NU 300 EXAM 1: CANCER, CULTURE, PAIN, MED-SURG NURSING

pain hierarchy of assessing pain

1) Numeric (0-10) 2) Wong-Baker FACES 3) Verbal Descriptor Scale 4) FLACC 5) Non-Verbal 6) Dementia

adult health nursing scope of adult health nursing

18 to >100 years of age Majority >65 years of age Patient (Client)/Family Manage ACTUAL or POTENTIAL health problems affecting the individual, significant other, and community

culture shock

A disorder that occurs in response to transition from one cultural setting to another A person's former behavior patterns are ineffective in such a setting and basic cues for social behavior are absent Expressions of shock may range from silence, immobility, agitation, rage or fury

health concepts

ACID-BASE BALANCE CELLULAR REGULATION CLOTTING COGNITION COMFORT ELIMINATION FLUID AND ELECTROLYTE BALANCE GAS EXCHANGE GLUCOSE REGULATION IMMUNITY MOBILITY NUTRITION PERFUSION SENSORY PERCEPTION SEXUALITY TISSUE INTEGRITY

describe advantages and disadvantages of oral chemotherapy

ADVANTAGES: More convenient, less toxic to patients and personnel DISADVANTAGES: Control of treatment is lost (Protection, Compliance, Correct administration, Recognition and management of side effects) Cannot be crushed, split, broken or chewed

Disseminated Intravascular Coagulation (DIC)

Abnormal activation of the proteins involved in blood coagulation, causing small blood clots to form in vessels and cutting off the supply of oxygen to distal tissues -clotting, bruising, orifice bleeding, altered lab values Goal is to prevent and recognize early Heparin is given early on

NEUROPATHIC PAIN

Abnormal pain processing Difficult to treat Burning, shooting, stabbing, pins and needles in nature

acculturation

An involuntary process of adopting to a dominant culture. The non-dominant cultural group is often forced to learn the new culture to survive. POSITIVES Has been linked to better health care access and utilization, cultural enrichment. NEGATIVES Stress, anxiety, similar health outcomes as the dominant culture in future generations of first generation immigrants, alienation from culture of origin

how should bodily fluids from patients receiving chemotherapy be handled?

Anyone preparing, giving, or handling chemotherapy drugs or handling excreta from patients receiving chemotherapy should wear PPE -double gloves or chemo gloves, gown, mask, eye protection

Tumor Lysis Syndrome

As cancer cells die from treatment, they degrade and release K+ and purines into the blood stream faster than the body can get rid of them. Purines deposit uric acid crystals which deposit in the kidneys injuring the kidneys. Patients develop hyperkalemia Rx - HYDRATION, HYDRATION, HYDRATION 3-5L the day before, on, and 3 days after treatment Some fluids should be alkaline Prevent NV Polystyrene sulfonate, glucose & insulin for K+ Allopurinol for Uric Acid

steps of nursing process

Assessment- Notice Diagnosis- Analysis, interpreting Planning- responding Implementation- responding Evaluation- reflecting

benign vs malignant cells

BENIGN: does not spread controlled growth rate smaller cell nucleus non-cancerous MALIGNANT: migrates rapid and uncontrolled growth chromosomal abnormalities

methods of treating/assessing pain

Behavorial: FLACC, Non-verbal, Dementia (Use if the patient is unable to give a self-report) reduce patient focus on pain guided imagery, distraction, relaxation techniques Pharmaceutical analgesic, nonanalgesics, anticonvulsant, antidepressant Non-pharmaceutical PT/OT, Aquatherapy, Acupuncture, Low-Impact exercises (yoga, walking), Hot/Cold therapy, TENS, massage

health problems individuals with dwarfism may encounter

Common health problems: arthritis, hydrocephaly, ear infections, obesity, spinal stenosis, menstrual complications, reduced fertility, fibroids, early menopause. Common surgeries: Myringotomy, spinal fusion, laminectomy, joint replacement, osteotomy, leg-lengthening surgeries, etc. High risk for falls. Provide adaptive resources(footstools, reaching tools, etc.)

