Multidimensional Care II Exam 1 Study Guide, Exams of Nursing

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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 ▪ C hanges in bowel/bladder habits, A sore throat that does not heal, U nusual bleeding/discharge, T hickening or lump in breast or elsewhere, I ndigestion or difficulty swallowing, O bvious change in wart/mole , N agging 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

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

▪ Cons: loss of function and some cancer cells could escape surgery

• Ex: CA cells left behind or mobilized into vasculature causing metastases o Radiation ▪ Destroys cancer cells with minimal damaging effects ▪ Side Effects
• Rash, altered taste, fatigue, bone marrow suppression, hair loss ▪ Interprofessional collaborative care:
• Do not remove ink markings
• Teach patients to avoid skin irritants
• Teach patients about risk for fractures
• Implement exercise and sleep interventions
• Care for dry mouth
• Nutritional supplementation. o Chemotherapy ▪ Treatment of cancer with chemical agents. ▪ Damages DNA and interferes with cell division o Immunotherapy ▪ Modifies patients biological responses to tumor cells ▪ Side Effects:
• Fluid retention, electrolyte imbalances, bone marrow supp. Skin reaction, hypertension, GI distress, mucositis o Photodynamic Therapy ▪ Selective destruction of CA cells via chemical reaction triggered by types of light o Hormonal Therapy ▪ Changing hormone responses
• Ex: some hormones make hormone sensitive tumors grow more rapidly. Inhibits these responses. ▪ Side Effects:
• Masculizing effects in women, feminizing effects in men, acne, fluid retention, hypercalcemia, DVT. - Surgical classification types

o Prophylactic surgery ▪ Removes potentially cancerous tissue as a means of preventing CA development ▪ Performed when a patient has existing premalignant conditions or strong predisposition for development of CA

• Ex: removing benign polyp from colon o Diagnostic Surgery ▪ Biopsy: removal of all or part of a lesion to confirm or r/o CA Dx. o Curative Surgery ▪ Removes all CA tissue. o Cytoreductive surgery ▪ Removes part of the tumor when entire removal of the mass is not possible.

▪ Decreases size of tumor = alleviation of sx and enhance success of CA tx. o Palliative Surgery ▪ Sx relief and improving quality of life

• Ex: removing tumor tissue that causes pain/obstruction o Reconstructive Surgery ▪ Increases function/enhances appearance
• Ex: breast reconstruction s/p mastectomy. - S/E of therapies

o Adverse effects of surgery ▪ Loss of function ▪ Reduced function ▪ Scarring/disfigurement ▪ Grieving about altered body image/change in lifestyle o Adverse effects of chemo ▪ Fatigue, alopecia, n/v, muscositis, skin changes, neutropenia, anemia and thrombocytopenia. o Adverse effects of radiation ▪ Local skin changes, irritation, alopecia, fatigue, altered taste

- Oncological emergency classification types (what are they, how do

you assess it, how do you treat it?) o Sepsis ▪ CA patients are at an increased risk for infection ▪ Interventions for Sepsis:

• Prevention – ID patients who are at risk for sepsis
• Maintain aseptic technique with immunocompromised patient
• Monitor patients for s/s of infection
• Administer Abx as prescribed o Intravascular coagulation o Interventions for DIC
• Administer anticoagulants in the early phase
• Administer cryoprecipitated clotting factors as prescribed as DIC progresses and hemorrhage is the main concern o SIADH ▪ Tumors can produce, secrete, or stimulate substances that mimics ADH. ▪ S/S of SIADH:
• Weakness, muscle cramps, loss of appetite and fatigue. Sodium levels 115 – 120
• Serious s/s are weight gain, personality changes, confusion, and extreme muscle weakness. If sodium levels near 110 seizures/coma/death can occur ▪ SIADH interventions
• Fluid restriction and increased sodium intake

• 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 o f sp i na l co rd comp re ss i o n

• 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 o f H yperc a lcem i a

• 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 o f S VC :

• 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

• 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)

• Nausea/Vomiting, confusion, fatigue, HA, seizures, coma, tachycardia, respiratory distress
• Weak, thready pulse ▪ Hypernatremia (>145)
• Remember big and loaded
• E dema , red / flu shed s ki n , th i r st , fe ver , Late an d ser i o u s s/ s: n /v, swollen /dr y to n gue i n crea sed mu scle t one. 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

o 3 hormones help control fluid and electrolyte balance: ▪ Aldosterone

• Secreted by adrenal cortex when ECF NA+ levels are low
• Prevents water and sodium loss, prompts kidneys to reabsorb sodium and water from the urine into the blood.
• Promotes renal K+ excretion ▪ ADH
• Released from the posterior pituitary gland
• ADH acts on renal nephrons – water is reabsorbed o Body will retain fluid ▪ Natriuretic Peptides
• Hormones secreted by special cells in the atria (ANP) and ventricles (BNP)
• Secreted in response to increased blood volume and pressure
• NP binds to receptors in nephrons and stops the absorption of sodium in the kidneys. = decreased blood volume and decreased blood osmolality. - Assessment and treatment of dehydration and fluid overload

o Dehydration: ▪ LOC ▪ Assessment

• Skin turgor, VS, cap refill, mucous membranes, intake/output o Dehydration Treatment ▪ Fluid replacement – provide oral rehydration if tolerated and IVF if severe dehydration ▪ Monitor I&O ▪ Administer O2 as prescribed ▪ Monitor electrolyte levels ▪ Drug therapy o Fluid Overload: ▪ Increased fluid in the ECF caused by abnormal retention of water and sodium ▪ Causes: CHF, renal failures, inc. sodium intake ▪ Assessment
• Bounding pulse, elevated BP distended veins, SOB, crackles in lungs, altered LOC, HA, pitting edema, diarrhea, increased GI motility. o Treatment for fluid overload ▪ Administer diuretics ▪ Restrict fluid and sodium intake ▪ Monitor I&O ▪ Monitor daily weights ▪ Monitor electrolyte values

o Dehydration: ▪ Loss of fluid from the ECF ▪ Causes: Burns, diarrhea, hemorrhage, DKA, diuretic use ▪ Assessment

• Abd. Distention, fever, pale,moist skin, tachycardia, tachypnea, weak pulses, flat neck veins o Treatment
• Is
• Hypotonic solutions o Fluid shift = water going into the cells
• Hypertonic solutions o Dextrose/Sodium chloride 3% ▪ Fluid shift = outside of the cell ▪ Pulmonary edema ▪ drug - Electrolyte changes with disease processes or treatment (i.e. DKA, end-stage renal failure, vomiting)

- Electrolyte replacements (type and how is it administered?)

Renin angiotensin pathway: Kidney releases Renin in response to decreased

perfusion/low BP liver (secretes angiotensin) = angiotensin I vasoconstrictor circulates and is converted by ACE to angiotensin II which vasoconstricts and elevates BP.

Edema:

Changes with normal hydrostatic pressure differences

Assessment for edema:

Albumin and plasma protiens.