Module #3 Exam Blueprint

Pathophysiology Review: Altitude-Related Illnesses

As altitude increases, atmospheric (barometric) pressure decreases. Oxygen makes up 21% of the pressure. Therefore as this pressure falls, the partial pressure of oxygen in the air decreases, resulting in less available oxygen to breathe. The pathophysiologic consequence is hypoxia, which is more pronounced as elevation increases.

Interprofessional Collaborative Care: Drowning

Aspiration of both fresh water and salt water causes surfactant to wash out of the lungs. (makes breathing ineffective due to airway resistance.) Pulmonary edema is the result of drowning in both fresh & saltwater. The victim's outcome may be negatively affected by contaminants in the water such as chemicals, algae, microbes, sand, and mud. Once the person is safely removed from the water, airway and cardiopulmonary support interventions begin, including oxygen administration, endotracheal intubation, CPR, and defibrillation, if necessary. In the clinical setting, gastric decompression with a nasogastric or orogastric tube is needed to prevent aspiration of gastric contents and improve ventilatory function.

Interprofessional Collaborative Care: Altitude-Related Illnesses

Assessment findings for the typical patient with AMS include throbbing headache, anorexia, nausea, vomiting, chills, irritability, and apathy. Acetazolamide, a carbonic anhydrase inhibitor, is commonly prescribed to prevent or treat AMS. For best results, the drug should be taken 24 hours before ascent and be continued for the first 2 days of the trip. Dyspnea at rest is abnormal and may signal the onset of HAPE. HAPE: Patients notice poor exercise tolerance and a prolonged recovery time after exertion. Fatigue, weakness, and other signs and symptoms of AMS are present. Important signs and symptoms of HAPE include a persistent dry cough and cyanosis of the lips and nail beds. Crackles may be auscultated in one or both lungs. Pink, frothy sputum is a late sign of HAPE. If AMS progresses to high-altitude cerebral edema (HACE), the patient cannot perform ADLs and has extreme apathy. A key sign of HACE is the development of ataxia, mental status change, confusion, & impaired judgment.

Risk factors for cardiovascular disease.

Being overweight Physical inactivity Smoking High blood pressure Diabetes mellitus Inflammation Occupation

Nursing interventions to help prevent infections in the tracheostomy client.

Bronchial hygiene promotes a patent airway and prevents infection. Turn and reposition the patient every 1 to 2 hours, support out-of-bed activities, and encourage ambulation to promote lung expansion and gas exchange and help remove secretions. Coughing and deep breathing, combined with chest percussion, vibration, and postural drainage, promote pulmonary hygiene. Oral hygiene keeps the airway patent, prevents infection from bacterial overgrowth. Assess the mouth for reduced tissue integrity. These devices require changing when soiled or at least daily to keep them clean, to prevent infection. In the hospital, use sterile technique for suctioning and for all equipment

General Complication: Altered Respiratory and Cardiac Function

Cancer can disrupt respiratory function, capacity, and gas exchange and may result in death. Tumors that grow in the airways cause obstruction. If lung tissue is involved, lung capacity is decreased, leading to dyspnea and hypoxemia. Patients are at risk for hypoxemia and hypoxia with either primary or metastatic lung tumors or if pleural effusion develops. Tumors can also press on blood and lymph system in the chest, which results in airway compression and dyspnea. Superior vena cava (SVC) syndrome is an oncologic emergency that results from compression of this vessel. Chemotherapy agents can also contribute to cardiac dysfunction through loss of myocardial muscle mass, leading to heart failure.

Apply knowledge of anatomy and physiology to perform a rapid/focused neurologic assessment

Cerebellar assessment: Fine coordination of muscle activity is tested. Mental status assessment: is generally divided into assessment of consciousness and cognition. Cranial nerves: are typically tested to establish a baseline from which to compare progress or deterioration. Motor Function: observe the patient for involuntary tremors or movements. (decorticate posturing / decerebrate posturing) Assessment of Reflex Activity: The deep tendon reflexes of the biceps, triceps, brachioradialis, and quadriceps muscles and of the Achilles tendon can be tested as part of the complete neurologic assessment Sensory Function: Pain, temperature & light touch discrimination are done to assess senses. GCS: The typical record contains data related to alertness, orientation, movement of arms and legs, and pupil size and reaction to light.

Safety Precautions when administering Chemotherapy

Chemotherapy drugs can absorbed through the skin and mucous membranes. As a result the nurses and pharmacists who prepare or give these drugs are at risk for absorbing them. Anyone preparing, giving, or disposing of chemotherapy drugs or handling excreta from patients within 48 hours of receiving IV chemotherapy must wear approved personal protective equipment (PPE) Because these oral agents can be absorbed through skin and mucous membranes and exert toxic effects, the person who handles and administers them needs to use PPE in the same way as during IV chemotherapy administration. Oral agents must not be crushed, split, broken, or chewed. These drugs are biohazardous and must be discarded in accordance with agency policy. Such equipment includes eye protection, masks, double gloves or "chemo" gloves, and nonpermeable gown.

