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UTA NURS 3561 Exam 3

UTA NURS 3561 Adults Exam 3

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
Created by: camellia
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