Med Surg 2 week 1

Cancer: What are the signs and symptoms?

· Change in bowel or bladder habits · A sore that doesn't heal · Unusual bleeding or discharge · Thickening or lump in the breast or elsewhere · Obvious change in a wart or mole · Nagging cough or hoarseness

Cancer: How do you treat?

· Chemotherapy · Radiation · Brachytherapy · Teletherapy · Bone marrow transplant

Older adult dementia

· Chronic, progressive, and possibly with an unknown cause (Alzheimer's disease, vascular dementia) · Slowed neurotransmission, vascular circulation impairment, disease states, poor nutrition, and structural brain changes caused dementia · Not reversable · The most common type of dementia is AD (Alzheimer Disease) account for up to 70% of older adults with dementia.

Older adult respiratory changes

· Decreased chest wall movement, vital capacity, and cilia, which increases the risk for respiratory infections · Increased in residual lung volume · Decrease in muscle strength, endurance, and vital capacity · Decreased gas exchange and diffusing capacity · Decreased cough efficiency

Older adult GU changes

· Decreased in detrusor muscle contractility, bladder capacity, flow rate and ability to withhold voiding, increase in residual urine · Prostate hypertrophy in males · Decline in estrogen or testosterone production · Atrophy of breast tissue in females · Female: relaxed perineal muscles, urethral dysfunction - stress incontinence

Older adult cardiovascular changes

· Reduced cardiac out · Decreased peripheral circulation · Diminished ability to respond to stress · Heart rate and stroke volume do not increase to maximum demand · Slower heart recovery rate and increased BP

Older adult gastro changes

· Decreased production of saliva · Decreased digestive enzymes · Decreased intestinal motility, which can lead to increased risk of constipation · Increased dental problems · Decreased sense of thirst, smell, and taste · Difficulty swallowing food, delayed esophageal and gastric emptying

When performing a GI assessment on an older client the nurse expects the following findings: (SATA) A Decreased GI motility B Fullness and dyspepsia C. Increased gastric emptying D. Constipation E. Increased sense of thirst

A Decreased GI motility B Fullness and dyspepsia D. Constipation

The nurse is working with a group of older adult clients. What is the most effective nursing approach to assist the group in understanding health promotion? A. Teach the importance of balanced adequate nutrition B. Promote diet, exercise, and health activities necessary to maintain health C. Identify health conditions and the importance of managing symptoms D. Encourage family to maintain contact and assist in caregiving

B. Promote diet, exercise, and health activities necessary to maintain health

Cancer: How do you Diagnose?

-Laboratory test- A PSA test -MRI, CT scan, PET scan. -Mammograms -Biopsy

Cancer: What is it?

A group of diseases characterized by uncontrolled and unregulated growth of cells. It can be Benign or Malignant. In cancer cell division the cells divide non-stop and leads to uncontrolled growth because the cells do not die and eventually turn into tumors.

The nurse is preparing a plan of care for a patient who is neutropenic. Which of the following precautions should the nurse include in the plan? SATA A. Don a mask, gloves and gown B. Restrict visitors who have active infections C. Advise client to eat cooked foods only D. Allow family members to bring fresh flowers E. Monitor patient for signs or symptoms of infection

A. Don a mask, gloves and gown B. Restrict visitors who have active infections C. Advise client to eat cooked foods only E. Monitor patient for signs or symptoms of infection

The nurse knows that in order to administer chemotherapy to a client she must: A. Wear a lead apron at all times B. Be specifically trained in chemotherapy handling C. Have a minimum of 2 yrs. of ICU experience D. Not leave the room until infusion is complete

B. Be specifically trained in chemotherapy handling

The nurse understands that chemotherapy agents have the following effects on the cell: A. It prevents the cell from diving. B. It disrupts the process of cell replication and proliferation of all fast-growing cells. Both healthy and cancerous C. It only targets cancerous cells D. It stops the cancerous cells from growing back

B. It disrupts the process of cell replication and proliferation of all fast-growing cells. Both healthy and cancerous

Older adult nervous system and senses

· Slower reaction time · Decline in visual acuity · Decreased ability for eyes to adjust from light to dark, leading to night blindness · Inability to hear high-pitched sounds (presbycusis) · Reduced spatial awareness · Decreased in brain volume and cerebral blood flow · Reduced speed in nerve conduction Vision: Presbyopia - decreased ability to focus on close objects, pupils become more rigid and lenses more opaque

