NSG 170 MASTER FINAL COMBINATION

How is the child treated for Leukemia

-combination chemotherapy -HSCT -Radiation therapy

Patients with fluid volume deficit will try to compensate with:

Tachycardia, pale cool skin, decreased urine output

HCO3-

Tells origin of disturbance Regulated by kidneys and can be used to determine if an acid base disturbance is metabolic in origin 22-26 mEq/L <22= acidosis >26= alkalosis

PaCO2

Tells origin of disturbance Regulated by lungs and can be used to determine if an acid base disturbance is respiratory in origin 35-45 mmHg <35= alkalosis >45= acidosis

Assessing newborn (temperature)

Temperature q30mins for first 2 hours, then according to hospital protocols Thermistor probe on abdomen for continuous temp Assess frequently for metabolic acidosis, hypoglycemia, and hypertension along with signs of cold stress

PSA

a protein that is secreted by cells in the prostate gland to help liquefy the semen. Disease-related changes in the prostate usually trigger an increase in the production of PSA.

Frostbite

a victim is often unaware because frozen tissue is numb

RH factor screening:

blood type and RH factor screened in 1st trimester; RhoGAM is given when the mother is rH negative, and the father is rH positive @28 gestation and delivery (or Rh positive fetus)

body fluids required for homeostasis

blood, serum, albumin, urine, bile, hormones, cerebrospinal fluid

Chadwick's sign

bluish purple discoloration of cervix, vagina, and labia during pregnancy as a result of increased vascular congestion; one of the earliest signs of pregnancy

Sepsis (complication of infection / lactic acid elevation) results from

bone marrow suppression following chemotherapy

GI changes in pregnancy

esophagus and stomach (heartburn); intestines (emptying time increased); liver and gallbladder (functional changes)

Genetics (risk factor for cancer) - 5% of all cancers

ex. BRCA gene & breast cancer Crohn's Disease

Hydrammnios

excessive amount of amniotic fluid

Cold stress (newborn)

excessive heat loss that requires newborn to use compensatory mechanisms (nonshivering thermogenesis + tachypnea) to maintain core body temp The biggest concern is respiratory distress.

Hypothermia

excessive heat loss, inadequate head production to counteract loss, impaired hypothalamic thermoregulation

Ptyalism

excessive salivation during pregnancy

hypermesis gravidarum

excessive vomiting during pregnancy; should be reported immediately

Causes of hypothermia

exposure to cold environment immersion in cold water lack of adequate clothing and shelter ingestion of alcohol or drugs overwhelming sepsis

Hyperthermia

exposure to heat, inability to cool, impaired hypothalamic thermoregulation

Assessment finding associated with Neoplasia

- visible lesions - physical asymmetry - palpable masses - presence of blood in stool or on pelvic exam

fluid output

-1400-1500 mL/day of urine -insensible fluid loss through skin and lungs -feces -obligatory losses: required to maintain normal body function- 500 mL/day

Recommended fluid intake per day

-2,500 mL/day at moderate activity and temperature -water content of food contributes 750 mL/day

Alveoli enlarge

into air-filled spaces called bullae, small bronchioles collapse, air is trapped, no fresh oxygen is coming in, CO2 can be expelled (overstretched balloon)

Children & adolescents assessment:

irritability in infants, thirst in children, lethargy and sleepiness, decreased skin turgor, dry mucous membranes, increase pulse, seizure activity

Hypophosphatemia symptoms:

irritability, fatigue, apprehension, dysphagia, diplopia

Dysplasia

is a broad term that refers to the abnormal development of cells within tissues or organs. It can lead to a wide range of conditions that involve enlarged tissue or pre-cancerous cells

Thyroxine aka chemical thermogenesis

is a hormone released by the thyroid and then epinephrine is released

to prevent fluid loss in newborns

keep head covered and body well wrapped

primary regulator of body fluids

kidneys

Active internal rewarming

moderate to severe hypothermia (80-90 degrees) and include cardiopulmonary bypass, warm fluid administration, warm humidified O2 and peritoneal lavage MONITOR for V FIB as temp increases from 88-90 degrees

Hypotonic dehydration

more sodium loss than water loss, may result from severe, prolonged vomiting and diarrhea, burns and renal disease

Causes of hyperthermia

may occur in response to infection may occur in response to tissue breakdown (following surgery, trauma, MI)

How gender affects body fluid:

men have more body fluid than women

Annual digital rectal examination (Secondary Prevention)

men older than 50 years to assess for prostate cancer

Biguanide

metformin (Glucophage, Glumetza, Riomet) Monitor glucose levels frequently, assess renal function before beginning and yearly after. STOP for contrast/iodine after CT scan (about 48 hours)

Children and thermoregulation:

more variable temperatures handle higher temps

Infants & young children with electrolytes:

more vulnerable to fluid and electrolyte imbalances because of physiological differences, body surface area is greater

Antimetabolites (chemotherapy)

most cells require metabolites to begin or continue cellular regulation. These drugs closely resemble metabolites and fool cancer cells into using the antimetabolites in their cellular reactions

filtration

movement of fluids and solutes together across a membrane from one compartment to another from area of higher pressure to lower pressure

osmosis

movement of water across cell membranes from less concentrated solution to more concentrated solution

Hypovolemia has ______________

multiple signs and symptoms

Hypokalemia symptoms:

muscle weakness, leg cramps, numbness, tingling, fatigue, flat T wave

Hypomagnesium symptoms:

muscle weakness, tetany, seizures

Pregnant women with electrolytes:

nausea and vomiting very common, hyperemesis gravidarum is serious

Adverse reactions to potassium replacement

nausea, vomiting, abdominal pain and diarrhea, hemorrhage, obstruction, phlebitis, hyperkalemia, cardiac arrest

Thermoregulation

process that balances head production and heat loss to maintain the body's temperature

Pregnant women & fluid volume deficit:

risk for fluid volume deficit, avoidance of caffeine, alcohol and diet drinks

The pituitary gland ______________

stores and releases ADH

Solutes

substances dissolved in a solution (electrolytes and nonelectrolytes)

By 16 weeks gestation

the fundus reaches midway between the symphysis pubis and the umbilicus

Hypocalcemia causes:

inadequate intake, increased loss, malabsorption or increased binding of calcium

Elevated estrogen and progesterone levels causes _______ in maternal body temp during first trimester

increase

Sources of heat loss:

-Skin -Evaporation of sweat -Warming and humidifying inspired air -Eliminating urine and feces

Hyponatremia

*Oral sodium supplements for mild cases *Intravenous sodium supplementation for severe cases

____stored in bones

(90%)

Celsius to Fahrenheit

(C x 1.8) + 32 = F

observable signs of fluid imbalance

-edema of lower extremities or hands and face -flushed face, neck, arms -dry, cracked lips -dry mucous membranes, skin -sunken eyes

Movement of body fluid across cell and capillary membranes accomplished by ________

-osmosis -diffusion -filtration -active transport

Specific Gravity of Urine

1.015-1.024 SG is high when solutes are high

Oncology pt with a fever of _______ is an EMERGENCY

100F or higher

Fluid loss from excessive sweating, inadequate intake, or insensible water loss

IV fluid replacement using crystalloids

defervescence stage of fever

4th stage of fever: initiation of sweating

Heat cramps S&S

Muscle cramps with profound diaphoresis, and thirst

Moderate hypothermia

82.4-89.6 or 28-32 celsius

Newborn body temperature

97.9-99.7

Nursing care for hypernatremia:

prevention and close monitoring of fluid I & O

Cirrhosis

This end stage liver disease is the gradual destruction of liver tissue that disrupts blood flow to liver lobules.

Remittent fever

This is a body temperature that fluctuates more than 3.6°F over a 24-hour period.

Blood Loss

Fluid replacement using blood transfusions or IV colloids (large-molecule protein solutions such as albumins)

Pulmonary Function Test

*Uses spirometer hooked to measuring device (resp tech) *Determines lung volume, ventilation, and gas exchange *Wide range of normals: Ht, Wt, Age, Gender *No smoking 4-6 hours prior *No bronchodilators or opioids 6 hours prior

African Americans

*Water weight varies based on factors *Greater sensitivity to salt leads to hypertension, which then requires higher dosages of antihypertensive drugs.

Convection

Through the motion of air or water across skin

Exercise (diabetes)

Exercise 3 times a week, don't skip more than 2 days. Perform resistance training twice a week Use proper footwear, inspect feet after, and avoid when metabolic control is out of control

Adverse reactions to NSAIDs

Abdominal pain, bleeding, nausea and vomiting and ulcers

Decreases BMR

Aging, prolonged fasting, and sleep

Emphysema

Alveolar problem

Ovulation occurs

Approx 14 days BEFORE a women's nect menstrual period would begin

Salicylates example:

Aspirin (acetylsalicylic acid)

Modifiable Risk Factors For Hyperthermia

*Wearing loose-fitting, light-colored, lightweight clothing and allowing the body to acclimate to the heat *Avoiding overexposure to the sun and using sunscreen *Ensuring an adequate intake of fluids to replace losses from sweating *Being aware of medications that predispose to the development of heat sensitivity

Patient teaching for Skin for pt undergoing radiation

- clean skin cautiously to avoid removing ink/dye markings - Avoid sun exposure for 1 year - Protect irradiated area with soft non-constrictive clothing - Avoid using washrag/loofa and OTC lotions

True Labor Contractions

- contractions that intensify with walking or position change / contractions that become more regular as time goes by - begin in the lower back and radiate to the lower portion of the abdomen.

Alterations in Blood Components during pregnancy

-Erythrocytes increase -Leukocytes increase -Platelets may decrease slightly but remain w/i normal range

Prenatal visit frequency:

-Every 4 wks until 28 wks -Then every 2 wks until 36 wks -Then every week until delivery -High risk pregnancy pt will be seen more frequently

alterations to fluids and electrolytes

-FVD (dehydration) -FVE -elevated electrolyte level -low electrolyte level -chronic kidney disease (CKD) -acute kidney injury (AKI)

________ plays a major role in transmitting nerve impulses and activating enzymes

CALCIUM

What to do for heat stroke:

Call 9-1-1 take immediate action to cool the victim by any means until help arrives (ice bath, cool towels)

Hemoglobin

Carries oxygen

Urine specific gravity is useful in _________

Dehydrated adults, older children

Pituitary Gland

Growth Hormone

What may the nurse see in a pt with Leukemia

-Fatigue -Lethargic -Fever -Pallor -Excessive bruising (low platelet) -Bone/Joint pain (from over production of RBC) -Lymphadenopathy (abnormal in size/consistency) -Hepatosplenomegaly (liver and spleen swell beyond normal size) -Abornmal WBC (lower/higher than normal) -mild anemia -thrombocytopenia

Colonscopy (Secondary Prevention)

-most accurate screening tool to identify colon cancer -regular screening should begin at age 45 and then every 10 years

Sweating

Inhibited to decrease heat loss

Solvents

Liquids that hold a substance in solution (WATER)

Hypotension

Low blood pressure

Hypothermia

More heat is lost than produced

NSAID drug reactions:

Oral anticoagulants Salicylates

Hematocrit

Percentage of packed RBCs per dL of blood Label is % Varies with age

Menopause

Permanent end of ovulation and menses

Cyclins

Protein products that promote cell division

Calcium Ca++

-most is found in skeletal system, small amount in ECF -vital in regulating muscle contraction and relaxation, neuromuscular and cardiac function -with aging, intestines absorb calcium less effectively, more excreted by kidneys -richest source: milk and milk products -also found in dark green leafy vegs and canned salmon

Diagnostic tests for fluid volume deficit:

Serum electrolyte panel & urine specific gravity

Heat Balance

The amount of heat produced is the same amount of heat lost

Special precautions for the child with Leukemia

-neutropenic precautions -infection control - should NOT receive live-virus or live bacterial vaccines such as measles-mumps-rubella and varicalla -avoid ppl/children w. chickenpox

two compartments of extracellular fluid

1. intravascular fluid -20% of ECF -found within vascular system 2. interstitial -75% of ECF -surrounds the cells

other components of extracellular fluid

1. lymph 2. transcellular fluid -CSF, pericardial, pancreatic, pleura, intraocular -bilary, peritoneal and synovial fluids

Gluconeogenesis

The formation of glucose from fats and proteins

Magnesium Mg++

1.5-2.5 mEq/L -found in skeletal system, ICF -second most abundant ICF cation -important for intracellular metabolism (esp production, use of ATP) -protein, DNA snythesis -involved in regulating neuromuscular, cardiac function -found in cereal grains, nuts, dried fruit, legumes, green leafy vegs, dairy products, meat, fish

How long do you suction?

10-15 seconds

Severe hypothermia

below 82.4 or 28 C

Manifestations Of Type 2 Diabetes

*Hyperglycemia that is less severe than in type 1 diabetes *Polyuria *Polydipsia *Polyphagia (rarely) *Weight loss (uncommon) *Blurred vision *Fatigue *Paresthesias *Skin infections.

Patient teaching for a patient who has received an injection of iodine-131 (unsealed isotope)

"Do not share a toplet with anyone for 3 days"

Calcium Channel Blockers

*Inhibit flow of calcium ions across cell membrane of vascular tissue and cardiac cells *Relax arterial smooth muscle, lowering peripheral resistance through vasodilation

What is an appropriate response to a breast cancer patient who asks why 6 weeks of daily radiation is necessary?

"Research has shown more cancer cells are killed if the radiation is given in smaller doses over a longer period of time"

Polydipsia

(drinking increased amounts of fluid) because the increase in urine output causes dehydration

Polyphagia

(eating increased amounts of food) in response to a lack of energy in the cells, which stimulates hunger

Glucosuria

(excretion of glucose in the urine) because when the blood glucose level exceeds the renal threshold for glucose, which is about 180 mg/dl, glucose is excreted in the urine

Polyuria

(increased production of urine) because water is drawn into the general circulation, increasing renal blood flow

Human chorionic gonadotropic hormone hCG:

(urine test; pregnancy hormone; not a positive sign b/c other conditions can give a positive sign

COPD

*"A preventable and treatable disease with significant extra-pulmonary effects that may contribute to the severity in individual patients. Its pulmonary component is characterized by airflow limitation that is not fully reversible. The airflow limitation is progressive and associated with an abnormal inflammatory response of the lung to noxious particles or gases" *Defined by GOLD (Global initiative for chronic Obstructive Lung Disease) *A Leading cause of death and disability. *COPD includes diseases that cause airflow obstruction (emphysema, chronic bronchitis) *Periods of acute exacerbation *Destruction of the walls of the alveoli. Reduction of the pulmonary capillary bed increases pulmonary vascular resistance and pulmonary artery pressures. *Increased pulmonary artery pressure may cause right-sided heart failure (cor pulmonale) evidenced by edema, JVD, and hepatomegaly. *Air trapping and characteristic barrel chest appearance. *Decreased ability to "expire" CO2 leads to hypercapnea and respiratory acidosis and ultimately resp failure *Hypoxemia may lead to polycythemia. *30-50% of smokers develop COPD *Tends to lean forwards and use accessory muscles to breathe

Weight gain during pregnancy

**25-35 pounds 3-4 lb first trimester, underweight - 28-40 overweight 15-25 obese - 11-20

Magnesium

*1.5-2.5 mEq/L *Renal excretion and conservation *Parathyroid hormone and vitamin D control intestinal absorption. *Second most abundant cation in ICF *Vital to metabolism and to protein and DNA synthesis in ICF *Regulates neuromuscular and cardiac function in ECF

Sodium

*135-145 mEq/L *Aldosterone controls renal absorption and excretion. *Most abundant cation in ECF *Controls and regulates water balance

Phosphate

*2.5-4.5 mg/dL *Excretion and reabsorption regulated by kidneys *Most abundant anion in ICF *Forms bones and teeth *Vital to muscle, nerve, and red blood cell function and nutrient metabolism

Bicarbonate

*24-28 mEq/L *Renal excretion and reabsorption *Major buffer in acid-base regulation in the body

Potassium

*3.5-5.3 mEq/L *Aldosterone controls renal excretion and conservation. *Most abundant cation in ICF *Vital to skeletal, cardiac, and smooth muscle activity *Involved in maintaining acid-base balance.

Obese

*30-40% water *High percentage of body fat and low percentage of lean tissue

Children/Adolescents

*50% water *High respiratory and metabolic rates lead to greater insensible fluid loss from the lungs. *Physical activity requires proportionally higher fluid intake.

Older Adults

*50% water *Thirst response is often decreased. *Kidneys are less responsive to ADH and less able to conserve water. *May have less ability to conserve water. *Increased likelihood of heart disease, impaired renal function, and multiple drug regimens also contribute to risk for fluid and electrolyte imbalances. *Increased sensitivity to salt can lead to hypertension.

Women

*52% water *Higher percentage of body fat than men

Men

*60% water *Lower percentage of body fat than women

Infants

*65% water *High body surface area (relationship between height and weight) promotes insensible fluid loss. *Immature kidneys conserve less water and electrolytes and cannot fully regulate electrolyte or acid-base balance until 2 years old. *High metabolic rate requires high fluid intake. *Illnesses that cause fluid and electrolyte loss can dehydrate infants quickly.

Newborns

*75% water *Proportionally larger ECF because brain and skin (high in interstitial fluid) make up larger proportion of body weight

Calcium

*8.5-10.5 mg/dL (total) *4.25-5.25 mEq/L (free) *Parathyroid hormone and calcitriol increase movement from bone to ECF. *Calcitonin increases movement from ECF to bone. *99% found in bone, only 1% in ECF *Vital to muscle, neuromuscular, and cardiac function

Chloride

*95-105 mEq/L *Functions with sodium to regulate serum osmolarity and blood volume *Most abundant anion in ECF *Works with sodium to regulate water balance *Regulates acid-base balance

Concepts Related To Metabolism

*Acid-Base Balance: With an insulin deficiency, glucose is not able to be used by the muscles and cells. Glucose accumulates in the cells, and protein and fatty acids are used for energy. The breakdown of fatty acids and protein creates ketones which accumulate, leading to acidosis, tissue breakdown, shock, coma, and death. *Perfusion: Perfusion is affected by long-term hypothyroidism that has not been treated, leading to myxedema. Manifestations include fluid retention and edema, dyspnea, bradycardia, metabolic disorders, and cardiovascular collapse. *Oxygenation: Oxygenation is affected by ascites. The accumulation of fluid in the abdominal cavity causes pressure on the thoracic cavity, reduces the ability to expand the lungs, and leads to dyspnea and impaired oxygenation. *Stress and Coping: A new diagnosis of a health problem that affects metabolism or a change in the severity of an existing problem can cause feelings of powerlessness. The client needs to make life-long lifestyle changes.

