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269 Cards in this Set
- Front
- Back
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What is the formation of cells in blood stimulated by?
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the erythropoietin from the kidneys
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What % of blood is plasma?
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55%
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What % of blood is cells?
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45%
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What do RBCs do?
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transport oxygen
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What does the formation of RBCs depend on?
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stem cells, bone marrow, adequate amounts of iron, B12, FA, protein, B6, copper
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How long can a RBC live?
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120 days
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What breaks down the RBCs?
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liver and spleen break them down
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What are reticulocytes?
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immature RBCs
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What is the primary site for the production of RBCs?
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in the bone marrow, but could also be produced in the lymph nodes, thymus and spleen
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What are some of the s/s of anemia?
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SOB, fatigue, palpitations, pruritis, fever, bleeding, pain, confusion, neuropathy, sore tongue
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If you have a pt. with anemia, what would you expect their BP and HR to be?
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Low blood pressure and tachycardia
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What does an elevated reticulocyte count mean?
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that there is increased RBC production and body is responding to loss of RBCs
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Under what circumstances would your RBCs/hematocrit/hemoglobin be increased? decreased?
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increased by dehydration, hight altitude, chronic hypoxia, polycythemia
decreased in anemia, fluid overload, recent blood loss |
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What does MCV measure?
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the size of the RBCs
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Your pt. bloodwork comes back and his MCV is <80. How would you interpret this?
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as microcytic - iron deficiency, almost always means anemia
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Your pt. bloodwork comes back and his MCV is >100, what do you interpret this to mean?
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as macrocytic - B12,folic acid deficiency
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What do the MCH measure?
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Hbg content
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What are transferrin?
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proteins that transport iron
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What does ferritin measure?
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free iron in plasma
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What is the most common reason for anemia in adults?
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gastrointestinal bleeding
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What does it mean when a pts MCH comes back hypochromic?
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iron deficiency
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What type of disease is anemia?
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anemia is more often a symptoms rather than a disease unto itself
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What is the cause of anemia?
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blood loss
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What are some examples of problems that cause acute blood loss?
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trauma, surgery, GI bleed
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When does a person with acute blood loss become symptomatic?
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when the blood loss is >500cc
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Your pt has lost over 500cc of blood, what symptoms could he be experiencing?
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SOB, fatigue, weakness, pallor, restlessness, hypotension, tachycardia, murmur
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How much blood can a pregnant women lose and still possibly not show any symptoms?
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up to 1000cc
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If your pt. experiences chronic blood loss would they still show the same symptoms as your pt. who has acute blood loss?
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no, because the body adjusts to anemia if it occurs gradually, bone marrow responds
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What could cause a pt. to have chronic blood loss?
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may be due to inherited disorder such as sickle cell anemia, cancer, GI tract problems. Also think loss associated with menses in women
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Wht test would you do to diagnose anemia?
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CBC, indices, hemoccult, endoscopy
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How would you treat your pt who is diagnosed with anemia?
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treat the underlying cause (remember:usually a symptom, not the disease), blood products (rarely whole blood), iron supplements, diet, EPO (procrit)
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What nursing concerns would you have for a pt. with anemia?
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activity intolerance (fatigue, weakness), transfusion monitoring, education
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What type of education would you give to your pt. diagnosed with anemia?
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diet, taking iron supplements (how to identify an iron overload, how it is taken)
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what is hemosiderosis?
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iron overload
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What can you recommend to your pt about how to prevent anemia?
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hemoccult yearly starting at 40, colonoscopy q 5-10 years starting at age 50 (GI bleed is the #1 cause of anemia in adults)
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What is aplastic anemia?
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a deficiency of circulating RBCs because of failure of the bone marrow to produce these cells. (cessation of activity of all blood producing elements -rbc,wbc, platelets
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What causes aplastic anemia?
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in 1/2 of all cases the cause cannot be identified - the other half could be caused by drugs, insecticides, infections, congenital causes
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Although aplastic anemia can occur alone, it is usually seen with two other disorders. What are they and why do they usually occur together?
