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69 Cards in this Set
- Front
- Back
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Adaptations for chemotherapy
3 major ones |
Thrombocytopenia
Anemia Leukopenia (Neutropenia) |
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Care for Leukopenia patient
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sign outside room "neutropenic precautions"
handwashing disposable stethascope, shower daily non iritating soap hi protein, hi calorie diet no fresh flowers or plants in room, assess breath sounds often, private room monitor for signs of infection |
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Care of anemia patient
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monitor for dizziness,dyspnea,fatigue, pallor, syncope, headache, chest pain
assess foe signs of blood loss teach energy conservation assess labs h & h, rbc anticipate need for transfusion iron rich diet |
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care of thrombocytopenia patient
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observe for patechiae, ecchymosis, or hemotomas
assess for signs of bleeding UA for bllod, guiac test, prevent constipation,no rectal temps, suppositories,or enemas soft bristle toothbrush only electric razor, no vigorous nose blowing, avoid aspirin, avoid bladder catherization if possible, apply pressure 5-10 min following venipuncture,anticipate need for transusion for counts 10000-20000, protect pt from injury |
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early warning signs of cancer
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Change bowel or bladdr habits
A sore that doesnt heal Uunusual bleeding/discharge Thickening or lump Indigestion/difficulty swallowing Obvious change in wart/mole Nagging cough/hoarseness |
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Common Cancer Adaptations
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inflammation, weight loss, fatigue, fever or infection, bleeding (overt or covert), anemia, pressure, PAIN (late adaptation)
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Goals of chemotherapy
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Cure
Control tumor growth Palliative measures Relieve adaptations Decrease tumor size Prevent or treat metastases |
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Chemotherapeutic agent classifications
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Alkylating : cisplastin,busulfan
Cytotoxic antibx:Doxorubicin Plant alkaloids:vincristine hormones and hormone antagonists: asparaginase & procarbazine miscellaneous:estrogens, progestins, androgens antimetabolites:methyltrexate |
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Nursing considerations for internal radiation therapy
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Time
Distance Shielding |
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Bone Marrow suppression from chemotherapy may result in:
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Leukopenia
Thrombocytopenia Anemia All 3 together called pancytopenia |
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If an extravasation occurs what is done immediately?
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stop infusion immediately and appy ice
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Parkinson's adaptations
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Bradykinesia, rigidity,
tremors(resting), postural instability, shuffling gait, pill rolling, freezing phenomenon, masklike face, micrographia, dysphagia, progressive mental deterioration, dementia (40-70%), urinary retention, sexual dysfunction, hallucinations, sleep disturbances, dysphonia |
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Primary medications for Parkinson's
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Levadopa, Cardiadope
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What neutralizes Levadopa?
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Vitamin B6
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What does Levadopa do?
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Replaces dopamine in basal ganglia
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Other medications used for Parkinsons
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Anticholinergics: cogentin - helps counteract acetocholine
Antivirals: symmeterol amantidine helps decrease symptoms early in disease process Dopamine agonists: parlodel, requip: increases amt of dopamine (1st line of treatment) when added to levadopa cardiadope can help halt some of the effects Antihistimines: benedryl- help reduce tremors, sedative effects MAOI's : inhibit breakdown of dopamine COMT: comton, tasmar- block enzyme that metabolizes levadopa Antidepressants: elivil |
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Types of CVA's
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ISCHEMIC CVA: caused by thrombus or embolus
thrombotic- caused by atherosclerotic plaque embolic- caused by blood clot HEMMORRHAGIC CVA: caused by ruptured vessel, occurs suddenly usually during activity, seen in older pt w/ HTN (can not use clotbusters aka thrombolytics) |
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Priority diagnosis for patient with CVA
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Risk for aspiration
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Interventions for risk for aspiration
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assess gag reflex
food w/ consistancy pt can handle elevate HOB provide mouthcare have suction readily available small mouthfuls on unaffected side ascultate lungs before and after meals meds should be crushed and put in jello, applesauce etc asess LOC and orientation stay w/ pt while eating pt should flex neck slightly when eating to swallow provide thickened liquids |
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Multiple sclerosis adaptations
