Nursing 302 - Exam 3

interpersonal theory

- Harry Stack Sullivan emphasized the fact that early relationships w/ the parenting figure is crucial for personality development - if children do not have parental figures in their lives = at a higher risk for negative personality development

ED nursing diagnoses

- Imbalanced nutrition: less than body requirements related to refusal to eat (ANOREXIA) - Deficient fluid volume (risk for or actual) related to decreased fluid intake, self-induced vomiting, and laxative and/or diuretic use - Ineffective denial related to or delayed ego development and fear of losing the only aspect of life over which he or she perceives some control (eating) - Imbalanced nutrition: more than body requirements related to compulsive overeating (OBESITY) - Disturbed body image / low self-esteem related to retarded ego development, dysfunctional family system, or feelings of dissatisfaction with body appearance - Anxiety (moderate to severe) related to feelings of helplessness and lack of control over life events

family therapy (Maudsley approach)

- a family treatment for anorexia nervosa that focuses on supporting parents as they determine how to lead their child to eat appropriately - assesses the family's impact on maintaining the disorder - assists in methods to promote adaptive functioning by the pt

leukemia

- a group of malignant disorders involving unregulated production of abnormal and dysfunctional white blood cells in the bone marrow, which crowd normal cells and invade the organs different types: 1. acute myelogenous leukemia (AML): serious infection & abnormal bleeding; more common in adults 2. chronic myelogenous leukemia (CML): Philadelphia chromosome 3. acute lymphocytic leukemia (ALL): most common in children 4. chronic lymphocytic leukemia (CLL) risk factors: chemical agents, smoking, obesity, family hx, previous chemo treatment s/s: - nose bleeds - infection - stomach fullness - bone pain - increased ICP, headaches - wt. loss - fatigue dx: - CBC: abnormal WBCs, platelets, red cell counts - bone marrow biopsy

behavior modification

- a method used for treatment of ED - issues of control are central to the etiology of these disorders - for the program to be successful, the pt must perceive that he or she is in control of treatment - success when the pt... is allowed to contract for privileges based on wt gain; has input into the care plan; and clearly sees what the treatment choices are - the pt has control over eating, amount of exercise pursued, and whether to induce vomiting - staff and pt agree about goals and systems of rewards

fluoxetine

- an SSRI medication used in the treatment of both anorexia nervosa and bulimia nervosa - may cause some wt gain (anorexia) - decreases cravings of CHOs (bulimia) - tripling dose is seen to be effective! - black-box warning for suicidal ideations in adolescents!

anorexia nervosa

- an eating disorder that causes pts to obsess about their wt and what they eat; morbid fear of being overweight - risk factors: adolescent females (10-19 y.o.) - highest mortality rate among all eating disorders s/s - extreme wt loss: less than 75% of normal wt or 25% below normal wt - fluid and electrolyte imbalances: hypokalemia leading to irregular rhythms - lanugo (in severe cases) - amenorrhea - cold intolerance - low vitals (temp, BP, HR) - edema - gross distortion of body image - preoccupation w/ food - starvation that leads to malnutrition (refusal to eat) - anxiety, depression - vigorous exercise - use of diet supplements and laxatives - fear of gaining wt (subjective)

staging

- anatomic extent - size and spread of cancer

Diflucan (fluconazole)

- anti fungal (ergosterol synthesis inhibitor) used to treat and prevent fungal infections - less expensive than posaxonazole but range of treatment is less wide

Valtrex (valacyclovir)

- antiviral drug used to treat herpes virus infections (shingles, cold sores, genital herpes) - has a longer duration than acyclovir so fewer doses per day needed

cluster C

- behaviors described as anxious and fearful - avoidant, dependent, obsessive-compulsive

cluster B

- behaviors described as dramatic, emotional, or erratic - antisocial, borderline, histrionic, narcissistic

cluster A

- behaviors described as odd or eccentric - paranoid, schizoid, and schizotypal

bone marrow biopsy

- bone marrow extracted from iliac crest or sternum for evaluation - nurse's role: drugs!, keep pt still, emotional support, talking pt through procedure

class 1

- cancer class that consists of cancer prevention/screening and diagnosis - leukemia, lymphoma, multiple myeloma

