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Adult Health 2
Exam 1
| Question | Answer |
|---|---|
| Chronic illness definition & core characteristics | Medical condition lasting >3 months requiring long-term management Requires patients to: learn to live with symptoms, come to terms with identity changes, manage regimens Home is the primary center of care — patient + family assume day-to-day management responsibility |
| Chronic illness definition & core characteristics | Physical, psychological, and social impact; affects the whole family One chronic illness leads to others (e.g., diabetes → renal failure, blindness, peripheral neuropathy) Creates atmosphere of uncertainty — course is unknown and unpredictable Expensive; causes ethical dilemmas for patient, provider, and society |
| Why Chronic Illness Is Increasing — 6 Reasons | Medical advances: decreased mortality, people survive acute illness and live with chronic conditions Living longer: improved nutrition - longer life - more age related illnesses Pharmacology advances: drug expand lifespan without curing diseases (diabetes, heart disease, HIV/AIDS) Lifestyle changes: smoking, stress, high-fat diet, sedentary living |
| Chronic Illness Is Increasing — 6 Reasons | Early detection: improved screening, disease management programs, improved patient compliance Workplace safety: improved laws reduce acute injury but more workers survive to develop chronic issues |
| (Chronic illness) Factors Influencing Development | Increasing age — differentiate between aging and illness; not all change is disease Socioeconomic status — access to health care, nutrition, lifestyle factors Impaired healthcare management — affected by support systems, education, economics, culture Key cascades: terminal illness → chronic; critically ill → chronically critically ill |
| (Chronic illness) The continuum - 4 levels | 1 — Little Impact Independent functioning Mild asthma 2 — Moderate Limitation Some assistance needed Moderate COPD 3 — Significant Dependence Technology & support required Ventilator-dependent 4 — Complete Dependence Full care required End-stage Parkinson's |
| (Chronic illness) 8 trajectory phases | pre-trajectory: at risk; no symptoms yet trajectory onset: onset of symptoms or disability stable: symptoms and disability are managed unstable: exacerbation, complications, reactivation of illness in remission acute: sudden, severe symptoms - usually requires hospitalization crisis: critical, life threatening situation comeback: recovery after acute episode |
| (Chronic illness) 8 trajectory phases | downward: symptoms worsen despite attempts; patient usually managed at home in community dying: gradual or rapid decline despite all efforts; hospice |
| (Chronic illness) common issues | Decreased Mobility — PERSON framework: Protection, Elimination, Rest/Sleep/Activity, Self-concept, Oxygenation, Nutrition Nursing: Walk! Walk! Walk! Turning schedule. Involve PT/OT early. Document functional status daily. Fatigue — space activities around what matters most; exercise; make activities enjoyable |
| (Chronic illness) common issues | Chronic Pain — WHO standards; watch: fear of addiction, tolerance, substance abusers Depression — differentiate from fatigue; assess with standard tools — REFER |
| (Chronic illness) cultural attitudes | Western culture: Cure-oriented; system geared to acute care. Implication: Shift focus to management and QOL Stoic culture: Illness is to be accepted, not treated. Implication: Patient may refuse treatment Punishment culture: Illness seen as punishment for 'sins' . Implication: Won't seek help or learn self-care Authority figure culture: Expect to be told what to do; no patient input. Implication: Patient won't participate in decisions |
| (Chronic illness) cultural attitudes | Society should care culture: Don't learn self-care; families refuse involvement. Implication: Family won't engage in caregiving |
| (Chronic illness) family and social issues | Workplace role — employment may be impaired; role changes and income loss are common Social isolation — withdrawal from friends, community, social roles Family impact — roles shift; family members take on caregiver roles unexpectedly Caregiver role strain — physical and emotional exhaustion; assess and refer for support |
