Multidimensional Care II Exam 1 Study Guide, Exams of Nursing

Download Multidimensional Care II Exam 1 Study Guide and more Exams Nursing in PDF only on Docsity! Multidimensional Care II Exam 1 Study Guide Multidimensional Care II Exam 1 Study Guide *The exam questions are not limited to only what is listed on this guide, please refer to your chapter readings and module materials Ch. 21: Principles of Cancer Development • Benign vs. Malignant cells o Benign tumor cells grow due to hyperplasia • Seven warning signs of cancer o CAUTION ▪ Changes in bowel/bladder habits, A sore throat that does not heal, Unusual bleeding/discharge, Thickening or lump in breast or elsewhere, Indigestion or difficulty swallowing, Obvious change in wart/mole, Nagging cough/hoarseness. • Cancer development stages of malignancy o Initiation: ▪ Change in gene expression leading to loss of cellular regulation. ▪ Excessive cell division o Promotion ▪ Enhanced growth of an initiated cell by substances known as promoters • Promoters can be hormones, proteins (insulin and estrogen) o Progression ▪ Continued change of a cancer making it more malignant over time Multidimensional Care II Exam 1 Study Guide o Metastasis ▪ Cancer cells move from the primary location and establish remote colonies. • Cancer classification o Cancers are classified by type of tissue from which the arise ▪ Solid tumors: associated with the organ where they develop ▪ Hematological cancers: Originate from blood cell-forming tissues such as leukemia, lymphoma, and myelomas • Cancer prevention (primary vs. secondary) o Primary Prevention ▪ Avoidance of known/potential carcinogens • Ex: Teach adults to use skin protection during sun exposure • Ex: Eliminate ▪ Modifying associated factors • Modifying behavior to reduce the associated factor can decrease the risk of CA development. • Ex increased incidence of CA among adults who consume alcohol • Diets high in fat and low in fibers ▪ Removal of “at-risk” tissues • Ex: Chemoprevention • Vaccination o Ex: HPV vaccine o Secondary Prevention ▪ Regular screening for cancer does not reduce cancer incidence but can greatly reduce some types of CA deaths ▪ Teach all adults to participate in routine screenings • Annual mammography (45-54 years of age), Biennial (55+) • Annual breast exams, colonoscopy at 50, annual FOBT, Prostate screening for men 50+ • Testing for gene mutations o Ex: BRCA genes • Types of cancers (carcinoma, sarcoma, melanoma, lymphoma, leukemia, blastoma) Ch. 22: Care of Patients with Cancer • Diagnostic tests • Risk factors • Types of therapy (i.e. surgery, radiation, chemotherapy) o Surgery ▪ Can be used prophylactically or as curative Tx ▪ Used for diagnostics • Ex: biopsies Multidimensional Care II Exam 1 Study Guide • Administer antagonist • Monitor sodium levels • Treat underlying cause (CA) o Spinal cord compression ▪ Occurs when a tumor directly impacts the spinal cord or the spinal column collapses due to tumor ▪ S/S of spinal cord compression • Back pain, numbness, tingling, loss of urethral/vaginal/rectal sensation, muscle weakness. o Hypercalcemia ▪ Late manifestation of extensive malignancy usually occurs with bone metastasis. Bones will break down and release CA into blood stream ▪ S/S of Hypercalcemia • Fatigue, anorexia, n/v, constipation, polyuria. Late signs include muscle weakness, diminished DTR, paralytic ileus, dehydration and cardiac arrythmias. ▪ Hypercalcemia Interventions • Monitor serum CA levels and EKG • Administer oral or IVF • Administer medications that lower CA level • Prepare client for dialysis if condition is life threatening/pt has renal impairment o Superior vena cava syndrome ▪ Occurs when the SVC is compressed or obstructed by tumor growth ▪ S/S of SVC : • Early symptoms occur in the AM. Edema of the face, around the eyes and tightness of the shirt collar (Stoke’s sign) • Edema in the arms and hands, Sob, erythema