombosis/PE hematoma/hemorrhage infection increased pain, fever, white blood cell count may be atypical in geriatric population onset is typically 2 days or more after surgery wound dehiscence or evisceration Generally, from increased abdominal pressure, over extending/flexing.

Prophylactic surgery

removes "at risk" tissue to prevent cancer development. FAMILY HX PRESENCE OR ABSENCE OF S/S POTENTIAL RISKS/BENEFITS ABILITY TO DETECT CANCER EARLY STAGE COLECTOMY,MASTECTOMY, AND OOPHORAECTOMY

The public health nurse is presenting a health promotion class to a group at a local community center. Which intervention most directly addresses the leading cause of cancer deaths in North America?

smoking cessation

manifestations of type 1 diabetes

sudden weight loss/n or abdominal pain ( usually d/t DKA)

what you see in syphilis

swollen lymph nodes

The perioperative nurse is constantly assessing the surgical client for signs and symptoms of complications of surgery. Which symptom should first signal to the nurse the possibility that the client is developing malignant hyperthermia?

tachycardia

. The nurse is preparing a client for surgery prior to her hysterectomy without oophorectomy. The nurse is witnessing the client's signature on a consent form. Which comment by the client would best indicate informed consent?

the dr remove my uterus and told me risk of bleeding

chemotherapy is used primarily.

treat systemic disease rather than localized lesions taht are amenable to surgery or radiation.

manifestations of diabetics

vDepends on the level of hyperglycemia vClassically, the "Three Ps" are present oPolyuria oPolydipsia (ketones spill, take electrolytes, lead to thirst) oPolyphagia (from protein and fat breakdown) vFatigue, weakness, vision changes, tingling or numbness in hands or feet, dry skin, skin lesions or wounds that are slow to heal, recurrent infections

Outpatient Surgery/Direct Discharge

vDischarge planning, discharge assessment vProvide written, verbal instructions regarding follow-up care, complications, wound care, activity, medications, diet vGive prescriptions, contact information oDiscuss actions to take if complications occur vGive instructions to patient, responsible adult who will accompany patient vPatients are not to drive home or be discharged to home alone oSedation, anesthesia may cloud memory, judgment, affect decision-making ability

RESPONSIBILITIES OF PACU Nurse.

vFirst and foremost, review pertinent information given via SBAR, baseline assessment vAssess airway first, level of consciousness, cardiac, respiratory, wound, and pain vCheck drainage tubes, monitoring lines, IV fluids, and medications vAssess vital signs at the time of arrival to PACU and repeated per institution protocol vAdministration of postoperative analgesia vDetermining readiness for transfer to another unit or discharge patient to home, continuing or transitional care

uncomplicated grief

vGrief is not a linear process vThere is no right way to cope vNurse must promote family cohesion during grief and mourning vProvide opportunities after death for social and cultural rituals to facilitate acceptance of death and loss as permanent oReminiscing, reinvesting in new relationships/norms, relinquishing the past when appropriate

Management of DKA

vPrevent vRehydration with IV fluid, usually 0.9 or 0.45% NaCl oTo maintain tissue perfusion oTo excrete glucose oMay need 6-10L! Caution if FVE likely to occur §Assess lung sounds, urinary output, skin turgor, mucus membranes vIV continuous infusion of regular insulin (only insulin that can be given IV) to end ketone production and acid buildup oMeasure blood sugars hourly oChange to D5NS as glucose levels come down to avoid hypoglycemia

Management of DKA CONT......

vReverse acidosis and restore electrolyte balance oKetones are acidic oAcidosis leads to hyperkalemia oRehydration increases plasma volume and dilutes K levels, also causes increased urinary excretion of K §May need K replacement during therapy even if levels are normal to prevent hypoK §Do frequent EKG, lab monitoring

diagnostic findings of diabetes

vSymptoms PLUS random glucose over 200 •OR vFasting (minimum of 8 hours) blood glucose 126 mg/dL or more on 2 occasions •OR vOral glucose tolerance test over 200 •OR vHgB A1C (a 3 month average of blood glucose control used to monitor effectiveness of therapy) over 6.5% vRemember, symptoms in the elderly may be absent, nonspecific, or atypical

type 1 diabetes mellitus

vType 1 may have sudden weight loss, nausea, vomiting or abdominal pains (usually d/t DKA)

