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UTA NURS 3561 Adults Exam 3

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tumor angiogenesis   the process of the formation of blood vessels within the tumor itself  
initiation stage of cancer   initiator causes a genetic mutation  
promotion stage of cancer   a promoter causes rapid cell growth  
progression stage of cancer   a progressor causes cancer to become aggressive and spread  
Fine-needle aspiration (FNA)   small-gauge aspiration needle that provides cells from the mass for cytologic examination.  
large-core biopsy   cutting needles will deliver an actual piece of tissue (core) that can be analyzed with the advantage of preserving the histologic architecture of the tissue specimen.  
excisional biopsy   surgical removal of the entire lesion, lymph node, nodule, or mass; therefore it is therapeutic as well as diagnostic.  
incisional biopsy   (partial excision) may be performed with a scalpel or dermal punch.  
anatomic classification of tumors   tumor is identified by the tissue of origin, the anatomic site, and the behavior of the tumor (i.e., benign or malignant)  
carcinoma tissue of origin   embryonal ectoderm (skin and glands) and endoderm (mucous membranes of the respiratory, GI and GU tract)  
Sarcoma tissue of origin   embryonic mesoderm (connective tissue, muscle, bone and fat)  
Lymphoma and leukemia tissue of origin   hepatopoietic system (bone marrow or lymph glands  
histologic grading of tumors   the appearance of cells and the degree of differentiation are evaluated pathologically.  
Grade I of histologic grading of tumors   Cells differ slightly from normal cells (mild dysplasia) and are well differentiated (low grade).  
Grade II of histologic grading of tumors   Cells are more abnormal (moderate dysplasia) and moderately differentiated (intermediate grade).  
Grade III of histologic grading of tumors   Cells are very abnormal (severe dysplasia) and poorly differentiated (high grade).  
Grade IV of histologic grading of tumors   Cells are immature and primitive (anaplasia) and undifferentiated; cell of origin is difficult to determine (high grade).  
Grade X of histologic grading of tumors   Grade cannot be assessed.  
dysplasia   The enlargement of an organ or tissue by the proliferation of cells of an abnormal type, as a developmental disorder or an early stage in the development of cancer  
TNM classification system   used to determine the anatomic extent of the disease involvement according to three parameters: tumor size and invasiveness (T), presence or absence of regional spread to the lymph nodes (N), and metastasis to distant organ sites (M).  
T in TNM classification   tumor size and invasiveness  
N in TNM classification   presence or absence of regional spread to the lymph nodes  
M in TNM classification   metastasis to distant organ sites  
T0   No evidence of primary tumor  
Tis   Carcinoma in situ  
T1–4   Ascending degrees of increase in tumor size and involvement  
Tx   Tumor cannot be measured or found  
N0   No evidence of disease in lymph nodes  
N1–4   Ascending degrees of nodal involvement  
Nx   Regional lymph nodes unable to be assessed clinically  
M0   No evidence of distant metastases  
M1–4   Ascending degrees of metastatic involvement of the host, including distant nodes  
Mx   Cannot be determined  
clinical stage 0   cancer in situ (no invasion)  
clinical stage I   tumor limited to tissue of origin  
clinical stage II   limited local spread  
clinical stage III   extensive local and regional spread  
clinical stage IV   metastasis  
goals of collaborative care of cancer   cure, control, palliation  
testicular cancer “cure” timeframe   2 years d/t higher mitotic rate making less likely to recur  
postmenopausal breast cancer “cure” timeframe   20 years d/t slower mitotic rate making more likely to recur  
chemotherapy   the treatment of disease with chemical agents  
radiation therapy   emission and distribution of energy through space or material medium  
biologic therapy   treatment using biologic agents such as interferons, interleukins, monoclonal antibodies, and growth factors to modify the relationship between the host and the tumor  
myelosuppression   bone marrow suppression; can cause life-threatening and distressing effects including infection, hemorrhage, and overwhelming fatigue.  
leukopenia   an abnormal decrease in the number of total white blood cells to <4000/μL  
neutropenia   an abnormal reduction of the neutrophil count to <1000/μL; serious risk for life-threatening infection and sepsis.  