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leukopenia and thrombocytopenia
they occur together because the damaged bone marrow loses the ability to produce any of these cells (WBC, RBC, platelets) |
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What test would you use to diagnose aplastic anemia?
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CBC, reticulocyte count (will be low), bone marrow, dry tap
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What types of treatment might you expect for your pt. with aplastic anemia?
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remove cause, transfusion (only when anemia causes disability or is life threatening), protect from infection, splenectom, bone marrow transplant, immunosuppressive drugs if autoimmune
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What is anemia most commonly due to?
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nutritional deficiencies
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What is the most common reason for FE deficient anemia in men? women?
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men: GI
women: menses |
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What does a TIBC measure?
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the amt of iron bound to protein - will be elevated with iron deficiency
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What are some causes of iron deficient anemia?
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decreased intake, impaired absorption, persistent loss
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What are the s/s of iron deficient anemia?
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often absent until severe
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How would you treat iron deficient anemia?
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treat underlying cause, iron supplements
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When a pt. has anemia due to having a chronic disease, what types of diseases might you expect?
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chronic inflammatory diseases, infections, cancer, AIDS, Chrohns
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What is polycythemia vera?
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cancer of the RBC with excessive production of all bloood cell components
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What are some of the symptoms of polycythemia vera?
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plethoric (dark, flushed skin/membranes), thrombosis, elevated uric acid and K may occur from RBC breakdown
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If polycythemia vera has an increase in the production of RBCs, why is this a problem then?
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because even though the production is increased they are not normal in function (bleeding, hypoxia, infection)
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What are some types of treatment for polycythemia vera?
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phlebotomy, anticoagulants, hydration, oral chemo agents
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What are the two types of malignant lymphomas?
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hodgkins and non-hodgkins
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What is the first s/s of hodgkins disease?
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large painless node (usually in the neck)
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What do they believe is the probable cause for hodgkins disease?
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viral or chemical agents
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What are the s/s of hodgkins disease?
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large painless node usually in the neck, fever, malaise, night sweats
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What are some diagnosic tests you could perform for the diagnosis of hodgkins disease?
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biopsy of nodes, CT chest/abd, laparotomy, CBC, LFT, bone marrow bx
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What is the most common presentation of a pt with non-hodgkins lymphoma?
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swollen, painless nodes, can be anywhere in the body
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What is ATP?
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autoimmune thrombocyctopenic purpura
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Define ATP
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it is when a persons own body produces an antibody directed towards the person's platelets (production of platelets is normal but they are destroyed quickly)
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What are the s/s of ATP?
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ecchymoses, petechia, bleeding, anemia
an intracranial bleed can cause neuro symptoms |
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What is the treatment for ATP?
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immunosuppressive drugs, platelet transfusions, splenectomy
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Why would a splenectomy be a form of treatment for ATP?
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because by removing the spleen, it slows down the destruction of platelets
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What is TTP?
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thrombotic thrombocytopenic purpura
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Define TTP
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disorder of platelet aggregation leading to a low platelet count (platelets clump together)
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What type of disorder is TTP?
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an autoimmune disorder
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What are the manifestations of TTP?
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renal failure, MI, stroke
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If a pt. with TTP is not treated, when does it become fatal?
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3 months
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What are some of the treatments for TTP?
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immunosuppressive drugs, antiplatelet medications, Fresh frozen plasma
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What is ATP characterized by?
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ATP is characterized by disruption of platelets by own antibodies which increases risk for bleeding
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Explain HIT
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# 2 HIT is the problem of clot formation, not bleeding due to antibodies that form in response to heparin and bind to platelets.
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What is TTP?
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TTP is the problem of increased platelet aggregation which leads to risk of clots
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Describe megaloblastic anemia
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Megaloblastic Anemia is a disorder of folic acid deficiency and consequent production of fewer but larger red blood cells.