Client Education for Cancer Treatment: Prevention of infection

During the times your white blood cell counts are low: • Avoid crowds and other large gatherings of people who might be ill. • Do not share personal toiletries. • If possible, bathe daily. If total bathing is not possible, wash the armpits and entire perineal area twice a day with an antimicrobial soap. • Wash your hands thoroughly with an antimicrobial soap before you eat and drink, after touching a pet, after shaking hands with anyone, as soon as you come home from any outing, and after using the toilet. • Do not drink perishable liquids that have been standing at room temperature for longer than an hour. • Use food safety when preparing meals. • Wash fresh fruits and vegetables prior to eating. • Do not change pet litter boxes or clean up after pets. Wear gloves if necessary. • Take your temperature at least once a day and whenever you do not feel well. • Report any of these indicators of infection to your oncologist immediately: • Temperature greater than 100.4°F (38°C) • Persistent cough (with or without sputum) • Pus or foul-smelling drainage from any open skin area or normal body opening • Presence of a boil or abscess • Urine that is cloudy or foul smelling or that causes burning on urination • Take all drugs as prescribed. • Wear gardening gloves when working in the garden or with houseplants. • Wear a condom when having sex. If you are a woman having sex with a male partner, ensure that he wears a condom.

chemotherapy induced nausea and vomiting (CINV)

ETI: Begins with administration of the agent and may last up to 7 days following RX Anxiety may cause CINV Preventative meds should be given at regularly scheduled times before the CINV starts (RN responsibility to make sure these meds are given BEFORE CINV starts) MEDS: antiemetics INTERVENTIONS: Assess for dehydration (tachycardia), vomiting, and electrolyte imbalances Complementary measures to reduce CINV: Music, Progressive muscle relaxation, Guided imagery, Acupressure, Distraction, Concord grape juice before meals

Risk factors for neurologic health problems.

Engaging in risky physical activities, such as motorcycle or car racing without wearing a helmet or taking other safety precautions / diving into shallow water.

Facial (VII)

Facial Expressions & Taste

Signs & symptoms of Heart Failure

General - Dyspnea at rest or on exertion - Weakness/fatigue - SOB - Reduction in exercise capacity - Increase in BNP (B-type Natriuretic Peptide): normal < 100 pg/mL Left-side HF - Orthopnea - Nocturnal cough - Bibasilar rales - S3 gallop (abnormal heart sound) - Stroke Volume < 40% Right-Sided HF - Edema - Ascites - JVD - Hepatojugular reflux - Hepatomegaly

Alopecia

Hair loss may occur as whole-body hair loss or may be as mild as only a thinning of the scalp hair. When body hair loss includes pubic hair, patients may struggle with their body image and sexuality.

Mechanical properties of the heart.

Heart rate (HR) refers to the number of times the ventricles contract each minute. Stroke volume (SV) is the amount of blood ejected by the left ventricle during each contraction. Preload refers to the degree of myocardial fiber stretch at the end of diastole and just before contraction. Afterload, is the pressure or resistance that the ventricles must overcome to eject blood through the semilunar valves and into the peripheral blood vessels.

Pathophysiology Review: Heat Exhaustion

Heat exhaustion is a syndrome resulting primarily from dehydration. It is caused by heavy perspiration and inadequate fluid and electrolyte intake during heat exposure over hours to days. Profuse diaphoresis can lead to profound, even fatal, dehydration and hyponatremia caused by excessive sodium lost in perspiration. If untreated, heat exhaustion can lead to heat stroke, which is a true medical emergency that has a very high mortality rate.

Pathophysiology Review: Heat Stroke

Heat stroke is a medical emergency in which body temperature may exceed 104°F (40°C). It has a high mortality rate if not treated in a timely manner. The victim's thermoregulation mechanisms fail and cannot adjust for a critical elevation in body temperature.

Nursing interventions used to help people with tracheostomies cope

Help him or her set realistic goals, starting with involvement in self-care. Work with the family to ease the patient into a more normal social environment. Provide encouragement and positive reinforcement while demonstrating acceptance and caring behaviors. Assess the caregiver(s) for the need for counseling. After surgery the patient may feel shy and socially isolated. He or she can wear loose-fitting shirts, decorative collars, or scarves to cover the tracheostomy tube.

Pathophysiology Review: Hypothermia

Hypothermia is a core body temperature below 95°F (35°C). Common predisposing conditions that promote hypothermia include: • Cold-water immersion • Acute illness (e.g., sepsis) • Traumatic injury • Shock states • Immobilization • Cold weather (especially for people who are homeless or work outdoors) • Older age • Use of medications (e.g., phenothiazines, barbiturates) • Inappropriate alcohol and substance use • Undernutrition • Hypothyroidism • Inadequate clothing or shelter (e.g., the homeless population)

Interprofessional Collaborative Care: Hypothermia

Hypothermia is commonly divided into three categories by severity: mild (90° to 95°F [32° to 35°C]); moderate (82.4° to 90°F [28° to 32°C]); and severe (below 82.4°F [28°C]). Treatment decisions are based on the severity of hypothermia. General management principles apply to both moderate and severe hypothermia. Protect patients from further heat loss and handle them gently to prevent ventricular fibrillation. Positioning the patient in the supine position prevents orthostatic changes in blood pressure from cardiovascular instability. • Administer drugs with caution and/or spaced at longer intervals because metabolism is unpredictable in hypothermic conditions. • Remember that drugs can accumulate without obvious therapeutic effect while the patient is cold but may become active and potentially lead to drug toxicity as effective rewarming is under way. • Collaborate with the health care provider to consider withholding IV drugs, except vasopressors, until the core temperature is above 86°F (30°C). • Initiate CPR for patients without spontaneous circulation. • For a hypothermic patient in ventricular fibrillation or pulseless ventricular tachycardia, one defibrillation attempt is appropriate. Be aware that defibrillation attempts may be ineffective until the core temperature is above 86°F (30°C). The patient's trunk should be actively rewarmed before the extremities. Core rewarming methods for moderate hypothermia include administration of warm IV fluids; heated oxygen or inspired gas to prevent further heat loss via the respiratory tract.

