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NURSING 111 EXAM 1 STUDY
NOTES
- What precautions does the nurse take when giving any type of Chemo medications o Any person who is giving chemotherapy drugs should be well protected. o PPE- protection mask, double glove or “chemo” gloves, gown. o This is for up to 48 hours. o Even with oral chemo drugs o Nurse should educate the patient and/or family to make sure they wear gloves when they take the medication. Extravasation: drug leaks into surrounding tissues “infiltration” Most important intervention is PREVENTION! Anything over 0.5 ml of drug surgery may be needed. Intervention is to monitor blood return and access site Vesicant: chemical or drug that can cause tissue damage on direct contact or extravasation. IMMEDIATE ATTENTION. Cold can be used or warm can be used. Neutralizing solution is the antidote that can be used
- What is Superior vena cava syndrome and what are the symptoms associated with this syndrome o Compression of the SVC by a tumor o Early s/s: o Periorbital edema o Nosebleeds o Peripheral edema and dyspnea o Upper torso swelling o Late s/s: o Erythema of upper body o Dyspnea o Cyanosis o Hemorrhage o Hypotension o Stridor indicates RAPID SVCS progression (better seen in a supine position) o Treatment: o Radiation o Stent ▪ Temporary relief
- What will the nurse do for a patient following a prostatectomy and what should be done for dark red urine output? o Prostatectomy is the removal of the prostate gland along with the seminal vesicles.
o Mouth care every 12 hours o Low neutrophils can also mask infection o Also focus on keeping normal flora under control. ▪ Thrombocytopenia - low platelets o At risk for bleeding o Bleeding precautions o Soft bristle toothbrush o Electric razor o Monitor for bruising, nosebleeds, blood in urine or stool ▪ Treatment:
**- Epoetin alfa
- Know all signs/symptoms of Neutropenia and Thrombocytopenia o Thrombocytopenia o Easy/excessive bruising o Prolonged bleeding from cuts o Blood in urine or stools o Fatigue o Enlarged spleen o Jaundice o Neutropenia o Fever o Mouth ulcers o Sore throat o Susceptibility to infection
- What kind of education would you give someone receiving external radiation o Radiation is used to kill cancer cells, provide control, or relieve symptoms. o The exposure to radiation alters DNA and changes cellular regulation. o Keep in mind that good cells are also destroyed. o Treatment is usually 15-30 minutes 5 days a week. o Teletherapy o radiation delivers by an external beam; patient is not hazardous to others o Brachytherapy o Radiation delivered by internal devices o Short close therapy that comes into direct contact with the tumor o Radioactive isotopes are expelled either in solid form or within body fluids (THIS PATIENT IS A HAZARD!) unsealed isotopes are eventually eliminated in waste products. Wastes are radioactive and must ensure that they are not directly touched by anyone The type of radiation chosen depends on the patients’ health, but the idea is to kill the cancer with the minimal damage to the normal cell.
Side effects of radiation are fatigue, xerostomia (dry mouth), vomiting, alopecia, radiation dermatitis, nausea, and can increase risk of malignancies. Skin becomes photosensitive and increases risk for sunburn or sun damage, altered taste sensations o Education : (outpatient) o Use mild soap o Wash with hands instead of a washcloth o Do not wash off markings o Wear soft loose clothing o Avoid heat/sun exposure o Pat dry instead of rub o Use non-aluminum containing deodorant Inpatient: o Pregnant women and children under 16 should not deal with patient o limit visitors to ½ hour, wear lead apron o switch staff to limit excessive exposure o wear dosimeter film badge (measures how much radiation exposure) o private room o keep all linen in room until completed or it is taken out
- Know the stages of cancer development; malignant transformation occurs through…
- Initiation: change in gene expression leads to loss of cellular regulation o Cell still appears normal o mutation does not impair cells ability to replicate o still able to carry out original function; irreversible mutation of gene (appears normal but there are changes)
- Promotion: enhanced growth of initiated cell by substances known as promotors (promotors can be insulin, estrogen, etc. and cause the cell to divide more frequently) o Promoting agent stimulates the growth and division of cellular proliferation o Reversible event
- Progression: continued growth; 1 cm tumor has billion of cells that contain its own blood supply
- (basically trying to break off)
- Metastasis: moves from primary location and breaks off into remote colonies (bone, lung, liver, brain, etc.)
