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133 Cards in this Set
- Front
- Back
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what is a benign tumor of the uterus called?
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fibroid tumor (myoma)
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Where does a fibroid tumor/myoma arise from?
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Muscle tissue of the uters
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Where is a fibroid tumor/myoma found?
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In the lining, wall and outside surface of the uters
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What hormone is a fibroid tumor/myoma dependent on?
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Estrogen
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When do fibroid tumors/myomas decrease?
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After menopause
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What are the symptoms of a symptomatic fibroid tumor/myoma?
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Pain, pressure, backache, bloating, constipation and urinary problems.
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What is Menorrhagia?
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excessive bleeding
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what is Metrorrhagia?
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Irregular bleeding
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What can fibroid tumor/myoma interfere with?
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Fertility
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How are fibroid tumors/myomas diagnosed?
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History of one or more spontaneous abortions, ultrasound, bimanial exam.
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What can cause symptoms of a fibroid tumor/myoma?
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Pregnancy
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What is a medical management of a small fibroid tumor/myoma?
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Observation
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What is a medication for a fibroid tumor/myoma?
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Leuprolide (lupron)
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What are surgical management options for a fibroid tumor/myoma?
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Surgical Myomectomy, Hysterectomy, Total hysterectomy, Abdominal hysterectomy, Vaginal Hysterectomy, radical hysterectomy, and salpingo-oophorectomy.
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What is a myomectomy?
hysterectomy? total hysterectomy? salpingo-oophorectomy? radical hysterectomy? |
myomectomy-removal of a just the tumor (done for large or serveral fibroids)
hysterectomy-uterus is removed total hysterectomy-removal of uterus & cervix salpingo-oophorectomy-ovaries & tubes removed radical hysterectomy-same as BSO and lymph |
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What are the risk factors for Breast Cancer in Men?
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close relatives with breast cancer, presence of the BRCA 2 gene, Klinefelters syndrome (extra x chromsome-->endocrine condition of testicular failure) and radiation exposure
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Where is the lump located in Breast cancer in men?
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beneath the nipple-areola complex, usually painless
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What kind of breast cancer do men get?
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infiltrating ductal carinoma
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What is the difference between a lymph node infection and a malignant breast lump?
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Infection= tender
malignant lump= non-tender |
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What are the types of noninvasive malignant breast cancer?
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Carcinoma is Situ
ductal carcinoma in situ (DCIS) lobular carcinoma in situ (LCIS) |
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What are malignant cells changes in epithelial tissues that do not extend beyond the basement membrane?
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Carcinoma in Situ
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What is the treatment for a DCIS?
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total or simple mastectomy
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What is the treatment for a LCIS?
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prophylactic bilateral mastectomy, chemo, or tamoxifen
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What is a precursor to increased invasive carcinoma?
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LCIS (Lobular carcinoma in situ)
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How are noninvasive malignant breast cancers found?
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mammography
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What are the invasive carcinomas?
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infiltrating ductal ca
infiltrating lobular ca medullary ca inflammatory ca mucinous ca tubular ca pagets disease |
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1)What is a soild, irregular mass that hardens on palpation?
2)what has a present of an ill defined thickening and ill defined margin in one or both breast? 3)what grows in a capsule inside a duct, characterized by lymphocyte infiltration? 4)what is characterized by skin redness & induration, edema & warmth, nipple retraction and palpable axillary nodes & metastases are present? |
1)Infiltrating ductal ca
2)infiltrating lobular ca 3) medullary ca 4)inflammatory ca |
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What is the most common form of invasive breast cancer?
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infiltrating ductal ca
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What is used to target & identify non-palpable lesions that have been detected with mammography?
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Stereotatic guided biopsy
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what is used to determine if a lump is a cyst? and what will happen after?
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fine needle aspiration
lump will disappear |
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what is for soild tumors done to the entire mass plus a margin of surrounding tissue is removed?
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excisional biopsy
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what is examined for cell type, if malignant, estrogen and progesterone receptor studies done.
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tissue specimens
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What is a lumpectomy?
what is a mastectomy? |
removal of the lump
removal of breast tissue |
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What is a total (simple) mastectomy?
what is a modified radical mastectomy? |
removal of breast and nipple
removal of breast, nipple, and lymph nodes |
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When is a mastectomy done?
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if tumor is larger than 7cm, tumor involves the nipple-areola area, exhibits extensive inra-ductal disease involving multip quadrants, and when they cannot comply with radiation therapy.
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Where do most tumors occur in the breast?
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upper outer quardrant (tail of spence)
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What NSAIDS should be used for Breast Cancer?
