Scc 4Th Semester Final

Front 1

What is the etiology of lung cancer

Back 1

a. Cigarette smoking-75-85% of the cases
b. Air pollution
c. Occupational pollutants (coal, asbestos)
d. Second hand smoke

Front 2

Signs and symptoms of lung cancer, Systemic signs and symptoms, and signs and symptoms of metastisis

Back 2

. Insidious onset
a. spreads by direct invasion lymphatic and blood borne avenues
2. Chronic cough
3. Hemoptysis
4. Wheezing
5. SOB
6. Dull, aching chest pain--pleuritic pain
7. Hoarseness, Dysphagia (pressure on trachea and esophagus)
Systemic signs and symptoms
1. Weight loss, anorexia, fatigue, weakness
2. Bone pain, tenderness, swellinng
3. Clubbing of fingers and toes
4. S/S or endocrine, cardiovascular function
Metastasis
1. Metastasis of brain: Confusion, personality change, headache, impaired gait and balance
2. Bone metastasis-Bone pain, pathological fractures, spinal cord compression
3. Liver-Jaundice, RUQ pain, anorexia

Front 3

What is superior vena cava syndrome and the signs and symptoms of it

Back 3

. Results from compression of the vena cava by mediastinal tumors
i. Edema of face/neck
ii. H/ A, dizziness, vision, syncope
iii. Dilated veins of upper chest and neck
iv. Cerebral edema symptoms, laryngeal edema

Front 4

Diagnositc tests for Lung cancer

Back 4

Sputum cytology - First morning sputum for presence of malignant cells
Chest x-ray- Usually 1st evidence of lung cancer
Bronchoscopy: a. Visualize and obtain tissue for biopsy, b. Bronchial washing if tumor not visualized
CT
a.Evaluate and locate tumors (for needle biopsy)
b. Detect distant metastasis
c. Evaluate tumor response to treatment
Cytologic exam and biopsy
a) Aspiration of fluid from pleural effusion, percutaneous needle biospy and lymph biopsy
CBC, liver enzymes and calcium
a) Evidence of metastasis of paraneoplastic syndromes

Front 5

Treatments for lung cancer

Back 5

1. Combination Chemotherapy
a. Treatment of choice for oat cell small cell lung cancer b) Used as adjunct to surgery and radiation therapy
2. Surgery
a)Goal is to remove as much involved tissue as possible and reserve
b) Surgery is treatment of choice for non small cell cancer
c) Most tumors are inoperable or only partially resectable
3. Radiation Therapy
a) Used alone or with surgery b) Goal is cure or symptom relief
c) May be done prior to surgery to debulk tumors
d) May be used to lessen manifestations from bone or brain metastasis or superior vena cava syndrome
e) Nursing interventions
(1) Do not remove markings for radiation treatment
(2) Monitor for side effects: fatigue, skin reactions, esophagitis

Front 6

how long should you be looking for signs of toxicity after the pt has finished taking adriamycin or bleomycin?

Back 6

Effects continue for 6 months

Front 7

What drug causes birth defects

Back 7

methotrexate

-sperm banking, birth control

Front 8

What drug causes cardiovascular toxicity?

Back 8

ADRIAMYCIN!!

-observe for signs of CHF
-obtain EKG

Front 9

What drug causes pulmonary toxicity?

Back 9

BLEOMYCIN

-observe for pneumonia, CHF, SOB, coughing

Front 10

What drugs are toxic to the kidneys?

Back 10

ytoxan or methotrexate

- monitor BUN/creatinine
- increase oral intake to maintain hydration
-observe for signs of bleeding bladder (hemorrhagic cystitis)- dysuria, hematuria

Front 11

Tell me about alopecia r/t chemo

Back 11

-visible sign of dz
-hair falls out in clumps/breaks off
-have wig made before hair falls out
- don't brush or wash hair too often
-no color,dye, or perms at this time please

Front 12

How can you help your client get adequate nutrition during chemo?

Back 12

-May need enteral feedings or TPN
-small, frequent, high caloric feedings
-minimize food odors
-ask pt "what do you like?"
-antiemetics liberally- 30-60 min before eating

Front 13

A client is experiencing anorexia r/t chemo, WHY?

Back 13

-effect of chemo on hunger center
- N/V
-stomatitis

Front 14

Your client has stomatitis r/t chemo, what is some nursing care you will implement?

Back 14

nursing care you will implement? -frequently assess oral cavity
-mouth care w/ baking soda, magic mouthwash (don't you dare give them listerine!), nystatin swish and swallow, viscous lidocaine, soft toothbursh, NO FLOSS!, lip lubricant, avoid hot & spicy food, good fluid intake

Front 15

Nursing care for clients w/ thrombocytopenia

Back 15

-admin platelet transfusion
-use soft toothbrush, avoid razors, stools softeners, no aspirin

Front 16

what signs and symptoms would you expect to see in a pt with thrombocytopenia?

Back 16

signs are related to bleeding.
- petechiae, bruising, bleeding gums, hematuria
signs of bleeding in the brain- H/A, change in LOC, restlessness

Front 17

What nursing care would you want to provide for a client with anemia?

Back 17

client with anemia? -plan rest periods
-assist pt w/ activities
-admin Oxygen
-admin blood transfusions
-promote good hygiene

Front 18

Your client has anemia. What s/s would you expect to see?

Back 18

atigue, hypoxia, hypotension, tachycardia, anxiety

Front 19

What nursing care would you think about when caring for an immunosuppressed pt?

Back 19

good handwashing, prevent exposure to people w/ known infections, aseptic technique, observe for infection,reverse isolation is possible, neutropenic precautions ( no fresh fruit/flowers)

Front 20

What is the Nadir effect?

Back 20

Cells have different life spans- this causes lab values to reach lowest point at different times.
-WBC lowest at 7-10 days after treatment
- RBC lowest 7-10 days after
- Platelets- 10 days after

Front 21

What things would you want to teach your client regarding skin care while receiving radiation?

Back 21

aviod sun, trauma to skin, adhesive tape
- use caution w/ soaps
- no bath salts, perfumes, ointments or lotions
- no heat lamps, heating pads, ice packs
- wear soft, cotton light weight clothing
- may have medicated ointment prescribed

Front 22

What three ways can health car workers consider to protect themselves from a pt receiving radiation?

Back 22

ime- limit time spent with pt
distance- increase distance from radiation
shielding- use lead barriers

Front 23

Thrombocytopenia

Back 23

- Decrease in platelet count

- Normal platelet count is 150,000-300,000

Front 24

Anemia

Back 24

4.0-6.0 nl

Front 25

Neutropenia

Back 25

- Decrease in white blood cell count

- Normal white blood cell count is 5,000-10,000

Front 26

Name three side effects of chemotherapy

Back 26

1. Neutropenia
2. Anemia
3. Thrombocytopenia

Front 27

Nursing actions for IV chemotherapy infiltration

Back 27

1. STOP INFUSION FIRST
2. Apply Ice
3. Administer Antidote

Front 28

What general precautions should be taken when treating a cancer patient under radiation therapy

Back 28

Give them a private room
- Wear a film badge
- Have a sign on the door
- Encourage self care
- Limit visitors- No pregos!
- Precautions if implant is dislodged

Front 29

What is are the negative effects of Radiation Therapy?

Back 29

Radiation Therapy does not differentiate between cancerous cells, such as hair cells, gastrointestinal cells, epithelial cells, and reproductive cells

Front 30

Seven Warning Signs of Cancer

Back 30

Change in Bowel/bladder habits

A sore that does not heal

Unusual bleeding or discharge

Thickening or lump in the breast or elsewhere

Indigestion or difficulty swallowing

Obvious change in a wart or mole

Nagging cough or hoarseness

Front 31

Diagnostic Tests for Cancer

Back 31

–Cytology studies

CBC (Complete blood count)
- Tells whether or not if there is bone marrow suppression, not a real diagnostic tool for cancer

– PSA
- Prostate Specific Antigen
- For men

- CEA (Carcinogenic Embryonic Antigens)

- Both are not definitive tests for cancers, but they can indicate if previous cancers are coming back

Front 32

Cancer Related Health Risk Practice

Back 32

Smoking
-#1 preventable cancer

Nutrition
-Proper amount fiber = less cancer risk

Alcohol intake
-At risk for oral cancer (mouth, esophageal)

Sexual practices
-Sex at early age is a risk for cervical cancers

Other factors
–Viruses (Human Papilloma Virus) HPV
–Psychosocial factors

Front 33

Factors that contribute to the development of cancer(further descriptions on pg 513)

Back 33

1. Age
2. Genetic heritage
3. Hormonal factors
4. Immunologic factors
5. Drugs and chemicals
6. Radiation

Front 34

efine TNM classification

Back 34

T - anatomic size of the primary tumor
N - the extent of lymph node involvement
M - the presence or absence of metastasis

Front 35

Define Metastasis and describe three kinds

Back 35

spread to distant body parts

– Vascular spread - via blood stream
– Lymphatic spread - via lymph system
– Implantation - spread to a body cavity

Front 36

What care would you consider for a neutropenic child?

Back 36

- meticulous IV cath care
- frequent V/S to assess for septic shock: often only sign will be fever.
- increased HR/RR
- decreased BP
- give ordered antibiotics in timely manner

Front 37

What are interventions for tumor lysis syndrome?

Back 37

syndrome? -increased IV fluids 48 hr before chemo- much higher rates during chemo
- baseline and daily wts
- strict I/O & BP
-urinary alkalinization to increase pH to 7.0

Front 38

What occurs in tumor lysis syndrome?

Back 38

cancer cells break down and release potassium: watch out for HYPERKALEMIA!, purines released also: this causes hyperuricemia and allopurinol is needed to prevent uric acid production
-can quickly result in acute renal failure

Front 39

What is erythropoeitin?

Back 39

stimulates erythrocyte production
EX: epogen, procrit
-s/e: fever, diarrhea, tissue swelling

Front 40

What is G-CSF?

Back 40

stimulates neutrophils
EX: neupogen:
-do not give w/in 48 hours of chemo
-CBC 2x/week

Front 41

How long after a client begins receiving chemo will he/she begin to see the effects?

Back 41

7 -10 days

Front 42

What general diagnostic tests are indicated w/ cancer?

Back 42

CBC: RBC: HGB, HCT, RBC indices (anemia)
-platelets
-WBC- <500 is very low: increased risk for infection
-complete metabolic panel
-BUN/creatinine (before chemo)
-LFT (if jaundiced/suspect tumor there)
-urinalysis
-alpha-fetoprotein-liver tumors
-VMA/HVA- adrenal tumors, neuroblastoma
- elevated catecholamines- neiroblastoma

Front 43

Antineoplastic Drugs

Back 43

Interfere with the cell cycle of both Ca and normal cells
Cells most at risk:
Those in rapid proliferation
Blood forming cells
Bone marrow
Hair follicles
GI tract

Side effects:
Blood disorders
N/V
Hair loss

Not all Ca cells destroyed

Cycle specific drugs
Act at certain phases of cell division
Nonspecific drugs

Front 44

Chemotherapeutic agents types

Back 44

types Alkylating agents
-Poison mustard used in WW1

Antimetabolites

Mitotic Inhibitors
-derived from plants

Antibiotics
-Derived from microorganisms

Hormones

Radioactive

Misc.

