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Med-surgII exam 3
respiratory, oral cancer, hematology, oncology emergencies, hepatic disorders
| Question | Answer |
|---|---|
| Upper airway disorders | -respiratory infections/ larynx cancer - can be minor/life threatening - patient teaching is very important |
| Respiratory infection | - Health HX: smoker, environmental,cough -S/S: headache, cough, hoarseness, fever, stuffiness, fatigue Assessment: nose,neck,throat,lymph nodes |
| Larynx cancer (voice box) | - Head/neck CA has a high death rate due to ignoring symptoms and smoking - Categories of larynx CA: - Supraglottic (false cords, above) - Glottic (true vocal cords) - Subglottic (below vocal cords) |
| Symptoms and risk factors of larynx cancer | Risk factors: carcinogens, voice strain, chronic laryngitis, alcohol, nutritional: riboflavin diet(no milk,eggs or greens) -S/S: hoarseness >2 weeks, cough, lump, sore/ burning throat pain, wt loss, ear pain |
| Diagnosis/treatment of larynx cancer | Diagnosis- health HX, exam, larynscopic, biopsy Treatments: Radiation- teach about diet, bland foods no spice, try ensure/ thicken foods Chemo- 5fu/ cisplatin -watch airway/ carotid artery weakness |
| Laryngectomy | Types: - Partial: used for smaller cancers in ealier stages, only one vocal cord removed. voice may be horse but no swallowing problems noted -Total- complete removal of cords and two rings of the trachea, no voice, needs permanent trach |
| Laryngectomy care | Speech/communication therapy, Nutritional assessment Laryngeal tube- shorter than a trach tube but all air flows through the tube. must keep patent airway Complications: resp distress, hemorraging, infections, aspiration raise HOB, check GI tube residu |
| Chest/ Lower resp tract disorders | Atelectasis, pleural conditions, lung cancer |
| Atelectasis | collapse of the alveoli caused by bronchial obstructions by secretions due to impaired lung expansion -causes: hypo-ventilation, airway obstruction/compression, post op patient -S/S: productive cough, fever, resp distress, decreased breath sounds |
| Pleural conditions | Pleurisy, Pleural effusion, Empyema |
| Pleurisy | inflammation of both layers and pleura causing sharp rubbing pain |
| Pleural effusion | fluid collection in the pleural space >10 ml Causes: secondary to DX- heart failure, TB, pnemonia, pulm infection, PE, tumor diagnostics: chest xray,CT,trachea deviation, fluid analysis MGMT:treat DX, chest tube, thoracentesis,shunt |
| Lung cancer | Spreads very easy, #1 killer a/w CA 2 categories: small cell/NSCLC Small cell- spreads fast, arises in major bronchi/ infiltrates bronchi wall NSCLS- squamous cell, large carcinoma Staging- based on tumor size,location and lymph involvement |
| Lung CA symptoms/risks/treatments | Risks:smoking, environmental, genetics, underlying dx (copd/TB) S/S: cough-chronic to prodcutive, SOB, hemoptysis, chest/should pain, fever Diagnosis: chst xray,CT,MRI,needle aspiration TX:chemo, radiation,surgery |
| Lung cancer surgeries | Lung resections- recommended for NSCLC -lobectomy- small cell cancer (remove lobe) -pneumoectomy- remove entire lung -segmentectomy- remove segment of lobe |
| Trachestomy | bypasses upper airway obstructions |
| Lung cancer | #1 killer a/w cancer, spreads easily 2 categories: small cell/ NSCLC Small cell- spreads fast in major bronchi infiltrating bronchial walls NSCLC:arises in lrge carcincoma/squamous cell Staging: depends on tumor size, location, lymph involvement |
| Lung cancer risks/treatments/diagnosis | Risks: smoking, environmental,gender, genestics, underlying dx (copd/TB) Symptoms: cough devolps into productive, SOB, hemoptysis, chest/shoulder pain, fever Diagnosis: chest xray,PET,need aspiration Treatment:chemo/radiation/surgery |
