Unit 5, 6, 7

Laxatives and cathartics

Soften the stool and promote peristalsis. Although similar, laxatives are milder than cathartics. Chronic use of cathartics causes the large intestine to become less responsive to laxatives. Overuse of laxatives can cause serious diarrhea.

Impaired mood with Cx patients

Some long term cx survivors have impaired mood but greater psychological well being compared to cx free patients. Older survivors show greater well-being/spirituality than younger cx survivors.

Acute survival

Starts with the diagnosis of cancer. Therapeutic and diagnostic efforts dominate. Fear and anxiety are constant elements of this phase.

If patient is not a rousable on PCA

Stop PCA, elevate HOB, assess vital signs, DO NOT leave pts side, notify HCP/call for help, prepare to administer reversal agent.

Surfactant

Surfactant is a chemical produced in the Lungs to maintain the surface tension of the alveoli and keep them from collapsing

C. diff

Symptoms range from mild diarrhea to severe colitis. Caused by either an overgrowth of C. diff or by contact with it. Most common test is the ELSA test, it detects C. diff A and B in stool.

GI changes in the older adult

Systemic changes in the function of digestion and absorption of nutrients result from changes in older patients' cardiovascular and neurological systems rather than their GI system. p. 1089 -loss of muscle tone -decreased blood flow to organs -nerve impulses to anal region slow

A 62-year-old patient is being admitted to a surgical unit for a total hip replacement. The nurse reviews his medical record and learns that the patient has a history of impaired liver function and paresthesias in his feet. After assessing the patient's medical history further, the nurse is not sure what caused the liver impairment or paresthesia. To clarify, an appropriate question to ask the patient is which of the following? "Have you been treated for cancer in the past?" "What is the nature of your liver problem?" "Has the doctor discussed with you whether your liver problems will affect your recovery from surgery?" "How long have you had the numbness and tingling in your feet?"

"Have you been treated for cancer in the past?" This question reveals whether the patient is a cancer survivor and whether he underwent treatment that could have caused the liver impairment and paresthesia. Asking about the nature of the liver problem is appropriate but does not reveal the total nature of the patient's symptoms and cause. Asking how long numbness and tingling have been present and whether the doctor discussed how the liver problems will affect recovery are relevant but do not clarify what caused the patient's complications.

Katie, a child in remission for leukemia, and her mother come to the pediatrician's office for a routine physical examination. The nurse asks Katie about whether she is having continued symptoms. Her mom says," I don't know why you want all of this information about Katie's cancer treatment. The leukemia is gone." The best response from the nurse in support of the child and mother would be: "The doctor likes to keep the records complete on all of her patients." "Just because Katie is in remission does not mean that it will stay that way." "It is common for children to have delayed effects from treatment, so we need to know this to plan Katie's care properly." "I understand your concern. If you don't want to provide the information, sign this release form."

"It is common for children to have delayed effects from treatment, so we need to know this to plan Katie's care properly." This response answers the mother's concern and clarifies the fact that cancer treatment can cause long-term effects. It is a response that does not increase the mother's stress level. The doctor's desire for complete records does not address the true need for why the nurse wants to assess the patient. The nurse's statement that Katie's leukemia may not stay in remission addresses a truth about the child's cancer but is likely to add to the mother's stress. Having the mother sign a release form does not enable the nurse to continue with necessary data collection.

Mr. Stewart is a 62-year-old patient diagnosed with prostate cancer who underwent surgical removal of the prostate 3 days ago. He lives with his wife at home. The nurse is planning to provide discharge instructions for the patient. What would be the most effective initial question to ask of the patient and family in determining the approach to discharge instructions? "Mr. Stewart, have you had surgery in the past?" "The doctor has ordered you to go home with a urinary catheter. Tell me how you think you can manage this." "Mrs. Stewart, do you find it difficult to look at your husband's incision? If so, tell me how you feel." "Mr. Stewart, describe for me how much your wife normally helps you at home and what you can do on your own."

"Mr. Stewart, describe for me how much your wife normally helps you at home and what you can do on your own." This question helps the nurse identify what pattern of family caregiving skill exists in the home so appropriate instruction can be planned. Asking about previous surgery would have been asked before the patient's surgery. Asking how the patient will manage the urinary catheter is relevant but does not provide the initial information needed to understand who is the primary caregiver, the patient or wife. Asking about Mrs. Stewart's feelings about her husband's incision is also relevant but does not allow the nurse to identify the patient-and-wife pattern of care that is needed to plan effective teaching.