lymphoma

- cancers that originate in the lymphatic system - spreads generally quickly, usually throughout the whole body risk factors: Epstein-Barr Virus (EBV), HIV infection, radiation exposure, environmental factors, immunocompromised s/s: - enlarged lymph nodes - alcohol-induced pain - wt. loss - fatigue, weakness - chills - tachycardia - spleen/liver enlargement dx: - lymph node biopsy - CBC - CT, MRI - PET (looking for areas of metabolic activity = hot spots may indicate cancer) - bone marrow tests - Hodgkin's = Reed-Sternberg cells

cancer dx

- clinical exam of body parts (testicular, breast, digital rectal exams, etc.) - MRI, x-ray, mammogram, endoscopy - main dx tool: biopsy (prostate, breast, endoscopic, bone marrow)

care coordination

- consists of an RN care coordinator, geneticist, radiation oncologist, medical oncologist, radiologist, and surgeon - advantages: timely; convenient for provider, pt, and family - disadvantages: cognitive overload

benign tumor cells

- continuous or inappropriate cell growth - specific morphology - specific differentiated functions - tight adherence - no migration - orderly growth - normal chromosomes

lymphoma treatment

- depends on type and clinical behavior = more aggressive types are easier to treat - combination chemotherapy - radiation - fertility planning

tumor markers

- enzymes, hormones, and fetal agents that are overly expressed when cancer is present - enzymes: higher levels of acid phosphatase, alkaline phosphatase, and amylase in liver cancer pts and alcoholics - hormones: elevated levels of adrenal corticotropic hormone (ACTH) in pituitary cancer and human chorionic gonadotropin (hCG) in testicular cancer

bulimia nervosa

- episodes of uncontrolled binge eating, in secret, where pt eats a lot of food at one time, followed by self-induced behaviors like vomiting (purging), laxative and diuretic use, fasting, and excessive exercise - usually only stopped by abdominal discomfort - distorted body image and obsessive desire to loose wt - late in adolescence or early adulthood - occurs primarily in societies that emphasize thinness s/s - binge eating followed by compensatory behavior (purging, exercising, fasting, laxatives) - tooth and gum deterioration d/t stomach acid - scaly skin - may have calluses on knuckles (hints at purging behaviors) - normal body wt! - depression, anxiety, substance abuse = not uncommon - persistent worry of self appearance

initiation

- first stage of cancer development - occurs when oncogenes (gene that can transform a cell into tumor cell) are "turned on" - an irreversible mutation of a cell's genetic structure * not all mutated cells develop into a tumor but have potential - needs a stimulus to self-replicate and grow caused by...viruses, hormones, radiation, chemicals, genetics, and unknown factors

metastasis

- fourth stage of cancer development 1. malignant transformation 2. tumor vascularization 3. blood vessel penetration 4. arrest and invasion common areas: brain, lungs, lymph nodes, liver, bones

grading

- histologic (tissue level) degree of cell differentiation - appearance of cancer cells and tissue

personality disorder treatment

- interpersonal psychotherapy: understand and modify maladaptive behaviors - psychoanalytical psychotherapy: focuses on unconscious motivation/need for seeking total satisfaction from others - milieu/group therapy: appropriate for others who respond more adaptively to support and feedback from peers - cognitive behavioral therapy (CBT): recognize and correct internal mental schemata - dialectical behavioral therapy (DBT): treatment for chronic, self-injurious behavior of clients w/ BPD - medications treat symptomatic relief - SSRIs treat impulsivity and self-destructive acts - antipsychotics treat psychotic decompensation, illusions, ideas of reference, and paranoid thinking - lithium carbonate and propranolol treat episodes of violence in those w/ antisocial personality disorder

cancer prevention

- limit alcohol use - regular physical activity - maintain a normal body weight - obtain regular recommended screenings (prevent late detection) - avoid cigarette smoking and tobacco - use sunscreen and limit sun exposure - eat a healthy diet w/ fruits and vegetables

normal cells

- limited cell division - specific morphology - differentiated function - tight adherence (sticking together) - non-migratory - contact inhibition - apoptosis (programmed cellular death) - normal chromosomes (23 pairs)

stem cell transplant

- may be considered in the treatment of leukemia - allogenic: stem cells acquired through a matched donor, preferably a first sibling - autologous: pt receives their own stem cells - lengthy hospitalization * more painful for donor than recipient (given as IV infusion)

bulimia interventions

- monitor pt behavior for 1-2 hours after each meal - one on one supervision during meals - monitor for fluid and electrolyte imbalances: hypokalemia!! - monitor for cardiac arrhythmias - check for hidden (trashed) binging or purging as evidenced by food wrapped or laxative boxes - food diary during hospitalization - schedule healthy, balanced meals to avoid binge-purge cycles - increase control over stressful situations - Bupropion is appropriate for pts who do not purge