thrombocytopenia   a reduction of the platelet count to <150,000/μL; risk for serious bleeding if < 50,000/μL  
thrombocytopenia s/s   Petechiae, Ecchymoses, Active bleeding, Spleen enlarged, Headaches, Melena, Hematuria, Hypotension, Tachycardia, Prolonged menstruation  
Normal platelet count   150,000-400,000  
nadir   the lowest point, such as the blood count after it has been depressed by chemotherapy  
pancytopenia   marked decrease in the number of red blood cells, white blood cells, and platelets  
Anemia s/s   Fatigue, Dyspnea, Palpitations, Sweating, Tachycardia, Dizziness, Headaches, Angina, Difficulty sleeping, Poor concentration, Irritability, Cold intolerance, Anorexia, Pallor  
3 P’s for energy conservation   Plan, Prioritize (plan high-priority activities at time of increased energy), Pace (physical activity within limits)  
Mucositis   inflammation and ulceration of the mucous membrane lining the digestive tract  
Stomatitis   mucositis of the mouth  
Periodontium   supporting structure around teeth and bone structure  
Alopecia   partial or complete lack of hair resulting from normal aging, endocrine disorder, drug reaction, anticancer medication, or skin disease  
Major difference between benign and malignant neoplasms   the ability of malignant tumor cells to invade and metastasize  
Cancer with highest death rates   lung cancer  
Stomatitis, Mucositis, Espophagitis management   assess daily; provide supplements, analgesics, topical anesthetics, and artificial saliva as needed; avoid spicy or acidic foods, tobacco, and alcohol; frequent oral rinses with saline or salt and soda  
gastroesophageal reflux disease (GERD)   any clinically significant symptomatic condition or histopathologic alteration presumed to be secondary to reflux of gastric contents into the lower esophagus  
GERD aggravating substances   Substances that decrease LES pressure: chocolate, coffee, fatty foods, and alcohol; anticholinergics.  
GERD risk factors   obesity, pregnancy, cigarette/cigar smoking, hiatal hernias  
GERD drug therapy   H2R blockers, PPIs, Antacids  
peptic ulcer disease (PUD)   a condition characterized by erosion of the GI mucosa that results from the digestive action of HCl acid and pepsin  
acute ulcer   superficial erosion and minimal inflammation that has short duration and resolves quickly when the cause is identified and removed.  
chronic ulcer   long duration, eroding through the muscular wall with the formation of fibrous tissue that is present continuously for many months or intermittently throughout the person's lifetime.  
Gastric ulcer pain   high in epigastrium, 1-2 hrs after meals, burning or gaseous  
Duodenal ulcer pain   midepigastric region beneath xiphoid process, back pain, 2-4 hrs after meals  
PUD complications   hemorrhage, perforation, gastric outlet obstruction  
Ulcer perforation manifestations   sudden, sharp, intolerable severe pain beginning in the midepigastric area and spreading over the abdomen, which becomes rigid and board-like; n/v, tachycardia  
PUD treatment   rest, diet modification, drug therapy, quit smoking and alcohol, long-term f/u care, stress management  
PUD drug therapy   H2R blockers, PPIs, Antibiotics, Antacids, Anticholinergics, Cytoproctective therapy  
only drug approved for prevention of gastric ulcers induced by NSAIDs and aspirin   Misoprostol  
nursing management of PUD   compliance with regimen, reduce discomfort, no GI complications  
Diarrhea   the passage of at least three loose or liquid stools per day  
Chronic diarrhea   diarrhea lasting > 4 weeks  
Diarrhea causes   infection, disease, laxatives, antibiotics  
Diarrhea treatment   remove cause, fluid & electrolyte replacement, protection of skin, and medications  
major concerns of diarrhea   preventing transmission, fluid and electrolyte replacement, and resolution of the diarrhea  
action of antidiarrheals   coat and protect mucous membranes, absorb irritating substances, inhibit GI motility, decrease intestinal secretions, and decrease central nervous system stimulation of the GI tract  
Fecal Incontinence   Involuntary passage of stool occurs when the normal structures maintaining continence are disrupted.  