A nurse in an oncology outpatient clinic has been seeing a woman and her husband since the woman was diagnosed with breast cancer. Sometimes the husband appears supportive, asking questions about his wife's care. At other times the husband seems easily distracted and uninterested. The nurse decides to reassess the psychosocial condition of the patient and her husband. Which of the following questions best elicits needed psychosocial information? "In what way does the pain you have affect you on a daily basis?" "Describe to me what you eat in a typical day." "Tell me how you think you and your husband are dealing with your cancer." "Are the two of you having any relational difficulties because of your cancer?"

"Tell me how you think you and your husband are dealing with your cancer." The open-ended question is one that coaches the patient and husband into telling their story and explaining what is important to them. Asking a yes/no question about relational difficulties is a closed-ended question that does not prompt a full story. Asking about the pain's effect on a daily basis and what is eaten in a typical day do not elicit psychosocial information.

Caring for a patient with cancer is unique because of the effects of the disease and associated treatment. An understanding of a patient's symptom experience is critical and best revealed by a nurse asking which of the following questions? (Select all that apply.) "What symptoms do you think you are having as a result of your cancer?" "Describe for me how the symptoms affect you in your daily life." "Let's focus on your pain. Tell me how it affects you." "Can you describe for me how your family provides care for your symptoms?"

"What symptoms do you think you are having as a result of your cancer?" "Describe for me how the symptoms affect you in your daily life." "Let's focus on your pain. Tell me how it affects you." All three questions allow the nurse to explore any presenting symptoms and learn specifically how any symptoms are affecting the patient. The questions are open ended and allow the patient to tell his or her story. Asking how the family provides care for the patient’s symptoms does not reveal the nature and extent of the patient's symptom experience.

Maximaizing pain relief

"start low" (dose), "go slow" (titrating). Administer analgesics ATC rather than prn. pg. 982

Epidural nsg implications

-Adv effects: nausea, vomiting, urinary retention, resp depression, pruritis. -VS every 15 min (respiratory effort, skin color too) -Once stabilized, VS every hour -clearly label catheter -ALWAYS use infusion pump -Use surgical asepsis at catheter site -Notify HCP if signs of infection or pain at insertion site

What can cause diarrhea?

-Antibiotic use -Enteral nutrition -Food allergies and intolerances -Surgeries or diagnostic procedures

Risk factors for colon cancer

-Over 50 years old -Family history of colon cx -Personal hx of colon cx -Ethnic background: Jews of Eastern European decent -Race: African American -Diet: high in animal fats, low in fruits and veggies -Obesity and inactivity -Smoking and alcohol intake -Diabetes -Aw shit son -Not petting a cat enough

PCA benefits to patient

-Patient gains control over pain, dose not depend on RN -Patient has access to medication when needed -Decreased anxiety which leads to decreased use -Stabilizes serum drug levels

PCA teaching - critical!

-Teach use of PCA before procedures to pt knows how to work after awake from sedation -Instruct the patient of the purpose of the PCA -Explain the pump prevents the risk of overdose -Tell family or friends not to operate the PCA for the patient

Cancer-related fatigue interventions

-exercise -good sleep habits -balanced diet -counciling for depression

Nonpharmacological interventions

-relaxation and guided imagery (meditation, yoga) -distraction (music) -cutaneous stimulation (ice, hot pack, massage) -herbals -reducing pain perception

WBCs in urine

0-4 per low-power field. Greater numbers indicate UTI

Four elements of survivorship care

1) Prevent and detect new & recurrent cancers 2) Watch for spreading cancer or 2nd cancer 3) Intervention for consequences of cancer and its treatment 4) Coordination between specialist and primary care providers

Specific gravity

1.0053-1.030, measures concentration particles in the urine. High levels mean concentrated urine, low levels mean dilute urine.

Adult fluid intake

1100 - 1400 mL per day

Ileum

12 feet long absorbs water, fat, certain vitamins, iron, and bile salts

Normal urine output

1200-1500 mL/day *an output of less than 30 mL/hr indicates circulatory, blood volume, or renal alterations

urine pH

4.6 - 8.0, an acid pH helps protect against bacteria growth

Colon/Large intestine

5 - 6 ft long 3 parts: cecum, colon, rectum primary organ of bowel elimination muscular tissue allows accommodating of large quantities of waste and gas (flatus) Functions: absorption, secretion, elimination

Age for a recommended colonoscopy?

50, with no family history

Pain is considered chronic pain after...

