Adult Health Test 3

Front 1

Internal factors leading to CA

Back 1

inherited genetic mutations, hormones, immune conditions, and mutations occurring from metabolism.

Front 2

External factors leading to CA

Back 2

Carcinogenic substances, etc...10 or more years pass before any signs of CA noted

Front 3

Lifetime risk

Back 3

The probablility that over the lifetime, a person will become diagnosed with CA

Front 4

Viruses and bacteria linked to CA

Back 4

HIV, HPV, HBV, and helicobacter

Front 5

Carcinoma

Back 5

Originates in surface of tissue or body organs. 80-90% of CA

Front 6

Sarcoma

Back 6

Originates in bone, cartilage, muscle, connective, fatty, or fibrous tissue

Front 7

Myeloma

Back 7

Originates in plasma cells of bone marrow

Front 8

Lymphoma

Back 8

Originates in lymph system (e.g. Hodgkin's dz)

Front 9

Leukemia

Back 9

Originates in blood forming tissue

Front 10

Benign tumor char.

Back 10

Encapsulated, differentiated, no metastasis, rare recurrence, slightly vascularized, resembles parent cell

Front 11

Malignant tumor char.

Back 11

Rarely encapsulated, poorly differentiated, freq. metastasis and recurrence, moder. to marked vascularity, abnormal appear.

Front 12

Cancer staging

Back 12

Number (bigger=worse), localization, metastasis, or recurrent

Front 13

TNM Classification system

Back 13

T: size of tumor
N: regional lymph node involvement
M:metastasis

Front 14

Carcinoma in situ

Back 14

CA has not spread to other cell layers

Front 15

Invasive

Back 15

CA has spread beyond original layer of cells

Front 16

Freq. of CBE

Back 16

Q3yrs. ages 20-39
qyr. 40+

Front 17

Ductal carcinoma

Back 17

(aka intraductal carcinoma)CA is in lining of milk ducts

Front 18

Lobular carcinoma

Back 18

CA in lobules of breast, at increased risk of developing invasive carcinoma

Front 19

Adeno carcinoma

Back 19

Develops in glandular tissue

Front 20

DCIS

Back 20

(Ductal carcinoma in situ) non-invasive neoplasm that can but not always progress to invasive ca. Ductal origin, picked up on mammogram

Front 21

Fat and breast ca

Back 21

Fat produces a stronger form of estrogen than ovaries, can lead to b. CA

Front 22

ER/PR value

Back 22

estrogen receptor/progesterone receptor. A low proliferative activity a good prognostic indicator

Front 23

HER-2-NEU

Back 23

overexpression of this gene occurs in 20% of b.CA, poor prognostic indicator

Front 24

neo-adjuvant chemo

Back 24

tx for very large tumors. Chemo to shrink tumor, surgical removal, then chemo again

Front 25

Targeted therapy

Back 25

Gene therapy for HER-2-NEU

Front 26

Anti-estrogen therapy

Back 26

(ER/PR positive) Tamoxifen (pre-menopausal) Arimidex and Femara (post-menopausal). Stop estrogen prod. in fat cells (aromatase inhibitors)

Front 27

Prostate cancer

Back 27

Most common non-skin CA in males, 2nd leading CA death in males, AA highest incidence rate worldwide

Front 28

Risk factors for prostate CA

Back 28

75% dx in men aged 65+, ethinicity, family hx,diet high in sat. fats

Front 29

Symptoms of prostate CA

Back 29

Early dz: asymptomatic
Late stages: diff. urination, nocturia, hematurea
Metastasis: pain in lower back, pelvis and upper thighs

Front 30

PSA

Back 30

protein only secreted by prostate. Normal level 0-4 ng/ml. Can be elevated in benign and malignant tumors. Levels incr. w/ age and ethnicity

Front 31

DRE

Back 31

Digital rectal exam. Post. surface of prostate palpated. Yearly after age 50 unless AA or first degree fam. hx, then start at 45. Same w/ PSA. PSA must be drawn BEFORE DRE

Front 32

TRUS

Back 32

(trans-rectal ultrasound) determines density of prostate

Front 33

Gleason's score

Back 33

Two largest areas in biopsy sample graded from 1-5 (5 is worse) Added together to get score.

Front 34

Tx for prostate ca

Back 34

watchful waiting, surgical removal of prostate if confined to capsule, radiation if confined to prostate and surrounding area (good for poor surg. candid.), androgen blockade (dec.circulating testost.)