Active Transport

*Active transport is the movement of solutes against the normal movement of diffusion from a less concentrated solution to a more concentrated one. *A specific carrier on the cell membrane, enzymes, and metabolic energy are required to move a substance using active transport. *Active transport is especially important in maintaining sodium and potassium ion concentrations of the extracellular and intracellular fluid compartments.

Xanthines

*Aminophylline and Theophylline *Direct effect relaxing smooth muscles of the respiratory tract, both in the bronchi and in the blood vessels *Symptomatic relief or prevention of bronchial asthma and for reversal of bronchospasm associated with COPD *Adverse Effects: GI upset, nausea, tachycardia, seizure, brain damage, death *Contraindications: GI problems, coronary disease, respiratory dysfunction, renal or hepatic disease, alcoholism, hyperthyroidism *Avoid caffeine

Magnesium Sulfate

*Anticonvulsant *Treats low amounts of magnesium

Guidelines For Rewarming Tissue While Outdoors

*Apply firm pressure with a warm hand to areas of superficial frostbite. *Place frostbitten hands in axillae. *Remove wet shoes and socks from frostbitten feet, dry the feet, and cover them with dry shoes and socks. *Do not rub snow on frostbitten body parts.

Older Adult

*Assess for chronic conditions, medications, decreased sensation, or cognitive disorders, which increase the risk for hypothermia. *If the client is hypothermic: *Remove any wet clothing, dry the client, and help the client to dress in warm clothing. *Provide warm oral or IV fluids as ordered. *Once rewarming is complete, assess the client for psychosocial needs, such as need for social worker to assess ability of providing a safe home environment.

Factors That Affect Body Heat Production

*Basal metabolic rate (BMR) : This is the rate of energy used by the body to maintain essential body functions. This rate decreases with age. *Muscle activity : All muscle activity produces heat and increases the metabolic rate. *Thyroxine output: This increases cellular metabolism in the body and causes chemical thermogenesis, or the stimulation of heat produced in the body through cellular metabolism. *Epinephrine, norepinephrine, and sympathetic stimulation/stress response : Epinephrine and norepinephrine are neurotransmitters that cause the sympathetic nervous system to increase cellular metabolism. Epinephrine and norepinephrine act on liver and muscle cells to increase cellular metabolism. *Fever: This is a protective response that occurs in response to organisms and antigens that enter the body and cause an increase in cellular metabolism and body temperature.

Sympathomimetics

*Beta 2 selective adrenergic agonists *Albuterol & Levelalbuteral used for short relief; 2 puffs prn or QID *Salmeterol (Moderate to severe COPD) *Adverse Effects: GI upset, cardiac arrhythmias, hypertension, bronchospasm, sweating, pallor, flushing *Contraindications: heart dysrhythmias, diabetes, hyperthyroidism, heart disease, vascular disease *Take 30-60mins prior to exercise

Alpha Adeneric Blockers

*Block alpha receptors in vascular smooth muscle *Decrease vasomotor tone and vasoconstriction *Reduce serum levels of low and very low density lipoproteins *Typically end in -zosin

Anti-Cholinergcs

*Blocks vagally mediated reflexes by antagonizing the action of acetycholine *Short Acting: Ipratropium (Atrovent) *Long Acting: Tiotroprium (Spiriva) *Maintenance treatment of bronchospasm associated with COPD *Adverse Effects: Dizziness, headache, fatigue, nervousness, dry mouth, sore throat, palpitations, urinary retention *Assess for allergies to soy/peanuts *Contraindications: narrow angle glaucoma, BPH, bladder/neck obstruction, conditions aggravated by dry mouth/throat *Sugarless lozenges to relieve dry mouth

Surgical Management for COPD

*Bullectomy *Lung Volume Reduction Surgery *Lung Transplant

Profound hypothermia (body temperature below 28°C 82°F)

*Cardiopulmonary arrest (absence of pulse and respirations, lethal ventricular fibrillation) *Dilated and unresponsive pupils *Coma.

Retention of Sodium and Water

*Congestive heart failure *Liver cirrhosis *Renal failure *Adrenal gland disorders *Corticosteroid administration *Stress conditions causing ADH and aldosterone release

Key Points

*Corticosteroids decrease the inflammatory response. The inhalable form is associated with fewer systemic effects than other routes *To block various signs and symptoms of asthma, the leukotriene receptor antagonists block or antagonize the receptors for the productions of leukotrienes (responsible for allergic type inflammation similar to histamine) *The mast cell stabilizer cromolyn blocks the release of histamine and other chemicals associated with an allergic reaction. This decreases the inflammatory reactions.

Mast Cell Stabilizers

*Cromolyn (Nasalcrom) *Works at the cellular level to inhibit the release of histamine and inhibits the release of SRSA *Treatment of chronic bronchial asthma, exercise induced asthma, and allergic rhinitis *Few adverse effects *NOT USED FOR ACUTE ATTACKS!

Emphysema

*Destruction of the walls of the alveoli, with resulting enlargement of abnormal air spaces *Associated with COPD

Hyperkalemia

*Dialysis *Administration of glucose and insulin

Diffusion

*Diffusion the natural movement of molecules due to their random motion, can occur across the capillary membranes. Rate of diffusion depends on: 1. Size of molecules: Larger molecules diffuse more slowly than small ones. 2. Concentration of solution: Solutes move from a solution of higher concentration to one of lower concentration via diffusion. 3. Temperature of solution: Diffusion occurs more quickly at higher temperatures.

Mild hypothermia (body temperature 32°-35°C 90°-95°F

*Drowsiness *Slurred speech *Decreased coordination *Clumsiness *Confusion, disorientation, poor judgment, inappropriate behavior *Severe shivering *Increased respirations *Increased heart rate.

Child

*Educate parents about proper clothing for prevention of hypothermia, signs and symptoms of hypothermia, and treatment of mild hypothermia. *Provide age-appropriate teaching to the child on prevention, signs and symptoms, and treatment of hypothermia. *If the child is hypothermic: -Move the child to a warm, dry area. -Remove any wet clothing, dry the child, and dress the child in warm clothing. -Provide warm oral or IV fluids as ordered.

Loop Diuretics

*Inhibit sodium and chloride reabsorption form the loop of henle *Act on kidneys to increase flow of urine *May be used alone or in conjunction with other antihypertensives

Concepts Related to Fluid

*Elimination: Alterations such as diarrhea lead to fluid and electrolyte loss. *Cellular Regulation: Acute hemorrhage causes fluid volume deficit. *Cognition: Elevated or decreased electrolyte levels can lead to changes in cognition, with confusion and coma possibly resulting if levels are extremely low. *Thermoregulation: Fluid volume deficit leads to reduced ability to regulate heat loss. *Perfusion: Fluid loss results in decreased perfusion. *Assessment: Careful assessment permits identification of underlying cause of fluid and electrolyte imbalances and prevention or remediation of potential complications.

Chronic Bronchitis

*Excessive bronchial mucous secretion; characterized by a productive cough lasting 3 or more months in two consecutive years *Associated with COPD

Filtration

*Filtration is the movement of fluids and solutes together across a membrane. *During filtration, movement occurs from an area of higher pressure to an area of lower pressure; the higher pressure that causes the movement is called filtration pressure. *Hydrostatic pressure is the pressure exerted by a fluid on the walls of its container; for example, the hydrostatic pressure of blood is the pressure it exerts against the blood vessel walls. *Oncotic pressure opposes hydrostatic pressure in blood vessels. Any difference between the two represents a filtration pressure and will push or pull fluid into the blood vessels. *When hydrostatic pressure is greater than osmotic pressure, fluid filters out of blood vessels and may be trapped in body tissues causing edema (swelling).

Concepts Related To Thermoregulation

*Fluids and Electrolytes: An increase in body temperature causes sweating, which causes a loss in fluids and electrolytes. *Comfort: Changes in body temperature affect comfort level; pain tolerance decreases. *Infection: An elevated body temperature helps fight infections because organisms that cause infections thrive at normal body temperatures. The immune system responds to a fever by producing more white blood cells and antibodies to fight the infection. *Inflammation: During the first stage of inflammation, the body responds by dilating blood vessels to increase blood flow. This leads to redness and heat at the site of injury. *Development: Infants are the most susceptible to temperature fluctuations. Children tolerate temperature ranges the best. Few temperature regulation problems exist between the ages of puberty to old age. After the age of 75, individuals are at increased risk for hypothermia.

Manifestations Associated With Fever

*Flushing *Skin that is warm or hot to the touch *Tachycardia *Tachypnea *Fatigue *Malaise *Weakness *Decreased responsiveness *Difficulty concentrating *Skin rash *Poor appetite *Vomiting *Diarrhea *Body aches.

Inhaled Steroid

*Fluticasone (Flovent); Budesonide DPI (Pulmicort Flexhaler) *Decrease the inflammatory response in the airway *Prevention and treatment of asthma *Treat chronic steroid-dependent bronchial asthma *Adverse Effects: Sore throat, hoarseness, coughing, dry mouth, Pharyngeal and laryngeal fungal infections

Extracellular Fluid

*Found outside cells *Approximately one third of total body fluid in adults *Further divided into: -Intravascular fluid (plasma): 20% of ECF; found within vascular system -Interstitial fluid: 75% of ECF; surrounds cells -Lymph and transcellular fluids (cerebrospinal, pericardial, pancreatic, pleural, intraocular, biliary, peritoneal, and synovial fluids): 5% of ECF *Oxygen *Electrolytes: -Sodium -Chloride -Bicarbonate *Plasma also contains large amounts of the protein albumin. Interstitial fluid contains little or no protein.

Intracelluar Fluid

*Found within cells *Approximately two thirds of total body fluid in adults *Contains solutes (substances that dissolve in liquid): oxygen, electrolytes, glucose *Medium for metabolic processes *Oxygen *Glucose *Electrolytes: -Potassium -Magnesium -Phosphate -Sulfate

Febrile Seizure

*Generalized seizure that occurs in children as a result of a rapid temperature increase above 39°C or 102°F rectally. This temperature increase is associated with an acute illness and seen in children from age 6 months to 5 years. The incidence of febrile seizures peaks in toddlers with 1 out of every 25 children having at least one febrile seizure. *Risk factors for febrile seizures include a family history of the disorder, having had a febrile seizure before the age of 15 months, and frequent fevers. Greater than one-third of all children who have a febrile seizure will have another one. However, if the child is older when the first seizure occurs, the incidence that another seizure will occur is less.

Isotonic Solution

*Has the same osmolality as body fluid *5% Dextrose (Need Sugar? NPO?) *Normal Saline (Maintain homeostasis; replace fluid) *Lactated Ringers (Good for surgery; replaces fluid; good for acidosis because it converts lactate to bicarbonate) *Labs- CMP Neuro Checks *Watch for fluid overload: Lung sounds, edema, vital signs *Watch rate, consider CHF patients... Are they dehydrated?

Hypertonic Solution

*Have a higher osmolality than body fluids; fluid pulled out of the cell *Half Normal Saline *Good for patients that have a hypernatremia or cellular dehydration *Labs- sodium, potassium Neuro checks (seizure risk) *Don't give when intracranial pressure a concern, with burns, trauma, or low serum protein levels

Hypotonic Solution

*Have a lower osmolality than body fluid; fluid shifts into cells *5% Dextrose in Half Normal Saline (Need sugar and sodium) *5% Dextrose in Normal Saline *5% Dextrose in Lactated Ringers (Need Sugar, Perfect for NPO) *3% Normal Saline (Hyponatremia, Cerebral Edema) *Labs- CMP, Lactate level FSBS, sodium, neuro check *Watch for fluid overload: Lung sounds, edema, vital signs *Do not infuse too quickly

CLotting

*Heparin can prevent further clotting *The process of coagulation where blood is converted from a liquid to a gel

Metabolic Alkalosis

*High pH >7.45 *High bicarbonate >26 mEq/L *Most commonly due to vomiting or gastric suction *May also be due to medications, especially long-term diuretic use due to potassium shifts out of the cell, H+ goes in. Hypokalemia will produce alkalosis *Chronic ingestion of calcium carbonate or milk *Manifestations: symptoms related to decreased calcium, respiratory depression, tachycardia, symptoms of hypocalcemia/ hypokalemia *Correct underlying disorder, restore fluid volume with sodium chloride solutions, I&O, supply chloride (which allows for absorption of Na and ultimately the excretion of excess bicarbonate)

Respiratory Alkalosis

*High pH >7.45 *PaCO2 <35 mm Hg *Always due to hyperventilation *Manifestations: lightheadedness, inability to concentrate, numbness and tingling, sometimes loss of consciousness *Correct cause of hyperventilation

Regulation of Fluids

*Kidneys: primary regulator of body fluids and electrolytes; act through selective absorption and excretion of water and electrolytes in urine *Antidiuretic hormone (ADH): synthesized by the hypothalamus and secreted by the posterior pituitary, regulates water absorption by the collecting ducts of the kidneys and influences urine volume *Renin-angiotensin-aldosterone system: an enzyme pathway that acts on the blood vessels and nephrons of the kidneys; net effect is restoration of blood volume through sodium and water retention *Atrial natriuretic factor (ANF): a hormone released by cells in the atrium of the heart; causes water loss and inhibits thirst, reducing vascular volume.

Fixed Combination Respiratory Drugs

*LABA/Corticosteriod: Fluticasone/salmeterol (Advair, Advair Discus), Budesonide/formoterol (Symbicort) *SABA/Anti-cholinergic: Ipratropium/albuterol (Combivent)

Metabolic Acidosis

*Low pH <7.35 *Low bicarbonate <22 mEq/L *Most commonly due to renal failure (kidneys no longer can regenerate bicarb or regulate H+ ions) *Manifestations: headache, confusion, drowsiness, increased respiratory rate and depth (in attempt to compensate), decreased blood pressure, decreased cardiac output, dysrhythmias, shock; if decrease is slow, patient may be asymptomatic until bicarbonate is 15 mEq/L or less *Correct underlying problem, correct imbalance *Bicarbonate may be administered *With acidosis, hyperkalemia may occur as potassium shifts out of cell *As acidosis is corrected, potassium shifts back into cell, potassium levels decrease *Monitor potassium levels *Monitor ECG! *Serum calcium levels may be low when treating chronic metabolic acidosis *Must be corrected before treating acidosis (to avoid tetany)

Respiratory Acidosis

*Low pH <7.35 *PaCO2 >45 mm Hg *Always due to respiratory problem with inadequate excretion of CO2 *With chronic respiratory acidosis, body may compensate, may be asymptomatic *Symptoms may be suddenly increased pulse, respiratory rate and BP, mental changes. Very high PaCO2 can cause cerebrovasc dilitation causing feeling of fullness in head. *Potential increased intracranial pressure *Hyperkalemia (H+ ions shift into the cells and "crowd out" the K+ ions to leave the cell and enter ECF) *Treatment aimed at improving ventilation and depends on the related factors. **Chronic hypercapnea (greater than 50mmHg) causes the resp center to become insensitive to CO2 as stimulant, so O2 (hypoxia) becomes the driving factor, supplemental O2 should be used with caution**

ACE Inhibitors

*Lower blood pressure by preventing the conversion of angiotensin one into angiotensin two *Prevent vasoconstriction and sodium and water retention *Typically ends in -pril

Electrolyte Functions

*Maintaining fluid balance *Acid-base regulation *Facilitating enzyme reactions *Transmitting neuromuscular signals.

Oxygen Therapy for COPD

*May be used for exercise only, during acute exacerbation or continuous in the end stages. *Goal of supplemental O2: O2 sat of 90% *Long term O2 therapy has been shown to increase quality of life, reduce PAP and dyspnea and improve survival in severe COPD *Indicated when PaO2 is less than 55, evidence of tissue hypoxia, cor pulmonale, secondary polycythemia, impaired mental status.

Fluid Intake and Output

*Measurement of all fluid I&O over a 24-hour period is important for assessing a client's fluid and electrolyte balance *Fluid input sources that must be recorded are: -Oral fluids -Ice chips -Foods that are at room temperature (e.g., ice cream) -Tube feedings -Parenteral fluids -Intravenous medications -Catheter or tube irrigants *Fluid output sources that must be recorded are: -Urinary output -Vomitus and liquid feces -Tube drainage -Wound drainage and draining fistulas *To assess fluid status, nurse compares: -Total 24-hour fluid output to total fluid intake -Total 24-hour fluid output and total fluid intake to previous measurements *When output is much greater than intake, client is at risk for FVD *When output is much less than intake, client is at risk for FVE *In addition to standard fluid input and output sources above, the nurse must consider sources specific to clients with health alterations such as those sweating profusely or with rapid respirations.

Arterial Blood Gases

*Measurement of arterial oxygenation and carbon dioxide levels as well as acid-base balance. *Note the patient's body temperature and any O2 or mechanical ventilation used (Pre-Procedure) *Allen's Test (Pre-Procedure)

Hematocrit

*Measures the volume (percentage) of whole blood that is composed of RBC's *Increases with dehydration; decreases with overhydration

Anions

*Negatively charged *Examples include chloride (Cl−), bicarbonate (HCO3−), phosphate (HPO42−), and sulfate (SO42−)

Acid-Base Balances

*Normal plasma pH 7.35-7.45: (indicates hydrogen ion concentration) Lower pH - acidic; higher pH - alkalotic *Major extracellular fluid buffer system;bicarbonate-carbonic acid buffer system (should be 20:1 to maintain normal pH) *Kidneys regulate bicarbonate in ECF *Lungs under control of medulla regulate CO2, carbonic acid in ECF *If either bicarbonate or carbonic acid is increased or decreased so that the 20:1 ratio is no longer maintained, acid-base imbalance results

Superficial Frostbite

*Numbness, tingling, "pins and needles" feeling *Skin appears white, reddened, or cyanotic.

BUN and Creatinine

*Obtained to evaluate kidney function in eliminating nitrogenous waste products *BUN greater than 100 indicates severe renal impairment *Creatinine greater than 4 indicates severe renal impairment

Hyperosmolar Hyperglycemic State

*Occurs in individuals with type 2 diabetes *Blood glucose levels can reach 1000 mg/dl or more. *Most common precipitating factor is infection. *Treatment is to correct fluid and electrolyte imbalances and reduce blood glucose level.

Diabetic Ketoacidosis

*Occurs in those with type 1 diabetes *Fat stores break down to provide energy, causing ketosis. *Loss of bicarbonate to buffer *Metabolic acidosis occurs. Treatment is intravenous fluids and insulin.