TNM

- primary tumor: describes the size of the original (primary) tumor and whether it has invaded nearby tissues - regional lymph nodes: describes nearby (regional) lymph nodes that are involved - distant metastases: describes distant metastasis (spread of cancer from one part of body to another) * higher the number, worse the cancer is

cancer cells (malignant)

- rapid or continuous cell division - specific functions lost - loose adherence - migration - no contact inhibition - abnormal chromosomes (number and/or shape)

binge eating disorder (BED)

- recurrent episodes of eating significantly more (binging!) than most people would in a similar period of time under similar circumstances - does not engage in behaviors to rid the body of excess calories - poses the health risk of obesity! - BMI > 30 - etiology is unknown but treated as an addiction illness

promotion

- second stage of cancer development - "feeding" the cells: reversible proliferation of mutated cells promoting factors...obesity, smoking, alcohol, high dietary fat intake * key to prevention of cancer is removing promoting factors

progression

- third stage of cancer development - increased growth and invasiveness and spread to other sites - metastasis via blood and lymphatic system - tumor angiogenesis: if cells do not have enough oxygen, they send out HIF-1, stimulating the body to grow additional blood vessels *Avastin to prevent growth of new blood vessels

hypothalamus

- this part of the brain contains the appetite regulation center - regulates the body's ability to recognize when it is hungry, when it is not hungry, and when it has been sated

individual therapy

- this type of therapy may be helpful in ED when there is an underlying psychological problem(s) that are contributing to the maladaptive behaviors - not the primary source of treatment but may be additional mental health disorders - educates pt and allows them to identify coping strategies and problem-solving skills

anorexia interventions

- usually outpatient treatment - may need hospitalization if wt drops below 75% of normal wt, hypokalemia, malnutrition, suicidal ideations, etc. - increase caloric intake for gradual wt gain - physical needs first, then mental needs (wt restoration) - one on one supervision during feedings - encourage and reinforce progress toward healthy wt

antisocial personality disorder criteria

1. a pervasive pattern of disregard for and violation of the rights of others 2. failure to conform to social norms w/ respect to lawful behavior 3. deceitfulness 4. impulsivity 5. irritability and aggressiveness 6. reckless disregard for the safety of others 7. consistent irresponsibility 8. lack of remorse 9. extremely manipulative

biopsy

1. fine needle aspiration to collect a sample of cells - used for a mass you can feel 2. core needle biopsy to collect core of tissue w/ the use of US or MRI to guide the process - used for a deeper tumor 3. open (surgical) biopsy to remove all or part of abnormality

BPD criteria

1. frantic efforts to avoid real or imagined abandonments 2. a pattern of unstable and intense interpersonal relationships (alternating between idealization and devaluation) 3. markedly and persistently unstable self-image 4. impulsivity in at least two areas (spending, sex, substance abuse, reckless driving, binge eating) 5. recurred suicidal behavior, gestures, threats, or self-mutilation 6. affective instability 7. chronic feelings of emptiness 8. inappropriate, intense anger or difficulty controlling anger 9. transient, stress-related paranoia ideations 10. SPLITTING

cancer development

1. initiation 2. promotion 3. progression 4. metastasis

Zofran (ondansetron)

5-HT3 antagonist that is used to prevent and/or treat nausea and vomiting

D

A client is 5 feet 8 inches tall and weighs 105 pounds. The client has been taking laxatives daily and self-induces vomiting after eating. Which is the priority nursing diagnosis for this client? A. Ineffective denial B. Disturbed body image C. Low self-esteem D. Imbalanced nutrition, less than body requirements

A, D, E, F, G

A nurse is caring for a patient with anorexia nervosa. The patient was admitted for malnutrition concerns. Which interventions should the nurse implement? A. Strict record of protein and calorie intake B. Allow the patient to eat by themselves C. Light exercise should be encouraged D. Restrict exercise privileges E. Weigh the patient each morning before oral intake F. Stay with the patient during meals and 1 hour after the meal G. Help the patient identify triggers H. Let the patient choose what to eat