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What is the cause of megaloblastic anemia?
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Megaloblastic anemia is caused by B12 and/or folic acid deficiency
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What is pernicious anemia?
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Pernicious Anemia- it's an autoimmune disorder which affects the bodies intrinsic fator, which would decrease our ability to absorb B12
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What does a >100 macrocytic indicate?
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> 100 Macrocytic indicates a deficiency in B12
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What does a <80 microcytic indicate?
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< 80 Microcytic indicates a iron deficiency
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What happening when a person get autoimmune thrombocytopenia purpura?
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thrombocytopenia purpura- antibodies are directed towards the person's platelets decreasing them
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When is a pt. diagnosed with HIT?
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if the platelet count drops during or after heparin therapy (<150,000 or <50% of baseline)
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If your pt. is diagnosed with HIT, what should you as the nurse be monitoring this pt. for?
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must monitor labs and observe for signs of thrombus formation
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What does a functional assay detect?
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platelet activation
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What does an antigenic assay detect?
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antibody binding to the heparin complex
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What is procrit indicated for?
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indicated for the treatment of anemia related to chronic renal failure, drug side effect (AZT) chemotherapy, and to reduce the need for transfusions
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What are some contraindications for the use of Procrit?
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allergy to albumin or UNcontrolled hypertension
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What are some nursing implications when it comes to administering Procrit?
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monitor BP before and throughout treatment, monitor for signs of improving anemia, notify MD if BP elevated or HCT has reached normal levels
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What are two types of RBC indices and what do they do?
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MCV (measures size of RBC) and MCH (measures Hbg content)
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What are transferrin?
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protein that transport iron
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If your pt has iron deficient anemia what study would you expect to see increased?
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TIBC
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What does the TIBC study do?
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measures amount of iron bound to protein
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What would you be assessing for post operatively in a pt. who just underwent a bone marrow biopsy?
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observe for bleeding, LOC, respiratory status
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What is an esophageal tumor?
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Tumors that develop from the endothelium lining of the esophagus and spread rapidly because of there is nothing to contain their growth
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What are the s/s of an esophageal tumor?
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Dysphagia that gets progressively worse, weight loss, complaints of something being stuck in their throat, painful swallowing,May have c/o regurgitation, vomiting, foul breath, chronic hiccups-usually a sign of advanced disease
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what are some diagnostic tests used to diagnose an esophageal tumor?
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EGD (definative test) CAT scan and PET scan (will tell about the spread of the disease)
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What do pts who experience ischemic strokes usually have a hx of?
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a-fib
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does a thrombotic stroke have a slow or rapid onset?
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slow
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What is happening when a pt has an embolic stroke?
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the movement of a clot from some other area of the body causes blockage in a cerebral artery
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what are the 3 most common reasons for a hemorrhagic stroke?
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ruptured aneurysm, ruptures AV malformation, severe hypertension
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What would you NOT want to give to a pt. with a hemorrhagic stroke?
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heparin (any blood thinner)
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What is the most common reason for a hemorrhagic stroke?
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hypertension
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What is an aneurysm?
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a weakened area on a cerebral vessel
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What could be described as a spaghetti like tangle of blood vessels with abnormal blood flow between arteries and veins?
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an arteriovenous malformation
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What is the difference between a TIA and a reversible ischemic neurological deficit (RIND)?
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the TIA last from a few minutes to less then 24 hours while a RIND last from 24 hours to less than one week
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What are some of the risk factors for a stroke?
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hypertension, DM, heart disease, hypercholestermia, hypercoagulable state, illegal drug use(esp. cocaine), obesity and atrial fibrillation
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What is the "window of opportunity" for a stroke pt.?
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3 hours
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What will a CT Scan of the brain show?
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whether the pt. is experiencing an ischemic or hemorrhagic stroke
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Which type of stroke tends to get worse, not better?
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a hemorrhagic stroke
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What would you assess for in your stroke pt.?
