NURS 2040 Exam 2 (mobility, protection, metabolism, cancer)

parts of the spinal cord

1. Cervical (7) 2. Thoracic (12) 3. Lumbar (5) 4. Sacral (5) 5. Coccygeal (4)

administration sites for chemo

PICC line, port, hand (not encouraged)

parathyroid hormones (PTH)

What is secreted in response to hypocalcemia ◦Regulates calcium and phosphorus metabolism by acting on bones, the kidneys, and the GI tract DOES NOT affect metabolism

low back pain

acute or chronic localized or diffuse (specific area) radicular or referred (irritated nerve or radiating pain/larger area of pain)

HIV can be transmitted through

blood, semen, vaginal secretions, rectal fluid, breast milk

meningitis

inflammation of the meninges of the brain and spinal cord caused by viral, bacterial, or fungal agents CNS, musculoskeletal system

development of cancer

initiation, promotion, progression, metastasis

adrenal gland

outer cortex and inner medulla

compare/contrast addison's and cushing's disease

see image

William's position

semi Fowler's with knees flexed to reduce low back pain

parathyroid glands

small pea-like organs that regulate calcium and phosphate balance in blood, bones, and other tissues 4 small glands located close to or within back surface of thyroid gland normal Ca level- 9-11

patient and family education regarding infection/injury prevention

• Avoid uncooked meats, wash all fruit & vegetables • Brush teeth with soft toothbrush 4 x day • Do not garden/clean up after pets • Bath & moisturize daily • Avoid large crowds • Report increase in temp

Oncological Emergencies: Infiltrative

• Cardiac Tamponade • Decrease fluid around the heart • Carotid Artery Rupture • IV and blood products

nursing interventions r/t osteomyelitis

• Elevate the affected extremity • Assess and document the patient's NV status, including: • Pain • Movement • Sensation • Warmth • Temperature • Distal pulses • Capillary refill (not as reliable as the above indicators) • The affected limb may need to be amputated

chronic osteomyelitis

• May be a persistent problem • Ulceration & sinus tract formation • Localized pain • Drainage from affected area

Reduced Immunity Patients - Best Practices and Education

• Private room, if possible • Frequent Handwashing • Restrict Visitors • Use of Dedicated Equipment • Monitor Labs Daily • Avoid Use of Indwelling Catheters • Frequent Assessments

treatment of MS

• Treat disease and provide symptom relief • Drug therapy/ No cure ---Treat new attacks (exacerbations) ---Prevent the occurrence of future attacks ---Slow or prevent disease progression ---Treat the chronic symptoms of the disease • Psychosocial support

other drugs to treat MS

•CNS stimulants to treat fatigue •Muscle relaxants to treat spasticity (Balcofan) •Anticholinergics to treat bladder symptoms •Antidepressants/Antiseizure Drugs as indicated

cancer management

- surgery: usually chosen when a confined, local area - radiation: used to kill cancer cells but can also be used as local tx - pharmacologic management- biologic response modifiers and targeted therapies -can all be used separately or in conjunction

how cancer occurs

-cell DNA is damaged -proto-oncogenes become oncogenes and produce more cyclins -tumor suppressor genes malfunction -cell division goe unchecks -cell division become malignant

secondary prevention: screening and early detection

-identify those high at risk -early detection is key -personal and health hx -physical/self exam -screening tools: **pap test ** mammogram **colonoscopy **digital rectal exam **FOBT **PSA blood test

how does cancer happen?

-mutation happens in genes of DNA -carcinogen chemicals or energy causes mutation in DNA -cancer cells reproduce and don't stop at the check points

risk factors for hyperthyroidism

-women > men -family history -between 20-40 yo -pregnancy (during & 1 year after) -smoking -exposure to or excess of iodine/iodine drugs (table salt, kelp) -certain medical treatments and drugs (AIDS meds, MS meds) -trauma to thyroid -major stress -aspartame -nutritional/dietary deficiencies -bacterial/viral infections

diagnostic testing r/t lumbosacral back pain

-x ray -myelogram -MRI: images of spinal tissues, spinal cord, nerves, disks -CT -EMG- nerve conduction test at rest and with contraction

The nurse is providing medication instructions to a client with multiple sclerosis receiving baclofen. Which information should the nurse include in the instructions? 1.Watch for urinary retention as a side effect. 2.Stop taking the medication if diarrhea occurs. 3.Restrict fluid intake while taking this medication. 4.Notify the primary health care provider if fatigue occurs.

1 Baclofen, a skeletal muscle relaxant, also is a central nervous system (CNS) depressant, which can cause urinary retention. The client should not restrict fluid intake. Constipation, rather than diarrhea, is an adverse effect of baclofen. Fatigue is a CNS effect that is most intense during the early phase of therapy and diminishes with continued medication use. It is not necessary to notify the primary health care provider if fatigue occurs.

A client with Graves' disease has exophthalmos and is experiencing photophobia. Which nursing action would best assist the client with these manifestations? 1.Obtain dark glasses for the client. 2.Lubricate the eyes with tap water every 2 to 4 hours. 3.Administer methimazole every 8 hours around the clock. 4.Instruct the client to avoid straining or heavy lifting because this effort can increase eye pressure.

1 Because photophobia (light intolerance) accompanies this disorder, wearing dark glasses is helpful in alleviating the problem. Tap water, which is hypotonic, could actually cause more swelling to the eye because it could pull fluid into the interstitial space. In addition, the client would be at risk for developing an eye infection because the solution is not sterile. Methimazole is a thyroid inhibitor, but medication therapy for Graves' disease does not help to alleviate the clinical manifestation of exophthalmos. There is no need to avoid straining or heavy lifting with exophthalmos.

The clinic nurse evaluates a client's response to levothyroxine after 8 weeks of treatment. What therapeutic responses to the medication should the nurse expect? Select all that apply. 1. apical heart rate of 88/min 2. elevation of mood 3. improved energy level 4. skin is cool and dry 5. slight weight gain

1, 2, 3 The client's therapeutic response to levothyroxine (Synthroid) is evaluated by resolution of hypothyroidism symptoms. The expected response includes improved well-being with elevated mood (Option 2), higher energy levels (Option 3), and a heart rate that is within normal limits (Option 1). The nurse should consult the health care provider if the heart rate is >100/min, or if the client reports chest pain, nervousness, or tremors; this may indicate that the dose is higher than necessary. Pharmacological therapy manages the symptoms of hypothyroidism, but it takes up to 8 weeks after initiation to see the full therapeutic effect.

The nurse is monitoring a client receiving levothyroxine sodium for hypothyroidism. Which findings indicate the presence of a side effect associated with this medication? Select all that apply. 1.Insomnia 2.Weight loss 3.Bradycardia 4.Constipation 5.Mild heat intolerance

1, 2,5 Insomnia, weight loss, and mild heat intolerance are side effects of levothyroxine sodium. Bradycardia and constipation are not side effects associated with this medication, and rather are associated with hypothyroidism, which is the disorder that this medication is prescribed to treat.

nursing interventions r/t specific outcome goals:

1. have adequate peripheral perfusion to the residual limb 2. state that pain is controlled to between a 2 and 3 on a 0-10 pain intensity scale 3. perform mobility skills independently and not experience complications of decreased mobility 4. be free of surgical site infection 5. have a positive self esteem and lifestyle adaptation to live a productive, high quality life

assessment of myasthenia gravis

1.Generalized weakness, gradual onset -Ptosis, diplopia, dysphagia Shallow breathing -blank, mask-like face -gradual and progressive 2. PMH: MG at previous admission, diminished breath sounds on auscultation

A nurse is reviewing the primary health care provider's prescriptions for a client diagnosed with hypothyroidism. Which medication prescription should the nurse question and verify? 1.Acetaminophen 2.Docusate sodium 3.Morphine sulfate 4.Levothyroxine sodium

3 Medications are administered very cautiously to the client with hypothyroidism because of altered metabolism and excretion and depressed metabolic rate and respiratory status. Morphine sulfate would further depress bodily functions. Hormone replacement with levothyroxine sodium, a thyroid hormone, is a component of therapy. Stool softeners, such as docusate sodium, are prescribed to prevent constipation. Acetaminophen can be taken.

The nurse provides instructions to a client who is taking levothyroxine. The nurse should tell the client to take the medication in which way? 1.With food 2.At lunchtime 3.On an empty stomach 4.At bedtime with a snack

3 Oral doses of levothyroxine should be taken on an empty stomach to enhance absorption. Dosing should be done in the morning before breakfast.

The nurse has provided dietary instructions to a client with a diagnosis of hypoparathyroidism. The nurse should instruct the client that it is acceptable to include which item in the diet? 1.Fish 2.Cereals 3.Vegetables 4.Meat and poultry

3 The client with hypoparathyroidism is instructed to follow a calcium-rich diet and to restrict the amount of phosphorus in the diet. Vegetables are allowed in the diet. The client should limit meat, poultry, fish, eggs, cheese, and cereals.

A client with diabetes mellitus has had a right below-knee amputation. Given the client's history of diabetes mellitus, which complication is the client at most risk for after surgery? 1.Hemorrhage 2.Edema of the residual limb 3.Slight redness of the incision 4.Separation of the wound edges

4 Clients with diabetes mellitus are more prone to wound infection, wound separation, and delayed wound healing because of the disease. Postoperative hemorrhage and edema of the residual limb are complications in the immediate postoperative period that apply to any client with an amputation. Slight redness of the incision is considered normal, as long as the incision is dry and intact.

The clinic nurse is caring for an infant who has been diagnosed with primary hypothyroidism. The nurse is reviewing the results of the laboratory tests for thyroxine (T4) and thyroid-stimulating hormone (TSH). Which laboratory finding indicates a diagnosis of primary hypothyroidism? 1.A normal T4 level 2.An elevated T4 level 3.An elevated TSH level 4.A decreased TSH level

4 Diagnostic findings in primary hypothyroidism include a low T4 level and a high TSH level. The remaining options are not diagnostic findings of this condition.

hypothyroidism

A disorder caused by a thyroid gland that is slower and less productive than normal oDecreased metabolism due to low levels of thyroid hormones ◦ Either thyroid cells are damaged, function improperly OR ◦ Thyroid cells are fine; person does not ingest of the substances needed to make thyroid hormones oSometimes called Myxedema oMyxedema coma- rare but serious condition -women affected more than men -preexistence of an auto immune disorder puts a patient at higher risk

High Fowler's Position

A semi-sitting position; the head of the bed is raised 60 to 90 degrees

chemotherapy

A systemic treatment of drug therapy A way to attack cancer cells that are circulating through the body If cancer is limited to a solid mass, chemotherapy can be used after surgery to "clean up the leftovers" Also called "cytotoxic" therapy (cyto- cells, toxic- to kill) low neutrophils - neutropenia - greater potential for infection

A 30-year-old man with HIV is admitted to the acute care unit. Which assessment findings does the nurse recognize that may indicate that the patient currently has AIDS? (Select all that apply.) A. Kaposi's sarcoma B. HIV-positive status C. Wasting syndrome D. Esophageal candidiasis E. Persistent generalized lymphadenopathy

ABD

Metoclopramide

Antiemetic • Route: PO, IM, IV • Use: prevention of chemotherapy-induced emesis. Treatment of acute and recurrent diabetic gastroparesis. Facilitation of small bowel intubation in radiographic procedures. Management of gastroesophageal reflux. Treatment and prevention of postoperative nausea and vomiting when nasogastric suctioning is undesirable. ⇒ Unlabeled use: treatment of hiccups and adjunct management of migraine headaches. • Action: Blocks dopamine receptors in chemoreceptors trigger zone of CNS. Stimulates motility of the upper GI tract and accelerates gastric emptying

grave's disease

Autoimmune Disorder Often associated with other autoimmune disorders TSH is low General symptoms of hyperthyroidism are present... plus: oExophthalmos (proptosis) oGoiter oPretibial myxedema oFatigue oTremors

cervical neck pain

C5-6 more common Causes: • Degenerative disc disease • Herniated cervical disc • Meningitis • Osteomyelitis • Osteoporosis • Poor posture • Rheumatoid arthritis • Spondylosis (age related wear and tear) • Strain or sprain • Trauma • Tumor

effects of HIV infection

CD4+ T-cells become "HIV factory" to make new viral particles daily Gradually, CD4+ T-cell count falls, viral load rises Immune systems weakens (CD4 T cells are very important in immune system) Everyone with AIDS has HIV; not everyone with HIV has AIDS immunosuppressed patient develops opportunistic infections

cushing syndrome (hypercortisolism)

Condition caused by a sustained increase in glucocorticoid (cortisol) levels in the blood; refers to any form oExcess secretion of cortisol from the adrenal cortex -increase in plasma cortisol level -chronic exposure to excess corticosteroids oWomen > Men oCauses: ◦ problem in the adrenal cortex itself (adrenal Cushing's) ◦ Problem/tumor in the anterior pituitary gland (pituitary Cushing's) ◦ problem in the hypothalamus ◦ glucocorticoid therapy (Cushing's Syndrome)

CIPN

Critical Illness Peripheral Neuropathy • Damage to CNS - unsteady gait/problems with balance -neurotoxicity that can manifest itself peripherally (numbness to hands and feet) -diabetics more susceptible • Damage to the PNS - numbness and pain to hands and feet GOAL IS TO PREVENT INJURY

nursing interventions for hyperparathyroidism

Diet: Increased fluid intake (up to 4000 ml/day), moderate calcium intake, phosphorus supplements -prevent injury -cardiac function -I&O -monitor Ca level *total 9-10.5 mg/dL *ionized 4.5-5.6 mg/dL report drop in calcium *can be reported as numbness/tingling in muscles Ca level greater than 12- may exhibit psychosis with confusion, followed by coma or death

Kathy Michaels, a 37-year-old female, is talking with her gynecologist about concerns of sexually transmitted diseases (STDs). She asks to be tested for STDs. Later, the nurse calls to discuss the results with Ms. Michaels, which indicate she is positive for HIV. Ms. Michaels states, "Oh no, I have AIDS!" How should the nurse respond to Ms. Michaels' statement?

Explain to the patient what the differences are between HIV and AIDS: The distinction rests with the number of CD4+ T-cells the patient has and whether any opportunistic infections have occurred. Once AIDS is diagnosed, the diagnosis remains and the patient never reverts to being just HIV positive. Rationale: A diagnosis of AIDS requires that the person be HIV positive and have either a CD4+ T-cell count of less than 200 cells/mm3 or an opportunistic infection.

leading causes of cancer death in 2020

Females o Lung Cancer o Breast o Colorectal Males o Lung Cancer o Prostate o Colorectal The risk of an American woman developing cancer over her lifetime is 38.7% (a bit more than one in three). • Mortality rate: Males > Females in all racial and ethnic groups • African-Americans have the highest cancer mortality rates and Asian/Pacific Islanders have the lowest • Thyroid cancer more prevalent in women • Head and neck cancers more prevalent in men

benign tumor cell characteristics

HYPERPLASIA- a lot like normal cells continuous or inappropriate cell growth looks like tissue it came from, parent cell (skin tags, nasal polyps) small nuclear to cytoplasmic ratio, same as normal cell specific differentiated functions continue- sometimes it is performed outside of normal tissues (endometriosis- normal lining of uterus grows outside of uterus, extra tissue acts just like normal endometrial tissue) tight adherence of cells to each other occurs because continue to make fibronectin, protein that binds many are encapsulated, surrounded with fibrous connective tissue do not invade other tissue, tightly bound to each other orderly growth by hyperplastic expansion euploidy- normal number of chromosomes found in DNA

lab assessment of HIV

How official diagnosis is made -can take several weeks to show up on lab work once infected -"window period" - false NEGATIVE • Lymphocyte counts - 5k-10k -neutropenic precautions • CD4+ T-cell and CD8+ Tcell count - drop in Cd4 levels but not CD8 • Antibody tests -looking for HIV antibodies (want it to be negative) -may be up to 3 years before you have any antibodies but usually takes 3 week- 3 months • ELISA - most common -most inexpensive and accurate -if positive will have Western blot • Western blot -looking for multiple antibodies (4 or more) • Home tests (e.g., OraQuick In-Home HIV test) • Viral load testing • Blood chemistries, CBC, stool testing, biopsies

Chvostek's sign

Hypocalcemia (facial muscle spasm upon tapping) -sign of tetany -especially important to check post op

diagnostic tests for Cushing's disease (p 1162 Lewis)

Lab tests ◦ High Cortisol levels (blood, salivary, urine) **midnight/late night salivary cortisol test ◦ Increased serum glucose, Na level ◦ Decreased lymphocyte count, Ca level ◦ ACTH levels-depends on cause

lab and diagnostic studies r/t hyperparathyroidism

Labs: ◦ Serum PTH ◦ Serum Calcium, Phosphorus ◦ Urine Calcium ◦ Serum chloride ◦ Uric Acid, Creatinine, amylase, alkaline phosphatase -decreased vitamin D levels Diagnostic: ◦ DEXA Scan - bone density ◦ MRI ◦ CT ◦ Ultrasound

calcitonin

Lowers blood calcium levels -effects calcium and phosphorus balance -reduces bone reabsorption

Fludrocortisone (Florinef)

Monitor BP (potential side effect of hypertension) Instruct the patient to report weight gain or edema because sodium intake may need to be restricted.

filgrastim

Neupogen, Zarxio

T6 injury

Paraplegia, results in paralysis below the chest

Streptococcus Pneumoniae

Penicillin/cephalosporin (systemic infection, pneumonia), vancomycin (meningitis)

Thyroidectomy (Sub or Total) Care

Pre-Op Care: oTreated with thionamide drug therapy oHemodynamically optimized oHigh protein, high-carb, diet prior for days or weeks oPre-op teaching Post-Op Care: oMonitoring oPositioning **high fowler's or semi supporting head oPain control

General Side Effects of Radiation: GI

Radiation to upper GI and head/neck may cause: o Dysphagia/Difficulty opening mouth oMucositis/ Mouth ulcers o N/V/D oAnorexia oChanges to scent/taste of foods

General Side Effects of Radiation: Fatigue

Risk factors Contributing to Fatigue Include: • Anemia • Accumulation of toxic substances • Nutritional inadequacies • Emotional distress • Insomnia • Previous or concurrent therapies • Comorbid conditions

Triiodothyronine (T3)

Secreted by the thyroid gland; T3 increases metabolism in cells. -regulates protein, carb, and fat metabolism -can exert effects on HR and contractility -T3 is active form in body -absence can decrease body's metabolic rate up to 60%

Thyroxine (T4)

Secreted by the thyroid gland; also called tetraiodothyronine. T4 increases metabolism in cells. -gets converted into T3

ONCOLOGICAL EMERGENCIES: third space syndrome

Shifting of fluid from vascular space to interstitial space Occurs due to extensive surgical procedures Requires fluid, electrolyte, and plasma protein replacement

malignant tumor examples

Solid Tumors • Skin • Breast • Lung • Prostate • Colon • Bladder Hematological Tumors • Leukemias - cancer of the blood • Lymphomas- cancer of the lymphs • Multiple Myeloma- cancer of the plasma cells -most cancerous because the blood circulates

assessment of hypothyroidism (pg. 1151 Lewis)

Subjective and Objective Data History Physical Assessment Signs & Symptoms Psychosocial Assessment Laboratory Assessment -decreased T3 and T4 -increased TSH with primary -normal/decreased with secondary

Levothyroxine

Synthroid • Use: Thyroid supplementation in hypothyroidism, treatment or suppression of euthyroid goiters, adjunctive treatment for thyrotropin-dependent thyroid cancer • Action: Synthetic form of thyroxine (T4). Replacement of or supplementation to endogenous thyroid hormones. Principal effect is increasing metabolic rate of body tissues: Promote gluconeogenesis, Increase utilization and mobilization of glycogen stores, Stimulate protein synthesis, Promote cell growth and differentiation, Aid in the development of the brain and CNS.