Front 35

Lung cancer

Back 35

#1 cause of ca deaths in men and women

Front 36

Clinical features of lung CA

Back 36

Change in cough, chest pain, recurrent bronchitis/pneumonia, dyspnea, wheezing, hepoptysis, weight loss, dysphagia

Front 37

Small cell lung ca

Back 37

25%, dev. around mainstem bronchus, smokers, shorter doubling time, advanced when pt. presents

Front 38

Non-small cell lung CA

Back 38

Squamous cell:30%, adenocarcinoma(most common in non-smokers), large cell (least common)

Front 39

Combined modality therapy

Back 39

Chemo and XRT given conjunctively (XRT=radiation)

Front 40

s/s of Colon CA in different colon regions

Back 40

Ascending colon: fatigue, iron defecient anemia, palpitations
Transverse colon: alternating constip.and diarrhea
Descending colon: melena, abd. pain, hematochezia

Front 41

Screening for Colon CA

Back 41

Fecal occult test, flexible sigmoidoscopy q5y, colonoscopy q10y

Front 42

Duke's classification

Back 42

For colon CA, measures prognosis
A: 80-90% survival rate
B: 60%
C:25-45%
D: 5%
Anal: 48-68%

Front 43

S/E of XRT

Back 43

Fatigue, skin changes (dry and moist desquamation), stomatitis, esophagitis, low blood counts, n/v, diarrhea,cough

Front 44

S/E of Chemo

Back 44

n/v, diarrhea, constipation, stomatitis, neurotoxicity (tingling in fingers), cardiac toxicity, fatigue, low blood counts

Front 45

ANC

Back 45

Absolute neutrophil count. Pt. at risk for sepsis if less than 500.

Front 46

Thrombocytopenia

Back 46

Decr. plt. count

Front 47

Triad for venous thrombosis

Back 47

Venous stasis (bedridden, stroke, paraplegia, travel), hypercoagulability(genetic, protein C, chemo, estrogen tx,CA, sepsis, antithrombin), and injury to vessel wall (surgery, lines, contrast x-ray)

Front 48

Thrombophlebitis

Back 48

Thrombis w/ inflammation, venous thrombosis

Front 49

Phlebothrombosis

Back 49

Thrombis w/o inflammation

Front 50

Intrinsic pathway

Back 50

initiated by damage to vessel, septic shock, MI w/ partial occlusion, stress, anxiety, fear

Front 51

Extrinsic pathway

Back 51

initiated by external factors that damage b.v.

Front 52

Obstruction of venous return leads to...

Back 52

Edema, pain, compartment syndrome, critical limb ischemia

Front 53

Postthrombotic syndrome

Back 53

Recurrent DVT w/in one yr, impaired venous circulation, damaged valves, shiny skin, ulcers, venous claudication, swelling, stasis pigmentation,

Front 54

S/s of venous htn

Back 54

dilated veins, fluid leaking from vessel, impaired oxygen transport, ischemia, fat necrosis, skin pigmentation and ulceration

Front 55

Pulmonary embolism

Back 55

Dislodges from thrombus to R heart to pulm. artery. Gets stuck. Atelectasis b/c affected alveoli collapse. Incr. in pulmonary artery pressure and vascular resistance

Front 56

Symptoms of PE

Back 56

dyspnea, tachypnea, tachycardia, retrosternal chest pain, apprehension, hypotension, shock

Front 57

Venous ultrasonography

Back 57

DVT (NOT PE), more accurate than other indirect methods of measuring blood flow. Non-invasive, not effective in detective pelvis/iliac vein clot, operator dependant

Front 58

V/Q scan

Back 58

Compares ventilation w/ perfusion, for PE, no complications, only available at certain times, takes a long time to get images, no definitive answers just high or low probability

Front 59

CT scan angiogram

Back 59

incl. pelvis, thighs, and knees, used for DVT and PE, very accurate, takes seconds, requires monitoring, high flow iv, contrast, lg. dose of ionizing radiation. COMPLICATIONS: anaphylaxis, renal toxicity, infiltration of contrast

Front 60

Contrast venogram

Back 60

Direct injection of contrast, into foot or leg veins. If a clot, filling defects in lumen, must have radiologist, can induce phlebitis or cause a DVT, NPO 4h a procedure, if allergic to shellfish, need to give benadryl or Epi a injecting dye, difficult to inject if bad edema. Immediate results

Front 61

Nursing Implications for contrast venogram

Back 61

NPO 4h before, if allergic to dye, give benadryl or epi, monitor 4-6 h after procedure for allergic rxn, renal failure. Stop following meds 48 h before procedure: glucophage (causes acidosis), c/i w/ creatinine >2 and renal failure. Can cause n/v, flushing

Front 62

Prophylaxis hep therapy dosage

Back 62

5000 u sq q12h (or q8h if high risk), 1/2 life of 60 minutes

Front 63

LMWH dosage

Back 63

Lovonox: sq q12h
Arixtra: sq qd
*don't give if pt. has spinal hematoma-use heparin)
*dosage based on pts. weight

Front 64

What drug do you use if pt. develops HIT?