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fatigue, depression, weakness, numbness, difficulty w/ coordination, spasticity, loss of balance, pain, visual disturbances, parastesias, loss of proprioception, ataxia, tremors, emotional lability, bladder, bowel & sexual dysfuntions, dysphagia, dysarthrias
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Multiple sclerosis interventions
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decrease fatigue
manage pain encourage ROM exercises provide frequent rest periods check gag reflex refer for speech and swallow evaluation provide suction@ bedside encourage HIGH FIBER diet teach bowel & bladder training encourage verbalization of concerns promote functional alignment Prone to OA treat w/ calcium |
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CAD adaptations
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Increased HR, RR, B/P
papitations, SOB from hypoxia, dizziness from hypoxia, pain, edema, diaphoresis, changes in skin color |
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CAD medications
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diuretics, beta blockers, alpha blockers, ACE inhibitors, vasodilators, ARB's, Calcium channel blockers, anticoagulants, anti-platelets, lipid lowering agents, analgesics
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Loop diuretics
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affect absorption of Na+ and K+ in ascending loop of henle. blocks renal absorption of Na+ and water
Adverse effects: hypokalemia, orthostatic hypotension, otoxicity |
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Thiazide diuretics
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Interferes w/ Na+ and chloride absorption in distal tubules
Improves cardiac output contraindicated in pt w/ gout Adverse effects: orthostatic hypotension & hypotension, increased uric acid levels, anemia, hyperglycemia, hypokalemia, affects vasculature of smooth muscles |
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ARB's -aldosterONE receptor blockers (Aldactone)
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Inhibits aldosterone effects on kidneys...Spares the K+...increases Na+ & H2O excretion decreasing K+ excretion
Adverse effects: hyperkalemia, agranulocytosis contraindicated in renal disease |
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Potassium sparing diuretics
(amiloride, triamtrene) |
gets rid of Na+ & chloride
amiloride blocks Na+ and hold K+ triamtrene- does not interfere w/ aldosterone secretion Adverse effects: potassium retention |
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Beta Blockers (LOL)
atenolol, propranolol, metoprolol |
Blocks SNS in heart
lowers BP & HR adverse effects: bradycardia, hypotension, dry mouth, sexual dysfunction, drowsiness, CHF |
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Alpha1 blockers (OSIN)
doxazosin(cardura), prazosin, terazosin |
Peripheral dilator working directly on blood vessels
adverse effects C.V. collapse |
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Alpha2 agonists
reserpine, methyldopa, clonodine |
Impairs the uptake of norepinepherine
Inhibits vasoconstriction & slows HR adverse effects: may cause depression, nasal congestion, postural hypotension contraindicated in depression, chronic sinusitis, obesity, peptic ulcers cautious use: gallbladder disease, seizures, renal disorders |
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hyponatremia : Na+ below 135mEq/L
adaptations |
abdominal cramps
rapid weak pulse hypotension convulsions scanty urine |
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Hypernatremia: Na+ above 145mEq/L
adaptations |
dry,sticky mucous membranes
thirst firm tissue turgor |
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Hypokalemia: potassium below 3.5mEq/L
adaptations |
weak and faint
falling B/P malaise anorexia, vomitting distention soft,flabby musculature |
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Hyperkalemia: potassium above 5.6mEq/L
adaptations |
nausea, irritability, general weakness, scanty to no urine, intestinal colic, diarrhea, irregular pulse
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hypocalcemia: calcium below 8.5 mEq/L
adaptations |
tingling of fingers, neural excitability,
abdominal muscle cramps tetany convulsions, DTR's, osteoporosis, chvostek's sign, Troisseau's sign |
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hypercalcemia: calcium above 10.5mEq/L
adaptations |
relaxed musculature
flank pains kidney stones deep bone pain (shin splints) EKG changes hypertension decreased bowel motility N/V, constipation mental status changes |
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Nursing diagnosis for Hypocalcemia
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risk for injury r/t muscle excitability
altered nutrition altered bowel elimination |
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Diet for hyponatremia
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Increase Na+ in diet
restrict fluids (don't want to dilute ECF) administer hypertonic saline High sodium foods include: animal products such as milk,meat and eggs vegetable include: carrots, beets, leafy greens & celery DRINKING PLAIN WATER CAN DILUTE BLOOD SODIUM CONCENTRATIONS AND EXACERBATE SODIUM DEFICIENCY COMPLICATIONS |
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Assessments for F & E imbalance
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changes in skin & mucous membranes
vital signs(BP down, RR,HR up= fluid deficiency) (BP up fluid excess-heart working harder) neurological assessment (confused, dizzy) Body weight(hydration weigh daily, nutrition weigh weekly) Edema (anywhere) I & O specific gravity lab assessment: BUN, electrolytes, CR (decreased levels of Na+ & Ca show w/ dehydration) |
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Hypertonic solutions what does it do?
