Fuq Adult II
Mitochondrial Inheritance:
Usually from the mother, malfunction with cellular production of energy Mitochondrial disorders can appear in every generation of a family and can affect both males and females, but fathers do not pass mitochondrial traits to their children
Klinefelter Syndrome:
Having an Extra X as a male Occurs by random error
Nurse April is teaching a group of women to perform breast self-examination. The nurse should explain that the purpose of performing the examination is to discover:
Changes from previous self-examinations
What is the most sensitive indicator of neurologic dysfunction?
Changes in LOC (level of consciousness) Best way to check is GCS
The nurse is preparing Cytoxan (cyclophosphamide). Safe handling of the drug should be implemented to protect the nurse from injury. Which of the following actions by the nurse should be corrected?
The nurse should wear a mask and gloves
Which information obtained by the nurse about a patient with colon cancer who is scheduled for external radiation therapy to the abdomen indicates a need for patient teaching?
The patient swims a mile 5 days a week
Bereavement:
The period of time following the death of a loved one Grief is experienced and mourning occurs
Nurse Lucia is providing breast cancer education at a community facility. The American Cancer Society recommends that women get mammograms:
Yearly after age 40
Inheriting a genetic mutation from one parent:
doesn't always put you at risk for disease
Autosomal Dominant:
expressed even if it is paired with a recessive
What are tissues that can be donated for transplantation?
eyes, heart valves, bone, skin, veins and tendons.
Phenylketonuria (PKU) is a:
genetic disorder of metabolism; lack of the enzyme needed to turn phenylalanine into tyrosine results in accumulation of phenylalanine in the body fluids which causes various degrees of mental deficiency
Fragile X can cause:
hereditary intellectual disability
What helps to decrease cerebral metabolism?
high dose barbiturates- phenobarbital (used to control seizures) propofol (sedation) used for those at risk for having seizures
SIADH is the awareness that:
hyponatremia is a result of an excess of water rather than a deficiency of sodium.
Genetics:
is the study of individual genes Genes are sequences of DNA, at specific positions on chromosomes They provide critical codes that translate into proteins
What are organs that can be donated for transplantation?
kidneys, heart, lungs, liver, small bowel and pancreas.
DnR in place and 2 attending physicians signed withdrawal notes =
life support removed
Subdural hematoma:
may be acute, subacute, or chronic Bleeding between the dura mater and arachnoid layer From injury to brain tissue and blood vessels Usually venous in origin and develops slowly If rapid, arterial in origin Acute: 24-48 hours after severe trauma, significant increase in ICP, immediate deterioration. Tx: craniotomy, evacuation & decompression Subacute: 48H to 2 weeks after severe trauma, alteration in mental status. Tx: evacuation and decompression Chronic: weeks or months, usually >20 days after injury, nonspecific symptoms or progressive alteration in LOC. Tx: evacuation, decompression, and membranectomy
The client with cancer is receiving chemotherapy and develops thrombocytopenia. The nurse identifies which intervention is the highest priority in the nursing plan of care?
monitoring platelet count
To determine if a stroke is hemorrhagic or ischemic we would perform what type of head CT?
noncontrast
Giving instructions for breast self-examination is particularly important for clients with which of the following medical problems?
Ovarian cancer Clients with ovarian cancer are at increased risk for breast cancer.
One of the most serious blood coagulation complications for individuals with cancer and for those undergoing cancer treatments is disseminated intravascular coagulation (DIC). The most common cause of this bleeding disorder is:
Sepsis
If a hospice patient becomes incontinent or unable to urinate what is the primary intervention?
To place a foley catheter
A client with a subdural hematoma becomes restless and confused, with dilation of the ipsilateral pupil. The physician orders mannitol for which of the following reasons?
To promote osmotic diuresis to decrease ICP.
The nurse is evaluating the status of a client who had a craniotomy 3 days ago. The nurse would suspect the client is developing meningitis as a complication of surgery if the client exhibits:
A positive Brudzinski's sign.
DNR (do not resuscitate):
A written & signed physician's order instructing health care providers not to attempt CPR/shock. Indications must be specific. Needs to be current (an order from the previous admission does not apply).