6 months

Duodenum

8 - 11 inches long processes chyme from the stomach

Jejunum

8 ft long absorbs carbohydrates and proteins

Cancer survivors are at risk for treatment-related problems. Which of the patients listed below has the greatest risk for developing such a problem? An 80-year-old woman undergoing surgery for removal of a basal cell carcinoma on the face A 71-year-old man receiving high-dose chemotherapy and radiation for an advanced-stage lymphoma Correct A 26-year-old man receiving chemotherapy for testicular cancer that is localized to the testicle A 48-year-old woman receiving radiation for Hodgkin's disease that involves lymph nodes extending above and below the diaphragm

A 48-year-old woman receiving radiation for Hodgkin's disease that involves lymph nodes extending above and below the diaphragm The risk for treatment-related problems is associated with the complexity of the cancer itself; the type, variety, and intensity of treatments used; and the age and underlying health status of the patient. All of these patients are at risk for treatment-related problems, but the 71-year-old has the greatest risk because high-dose chemotherapy is combined with radiation.

Chronic pain

Chronic pain patients should have analgesics on a regular basis (even when pain subsides), NOT prn. Prn doses are ineffective and cause more suffering.

Compliance

Compliance is the ability of the lungs to distend or expand in response to increased intraavleolar pressure

A nurse working in a medicine clinic knows that it is important to recognize cancer survivors who are most at risk for posttreatment symptoms. Which of the following patients will likely be at greatest risk for posttreatment symptoms? A 50-year-old mother of three who was diagnosed with late-stage breast cancer and has hypertension A 20-year-old male college student diagnosed with leukemia whose father had lung cancer A 32-year-old Hispanic woman who has been diagnosed with local cervical cancer and receives Medicaid A 72-year-old African American male who had colorectal cancer with surgery, radiation, and a second round of chemotherapy because of failure of initial treatment and has diabetes

A 72-year-old African American male who had colorectal cancer with surgery, radiation, and a second round of chemotherapy because of failure of initial treatment and has diabetes This survivor has a more complex situation as a result of a combination of age, co-morbid conditions, and type of treatment.

Addiction

A primary, chronic, neurobiological disease whose development is influenced by genetic, psychosocial, and environmental factors (same as psychological dependence).

Oliguria

A urine output that is decreased despite normal intake. This often occurs when fluid is lost through other means (vomiting, perspiration), and early kidney disease.

NSAIDs

Mild to moderate acute intermittent pain relief (headache, muscle strain). Inhibit prostaglandins and thus inhibit cellular responses to inflammation. They do not depress CNS.

GI and depression

ANS slows impulses; peristalsis decreases, resulting in constipation

Chronic vs. Acute pain

Acute pain is protective, thus preventing harm; chronic pain is no longer protective.

Enema ordered "until clear"

Administer until fecal material is clear. No more than three enemas, after that notify HCP

Bladder capacity

Adult: 600-1000 mL, voiding every 2-4 hours Able to sense desire to void at 150-200 mL, child: 50-100 mL

Acetaminophen (Tylenol)

Most tolerated and safest analgesic. No anti-inflammatory effect. Major adverse effect is hepatotoxicity. Max 24 hour dose is 4grams. Often combined with opioids because it reduces dose of the opioid needed to achieve pain control.

PCA

Allows patient to self administer pain meds, minimal risk of overdose. Goal: to maintain a constant plasma level to analgesic to avoid problems with prn dosing.

Residual volume

Amount of air left in lungs after full expiration

Analgesics

Analgesics are the most common and effective method of pain relief. 1. nonopioids 2. opioids 3. adjuvants

Colon and elimination

At the rectum the colon converts fecal matter into its final form

Atelectasis

Atelectasis is a collapse of the of the alveoli that prevents normal exchange of oxygen and carbon dioxide

Diffusion

Movement of oxygen and carbon dioxide between alveoli and red blood cells/lung tissue. Increased thickness of the membrane (pulmonary edema, etc.) make it difficult to exchange gases

PTSD

Newly diagnosed cx patients 3-4% experience symptoms. After treatment 35% experience this. Being unmarried or less educated or lower income, and less social and emotional support increases the risk for PTSD.

Adjuvant drugs

Originally developed to treat conditions other than pain but also have analgesic properties, given to enhance analgesics. Ex. tricyclic antidepressants, anticonvulsants, corticosteroids.

Referred pain

Pain is in part of body separate from the source of pain.

ID: 41101248 Mr. Wallace is a 34-year-old who is a 5-year survivor of Hodgkin's disease. He continues to have symptoms related to his chemotherapy treatment. Mr. Wallace is a computer expert and enjoys Internet discussion groups. What is the best resource a nurse can recommend to help him access a survivorship care plan? Association of Cancer Online Resources National Coalition for Cancer Survivorship American Cancer Society National Cancer Institute

Because of the patient's computer interests, the Association of Cancer Online Resources (ACOR) is likely the best choice. National Cancer Institute (NCI)-designated cancer centers often also have access to survivorship care plans.