TNM staging system

T = size of Tumor N = Node involvement M = Metastases

pituitary gland

The endocrine system's most influential gland. Under the influence of the hypothalamus, the pituitary regulates growth and controls other endocrine glands. anterior and posterior

cell cycle

The regular sequence of growth and division that cells undergo G1- growth -cell prepares to be copy G1/S- checkpoint S- DNA replication -DNA doubled (exact copy of all chromosomes) G2/S Checkpoint- G2- growth, preparation for mitosis Mitosis- -cell division Cytokinesis- G0- resting phase

Neisseria meningitis

a bean-shaped diplococcus that is related to the causative agent of gonorrhea, it can cause a life threatening infection of the meninges (tissue that covers the spinal cord and brain)

cortisone

a corticosteroid produced in small amounts by the adrenal cortex Instruct the patient to take the drug with meals or a snack to avoid gastric irritation.

Pre-exposure prophylaxis (PrEP)

a pill containing antiretroviral drugs taken before someone is exposed to the virus to prevent HIV acquisition -doesn't REPLACE safe sex -if HIV is acquired, could make it harder to control disease once contracted -ANTIBIOTIC RESISTANCE

cerebrospinal fluid findings in bacterial and viral meningitis

bacterial meningitis: -appearance: cloudy/turbid -WBC- increased -Protein- increased -Glucose- decreased -CSF pressure- elevated viral meningitis: -appearance: clear -WBC- increased -Protein- slightly increased -Glucose- normal -CSF pressure- normal or elevated

cellular regulation and cancer

cellular regulation is necessary for: -normal growth of cells -replication of cells --mitosis -differentiation of cells- maturation into specific type of cell into a specialized function --i.e. skin cells- keratin, liver cells- bile, RBC- Hgb goal of cell regulation is to: -maintain homeostasis -normal cells have a certain life span and die afterwards (apoptosis) -immature cell: blast cells that have not grown up yet and are not yet differentiated (does not have a purpose) ^ this is what cancer cells look like!!!

cancer treatment guidelines

cure- complete removal of the cancer (no tx or no evidence of cancer for 5-10 years) control- stopping cancer that has recurred or metastasized palliation- care and therapy provided to relieve symptoms

which of the following assessment findings suggest local manifestations of osteomyelitis?

drainage and ulceration (local = at SITE) systemic = body system (fever, chills, etc)

adrenal hormones

hormones that are produced by the adrenal glands and that are involved in emotion and stress adrenal cortex: **Glucocorticoids (cortisol) -nutrition, immunosuppression, anti-inflammatory **Mineralocorticoids (aldosterone) -maintain sodium, water, potassium balance **Androgens -antigens and sex hormones "sugar, salt, sex" adrenal medulla: **epinephrine **norepinephrine

acute osteomyelitis

local manifestations: • Constant bone pain ***worsens with activity ***unrelieved by rest • Swelling • Tenderness • Warmth • Restricted movement systemic manifestations • Fever • Night sweats/Chills • Nausea • Malaise

Assessment of Hyperparathyroidism

monitor for symptoms: o Kidney *kidney stones *too much PTH or accompanying hypercalcemia *arrhythmias secondary to this electrolyte imbalance oSkeletal *bone pain, general pain, fractures, osteoporosis oGI Problems *N/V/D, anorexia, peptic ulcer disease, constant epigastric pain radiating to back oFatigue and lethargy *calcium responsible for nerve impulses *

Myasthenia Crisis vs. Cholinergic Crisis

myasthenia crisis: low dose of meds = RESP. EMERGENCY increased RR/pulse rise in BP Anorexia Cyanosis Bowel/bladder incontinence Decrease UO Unable to cough or swallow Cholinergic crisis: too much Ach Small pupils Salvation Diarrhea N/V Abdominal cramps Increased bronchial secretions, sweating Lacrimation: tears SOB-->bronchospasms Bradycardia Facial muscle twitching

risk factors for cancer

non-modifiable: -age (single most important) ***the older we are, the more exposure to carcinogens we have, the weaker our immune system is -hereditary modifiable: • Lifestyle choices ***marijuana r/t testicular cancer ***vaping r/t lymphoid pneumonia leading to lung carcinoma ***sunburns to skin cancer ***dietary obesity (increase in hormone dependant cancer- breast, bowel, ovary, endometrial, prostate) ***poverty • Occupational hazards • Environmental exposure ***epstein barre- burketts ***HPV • Combination of factors

risk factors of hypothyroidism

oMore common in women over age 60 oHave a close relative with an autoimmune condition oThyroid surgery oRadiation to the neck oIodine deficiency oHashimoto Thyroiditis -certain drugs (amiodarone)

nursing interventions r/t addison's disease

oPromoting fluid balance oMonitoring for fluid deficit oPreventing hypoglycemia oVital signs every 1 to 4 hours oDaily weights/I&O oMonitor lab values oMonitor response to hormone replacement therapy

hyperparathyroidism

oResults from an excess of parathyroid hormones (PTH) oPrimary - acts directly on kidney oSecondary -compensatory response oTertiary - hyperplasia of parathyroid oFunction of PTH: oRegulates serum calcium and phosphate levels oHypercalcemia and hypophosphatemia can result with hyperparathyroidism causes: -tumor -neck trauma/radiation -vitamin D deficiency/malabsorption -chronic kidney disease -bone disease

surgical management r/t lumbosacral back pain

performed by orthopedic or neurosurgeon **post op care for nurses is what is important • Minimally invasive surgery • Percutaneous lumbar discectomy • Intradiscal electrothermal plasty (IDET) • Conventional open surgical procedures • Diskectomy- removal of disk • Laminectomy • Spinal fusion- stabilize spine (fuse vertebrae together with graft to support and strengthen the back)

levels of cancer prevention

primary - risk reduction before dx is made by avoiding known carcinogens -putting on sunscreen to avoid sunburn secondary -early detection -mammogram

cardiovascular symptoms of cushing's disease

result of disturbed F&E imbalance -both NA and H2O are reabsorbed and retained leading to edema formation, blood pressure elevation, pulses that are full and bounding -hypervolemia oHypertension oDependent edema oBruising oPetechiae -bruising -blood vessel fragility

surgical management of osteomyelitis

sequestrectomy- may be performed to debride the necrotic bone *** Reconstruction with microvascular bone grafts bone grafts bone segment transfers muscle flaps amputation

types of cancer treatment

standard therapy- based on EBP investigational therapy- (clinical trials) personalized therapy- emerging, uses patients genetic information to guide tx decisions complementary, alternative, or integrative, medicine (CAM)- used in conjunction with traditional therapies, may help (meditation or massage)

consequences of immobility

systems affected: -cardiovascular -respiratory -musculoskeletal -integumentary -gastrointestinal -urinary/elimination patterns alterations in spinal cord can affect a patient's ability to perform ADL's

osteomyelitis

• A severe infection of the bone, bone marrow, + surrounding soft tissue • Caused by bacteria, viruses, or fungi ***diagnosed with cultures • Indirect or direct entry of organism ***Long-term IV catheters ***Long-term hemodialysis ***IV drug users ***Poor dental hygiene • Staphylococcus aureus is the most common cause • Treatment of infection may be complicated further by the presence of methicillin-resistant Staphylococcus aureus (MRSA) or other multiple drug resistant organisms (MDRO) -can lead to loss of mobility and function -can eventually lead to amputation

other clinical manifestations of AIDS

• AIDS dementia complex- 70% • AIDS wasting syndrome • Skin changes • Kidney Problems

perinatal transmission

• Across the placenta during pregnancy • Infant exposure at birth to blood and vaginal secretions • Exposure after birth through breast milk

genetics and cancer

• All cancers are genetic • Not all cancers are hereditary --majority of defects are not inhertied --gene mutation can occur due to environmental factors damaging DNA • Arise from a single cell • Follows a predictable trajectory

cancer classification (Lewis pg. 238)

• Anatomic Site (tissue of origin) • Histology (grading) -Appearance of cells • Extent of disease (staging) - Stage 0 through 4

other cancer treatments

• Biological Response Modifiers (Immunotherapy) and Targeted Therapies • Hormone Therapy • Hematopoietic Growth Factors • Hematopoietic Stem Cell Transplantation • Photodynamic therapy

nursing education r/t MS

• Building general resistance to illness: • Avoiding fatigue • Avoiding extreme heat and cold • Avoiding exposure to infection • Achieve good balance between exercise and rest • Eat nutritious and well balanced meals • Avoid hazards of immobility: • Contractures • Pressure ulcers • Medications • Bladder control

Ursodiol

• Class: gallstone dissolution agents • Route: PO • Use:gallbladder stone dissolution and prevention, primary biliary cirrhosis ⇒ Unlabeled use: biliary atresia. TPN-induced cholestasis • Action: lowers cholesterol content of bile and bile stones by suppressing cholesterol synthesis and secretion from the liver and inhibits intestinal absorption of cholesterol

prevention and health promotion r/t cancer:

• Evidence suggests that prevention of obesity reduces the risk of cancer of the: o Colon o Breast (postmenopausal) o Uterus o Kidney (renal cell) o Esophagus

complications r/t amputations

• Hemorrhage • Infection • Phantom limb pain *** More common in patients who had chronic limb pain before surgery • Neuroma *** Tumor consisting of damaged nerve cells • Flexion contractures

colon surgery- pre op

• High risk for post op infection • Bowel prep must be meticulous • Psychological support • Changes in body image and elimination • Pt education regarding: • Wound care • Nutrition (what kind of foods produce odors, gas, diarrhea...) • Exercise tolerance • Psychosocial stressors (participate in their own care and that they actually perform and are successful in their own colostomy care) • Ostomy training (prn)

colon surgery- post op

• High risk for: • Poor wound healing/infection • Obstructions • Bowel Perforations • Tumor Recurrence • Sexual Function Changes • Possible sexual dysfunction r/t impaired erection innervation • Sexual dysfunction less likely but possible r/t vaginal scarring or stenosis

cancer diagnosis

• History and Physical • Blood work (tumor markers) - CA-125 - ovarian -BRCA 1/2 - breast - CEA - colorectal -PSA- prostate - AFP- liver -CA-19-9- pancreatic, hepatobilliary, or gastric -B2M-mylo/leukemia/lymphomas • Diagnostic Imaging • Pathological Diagnosis: Biopsy

cardiotoxicities of chemo

• Inflammation from radiation injury -mix a lot of chemos in diluent, and additives can cause cardiac dysrhythmias • Damage to myocardium gives appearance of CHF • Chemo/diluents can also cause dysrhythmias MONITOR: • EKG and Ejection Fractions • Antidysrhythmics as ordered • Chemo drug might need to be changed

Lugol's solution

• Is a strong aqueous iodine solution • Used for almost a century as an adjuvant treatment in patients with Grave's disease planned for thyroidectomy. • Action: iodine has been shown to decrease thyroid hormones levels and reduce blood flow within the thyroid gland

prevention of bacterial meningitis

• Keeping up to date with recommended immunizations is the best defense • Good hygiene is also an important way to prevent most infections • Rifampin, ceftriaxone, ciprofloxacin are appropriate drugs for chemoprophylaxis • Chemoprophylaxis may be administered in conjunction with vaccinations

ONCOLOGICAL EMERGENCIES: Tumor Lysis Syndrome

• Large numbers of tumor cells destroyed rapidly, results in intracellular contents being released into bloodstream faster than the body can eliminate them • Can cause tissue damage, AKI, or death -potassium, phosphate, DNA, RNA (high potassium and high phosphorus is no good)

nursing management of HIV- tissue integrity

• Minimize diarrhea **Antidiarrheals **Keep perineal area clean and dry • Restore skin integrity **Antiretroviral drug therapy **Analgesics and comfort measures ** Appropriate skin care

nursing priorities r/t meningitis

• Monitor neuro status • Monitor vital signs • Monitor LOC • Monitor for seizure activity • Monitor Fluid volume/maintain hydration

nursing interventions r/t amputation

• Monitor neurovascular status • Prevent post-op complications • Assess Psychosocial status • Assess the residual limb for: ▪ Adequate circulation ▪ Infection ▪ Healing ▪ Flexion contracture • Assess the patient's ability to perform ADLs • Assess the patient's nutritional status • Assess the patient's ability to cope with body image change

breast cancer

• Most common cancer in American women after skin cancer • Risk factors cumulative and interacting -age, gender, genetics, family hx, previous chest radiation, weird medical hx • Most breast cancers are not inherited • Associated with a gene changes that occur after birth

ONCOLOGICAL EMERGENCIES: Hypercalcemia

• Most often with bone metastasis or multiple myeloma • S/S - fatigue, muscle weakness, constipation, loss of deep tendon reflexes (what we need Ca for), depression, EKG changes, nocturia • Treatment - hydration (up to 3L/day), loop diuretic, bisphosphonates, dialysis

long term key points r/t breast cancer surgery

• NO BPs, IVs, injections or blood draws • Avoid carrying heavy items • Affected arm should not be dependent • Avoid injuring skin (NO cutting cuticles), burns, compromised circulation

N

• NX : nearby lymph nodes cannot be evaluated. • N0 : nearby lymph nodes do not contain cancer.

clinical manifestations of breast cancer

• New lump in the breast or underarm • Often occurs in upper outer quadrant - bigger than size of pea • Thickening or swelling of part of the breast • Irritation or dimpling of breast skin • Redness or flaky skin in the nipple area or the breast • Pulling in of the nipple or pain in the nipple area • Nipple discharge, including blood • Any change in the size or the shape of the breast • Pain in any area of the breast

metastasis

• Occurs when primary cancer breaks off and establishes secondary site • Bloodborne metastasis -now metastatic or secondary tumors

pharmacologic management of amputations

• Opioid analgesics are not as effective for PLP as they are for residual limb pain • IV infusions of calcitonin during the week after amputation may reduce phantom limb pain • Beta-blocking agents are used for constant, dull, burning pain • Antiepileptic drugs such as pregabalin (Lyrica) and gabapentin (Neurontin) may be used for knifelike or sharp burning pain • Antispasmodics such as baclofen (Lioresal) may be prescribed for muscle spasms or cramping • Some patients improve with antidepressant drugs • Other pain management modalities • Mirror Therapy • A psychologist may be needed to provide psychotherapy

areas of the body affected by MS

• Optic nerve and chiasm • Cerebrum • Cerebellum • Spinal Cord

chemo- routes of administration

• Orally • IM • IV • Intraarterial (into an artery) • Intracavity (Surgically placed as wafers into the space once occupied by the tumor) • Intrathecal (into the cerebrospinal fluid • Perfusion • Subcutaneous • Topical

breast cancer- post op

• Post-breast therapy pain syndrome (BPTPS) • Phantom breast pain • Infection, seroma (accumulation of fluid) hematoma (bruise), lymphedema, wound care -possible nerve damage • Diminished arm, shoulder, and chest wall movement - exercise ASAP post op

surgical interventions for cancer

• SITE SPECIFIC CANCER TX - Used to remove a well defined mass thought to be malignant, and surrounding tissue ("margin") if it is confined to one area ---(breast, colon, lung) ---treatment of choice for removal of ENTIRE TUMOR • Surgery is sometimes used to obtain biopsy specimens, and for staging • Surgery cannot be used for all cancers -preventative: removing potentially cancerous tissue (from NONVITAL organs- prophylactic mastectomy (Brocha1-Brocha2 gene) -diagnostic: removing all or part of suspicious tissue for further examination (determine clinical plan and obtain staging) -control/curative: removing all cancer tissue (small, localized tumors- skin cancer) -supportive: insertion of therapeutic devices (for either comfort or progression of tx- G Tube - esophageal cancer) -cytoreductive / debulking: removing all parts of the tumor (alleviate symptoms- chest tumor making it difficult to breathe) -rehabilitation: reconstruction (improve appearance or functionality) -palliative: removing tissue that is causing pain or obstruction

administering IV chemotherapy safely

• Two RNs always check chemo (high alert) • Always spike chemo bag at waist level • Waterproof tape at all connections • Remove protective equipment prior to leaving patient's room • Adhere to hospital policies & procedures ** Don't give chemo unless you are CREDENTIALLED to give chemo

nursing management for Guillain-barre syndrome

• Ventilatory support during acute phase • Plasmapheresis used in 1st 2 weeks • IV administration of high-dose immunoglobulin • Nutritional Therapy • Mild dysphagia - Aspiration precautions • Severe dysphagia - Tube feeding • Paralytic ileus - TPN

immunosuppressants r/t MS

•Azathioprine (Imuran) •methotrexate • cyclophosphamide (Cytoxan) •mitoxantrone (Novantrone)

diagnostic tests r/t myasthenia gravis

•H & P • Electromyelogram (EMG) • Tensilon Test •CT Scan • Serum anti-AchReceptor antibodies

nonsurgical management of hyperthyroidism

◦ Monitoring for cardiac changes ◦ Reducing stimulation/adequate rest ◦ Promoting comfort -reduce room temp ◦ Drug therapy -monitor VS for temperature **increase may indicate thyroid storm **increase of even 1 degree should be reported to HCP and cardiac assessment should be performed

Adrenal Gland Hypofunction- Addison's disease

◦Decrease in Aldosterone AND CORTISOL ◦Increase excretion of sodium & water ◦ Retention of potassium *plasticity of cardiac muscle ◦ Hemoconcentration, acidosis, decrease C.O, shock and death ◦ Can lead to hypoglycemia Impaired secretion of cortisol causes: ◦ decreased Gluconeogenesis - making of glucose from protein ◦ Depletion of liver and muscle glycogen ◦ Leads to hypoglycemia ◦ decrease GFR ◦ decrease Gastric acid production ◦ decrease Urea nitrogen excretion ◦ Anorexia ◦ Weight loss

nursing interventions r/t hypoparathyroidism

◦Monitor for symptoms ◦Prevent complications ◦Educate pt./family about drug regimen ◦Dietary teaching (high Ca/low phos) ◦Advise the patient to wear a medical alert bracelet ◦Use a lift sheet to move or reposition a patient with hypocalcemia -bones are very fragile