One acronym for stroke assessment is FAST, what does it stand for?
Face (half dropping) Arm (pain or hanging at side) Speech (slurred) time ( If the person failed any part of the test, note the time and get help)
A female client with cancer is scheduled for radiation therapy. The nurse knows that radiation at any treatment site may cause a certain adverse effect. Therefore, the nurse should prepare the client to expect:
Fatigue
The removal of entire breast, pectoralis major and minor muscles and neck lymph nodes which is followed by skin grafting is a procedure called:
Halstead surgery
What should a male client over age 52 do to help ensure early identification of prostate cancer?
Have a digital rectal examination and prostate-specific antigen (PSA) test done yearly
A client with subdural hematoma was given mannitol to decrease intracranial pressure (ICP). Which of the following results would best show the mannitol was effective?
Urine output increases.
To confirm cardiac death
2 leads with asystole (isoelectric, flat line) NO pulse
What are primary assessments if a patient is believed to have a hematoma?
ABCs Assume neck injury Scalp & orifices for CSF drainage, blood GCS and neurologic function ICP or related S&S Memory & behavior
Heterozygous means?
Aa
What are the 2 FDA approved gene therapies?
Acute lymphoblastic leukemia Congenital retinal degenerative disorder
What are the major risk factors for prostate cancer?
African American, age over 50
What is Cytoxan?
Chemotherapy/immunosuppressive drug
What is the most common type of breast cancer?
Invasive (infiltrating) ductal carcinoma
Germline mutations:
Passed from parent to child and are present in the oocyte and sperm cells
Gina act stands for:
The Genetic Information Nondiscrimination Act of 2008
What is mydriasis?
"Blow pupils" Often related to brain injuries or medications
Which statement by a patient who is scheduled for a needle biopsy of the prostate indicates that the patient understands the purpose of a biopsy?
"The biopsy will help the doctor decide what treatment to use for my enlarged prostate."
What are the requirements for the withdrawal process?
2 attending physicians (1 primary, 1 consult) must do their own independent reviews of the chart & conclude the patient has a life-limiting illness One of the physicians place the DNR order, but withdrawal cannot occur until both have written a note attesting that patient has a life-limiting illness (poor prognosis) and withdrawal is an appropriate option.
Rhea has malignant lymphoma. As part of her chemotherapy, the physician prescribes chlorambucil (Leukeran), 10 mg by mouth daily. When caring for the client, the nurse teaches her about adverse reactions to chlorambucil, such as alopecia. How soon after the first administration of chlorambucil might this reaction occur?
2 to 3 weeks
Nausea and vomiting are common adverse effects of radiation and chemotherapy. When should a nurse administer antiemetics?
30min before therapy initiation
Fibrinolytic therapy qualifications include the BP must be:
<185/110 mmHg and then maintained at or below 180/105 mmHG for at least 24 hours after fibrinolytic therapy.
The Gina act is in place to:
A federal law that prevents health insurers and employers from discriminating based on an individual's genetic information The bill is intended to allow Americans to take advantage of the benefits of genetic testing without fear of losing their health insurance or their jobs
Directive to Physician:
A patient's written wish to a physician to be allowed to die without heroic/extraordinary measures; indicates specific measures to be used or withheld.
A 58-year-old man is going to have chemotherapy for lung cancer. He asks the nurse how the chemotherapeutic drugs will work. The most accurate explanation the nurse can give is which of the following?
Chemotherapy affects all rapidly dividing cells
A patient with metastatic cancer of the colon experiences severe vomiting following each administration of chemotherapy. An important nursing intervention for the patient is to
Administer prescribed antiemetics 30mins- 1 hour before the treatments
In hospice care, if a patient is constipated what do we do?
Administer stool softeners If that is not effective an enema may also be administered
Post mortum care:
After patient is pronounced dead, the nurse prepares or delegates preparation of the body for immediate viewing by the family The physician may inform the family. The nurse may, charge nurse, or house supervisor. Depends on facility protocols and situation.