Anemia

*Occurs when oxygen delivery is inadequate due to deficient volume of healthy RBC's or a decreased amount of normal hemoglobin *First sign is often fatigue

Bronchodilators

*Open Airways *Decrease bronchospasm

Fluid Volume Deficit

*Oral fluid replacement for mild cases *IV fluid replacement for severe cases *Subcutaneous fluid administration (hypodermoclysis) when IV access is problematic

Osmosis

*Osmosis is the movement of water across cell membranes from the side with the less concentrated solution to the side with the more concentrated solution to equalize the concentration in solutions on both sides of the membrane. *Osmosis is important for maintaining fluid balance. *Solutes may be crystalloids (salts that readily dissolve in solution) or colloids (protein molecules and other substances that do not readily dissolve in solution). The solvent is the component of a solution that dissolves a solute. *Concentration of solutes in body fluids is called osmolality. The osmolality of a solution is referred to as tonicity. *Isotonic solution has the same osmolality as body fluids (.g., normal saline). *Hypertonic solution has higher osmolality than body fluids. *Hypotonic solution has lower osmolality than body fluids. *Osmotic pressure is the ability of solution to pull water across a semipermeable membrane. -If two solutions are separated by a semipermeable membrane, the solution with the higher solute concentration has higher osmotic pressure and pulls water across the membrane to equalize the concentration of the two solutions. *Oncotic pressure or colloid osmotic pressure is the name given to the osmotic pressure exerted by plasma proteins that pull water from interstitial fluid into vascular fluid. This is important in maintaining vascular volume.

Diagnostics for COPD

*PFT *ABG *Chest X-ray *Alpha1 Anti-tripsyn in those <45 and strong family hx

Moderate hypothermia (Body temperature 28°-32°C 82°-90°F)

*Pale or cyanotic skin *Lack of shivering *Depression of mentation *Decreased cardiac output *Decreased blood pressure *Cardiac dysrhythmia (especially ventricular fibrillation) *Decreased renal blood flow, decreasing urinary output *Hallucinations *Drowsiness *Coma.

Peak Flow Meter

*Peak Expiratory Flow Rate: At home by patient's to monitor. Based on patient's personal best.

Complications of COPD

*Polycythemia (increased numbers of blood cells) *Atelectasis (Collapse of lung tissue affecting all or part of the lung, impacting the exchange of oxygen and carbon dioxide) *Pneumothorax (Air trapped outside the lung in the pleural space placing pressure on the lung tissue and causing atelectasis or "collapsed lung") *Pneumonia (Inflammation of the lung parenchyma-the respiratory bronchioles and alveoli-as a result of infection) *Cor Pulmonale (Right sided heart failure) *Pulmonary Hypertension (increased pressure in the pulmonary arteries. These arteries carry blood from your heart to your lungs to pick up oxygen)

Cations

*Positively charged *Examples include sodium (Na+), potassium (K+), calcium (Ca2+), and magnesium (Mg2+)

Corticosteriods

*Prednisone (end in "one" or "sone") *Act by altering the inflammatory process that leads to swelling and further narrowing. *May be given inhalation or systemic (oral or IV) *Long term complications of oral include hyperglycemia, increased risk of infection, swelling/wt gain, and osteoporosis *Inhaled can be given alone or in combination with a LABA *Must taper! Esp when switching to inhaled steroid! Adrenal insufficiency. *If taking a quick acting bronchodilator like Albuterol, should take it prior to the inhaled steroid

Thiazide Diuretics

*Prevent tubular reabsorption of sodium, promoting sodium and water excretion and reducing blood volume *Reduce systemic vascular resistance

Hypotonic Dehydration

*Proportionately more sodium is lost than water. *Fluid shifts from extracellular to intracellular components to compensate.

Guidelines For Rewarming Tissue In the Hospital

*Rapidly rewarm tissues in circulating water warmed to 40°-45°C (104°-105°F). *Keep tissue in the warm water for 20-30 minutes. *Do not massage the tissues. *Keep client on bed rest after rewarming, elevating affected extremities. *Administer analgesics and anti-inflammatory agents as ordered. *Debride blisters or necrotic tissue as ordered.

Beta Blockers

*Reduce BP by preventing beta receptor stimulation in the heart, resulting in decreased heart rate and cardiac output *Interfere with renin release by kidneys, decreasing the effects of angiotensin and aldosterone *Typically end in -lol

Vasodilators

*Reduce blood pressure by relaxing vascular smooth muscle and decreasing peripheral vascular resistance *Often prescribed in combination with a diuretic or beta blocker because they can cause reflex tachycardia and fluid retention

Freezing Of Human Tissue

*Skin freezes when temperature drops below 0°C (32°F). -Ice crystals form, increasing intracellular sodium content. -Causes initial vasoconstriction, then vasodilation and subsequent increased vascular permeability -Results in cellular and tissue edema *As exposure persists, vasoconstriction and increased viscosity of the blood cause tissue infarction and necrosis.

Goals for COPD

*Stabilize, manage disease progression *Symptom management *Avoid exacerbations *Promote functional ability and decrease disability *Smoking Cessation

Deeper Frostbite

*Stiffness and paresthesias *As thawing occurs, skin becomes yellow or white and loses elasticity. *The client feels burning pain. *Swelling, blisters, necrosis, and gangrene may develop. *Necrotic tissue may require amputation.

Dehydration

*The body loses more water than it is taking in *Average fluid intake per day is 2,500mL

Newborn

*Thoroughly warm and dry the newborn directly after birth. *Place the very-low-birth-weight (VLBW) newborn in a polyethylene wrapping directly after birth to decrease heat loss. *Swaddle the newborn directly after birth and cover the scalp with a head covering of insulated fabric or wool. *Monitor for signs of hypothermia. *Assess skin temperature. *Monitor blood glucose as ordered, as a decrease below 40 mg/dL may indicate cold stress. *If the newborn is hypothermic: -Maintain a neutral thermal environment (NTE). -Warm the newborn slowly, removing plastic wrap and head covering so that cool air will not be trapped inside them. Warm IV fluids prior to administering.

Loss of Fluid

*Urine: major route of fluid output; volume increases as fluid intake increases, decreases if loss through perspiration is large *Insensible fluid loss: not noticeable or measurable, occurs through skin (diffusion and unmeasurable perspiration) and lungs (water in exhaled air); increases with increased exercise and temperature *Sweat: noticeable and measurable loss of fluid through perspiration from skin *Feces: loss of water that is not absorbed in the colon.

Key Points

*Xanthine-derived drugs affect the smooth muscles of the resp tract. Effects are directly related to blood levels of theophylline (10-20 mcg/dL). Excess can lead to coma and death *Sympathomimetic (beta agonists) replicate the effects of the sympathetic nervous system; they dilate the bronchi and increase the rate and depth of resp *Anticholinergics affect the vagus nerve to relax bronchial smooth muscle and promote bronchodilation.

Leukotriene Receptor Antagonists

*Zafirlukast (Accolate); Montelukast (Singulair) *Selectively and competitively block or antagonize receptors for the production of leukotrienes which similar to histamine play a role in "allergic" inflammatory disorders (i.e. hay fever, asthma) *Prophylaxis and chronic treatment of bronchial asthma *Adverse Effects: Headache, dizziness, myalgia, nausea, diarrhea and abdominal pain, elevated liver enzyme concentrations, vomiting, and generalized pain *Hepatic or renal impairment (effects metabolism and excretion *NOT FOR ACUTE ATTACKS!

Contraction stress test (CST)

*also known as oxytocin challenge test If NST test are nonreactive. Any concern if fetal oxygenation is only marginally adequate when uterus at rest . nipple stimulation can induce temporary contraction; if babies HR dips it is a positive CST result and is a bad sign

Annual mammography begins at what age in women? (Secondary Prevention)

- 40 to 54 years annually - 55+ annually or biannual

Characteristics of Malignant Neoplasm:

- Abnormal growth patterns, abnormal functions and ability to disseminate to distant sites (metastasis) - Cells loss of specific appearance of their parent cell (anaplasia) - Specific functions lost partially or completely -Loose adherence, results in ability to break off from main tumor -Contact inhibition does not occur (cell doesn't know when to stop growing) -Large nuclear to cytoplasmic ratio: BIG nucleus and small cell

Infectious agents (risk factors for cancer)

- Bacteria such as H. pylori and viruses such as HPV

Direct visualization: also allows for biopsy. As seen in:

- Colonoscopy - Endoscopy

2-hour postload glucose test (OGTT)

- Normal: <140 mg/dL - Impaired glucose tolerance (IGT): 140-199 mg/dL - DM: ≥ 200 mg/dL

Characteristics of Benign Neoplasm

- Retain most of the morphologic and functional characteristics of normal cells but have excessive growth - capable of replication and mitosis, NOT capable of metastasis - Can still result in complications and death depending on where the tumor is and what it is pressing on -Tight adherence. Continues to make fibronectin

Lifestyle choices that may contribute to the development of cancer (30% of all cancer diagnosis)

- Smoking/tobacco use - Nutrition - Physical activity - Excessive weight

Folic acid nursing consideration

-400mcg should be taken by all women of childbearing age -Increase to 600mcg during pregnancy -4mg for women with previous neural tube defect children (10 times more than women childbearing age)

When and where does Implantation occur

-6 to 10 days after conception - The Upper Uterus

Fetal Period

-9 weeks after conception until birth Dramatic growth and refinement of organ systems (most organs less vulnerable to teratogens) -CNS vulnerable through entire pregnancy

hormones maintaining homeostasis

-ADH (regulates water excretion from kidney) -renin-angiotensin-aldosterone system -atrial-natriueretic factor (promotes sodium wasting, acts as potent diuretic, inhibits thirst)

How will the nurse assses a pt for Colon Cancer

-Abdomen for obv distention or masses -visible peristaltic waves accomp. by high pitched/tinkling bowel sounds; may indicate partial bowl obstruction -Risk factors?: person Hx of breast,ovarian, or endometrial cancer -Familial polyposis -Family Hx of CRC -lifestyle choices -assess liver function for metastasis

prOBable signs of pregnancy:

-Abdominal enlargement -Cervical softening (Goodell's sign) -Uterine changes -Pregnancy tests -Hegar's sign: compressibility of the lower uterus reflecting softening of the isthmus of the cervix -Ballottement: when the cervix is tapped the fetus floats upward in the amniotic fluid; a rebound is felt by the examiner when the fetus falls back

Chemotherapy may cause

-Alopecia -Mucositis -Myelosuppression (bone marrow suppression)

preSUmptive signs of pregnancy:

-Amenorrhea (absence of menstruation) -Nausea and vomiting -Fatigue -Urinary frequency -Breast and skin changes -Vaginal and cervical color changes (Chadwick's sign) -Fetal movement (quickening)

Bone marrow aspiration: Blood disease

-Anemia, blood cell conditions such as leukopenia, leukocytosis, thrombocytopenia, thrombocytosis, pancytopenia, and polycythemia -Cancers of blood or bone marrow such as leukemia, lymphoma and multiple myeloma

How will the nurse assess a pt for Breast Cancer

-Ask for personal/family Hx of breast cancer, and women's gynecologic/obestric history -OB history: age of menarche, menopause/symptoms, age at first childs birth, # of preg -Alcohol/OTC drug use, especially hormones containing estrogen -if lump, note size, shape, consistency, fixed/mobile, pain?

lifespan considerations-infants and children

-BSA proportionately greater, increasing insensible fluid loss -body weight that is fluid highest in birth and with preemies -infants and children <2 years lose greater proportion of fluid per day -respiratory and metabolic rates higher- leads to more water loss -immature kidneys unable to conserve or excrete solutes effectively when fluid status compromised

What tests are ordered for pt suspected of having Leukemia

-CBC (abnormally high/low WBC) -Bone marrow biopsy: confirmatory test; bone marrow aspirated and examined to see ratio of cells specific to leukemia -Lumbar puncture: to see if blasts are in spinal cord -cytogenetic analysis: to determine intensity of child's consolidation - Flow cytometry: commonly performed on initial bone marrow

Lab tests for cancer assessment/diagnosis

-CBC: looking for things like anemia & WBC count -Chemistry panel: looking for tumor markers (different cancers have different markers; they are also often used as a measurement of response to treatment; examples include CEA (carcinoembryonic antigen indicator of cancer in large intestine or rectum) and PSA (prostate specific antigen-indicator of prostate cancer) - Genetic Testing

Hormonal Manipulation (pharmacology)

-Can decrease hormones of 'hormone-sensitive tumors', which can slow cancer growth rate -Can slow the growth of cancer for years but is NOT curative

If fever in elderly, could mean:

-Cancer -Infection -Inflammation

What tests will be ordered for Colon Cancer?

-Colonoscopy -Sigmoidoscopy -Fecal Occult Blood test (avoid apirin, Vit C, iron, red meat for 48hr) -CT or MRI of chest, abdominal, pelvis, lungs, liver to find location of metastasis -Digital rectal exam for men 50+ -Genetic testing for pt w/ Fam Hx: FAP and Lynch syndrome

Alpha-fetoprotein (AFP) screening

-Considered a first step in screening b/c if abnormal diagnostic testing is ordered a blood sample from mom between 16-18 wks gestation can determine: -open body wall defects (neural tube defects) -chromosomal anomalies (trisomy21 with low levels); -Spina Bifida, multifetal gestation, and advanced gestational age are possible with increased AFP

Symptoms in elderly for infection:

-Decrease in appetite -Altered mental status

PRIMARY prevention for cellular regulation alterations

-Healthy diet -Regular physical activity -smoking cessation -Avoid excess exposure to sunlight -Prophylactic surgery (removing moles, colon polyps, breast) -Practice safe sex -Vaccination - Vaccines Gardasil & Cervarix for the prevention of HPV

Immunomodulating (Biologic response modifiers (pharmacology) )

-Helps regulate inflammation -Proliferates and enhances T and B cells. Activates NK cells

What tests will be ordered for a Breast cancer diagnosis/assessment

-High risk women can receive MRI screening -Breast Biopsy -Clinical breast exam -Liver enzymes: elevated enzymes may indicate liver meastasis

Risk factors for Hypothermia

-Infants/young children and the elderly -Alcohol/drug use -Impaired cognition -Geographic location -Low SES -Outdoor exposure -Endocrine disorders -Surgical procedures -Poor nutritional status

Risk factors for hyperthermia:

-Infants/young children and the elderly -Those with chronic illnesses -Non-Hispanic African American men age 75 and older -Low SES -Homeless -Geographic location -Individuals working outdoors -Athletes training/playing sports -Infection -Cancers

Older adult and thermoregulation:

-Loss of subcutaneous fat -Slower circulation and metabolic rate -Lack of activity -Reduced thermoregulatory efficiency -Usually lower temperature measurements than adults -May not display fever with infection

Secondary preventions for hyperthermia:

-Malignant hyperthermia-- genetic testing -Muscle biopsy- called caffeine halothane contracture test

Pharmacology nursing consideration for pregnant woman

-More about what we don't give than what we do give: limit meds to those absolutely necessary -OTC and herbal not always safe -Pharm literature has pregnancy risk categories for each drug -Only regular strength tylenol: no extra strength or NSAIDS

Mucocytis

-Mouth sores seen in cancer patients -Pt should NOT use mouthwash with alcohol or glycerine

Pts with chemo-induced peripheral neuropathy (CIPN) may experience

-Orthostatic hypotension -Loss of sensation in hands and feet -Impaired gait and balance

Which adverse effects are observed when a vesicant agent extravasates during chemotherapy?

-Pain -Infection -Tissue Loss

Female breast examination finding the nurse should report as suspicious for Breast Cancer

-Poorly defined, immobile, painless lump -skin coloring & thickening, large pores called peau d'orange (orange peel appearance) -Nipple retraction/discharge. ulceration or swelling of chest

Precautions to be taken in providing nursing care to patients with sealed radioactive implants

-Private room with private bathroom, with door shut as much as possible - Lead apron is worn during care; apron should always be between caregiver & pt -Nurse should wear dosimeter film badge, each caregiver should have separate dosimeter to calc radiation exposure -Preg nurse should not treat/ Preg women and children should not visit

Potential impairment of

-Process of ventilation (inadequate muscle or nerve function, airway constriction, impaired respiratory regulation) -There is an insufficient amount of hemoglobin or an insufficient number of RBCs to transport the gases (anemia, blood loss) -Compromise in perfusion (decreased cardiac output, constriction of peripheral vessels)

Before initiating chemotherapy; child is treated for presenting signs such as:

-Sepsis -Anemia -Hemorrhage -Metabolic Abnormalities

Nadir

-Significant after 2 weeks of chemo -(low point) in white blood cell, red blood cell and platelet counts, bone marrow suppression

Petechia in the pt with Leukemia

-Tiny, non blanching red spots in mouth & sclera

Routine visit assessments will include

-Vitals and weight -Urinalysis: protein, glucose, ketones, and nitrates (indication of infection) -Leopold's maneuvers: done towards end of pregnancy; palpating fetus through abdominal wall; indicates babies growth and position -Fundal height: from 16-18 wks the fundal height in cm is approximately equal to gestational age -Fetal HR: should be between 110-160bpm

Priority nursing intervention for a neutropenic patient

-WATCH for infection (prevention) AND fever which can lead to SEPSIS -avoid fresh flowers, fresh fruits/veggies -monitor WBC with differential and absolute neutrophil count -

Ultrasound used to determine:

-a variety of fetal and placental conditions during the 2nd trimester mom's bladder should be full in order for baby to be seen better -at 6weeks ultrasound can pick up Embryo heartbeat -Presence and location of pregnancy (Positive sign of pregnancy) -Gestational age -ID fetal abnormalities, esp neural tube defects

Factors that affect your body fluid:

-age -gender -body fat

Embryonic peroid

-approximately 3-8 weeks post-conceptual -Beginning coincides with first missed period -By the end of the 8th week all major organ systems are in place! Exposure to teratogens during this period are especially dangerous: may cause structural and functional damage to developing organs

Amniocentesis

-aspiration of amniotic fluid (2nd trimester) -Performed b/wn 15-20wks to determine chromosomal or biochemical abnormalities -materal age >35 is an indication (3rd trimester) -Used to determine fetal lung maturity or hemolytic disease -Few risk factors unless done earlier than 13 weeks gestation

Obestetric Risk Factors for pregnancy

-birth of previous infant more than 8lb - previous preterm birth -previous fetal/neonatal death -Rh sesitization

Active external rewarming

-body to body contact -fluid or air filled warming blankets -radiant heat lamps

independent interventions

-compare input and output frequently -assess choice and types of fluids consumed, especially those with diuretic effect -weigh pt daily -engage pt in plan of care -provide pt ed as indicated, esp regarding med regimens and side effects

nursing assessment/history

-current, past medical history -meds -functional, developmental, socioeconomic factors -age -lifestyle -food and fluid intake, fluid output