A 41-year-old man who underwent a craniotomy for the removal of a brain tumor 6 months ago comes to the clinic for his monthly follow-up visit. In planning your assessment, you anticipate that the patient may possibly experience which of the following late effects of surgery? (Select all that apply.) Pain Fatigue Blurred vision Difficulty breathing Poor attention span

Blurred Vision Poor attention span The common symptoms following brain cancer include impaired cognitive function; motor sensory alterations; altered vision, swallowing, and language; and bowel and bladder control.

Permanent survival "cure"

Patient is "cured" but experience has effected life: employment, insurance issues are common. At risk for long-term secondary effects of treatment.

Epidural nerve block

Permits control or reduction of severe pain and reduces the patients overall opioid requirement, thus minimizing adverse effects. Short or long term depending on patients condition.

urine blood/blood occult

Positive when erythrocytes, hemoglobin, or myoglobin are present in urine.

Stereognosis

Recognition of an objects size, shape, and texture.

You're awesome..

Remember, each patient has a unique situation and a perception of what is "right" for him or her.

Deep or visceral

Resulting from stimulation of internal organs. Pain is diffuse and radiates in several directions. (angina, gastric ulcer)

Superficial or cutaneous pain

Resulting from stimulation of skin, pain is short in duration and localized. Usually a sharp sensation.

Enema by the numbers..

Size: Adult 22-30 Fr; Child 12-18 Fr Volume: Adult 750-1000 mL; Child varies per age, see pg. 1112 Length of insertion: Adult 3-4 inches; Child 2-3, infant 1-1.5 in

Having trouble breathing?

Decreased lung compliance, increased airway resistance, and the increased use of assessory muscles increase the work of breathing, resulting in increased energy expenditure. Therefore the body increases it's metabolic rate and the need for more oxygen. The need for elimination of carbon dioxide also increases. This sequence is a vicious cycle for a patient with impaired ventilation causing further deterioration of respiratory status in the ability to oxygenate adequately. p. 822

GI and stress

During emotional stress the digestive process is accelerated, and peristalsis is increased leading to diarrhea and gaseous distention. Diseases associated with stress: ulcerative colitis, IBS, gastric and duodenal disorders, Crohn's.

Extended survivial

During when patient goes into remission or has ended the rigorous course of treatment, enters a course of watchful waiting. Fear of reoccurrence is common.

Education to cancer patient

Educate about effects of cancer and its treatment, short and long term effects. Reinforce the HCP explanations of the risks related to their cancer and treatment. Explain to them what they need to monitor, and what they need to discuss with the HCP in the future. Teach about the possibility of treatment side effects (pain, neuropathy, etc) they will be more likely to report their symptoms. Because of higher risk for developing a second cancer, educate about lifestyle changes, ongoing cancer screening, early detection practices.

Kinesthetic

Enables a person to be aware of position and movement of body parts

Regional anesthesia

Epidural, pudendal block, spinal anesthesia

Chemotherapy-related cognitive impairment (CRCI)

Est to occur in 17% - 75% receiving chemo treatment. Happens during all phases of treatment. S/Sx include dec attention span, easily distracted, difficulty walking and significant behavior changes.

Topical analgesics

Eutectic mixture of local anesthetics (EMLA) via a disk or thick cream to skin 30-60 min before minor procedures (IV start, IM injection). Do not place around eyes, tympanic membrane, or over large skin surfaces. p. 984

A support group of cancer survivors is discussing cancer-related fatigue (CRF). The survivor most likely to gain relief from CRF is the survivor who does which of the following? (Select all that apply.) Takes naps during the day and evening Drinks energy drinks daily Exercises every other day Eats a balanced diet

Exercises every other day Eats a balanced diet Evidence has shown that CRF can be minimized with regular exercise and eating a well-balanced diet. Taking naps does not relieve the fatigue. High-carbohydrate energy drinks have not been shown to favorably influence CRF.

Expiration

Expiration is a passive process it depends on elastic recoil

The period during which a cancer patient goes into remission following the basic, rigorous course of chemotherapy and enters a phase of watchful waiting, is called _______________

Extended survival

Stomach secretes...

