Med Surge Exam

Front 1

Identify characteristics of neoplastic (Abnormal Tissue) Growth:
Benign:
Malignant:

Back 1

Neoplasm: Abnormal replication of cells
Benign: Indicates a neoplasm that is usually harmless.
-Almost always Encapsulated by (fibrous capsule)
-Capsule restricts the spread, prevents release of cells

Malignant: uncontrolled growth can lead to death, growths are quite different from normal cells.
-Known as cancer

Front 2

Cancerous Growth changes what?

Back 2

DNA makeup and function, and also the DNA structure.

Front 3

Cancer Cells:

Back 3

Do not look like or behave like normal cells

Front 4

Oncogenes:

Back 4

Activate cell division and influence embryonic development.
Cancer producing gene

Front 5

The spread of Tumor cells is called what?

Back 5

Metastasis (movement of cancer cells)

Although, not all malignant cells metastasize most do.

Attacking nearby tissue
•
Blood
and body fluids
•
Entering
a body
cavity ( ABD cavity)
•


Prognosis (prediction of survival)
depends on how much the malignant
cells have attacked body tissues

Front 6

-oma?

Back 6

=tumor can designate swelling (collection of fluids)
-Ex: Hematoma (bruise)
as well as swelling (containing malignant cells)

Front 7

Malignant growths are divided into 4 types:

Back 7

-Sarcoma- Mesenchymal tissue (bones,muscle,CT)
-Carcinoma- Orig. Epithelial tissue. Most cancers
-Leukemia/Lymphoma- Cancers related to blood- forming system
Melanomas- Skin Cancer

Front 8

TNM staging System:

Back 8

T: Primary Tumor
N:Regional Nodes
M: Metastasis

Front 9

All cancer results from?

Back 9

Defects in the DNA of genes

Front 10

Carcinogens:

Back 10

Cancer Causing Substances

Front 11

Warning Signs of Cancer:
CAUTION
CLAMS
DABBS

Back 11

-Unusual Bleeding or Discharge:
-A sore that does not Heal
-A change in bladder or bowel habits
-A lump in breast or other part of the body
-A nagging persistent cough
-A obvious change in a mole
-Difficulty in Swallowing

Front 12

Australians have the highest rate of skin cancer in the world and have developed a message that is a good way to instruct your pts:

Back 12

slip,slap,slop,strap-slip on protective clothing, slap on a hat, slop on some sunscreen, and strap on some sunglasses.

Front 13

Nutrition Considerations
Minimizing the risk for Cancer:

Back 13

Avoid:smoked,salt cured, nitrate-cured, and charred.
Eat 5 or more servings of a variety of fruits and vegetables.
Include calciferous veggies, containing beta-carotene (tomatoes, onion, garlic, citrus fruits)

Front 14

Cytocology:

Back 14

Most widely used test to is the Pap
-examines cells to determine weather they are malignant or premalignant.

Front 15

American Cancer Society for early detection:

Breast:

Back 15

Self examination for any lumps, nodules or changes in contour.
Physician check every 3 years until age 40, than every year. Mammograms routinely.
1-2 yrs after age 50

Front 16

American Cancer Society for early detection:

Colon Rectum:

Back 16

@ age 50 begin screening: with,
-yearly FOBT (fecal occult bld test) or fecal immunochemical test (FIT)
-Sigmoidoscopy q 5 yrs
-enema q5 yrs
-colonoscopy q10 yrs

Front 17

American Cancer Society for early detection:

Cervix & Uterus

Back 17

-pelvic exam q yr
-@ 21 yearly pap
-@ 30 after 3 consecutive paps can do q 2-3 yrs
-@ 70 may discontinue screening if normal result in the last 10 years.

Front 18

American Cancer Society for early detection:

Testicles & Prostate:

Back 18

-@ 14 perform testicular self exam (TSE)
-@ 40 baseline digital rectal examination (DRE)

Front 19

American Cancer Society for early detection:

SKIN:

Back 19

- self exam of skin once a month
- dermatologist
- melanoma may manifest as a mole

Front 20

American Cancer Society for early detection:

Oral:

Back 20

-Regular dental examination
-Inspect mouth regularly

Front 21

American Cancer Society for early detection:


High Risk Exceptions:

Back 21

- genetic disposition
- family history

Front 22

Assigning and Delegating by the LPN/LVN Charge Nurse
• Are tasks/activities in nursing assistant's job description?
• May nursing assistant refuse nursing task/activity?
• What accountability is held for nursing task/activity?