| Lung cancer surgeries | -Lung resection- recommended for NSCLC -Lobectomy- small cell, remove a lobe -Pneumoectomy- remove the entire lung -Segmentectomy- remove a segment on the lobe |
| Trach care | trach-bypasses the upper airway obstructions Avioding complications: suctioning, dressing/tape change, asses lung sounds, monitor s/s of infection, admin O2, have ambu bag within reach |
| Oral Cancer | Causes: tobacco, alcohol, HPV,>40/black Symptoms:PAINLESS sore or more > 2 weeks later signs= impaired chewing, enlarged lymph nodes, blood tinged sputum MGMT: raidiation,chemo,surgery -avoid spicy/hot foods, oral care to prevent infection, gentle br |
| Oral Cancer surgeries | Hemiglossectomy- removal of half the tongue Total glossectomy- tongue removal |
| Radical neck dissection | worry about carotids/ trachea -post op- monitor airway, pain, bleeding - complications: hemorraging, chyle fistula- constantly draining, nerve injury-clavical/matoid -place pt in fowlers, sunction, liquid/soft diet, puree foods |
| Bone marrow | site of hematopresis(blood cell formation) -stems cells:premature bone marrow cells that differeniate into myeloid,lymphoid and mature stem cells -myeloid:RBCS,WBCS,Platlets -Lymphoid: T/B cells |
| RBC(erythrocytes) | Transport O2 between tissues/lungs -Mature RBCs= hemoglobin -Produced by the liver if marrow fails |
| WBC(leukocytes) | - need FOLIC ACID for WBC development-eledry should take folic acid replacement 2 types of WBCS::lymphoids/granucytes to fight infection Lymphyctes:T/B cells- T cells react to forgein agent and B cells create antibodies and trigger T cells |
| Platelets(thromocytes) | stored and released in the SPLEEN Functions: clotting, bleeding control, aggregation, release fibrin to stabilize clot |
| Spleen | antibody synthesis/ hematopesis/phagcytosis |
| Liver | RBC production is imparied bone marrow BLOOD COAGULANT Proteins-albumin/globulins |
| Lymphatic | filtration/ lymphocyte differentaition |
| Hemostatsis | stop bleeding - blood vessels allow blood to injury -platlets aggregate site -plasma coagulate and stabilize clot with fibrin -plasma proteins- albumins, fibrogen, globulins -albumin maintain fluid balance |
| Bone marrow transplant | graft vs host DX: can occur in first 100 days, give immunosurpressants immunosupressants- blisters, rash, abd pain MGMT during infusion: vitals, O2,fevers,chills,SOB,aniexty,taste changes Watch for infection- varicella, eyes, liver, skin, plum abnorm |
| Coagulpathies | bleeding and clotting disorders:DIC,anemia,Thrombocytopenia ,Myeloproliferative,thrombocytosis |
| DIC(disseminated intravascular coagulation) | Acute complications of SEPSIS, liver dx,transfusions Phase 1: little clots devolp throu circulation Phase 2: inability to clot- hemmorage Cause- sepsis causes overproduction of fibrin S/S: decreased platlets, increased FSP/d-dimer, depends on phase 1/ |
| Anemia | S/S a/w hypoxia |
| Thrombocytopenia | decrease in platlets 3 Types:ITP.TTP,HIT TX: steriods,transfusion, immunosurpessants, splenectomy(platlet destruction |
| ITP(idopathic) | - ITP:common in kids/woman, acute a/w with kids post virus 6months self limiting, chronic- may be triggered by lupus S/S: petiachie,easy brusing, decreased platlets TX: infusion/immunosurpressants |
| TTP | caused by a large thrombus collecting platlets |
| HIT(heparin induced) | give argatroban (safe anticoagulant) |
| Myeloproliferative disorders | Increased number of cells -polychemiavera |