General Complication: Impaired Immunity and Clotting

Impaired immunity and decreased production of healthy bone marrow can occur when cancer starts in or invades the bone marrow, where blood cells & WBC's are formed. Bone marrow dysfunction causes anemia and thrombocytopenia by decreasing the number of red blood cells and platelets, respectively.

First Aid/Prehospital Interventions: Lightning

Initial care includes spinal stabilization with priority attention to maintenance of an adequate airway, effective breathing, and circulation through standard basic and advanced life support measures. Cardiopulmonary resuscitation (CPR) is performed immediately when a patient is in cardiac arrest.

How to Prepare a client for a stress test

Instruct the patient to get plenty of rest the night before the procedure. He or she may have a light meal 2 hours before the test but should avoid smoking or drinking alcohol or caffeine-containing beverages on the day of the test. Usually cardiovascular drugs such as beta blockers or calcium channel blockers are withheld on the day of the test to allow the heart rate to increase during the stress portion of the test. Patients are advised to wear comfortable, loose clothing and rubber-soled, supportive shoes. Remind them to tell the provider if symptoms such as chest pain, dizziness, shortness of breath, or an irregular heartbeat are experienced during the test.

Pathophysiology Review: Lightning Injuries

Lightning produces injury by directly striking a victim, splashing off a nearby object, or traveling through the ground. Although few people die after a lightning strike, many survivors are left with permanent disabilities. Because water is a conductor of electricity and current takes the path of least resistance to the ground, any wetness on the body increases the flashover effect of a lightning strike. Lightning flashover produces an explosive force that can injure victims directly and cause them to fall or to be thrown. The clothing and shoes of victims may be damaged or blown off in the process.

General Complication: Motor and Sensory Deficits

Motor and sensory perception deficits occur when cancers invade bone or the brain or compress nerves.

First Aid/Prehospital Interventions: Bites & Stings

Move to safety, away from snake Call for immediate emergency assistance Encourage rest to decrease venom circulation Remove jewelry and constrictive clothing Take photos of snake from a safe distance to aid in identification Immobilize affected extremity in position of function—maintain at level of heart Keep patient warm, provide calm environment Do not incise or suck wound, apply ice, or use a tourniquet Quickly remove stinger with tweezers or by gently scraping or brushing it off with the edge of a knife blade, credit card, or needles (if present) & apply ice. If patient has history of allergic reactions to stings or has wheezing, facial swelling, and respiratory distress, epinephrine must be given immediately. Do not apply heat because it increases enzyme activity and potentially worsens wound. Apply ice pack to decrease action of neurotoxins. Monitor for systemic toxicity; support airway, breathing, and circulation as needed. Transport to acute care facility as soon as possible.

Complications with Oxygen Therapy: Combustion

Oxygen enhances combustion so fire burns better in its presence, but it does not burn or explode.

symptoms of cardiac disease

Pain or discomfort, considered a traditional symptom of heart disease, can result from ischemic heart disease, pericarditis, and aortic dissection. The patient with advanced heart disease may experience orthopnea (dyspnea that appears when he or she lies flat). Dyspnea (difficult or labored breathing) can occur as a result of both cardiac and pulmonary disease. Fatigue may be described as a feeling of tiredness or weariness resulting from activity. The patient may report that an activity takes longer to complete or that he or she tires easily after activity. A feeling of fluttering or an unpleasant feeling in the chest caused by an irregular heartbeat is referred to as palpitations. A sudden weight increase of 2.2 lb (1 kg) can result from excess fluid (1 L) in the interstitial spaces. The best indicator of fluid balance is weight. Excess fluid accumulation is commonly known as edema. Extremity pain may be caused by two conditions: ischemia from atherosclerosis and venous insufficiency of the peripheral blood vessels. Patients who report a moderate-to-severe cramping sensation in their legs or buttocks associated with an activity such as walking have intermittent claudication related to decreased arterial tissue perfusion.

Components related to cardiovascular system assessment.

Patient History: obtaining information about risk factors and symptoms of cardiovascular disease (CVD). Physical Assessment: Physical assessment begins with the patient's general appearance. Assess general build and appearance, skin color, distress level, level of consciousness, shortness of breath, position, and verbal responses. Skin assessment includes color and temperature. The best areas in which to assess circulation include the nail beds, mucous membranes, and conjunctival mucosa. Extremity assessment: assessing the patient's hands, arms, feet, and legs for skin changes, vascular changes, clubbing, and edema. Arterial blood pressure is measured indirectly by sphygmomanometry. Pulse Assessment provides information about vascular integrity and circulation. Observe the venous pulsations in the neck to assess the adequacy of blood volume and central venous pressure (CVP). Inspection: evaluates heart rate and rhythm, cardiac cycle (systole and diastole), and valvular function.