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LOC/GCS, assess for posturing, pupillary assessment, difficulty speaking, balance instability, muscle strength different on one side of body, past med. hx, illegal drug use
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What are the functions of the liver?
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stores glucose, site of gluconeogenesis, makes plasma proteins, uses nitrogen, forms cholesterol, aids in fat metabolism
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Your liver metabolizes most drugs, if your pt. has liver failure what would you want to monitor your pt. closely for?
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drug toxicity
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At any given time, what is the blood volume in your liver?
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13%
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If your pt. has liver disease, what would expect their stool and urine to look like?
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stool would be clay colored (light in color)
Urine would be dark |
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Why would your liver disease pt.s urine be dark in color?
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because of bilirubin being excreted and not broken down by the liver
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What would be a late manifestation of liver disease?
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an elevated bilirubin
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What are some things you would look for, in relation to the skin, in a pt you suspect might have liver disease?
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color, edema, ascites, bruising, spider angiomas
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In a pt. with liver disease, would the serum protein - albumin be high or low?
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low
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What are some diagnostic test for liver disease?
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PTT/INR/clotting factors, serum ammonia, antigen/antibody tests for hep., CT/MRI/ultrasound, endoscopy, paracentesis, biopsy
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What would you monitor for post operatively after a liver biopsy?
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bleeding, frequent VS, Bed rest for 24 hours, be sure pt. is lying on affected side with pressure dressing
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What is hepatitis?
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acute inflammation of the liver
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What does it mean if a pt. has chronic persistent hepatitis?
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that the pt. doesn't clear the virus but it doesn't effect their liver. They are contagious to other people
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What are some of the s/s of hepatitis?
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sometimes subclinical, fever, chills, malaise, anorexia, n/v, RUQ pain, elevated liver enzymes and bilirubin, jaundice, dark urine, clay colored stool, pruritis
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Are hep A, hep B and hep C all treated the same?
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no, all are treated differently
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What are some nursing concerns you might have for your pt. who has hepatitis?
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activity intolerance, fluid deficit, nutrition, skin integrity, bleeding, protential for drug toxicity, transmission to others
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How is hep A transmitted?
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viral, fecal oral route of transmission
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What is hepatitis A?
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infection of hepatocytes by the virus
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What is the prognosis for a pt. with Hep A?
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very good, no chronic carrier state
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Are symptoms of hep A worse if you are young or worse if you are old?
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symptoms are usually worse if the pt is older
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What tests would you use to diagnose hep. A?
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you would check for elevated enzymes and your pt would test positive for the anti-HAV
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When can you give your pt. the gamma globulin?
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post exposure but within 2 weeks, it won't work after that
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How is Hep B transmitted?
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same as HIV
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What are some of the risk factors of Hep B?
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IVDU, sexually active, infants born to infected women, tattoos
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What % of liver cancer is caused by Hep B?
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75 - 95 %
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What are some causative agents in regards to liver disease?
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toxins, infectious diseases, drugs, ETOH, industrial chemicals, viruses, tylenol (too much), blood transfusions hx
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Which type of hepatitis does not have a risk of having a chronic carrier?
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hep A
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What is the #1 way to prevent the spread of hepatitis A?
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hand washing
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Who is more likely to become a chronic carrier of hepatitis? adults or children?
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children 90-95% become chronic carriers
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What are some risk factors for becoming a chronic carrier of Hep B?
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children, steroid dependent, male, high viral load
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The presence of this indicates greater infectivity and active disease of hep B?
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E antigen
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If your hep B pt. is a chronic carrier what will they never develop?
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a positive anti-HBSAG (surface antibody)
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What is the most common bloodborne infection in the US?
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Hep C
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What is the most common cause of chronic hepatitis and liver cancer?
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hep C
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What is the most common reason for a liver transplant?
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hep C
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What are some high risk behaviors for hepatitis C transmission?
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IVDU, nasal cocaine, tattoos, hemodialysis, sex
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What % of IVDU get infected with Hep C?