Side effects of radiation: (can be acute or long-term and are site-specific)

-debilitating fatigue that can last for months -local skin changes and hair loss -taste alterations -Bone marrow suppression - -Risk of secondary malignancy b/c radiation can damage and mutate normal cell DNA in surrounding cells

Grading of cancer

-determines tissue origin and its histologic grade -Gx: grade cannot be determined -G1,G2,G3,G4. with G4 being tumor cells poorly differentiated and retain no normal cell characteristics. cannot determine the tissue origin.

chronic diseases in children that normally present with alterations in electrolytes

-diabetes, cystic fibrosis (lose sodium through sweat) additional assessments may be needed to diagnose dehydration; evaluation of kidney function

older adults and fluid balance

-diminished thirst -decline in kidney function -reduced fluid reserve -nephrons become less able to conserve water in response to ADH (remains normal) -increased levels of ANF -increased sensitivity to salt -isolation may reduce social interaction assoc with drinking fluids -reduced availability or access to preferred fluids -increased likelihood of heart disease, impaired renal function and polypharmacy

collaborative interventions

-education on appropriate use of electrolyte replacement fluids and salt tablets -oral replacements or initiation of IV therapy for significant fluid loss (hypodermoclyisis when IV access in problematic) -electrolyte supplements -diuretics (FVE)

Pathology (r/t cancer dianosis)

-examination of cells and tissues for a diagnosis of malignancy, tissue type, and grade of tumor -only definitive way to determine if a tumore is malignant or benign

extracellular fluid

-fluid outside the cell -one third of total body fluids -two compartments -what labs measure

intracellular fluid

-found within the cell -approximately two-thirds of adult body fluid -vital to normal cell functioning -contains solutes (oxygen, electrolytes and glucose)

Lactated Ringers (LR) and Normal Saline

-hypotensive and hypovolemic patients -volume expansion

diffusion

-intermingling of molecules in liquids, gases or solids -rate of diffusion varies by size of molecules, concentration of a solution, temperature of a solution

health promotion: heat-related illness

-limit outdoor activity during hottest part of the day -take frequent breaks for rest and water -drink water before beginning to feel thirsty -wear lightweight clothes -work or exercise with others when engaging in activities outside

Potassium K+

-major cation in ICF, small amount in plasma, ECF -ratio of intracellular to extracellular K+ important for neuromuscular response to stimuli -vital for skeletal, cardiac, smooth muscle function -involved in maintaining acid-base balance -contributes to intracellular enzyme reactions -must be ingested daily -found in many fruits, vegs, meat, fish

How will the nurse assess a pt with Leukemia

-mental and neurological function due to infiltration of CNS -Health Hx -activity level, bruising, stomaches, SEVERE leg pain -petechiae in mouth and sclera

Examples of benign tumor cells

-moles -uterine fibroid tumors -skin tags -endometriosis -nasal polyps

Tumor Lysis Syndrome: definition, effect on body, nursing indications

-occurs when a large number of tumor cells are killed rapidly and their intracellular contents are released into bloodstream faster than the body can eliminate them -can cause tissue damage, AKI, and death; Hyperkalemia and hyperuricemia are seen -Encourage pt to hydrate to excrete potassium

osmotic pressure

-power of a solution to draw water across membrane -colloid osmotic pressure (oncotic pressure) -plasma proteins pull water from interstitial space into vascular compartment (important in maintaining vascular volume)

What will the patient with Colon Cancer look like

-rectal bleeding -Anemia -Changes in stool consistency and shape -Fatigue -Abdominal fullness -Vague abdominal pain -Constipation

Frostbite signs and symptoms:

-redness or pain in any skin area may be the first sign -a white or grayish-yellow skin area -Skin that feels unusually firm or waxy -numbness

Primary prevention interventions for hypothermia:

-reduce ingestion of alcohol or other drugs -hypoglycemia in people with diabetes -clothes in layers, cover the head -physical activity increases body heat -immediately begin rewarming -ensure dry environment -warm compresses applied to patient's core

kidneys

-regulate and filter waste, return electrolytes to blood -regulate volume, osmolality of ECF -adjust reabsorption of water from plasma filtrate -significant role in acid-base regulation

How will Colon Cancer patient be treated?

-removing colon polyps to prevent colon cancer - use of asprin and celecobix (celebrex) to reduce risk of CC -W/ DIAGNOSIS: chemo/radiation

Colonoscopy

-screening starts at age 50; then every 10 yrs, sigmoidoscopy ever 5 year -done to see if any polyps are present

diagnostic tests

-serum electrolytes -CBC (hematocrit affected by changes in plasma volume) -osmolality (serum and urine) -urine specific gravity

physical examination

-skin -oral cavity and mucous membranes -eyes -cardiovascular, respiratory systems -neurologic, muscular status -daily weights -VS -fluid intake and output -FVD: output exceeds intake -FVE: input exceeds output

Hypoglycemia causes

-too much insulin or oral hypoglycemic agent -too little food -excess physical activity

Bone marrow aspiration/biopsy

-use of needle to aspirate bone marrow from posterior/anterior illiac crest -Allows for diagnosis of disease and stage/progression of disease

water

-vital to health -normal cellular functioning medium for metabolic reactions -transports nutrients and waste products -acts as lubricant insulator and shock absorber -helps to regulate and maintain body temperature

Carcinogen Exposure (risk factor for cancer)

-voluntary/modifiable: smoking -involuntary: asbestos, pollution, etc.

rectal and tympanic are __________ than oral temps

1 degree higher

Axillary and temporal is _________ than oral temps

1 degree lower

Circadian rhythms

24 hour interval of heat change. Morning temperature is 1-2 degrees lower than in the late afternoon Variation tends to be greater in infants and children

Three most common new cancer diagnosis in Women

1. Breast 2. Lung/Bronchus 3. Colon/Rectum

Criteria (diabetes diagnosis)

1. FBG ≥ 126 mg/dL 2. 2hr plasma glucose ≥ 200 mg/dL during OGTT 3. A1C ≥ 6.5% 4. random plasma glucose ≥200 mg/dL

Three most common new cancer diagnosis in Men

1. Prostate 2. Lung/Bronchus 3. Colon/Rectum

Sodium Na+

135-145 mEq/L most abundant cation in ECF controls, regulates water balance contributes to serum osmolality found in many foods suggested intake: 1500-2300 mg/day

When is the most accurate time to determine gestational age through ultrasound?

1st trimester

Teratogenic substances

1st, 2nd, or 3rd hand smoke Alcohol (leading cause of intellectual disability) and other illicit drugs Hot tubs Infectious diseases Chemicals (hair dye, dry cleaning fluid, nail salon chemicals, etc) Pesticides Radiation Some medications; anesthesia; live virus immunization Some complementary and alternative therapies

How is scoring done for BPP

2 points (present) or 0 points (absent) 10/10 perfect score 8/10 reassuring 4/10 or less is non reassuring

Phosphate PO4 3-

2.4-4.5 mg/dL in adults -much higher levels in children- bodies still growing -major anion of ICF -essential for functioning of muscles, nerves, RBC's -involved in metabolism of protein, fat, carbs -found in meat, fish, poultry, milk products, legumes

Extracellular water is _________ of body weight

20%

Oxygen consumption increase by about ___% during pregnancy; why?

20% -light hyperventilation and decreased airway resistance to allow oxygen needs to be met; hormones play a role in airway resistance

Bicarbonate HCO3-

22-26 mEq/L -found in both ICF, ECF -primary function: regulate acid-base balance -produced through metabolic processes in sufficient amounts to meet body needs

Chill stage of fever

2nd stage of fever associated with sensation of being chilled although temperature is rising.

Potassium K+ levels

3.5-5.0 mEq/L (normal serum level) (labs) 125-140 mEq/L (normal ICF level)

Clinical Manifestations (diabetes)

3 P's: polyphagia, polyuria, polydipsia Fatigue, weakness, sudden vision changes, paresthesias, dry skin, lesions/wounds, recurrent infections

Examples of hypertonic solutions

3% Sodium Chloride D5NS D5LR

flush stage of fever

3rd stage of fever associated with the hypothalamus reaching a new set point due to shivering causing warmth.

Intracellular water is ________ of body weight

40%

A normal physiological change of pregnancy is that blood volume increases by ____%?

45%

Diabetes management

5 components: nutritional therapy, exercise, monitoring, pharmacologic therapy, and education

Iron sources

50-175 ug/dL Liver, broccoli, spinach, dark leafy greens, potatoes with skin, eggs, chicken, iron fortified cereal, and pork

Mild hypothermia

89.6-95

Chloride Cl-

95-105 mEq/L -major anion of ECF -with sodium, regulates serum osmolality -major component of gastric juice -buffer in O2-CO2 exchange in RBC's -found in same foods as sodium

Adult body temperature

96.7-100.5

Normal core body temperature:

96.8-101.3

Newborn temperature

97.9-99.7 (36.6-37.6)

Demographic Risk factors for pregnancy

< 16 yrs or >35 yrs Low socioeconomic status nonwhite race multiparity

Random plasma glucose

>200mg/dL on more than one occasion to diagnose diabetes

Sexuality

A central aspect of being human encompassing sex, gender identities and roles, sexual orientation, eroticism, pleasure, intimacy, and reproduction. Exemplars: Family planning STIs Menopause Erectile dysfunction

Exchange lists

A diet-planning tool that groups foods together based on their carbohydrate, protein, and fat content. One food on the list can be exchanged for another food on the same list.

Glucagon

A hormone that stimulates breakdown of glycogen in the liver; formation of carbohydrates in the liver; and breakdown of lipids in the liver and adipose tissue

Somatostatin

A neurotransmitter produced by delta cells that inhibits production of glucagon and insulin.

Naegele's Rule ( to calc EDD)

FDLMP + 7days - 3months + 1 year

isotonic solution

A solution in which the concentration of solutes is essentially equal to that of the cell which resides in the solution- no movement across the cell membrane same osmolality as body fluids loss of equal amount of fluid and electrolytes

hypertonic solution

A solution in which the concentration of solutes is greater than that of the cell that resides in the solution; higher osmolality than body fluids loss of more water than electrolytes pulls fluid from the cell into the vascular space used with pts with elevated intracranial pressure

Sexual Health

A state of well-being in relation to sexuality across the lifespan that involves physical, emotional, mental, social, and spiritual dimensions. Sexual health is an intrinsic element of human health and is based on a positive, equitable, and respectful approach to sexuality, relationships and reproduction, that is free of coercion, fear, discrimination, stigma, shame, and violence.

Neoplasm

A tumor. Abnormal growth that is uncontrolled and progressive. Classified as benign or malignant

Climacteric Menopause

A womans ability to reproduce decreases over a period of years Most often occurs between the ages of 45 and 50.

The pituitary gland stores and releases _______

ADH

Forced Vital Capacity (FVC)

AMount of air that can be forcefully expelled or exhaled after the lungs are maximally inflated Appx 4 L in adult

Diabetes

Group of metabolic diseases characterized by increased levels of glucose in blood (hyperglycemia) due to defects in insulin secretion, insulin action, or both

Increases BMR

Growth, infection, fever, emotional tension, extreme environmental temperatures, and elevated levels of certain hormones (thyroid + epinephrine)

Thermoregulation

Process of maintaining balance between heat loss and heat production in order maintain core internal temperature Related to newborn's rate of metabolism and O2 consumption

ACE inhibitor drugs

Produce vasodilation and decrease blood pressure (benazepril, and catopril)

Perfusion issues

Ability to transport oxygen containing hemoglobin to cells and return CO2 containing hemoglobin to the alveoli Can be caused by decreased cardiac output as well as by thrombi, emboli, vessel narrowing (pulmonary hypertension) or blood loss

Contraceptives

Abstinance IUD, implant Vasectomy Tubal ligation Birth control shot Vaginal ring Birth control patch Birth control pill Diaphragm Condom Pull-out method

Implementation for hyperthermia

Acetaminophen, ibuprofen Antibiotics monitor temp every 2 hours promote adequate fluid and nutritional intake monitor I & O apply ice bag covered with towel to groin cover client with only a sheet

Most common type of leukemia in children

Acute Lymphocytic Leukemia (ALL)

Administration of chemotherapy along with surgery or radiation

Adjuvant therapy

Most important risk factor for developing cancer, and why?

Age. 75% of new cancer diagnosis are in the 55+ community. - highest cumulative time being exposed to carcinogens and free radicals.

Hypernatremia

Administration of ADH if due to reduced ADH production

Asthma therapeutic management

Administration of medications and treatments Education for child and family Avoidance of triggers Recognize early signs of asthma episode Measures to prevent asthma attack

Family Planning

Adolescents (ages 11-21) Menarche usually occurs between the ages of of 9-15. Most girls will achieve sexual maturity 2-5 years after the start of menstruation.

Type 1

Affects 5% and characterized by destruction of beta cells May be genetic, immunologic, or environmental. Destruction of beta cells result in decreased insulin, increased glucose production, and fasting hyperglycemia More likely to get DKA

Chronic bronchitis

Airway problem

Hematopoietic Stem cell transplantation (Leukemia)

Allows for high doses of chemo b/c hematopoietic will be restored. Healthy stem cells are inserted into the child's blood stream & migrate to the mrrow to replenish immune function SE: graft-vs-host disease (rejection)

Cor pulmonale

Alteration of structure and function in right RV of heart; pulmonary HTN

Residual volume

Amount of air remaining in the lungs after forced expiration Appx. 1 L

neoplasia

An abnormal and progressive multiplication of cells not needed for normal development or tissue replacement

Insulin

Anabolic hormone secrete by Beta cells in islets of Langerhans While eating, insulin secretion increases and moves glucose from blood to muscle, liver, and fat cells

Common side effects of chemotherapy on the bone marrow (hematopoietic side effect)

Anemia Neutropenia Thrombocytopenia

Nursing process for Acetaminophen

Assess patient's med history for OTC products containing acetaminophen Monitor for adverse reactions Use liquid form for children/patients that have difficulty swallowing

Asthma

Asthma is a chronic inflammatory disease of the lungs characterized by recurring episodes of hyperreactive inflammatory response caused by a variety of triggers, which make the smooth muscles of the bronchioles in the lungs restrict. This restriction, in turn, creates an intermittent obstruction of airflow. In the pediatric client, a narrower airway increases airway resistance, greater than in the adult. Airway resistance is the effort or force needed to move the oxygen through the trachea to the lungs.

POSITIVE signs of pregnancy

Auscultation of fetal heart sounds Fetal movements felt by examiner Visualization of fetus by ultrasound

Transport issues

Availability of hemoglobin and its ability to carry oxygen from alveoli to cells for metabolism and to carry carbon dioxide produced by cellular metabolism from cells to alveoli to be eliminated Occurs when the amount of hemoglobin is low; anemia for any reason, sickle cell crisis where the spleen destroys red cells prematurely

Secondary preventions for hypothermia

No real screening, just look for: -outdoor exposure -alcohol/drug abuse -endocrine disorders -neurological impairment

Prodomal period (fever)

Nonspecific complaints such as mild headache and fatigue

Chemo administration calculations

Based on body surface area calculations 1. Usually a West nomogram chart, or a BSA calculator is used 2. Metric BSA (m2)=√wt (kg)*ht (cm)/3600 3. Household BSA (m2)=√wt(lb)*ht (in)/3131

Hyponatremia is where sodium is ____________

Below 135

Avoid contact with cold surfaces

Best way to prevent heat loss in newborns?

Bulimia

Binged eating followed by forced vomiting

3rd Trimester Risk factors

Bleeding Placenta previa: painless bright red bleeding Abruption: painful ridgid, bleeding may be concealed behind placenta PROM (premature rupture of membranes before onset of labor); PPROM (preterm rupture of membranes, before 37 wks gestation) High blood pressure Pre-eclampsia Eclampsia Gestational diabetes STIs Comorbidities Previous pregnancy loss Multiple pregnancy

2nd Trimester Risk Factors

Bleeding (spontaneous abortion, placenta previa (painless bright red bleeding), abrupto placenta) Cramping Rupture of membranes (ROM, PROM, PPROM) (escape of fluid from vagina) High blood pressure Pre-eclampsia (continuous pounding headache, change in vision) Eclampsia (convulsions) Gestational diabetes STIs Comorbidities Previous pregnancy loss Multiple pregnancy

ARBs

Block vasoconstriction and promote relaxation of blood vessels, thereby lowering blood pressure

Heat production

Primary source is metabolism (increased by hormones + exercise)

HbA1c

Blood test that measure glycated hemoglobin in the blood, the results determine the average blood glucose for the previous 2-3 months Normal 6% or less, 6.5%+ x2 = diabetes, <7% = controlled diabetic

Hyperthermia

Body Temperature above normal range

Most common metastasis site of Breast cancer:

Bone Lungs Liver Brain

Mucloytics

Break down sticky, thick secretions Uses: atelectasis, bronchitis, complications of CF Acetylcysteine antidote for Acetaminophen toxicity: activated charcoal decreases effectiveness Not recommended for asthma patients due to risk of bronchospasm Acetylcysteine (rotten egg smell)

Testing ketones

By-products of fat breakdown in blood and urine.