| (Chronic illness) nursing considerations | Patient/family often MORE knowledgeable about illness management than the nurse Never assume long-standing diagnosis = full knowledge Consider psychological and social state when teaching: readiness, coping, phase of illness Re-assess periodically — anticipatory counseling Respect patient autonomy — decisions, values, lifestyle choices Grief reaction occurs in any sequence; nurse must 'listen without fixing' |
| Rehabilitation definition and core principles | Dynamic, health-oriented process — assists ill or disabled individual to achieve greatest level of physical, mental, spiritual, social, and economic functioning within realistic limits May be necessary for ACUTE as well as CHRONIC illness Focus on EXISTING abilities — build on strengths, not limitations Never do for the patient what they can do for themselves |
| Rehabilitation definition and core principles | Holistic and individualized: physiological, psychological, spiritual Goal: maximal independence and QOL as defined by the patient Rehabilitation begins with INITIAL CONTACT Psychological reaction to disability = grief reaction — essential to adapt; occurs in any sequence |
| Rehabilitation definition and core principles | RN's willingness to 'listen without fixing' is essential for grief process to progress Patient motivation is essential — without it, rehab cannot succeed; assess early and often Success breeds success' — small wins build momentum; remain non-judgmental |
| (Rehabilitation) 5 rehab settings | 1. acute care 2. general rehab center 3. speciality rehab center 4. nursing home 5. home |
| (Rehabilitation) rehabilitation team | Physiatrist: Physician specialized in rehab medicine — leads the medical plan Physical therapist: Muscle strength, gait, balance, ambulation, alignment, posture Occupational therapist: ADLs, adaptive devices, fine motor coordination Speech therapist: Speech, communication, swallowing issues Nurse: Central coordinator — 24/7 implementation, advocate, educator, discharge planner |
| (Rehabilitation) Nurse's role | Prioritize & Coordinate — coordinate all care around rehab goals Know & Follow Through — know what specialists prescribed; assist patient 24 hours a day Delegate Purposefully — incorporate rehab goals when assigning tasks to UAPs Advocate — advocate for patient wishes throughout the process Discharge Planning — participate actively from day one |
| (Rehabilitation) nursing process in rehab | Assess: Functional ability Head-to-toe physical Rehab goals Motivation to engage Coping patterns Family status/resources Concerns about sexuality Plan: Realistic goals + timeframes WITH patient Short-term goals = steps toward long-term Select activities patient agrees to |
| (Rehabilitation) nursing process in rehab | Implement: Start teaching where patient is Emphasize abilities Conserve energy Adaptive devices Evaluate: Day by day — help patient see progress Adjust plan BEFORE patient feels like a failure |
| (Rehabilitation) Pre-Pt clinical check | Assess BP + pain (hold if unstable) · Medicate for pain before therapy (timing!) · Ensure patient has eaten · Communicate to PT and MD · Document everything |
| Home Care Nursing history | 1859: William Rathbone & Florence Nightingale — school to train visiting nurses for home care of the poor 1888: Lillian Wald — National Organization for Public Health Nursing; coined 'public health nursing' 1893: Lillian Wald — Henry Street Settlement House (NYC) 1965: Medicare funding began — MUST KNOW criteria: MD orders, homebound, intermittent skilled nursing, unstable condition, measurable goals, certified agency 1990s: OASIS by CMS; PPS (2000): payment per 60-day episode; OBQI required |
| Home Care Nursing history | 21st C: Telehealth: phone/video, remote monitoring (blood glucose, EKG, asthma, pacemaker); P4P coming |
| Home Care Nursing payors | medicare: Federally funded; CMS oversight (formerly HCFA) medicaid: State-administered, needs-based; jointly CMS + State private insurance: Mostly HMOs; coverage varies by plan |
| Home Care Nursing types of community agencies | Visiting Nurse Services (VNS): voluntary; funded by donations and patient insurance; not dependent on state.tax dollars Hospital-based: created to benefit reimbursement; tightly integrated with acute care Proprietary: for profit, often specialize (IV, pediatrics, dialysis, private duty, HHAs) Public Health Departments: prevention, health promotion, immunization, screening, education, epidemiology, maternal-child health |