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90%
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What Hep C genotype is the most common?
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genotype 1
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What Hep C genotype is most resistent to treatment?
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genotype 1
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Which hepatitis is the #1 cause of cirrhosis, liver cancer, liver transplantation?
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Hep C
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What % of hepatitis C patients will become chronic carriers?
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75-85%
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What would you suspect if your patients labs came back with elevated liver fuctions?
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Hepatitis
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What are some common medications used in the treatment of Hep C?
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Interferon, ribavirin
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What would you want to monitor your pt for if they are taking interferon?
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Monitor for anemia, pancytopenia(decr. WBC,RBC and Platelets levels), depression
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Describe cirrhosis of the liver
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diffuse inflammation and fibrosis of the liver resulting in decreased liver function
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What are some causes of cirrhosis of the liver?
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hepatitis, alcoholism, malnutrition
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What % of hepatitis C patients will become chronic carriers?
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75-85%
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What are some things that can happen over time when there is obstruction of the hepatic blood flow?
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edema, ascites, spenomegaly, esophageal varices, hemorrhoids
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What would you suspect if your patients labs came back with elevated liver fuctions?
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Hepatitis
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What are some common medications used in the treatment of Hep C?
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Interferon, ribavirin
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What are some s/s of cirrhosis of the liver?
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anorexia, N/V, indigestion, weight loss, ascites, pruritis, spider hemorrhages, abd. pain, elevated LFTs
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How would you diagnose cirrhosis of the liver?
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elevated LFTs, abnormal clotting studies, pancytopenia, elevated serum ammonia level (late in disease), CT/MRI
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What type of diet would you place your pt on if they have cirrhosis of the liver?
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low sodium, high protein diet because it helps with ascites except if they are late in the disease and then it would be a low protein diet.
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What would you want to monitor your pt for if they are taking interferon?
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Monitor for anemia, pancytopenia(decr. WBC,RBC and Platelets levels), depression
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Describe cirrhosis of the liver
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diffuse inflammation and fibrosis of the liver resulting in decreased liver function
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What are some causes of cirrhosis of the liver?
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hepatitis, alcoholism, malnutrition
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What are some things that can happen over time when there is obstruction of the hepatic blood flow?
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edema, ascites, spenomegaly, esophageal varices, hemorrhoids
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What are some s/s of cirrhosis of the liver?
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anorexia, N/V, indigestion, weight loss, ascites, pruritis, spider hemorrhages, abd. pain, elevated LFTs
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How would you diagnose cirrhosis of the liver?
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elevated LFTs, abnormal clotting studies, pancytopenia, elevated serum ammonia level (late in disease), CT/MRI
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What type of diet would you place your pt on if they have cirrhosis of the liver?
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low sodium, high protein diet because it helps with ascites except if they are late in the disease and then it would be a low protein diet.
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What % of hepatitis C patients will become chronic carriers?
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75-85%
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What would you suspect if your patients labs came back with elevated liver fuctions?
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Hepatitis
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What are some common medications used in the treatment of Hep C?
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Interferon, ribavirin
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What would you want to monitor your pt for if they are taking interferon?
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Monitor for anemia, pancytopenia(decr. WBC,RBC and Platelets levels), depression
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Describe cirrhosis of the liver
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diffuse inflammation and fibrosis of the liver resulting in decreased liver function
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What are some causes of cirrhosis of the liver?
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hepatitis, alcoholism, malnutrition
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What are some things that can happen over time when there is obstruction of the hepatic blood flow?
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edema, ascites, spenomegaly, esophageal varices, hemorrhoids
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What are some s/s of cirrhosis of the liver?
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anorexia, N/V, indigestion, weight loss, ascites, pruritis, spider hemorrhages, abd. pain, elevated LFTs
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How would you diagnose cirrhosis of the liver?
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elevated LFTs, abnormal clotting studies, pancytopenia, elevated serum ammonia level (late in disease), CT/MRI
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What type of diet would you place your pt on if they have cirrhosis of the liver?