Front 45

Alkylating agents

Back 45

Act by interfering with the structure of DNA
Defective DNA unable to reproduce
Cycle nonspecific
Affect all rapidly proliferating cells
Cause irreversible infertility
Cyclophosphamide (Cytoxan)

Front 46

Antimetabolites

Back 46

Cycle specific agents
Act only on dividing cells during S phase
Most effective on rapid growing cancers.
Methotrexate (MTX)

Front 47

Mitotic Inhibitors-Plant alkaloids
(Think Vinca)

Back 47

Most interfere with cell division or mitosis
Others act in G2 or S phase
Vincristine Sulfate (Oncovin)
VP-16

Front 48

Nursing implications for external radiation tx

Back 48

external radiation tx External
Adverse effects: skin changes, blanching, erythema, hemorrhage, ulceration, n/v, diarrhea
Assess lung sounds for rales
Record other medications
Monitor WBC and platelets
Teaching:
Plain H2O, no soap, etc.
Do not rub, scratch, or scrub
Apply neither heat or cold
Wear loose, soft clothing
Protect skin from sun exposure during and 1 year after SPF 15
Plenty of rest and eat a balanced diet

Front 49

Nursing implications for internal radiation treatment

Back 49

internal radiation treatment Internal: an implant is placed into the affected tissue
Patient must be in a Private room
Limit visits to 10-30 min. at least 6ft away
Monitor S.E.
-burning sensations, excessive perspiration, chills and fever, N/V, diarrhea
Assess for fistulas or necrosis
Teaching:
Stay in bed and rest quietly while in place
Avoid close contact with others until discontinued
Dispose of excretory materials in special containers or in a toilet not used by others
Eat a balanced diet
Carry out ADLs as able.

Front 50

Nursing Implications for Immunotherapy

Back 50

Monitor for side effects
Monitor enzymes
Evaluate response
Assess coping behaviors
Manage fatigue and depression
Encourage self care.
Close supervision
Teaching:
Increase fluid intake,
Take analgesics and antipyretic meds
Maintain bed rest until symptoms abate
SC injection or IV pump management.

Front 51

Pain management in the cancer patient

Back 51

C injection or IV pump management.
Pain management in the cancer patient Type:
Direct tumor involvement
Associated with treatment
Unrelated to Ca or Tx
Give medication on a regular schedule
No limit to amount client can receive.
MS is the drug of choice
Pharmacologic:
Careful initial and ongoing assessment
Evaluate functional goals
Nonnarcotic drugs (ASA or ibuprofen) with adjuvants (corticosteroids or antidepressants).
Progress to stronger drugs (Percodan or Darvon to dilaudid)
Try combinations and escalate dosages.

Front 52

Bone marrow transplantation

Back 52

To stimulate non functioning marrow or replace marrow
BMT given as an IV infusion of bone marrow cells from donor to patient
Commonly used in leukemias
Being expanded to include treatment of solid tumors, such as breast tumors.

Front 53

Anorexia, Nausea and Vomiting

Back 53

Provide Foods that the patient enjoys, but in small amounts
Food high in protein and vit. C to encourage cellular growth and repair
Vitamin and Mineral supplements
Give antiemetics: (pre better than post)
Ondansetron (Zofran)
Granisetron (Kytril)
Dronabinon (Marinol)
Metocloramide (Reglan)
Limit excess physical activity, liquids only before drug tx, relaxation techniques, hypnosis, guided imager

Front 54

Stomatitis

Back 54

Daily assessment of integrity of oral mucous membranes
Routine mouth care q 2-4 hours, q2hr if develops
Thoroughly rinse mouth after meals
Avoid commercial mouth washes, use 1 tsp baking soda in 500 ml of H20
Soft bristle toothbrush or toothette
Use bland, high caloric liquids
Local anasthetics such as lidocaine 30 min. before meals, children 1 hr before meals

Front 55

Xerostomia (Dry mouth)

Back 55

Drink fluids
Rinse mouth with baking soda solution
Artificial saliva
Lubricate lips with water soluble gel

Front 56

Oncologic Emergencies

Back 56

Pericardial effusion and Neoplastic Cardiac tamponade
Superior vena cava syndrome
Sepsis and septic shock
Spinal cord compression
SIADH
Obstructive Uropathy
Hypercalcemia
Hyperuricemia

Front 57

Safe handling of cytotoxic drugs.

Back 57

drugs. Wear while giving or mixing
Surgical Mask
Protective goggles or glasses
Gloves
Long-sleeved protective gown
Wash hands
Check tubing to ensure all connections are tight
Label with special hazard label
Bleed infusion into gauze is plastic bag
All contaminated materials are disposed of in hazard container and wash hands thoroughly
Manage spills
-Spill kit
-Disposable respirator mask and shoe covers suggested
Post procedure.

Front 58

Nolvadex (tamoxifen)

Back 58

hormone antagonist/ antiestrogens

Front 59

Megace (megestrol)

Back 59

hormones/progestins

Front 60

Granulocyte Colony Stimulating Factor (G-CSF or Filgastrin)

Back 60

biological response modifiers - hematopoietic growth factors

Front 61

Neulasta

Back 61

biological response modifiers - Hematopoietic growth factors
Stimulates neutrophil production

Front 62

Erythropoietin (Epotin Alfa, Procrit)

Back 62

biological response modifiers - Hematopoietic growth factors
Stimulates RBC production

Front 63

Hypercalcemia

Back 63

occurs when the serum calcium level exceeds 11 mg/dL.

Front 64

Superior Vena Cava Syndrome (SVCS)

Back 64

occurs in patients with lung cancer when the tumor or enlarged lymph nodes block the circulation in the vena cava

Front 65

What classification are interferons?

Back 65

Biologic Response Modifiers- Antineoplastic agents

Front 66

What is/are the mechanism of interferons?

Back 66

1. Alter response of host to tumor cells.
2. Inhibits DNA and protein synthesis in tumor cells.
3. Stimulates tumor-associated antigens

Front 67

Nursing Implications for:
doxorubicin hydrochloride
(Adriamycin)

Back 67

1. monitor for the developent of bone marrow depression and cardiotoxicity.
2. avoid leakage of drug solution into surrounding tissue during injecton.
3. may produce red urine for 1-2 days, but this is not hematouria.
4. observed for changes in nail beds on fingers and toes.
5. refrigerated, reconstitued solution is stable for 48 hours.

Front 68

Main side/adverse effects of:
doxorubicin hydrochloride
(Adriamycin)

Back 68

1. bone marrow depression
2. cardiac toxicity
3. nausea and vomiting
4. alopecia
5. irritation at injection site

Front 69

Mechanism of:
doxorubicin hydrochloride
(Adriamycin)

Back 69

. inhibit protein RNA synthesis, binds to DNA
2. "act by interfering with one or more stages of RNA and/or DNA synthesis. This actins interferes with cell's ability to grow and reproduce normally."
3. Cell-cycle nonspecific.

Front 70

Mechanism of:
vincristine sulfate
(Oncovin)

Back 70

"Act by specifically interfering with cell division or mitosis, i.e., the M phase of the cell cycle."

Front 71

Main side/adverse effects of:
vincristine sulfate
(Oncovin)

Back 71

(Oncovin) 1. peripheral neuropathy
2. alopecia
3. irritation at injection site

Front 72

Nursing implications for:
vincristine sulfate
(Oncovin)

Back 72

1. Avoid leakage of drug solution into surrounding tissue during injection.
2. monitor client for development of neuromuscular changes.
3. do not mix with anything but normal saline or glucose in water.
4. stool softner maybe use in preventing constipation
5. reconstitued refigerated solution maybe kept for 2 weeks.

Front 73

Nursing implications for:
methotrexate
(Mexate, MTX)

Back 73

1. Avoid use with nonsteroidal, anti-inflammatory drugs(NSAIDs)
2. Also indicated for use in the treatment of rheumatoid arthitis and psoriasis.
3. Sunscreen should be use to protect skin exposed to sunlight.
4. because of abortion and anomaly risks, client sholud avoid conception during and immediately following treatment.

Front 74

Main side/adverse effects of:
methotrexate
(Mexate, MTX)

Back 74

1. ulcerative stomatitis
2. nausea and vomiting
3. bone marrow depression
4. diarrhea

Front 75

Mechaniam of:
methotrexate
(Mexate, MTX)

Back 75

1. Folate antagonist
2. starve cells
3. cell-specific (s-phase)
4. "interfere with various metabolic actions of the cell and thereby result in cell destruction or inability to replicate itself."

Front 76

What is External Radiation?

Back 76

Linear accelerators use high energy x-ray beams, and are the most commonly used machines for RT.

Front 77

Radiation Therapy used with chemotherapy is know as _______ therapy.

Back 77

Adjuvant

Front 78

Which cells are least effected by RT?

Back 78

Muscles, nerves, and bone tissue

Front 79

Toxicities of RT:

Head area

Back 79

Alopecia
loss of teeth enamel, diminishing salivation and taste,
swallowing difficulty,
dry conjunctiva,
xerostomia,
stomatitis

Front 80

Toxicities of RT:

Chest area:

Back 80

Acute pulmonary toxicity
esophagitis
heart damage (slows down valves functions)

Front 81

Toxicities of RT:

Abdomen:

Back 81

N/V
Diarrhea
Constipation
Cystitis
Anorexia
Sterility

Front 82

Other complaints of RT is tiredness post-therapy, what causes the patient to become so tired?

Back 82

tiredness is due to quick anemia. (blood components are most affected by RT)

Front 83

Why are steroids used as part of cancer treatment?

Back 83

Cancer cause inflammation in the body

Front 84

Two types of anti-tumors antibiotics

Back 84

Adriamycin (Doxorubicin)
Mitomycin

Front 85

Mitomycin causes severe _____ _____ toxicity.

Back 85

bone marrow

Front 86

Drugs that are used pre-chemo, during/post treatment.

Back 86

Ativan- decrease anxiety
Benadryl- for inflammation and prevent anaphylaxic
Decadron- decrease inflammation
Protonix- for GERD
Reglan- speeds up stomach emptying
Zofran or Aloxi- antiemetics.