Opiate pain medications

(Hydrocodone, Fentanyl, Morphine Sulfate, Oxycodone)* • General use: Management of moderate severe pain • General action: binds to opiate receptors in the CNS, where they act as agonist of endogenously occurring opioid peptides (eukpalins and endorphins). The result is alteration to perception of and response to pain • Warning: prolonged use leads to tolerance and it is a CNS depressant • Opiate Addiction medication (Suboxone, Methadone)* side effects: -confusion, dizziness, sedation, hypotension, bradycardia, constipation, dyspepsia, nausea, resp. depression patient assessment: -asses BP, pulse, RR -assess bowel function (increase fluids and admin laxatives) -assess type, location, and intensity of pain -assess for addiction, abuse, or misuse -Opiate overdose antidote (Naloxone*) patient edu: -take as directed and not more than recommended amount -renal damage may occur with prolonged use -severe/permanent liver damage may result from prolonged use -do not stop taking suddenly -may cause drowsiness/dizziness (avoid with alcohol or other CNS depressants) -advise to turn, cough, and deep breath q2h to prevent atelectasis

classification of chemo drugs

*alkylating agents* -ex. cyclophosphamide (cytoxan) -side effects: *ototoxicity* (tinnitus, hearing loss, vertigo, report to provider immediately), vision problems, kidney damage (inc fluids during treatment may help prevent) *antimetabolites* -ex. methotrexate, hydroxyurea *platinum agents* -ex. cisplatin (platinol- AQ) -side effects: *neurotoxicity*- dose-limiting, uses smaller doses even if means more frequent, usually peripheral neuropathies- not hot bath water, shoes on all the time *antitumor antibiotics* -ex. doxorubicin (adriamycin) -side effects: *cardiotoxicity* leading to electrophysiology dysfunction and/or muscle damage --> dysrhythmias, reduced pumping capabilities, palpitations, s&s of HF *mitotic inhibitors* -vinca alkaloids: vincristine (oncovin) -taxanes: paclitaxel (taxol), docetaxel (taxotere) *corticosteroids* -ex. dexamethasone (decadron), hydrocortisone (cortef), methylprednisolone (medrol), prednisone -used with chemo to help with Gi side effects -side effects: increased appetite & weight gain (good here), edema, hyperglycemia, mood swings, insomnia, HT *hormones- will discuss with each type of cancer* -anti-estrogens -estrogens -aromatase inhibitors

surgical side effects for the cancer patient

- Nutritional deficits - blood disorders (anemia, thromboembolism) -physical compromise caused by prior cancer tx -GI bleeding -respiratory compromise including pneumonia -F&E imbalances

radiation therapy

- cure, control, palliate • High energy radiation kills cancer cells ---Damages the DNA, causing cell death • Gamma Rays (ionizing, most commonly used due to ability to penetrate tissues and damage cells) -has enough energy to irreparably damage cells -teletherapy - zapping cancer • Alpha Particles • Beta Particles- weaker and must be placed very close to cancer cells -brachytherapy • IMRT -Intensity Modulated Radiation Therapy • IGRT -Image Guided Radiation Therapy

Acute Adrenal Insufficiency Addisonian Crisis

-*LIFE-THREATENING* -event in which the need for cortisol and aldosterone is greater than the available supply -usually occurs in a response to a stressful event -sodium levels fall, potassium levels rise -severe HTN results from decrease or loss of aldosterone emergency care: Hormone Replacement ◦ Rapid infusion NS or D5NS ◦ hydrocortisone sodium, dexamethasone ◦ Initiate an H2 histamine blocker (ranitidine) IV for ulcer prevention Hyperkalemia management ◦ insulin/dextrose; Kayexalate; diuretics; K+ restriction ◦ Monitor I&O, HR, rhythm ◦ Hypoglycemia Management ◦ Maintain IV access, IV glucose ◦ IM glucagon, hourly blood glucose LOW SODIUM HIGH POTASSIUM -loop or thiazide diuretics -avoid potassium sparing diuretics -

Pyridostigmine

-Anticholinesterse - increases ACh -Increases muscle strength -Used in myasthenia gravis (long acting) -Does not penetrate CNS • Class: antimyasthenics, cholinergics • Route: PO, IM, IV • Use: used to increase muscle strength in the symptomatic treatment of myasthenia gravis. Reversal of nondepolarizing neuromuscular blocking agents. Prophylaxis of lethal effects of poisoning with the nerve agents soman • Action: Inhibits the breakdown of acetylcholine and prolongs its effects (anticholinesterase). Effects include: miosis, increased intestinal and skeletal muscle tone, bronchial and ureteral constriction, bradycardia, increased salivation, lacrimation, and sweating Patient assessment: -cholinergic crisis- overdose (increased resp. secretions/saliva, bradycardia, N/V, cramping, diarrhea, diaphoresis) -myasthenic crisis- underdose (musc. weakness, dyspnea, dysphagia) Patient Edu: -take med as directed do not skip or double up on missed doses -taking dose late may result in myasthenic crisis -taking dose early may result in cholinergic crisis)

Hypoparathyroidism - Overview

-Inadvertent consequence of thyroid surgery or parathyroid surgery -Autoimmune, congenital hypoparathyroidism, and DiGeorge syndrome are less common causes -Clinical: -Low circulating levels of PTH, hypocalcemia, and hyperphosphatemia -Major clinical manifestations related to severity and chronicity of hypocalcemia→ Hallmark of hypocalcemia is tetany*, which is neuromuscular irritability -Hypocalcemia symptoms range from circumoral (around mouth) numbness or paresthesias of distal extremities and carpopedal spasm (see image) to life-threatening laryngospasm and generalized seizure. -Troussea sign and Chvostek sign are classic findings on PE→ Troussea sign refers to carpopedal spasms from occlusion to artery by a blood pressure cuff for several minutes. Chvostek sign is facial nerve tapping that induces contractions of muscles of the eye, mouth, or nose. -Mental status changes: emotional instability, anxiety and depression, confusional states, hallucinations, and frank psychosis -Intracranial manifestations: calcifications of basal ganglia, parkinsonian-like movement, ↑ICP → calcification likely due to ↑phosphate levels that result in tissue deposits with Ca2+ from local extracellular milieu -Ocular: calcification of lens and cataract formation -CV: conduction defect that cause Characteristic QT interval prolongation in ECG -Dental: Highly characteristic dental hypoplasia, failure of eruption, defective enamel and root formation -Treatment: combination of oral Ca2+ and 1,25-DHC supplements

management of mucositis

-Soft toothbrush, may avoid flossing -Saline rinse -Ice chips -Pain medication -Morphine mouthrinses • Avoid alcohol-containing mouthwashes; saline might help • Avoid tobacco, alcohol, acidic or spicy foods • Apply water-based lip balm frequently • Encourage patient to increase water consumption - 2L/day

complications of lumbar spine surgery

-nerve damage -paralysis -loss of sensation -anxiety/psychosocial -infection rate -opioid addiction -increased HR/BP -urinary retention- damage to sacral spinal nerves -DVT prevention *lovenox *heparin -paralytic ileus (lack of bowel movement) *movement ASAP -fat embolism - chest pain, dyspnea, low O2 saturation -VTE/PE -fluid volume deficit *hypotensive *tachycardic *I&O -bleeding

causes of hypothyroidism

-primary due to failure of thyroid gland -secondary due to deficiency of TRH, TSH -inadequate dietary supply of iodine

normal cell characteristics

-uniform in size -nuclei are characteristics of tissue in which the cells belong • Specific Morphology (shape) • Smaller Nuclear-to Cytoplasmic Ratio (small nucleus, a lot of cytoplasm) • Has a Differentiated Function • Apoptosis - eventual cell death • Tight Adherence- fibronectin- keeps normal tissues bound together tightly • Non-Migratory • Orderly and Well Regulated Growth • Live in G-Zero (G0) state- rest state, not constantly reproducing • Have Contact Inhibition- cell division is stopped when surrounded by other cells

A client is admitted to the cardiac care unit with atrial fibrillation. Vital signs are shown in the exhibit. Which prescription should the nurse perform first? Click on the exhibit button for additional information. 1. Admin dilitiazem 20 mg IVP 2. admin rivaroxaban 20 mg PO 3. draw blood for a thyroid function test 4. send the client for echocardiogram

1 Atrial fibrillation is characterized by a disorganization of electrical activity in the atria due to multiple ectopic foci. It results in loss of effective atrial contraction and places the client at risk for embolic stroke due to thrombi formed in the atria from stasis of blood. During atrial fibrillation, the atrial rate may be increased to 350-600/min. The ventricular response (pulse rate) can vary. The higher the ventricular rate, the more likely the client will have symptoms of decreased cardiac output (ie, hypotension). Ventricular rate control is a priority in clients with atrial fibrillation. This client has an irregular heart rate of 140/min and is not currently hypotensive. However, if the high ventricular response is allowed to continue, it is likely that the client will begin to show signs and symptoms of decreased cardiac output such as hypotension. Therefore, giving the client diltiazem (a calcium channel blocker) is the priority as its purpose is to decrease the ventricular response rate to <100/min. Other medications such as beta blockers (metoprolol) or digoxin may also be used to control the ventricular rate.

The nurse is receiving a client from the postanesthesia care unit following left above-knee amputation. Which is the priority nursing action at this time? 1.Elevate the foot of the bed. 2.Position the residual limb flat on the bed. 3.Put the bed in a reverse Trendelenburg's position. 4.Keep the residual limb flat, with the client lying on his or her operative side.

1 Edema of the residual limb is controlled by elevating the foot of the bed for the first 24 hours after surgery. After the first 24 hours, the residual limb is placed flat on the bed to reduce hip contracture. Edema is also controlled by residual limb wrapping techniques.

The nurse is caring for a client with myasthenia gravis who has received edrophonium by the intravenous route to test for myasthenic crisis. The client asks the nurse how long the improvement in muscle strength will last. Which response should the nurse make to the client? 1."It will last for 4 to 5 minutes." 2."It will last for about 30 minutes." 3."It will last longer than 60 minutes." 4."It will last approximately 10 minutes."

1 Edrophonium commonly is given to test for myasthenic crisis. If the client is in myasthenic crisis, muscle strength improves after administration of the medication. Within 30 to 60 seconds, most myasthenic clients show a marked improvement in muscle tone that lasts for 4 to 5 minutes. Options 2, 3, and 4 are incorrect.

The nurse is teaching a client with hyperparathyroidism how to manage the condition at home. Which response by the client indicates the need for additional teaching? 1."I should consume less than 1 liter of fluid per day." 2."I should use my treadmill or go for walks daily." 3."I should follow a moderate-calcium, high-fiber diet." 4."My alendronate helps keep calcium from coming out of my bones."

1 In hyperparathyroidism, clients experience excess parathyroid hormone (PTH) secretion. A role of PTH in the body is to maintain serum calcium homeostasis. When PTH levels are high, there is excess bone resorption (calcium is pulled from the bones). In clients with elevated serum calcium levels, there is a risk of nephrolithiasis. One to two liters of fluids daily should be encouraged to protect the kidneys and decrease the risk of nephrolithiasis. Moderate physical activity, particularly weight-bearing activity, minimizes bone resorption and helps protect against pathological fracture. Walking, as an exercise, should be encouraged in the client with hyperparathyroidism. Even though serum calcium is already high, clients should follow a moderate-calcium diet, because a low-calcium diet will surge PTH. Calcium causes constipation, so a diet high in fiber is recommended. Alendronate is a bisphosphate that inhibits bone resorption. In bone resorption, bone is broken down and calcium is deposited into the serum.

A primary health care provider has prescribed propylthiouracil for a client with hyperthyroidism. The nurse recalls that first-line treatment calls for methimazole for medication therapy. The nurse should question the client about her past medical history, specifically regarding which condition? 1.Pregnancy 2.Renal failure 3.Prolonged QT interval 4.Adverse reaction to levothyroxine

1 Methimazole and propylthiouracil are both used to treat hyperthyroidism. Methimazole is considered first-line treatment; however, this medication cannot be used for clients who are in their first trimester of pregnancy, have had a previous adverse reaction to methimazole, or need rapid reduction of symptoms. Renal failure, prolonged QT interval, and adverse reaction to levothyroxine are not related to contraindications for methimazole.

The nurse is caring for a client with a serum phosphorus level of 5.0 mg/dL (1.61 mmol/L). What other laboratory value might the nurse expect to note in the medical record? 1.Calcium level of 8 mg/dL (2.0 mmol/L) 2.Calcium level of 11.2 mg/dL (2.8 mmol/L) 3.Potassium level of 2.9 mEq/L (2.9 mmol/L) 4.Potassium level of 5.6 mEq/L (5.6 mmol/L)

1 Parathyroid hormone is responsible for maintaining serum calcium and phosphorus levels within normal range. Therefore, if these laboratory values are altered, this suggests dysfunction of the parathyroid gland. When calcium levels are elevated (normal is 9 to 10.5 mg/dL [2.25 to 2.75 mmol/L]) and phosphorous levels are decreased (normal is 3.0 to 4.5 mg/dL [0.97 to 1.45 mmol/L]), this suggests hyperparathyroidism. If the phosphorus level is elevated, the nurse should expect the calcium level to be low. Therefore, option 1 is the correct answer.

The nurse is completing an assessment on a client who is being admitted for a diagnostic workup for primary hyperparathyroidism. Which client complaints would be characteristic of this disorder? Select all that apply. 1.Polyuria 2.Headache 3.Bone pain 4.Nervousness 5.Weight gain

1, 3 The role of parathyroid hormone (PTH) in the body is to maintain serum calcium homeostasis. In hyperparathyroidism, PTH levels are high, which causes bone resorption (calcium is pulled from the bones). Hypercalcemia occurs with hyperparathyroidism. Elevated serum calcium levels produce osmotic diuresis and thus polyuria. This diuresis leads to dehydration (weight loss rather than weight gain). Loss of calcium from the bones causes bone pain. Options 2, 4, and 5 are not associated with hyperparathyroidism. Some gastrointestinal symptoms include anorexia, nausea, vomiting, and constipation.

A client with hyperthyroidism has been given methimazole. Which nursing considerations are associated with this medication? Select all that apply. 1.Administer methimazole with food. 2.Place the client on a low-calorie, low-protein diet. 3.Assess the client for unexplained bruising or bleeding. 4.Instruct the client to report side and adverse effects such as sore throat, fever, or headaches. 5.Use special radioactive precautions when handling the client's urine for the first 24 hours following initial administration.

1, 3, 4 Common side effects of methimazole include nausea, vomiting, and diarrhea. To address these side effects, this medication should be taken with food. Because of the increase in metabolism that occurs in hyperthyroidism, the client should consume a high-calorie diet. Antithyroid medications can cause agranulocytosis with leukopenia and thrombocytopenia. Sore throat, fever, headache, or bleeding may indicate agranulocytosis and the primary health care provider should be notified immediately. Methimazole is not radioactive and should not be stopped abruptly, due to the risk of thyroid storm.

The nurse administers a dose of radioactive iodine to a female client for treatment of hyperthyroidism. Which of the following precautions should the nurse teach the client to follow on discharge? Select all that apply. 1. avoid close contact with pregnant women, infants, and children 2. if applicable, you may resume breast feeding when you get home 3. if possible, use a separate toilet from your family, and flush 2-3 times after each use 4. use disposable cups, plates, and utensils, and do not share food items with others 5. wash your clothing and towels separately from the rest of the laundry in your home

1, 3, 4, 5 Radioactive iodine (RAI) treats hyperthyroidism by partially damaging or destroying the thyroid gland. RAI has a delayed response, requiring up to 3 months for maximal effect. After treatment, the client emits radiation, and excreted bodily fluids are radioactive. The nurse teaches home precautions to protect those who come in contact with the client. Depending on the dosage, clients should use the following precautions for up to 1 week: Limit close contact and time spent with pregnant women and children (Option 1). Use a separate toilet, and flush 2 or 3 times after each use to remove urine residue (Option 3). Use disposable cups, plates, and utensils, and do not share foods that could transfer saliva (Option 4). Isolate personal laundry (eg, clothing, linens) and wash it separately (Option 5). Sleep in a separate bed from others. Do not sit near others for a prolonged time (eg, train or flight travel).

The home health nurse is visiting a client with myasthenia gravis and is discussing methods to minimize the risk of aspiration during meals related to decreased muscle strength. Which suggestions should the nurse give to the client? Select all that apply. 1.Chew food thoroughly. 2.Cut food into very small pieces. 3.Sit straight up in the chair while eating. 4.Lift the head while swallowing liquids. 5.Swallow when the chin is tipped slightly downward to the chest.

1,2,3,5 The client avoids swallowing any type of food or drink with the head lifted upward, which could actually cause aspiration by opening the glottis. The client should be advised to sit upright while eating, not to talk with food in the mouth (talking requires opening the glottis), cut food into very small pieces, chew thoroughly, and tip the chin downward to swallow.

The nurse is reviewing the medication administration record of a client with atrial fibrillation. Which of the following should the nurse monitor before giving these medications? Select all that apply. 1. Digoxin level 2. Glucose 3. INR 4. Platelet Count 5. Serum potassium Medications Prednisone: 20 mg by mouth, daily Metoprolol: 50 mg by mouth, daily Digoxin: 0.5 mg by mouth, daily Enoxaparin: 40 mg subcutaneously

1,2,4,5 The complete blood count (hemoglobin, hematocrit, platelet count) should be assessed periodically with the administration of enoxaparin, an anticoagulant that can cause bleeding and thrombocytopenia (Option 4). Digoxin levels are monitored for suspicion of digoxin toxicity (ie, serum levels >2 ng/mL) (Option 1). Potassium levels should also be monitored in clients receiving digoxin, as hypokalemia can potentiate digoxin toxicity (Option 5). Prednisone is a glucocorticoid that can cause hyperglycemia. Glucose levels should be monitored periodically in clients receiving this medication (Option 2). (Option 3) Low-molecular-weight heparins (eg, enoxaparin, dalteparin) produce a stable response at recommended dosages and negate the need for monitoring of activated partial thromboplastin time (aPTT) or international normalized ratio (INR) levels. aPTT is monitored when administering unfractionated heparin. INR is monitored in clients receiving warfarin (Coumadin).

The occupational health nurse is called to care for an employee who experienced a traumatic amputation of a finger. Which actions should the nurse take to provide emergency care and prepare the client for transport to the hospital? Select all that apply. 1.Elevate the extremity above heart level. 2.Assess the employee for airway or breathing problems. 3.Remove the layered gauze every 10 minutes to check the bleeding. 4.Wrap the severed finger in moistened gauze, and place it in a bag of ice water. 5.Examine the amputation site and apply direct pressure to the site using layers of gauze.

1,2,5

The nurse is caring for a client with respiratory failure related to Guillain-Barré syndrome. The nurse plans care knowing that what other extrapulmonary causes can lead to respiratory failure? Select all that apply. 1.Stroke 2.Pneumonia 3.Sleep apnea 4.Myasthenia gravis 5.Obstructive lung disease 6.Opioid analgesics, sedatives, anesthetics

1,3,4,6 Extrapulmonary causes of respiratory failure include the following: stroke; sleep apnea; myasthenia gravis; and opioid analgesics, sedatives, and anesthetics. Both obstructive lung disease and pneumonia are intrapulmonary causes of respiratory failure.