Chlamydia

Cause: Trochomatic bacterium Must have a host to survive Incubation 7-21 days. Symptoms: Diagnosis: Swab or culture Nucleic acid amplifier test (NAAT)- quickest and most acurate Lab will gram stain a swab Lab can also culture. Treatment: Antibiotics- Azythromycin or docycycline Prevention: Limiting direct contact (condom/dental dam) To prevent neonatal transmission treat the pregnant woman.

epineprhine and norepinephrine

Hormones released to alter metabolism when additional heat is required to maintain temperature

Seven warning signs of cancer: CAUTION

C: change in bowel movement A: a lesion that wont heal U: unusual bleeding or discharge T: thickening or lump in breast or elsewhere I: indigestion/difficulty swallowing O: obvious changes in wart or mole N: nagging cough or persistent hoarseness

If you suspect infection, do a _______

CBC

Diagnostic tests for thermoregulation:

CBC, imaging studies, ABGs, blood sugar, BMP, coagulation studies

Medulla

CHemoreceptors sense CO2 levels, when elevated, tell diaphragm and IC muscles to contract, neg pressure pulls in air 21% FiO2

Heat stroke S&S

CNS issues: confusion, delirium, bizarre behavior, seizures; elevated temp (105+), anihidrosis, tachypnea, hypotension, and tachycardia

Decongestant

Cause vasoconstriction which decreases inflammation and decreases capillary permeability Topical decongestants have minimal adverse reactions and act quickly Systemic decongestants: combined with MAOIs may cause HTN crisis, combined with other sympathomimetic drugs may cause greater CNS stimulation Rine drugs, zolone drugs

Potassium Sparing Diuretics

Cause water and sodium excretion by the kidneys

SGLT-2 Inhibitors (-flozin)

Canagliflozin, Dapagliflozin Give before 1st meal of day, correct volume deficiency first, monitor for ketoacidosis Adjunct to diet & exercise

Chemotherapy Cytotoxic effect on cells:

Cancerous/Healthy and all rapidly diving Including: skin, hair, intestinal tissue, spermatocytes, and blood-forming cells. ((cardiotoxic, nephrotoxic, hepatotoxic, dermatologic toxicity, GI toxicity))

Exertional heat stroke

Caused by strenuous physical activity in hot environment

Alveoli

Cells that produce surfactant; surfactant controls surface tension and keeps the alveoli from collapsing and sticking to themselves; surfactant produce only with sufficient amounts of oxygen

1st gen sulfonylureas (-amide)

Chlorpropamide Tolbutamide Tolazamide Rapidly absorbed in GI = usual side effects 1st oral antidiabetics, onset 1 hour

Prediabetes

Classified as impaired glucose tolerance or impaired fasting glucose: Concentrations of blood glucose fall between normal levels and those that are diagnostic for diabetes

Metabolic Syndrome

Cluster of metabolic abnormalities (major risk factor for CVD), need 3+ of these conditions to be diagnosed: - Insulin resistancec (FBG >100 mg/dL) -Central obesity -Dyslipidemia >159 mg/dL -BP >130/85 -Proinflammatory or prothrombic state

Diabetic neuropathy

Complication of long term diabetes mellitus; metabolic and vascular changes result in damage to peripheral + autonomic nerves Sensation of numbness, prickling, or parethesias. Sensory loss can result leading to injury, infection, and gangrene

Etiology and Prevalence of COPD

Cigarette smoking Alpha 1-antitrypsin deficiency Asthma COPD is 4th leading cause of morbidity and mortality in US 12 times greater for adults with asthma

Management (hypothermia)

Circulation, Airways, Breathing are #1 priority Vitals, CVP, I&O's ABG's should be evaluated Continuous ECG Arterial line to record BP Rewarming the patient External cardiac compressions as directed in temps >88 degrees

Fluid volume deficit: burns

Huge loss of body fluids Fluids leak into interstitial spaces Hypotonic dehydration in initial period after burn longer term

Peripheral Vascualr Disease

Conditions affecting the peripheral arteries and veins; impaired blood supply to peripheral tissues particularly in the lower extremities

4 mechanisms (heat loss)

Conduction (3%) Convection (34%) Evaporation (24%) Radiation (39%)

Evaporation

Conversion of a liquid into a vapor

Evaporation

Conversion of water to vapor

Managing Hyperthermia

Cool IV fluids (NS or lactated ringers) Remove clothing - reduce temp to 102 ASAP Cool sheets, towel, sponging, ice, immersion in cold bath Electric fan (convection + evaporation) Cooling process should stop at 100.4 to prevent iatrogenic hypothermia

Newborn/Fetus (gestational diabetes)

Cord prolapse Congenital anomaly Macrosomia from hyperinsulinemia Birth trauma due to increased size of fetus Preterm birth Fetal asphyxia Death Polycythemia Larger baby + childhood obesity/carb intolerance

Hypothermia (2)

Core internal temperature less than 95 degrees, alcohol increases susceptibility due to systemic vasodilation. Wet clothing and immersion in cold water increases heat loss by 25%, trauma victims are also at risk.

Vaginal wall prolapse

Cytocele-anterior wall, effects bladder and urethra; bladder protrudes into vagina; incomplete emptying.

Short acting

Humulin R, Novolin R Regular insulin - can be given IV (lasts 4 hours) subcut lasts 13-24 hrs Should eat within 20-30 minutes after taking

Noninvasive Breast Cancer: Ductal carcinoma in situ (DCIS) Lobular carcinoma in situ (LCIS)

DCIS: cancer cell located within the duct and have not invaded the surrounding breast tissue LCIS:cancer calls contained within the lobules of breast -These cancers remain in the mammary duct

Nursing care with hypervolemia

Daily weights assessment of edema restrict fluids monitor vitals and blood pressure

Folate sources

Dark leafy green veggies, fruits and fruit juices, nuts, beans, peas, seafood, eggs, dairy products, meat, poultry and grains

3-5 degrees

Decrease in temperature within minutes of delivery

NSAIDs treat:

Decrease inflammation Reduce pain Decrease fever

FVE lab findings

Decreased serum osmolality decreased hematocrit decreased BUN level decreased serum sodium level decreased urine specific gravity

BP changes little during pregnancy despite an increase in blood volume due to

Decreased systemic vascular resistance

Vasoconstriction

Decreases heat loss

Cold stress complications

Depleted brown fat stores, increased O2 need, respiratory distress (priority), increased glucose consumption (hypoglycemia), metabolic acidosis, jaundice, hypoxia, and decreased surfactant

Amniotic fluid

Derived from fetal urine and materal blood cells; protects fetus and promotes development

Why decreased RBCs?

Destruction- mechanical Decreased production- age related Decreased iron- do not meet needs of body

Syphillis

Diagnosis: ·Take a swab or culture to test for syphillis. ·The screening looks for either non-treponemal (negative) or treponemal (positive). ·Tests are either VDRL (tests for antibodies) or RPR (rapid plasma reagin; faster), which are both inlikely to have false negatives. ·However, lupus can make the test wrong. Treatment: ·Antibiotics-Penicillin ·You must use a longer duration for therapy when in advanced stages. Prevention: ·Prevent transmission by ·limiting direct contact = condoms or dental dams ·To prevent neonatal transmission treat the pregnant woman.

Factors leading to increased fluid loss:

Diarrhea Burns Nausea, vomiting Acute or chronic renal failure Hemorrhage Diabetic ketoacidosis

Initial Management (gestational diabetes)

Dietary modification + glucose monitoring If hyperglycemia persists, insulin is prescribed Goals for blood glucose levels during pregnancy are 95 mg/dL (5.3 mmol/L) or less before meals and 120 mg/dL (6.72 mmol/L) or less 2 hours after meals Treatment of GDM includes close observation of mother and fetus because even mild hyperglycemia has been shown to be detrimental to the fetus

Radiation

Diffusion or dissemination of head by electromagnetic waves; process of heat transfer with NO physical contact

Radiation

Diffusion or dissemination of heat by electromagnetic waves (60%) Varies with temperature of environment; temperature must be lower than body for heat loss to occur

Neuropathic pain

Direct consequence of a lesion or disease affecting abnormal functioning of PNS or CNS; exact cause unknown but may originate peripherally or centrally Can be short in duration but usually chronic - described as burning, electric, tingling, or stabbing

Preventative measures for a pt at high risk for developing breast cancer

Discuss need for mastectomy Long term use of vitamin D and tamoxifen

Topoisomerase inhibitors (chemotherapy)

Disrupt the enzyme topoisomerase. The result is increased DNA breakage and eventual cell death

Fertilization occurs

Distal third of fallopian tube

Treatment for hypervolemia:

Diuresis and fluid and sodium restrictions

Other causes of fluid loss

Diuretic therapy, renal disorders, endocrine disorders Heavy sweating Hemorrhage chronic abuse or laxatives, enemas

Fluid Volume Excess

Diuretics

Antitumor antibiotics (chemotherapy)

Drugs developed originally as antibiotics but also have effects on cancer cells. Damage the DNA and interrupt DNA/RNA synthesis

Fasting (effects)

During fasting the pancreas releases basal insulin (small), glucagon via alpha cells released when blood glucose levels decrease This stimulates liver to release stored glucose Insulin & glucagon maintain constant level of glucose in blood by stimulating liver

higher sodium levels in ____ higher potassium levels in ____

ECF Na is higher ICF K is higher

active transport requires ________

ENERGY

Meal suggestion for pregnant women experiencing nausea:

Eat small frequent meals throughout the day, Eat dry toast or crackers before getting out of bed -B6 vit/ginger can sometimes help with nausea

Secondary Hypertension

Elevated blood pressure identifiable from an underlying cause (kidney disease, corarctation of the aorta, endocrine disorders, neurological disorders, drug use, pregnancy, hypothyroidism, obstructive sleep apnea)

Fever

Elevation in body temperature caused by an upward displacement of the set point of thermoregulatory center in the hypothalamus Most prominent manifestations of the acute phase response

Ascites

Excess fluid in the peritoneal cavity; clear indication of liver disease

Basal Metabolism

Energy required to carry on involuntary activities of body at rest Men have a higher BMR due to larger muscle mass

Neutral thermal environment

Environment in which body temperature is maintained without an increase in metabolic rate or oxygen use.

Effects (cold environment)

Environmental temp decrease = increased O2 consumption, tachypnea, and increased metabolic rate

Estrogen

Estrogen, or oestrogen, is the primary female sex hormone. It is responsible for the development and regulation of the female reproductive system and secondary sex characteristics. There are three major endogenous estrogens in females that have estrogenic hormonal activity: estrone, estradiol, and estriol. Produced in the ovaries and corpus luteum Highest levels of estrogen are in the middle of menstraul cycle and lowest during a period. Estrogen levels drop at menopause

Dosage calculations: Calculating IV infusion rate

Ex: nurse is preparing to administer dextrose 5% in water 500 mL IV to infuse over 4 hours. The nurse should set the IV infusion pump to deliver how many mL/hr> -Volume (mL)/Time (hr) = X -500 mL/5hr = 125 mL/hr

Nursing intervention for fatigue induced radiation

Exercise/sleep interventions can be helpful in management, may be due to increased energy demands needed to repair damaged cells

Flammable solutions containing high concentrations of alcohol or oil should not be used in rooms with oxygen. Therefore, hand hygiene using alcohol-based foams or gels should be avoided when caring for patients on oxygen therapy.

False

Exemplars of Sexuality

Family Planning STIs Menopause Erectile Dysfunction

Acute transfusion reactions

Febrile Hemolytic Allergic Bacterial Circulatory overload Transfusion-associated graft-versus-host disease (GVHD)

Remittent fever

Fever does not return to normal temperature and fluctates between a few higher and lower

Neurogenic fever

Fever with an origin in the CNS usually caused by CNS trauma, intracranial bleeding, or increase in ICP. Resistant to antipyretics and not associated with sweating.

Breast Issues

Fibrocystic breasts Fibroadenoma Breast cancer Benign vs. cancerous masses Breast self exam

Intermittent fever

Fluctuating fever that returns to or below baseline then rises again.

Isotonic Dehydration

Fluid loss is not balanced by fluid intake. Because losses of sodium and water are proportionally equal, sodium levels are normal. Most fluid loss is extracellular. Symptoms may include vomiting and diarrhea

Hyperglycemia clinical manifestations

Flushed, hot, dry skin -- give insulin or oral hypoglycemic agent 3 P's, dry mouth, blurred vision, weakness, headache, dyspnea, acetone breath, drowsy, lethargic, unconsciousness Low BP, weak rapid pulse

Corticosteroids

Forms: systemic IV, inhaled Most effective treatment and prevention of acute asthma attacks Special considerations: peds-growth, elderly-osteoporosis, diabetics- more carefully monitor blood glucose, passed to infant through breast milk -One drugs

Adrenal Glands

From the adrenal cortex, aldosterone and cortisol; from the adrenal medulla, androgens and some estrogen progesterone

Adverse reactions to Salicylate

Gastric distress Nausea/vomiting Bleeding

Sexuality risk factors

Gender Lifestyle choices Age Family planning choices Co-morbidity conditions

Risk factors for Leukemia

Genetic factors Down Syndrome preexisting chromosomal abnormalities Exposure to ionizing radiation / chemical toxins Turners syndrome

Preeclampsia

Gestational hypertension; accompanied by signs of end organ damage

Nursing process with Salicylate:

Give with food, milk or water to reduce GI reactions Leading cause of poisoning in children

Long-acting

Glargine (Lantus, Toujeo, Basaglar) Detemir (Levemir) Degludec (Tresiba) Subcut. only, lasts 24 hours or more; used as a basal dose

2nd gen sulfonylureas

Glimepiride (DiaBeta) Glipizide (Glucotrol) Glyburide (Amaryl) 1 hour onset, may only need 1-2 doses per day Hypoglycemia most common side effect

Glyconeogenesis

Glycogen broken down in time of need to supply a ready source of glucose

Hormones involved in conception

Gonadotropin-releasing hormone (GNRH) Follicle-stimulating hormone (FSH) Luteinizing hormone (LH); Estrogen Progesterone

GTPAL

Gravida (# pregnancies) Term (38-42 weeks) Preterm (20-37 weeks) Abortions Living Children

Number of fetuses in pregnancy does not affect

Gravida or Para Ex: women carrying twins, still counted as 1 pregnancy

Which body tissue cells have the capacity of diving throughout one's lifespan

Hait Uterus Bone marrow Stomach

Male breast examination finding the nurse should report as suspicious for Breast Cancer

Hard, painless, subareolar mass

Implementation for newborns with hypothermia:

Head coverings Swaddling, nesting

Why is low potassium a concern to the nurse treating a cancer patient, what does the nurse expect?

Heart function. -can expect an order for telemetry function

Heat exhaustion S&S

High temperature accompanied by headache, anxiety, syncope, profuse diaphoresis, goose flesh, and orthostasis

Brown fat

Highly vascular specialized fat able to convert chemical energy directly to heat via SNS Produced in 3rd trimester Capable of intense metabolic activity

Hyperthermia vs. Fever

Hyperthermia: abnormal temperature regulation, but set point unchanged Fever: normal thermoregulatory system, but at a higher set point

Urban hypothermia

Hypothermia associated with high mortality rate especially in older adults, infants, people with concurrent illnesses, and those who are homeless

Complications of COPD

Hypoxemia/tissue anoxia Acidosis Respiratory infections Cardiac failure, cor pulmonale Cardiac dysrhythmias

ABGs

Indicator of alterations in acid/base balance pH tells if there is an acid/base disturbance 7.35-7.45 <7.35= acidosis >7.45= alkalosis

Specific Gravity

Indicator of urine concentration that can be performed quickly and easily by nursing personnel (1.005-1.030)

COPD exemplar

Includes emphysema and chronic bronchitis Characterized by bronchospasm and dyspnea Tissue damage not reversible Tissue damage increases in severity -> respiratory failure

Serum electrolyte panel:

Includes serum electrolytes, creatinine and glucose tests Elevated blood urea nitrogen, low serum bicarbonate help identify moderate, severe dehydration

Fever Tx

Increase comfort and prevent complications. Administer any ordered antibiotics or antivirals Antipyretics may be used Modify external environment: cool sponge baths, cool packs, hypothermia blankets Increase oral fluids (3L/day) and add simple carbs

Expectorants

Increase production of respiratory secretions- reduce thickness, adhesiveness, and surface tension of mucus; making it easier to clear airway Relieve symptoms of non-productive cough associated with bronchitis, colds, emphysema, influenza, sinusitis, bronchial asthma, minor bronchial irritation Guaifenesin most commonly used

Fever (pyrexia)

Increased body temperature caused by pyrogens to increase thermoregulatory set point in hypothalamus or by chemicals

hypercarbia

Increased carbon dioxide level in the bloodstream.

Shivering

Increases heat production

Nursing interventions for a patient with hypercalcemia secondary to bone metastasis

Increasing oral fluids, Observing for muscle weakness, dehydration

Invasive Breast Cancers

Infiltrating Ductal Carcinoma: most common type of invasive. As tumor grows, fibrosis devolps around cancer. may result in skin dimpling/pitting (peau d'orange) Inflammatory Breast Cancer: etythema and edema. Rapidly growing breast lump w/ symptoms of tender, firm, enlarged breast/itching

Chronic bronchitis (COPD)

Inflammation of bronchi and bronchioles Caused by chronic exposure to irritants Inflammation, vasodilation,, congestion, mucosal edema, bronchospasm Affects only airways, not alveoli PRoduction of large amounts of thick mucus

Allergic rhinitis

Inflammatory disorder of the nasal mucosa Seasonal, recurrent and triggered by specific allergies Usually family history Some children have symptoms year round Rhinorrhea, itching, and paroxysmal sneezing Allergic salute Allergic shiners Treatment: medication management, environmental management, desensitization therapy Interventions: allergy and asthma network, teaching environmental modifications, assess effectiveness and side effects, monitoring for complications after allergy injections

Modifiable Risk Factors For Hypothermia

Ingestion of alcohol and other substances, and effects of acute and chronic illnesses that reduce an individual's ability to recognize danger in cold weather. Neonates and older individuals are the most at risk for hypothermia. Older individuals with a reduced metabolic rate who are prescribed sedatives are also at risk for hypothermia.14

Anticholinergics

Inhaled forms Work locally Bronchodilator Relieve symptoms of COPD Ipratropium bromide-most common

Shivering

Initiated by impulses from hypothalamus that can cause body temperature to increase 3-5 times; increases heat production by muscles Contraction of pilomotor muscles reduces surface area available for heat loss

Steps of cancer development

Initiation, promotion, progression

Neurotoxic chemotherapy agents

Injure peripheral nerves, leading to peripheral neuropathy - reduced sensory perception

Ischemia

Insufficient flow of oxygenated blood to tissues, may result in hypoxia > cellular injury and death

Pancreas

Insulin

Antimitotic agents [mitosis inhibitors] (chemotherapy)

Interfere with the formation and actions of microtubules so cells cannot complete mitosis during cell division. Cancer cells do not divide or divide only once.