fidelity

Dedication, loyalty, truthfulness, advocacy and fairness to patients Nurses are encouraged to keep their commitments, based on their virtue of caring

cultural diversity

Differences among people which may or may not be visible

topical route

Duragesic (Fentanyl)-72 hrs!!

cognitive impairment

ETI & S/S: Difficulty concentrating Difficulty learning new information Memory loss May last for a few years after Chemotherapy ends Idiopathic - structural changes do occur in the brain and are usually gone by 3 years after Chemotherapy ends INTERVENTIONS: PRIORITY directed toward supporting the patient -Listen -Reassure others have had the same experience and it is temporary -Discourage activities that impair cognition

etiological factors of cancer Who are the people at the highest risk for cancer?

Exposure to Carcinogens: Chemical Physical Viral Dietary Genetic Predisposition Immunocompromised patients

quality indicators

Falls Falls with injury Pressure Injury Turnover

Madeline Leininger and Theory of Transcultural Nursing

Focus on health, care and illness patterns of people with similarities and differences in their cultural beliefs, values and practices

what safety measures should be employed by nurses giving PO chemotherapeutic agents?

Have the same PPE requirements as IV agents

What health problems do LGBT individuals encounter

Health disparities: Lesbians: Higher incidence of substance abuse and obesity. Are more prone to lung cancer, cardiovascular disease, depression and suicide. Bisexual women engage in more substance abuse, report more back problems, digestive disorders, & chronic fatigue. Gay men or MSM: Higher rates of colon & anal cancers, eating disorders, risky sexual behaviors, substance abuse, depression & suicide. Transgendered: Exogenous hormones increase cardiovascular risks, liver disease, diabetes, high lipids, infertility, malignant or benign liver tumors.

S/E of: Ibuprofen Acetaminophen Morphine

IBUPROFEN Watch renal function (BUN, Creatinine) Increased GI bleed, stomach ulcers, decreased platelet aggregation, CV complications APAP Monitor LFTs MORPHINE Constipation, NV, itching, pinpoint pupils, respiratory depression

PCA

Improved pain relief and patient satisfaction Delivers set amount through IV Morphine PCA 2/15/4/32 means: 2 mg q 15 min with a 4 hr lockout of 32 mg

epidural route

Instillation of blocking agent into epidural space SE: urinary retention, hypotension Toxicity: ringing in ears, metallic taste, irritability, seizures

culture

Integrated patterns of behavior acquired over time. They include beliefs, values, customs, norms, habits, language, thoughts and ways of life.

what is EBP and why is it important to the delivery of safe-high quality care?

Integration of the BEST current evidence and practices to make decisions about patient care. Promotes safety Based on reliable studies, guidelines, consensus, and expert opinion Nurses must respect the values of the patient at all times even if they differ from their own ANA Code of Ethics Provision 5.5: Nurses must maintain competence and STRIVE FOR EXCELLENCE in their nursing practice, whatever the role or setting

considerations nurses take into account regarding nutrition

Nutrition: Meaning of food, nutritional deficiencies, food preferences, rituals. Respect patient's preferences and beliefs about food and what it means to them. Coordinate the diet with the registered dietician to ensure that patients receive foods they can tolerate and are culturally appropriate.

Conduct and document a complete pain assessment: What does it entail? (COLDSPA or OLDCART) Hierarchy of pain assessments?

OLDCART Onset: when did it start? Location: where is it? Duration: constant or intermittent? Characteristics/Intensity: Describe the pain. Pain scale, superficial vs deep, stabbing/aching/sharp/dull Aggravating factors: what makes it worse? Relieving factors: what makes it better? Treatment: what have you done or tried? ICE Impact on daily life/ADLs Coping strategies Emotional response COLDSPA Character Onset Location Duration Severity Pattern Associated Factors SELF REPORT is GOLD standard

Syndrome of Inappropriate Antidiuretic Hormone (SIADH)