Interprofessional Collaborative Care: Heat Exhaustion

Patients with heat exhaustion usually have flulike symptoms with headache, weakness, nausea, and/or vomiting. Body temperature may not be significantly elevated. The patient may continue to perspire despite dehydration. Instruct the patient to immediately stop physical activity and move to a cool place. Use cooling measures such as cold pack, soaking, and/or fanning. NO PLAIN WATER. In clinical settings, rehydrate with IV fluids if NV persists. Draw Blood for serum electrolyte analysis.

Interprofessional Collaborative Care: Frostbite

Patients with more severe and deeper forms of frostbite need aggressive management. For all degrees of partial-thickness-to-full-thickness frostbite, rapid rewarming in a water bath at a temperature range of 99° to 102°F (37° to 39°C) is indicated to thaw the frozen part, The part should be swirled in the water and not allowed to touch the sides of the container to prevent tissue damage.

Psychosocial Issues and Cancer

Psychosocial issues can occur during chemotherapy. For many chemotherapy regimens, drugs are given over a period ranging from 30 minutes to 8 hours or longer. During this time the patient may be confined to a treatment area, which is a constant reminder of the disease and its treatment. Distraction methods such as virtual reality, guided imagery, reading, watching television, and talking with visitors may help reduce the sense of unpleasantness.

First Aid/Prehospital Interventions: Frostbite

Recognition of frostbite is essential to early, effective intervention and prevention of further damage to tissue integrity . Asking a significant other to frequently observe for early signs of frostbite such as a white, waxy appearance to exposed skin, especially on the nose, cheeks, and ears, is an effective strategy to identify the problem before it worsens. In this case the best remedy is to have the person seek shelter from the wind and cold and attend to the affected body part. Superficial frostbite is easily managed using body heat to warm the affected area. Teach patients to place their warm hands over the affected areas on their face or to place cold hands under the arms.

Interprofessional Collaborative Care: Snakebites and Arthropod Bites and Stings

Recognize that the first priority is to move the person to a safe area away from the snake and encourage rest to decrease venom circulation. Respond (when in the safe area) by removing jewelry and constricting clothing before swelling worsens. Call for immediate emergency assistance. Do not attempt to capture or kill the snake, but do take digital photographs at a safe distance if possible to aid in snake identification.

physiologic changes associated with aging affecting the neurological assessment

Slower cognitive processing time: Provide sufficient time for the affected older adult to respond to questions and/or direction. Decreased sensory perception of touch: remind client to measure water temperature, look where they're walking. Possible change in perception of pain: Ask the patient to describe the nature and specific characteristics of pain. Change in sleep patterns: ascertain sleep patterns and considerations. Altered balance and/or decreased coordination: Instruct the patient to move slowly when changing positions. Increased risk for infection: Monitor the patient carefully for signs and symptoms of infection.

Changes in Cognitive Function

Some patients receiving chemotherapy report changes in cognitive function. It can be reported as a reduced ability to concentrate, memory loss, and difficulty learning new information. This problem, termed chemo brain, is often reported during treatment and can last for years after completion of treatment. Cognitive impairment has been reported in up to 75% of patients with breast cancer.

Vagus (X)

Swallowing, speaking, thoracic and abdominal organs

signs/symptoms of oxygen toxicity

Symptoms start with dyspnea, nonproductive cough, chest pain beneath the sternum, GI upset, nasal stuffiness, and crackles on auscultation. As exposure to high levels of oxygen continues, problems become more severe, with decreased vital capacity, decreased compliance, and hypoxemia.

Hypothermia/Frostbite Prevention:

Teach the importance of wearing synthetic clothing because it moves moisture away from the body and dries fast. Cotton clothing, especially worn as an undergarment, holds moisture, becomes wet, and contributes to the development of hypothermia. It should be strictly avoided in a cold outdoor environment; this rule applies to gloves and socks as well because wet gloves and socks promote frostbite in the fingers and toes. Wearing too many pairs of socks can decrease circulation and lead to frostbite. Clothing should be layered so that it can be easily added or removed as the temperature changes. The inner layers, such as polyester fleece, provide warmth and insulation. The outer layer blocks wind and provides moisture protection. This layer is best made of a windproof, waterproof, breathable fabric. Body heat is lost through the head, so a hat should always be worn. A facemask should be used on particularly cold days when wind chill poses a risk. Sunscreen (minimum sun protection factor [SPF] 30) and sunglasses are also important to protect skin and eyes from the sun's harmful rays.

Complications with Oxygen Therapy: Infection

The humidifier or nebulizer may be a source of bacteria and fungus, increasing the risk for infection.

General Complication: Cancer Pain and Quality of Life

The patient with cancer may have pain and is at risk for chronic pain. Pain does not always accompany cancer, but it can be a major problem.

First Aid/Prehospital Interventions: Hypothermia

The patient with mild hypothermia needs to be sheltered from the cold environment, have all wet clothing removed, and undergo passive or active external rewarming. Passive methods involve applying warm clothing or blankets. Active methods incorporate use of heating blankets, warm packs, and convective air heaters or warmers. If a heating blanket is used, monitor the patient's skin at least every 15 to 30 minutes to reduce the risk for burn injury. In the case of mild, uncomplicated hypothermia as the only health problem, having the victim drink warm high-carbohydrate liquids that do not contain alcohol or caffeine can aid in rewarming. Alcohol is a peripheral vasodilator; both alcohol and caffeine are diuretics. These effects can potentially worsen dehydration and hypothermia.

