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NU310 EXAM 1 STUDY GUIDE WITH COMPLETE SOLUTIONS
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Atelectasis: types, symptoms, treatments, and assessment finding symptoms: insidious, cough, sputum production, low-grade fever, respiratory distress, anxiety, hypoxia occurs if large areas of the lung are affected
Tuberculosis: risks
- Close contact with someone who has active TB
- Immunocompromised status
- Inadequate health care
- Preexisting medical conditions or special treatment
Tuberculosis: prevention -Isolation precautions immediately for all patients who are suspected or confirmed to have active TB -Isolation precautions include: private room with negative pressure Wearing of disposable particulate respirators, fitted snugly to the face, for example, N masks Continue to implement isolation precautions until clinical improvement indicates that the patient is no longer infectious Put in place special precautions during cough-inducing procedures
Tuberculosis: diagnosis If patient is encountered presenting any of the following Positive skin test Blood test Sputum culture for acid-fast bacilli Continue with diagnostic work-up Complete history and physical examination Tuberculin skin test Chest x-ray Drug susceptibility testing Tuberculosis: diagnosis tuberculin skin test, TB blood test, sputum culture. Once a patient develops a positive
skin test, blood test, or sputum culture, a chest x-ray and drug susceptibility test is done.
Tuberculosis: management -TB is managed principally with anti-TB drugs for 6 to 12 months Initial phase: includes multiple-drug regimen (8 weeks) Continuation regimen is 4 or 7 months -Client is no longer contagious after 2 to 3 weeks of continuous medication treatment -Medication treatment can be used as a prophylaxis for those at risk
Tuberculosis: nursing interventions airway clearance is facilitated by: fluid intake encourages systemic hydration and serves as an effective expectorant, postural drainage the medication regimen is reinforced in conjunction with activity and nutrition, infection is prevented-airborne precautions postural drainage technique of placing a patient in a position so that gravity helps in the expectoration of secretions from bronchi and lobes of lungs
Pulmonary Emboli: evaluation dyspnea, chest pain, anxiety, fever, tachycardia, apprehension, cough, diaphoresis, hemoptysis, and syncope. The most common sign is tachypnea (rapid respiratory rate).
Pulmonary Emboli: diagnostics Chest x-ray: may reveal infiltration, atelectasis, elevation of the diaphragm on the affected side, or a pleural effusion. The chest x-ray is most useful for excluding other possible causes ECG: the most common abnormality is a nonspecific S-T wave abnormalities Pulse oximetry: Arterial blood gas analysis: may reveal hypoxemia or hypocapnia, but they also may appear normal MDCTA: is the criterion standard for diagnosing PE. It provides a high-quality visualization of the lung parenchyma (if the MDCTA is not avail. a pulmonary arteriogram or V./Q. scan are diagnostic alternatives)
-Limited community assets -Health care access, delivery, and quality -Lack of insurance coverage
Asthma: prevention -Patients are taught to avoid the causative agents whenever it's possible. -A patient with recurring asthma should be tested to determine what substances trigger the symptoms.
Asthma: evaluation -Family medical history -Environmental -Occupation related to irritants -Medical conditions: GI reflux, drug-induced asthma, allergies. Labs showing -Sputum and blood tests, ABGs, Pulse oximetry
Asthma: diagnostics -sputum and blood tests may reveal eosinophilia (elevated levels of eosinophils) -Serum levels of IgE may be elevated -Abg analysis and pulse oximetry reveal hypoxemia during acute attacks. -Initially, hypocapnia and respiratory alkalosis are present. As the patient's condition worsens and they become more fatigued, the PaCO2 may increase.