Occurs mostly with brain tumors Excess ADH is released → Fluid volume overload with low sodium levels

who are members of interprofessional team

Patient Family Nurses Unlicensed Assistive Personnel (UAP) Physician Respiratory Therapy Occupational Therapy Physical Therapy

risks involved in the use of informatics and technology

Patient privacy at risk Photos of patients Facebook and other social media

QSEN competencies

Patient-centered care Evidence-based practice Teamwork and collaboration Safety Quality improvement Informatics (at end of chapter)

health disparities

Preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by socially disadvantaged populations Decrease health care disparities caused by: Poor communication Health care access Health literacy Health care provider biases Discrimination Special Needs of Older Adults, Ethnic Minorities, LGBTQ population

prevention strategies for cancer

Primary prevention: modify lifestyle remove risk tissues (moles, breasts, ovaries, etc) vaccinations genetic testing Secondary: screening (mammogram, 40 y.o.; colonoscopy, 50 y.o.; etc)

TNM staging for cancer

Primary tumor (T) Tx, To, Tis, T 1-4 Regional Lymph Nodes Nx, No, N 1-3 Distant Metastasis Mx, Mo, M 1

Purnell's Domain purpose

Proposed 12 essential areas to assess and understand a culture. Each domain includes concepts that need to be assessed when providing care to patients in various settings. These domains can also be used to help nurses understand their own culture.

QSEN

Quality and Safety Education for Nurses safety and excellent care for our patients

Why is teamwork and collaboration important in healthcare? ANA Code of Ethics 1.5

Respect for persons extends to all individuals with whom the nurse interacts. Nurses maintain professional, respectful and caring relationships with colleagues and are committed to fair treatment, integrity-preserving compromise, and the resolution of conflicts. Nurses function in many roles and many settings, including direct care provider, care coordinator, administrator, educator, researcher, and consultant. In every role, the nurse creates a moral environment and culture of civility and kindness, treating others, colleagues, employees, co-workers, and students with dignity and respect. This standard of conduct includes an affirmative duty to act to prevent harm. Disregard for the effect of one's actions on others, bullying, harassment, manipulation, threats or violence are always morally unacceptable behaviors. Nurses value the distinctive contribution of individuals or groups, and collaborate to meet the shared goal of providing efficient, effective, and compassionate health services seeking to achieve quality outcomes in all settings.

cultural competence

Respecting all differences and not letting one's biases influence others

acute pain

Temporary Sudden onset Localized Physiological responses: Increased HR, BP, RR Dilated pupils Sweating Behavioral responses: Restlessness Inability to concentrate Apprehensive Distressed

what is the nurse's role who is caring for the patient receiving chemotherapy?

The goal is to protect the patient from life threatening side effects and manage the distressing side effects. For some the side effects are so miserable, patients opt to stop taking the chemotherapy.

patient autonomy

The right of a patient to make informed choices regarding his or her health care.

social justice

To uphold moral, legal, and humanistic principles related to health

health care practices

Traditional, magico-religious practices, self treatment, views on mental illness, use of blood products, organ donation table in book???

role of RN in delegation

Transferring to a competent person the authority to perform a selected nursing task or activity in a selected patient care situation

Spinal Cord Compression

Tumors impinge on the cord or vertebrae collapse Permanent damage Rx with high dose steroids or radiation and/or surgery

what does Joint Commission recommend to ensure patient centered care

Understandable discharge instructions Explanation of self care activities Ongoing emergency care information List of community resources Knowledge of language, culture, and health literacy Medication reconciliation

examples of integrating informatics and technology into patient care

Use of information and electronic technology to communicate, manage knowledge, prevent error, and support decision making EHR Document nursing and interprofessional care Nurses work station or at the bedside (POC) Retrieval of data for EBP and Quality Improvement Radiofrequency Identification (RFID) Track any person or object electronically Bar-Code Medication Administration (BCMA)

clinical judgement

an interpretation or conclusion about a patient's needs, concerns, or health problems, and/or the decision to take action (or not), use or modify standard approaches, or improvise new ones as deemed appropriate by the patient's response

veracity

being honest and telling the truth and is related to the principle of autonomy

Nonmaleficence

duty to do no harm

sepsis

goal is to prevent and recognize early signs of infection -temp >104* -assess wound -cloudy urine