Front 87

T-Cells

Back 87

Originate from stem cells. Monitors the immune system. Acts directly on antigens to destroy them

Front 88

Blast Cell

Back 88

An immature form of a blood cell (ex. erythroblast, lymphoblast,etc.) (should not see blast cells in circulating blood)

Front 89

Absolute Neutrophil Count (ANC)

Back 89

The real number of white blood cells that are neutrophils. (vulnerable to infections)

Front 90

Sarcoma

Back 90

arises from connective tissue

Front 91

Adenocarcinoma

Back 91

landular or parenchymal tissue

Front 92

surface epithelium

Back 92

Squamous cell carcinoma

Front 93

hypermetabolic state

Back 93

an increase in resting metabolic expenditure of 50% to 100% above normal; often found in burn patients

Front 94

Curling's ulcer

Back 94

type of gastroduodenal ulcer caused by generalized stress response common in burn patients

Front 95

A permanent skin graft that may be available for the patient with large body surface area burns who has limited skin for donor harvesting is

Back 95

epithelial autograft

Front 96

Identify one major complication of burns, believed to be stress related, that may occur in the endocrine system during the acute burn phase.

Back 96

stress dm

Front 97

Identify one major complication of burns, believed to be stress related, that may occur in the neurologic system during the acute burn phase.

Back 97

Dementia

Front 98

The nurse suspects the possibility of sepsis in the burn patient based on changes in:

Back 98

vital signsa. Early signs of sepsis include an elevated temperature and increased pulse and respiratory rate accompanied by decreased BP and, later, decreased urine output and perhaps paralytic ileus. A burn wound may become locally infected without causing sepsis.

Front 99

At the end of the emergent phase and the initial acute phase of burn injury, a patient has a serum sodium of 152 mEq/L and a serum potassium of 2.8 mEq/L. The nurse recognizes that these imbalances could occur as a result of:

Back 99

. At the end of the emergent phase, fluid mobilization moves potassium back into the cells and sodium returns to the vascular space, causing a hypokalemia and a hypernatremia. As diuresis in the acute phase continues, sodium will be lost in the urine and potassium will continue to be low unless replaced. Excessive fluid replacement with 5% dextrose in water without potassium supplementation can cause a hyponatremia with a hypokalemia. Prolonged hydrotherapy and free oral water intake can cause a decrease in both sodium and potassium.

Front 100

Three factors that increase nutritional needs during the emergent and acute phases of burn injury are

Back 100

. HYPERMETABOLIC STATE resulting from increased plasma catacholamines and substrate mobilization

2. MASSIVE CATABOLISM resulting from protein breakdown and increased gluconeogenesis

3. CALORIES and PROTEIN for tissue repair

Front 101

The nurse positions the patient with ear, face, and neck burns:

Back 101

c. Patients with ear burns are not allowed to use pillows, because of the danger of the burned ear sticking to the pillowcase, and patients with neck burns are not alllowed to use pillows, because contractures of the neck can occur.

Front 102

The nurse assesses absent bowel sounds and abdominal distention in a patient 12 hours postburn. The nurse notifies the physician and prepares to:

Back 102

. The patient with large burns often develops paralytic ileus within a few hours, and a nasogastric tube is inserted and connected to low, intermittent suction. After GI function returns, feeding tubes may be used for nutritional supplementation and H2 blockers may be used to prevent Curling's ulcers. Free water is not given to drink because of the potential for water intoxication.

Front 103

A patient with deep partial-thickness burns over 45% of his trunk an dlegs is going for debridement in a hydrotherapy tank 48 hours postburn. The drug of choice to control the patient's pain during this activity is:

Back 103

Morphine is the drug of choice for pain control, and during the emergent phase, it should be administered IV because GI function is impaired and IM injections will not be absorbed adequately.

Front 104

A patient's deep partial-thickness burns are treated with the open method. The nurse plans to:

Back 104

When the patient's wounds are exposed with open method, the staff must wear hats, masks, gowns, and gloves. Sterile water is not necessary in the debridement tank, and topical antiinfective agents should be applied with sterile gloves. Open method of treatment does not use dressings.

Front 105

The physician orders IV mannitol (Osmitrol) and sodium bicarbonate to be given in addition to replacement fluids to a patient in the emergent phase of burn injury. The nurse understands that the rationale fo rtheses drugs is to help prevent:

Back 105

d. Acute tubular necrosis occurs when kidney tubules are mechanically blocked by myoglobin (from muscle cell breakdown) and hemoglobin (from RBC breakdown). Fluid intake at a rate to maintain urinary output at 75 to 100 ml/hr, osmotic diuretics such as mannitol, and sodium bicarbonate to alkalinize the urine help flush the myoglobin and hemoglobin from the circulatory system through the kidneys.

Front 106

Nasotracheal or endotracheal intubation is instituted in burn patients who have:

Back 106

b. Patients with major injuries involving burns to the face and neck require intubation within 1 to 2 hours after burn injury to prevent the necessity for emergency tracheostomy, which is done if symptoms of upper respiratory obstruction occur. Carbon monoxide poisoning is treated with 100% oxygen, and eschar constriction of the chest is treated with an escharotomy.

Front 107

A patient has a 20% TBSA deep partial-thickness and full-thickness burn to the right anterior chest and entire right arm. It is most important that the nurse assess the patient for:

Back 107

In circumferential burns, circulation to the extremities can be severely impaired, and pulses should be monitored closely for signs of obstruction by edema. Swelling of the arms would be expected, but it becomes dangerous when it occludes vessels. Pain and eschar are also expected.

Front 108

One clinical manifestation that the nurse would expect to find during the emergent phase in a patient with a full-thickness burn over the lower half o the body is:

Back 108

. Because of the hypovolemia and relative fluid loss, intense thirst is a common finding in the intially burned patient. Severe pain is not common in full-thickness burns, nor is unconsciousness unless there are other factors present. Fever is a sign of infection in later burn phases.

Front 109

The response of the immune system to a burn injury includes:

Back 109

Burn injury causes widespread impairment of the immune system, with depression of neutrophil activity, decreased T-helper cells and decreased levels of interleukins.

Front 110

The initial cause of hypovolemia during the emergent phase of burn injury is:

Back 110

a. Although all the selections add to the hypovolemia that occurs in the emergent burn phase, the initial and most pronounced effect is caused by fluid shifts out of the blood vessels as a result of increased capillary permeability.

Front 111

What are the criteria for the emergent phase of burn injury? What is the approximate time frame for it?

Back 111

Criteria: fluid loss and formation of edema

Time frame: usually 24-48 hours but may be up to 5 days

Front 112

The initial intervention in the emergency management of a burn of any type is to:

Back 112

he first intervention is to remove the source and stop the burning process. Airway maintenance would be second, then establishing IV access, followed by assessing for other injuries.

Front 113

When assessing a patient's full-thickness burn injury during the emergent phase, the nurse would expect to find:

Back 113

a. Dry, waxy white, leathery, or hard skin is characteristic of full-thickness burns in the emergent phase. Deep partial-thickness burns in the emergent phase are red, shiny, and have blisters. Edema may not be as extensive in full-thickness burns because of thrombosed vessels.

Front 114

after mva signs of internal bleeding

Back 114

thirst and restlessness indicate hypovolemia and hypoxemia

Front 115

with chemo pt at high r/f

Back 115

nosocomial infx

Front 116

when is drain ready for removal after mastectomy

Back 116

less then 30ml in 24 hr period

Front 117

why moderately elevate the arm after mastectomy

Back 117

to aid in drainage and reduce pain

Front 118

burn 3 phases

Back 118

emergent/resusative
immediate phase
rehabilitation

Front 119

full thickness burn

Back 119

epidermis dermis and sometimes subq possibly connective tissue muscle and bone

Front 120

breast ca

Back 120

Risk Factor
Female, Age, Inherited geneti mutations (BRCA1 and BRCA2
Biopsy-confirmed hyperplasia

Front 121

DCIS

Back 121

Ductal carcinoma in situ (most common)
Non-Invasive
Cancer cells are contained within the ducts

Front 122

Radical Mastectomy

Back 122

Removal of breast tissue, pectoralis majory and minor and all the axillary lymph nodes

Front 123

Modified radical mastectomy

Back 123

Removal of teh breast tissue and some or all of the axillary nodes. Pectoralis major is saved but minor might removed to allow easier access to axillia for dissection

Front 124

Simple Mastectomy

Back 124

Removes only the breast tissue itself. Chest wall muscles are spared adn there is no axiallary dissection

Front 125

Manifestations of Chronic Pain

Back 125

Flat affect
*Decreased mobility
*Fatigue
*Social withdrawal
*Depression
Goal: enhance quality of life with pain control

Front 126

europathic Pain

Back 126

*Characteristics
-Sensation of pain elected by a non-noxious stimuli
-Nerve related distribution: follows nerve pathway
-Resistant to standard opiods
Constant pain
Anti-Seizure Drugs
NSAIDS

Front 127

Adjuvant Analgesics

Back 127

-Medications for clients with cancer aimed at treating target symptoms
-Neuropathic pain
-Pain associated with spinal cord compression
-Somnolence (prolonged drowsiness or sleepiness)
-Anxiety
-Muscle spasms/myoclonic jerks
Subset of drugs: Anticonvulsants Ex: Neurotin used for neuropathic pain

Front 128

Nursing Interventions for Newly Diagnosed Client with Cancer

Back 128

Cancer *Be available, especially during difficult times: new diagnosis, recurrent disease
*Display caring attitude
*Listen actively to fears, concerns
*Provide symptom relief
*Provide information re: treatment
*Maintain open relationship based on trust, caring, honesty

Front 129

In Situ Breast Cancer

Back 129

*Non-invasive breast cancer
*May be ductal carcinoma in situ (DCIS) or lobular carcinoma in situ (LCIS)
*A pre-infiltrating cancer, advances to more aggressive disease
*With early detection, more women diagnosed with in situ
*4-6% of breast cancers

Front 130

Care After Biopsy

Back 130

*Small dressing 2-3 days
*Surgical bra 2-3 days
*Analgesics for pain
*Told when and by whom the test results will be given

Front 131

Treatment of DCIS

Back 131

*Breast-conserving surgery and radiation therapy, with or without tamoxifen.
*Total mastectomy with or without tamoxifen (estrogen blocker)
*Breast-conserving surgery without radiation therapy. A large national clinical trial comparing breast-conserving surgery and tamoxifen with or without radiation therapy is currently under way. (many clinical trials)

Front 132

Hormonal Therapy ONLY USED IF SOMEONE IS ESTROGEN POSITIVE

Back 132

*Four benefits for pre/post menopausal women (TAMOXIFEN ACCOMPLISHES THESE BENEFITS)
-reduce recurrence
-halt progression of metastasis
-reduce risk of CA in other breast
-prevent osteoporosis

Front 133

Hormonal Therapy

Back 133

*SERMs - selective estrogen-receptor modulators
*Aromatase Inhibitors - monoclonal antibodies
*Used in ER/PR +patients

Front 134

Aromatase Inhibitors

Back 134

*Postmenopausal women ONLY - inhibits aromatase, enzyme that synthesizes endogenous estrogen, prevents estrogen production at level of ovaries.
*Others: letrozol (Femara), Anastrozol (Arimidex), Emestane (Aromasin)

Front 135

Side Effects: SERMs (i.e. Tamoxifen)

Back 135

SERMs-Tamoxifen
-Hot flashes
-Weight gain/fluid retention
-DVT
-Endometrial cancer
-N/V

Front 136

Side Effects: Aromatase Inhibitors (i.e. Arimidex)

Back 136

Generally well-tolerated
Much better compliance
Increase in osteoporosis long term
*Nausea
*Headache
*Hot Flashes

Front 137

iological Therapy: Herceptin
(only treatment for HER-2-neu oncogene)

Back 137

(only treatment for HER-2-neu oncogene) *Monoclonal Antibody works against HER-2-neu oncogene over-expressed by breast CA cells
*Seen in 25% of patients, cells more agressive
*It is FDA approved for met. breast CA.
EVERYONE HAS THIS GENE BUT IT IS OVER-EXPRESSED BY BREAST CANCER CELLS.