| Home Care Nursing, Nurse's role & competencies | Autonomous practice: Works independently; accountable for own practice Patient education: MOST IMPORTANT intervention — goal is self-management; baccalaureate = entry level Skilled assessment: Highly skilled in assessment, diagnosis, evaluation, communication Coordination: Coordinator of all care; collaborates with all disciplines; locates community agencies |
| Home Care Nursing, Nurse's role & competencies | Documentation: Measurable details EVERY visit: 'Walked 8 feet without breathlessness' — NOT 'tolerated activity well' Reimbursement Awareness: Knows criteria; develops reimbursable plans; makes case for insurance coverage |
| Home Care Nursing, HOME | environment: patient owns it, nurse is a guest autonomy: works alone, autonomous practice ambiguity: you never know whats behind the door safety: patient, HHA, RN, agency responsible 24/7 family: must include in planning and care reimbursement: in your face every day |
| Home Care Nursing, HOSPITAL | environment: healthcare workers own it autonomy: team available for 2nd opinion ambiguity: get a report, know what to expect safety: patient and self, 24-hr staff present family: should include reimbursement: social work assists |
| Home Care Nursing major challenges | sensitive issues: Advance directives, informed consent, who pays, sexuality patient safety Cords, cooking, refrigeration, heating, cleanliness Transportation, ability to buy food & pay rent If unsafe — family members must be addressed; must be removed if necessary |
| Home Care Nursing major challenges | ethical & legal Confidentiality while involving family; managing costs; avoiding legal risk Emergency preparedness Agency disaster plan required; assess patient's specific risks (vent/O2) Network, kit, evacuation route; neighborhood safety |
| Home Care Nursing must know key concepts | SAFETY — Patient/Home · Auxiliary staff in home · RN personal safety CONFIDENTIALITY — HIPAA; involve family while protecting patient's private information INFECTION CONTROL — Aseptic technique in uncontrolled home environment RISK MANAGEMENT — Document, report, follow agency policies; protect patient and self |
| Home Care Nursing , plans of care & OASIS | Plan must be: appropriate, time-limited, and reimbursable OASIS: completed at admission, every 60 days (recertification), and discharge → submitted electronically to CMS 1993: ANA established certification exam; baccalaureate degree = entry level |
| Palliative care | Who/when: any age, any stage; begins at diagnosis alongside curative treatment Focus: symptom management+psychosocial/spiritual support Setting: hospital, outpatient, community/home, LTC - multiple settings Insurance: various payers Key point: does not replace medical treatment |
| Hospice care | Who/when: subset of palliative; prognosis ≤6 months; curative tx STOPPED Focus: comfort, dignity, life review, bereavement Setting: home, freestanding, or institutional Insurance: medicare part A benefit Key point: both extend support to families through bereavement |
| Goals of Palliative Care Patient-Centered Aims | Improve QOL for patient + family Anticipate, prevent, and treat suffering Manage pain and burdensome symptoms Reduce unnecessary care transitions Coordinate care across providers + settings Support decision-making + clarify goals |
| Goals of Palliative Care Care Delivery Principles | Interprofessional collaborative practice Early integration into treatment plan Address physical, psychosocial, spiritual needs Therapeutic communication is central Extends into family bereavement after death Cultural humility throughout |
| End of life / Palliative Care: 4 illness trajectories | sudden death: unexpected; minority of deaths (Trauma, MI, stroke) terminal illness: short, steady decline before death (Most cancers) organ failure: slow decline with episodic crises (CHF, COPD) Frailty: slow decline over years (Dementia, Alzheimers) |
| End of life / Palliative Care therapeutic communication, critical conversations | Diagnosis disclosure; treatment failure/transition Goals-of-care discussions; hospice referral Code status / advance directives |
| End of life / Palliative Care therapeutic communication, therapeutic skills (Nurse, spikes) | Open-ended questions; active listening Respond to emotion BEFORE information Ask permission before sharing info; use silence Use qualified medical interpreter — NOT family |