Back 64

Arixtra sq qd
*If can't have hep, use Argatroban, hematologist prescribes, IV, hemoccult x3

Front 65

Continuous drip hep

Back 65

1000 u/hr, ptt in 6h, q6h after that until therapeutic, then once more in 6h, then daily.

Front 66

Warfarin

Back 66

Start tx while on hep; takes 3-5 days to become therapeutic, monitor INR (2-3), STOP 4-5 days before a procedure, reverse w/ Vit. K (10 mg SLOWLY in ER), c/i in first trimester

Front 67

Heparin reversal

Back 67

Protamine sulfate

Front 68

Throbolytics

Back 68

dissolve thrombus, severe problem with bleeding, streptokinase can only be used once (must pre-medicate)

Front 69

Non-pharmacologic interventions for DVT/PE

Back 69

Catheter based: mechanical dissolution or suction of clot
Surgical: removal of clot in extremity or pulm. artery
Vena cava interruption: umbrella inserted through jugular or femoral veins

Front 70

PE s/s

Back 70

hemoptysis, tachycardia, EKG changes, crackles, dyspnea, pleuritic chest pain, apprehension, diaphoresis, S3 or S4

Front 71

ABG changes w/ PE

Back 71

Increased CO2
Decreased O2 and sats

Front 72

dx of PE

Back 72

chest x-ray, ABGs, V/Q lung scan, pulmonary angiogram and CT scan.

Spiral CT scan BEST

Front 73

Tx of PE

Back 73

anticoagulants, thrombolytics, O2, monitoring, IV positive inotropics, tx anxiety, teach

Front 74

Prevention of PE

Back 74

active and passive ROM in bed-ridden pts, ambulate and SCDs post-op, avoid tight clothes and pressure under popliteal area

Front 75

Acute coronary syndrome

Back 75

The spectrum of clinical syndromes (unstable angina, MI, sudden death) representing coronary occlusion.

Front 76

Causes of ACS

Back 76

Unstable plaque, plaque rupture, unstable angina, microemboli, occlusive thrombus

Front 77

New markers for CAD

Back 77

1. hs-CRP (highly sensitive C-reactive protein), shows systemic endothelial inflamm., predicts future CV events
2. Leukocyte count: inflammation, twice the risk for CAD, CVA, and MI, inexpensive.
3. Homocysteine level: strong independ. factor for CAD, PVD, and cerebral. Elevated in progression of atherosclerosis. c/i in renal dz
4. Traditional lipid panel
5. LDL-C: seven diff. particles, smallest 300% inc. chance of CAD

Front 78

Tx for hypercholesterolemia

Back 78

Statins-block prod. of hepatic HMG-CoA
Bile acid binding resins
Nicotinic acid-B3, inhibits lipoprotein synthesis
Fibric Acid derivatives
Intestinal absorp. blockers

Front 79

Stable angina

Back 79

Pain precipitated by exertion but relieved w/ rest. Resting EKG may be no change or T-wave inversion

Front 80

S/s of stable angina in men

Back 80

Retrosternal pain, heaviness, pressure radiates to back

Front 81

s/s of stable angina in women

Back 81

Epigastric or back discomfort

Front 82

s/s of stable angina in diabetics

Back 82

No typical pain but may have nausea, fatigue, diaphoretic

Front 83

Mgt. of stable angina

Back 83

Treat risk factors (htn, smoking, diet), decr. myocardial demand, drug therapy

Front 84

Unstable angina

Back 84

Angina of new onset at rest or w/ minimum exertion, inr. freq., severity, or duration.

Front 85

Tx of unstable angina

Back 85

Hospitalization, ASA therapy, LMWH, plavix, GP IIb/IIIa receptor antagonists, antianginal therapy (IV NTG or b-blockers) invasive strategy

Front 86

Acute MI based on these findings:

Back 86

Clinical presentation, serial EKG (x3), lab findings (CKMB, troponin->markers in bloodwork that say MI)

Front 87

Clinical presentation for Male having MI

Back 87

Severe unrelieved chest pain, may radiate to back, neck, shoulder, arm, atypical chest, stomach, back or abd. pain, n/v, dizziness, SOB, anxiety, palpations, cold sweat

Front 88

Clinical manifestation of diabetic having MI

Back 88

Silent MI, n, fatigue, SOB

Front 89

Clinical manifestation of female having MI

Back 89

Don't always have typical chest pain, Jaw, shoulder, upper back pain, abd. pain, SOB, fatigue, syncope, weakness, dizziness, n, cold sweats

Front 90

EKG changes w/ ischemia

Back 90

Inverted or peaked T-wave, elevated Q wave, elevated ST segment

Front 91

Lab values for MI

Back 91

Serum creatine kinase (CK-MB) isoenzyme, elevated 3-6h after, peaks 12-18.
Troponin T cardiac iso-enzyme: elevates w/in 3-6h after onset of pain, lasts 14-21days
Myoglobin: elevated w/in 2h but not MI specific
Troponin I more specific but takes 12h

Front 92

Stress test and women

Back 92

Give a false positive because not calibrated for women.