Front 138

Side Effects: Herceptin

Back 138

*Infusion complications: fever, rigors, rash, SOB (recall hypersensitivity, Benadryl/steroids)
*Flu-like syndrome with first few doses
**Cardiac damage that resembles CHF**
*(Other Chema add to cardiac problems/radiation to chest
STRUGGLE IS DOES THE RISK OUTWEIGH THE BENEFIT

Front 139

sequelae/Complications (Post Mastectomy)

Back 139

Pain (recall)
*Infection/Lymphedema prone to infection due to node dissection. Place sign above bed: No blood draws, IV's, Injections, or BP in affected arm see (care of arm in handout)
*Bleeding-JP to prevent fluid buildup; not to exceed 300cc in 24 hours

Front 140

The Nurse's Role: How to help your client

Back 140

*Acknowledge your client's feelings of hopelessness
*Provide new perspectives
*Help your client see he/she has someone to live for
*Call attention to esthetic experiences
*Respond to clients' use of reality surveillance
*Establish attainable goals
*Help client re-establish control

Front 141

What is Hypercalcemia?

Back 141

-fatigue
-confusion
-weakness
-tachycardia

Front 142

What Nutritional meals to provide for cancer patients?

Back 142

small meals
-frequent meals
-high protein
-high calories
-high fat
-snacks
-fluid 2-3 L per day
-vitamins and minerals

Front 143

Nutrition Prevention for Cancer?

Back 143

-decrease fat to 30%
-increase fiber, fruits, vegetables, legumes
-increase citrus fruits
-decrease salt cured, pickled and smoked foods
-minimize contaminants from pesticides
-alcohol used in moderation

Front 144

antineoplastic

Back 144

monitor platelets, cbc, renal and liver fnx

may be ototoxic/nephro/hepato toxic

monitor v/s through out tx
andmin antiemetics before during and after tx

Front 145

teach pt with anti neoplastics

Back 145

s/s to report
gi bleeding tinnitus hearing loss dizzy
teach wash hands stay away from infectious areas
uses birth control
skin check q day
use soft toothbrush

never give chemo if wbc is below 3000

Front 146

decrease RBC signals bone marrow suppression

Back 146

s/e of chemo

Front 147

hemorrhagic cystitis

Back 147

possible chemo s/e

Front 148

plant alkaloid agents

Back 148

nerve damage side effects

Front 149

methotrexate

Back 149

avoid the sun

Front 150

chemo diet

Back 150

increase protein, iron,vit c/b vits, and calories

Front 151

kaioecatate and limotal

Back 151

anti d

Front 152

radiation dosages increased with

Back 152

cretin lotions on skin

Front 153

chemical burn

Back 153

remove clothes flush area with cool clean water, double gloves to prevent chemicals on you

Front 154

thermal burn

Back 154

remove clothes and jewelry moist dressing

Front 155

electric burns

Back 155

monitor brain, heart, lungs be sure current is off

Front 156

rule of 9's

Back 156

trunk 18
arms 4 1/2
face 4 1/2
back 18
legs 9
groin 1

Front 157

blister indicate plasma lost in the blood

Back 157

indicator for hypovolemia and shock

Front 158

burns predispose stress ulcers monitor for bleeding

Back 158

check for bleeding

Front 159

burns monitor for hypvolemic shock

Back 159

r/t kidney shut down

Front 160

after burn administer td

Back 160

booster if not IZ in the last 5 yrs

Front 161

ekg for

Back 161

electric burns

Front 162

chemical burn monitor for

Back 162

anorexia and paralytic illius r/t not eating

Front 163

granulating tissue

Back 163

pink / moist/ no drainage

Front 164

after skin graft

Back 164

supine in bed gravity helps graphs adhere

Front 165

rhabdomyolysis

Back 165

breakdown of skeletal muscle breaks down to myoglobinuria that places kidneys at risk for acute failure monitor ua, and DIC

Front 166

compartment syndrome

Back 166

increased compartment pressure decrease in capillary perfusion

Front 167

compartment syndrome types

Back 167

from restrictive dressing and stuff like splints or bleeding edema or chemical response like in a snake bite

Front 168

compartment syndrome manifestations

Back 168

6 p's DO NOT elevate
NO ICE
suction decompression acute may require amputation to decrease myoglobinemia

Front 169

Spinal Cord Injury

Back 169

Immobilization
-Cervical spine X-rays and possible CT studies
-Reduction with cervical or halo traction
-Emergency administration of methylprednisolone (IV to reduce swelling)
-Assess for distributive (spinal) shock
∑ May need vasopressors
-Need complete neurological exam
∑ Frequent assessment and documentation of motor & sensory status of all extremities
-Postural reduction or surgical fusion

Front 170

Priority Assessments of SCI

Back 170

-Airway and ventilation
-Paralysis of diaphragm & intercostals muscles will result in ineffective breathing patterns
∑ C1-C3: ventilator dependent
∑ C4-C5: may or may not need ventilator
∑ Below C5: have intact diaphragmatic breathing

Front 171

Assessment of SCI

Back 171

-Entire body: motor/sensory
-Reflexes
-Spinal shock
-Sensory/motor loss
-Autonomic dysfunction
-Bowel/bladder dysfunction

Front 172

Spinal Shock

Back 172

-Common with complete lesions
-Decreased venous return
-Venous stasis
-Hypotension
-Bradycardia

Front 173

Emergency Management of SCI

Back 173

Ventilation/perfusion
-Stabilization: tongs, surgery, halo
-Corticosteroid protocol
-Kinetic bed: to prevent secretions, moves pt side to side to use respiratory muscles and not develop pneumonia

Front 174

Nursing Care: SCI

Back 174

Oxygenation
-Potential for ineffective airway clearance
-Potential for decreased CO r/t spinal shock
-Fluids
-Drugs

Front 175

Autonomic Dysreflexia

Back 175

-Occurs T6 or above after resolution of spinal shock
-Intense sympathetic response to stimuli
∑ Kinked catheter
∑ Impaction
-Severe hypertension, headache, and bradycardia
-Assess and remove the cause

Front 176

Nursing Assessment GCS

Back 176

Rapid standardized tool consisting of eye opening, verbal response, and motor response
-Scoring:
• Best response, trend more meaningful than actual numbers, report specific abnormalities

Front 177

Nursing Assessment GCS

Back 177

-Rapid standardized tool consisting of eye opening, verbal response, and motor response
-Scoring:
∑ Best response, trend more meaningful than actual numbers, report specific abnormalities
∑ High number (approaching 15) means normal functioning
Low number (approaching 3) indicates impaired functioning

Front 178

What is TOP Priority with Burns

Back 178

remove from danger. either flames or vapor or chemical or electrical source. need to protect rescuer also

Front 179

What are some of the metabolic concerns in the emergent stage? (right after the burn)

Back 179

Hyperkalemia from tissue lysis
hyponatremia
metabolic acidosis
elevated hemocrit

Front 180

What are some of the metabolic concerns in the 2nd Acute phase?

Back 180

decreased hematocrit
increased urine output
hyponatremia
hypokalemia
met. acidosis

Front 181

What is a danger in the Acute phase?

Back 181

Upper airway edema - may develop as late at 48 hrs post burn

Front 182

What is the best type of fluid to use for replacement therapy for burn pts?

Back 182

Colloids and later crystalloids (sodium chloride and Lactated ringers)

Front 183

What are some of the Cardivascular problems?

Back 183

.Hypovolemia - decreases perfusion and O2 delivery
2. which causes Burn Shock - BP drops, which releases catecholamines which cause vasoconstriction and an increase in pulse rate, which further decreases cardiac output

Front 184

A priority nursing intervention for the Cardiovascular problems of burns is?

Back 184

Fluid unless there is massive edema

Front 185

What are some of the Pulmonary problems with burns?

Back 185

pulse ox may show 100% but hemoglobin likes carbon so may be false reading.
Assessment is priority!!!! look for signs of inhalation
but before intervention look for eschar restriction
Can cause ARDS-resp. failure

Front 186

interventions for Pulmonary problems with burns

Back 186

Give 100% humidified O2 regardless of what pulse ox shows BUT 1st check eschar for tightness may need to do escharotomy before can give O2
May need to intubate and may need mechanical ventilation

Front 187

What are signs that there may be Pulmonary involvement?

Back 187

1. burns to face
2. burned in enclosed space
3. singed facial hair
4. hoarseness, dry cough, stridor, sooty sputum or bloody sputum
5. hypoxemia &/or tachypnea

Front 188

What are some Gastro alternations due to burns?

Back 188

1. paralytic ileus (absence of peristalsis)
2. Curlings Ulcers
3. Abdominal Compartment Syndrome

Front 189

What are signs of Curling's ulcers?

Back 189

blood in stool
coffee ground and/or bloody vomit

Front 190

What are the signs of Abdomal Compartment Syndrome?

Back 190

This can happen especially if fluid is delayed
Hallmark sign is the Blood pressure increases >25-30mmHG over time

Front 191

What are the signs of Sepsis in a burn patient?

Back 191

. lrg amount of bacteria per gram of tissue
2. inflamation
3. sludging and thrombosis of dermal blood vessels

Front 192

How do you test for extremity Compartment Syndrome?

What is a nursing intervention for compartment syndrome?

Back 192

1. pulses hourly with a Dopplar device
2. assess cap. refill, sensation and movement

Front 193

What are some of the meds used topically for burns?

Back 193

burns? Silver containing meds
Benedine
Mafenide acetate
Acticoat

Front 194

What are nursing interventions for dressings?

Back 194

. peripheral pulses checked frequently
2. elevate extremities on two pillows
3. if pulse is diminished then remove the dressings (with permission of physician)

Front 195

What type of dressing are used and not used?

Back 195

compression are used

Never wet to dry

Front 196

What type of pain management is used?

Back 196

Opioid via IV

titration is crucial

Morphine is drug of choice

Fentanyl for procedural pain

PCA is good choice

Front 197

What is a hyperdynamic response?

Back 197

increased body temp
increased O2 and glucose consumption
increased O2 production
increases lysis
starts 5th day and continues until 24 mths

Front 198

What is a hypermetabolic response?