Anemia

• Monitor for fatigue, pallor, dizziness, and shortness of breath • Schedule activities with rest periods in between, using energy saving measures (sitting during showers and ADL's) • Monitor Hgb values to determine response to meds. Be prepared to administer blood

nurse is giving discharge teaching to the older adult who is going home on several medications. To ensure that the client self-administers correctly and safely, which is the best action plan that the nurse implement? A. Ask the client to explain and demonstrate self-administration techniques B. Perform pill count of each prescription bottle at home during every visit C. Instruct the client to double up on medication if a dose is missed D. Give the client pamphlets with information about the medications he will be taking

A. Ask the client to explain and demonstrate self-administration techniques

The nurse is teaching the client about skin changes associated with Melanoma. The nurse should advise the client to report any lesions with following characteristics: SATA A. Asymmetry B. Slow growing C. Fast growing D. Irregular borders E. Changes in shape or color F. Same shade as the rest of the skin lesions

A. Asymmetry C. Fast growing D. Irregular borders E. Changes in shape or color

An older client asks the nurse what neurological and vision changes should he expect: (SATA) A. Reduced visual acuity B. Decrease in ability to learn to grasp new concepts C. Eye floaters D. Increased agility E. Increased sensitivity to glare

A. Reduced visual acuity B. Decrease in ability to learn to grasp new concepts C. Eye floaters E. Increased sensitivity to glare

The nurse explains to the patient receiving brachytherapy alone for cervical cancer that she: ( SATA) A. Requires use of radioactive precautions during nursing care B. Should not be around pregnant women or children C. Cannot eat fresh fruit D. Can flush radioactive seeds down the toilet if they become dislodged

A. Requires use of radioactive precautions during nursing care B. Should not be around pregnant women or children (The nurse must be aware that patient are emitting radioactivity, healthcare provider must use a dosimeter film badge)

A client recently diagnosed with leukemia is asking the nurse how chemotherapy is going to affect his immune system. The nurse tells the patient that chemotherapy usually causes SATA A. Thrombocytopenia B. Anemia C. Leukopenia D. Hyperglycemia E. Neutropenia F. Leukocytosis

A. Thrombocytopenia B. Anemia C. Leukopenia E. Neutropenia (Chemotherapy causes low white blood cell, neutrophil, platelet and red blood cell and Hbg levels. Patient receiving chemotherapy usually have lowest blood counts 7-10 days after starting therapy)

A nurse is providing discharge teaching for a client who is postoperative following a simple mastectomy. The client is to begin outpatient radiation therapy the next day. Which of the following instructions should the nurse give the client A. Remove any tattoos or markings on the radiation site B. Remind the client to use mild soap and water while bathing C. Use an antibiotic ointment to prevent skin breakdown D. Lubricate the skin with lotion

B. Remind the client to use mild soap and water while bathing

The nurse is reviewing the chart of a client who had a breast biopsy. The test results indicate the following T3N2M1. How will the nurse interpret this information? A The cancer is localized and not invasive at this time B. The cancer is advanced, there is lymph node involvement and metastasis C The tumor is advanced with lymph node involvement but not evidence of metastasis D. The lymph nodes are involved but the presence of metastasis cannot be determined

B. The cancer is advanced, there is lymph node involvement and metastasis

A small lesion is incidentally discovered in a client's breast on X-ray. The nurse explains that this definitive test must be done to determine if the lesion is malignant. A. Mammogram B. CT scan C. BRCA genetic testing D. Tissue Biopsy

D. Tissue Biopsy

Lab values

RBC: F: 4.2 to 5.4 M: 4.7 to 6.1 WBC: 5,000 to 10,000 Platelet: 150,000 to 400,000 HGB: F: 12 to 16 M: 14 to 18

Older adult safety considerations

· Install bath rails, grab bars, and handrails on stairways · Remove throw rugs · Eliminate clutter from walkways and hallways · Remove extensions and phone cords from walkways and hallways · Properly use mobility aids · Practice safe medication use · Ensure adequate lighting · Wear eyeglasses and hearing aids if needed · Prevent substance use disorder · Install smoke and carbon monoxide detectors in the home · Secure firearms in a safe location · Wear a seatbelt when operating a vehicle · Avoid driving a vehicle during or after drinking alcohol or taking substances that impair sensory and motor functions Wear a helmet while bike riding, skiing, and other recreational activities thar increase the risk of head injury