Life cycle of HIV

1. Binding & fusion, 2. reverse transcription 3. integration 4. transcription 5. assembly, 6. budding. Absoprtion into cell-penetration (uncoating) -RNA (Reverse transciptase) - RNA/DNA - circular ds DNA -integration to cell neucleus - transcription mRNA -transactivation -mRNA assembly - budding and exit from cell

controlling outbreaks of meningitis in the community

1. Investigate cases immediately 2. Report cases to Regional Epidemiologist and Infectious Disease Epidemiology 3. Determine who is at risk by interviewing physician, family or possibly the case 4. Organize notes and respond as though this will be an outbreak 5. Isolate the patient/case/Masks, Gowns/Gloves 6. Monitor Na+ and Clotting Factors for potential complications

Metastasis: Angiogenesis

1. Tumors can not grow beyond 1-2mm in diameter without a blood supply 2. Cancer cells stimulate new blood vessel development to maintain their viability: pro-angiogenic cytokines- VEGG new vasculature provides oxygen & nutrients, new endothelial cells secrete growth factors that stimulate cancer cell growth Tumors need to •Get oxygen and •Lose waste products

A hospitalized client with thyrotoxicosis receives atenolol 50 mg PO daily. Which statement by the nurse accurately reinforces the client's understanding of this medication's purpose? 1. atenolol is an iodine based med that blocks the release of thyroid hormones 2. it is used to treat some symptoms of hyperthyroidism, such as increased HR 3. this drug is radioactive and damages or destroys the thyroid tissues 4. it inhibits the synthesis of thyroid hormones

2 Beta-adrenergic blockers (atenolol, metoprolol, and propranolol) are used to relieve some of the symptoms of thyrotoxicosis (thyroid storm), a complication of hyperthyroidism in which excessive thyroid hormones are released into the circulation. Beta blockers block the effects of the sympathetic nervous system and treat symptoms such as tachycardia, hypertension, irritability, tremors, and nervousness in hyperthyroidism. (Option 1) Atenolol is not iodine based. Iodine is used to treat thyrotoxicosis or to prepare the client for a thyroidectomy. In large doses, iodine quickly blocks the release of T4 and T3 from the gland within hours. In addition, iodine decreases thyroid gland vascularity and is helpful when preparing the client for a thyroidectomy. (Option 3) Atenolol does not contain radioactive iodine, the primary treatment for hyperthyroidism. It damages or destroys the thyroid tissue, therefore limiting thyroid secretion and eventually making the client hypothyroid. (Option 4) Propylthiouracil and methimazole (Tapazole) are first-line antithyroid drugs used to inhibit thyroid hormone synthesis.

The nurse should tell the client who is taking levothyroxine to notify the primary health care provider (PHCP) if which problem occurs? 1.Fatigue 2.Tremors 3.Cold intolerance 4.Excessively dry skin

2 Excessive doses of levothyroxine can produce signs and symptoms of hyperthyroidism. These include tachycardia, chest pain, tremors, nervousness, insomnia, hyperthermia, extreme heat intolerance, and sweating. The client should be instructed to notify the PHCP if these occur. Options 1, 3, and 4 are signs of hypothyroidism

The nurse is preparing to care for a client after parathyroidectomy. The nurse should plan for which action for this client? 1.Maintain an endotracheal tube for 24 hours. 2.Administer a continuous mist of room air or oxygen. 3.Place the client in a flat position with the head and neck immobilized. 4.Use only a rectal thermometer for temperature measurement.

2 Humidification of air or oxygen helps to liquefy mucous secretions and promotes easier breathing after parathyroidectomy. Pooling of thick mucous secretions in the trachea, bronchi, and lungs will cause respiratory obstruction. The client will not necessarily have an endotracheal tube in place. Tympanic temperatures can be taken. Semi-Fowler's position is the position of choice to assist in lung expansion and prevent edema. Rectal temperatures only are not required.

The nurse caring for a client with a diagnosis of hypoparathyroidism reviews the laboratory results of blood tests for this client and notes that the calcium level is extremely low. The nurse should expect to note which finding on assessment of the client? 1.Unresponsive pupils 2.Positive Trousseau's sign 3.Negative Chvostek's sign 4.Hyperactive bowel sounds

2 Hypoparathyroidism is related to a lack of parathyroid hormone secretion or a decreased effectiveness of parathyroid hormone on target tissues. The end result of this disorder is hypocalcemia. When serum calcium levels are critically low, the client may exhibit Chvostek's and Trousseau's signs, which indicate potential tetany. The remaining options are not related to the presence of hypocalcemia.

A client scheduled to undergo subtotal thyroidectomy is taking a potassium iodide solution. The client complains to the nurse that she is experiencing a brassy taste in her mouth when taking the medication. Which instruction should the nurse provide to the client? 1.Dilute the medication in 8 oz of water. 2.Report the symptom to the primary health care provider (PHCP). 3.Continue to take the medication because the symptom is normal. 4.Take one half dose of the prescribed medication for the next 2 days.

2 The client should be instructed about symptoms of iodism that can occur with the administration of potassium iodide solution. These symptoms include a brassy taste, burning sensation in the mouth, and soreness of the gums and teeth. The client should be instructed to withhold the medication and notify the PHCP if these symptoms are noted.

The nurse is caring for a client who suddenly starts complaining of palpitations, restlessness, and anxiety. The nurse obtains a stat electrocardiogram (ECG) which shows this rhythm. Refer to figure. The nurse should perform which actions in anticipation of appropriate medication therapy with amiodarone? 1.Obtain an infusion pump and prepare to administer 150 mg over 1 hour followed by a maintenance dose. 2.Obtain an infusion pump and prepare to administer 150 mg over 10 minutes followed by a maintenance dose. 3.Obtain a syringe and administer 150 mg over 1 minute via intravenous push followed by a maintenance dose. 4.Obtain a syringe and administer 360 mg over 2 minutes via intravenous push followed by a maintenance dose.

2 The dysrhythmia shown in the figure is atrial fibrillation with a rapid and irregular ventricular rate. This dysrhythmia is life-threatening due to the risk for clot formation and inadequate cardiac output. Amiodarone is a class III antidysrhythmic medication that is highly effective against both atrial and ventricular dysrhythmias. When used in emergent situations for life-threatening dysrhythmias, this medication should be given using an infusion pump so an accurate dose can be administered. An initial loading dose of 150 mg over 10 minutes should be infused as a bolus using the pump. Next, maintenance doses of 360 mg over 6 hours, then 540 mg over 18 hours, followed by 720 mg over 24 hours are infused. The infusion is titrated based on blood pressure.

A client with primary hypothyroidism has been taking levothyroxine for a year. Laboratory results today show high levels of TSH. Which statement by the nurse to the client is appropriate? 1. a new prescription will likely be issued to decrease dose 2. dosages may need to be increased to improve TSH levels 3. dose should be held and TSH will be reassessed in 3 months 4.start taking dose with dietary fiber or Ca to increase effectiveness

2 Thyroid-stimulating hormone (TSH) is released from the pituitary gland to stimulate the thyroid to secrete hormones (T3, T4). When sufficient thyroid hormone is circulating, negative feedback causes a normally functioning pituitary to slow or stop the release of TSH. In primary hypothyroidism, the thyroid is unable to synthesize enough T3 or T4, slowing the metabolic rate. In response to low circulating thyroid hormones, the pituitary continues to release TSH, resulting in high TSH levels. Levothyroxine (Synthroid), a thyroid hormone replacement drug, is commonly used to treat hypothyroidism. Levothyroxine dosing is adjusted to regulate circulating thyroid hormone levels; this creates a euthyroid (normal) state and TSH levels are decreased (Option 2).

The nurse in an outpatient clinic is caring for a client with Addison disease who has been taking hydrocortisone 20 mg daily for the last 8 years. Which client data is most important to report to the health care provider? 1. BP 140/90 2. low-grade fever 100.4F 3. mild increase in fasting blood glucose 4. weight gain of 6 lb 3 mos

2 Addison disease (primary adrenocortical insufficiency) is characterized by a deficiency in all three types of adrenal steroids (ie, glucocorticoids, androgens, mineralocorticoids), most commonly caused by an autoimmune response. Corticosteroid therapy (eg, hydrocortisone, dexamethasone, prednisone) is the primary treatment for Addison disease. Long-term use of corticosteroids can cause immunosuppression, and the anti-inflammatory effects may also mask signs of infection (eg, inflammation, redness, tenderness, heat, fever, edema). Signs and symptoms of infection (eg, low-grade fever) should be reported to the health care provider immediately as infection can develop quickly and spread rapidly (Option 2). In addition, physiological stress such as infection can trigger Addisonian crisis, a life-threatening complication of Addison disease that would require an increase in the corticosteroid dose. (Options 1, 3, and 4) Side effects of long-term corticosteroid therapy mimic the signs and symptoms of Cushing syndrome, including buffalo hump, moon-shaped face, and hypokalemia. Increased weight, blood pressure, and blood glucose levels can also occur; however, these effects are not as life-threatening as infection.

The nurse is preparing to administer medications to a client admitted with atrial fibrillation. The nurse notes the vital signs shown in the exhibit. Which medications due at this time are safe to administer? Select all that apply. Click on the exhibit button for additional information. 1. Dilitazem extended release PO 2. Heparin subcutaneous injection 3. Lisinopril PO 4. Metoprolol PO 5. Timolol opthalmic

2, 3 Clients with atrial fibrillation can have either bradycardia (slow ventricular response) or tachycardia (rapid ventricular response). This client's vital signs are significant for bradycardia (heart rate [HR] <60/min). Therefore, medications that can decrease HR should be held and the health care provider (HCP) notified. The reason for holding the medication (HR 46/min) and an HCP contact note should be documented. Heparin is an anticoagulant; the subcutaneous injection is most commonly used to prevent deep venous thrombosis in hospitalized clients on bed rest. This medication will not affect the vital signs and is safe to administer (Option 2). Lisinopril, an ACE inhibitor, does not lower HR and is not contraindicated in clients with bradycardia (Option 3). The client is not hypotensive; therefore, lisinopril is safe to administer. (Option 1) Non-dihydropyridine calcium channel blockers (eg, diltiazem, verapamil) can decrease HR and should be held in clients with bradycardia. (Options 4 and 5) All beta blockers (eg, metoprolol, timolol, atenolol), including eye drops that can be absorbed systemically, can decrease the HR and should be held until the prescriptions can be clarified by the HCP. Educational objective:Medications that decrease the heart rate should be held in clients with bradycardia. These include beta blockers such as metoprolol and timolol (including eye drops) and some types of calcium channel blockers (eg, diltiazem, verapamil).

The nurse provides medication teaching to a client with primary adrenal insufficiency (Addison's disease) who is prescribed hydrocortisone 10 mg by mouth 3 times a day. Which instructions should be included in the client's teaching plan? Select all that apply. 1. discontinue if you note mood changes or disruptions in behavior 2. make an appt with an optometrist yearly to assess for cataracts 3. report even a low grade fever to HCP 4. report signs of hyperglycemia including increased urine, hunger, and thirst 5. take med on an empty stomach 6. the dose may need to be decreased during times of stress

2, 3, 4 Clients taking long-term corticosteroid replacement should be taught the following: Do not discontinue glucocorticoid therapy abruptly. Abrupt discontinuation could lead to addisonian crisis, a life-threatening complication (Option 1). Report any signs and symptoms of infection to the HCP immediately. Corticosteroid use can cause immunosuppression, and infection can develop quickly and spread rapidly. Corticosteroids' anti-inflammatory effects may also mask signs of infection such as inflammation, redness, tenderness, heat, fever, and edema (Option 3). Stay attuned to signs and symptoms of stress and increase dose of corticosteroid during times of stress. A stress response (surgery, trauma) can cause a sudden decrease in cortisol levels, triggering addisonian crisis (Option 6). A side effect of corticosteroid therapy is hyperglycemia. Report signs of hyperglycemia, including increased urine, hunger, and thirst. Clients with diabetes mellitus must be vigilant in checking blood glucose levels (Option 4). Corticosteroids are catabolic to bone (osteoporosis) and muscle (muscle weakness). A diet high in calcium (at least 1500 mg/day) and protein (1.5 g/kg/day) but low in fat and simple carbohydrates is recommended. Cataracts are a side effect of corticosteroids, particularly glucocorticoid therapy. Make an appointment with an optometrist yearly to assess for cataracts (Option 2). Corticosteroid medications can cause gastric irritation and should not be taken on an empty stomach (Option 5). Recognize signs and symptoms of Cushing syndrome and report to the PHCP. Develop a regular HCP-approved exercise program.

The clinic nurse is instructing a client who is newly prescribed transdermal scopolamine to prevent motion sickness during an upcoming vacation on a cruise ship. Which of the following statements made by the nurse are appropriate? Select all that apply. 1. apply the patch when the ship starts moving and not before 2. dispose of the patch out of reach of children and pets 3. make sure to remove the old patch before applying a new one 4. place the patch on a hairless, clean dry area behind the ear 5. wash hands with soap and water after handling the patch

2, 3, 4, 5 Scopolamine is an anticholinergic medication used to prevent nausea and vomiting from motion sickness and as an adjunct to anesthesia to control secretions. Transdermal scopolamine is placed on a hairless, clean, dry area behind the ear for proper absorption (Option 4). Clients should be instructed to: Apply the patch ≥4 hours before starting travel to allow for absorption and medication onset (Option 1). Transdermal patches have a slower onset but a longer duration of action. Replace the patch every 72 hours as prescribed to ensure continuous medication delivery. Remove and discard the old patch before placing a new one to prevent accidental overdose (Option 3). Dispose of the old patch out of reach of children and pets to avoid accidental ingestion (Option 2). Wash hands with soap and water after handling the patch to avoid inadvertent drug absorption or contact with the eyes (Option 5).

The primary health care provider is preparing to administer edrophonium to the client with myasthenia gravis. In planning care, the nurse understands which about the administration of edrophonium? Select all that apply. 1.Edrophonium is a long-acting cholinesterase inhibitor. 2.Atropine is used to reverse the effects of edrophonium. 3.If symptoms worsen following administration of edrophonium, the crisis is cholinergic. 4.Edrophonium is used to distinguish between a myasthenic crisis and a cholinergic crisis. 5.An improvement in symptoms following administration of edrophonium indicates myasthenic crisis.

2,3,4,5 Edrophonium is an ultra-short-acting reversible cholinesterase inhibitor that can be used to distinguish between a cholinergic and a myasthenic crisis. To distinguish between overtreatment (cholinergic crisis) and undertreatment (myasthenic crisis), edrophonium is administered; this is often referred to as a Tensilon test. Overtreatment of myasthenia gravis with reversible cholinesterase inhibitors results in a cholinergic crisis. Undertreatment can result in a myasthenic crisis. Both cholinergic and myasthenic crises result in increased muscle weakness or paralysis. If symptoms improve after the administration of edrophonium, the crisis is myasthenic; if symptoms worsen, the crisis is cholinergic. Atropine must be readily available so that edrophonium can be reversed if the symptoms worsen.

A client diagnosed with hypothyroidism is taking levothyroxine. The client returns to the clinic 1 week after beginning the medication and tells the nurse that the medication has not helped. What is the appropriate nursing response to the client? 1.A higher dosage is required. 2.The medication may need to be changed. 3.Full therapeutic effect may take 1 to 3 weeks. 4.Full therapeutic effect may take up to 4 months.

3

A client is admitted with palpitations. The ECG shows supraventricular tachycardia (SVT) with a rate of 220/min. The nurse has received an order to administer adenosine 6 mg IV. Which action should the nurse take? 1. Adenosine is contraindicated for SVT. Verify the order with the HCP. 2. Admin med only through CVA 3. Admin med rapidly over 1-2 seconds followed by saline flush 4. mix med in 50 mL NS and admin over 10 min

3 Adenosine is the first-line drug of choice for the treatment of paroxysmal supraventricular tachycardia (SVT; a rapid rhythm exceeding 150/min). The half-life is <5 seconds, so adenosine should be administered rapidly as a 6-mg bolus IV over 1-2 seconds followed by a 20-mL saline flush. Repeat boluses of 12 mg may be given twice if the rapid rhythm persists. The injection site should be as close to the heart as possible (eg, antecubital area). The client's ECG should be monitored continuously. A brief period of asystole is due to adenosine slowing impulse conduction through the atrioventricular node. The client should be monitored for flushing, dizziness, chest pain, or palpitations during and after administration. (Option 1) Adenosine is the first-line drug for paroxysmal SVT. (Option 2) Although the drug should be administered as close to the heart as possible, central venous access is not required. (Option 4) Because of the drug's short half-life (5-10 seconds), it should be administered rapidly, not slowly, and should not be diluted.

A nurse is caring for a client with a dysfunctional thyroid gland and is concerned that the client will exhibit a sign of thyroid storm. Which is an early indicator of this complication? 1.Bradycardia 2.Constipation 3.Hyperreflexia 4.Low-grade temperature

3 Clinical manifestations of thyroid storm include a fever as high as 106º F, hyperreflexia, abdominal pain, diarrhea, dehydration rapidly progressing to coma, severe tachycardia, extreme vasodilation, hypotension, atrial fibrillation, and cardiovascular collapse.

The nurse is admitting to the hospital a client with a diagnosis of Guillain-Barré syndrome. The nurse knows that if the disease is severe, the client will be at risk for which acid-base imbalance? 1.Metabolic acidosis 2.Metabolic alkalosis 3.Respiratory acidosis 4.Respiratory alkalosis

3 Guillain-Barré is a neuromuscular disorder in which the client may experience weakening or paralysis of the muscles used for respiration. This could cause the client to retain carbon dioxide, leading to respiratory acidosis and ventilatory failure as the paralysis develops. Therefore, the remaining options are incorrect.

The nurse is caring for a client after thyroidectomy. The nurse notes that calcium gluconate is prescribed for the client. The nurse determines that this medication has been prescribed for which purpose? 1.To treat thyroid storm 2.To prevent cardiac irritability 3.To treat hypocalcemic tetany 4.To stimulate release of parathyroid hormone

3 Hypocalcemia, resulting in tetany, can develop after thyroidectomy if the parathyroid glands are accidentally removed during surgery. Manifestations develop 1 to 7 days after surgery. If the client develops numbness and tingling around the mouth, fingertips, or toes; muscle spasms; or twitching, the primary health care provider is notified immediately. Calcium gluconate should be readily available in the nursing unit.

The nurse is caring for a client who had an above-knee amputation 2 days ago. The residual limb was wrapped with an elastic compression bandage, which has come off. Which immediate action should the nurse take? 1.Apply ice to the site. 2.Call the primary health care provider (PHCP). 3.Rewrap the residual limb with an elastic compression bandage. 4.Apply a dry, sterile dressing and elevate the residual limb on 1 pillow.