Kussmaul breathing

very deep, rapid breathing that is associated with diabetic ketoacidosis and kidney failure; also known as air hunger

cachexia

weakness and wasting of the body due to severe chronic illness( severe lean muscle loss)

Chemotherapy Administration

- Dosage - Extravasation - Hypersensitivity reactions

RADIATION THERAPY TOXICITY

- localized in irradiated region - increased with concomitant chemotherapy - altered skin integrity - altered oral mucosa - risk for infection and bleeding

Principles of Hospice Care

-Death must be accepted -Patient's total care best managed by interdisciplinary team whose members communicate regularly -Pain, other symptoms must be managed -Patient, family should be viewed as single unit of care -Home care of dying necessary -Bereavement care must be provided to family members -Research, education should be ongoing

Acute complications of diabetes

-Diabetic ketoacidosis (DKA) -Hyperglycemic hyperosmolar state (HHS) -Hypoglycemia (insulin shock)

chemotherapy

1. DRUGS USED IN ATTEMPT TO DESTROY CANCER CELLS BY INTERFEREING WITH CELLULAR FUNCTION REPLICATION. 2. ITS ALSO DESTROY NORMAL CELLS LEADING TO STYSTEMIC SIDE EFFECTS 3. HARMFUL TO STAFF ADMINISTERING IF PRECAUTIONS NTO TAKEN 4. USE FOR SYSTEMIC CANCER 5. CAN COMBINED

Indications of extravasation during administration of vesicant agents include the following:

ABSENCE OF BLOOD RETURN FROM THE IV CATHETER RESISTANCE TO FLOW OF IV FLUID BURNING OR PAIN SWELLING OR REDNESS AT THE SITE

DKA

Absence or inadequate amount of insulin resulting in abnormal metabolism of carbohydrate, protein, and fat

The nurse is caring for a 39-year-old woman with a family history of breast cancer. She requested a breast tumor marking test and the results have come back positive. As a result, the patient is requesting a bilateral mastectomy. This surgery is an example of what type of oncologic surgery? A) Salvage surgery B) Palliative surgery C) Prophylactic surgery D) Reconstructive surgery

C) Prophylactic surgery

Exercise Precautions of diabetes

Avoid if blood glucose 250+, have ketones in urine. Insulin normally decreases with exercise. (eat 15 g of carb. to prevent hypoglycemia. May need snack after to avoid post-exercise hypoglycemia hours after finishing) Type 2 might not need snack if they don't take insulin/oral agents. Need to monitor before,during,before. Gerontologic considerations include modifying for physical impairment therapist , train with a physical

Assessment of DKA patient

Blood glucose levels between 250 and 800 mg/dL Severity of DKA not only due to blood glucose level Ketoacidosis is reflected in low serum bicarbonate, low pH; low PCO2 reflects respiratory compensation (Kussmaul respirations) Ketone bodies in blood and urine Electrolytes vary according to degree of dehydration; increase in creatinine, Hct, BUN

DKA s/s

D-ehydration K-etones in urine/blood, Kussmauls and K+ A-cidosis, Acetone breath, Anorexia d/t nausea

Foot and leg problems with diabetes

Daily foot inspections necessary! Do not self-treat wounds. Wash feet daily Keep skin dry. Trim toenails straight across with a clipper Do not soak feet. Do not walk around barefoot. Management is focused on prevention, podiatric treatment.

Reducing anxiety of std's

Encourage patient to discuss anxieties and fears Provide factual information and individualized education Assistance in planning discussion with partners Referral to a social worker or other specialists

A patient on the oncology unit is receiving carmustine, a chemotherapy agent, and the nurse is aware that a significant side effect of this medication is thrombocytopenia. Which symptom should the nurse assess for in patients at risk for thrombocytopenia

Epistaxis (nose bleed)