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causes cell shrinkage: pulls fluid out of cell and into blood. Cells become puckered from the loss of fluid inside the cell
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Types of hypertonic solutions
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D5NS
D51/2NS D5RL 50% dextrose in H2O |
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Assessment/ implications for pt in hypertonic state
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closely monitor for fluid volume overload
too much can lead to cellular dehydration Intracellular dehydration can lead to dehydration leading to coma assess for pulmonary edema DO NOT give hypertonic solution to pt w/ DKA or CHF (can't process the fluid) |
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Adaptations for Emphysema (pink puffers)
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CO2 retention, SOB, pursed lip breathing, mucous, ineffective cough, barrel chest, thin appearance, easily fatigued, orthopnea, DOE, wheezing, anxious, digital clubbing, use of accessory muscles, prolonged expiration time, bronchi collapse on expiration
leads to right sided heart failure (cor pulmonale) |
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TB adaptations
note only definative test for TB is sputum culture...3 cultures to say pt is negative |
chronic cough(productive)
night sweats, fatigue, malaise, anorexia, weight loss, low grade temperature, hemoptysis(advanced)induration |
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TB medications
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INH-avoid foods w/ tyramine & histamine(tuna,aged cheeses,red wine,soy sauce)
Rifampin-can increase metabolism of digoxin, coumadin, beta blockers,corticosteroids & hypoglycemics. (can make urine orange) Pyrazinamide Ethambutol Streptomyacin |
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Types of hypertonic solutions
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D5NS
D51/2NS D5RL 50% dextrose in H2O |
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Assessment/ implications for pt in hypertonic state
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closely monitor for fluid volume overload
too much can lead to cellular dehydration Intracellular dehydration can lead to dehydration leading to coma assess for pulmonary edema DO NOT give hypertonic solution to pt w/ DKA or CHF (can't process the fluid) |
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Adaptations for Emphysema (pink puffers)
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CO2 retention, SOB, pursed lip breathing, mucous, ineffective cough, barrel chest, thin appearance, easily fatigued, orthopnea, DOE, wheezing, anxious, digital clubbing, use of accessory muscles, prolonged expiration time, bronchi collapse on expiration
leads to right sided heart failure (cor pulmonale) |
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TB adaptations
note only definative test for TB is sputum culture...3 cultures to say pt is negative |
chronic cough(productive)
night sweats, fatigue, malaise, anorexia, weight loss, low grade temperature, hemoptysis(advanced)induration |
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TB medications
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INH-avoid foods w/ tyramine & histamine(tuna,aged cheeses,red wine,soy sauce)
Rifampin-can increase metabolism of digoxin, coumadin, beta blockers,corticosteroids & hypoglycemics. (can make urine orange) Pyrazinamide Ethambutol Streptomyacin PT MUST COMPLY TO STRICT MEDICATION REGIMEN TO GET WELL, MUST TAKE MEDS FOR 9-18 MONTHS. take meds on empty stomach |
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The 2 types of diabetes and their onsets
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Type I diabetes: usually before age 30
autoimmune(destruction of pancreas) do not produce insulin so they are insulin dependent Type II diabetesusually onset in adulthood but is increasing among the young Can have insulin resistance or insufficient insulin secretion can be both insulin dependent and non insulin dependent |
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Stessors for type II diabetes
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age, obesity, sedentary lifestyle, genetic predisposition, metabolic syndrome, htn, diet, lack of exercise, pregnancy, steroids, TPN, higher in african amer & hispanics
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Adaptations for diabetes
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polyuria, polydipsia, polyphagia
weight loss(due to catabolic state) blurred vision, malaise/fatigue |
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Tests to diagnose diabetes
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random serum glucose
fasting plasma glucose two hour post load glucose |
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types of glucose monitoring
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self-monitoring blood glucose
continuous glucose monitoring system HgbA1C-normal 4-6%(shows 90 days helps find out diet compliance) urine glucose testing urine ketone testing (seen in type I) |
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Most important aspects for diabetes management
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Nutrition
Exercise Medication Glucose monitoring |
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Nursing interventions for diabetes management
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monitor glucose
nutrition high carbs consistant carbs (3 meals & 1-2 snacks/day) want 60gm carbs per meal Low protein 10-20% of diet) should be lean protein fats 20-30% nonsaturated promote exercise 30min every day(dont exercise w/ elevated glucose levels) medications: oral hypoglycemics, insulin |
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examples of soluble fibers that help lower glucose levels
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prunes, nuts, oatmeal, oranges, apple, carrots, broccoli
introduce slowly monitor for hypoglycemia |
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Insoluble fibers that help with irregularity
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wheat, wheat bran, dark green veggies, fruit skins
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What are the sick day rules?
