Multidimensional Care II MDC 2 Exam 1 Blueprint, Exams of Nursing

Download Multidimensional Care II MDC 2 Exam 1 Blueprint and more Exams Nursing in PDF only on Docsity! 1 NUR 2392- Multidimensional Care II MDC 2 Exam 1 Blueprint Latest 2023- 2024 Tumor 1. Define (associate the 9 characteristics/features of each) Benign:  Specific morphology – resemble the tissues they originated from  A smaller nuclear-to-cytoplasmic ratio – similar to normal cells  Specific differentiated function – contributes to the body function  Tight adherence - bind closely together due to the production of fibronectin  No migration – do not invade other tissues  Orderly growth – rate of growth is normal by expansion  Euploidy – normal chromosomes per cell Malignant tumor:  Anaplasia – loss of appearance of parent cell  A larger nuclear-to-cytoplasmic ratio – larger nucleus  Specific functions are lost – serve no purpose  Loose adherence – loosely bound due to the lack of fibronectin production  Migration – spread easily (metastasize)  Contact inhibition does not occur – loss of cellular regulation  Rapid or continuous cell division – loss of cellular regulation  Aneuploidy – Abnormal chromosomes Determination of the tissue of origin is difficult and perhaps impossible. 9. What does the TNM staging tell us 10.Application: a. 53 year female is diagnosed with Lung Cancer it is stage T3 N2 MO how would you describe this patient’s lung cancer status. Tumor is present and fairly large in size, nearby lymph nodes involved, no metastasis b. Is there metastasis No Primary Tumor (T) Tx Primary tumor cannot be assessed T0 No evidence of primary tumor Tis Carcinoma in situ T1, T2, T3, T4 Increasing size and/or local extent of the primary tumo Regional Lymph Nodes (N) Nx Regional lymph nodes cannot be assessed N0 No regional lymph node metastasis N1, N2, N3 Increasing involvement of regional lymph nodes Distant Metastasis (M) Mx Presence of distant metastasis cannot be assessed M0 No distant metastasis M1 Distant metastasis 11.Describe the difference between these type of cancer prevention and list the correlating strategies: Primary prevention is the use of strategies to prevent the actual occurrence of cancer. This type of cancer prevention is most effective when there is a known cause for a cancer type. Secondary prevention is the use of screening strategies to detect cancer early, at a time when cure or control is more likely. 12. Example: You identify that your 30 year old patient has a “family history of colon cancer” that hasn’t reached the patient. What level of prevention will you focus on? Primary prevention 13.Examples of modifying behaviors to reduce the risk of cancer (Page 381 under primary prevention): Avoidance of known or potential carcinogens, Modifying associated factors, Removal of “at-risk” tissues, Chemoprevention, Vaccination Cancer Management: Drug Therapy, Surgery, Radiation, photodynamic therapy 14.Treatment approach: Describe these terms in reference to a cancer diagnosis and surgical approach. Pg 386. In your own words describe a scenario for each surgical approach. 1. Curative: removes all cancer tissue 2. Prophylactic: removes potentially cancerous tissue as a means of preventing cancer development 3. Diagnostic: (excisional biopsy) is the removal of all or part of a suspected lesion for examination and testing to confirm or rule out a cancer diagnosis 4. Palliative: focuses on providing symptom relief and improving the quality of life but is not curative 5. Reconstructive: or rehabilitative surgery increases function, enhances appearance, or both 15. What nursing intervention would you expect for your patient post- op surgery for cancer removal (mastectomy). Coordinate with the interprofessional team to provide support and assistance to the patient and his or her family. Encourage the patient and family to ask questions and express their concerns. Help the patient accept changes in appearance or function by encouraging him or her to look at the surgical site, touch it, and participate in its care, including dressing changes. Provide information about support groups. 16. Cancer management requires a collaborative approach, including a multidisciplinary team. Determining the plan following diagnosis is which collaborative intervention? 