Back 198

1. increased risk of infectin
2. decreased healing rate
3. so increase anabolic process w/ nutrition & muscle activity - give carbs, lipids and protein-med Propanolol
insulin given

Front 199

What is a hypercatabolic response?

Back 199

flight or fight response

Front 200

What is priority in the Emergent stage burns

Back 200

. 1st aid (see other slide)
2. prevention of shock
3. prevention of resp. distress
4. trmt of concomittant injuries
5. wound assessment and begin care

Front 201

What is priority in the Acute/Intermediate stage

Back 201

48-72 hrs post burn
1. continued assessment and maintenance of resp. and circulatory status
2. fluid and electrolyte balance
3. gastrointestinal funtion
4. infection prevention
5. wound care and closure 6.prevention of complications 7. nutritional
8. pain care

Front 202

What is priorty in the Rehabilitation phase?

Back 202

Prevention of scars and contractures
- rehab of physical, emotional, psychological
- functional and cosmetic reconstruction
- psychosocial counsuling

Front 203

What are nursing interventions for the renal problems from electrical burns?

Back 203

Prone to acute renal failure - altered due to decreased blood volume so adequate fluid volume replacement helps

keep strict I & O's

Front 204

What is considered a Major burn?

Back 204

>25% partial, >10% full
Also burns on the face,hands, eyes, ears or perineum and all Electrical burns and all burns complicated by medical conditions such as COPD or diabetes

Front 205

When does fluid overload start?

Back 205

after 48-72 hrs
burns

Front 206

A nurse is preparing for removal of an endotracheal tube from a client. In preparing to assist the physician in this procedure, which initial nursing action is most appropriate?

Back 206

suction the endo tube

Front 207

A client is intubated with an endotraceal tube by the anesthesiologist. What is the responsibility of the nurse regarding checking for tube placement immediately following tube insertion ?

Back 207

auscultating is an immediate action

Front 208

A nurse caring for a client on a mech vent, hears the high-pressure alarm. The nurse suspects that the most likely cause is?

Back 208

when the preset peak inspiratory pressure limit is reached by the ventilator b4 it has delivered a set tidal volume sets off a high-pressure alarm
causes include tubing obstruction or kinks, breathing "out of phase" or "buckling the ventilator", accumulation of secretions, condensation of water in the vent. tubing, coughing or Valsalva's maneuvers, increased airway resistance, bonchospams, decreased pulmonary compliance or pneumothorax.

Front 209

A nurse caring for a client on a mech. vent. The low-pressure alarm sounds. The nurse suspects that which of the following is the cause of this alarm?

Back 209

disconnection of the vent.tubing




4, it sounds when little or no pressure is generated during the del of the machine breaths. Causes include disconnection of the tubing or a cuff leak. also by exaggerated client resp effort generating extreme negative pressure

Front 210

A physician writes an order to begin to wean the client from the mechanical vent. by use of intermittent mandatory ventilation/synchronized intermittent mandatory vent. The nurse determines that the process of weaning will occur by?

Back 210

the resp rate is decreased gradually until the clien assumes all of the work of breathing. works exceptionally well in the weaning of clients from short-term mech. vent such as that used in clients who have undergone surgery. The resp rate is decreased hourly until the client is weaned and is ready for extubation

Front 211

A nurse is reviewing the ventilator settings on a client with an endotracheal tube attached to mechanical vent. The nurse notes that the tidal volume is set at 700 ml and determines that the tidal volume indicates/

Back 211

the amt of air delievered with each set breath

Front 212

A client has been admitted with chest trauma after a motor vehicle accident and has undergone subsequent intubation. A nurse checks the client when the high-pressure alarm on the vent. sounds, and notes that the client has absence of breath sounds in the right upper lobe of the lung. The nurse immediately assesses for other signs of?

Back 212

right pneumothorax




4. is characterized by restlessness, tachycardia, dyspnea, pain with respiration, asymmetrical chest expansion, and diminished or absent breath sounds on the affected side. can cause increased airway pressure b/c of resistancde to lung inflatio.

Front 213

A client is placed on a ventilator. Because hyperventilation can occur when mechanical ventilation is used, the nurse should monitor the client for signs of?

Back 213

increased rate and depth of breathing results in excessive elimination of CO2, and resp. alkalosis could result

Front 214

The nurse knows that when a client has a trach tube with a high-volume, low-pressure cuff, it is used primarily to prevent?

Back 214

mucosal necrosis

Front 215

The nurse knows that side effects of PEEP are?

Back 215

decreased venous return (supine, legs up?) decreased cardiac output, increased cardiac workload, increased intrathoraic pressure

Front 216

SIADH

Back 216

SIADH: major signs and symptoms
SIADH:
Spasms
Isn't any pitting edema (key DDx)
Anorexia
Disorientation (and other psychoses)
Hyponatremia



SIADH: causes
SIADH:
Surgery
Intracranial: infection, head injury, CVA
Alveolar: Ca, pus
Drugs: opiates,antiepileptics, cytotoxics, anti-psychotics
Hormonal: hypothyroid, low corticosteroid level

Front 217

What is used to prevent breast cancer?

Back 217

taxol

Front 218

What is a Plant Alkaloid for chemo?

Back 218

oncovin

Front 219

What is an Antibiotic Antineoplastic Agent? chemo

Back 219

Bleomycin, Adriamycin

Front 220

What is a Antimetabolite agent? chemo

Back 220

Folic acid analogues(methotrexate)
Pyrimidine analogues 5-FU

Front 221

What is a normal platelet count

Back 221

150,000 to 300,000 so hold chemo if less than 100,000
bleeding risk if less than 50,000

Front 222

What are some problems with Reglan?

Back 222

monitor for respirations, moves quickly through GI tract & constricts cardiac spincture

Front 223

What is Versed used for?

Back 223

anesthesia drug, conscious sedation, minor surgeries and endoscopy, not analgesic so often combined with one
VERY HIGH AMNESIA RATE

Front 224

What are the side effects of Versed?

Back 224

respiratory depression & cardiac arrest
Pt MUST BE MONITORED AT ALL TIMES

Front 225

What drug interaction does Versed have?

Back 225

when given with opioids must decrease the dosage of the opioids in half-synergises the opioid

Front 226

Evidence-based practice is defined as:

Back 226

the integration of
best research evidence with
clinical expertise and
patient values-
it involves accurate and throughtful decision making about health care delivery for clients

Front 227

silvidine

Back 227

monitor renal and hepatic

Front 228

suction before deflating ET tube after

Back 228

check breath sounds and sp02

Front 229

secondary spinal cord injury

Back 229

72 hrs or later
ischemia, edema, free radicals, ca influx
solumedrol decrease inflammation 30mg/kg

Front 230

t5

Back 230

decrease GI motility=illius=stress ulcers

Front 231

c5 diaphragm breathing

Back 231

spinal cord

Front 232

c spine interventions

Back 232

airway/halo/cath/immobilize/ monitor bp r/t vasodilation

Front 233

low dose dopamine

Back 233

for renal perfusion

Front 234

urine output for electrical burns

Back 234

75ml hr r/t flushing out myoglobin and RBC 's free floating

Front 235

burn diet

Back 235

increase cals, proteins, and carbs based on labs like albumin

Front 236

major symptoms of CS

Back 236

pain unrelieved by narcotics
& pain increases with passive stretch or touch

Front 237

compartment syndrome

Back 237

monitor renal from floating myoglobin backing up in tubles tx faciatomy or ambutation

Front 238

rhamdomyolysis

Back 238

breakdown of skeletal muscles leads to myoglobinuria r/f ARF monitor urine for ph and myoglobin, color and amount. Monitor for
DIC teach avoid accessive heat

Front 239

nociceptive pain

Back 239

pain that is caused by damage to somatic or visceral tissue and occurs abruptly after an injury or disease, persists until healing occurs, and often is intensified by anxiety or fear

Front 240

transduction

Back 240

he conversion of a mechanical, thermal, or chemical stimulus into a neuronal action potential

Front 241

modulation

Back 241

involves the activation of descending pathways the exert or inhibit pain

Front 242

triclyic effect

Back 242

modulation

Front 243

PET scan

Back 243

measures metabolic activity in brain regions to assess for cell death
Pee first
IV lines X2
maybe asked to perform different activities during test

Front 244

myelogram

Back 244

ask about allergies
Pt to lie flat for a few hrs after

Front 245

nl icp 0-15 mm hg

Back 245

ICP

Front 246

manifestations of ICP

Back 246

LOC, vitals= cushgings triad=widening pluse pressure, occular changes, decreased motor fnx

Front 247

part of the brain that is responsible for reception and interpretation of speech

Back 247

Wernicke area

Front 248

part of the brain that contains the primary auditory cortex

Back 248

temporal lobe

Front 249

What are the normal ABG lab values?

Back 249

pH: 7.35-7.45
PCO2: 35-45 mmHg
Bicarbonate (HCO3): 20-30
PO2 80-100 mmHg
Oxygen Saturation 96-100%
Base Excess +/- 2.0 mEq/L

Front 250

Clinically describe SIADH

Back 250

SIADH occurs when ADH is released despite normal or low plasma osmolarity. SIADH results from an abnormal production or sustained secretion of ADH and is characterized by fluid retension, serumhypoosmolaity, dilutional hyponatremia, hypochloremia, concentrated urine in the presence of normal or increased intravascular volume, and normal renal function. This syndrome occurs more commonly in older adults. SIADH is thought to be the most common cause of of hyponatremia in older adults. SIADH has many causes, the most common cause is malignancy, especially small cell lung cancer. These cancerous cells are capable of producing, storing, and releasing ADH.
Specific diagnostic criteria that define SIADH include the following:
•Hyponatremia (serum sodium <135 mEq/L)
•Hypotonicity (plasma osmolality <280 mOsm/kg)
•Inappropriately concentrated urine (>100 mOsm/kg water)
•Elevated urine sodium concentration (>20 mEq/L), except during sodium restriction
•Clinical euvolemia
•Normal renal, adrenal, and thyroid function

Front 251

What is the parkland formula?

Back 251

4ml lactacted ringer's solution per kg body weight per %TBSA=total fluid requirements for the first 24 hours after burn.

Application:
1/2 of total in first 8 hours
1/4 of total in second 8 hours
1/4 of total in third eight hours

Front 252

What are the carbon monoxide poisoning characteristics?

Back 252

Carbon monoxide poisoning is produced by the incomplete combustion of burning materials. Inhaled CO2 displaces oxygen. This causes: Hypoxia, Carboxyhemoglobinemia and death. Treat with 100% of humidified oxygen. CO2 poisoning may occur with the absence in a burn to the skin. Skin color described as "cherry red" in appearence.
*Mechanical obstruction can occur quickly.
*Presence of facial burns
*Singed nasal hair
*Hoarseness painful swallowing
*Darkened oral and nassal membranes.
* Pulmonary edema may or may not occur for 12-24 hours after the burn.

Front 253

What is the debridement procedure and the nursing process for a burn patient?