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Advil
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What are the most common sites for advance breast cancer bone metastases?
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vertebral column, ribs, sternum and pelvis
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What is defined as "a abnormal collection of excessive tissue proteins, edema, chronic inflammation, and fibromis?"
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lymphedema
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What is primary lymphedema?
what is secondary lymphedema? |
abnormality in lymphatic system
lymphatic injury (breast cancer treatment) |
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During radiation therapy, how should the patient clean the site?
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do not wash the area with soap, only rinse with later only, no lotion or power
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what are the interventions if lympedema is present?
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elevate affected arm on pillows, arm exercises, wear an elastic arm bandage but only during waking hours
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What is defined as "destruction of pancreatic beta cells, leading to absolute insulin deficiency?"
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Type 1 diabetes
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What is type 1 diabetes prone to?
describe them. |
ketoacidiosis-hyperglycemia & excessive ketones
hypoglycemia-low blood glucose level |
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What is defined as "can manufacture some insulin but does not produce sufficient amount of insulin?"
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Type 2 diabetes
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What is defined as "beta cells are chronically exposed to high blood levels of glucose which becomes progressively less efficient?"
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desensitization
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When does insulin resistance occurs?
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when both glucose and blood insulin levels are elevated
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what hormones can lead to diabetes?
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growth hormones
corisol glucagon ephinephrine |
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what drugs can lead to diabetes?
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glucocorticoids
thiazides vacor (rat poison) |
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what disease can lead to diabetes?
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pancreatitis, removal of the pancreas, cystic fibrosis and cushing disease
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what is defined as "impaired glucose tolerance (IGT) or impaired fasting glucose (IFG)?
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Pre-diabetes
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How does insulin work?
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decrease blood glucose by accelertaing its movement from the blood into muscle, liver and fat cells
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without insulin, what 3 metabolic problems occur?
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decrease glucose utilization
increase fat mobilization increase protein utilization |
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What are the 3 P's?
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polyuria-increase urination & large U/0
polydipsia-increase thrist & large U/O polyphagia-Increase appetite and weight loss |
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what are the signs and symptoms of diabetes?
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blurred vision
weight loss (usually type 1) fatigue vaginitis skin and wound infections (staph aureus & candida) circulatory problems paresthesias impotence |
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what is the normal range of sermun glucose?
How do you diagnosis diabetes? |
70-110
fasting serum glucose >126 casual glucose >200 x2 occasions 2 hour postprandial blood glucose >200 |
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What is ketonuria?
what does ketonuria indicate? |
presence of ketones in urine
indicates that the body is using fat as a major source of engry-->ketoacidosis |
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When do you monitor for ketoacidosis?
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illness and when glucose is >300
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What are the rapid acting insulins?
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lispro (humalog)
aspart (novolog) Glulisine (apidra) |
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What are the short acting insulins?
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Regular (humalog R, Novolin R, lletin II regular)
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What are the intermediate acting insulins?
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NPH
(Humulin N, lletin II lente, novolin L, Novolin N) |
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What are the very long acting insulin?
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glargine (lantus)
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What is the onset, peak and duration of the rapid acting insulins?
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Humalog- onset: 10-15 min, peak: 1 hour duration: 2-4 hour
Novolog- onset: 5-15 min Peak: 40-50 min duration: 2-4 hours Apidra- onset: 5-15 min peak: 30-1 hour duration 2 hours |
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What is the onset, peak and duration of the short acting insulins?
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Regular (humalog R, Novlin R, llentin II regular)
onset: 30-1 hour peak: 2-3 hours duration: 4-6 hours |
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What is the onset, peak and duration of the intermediate acting insulins?
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NPH- onset: 2-4 hours
peak: 4-12 hours duration: 16-20 hours Humulin N, lletin II lente, Novolin L, Novolin N- onset: 3-4 hours peak: 4-12 hours duration: 16-20 hours |
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What is the onset, peak and duration of the very long acting insulins?
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lantus- onset: 1 hour peak: none duration: 24 hours
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What are the oral anitdiabetes agents?
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1)sulfonylureas (hypoglycemic)
2)non-sulfonylureas insulin secetagogues (hypoglycemic) 3)Biguanides (insulin sensitizer) 4)Thiazolidinediones (insulin sensitizer) 5)Alpha-glucosidase (insulin sensitizer) 6)Dipeptyldal-Peptidase-4 inhibitor (hypoglycemic) |
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what are the sulfonylureas agents?
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chlopropamide (diabinese)-1st generation
Glipizide (glucotrol)-2nd gen Glyburine (diabeta, micronase)-3rd gen |
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1)What are the non-sulfonylureas insulin secetagogues agents?