| End of life / Palliative Care, nurse's role in family meetings | Before: Stakeholder analysis Confirm private setting Review chart + updates Pre-meet with patient During: Advocate for patient values Interpret jargon for family Respond to emotion first Track who has spoken After: Summarize decisions in chart Reinforce next steps Provide written info Plan follow-up |
| End of life / Palliative Care, 4 advance directives | Living will: Patient's written preferences for end-of-life care, Activated when patient cannot speak for self DPOA-HC: Designates a surrogate decision-maker, Surrogate speaks when patient is incapacitated DNR order: Medical order to withhold CPR in cardiac arrest, Provider-signed; specific to resuscitation only POLST: Translates preferences into medical orders, Portable across settings; signed by patient/surrogate + provider |
| End of life / Palliative Care, 4 advance directives | Sanctioned by Patient Self-Determination Act (1991). All adults should be encouraged to complete — underutilized |
| End of life / Palliative Care, hope fostering | love of family and friends spirituality/ faith setting achievable goals positive clinician relationships humor and uplifting memories |
| End of life / Palliative Care, hope hindering | abandonment and isolation uncontrolled pain or discomfort devaluation of personhood dismissive communication/ lack of information |
| End of life / Palliative Care, FICA spiritual assessment (F) | Faith/ belief do you consider yourself spiritual or religious? what gives your life meaning? |
| End of life / Palliative Care, FICA spiritual assessment (I) | Importance/ Influence what role does your faith play in your life and in your health? |
| End of life / Palliative Care, FICA spiritual assessment (C) | community are you part of a spiritual community? is it a source of support? |
| End of life / Palliative Care, FICA spiritual assessment (A) | address in care how would you like me to address these issues in your care? |
| End of life / Palliative Care, grief terms | Grief: Personal internal feelings that accompany a loss (Sadness, anger, numbness, longing) Mourning: Outward expressions of grief and behaviors (Crying, rituals, wearing black) Bereavement: Period of mourning following a loss (Weeks to months after death) |
| End of life / Palliative Care, grief terms | Anticipatory grief: Grief experienced BEFORE the death (Hope vs guilt; relief vs sadness; Kübler-Ross stage) Complicated grief: Prolonged sadness/worthlessness >6–12 months; interferes with daily life (Self-destructive behaviors → refer; psych ± medication) |
| End of life / Palliative Care, expected signs in final days | EXPECTED: Skin mottling (extremities) · Cheyne-Stokes/agonal breathing + apnea · 'Death rattle' · Decreased urine output/incontinence · Increasing somnolence · Decreased appetite NOT expected: Sudden return of full appetite · Acute hemorrhage requiring transfusion (these are COMPLICATIONS) Hearing believed intact — keep talking to patient even when unresponsive; encourage family to do the same |
| End of life / Palliative Care, nursing care in final hours, comfort measures | Reposition gently; mouth and skin care Elevate HOB; side-lying for secretions Anticholinergics for terminal secretions Opioids first-line for dyspnea Cluster care; minimize stimulation Avoid deep suctioning |
| End of life / Palliative Care, nursing care in final hours, family support | Normalize dying signs; teach what to expect Allow rituals + cultural practices at bedside Offer chaplaincy and bereavement resources Permit a 'rally' — follow patient lead Use qualified interpreter for clinical conversations |
| End of life / Palliative Care, culturally sensitive EOL Care | DO: Set aside assumptions · Ask about decision-making preferences · Respect rituals · Use qualified interpreter · Acknowledge historical mistrust DON'T: Assume uniform code-status preferences · Disclose prognosis directly without asking family preference first · Use family as interpreters |
| Cancer Core epidemiology | 1.9M+ new U.S. cases (2023); 609K+ expected deaths; 88% of dx in adults ≥50 years; 57% in ≥65 Top deaths — Males: lung, prostate, colorectal · Females: lung, breast, colorectal |
| Cancer Core carcinogenesis | step 1: initiation, Carcinogen → DNA mutation; repair or apoptosis suppressed step 2: promotion, Proliferation of initiated cells — reversible if carcinogen removed step 3: progression, Cells acquire malignant behavior; invade and metastasize Spread via lymphatic and hematogenous routes 5–10% of adult cancers show familial predisposition (BRCA1/2, MEN1/2) |