First Aid/Prehospital Interventions: Altitude Related Illness

The person is instructed not to ascend to a higher altitude, especially for sleep, until symptoms lessen. If symptoms persist or worsen, he or she should be moved to a lower altitude as soon as possible. One drug that is indicated in the treatment of moderate-to-severe AMS is dexamethasone. When it occurs, HAPE is a serious condition that requires quick evacuation to a lower altitude, oxygen administration, and bedrest to save the patient's life. If descent must be delayed because of weather conditions or other factors, oxygen administration as soon as possible is essential. Keep the patient warm at all times.

Indications and contraindications for noninvasive positive pressure ventilation (NPPV)

This technique uses positive pressure to keep alveoli open and improve gas exchange without the dangers of intubation. It is used to manage dyspnea, hypercarbia, and acute exacerbations of chronic obstructive pulmonary disease (COPD), cardiogenic pulmonary edema, and acute asthma attacks. (Typically used for sleep apnea). Gastric inflation (caused by extended periods of pressurized air) can lead to vomiting and the potential for aspiration. Thus NPPV is recommended only for use in alert patients who have the ability to protect their airway.

Interprofessional Collaborative Care: Lightning

Those with a mild injury may only be stunned or confused. Those with moderate injury may have confusion or be comatose, and experience temporary paralysis. Severely injured patients often experience cardiac arrest. Collaborate with the interprofessional health care team to perform a thorough evaluation to identify obvious and occult (hidden) traumatic injuries because the patient may have suffered a fall or blast effect during the strike. A computed tomography (CT) scan of the head may be performed to identify intracranial hemorrhage. A creatine kinase (CK) measurement may be requested to detect skeletal muscle damage resulting from the lightning strike. Tetanus prophylaxis is necessary if the patient has experienced burns or any break in skin integrity.

Tracheostomy care

Tracheostomy care keeps the tube free of secretions, maintains a patent airway, and provides wound care. It is performed whether or not the patient can clear secretions.

General Complication: Altered GI Function

Tumors of the GI tract or advanced cancers increase the metabolic rate and the need for nutrients; however, many patients develop disease-related and treatment-related appetite loss, and alterations in taste that have a negative impact on nutrition, leading to weight loss. Abdominal tumors may obstruct or compress structures anywhere in the GI tract, reducing the ability to absorb nutrients and eliminate wastes. This problem needs to be addressed promptly to avoid complications such as a bowel obstruction.

Pathophysiology Review: Bites and Stings

Venom immobilizes and aids in digestion of prey; may be lethal Has local and systemic effects Enzymes break down human tissue proteins, alter tissue integrity Some Venoms contains nerve and muscle toxins

Interprofessional Collaborative Care: Heat Stroke

Victims of heat stroke have a profoundly elevated body temperature (above 104°F [40°C]). Although the patient's skin is hot and dry, the presence of sweating does not rule out heat stroke. Mental status changes occur as a result of thermal injury to the brain and are the hallmark findings in heat stroke. Best Practice: • Give oxygen by mask or nasal cannula; be prepared for endotracheal intubation. • Start at least one IV with a large-bore needle or cannula. • Administer fluids as prescribed, using cooled solutions if available. • Use a cooling blanket. • Obtain baseline laboratory tests as quickly as possible: urinalysis, serum electrolytes, cardiac enzymes, liver enzymes, and complete blood count (CBC). • Do not administer aspirin or any other antipyretics. • Insert a rectal probe to measure core body temperature continuously or use a rectal thermometer and assess temperature every 15 minutes. • Insert an indwelling urinary drainage catheter. • Monitor vital signs frequently as clinically indicated. • Assess arterial blood gases. • Administer muscle relaxants or benzodiazepines as prescribed if the patient begins to shiver. • Measure and monitor urine output and specific gravity to determine fluid needs. • Stop cooling interventions when core body temperature is reduced to 102°F (39°C).

Pathophysiology Review: Frostbite

Wet clothing is a poor insulator and facilitates the development of frostbite. Fatigue, dehydration, and poor nutrition are other contributing factors. People who smoke, consume alcohol, or have impaired peripheral circulation have a higher incidence of frostbite. Any previous history of frostbite further increases a person's susceptibility.

Complications with Oxygen Therapy: Absorptive Atelectasis

When high oxygen levels are delivered, nitrogen (which maintains surfactant) is diluted, oxygen diffuses from the alveoli into the blood, and the alveoli collapse.

Complications with Oxygen Therapy: Drying of the Mucous Membranes

When the prescribed oxygen flow rate is higher than 4 L/min, humidify the delivery system to prevent tissue injury and loss of tissue integrity.

lab tests to be monitored when receiving cancer treatment therapy

White blood cell count: umor cells can metastasize into the bone marrow and reduce the production and function of healthy white blood cells (WBCs) that are needed for normal immunity. Absolute neutrophil count: An absolute neutrophil count may be used to check for infection, inflammation, leukemia, and other conditions. Hematocrit: This is because cancers cause inflammation that decrease red blood cell production. In addition, many chemotherapies are myelosuppressive, meaning they slow down the production of new blood cells by the bone marrow. Hemoglobin: Cancer treatments, such as chemotherapy and radiation therapy, as well as cancers that affect the bone marrow, can cause anemia. When you are anemic, your body does not have enough red blood cells. Red blood cells are the cells that that carry oxygen from the lungs throughout your body to help it work properly. Platelet count: Bone marrow dysfunction causes anemia and thrombocytopenia by decreasing the number of red blood cells and platelets, respectively. The patient with anemia can have fatigue, shortness of breath, and tachycardia. The patient with thrombocytopenia will have impaired clotting and increased risk of bleeding. These changes may be caused by the disease or by cancer treatment, especially chemotherapy.