Back 253

procedure and the nursing process for a burn patient? Escharotomy – removal of the eschar formed on the skin and underlying tissue of severely burned areas; procedure is particularly helpful in restoring circulation to the extremities of patients in which the eschar forms a tight swollen band around the circumference of the limb
Debridement – removal of loose, necrotic skin.
Two types of wound treatment used to control infection are the open method and the use of multiple dressing changes.
Open method – burn is covered with a topical antibiotic and has no dressing over the wound
Multiple dressing changes – sterile gauze dressings are impregnated with or laid over a topic antibiotic; may be changed two to three times every 24 hours to once every three days.

Analgesic Drug Therapy for Burn Patients
Morphine (the drug of choice for pain control)
Meperidine (Demerol)
Fentanyl (Sublimaze)
Buprenorphine (Buprenex)

A hypermetabolic state proportional to the size of the wound is noted.
Resting metabolic expenditure may be increased by 50% to 100% above normal in patients with major burns.
Core temperature is elevated.
Plasma catecholamines, which stimulate heat production, are increased.
Massive catabolism can occur and is characterized by protein breakdown and increased gluconeogenesis.
Caloric needs are often in the 5000 kcal per day range.

Front 254

What are three types of cerebral edema?

Back 254

Vasogenic Cerebral Edema
Cytotoxic Cerebral Edema
Interstitial Cerebral Edema

Front 255

Briefly describe Vasogenic Cerebral Edema.

Lewis page: 1493

Back 255

Vasogenic Cerebral Edema is the most common type of edema, it occurs mainly in the white matter and is attributed to changes in the endothelial lining of the cerebral capillaries. These changes allow leakage of macromolecules from the capillaries into the surrounding extracellular space, resulting in an osmotic gradient that favors the flow if water from the intravascular to the extravascular space.

Front 256

Describe briefly Cytotoxic Cerebral Edema.

Back 256

Results from local disruption of the functional or morphologic integrity of cell membranes and occurs most often in the gray matter. Cytotoxic Cerebral Edema develops from destructive lesions or trauma to brain tissue resulting in cerebral hypoxia or anoxia, sodium depletion, and syndrome of inappropriate antidiuretic hormone (SIADH). Cerebral edema results as fluid and protein shift from the extracellular space directly into the cells, with subsequent swelling and loss of cellular function.

Front 257

Briefly describe Interstitial Cerebral Edema.

Back 257

Is the result of periventricular diffusion of ventricular CSF in a patient with uncontrolled hydrocephalus. It can also be caused by enlargement of the extracellular space as a result of systemic water excess (hyponatremia). Fluid moves into the cells to equilibrate with the hypoosmotic interstitial fluid. Regardless of the cause of the cerebral edema, manifestations of IICP result unless compensation is adequate.

Front 258

What are 5 complications of shock?

Back 258

1. ARDS acute respiratory distress syndrome
2. Acute Renal Failure
3. GI complications
4. DIC- Disseminated Intravascular Coagulation
5. MODS- Multiple Organ Dysfunction Syndrome

Front 259

characterized by loss of blood vessel tone and enlargement of vessel compartment
Ex anaphalaxis

Back 259

Distributive Shock

Front 260

RN interventions for IICP?

Back 260

Mntr neuro status, maintain airway patency, elevate HOB 30-45 deg, keep neck straight, institute seizure precautions

Front 261

What is areflexia?

Back 261

spinal shock

Front 262

S/S of autonomic dysreflexia?

Back 262

Severe pounding HA w/ paroxysmal HTN, profuse diaphoresis, nasal congestion, & bradycardia

Front 263

Trigger of autonomic dysreflexia?

Back 263

distended bladder or bowel, pain stimulation

Front 264

Immediate intervention for autonomic dysreflexia?

Back 264

Place pt in sitting position, empty bladder, fecal impaction, other triggers

Front 265

4 pain Antidepressant Medications: Tricyclic: (TCA’s)
amitriptyline (Elavil)

Back 265

Antidepressant Medications: Tricyclic: (TCA’s)
amitriptyline (Elavil)

Actions: Block reuptake of neurotransmitters serotonin, norepinephrine, and/or dopamine in body.

S.E.
Commonly occurs with TCAs
1. Blurred vision---------------symptoms should subside in few wks. Do not drive until vision clear.
2. Constipation-----------------high fiber diet, monitor fluid & food intake increase exercise, if possible.
3. Urinary retention-----------pt report hesitancy or inability to urinate, monitor intake & output, instruct pt to see Dr.
4. Orthostatic hypotension---------rise slowly from lying to sitting, Monitor BP (lying & sitting), avoid hot showers and tub baths.
*  Seizure threshold---------observe closely if history of seizures, institute seizure precautions.
* Tachycardia, arrthythmias------Carefully monitor BP, pulse rate & rhythm, report any change to Dr.
• Photosensitivity-------------------wear protective sunscreens, clothing, sunglasses.
* Priapism (with Desyrel)---withhold drug & notify Dr.
* Weight gain---------------------encourage  activity,
instructions on reduced calorie diet.

Nursing Implications/Pt teaching
Effective for migraine headache, tension-type headache, postherpetic neuralgia, painful diabetic neuropathy, arthritis, low back pain, and other painful conditions.

Front 266

burn Fluid Resuscitation - Special Needs

Back 266

Fluid Resuscitation - Special Needs

• Patients who will require more fluids - high voltage electrical injuries
- inhalation injury
- delayed resuscitation
- associated trauma
- preexisting dehJdration
- alcohol use or abuse
- memlabs

Front 267

What is the clinical triad of neurogenic shock?

Back 267

-Hypotension- because of dilation of the vasculature
-bradycardia- because of parasympathetic system stimulation
-Hypothermia- because of loss of sympathetic nervous system function

Front 268

trigiminalneuralgia

Back 268

compression of blood vessels? cranial nerve 5. Caused by HSV mouth infz .
Tx anti sz drug therapy.

Front 269

trigiminal neuralgia

Back 269

burning knife like feeling in face, twitching, grimacing, of the eyelid. Triggered by light, chewing, brushing, hot/cold.talking!

Front 270

trigiminal neuralgia Dx

Back 270

CT/MRI/EMG
TX tegratol dilantin neurontin topamax. Nerve block can be done also lasting about 6 months. Surgical glycerol rhizotomy inj of glycerol and microvascular decompression and gamma knife radio surg are options

Front 271

nursing care of trigiminal neuralgia

Back 271

assess attacks triggers and factors nutrition and hygiene
1.pain free, nutrition,hygiene, decrease anxiety and return to nl

Front 272

trigiminal neuralgia acute intervention

Back 272

PAIN, theraputic environment w/ no draft, soft toothbrush, warm mouth wash, high protein/cals, instruct about diagnostics . After surg eval hearing/vision/eye gtts? crainotomy nursing care

Front 273

bells palsy

Back 273

facial nerve 7 maybe R/T HSV c/o pain around ears , flat in between eyes. Dx s/s decrease muscle movement tearing pain.

Front 274

bells drug therapy

Back 274

corticosteriods before paralysis complete Predisone and an anti hsv

Front 275

nurse care bells palsy

Back 275

pain, nutrition status, oral hygiene, no eye injury, return to previous state. Mild analgesics, hot wet pack, protect from cool draft, chew unaffected side, dark glasses, artificial tears

Front 276

guillian-barre syndrome

Back 276

fatal form of polyneuritis. Loss of neuro transmission to limbs after viral trauma surg hiv etc

Front 277

guillian-barre syndrome manifestations

Back 277

1-3 weeks after infx
hypotonia areflexia, decrease eye motor nerves abnormal vagal responce SIADH RESP FAILURE!
DX CSF with high protein/abnl EMG
Tx high dose immunoglobulin so hydrate well monitor for dysphagia do they need tube feeding? Monitor for illius!

Front 278

guillian barre nursing

Back 278

monitor paralysis, resp fnx, ABG, autonomic dysreflexia takes form of badycardia and ectopy BP, cardiac rate. GIVE vassopressors and volume expanders bur fluid restric for SIADH

Front 279

guillian barre
more nursing goals

Back 279

ventilation free from aspiration pain control communication effective nutrition return to fnxing

Front 280

guillian barre more nursing

Back 280

monitor resp and ABG monitor for UTI r/t urine retention electrolytes

Front 281

botulism

Back 281

found in soil destroys neurotoxins N/V/D no in home canning, don't use swollen cans, if food projectiles out of a can dont eat it! LOL =)
s/s like GB syndrome TX like GB syndrome

Front 282

tetanus

Back 282

neurotoxin found in soil incubation 7-31 jaw stiffness rigid muscles monitor resp! hyperthemia arrythmias SZ percautions!!! LABS and echo. GIVE td deep sedation PCN NG tube

Front 283

tetnus nursing care

Back 283

cleanse all wounds with soap and water TEACH booster
td managment: quite room, sedation, trach, vent, cath, skin care, emotional support

Front 284

neutrosyphilis

Back 284

infx any were in the nervous system by treponema pallidum results form poorly tx'ed syphilis. degenerative spinal cord and brain stem. PCN, sx care and protect from injury

Front 285

secondary spinal cord injury

Back 285

R/T ongoing damage from 1st injury

Front 286

spinal shock

Back 286

decreased reflexes, loss of sensation, flaccid paralysis below injury level

Front 287

neurogenic shock

Back 287

loos of vasomotor tone = hypo tension, bradycardia, warm dry extremities

Front 288

mechanism of injury

Back 288

flex ion, hyper extension, flex ion-rotation, and compression

Front 289

central cord syndrome

Back 289

damage to the center= motor weakness, sensory loss. Upper limbs affected more

Front 290

broen-sequard syndrome

Back 290

damage to one half of the spinal cord. Loss of motor fnx and positionand vibratory sense vasomotor paralysis on the same side as the lesion. The opposite side has loss of pain and temp below the level of lesion

Front 291

posterior cord syndrome

Back 291

compression or damage to the posterior spinal artery. Loss of preconception. How ever pain ,temp , motor sensation below the level of the lesion are intact

Front 292

conus medullaris syndrome

Back 292

damage to the lowest portion of the spinal cord= paralysis of the lower limbs bowel and bladder

Front 293

spinal cord post injury problems

Back 293

resp complications usually on vent. if t6 monitor cardio system. all monitor urinary system for spinal shock. monitor GI reglan for gastric emptying prevacid for stress ulcers, monitor skin, monitor for decrease ability to sweat and reg body temp, with NG tube monitor lytes, monitor for DVT

Front 294

emergency spinal cord management

Back 294

airway, stabilize c spine, 02, 2 large bore IV NS or LR, assess for other injuries, control bleeding, CT scan, traction, methylpredinsone high dose meds
ongoing; vs, loc, 02, cardiac rhythm, urine output, keep warm, monitor urinary output and hypotension, anticipate intubation /gag reflex

Front 295

MP /solumedrol

Back 295

loadin dose needed at 30 mg/kg and maintain for 48 hrs to improve fnxing

Front 296

resp dysfnx with spinal cord

Back 296

really important first 48 r/t spinal cord edema. breath sounds, ABG, tidal volume, vital capacity, skin color, breathing pattern, subjective comments, amt and color of sputum.