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Take insulin or oral meds
Test blood glucose Report elevated levels Supplement insulin if needed Eat meals Prevent dehydration Report N/V/D Hospitalization may be necessary If diarrhea or vomitting need sugar so have reg coke not diet, have gatorade or cookie |
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Typse of insulin and onset & peaks
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Rapid:Novolog, Humalog onset 5-15 min peak50min-1hr
Regular: Humilin R onset 1/2hr peak 2-3 hr Intermediate, NPH: Humilin N onset 2-4hr peak 6-10 Long: Lantus onset 1 hr no peak its constant |
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Types of Oral hypoglycemics and actions
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Sulfonylreas: Glucotrol, Micronase: stimulate pancreas to make insulin
Biguanides: Glucophage, Metformin: helps body use glucose more efficiently, prevents liver from making too much glucose Thiazolidinesdiones: Avandia, Actose: inhibit glucose from the liver Meglitinides: Starlix, Prandin: work @ pancreas to stimulate beta cells to release insulin TAKE W/ FOOD Alpha-glucosidase Inhibitors: Precose, Glyset: delays absorption of glucose in the GI tract. Give with meals |
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Stressors for hypertension: B/P above 140/90 for a sustained time
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stress, obesity, age, hyperlipedemia, diabetes, smoking, medications, recreational drugs, surgery, sedentary lifestyle, nutrition & diet
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Interventions for HTN
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teach proper diet:oatmeal, multigrain, omega 3's, fresh fruit & veggies, avocado
exercise, limit ETOH, smoking cessation, stress reduction techniques, medication as prescribed |
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Thrombophlebitis 2 types superficial and Deep (DVT)
adaptations |
Superficial: hyperemia, erythems, edema, pain
Deep: hyperemia, edema, erythema, pain, + Homans sign, cyanosis(late sign), increased temp >100.4 mild elevated WBC's |
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Thrombophlebitis interventions
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vitals: inc RR & labored, increased pulse,mild inc temp,
auscultate lungs, assess EKG, assess labs(PT,PTT<fibrinogen, INR, CBC, ABG), elevate legs, maintain bedrest, compression stocking on uneffected leg, O2 therapy, warm moist heat, IV therapy, administer meds |
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Thrombolytic therapy (clotbusters) What are guidelines & what do they do?
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Must be given IV within 3 days of acute thrombus for thrombophlebitis
Disolves thrombus in about 50% of pt causes less long term damage to venous valves reduces incidence of post thrombolytic syndrome almost 3 times risk of bleeding as opposed to heparin must be stopped if bleeding can not be controlled |
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Names of thrombolytic agents
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Steeptokinase: used for MI, PE, DVT ...for streptokinase chest pain <20min, give within 6 hours
alteplase recombinant.used for MI, ischemic stroke, PE reteplaseUsed for thrombosis of acute MI urokinase: used for PE, AV cannula occlusion TPA is a type of thrombolytic agent that should be given w/ heparin |
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Nursing interventions for amputations
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no oils or creams on stump
compression bandage elevate post op for at least 24 hr can have complication of hip flexures so turn pt to prone position about 48 hr post of to avoid the hip flexion provide pain relief provide emotional support assess stump dressing |