Oculomotor Nerve (III) / Trochlear (IV) / Abducens (VI)

eye movement (motor)

Palliative surgery

focuses on providing symptom relief and improving the quality of life but is not curative. Examples include removal of tumor tissue that is causing pain, obstruction, or difficulty swallowing.

Complications of Cerebral Angiography

hemorrhage, allergy, vasospasm, thrombosis, hematoma, embolism, stroke

High-flow systems

include the Venturi mask, aerosol mask, face tent, high-flow nasal cannula (HFNC), tracheostomy collar, and T-piece. These devices deliver an accurate oxygen level when properly fitted, with oxygen concentrations from 24% to 100% at 8 to 15 L/min.

Reconstructive or restorative surgery

increases function, enhances appearance, or both. Examples include breast reconstruction after mastectomy, bowel reconstruction, revision of scars, and cosmetic reconstruction in head and neck cancer.

Diagnostic surgery

is the removal of all or part of a suspected lesion for examination and testing to confirm or rule out a cancer diagnosis. Cancer treatment is not initiated without tissue confirmation of a cancer diagnosis.

Accessory (XI) Nerve

neck muscles to coordinate head movements

Partial rebreather masks

provide oxygen concentrations of 60% to 75% with flow rates of 6 to 11 L/min.

Nonrebreather masks

provide the highest oxygen level of the low-flow systems and can deliver greater than 90%, depending on the patient's breathing pattern. This mask is often used with patients whose respiratory status is unstable and who may require intubation.

Curative surgery

removes all cancer tissue. Surgery alone can result in a cure when all visible and microscopic tumor is removed. It is most effective for small localized tumors or noninvasive skin cancers such as basal cell lesions.

Debulking surgery

removes part of the tumor if removal of the entire mass is not possible. It decreases the size of the tumor and the number of cancer cells, which may help alleviate symptoms, enhance the success of other types of cancer treatment, and increase survival time.

Prophylactic surgery

removes potentially cancerous tissue as a means of preventing cancer development. It is performed when a patient has either an existing premalignant condition or a strong predisposition for development of a specific cancer. For example, removing the opposite breast in a patient who has a genetic mutation (e.g., BRCA1, BRCA2) to prevent cancer in the unaffected breast is considered prophylactic surgery.

Vestibulocochlear (VIII)

sensory, hearing and balance

Trigeminal (V)

sensory: face, teeth, tongue motor: muscles of mastication

Glosopharyngeal (IX)

taste, gag reflex

Chemotherapy-Induced Peripheral Neuropathy:

the loss of sensory perception or motor function of peripheral nerves associated with exposure to certain anticancer drugs. The results of CIPN on function are widespread, with the most common problems including loss of sensation in the hands and feet, impaired gait and balance, orthostatic hypotension, erectile dysfunction, neuropathic pain, loss of taste discrimination, and constipation. Patients may also lose the ability to perform functional or fine motor abilities such as holding a pen, buttoning a shirt, playing an instrument, or feeling the ground while walking.

Optic Nerve (II)

the nerve that carries neural impulses from the eye to the brain

olfactory nerve (1)

the nerve that carries smell impulses from the nose to the brain

Hypoglossal (XII)

tongue movement

Nasal Cannula

used at flow rates of 1 to 6 L/min. Oxygen concentrations of 24% (at 1 L/min) to 44% (at 6 L/min) can be achieved.

Simple facemasks

used to deliver oxygen concentrations of 40% to 60% for short-term oxygen therapy or in an emergency. A minimum flow rate of 5 L/min is needed to prevent rebreathing of exhaled air.

Heat-Related Illness Prevention:

• Avoid alcohol and caffeine. • Prevent overexposure to the sun; use a sunscreen with an SPF of at least 30 with UVA and UVB protection. • Rest frequently and take breaks from being in a hot environment. Plan to limit activity at the hottest time of day. • Wear clothing suited to the environment. Lightweight, light-colored, and loose-fitting clothing is best. • Pay attention to personal physical limitations; modify activities accordingly and take the time necessary to properly acclimate to a hot environment (typically 2 weeks). • Take cool baths or showers to help reduce body temperature. • Stay indoors in air-conditioned buildings if possible. • Ask a neighbor, friend, or family member to check on the older adult at least twice a day during a heat wave.

Drowning Prevention:

• Constantly observe people who cannot swim and are in or around water. • Do not swim alone. • Test the water depth before diving in head first; never dive into shallow water. • Avoid alcoholic beverages and substance use when swimming and boating and while in proximity to water. • Ensure that water rescue equipment such as life jackets, flotation devices, and rope is immediately available when around water.

Snakebite Prevention:

• Do not keep venomous snakes or constricting snakes as pets. • Be extremely careful in locations where snakes may hide, such as tall grass, rock piles, ledges and crevices, woodpiles, brush, boxes, and cabinets. Snakes are most active on warm nights. • Wear protective attire such as boots, heavy pants, and leather gloves. • When walking or hiking, use a walking stick or trekking poles. • Inspect suspicious areas before placing hands and feet in them. • Do not harass any snakes you may encounter. Striking distance can be up to two thirds the length of the snake. Even young snakes pose a threat; they are capable of envenomation from birth. • Be aware that newly dead or decapitated snakes can inflict a bite for up to an hour after death because of persistence of the bite reflex. • Do not transport the snake with the victim to the medical facility for identification purposes; instead, take a digital photo of the snake at a safe distance if possible.