3 If the client with an amputation has a cast or elastic compression bandage that slips off, the nurse must wrap the residual limb immediately with another elastic compression bandage. Otherwise, excessive edema will form rapidly, which could cause a significant delay in rehabilitation. If the client had a cast that slipped off, the nurse would have to call the PHCP so that a new one could be applied. Elevation on 1 pillow is not going to impede the development of edema greatly once compression is released. Ice would be of limited value in controlling edema from this cause. If the PHCP were called, the prescription likely would be to reapply the compression dressing anyway.

A client who has been taking iodine solution is admitted to the emergency department, and an iodine overdose is suspected. Gastric lavage is initiated to remove the iodine from the stomach. In addition to treatment with gastric lavage, the nurse anticipates that which medication will be administered? 1.Vitamin K 2.Acetylcysteine 3.Sodium thiosulfate 4.Calcium gluconate

3 Iodine solution can cause iodine toxicity. Iodine is corrosive, and an overdose will injure the gastrointestinal tract. Symptoms include abdominal pain, vomiting, and diarrhea. Swelling of the glottis may result in asphyxiation. Treatment consists of gastric lavage to remove iodine from the stomach and administration of sodium thiosulfate to reduce iodine to iodide. Vitamin K is the antidote for warfarin. Acetylcysteine is the antidote for acetaminophen overdose. Calcium gluconate is used for acute hypocalcemia.

Levothyroxine is prescribed for a client diagnosed with hypothyroidism. Upon review of the client's record, the nurse notes that the client is taking warfarin. Which modification to the plan of care should the nurse review with the client's primary health care provider? 1.A decreased dosage of levothyroxine 2.An increased dosage of levothyroxine 3.A decreased dosage of warfarin sodium 4.An increased dosage of warfarin sodium

3 Levothyroxine accelerates the degradation of vitamin K-dependent clotting factors. As a result, the effects of warfarin are enhanced. If thyroid hormone replacement therapy is instituted in a client who has been taking warfarin, the dosage of warfarin should be reduced.

The nurse has administered prochlorperazine to a client for relief of nausea and vomiting. The nurse should then assess the client for which frequent side or adverse effect of this medication? 1.Diarrhea 2.Drooling 3.Blurred vision 4.Excessive tearing

3 Prochlorperazine is a phenothiazine-type antiemetic and antipsychotic agent. A frequent side or adverse effect is blurred vision. Other frequent side and adverse effects of this medication are constipation, dry mouth, and dry eyes.

The nurse is caring for a client who is scheduled to have a thyroidectomy and provides instructions to the client about the surgical procedure. Which client statement indicates an understanding of the nurse's instructions? 1."I expect to experience some tingling of my toes, fingers, and lips after surgery." 2."I will definitely have to continue taking antithyroid medications after this surgery." 3."I need to place my hands behind my neck when I have to cough or change positions." 4."I need to turn my head and neck front, back, and laterally every hour for the first 12 hours after surgery."

3 The client is taught that tension needs to be avoided on the suture line; otherwise hemorrhage may develop. One way of reducing incisional tension is to teach the client how to support the neck when coughing or being repositioned. Likewise, during the postoperative period the client should avoid any unnecessary movement of the neck. That is why sandbags and pillows frequently are used to support the head and neck. Any postoperative tingling in the fingers, toes, and lips probably is due to injury to the parathyroid gland during surgery, resulting in hypocalcemia. These signs and symptoms need to be reported immediately. Removal of the thyroid does not mean that the client will be taking antithyroid medications postoperatively. Thyroid replacement medications are necessary.

The nurse is admitting a client with Guillain-Barré syndrome to the nursing unit. The client has complaints of inability to move both legs and reports a tingling sensation above the waistline. Knowing the complications of the disorder, the nurse should bring which most essential items into the client's room? 1.Nebulizer and pulse oximeter 2.Blood pressure cuff and flashlight 3.Nasal cannula and incentive spirometer 4.Electrocardiographic monitoring electrodes and intubation tray

3 The client with Guillain-Barré syndrome is at risk for respiratory failure because of ascending paralysis. An intubation tray should be available for use. Another complication of this syndrome is cardiac dysrhythmias, which necessitates the use of electrocardiographic monitoring. Because the client is immobilized, the nurse should assess for deep vein thrombosis and pulmonary embolism routinely. Although items in the incorrect options may be used in care, they are not the most essential items from the options provided.

The nurse should include which interventions in the plan of care for a client with hyperthyroidism? Select all that apply. 1.Provide a warm environment for the client. 2.Instruct the client to consume a low-fat diet. 3.A thyroid-releasing inhibitor will be prescribed. 4.Encourage the client to consume a well-balanced diet. 5.Instruct the client that thyroid replacement therapy will be needed. 6.Instruct the client that episodes of chest pain are expected to occur.

3, 4 The clinical manifestations of hyperthyroidism are the result of increased metabolism caused by high levels of thyroid hormone. Interventions are aimed at reduction of the hormones and measures to support the signs and symptoms related to an increased metabolism. The client often has heat intolerance and requires a cool environment. The nurse encourages the client to consume a well-balanced diet because clients with this condition experience increased appetite. Iodine preparations are used to treat hyperthyroidism. Iodine preparations decrease blood flow through the thyroid gland and reduce the production and release of thyroid hormone. Thyroid replacement is needed for hypothyroidism. The client would notify the primary health care provider if chest pain occurs because it could be an indication of an excessive medication dose.

A newly admitted client describes symptoms of dizziness and feeling faint on standing. The client has a history of type 2 diabetes, coronary artery disease, and bipolar disorder. Which medications may be contributing to the client's symptoms? Select all that apply. 1. Atorvastatin 2. Metformin 3. Metorprolol 4. Olanzapine 5. Omeprazole

3, 4 Drugs commonly associated with orthostatic hypotension include: Most antihypertensive medications, particularly sympathetic blockers such as beta blockers (eg, metoprolol) and alpha blockers (eg, terazosin) (Option 3) Antipsychotic medications (eg, olanzapine, risperidone) and antidepressants (eg, selective serotonin reuptake inhibitors) (Option 4) Volume-depleting medications such as diuretics (eg, furosemide, hydrochlorothiazide) Vasodilator medications (eg, nitroglycerine, hydralazine) Narcotics (eg, morphine) Clients at risk for developing orthostatic hypotension should be instructed to: Take medications at bedtime, if approved by the health care provider Rise slowly from a supine to standing position, in stages (especially in the morning) Avoid activities that reduce venous return and worsen orthostatic hypotension (eg, straining, coughing, walking in hot weather) Maintain adequate hydration

The nurse should include which interventions in the plan of care for a client with hypothyroidism? Select all that apply. 1.Provide a cool environment for the client. 2.Instruct the client to consume a high-fat diet. 3.Instruct the client about thyroid replacement therapy. 4.Encourage the client to consume fluids and high-fiber foods in the diet. 5.Inform the client that iodine preparations will be prescribed to treat the disorder. 6.Instruct the client to contact the primary health care provider (PHCP) if episodes of chest pain occur.

3, 4, 6 The clinical manifestations of hypothyroidism are the result of decreased metabolism from low levels of thyroid hormone. Interventions are aimed at replacement of the hormone and providing measures to support the signs and symptoms related to decreased metabolism. The client often has cold intolerance and requires a warm environment. The nurse encourages the client to consume a well-balanced diet that is low in fat for weight reduction and high in fluids and high-fiber foods to prevent constipation. Iodine preparations may be used to treat hyperthyroidism. Iodine preparations decrease blood flow through the thyroid gland and reduce the production and release of thyroid hormone; they are not used to treat hypothyroidism. The client is instructed to notify the PHCP if chest pain occurs because it could be an indication of overreplacement of thyroid hormone.

The nurse plans teaching for a client who was newly prescribed levothyroxine sodium after thyroid removal. Which instructions will the nurse include in the teaching plan? Select all that apply. 1. drowsiness is a common side effect, take at bed time 2. notify HCP if you become pregnant as this med is harmful to the fetus 3. notify HCP if feel fluttering or rapid HR 4. take med with meal to prevent stomach upset 5. you will need to take this for the rest of your life

3, 5 Levothyroxine sodium (eg, Levoxyl, Levothroid, Synthroid) is used to replace thyroid hormone in clients with hypothyroidism (inadequate thyroid hormone) and for those who have had their thyroid removed. These clients must understand that this medication must be taken for the rest of their lives (Option 5). A client's dose is adjusted based on serum TSH levels to prevent too much or too little hormone. Clients must be taught to report signs of excess thyroid hormone such as heart palpitations/tachycardia, weight loss, and insomnia (Option 3). (Option 1) Clients with hypothyroidism experience lethargy and somnolence. Hormone replacement therapy will increase metabolic activity and alertness. (Option 2) This medication is a hormone that is normally present in the body, so it is safe to take during pregnancy. The dose may need to be altered due to the metabolic demands of pregnancy, but the drug will not harm the fetus. (Option 4) It is best to take this medication first thing in the morning as it is best absorbed on an empty stomach (1 hour before or 2 hours after a meal).

The client is admitted to the hospital with a diagnosis of Guillain-Barré syndrome. Which past medical history finding makes the client most at risk for this disease? 1.Meningitis or encephalitis during the last 5 years 2.Seizures or trauma to the brain within the last year 3.Back injury or trauma to the spinal cord during the last 2 years 4.Respiratory or gastrointestinal infection during the previous month

4 Guillain-Barré syndrome is a clinical syndrome of unknown origin that involves cranial and peripheral nerves. Many clients report a history of respiratory or gastrointestinal infection in the 1 to 4 weeks before the onset of neurological deficits. On occasion, the syndrome can be triggered by vaccination or surgery.

The nurse is providing education to a pregnant client diagnosed with symptomatic hypothyroidism regarding levothyroxine therapy during pregnancy. Which is appropriate teaching for the nurse to include? 1. after symptoms resolve, levothyroxine may be discontinued 2. levothyroxine should be taken in the evening with a prenatal vit 3. med dose will remain the same throughout pregnancy 4. symptoms should begin improving within 4 weeks of starting levothyroxine

4 Hypothyroidism during pregnancy places clients at increased risk for other complications of pregnancy (eg, preeclampsia, placental abruption, preterm labor). Symptoms of hypothyroidism may include fatigue, cold intolerance, constipation, dry skin, and brittle hair/nails. Levothyroxine (Synthroid) is the first-line medication for treatment of hypothyroidism during pregnancy. The client may experience some relief of symptoms beginning approximately 3-4 weeks after initiating levothyroxine therapy (Option 4). Hormone levels are usually rechecked every 4-6 weeks until normal thyroid hormone levels are achieved. It may take up to 8 weeks after initiation to see the full therapeutic effect.

The nurse provides education to the client with hyperthyroidism about potassium iodide before medication administration. The client is scheduled for a subtotal thyroidectomy. Which response by the client indicates understanding? 1."It replaces thyroid hormone." 2."It prevents iodine absorption." 3."It increases thyroid hormone." 4."It suppresses thyroid hormone."

4 Potassium iodide is administered to hyperthyroid individuals in preparation for thyroidectomy to suppress thyroid function. Initial effects develop within 24 hours. Peak effects develop in 10 to 15 days. In most cases, plasma levels of thyroid hormone are reduced with propylthiouracil before potassium iodide therapy is initiated. Then potassium iodide, along with propylthiouracil, is administered for the last 10 days before surgery. Therefore, the remaining options are incorrect

A client with myasthenia gravis has difficulty chewing and has received a prescription for pyridostigmine. The nurse should check to see that the client takes the medication at what time? 1.With meals 2.Between meals 3.Just after meals 4.30 minutes before meals

4 Pyridostigmine is a cholinergic medication used to increase muscle strength in the client with myasthenia gravis. For the client who has difficulty chewing, the medication should be administered 30 minutes before meals to enhance the client's ability to eat. The times noted in the remaining options will not be helpful to the client.

A primary health care provider (PHCP) prescribes quinidine gluconate for a client. The nurse decides to withhold the medication and contact the PHCP if which assessment finding is documented in the client's medical record? 1.Muscle weakness 2.History of asthma 3.Presence of infection 4.Complete atrioventricular (AV) block

4 Quinidine gluconate is an antidysrhythmic medication used to maintain normal sinus rhythm after conversion of atrial fibrillation or atrial flutter. It is contraindicated in complete AV block, intraventricular conduction defects, and abnormal impulses and rhythms caused by escape mechanisms, and with myasthenia gravis. It is used with caution in clients with preexisting muscle weakness, asthma, infection with fever, and hepatic or renal insufficiency.

A client has just returned to a nursing unit after an above-knee amputation of the right leg. The nurse should place the client in which position? 1.Prone 2.Reverse Trendelenburg's 3.Supine, with the residual limb flat on the bed 4.Supine, with the residual limb supported with pillows

4 The residual limb is usually supported on pillows for the first 24 hours after surgery to promote venous return and decrease edema. After the first 24 hours, the residual limb usually is placed flat on the bed to reduce hip contracture. Edema also is controlled by limb-wrapping techniques. In addition, it is important to check the primary health care provider's or surgeon's prescriptions regarding positioning after amputation, because there are often differences in preference in terms of positioning after the procedure related to risks associated with hip and knee contracture.

The home health nurse has been discussing interventions to prevent constipation in a client with multiple sclerosis. The nurse determines that the client is using the information most effectively if the client reports which action? 1.Drinking a total of 1000 mL/day 2.Giving herself an enema every morning before breakfast 3.Taking stool softeners daily and a glycerin suppository once a week 4.Initiating a bowel movement every other day, 45 minutes after the largest meal of the day

4 To manage constipation, the client should take in a high-fiber diet, bulk formers, and stool softeners. A fluid intake of 2000 mL/day is recommended. The client should initiate a bowel movement on an every-other-day basis and should sit on the toilet or commode. This should be done approximately 45 minutes after the largest meal of the day to take advantage of the gastrocolic reflex. A glycerin suppository, bisacodyl suppository, or digital stimulation may be used to initiate the process. Laxatives and enemas should be avoided whenever possible because they lead to dependence.

myxedma coma

A rare but serious disorder that results from persistently low production of thyroid hormones. Cause: acute illness, rapid withdrawal of thyroid meds, anesthesia, surgery, hypothermia & use of sedatives & opioids -life threatening emergency hypothyroid crisis: -any other significant problem or new diagnosis is at risk - mortality rate of 60% -thickness/edema that forms that is made of mucus and water (cellular level) -changes organ texture -nonpitting, generalized body edema -anasarca: hoarseness, thick skin, diminished hearing, paralytic ileus, unresponsive, enlarged tongue, hypoglycemic, hypothermic, decreased breathing, hypotension Causes: -insufficient thyroid supplementation -severe hypothyroid state -increased stressor (trauma, cold, anesthesia, infection) -can be so deadly because of: potential airway obstruction but decreased metabolism can cause heart muscle to become flabby, and chamber size to increase causing decreased CO -most common cause of death is respiratory failure - maintain sats above 90% and look for cyanosis

postoperative care r/t lumbosacral surgery

ASSESSMENT: momement, strength, sensory perception • Maintain proper alignment of spine • Prevention/assessment of complications • Neurologic assessment; vital signs • Patient's ability to void • Pain control • Wound care • CSF check - glucose is indicative of CSF **notify HCP/surgeon **put patient flat • Patient positioning/mobility • Discharge teaching **Home care management **Community resources

Promethazine

Antiemetic • Class: antiemetics, antihistamines, sedative hypnotics, phenothiazines • Route: PO, IM, Rectal, IV • Use: treatment of various allergic conditions and motion sickness. Preoperative sedation. Treatment and prevention of nausea and vomiting. Adjunct to anesthesia and analgesia • Action: Blocks the effects of histamine. Has inhibitory effect on the chemoreceptor trigger sone in the medulla, resulting in antiemetic properties. Alters the effects of dopamine in the CNS. Possesses significant anticholinergic activity. Produces CNS depression by indirectly decreased stimulation of the CNS reticular system

benign vs. malignant

Benign- non cancerous • Well differentiated • Encapsulated - thin fibrous capsule around it • Can not invade other tissue and organs - might expand it • Rarely recur • Under microscope cell looks like the original cell (skin cell looks a skin cell) -can grow and should be removed if they are impairing on the quality and functionality of life Malignant- cancerous • Undifferentiated or poorly differentiated • Non-encapsulated • Invasive • Irregularly shaped with finger-like projections that invade neighboring tissues • Vast difference in appearance between normal cells and malignant cells (under microscope cells don't always look like the cell it originated from) • Able to spread (metastasize) -should always be removed for cure, remission, or relief of symptoms

seven major warning signs of cancer

C - change in bowel or bladder habits A - sore that does not heal U- unusual bleeding/discharge T- thickening or lump in the breast/elsewhere I - indigestion or diffculty in swallowing O- obvious change in wart or mole N- nagging cough or hoarseness

HIV progression

Can take months to years to progress from HIV to AIDS ---can have "asymptomatic infection or clinical latency" between this time ---repeated exposure to HIV or other STD's will cause more rapid progression 2-4 weeks to acute infection of HIV ---flu like symptoms after exposure ---high viral load (increase HIV load) and quick drop of CD4 count but then returns to normal again ---most infectious at this stage due to high volume of HIV system, usually don't know it Personal life factors can affect timing progression: **Frequency of re-exposure to HIV **Presence of other STDs **Nutrition status **Stress

stump care

Compression bandage... removed and reapplied 3 to 4 times per day... After healing. bandaging is only done when the prosthesis is not in use

treatment related to cervical neck pain

Conservative treatment • Neck Exercises • Soft collars • Heat/Ice • Massage • Rest • NSAIDS Surgical management • Anterior cervical diskectomy (front or back)- common **maintain airway (ABC'S) **immobility of neck to avoid further damage ** assess respiratory statues **high fowlers position ** suction ready **O2 as needed **rapid response ready **stridor is EMERGENCY (no air through trachea) **skin integrity (swelling, incision intact, etc) **would drainage / WBC count • Fusion

dexamethasone

Corticosteroid • Class: anti-inflammatories (steroidal) • Route: PO, IM, IV • Use: used systemically and locally in a wide variety of chronic diseases (inflammatory, allergic, hematologic, endocrine, neoplastic, dermatologic, autoimmune disorders, management of cerebral edema, diagnostic agent in adrenal disorders) ⇒ Unlabeled use: short-term admin to high-risk mothers before delivery to prevent respiratory distress syndrome in newborn. Adjunctive management of nausea and vomiting from chemotherapy. Treatment of airway edema prior to extubation. Used in neonates with bronchopulmonary dysplasia to facilitate ventilator weaning • Action: in pharmacologic doses, suppresses inflammation and the normal immune response. Suppresses adrenal function at chronic does of 0.75mg/day. Has negligible mineralocorticoid activity.