HIGHEST priority

safety

role of the nurse as an advocate for patients with pain

• Nurses must coordinate care and provide safe transition management, provide information, perform thorough and objective pain assessments, and take into account the ethical and legal ramifications of treating patients who are experiencing pain. • Nurses must have knowledge and experience with theories on pain and how it is treated serves to make nurses better able to treat patients who have pain—whether it is chronic or acute • Advocate by believing patient's self report of pain

ASKED model of cultural competence

AWARENESS Are you aware of your personal biases and prejudices toward cultures different from yours? SKILL Do you have the skill to conduct a cultural assessment and perform a culturally based physical assessment? KNOWLEDGE Do you have knowledge of the patient's worldview(how a person looks at the universe to form values in their life and world)? ENCOUNTERS How many face to face encounters have you had with patients from diverse cultural backgrounds? DESIRE What is your desire to want to be culturally competent?

steps in developing cultural humanity

Ability to maintain an interpersonal stance that is other-oriented (or open to the other) in relation to aspects of cultural identity that are most important to the person. Maintain lifelong learning Engage in continuous self-reflection Become comfortable with "not knowing" Recognize there may be power/privilege dynamics

Homelessness issues Different types of homelessness

Absolute: Having no physical home Relative: Have some sort of shelter, but it may not be safe or sanitary. The homeless avoid the health care community because: -Mistrust of health care providers -Fear of discrimination -Language barriers -Inability to understand medical information -Inability to adhere to treatment Prone to cardiovascular disease, infection and mental disorders

what is medication reconciliation

Actual current medications prescribed at the time of admission, transfer, or discharge

Addiction vs tolerance? Does withdrawal mean you're addicted?

Addiction: psychological continued, compulsive cravings and use despite harm tolerance: normal, decreased response to drug effects over time physical dependence: normal response that occurs with opioids are repeatedly administered over time withdrawal: N/V, abdominal cramping, muscle twitching, sweating, delirium, convulsions manage by tapering off slowly withdrawal does not mean addiction; you can withdraw from a med and only be on it a short amount of time placebo: pretends to give medicine but it is ethically wrong and report anyone who does it

stereotyping

Assuming that all people from a particular culture are the same.

how does cancer impact the following?

BONE MARROW: suppresses WBC and RBC production MOTOR AND SENSORY: Invasion of bone, brain, nerves Pain Bone metastasis- pain, fractures, spinal cord compression & hypercalcemia which leads to decreased mobility PSYCHOSOCIAL: fear NEUROLOGICAL: Peripheral Neuropathy RESPIRATORY AND CARDIAC: Compression of the airways and vasculature GI TRACT: Increased need for nutrients (Protein and Carbs esp.) for tumor growth Cachexia (weakness and wasting of the body)

Hypercalcemia

Bones metastasis and immobility →Ca++ release from the bone Slow elevation may be fatal Rx with hydration (NS) and dialysis

what is the stimulus for the conversion of normal cells to malignant cells?

Carcinogenesis, also called oncogenesis or tumorigenesis, is the formation of a cancer, whereby normal cells are transformed into cancer cells. The process is characterized by changes at the cellular, genetic, and epigenetic levels and abnormal cell division. Oncogenes start the reproduction process, suppressor genes halt cellular reproduction

patient-centered care some examples

Caring, Compassion, Holism Respect for diverse preferences and needs Managing Chronic Health Issues and Acute Pain Individualized coordinated care ANA Code of Ethics 1 The nurse practices with compassion and respect for the inherent dignity, worth, and personal attributes of every person, without prejudice. • Pet therapy • Massage therapy • Guided imagery • Biofeedback • Exercise and fitness programs • Nutritional supplements • Massage therapy • Health-focused television • Music therapy • Acupuncture • Acupressure • Disease management programs

S/S of cancer nurses should screen for

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

who is qualified to administer chemotherapy?

Chemotherapy can only be given by the RN with extra training/certification. All RNs monitor and provide care for patients receiving chemotherapy

explain to the patient how chemotherapy treats cancer and affects non-cancerous cells?