Asthma: management -Pharmacotherapy (meter dosed inhalers) -Quick-relief medications: Beta2-adrenergic agonists (i.e., albuterol, ventolin.) Anticholinergics (e.g., atrovent)
-Long-acting medications Corticosteroids : inhaled form and/ or systemic Long-acting beta2-adrenergic agonists Leukotriene modifiers Asthma: nursing care The patient requires a history of allergic reactions to medications prior to medication administration The nurse identifies medications the patient is currently taking Administer medications as prescribed and monitor the patient's response to medications Administer fluids The nurse monitors the patient's respiratory status by monitoring the severity of symptoms, breath sounds, peak flow, pulse oximetry, and vital signs COPD: symptoms Chronic cough, sputum production, and dyspnea Weight loss Respiratory insufficiency and respiratory infections Emphysema patients have barrel chest Musculoskeletal wasting Symptoms worsen over time!!
COPD: physical findings barrel-shaped chest, clubbing of fingers, edema, prominent accessory muscles
types of COPD chronic bronchitis and emphysema
COPD- indications of, lab changes -spirometry: measures reduced forced expiratory volume to forced vital capacity ratio to determine severity of obstruction and reversibility of it. -ABG
expelled during exhalation with resultant tension on the heart and great vessels.
Chest Tubes- indications and care Chest tubes and a closed drainage system are utilized to re-expand the involved lung and to remove excess air, fluid, and blood, and may be used in patients who have had a thoracotomy (see above discussion). Chest drainage systems also are commonly applied in the care of spontaneous pneumothorax and trauma involving pneumothorax
Nursing management of a chest tube and patient with a chest tube
- Assessment:
-Respiratory Assessment
-Chest Tube Site Assessment: Assess the site of chest tube insertion for any redness, swelling, or infection. Subcutaneous emphysema (air in the tissues).
Assess dressing for intactness and leakage.
-Drainage System Assessment: Assess regularly the color and character and amount of drainage. Bubbling in the water seal chamber indicates an air leak.
- Monitoring:
Vital Signs
- Chest Tube Drainage System: Provide appropriate care for chest tube drainage, ensuring its functionality.
- Pain Management: Monitor and alleviate pain around the site of insertion of the chest tube by medicating analgesics accordingly prescribed and conducting effectiveness.
- Mobility/ Positioning: Allow and promote early ambulation for the prevention of complications.
- Coughing and Deep Breathing
- Care for Dressing : This involves frequent change of dressing according to institution policy. Make the dressing clean and dry for preventing infection
- Care related to complications : Observe the development of air leak tension, pneumothorax or chest tube system obstruction.
- Teaching to patient
- Psychosocial Interventions : Assure emotional support and less anxiety and fears that patient might feel towards chest tube insertion.
- Documentation
Normal Chest Tube Client Expected Chest Tube Output: The chest tube drainage should be clear or slightly bloody early postoperatively.
Water Seal Chamber: Intermittent bubbling during coughing or deep breathing is considered normal. Continuous gentle bubbling may also appear during expiration.
Airtight Seal in Water Seal Chamber:
Fluctuation of the water level with the initiation and expiration of inspiration and expiration is normal.
Tidaling in Water Seal Chamber:
Pain and Respiratory Distress: Increased pain or sudden respiratory distress may suggest complications such as tension pneumothorax or infection.
Fever and Signs of Infection: Increased temperature, redness, or purulent drainage from the insertion site may indicate infection. notify provider
Incidence number of new cases occurring in a specific population during a year, expressed as the number of cancer diagnoses per 100,000 people
Prevalence total number of people alive today whose cancer has been diagnosed in the current year and those whose cancer has been diagnosed previously.