of upper body, epistaxis. • Late signs are airway obstruction, hemorrhage, cyanosis, LOC change, and decreased cardiac output ▪ Interventions for SVC: • Assess for early s/s • Prepare the client for high-dose radiation to the mediastinal area, and possible surgery to place a stent in the superior vena cava. o Tumor lysis syndrome ▪ Occurs when large quantities of tumor cells are destroyed rapidly and intracellular components such as potassium and uric acid are released to the blood stream ▪ Usually occurs during a patients first chemotherapy ▪ Interventions for TLS • Encourage oral hydration Multidimensional Care II Exam 1 Study Guide • Administer diuretics • Administer medications such as allopurinol • Prepare to administer IV glucose and insulin to treat hyperkalemia • Prepare client for dialysis if hyperkalemia/uricemia persist. Ch. 7: End-of-Life Care Concepts • Hospice vs. Palliative care o Hospice ▪ Quality/compassionate care for people facing a life-limiting illness/injury • Less than 6 months to live ▪ Uses team-oriented approach to provide medical care, pain mgmt, emotional/spiritual support (for both pts and family) • Does not provide curative treatments • Usually provided in 60-90 day periods • Ongoing care is provided by RN’s, social workers, volunteers and chaplains o Palliative care: ▪ Care for patients with life-threatening dz. • Any stage of illness ▪ Consultations are provided for curative therapies or therapies that prolong life ▪ Care is not limited by time periods ▪ Care provided by physicians (PCP) • Assessment findings o Weakness, sleeping more, anorexia, changes in organ system function, cold/mottled extremities, changes in breathing pattern, decreased LOC. • Managing symptoms and needs o Managing Dyspenia: ▪ Bronchodialtors, diuretics, anticholinergics, O2 (for comfort), fan, repositioning o Managing N/V: ▪ Antiemetics, remove sources of odor, comfortable room temp, aromatherapy o Managing delirium/agitation ▪ Assess for pain, urinary retention, constipation. Music therapy, aroma therapy o Managing refractory sx of distress ▪ Proportionate palliative sedation Ch. 11: Care of Patients with Problems of Fluid and Electrolyte Balance • Lab values for normal ranges (see “Need to Know Labs” form) o Sodium (136 – 145) ▪ Hyponatremia (< 136) Multidimensional Care II Exam 1 Study Guide • Nausea/Vomiting, confusion, fatigue, HA, seizures, coma, tachycardia, respiratory distress • Weak, thready pulse ▪ Hypernatremia (>145) • Remember *big and loaded* • Edema, red/flushed skin, thirst, fever, Late and serious s/s: n/v, swollen/dry tongue increased muscle tone. o Potassium (3.5-5.0) ▪ Hypokalemia (<3.5) • Cardiac dysrhythmia, ST elevation, decreased DTR, paralysis, decreased GI motility, hypoactive bowel sounds, constipation ▪ Hyperkalemia (> 5.0) • Cardiac dysrhythmia (ST depression, Vfib), hypotension, bradycardia, diarrhea, hyperactive bowel sounds increased DTR , muscle weakness o Calcium (9-10.5) ▪ Absorption requires active form of Vit. D ▪ Hypocalcemia • Foods: milk, cheese, yogurt, seafood, leafy green veg • Muscle twitching, cramping, confusion, Chvostek’s sign and Trousseaus sign. ▪ Hypercalcemia (> 10.5) o Phosphorus (3.0 – 4.5) ▪ Hypophosphatemia • Foods: protein, dairy, nuts. • Muscle dysfunction, weakness, ▪ Hyperphosphatemia (>4.5) • Calcium deposits in soft tissues o Magnesium (1.3 – 2.1) ▪ Critical for skeletal muscle contraction, ATP formation, cell growth ▪ Hypomagnesemia (< 1.3) • Muscle twitching, weakness, tachycardia, increased DTR, abnml eye movements, diarrhea ▪ Hypermagnesemia (> 2.1) • N/V, flushing, renal failure, bradycardia, hypotension, decreased DTR, shallow resp, hypoactive bowel sounds o Chloride (98-106) ▪ Imbalance occurs as a result of other electrolyte imbalances ▪ Hypochloremia: • n/v/d, fever ▪ Hyperchloremia • Swollen dry tongue, n/v/d, confusion • Fluid balance and hormonal regulation