Fecal incontinence treatment   remove cause, bowel retraining, skin care  
Constipation   a decrease in frequency of bowel movements from what is “normal” for the individual, difficult-to-pass stools, a decrease in stool volume, and/or retention of feces in the rectum.  
Constipation causes   decreased mobility, decreased fluids, medications, decreased fiber, ignoring call to stool, disease.  
Fecal impaction   complication of constipation; the accumulation of hardened feces in the rectum or sigmoid colon that cannot be expelled.  
Intestinal rupture   complication of constipation  
Valsalva maneuver   complication of constipation; a maneuver that involves contraction of the chest muscles on a closed glottis with simultaneous contraction of the abdominal muscles  
Intestinal obstruction   complication of constipation; intestinal contents cannot pass through the GI tract.  
Hemorrhoids   complication of constipation; varicosities in the lower rectum or anus caused by congestion in the veins of the hemorrhoidal plexus  
Diverticulosis   complication of constipation; multiple noninflamed diverticula (outpouchings of the colon); can progress to diverticulitis  
Constipation treatment   fluids, positioning, fiber, digital removal, exercise, time, heeding the urge, laxatives and enemas.  
C. difficile causes   antibiotics that destroy normal intestinal flora, mainly clindamycin  
Drug treatment for C. difficile   Metronidazole (Vancomycin if not effective)  
inflammatory bowel disease (IBD)   chronic, recurrent inflammatory diseases of the intestinal tract that include ulcerative colitis and Crohn's disease  
ulcerative colitis   chronic inflammatory bowel disease that causes ulceration of the colon and rectum  
IBD clinical manifestations   diarrhea, bloody stools, weight loss, abdominal pain, fever, and fatigue  
Crohn’s disease differentiating factors   can be anywhere (terminal ileum), skip lesions, only slight cancer risk, no cure, affects all mucosal layers, weight loss is common  
Crohn’s disease manifestations   nonbloody diarrhea of usually not more than four to five stools daily  
Ulcerative colitis differentiating factors   limited to the colon, continuous lesions, big cancer risk, can be cured with colectomy, affects top layer only, weight loss is rare  
Chrohn’s disease complications   strictures, fistulas (b/t intestine, bladder, or vagina), abscesses  
Ulcerative colitis complications   hemorrhage, cancer (especially colon), tenesmus  
stricture   complication of Chrohn’s disease; an abnormal temporary or permanent narrowing of the lumen of a hollow organ  
anal fistula   complication of Chrohn’s disease; an abnormal tunnel leading from the anus or rectum that may extend to the outside of the skin, vagina, or buttocks and often precedes an abscess.  
Anorectal abscesses   complication of Chrohn’s disease; collections of perianal pus that are the result of obstruction of the anal glands.  
tenesmus   complication of ulcerative colitis; spasmodic contraction of the anal sphincter with pain and persistent desire to empty the bowel  
IBD therapy goals   induce & maintain remission; heal mucosa; restore and maintain nutrition; maintain quality of life  
Acute abdominal pain   Symptom associated with tissue injury, including damage to abdominal or pelvic organs and blood vessels.  
Life threatening causes of acute abdominal pain   hemorrhage, obstruction, perforation  
Acute abdominal pain goal of management   to identify and treat the cause, and monitor and treat complications, especially shock  
Acute abdominal pain assessment   take vitals immediately to assess for hypovolemia (increased pulse, decreased BP), monitor I&Os, inspect abdomen, auscultate bowel sounds, gently palpate abdomen, assess pain.  
Acute abdominal pain diagnostic studies   CBC, urinalysis, abdominal x-ray, and electrocardiogram are done initially, along with an ultrasound or CT scan  
Hypovolemic shock s/s   ↓ Blood pressure, ↓ Pulse pressure, Tachycardia, Cool/clammy skin, ↓ LOC, ↓ Urine output (<0.5 mL/kg/hr)  
Appendicitis   an inflammation of the appendix  
Appendicitis clinical manifestations   periumbilical pain; anorexia, nausea, and vomiting; localized and rebound tenderness, muscle guarding; distended/hard abdominal  
Appendicitis complications   perforation (rupture) can cause to peritonitis/abscesses  
Appendicitis treatment   localized: immediate surgical removal (appendectomy); Ruptured with peritonitis/abscess: antibiotic therapy and parenteral fluids 6 to 8 hours before appendectomy to prevent sepsis and dehydration  
Appendicitis patho   Feces, foreign body, tumor, or intramural thickening obstruct lumen > distention, venous engorgement, and accumulation of mucus and bacteria > gangrene and perforation (if not treated quickly)  
Appendicitis diagnostic studies   WBC (elevated in 90% of cases), urinalysis (to rule out genitourinary conditions), and CT scan/ultrasound.  