HCl, mucous, pepsin, intrinsic factor.

disclose feelings about cancer

Hiding thoughts and concerns to protect loved ones actually causes distress. If cancer survivors and their partners were educated in how to disclose feelings and disclosed them, relationships and intimacy were improved. pg. 94

Inspiration

Inspiration is an active process stimulated by chemical receptors in the aorta

Forced vital capacity

Maximum amount of air that can be removed from the lungs during forced expiration

sandwich generation

Members of the "sandwich generation" (i.e., caregivers who are 30-50 years old) are often caught in the middle of caring for their own immediate family and a parent with cancer.

To successfully assess if a patient is experiencing cognitive changes as a result of cancer treatment or complications of treatment, which of the following questions by a nurse is likely most relevant? Describe for me your medication schedule. How distressed are you feeling right now on a scale of 0 to 10? Tell me about when you first noticed symptoms from your chemotherapy. Tell me what you notice differently in your ability to get work done at your office.

Tell me what you notice differently in your ability to get work done at your office. Asking the patient to explain what is different about the ability to get work done in the office is the only one that really attempts to determine changes in the cognitive ability of the patient before and after treatment. The patient's medication schedule and distress level are concerned with other potential problems unrelated to cognitive function. Asking when symptoms were first noticed is a very global question that does not really look at the long-range effects of cancer treatment on survivors.

Tidal volume

The amount of air exhaled after normal inspiration

Mr. Timmons has been receiving treatment for colon cancer on and off for a year. He received multiple chemotherapy regimens and a course of radiation. The 58-year-old patient is able to perform his own hygiene but needs assistance from his wife to move about safely in the home because of ongoing fatigue and weakness. His wife assists him with dressing when he becomes excessively tired. This caregiving skill pattern is best described as which of the following? The self-caregiving pattern The collaborative care pattern The family caregiving pattern The team caregiving pattern

The collaborative care pattern The collaborative care pattern is one in which patients and caregivers share care activities and respond together to illness demands. The patient in this case study is not primarily independent (self-caregiving pattern), and his disease has not progressed to the point at which he is totally dependent on his wife (family caregiving pattern). The team caregiving pattern is not a caregiving skill pattern.

Colon and secretion

The large intestine aids in electrolyte balance. It secretes bicarbonate in exchange for chloride, it also excretes 4 to 9 mEq of potassium daily

Ben, a 31-year-old nursing student, is caring for Maria, a 45-year-old Latina woman who is receiving chemotherapy following surgery for breast cancer. Based on the evidence about cultural influences on cancer patients, Ben knows that which factor will likely influence this patient's ability to cope with her cancer? Transportation resources to the oncology clinic Whether the patient's physician is male or female The stigma family members place on cancer The level of social support available to the patient

The level of social support available to the patient Latina breast cancer survivors experience lower levels of social support and quality of life than comparable Caucasian women.

Pulmonary circulation

The primary function of pulmonary circulation is to move blood to and from alveoli capillaries and exchanges gases.

Bacteria, casts, crystals in urine

There should be none!

Coffee, tea, cocoa, cola...

These contain caffeine, and they promote urine formation (diuresis)

Food intolerance

This is not an allergy but rather a particular food that causes the body distress within a few hours of digestion. Ex. milk, gluten

RBC in urine

Up to 2

Opioids

Used for moderate to severe pain relief. Adv effects: nausea, vomiting, *constipation*, itching, urinary retention, myoclonus, altered mental processess. Respiratory depression in the opioid naive patient, RR < 8

Common holistic health approaches

Wellness education, regular exercise, rest, attention to good hygiene practices, nutrition, and management of interpersonal relationships.

Physical dependance

a state of adaption that is manifested by a drug class specific withdrawl sydrome that can be produced by adrupt cessation, rapid dose reduction, decreasing blood level or drug, and/or administration of an atagonist

Medications causing constipation

anticholinergics, antispasmodics, anticonvulsants, antidepressants, antihistamines, antihypertensives, antiparkinsonisms, bile acid sequestrants, diuretics, antacids, iron supplements, calcium supplements, and opioids.

urine glucose

normally glucose is not present in urine. Often patients with DM will have some.

urine protein

normally protein is not present in the urine. It is common in renal disease.

urine ketones

normally there are none in the urine. Patients with poorly controlled DM may have some.

Radiating pain

pain perceived at the source and in surrounding or nearby tissues

Colon and absorption

the large intestine absorbs water, sodium, and chloride from food that has passed from the small intestine. Healthy people absorb more than a gallon of water and ounce of salt every 4 hours. The amount of water absorbed depends on the speed colonic contents move (peristalsis).

Drug tolerance

the tendency for larger doses of a drug to be required over time to achieve the same effect

bulk forming foods

whole grains, fresh fruits, and vegetables help flush fats and waste products from the body with more efficiency