A 25-year-old patient is inquiring about the methods or ways to detect cancer earlier. The nurse least likely identifies this method by stating:
Annual Pap smear for sexually active women only PaP smear should be performed yearly for all women over age 40
What is Medication prevention for strokes:
Anticoagulants - Warfarin, Xarelto (rivaroxaban), Eliquis (apixaban) Antiplatelet aggregation- aspirin, clopidogrel (Plavix)
What are the the requirements for a DNR in a capacitated patient (A&O)?
Any level licensed physician caring for the patient can order it
Nurse Donald is caring for a client following a modified radical mastectomy. Which assessment finding would indicate that the client is experiencing a complication related to this surgery?
Arm edema on the operative side
Nurse Janet is assigned in the oncology section of the hospital. Which of the following orders should the nurse question if a client is on radiation therapy?
Aspirin every 4 hours Radiation therapy makes the platelet count decrease.
The nurse is reviewing the laboratory results of a client receiving chemotherapy. The platelet count is 10,000 cells/mm. Based on this laboratory value, the priority nursing assessment is which of the following?
Assess level of consciousness Fatal central nervous system hemorrhage, massive gastrointestinal hemorrhage, or intracranial hemorrhage can occur when the platelet count is fewer than 10,000.
For cancer patients experiencing neutropenia, what is a required intervention?
Assessing breath sounds pneumonia is often a side effect so breath sounds must be evaluated
Huntingtons disease is:
Autosomal dominant
Pku is:
Autosomal recessive
What is one important distinction for the bedside nurse concerning organ donation?
Bed side nurses DO NOT approach families about organ donation
A male client is diagnosed as having a bowel tumor and several diagnostic tests are prescribed. The nurse understands which test will confirm the diagnosis of malignancy?
Biopsy of the tumor
What is important to not about the treatment for PKU?
Dieting Controlled phenylalanine restricted diet in the first days or weeks of life Restricted protein diet of: Beans Fish Meat Eggs Nuts Sweeteners Aspartame Diet consists of: Fruits Vegetables Bread Pasta Cereals
Clinical manifestations of Klinefelter syndrome:
Breast development Small testes Sterile Low intelligence Not intellectually disabled
For the organ donation process:
Call OPO (Organ Procurement Organization) for evaluation if patient meets criteria (example: intubated with GCS<5) Provide the OPO coordinator with medical information (permitted by JCAHO) If family is open to organ donation you may be asked to draw a large amount of labs
When assessing a patient's needs for psychologic support after the patient has been diagnosed with stage I cancer of the colon, which question by the nurse will provide the most information?
Can you tell me what has been helpful to you in the past when coping with stressful events?
What is palliative care?
Care or treatment focusing on reducing the severity of symptoms Begins during curative or restorative health care Extends into end-of-life care Bereavement care follows death
Surgical prevention of TIA ( transient ischemic attack) & stroke prevention
Carotid Endarterectomy Angioplasty and/or stenting an artery in the brain
What are main pathologic issues with sickle cell anemia?
Cells have funny (crescent) shape so they cannot carry as much oxygen (patient may require 02 nasal cannula) Also is more susceptible to dehydration that will make the condition worse
clinical manifestations for trisomy 13:
Cleft Lip and palate Extra fingers and toes o Polydactylism
For a female client with newly diagnosed cancer, the nurse formulates a nursing diagnosis of Anxiety related to the threat of death secondary to cancer diagnosis. Which expected outcome would be appropriate for this client?
Client verbalizes feelings of anxiety.
Dic is essentially:
Clotting and hemorrhaging at the same time
What are some examples of deletions:
Cri du Chat (5p) WAGR syndrome (11p) Rubinstein Taybi (16p) Miller Dieker and Smith Magenis (17p)
Considerations when preparing a body:
Cultural customs In accordance with state law Agency policies and procedures Considerations when preparing the patient's body Remember to still refer to the patient not only the body. Position the patient in a comfortable manner. Close the patient's eyes Replace dentures Wash the body as needed Place pads under perineum Remove invasive devices (unless family want an autopsy, also call medical examiner) and dressings Straighten body Immediately after death position patient in supine, HOB 30 degrees Leave pillow to support head Family should be allowed privacy and time with the deceased person Unexpected or unanticipated death Preparation of the body for viewing or release to a funeral home depends on state law and agency policies and procedures All hospitalized prisoner deaths in Florida are an automatic medical examiner case All staff must vacate the room until an investigator has cleared the scene
What are some Autosomal Recessive (person needs 2 copies of mutated version) diseases?