Perforated ulcer manifestations   sudden, sharp, intolerable severe pain beginning in the midepigastric area and spreading over the abdomen, which becomes rigid and board-like. Possible nausea/vomiting and tachycardia (as shock develops).  
Sepsis s/s   Ruptured appendix with peritonitis or abscess  
Peritonitis   localized or generalized inflammatory process of the peritoneum caused by chemical irritants or bacteria.  
Primary peritonitis   occurs when blood-borne organisms enter the peritoneal cavity (ascites with cirrhosis)  
Secondary peritonitis   occurs when abdominal organs perforate or rupture and release their contents (bile, enzymes, and bacteria) into the peritoneal cavity  
Peritonitis clinical manifestations   abdominal pain, ascites, rebound tenderness, boardlike abdomen, n/v, muscular rigidity, and spasm  
Peritonitis complications   hypovolemic shock, sepsis, intraabdominal abscess formation, paralytic ileus, and acute respiratory distress syndrome  
Peritonitis treatment   surgery to locate the cause of the inflammation, drain purulent fluid, and repair the damage; Non-Surgical (milder cases/poor surgical risks): antibiotics, NG suction, analgesics, and IV fluid  
Peritonitis goals   (1) resolution of inflammation, (2) relief of abdominal pain, (3) freedom from complications (especially hypovolemic shock), and (4) normal nutritional status  
Peritonitis diagnostic studies   CBC, WBC, serum electrolytes; Abdominal x-ray, Abdominal paracentesis and culture of fluid, CT scan or ultrasound, Peritoneoscopy  
Peritonitis abdominal pain interventions   knee flexed position, quiet environment, NG tube, medication  
Peritonitis risk for fluid volume deficit   I&Os, large bore IV, NPO, NG to decompress  
Hypovolemic shock interventions   monitor VS and I&Os, large bore IV, monitor electrolytes  
Gastroenteritis   Inflammation of mucosa of the stomach and small intestine.  
Gastroenteritis Clinical Manifestations   N/V, Diarrhea, Abd. Cramping, distention.  
Gastroenteritis Nursing Management   I/O, symptomatic management  
Colorectal cancer risk factors   increasing age, family or personal hx, colorectal polyps, and IBD.  
Colorectal cancer left-sided manifestations   bleeding, alternating constipation and diarrhea, ribbonlike stools  
Colorectal cancer right-sided manifestations   asymptomatic  
Tests to find both early colorectal cancer and polyps   Flexible sigmoidoscopy (done every 5 years), Colonoscopy (done every 10 years), Double-contrast barium enema (done every 5 years), CT colonography (virtual colonoscopy) (done every 5 years)  
age screening for colorectal cancer should be initiated   50 years-old  
Colonic polyps   arise from the mucosal surface of the colon and project into the lumen; account for 85% of colorectal cancers  
Most common causes of small bowel obstructions   Surgical adhesion, hernias, and tumors  
Small bowel obstruction clinical manifestations   rapid onset; frequent & copious vomiting; colicky, cramplike, intermittent pain; feces for a short time; greatly increased abdominal distention  
intestinal obstruction treatment   NPO status, NG tube, IV fluids with potassium, analgesics; surgery if not resolved in 24 hrs or deteriorates  
intestinal obstruction goals   (1) relief of the obstruction and return to normal bowel function, (2) minimal to no discomfort, and (3) normal fluid and electrolyte and acid-base status  
Small bowel obstruction diagnostic studies   CT scans, abdominal x-rays (show gas, fluids or perforation); Sigmoidoscopy or colonoscopy; CBC, Serum electrolyte, amylase, and BUN  
Intestinal strangulation s/s   Severe, constant pain with rapid onset; abdominal tenderness and rigidity; guarding; elevated temperature (above 100 F); elevated WBC and Decreased Hgb/Hct  
nonmechanical obstruction   result from a neuromuscular or vascular disorder (most common form is paralytic ileus)  
Paralytic ileus   lack of intestinal peristalsis; most common form of nonmechanical obstruction  
Mechanical obstruction   a detectable occlusion of the intestinal lumen  
Most common cause of small bowel obstruction   surgical adhesion, followed-by hernias and tumors  
Most common cause of large bowel obstruction   carcinoma, followed by volvulus and diverticular disease  
Pseudo-obstruction   an apparent mechanical obstruction of the intestine without demonstration of obstruction by radiologic methods  
End stoma   can be permanent or temporary; surgically constructed by dividing the bowel and bringing out the proximal end as a single stoma.  