Chemotherapy is systemic and kills cancer cells making it necessary for metastatic cancers. Chemotherapy also kills healthy cells, particularly rapidly dividing cells (skin, hair, intestinal tissues, sperm and blood forming cells) Chemotherapy may be used alone or as adjunctive therapy with radiation and/or surgery. Genetic therapy is available to help determine the most effective agents for patients. Doses are based on square meters of body surface area Most chemotherapy is delivered via the preferred IV route (watch for extravasation)

ethnicity

Common social customs, values and beliefs of a group. Not race.

guidelines for communicating with Non-English speaking patients

Communication: Dominant language, voice variations, willingness to share thoughts/feelings, eye contact, use of touch. Use dialect-specific interpreters familiar with health care Avoid the use of relatives Speak slowly and allow patient time to translate Use common words in the patient's language Maintain eye contact where appropiate Be careful with nonverbal facial expressions and body language

describe process of quality improvement

Continuous process using indicators (data) to monitor care outcomes and develop solutions to change and improve care PDSA PLAN DO STUDY ACT Identify indicators to monitor quality and effectiveness of health care Assess and evaluate data Recommend ways to improve processes Implement activities to improve care processes

What is the nurse's role in surgery for patient's with cancer?

Coordinate care Encourage patient to express their feelings Encourage patient to look at and touch the operative site Encourage patient to participate in care ( ex: wound dressings) Provide support group contact for patients and families Have some who has coped with the same issue come for a visit Referral to a mental health care provider may be needed if the patient has persistent depression Develop exercise regimes to maintain strength and function

alopecia

ETI & S/S: May be only thinning → full body loss. Temporary and grows back beginning about 1 month after Chemotherapy stops. New hair may be different in texture, color, & thickness. Cannot be prevented if the chosen drug causes it. INTERVENTIONS: PRIORITY is protecting scalp from injury (sunscreen, head coverings, etc) Cutting hair before Chemotherapy allows for a better wig fit Getting the wig before chemotherapy gives the hair dresser the chance to make a wig resembling the patient's hairstyle

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

explain how radiation works for patients with cancer

Given over multiple doses/days Directed at the tumor to kill or halt mitosis of tumor cells TELETHERAPY: Radiation is delivered from outside the patient so the patient is not radioactive BRACHYTHERAPY: Radiation is delivered from within the patient therefore the patient is radioactive UNSEALED isotopes are given IV or PO and the patient is radio active until the isotope is eliminated. Excreta is radioactive. SEALED isotopes are solids implanted in or near the cancer. The patient emits radio waves but excreta is not radioactive. Implants may be left in permanently or for short prescribed time periods.

grading system for cellular characteristics

Grading addresses how malignant a tumor is. The more aggressive and less similarity to the tissue of origin, the higher the grade. The higher the grade, the poorer the outcome Gx: grade not determined G1: well differentiated low grade of malignant change malignant and strong growing G2: more moderately differentiated G3: poorly differentiated few normal characteristics G4: no normal characteristics finding tissue of origin is nearly impossible

mucositis

INTERVENTIONS • Examine your mouth every 4 hours • Brush the teeth and tongue with a soft-bristled brush or sponges every 8 hours and before meals. • Rinse the mouth with a solution of one-half peroxide and one-half normal saline every 12 hours. • Avoid the use of mouthwashes that contain alcohol; use a bland rinse (normal saline) • Drink 2 or more liters of water per day • Avoid using tobacco or drinking alcoholic beverages. • Avoid spicy, salty, acidic, dry, rough, or hard food. • Cool liquids to prevent burns or irritation

chronic pain

Longer than 3 months Gradual onset No biological purpose May not be associated with physiological responses Interferes with ADLs and relationships Behavioral responses: Depression Hopelessness

peripheral neuropathy

Loss of sensation in the feet or hands, Orthostatic hypotension, Erectile dysfunction, Neuropathic pain, Loss of taste, Constipation INTERVENTIONS: protect from injury inspect feet prevent falls Avoid extremes of temperature, test water temp Eat foods that are high in fiber Drink 2-3 L of fluids

Extravasation of Chemotherapy

Major complication of IV Chemotherapy with vesicants. When the IV infiltrates, the drug is given into soft tissue and due to the vesicant nature, the tissue is destroyed. If not prevented: Heat or cold may be applied dependent on the particular agent used. Antidotes or chemoprotective agents may be injected into the site. Surgery may be needed.

what are core measures?