HIV classification

Defined by Highest Clinical Stage In Which Pt. Is Qualified Stage 1: >500 no S&S of infection Stage 2: 200-499 CD4 cells- no/minimal signs of infection Stage 3: CD4 count below 200 - AIDS virus diagnosed, and some form of opportunistic disease Stage 4: unknown CD4 count below 200 and an opportunistic disease opportunistic disease: disease a normal healthy adult is usually able to fight off

methods of metastases

Direct Invasion: invading nearby tissue or organs : invading nearby tissue or organs Serosal Seeding: invading a body cavity and adhering to an organ within the cavity -peritoneal cavity- bowel Lymphatic Spread: Entering the lymphatic system and spreading; may ultimately enter the bloodstream this way -spread to local or distant lymph nodes because of lymphatic drainage system Hematologic Spread: Hematologic Spread: Carried to distant sites by blood flow Carried to distant sites by blood flow -predictable trajectory -EXAMPLE: colon cancer ---> liver

clinical manifestations of colorectal cancer

Early -usually nonspecific, do not appear until advanced -weight loss -weakness/fatigue Progressing: -rectal bleeding and/or melena (Hematochezia) -abdominal pain or tenderness -anemia -alternating constipation and diarrhea Advanced: • Based on where cancer is located • Right side (ascending) -usually silent and evolve to pain with palpable mass • Left side (descending) - may lead to obstruction -narrow, ribbon-like stools (because there is a tumor there pushing and changing shape) -sensation of incomplete evacuation (rectal cancer) -

Epoetin Alpha

Epogen, Procrit • Route: IV, Subcut • Class: antiemetics, hormones, erythropoiesis stimulating agents (ESA) • Use: anemia associated with chronic kidney disease (CKD), anemia secondary to AZT in HIV infected patients, anemia from chemotherapy in patients with nonmyeloid malignancies, reduction of need for allogeneic red blood cell transfusions in patients undergoing elective, noncardiac, nonvascular surgery • Action: stimulates erythropoiesis (production of red blood cells)

nursing interventions for CINV

Encourage use of nutritional supplements • Maybe necessary if overall nutritional intake is decreasing (Ensure) Pt may require analgesics prior to meals • Swallowing may be painful/difficult (topical analgesic PRN "magic mouth wash") Oral cavity care • Assess oral cavity every shift • Frequent oral rinses with saline or salt and soda solution • Topical analgesics prn Administer Antiemetics • Serotonin Antagonists, ex: Zofran Provide emotional support • Encourage verbalization of feelings Provide treatment in a calm, softly lit area • Provide other comfort items such as headphones, blankets Suggest dietary modifications • Small meals of bland, cool or cold food • Provide liquids to prevent dehydration • Small, light meal before treatment might help Pt/family education and involvement • Discourage irritants such as tobacco, alcohol, spicy or acidic foods • Assess oral mucosa daily

internal radiation- brachytherapy

Implanted into affected tissue or body cavity by implantation of seeds, rods. -emitted in the waste products Used commonly with cervical, prostate, breast and skin cancer. Short and long term • Can be "sealed" or "unsealed" •High doses of radiation can be delivered directly to the tumor •Often used before or after external beam therapy to control tumor growth

clinical manifestations of hyperthyroidism (p. 1151 Lewis)

Increased appetite but losing weight Hypermotile bowels (increased peristalsis, abd. bloating and pain) Heat Intolerance Insomnia Palpitations Increased sweating Hair and skin changes Emotionally labile -women may have menstrual problems or fertility challenges

nutritional impact of hyperthyroidism

Increased protein, carbohydrate, and lipid metabolism = • Lipids depleted • Glucose intolerance decreases • Protein degradation increases Increased appetite, increased weight loss -avoid high fiber, spicy foods

Prednisone

Instruct the patient to report illness because the usual daily dosage may not be adequate during periods of illness or severe stress.

Hydrocortisone (Cortef, Hycort)

Instruct the patient to report the following S/S of excessive drug therapy, which indicate Cushing's syndrome and a possible need for a dosage adjustment: • Rapid weight gain • Round face • Fluid retention

how chemotherapy works

It causes damage to the cancer cells, leading to cell death Cell-cycle specific drugs provide the greatest cancer cell kill when given in divided, frequent doses (or continuous infusion) Non-cell-cycle specific drugs kill more cancer cells when more drug is given. Side effects, however, limit the doses we can administer.

AIDS defining illness

Kaposi Sarcoma Burkitt's lymphoma Mycobacterium Tuberculosis Fungal Infection Herpes Cytomegalovirus And many more

clinical manifestations of hypothyroidism

Lethargy **main reason for seeking treatment Weakness Dry skin/cool skin Cold intolerance Weight gain/no appetite Constipation Coarse hair bradycardia/hypotension fluid retention/edema **especially around eyes/face **"thick skin" increased sensitivity to opioids, barbiturates, and anesthesia

diagnosis of guillain-barre syndrome

Lumbar puncture with CSF Analysis- tested for a type of change that commonly occurs in people who have GuillainBarre syndrome. EMG - abnormal Nerve Conduction Velocity- abnormal Elevated protein after 7-10 days

General Side Effects of Radiation: pain

Mucositis, skin reactions, gastroenteritis, proctitis bone metastases radiation-induced neuropathies

Cyclobenzaprine (Flexeril)

Muscle Relaxant • Sye-kloe-ben-za-preen • Class: skeletal muscle relaxants (centrally acting) • Route: PO • Use: management of acute painful musculoskeletal conditions associated with muscle spasm ⇒ Unlabeled use: management of fibromyalgia • Action: Reduces tonic somatic muscle activity at the level of the brainstem. Structurally similar to tricyclic antidepressants Side effects: dizziness, drowsiness, dry mouth, constipation, urinary retention pat edu: take med as directed at same time each day -may cause drowsiness, dizziness, or blurred vision (avoid driving) -avoid alcohol or other CNS depressants -notify about other OTC meds -advise to notify about serotonin syndrome (mental changes, HR changes, neuromusc. aberrations), irregular HR, allergic reaction

additional symptoms of Cushing's disease

Musculoskeletal o Muscle atrophy o Osteoporosis (bone density loss) o Pathologic fractures **increased cortisol leads to bone demineralization **nitrogen depletion and mineral loss that can lead to pathological fractures Integumentary o Thinning skin o Striae and increased pigmentation o Fragile capillaries **move and assist gently IMMUNE SYSTEM SYMPTOMS o Increased risk for infection o Reduced IMMUNITY o Decreased inflammatory responses o Signs and symptoms of infection/inflammation possibly masked **high levels of corticosteroids reduce lymphocyte production and shrink organs containing lymphocytes such as spleen and lymph nodes

Numbers after the N

N1, N2, N3, N4: -when there is lymph node involvement -describe the size, location, and/or the number of lymph nodes involved. -The higher the N number, the more lymph nodes there are that contain cancer.

hormones- overview

NEGATIVE FEEDBACK- needed to keep everything in balance -too much, stop sending out -too little, send out Chemical messengers secreted by specialized glands in response to stimulation Transported via blood to target cells and tissues Exerts physiological control on these cells The control of cellular function by any hormone depends on a series of reactions working through negative feedback control mechanisms REMEMBER: Everything is a balance!!! When not in balance... disorders happen

Efavirenz

NNRTI • Class: antiretrovirals, nucleoside reverse transcriptase inhibitors • Route: PO • Use: HIV infection • Action: inhibits HIV reverse transcriptase resulting in disruption of DNA synthesis

Tenofovir

NRTI • Class: antiretrovirals, nucleoside reverse transcriptase inhibitors • Route: PO • Use: HIV infection, Chronic hepatitis B • Action: phosphorylated intracellularly; tenofovir diphosphate inhibits HIV reverse transcriptase resulting in disruption of DNA synthesis

transmission of HIV and health care workers

Needle stick ("sharps") injuries Exposure of nonintact skin/mucous membranes to blood and body fluids Standard Precautions is best prevention Post exposure prophylaxis (PEP)

assessment of hyperthyroidism

Objective data includes VS changes, increased BP, tachycardia, hair becomes fine and brittle, diarrhea hx physical assessment -ALWAYS WANT APICAL PULSE -(at risk for dysrhythmias) Symptoms include weight loss, nervousness, insomnia, SOB psychosocial assessment lab assessment : -TSH (sensitive assay) -Total Serum T3 & T4 test -Serum Free T4 -Thyroid Antibodies (TPO) diagnostic tests: -RAI Uptake Test (Thyroid Scan): radioactive iodine **in addition to labs **evaluates position, size, and function of thyroid gland **radioactive iodine is given by mouth **uptake of iodine uptake is measured **normal is between 5-35% in 24 hours (more than than is hyperthyroidism) -ultrasound

assessment of hypoparathyroidism

Objective data includes a positive sign of Chvostek sign, Trousseau sign, laryngeal spasm, titanic spasm (excessive / inappropriate muscle contractions) oMild tingling and numbness to muscle tetany oIrritability to psychosis oLoss of tooth calcium and enamel

Chemotherapy-Induced Bone Marrow Suppression- Chemotherapy-induced neutropenia

Occur when any blood count is at its nadir -point where WBC's are at their lowest point -each medication has a different nadir point ---Severe reduction in number of neutrophils ---Neutrophils are the most common granulocytic WBC ---Major risk for infection, often from the organisms that live in or on our bodies naturally ---DROP in WBC and neutrophils, will want to be on neutropenic precautions • Management: • Early identification • Growth stimulators (Filgrastim/Neupogen®) to increase segmented neutrophils • Meticulous hygiene • Low-bacteria diet (controversial)

Saturated solution of potassium iodide (SSKI)

Prophylactic for Radioactive Iodine Therapy hyperthyroidism • Iodine has been shown to decrease thyroid hormone levels and reduce blood flow within the thyroid gland

Assessment of Addison's Disease

Pt usually experiences progressive weakness, fatigue, nausea, vomiting, and craving for salt. -abd pain radiating to adrenal glands -hyponatremia leading to low BP and decreased LOC is often one of the first indicators of adrenal insufficiency -hyperkalemia- can lead to cardiac dysrhythmias and cardiac arrest

brachytherapy- unsealed radiation

Radioactive isotopes are unsealed and suspended in fluid -- Given via IV or instilled in body cavities -- Emitted in waste products radiation safety with unsealed sources: --secretions may be contaminated with radioactivity --healthcare personnel must be gowned and gloved (follow guidelines for linens and trash) --ALARA: *as low as reasonably achievable *time: limit the time in contact with the radioactive source/patient *distance: maximize the distance from the source *shielding: use the proper shielding to reduce exposure

Zidovudine

Retrovir Class: antiretrovirals, nucleoside reverse transcriptase inhibitors • Use: HIV and reduction of maternal/fetal transmission of HIV ⇒ Unlabeled use: chemoprophylaxis after occupational exposure to HIV • Action: Following intracellular conversion to its active form, inhibits viral RNA synthesis by inhibiting the enzyme DNA polymerase. Prevents viral replication

oncological emergencies

Sepsis DIC Metabolic: -SIADH -Hypercalcemia -Tumor Lysis Syndrome Obstructive: -Spinal Cord Compression -Superior Vena Cava Syndrome -third space syndrome

ONCOLOGICAL EMERGENCIES: Sepsis

Sepsis - bloodstream infection - Can lead to septic shock • Neutropenic patients don't present with typical septic shock warning signs - normal bacterial flora entering through bloodstream at any site of skin breakdown • Low grade fever usually the only sign -treat with antibiotics

numbers after the T

T1, T2, T3, and T4 : - describe the tumor size and/or - amount of spread into nearby structures. - The higher the T number, the larger the tumor and/or the more it has grown into nearby tissues.

thyroid hormones

T3, T4, calcitonin oControls body metabolism -regulates protein, carbohydrate, and fat metabolism -can exert effects on HR and contractility oHypothalamus senses high or low levels of T3 & T4 and sends signals to the pituitary via thyroid releasing hormone TRH oThe pituitary sends TSH to the thyroid gland and the thyroid gland makes and releases thyroid hormones hypothalamus secretes TRH to anterior pituitary which secretes TSH to the thyroid which secretes T3, T4, calcitonin

C4 injury

Tetraplegia, results in complete paralysis below the neck (the higher the level of the spine, the more severe the injury)

pathophysiology of myasthenia gravis

There are antibodies directed against acetylcholine receptors on the muscle surface which cause an increased rate of receptor destruction and leads to weakness • Etiology: autoimmune disease/thyoma • Women more likely to be affected/ at an earlier age • Triggers: Stress, surgery, infection, drug overdose or inadequate dose • Acetylcholine receptor antibodies interfere with impulse transmission • T cell process produces Ach receptors antibiodies which reduce normal neurotransmissions • Antibodies attack acetylcholine (ACh) receptors, resulting in less ACh receptor sites at the neuromuscular junction --- Prevents ACh from attaching and stimulating muscle contraction • Follows an unpredictable course of periodic exacerbations and remissions

primary prevention for other modifiable risk factors

UV radiation diet high in fat, preservatives contaminated drinking water and exposure to some viruses can lead to: Hep B and C HPV Esptein-Barr virus HIV

tensilon test

Used to diagnose MG and to differentiate between myasthenic crisis and cholinergic crisis. -edrophonium is given intravenously: -acts within a few seconds and lasts for a few seconds -2 mg of the drug injected IV over 15 seconds -if no response occurs within 30-45 sec, and addtl 8 mg dose is injected -and evaluation of the response requires objective assessment of one or more signs such as degree of ptosis and range of ocular movements

clinical manifestations of guillain-barre syndrome

Usually follows a viral infection by about 10 days Weakness begins in the lower extremities and progressively involves trunk and upper limbs and finally involves the respiratory muscles Dysphagia and facial weakness may occur If the autonomic nerves become involved: Labile blood pressure and cardiac rate Postural hypotension Episodes of profound bradycardia Occasional asystole • Prickling, "pins and needles" sensations in fingers, toes, ankles or wrists • Weakness in legs that spreads to your upper body • Unsteady walking or inability to walk or climb stairs • Difficulty with eye or facial movements, including speaking, chewing or swallowing • Severe pain that may feel achy or cramp-like and may be worse at night • Difficulty with bladder control or bowel function • Rapid heart rate • Low or high blood pressure • Pain: Up to half of people with Guillain-Barre syndrome experience severe nerve pain, which may be eased with medication. • Bowel and bladder function problems: Sluggish bowel function and urine retention may result from Guillain-Barre syndrome. • Blood clots: Patients who are immobile due to Guillain-Barre syndrome are at risk of developing emboli. --Anticoagulation is prescribed • Pressure ulcers: Being immobile also puts patient at risk of developing pressure ulcers. Frequent repositioning may help avoid this problem. • Relapse

Ondansetron

Zofran Antiemetic • On-dan-se-tron • Trade: Zofran • Class: antiemetics, 5-HT3 agonists • Route: PO, IV, IM • Use: Prevention of nausea and vomiting associated with post op, chemo, or radiation • Action: Blocks the effects of serotonin at 5-HT3 receptor sites located in vagal nerve terminals and the chemoreceptor trigger zone in the CNS

adrenal glands

a pair of endocrine glands that sit just above the kidneys and secrete hormones (epinephrine and norepinephrine) that help arouse the body in times of stress. all are corticosteroids

contact inhibition

a process that stops additional cell growth when cells become crowded -when cells are removes, cells at the edge of the gap begin to divide -normal cells stop dividing when bottom of dish is covered -cancer cells continue to diving, piling on top of each other

negative feedback- glucose example

a regulatory substance produced in an organism and transported in tissue fluids such as blood to stimulate specific cells or tissues into action. food is consumed and digested causing glucose to rise in response to higher glucose levels, the pancreas secretes insulin into the blood in response to higher insulin levels glucose is transported into cells and liver cells store glucose and glycogen ---> glucose levels drop in response to lower concentration in glucose, the pancreas stops secreting insulin

thyroid storm

a relatively rare, life-threatening condition caused by exaggerated hyperthyroidism -whenever there is an acute increase in temperature after surgery or extreme temperatures Key Symptoms: ◦High Fever ◦Severe Hypertension ◦Tachycardia Agitation, restlessness, tremors are common. Progresses to confusion, psychosis, delirium, and seizures. Mortality rate is high. Treat Quickly: Cooling measures but prevent shivering, replace fluids, glucose, and electrolytes, stabilize cardiovascular function and decrease respiratory distress, reduce TH secretion

malignant cancer cell characteristics

abnormal, no useful function/purpose and are harmful to normal body features • Larger Nuclear to Cytoplasmic Ratio- distinct difference • Specific Functions Are Lost • Migration Occurs- not tightly BOUND together (NO FIBRONECTIN) --Contact Inhibition Does Not Occur • Rapid or Continuous Cell Division (Loss of Regulation) • Aneuploidy- abnormal number of chromosomes, disrupting normal protein function -NO PREDETERMINED LIFESPAN -ability for cells to metastasize is unique to cancer cells

3 routes of accidental chemo contact

absorption, inhalation, or ingestion

stages of HIV

acute infection: ---during this stage large amount of virus produced in the body ---many people develop flu like symptoms clinical latency ---HIV virus multiplies at very slow rate but is still active ---people may not have any symptoms and with proper therapy this stage may last for several decades -some people may progress quicker AIDS ---considered to have AIDS when Cd4 count falls below 200/mm3 ---without treatment people survive 2-3 years and ar prone to many infections

definition of AIDS

all HIV-infected individuals who have fewer than 200 CD4+ T cells/microliter of blood or a CD4+ cell percentage of lymphocytes of less than 14

pathophysiology of guillain-barre syndrome

antibodies that the body created for infection, incorrectly start attacking myelin sheath in peripheral nervous system • These sensations can quickly spread, eventually paralyzing the whole body. • In its most severe form Guillain-Barre syndrome is a medical emergency. • Most people with the condition must be hospitalized to receive treatment • The exact cause of Guillain-Barre syndrome is unknown. But it is often preceded by an infectious illness such as a respiratory infection or the stomach flu.

cancer

any malignant growth or tumor caused by abnormal and uncontrolled cell division • Often considered a disease of aging • 1.7 million people diagnosed with some type of invasive cancer annually -uncontrolled cell growth and the spread of abnormal cells

Trousseau's sign

arm/carpal spasm associated with hypocalcemia -early sign of hypocalcemia -take BP cuff, inflate above systolic pressure, leave inflated, and then deflate -if there is the carpal tunnel spasm, this is a positive response

diagnostic studies r/t amputation

arteriography, doppler studies, venography

Cholestyramine

bile acid sequestrant • Use: Management of primary hypercholesterolemia. Pruritus associated with elevated levels of bile acids ⇒ Unlabeled use: Diarrhea associated with excess bile acids • Action: Bind bile acids in the GI tract, forming an insoluble complex. Result is increased clearance of cholestero

herniated nucleus pulposus

can press on the adjacent spinal nerve (usually the sciatic nerve), causing severe burning or stabbing pain down into the leg or foot -can also cause leg weakness -spasms -bowel and bladder incontinence/retention

infiltration of chemo

chemo is a vessicant

CINV

chemotherapy induced nausea and vomiting •Acute: Occurs within the first 24 hours •Delayed: Occurs 24 hours or more •Breakthrough: Occurs despite use of antiemetics •Anticipatory: A conditioned response -2 of most feared side effects of chemotherapy -emetogenic - vomiting inducing -can lead to: dehydration, changes in body-electrolyte balance, impede body's ability to take in nutrients, induce fear of future cancer treatments, aspiration pneumonia, fractures from severe vomiting in pt's with bone cancer

drug therapy r/t lumbosacral back pain

cyclobenzaprine • Use: • Centrally acting muscle relaxant • Action: •Alleviates muscle spasm associated with acute painful musculoskeletal conditions • Side effects • Anticholinergic effects • Drowsiness; dizziness • Headache Discontinue over 1 week to avoid rebound spasms Have patient avoid alcohol and other depressants

Multiple Sclerosis (MS)

destruction of the myelin sheath on neurons in the CNS and its replacement by plaques of sclerotic (hard) tissue ❑ It is an Auto Immune Disease which is when the body starts to destroy itself. ❑ It is a life-long disease with no cure. ❑ In MS, the body attacks and destroys the fatty tissue called myelin that insulates an axon/nerve, and is called demyelination. ❑ If damage is severe it can also destroy the nerve/axon itself. ❑ MS affects the central nervous system and inflames the white matter in the brain which creates plaques.

propanolol

esophageal varices • Use: Management of hypertension, angina, arrhythmias, hypertrophic cardiomyopathy, thyrotoxicosis, essential tremors, pheochromocytoma. Also used in the prevention and management of MI, and the prevention of vascular headaches. Proliferating infantile hemangioma requiring systemic therapy. ⇒ Unlabeled use: used to manage alcohol withdrawal, aggressive behavior, antipsychotic associated akathisia, situational anxiety, and esophageal varices. Post-traumatic stress disorder (PTSD) • Action: Blocks stimulation of beta1(myocardial) and beta2 (pulmonary, vascular, and uterine)- adrenergic receptor sites; its mechanism for the treatment of infantile hemangiomas is unknown. ⇒ Effects: Decreased heart rate and BP. Suppression of arrhythmias. Prevention of MI. Hemangioma resolution.

the nurse should instruct the client with low back pain to avoid:

exceeding the prescribed exercise program

hyperthyroidism

excessive activity of the thyroid gland Excessive thyroid hormone secretion Can be temporary or permanent-depending on cause Grave's disease - most common cause -autoimmune disease of unknown cause thyrotoxicosis- physiological effects of clinical symptoms of high metabolism -stimulates most of body system causing hypermetabolism and increase in SNS activity (INCREASED HR) -increased need for dietary protein, calories, and carbs secondary to rapid metabolism

deliveries of radiation

exposure = amount of radiation delivered dose= always less than exposure because some energy is lost in transportation • Though placement of a radiation source internally, near the tumor • Through ingestion or injection of radioactive material • Through machines that can target tumor location = teletherapy • (Radiosurgery)

Mengies

fibrous connective covering of spinal cord and brain

extravastion r/t chemo

fluid that causes blistering and tissue sloughing if infiltrates.