Hartmann’s pouch   procedure where distal segment of GI tract is oversewn and left in abdominal cavity intact; potential for the bowel to be reanastomosed and the stoma to be closed.  
Loop stoma   usually temporary; constructed by bringing a loop of bowel to the abdominal surface and then opening the anterior wall of the bowel to provide fecal diversion (one stoma with a proximal and distal opening).  
Double-barreled stoma   usually temporary; both the proximal and distal ends are brought through the abdominal wall as two separate stomas (functioning stoma & mucus fistula)  
Indications for ileostomy   ulcerative colitis, Crohn’s disease, diseased/injured colon, birth defect, familial polyposis, trauma, cancer  
Indications for colostomy   Perforating diverticulum; trauma; inoperable tumors of colon, rectum, or pelvis; rectovaginal fistula; Cancer of the rectum or rectosigmoidal area; trauma  
mesalamine (Asacol, Pentasa)   5-Aminosalicylates (5-ASA); decreases GI inflammation through direct contact with bowel mucosa  
Infliximab (Remicade)   immunomodulator; inhibits the cytokine tumor necrosis factor (TNF)  
diphenoxylate with atropine (Lomotil)   Opioid and anticholinergic; decreases peristalsis and intestinal motility may increase  
loperamide (Imodium, Pepto Diarrhea Control)   Inhibits peristalsis, delays transit, increases absorption of fluid from stools  
H2-receptor blockers action   antisecretory; reduces gastric acid secretion and promotes ulcer healing; onset 1hr (take longer than antacids)  
Proton pump inhibitors action   antisecretory; reduces gastric acid secretion and promotes ulcer healing; more effective than H2-receptor blockers  
Antacid action   increase gastric pH by neutralizing the HCl acid.  
Cytoprotective therapy   Sucralfate (Carafate) accelerates ulcer healing by forming ulcer-adherent complex covering the ulcer; Misoprostol protective and antisecretory  
hepatitis   inflammation of the liver  
hepatitis causes   drugs (including alcohol), chemicals, autoimmune diseases, metabolic abnormalities and rarely bacteria.  