2) what are the Biguanides agents? |
1)Repaglinide (prandin)
2)metformin (glucophage) |
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1) what are the Alpha-glucosidase agents?
2) what are the Dipeptyldal-Peptidase-4 inhibitor agents? |
1) miglitol
2)sitagliptin (januvia) |
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How many ml does insulin contain?
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100 USP units
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When does a sliding scale happen?
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When glood glucose is >150
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What insulin can be given IV?
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regular
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what is lipodystrophy?
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thickening of injection site
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What level of blood glucose does hyperglycemia occur?
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>126
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what glucose level does hypoglycemia occur?
why does it occur? |
<50-60
too little of food, too much insilin or oral hypoglycemic agents, alcohol intake |
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What is neuroglycopenia?
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decrease glucose to the brain
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what are the hypoglycemic interventions for the conscious state?
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ingest 10-15 g of simple CHO
3-4 glucose tabs 4-6 oz fruit juice or regular soda 6-10 hard candies 2-3 tbs sugar or honey |
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what are the hypoglycemic interventions for the unconscious state?
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glucagon 1 mg IM or IV
or 50% dextrose in 1 amp over 2-3 min IV-->start 5% D/W IV solution accucheck q 15 min until level >100 then snack of protein & starch (milk/cheese & crackers) |
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Diabetic ketoacidosis can occur with what glucose level?
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>500
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During what state does the body try to compenstate by buffering acid using bicarbonate which is excreted as CO2 & H2O and fails. breath has a fruity or acetone like odor, respirations increase in rate and depth (kussmaul)
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Ketoacidosis
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What can results from ketoacidosis besides coma and death?
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hypovolemic shock
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what does the managment consist of for ketoacidosis?
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fluids (NS),
electrolytes replacement (restore K-slowly IV check for U/0 if below 0.5 tell MD) insulin (first 2-3 hours NS @ 500-1000 ml/hr next serveral hours -1/2 NS @ 200-500 ml/hr when BS reaches 300 or less IV solution to D5W @ doctors rate) reverse shock (blood, albumin other plasma volume expanders) pH < 7.1 -sodium bicarbonate |
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What is a type 2 diabetic condition? and what is it characterized by?
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HHNS (hyperglycemic, hypersmolar, nonketotic syndrome)
extreme hyperglycemia (600-1200) and profound dehydration |
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what is the main difference between DKA and HHNS?
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in HHNS mild or undetectable (absence) of ketonuria
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What is the treatment of HHNS?
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same as DKA but insulin is given slower because pancreas is making insulin. add dextrose when blood glucose reach 250-300
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What are chronic diseases of the arterial system?
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arterioscleosis
atherosclerosis |
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What is characterized by abnormal thickening and hardening of the vessels walls?
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arterioscleosis
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What part of the artery stiffens and thickens which decreases the lumen in arterioscleosis?
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tunica intima
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What is a form of arterioscleosis?
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atherosclerosis
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What is caused by soft depoits of intra-arterial fat & fibrin that harden over time?
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atherosclerosis
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What are the kinds of endothelial injury that leads to atherosclerosis?
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smoking, HTN, diabetes, dyslipidemia, autoimmune disease, and infections
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What is the leading contributor to coronary artery and cerebral disease?
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atherosclerosis
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What are the 3 layers of arterioles and what are they composed of?
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intima (inner smooth endothelial cells)
media (smooth elastic middle layer, allowing for constriction and dilation) adventitia (outer layer of connective tissue) |
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What is the anatomy of the arterial circulation?
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aorta-->branches (femoral)-->arteries-->arterioles-->capillaries-->venules-->veins
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What is lymph fluid composed of?
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dissolved proteins and water
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How is lymph fluid returned?
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returns via venous system
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how much lymph fluid is reabsorbed?
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3 L
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What is the anatomy of the lymphatic circulation?
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larger vessels-->lymphatic venules-->lymphatic veins-->thorax (2 ducts)
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What are the arterial occlusion sites?
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aortoiliac bifurcation
R or L femoral occlusion popliteal/tibial occusion |
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What are the areas affected by arterial occlusions?
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calf claudication
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What are the non invasive studies of arterial occlusion diagnostic?
What are the invasive studies of arterial occlusion diagnostic? |
non-invasive
doppler ultrasound flow study MRI Ankle-brachial index calculation Invasive arteriography spiral ct |
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What is a medication for an arterial occlusion?
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vasodilator: trental; Plental
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what are the signs and symptoms of an arterial occlusion?