Medicare and/or Medicaid (CMS) funding requires health care organizations to follow Examples: Heart failure Stroke VTE Acute MI

Explain role of 3 analgesic groups in pain managements Why is a multimodal approach to pain management effective?

NSAIDS ibuprofen renal function (BUN, creatinine) Increased GI bleed, stomach ulcers, decreased platelet aggregation, CV complications Helps with inflammatory pain (RA) ACETAMINOPHEN hepatotoxic, monitor LFT's first line for musculoskeletal pain OPIOID Moderate-severe pain major S/E ADJUVANT given for something more than pain codeine for coughing, opioid for diarrhea, etc anticonvulsants and antidepressants for pain

what can the nurse do to prevent and provide comfort for the side effects of radiation?

Patients are anxious and fearful so offer accurate, objective information about the process, purpose, and side effects. Skin in the path of radiation becomes very dry and may breakdown. Shield bone marrow, skin, mucous membranes, hair follicles, sperm & eggs when possible. Consult a dietitian as dysphagia and altered taste accompany radiation from chest level up. Head and neck radiation leads to xerostomia (dry mouth) which leads to life long increased incidence of tooth decay. *table 22-2*

photodynamic therapy

Patients are given IV medications which deposit in all cells but dissipate from normal cells in a couple of days (2-3 days). After the dissipation time, the patient receives laser therapy which destroys the cancer cells with the medication still present. Patients have marked photosensitivity for 12 weeks following therapy and should be instructed on how to protect from light and to remain homebound for 3 months *chart 24-11* for teaching INTERVENTIONS Plan to avoid leaving your home during daylight hours for anywhere from 1 to 3 months. Cover all windows with light-blocking shades or heavy drapes/curtains. Replace high-wattage light bulbs with lower-wattage ones Wear all protective clothing Drink plenty of H2O Continue to wear dark glasses, even indoors

RIGHTS of delegation

Right Task Right Circumstances Right Person Right Communication Right Supervision ANA Code of Ethics 4 The nurse has authority, accountability, and responsibility for nursing practice' makes decisions and takes action consistent with the obligation to promote health and to provide optimal care.

anemia

S/S: • Pallor • Cool to the touch, cold intolerance • Nails become brittle, clubbed fingernails (>160*) • Tachycardia • Murmurs and gallops • Orthostatic hypotension • Dyspnea on exertion • Decreased O2 sat (normal 95-100) • fatigue MEDS: Epoetin Alfa (Epogen and Procrit) Darbrpoetin Alfa ( Aranesp) -Side effects: Hypertension Hypercoagulability Stroke MI (heart attacks) Promotes growth of some forms of cancers INTERVENTIONS: • Instruct the patient to stop activity when shortness of breath or palpitations are present • Perform complete bed bath only every other day • Provide four to six small meals • Urge the patient to drink small amounts of protein shakes • Monitor oxygen saturation and respiratory rate during any activity

steps of SBAR communication

SITUATION Briefly describe situation BACKGROUND Briefly state pertinent history what got us to this point? ASSESSMENT Summarize the facts What do you think is going on? RECOMMENDATION What are you asking for? What needs to happen next?

Superior Vena Cava Syndrome

SVC compression/obstruction from tumor or blood clot Edema of head, neck, face, eyes in the morning → engorged blood vessels and erythema of the upper body, epistaxis, dyspnea → hemorrhage, cyanosis, mental status changes, ↓CO,↓BP & death Rx -high dose radiation, stents, angioplasty, surgery to de-bulk tumor

Joint Commission require in regards to spirituality? How can nurses support spirituality?

Spirituality: Religious beliefs & practices, use of prayer, practices that give meaning to life. The joint commission requires all health care facilities to address the spiritual needs of their patients. Professional chaplains that are trained to help patients meet their spiritual needs are available in most healthcare facilities. They assist families to allay fear and anxiety and help them cope with their loved one's illness or end of life. They can support staff when difficult situations occur.

hormonal therapy for patients with cancer

Used to deprive tumors of what they need to grow FEMALES: Masculine hair pattern Amenorrhea Loss of breast tissue Acne Fluid retention Hypocalcemia Liver dysfunction VTE MALES: Female hair pattern Thinner facial skin Female fat pattern Gynecomastia Bone loss Testicular and penile atrophy VTE Fluid retention Hypocalcemia Liver dysfunction

cultural sensitivity

When a person is aware of and respects cultural differences therefore, avoiding language or actions that may be offensive when interacting with people of diverse cultures.