Front 297

spinal cord nutrition

Back 297

high catabolism happening have NG tube high protein and high cal for tissue repair

Front 298

spinal cord bowel and bladder

Back 298

no sensation of fullness immediately after injury. can result in reflux to kidney and ARF. Give foley, may be tx'ed for UTI just in case. Constipation is generally a problem, give suppository or enema regularly and at the same time, followed by digital stimulation, done in bed at first then as pt progresses done sitting.

Front 299

autonomic dysrefleixa

Back 299

LIFE Threatening. cause by bladder dystension. manifested by hypertension, blurred vision, HA, diaphoresis above lesion, nasal conjestion, anxiety.
RN= elevate HOB, notify MD, cath pt to decrease bladder, or digital impaction removal, remove skin stimulation, monitor vs, teach cause to fam and pt

Front 300

autonomic dysrefleixa decreasing chance

Back 300

maintain reg bowel and bladder habits, monitor i/o, wear medi alert,

Front 301

neurogenic bladder

Back 301

may happen during recovery teach pt. may need iv pyelogram, surgical option or diversion.

Front 302

types of neurogenic bladder

Back 302

reflexic,arflexic, sensoey
reflex empties when full, areflexia fills with no empty and sensory lacks stimulation of need to urinate

Front 303

neurgenic bowel

Back 303

give high fiber and fluids. train bowel evacuation is planned 30-60 min after first meal of day

Front 304

neurogenic skin

Back 304

integumentry care basically

Front 305

halo vest care

Back 305

teach pt and fam
inspection pins, clean w/peroxide and water/ apply antibiotic ointment/ dry vest with blow dryer if needed/don't grap bars/ can wear cotton shirt under

Front 306

ICP maifestations

Back 306

change in vs, loc, ocular signs, decrease motor fnx, HA,V can lead to poor cerebral perfusion and herniation

Front 307

icp drug therapy

Back 307

mannitol,glycerial and urea are used as osmotic diuretics. Loop diuretics may be used, cortico steroids for edema monitor for hyperglycemia and gi bleed and hyponatremia

Front 308

pt with icp

Back 308

needs extra glucose r/t extra fuel for brain metabolism

Front 309

icp rn

Back 309

gcs= open eyes,best motor , best verbal, neuro assessment, vs for crushing triad and resp pattern/ #1 patent airway hob at 30 degrees ng for abd ditension, narcs, and may be sedated, monitor fluids and lytes, valsalvia increases icp!!! no rapid position changes, protect from injury

Front 310

head trauma complications

Back 310

epidural hemotoma=hemorrhage= lucid then decrease loc, ha, rapid surg intervention
subdral hematoma.

Front 311

head trauma rn

Back 311

airway, cspine stable, 02, iv, control bleeding, asses for other wounds, remove clothing. ongoing, warm, vs, loc, cardiac rhythm, gcs, pupils, assume neck injury w/head injury,admin fluids with caution to prevent increases icp

Front 312

brain tumor rn care

Back 312

neuro motor ablity fnc, balance, wathc pt perform adl's question med hx, monitor for n/v and sz

Front 313

meningitis ha n/v nuchal rigidity, positive kernigs and brudinski

Back 313

dx csf. rn care pain, low light decrease environmental stimuli, anti sz drugs, monitor ICP, monitor med for fever.

Front 314

nerves 3,5,6

Back 314

tested by follow finger

Front 315

nerve 7 facial

Back 315

raise eyebrow

Front 316

trigeminal 5

Back 316

tested by cotton ball on face

Front 317

co inhalation

Back 317

give 100% humidified air check co level skin color cherry red

Front 318

inhalation injury

Back 318

monitor for airway occlusion

Front 319

electrical burn

Back 319

check for FX's , c spine immobilized, get spinal xray, R/F cardiac arrest mycroglobinuria= atn, fib or standstill. Continues cardiac monitoring, severe metabolic acidosis,

Front 320

electric burn continue

Back 320

infuse LR urine output 75-100 ml hr,mannitol maybe given to maintain urine output

Front 321

deep burn fluid vessicles

Back 321

severe nerve pain

Front 322

full thickness

Back 322

dry waxy white leather no pain at that site, possible muscle, bone, tendon involvement

Front 323

RN chemical burn

Back 323

airway, assess after decompensation measures, brush dry chemical for skin irrigation, flush chemicals from wound, remove clothing and jewlery, LARGE bore iv, fluid replacement, blot skin dry with clean towels, cover burn with dry sterile dressing, intubate? poison control center, protect self from exposure. monitor airway exposed to chemicals

Front 324

rn thermal burn

Back 324

airway, stop burning, inspect for airway burn, 02, intubate? LARGE iv, rome clothing and jewlery, treat associated injuries, iv analgesia, dry dressing, cool compress, foley, burn center, td.
ongoing, vs.loc, 02, rhythm, temp, pain, pt responce

Front 325

burn complications

Back 325

shock arrythmais,impaired circulation, airway obstruction, inhilation injury, ATN or ARF

Front 326

burn emergent phase

Back 326

fluids, cath,i/o, start hydrotherapy or cleansing, assess burns, td, pain

Front 327

burn acute phase

Back 327

fluids, assess wounds, observe for complications, cleaning, debridment, pain and anxiety, diet, pt

Front 328

burn rehab phase

Back 328

teaching, self care, prevent contractions, surgery

Front 329

parkland baxter formula

Back 329

4 ml lr per kg
1/2 first 8 hrs
1/4 second 8 hrs
1/4 third 8 hrs

Front 330

minerals

Back 330

provide cellular integrity and mineral formation

Front 331

silvadine

Back 331

sulfa allergies????

Front 332

sulfamylon

Back 332

may be pain with application

Front 333

bacitracin

Back 333

may cause itch??

Front 334

mupirocin

Back 334

works for organisms silvidine can get, monitor for renal tox and rash!``

Front 335

burn nutrition

Back 335

usually has illius then progress to clear liquid and hypermetabolic state. 5000 cals q day needed increase cals and proteins!

Front 336

burns and lytes

Back 336

monitor low na and high k

Front 337

crushings ulcer

Back 337

ileus results in sepsis monitor for D with tube feedings. erosion and lesions caused by stress use h2 blocker zantac or tagament to inhibit histimine and stimulation of HCL.

Front 338

acute phase burns

Back 338

may have blood in stool

Front 339

cea biopsys grown of pt's own skin for graft

Back 339

thin frail skin contractions may develop

Front 340

burn meds

Back 340

pain and amesia meds 15 min before dressing change

Front 341

histological grading

Back 341

grade 1 mild dysplasia
grade 5 cells immature and primitive

Front 342

cancer staging

Back 342

stage 0= in situ
1= limited growth
2= limited local spread
3= extensive local and regional
4= mets

Front 343

tnm

Back 343

T= tumor
to = no evidence
T is= in situ
T 1-4 = grading
N= nides
No = no evedince
etc, as above
Mo= no mets
M1-4= mers

Front 344

colon and rectum screen at 50

Back 344

FOBT q year
flex sig q 5
BE 5-10 yrs
colonoscopy q 10

Front 345

prostate screening

Back 345

psa at 50 or 45 y/o if hx in fam

Front 346

burns

Back 346

The emergent phase:
The emergent phase is the period of time required to resolve the immediate problems resulting from burn injury. This phase may last from burn onset to 5 or more days, but it usually lasts 24 to 48 hours. This phase begins with fluid loss and edema formation and continues until fluid mobilization and diuresis begin.
The acute phase:
The acute phase begins with the mobilization of extracellular fluid and subsequent dieresis. The acute phase is concluded when the burned area is completely covered by skin grafts or when the wounds are healed. This may take weeks or many months.
The rehab phase:
The rehabilitation phase is defined as beginning when the patient’s burn wounds are covered with skin or healed and the patient is able to resume a level of self care activity. This can occur as early as 2 week or as long as 2 or 3 months after the burn injury. Goals for this period are to assist the patient in resuming functional role in society and to accomplish functional and cosmetic reconstruction.

Front 347

groshong cath

Back 347

no hep flush is in the superior vena cava

Front 348

picc lines

Back 348

ac fossa to the superior vena cava
monitor for phlepitis when removed if sx the cx tip of cath

Front 349

port care

Back 349

dressing change cleaning and flushing use huber needle monitor for bleeding thrombus hemorrhage and sludge accumulation

Front 350

intraarterial chemo

Back 350

chemo in the arteries

Front 351

intraperitoneal chemo

Back 351

in the peritoneal cavity Tenckhoff, hickman or groshong it the peritoneal cavity with dwell and drain time

Front 352

intrathecal or intrventricular chemo

Back 352

lumbar puncture and chemo through that monitor for ha n/v and nuchal rigidity

Front 353

intravesical bladder chemo

Back 353

chemo installed in bladder reduces urinary and sex fnx

Front 354

interferions

Back 354

no po. protect cells from viruses monitor for flu like sx and fever

Front 355

interlekins

Back 355

monitor for capillary leak syndrome. Activation of the immune system

Front 356

monoclonal ab

Back 356

immunoglubulins by b lymos, attack tumor cell via infusion . Fever chils, uticaria

Front 357

Her2/nu

Back 357

hercrptin binds to this and inhibits the growth of cells with over expressed her2/nu

Front 358

colony stimulating factors

Back 358

neupogen, neulesta stimulates fnx and production of neutrophils

Front 359

EPO

Back 359

procrit and aranesep
for anemia

Front 360

numega

Back 360

platelet growth factor monitor for edema

Front 361

BMT complications

Back 361

infx give abx before procedure and graft host disease

Front 362

cancer diet

Back 362

high cals! and high protein

Front 363

superior vena cava syndrome

Back 363

obstructed by a tumor chemo and rad are the tx

Front 364

spinal cord compression

Back 364

tumor in the epidermal place back pain aggravated by valsalva report changes with bowel and bladder r/t autonmic dysfnx. surg is the tx

Front 365

third space syndrome

Back 365

edema with hypovolemic sx at first then htn and wt gain, sob tc fluid lytes and plasma proteins.