Extracellular water is composed of:

Intravascular, Interstitial and transcellular

Convection

Involves flow of heat from body surface to cooler surrounding air i.e. near cool drafts Use clothing/blankets to reduce exposure and work in warm areas

Radiation (risk factor for cancer)

Ionizing: x-rays Ultraviolet: sun

Anemia labs

Iron, folate, vitamin B6, Vitamin B12

Hemoglobin

Iron-rich protein in RBCs O2 carrying capacity of RBCs g/dL Varies with age

Treatment for hypovolemia

Isotonic or hypotonic IV solution

Manifestations of chronic dehydration:

Itchy skin, brittle hair, loss of thirst reflex

Urine Ketone Test

Ketones are by-products of fat metabolism (triglycerides), acetoacetic acid, acetone, and b-hydroxybutyric acid Abnormal: ketones present in urine, indicating carb dehydration, which may suggest DKA, starvation, or a metabolic complication of TPN and can occur with high-fat diets, prolonged vomiting, or diarrhea

Organs involved in homeostasis include:

Kidneys Lungs Heart Adrenal glands Parathyroid glands Pituitary gland

Fluid volume deficit: inadequate intake

Lack of access to fluids Inability to request or swallow fluids Oral trauma Altered thirst mechanisms Excessive exercise during very hot weather

Differences in child's respiratory system with asthma

Lack of surfactant Smaller airways and undeveloped cartilage Obligatory nose breather (infant) Less well-developed intercostal muscles Brief periods of apnea common (newborn) Faster RR, increased metabolic needs Eustachian tubes relatively horizontal Tonsillar tissue enlargement More flexible larynx, susceptible to spasm Abdominal breathers Fewer alveoli

Rapid-acting

Lispro (Humalog) Aspart (Novolog) Glulisine (Apidra) Inalational - Afrezza Can be given IV - usually to treat postprandial hyperglycemia and lasts 5 hours or less

Furosemide (Lasix)

Loop diuretic Block Na and Cl reabsorption in ascending loop Can be used w/ renal impairment Used for pulmonary edema, edema caused by liver/cardiac/kidney disease, htn Also used for hypercalcemia related to kidney stone formation Can cause dehydration, hyponatremia, hypochloremia, hypotension, ototoxicity, hypokalemia (and hyperglycemia, hyperuricemia, decreased Ca and Mg) Can cause dig toxicity due to hypokalemia, lithium toxicity due to hyponatremia Antihypertensives have additive effect NSAIDs reduce diuretic effect Daily weights and I/O Take early in the day

Physical effects (fever)

Loss of appetite Headache Hot/dry skin Flushed face Thirst Fatigue Muscle aches Tachypnea + tachycardia Seizures (young) Confused (older)

Radiation

Loss of body heat to cooler, solid surfaces that are in proximity but not in direct contact with the newborn Keep cribs/isolettes away from outside walls, cold windows, and A/C units

Evaporation

Loss of heat when liquid is converted to a vapor Dry immediately after birth and baths and change any wet linens/clothes promptly

Emphysema (COPD)

Loss of lung elasticity Hyperinflation of lung Dyspnea, increased RR Air trapping Increased work of breathing

Children & adolescents sources of fluid loss:

Low-birth weight infants kept under radiant warmers, lose more fluid through skin and lungs, more prone to vomiting and diarrhea, more likely to experience imbalance from excrete, overuse diuretics

Site of common colon cancer metastasize

Lung Brain Bones Adrenal Glands

Why is pt at risk for lymphedema after mastectomy, nursing teaching/interventions

Lymph-nodes are removed -elevate extremities of affected side, turn often avoid constrictive clothing, d/n check BP on surgical side/iv/inj/draw blood

Why is a drop in magnesium levels a major concern to the nurse treating a cancer patient

Magnesium levels are critical to the function of cardiac muscles

Electrolytes are important for

Maintaining fluid balance Contributing to acid-base regulation Facilitating enzyme reactions Transmitting neuromuscular reactions

Secondary Prevention: Screening

Mammogram Begin at age 40 Annual screenings Pap Smear ACS- begin at age 21 ACS- 21 to 29 every 3 years ACS- 30 to 65 every 5 years + HPV test ACS- 66+ none precancerous lesion-annual testing x20 years

Side effects of hormonal manipulation (pharmacology)

Masculinizing effects in women Feminizing effects in men (gynecomastia) Fluid retention Acne Hypercalcemia Liver dysfunction Venous thromboembolism

Forced expiratory flow (FEF)

Maximal flow rate attained during the middle of the FVC maneuver

Rapid Thawing

May drastically decrease tissue necrosis

PaO2

Measurement of O2 pressure in arterial blood, how well O2 is able to move from lungs to blood >80 mmHg

Supportive care (hypothermia)

Mechanical ventilation with PEEP and heated + humidified O2 Warmed IV fluids Sodium bicarbonate Antiarrhythmic meds Catheter insertion Over-the-bed heaters to extremities Forced air warming blankets

DKA

Metabolic derangement that occurs most commonly in persons with type 1 diabetes and results from a deficiency of insulin; highly acidic ketone bodies are formed, and metabolic acidosis occurs DKA is commonly preceded by a day or more of polyuria, polydipsia, nausea, vomiting, and fatigue with eventual stupor and coma if not treated Breath has a characteristic fruity odor due to the presence of ketoacids

Antiemetic drugs for morning sickness

Metoclopramide (Reglan) Promethazine (Phenergan) Prochlorperazine (Compazine) Trimethobenzamide (Tigan) Ondansetron (Zofran)

Nursing care with hypovolemia:

Monitor fluid balance Perform frequent vital signs Assess skin turgor Monitor heart rate

Rotavirus

Most common cause of diarrhoeal disease among infants and young children. It is a genus of double-stranded RNA viruses in the family Reoviridae. Nearly every child in the world is infected with rotavirus at least once by the age of five. Immunity develops with each infection, so subsequent infections are less severe; adults are rarely affected.

Nonexertional heat stroke

Most common type of heat stroke, usually in environmental temp of 102.5+ (heat index 95+) in those that are older, very young, not acclimatized, and certain medications.

Pituitary Gland

Promotes growth of tissues by enhancing protein synthesis and promoting use of fat for energy, thus conserving glucose. Release is stimulated by GH-releasing hormone in response to low GH levels, hypoglycemia, increased amino acids, low fatty acids, and stress

Oral Glucose Tolerance Test (OGTT)

Most sensitive method of evaluating borderline cases of diabetes mellitus, monitors plasma glucose levels 3 hrs. after ingestion of a challenge dose of glucose to assess insulin secretion and the body's ability to metabolize glucose

Heat stroke

Most serious, acute medical emergency caused by failure of heat-regulating mechanisms of body Inability to maintain cardiac output and associated with dehydration Usually occurs in extended heat waves, esp. with humidity Causes thermal injury at cellular level. Thick blood = damage to heart, liver, and kidneys

Pregnancy is a hypercoagulable state, meaning

Mothers blood clots more readily; which offers protection from hemorrhage during childbirth but increases the risk of thrombus formation

Diffusion

Moves from higher to lower concentration O2 from alveoli-pulmonary capillaries-plasma-attached to hgb to be transported (perfused to cells)

Intermediate acting

NPH (Humulin N, Novolin N) CLOUDY Usually given after food, duration up to 24 hours Subcut. only

Factors preventing normal intake

NPO status dysphagia lack of potable water Inaccurate fluid replacement compared to loss Fluid shifts due to burns, albuminuria or diabetes insipidus

Conserving heat (newborn)

Newborn attempts via increasing metabolic rate, increasing muscular activity, vasoconstriction, and assuming fetal position

Cold stress S&S

Newborn esp. at risk 12 hours after birth, greatest risk are preterm newborns As temp lowers newborn becomes less active, lethargic, hypotonic, and weaker

Radiation

No physical contact

The nurse notes that the hemoglobin level of a woman at 35 weeks of gestation is 11.5 g/dL. The nurse's next action should be to :

Note this is within normal range for pregnancy ( < 11 g/DL 1st and 3rd trimester and <10.5 g/dL in 2nd)

Nutritional Therapy

Nutrition, meal planning, weight control, and increased activity are the foundation of diabetes management

Cell metabolism

O2 released from hemoglobin diffuses into cell for metabolic process ->> CO2 biproduct

Screening of gestational diabetes

Obesity Personal gestational diabetes Hx Glycosuria Strong family Hx of diabetes Ethnic groups at risk: Hispanic Americans, Native Americans, Asian Americans, African Americans, and Pacific Islanders. If these women are not positive at first screening should be retested between 24-28 weeks of gestation

Age + Gender

Older adults lose thermoregulatory control (lower average temperature) Very young + very old more sensitive to temperature extremes Women increase in temperature due to hormonal changes (0.5-1 degrees)

Iron supplements should be taken:

On empty stomach With orange juice If liquid, taken with a straw

Recurrent (relapsing) fever

One or more episodes of fever, each as long as several days, with one or more days of normal temp between episodes -infectious diseases

Rapid acting (onset, peak, duration)

Onset - 5 to 15 minutes Peak - 30 minutes to 1 hour Duration - 2 to 4 hours

Long-acting (onset, peak, duration)

Onset: 1 or 6 hours NO PEAK - continuous Duration: 24 or 24-36 hours

Intermediate acting (onset, peak, duration)

Onset: 2-4 hours Peak: 4-12 hours Duration: 16-20 hours After eating

Short acting/Regular (onset, peak, duration)

Onset: 30-60 minutes Peak: 2-3 hours Duration: 4-6 hours 20-30 mins before meals

Salicylate drug interaction:

Oral anticoagulants Corticosteroids

Acetaminophen Drug interactions:

Oral anticoagulants and alcohol

Input and output includes

Oral fluids, ice chips Foods that are liquid at room temperature Tube feedings Parenteral fluids IV medications Catheter or tube irrigants Urinary output Vomitus, liquid feces Tube drainage Wound, fistula drainage

Treatment for hypokalemia:

Oral or IV replacement therapy

Clinical therapies for fluid volume deficit:

Oral rehydration and intravenous fluids

Mannitol

Osmotic diuretic: used short term for reduction of intracranial pressure or to promote excretion of renal toxins. Tox: expansion of extracellular fluid volume with resulting hyponatremia, headache, nausea. With excessive use, dehydration and hypernatremia.

Most common cause of life-threatening infections in individuals with bone marrow suppression

Overgrowth of their own normal flora

OGTT

Overnight fasting, avoid caffeine, no smoking for 12 hours prior to test, fasting glucose is obtained, 100 g glucose load is given, and serum glucose levels are determined at 1, 2, and 3 hours following ingestion

While suctioning a patient, vagal stimulation occurs. What is the appropriate nursing action?

Oxygenate the patient with 100% O2

Most important nursing intervention for extravasation from vesicants

PREVENTION -checking on patient every 15-30 min -Central line/port is optimal for chemo

PSA

PSA test is a blood test used primarily to screen for prostate cancer. The test measures the amount of prostate-specific antigen (PSA) in your blood. PSA is a protein produced by both cancerous and noncancerous tissue in the prostate, a small gland that sits below the bladder in men.

Hypertonic Dehydration

Proportionately less sodium is lost than water. Fluid shifts from intracellular to extracellular components to compensate. Onset of signs and symptoms of dehydration may be delayed.

Allodynia

Pain due to a stimulus that does not normally provoke pain

Hypothermia S&S

Pale skin, apathy, poor judgement, ataxia, dysarthria, drowsiness, coma, hypotension, bradycardia, acidosis

Hypoglycemia clinical manifestations

Pale, cold, clammy -- give 50 Dextrose or OJ with sugar packet Impairment of brain function Sweating, palpitations, sleepiness, anxiety, tremors + irritability/aggression Blurred vision, headache, slurred speech, lack of coordination, weakness, hunger, loss of consciousness, convulsions

Homeostasis

Part of the delicate balance of fluid and electrolytes that promotes the body's functions

Filtration

Passage of fluid through a permeable membrane from the area of higher to lower pressure

Tele therapy: external with gamma rays

Patient is NOT radioactive and is NOT hazardous to others

Ventricular fibrillation and hypothermia

Patient with temperature lower than 90 degrees experiences spontaneous ventricular fibrillation if touched of moved Defibrillation doesn't work with temp <88 degrees, must be rewarmed first Watch for V fib while rewarming from 88-90 degrees

Self breast exam

Perform your own self breast exam 1 week after the onset of your first period.

Primary Hypertension

Persistently elevated systemic blood pressure

Ventilation issues

Process of inhaling O2 in lungs and exhaling CO2 from lungs, may be impaired due to unavailability of O2; high altitudes, any disorder affecting the nasopharynx and lungs May occur with: inadequate bone, muscle or nerve function such as rib fracture that reduces inhalation due to pain, muscle weakness that prevents full thoracic expansion or cervical spinal cord injury that limits movement of the diaphragm; narrowed airways from bronchoconstriction (Asthma) or obstruction (COPD, CF), poor gas diffusion in alveoli, such as pulmonary edema, ARDS or PNA

Thiazolidinediones (-glitazone)

Pioglitazone (Actos) Rosiglitazone (Avandia) Monitor liver enzymes every 2 months for 1st year May exacerbate CHF Take without regard for food, notify any vision changes

Vitamin B6 sources

Pork, poultry, fish, bread, whole grain cereals, eggs, veggies soybeans

Gas exchange

Process by which oxygen is transported to the cells and carbon dioxide is transported from the cells

nonshivering thermogenesis (NST)

Process in which brown fat is oxidized in response to cold exposure

Hypokalemia

Potassium Supplements

Spironolactone (Aldactone)

Potassium sparing diuretic. Block's actions of aldosterone at the late DCT and collecting duct, thus increasing Na+/H2O secretion and sparing K+ secretion. can cause hyperkalemia, deepened voice and impotence in males, irregular menstruation in females; drowsiness, metabolic acidosis increased risk of hyperkalemia with ACE inhibitors, angiotensin receptor blockers, and direct renin inhibitors avoid potassium supplements, salt substitutes

Progesterone

Prepares the endometrium for potential of pregnancy after ovulation The lowering of progesterone levels spark menstruation if an egg has not been fertalized.

Proteases

Present in healthy lung to destroy and eliminate inhaled particulates Cig smoking triggers an increase in ____ -> damage to alveoli and small airways decreasing elasticity Alveoli lose elasticity, some total destruction, some large and floppy Airways narrow, scar, inhibiting airflow to alveoli

What is the primary nursing intervention in the care of an older adult patient with a history of diverticular disease and pernicious anemia?

Preventing falls

Male reproductive issues

Prostate Disorders: BPH, prostatitis, cancer Testicular cancer: Ages 20-35; monthly testicular exams; highly curable in early stages Erectile Dysfunction: Perfussion issue; meds (antihypertensives); diseases (HTN, DM); smoking, ETOH; slidenafuil- No with nitrate drugs.

Male Secondary Prevention: Screening

Prostate Exam: Digital rectal exam (DRE) Lab Prostate specific antigen (PSA) Screening for prostate cancer Monitor response to treatment

colloids

Protein substances that increase the colloid oncotic pressure

Suppressor Gene Products

Proteins that inhibit cell division

Radiography Tests: definition & examples

Provide an image of the tumor that shows size, location and activity - XRays - MRI - CT - Radioisotope scans - Ultrasounds -Diagnostic mammography

nursing priorities for pt undergoing SURGERY for cancer treatment

Psychosocial support for the patient and family, Achieving or maintaining maximum function

At 13-16 weeks fetal movements can start to be felt called

Quickening

Carbohydrates

Quickly digested and 100% is converted to glucose CNS relies on carbs almost exclusively Liver stores glucose and regulates entry into blood

Why transfusions?

RBC transfusions: given to replace cells lost from trauma or surgery Platelet transfusions: given for low platelet counts, active bleeding, scheduled for invasive procedure Plasma transfusions: given to replace blood volume and clotting factors

How is heat lost from skin?

Radiation + conduction

Normal Body Temperature

Ranges between 36°-37.5°C (96.8°-99.5°) in adults

Acetaminophen (Tylenol) treats:

Reduce fever Relieve headache, muscle pain, general pain Treat flulike symptoms

Anemia

Reduction in either the number of RBCs, amount of hemoglobin or hematocrit

Parathyroid

Regulates the body's calcium and phosphorus

Salicylate treats:

Relieves pain Reduce fever Reduce inflammation Anticlotting factors Also inhibits lately aggregation

Meglinitides (-nide)

Repaglinide (Prandin) Nateglinide (Starlix) Onset 15-60 minutes, may be given with metformin. Give 30 mins before meals If meal is skipped, skip next dose to prevent hypoglycemia

Bone marrow and stem cell transplant

Replaces diseased or destroyed cells from bone marrow with normal healthy cells Cells must be a close match (autologous or allogeneic) Neutropenic isolation required b/c pt has no immune system Multiple complications can occur

Asthma

Reversible obstructive airway disease characterized by increased airway responsiveness to a variety of stimuli, bronchospasm resulting from constriction of bronchial smooth muscle, inflammation and edema of the mucous membranes that line the small airways and the subsequent accumulation of thick secretions in the airways

Why is the Upper Uterus the best area for implantation and placental development?

Rich Blood supply to support optimal gas exchange, thick uterine wall which prevents deep placenta attachment, limits blood loss after birth; strong muscle fibers compress vessels after placenta detaches

Heat loss

SKIN is primary site. Circulating blood brings heat to skin where it escapes via arteriovenous shunts that are controlled by the sympathetic nervous system Heat is transferred to external environment via radiation, convection, evaporation, and conduction

Antipyretics examples:

Salicylates, acetaminophen & NSAIDs

How to dispose of bedding of a patient with a sealed radiation implant:

Save all dressing and bed linens in the patient's room until after the radioactive source is removed. After source is removed, dressings and linens can be disposed of in usual manner.

prevention strategies related to complications of reproduction :

Screening for STIs (syphilis), hep B, TB skin test, rubella titer (varicella?)

Baroreceptors

Sense blood pressure and relays the information to the brain so a proper blood pressure can be maintained

Osmoreceptors

Sensory receptor primarily found in the hypothalamus of most homeothermic organisms that detects changes in osmotic pressure

stage 1: menstrual phase

Shedding of the endometrium caused by a decrease in estrogen and progesterone. Triggers menstrual bleeding

Third Spacing

Shift of fluid from the vascular space into interstitial spaces, where it is not available to support normal physiological functioning.

Maternal assessment of fetal movement; aka "kick counts"

Should feel 5-10 movements/hr At least 10 movements within 2 hrs

Kangaroo care

Skin to skin contact with mothers is recommended as initial method for maintaining newborn body temperature; this should be first line of treatment for hypothermia and as a measure to reduce discomfort from painful procedures

Late deceleration:

Slowing of the FHR after onset of a contraction that persists after the contraction ends (concerning)

Adolescent Sexual Development

Spans ages 11-21

Mast cell stabilizers

Stabilize mast cell membrane preventing the release of inflammatory mediators Prevention and long term control of asthma symptoms Drug of choice for children and patients with exercise induced asthma Cromolyn sodium Nedocromil

The Tanner Stages of adolescent sexual development

Stage 1: Preadolescent Stage 2: "downy" pubic hair. Breasts elevate to small mounds. Stage 3: Darker pubic hair. Breast and areola (on females) enlarge. Males begin enlargement of testes and scrotum. Stage 4: Coarse, curly pubic hair. Penis, testes and scrotum enlarge further. Projection on areola and papilla forming secondary mound in females. Stage 5: Adult matures distribution of pubic hair. Adult penis and testes. Mature breasts in females.