17.List some diagnostic imaging procedures used for various types of cancer: a. Breast b. Lung c. Colon d. Esophageal Treatment approach, when does this occur: 1. Neo-adjuvant: When something is used before another ie when chemo is used to shrink a tumor before surgery. 2. Adjuvant: When chemo is used to kill remaining cells following surgery or radiation 3. Combination Therapy Drug therapy d. List the side effects of radiation i. Create a teaching statement for a patient who will be receiving radiation. Include how to address side effects. e. Describe radiation exposure? The amount the of radiation delivered to tissue. f. Describe radiation dose? The amount that the tissue absorbs. Radiation dose is always less than radiation exposure. 21.Describe Oncologic Emergencies, presentation and treatment a. Metabolic i. Hypercalcemia (Metabolic Emergency): occurs in up to a third of patients with cancer. It is a metabolic emergency and can lead to death. Breast, lung, and renal cell carcinomas; multiple myeloma; and adult T-cell leukemia and lymphoma are the most common causes among cancer patients. These cancers can secrete parathyroid hormone, causing bone to release calcium. Bone metastasis can stimulate bone breakdown (osteoclast activity) and bone resorption, which releases more calcium from bone and leads to hypercalcemia. In addition, systemic secretion of vitamin D analogues by the tumor can also cause elevated calcium levels in the bloodstream. Dehydration worsens hypercalcemia. ii. Tumor Lysis Syndrome (TLS) Metabolic 1. What are the characteristics of this syndrome? Severe or untreated TLS can cause tissue damage, acute kidney injury (AKI), and death. Serum potassium levels can increase to the point of hyperkalemia, causing cardiac dysfunction. The large amounts of purines form uric acid, causing hyperuricemia. These uric acid crystals precipitate in the kidney, blocking kidney tubules and leading to AKI. Sudden development of hyperkalemia, hyperuricemia, and hyperphosphatemia has life- threatening effects on the heart muscle, kidneys, and central nervous system. Early symptoms of TLS include lethargy, nausea, vomiting, anorexia, flank pain, muscle weakness, cramps, seizures, edema, and altered mental status. 2. What would you expect the intervention? Hydration prevents and manages TLS by diluting the serum potassium level and increasing the kidney flow rates. These actions prevent the precipitation of uric acid crystals, increase the excretion of potassium, and flush any kidney precipitates. iii. SIADH: water is reabsorbed in excess by the kidneys and put into systemic circulation. The retained water dilutes blood sodium levels, causing hyponatremia. Mild symptoms include weakness, muscle cramps, loss of appetite, and fatigue. Serum sodium levels range from 115 to 120 mEq/L (mmol/L) or lower (normal range is 135 to 145 mEq/L [mmol/L]). With greater fluid retention, weight gain, nervous system changes, personality changes, confusion, and extreme muscle weakness occur. As the sodium level drops toward 110 mEq/L (mmol/L), seizures, coma, and death may follow depending on how rapidly hyponatremia occurs. b. Hematologic i. Febrile Neutropenia ii. Sepsis: is a condition in which organisms enter the bloodstream (bloodstream infection [BSI]) and can result in septic shock, a life- threatening condition. Adults with cancer who have low white blood cell counts (WBCs) (neutropenia) and impaired IMMUNITY from cancer therapy are at risk for infection and sepsis. iii. DIC: is a problem with the blood-CLOTTING process. DIC is triggered by many severe illnesses, including cancer. In patients with cancer DIC often is caused by gram-negative sepsis, although viral and other bacterial infections can trigger it. A patient's normal bacterial flora enter the bloodstream through any site of skin breakdown and cause a severe infection, especially when neutropenia is present. Other causes of sepsis include liver disease, intravascular hemolysis, prosthetic devices, or metabolic acidosis. Extensive, abnormal CLOTTING occurs throughout the small blood vessels of patients with DIC. This widespread clotting depletes circulating clotting factors and platelets. As this happens, extensive bleeding occurs. Bleeding from many sites is the most common problem and ranges from oozing to fatal hemorrhage. Clots block blood vessels and decrease blood flow to major body organs and result in pain, ischemia, strokelike