Hepatitis diet   low-fat, small frequent meals, larger meals in AM, adequate fluid intake  
HAV transmission   Fecal-oral (primarily fecal contamination and oral ingestion)  
HAV manifestations   anorexia, nausea, RUQ discomfort, weight loss, fatigue, malaise, light- or clay-colored stools if conjugated bilirubin unable to flow out of liver  
HBV transmission   Percutaneous (parenteral)/permucosal exposure to blood or blood products; sexual contact; preinatal transmission  
HCV transmission   Percutaneous (parenteral)/mucosal exposure to blood or blood products; High-risk sexual contact; Perinatal contact  
HDV transmission   same as HBV: Percutaneous (parenteral)/permucosal exposure to blood or blood products; sexual contact; preinatal transmission  
HEV transmission   Fecal-oral  
cirrhosis   chronic progressive disease of the liver characterized by extensive degeneration and destruction of the liver parenchymal cells  
cirrhosis causes   chronic liver disease (excessive alcohol intake and nonalcoholic fatty liver disease NAFLD)  
nonalcoholic fatty liver disease (NAFLD)   a group of disorders that are characterized by hepatic steatosis (accumulation of fat in the liver) that is not associated with other causes such as hepatitis, autoimmune disease, or alcohol  
Primary sclerosing cholangitis   a chronic inflammatory condition affecting the liver and bile ducts  
Cirrhosis manifestations   Early: abrupt onset of anorexia, dyspepsia, flatulence, n/v, and change in bowel habits (diarrhea or constipation); Later: Jaundice, skin lesions (spider angiomas), hematologic problems, endocrine problems, peripheral neuropathy  
When paracentesis performed   when ascites is accompanied by severe respiratory distress or abdominal pain  
acute pancreatitis   an acute inflammatory process of the pancreas caused by autodigestion and marked by symptoms of acute abdomen and escape of pancreatic enzymes into the pancreatic tissues  
pancreatitis causes   Biliary tract disease, Alchoholism, Trauma (post surgical & abdominal), Viral infections (mumps & coxsackievirus B), Penetrating duodenal ulcer, Cysts, abscesses, Cystic fibrosis, Kaposi’s sarcoma, Certain drugs  
pancreatitis clinical manifestations   Epigastric pain, N/V, Abdominal tenderness, Low-grade fever, Leukocytosis, Hypotension, Tachycardia, Jaundice, ↓ or absent BS, Hypovolemia, Grey Turner’s spots & Cullen's sign  
Cullen’s sign   bluish periumbilical discoloration caused by seepage of blood-stained exudate from the pancreas  
Grey Turner’s spots   bluish flank discoloration caused by seepage of blood-stained exudate from the pancreas  
Pancreatitis complications   pseudocyst, abscess, pleural effusion, Atelectasis, pneumonia, hypotension, hypocalcemia  
pancreatic pseudocyst   a cavity continuous with or surrounding the outside of the pancreas  
pancreatic pseudocyst manifestations   abdominal pain, palpable epigastric mass, n/v, anorexia, elevated serum amylase  
pancreatic pseudocyst treatment   Internal drainage procedure with an anastomosis between pancreatic duct and the jejunum  
pancreatic abscess   a large fluid-containing cavity within the pancreas  
pancreatic abscess manifestations   upper abdominal pain, abdominal mass, high fever, leukocytosis  
pancreatic abscess treatment   Prompt surgical drainage to prevent sepsis  
pancreatitis pain control   Demerol, morphine, antispasmodic, avoid atropine-like when paralytic ileus present  
Most effective means of relieving pain associated with acute pancreatitis   NPO status  
Chronic Pancreatitis   Progressive destruction of pancreas with fibrotic replacement of the tissue  
Symptoms of pancreatic insufficiency   Weight loss, Mild jaundice/dark urine, steatorrhea  
steatorrhea   greater than normal amounts of fat in the feces (foul-smelling, frothy stools)  
Pancreatic enzyme products (PEPs)   Creon, Zenpep, and Pancrease; contain amylase, lipase, and trypsin and are used to replace the deficient pancreatic enzymes.  
Cholelithiasis   stones in the gallbladder  
Cholelithiasis treatment   Cholesterol solvents, Drugs to dissolve stones, Endoscopic sphincterotomy, Extracorporeal shock-wave lithotripsy, Surgery  
choledocholithiasis   stones in the common bile duct  
cholecystitis   inflammation of the gallbladder  
Cholecystitis clinical manifestations   Indigestion, Pain – moderate to severe, Fever, Jaundice, RUQ tenderness, Restlessness, Diaphoresis, N/V  
Cholangitis   inflammation of biliary ducts  
cholecystectomy   removal of gallbladder  
common cholecystectomy post-op problem   referred pain to shoulder d/t CO2; place in Sims’ position (left side with right knee flexed)  
Expected drainage from T-Tube   500-1000 mL/day of bright yellow to dark green bile which is thick and acidic  
cause of steatorrhea   no bile salts in duodenum, preventing fat emulsion and digestion  
Parkinson's disease (PD)   a disease of the basal ganglia characterized by a slowing down in the initiation and execution of movement (bradykinesia), increased muscle tone (rigidity) tremor at rest, and impaired postural reflexes  
Parkinson’s disease symptoms (triad of PD)   tremor, rigidity, and bradykinesia  
generalized seizures   seizures characterized by bilateral synchronous epileptic discharge in the brain with loss of consciousness for a few seconds to several minutes  
tonic-clonic (grand mal) seizure   seizure characterized by loss of consciousness and falling to the ground, followed by stiffening of the body for 10 to 20 seconds and subsequent jerking of the extremities for another 30 to 40 seconds  
absence (petit mal) seizure   seizure characterized by a brief staring spell and a very brief loss of consciousness that usually occurs only in children and rarely continues beyond adolescence  
atypical absence seizure   seizure characterized by a staring spell accompanied by other signs and symptoms, including brief warnings, peculiar behavior during the seizure, or confusion after the seizure.  