| Polycemia vera | increased RBCs, hypercellular bone marrow, S/S: increased blood volume/viscosity, enlarged spleen, itching, increased H&H for a substained time, headache,HTN 3 cardnal signs: increased RBC mass, norm O2, enlarged spleen TX: remove 500 ml 1-2xwk,antico |
| Thrombocytosis | stem cell disorder in bone marrow,increased platlets, unknown causes, hemmoraging/vascular occulision can occur S/S: burning,pain,warmth,headache,petichie Risks: >60, thrombolitic events |
| Hematologic maligances | myelomas:mulitple/waldenstorms Lymphomas:hodgskins/non-hodgkins Leukemias:ALL,CLL,HCL,AML,CNL |
| ALL(acute lymphatic leukemia) | a/w YOUNG KIDS, over production of immature white cell B cell, very curable, 4-5 yr olds and eledry 405 cure rate S/S: fatigue, fever,infection,bleed/bruise joint and bone pain, elarged lymphs/spleen TX: chemo/local raidation/BMT for long term survival |
| CLL CLL(chronic lymphaotic leukemia) | common in eledry pts,mature leukemia cells S/S: asyptomatic- enlarged lymph nodes, DRENCHING NIGHT SWEATS,fever, wt loss |
| AML(acute myeloid leukemia) | effects all ages, 5 yr survival rate that decreases with age, decreased cell production S/S: fever, infections from neutropenia, very weak, pain from enlarged liver/spleen, bleeding complications: bleeding/infection- two causes of death |
| CML(chronic myeloid leukemia) | myeloid stem cell mutation,uncontrolled cell growth,BMT=cure S/S: tierd, increased WBCs, anorexia,SOB, pain, enlarged liver/spleen- tenderness |
| Lymphomas | tumors usually start in the lymph nodes |
| Hodgkins | M>W, early 20s/>50 unknown causes/a/w viral and pts on immunosuressants, reed sternberg cell S/S: PAINLESS enlraged lymph nodes, all organs can be invaded DX: increased nodes, reed sternberg, pet scan, Xray |
| Non-hodgskins | lymphoid tissues are infiltrated by CA cells in multi sites, delayed DX because no S/S S/S: DRENCHED NIGHT SWEATS,fever, nausea, wt loss DX: cat scan, pet scan, BM biospy Classification- eledry, age, blood levels,risk for failure |
| Mulitple Myelomas | increased # of immuglobins (M.protein) classic sign= bone pain(back/ribs), bone injury, increased M protein No cure, spreads to other organs/longbones Two markers: increased albumin/beta 2 mircoglobin 5 yr survival rate |
| Blood transfusion | acute blood loss |
| Reactions to blood transfusions | Acute hemolytic: error with blood, chest/back pain, fever, chills Allergy- hives/itching Fibrile: reaction to WBCs- S/S MGMT Delayed hemolotic- 14 days after- signs- fever, increased billirubin, anemia TRALI: transfusion related lung jury, 1-2 hrs pos |
| Oncology emergencies | SVC,hypercalemia,DIC,spincal cord compression |
| Suprerior vena cave syndrome | compression/invasion of SVC by tumor/lymph/thrombus -a/w lung/breast CA S/S: SOB,cough,hoarseness,chest pain, FACIAL EDEMA, decreased swallowing, increased ICP, JVD, decreased LOC -MGMT:radiation,chemo,stents,anticoagulants, corticosteriods, dierectics |
| Hypercalcemia | increased calicum is released from the bones and kidneys cant excrete it S/S: fatigue, confusion, decreased LOC, dehydration, N/V, dyshythmias MGMT: increase fluids, increase molbilty, antiemetics, pt edu of S/S |
| DIC | coagulation disorder that results in thrombus/bleeding Phase1=excessive cloting (chronic) phase2- hemmoraging (acute) MGMT: chemo/raidation/SX- treat underlying DX first-sepsis, blood transfusion, anticoagulants |
| Spinal cord compression | a/w tumor, lymphomas,decreased nerve supply, breast/lung/kidney/prostate CA S/S: local inflamm, decreased blood supply, increased pain with movement, decreased ROM, MGMT: raidation to decrease tumor, corticosteriods, SX,chemo |
| Hepatic disorders | Liver Dx, cirrhosis, encephalaphy, hepatis |