Front 366

SIADH

Back 366

cancers cells mess with ADH wt gain weakness anorexia n/v sz personality changes
Tx fluid restrictions and 3% nacl

Front 367

hypercalcemia

Back 367

apathy depression fatigue ecg changes polyureia monitor for renal failure etc.
TX hydration and a diuretic infusion of aredia

Front 368

tumor lysis syndrome

Back 368

rapid destruction of tumor cells r/t chemo
sx hyper uricema,kalemia,phosphate, and low na
increase urine and hydration decrease uric acid with allopurinol

Front 369

cardiac tamponade

Back 369

fluid in pericardium secondary to RAD sx cp sob cough hiccups loc, n/v, pulsus paradoxus,
tx 02 hydration vassopressor

Front 370

carotid artery rupture

Back 370

apply pressure w/ blowout
fluids and try to stabilize

Front 371

Interpret the following:

•pH 7.23 PCO2 67 HCO3 35

•pH 7.48 PCO2 48 HCO3 32

•pH 7.30 PCO2 40 HCO3 30

•pH 7.49 PCO2 30 HCO3 17

Back 371

pH 7.23 PCO2 67 HCO3 35
Respiratory Acidosis: the body is attempting to compensate by increasing bicarbonate

•pH 7.48 PCO2 48 HCO3 32
Metabolic alkalosis: The body is attempting to compensate by retaining CO2 to increase acidity.

•pH 7.30 PCO2 40 HCO3 30
Metabolic acidosis
If teh body were trying to compensate the pCO2 would be decreasing--to decrease the acid content in the body.
•pH 7.49 PCO2 30 HCO3 17
The body is attempting to compensate by getting rid of HCO3 (base)

Front 372

Central venous access Devices
Occlusion/Thrombosis

Back 372

Occlusion/Thrombosis S/S:
SVCS super vena cava syndrome (dyspnea, cough, sensation of skin tightness, unilateral edema, cyanosis of face, distended jugular, temporal, and arm veins)
swelling below insertion point
pain along vein
earache or jaw pain
unilateral arm or neck pain
Sluggish flow rates
inability to flush or aspirate

Cause
Trauma to vein intima
Extended dwell time or short term catheter
Fibrin sheath
Sluggish flow rate
Inadequate flushing of each port
Prepare to possibly give fibrolytic to declot

Front 373

Central venous access Devices
Occlusion/Thrombosis
Nursing Action

Back 373

Nursing Action
Be sure each port gets flushed as recommended
Verify compatability of IV medications before administration
Raise arms overhead, cough and Deep breathe
Use polyurethane or silastic catheters
Venogram confirms presence
Monitor for Sx of P.E.
"Pulsatile flush with NS or heparin"
Silastic catheters may be declotted with trombolytic drugs
Drug precipitates may be dissolved with the installation of hydrochloric acid

Front 374

Central venous access Devices
what are the signs and symptoms when a CVA device dislodges, what is the cause, what are the nursing actions?

Back 374

S/S-Medication or fluid leaking from catheter or insertion site
Nursing actions:
Note presence of suture and amount of tubing protruding from insertion site
Report MD
Catheter rupture due to vigorous flushing

Front 375

what are the signs and symptoms when a CVA device has an Air embolus in it. What is the cause and what are the nursing actions?

Back 375

Air Embolus
S/S-Chest pain, anxiety, Increased HR, drop in BP, drop in O2 sat, loud churning over precordium.
Cause: Air entering central circulation usually via the central line
Nursing Actions:
clamp the central line
position pt on left side in trendelenburg
Notify the MD stat
Monitor VS and O2 sat
Obtain peripheral IV access

Front 376

Supraventricular Tachycardia (SVT)
Nursing implications:

Back 376

No treatment required unless patient symptomatic.
• Assess need for oxygen supplement.
• Assure patient has patent IV access
• Document rhythm strip, vital signs and patient activity prior or during SVT

Front 377

Supraventricular Tachycardia (SVT)
Pharmacological and medical management:

Back 377

• Vagal maneuvers: bear down like straining at stool, gag or vomit
• MD”s only-carotid sinus massage-periorbital pressure
• Oxygen therapy
• Meds:
o Adenosine, med given fast as you can shoot it in, and flush fast
o Verapamil
o Procainamide
o Propranolol
o Esmolol
• Synchronized Cardioversion
• Ablation if frequently recurrent

Front 378

Atrial Flutter
Pharmacological and medical management

Back 378

Pharmacological and medical management
• Synchronized cardioversion
• Meds to slow heart rate-beta blockers and calcium channel blockers

Front 379

Atrial Fibrillation
Nursing Implications:

Back 379

Nursing Implications:
• Assess need for Oxygen supplement
• Assure patient has patent IV access
• Document Rhythm Strip, vital signs
• Monitor anticoagulant administration and related symptoms

Front 380

Premature ventricular contractions (PVCs) Ectopic focus in ventricles
Nursing implications:

Back 380

• Assess perfusion of PVC-Pulse deficit—pulse may not be felt with PVC
• Do PVC’s occur with activity or increase with exertion?
• Are PVC’s associated with client c/o angina
• Document rhythm strip with estimate of frequency and type
• No treatment required if infrequent and asymptomatic.
• Advise patient against stimulant use (caffeine, nicotine) consider aminophylline, dopamine, epinephrine
• Monitor ECG continuously during lidocaine or amiodarone administration; may monitor lidocaine blood levels and observe for neurological side effects.

Front 381

Premature ventricular contractions (PVCs) Ectopic focus in ventricles
Pharmacological and medical management

Back 381

Pharmacological and medical management
• Treat underlying cause. Ex. Give potassium, magnesium, or calcium, Or 02
• Meds: Lidocaine bolus then maintenance drip to infuse: 1-3 mg/min
• Amiodarone

Front 382

Ventricular Tachycardia (VT)
Nursing implications:

Back 382

Nursing implications:
• Check Pulse—If no pulse (call code) or unstable, then defibrillate
• Assure patient has patent IV access
• Administer lidocaine, or amiodarone or procainamide per protocol
• Assess need for oxygen supplement-pulse oximetry
• Document rhythm strip, vital signs

Front 383

Ventricular Fibrillation
Pharmacological and medical management

Back 383

Pharmacological and medical management
• Medications
o Epinephrine
o Lidocaine
o Amiodarone
o Procainamide
• Intubate and oxygenate

Front 384

cn 1

Back 384

• CNI: This nerve checks for visual capabilities. Patients are usually given the Snellen Chart (a chart with rows of large and small letters). Patients read letters with one eye at a time.

Front 385

• CN III, IV, and VI

Back 385

These nerves examine the pupillary (the circular center structure of the eye that light rays enter) reaction. The pupils get smaller, normally when exposed to the light. The eyelids are also examined for drooping or retraction. The eyeball is also checked for abnormalities in movement

Front 386

cn 5

Back 386

V: The clinician can assess the muscles on both sides of the scalp muscles (the temporalis muscle). Additionally the jaw can be tested for motion resistance, opening, protrusion, and side-to-side mobility. The cornea located is a transparent tissue covering the eyeball and could be tested for intactness by lightly brushing a wisp of cotton directly on the outside of the eye.

Front 387

pCO2

Back 387

35-45

Front 388

HCO3

Back 388

22-26

Front 389

WBC

Back 389

5-11

Front 390

HCT

Back 390

38-47 female
40-54 male

Front 391

neutrophils

Back 391

40-70

Front 392

lymphs

Back 392

16-46

Front 393

dig

Back 393

0.5-2.0

Front 394

propanolol

Back 394

40-85

Front 395

quininde

Back 395

3.0-6.0

Front 396

ca

Back 396

8.5-10.5

Front 397

ck-MB

Back 397

0.2-5

Front 398

ck

Back 398

25-145

Front 399

triponion

Back 399

0.35-0.6

Front 400

myoglobin

Back 400

less then 110

Front 401

PWAP

Back 401

nl 6-12 mm hg

Front 402

allans test

Back 402

pressure placed on the radial and ulnar arteries check for insufficiency to see if there is blood return to the hand to see if a line can be inserted in an artery

Front 403

sawan -ganz

Back 403

for PWAP two ports usually on in r atrium one in r ventricle
atrium is CVP and blood withdrawl
second for infusion or blood sampling do not inflate more the 8-15 seconds

Front 404

cvp

Back 404

right ventricle preload

Front 405

VAB

Back 405

pt's stay in bed monitor for same sx as intraortic balloon pump

Front 406

rn care artificial airway

Back 406

correct placement and cuff inflation monitor 02 and ventilation patency oral care foster communication

Front 407

et tube cuff inflation

Back 407

20-25 measure and chart q 8 hrs

Front 408

CMV controlled mechanical ventilation

Back 408

breaths delivered at a set rate

Front 409

ACV assist control

Back 409

pt can breathe faster then set rate but not slower

Front 410

Vt

Back 410

tidal volume

Front 411

SIMV synchronized intermittent mandatory ventilation

Back 411

pt receives Fi02 on spontaneous breaths but self regulates rate and depth

Front 412

peep

Back 412

positive pressure is applied to the airway during exhalation increases functional residual capacity and improves oxygenation

Front 413

cpap

Back 413

same as peep but during spontaneous breathing

Front 414

high frequency vent

Back 414

for peds tidal volume is rapid!!!

Front 415

complications w/vents

Back 415

vessel compression from increased pressure/barotrauma can lead to pnumo/ volume trauma/ aveloar hyperventilation or hypo/ pnu/ na h20 imbalance

Front 416

rapid sequance intubation

Back 416

sedatives and paralysis to intubate to minimize the R/F aspiration
amidate and anectine

Front 417

mesenchymal

Back 417

benign lung tumors

Front 418

temador

Back 418

chemo agent that crosses blood brain barrier

Front 419

rn care brain tumors

Back 419

self harm prevention safety decrease environmental stimuli monitor for sz motor language and sensory can be affected monitor nutrition

Front 420

livewr cancer care

Back 420

palliative
radiofrequency
cryosurg chemo and chemobolization=cath in an artery

Front 421

non invasive breast cancer

Back 421

usually in situ
excision mastectomy lumpectomy rad and or tamoxifin

Front 422

pagets

Back 422

nipple lesion Breast CA

Front 423

cardiogenic shock

Back 423

02 iv fluid bolus? dopamine doubutamine

Front 424

wide complex tachycardia

Back 424

amiodaron lidocaine procanimide
unstable cardioversion

Front 425

PVC

Back 425

02 iv amiodarone lidocaine procanimide

Front 426

svt stable

Back 426

vagal adenosine amiodorine
unstable cardioversion 100/200/360 joules

Front 427

pea

Back 427

cpr intubate bolus epi atropine

Front 428

stable afib

Back 428

cardizem
verapamil
procanimide

Front 429

vfib

Back 429

epi amiodorone epi amiodorone procanimide mag sulf? na bicarb?m

Front 430

bradycardia

Back 430

atropine bolus 02 consider vasopressor dopamine and epi drip

Front 431

romazacon reversies

Back 431

benzos like versed

Front 432

phentolamine

Back 432

use if dopamine has infiltrated

Front 433

siadh

Back 433

restric fluids to 800-1000ml q d

Front 434

ticlodipine

Back 434

to prevent a throbolitic stroke

Front 435

spacisity

Back 435

the return of reflexes indicates shock is resolving

Front 436

baclofen

Back 436

muscle relaxer for spacicity

Front 437

c4 and c5 need

Back 437

mechanical vents r/t cord edema

Front 438

c spine injury

Back 438

use jaw thrust to open airway