myoclonic seizure   seizure characterized by a sudden, excessive jerk of the body or extremities.  
atonic (“drop attack”) seizure   involves either a tonic episode or a paroxysmal loss of muscle tone and begins suddenly with the person falling to the ground  
tonic seizure   involves a sudden onset of maintained increased tone in the extensor muscles  
Clonic seizures   begin with loss of consciousness and sudden loss of muscle tone, followed by limb jerking that may or may not be symmetric  
partial seizures   seizures that begin in a specific region of the cortex and may be confined to one side of the brain and remain partial or focal in nature, or they may spread to involve the entire brain  
Nursing actions during a seizure   providing for privacy, loosening restrictive clothing, removing the pillow and raising side rails in the bed, and placing the client on one side with the head flexed forward  
Parkinson’s teaching   exercise in AM, avoid sitting in soft deep chairs, rock back and forth to initiate movement and buy clothes with Velcro fasteners and slide-locking buckles  
abdominal pain associated with Hepatitis   RUQ (discomfort)  
abdominal pain associated with Acute Pancreatitis   LUQ or epigastric area and radiating to the back (severe and unrelenting)  
abdominal pain associated with Cholecystisis/Cholelithiasis   RUQ, radiating to right scapula and shoulder  
abdominal pain associated with cirrhosis   RUQ or epigastrium (full, heavy feeling)  
abdominal pain associated with liver cancer   RUQ or epigastrium  
abdominal pain associated with cecum obstruction   RLQ  
abdominal pain associated with Crohn’s   RLQ  
abdominal pain associated with diverticulitis   LLQ  
abdominal pain associated with constipation   LLQ  
abdominal pain associated with ulcerative colitis   LLQ  
abdominal pain associated with small bowel obstruction   Periumbulical and LUQ  
abdominal pain associated with appendicitis   Periumbulical and LUQ (early) or RLQ  
abdominal pain associated with gastroenteritis   Periumbulical and LUQ  
Esophagitis   inflammation of the mucosal lining of the esophagus caused by infection, irritation from a nasogastric tube, or, most commonly, backflow of gastric juice from the stomach  
Chemo/radiation stomatitis, mucositis, esophagitis management   assess oral mucosa daily, nutritional supplements, analgesics, diet modification, frequent oral rinses with saline or salt and soda, artificial saliva, no tobacco/alcohol, anesthetics  
Chemo/radiation nausea/vomiting management   eat/drink when not nauseated, antiemetics (before and after), diversion  
Chemo/radiation anorexia management   monitor weight; small, frequent, high-protein, high-calorie foods; encourage don’t nag; pleasant eating environment  
Chemo/radiation diarrhea management   antidiarrheals; low-fiber, low residue diet; 3L fluid intake  
Chemo/radiation constipation management   stool softners; high-fiber foods; fluid intake  
Chemo/radiation hepatotoxicity management   monitor liver function tests (serum bilirubin, urinary bilirubin, urinary urobilinogen, serum protein, ammonia, PT, Vitamin K, ALP, AST, ALT, GGT, cholesterol)  
Chemo/radiation anemia management   monitor Hgb and Hct; iron supplements and erythropoietin; foods promote RBC production  
foods promote RBC production   red meat, liver, fish, eggs, enriched and whole grains, green leafy vegetables, legumes, dried fruits, potatoes, cornmeal, bananas, milk, citris fruit, strawberries, cantaloupe  
Chemo/radiation leukopenia management   monitor WBC (especially neutrophils); monitor for fever; avoid large crowds; WBC growth factors  
Chemo/radiation thrombocytopenia management   monitor for bleeding; monitor platelet counts  