Cancer a large group of diseases characterized by the uncontrolled growth and spread of abnormal cells
Tumor any abnormal proliferation of cells; clumping of neoplasmic cells
Benign tumor stays confined to its original location and harmless depending upon where the neoplasm -noncancerous
Malignant tumor Invasion into other tissue, metastasizes to other locations; tends to worsen over time
-cancerous Neoplasm Any new growth or tissue that doesn't have physiological function benign/malignant Biopsy examination made of microscopic appearance of cells development Metastasis not encapsulated fibrous capsule has the ability of spreading to various organs Mutant cells alteration or RNA and DNA within a cell can result in an abnormal production of cell very different in form, quality and function from cell Differention cellular maturation or the extent to which a cell looks like its parent cells
Oncogenes -portions of DNA that when activated make cells malignant cells -BRCA1 and BRCA2 are human genes that produce tumor suppressor proteins. These proteins assist in repairing damaged DNA -Specific inherited mutations in BRCA1 and BRCA2 increase the risk of female breast and ovarian cancers, and they have been associated with increased risks of several additional types of cancer.
Types of Cancer Carcinomas- constitute 90% of cancers, are cancers of epithelial cells.
Sarcomas- are rare and consist of tumors of connective tissues (connective tissue, muscle, bone etc.).
Leukemias and lymphomas- constitute 8% of tumors. Sometimes referred to as liquid
smoking (chemicals)
Radiation: e.g. skin cancer, 80% related to sun and tanning beds, diagnostic and therapeutic procedures
Warning signs of cancer and reducing risks A change in bowel or bladder habits A sore that does not heal Unusual bleeding or discharge Thickening or a lump in the breast, testicles or any part of the body Chronic indigestion or swallowing problems An obvious change in a wart or a mole or skin condition A nagging cough or hoarseness
Nursing care of a client with cancer -Health history -Routine assessment, check up, and screenings -Client awareness -Diagnostic evaluation -Screening examination recommendations by American Cancer Society; specifics are made according to age and frequencies --Breast Cancer: self-breast exam, breast examination by health care professionals, screening mammogram --Colon and Rectal Cancer: fecal occult blood, flexible sigmoidoscopy, colonoscopy --Cervical, Uterine Cancer: Papanicolaou (Pap) test --Prostate Cancer: digital rectal exam, Prostate-specific antigen (PSA) test -Explain procedure fully to alleviate anxiety and encourage cooperation -Demonstrate procedures or self assessments to insure accuracy of results
-Use opportunity to teach health habits such as staying out of the sun, diet high in fruit and roughage and low in fat,
Cancer Treatment Treatment Goals: depending on type and stage of cancer Cure Recover from specific cancer with treatment Alert for reoccurrence May involve rehabilitation w/physical and occupational therapy
Control: of symptoms and progression of cancer Continued surveillance Treatment when indicated (e.g. some bladder cancer, prostate cancer)
Palliation of symptoms: may involve terminal care if client's cancer is not responding to treatment
Surgery Goal: diagnosis, staging, and/ or treatment -Diagnostic: cytologic specimens, needle biopsy, excisional or excisional biopsy -Treatment: Involves removal of body part, organ, sometimes with altered functioning (e.g. colostomy); Debulking (decrease size of) tumors in advanced cases -Recurrence and metastasis -Palliation -Reconstructive -Preventive Nursing care as for post op care would care, infection prevention, monitoring for complications teaching, psychologic support, follow up
Radiation Therapy -Goal: primary treatment, adjuvant therapy, palliation -Radiation: kill or reduce tumor, relieve pain or obstruction Destroy cancer cells with
Neutropenic precautions
Private room
Good handwashing
Monitor temp q 4 hours, monitor for chills, UTI, pneumonia
Limit visitors to healthy adults
No flowers or plants
Monitor neutrophil count
Side effects of chemo: Neutropenic precautions -Private room -Good handwashing -Monitor temp q 4 hours, monitor for chills, UTI, pneumonia