symptoms, dyspnea, tachycardia, reduced kidney function, and bowel necrosis. c. Structural i. Spinal Cord Compression (oncologic emergency): is an oncologic emergency that requires immediate intervention to relieve pain and prevent neurologic damage. Damage 23. What electrolyte disorder would you expect with hypoparathyroidism? Calcium down and phosphorous up 24. What electrolyte disorder would you expect to find with diabetic keto- acidosis? Hyperkalemia, hyponatremia, hyperglycemia 25. Working in the ED, you were assigned a patient who just finished running a marathon. The temperature was 87 degrees. What electrolyte disorder will you anticipate? Hypovolemia, hyponatremia, hypochloremia 26.List 4 nursing diagnosis for a patient with dehydration (what is happening on a physiological level) -Risk for falls due to hyponatremia which can cause seizures or orthostatic hypotension - List characteristics of how that patient would present to you in the ED. Describe how they would look and their vitals. a. . b. . c. . d. . 27. What is your priority intervention in correcting severe dehydration? Rehydrating with possibly hypertonic solution if low in sodium 28.A patient was admitted with Congestive Heart Failure who is up 50 lb second to fluid overload after having consumed chips and hot dogs all weekend (high in sodium content). The treatment plan in aggressive diuresis with a loop diuretic called furosemide. Morning labs indicate that Serum Potassium levels 1.5 mEq/dl. a. What is the normal serum potassium range? 3.5-5.0 b. What is your patient as risk for because of the potassium level? Cardiac issues, decreased DTR, muscle cramping, flaccid paralysis c. How did the Potassium level get so low in the 1st place? The diuretic pulled all of the potassium and he peed it out d. What is the treatment plan to correct the electrolyte imbalance? Give IV of potassium and potassium rich diet, don’t push IV do it slowly with IV monitor e. What is the dose and route of administration? No more than 20/hour through IV 29. The CHF patient is ready for discharge. He is back down to his baseline weight. He interested and ready to learn. What will you teach this patient and prevent him from going into fluid overload and better manage his CHF. CHF can cause a fluid overload so he needs to have a low sodium diet so that there won’t be a high serum sodium level which will pull more water into his blood causing his heart to work harder. Chances are a lot of his hormones aren’t working probably anymore either so his body isn’t able to regulate RAAS very well which can cause his BP to escalate along with sodium levels 30. Discuss probable lab findings of a patient who is hypovolemic. Increased everything 31. List causes of hypovolemia? Trauma, Burns, Bleeding, Shock, Dehydration 32.A patient is admitted with alcoholism. a. List characteristics of a patient admitted with delirium tremens. b. What electrolytes disorders would you anticipate? Hypomagnesemia, as well as low phosphate, potassium, calcium 33.What is palliative care? a. What does palliative care focus on? Palliative care provides support to the patient and family from the time of diagnosis through the treatment plan. Palliative care supports the whole person and not just the disease. The goal of palliative care is to prevent and treat symptoms and side effects of cancer treatment as soon as possible. In addition to treatment of the disease, palliative care also focuses on psychological, social, and spiritual issues. It provides a support system for the patient and family during the entire disease process. Palliative care can be provided in both the hospital, outpatient, and home setting. 34. What is Hospice? provides care to patients who are facing an incurable disease in which treatment is no longer an option for possible cure. The goal of hospice is to improve the quality of life for the patient in their final days. Hospice provides supportive care to the patient to help relieve the symptoms of cancer. It also serves as a support system for the patient and family during this difficult time. Hospice care can be performed in the hospital, hospice facility, or home setting. It offers a variety of services such as therapy, counseling, financial and emotional support to the patient and family, and includes support to the family once their loved one has passed.