Cystic fibrosis Hemochromatosis Sickle Cell anemia PKU
Kubler-Ross — Five Stages of Grief:
Denial Anger Bargaining Depression Acceptance
Dextrostik or Tes-Tape strip test is used for:
Determining CSF leakage to determine whether glucose is present CSF give a positive reading for glucose
Nurse Joy is caring for a client with an internal radiation implant. When caring for the client, the nurse should observe which of the following principles?
Do not allow pregnant women into the client's room
Trisomy 21:
Down syndrome 3 copies of chromosome 21 because of nondisjunction in the parents
A female client is receiving chemotherapy to treat breast cancer. Which assessment finding indicates a fluid and electrolyte imbalance induced by chemotherapy?
Dry oral mucous membranes and cracked lips
Epidural Hematoma is an:
EMERGENCY Bleeding between the dura & inner surface of the skull Major artery or venous origin S&S: Unconsciousness at the scene, brief lucid interval followed by decrease in LOC, other: headache, nausea, and vomiting Treatment: rapid surgical intervention to evacuate the hematoma and prevent cerebral herniation along with medical management to prevent increase ICP
Trisomy 18 is?
Edwards syndrome 3 copies of chromosome 18 because of nondisjunction in the parents
A client is diagnosed with progressive prostate cancer. The nurse expects which drug is given?
Emcyt (estramustine)
Neoplasm can be classified as either benign or malignant. The following are characteristics of malignant tumor apart from:
Encapsulated
A male client is admitted to the hospital with a suspected diagnosis of Hodgkin's disease. Which assessment findings would the nurse expect to note specifically in the client?
Enlarged lymph nodes
What are the most common causes of viral meningitis?
Enteroviruses, arboviruses, HIV, & HSV are the most common causes of viral meningitis. Enteroviruses most often spread through direct contact with respiratory secretions. Usually presents as a headache, fever, photophobia, and stiff neck.
A 56-year-old woman is currently receiving radiation therapy to the chest wall for recurrent breast cancer. She calls her health care provider to report that she has pain while swallowing and burning and tightness in her chest. Which of the following complications of radiation therapy is likely responsible for her symptoms?
Esophagitis
A patient with Hodgkin's lymphoma is undergoing external radiation therapy on an outpatient basis. After 2 weeks of treatment, the patient tells the nurse, "I am so tired I can hardly get out of bed in the morning." An appropriate intervention for the nurse to plan with the patient is to
Establish a time to take a short walk every day
The nurse is teaching a 17-year old client and the client's family about what to expect with high-dose chemotherapy and the effects of neutropenia. What should the nurse teach as the most reliable early indicator of infection in a neutropenic client?
Fever
What are the key signs of bacterial meningitis?
Fever, severe headache, N/V, and nuchal rigidity (neck stiffness) Photophobia, decreased LOC and signs of increased ICP may be present. Most common complication is increased ICP
Nurse April is teaching a client who suspects that she has a lump in her breast. The nurse instructs the client that a diagnosis of breast cancer is confirmed by:
Fine needle aspiration
Risk factors for colorectal cancer:
Genetic mutation Familial adenomatous polyposis Hereditary non-polyposis Colorectal cancer
Living Will:
Give instructions about future medical care & treatment or the wish to die without heroic/extreme measures. Must identify specific treatments wanted or not wanted at end of life
Advance directives:
Give instructions about future medical care & treatments, who should make the decisions if person can't communicate; must comply with state law (e.g. euthanasia)
Medical Power of Attorney:
Gives someone the authority to handle your medical affairs should you be incapacitated
Durable power of Attorney:
Gives someone the authority to handle your non-medical affairs, should you become incapacitated
What is the hierarchy for patients incapacitated without a POA?