Front 93

PTCA

Back 93

Drug-coated stents.

Front 94

MONA

Back 94

Morphine
Oxygen
Nitro
Aspirin

Front 95

Acute mgt. of MI

Back 95

Relieve ischemic pain, provide O2, Manage hypotensn, pulmonary edema, & arrythmias. If 3 nitro patches and MSO4 don't work, hook up to nitro drip.

Front 96

Management of ST elevation in MI

Back 96

get to cath lab, STAT. No cath lab? Give thrombolytic or carbolytic
*Get lab values for cardiac enzymes, CBC, PT/PTT, CMP, lipids, EKG continuous, pulsox

Front 97

Management of inverted T MI

Back 97

MONA, have more time than ST elevation

Front 98

Meds for MI

Back 98

ASA: Non-enteric coated, 160-325 mg immediately
Hep: IV bolus, then line
B-blockers: IV loading dose, then PO
Nitro: SL 0.4mg
Morphine: if chest pain not relieved by NTG

Front 99

Lethal rhythms

Back 99

Pulseless vtach. and vfib

Front 100

Tx of heart failure

Back 100

ACE inhibitors, diuretic, digitalis, B-blockers, Aldosterone antagonists, and vasodilators

Front 101

Nesiritide

Back 101

synthetic B-type natriuretic peptide, promotes nomal cardiac function and fluid status. Give IV bolus then drip. Can use w/ renal pts, ACS, and diastolic dysfunction

Front 102

Natrecor

Back 102

improves hemodynamics and CHF symptoms (Dyspnea), increases urinary o, decreases diuretic need

Front 103

CV effects of smoking

Back 103

Incr. coronary vascular resistance, decr. blood flow in the absence of atherosclerosis, may cause sudden arterial constric. & angina, accelerates atherogenisis, thrombogenic state

Front 104

Tx of uncomplicated htn

Back 104

<65, diuretics, beta blockers

Front 105

Tx of htn w/ DM

Back 105

ACE inhibitors, ARBs

Front 106

Stages of Htn

Back 106

Normal 120/80
Pre-htn 139/89
Stage 1 159/99
Stage 2 >160/100

Front 107

Complex htn pt.

Back 107

Htn puls one or more additional risk factors: CAD, DM, metabolic syndrome, renal dz, AA, Hispanic

Front 108

Tx of complex htn

Back 108

Polytherapy (diuretic, B-blocker, ACE inhib, Ca channel blockers, ARBs) Use two or more

Front 109

Hypertensive crisis

Back 109

Diastolic >120-130, upper levels of Stage 3 htn, Optic disk edema, end-organ complications, HA, blurred vision, focal neurologic symptoms

Front 110

Cardene

Back 110

Ca channel blocker, continuous IV, tx htn emergencies

Front 111

Sodium Nitroprusside

Back 111

Immediate onset, allows for minute to minute titration of BP, goal DBP 110-120. Monitor for thiocyanate poisoning...metabolic acidosis, vomiting. Tx. w. Vit. B derivative to bind w/ cyanide

Front 112

Severe asthma

Back 112

Rapid onset attack, more from bronchospasm than inflammation, quickly reversed w/ bronchodilators, exposure to allergens, inhale a B-2 agonist, give anticholinergic (Atropine, atrovent), control inflammation, inhaled corticosteroids (prevent mast cell from emptying)

Front 113

Clinical manifestations of emphysema

Back 113

Enlarged resp. airspaces (blebs), destruction of alveolar septa, A-1 antitrypsin breaks down lungs, progressive dyspnea on exertion, dyspnea at rest, enlarged R-ventricle (cor pulmonale), cyanosis, clubbing, pitting peripheral edema, look dusty

Front 114

Mgt. of COPD

Back 114

Bronchodilation w/ Anticholinergic (Atrovent) and B-blockers (albuterol), inhaled steroids, combivent inhaler (atrovent and albuterol) more effective

Front 115

Clinical manif. of pneumonia

Back 115

Fever, chills, sweats, pleuritic pain, cough, sputum production, hemoptysis, ha, fatigue