- Know how to interpret the TNM staging system - Staging is important because it influences the treatment. Staging includes tumor size, lymph
LYMPH NODES : N0- No lymph nodes, N1- metastasis to ipsilateral movable axillary, N2- metastasis to ipsilateral fixed axillary, N3- metastasis to intraclavicular/supraclavicular METASTASIS : M0- no distant metastasis, M1- distant metastasis T4, N3, M1 = bad bad bad pallative care 10.What drug does the physician order for the chemo patient with low hemoglobin levels? o Epoetin alfa (Procrit)- increases RBC’s and increases blood oxygen levels 11.What the normal ranges for platelet counts and what nursing intervention should the nurse do for a low platelet count o 150,000-450, o Give the patient blood o Epoetin alfa o Avoid injections and venipunctures 12.What intervention/education should the nurse suggest to the early diagnosed cancer patient concerning memory problems
- Encourage patient to keep a journal, provide cognitive training; cognitive changes are high and very common in women with breast cancer. Duloxetine has also been given to cancer patients and shown improvement. Main goal with cancer patient and cognitive issues is to prevent injury 13.What is mucositis and what interventions does the nurse do to treat it
- Mucositis is the inflammation of the mucosa. (Sores in the mouth)
- Interventions: o The patient is at risk for electrolyte imbalance, due to not being able to eat. o Encourage patient to look inside of the mouth every 4 hours o Brush teeth and tongue o Avoid salt o Avoid spicy foods o Avoid mouthwashes that contain alcohol o Avoid cigarettes o Use swish and swallow o Cryotherapy (use withnice chips) o sodium bicarbonate rinses o IV injections of palifermin 14.What is the difference between Basal Cell and Squamous cell carcinomas - Basal: o are slow growing and metastasis is rare
o normal cells are similar as they do not mutate and destroy o more internal accounts for 90% of skin cancer
- Squamous:
18.What is Tumor lysis syndrome
o Rapid destruction of tumor cells that causes potassium and purines to leak into the blood stream causing hyperkalemia causing cardiac dysfunction and can also cause AKI if untreated. Positive sign that the cancer treatment is effective, but just working too quickly o Treatment: o FLUIDS o Glucose o Insulin 19.What interventions would the nurse incorporate for the patient diagnosed with a brain tumor o Common side effect of patients with brain tumors. SIADH is when the water is reabsorbed rapidly by the kidneys. Causes hyponatremia (SALT LOSS) o Interventions: o Monitor I’s & O’s* o Monitor vitals for ICP*** o Monitor specific gravity***** S- stupor/coma/confusion L- limp muscles A- Anorexia O- orthostatic hypotension L- lethargy S- seizures/headache T- tendon reflexes decreased S- stomach cramps Goal is to restore normal fluid balance. Interventions strict I& O’s, increase salt intake, monitor every 2 hours and recognize worsening signs (crackles in lungs, vein distention), fluid restriction 20.What type of education will the nurse teach the patient who takes herbal medications when receiving treatment for cancer o Questions to ask the patient: o Do you take herbals? o What kind? o When was the last time it was taken? o Cancer patients should talk to their doctor first about continuing herbal supplements because there can be multiple interactions. Hormonal manipulation- black cohosh Antiplatelet- ginkgo
**- T’ai Chi does not cure the cancer
- Helps improve symptoms associated with cancer
- Helps reduce muscle and joint pain** 25.What types of interventions can the nurse provide for cancer comfort **- Pain management morphine and oxygen
- Aromatherapy
- Guided imagery** 26.What is Palliative care and what purpose does treatment do for this type of patient **- Improved quality of life but no cure
- Promotes comfort and dignity** 27.What is Hospice and the role of the nurse working with the patient and family **- Helps with bereavement (mourning after the death of a loved one)
- Goal is to achieve highest quality of end of life o Would you like to stay with this patient for a while? o Do you want me to call someone for you?** 28.What is the difference between agonal breathing, apneustic breathing, and cheyne-stokes respiration? **1. Agonal respirations: gasping respiration, labored breathing
- Apneustic breathing: deep, gasping, with a pause at inspiration
- Cheyne stokes: death rattle with periods of apnea (respirations right before death)
- Dyspnea: unpleasant awareness of increased need to breathe** 29.What are signs/symptoms of impending death and which sign doing the nurse determine is showing nearing death **- Mottling