Histologic Classification of Tumors

· Tumor size and invasion (T), presence or absence of regional spread to the lymph node (N), and metastasis to distant organ sites (M) TUMOR (T) -TX: Unable to evaluate the primary tumor or it can't be measured -TØ: No evidence of primary tumor or it cannot be found -Tis: Tumor in situ, means the cancer cells are only growing in the layer of cells where it started. -T1, T2, T3, and T4: Tumor size and/or extent of tumor spread to nearby areas NODE (N) -NX: Unable to evaluate or assess regional lymph nodes -NØ: There is No evidence of regional node involvement -N1, N2, and N3: Number of nodes that are involved and/or extent of spread METASTASIS (M) -MX: Unable to evaluate distant metastasis -MØ: No evidence of distant metastasis -M1: Presence of distant metastasis has been found in other organs/tissues

Neutropenia

• Monitor temperature (temperature above >37.8 (100) is consider fever, WBC, and ANC (absolute neutrophil count) • With neutropenia may not develop typical signs and symptoms of infection • Monitor skin and mucous membranes for infection (breakdown, fissures, & abscess) • Blood culture before Antibiotic • Hygiene

Cancer: What are the risk factors/Causes it?

• Older adults • Obesity • Smoking • Genetic predisposition • Chronic GERD • Air pollution • Hormone therapy • Diet (high in fat, red meat, low fiber, processed meats, preservatives, excessive alcohol intake) • Viruses (Hepatitis B/C (liver), Epstein Barr (lymphoma), H. pylori (stomach/lymphoma), HPV (cervical), HIV (lymphoma/Kaposi sarcoma)

Thrombocytopenia

• Platelet count <150,000 (at severe risk for bleeding <50,000) • Monitor for petechiae, ecchymosis, bleeding of gums, nosebleeds, and blood in stools, urine, or vomitus • Institute bleeding precautions (avoid IV's or injections or invasive procedures if possible) • Apply pressure for 10 mins after venipuncture • At home: use electric razors, use soft toothbrush, avoid blowing nose vigorously, ensure dentures fit appropriately • Avoid NSAIDS • Prevent injury: wear closed toes shoes, remove tripping hazards in home

The nurse receives report on assigned clients. Who would the nurse see first. A. 77yr old male recently diagnosed with prostate cancer who is complaining of pain 4/10 and received morphine 1hr ago B. 53 yr old female who received chest radiation and is complaining of dyspnea and has JVD distention C. 65 yr old male diagnosed with lymphoma who is complaining of lower extremity weakness and paresthesia D 50 yr old male with a heart murmur

B. 53 yr old female who received chest radiation and is complaining of dyspnea and has JVD distention

A nurse is teaching a client about the side effects of chemotherapy medication. Which of the following nursing statements should the nurse include in the teaching? A. Clients lose their hair, but it usually grows back nice and thick within days." B. Most clients do not experience nausea. C. Hair loss is common and includes eyebrows and eyelashes. D. Most clients start to gain weight during their treatment."

C. Hair loss is common and includes eyebrows and eyelashes. (This nursing statement is correct, because alopecia occurs as a whole-body hair loss for most clients administered chemotherapy. Other common side effects are nausea, vomiting, anorexia, mucositis, leukopenia, thrombocytopenia, anemia, irreversible lung damage)

Chemotherapy Side effects

· Alopecia · Neutropenia · Bone marrow suppression · Anemia · Thrombocytopenia · Nausea · Vomiting · Anorexia · Mucositis · Stomatitis · immunosupressed

Nausea, Vomiting, Anorexia

• Give Antiemetics (to rise levels) before chemo and several days after treatment even if controlled. (give before, during, after) • Eat dry carbs (toast, crackers) before chemo • Removing vomiting cues: such as odors or supplies associated with nausea (dirty or stinky) • Calorie count: Add protein powder, cheese, yogurt to food. • Megestrol (med) - increase appetite • Offer small frequent meals, avoid drinking fluids with food, serve food cold, and use plastic utensils (metal ones can taste bad) • Monitor for malnutrition • Monitor Weight 10% loss Wasting Syndrome • Consult nutrition specialist. Increase protein and calories