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claudication, dependent rubor, arterial steal, bruits
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what are the characteristics of dependent rubor?
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uneven pulse strength, hypertrophied toenails, loss of hair, tissue atrophy, shiny skin, ulcerations, gangrene, purplish discoloration.
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When does claudication occur?
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occurs when a muscle is forced to contract with out adequate blood supply-->muscular hypoxia and metabolite accumulation
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What are the surgical management of aterial occlusion?
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endovascular interventions
(angioscopy, laser, mechanical atherectomy, thrombolytic therapy, and stents. PTCA-percutaneous transluminal angioplasty (stretches the artery enlarging the lumen. Arterial bypass-ateriography (first to indicate level of obstruction) endarterectomy-incision is made into artery and the plaque is removed, artery is sutured. |
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In the Arterial bypass-ateriography, what vein is used?
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saphenous vien
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What are some post op nursing care for an aterial occlusion?
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bed rest with legs flat, pulses distal to surgical site monitored q1hr x 24 hrs (MD notified if pulse is no longer-->return to surgery), monitor skin color, cap refull, sensory and functions, maintain U/O >30 ml/hr, no leg crossing and extremity dependent positioning, monitor edema (some expected; last 4-8 weeks), daily ASA
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What are some post-op complications of arterial occlusion?
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pseudoaneurysm, hematoma, infection, compartment syndrome-->myoglobin release (rusty urine)
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What are the 5 P's?
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Pain, pallor, pulselessness, paresthesia, paralysis
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What is Raynauds phenomenon?
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intermittent attacks of pallor followed by cyanosis, then redness of digits, then return to normal.
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Treatment of raynauds diesease?
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avoid stress, wear gloves, avoid cigraretters, and safety concerns.
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What are known as "abnormal tortuous veins?"
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varicosities
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how are varicosities caused?
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caused by incompetent valves in the superficial saphenous veins.
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how are varicose veins diagnosed?
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doppler ultrasound
MRI tandelenberg test |
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what is knows as "skin changes from chronic edema, skin becomes thickened, hardened, infiltrated with plasma proteins, and has an orange peel appearance."
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Brawny edema
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how is brawny edema different from cardia edema?
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it does not pit on digital pressure
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what are the nonsurgical treatment for varicose and spider veins? describe them.
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sclerosing agent: hypertonic saline in injected into vein and they wear a compression bandage for a period of time.
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what are the surgical treatment for varicose veins?
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vein ligation (tying off) or stripping (removal) on incompetent veins
compression bandages minimun 6 weeks, elevated extremities to minimize post-op edema, gradually increasing amounts of ambulation |
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what is a positive homans sign caused by?
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DVT
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Who should be getting DVT therapy?
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recent abdominal/pelvic surgery, hypercoagulation, varicose veins, obese, BC pills, elderly and bedridden
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What is the prevention for DVT?
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elastic compression stockings, SubQ Herparin, exercise, A-pumps (intermittent pneumatic compression device)
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What are complications of DVT?
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Brawny edema, pulmonary embolism, vavular destruction.
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What medications would you use for DVT?
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anticoagulant therapy
Heparin IV Coumadin thrombolytic therapy- causes thrombus to lysis and dissolve TPA (tissue plasminogen activator) urokinase (used for PE) streptokinase (usually given after MI) |
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What is the normal range for INR for someone on heparin?
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2-3 (2.5 ideal)
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what are some contraindications for anticoagulation therapy?
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GI bleeding, trauma, recent surgery, liver disease, recent CVA, post-partum
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What are the signs and symptoms for AAA?
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small AAA asymptomatic
pulpation abdomen mass with or without pain (bruit may be heard) back pain mottled LE dyspnea cough loss of voice/hoarseness |
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What are the Signs and symptoms of a ruptured AAA?
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severe abdominal pain, back, and flank pain
pulsating abdominal mass or rigid abdomen from internal bleeding Signs of shock: SB/P <100 HR >100 Ecchymosis in flank and peri-anal area N & V w/ sudden hypotension decreased RBC and increased WBC |
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What are the dx tests for a ruptured AAA?
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U/S, CT, MRI, Transesophageal echocardiography
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What are the surgical interventions for a ruptured AAA?
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resection & bypass graft, endovascular stent graft (EVSG)
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What are the signs and symptoms of a arterial embolism?
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pain, pallor, pulselessness, paresthesia, paralysis
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What are the signs and symptoms of post op care after a ruptured AAA that you have to report to the MD?
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absence or decreased pulses, cool, pale, mottled skin, pain, tenderness, redness in calf or leg, and back pain
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