C

A patient who is scheduled for a breast biopsy asks the nurse the different between a benign tumor and a malignant tumor. Which answer by the nurse is correct? A. "Benign tumors do not cause damage to other tissues" B. "Benign tumors are likely to recur in the same location" C. "Malignant tumors may spread to other tissues or organs" D. "Malignant tumors are easier to remove than benign tumors"

C

The nurse is caring for a patient diagnosed with stage I colon cancer. When assessing the need for psychologic support, which question by the nurse will provide the most information? A. "How long ago were you diagnosed with this cancer?" B. "Do you have any concerns about body image changes?" C. "Can you tell me what has been helpful to you in the past when coping with stressful events?" D. "Are you familiar with the stages of emotional adjustment to a diagnosis like cancer of the colon?"

D

The nurse is caring for a patient who smokes two packs/day. Which action by the nurse could help reduce the patient's risk of lung cancer? A. Teach the patient about the seven warning signs of cancer B. Plan to monitor the patient's carinoembryonic antigen (CEA) level C. Teach the patient about annual chest x-rays for lung cancer screening D. Discuss risks associated with cigarette smoking during each patient encounter

A

The nurse is teaching a wellness class to a group of women at their workplace. Which findings represent the highest risk for developing cancer? A. Body mass index of 35 kg/m2 and smoking cigarettes for 20 years B. Family history of colorectal cancer and consumes a high-fiber diet C. Limits fat consumption and has regular mammography and Pap screenings D. Exercises five times every week and does not consume alcoholic beverages

C

The nurse teaches a patient who is scheduled for a prostate needle biopsy about the procedure. Which statement, if made by the patient, indicates that teaching was effective? A. "The biopsy will remove the cancer in my prostate gland" B. "The biopsy will determine how much longer I have to live" C. "The biopsy will help decide the treatment for my enlarged prostate" D. "The biopsy will indicate whether the cancer has spread to other organs"

society culture

What two things are eating disorders influenced by?

D

Which assessment finding would the nurse expect in clients diagnosed with bulimia nervosa? A. They are below normal weight B. They binge when they experience hunger C. They will be highly motivated to seek help D. They are within their normal weight range

B

Which is a characteristic of the diagnosis of anorexia nervosa? A. Obsession with weight gain B. Body image disturbance C. Disregard for the feeling of others D. Healthy family relationships

Amphojel (aluminium hydroxide)

an antacid that is commonly used after chemotherapy and/or radiation

Emend (Aprepitant)

an antiemetic chemical compound that belongs to a class of drugs called substance P antagonists (SPA)

Cystosar-U (cytarabine)

an antimetabolite and pyrimidine analog that suppresses DNA synthesis

Lorazepam Intensol (lorazepam)

an oral solution that contains a concentrate of benzodiazepine to reduce anxiety

< 17 ( < 15 in extreme cases)

anorexia is characterized by a BMI of what number?

oncofetal antigens

antigens which are typically found in fetal cells - when a gene mutation has occurred in an adult cell, the mutated cells may go back to producing fetal antigens

Trexall (methotrexate)

antineoplastic agent antimetabolite and folic acid analog that disrupts DNA synthesis

Zovirax (acyclovir)

antiviral drug that treats herpes virus infections (shingles, genital herpes, mononucleosis, topical cream for chickenpox)

Aredia (pamidronate disodium)

biphosphate used to treat hypercalcemia from osteoclastic bone lesions

class 4

cancer class that consists of cancer treatment modalities of chemotherapy, radiation, biologic response modifier therapy, and hormonal therapy (oncological emergencies)

class 3

cancer class that consists of surgical cancer treatment for brain, ovary, breast, prostate, larynx, and lung cancer

class 2

cancer class that consists of surgical cancer treatment for colon, bladder, and cervical cancer (ostomy surgeries)

schizotypal personality disorder

cluster A disorder - aloof and isolated - magical thinking - ideas of references - illusions - cannot orient thoughts logically (distorted thinking) - may demonstrate psychotic symptoms under stress

paranoid personality disorder

cluster A disorder - pervasive mistrust and suspicion of others - constantly on guard - hypervigilant - tense and irritable - insensitive to the feelings of others - attributing their short-comings to others - envious and hostile toward those who are successful - aggression and violence - feels as though people are trying to take advantage of them