- Restrict visitors to well adults -No flowers/plants -Watch CBC's for neutrophil count thrombocytopenia Chemotherapy side effects: thrombocytopenia (drop in platlet count below 100,000) -Test pt for bleeding in stool and urine -Avoid punctures for IV or IM
-Treat pt gingerly -Use electric razor -Avoid placing foley or rectal thermometers -Avoid traumatic oral care w/soft bristle brushes avoid flossing avoid hard candy -Watch for changes in pupils that indicates intracranial bleeds -Stool softeners to avoid straining Chemotherapy side effects : mucocitis Inflammation and ulceration of mucous membranes and entire GI tract Rinse mouth with ½ normal saline and ½ peroxide every 12 hours Topical analgesic medication Avoid mouthwashes with alcohol Avoid spicy or hard food Watch nutritional status
Side effects of chemo: Alopecia (Hair loss) 2-3 weeks after treatment is started Affects all the hair, including eyebrows, eyelashes Within 4-8 weeks after treatment hair begins to grow back -Before hair loss, have pt. select wig of similar color as hair
Side effects of chemotherapy: Peripheral Neuropathy -Numbness and tingling to fingers and toes in glove and stocking distribution -may cause gait and possible falling problems
Treatment Modalities -Surgery -Radiation Therapy
-Triggered by severe illness, usually sepsis in cancer patients -Abnormal clotting uses up existing clotting factors and platelets quickly then the pt hemorrhages -Mortality rate is 70% -Prevention of sepsis is key currentState.bottom
Oncologic emergencies: Spinal Cord Compression -Pressure from expanding tumor or vertebral collapse can cause irreversible paraplegia -Back pain initial symptom with progressive paresthesia and paralysis --Paralysis is usually permanent -Treatment: early detection -High dose corticosteroid to decrease the swelling -radiation or surgical decompression currentState.bottom
Oncologic emergencies: Obstructive Uropathy -Concern: blockage of urine flow; undiagnosed can result in renal failure -Treatment: restore urine flow currentState.bottom
Oncologic emergencies: Hypercalcemia -High calcium usually from bone metastases May also originate from lung, head, neck, kidney and lymph nodes cancer secreting parathyroid hormone causing release of calcium from the bone Symptoms: Fatigue, muscle weakness, polyuria, constipation, progressing to coma, seizures Treatment Restore fluids with intravenous saline which increases excretion of calcium Loop diuretics increases calcium excretion Calcium chelators such as mithracin Inhibit calcium resorption from the bone with calcitonin, diphosphonate
Oncologic emergencies: SIADH (Syndrome of Inappropriate Antidiuretic Hormone Secretion)
-Ectopic ADH production from tumor leads to excessive hyponatremia -Holds on to too much fluid which decreases sodium levels -Symptoms Weakness, muscle cramps, fatigue, ALOC, headache, seizures -Treatment: restore sodium level, Fluid restriction Increase sodium, Antibiotic demeclocycline works in opposition to ADH( Limits ADH effect on distal renal tubules so they can excrete water)
Oncologic emergencies: Tumor Lysis Syndrome
Tumor Lysis Syndrome: -Occurs w/ rapid necrosis of tumor cells w/ chemotherapy -When tumor cells die they release potassium and purines -Potassium elevation causes cardiac arrhthymias, muscle weakness, twitching, cramps -Purines convert to uric acid which causes renal failure, flank pain, gout -Hyperphosphatemia w/ secondary to hypocalcemia causes heart block, HTN, renal failure -Treatment: Hydration- increase fluid intake before and after chemo, Diuretics to increase urine flow, Allopurinol to increase uric acid excretion, May need dialysis
Pre-operative teaching and assessments preoperative assessments: nutritional & fluid status, dentition, drug/alcohol use, respiratory status, cardiovascular status, hepatic renal function, endocrine function, immune function, previous/current medications, psychosocial factors, spiritual/cultural beliefs. teachings: complete teachings of procedure, preventing possible complications (DVT, VTE, SSI), pain management, nutrition, deep breathing, coping strategies, mobility.
Lab data- establishing a baseline of normal and abnormal, labs required/obtained pre-op and why? preoperative diagnostic tests: urinalysis/culture, CBC, Chemistry, ECG, ABG, PT/PTT, CXR, Pregnancy test, HbA1C, pulmonary function test, drug test