Pancrelipase

for pancreative enzyme deficiency used every time they eat • Use: Pancreatic insufficiency associated with: chronic pancreatitis, pancreatectomy, cystic fibrosis, GI bypass, surgery, Ductal obstruction secondary to tumor • Action: contains lipolytic, amylolytic, and proteolytic activity ⇒ Effect: increased digestion of fats, carbohydrates, and proteins in the GI tract

Methimazole

hyperthyroidism • Use: palliative treatment of hyperthyroidism, used as an adjunct to control hyperthyroidism in preparation for thyroidectomy or radioactive iodine therapy • Action: inhibits the synthesis of thyroid hormones

Propylthiouracil

hyperthyroidism • Use: to decrease signs and symptoms of hyperthyroidism. • Action: inhibits the synthesis of thyroid hormones

Thyroidectomy complications

hypoparathyroidism bleeding injury to the laryngeal nerve respiratory distress -compression, swelling -stridor -drooling (symptom of airway obstruction) laryngeal spasms hypocalcemia -check posterior dressing knowing there will be drainage within first 24 hr

when planning to move a person with a possible spinal cord injury, the nurse should direct the team to:

immobilize the head and neck to prevent further injury

diagnosing MS

increased protein (IgG) in CSF MRI is gold standard- shows Periventricular plaques • History and physical (H&P) • At least two episodes of symptoms --- Occur at different points in time --- Result from involvement of different areas of the central nervous system • Absence of other treatable causes for the symptoms • Results of neurological testing

Guillain-Barre syndrome

inflammation of the myelin sheath of peripheral nerves, characterized by rapidly worsening muscle weakness that may lead to temporary paralysis -an acute, rapidly progressing, and potentially fatal form of polyneuritis. It is a rare disorder in which your body's immune system attacks nerves. Characterized by weakness and tingling in extremities which are usually the first symptoms.

what type of meningitis is important for a public health response?

is it viral or bacterial? bacterial- highly contagious isolate communities at high risk for outbreak: -schools -jail -college -anywhere there is close contact with many people educate about prevention: -HANDWASHING

the cell cycle and checkpoints

mechanisms that monitor the preparedness of a eukaryotic cell to advance through the various cell cycle stages Cell growth checkpoint (G1) -occurs toward the end of growth phase 1 -checks whether the cell is big enough and has made the porper proteins for the synthesis phase -if not, the cell goes through a resting period until it is ready to divide DNA Synthesis Checkpoint: -occurs during synthesis phase (S) -checks whether DNA has been replicated correctly -if so, cell continues on to mitosis Mitosis checkpoint: -occurs during mitosis phase -checks whether mitosis is complete -if so, cell divides, and cycle repeats

cell structure

membrane cytoplasm nucleus- houses all material responsible for cellular duplication DNA- arranged in particular order in packed infrastructures called chromosomes --normal behavior of each cell is controlled by DNA! --DNA houses all genetic material and is responsible for cellular duplication ribosomes- where rNA is found rNA- lysosomes golgi apparatus- store house of cell mitochondria- energy supply house Rough ER/Smooth ER- used to make proteins that tell our body what to do

viral meningitis

meningitis caused by a virus and not as severe as pyrogenic meningitis • Incubation period is about 3 to 6 days • Duration of the illness is approximately 7 to 10 days • Infectious period can last several weeks after symptoms have resolved • Diagnosed by laboratory tests of a patient's spinal fluid • Many times tests are done to rule out Bacterial Meningitis There is no specific treatment for viral meningitis. -Enteroviruses are most often spread through direct contact with an infected person's stool. -Enteroviruses and other viruses (such as mumps and varicella-zoster virus) can also be spread through : ---direct ---indirect contact with respiratory secretions (saliva, sputum, or nasal mucus) of an infected person.

Immunomodulator's r/t MS

modify disease process and prevent relapse •Interferon Beta 1a (Avonex and Rebif):IM/ is a protein that is a replica of human interferon. It suppress the immune system and helps to maintain the blood-brain barrier. This drug is useful to people who have definite progressive MS. One side effect of the drug is a flu like symptom. ■ Interferon Beta 1b (Betaseron): SC /is slightly different from our own interferon. Side effects include irritation, bruising, and redness at the site of injection and the flu like symptoms. This is also given to people who have definite

diagnostic tests and drugs r/t addison's disease

o ACTH stimulation test is gold standard oDrugs o Mineralocorticoids o Glucocorticoids **daily and life long **given in divided doses **may need to increase doses during stressful times to prevent addison's crisis

drug therapy of hyperthyroidism

oAntithyroid oMethimazole (Tapazole) oPropylthiouracil (PTU, Propyl-Thyracil) **-drugs block thyroid hormone production by preventing iodine binding at thyroid gland oIodine oLugol's solution oSaturated solution of potassium iodide (SSKI) **short term therapy- given before surgery to get a patient as close to normal thyroid state as possible **decrease blood flow through thyroid gland with decreases production of thyroid hormone **be aware these drugs can cause mouth sores, GI distress, rash, metallic taste and CAN INDICATE TOXICITY oBeta Blockers oPropranolol oAtenolol

physical characteristics of Cushing's disease

oMoon face oBuffalo hump oTruncal obesity -fat in belly oWeight gain -slow turnover of plasma fatty acids -redistributes fat (resulting in moon face/buffalo hump) oHirsutism -hairy in places hair should not be

treatment of Cushing's disease

oPatient Safety/Injury Prevention oDrug therapy **will require lifelong steroid therapy if surgical removal oSurgical treatment ◦ Removal of a pituitary adenoma ◦ Total hypophysectomy (surgical removal of the pituitary gland) ◦ Adrenalectomy (if cause is adrenal tumor)

nursing intervention r/t cushing's disease

oPrevent injury- skin breakdown, bone fractures, GI bleed **use paper tape **lift sheets **gait belt **fall precautions **ulcer formation from increased HCl secretion **GI bleeding is common with hypercortisolism oMonitor I & O, signs of fluid overload **bounding pulse, increased neck vein distension, lung crackles, increased peripheral edema, reduced urinary output **rapid weight gain oElectrolytes **potassium and sodium **maintain sodium restriction **high calorie diet **increase calcium and vitamin D **no alcohol ** anything that can cause GI upset/irritation oMaintain fluid and Na restrictions oPrevent infections **monitor CBC and for S&S of infection **excess cortisol suppresses infection indicators **handwashing, avoid oPt education **never skip a dose

nursing interventions r/t hypothyroidism

oVital Signs and physical assessment oMonitoring for condition changes and preventing complications oSkin breakdown oConstipation oExcessive sedation oEducate patients and families about thyroid replacement therapy oLife long need oDon't switch brands **response to different drug brands can vary -monitor hormone and med levels

ONCOLOGICAL EMERGENCIES: Superior Vena Cava Syndrome

obstructive •Superior vena cava compressed or obstructed by tumor growth or thrombosis -can cause: *facial edema *peri-orbital edema (swelling around eye sockets) *distention of veins in head, neck, and chest *headaches and seizures *edema of arms and hands *dyspnea late signs: *Hemorrhage *Cyanosis *Mental status change *Decreased cardiac output *Hypotension if earlier, may consider stent in vena cava

opportunistic infections seen with AIDS

oral thrush- nutrition becomes a significant problem due to mouth pain kaposi's sarcoma

lactulose

osmotic laxative • Use: treatment of chronic constipation. Adjunct in the management of portal-systemic (hepatic) encephalopathy (PSE) • Action: Increases water content and softens the stool. Lowers the pH of the colon, which inhibits the diffusion of ammonia from the colon into the blood, thereby reducing blood ammonia levels

L1 injury

paraplegia, results in paralysis below the waist

Surgical Management of Hyperparathyroidism

parathyroidectomy Partial or complete removal of parathyroid glands: oCertain criteria must be met oUsually endoscopic oCan be done as outpatient o Autotransplantation might be necessary: **transplant somewhere else to make sure entire function of parathyroid is not lost

mitosis

part of eukaryotic cell division during which the cell nucleus divides These Cells Continue to Divide in Adulthood: • Skin • Hair • Mucous Membranes • Bone Marrow • Linings of the Organs such as: o Lungs o Stomach o Bladder o Uterus NO LONGER OCCURS IN FULLY DEVELOPED CELLS: • Heart Muscle- heart increases in size, but this is done by HYPERTROPHY- (cell is enlarged but more cells are not made) HYPERPLASIA- increase in number • Skeletal Muscle • Neurons -when these cells die, they are replaced by SCAR TISSUE

Spironolactone

potassium sparing diuretic • Use: Management of primary Management of primary hyperaldosteronism. Management of edema associated with HF, cirrhosis and nephrotic syndrome. Management of essential hypertension. Treatment of hypokalemia (counteracts potassium loss caused by other diuretics). • Action: Causes loss of sodium bicarbonate and calcium while saving potassium and hydrogen ions by antagonizing aldosterone.

hematopoietic side effects of chemo

prevent from life threatening side effeects- bone marrow suppression: • Anemia --Decreased production of RBCs and HGB -anemia patients feel fatigued due to lack of O2 circulating through the body -procrit (hemoglobin might take a hit so admin procrit) • Neutropenia --Decreased immunity Increased risk for infection - especially Sepsis • Thrombocytopenia --Decreased number of platelets --Impaired clotting and bleeding

thyroid gland

produces hormones that regulate metabolism, body heat, and bone growth -very high blood flow area -function is to take iodine found in foods and convert into thyroid hormones

Atazanavir

protease inhibitor Class: antiretrovirals, protease inhibitors • Route: PO • Use: HIV infection • Action: Inhibits the action of HIV protease, preventing maturation of virions

clinical manifestations of myasthenia gravis

ptosis, muscle weakness, double vision, difficulty swallowing • Fluctuating weakness of skeletal muscle • Moving of the eyes and eyelids • Chewing • Swallowing • Speaking • Breathing • Muscles usually strongest in the morning and become exhausted with continued activity • Strength usually restored after period of rest

external beam radiation- teletherapy

radiation applied to a tumor from a distant source • Because the source is external, the patient is not radioactive, and there is no hazard to others

C6 injury

results in partial paralysis of hands and arms as well as lower body

HIV infectious process

retrovirus- attacks rNA -gets into cell, attaches genetic instructions -copies from there -not going to die of HIV, going to die of AIDS HIV cannot replicate unless it gets INTO cell CD4 T cell is target cell of HIV virus

surgical management of hyperthyroidism

subtotal thyroidectomy total thyroidectomy -when large goiter causes tracheal or esophageal compression -goal is to decrease effect of thyroid hormone on cardiac function and reduce thyroid secretion

ONCOLOGICAL EMERGENCIES: SIADH

syndrome of inappropriate anti-diuretic hormone -abnormal secretion of ADH -increased water absorption and dilution of sodium *weakness, muscle cramps -confusion -urine output of 15mL/hr -lung cancer is common cause • Monitor patients every 2 hours for increase in fluid overload: • Bounding pulse • JVD • Crackles in lungs • Increased peripheral edema • Reduced urine output • Take measures to correct sodium-water imbalance • Untreated/Unmonitored SIADH = Pulmonary Edema = Death -when pt has low sodium, suspect SIADH and RULE THIS OUT

endocrine system

the body's "slow" chemical communication system; a set of glands that secrete hormones into the bloodstream Works with the nervous system to regulate physiologic function: -metabolism -nutrition -elimination -temperature -fluid and electrolyte -growth and reproduction Endocrine glands secrete hormones directly into the blood -"find" target tissue -hormones travel through blood but exert actions/functions only on these target tissues -"lock and key" Disorders are due to either an excess or a deficiency of hormones "master switchboard of endocrine system" maintains equilibrium at cellular level (homeostasis)

Semi-Fowler's Position

the head of the bed is raised 30 degrees; or the head of the bed is raised 30 degrees and the knee portion is raised 15 degrees

Drug & Surgical Interventions for Hypothyroidism (page 1155 Lewis)

therapy started at low doses and gradually increased to reduce possible side effects of HTN and HF oPharmacologic therapy oLevothyroxine (Synthroid) oSubtotal or total thyroidectomy if large goiter -use of fiber supplements can interfere with absorption -take 1-2 hr before or after meal -can interact with anticoagulants, digitalis, and other drugs -monitor for: effectiveness **how are you sleeping? **how are your bowel movements?

you cannot catch AIDS from:

toilet seat, handshake, dirty dishes, swimming, sharing a bath towel

ONCOLOGICAL EMERGENCIES: Spinal Cord Compression

tumor pressing on spinal cord and requires immediate intervention *early recognition key to positive outcome *symptoms: LBP thoracic region, neuro changes, muscle weakness, feeling of heaviness in limbs, tingling, or unsteady gait -dx suspected by assessment but CONFIRMED BY MRI GOAL: prevent neurological damage and pain releief -TX: high dose corticosteroids

hyperthyroidism management: radioactive iodine therapy

use of radioactive iodine to eliminate thyroid tumors -during this time patient is considered radioactive and precautions are necessary: **bodily fluids ** Outpatient (one dose may be sufficient) Radiation precautions: teach home precautions to patient and family Some patients become hypothyroid as a result of treatment (the patient then needs lifelong thyroid hormone replacement)

management of skin changes in cancer patients

use: mild, moisturizing soaps without deodorant and tepid water - avoid scrubbing keep: skin as moist as possible (moisturizers should not contain metal, or be scented) avoid: exposure to irritants (perfumes, sun, wind, extreme temperatures - including hot water) wear: loose-fitting clothing (cotton) avoid: tape, bandages, make-up on treated skin don't: swim in chlorinated water or wash clothes in harsh detergents

nursing assessment r/t scoliosis

• A complete history • Onset of problem, in adolescence or adulthood • What treatments may have been used in the past • Complete a thorough pain assessment for patients reporting back pain • Observe the patient from the front and back • Asymmetry of hip and shoulder height • Prominence of the thoracic ribs and scapula on one side (size and symmetry usually not equal) • Visible curve in the spinal column • Assess for leg length differences •gait, balance, asymmetric leg movement/deformity • assess need for ambulatory devices or skin integrity with braces • psychosocial aspect of braces • The adult spinal column is less flexible and therefore less likely to respond to exercises, weight reduction, bracing, and casting for correction of the deformity

amputations

• Amputation is the removal of a body extremity • The psychosocial aspects are as devastating as the physical impairments *** Change in body image and self-esteem • Collaborate with members of the health care team, including prosthetists, rehabilitation therapists, psychologists, case managers, and physiatrists (rehabilitation physicians) • The higher the level of amputation, the more energy is required for mobility • Most upper extremity amputations result from trauma goal: preserve the most extremity length & function

Again, Ms. Michaels indicates understanding of the nurse's explanation. She then asks "Does this virus just remain the same in my body and nothing will happen, or will I be getting sick?" How should the nurse respond to Ms. Michaels' question?

• Answer: In most cases, the first episode occurs within 4 weeks. Manifestations of this acute HIV infection can be fever, night sweats, chills, headache, and muscle aches. All of these problems can be caused by exposure to almost any virus (e.g., influenza) — not just to HIV. • Rationale: The time from the beginning of HIV infection to development of AIDS ranges from months to years, depends on how HIV was acquired, personal factors, and interventions.

Ms. Michaels seems relieved with the explanation and states "I am so glad it's not AIDS. It's just like an infection." She then asks the nurse, "Can I take some antibiotics to kill the infection, then?" How should the nurse respond to Ms. Michaels' question?