Hypoxia

State in which oxygen reaching cells is insufficient

Leukotrine modifiers

Stop the effects of leukotrienes, airway constriction, increased permeability of the vasculature, increased secretions, activation of inflammatory response, used in place of steroids for control of mild to moderate asthma Montelukast, zafirlukast, zileuton

Example of evaporation

Sweating

Fluid volume deficit other reasons:

Sweating, especially in hot, humid weather Artificially heated indoor air Altitudes Very cold, dry environments for extended time

Herpes

Symptoms: · cold sores · Genital sores · Viral infection caused by herpes simplex virus · Incubation 4-7 days · Transmitted: oral, vaginal, and anal sex; contact with open sores · Prevent transmission by limiting direct contact · To prevent neonatal transmission treat the pregnant woman. If pregnant woman has active sores then they need to have a c-section. · Diagnose with swab and smears or cytopathic culture; with smear you can visualize multi-nucleated cells. ·Treatment: Antivirals: aciclovir, famciclovir, and valaciclovir.

Gonorrhea

Symptoms: · vaginal discharge (yellow or green) that is profuse and odorous ·Dysuria ·May cause Pelvic Inflammatory Disease Cause: ·Gonoccus bacterium ·When in the body it attaches to wall or epithelial cells ·Natural defenses is WBC (we have no immunologic memory to gonococcus) ·Incubation 2-7 days. Diagnosis: ·Swab or culture ·Lab will gram stain a swab and if theres gonorrhea present then there will be gram negative cocci. ·Lab can culture and if there is gonorrhea it grows on Thayer Marlin medium. Treatment: ·antibiotics- Ceftriaxone (usually treat for chlamydia as well with azithromycin or doxycycline) Prevention: ·Prevent transmission by limiting direct contact = condoms or dental dams ·To prevent neonatal transmission treat the pregnant woman.

Renin Angiotensin Aldosterone System (RAAS)

System initiated by special receptors in the juxtaglomerular cells of the kidney nephrons that respond to changes in renal perfusion

Symptoms of fluid volume deficit:

THIRST lethargy, weakness Dry mucous membranes Reduced urine output If not treated can lead to coma and death

Prenatal growth and development proceeds in a cephalocaudal pattern meaning

The Brain will develop first

Hypothalamus

The body's temperature regulator

Glycogenolysis

The breakdown of liver glycogen

solvent

The component of a solution that can dissolve a solute water is the solvent in the body

Type 2 Diabetes

Usually 30+ and obese, affects 95% of diabetics Insulin resistance or impaired insulin secretion May lead to metabolic syndrome Onset may last for years and be detected incidentally

Type 1 Diabetes

The individual usually inherits the risk factor for type 1 diabetes from each parent. Environmental factors also contribute to the development of this disorder such as cold weather or exposure to a virus. The genes HLA-DR3 and HLA-DR4 have been identified in people with type 1 diabetes

Hypodermoclysis (HDC)

The infusion of fluids into subcutaneous tissue.

Temperature

The difference between amount of heat produced by the body and the amount of heat lost to the environment measured in degrees

Conduction

The direct transfer of heat from one object to another object that it is touching e.g. contact with cold mattress, scale, etc. Put baby skin-to-skin

Conduction

The direct transfer of heat from one substance to another substance that it is touching Blood conducts heat to skin surface i.e. cooling blankets, cold surfaces

Work of breathing

The effort required to expand and contract the lungs

Graves Disease

This autoimmune disorder is the most common cause of hyperthyroidism which occurs when immunoglobulin produced by B lymphocytes stimulates the over-secretion of thyroid hormones.

Tonicity

The osmolality of a solution

stage 3: Secretory phase

The ovum is released by the follicle, triggered by the sharp rise in Estrogen and Luteinizing hormone

menopause

The permanent cessation of ovulation and menses. Considered menopausal when there has been no menstraul bleeding for 12 consecutive months. Typicakky occurs between ages 45-50. Most common symptoms are hot flashes and sweating. May also cause thinning of hair, memory problems, and weight gain. Symptoms may be treated with hormone therapy such as estrogen and progesterone. Hormone therapy may increase risk of blood clots, breast cancer, CVA, and heart disease.

stage 2: follicular phase

The preovulation phase, the ovary and follicle prepare for the release of an ovum through the influence of follice-stimulating hormone and Estrogen

Perimenopause

The time from the onset of symptoms until 1 year after the last menstraul period.

Heat Transfer

The way heat moves between places or objects

Methylxanthines

Theophylline toxicity- diet high fat meals can increase risk, must monitor blood levels, therapeutic serum levels 10-20mcg/mL Decrease airway reactivity and bronchospasm- bronchodilation, decreased inflammatory response Non-reversible airway disease- increase brain's sensitivity to CO2 Reduce diaphragm fatigue ACE (asthma, chronic bronchitis, emphysema) Phylline drugs, caffeine

Hydrochlorothiazide

Thiazide diuretic prototype: acts in distal convoluted tubule blocks reabsorption of sodium and chloride and prevents reabsorption of water promotes diuresis when renal function not impaired first choice med in hypertension edema of mild to moderate heart failure and liver and kidney disease reduce urine production in diabetes insipidus can cause dehydration, hyponatremia, hypokalemia, hypochloremia, hyperglycemia, hyperuricemia, hypomagnesmia, increased LDL cholesterol avoid in pregnancy and breastfeeding

Heat loss (predisposition)

Thin skin Lack of shivering ability Limited metabolic stores Limited voluntary muscle use Lack of subcut fat Can't change posture, adjust clothing/blankets, or communicate

Transfer of heat

This depends on temperature of environment, air speed, and water vapor pressure (humidity)

Diabetes Mellitus

This is a disorder that leads to hyperglycemia because of defects in insulin secretion, insulin action, or both. Diabetes mellitus causes abnormalities in carbohydrate, protein, and fat metabolism. Type 1 diabetes mellitus is caused by the destruction of beta cells in the pancreas which leads to insulin deficiency. Type 2 diabetes mellitus is caused by insulin resistance, in addition to some insulin deficiency.

Relapsing Fever

This is a fever lasting a few days, occurring between periods of normal body temperature.

Hypothyroidism

This is the insufficient production of thyroid hormone by the thyroid gland. This disorder may be congenital or acquired.

Osteoporosis

This is the loss of bone mass which causes bone fragility and increases the risk of fractures.

Skin

This is the primary source of heat loss

Intermittent Fever

This is when the body temperature alternates between a normal and elevated temperature at regular intervals.

Shivering (hypothermia)

This may be suppressed at temperatures under 90 degrees, self warming mechanisms become ineffective

Seizure (hyperthermia)

This may occur after a recurrence of hyperthermia 3-4 hours after first episode

Obesity

This results when the body stores excess calories as fat. It can also occur when less energy is expended. Hormones involved in regulating this disorder include thyroid hormone, insulin, and leptin. Genetics is also believed to be a component of this disorder. The incidence of obesity has doubled since 19804 and increases the risk of developing type 2 diabetes, cardiac disorders, cancer, and dementia. Body mass index is used to determine the severity of obesity.

Type 2 Diabetes

This type of diabetes is seen in families, so it may be due to poor nutritional habits within the home environment. Children whose parents developed the disease before the age of 50 have a higher risk of also developing type 2 diabetes than children whose parents developed the disease after 50 years of age

Constant Fever

This type of fever minimally fluctuates but always stays above the normal range. In some health problems a fever spike occurs. This is a temperature that reaches the level of a fever very quickly and then returns to normal within a few hours. This can be caused by bacterial blood infections. Two other health problems can cause temperature elevations that are not considered fevers. Heat exhaustion results after excessive heat exposure and heat stroke, a more serious form of heat exhaustion, if not treated, can lead to death.

Conduction

Through physical contact

Thyroid Gland

Thyroxine (T4) and Calcitonin

Anoxia

Total lack of oxygen in the body tissues

The nurse is caring for a patient with a cuffed tracheostomy and is aware the patient is at risk for developing which complication? `

Tracheomalacia

Female Reproductive cycle

Traditional cycle is 28 days, but may range between 20 and 45 days. Day 1 is considered the first day of period. The ovum cannot be fertilized longer than 24 hours after ovulation. Sperm may remain in the reproductive tract up to 80 hours after intercourse. Ovulation occurs around 14 days before the next menstrual period begins. The corpus luteum maintains "the high estrogenand progesterone secretion neccessary to make final preparation of the uterine lining for a fertilized ovum"

Insulin effects

Transports + metabolizes glucose for energy Stimulates storage of glucose in liver and muscle Signals liver to stop releasing glucose Enhances storage of dietary fat in adipose Accelerates transport of amino acids into cells Inhibits breakdown of stored glucose, protein, and fat

Antitussives

Treat non-productive cough Drug interaction with MAOI's can lead to coma Codeine with other CNS depressants may increase CNS depression (lethargy, respiratory depression, coma, and death) Codeine, hydrocodone, dextromethorphan hydrobromide

TNM staging

Tumor-Node-Metastasis 'T/N/M'x = cannot be assessed 'T/N/M'0 = no evidence T1-4 = increasing size of primary tumor N1-3= increasing involvement of regional lymph nodes M1 = Distant metastasis

1st Trimester Risk Factors

Unplanned pregnancy Multiple pregnancy (twins, etc) Maternal age Comorbidities STIs Bleeding (spontaneous abortion)

Beta2-adrenergic agonists

Used for bronchodilation Inhalation, systemic, long acting, short acting Decrease the bronchodilating effects of these drugs Often used with inhaled corticosteroids Treat symptoms of COPD and asthma Albuterol, bitolterol, levalbuterol, erol drugs

Uterine prolapse

Uterus sags into vagina Treatment: surgical pessaries pelvic exercises

Chorionic Villus Sampling possible complication symptoms:

Vaginal Bleeding, Passage of Amniotic fluid suggests possible miscarriage and should be reported -test used to diagnos fetal chromosome, metabolic, or DNA abnormalities between 10-13 weeks

Is COPD a ventilation, transport or perfusion problem?

Ventilation

Forced expiratory volume in 1 second (FEV1)

Volume of air expelled in 1 second from the beginning of the FVC 75% to 85% of FVC

Functional Residual Capacity (FRC)

Volume of air that is left in the pt's lungs after normal expiration

Most common excessive loss of GI fluids:

Vomiting Diarrhea GI suctioning Intestinal fistulas Intestinal drainage

Glycogenesis

When muscle/liver glycogen stores are low, glucose is converted to glycogen and stored

Brown fat (2)

When the newborn is cold, norepineprhine is released to stimulate brown fat metabolism by breaking down triglycerides, which increases blood flow through brown fat by increasing cardiac output. This blood flow produces heat.

What is an adverse effect of radiation to the head and neck

Xerostomia (dry mouth)

what would you give a patient who is taking a diuretic such as lasix/furosemide (potassium wasting)

a banana for extra potassium

sodium-potassium pump

a carrier protein that uses ATP to actively transport sodium ions out of a cell and potassium ions into the cell

sodium-potassium pump

a carrier protein that uses ATP to actively transport sodium ions out of a cell and potassium ions into the cell...located in the cell membrane

ANF

a diuretic peptide hormone from the heart; helps body protect itself from an increase in fluid volume increase urine flow, driven by an increase in Na+ excretion (where salt goes, water follows) decrease blood volume/H20 inhibits renin, AT II, aldosterone and ADH increases GFR and decreases Na+ uptake in distal tubule

Gestational Diabetes

a form of diabetes mellitus that occurs during some pregnancies

Treatment for hypernatremia is usually:

a hypotonic electrolyte solution

Non-Stress Test (NST)

a method for evaluating fetal status during the antepartum period by observing for accelerations of the fetal heart rate and consists of monitoring only; reactive results are reassuring and indicate adequate fetal oxygenation and intact neural pathways ; accelerations w/ or w/out fetal movement within a 20 minute period and peaking at least 15bmp above baseline lasting 15 seconds from baseline to baseline

Hyponatremia is caused by _____________

active losses or by dilution hyponatremia

carcinoma in situ

abnormal cells that grow in their normal place; sometimes called pre-cancerous; have not spread

Oligohydrammnios

abnormally low volume of amniotic fluid at term (<500 mL)

Hypernatremia is where sodium is ___________

above 145

Goals for adults may include that patient will ___________

achieve fluid and electrolyte balance, drink 15000 ML fluid a day, relate need to replace fluids lost during exercise with sports drinks, return to normal hydration status

Vibroacoustic stimulation test

adds loud noise as additional stimuli to the NST

Hypomagnesemia often results from:

alcoholism or GI losses

Cellular Regulation

all functions carried out within the cells to maintain homeostasis, including its responses to extracellular signals (hormones, cytokines, and neurotransmitters) and the way each cell produces an intracellular response.

Necrotic tissues usually means ________________

amputation or debridment

Vitamin B 12 sources

animal products, eggs, milk and milk products

Electronic fetal monitoring (EFM)

antepartum fetal surveillance

If symptoms are sever with hyperthermia _______

apply ice packs to armpits and groin elevate lower extremities cooling must begin urgently fan face to reduce temp around patient's head and brain

imbalance of K can cause

arrhythmias

Nursing treatment for hypokalemia:

assessment of cardiac and monitor signs and symptoms

Hyperphosphatemia symptoms:

asymptomatic

Fasting plasma glucose (FPG)

blood glucose determination obtained in the laboratory after fasting for at least 8 hours

Example of conduction

baby laying on a metal table, sitting in the cold seat of a car, holding hands

Example of radiation:

baby without a hat on, letting coffee sit out and cool

Hypothermia

below 95 or 35 celsius

Hypothermia

below normal body temperature, occurs when body cannot compensate to retain heat Chronic conditions (alcoholism, hyperthyroidism, malnutrition) increases risk along with perioperative and very young/old

Signs and symptoms of hypothermia in infants:

bright red, cool skin very low energy

how does the body compensate for f&e imbalance?

by shifting f&e from one component to another

Staging of cancer (TNM)

determines size, location, and metastasis of tumor and determines the stage of the disease

Hypercalcemia is where __________

calcium levels go above 10.5

Hypocalcemia is where __________

calcium levels go below 8.5

Caloric requirements

calculate energy needs and caloric requirements based on age, gender, height, and weight with activity factored in

what effect does stress have

can increase cellular metabolism, blood glucose concentration, catecholamine levels can increase production of ADH (promotes fluid retention and decreased urine output)

The umbilical cord has ONE vein that

carries freshly oxygenated and nutrient rich blood from the placenta back to the fetus

The umbilical cord has TWO arteries that

carry blood high in carbon dioxide and other waste products away from the fetus

Hematopoietic (Biologic response modifiers (pharmacology) )

cause proliferation of RBC, WBC, Platelets -Decrease the duration of anemia, neutropenia, and thrombocytopenia: treat the symptoms of chemo so that higher doses of chemo can be used -Avoid administering w/i 24 hrs of chemo drugs b/c chemo will kill new cells being stimulated by hematopoietic -Establish baselines

aldosterone

causes kidneys to retain sodium

Transcellular

cerebral spinal, sweat, pericardial and digestive system

Changes in breast during pregnancy

change in size and appearance; become highly vascular; striae gravidarum (stretch marks) may appear; colostrum present by 12-16 weeks

CINV

chemotherapy induced nausea and vomiting

Integumentary system changes in pregnancy

circulation increases causing increased activity of sweat glands; hyperpigmentation (melasma, chloasma, mask of pregnancy, linea nigra); hair grows more rapidly

Arteriovenous shunts

connect veins to arterioles; bypass capillaries to bring heat to skin when open and retain heat when closed Controlled almost exclusively by sympatheric nervous system in response to changes in core and environmental temperatures

Adrenal glands help the body by:

conserving sodium, saving chloride and water and excreting potassium

Braxton Hicks contractions

contractions that come and go; common during late pregnancy and function to increase blood flow to the uterus.

Evaporation

conversion of a liquid to a vapor

Sensory changed during pregnancy

corneal edema causes thickening leading to discomfort for women who wear contact lenses; estrogen may cause a sensation of blocked ears or temporary hearing loss; immune system function is altered to allow the fetus to grow undisturbed

treatment for mild nausea during pregancy

crackers before rising high-protein snacks throughout the day frequent, small amount of liquids

soultes

crystalloids, colloids include electrolytes, O2, CO2, glucose, urea, amino acids, proteins

Overexpressed oncogenes may lead to

development of cancer

Comorbidities (risk factors for cancer)

diabetes, heart disease, hypertension, stroke, arthritis

radiation therapy

damages cell DNA making them unable to reproduce or function

Chloasma

darkening of face in the shape of "mask", normal during pregnancy

Fluid volume deficit:

decrease in intravascular, interstitial and/or intracellular fluid

Hypovolemia

decreased blood volume, occurs when loss of extracellular fluid volume exceeds the intake of fluid

Why might pt have cognition alterations

decreased perfusion to brain medications can cause "brain fog"

During 2nd and 3rd trimester, maternal body temp ____________

decreases

Flexed posture:

decreases the surface area exposed to the environment

hypoxemia

deficient amount of oxygen in the blood

insufficient fluid intake or lack of sufficient reserves results in

dehydration

what is the purpose of the fetal monitor

determine if the fetus is receiving adequate amounts of oxygen

Loss of interstitial fluid leads to ____________

diminished skin turgor

Older adults with electrolytes:

diminished thirst decline in kidney function reduce fluid reserve Increased levels of atrial natriuretic factor increased sensitivity to salt increased likelihood of heart disease

Convection

dispersion of heat by air currents; areas of unequal density i.e. wind chill

Treatment for hypercalcemia:

diuresis and management of the underlying cause

Radiation Therapy (Leukemia)

dose, frequency, location depend on disease process. SE: appear 7-10 days after initiation of therapy; includes fatigue, skin damage/change, second malignancy (10-15 yrs after exposure)

Too much sodium

draws water in, hypothalamus sends ADH to reabsorb water in kidneys

Adverse reactions to calcium replacement:

drowsiness, headache, muscle weakness, constipation, ECG changes, arrhythmias, cardiac arrest and coma

Older adults & indications of dehydration:

dry mucous membranes, tongue furrows, chronic dehydration

excess fluid results in

edema and hypervolemia

Signs and symptoms with hypervolemia:

edema, distended neck veins, crackles, tachycardia, increased blood pressure

pharmacologic therapy

electrolyte correction depends on specific electrolyte, whether deficit or excess blood transfusions IV fluids electrolyte correction

use of diuretics and meds such as benzos leads to

electrolyte imbalances

Biologic response modifiers (pharmacology)

enhances/restores immune system defenses while having a toxic effect on cancer cells

Cachexia

extreme body wasting and malnutrition

Hyperpyrexia

extremely high body temperature or fever (106+) Medical emergency -- must be cooled to prevent brain damage

Heat exhaustion symptoms:

faint or dizzy excessive sweating Cool, clammy skin Nausea or vomiting Rapid, weak pulse Muscle cramps

Preembryonic period

fertilization to implantation of blastocyst; approximately first 2 weeks after conception

Musculoskeletal changes during pregnancy

fetal demands for calcium is high(especially in 3rd trimester) but the amount transferred from mother is small in comparison with her stores and there is no loss to maternal bone density; estrogen and progesterone cause increased mobility of pelvis ligaments allowing for progressive postural changes; rectus abdominis muscles separate (diastasis recti)

Fever of unknown origin (FUO)

fever with an undetermined cause; 101+ for 3+ weeks

Progesterone

first produced by corpus luteum and then by the fully developed placenta -maintains endometrium layer for implantation -prevents spontaneous abortion by relaxing smooth muscles -prevents tissue rejection -stimulates devlopment of lobes/lobules for lactation -suppresses immunoresponse

Estrogen

first produced by corpus luteum and then primarily by the placenta -stimulates uterine growth/increases blood supply -aids in the developing ductal systems in breast -Associated w. hyperpigmentation

Hyperinflation

flattens diaphragm

Nurses must monitor _____________ with hyponatremia

fluid I & O daily weights central nervous system changes

Interstitial

fluid between tissues, organs and cells and lymph fluid

Third spacing

fluid shifts from vascular space to other area....aka pitting edema

Hypotonic solution:

fluid shifts into cells and hydrates the cells

Hypertonic solution:

fluid shifts out of the cells

stage 4: ischemic phase

follicle transforms into the Corpus Luteum and releases Progesterone which causes the uterine wall to thicken in preparation for the fertilized egg. - An ovum must be fertilized w/in 24HR by the sperm for conception to occur. -If ovum is not fertilized the Corpus Luteum degenerates and the hormones Pregesterone/Estrogen decrease triggering the shedding of the uterine wall and beginning of new cycle

a glucose challenge test is performed

for all pregnant mothers between 24-28 weeks

conditions that create imbalance of fluids and electrolytes

gastroenteritis burns kidney disorders NPO anorexia/bulemia dehydration exercise in hot conditions

most common causes of fluid imbalance in school-age children and adolescents

gastroenteritis and diarrhea

School age children & adolescents with electrolytes:

gastroenteritis, diarrhea, diabetes and cystic fibrosis

total body water affected by

gender and body size more obese= less muscle, more fat, less water women=more body fat, less body fluid

What to do for heat exhaustion:

get to a cool shaded area or air conditioned place drink water if fully conscious Take a cool shower or use cold compresses

Hyperthermia

greater than 101.3 or 38.5 celsius

Osmotic diuresis

greatly increased urination and dehydration that results when high levels of glucose cannot be reabsorbed into the blood from the kidney tubules and the osmotic pressure of the glucose in the tubules also prevents water reabsorption.