Guardian Spouse (even if separated) Children (if over 18) Must have majority agreement (e.g. 3 out of 5) Parents Siblings Must have majority agreement Adult relative who has exhibited care and close contact A close friend of the patient Court-appointed clinical social worker if no family
What is the diagnostic test for PKU:
Guthrie card test-heel stick after 24 hours of life- after ingestion of protein.
Why would we want to raise the HOB of a patient with neurological dysfunction?
HOB elevated 15-30 degrees unless cervical injury Facilitates compensation - decreases ICP Monitor ICP & CPP - adjust head of bed accordingly Avoid neck flexion - obstruct venous outflow - increases ICP
CsF leaking management:
Halo Sign: CSF leak, blood in center & yellowish ring encircles the blood. Pad over nose or under ear - NOT IN Caution patient not to sneeze, cough or blow nose No NG No nasotracheal suction
Nurse Amy is speaking to a group of women about early detection of breast cancer. The average age of the women in the group is 47. Following the American Cancer Society guidelines, the nurse should recommend that the women:
Have a mammogram annually
During a routine health examination, a 30-year-old patient tells the nurse about a family history of colon cancer. The nurse will plan to
Have the patient ask the doctor about specific tests for colon cancer
Que es Turner Syndrome?
Having only one X chromosome as a female Occurs by random error
What is usually the last sense to leave the patient in hospice?
Hearing We should still talk to the patient
Defects seen in Patau syndrome:
Heart Brain Kidneys Most abort Live span < 1 month
Clinical Manifestations of Edwards syndrome:
Heart defects Displaced liver Low-set ears Abnormal hands Severe intellectual disability 98% abort Lifespan < 1 year
Hyperosmotic agents such as mannitol would be used for?
Hemorrhagic stroke
What is important to note about controlling body temperature?
Hyperthermia is damaging to brain Hypothermia may be protective (slows cellular metabolism)
When is TPA able to be given?
IV tPA should be administered to all eligible acute stroke patients within 3 hours of last known normal and to a more selective group of eligible acute stroke patients within 4.5 hours of last known normal.
What is important to monitor when administering Nimopidine?
If pulse is ≤60 beats/min or SBP is <90 mm Hg, hold the medication and contact the provider.
Monroe-Kellie Doctrine:
If the volume of any 1 of the 3 components increases within the cranial vault and displaces another volume component, the total intracranial volume will not change If volume of one or more components continues to increase, then ICP rises and decompensation occurs
During a routine physical examination, a firm mass is palpated in the right breast of a 35-year-old woman. Which of the following findings or client history would suggest cancer of the breast as opposed to fibrocystic disease?
Increased vascularity of the breast
The nurse is caring for the client with increased intracranial pressure. The nurse would note which of the following trends in vital signs if the ICP is rising?
Increasing temperature, decreasing pulse, decreasing respirations, increasing blood pressure.
A male client with a nagging cough makes an appointment to see the physician after reading that this symptom is one of the seven warning signs of cancer. What is another warning sign of cancer?
Indigestion
For a female client newly diagnosed with radiation-induced thrombocytopenia, the nurse should include which intervention in the plan of care?
Inspecting the skin for petechiae once every shift
A client admitted to the hospital with a subarachnoid hemorrhage has complaints of severe headache, nuchal rigidity, and projectile vomiting. The nurse knows lumbar puncture (LP) would be contraindicated in this client in which of the following circumstances?
Intracranial pressure (ICP) is increased.
Gene Therapy is:
Investigation technique to treat cause of disease Replacement of a mutated gene with a healthy copy Deactivating dysfunctional genes to help fight disease
A 32-year-old male patient is to undergo radiation therapy to the pelvic area for Hodgkin's lymphoma. He expresses concern to the nurse about the effect of chemotherapy on his sexual function. The best response by the nurse to the patient's concerns is
It is possible you may have some changes in your sexual function, and you may want to consider pretreatment harvesting of sperm if you want children
Clinical manifestations of Down syndrome:
Large tongue Flat face Slanted eyes Single crease across palm Low intelligence o Mild to severe
What is the major sign of prostate cancer?