• Answer: The nurse should explain about the differences between a virus and bacteria, and that antibiotic treatments target bacterial infections. However, HIV can be treated with antiretroviral drug therapy. • Rationale: Antibiotics are used for bacterial infections and do not work with viral infections. Antiretroviral drug therapy will decrease viral replication, but will not kill the virus.

nonsurgical management of osteomyelitis

• Antibiotic therapy • More than one agent may be needed • Prolonged therapy for > 3 months may be needed • PICC line antibiotics at home • Hyperbaric oxygen (HBO) therapy - increase oxygen to affected areas to promote healing • Negative pressure wound therapy

therapy for myasthenia gravis

• Anticholinesterase drugs: aimed at enhancing function of the neuromuscular junction: pyridostigmine/neostigmine • Corticosteroids: Suppress immune system • Immunosupressants • Other: Plasmapheresis, IV immunoglobulins --take blood/plasma and separate cells and replace with filtered and treated plasma • Surgery: Thymectomy

collaborative management of HIV

• Assessment • History & Physical assessment/clinical manifestations: - Infections:Opportunistic, protozoal, fungal, bacterial, viral - Malignancies: Kaposi's sarcoma (KS), malignant lymphomas, invasive cancers, HPV, TB - Endocrine complications • Psychosocial assessment - Assess coping and support systems

myasthenia gravis

• Autoimmune disease of the neuromuscular junction characterized by fluctuating weakness of certain skeletal muscle groups -peripheral nervous system disorder -weakness worsens with repetition -pregnancy, surgery, trauma, emotional/physical stress can all be triggers for MG -stimulation of contraction of the smooth muscle • Affects neurotransmitter Acetylcholine • Antibodies attack acetylcholine (ACh) receptor sites • Acetylcholine receptor antibodies interfere with impulse transmission • Prevents ACh from attaching to Ach receptors

bacterial meningitis

• Average incubation period is about 4 days • Diagnosis based on S/S, LP, BC, CT scan • Range of antibiotics can treat bacterial meningitis: penicillin, ampicillin, vancomycin, ceftriaxone inflammation of the protective membranes covering the brain and spinal cord caused by various types of bacteria -Bacterial meningitis is contagious. The bacteria are spread through the exchange of respiratory and throat secretions (i.e., coughing, kissing). -None of the bacteria that cause meningitis are as contagious as things like the common cold or the flu. -The bacteria are not spread by casual contact or by simply breathing the air where a person with meningitis has been. -Keeping up to date with recommended immunizations is the best defense. -Good hygiene is also an important way to prevent most infections. -Rifampin, ceftriaxone, and ciprofloxacin are appropriate drugs for chemoprophylaxis in adults. The drug of choice for most children is rifampin. -Chemoprophylaxis may be administered in conjunction with vaccinations.

lumbosacral back pain (low back pain)

• Back pain affects 80% of adults at some time in their life • Low back pain is the leading cause of work disability • Contributing factors • Age • Lifestyle factors- obesity/activity level • Osteoporosis • Heavy physical lifting / trauma • Poor posture • Smoking • Pregnancy •repetitive motions • Low back pain (LBP) occurs along the lumbosacral area of the vertebral column Common causes • Herniated disc and scoliosis are two common causes -can occur gradually from things like OA or degeneration or all of a sudden with trauma -if disk is not compressing nerve, patient may not have any symptoms (symptoms can range greatly)

preventing sexual transmission of HIV/AIDS

• CDC describes ABCs of safer sex: • A - Abstinence • B - Be faithful • C - Condom use -PREVENTION OF FURTHER INFECTION AND EDUCATION -assess for risk factors (unprotected sex, drug use) -goal is to develop safer and less risky behaviors

GI symptoms r/t chemotherapy- mucositis

• Can affect any part of GI tract • Especially severe in patients treated for head and neck cancers • Primary issue is pain • Related: nutrition due to pain

chemotherapy induced alopecia

• Can vary from thinning hair to total hair loss • Scalp hair is very susceptible because its cells reproduce rapidly • Body hair not as susceptible although not immune • Starts ~7-10 days after chemo starts • Scalp is very tender during hair loss • Hair may grow back with a different color and/or texture • Avoid excessive shampooing, styling, brushing • Discussing impact of hair loss with patient -protect scalp- mild shampoos, avoid coloring and blowdrying, soft bristle brushes

elective amputation

• Complications of peripheral vascular disease and Ischemia in distal areas of the lower extremity • Diabetes mellitus is often an underlying cause • Amputation is considered only after other interventions have not restored circulation to the lower extremities

Development of Cancer: Progression

• Continued change of a cancer • Tumor makes VEGF to trigger blood vessel growth: --VASCULAR ENDOTHELIAL GROWTH FACTOR --TUMORS NEED THEIR OWN BLOOD SUPPLY --once tumor is about the size of a pencil eraser • Original tumor is called Primary Tumor

drug therapies that impair protection

• Cytoxic drugs • Chemotherapy and Immunosuppressant medications • Interference with rapidly dividing cells, including bone marrow • Steroids • Anti-inflammatory, limit movement of many WBCs • Disrupt arachidonic acid-main precursor for the inflammatory chemical cascade • Reduce number of circulating T cells • Interfere with IgG production • Cyclosporine • Suppresses CD4 cells, used to prevent transplant rejection (graft vs. host) • DMARDs • Used for autoimmune diseases (we went over those in NURS 1062) • Radiation-Induced Immune Deficiencies Similar toxicity to WBCs as chemotherapy but on smaller scale, cell-producing areas such as the femur are avoided and/or shielded

symptoms of MS

• Depression • Fatigue • Memory change • Pain • Spasticity • Vertigo • Tremor • Double Vision/Vision Loss ■ Weakness ■ Dizziness/Unsteadiness ■ Numbness/Tingling ■ Ataxia ■ Euphoria ■ Speech disturbance ■ Bladder/Bowel/Sexual dysfunction • Symptoms occur intermittently over months to years • Chronic progressive deterioration or periods of exacerbations and remissions • S&S vary according to areas of CNS involved

nursing management of HIV- enhancing nutrition

• Drug therapy ** THC • Nutrition therapy ** Softer, palatable foods -ice cream • Mouth care ** "Magic mouthwash"

Development of Cancer: Promotion

• Enhanced growth of initiated cell • Some normal body cells can act as promotors - Hormones - Insulin • Latency period: the time between a cell's initiation and the development of an overt tumor -further exposure increases likelihood of malignant transformation EXAMPLE: -smoker starts drinking and is exposed to asbestos at work

cancer cells that Metastasize Can:

• Enter and survive in the bloodstream and exit when it is stopped in a capillary bed • Adhere to a cell wherever it lands • Enter the organ where it landed • Respond to growth factors to start the formation of new blood vessels to feed itself in its new location.

neutropenia- know their numbers

• Equations: ANC = ABSOLUTE NEUTROPHIL COUNT (1) Neutrophils (segs) and bands reported as a percentage: ANC=WBC* x ((segs / 100) + (bands / 100)) (2) Neutrophils (segs) and bands reported in total numbers: ANC = (segs + bands) x 1000

ONCOLOGICAL EMERGENCIES: Disseminated Intravascular Coagulation (DIC)

• Extensive clotting occurs throughout the small blood vessels • Widespread clotting depletes circulating clotting factors and platelets • Excessive, extensive bleeding occurs -monitor lab values: CBC/PT/PTT/INR/D-Dimer -treat underlying cancer and give supportive measures (blood, platelets)

symptoms of viral/bacterial meningitis

• Fever and chills •Mental status changes •Nausea and vomiting • Sensitivity to light (photophobia) or noise (phonophobia) • Severe headache • Stiff neck (nuchal rigidity) -sleepiness, lethargy -increases CSF production and increases ICP (intracranial pressure)

Development of Cancer: Initiation

• First Step in carcinogenesis- how a cell becomes a cancerous cell • Mutation in the cell's genetic structure • Loss of cellular regulation ---Oncogenes can be activated ---Tumor suppressor genes can be damaged -exposure to a cancer causing agent -involves permanent damage in the cellular DNA r/t this exposure EXAMPLE: -smoker starts smoking -hormones such as insulin or estrogen

breast cancer surgery- pre op

• Fully educated on surgical options -conservative, breast-sparing, mastectomy, radical mastectomy, etc -depends on tumor and provider recommendation and what the patient wants • Psychosocial distress -loss of a body part -emotionally difficult for many women

complications with cervical spine surgery

• Hoarseness due to laryngeal injury • Temporary dysphagia • Esophageal, tracheal, or vertebral artery injury • Wound infection • Injury to the spinal cord or nerve roots • Dura mater tears with associated cerebrospinal fluid leaks • Pseudoarthrosis caused by nonunion of fusion • Graft and screw loosening if a fusion was performed

M

• MX : metastasis can't be evaluated. • M0 : no distant cancer spread was found. • M1 - 4: distant metastases were found

anemia management r/t HIV

• Management depends on the cause : • Nutrition • Iron, Vitamin C*, B12, Folic Acid rich foods • Volume • Transfusions of packed RBC v. whole blood • Production • Epoetin alfa: Elevates Hct by stimulating RBC production • May lead to H/A, HTN, thrombotic events

chemo-brain

• Memory loss • Difficulty learning new information • Decreased ability to concentrate • Trouble finding the right word • Difficulty managing daily activities -can last up to 1 year after treatment (may be hormonal connection) -encourage "brain games" and NOT TO mix drugs and alcohol

Causes of Guillain-Barre Syndrome

• Most commonly, infection with campylobacter, a type of bacteria often found in undercooked poultry • Influenza virus • Epstein-Barr virus • HIV, the virus that causes AIDS • Mycoplasma pneumonia • Surgery • Hodgkin's lymphoma • Rarely, influenza vaccinations or childhood vaccinations

treatment of guillain-barre syndrome

• Plasma exchange (plasmapheresis): The liquid portion of part of blood (plasma) is removed and separated from blood cells. The blood cells are then put back into the body, which manufactures more plasma to make up for what was removed. Plasmapheresis may work by ridding plasma of certain antibodies that contribute to the immune system's attack on the peripheral nerves. • Immunoglobulin therapy: Immunoglobulin containing healthy antibodies from blood donors is given intravenously. High doses of immunoglobulin can block the damaging antibodies that may contribute to Guillain-Barre syndrome. • Immunomodulatory treatment has been used to hasten recovery. Intravenous immunoglobulin (IVIG) and plasma exchange have proved equally effective. • Acute Rehab • Maintenance Rehab

priority patient problem with HIV

• Potential for infection -compromised immune system • Inadequate oxygenation • Pain • Inadequate nutrition -pain -mucosal damage r/t opportunistic infections • Diarrhea -skin breakdown -fluid/electrolyte balance • Reduced skin integrity • Confusion -AIDS dementia syndrome • Reduced self-esteem -isolation • Potential loss of social contact

health promotion/maintenance in lumbosacral back pain (lewis pg. 1485)

• Preventive measures • Good posture • Proper lifting • Exercise • Ergonomics • Equipment that can be used Nonsurgical Management • Positioning -William's position -Semi fowlers position • Drug therapy • NSAIDs - (decrease pain and swelling) • Opioids - Ultram (CNS depressant caution) • Muscle relaxants - (cyclobenzaprine) • Antidepressants (as adjunctive therapy) • Heat therapy - helps increase blood flow and promote healing if it is due to injured nerves **20 min on 20 min off for skin integrity • Physical therapy • Weight control • Complementary and alternative therapies *acupuncture *yoga • Epidural corticosteroid injections

nursing interventions r/t MS

• Promote neurological function, Provide safety, Prevent injuries & reduce factors that precipitate exacerbations: • Exercise • Schedule activity and rest periods • Warm packs over spastic areas • Swimming and cycling are useful • Enhance bowel & bladder control • Manage speech and swallowing difficulties • Improve sensory & cognitive function

parenteral transmission of HIV

• Proper cleaning of: -- Needles and syringes --Other drug paraphernalia • Needle exchange program

molecular basis of cancer

• Proto-Oncogenes: -genes that normally help cells grow -when this mutates or changes, can grow out of control -"car is in idle" • Oncogene: -"bad gene, oncology gene" -"hits gas pedal" -cell is beginning to divide out of control -cyclin is a protein needed for cell duplication, and this is what oncogene's produce • Tumor Suppressor Genes -controls amount of cyclin that is produced • Mutator Genes

nursing management of HIV- supporting self esteem

• Provide climate of acceptance • Promote trusting relationship • Encourage expression of feelings • Identify positive aspects of self • Allow for privacy; avoid isolation • Encourage self-care, independence, control • Guided imagery

the spinal cord

• Relays messages to and from the brain • Injuries, tumors, infections (trauma is the leading cause) • Inflammatory and autoimmune diseases • Degenerative diseases • The spinal cord itself may be damaged, or the spinal nerves leading from the cord to the extremities may be affected -complete or incomplete **complete- no longer function (sever communication with spinal cord) **incomplete- can function (more common) • INFLAMMATION • Both the spinal cord and the nerves can be involved • MOBILITY • SENSORY PERCEPTION- always want to monitor, did something change from baseline? • PAIN

traumatic amputation

• Result from accidents or war and are the primary cause of upper extremity amputation • Multiple limbs or parts of limbs may be amputated • Thousands of veterans of war in the United States are amputees and have had to adjust to major changes in their lifestyles -industrial machines

scoliosis

• Scoliosis is a lateral S-shaped curvature of the thoracic and lumbar spine • Congenital • Abnormalities are present at birth • Neuromuscular • Results from a neuromuscular condition • Cerebral palsy/spinal cord trauma • Idiopathic • Most common spinal deformity • Cause is unknown • Untreated scoliosis can lead to back pain, deformity, and cardiopulmonary complications

Pathophysiology of MS

• Sensitized T cells will enter the brain and promote antibody production that damages the myelin sheath • Plaques of sclerotic tissue appear on the demyelinated axons interrupting the neuronal transmission • Usually affects young adults between the ages of 20 and 40 •difficult to diagnose in the early stages •characterized by periods of remissions and exacerbations and progresses at very different rates. ---•Chronic progressive deterioration • Female: male ratio = 2:1 • More frequent in populations native to areas further away from the equator •Onset of disease often insidious and gradual ---Symptoms occur intermittently over months to years •S&S vary according to areas of CNS involved

Chemotherapy-Induced Bone Marrow Suppression- Chemotherapy-induced thrombocytopenia

• Severe reduction in the number of platelets • Major risk for bleeding -fall risk • Management • Soft toothbrush, no flossing! (Tell dentist) • Avoid activities that could cause bruising • Check with oncology team/pharmacist re: OTCs • Platelet transfusions if platelet count is very low

Chemotherapy-Induced Bone Marrow Suppression- Chemotherapy-induced anemia

• Severe reduction in the number of red blood cells • Major risk for hypoxia • Hypoxia can lead to: • Fatigue • Poor concentration • Shortness of breath • Cold intolerance • Increased heart rate • Headache • Dizziness

risk of HIV from transfusions

• Since 1985, all donated blood in the United States has been tested for HIV, therefore the risk is extremely low. However, there is still risk of transmission if donation was made close to the time of infection • Worldwide, there are many countries that do not test all donations, and transmission by transfusion is much higher -many hemophiliacs developed HIV because of this reason -risk is extremely low, but higher if blood donation was close to time of infection

side effects of radiation therapy

• Skin -- Skin changes: *erythema (redness) *dry desquamation (keep skin moisturized, avoid irritants) *wet desquamation- red, weeping skin, warm and tight to touch, shiny appearance with drainage can be clear to cloudy, can have areas of crust or scabs (very painful and can become infected) • Photosensitivity • Fatigue • Pain •GI once treatment is over and skin damage is clear, danger is not over- must continue to protect skin for at least 1 year after treatment

brachytherapy- sealed radiation

• Solid radiation sources are implanted in the body • Are used in the form of seeds, ribbons, or needles • Are placed into or adjacent to tumors so that the cancer cells receive high doses of radiation and only small parts of normal tissue are exposed • Can be temporary or permanent • Some devices held in place by special applicators Radiation Safety for Patients/Family with Sealed Implants: -Keep patients in private room with private bathroom -Keep door closed as much as possible -Pregnant women and children under the age of 16 should not visit -Visitors should limit visiting time -Should remain at least 6 feet away from patient -Do not bodily waste with bare hands -Save linens and dressings until after radioactive source is removed -Pregnant nurses should not be assigned (male or female if attempting to conceive) -Wear a dosimeter to measure exposure -Wear lead apron and do not turn back to patient

physical assessment r/t MS

• Strength • Tone • Range of motion • Balance • Coordination • Cardiovascular and respiratory status • Bed mobility and transfer • Bowel and bladder impairment ■ Swallowing ■ Speech and communication impairment ■ Visual status ■ Sensory impairment ■ Activities of daily living ■ Cognition ■ Physical environment ■ Medical stability.

T

• TX : tumor can't be measured -too small • T0 : no evidence of primary tumor • Tis : in situ (in place) cancer or pre-cancer

colorecral cancer

• Third leading cause of cancer related deaths • More common in men • Higher incidence in African American population • Risk factor increases with age ---Family history ---History of IBD ---poor diet -nearly all of these cancers begin as polyp and are found in rectum sigmoid colon -slow growing cancer

factors contributing to low back pain

• Trauma • Changes in vertebral support - compression fractures • Malalignment - scoliosis • Vascular changes - less blood support/lack of perfusion needed (hypotensive) • Intervertebral disk disease- herniation/bulging

treatment r/t scoliosis

• Treated conservatively with moist heat, pain medication, and exercise • Those with greater than 40 degrees of curvature may require surgical intervention • Traditional open surgical reconstructive procedure • Surgical fusion and insertion of instrumentation, including plates, screws, or rods to stabilize the spine • The metal instrumentation supports the spine and immobilizes the fused area during healing

clinical manifestations of MS

• Visual problems: diplopia/blurred vision/nystagmus • Motor dysfunction • Fatigue • Mental changes: mood swings/ depression • Spasticity

causes of meningitis

• bacteria • viruses (most common) • physical injury • cancer • drugs (NSAID, antibiotics, IvIG) • severity/treatment of illnesses differ depending on the cause (it is important to know the specific cause of meningitis)

nursing interventions r/t myasthenia gravis

•Administer prescribed meds/Watch for side effects of meds •Balance Diet/ Prevent chewing and swallowing problems • Promote respiratory function • Prevent fatigue •Maximize functional abilities • Prepare for complications like myasthenic crisis and cholinergic crisis •Aspiration/ Respiratory Insufficiency/ Infection • Prevent problems associated with impaired vision resulting from ptosis of eyelids • Provide patient and family coping

corticosteroid treatment of MS

•Decrease edema and inflammation at site of demyelination • Solu Medrol- methylprednisolone • Prednisone

prevention/treatment of HIV/AIDS

•Drug therapy • Antiretroviral drugs - Multiple drugs used together in combinations (HAART) **multiple drugs used in combination to prevent spread/infection of HIV **decrease viral load in patients • NRTIs -terminate viral replication -reverse transcriptase inhibitor -zidovudine (Retrovir) • NNRTIs -blocks enzyme activity -nonnucleoside reverse transcriptase inhibitor -efavirenze (Sustiva) • PIs -inhibits and prevents maturation of HIV -protease inhibitor -Saquinavir (Invirase) • Fusion inhibitors -blocks viral entry and replication -enfuvirtide (Fuzeon) • Entry inhibitors -blocks viral entry -CCRS antagonist -maraviroc (Seizentry) -HAART- highly active antiviral therapy ***treatment with 3-4 of these drugs -if they decide to stop taking or stop complying with drug, will be more difficult to slow disease progression down (ANTIBIOTIC RESISTANCE) -can also be very expensive

chemo side effects

•Hematopoietic • CINV • Mucositis • Alopecia • Chemo Induced "Brain Fog" • CIPN

Acquired Immune Deficiency Syndrome (AIDS)

•Human immune deficiency virus (HIV) can progress to AIDS • Most common immune deficiency disease in the world • Serious worldwide epidemic