First Aid/Prehospital Interventions: Heat Stroke

• Ensure a patent airway. • Remove the patient from the hot environment (into air-conditioning or into the shade). • Contact emergency medical services to transport the patient to the emergency department. • Remove the patient's clothing. • Pour or spray cold water on the patient's body and scalp. • Fan the patient (not only the person providing care, but all surrounding people should fan the patient with newspapers or whatever is available). • If available, place ice in cloth or bags and position the packs on the patient's scalp, in the groin area, behind the neck, and in the armpits. • If immediate immersion in cold water is possible, support the patient in the water for rapid cooling and protect the patient's airway. (Note: this is the best method to treat heat stroke.) Do not give food or liquid by mouth because vomiting and aspiration are risks in patients with neurologic impairment. Immediate medical care using advanced life support is essential.

Client Education for Cancer Treatment: Mucositis

• Examine your mouth (including the roof, under the tongue, and between the teeth and cheek) regularly. • If sores or drainage is present, contact your cancer health care provider. • Brush the teeth and tongue with a soft-bristled brush or sponges at least every 8 hours and after meals. • Avoid the use of mouthwashes that contain alcohol. • "Swish and spit" room-temperature tap water, normal saline, or salt and soda water on a regular basis (at least four times a day) and as needed according to changes in the oral cavity. • Drink 2 or more liters of water per day if another health problem does not require limiting fluid intake. • Take all drugs, including antibiotics and drugs for nausea and vomiting, as prescribed. • Use topical analgesic drugs as prescribed. • Take pain medications on schedule as needed. • Apply a water-based moisturizer to your lips as needed. • Use prescribed "artificial saliva" or mouth moisturizers as needed. • Avoid using tobacco or drinking alcoholic beverages. • Avoid spicy, salty, acidic, dry, rough, or hard food. • Use caution when drinking and eating hot foods to prevent burns. • If you wear dentures, keep them clean and make sure they fit well.

Recognize & Intervene for Complications of Cardiac Catheterization

• Myocardial infarction (MI) -Monitor vital signs record and report -Administer prescribed 02 -Administer prescribed NTG patch to promote vasodilation and therefore increase 02 delivery -Administer prescribed aspirin to inhibit platelet formation of thrombus -Administer prescribed opioids or analgesia to decrease chest pain and regularly elevate pt response • Stroke -Thrombolysis - "clot buster" medicine. -Thrombectomy. (Surgery) -Aspirin and other antiplatelets. -Anticoagulants (heparin or warfarin). -Blood pressure medicines. • Arterial bleeding -Apply direct pressure to the bleeding wound. Apply firm pressure over the wound. -Raise the injured area. • Thromboembolism -Thrombolysis - "clot buster" medicine. -Aspirin and other antiplatelets. -Anticoagulants (heparin or warfarin). • Lethal dysrhythmias Defibrillator • Death

Lightning Strike Prevention:

• Observe weather forecasts when planning to be outside. • A lightning strike is imminent if your hair stands on end, you see a blue halo around objects, and you hear high-pitched or crackling noises. If you cannot move away from the area immediately, crouch on the balls of your feet and tuck your head down to minimize the target size; do not lie on the ground or make contact with your hands to the ground. • Seek shelter when you hear thunder. Go inside the nearest building or an enclosed vehicle. Avoid isolated sheds and cave entrances. Do not stand under an isolated tall tree or structure (e.g., ski lift, flagpole, boat mast, power line) in an open area such as a field, ridge, or hilltop; lightning tends to strike high points. Instead, seek a low area under a thick growth of saplings or small trees. • Leave water immediately (including an indoor shower or bathtub) and move away from any open bodies of water. • Avoid metal objects such as chairs or bleachers; put down tools, fishing rods, garden equipment, golf clubs, and umbrellas; stand clear of fences, exposed pipes, motorcycles, bicycles, tractors, and golf carts. • If inside a car with a solid hood, close the windows and stay inside. If in a convertible, leave the car at least 49 yards (45 meters) away and huddle on the ground. • If inside a tent, stay away from the metal tent poles and wet fabric of the tent walls. • If you are caught out in the open and cannot seek shelter, attempt to move to lower ground such as a ravine or valley; stay away from any tall trees or objects that could result in a lightning strike splashing over to you; place insulating material between you and the ground (e.g., sleeping pad, rain parka, life jacket). • If inside a building, stay away from open doors, windows, fireplaces, metal fixtures, and plumbing. • Turn off electrical equipment, including computers, televisions, and stereos to avoid damage. • Stay off land-line telephones. Lightning can enter through the telephone line and produce head and neck trauma, including cataracts and tympanic membrane disruption. Death can result. Avoid use of cellular phones, which can transmit loud static that can cause acoustic damage.