Chemo/radiation alopecia management   coping skills; cut hair before; avoid excessive shampooing, brushing, combing, hair dryers, curlers; self-image support  
Radiation skin reaction management   mild soap, lotion, expose to air, no tight-fitting clothes, no harsh fabrics, gentle detergents, no direct sun exposure, no excessive heat or cold temperatures, no swimming  
Chemo/radiation hemorrhagic cystitis management   increased fluid intake; monitor urgency, frequency, and hematauria; cytoprotectant agent and hydration  
Chemo/radiation reproductive dysfunction management   discuss before; offer banking before  
Chemo/radiation nephrotoxicity management   monitor BUN, Creatinine; potentiating drugs; sodium bicarbonate  
Chemo/radiation ICP management   monitor neurologic status; corticosteroids  
Chemo/radiation peripheral neuropathy management   monitor for parathesias, areflexia, weakness; temporary chemo dose interruption; antiseizure drugs  
Chemo/radiation cognitive changes management   daily planner, sleep/rest, exercise brain, no multitasking  
Chemo/radiation Pneumonitis management   monitor for dry, hacking cough, fever, and exertional dyspnea  
Chemo/radiation pericarditis and myocarditis management   monitor for clinical manifestations  
Chemo/radiation cardiotoxity management   monitor ECG, drug therapy modification  
Chemo/radiation hyperuricemia management   monitor uric acid levels, prophylactic Allopurinol, increased fluid intake  
Chemo/radiation fatigue management   encourage rest, maintain usual patterns, pace activities; moderate exercise  
Breast cancer screening guidelines   yearly mammograms starting at 40 y/o  
Colon and rectum cancer screening guidelines   colonoscopy every 10 years starting at 50 y/o  
Cervix cancer screening guidelines   yearly pap test starting 3 yrs after first intercourse  
Endometrium cancer screening guidelines   high-risk pts biopsy annually starting at 35 y/o  
Prostate cancer screening guidelines   offer PSA and rectal exam yearly starting at 50 y/o  
ulcer perforation management   NG tube; fluids (LR and albumin); blood replacement; CVP; foley; heart monitor; OR for repair  
Ostomy complications   mechanical breakdown, chemical breakdown, rash, leaks, dehydration, infection  
PUD post-op complications   dumping syndrome, post prandial hypoglycemia, bile reflux gastritis  
Dumping syndrome   PUD post-op complication; generalized weakness, sweating, palpitations, dizziness, abdominal cramps, borboygmi, and urge to defecate; begin 15-30 minutes after eating a meal with hyperosmolar composition and last no longer than 1hr.  
Postprandial hypoglycemia   PUD post-op complication; sweating, weakness, mental confusion, palpitations, tachycardia, and anxiety; begin 2hrs after eating a meal high in carbohydrates.  
Bile reflux gastritis   PUD post-op complication; continuous epigastric distress that increases after meals and is relieved temporarily with vomiting; surgery involving pylorus causes reflux into stomach.  
PUD post-op changes in gastric secretions   usually bright red at first, with a gradual darkening within the first 24 hours after surgery; changes to yellow-green within 36 to 48 hours.  
PUD Post-op care   NGT secretions; assess abdomen, I&O, pain, IVF, check electrolytes  
Acute hepatitis manifestation   may be asymptomatic; malaise, anorexia, fatigue, nausea, occasional vomiting, and abdominal (RUQ) discomfort  
Chronic hepatitis manifestations   malaise, easy fatigability, hepatomegaly, myalgias/arthralgias, elevated liver enzymes (AST and ALT)  
Hepatitis management   well-balanced diet, vitamin supplements, rest, no alcohol, drug therapy (for HBV and HCV)  
Jaundice   symptom of yellowish discoloration of body tissues that results from an increased concentration of bilirubin in the blood  


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