- Increased secretions
- Decreased urinary output
- Atrophy
- Cool skin
- Decline physical function
- Cyanotic extremities
- Cheyne-stokes
- Decreased circulation** 30.What is the most important treatment the nurse does for the dying patient? **- Provide pain management (morphine)
- Reposition the patient towards dying process for comfort
- If the patient is admitted to hospice and they want anything specific and not actively dying, give them WHATEVER THEY WANT!** 31.What are advance directives and what education does the nurse provide the patient/family
- A written document that determines what measures what the patient will accept when they **no longer cognitively able to say what they want
- Nurses can witness but not be the sole witness of the patient** 32.What actions should the nurse take for the death of the patient and their families - THINK ABOUT THE CULTURE o Family needs a priest o Wants incents o Family wants to stay with the patient 33.What is the difference between hospice and palliative care? o Hospice - prognosis is 6 months or less to live, care is provided when curative treatment has been stopped, ongoing care is provided by RN’s social workers, chaplains, and volunteer’s, bereavement o Palliative - patients can be in any stage of serious illness, consultation is provided that is concurrent with curative therapy that prolongs life, care is not limited by specific time periods, follow up visits 34.How does one identify pain in the cancer patient?
- Unresponsive patient o Facial grimaces o Restlessness o Moaning o Vitals o Rely on the family 35.What task are unlicensed staff allowed to do for the dying patient **- Turning patient to the left side will help with the agnail breathing
- ADLs** o LPNS CANNOT ▪ Assess ▪ Educate/teach 36.What interventions does the nurse do for “death rattle” **- Reposition patient
- Administer anticholinergics (atropine)
- Benzo’s can be given to decrease fear
- COMFORT CARE IS NUMBER ONE**
- What are the catholic custom associated with death and dying? - Get their last rights before passing Roman Catholic tradition encourages people to receive Sacrament of the Sick, administered by a priest at any point during an illness. This sacrament may be administered more than once. Not receiving this sacrament will NOT prohibit them from entering heaven after death. Patient also may have an emergency baptism
- What is terminal dehydration o voluntary stopping of eating and drinking (VSED)
o It is not painful when managed with palliative measures
- What is the purpose of proportional palliative sedation o A care management approach: ▪ involving the administration of drugs ▪ Benzodiazepines for the purpose of lowering patient consciousness ▪ Purpose is to provide comfort and not hasten death ❖ Cellular regulation: process of cellular responses in order to undergo reproduction, differentiation, and proliferation. Any continued cellular growth after normal development is abnormal (neoplasia) ❖ 7 warning signs of cancer= CAUTION o C- change in bladder/bowel habits o A- a sore that does not heal o U- unusual bleeding or discharge o T- thickening or lump in the breast/elsewhere o I- indigestion or difficulty swallowing o O- obvious change in wart or mole o N- nagging cough or hoarseness ❖ Prevention o Primary- reduce risk for cancer development o Secondary- early detection, participation in screenings o Tertiary- focus on the management of long-term cancer clients, prevention from recurrence ❖ Cachexia- extreme wasting and malnutrition o Eat frequent meals, increase protein, supplements, NG tube, PEG tube ❖ Chemotherapy is used to kill cancer cells and disrupt cellular regulation o Neoadjuvant- can be used to shrink a tumor o Adjuvant- combination treatment used to kill a tumor (chemo and radiation) o Given on a scheduled basis ▪ time to maximize and kill cancer cells ▪ minimize damage to normal cells o Regimen allow for a total number of days to do chemo and days to be off. The intent is to allow normal cells to recover but prevent abnormal cell recovery ❖ Nadir- when white blood cell counts are at their lowest o To prevent immunity and immunosuppression, nadirs are avoided that occur at the same time ❖ Immunotherapy- improves immunity, uses biological response modifiers which alters a patients biological response to cancerous tumor cells. This type of therapy is used when tests show that it will respond well.
o Used to stimulates patients’ immune system to recognize cancer cells and destroy them