Client Education for Cancer Treatment: Chemotherapy-Induced Peripheral Neuropathy

• Protect feet and other body areas where sensation is reduced; always wear shoes with a protective sole. • Be sure that shoes are well fitting to prevent creating sores or blisters from friction. • Inspect your feet daily (with a mirror, if needed) for open areas or redness. • Avoid extremes of temperature; wear warm clothing in the winter, especially over hands, feet, and ears. • Test water temperature with a thermometer when washing dishes or bathing. Use warm water rather than hot water (less than 105°F or 40.6°C). • Use gloves when washing dishes or gardening. • Do not eat foods that are too hot; allow them to cool before placing them in your mouth. • Eat foods that are high in fiber (e.g., fruit, whole-grain cereals, vegetables). • Drink 2 to 3 liters of fluid (nonalcoholic) daily unless your primary health care provider orders a fluid-restricted diet. • Get up slowly from a lying or sitting position. If you feel dizzy, sit back down until the dizziness fades before standing; then stand in place for a few seconds before walking or using the stairs. • To prevent tripping or falling, look at your feet and the floor or ground where you are walking to assess how the ground, floor, or step changes. • Avoid using area rugs, especially those that slide easily. • Keep floors free of clutter that could lead to a fall. • Use handrails when going up or down steps.

Client Education for Cancer Treatment: Preventing Injury or Bleeding

• Use an electric shaver. • Use a soft-bristled toothbrush. • Do not have dental work performed without consulting your cancer health care provider. • Do not take aspirin or any aspirin-containing products unless prescribed. Read the label to be sure that the product does not contain aspirin or salicylates. • Do not participate in contact sports or any activity likely to result in your being bumped, scratched, or scraped. • Avoid hard foods that would scrape the inside of your mouth. • Eat only warm, cool, or cold foods to avoid burning your mouth. • Check your skin and mouth daily for bruises; swelling; or areas with small, reddish-purple marks (petechiae) that may indicate bleeding. • Notify your cancer health care provider if you: • Are injured and persistent bleeding results • Have menstrual bleeding that is excessive for you • See blood in your vomit, urine, or bowel movement • Avoid trauma with intercourse. • Avoid anal intercourse. • Take a stool softener to prevent straining during a bowel movement. • Do not use enemas or rectal suppositories. • Do not wear clothing or shoes that are tight or that rub. • Avoid blowing your nose or placing objects in your nose. If you must blow your nose, do so gently without blocking either nasal passage. • Avoid activities that increase the pressure in your brain.

Client Education for Cancer Treatment: Skin Protection During Radiation Therapy

• Wash the irradiated area gently each day with either water or a mild soap and water as prescribed by your radiation therapy team. Rinse soap thoroughly from your skin. • Avoid friction to the area being treated. Use your hand rather than a washcloth. • If ink or dye markings are present to identify exactly where the beam of radiation is to be focused, take care not to remove them. • Dry the treatment area with patting rather than rubbing motions; use a clean, soft towel or cloth. • Use only powders, ointments, lotions, or creams that are prescribed by the radiation oncology department on your skin at the radiation site. • Wear soft clothing over the skin at the radiation site. • Avoid wearing belts, buckles, straps, or any type of clothing that binds or rubs the skin at the radiation site. • Avoid exposure of the irradiated area to the sun: • Protect this area by wearing clothing over it. • Try to go outdoors in the early morning or evening to avoid the more intense sun rays. • When outdoors, stay under awnings, umbrellas, and other forms of shade during the times when the sun's rays are most intense (10 a.m. to 4 p.m.). • Avoid heat exposure.

Arthropod Bite/Sting Prevention:

• Wear protective clothing, including gloves and shoes, when working in areas known to harbor venomous arthropods such as spiders, scorpions, bees, and wasps. • Cover garbage cans. Bees and wasps are attracted to uncovered garbage. • Use screens in windows and doors to prevent flying insects from entering buildings. • Inspect clothing, shoes, and gear for insects before putting on these items. • Shake out clothing and gear that have been on the ground to prevent arthropod "stowaways" and inadvertent bites and stings. • Consult an exterminator to control arthropod populations in and around the home. Eliminating insects that are part of the arthropod's food source may also limit their presence. • Identify nesting areas such as yard debris and rock piles; remove them whenever possible. • Do not place unprotected hands where the eyes cannot see. • Avoid handling insects and arthropods or keeping them as "pets." • Do not swat insects, wasps, and Africanized bees because they can send chemical signals that alert others to attack. • Carry a prescription epinephrine autoinjector and antihistamines if known to be allergic to bee and wasp stings. Ensure that at least one significant other person is also able to use the autoinjector.

Mucositis

(inflammatory process that affects the mucous membranes of the oral mucosa and GI tract) is a dose-limiting side effect of cancer therapy, and severe cases may stop or delay treatment.

Complications with Oxygen Therapy: Oxygen Toxicity

A continuous oxygen level greater than 50% for more than 24 to 48 hours may injure the lung and reduce tissue integrity.

levels of consciousness

Alert: awake and responsive Confused: note that confusion can occur anywhere along this spectrum and is not always present prior to the patient becoming somnolent, lethargic, etc... It is possible to have a patient who is somnolent or even lethargic and still oriented. Somnolent: sleepy Lethargic: very drowsy, falls asleep in between care Obtunded: difficult to arouse Stuporous: very difficult to arouse Unresponsive/Coma: unarousable

General Complication: Altered Peripheral Nerve Function

Although tumors in the spine can change peripheral nerve function, the more common cause is chemotherapy. Patients with chemotherapy-induced peripheral neuropathy (CIPN) report loss of sensation, especially in the lower extremities. Symptoms include numbness, tingling, neuropathic pain, and changes in gait and balance.