| Liver | largest gland, RUQ, very vascular Storage: minerals, vitamins Protection: detox,RBCC destruction/bacteria, secretes bile/bilirubin,plasama proteins Metablizes:gluclose,ammonia,protein,fat, drugs |
| Cirrhosis of the liver | types: alcoholic,postnercotic,billary causes:alcoholism a/w nutrition,infection, nuturtional defenicies S/S:jaundice,portal HTN, ascites, coma, edema, decreased LOC, spleen/liver enlarge complications:bleeding, hepatic encephalaophy, FVE |
| Jaundice | yellow-green body tissues a/w increased bilirubin levels Types:hemolytic,hepatocelluar/obsrtuctive(liver Dx), hereitary -hepatocelluar S/S:appear ill, decreased appetite, nausea, fatigue, headache chills -obstructive:dark/orange urine, impaired fat dig |
| Portal HTN | flow obstruction in liver leads to HTN which results in ascities in abd/peritoneal |
| Ascites | increased fluid retention/decreased albumin synthesis Assesment:abd girth, daily wt, fluid wave TX: low Na diet, diurectics, paracenteis, bed rest |
| Hepatic encephalaphy/coma | complication of liver Dx, accum of ammonia/toxins in the blood -assesment: EEG,decreased LOC/neuro checks, seizures, monitor electrolyes Asterxiz-flapping tremor, damage to brain cells MGMT: elmin cause of Dx, decreased ammonia levels,IV gluclose |
| Bleeding Esophagel varices | a/w patients with cirrohsis -S/S: hemtatemesis, shock, deteroration - pt w/ cirrohsis should have endo q 2 yrs Tw: shock tx,O2,Iv fluids, blood, nitro, decrease HTN, portal shunts, ballon tamponade, |
| Hepatitis | inflamm of the liver caused by a virus, bacteria or drugs Viral- systemic virus that causes necrosis/liver inflamm Non-viral:toxin/drug induced |
| Hep A(HAV) | FECAL-ORAL transmission, spread by poor hyngine, hand to mouth, foods/fluids -incubuation 15-50 days/ lats 4-8 weeks -S/S: flu like, low fever, anorexia, jaundice, indigestion, epigastric pain, enlraged liver/spleen MGMT: good hygeine, vaccine,rest |
| Hep B(HBV) | BLOOD TO BLOOD, salvia, sexually, mother to infant, major cause of cirrohsis/ liver CA - long incubation 1 to 6 months S/S: flu like, low fever,jaudice, indeigestion MGMT: vaccine, standard precuations, nutritonal support, meds: interferon, hepsera,Epi |
| Hep C | BLOOD TO BLOOD, sexual,needles, blood borne infection -liver transplant is common -incubation varies S/S:mild MGMT: blood screening, prevent needle sticks, no alcohol, anti viral: riapfam/interferon |
| Hep D | only people with HEP B can get HEP D, BLOOD TO BLOOD, sexual S/S: similar to B but deveolp liver Dx/ cirrohsis faster |
| Hep E | FECAL-ORAL, resembles Hep A but is self limiting with abrupt onset, no chronic form 15-65 day incubation period |
| Pancreatis | inflamm of exocrine tissues caused by digestive enzymes attacking the pancreas, can be very deadly Cardinal signs: abd pain, increased proteins, nausea/vomitting Causes:cholethasis,viral,alcohol,trauma, obesity, increased calcium/lipids,idoptthc |
| Acute Pancreatitis | duct is obstructed and enzymes back up into the pancreas causing auto digest/infalmm S/S: serve abd pain, acutely ill, nausea/vomitting, fever, confusion,jaundice, eccymosis on flank/umblical, shock S/S Tx: pain MGMT,NGT,NPO,IVF,nausea control |
| Chronic pancreatitis | progressive inflamm with pancreas destructions, cells are replaced by fibrous tissues and obstruct CBD S/S: recurrent serve upper abd/back pain, vommiting, wt loss, Complications: fluid/eletroye imbalance, nercosis of pancreas, DIC, organ dysfxn |
| NGT | decompress stomach, monitor drainage, measure tube placement, check placement with 20-50ml air blous, irrigate every 4 hrs, watch for sudden change in drainage it could mean displacement |
Created by:
ndeluca08
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