schizoid personality disorder

cluster A disorder - profound deficient in the ability to form personal relationships - discomfort w/ human interaction - appear cold and aloof - prefer to work in isolation - uneasy in the presence of others - inappropriately serious about everything - bland affect - no spontaneity - inability to respond to others in an emotional manner

antisocial personality disorder

cluster B disorder - a general disregard for the rights of others - exploit and manipulate others for personal gain/desires - do not accept responsibility for their own actions/behaviors - tendency to ignore authority/rules

histrionic personality disorder

cluster B disorder - dramatic and excitable - emotional people - difficulty maintaining long-lasting relationships - require constant affirmation of approval and acceptance from others - attention seeking - overly gregarious and seductive - easily influenced by others - strongly dependent

narcissistic personality disorder

cluster B disorder - exaggerated sense of self-worth - lack empathy - overly self-centered - exploiting others to fulfill their own desires - believe they are entitled to special rights/privileges - mood can easily change d/t low self-esteem

borderline personality disorder (BPD)

cluster B disorder - pattern of intense and chaotic relationships - affective instability - fluctuating attitudes toward other people - lack a clear sense of identity - characterized by job losses and marriage breakups - fear of abandonment - always in a state of crisis - hx of suicide ideations/attempts - excessively seeks reassurance

dependent personality disorder

cluster C behavior - lack of self-confidence - allow others to make decisions - feel helpless when alone - submissive and passive roles in relationships - tolerate mistreatment from others - low self-worth - easily hurt by criticism and disapproval

avoidant personality disorder

cluster C behavior - sensitive to rejection - lead a very socially withdrawn life - awkward and uncomfortable in social situations - often lonely and express feelings of being unwanted - view others as critical, betraying, and humiliating

obsessive-compulsive disorder

cluster C behavior - very serious and formal - overly disciplined - perfectionistic - preoccupied w/ rules - intense fear of making mistakes - inflexible and lack spontaneity - work diligently and patiently at tasks that require accuracy and discipline

Fligrastim (Neupogen)

colony stimulating factor that increases WBCs

Hydrea (hydroxyurea)

cytotoxic drug used to decrease the number of nonfunctional WBCs

Decadron (dexamethasone)

glucocorticoid that is used to treat inflammation and swelling (edema)

Avastin (bevacizumab)

inhibits the growth of blood vessels in tumors

Miralax (polyethylene glycol)

laxative used to treat occasional constipation

CEA

name the oncofetal antigen found in GI tract cancer

AFP

name the oncofetal antigen found in liver cancer

CA-125

name the oncofetal antigen found in ovarian cancer

CA-19-9

name the oncofetal antigen found in pancreatic cancer

PSA (prostate specific antigen)

name the oncofetal antigen found in prostate cancer

Roxicodone (oxycodone hydrochloride)

oral opioid analgesic for moderate to severe pain

leukemia treatment

phases of chemo 1. induction: high doses of drugs; may be over 4 weeks; goal at end is to have bone marrow biopsy free of abnormal cells 2. intensification: more aggressive chemo; targets cells at a different cell cycle stage 3. consolidation: started after remission is achieved; goal is to kill any remaining newly developing leukemic cells supportive care - Hydrea: decrease number of abnormal WBCs - leukapheresis: machine removes WBCs - antibiotics, antivirals, antifungals: prophylaxis d/t decreased number of working WBCs - blood transfusions: decrease anemia/bleeding concerns

cancer's 7 warning signs

remember: s/s that cannot be explained

cancer treatment

this depends on... - type, locations, and size of tumor - stage, grade, classification - quality of life (patient physiologic state) - patient desire

sarcoma

tissue of origin is connective tissue, muscle, bone, and fat

carcinoma

tissue of origin is skin, glands, mucus membrane linings of the respiratory, GI, and GU tract

gliomas

tissue of origin is the brain (tissue or cells) - astrocytoma, glioblastoma

hematopoietic

tissue of origin pertaining to the formation of blood or blood cells - lymphoma and leukemia

Duragesic (fentanyl)

transdermal opioid analgesic

true

true or false: no medications are specifically indicated for eating disorders

true

true or false: topiramate and lisdexamfetamine reduce incidences of binge eating in patients with BED

Zyloprim (allopurinol)

used to treat hyperuricemia by binding w/ uric acid so that it can be excreted

biopsy

what procedure is used to officially diagnosis cancer?