Back 22

Assigning and Delegating by the LPN/LVN Charge Nurse
1-When assigning Yes, When Delegating No
-2 Assigning No, Delegating yes
3- Assigning, UAP is held responsible, When delegating LPN held responsible.

Front 23

Health Maintenance Organization (HMO)

Back 23

Health Maintenance Organization (HMO)
• Prepaid fee for comprehensive care
• Exclusive buildings and physicians
• Practice of preventive medicine
• Discourages excessive diagnostic tests and treatments
• Limited option of choosing physician
• Point of service (POS)

Front 24

Preferred Provider Organization (PPO)

Back 24

Preferred Provider Organization (PPO)
• Alternative to the strict utilization review system
• Fee-for-service
• Negotiated discount fees
• Better health coverage with preferred providers in the network
• Physicians engage in both private practice and PPO

Front 25

Medicare Part A

Back 25

Medicare Part A
• Helps pay for inpatient hospital care
• Available without cost to eligible individuals
• Helps pay for inpatient hospital care: drugs, supplies, laboratory tests, radiology, and intensive care unit
• Covers 20 days posthospitalization for skilled nursing facility care for rehabilitation services, home health care services under certain conditions, and hospice care
• Does not pay for nursing home custodial services, private rooms, telephones, or televisions provided by hospitals or skilled nursing facilities

Front 26

Medicare Part B

Back 26

Medicare Part B
• Requires a deductible and pays 80% of most covered charges
• The patient is responsible for the remaining 20%
• For medically necessary health services
• Does not pay for most prescription drugs, routine physicals, services not related to treatment of illness or injury, dental care, dentures, cosmetic surgery, routine foot care, hearing aids, eye examinations, or glasses

Front 27

Medicare Part C

(Managed Care)

Back 27

Medicare Part C
• Medicare Advantage plans, such as HMOs or regional PPOs
• Provides Parts A, B, and D benefits to people who elect this type of coverage instead of the original fee-for-service program

Front 28

Medicare Part D

Back 28

Medicare Part D
• Outpatient prescription drug benefit
• Available to all Medicare enrollees in the original fee-for-service program for an additional monthly fee

Front 29

The Medicaid Program

Back 29

The Medicaid Program
• State Children’s Health Insurance Program (SCHIP) supplements Medicaid for children of low- income families
• Primary source for low-income individuals with disabilities or chronic illnesses and those who need mental health services and substance abuse treatment
• Does not cover low-income Medicare beneficiaries, including for long-term care and vision and dental care
• Dual eligible

Front 30

Goals for Health Care

Back 30

Goals for Health Care
• Need for cost containment(holding cost to within fixed limits, while remaining competitive)
• Healthy People 2010 and health promotion( Promotion of Health Wellness)
• Holistic care of medical-surgical patients( being aware of and attending to physiologic,psychological,social,cultural, and spiritual needs)

Front 31

The Patient with Dependent Behavior

-What things do you do?

Back 31

The Patient with Dependent Behavior
• Spend time with the patient
• Establish trust
• Anticipate needs and wants
• Assure patient that needs will be met if not medically contraindicated
• Focus on the patient’s abilities
• Encourage independence
• Praise matter-of-factly
• Setlimits

Front 32

The Patient with Withdrawn Behavior

Back 32

The Patient with Withdrawn Behavior
• Provide a consistent routine of care
• Reduce environmental stress
• Limit the number of health care providers with whom the patient must interact
• Be alert to personal space needs
• Avoid whispering, secretive behavior, teasing, and joking

Front 33

The Patient with Depressed Behavior

Back 33

The Patient with Depressed Behavior
• Sit quietly next to the patient
• Encourage and assist patient engagement in activities of daily living
• Be aware that the pace of work will be slower
• Give directions for diagnostic tests one at a time• Offer patient sincere feedback
• Sincerely emphasize patient’s good qualities
• Avoid stories that illustrate that the patient’s situation could be worse
• Avoid being bright and cheerful in the patient’s presence
• Take threat of suicide seriously!!!!!!!!!

Front 34

The Patient with Hostile Behavior

Back 34

The Patient with Hostile Behavior
• Talk to the patient
• Listen and intervene as appropriate
• Allow patient who is hostile to make reasonable suggestions and choices about his/her care
• Meet appropriate patient suggestions
• Avoid empty promises

Front 35

The Patient with Manipulative Behavior

Back 35

The Patient with Manipulative Behavior
• Avoid being flattered by compliments
• Tell patient to ask directly when they need something
• Assure the patient that all direct, reasonable requests will be considered• Make plans with the patient
• Take any threat of suicide seriously
• Avoid becoming defensive
• Avoid trying to impress upon the patient how busy you are with other responsibilities