Late: weak or interrupted urine flow Inability to urinate Trouble beginning urine flow Gotta go, gotta go... Blood in urine (pain or burning)
The community nurse is conducting a health promotion program at a local school and is discussing the risk factors associated with cancer. Which of the following, if identified by the client as a risk factor, indicates a need for further instructions?
Low fat- high fiber diet A diet high in fat may be a factor in the development of breast, colon, and prostate cancers. High-fiber diets may reduce the risk of colon cancer.
A 36-year-old man with lymphoma presents with signs of impending septic shock 9 days after chemotherapy. The nurse would expect which of the following to be present?
Low-grade fever, chills, tachycardia
Review X-Linked Recessive inheritance pattern, an example Hemophilia or colorblindness
Males have one Y and one X Females have 2 X Men are more likely to get X linked disorders because they have no normal X if they receive 1 X from the mother
What is not covered under the gina act?
Manifest disease-someone who is already sick- diagnosed health condition: Insurers cannot use genetic test. However they can use the diagnosis of the health condition by a provider with physical assessment Military employment Long term care insurance, life insurance or disability insurance
What is the major risks for the trisomy defects?
Maternal age
What is important to note about cancers in stage 2?
May have lymph node involvement depending on the cancer
Nausea and vomiting is an expected side effect of chemotherapeutic drug use. Which of the following drugs should be administered to a client on chemotherapy to prevent nausea and vomiting?
Metozol (metoclopramide)
Mitochondrial Inheritance examples:
Mitochondrial Diabetes Mitochondrial myopathy Leigh syndrome Leber's hereditary optic neuropathy
What is the normal value for ICP?
Normal ICP: 0-15 mm Hg Elevated ICP: 16-19 mm Hg Increased ICP: >20mm Hg, if sustained requires treatment
With vomiting related to neurologic changes:
Not preceded by nausea - pressure changes Projectile - increased ICP
Nursing Management at the end of life:
Nurses spend more time with patients near the end of life than any other health care professionals Respect, dignity, and comfort are important for patient and family Holistic Psychosocial and physical needs
Which intervention is appropriate for the nurse caring for a male client in severe pain receiving a continuous I.V. infusion of morphine?
Obtaining baseline vital signs before administering the first dose
The oncology nurse specialist provides an educational session to nursing staff regarding the characteristics of Hodgkin's disease. The nurse determines that further education is needed if a nursing staff member states which of the following is characteristic of the disease?
Occurs most often in the older client Hodgkin's disease is a disorder of young people up to age 40 and among adults. It is more common in adolescents between the ages of 15 and 19.
What helps to decrease brain volume?
Osmotic Diuretics (mannitol, hypertonic saline) Loop diuretics (furosemide) Both will reduce fluid off the brain Corticosteroids (dexamethasone - decreases inflammation)
Hospice nurses are pivotal for:
Pain control Symptom management Spiritual assessment Assessment and management of family needs
Trisomy 13 is:
Patau syndrome
What is Nimodipine?
Patients with SAH ( subarachnoid hemorrhage ) may receive the calcium channel blocker to treat cerebral vasospasms and minimize cerebral damage. It may be given either before or after aneurysm clipping or coiling.
A male client is in isolation after receiving an internal radioactive implant to treat cancer. Two hours later, the nurse discovers the implant in the bed linens. What should the nurse do first?
Pick up the implant with long-handled forceps and place it in a lead-lined container Notify radiation department after
The nurse is interviewing a male client about his past medical history. Which preexisting condition may lead the nurse to suspect that a client has colorectal cancer?
Polyps Colorectal polyps are common with colon cancer.
Chemotherapy is one of the therapeutic modalities for cancer. This treatment is contraindicated to which of the following conditions?