| Cancer core, benign cells | Growth: slow, controlled invasion: non invasive, encapsulated metastasis: does not metastasize differentiation: well differentiated, normal appearance effect on body: localized, may compress structures |
| Cancer core, malignant cells | growth: rapid, uncontrolled invasion: invasive, infiltrates surrounding tissue metastasis: can metastasize via lymph/blood differentiation: poorly differentiated; anaplastic effect on body: systemic effects; cachexia; organ failure |
| Cancer core, modifiable risk factors | Tobacco — ~30% of cancer deaths; most lethal carcinogen Alcohol use Diet — processed/red meat; low plant intake Physical inactivity + obesity (linked to 13 cancers) UV/sun exposure Occupational exposures (asbestos) Infections: HPV, HBV, EBV, H. pylori |
| Cancer core, non-modifiable risk factors | Age — most cancers ≥50 yrs Genetics: BRCA1/2, MEN1/2 Sex and race/ethnicity Hormonal: early menarche, late menopause, nulliparity Family history (3-generation pedigree) Immunocompromise — transplant, HIV/AIDS |
| Cancer core, critical note | Unintentional weight loss = clinical FINDING — NOT a risk factor |
| Cancer core, 3 levels of prevention | Primary prevention: risk reduction, Health promotion; exercise ≥150 min/wk; HPV + HBV vaccination; tobacco cessation; nutrition counseling Secondary prevention: screening + early detection, ACS-recommended screenings; identify precancerous lesions; address access barriers Tertiary prevention: survivorship + surveillance, Monitor for recurrence; screen for secondary malignancies; ongoing health promotion |
| Cancer core, ACS screening guidelines | Breast: method-mammogram, start age 45 (option from 40) Cervical: method: HPV test or PAP co-test, start age 25 Colorectal: method- stool test or colonoscopy, start age 45-75 (ACS)/ 50 (USPSTF) Lung: method- annual low-dose CT (high risk only), start age 50-80 Prostate: method- share decision-making, start age 50 |
| Cancer core, TNM staging T- primary tumor | Tis = carcinoma in situ (noninvasive); T0 = no evidence; T1–T4 increasing extent; Tx = cannot assess |
| Cancer core, TNM staging N- lymph nodes | N0 = none; N1–N3 increasing involvement; Nx = cannot assess |
| Cancer core, TNM staging M- metastasize | M0 = none; M1 = present; Mx = cannot assess |
| Cancer core grading Grade I | Well-differentiated; best prognosis |
| Cancer core grading Grade II | Moderately differentiated |
| Cancer core grading Grade III | Poorly differentiated |
| Cancer core grading Grade IV | Anaplastic; aggressive; worst prognosis |
| Cancer core, chemo classes Class alkylating | ex. Cisplatin, carboplatin, busulfan key side effects: BMS, N/V, renal toxicity |
| Cancer core, chemo classes class nitrosoureas | ex. Carmustine, lomustine key side effects: Delayed BMS (cross BBB) |
| Cancer core, chemo classes class Topo inhibitors | ex. Irinotecan, topotecan key side effects: BMS, diarrhea |
| Cancer core, chemo classes class antometabolites | ex. 5-FU, capecitabine, MTX key side effects: BMS, N/V, mucositis |
| Cancer core, chemo classes class antitumor antibiotics | ex. Bleomycin, doxorubicin key side effects: Cardiotoxicity, BMS |
| Cancer core, chemo classes class mitotic inhibitors | ex. Paclitaxel, vincristine key side effects: Neuropathy, alopecia |
| Cancer core nadir | Nadir = Days 7–14 after chemo — neutropenia, thrombocytopenia, anemia · Fever ≥100.4°F → report immediately · Do NOT increase dose at nadir · Transfusions guided by symptoms — NEVER routinely scheduled |
| Cancer core, chemo acute risks (Extravasation) | details: Leakage into tissue; irritant vs. vesicant action: Vesicants → tissue necrosis; trained staff + antidotes |
| Cancer core, chemo acute risks (Hypersensitivity) | details: IgE (carboplatin, oxaliplatin) or non-IgE (rituximab, cetuximab) action: STOP infusion; follow emergency protocol |
| Cancer core, chemo safe handling | Class II (or III) BSC · Closed-system devices + leak-proof IV bags · PPE: double-layer powder-free gloves + gown + surgical N-95 + eye protection · Chemo-hazardous containers (NOT standard biohazard) · ONS + ASCO standards |
| Cancer core, radiation - brachytherapy safety | Private room with radiation signage at door Visitors: ≥6 feet (NOT 3 feet), ≤30 min/day Nurse wears personal dosimeter (caregiver badge) Pregnant staff and children NOT assigned Dislodged implant: NEVER handle directly — long-handled forceps → lead-lined container Most sensitive tissues: bone marrow, lymph, GI, hair follicles, gonads |