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low sodium, high protein diet because it helps with ascites except if they are late in the disease and then it would be a low protein diet.
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Why would you give your pt with cirrhosis of the liver serum albumin and what is usually given afterwards?
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it helps bring fluids out of tissues into the blood vessels and it is usually followed by lasix
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If your pt has cirrhosis of the liver what would you want to vaccinate them from?
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flu, pneumonia, hep A and B
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What are some nursing concerns for your pt. who has cirrhosis of the liver?
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activity intolerance, respiratory compromise, fluid excess, high risk for infection, nutrition, clotting problems, skin integrity, pain, knowledge deficit
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What is portal hypertension?
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increased pressure in the liver (portal vein)
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What are some s/s of portal hypertension?
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splenomegaly, ascites, development of collateral circulation (esophageal varices)
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What is the most common s/s of portal hypertension?
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esophageal varices
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How would you treat the ascites associated with portal hypertension?
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diuretics, serum albunim, paracentesis, peritoneal-venous shunt
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What medications can help to lower the pressure in the portal vein?
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enderol and vasopressin
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Why is metastasis common with esophageal tumors?
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because of the close relationship to the lymphatic system.
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what are the s/s of esophageal tumors?
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dysphagia that gets progressively worse, complaints of something stuck in throat, weight loss, odyophagia(painful swallowing), regurgitation, vomiting, foul breath, chronic hiccups, eventually pulmonary problems
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what is a common sign of advanced esophageal tumors?
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chronic hiccups, regurgitation, vomiting, foul breath
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What diagnostic tests are performed for esophageal tumors?
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Pt. hx/risk factors, EGD, CT scan/PET scan
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Which diagnostic test for esophageal tumors is the most definative?
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EGD
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What are some treatments that the doctor might prescribe for your pt. with esophageal tumors?
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nutritional support, speech therapy, swallowing therapy, chemotherapy/radiation, photodynamic therapy, esophageal dilation, esophagectomy(or an MIE), esophagogastrostomy
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As the nurse, how could you help your pt. to improve his/her ability to swallow?
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offer lollipops for tongue strength, ofer food with head in chin tuck position, place food in the back of mouth
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What is the nurses highest priority when it comes to her post operative esophageal cancer pt?
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respiratory care - may be on ventilator, T,C& DB,assess breath sounds, semi fowlers to high fowlers position, o2 therapy, o2 sat. levels, chest tube care
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Sometimes during esophageal surgery there is pressure placed on the heart, what would you assess your pt. for that would be a sign of this?
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hypotension
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What would you do to combat post operative hypotension in your pt. who has just had esophageal surgery?
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admin. IV fluids but monitor for signs of fluid overload
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If your pt. experiences Atrial fibrillation after having esophageal surgery, what would your suspect is the cause?
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irritation of the vagus nerve during surgery
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What is gastric carcinoma and how does it spread?
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cancer of the stomach and it spreads within the walls of the stomach and to surrounding organs
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What are some reasons for the development of gastric carcinoma?
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H. Pylori infection, pernicious anemia, gastric polyps, chronic atrophic gastritis and achlorhydria (abs.of secretions of hydrocholoric acid)
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what type of s/s would you intially see in a pt. with gastric carcinoma?
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they are usually asymptomatic at first
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Once your pt with gastric carcinoma begins to show s/s, what would they likely be experiencing?
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indigestion, heartburn, abdominal discomfort, epigastric or back pain, progressive weight loss, N/V, weakness, fatigue, anemia, hepatomegaly, palpable lymph nodes
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What three areas does the Glascow coma scale score on?
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eye opening, motor response and verbal response
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What are the two indications that there is dysfunction of the brainstem?
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decorticate positioning and decerebrate positioning
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What is a LATE sign of neurological damage?