Pregnancy, recent surgery, and bone marrow depression
End of life goals:
Provide comfort and supportive care during dying process Improve quality of remaining life Help ensure a dignified death Provide emotional support to family
The nurse is concerned about the patient undergoing cancer treatments because Disseminated Intravascular Coagulation (DIC) can occur, a major complication. The nurse recognizes the side effects of cancer treatments and understands that this is the most common cause of DIC:
Sepsis
In sickle cell anemia:
Recessive allele Long rod-like molecules Stretches RBC to sickle shape ss= has sickle cell Ss= is a carrier
Goals for palliative care:
Regard dying as a normal part of life Symptom relief (pain, nausea, SOB, anxiety) Affirm life, and not hasten nor postpone death Enhance quality of life Offer the support needed for patients to remain as active as possible until death Family support
The goal of gene therapy is to:
Replace mutated gene that causes the disease with a normal gene; uses vector to deliver therapeutic gene to target cell
What is generally the first thing to go at the end of life?
Respirations Heart will stop beating within a few minutes
Which of the following signs and symptoms of increased ICP after head trauma would appear first?
Restlessness and confusion
what measures may be implemented to protect a patient who is A&O x0
Restraints Light sedation possible Padded side rails
A 34-year-old female client is requesting information about mammograms and breast cancer. She isn't considered at high risk for breast cancer. What should the nurse tell this client?
She should eat a low-fat diet to further decrease her risk of breast cancer
Clinical manifestations of Turner Syndrome:
Short stature Do not go through puberty Produce little estrogen Sterile Extra skin on neck Webbed, short neck, Usually normal intelligence Visual spatial difficulties
What are gastrointestinal changes seen at end of life?
Slowing of digestive tract and possible cessation of function Loss of sphincter control Bowel movement may occur before imminent death or at the time of death
Nursing management for hematoma:
Stabilize cervical spine Apply O2 Establish IV access with 2 large bore catheters to infuse NS or lactated ringers Intubate if GCS is <8 Remove patients clothing Maintain normothermia using blankets & warm IV fluids Monitor VS, GCS, pupil size & reactivity GIVE FLUIDS CAUTIOUSLY to prevent fluid overload and increasing ICP Focus on control of ICP and prevention of secondary brain injury Note: condition can deteriorate rapidly - herniation of brain - think brainstem Prevention of complications May require rehab
A client is diagnosed with breast cancer. The tumor size is up to 5 cm with axillary and neck lymph node involvement. The client is in what stage of breast cancer?
Stage II (Stage III is larger than 5cm)
What is the Glascow Coma Scale used for?
Standard system for assessing the LOC The 3 areas assessed are patients' ability to: Open eye in response to painful or verbal stimulus Speak Obey commands Mechanical ventilation and sedation should be taken into consideration Scoring Highest: 15, fully alert Lowest: 3 GCS of 8 or < usually indicates coma Trending this data allows for tracking of progress
Pharmacogenetics:
Study of genetic variability of drug responses due to variation of single genes
Pharmacogenomics:
Study of variability of drug response due to variation in multiple genes
On a clinic visit a client who has a relative with cancer, is asking about the warning signs that may relate to cancer. The nurse correctly identifies the warning signs of cancer by responding:
Sudden weight loss of unexplained etiology can be a warning sign of cancer.
what is a treatment for Klinefelter Syndrome:
Testosterone will help produce more muscle mass, hair growth, and increased sex drive but will not correct testicular size, breast growth or infertility.
When reviewing the chart for a patient with cervical cancer, the nurse notes that the cancer is staged as Tis, N0, M0. The nurse will teach the patient that
The cancer is localized to the cervix
What are the the requirements for a DNR in a incapacitated patient?
The surrogate decision maker If there is no POA, then there is a hierarchy order list to follow.
Patients who are at end of life and are to extubated:
To relieve pain, SOB and anxiety, patients are usually medicated PRIOR to extubation with: Morphine IV Morphine Boluses May include benzos (Ativan) All medications except those for comfort are discontinued Tube feeds shut off - ethical dilemma
In staging and grading neoplasm TNM systems is used. TNM stands for:
Tumor, node, metastasis
what does codominant alleles mean?
Two alleles are both dominant A allele for A blood B allele for B blood They are both dominant so you get AB blood.