| Cancer core, Lymphedema After Axillary Dissection | action: Elevate affected arm above heart level · No BP cuffs/blood draws/IVs on affected arm — LIFELONG · NO vigorous massage (contraindicated) monitor: Arm circumference · Skin integrity · Sensation · Capillary refill · Range of motion |
| Cancer core, oncologic emergencies SVC syndrome emergency | key signs: Dyspnea, facial swelling, dilated chest veins; avoid UE sticks treatment: Radiation, chemo, anticoagulation |
| Cancer core, oncologic emergencies Spinal cord compression emergency | key signs: Back/neck pain, motor loss, urinary retention treatment: MRI, steroids, radiation, surgery |
| Cancer core, oncologic emergencies Hypercalcemia emergency | key signs: Fatigue, confusion (Ca >10.4 mg/dL) treatment: IV hydration, bisphosphonates |
| Cancer core, oncologic emergencies Tumor Lysis syndrome emergency | key signs: Hyper-K, hyperuricemia, AKI treatment: Fluids, allopurinol, electrolyte correction |
| Cancer core, survivor ship care plan - all patients at end of primary treatment | Treatment summary (diagnosis + all therapies); follow-up schedule; surveillance for recurrence Screening for secondary malignancies; symptom + rehab referrals; psychosocial + spiritual support Genetic counseling if hereditary syndrome; coordination between specialists + primary care |
| Laryngeal cancer clinical manifestation | Hoarseness >2 weeks — classic early warning sign Persistent cough; sore throat / throat burning Lump in neck; unilateral nasal obstruction Unintentional weight loss |
| Laryngeal cancer diagnosis, treatment, laryngectomy | Diagnosis: Laryngoscopy + biopsy Treatment: Surgery, radiation, chemotherapy Laryngectomy: Surgical removal of the larynx Permanent tracheostomy required after total laryngectomy Voice rehabilitation needed post-op Body image concerns — psychosocial support essential |
| Lung cancer Etiology & classfication | Primary cause: inhaled carcinogens — primarily cigarette smoke Also: e-cigarettes, second-hand smoke, occupational hazards, genetic mutations SCLC (Small Cell) = 10–15% NSCLC (Non-Small Cell) = 80–85% |
| Lung cancer Manifestations & management | S/S: cough/change in cough, dyspnea, hemoptysis Dx: CXR, CT scan, biopsy Screening: annual low-dose CT — high-risk ages 50–80 Tx: surgery, radiation, chemo; thoracotomy if needed |
| Leukemia overview | Unregulated proliferation of leukocytes in bone marrow — only one cell type typically increased Persistent leukocytosis = evaluate for malignancy Acute: abrupt onset, rapid progression, immature cells Chronic: slower; majority of WBCs produced are mature |
| Leukemia AML - Acute Myeloid Leukemia | key pathology: Mutation in myeloid HSC; most common; median age 68; bone Hallmark signs/symptoms: Neutropenia → fever/infection; anemia → fatigue/pallor; thrombocytopenia → petechiae/bleeding; complications: bleeding (GI/pulmonary/intracranial), infection, tumor lysis syndrome marrow >20% blasts Treatment: Induction (cytarabine) + consolidation; allogeneic HSCT |
| Leukemia CML - Chronic Myeloid Leukemia | key pathology: BCR-ABL gene (Philadelphia chromosome); 15% of new leukemias; phases: chronic → accelerated → blast crisis Hallmark signs/symptoms: Fatigue, splenomegaly, bone pain, fevers, weight loss Treatment: TKIs first-line (imatinib, dasatinib, nilotinib); HSCT (age <65); TKI SE: fatigue, pruritus, rash, headache |
| Leukemia ALL - Acute Lymphoblastic Leukemia | key pathology: Immature lymphoblasts; B-cell 75%, T-cell 25%; 75–80% in children; median age 15; BCR-ABL in 20% Hallmark signs/symptoms: Nonspecific; enlarged liver/spleen; bone pain; CNS: cranial nerve palsies, headache, vomiting; extranodal: testes, breasts Treatment: Induction → consolidation → maintenance; intrathecal chemo for CNS; TKIs for Philadelphia+; HSCT if high relapse risk |
| Leukemia CLL - Chronic lymphocytic leukemia | key pathology: Most prevalent adult leukemia in West; malignant B-lymphocyte clone; median age 72; 10% incidence with 1st/2nd-degree relative Hallmark signs/symptoms: Lymphocytosis always present; many asymptomatic; lymphadenopathy (severe/painful); splenomegaly Treatment: Watch-and-wait if asymptomatic; immunotherapy + chemo; TKIs for TP53 mutation |