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posturing
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Explain decorticate positioning
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arms, wrists and fingers flexed with internal rotation (arms in over chest)
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Explain decerebrate positioning
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rigid extension of arms and legs, pronation of the arm (arms out to sides)
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You have a pt. who has a low GCS level, what are some subtle changes in their LOC that you should report to the doctor?
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headache, restlessness, irritablitiy or very quiet, slurred speech or changes in level of orientation
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Your doing your PERRLA assessment on your pt. and note that his pupils are fixed and dilated. What do you know this to be an indication of and what should you do?
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this is an indication of neurological deterioration and the physician should be notified immediately
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What is aphasia?
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inability to use or comprehend language
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What is alexia?
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reading problems
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What is agraphia?
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difficulty with writing
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What is hemiplegia?
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paralysis on one side of the body
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What is hemiparesis?
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weakness on one side of the body
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What is flaccid paralysis?
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extremities just fall to the side - pt. does not have the ability to hold them up
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What is spactic paralysis?
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contractures (lack of movement) in a joint
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What is agnosia?
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inability to use an object correctly
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What is apraxia?
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inability to carry out purposeful motor activity
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What is neglect syndrome?
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unaware of one side of the body - doesn't even know it exists
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What is ptosis?
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drooping eyelid
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What is anaurosis fugaz?
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brief period of blindness in one eye
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What is hemianopsia?
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blindness in half the visual field
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What lab test would you use to determine a stroke?
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no lab test can determine a stroke - only the symptoms and a CT Scan can do that
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What diagnostic tests would you use to determine whether your pt. has had a stroke?
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CT Scan, MRI/MRA
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Which diagnostic test will tell you if your pt. has a cerebral hemorrhage?
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CT Scan
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How soon must the CT Scan be read?
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within 45 minutes of arriving at the ER
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Why would a carotid artery angioplasty be done?
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to visualize the cerebral circulation, helps to identify aneurysms, injuries, strictures/occlusions, tumors, AV malformation
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What drug can you NOT give with contrast dye?
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metformin
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What type of stroke would you use thrombolytic therapy for?
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ischemic stoke
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What type of stroke would you NEVER use thrombolytic therapy for?
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hemorrhagic stroke
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What is hydrocephalus?
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increased CSF within brain that causes ICP
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What are vasospasms?
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narrowing of cerebral artery causing decreased blood flow
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Explain dysarthia
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slurred speech due to decreased muscle control of tongue - may also have swallowing problems
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Explain expressive aphasia
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understands speech but can not answer
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Explain receptive aphasia
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can talk but words don't make sense. No understanding of the spoken or written word
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What type of labs would you expect to see from your gastric carcinoma pt?
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decr. H/H, decr. iron levels, stool positive for occult blood, hypoalbuminemia, abnormal LFTs, elevated CEA
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What is the most definative diagnostic test for gastric carcinoma?
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biopsy via EGD
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What is the preferred treatment option for your pt. with gastric carcinoma?
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surgery - either a total or partial gastrectomy (billroth 1 or 2)
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What do we need to monitor our gastric carcinoma pt for post operatively?
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dumping syndrome
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What are the s/s of dumping syndrome?
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vertigo, tachycardia, syncope, sweating, pallor, palpitations, desire to lie down. Usually occur 30 min. after eating
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How would you minimize dumping syndrome?
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eating small meals more frequently and by not drinking liquids during meals or anytime they eat solid foods
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Explain dumping syndrome
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occurs due to the rapid emptying of food into the small intestines
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What lab is used to monitor a pt. with gastric carcinoma as well as after surgery for gastric carcinoma?
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CEA labs. They will be elevated if the cancer comes back. Are elevated initially but will decrease after treatment
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What does colorectal cancer usually develop from?
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precancerous polyps
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What is a common symptom of colorectal cancer?
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rectal bleeding - may or may not be visible to the naked eye
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What is hematochezia?
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passage of red blood through the rectum
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What are the s/s of colorectal cancer?