Endocrine changes during pregnancy

hCG and estrogen may cause nausea in early pregnancy; increased progesterone causes relaxation of smooth muscles resulting in stasis of urine and constipation; progesterone maintains uterine lining, prevents contractions, and helps prepare breasts for lactation;

What does Zygote (fertilized ovum) secrete to signal pregnancy has begun

hCG; with continued production of HCG, the corpus luteum continues to secrete estrogen and progesterone which maintain the decidua in the secretory phase

The skin ______________

has both sensible and insensible perspiration

Infants and thermoregulation:

have brown adipose tissue thin epidermis less subcutaneous fat blood vessels closer to the skin flexed posture

Heat illness

heat cramps, heat exhaustion, heat stroke Usually caused by loss of electrolytes

Biophysical profile (BPP):

higher the score the better out of 10 possible pts 1. NST (non-stress test) 2. Fetal breathing movements 3. Gross fetal movements 4. Fetal tone 5. Amniotic fluid volume

nonshivering thermogenesis

how do newborns produce heat?

Trousseau sign & chvostek sign is with:

hypocalcemia

Blood sugar monitors for __________

hypoglycemia with hypothermia

diabetes mellitus and hypertension are associated with

hyponatremia hypomagnesmia hypokalemia

Adverse reactions to magnesium replacement:

hypotension, circulatory collapse, flushing, depressed reflexes, pain and sclerosis, respiratory paralysis

Thermoregulatory center is in the _______________

hypothalamus

Orthostatic hypotension is a sign of ___________

hypovolemia

NSAID examples:

ibuprofen (Advil, motrin), naproxen

If suspected head trauma, do _____________

imaging studies

Sealed/Solid Brachytherapy

implanted within or near a tumor; emit continuous low energy radiation; may be temporary or permanent -patient emits radiation but excreta does NOT

Intravascular

in blood vessels, plasma

Older adults & fluid volume deficit:

increase risk for rapid dehydration because blunted thirst perception and altered hormone response, increased risk for imbalance, voluntary fluid restriction, medications may lead to dehydration

Hypervolemia

increased blood volume, an isotonic expansion of the extracellular fluid caused by the abnormal retention of water and sodium in approximately the same proportions in which they normally exist in the extracellular fluid

Urinary System changes during pregnancy

increased frequency of urination; increased risk of urinary tract infection; mild proteinuria; renal blood flow increases

Hypercalcemia symptoms:

increased thirst and urination, belly pain, nausea, bone pain, muscle weakness, confusion, fatigue, kidney stones

Thyroid hormone

increases basic metabolic rate over time to generate heat

Chronic inflammation

increases number of mucous secretions glands

The thyroid gland:

increases the blood flow in the body and increases the renal circulation

The nervous system ________________

inhibits and stimulates mechanisms influencing fluid balance

Hyperkalemia symptoms:

intermittent colic, nausea, vomiting, peaked T wave

Increased ADH

leads to concentrated urine, due to reabsorption of water, causing increased volume of body fluids

HCT values with severe loss of blood

leads to falsely high values, wait to assess HCT

Hypertonic dehydration

less sodium loss than water loss, may result from end stage renal disease, diabetes insidious, IV fluid or tube feedings with high electrolyte levels

Thermostatic set point

level at which body temperature is regulated so that core temperature is maintained within the normal range Temperature <93.2 or 105.8> indicates impaired ability

Primary prevention interventions for hyperthermia:

lightweight clothing, sunscreen environmental control medication predisposing to heat sensitivity monitor airway, breathing and ventilation and circulation provide cool fluids, preferably with electrolytes remove patient's clothing fan or mist lightly call 9-1-1 if heath exhaustion or heat stroke is suspected

Hypothermia in infants:

limited insulating subcutaneous fat loses 4 times more heat poor thermal stability radiation and conduction losses

Lab Indicators of bone metastasis

liver enzymes, serum calcium, alkaline phosphate

Adverse reactions to acetaminophen:

liver toxicity

Dehydration:

loss of water

hypotonic solutions

lower osmolality than body fluids less solute than hypertonic fluids causes fluids to move into cells used for dehydration and hypernatremia

Common cancers related to tobacco use

lung, tongue, larynx

__________ is an ___________ for many intracellular enzyme systems and plays a role in both carbohydrate and protein metabolism

magnesium; activator

hypercalcemia results from:

malignancy or hyperparathyroidism and results in weakness and cardiovascular effects

Euglycemia

normal level of sugar in the blood 70-100

examples of isotonic solutions

normal saline (0.9% sodium chloride) lactated ringers

Isotonic dehydration

normal sodium level, may result from vomiting, diarrhea, hemorrhage

Hyperglycemia causes

not enough medication or missed insulin, excess food, illness, infection, stress, steroids,

NSAIDs nursing process:

not recommended for nursing mothers pain relief may take 2-4 weeks Take with food or milk

Para

number of pregnancies that have ended at 20 or more weeks, regardless if infant was born alive or not; anything less than 20 completed weeks is considered an abortion (spontaneous or induced)

Carb counting

nutritional tool used for blood glucose management because carbs are the main nutrients in food that influence blood glucose levels - patients will be education to have a "carb budget" per meal (i.e. 45-60 g)

Nursing interventions for hyperkalemia:

observes for signs of muscle weakness and arrhythmias

Superior vena cava syndrome

occurs when tumors block venous return from head, neck and upper trunk

Inhaled insulin

onset: < 15 min peak: about 50 min duration: 2-3 hr

Timing of pregnancy

open cervix hormones right lining of uterus mucous to move sperm This is hindered by amenorrhea, which could be caused by obesity, and no body fat.

Children & adolescents treatment:

oral rehydration, hospitalized children and severe dehydration, IV fluids

Respiratory alkalosis

pH above 7.4, PCO2 below 35

Respiratory acidosis

pH below 7.4, PCO2 above 45

Convection

process of heat transfer through the fluid motion of air or water across the skin

Evaluation for fluid volume deficit and dehydration:

patient has adequate fluid intake patient's vitals are normal patient's urinary output is within normal limits patient has water and electrolytes that are measured by serum electrolytes, democrat and assessment findings

Chemotherapy

pharmacologic agents used to prevent cancer cells from multiplying, invading, or metastasizing

major anions of intracellular fluid

phosphate and sulfate

Body cells that have the ability to wander throughout body despite not being cancerous

platelets, Leukocytes

_____stored in cells

potassium

Hyperkalemia is where ___________

potassium levels are above 5

Hypokalemia is where ____________

potassium levels are below 3.5

Hyperkalemia treatment involves:

potassium restriction and/or medications

primary cations of intracellular fluid

potassium, magnesium

Gestational Age

prenatal age of the developing baby (measured in weeks) calculated from the FDLMP

Alkylating agents (chemotherapy)

prevent proper DNA and RNA synthesis, inhibits cell division Ex: Altretamine (commonly used for ovarian cancer)

extracellular fluid (ECF)

principal electrolytes: sodium, calcium, bicarbonate (chloride?) acts as transport system carries nutrients to cells, waste products from cells

Disseminated Intravascular Coagulation (DIC) in r/t thrombocytopenia

problem with clotting process; often caused by gram negative sepsis. clotting of small vessels decreases blood flow to major organs and can result in tachycardia and dyspnea

Reproduction

process by which human begins produce a new individual

Antioxidants

protect the cells against the effects of free radicals

How may the nurse treat Xerostomia (dry mouth)

pt can use mint or ice chips

Brachytherapy: internal with beta isotopes

pt emits radiation and is a potential hazard to others

Adverse reactions to sodium replacement:

pulmonary edema hypernatremia potassium loss

Hypermagnesium symptoms:

rare

Hypermagnesemia is ________________

rare and usually caused by renal failure

Implementation for fluid volume deficit and dehydration:

record intake and output Weigh patient daily take vital signs administer fluids as prescribed monitor lab values administer IV fluid monitor for changes in mental status reposition every 2 hours institute safety precautions educate

most accurate temperature

rectal

2/3 of tumors in colorectal cancer occur where

rectosigmoid region

Goals for children may include that parents will ____________

relate strategies to prevent dehydration, describe appropriate home management of fluid replacement for diarrhea, vomiting and describe when to seek healthcare

Implementation for hypothermia:

removing from cold, rewarming hyperthermia blanket warm IV fluids dry clothing monitor vital signs, urine output assess for cold-related injuries asses skin color and temp

Hyperphosphatemia usually results from:

renal failure and is often asymptomatic

Calcium Ca++ levels

reported in two ways Normal total serum calcium level: 9-11 mg/dL Normal ionized serum calcium level 4.25-5.25 mg/dL

Hypernatremia symptoms:

restlessness, weakness, disorientation, delusions, hallucinations

Cancer is common cause of SIADH (Syndrome of inappropriate antidiuretic hormone secretion): The nurse assesses for

s/s of fluid overload

Oral rehydration is the:

safest, most effective treatment for fluid volume deficit if patient is alert and can drink, replace fluids gradually

crystalloids

salts that dissolve readily into true solutions NS, LR

Intravenous fluids is for:

severe deficit or when patient cannot ingest fluids, lactated ringer's solution is preferred

hyperemesis gravidarum

severe nausea and vomiting in pregnancy that can cause severe dehydration in the mother and fetus requiring hospitilazation complications: weight loss, dehydration, electrolyte imbalance may need IV fluids and antiemetics

Signs and symptoms of hypothermia in adults:

shivering exhaustion confusion fumbling hands memory loss slurred speech drowsiness delayed capillary refill weak, delayed pulse nausea

Fecal Occult Blood (Secondary Prevention)

shows if there's blood in stool but does not indicate where blood is coming from; a positive FOB would indicate a colonoscopy is needed - Yearly for all at risk adults

water follows

sodium

body does not store_____ and ______

sodium chloride

Goodell's sign

softening of the cervix

active transport

substances move across membranes from less concentrated solution to more concentrated solution metabolic energy is expended (unlike in diffusion and osmosis) important in maintaining differences in sodium and potassium ion concentrations of ECF, ICF

low sodium

suppresses ADH

Malignant hyperthermia

surgeries can cause this potentially fatal inherited disorder serious reaction to inhalation anesthetic gases and succinylcholine

Unsealed brachytherapy

suspended in a fluid and given by the oral or IV route -the patient AND excrete ARE radioactive

insensible perspiration

sweat that evaporates from the skin before it is perceived as moisture Controlled by SNS using AH

Example of convection

swimming, fan blowing against your body after gardening

Core temperature

temperature of the deep tissues: 97-99.5

Sustained (continuous) fever

temperature remains above normal with minimal variations -often seen in inadvertent drug-induced fever

Diffusion

tendency of solutes to move freely throughout a solvent

Hypocalcemia symptoms:

tetany, Trousseau sign, tingling in hands and lips, easily fractured bones

Hypocalcemia results in _______ and requires _________

tetany; IV administration of calcium

A fetal heart rate tracing shows an early deceleration pattern, the nurse is aware this indicates which interpretation

the FHR slows early in contraction, which is a normal finding

tonicity

the ability of a surrounding solution to cause a cell to gain or lose water osmolality of a solution

Differentiation

the acquisition of a specific cell function, a normal process by which a less specialized cell becomes a more specialized cell type

At 20 weeks gestation

the fundus can be palpated at the umbilicus

By 12 weeks gestation

the fundus is able to be palpated above the symphysis pubis

At 36 weeks gestation

the fundus reaches highest level at xiphoid process

osmolality

the concentration of solutes in body fluids

By 40 weeks gestation (lightening)

the fetal head descends into pelvic cavity, also know as Lightening. usually occurs in last 2 weeks

Tumor angiogenesis

the growth of new blood vessels that tumors need to grow; caused by the release of chemicals by the tumor and by host cells near the tumor (fatigue and wt loss are common symptoms of cancer b/c tumors "steal" nutrients and O2)

Parathyroid glands regulate ______________

the levels of calcium in the extracellular fluid

Proliferation

the reproduction of new cells through cell growth and division

How body fat affects body fluid:

thin people have more body fluid because fat cells contain less water

fluid intake regulated by

thirst center in hypothalamus- triggered by osmotic pressure, vascular volume and angiotensin

Heat stroke symptoms:

throbbing headache No sweating red, hot, dry skin nausea or vomiting rapid, strong pulse may lose consciousness

Why does thick mucous plug develop in cervical canal

to prevent bacterial ascent into uterus

Conduction

transfer of heat to another object during direct contact

Prostate-specific antigen (PSA) (Secondary Prevention)

type of tumor marker test, it is used to screen for prostate cancer and to monitor the disease after treatment (levels should decrease if therapy is effective); elevated levels may be associated with prostate cancer.

most electrolytes enter body through dietary intake and are excreted in

urine

Hypophosphatemia can result from:

use of nutritional supplements

Hyponatremia symptoms:

vomiting, diarrhea, fistula, sweating

Osmosis

water passes from an area of lesser solute concentration to a greater concentration until equilibrium is established

most accurate assessment tool for fluid balance

weight change

Supine hypotensive syndrome

weight of the uterus can partially occlude the Vena Cava and the Aorta; corrected quickly with position change

Fluid Volume deficit & dehydration assessment:

weight, vitals, peripheral pulses, capillary refill, skin color, JVD, urine output, renal or endocrine disease, recent illness

Afebrile

without fever

Emergency asthma management

worsening wheeze, cough or shortness of breath no improvement after bronchodilator use difficulty breathing trouble with walking or talking discontinuation of paly Listlessness or weak cry gray or blue lips or fingers

How age affects body fluid:

younger people have a higher percent of body fluid than the elderly....this is why the elderly get dehydrated often

Breast Exams

· Best time is 1 week after the start of menstraul periods

Trichomoniasis

· Caused by a protozoa parasite · Most common curable STI Transmission: · Lower genital tract of a woman · Inside penis Signs and stmptoms · Itching or burning of the vaginal area · Dysuria · Foul smelling green discharge Treatment · Antibiotics such as metronidazole or tinizole

Syphilis

· Caused by spirochete bacteria · Transmission: oral, vaginal, and anal sex; blood exposure Progresses through 3 stages: · Primary syphilis: first sign is a chancre (ulcer) that develops on the site of entry around 10-90 days after exposure. Most often found on the genitalia, lips, nipples mouth and anus · Secondary syphilis: develops 6 weeks to 6 months after onset of primary syphilis. Becomes system disease. Most common manifestation is flulike symptoms and a rash that can develop over the whole body (including palms of hands and soles of feet). Lesions are highly contagious and should only be touched with gloves on · Latent syphilis: occurs after the first year of infection. Can only be infectious to the fetus of a pregnant woman · Tertiary syphilis: occurs after 4 years of infection. Can affect any organ system. May be fatal Treatment: · Benzathine penicillin G

Testicular Cancer

· Commonly effects ages 20-35 ·perform monthly exams (best done in the shower)

Mammograms

·Begin at the age of 40 ·Done annually

Pap smear

·Begins at the age of 21 ·21-29 every 3 years ·30-65 every 5 years + HPV testing ·66+ none

Prostate Screening

·Men ages 55-69 should have annual prostate screening ·Digital rectal exam ·PSA: PSA test is a blood test used primarily to screen for prostate cancer. The test measures the amount of prostate-specific antigen (PSA) in your blood. PSA is a protein produced by both cancerous and noncancerous tissue in the prostate, a small gland that sits below the bladder in men.

Erectile Dysfunction

·The most common sexual problem men report to their doctor. ·Characterized by trouble getting or maintaining an erection. May be caused by physical or psychological issues. Potential causes: ·Being over 50 ·HTN ·DM ·Obesity ·Drugs ·Anxiety Depression Treatment: · phosphodiesterase type-5 inhibitors aka Viagra (sildenafil) and Cialis (tadalafil) · Testosterone Therapy · Penile injections · Penile implants ·Tell patients taking nitrates for the heart to NEVER take PDE5 inhibitors. May cause a fatal reaction.

examples of hypotonic fluids

• 0.45% sodium chloride (D5 0.45%NS)

FVD lab findings

• Increased serum osmolality • Increased hematocrit • Increased blood urea nitrogen (BUN) level • Increased serum sodium level • Increased urinary specific gravity