What is mild-moderate pain and how is it treated? Severe pain?

mild-moderate pain: nonopioid and NSAIDs severe pain: opioids

thrombocytopenia

normal Platelet count 150,000 to 450,000 ETI: Platelet counts <50,000/mm3 leads to prolonged bleeding Platelet counts < 20,000/mm3 leads to spontaneous and uncontrollable bleeding MEDS: Oprelvekin (Neumega) may be used to stimulate production of platelets S/E: Fluid retention, hypotension, tachycardia, conjunctival bleeding INTERVENTIONS: • Avoid IM injections and venipunctures or use smallest needle possible • Apply firm pressure to the needle stick site for 10 minutes or until the site no longer oozes blood. • Apply ice to areas of trauma. • Test all urine and stool for the presence of occult blood. • Observe IV sites every 4 hours for bleeding. •Do not administer enemas • Use a soft-bristled toothbrush or tooth sponges •Use an electric shaver •Do not take aspirin •Notify your cancer health care provider if you: -Are injured and persistent bleeding results -Have excessive menstrual bleeding -See blood in your urine or bowel movement •Take a stool softener

neutropenia

normal WBC 4,000-11,000 ETIOLOGY: myleosuppression increased infection risk S/S: depressed immune response, fever and purulent drainage may not manifest MEDS: biological response modifiers (BRM) and growth factors to counteract the myelosuppression INTERVENTIONS: • PRIORITY- protect the patient from infection in the hospital and to educate the patient and family on how to prevent infection in the home • Monitor vital signs every 4 hours, including temperature. • Inspect the patient's mouth at least every 8 hours. • Inspect the patient's skin and mucous membranes (especially the anal area) for the presence of fissures and abscesses at least every 8 hours. • Change wound dressings daily. • Obtain specimens of all suspicious areas for culture (as specified by the agency), and promptly notify the physician. • Assist the patient in coughing and deep-breathing exercises • Change IV tubing daily • Monitor the WBC • Avoid the use of indwelling urinary catheters. • Keep fresh flowers and potted plants out of the patient's room - hospital policy based. • Teach the patient to avoid eating raw fruits and vegetables • Do not drink water, milk, juice, or other cold liquids that have been standing at room temperature for longer than an hour • Take temp daily

NOCICEPTIVE PAIN

normal transmission of pain

beneficence

nurse's action should promote good; kindly action; maximize benefits

What safety measure should be instituted for radiation therapy? (to protect patient and other personnel)

• Assign the patient to a private room with a private bath. • Place a "Caution: Radioactive Material" sign on the door of the patient's room. • If portable lead shields are used, place them between the patient and the door. • Keep the door to the patient's room closed as much as possible. • Wear a dosimeter film badge at all times while caring for patients with radioactive implants. The badge offers no protection but measures a person's exposure to radiation. Each person caring for the patient should have a separate dosimeter to calculate his or her specific radiation exposure. • Wear a lead apron while providing care. Always keep the front of the apron facing the source of radiation (do not turn your back toward the patient). • Pregnant nurses should not care for these patients; do not allow pregnant women or children younger than 16 years to visit. • Limit each visitor to one-half hour per day. Be sure visitors stay at least 6 feet from the source. • Never touch the radioactive source with bare hands. In the rare instance that it is dislodged, use a long-handled forceps to retrieve it. Deposit the radioactive source in the lead container kept in the patient's room. • Save all dressings and bed linens in the patient's room until after the radioactive source is removed. After the source is removed, dispose of dressings and linens in the usual manner. Other equipment can be removed from the room at any time without special precautions and does not pose a hazard to other people

Joint Commission National Patient Safety Goals

• Identify patients correctly. • Improve staff communication. • Use medicines safely • Use alarms safely • Prevent infection • Prevent mistakes in surgery