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rectal bleeding, anemia, change in bowel habits/stool(pencil like stools), abdominal cramping/feeling bloated
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When might the s/s of colorectal cancer not be as noticable?
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when the tumor is on the right side of the colon
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What might the labs on your pt with colorectal cancer show?
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a decr. H/H, elevated LFTs with liver metastasis, positive for occult blood in the stool
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What is the most definative test for colorectal cancer?
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colonoscopy
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What is the primary treatment for colorectal cancer?
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surgery either with or without radiation or chemo
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What is an abdominoperineal (AP) resection?
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removal of the sigmoid colon, rectum and anus through abdominal and perineal incisions
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What would you do for your pt who has just returned from having a colon resection?
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prevent respiratory problems by supplying O2, monitoring his O2 sats, have him T,C,DB, get him up and moving
Will still be NPO so listen for bowel sounds and begin a progressive diet either once bowel sounds return or anytime if they have a colostomy Take care of the stoma Take care of the drain if needed |
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What is malabsorption syndrome?
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an inability to absorb nutrients due to flattening of the mucosa of the small intestines
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What are some s/s of malabsorption syndrome?
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diarrhea (common), steatorhhea (fat in stool -common), weight loss, bloating and flatus, easy bruising, anemia, bone pain, edema
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What might the lab test show in your pt with malabsorption syndrome?
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anemia, decr. H/H, decr. iron levels, decr. levels of selected vitamins, decr. albumin/protein
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What deficiencies might be involved with malabsorption syndrome?
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deficiencies in bile salts, enzyme, presence of bacteria, changes in the lining of the small intestines or changes in lymph or circulatory system
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What are the s/s of oral cancer?
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leukoplakia, erythroplakia, unusual thickening or lumps on the buccal mucosa, sore that does not heal, soreness, pain or burning sensation, pain that radiates into the ear, enlarged lymph nodes
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What s/s of oral cancer indicates that the cancer is advanced?
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when pain radiates into the ear
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What are some pt. risk factors for oral cancer?
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tobacco use, alcohol consumption, sun exposure, certain occupations
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What is the definative diagnostic test for oral cancer?
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Biopsy
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What will a CT Scan tell you about your pts oral cancer?
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tells about the spread
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What is your highest priority for your pt. with oral cancer?
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airway management
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What would you do for your oral cancer pt., both pre and post operatively, to help with his airway management?
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assess breath sounds, respiratory rate, O2 sat levels
Provide trach care if needed manage secretions(have suction available), position in semi fowlers or high fowlers position, incr. fluids to loosen up secretions, T,C&DB |
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What would you as the nurse be concerned with in your pt. with oral cancer?
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airway management, aspiration, providing good oral hygiene, pt. education, pain control, nutritional support post operatively
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If you are administering blood to a pt. what gauge should your catheter be?
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at least a 20 gauge
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How soon after obtaining blood from the blood bank should it be administered?
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within 20 minutes
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What MUST the nurse do before administering the blood that she has received from the blood bank?
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verify it with another RN
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Explain the infusion rate
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– Regulate the infusion rate-start slowly administering 25-50 mL during the first 15 minutes. Most packed red blood cells should infuse over 1 ½ to 2 hours. Blood products usually should not hang more than 4 hours
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When should you monitor your pt.s VS if you are giving them a blood transfusion?
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Monitor patient’s vital signs appropriately usually every 5 minutes for the first 15 minutes then every 15 minutes for one hour and then hourly until done. Obtain a set of vital signs at the completion of the infusion
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When is a reaction to a blood transfusion most likely to happen?
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within the first 15 minutes
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What is the first thing that your paient might express if they are having a reaction to their blood transfusion?
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chills (complaints of feeling cold)
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What should you do if you suspect that your pt. is having a reaction to a blood transfusion?
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Stop infusion immediately
Change IV tubing and keep vein open with NS Notify the MD and the blood bank Send the unit of blood and tubing to blood bank Follow hospital policy for urine and blood samples Monitor and treat patient as ordered Document |