Jenny with an advanced breast cancer is prescribed Nolvadex (tamoxifen). When teaching the client about this drug, the nurse should emphasize the importance of reporting which adverse reaction immediately?
Vision changes
Which information noted by the nurse reviewing the laboratory results of a patient who is receiving chemotherapy is most important to report to the health care provider?
WBC count of 1700/µl
When do we use palliative care?
When a diagnosis of a life-limiting illness is made, and patients need symptom relief Examples Cancer COPD CHF Involves: Interprofessional collaboration Ongoing communication Care in multiple settings
What is the key to cancer prevention?
When cancer is in the promotion level The activity of promoters is still reversible This includes dietary fat, obesity, cigarette smoking, and alcohol consumption
If the infecting organism is Meningococcus:
a skin rash may be present. Tumbler test may be done by pressing the base of the drinking glass against the rash. The rash does not blanch or fade under pressure.
Meningitis is an:
acute inflammation of the meningeal tissues surrounding the brain and the spinal cord. Usually occurs in fall, winter, or early spring It is often related to a viral respiratory disease. College students who live in dorms, or people living in institutions (prisoners) have a high risk for contracting meningitis
Acquired (somatic) mutations:
occur in the DNA of a cell some time in an individual's life. A mistake is made in cell division or environmental factors alter the DNA. These somatic mutations cannot be passed on to the next generation.
CCP(cerebral perfusion pressure):
balance between ICP and MAP CPP = MAP - ICP Normal CPP: 60-100 <50 = ischemia & neuronal death
Intracerebral Hematoma:
bleeding within the tissue Bleeding within the brain tissue, frontal & temporal lobes, rupture of intracerebral vessels. Tx: clipping, coiling, embolize, surgical resection
Homozygous means?
both alleles are alike AA aa
what is the gold standard for screening colorectal cancer?
colonoscopy (10years)
What are the signs and symptoms of basilar fracture?
cranial nerve deficits, postauricular bruising (battle's sign) and periorbital bruising (racoon eyes)
Hospice care is provided when:
curative care is a forgone conclusion Requires physician certification that life expectancy is 6 months or less
Tamoxifen, a selective estrogen receptor modulator, may cause what side effects?
ocular side effects such as dryness, irritation, and cataracts. The client must report changes in visual acuity immediately because this adverse effect may be irreversible.
Genomics is the study:
of all a person's genes (genome) including interaction of these genes and environmental factors
Autosomal Recessive:
only visible when paired with another recessive
What is important to note about health promotion with bacterial meningitis?
prevent respiratory tract infections through vaccination programs for pneumococcal pneumonia and influenza. Meningococcal vaccines. Early and vigorous treatment of respiratory tract and ear infections is important. Close contact with someone who has bacterial meningitis should receive prophylactic antibiotics.
Aphasia:
receptive aphasia (loss of comprehension), expressive aphasia (inability to produce language), global aphasia (total inability to communicate) Dysphasia (impaired ability to communicate)
Cushings triad:
refers to a set of signs that are indicative of increased intracranial pressure (ICP) Systolic HTN with widening pulse pressure Bradycardia with a full bounding pulse Irregular respiratory pattern ***MEDICAL EMERGENCY*** - brain stem compression
CSF rhinorrhea (leaking out of nose or mouth) or otorrhea (Leaking out of ears) =
report to HCP immediately - risk for meningitis Usually confirms that fracture has traverses the dura
ICP can be an issue because:
rreversible brain damage can occur bc it decreases cerebral perfusion pressure
Surgery is usually appropriate for?
slow growing tumors
what are the leading causes of bacterial meningitis?
streptococcus pneumoniae and Neisseria meningitidis
debulking:
used to removes as much of the tumor as possible if all of it cannot be removed- it makes other treatments such as chemo or radiation more effective
If a deletion occurs and the material is essential:
will result in disease
Parents of pediatric clients who undergo irradiation involving the central nervous system should be warned about postirradiation somnolence. When does this neurologic syndrome usually occur?
within 5-8 weeks