| Leukemia nursing management (ALL LEUKEMIAS) | Administer blood products; treat infections promptly; granulocytic growth factors for life-threatening infections Monitor adverse therapy effects; infection and bleeding precautions education Address anxiety and grief; coordinate home care for catheter management |
| Lymphoma | Cure rate: ~90% overall — one of the most curable cancers Demographics: More common in males; peak ages 15–34 AND >60; 5-yr survival: 92–94% localized, 78% distant Risk factors: EBV, HIV, HHV8; family history; immunosuppression; cytotoxic exposure; Agent Orange Pathology: Unicentric origin → spreads by contiguous extension along lymphatics; hallmark = Reed-Sternberg cell (gigantic B-lymphocyte) |
| Lymphoma | WHO subtypes: Nodular sclerosis (most common, highly curable) · Mixed cellularity · Lymphocyte depleted · Lymphocyte rich · NLPHL (slow-growing, 'popcorn cells') Class signs/symptoms: Painless, firm cervical lymphadenopathy; mediastinal mass → dyspnea; mild anemia B symptoms (advanced): Fever + Drenching night sweats + Unintentional weight loss — all 3 = B symptoms → worse prognosis Diagnosis: Excisional lymph node biopsy (Reed-Sternberg cells); CXR, CT, PET; CBC; HIV + hepatitis B/C testing |
| Lymphoma | Treatment: Early (I–II): ABVD or Stanford V ± radiation · Advanced (III–IV): ABVD + additional cycles · Refractory: brentuximab, nivolumab, pembrolizumab Late effects: Secondary malignancies · Cardiovascular disease · Hypothyroidism · Infertility Nursing: Most care outpatient; educate on infection prevention; screen for secondary cancers; reduce modifiable risks |
| Multiple Myeloma CRAB | CRAB: C = Hypercalcemia · R = Renal dysfunction · A = Anemia · B = Bone destruction |
| Multiple Myeloma Overview | Malignant disease of mature B lymphocytes (plasma cells) 1.8% of all cancers; 17% of hematologic malignancies; median age 70 Malignant plasma cells → nonfunctional M protein Bone destruction via osteoclast activation (IL-6 mediated) May evolve from MGUS (0.5–1%/year progression) |
| Multiple Myeloma Diagnosis | Serum protein electrophoresis (M protein) Bone marrow biopsy; beta-2 microglobulin (tumor burden) Skeletal imaging: CT, MRI, PET; CBC, BUN, creatinine, calcium |
| Multiple Myeloma Complications | Infection (low immunoglobulins) Hyperviscosity syndrome Spinal cord compression Peripheral neuropathy (up to 75%) VTE risk with corticosteroids |
| Multiple Myeloma Treatment & Nursing | No cure — symptom reduction, slow progression Bortezomib- or daratumumab-based regimens; CAR-T for advanced Nursing: pain mgmt; hydration + bisphosphonates for hypercalcemia; fracture precautions; monitor renal function; infection prevention |
| Colorectal Cancer Epidemiology & risk | 3rd most common U.S. cancer; ~152,810 new cases/yr; median age 66 Incidence ↓ in >50 but ↑ in <50 Risk: family hx, sedentary/obese, poor diet, Lynch syndrome (HNPCC), FAP |
| Colorectal Cancer pathophysiology & prognosis | 90% adenocarcinoma; APC gene mutation → polyp → invasive cancer Common mets: liver, peritoneum, lungs Prognosis Localized: 91% · Distant: 13% 5-yr survival |
| Colorectal Cancer symptoms by location | Right: dull pain, melena (dark tarry blood) Left: obstruction symptoms, hematochezia (bright red blood) Rectal: tenesmus, incomplete evacuation General: change in bowel habits, anemia, weight loss, fatigue |
| Colorectal Cancer diagnosis & treatment | Gold standard: colonoscopy with biopsy; CEA for follow-up ACS screening: age 45; USPSTF: 50 Abdominoperineal resection → permanent colostomy Stage III: FOLFOX (5-FU, leucovorin, oxaliplatin) ERAS pathway: reduces perioperative stress, shorter LOS |
| Bladder cancer key facts | 4th most common cancer in U.S. males; avg dx age 73 Most are transitional cell carcinoma (urothelial); arise in trigone Lifetime risk: males 1 in 28; females 1 in 91 Mets: liver, bone, lungs |
| Bladder cancer hallmark sign | Painless, visible (gross) hematuria Also: urinary frequency/urgency, recurrent UTI symptoms, dysuria Pelvic/back pain → suggests metastasis |
| Bladder cancer prevention | Smoking cessation = single most important Adequate hydration; promptly treat UTIs; PPE for occupational exposure Lifelong cystoscopy surveillance after curative treatment |
| Bladder cancer treatment | TURBT — first-line tx + diagnostic for superficial tumors Fulguration — cauterization of papillomas BCG (intravesical) — stimulates immunity; ↓ recurrence in non-muscle-invasive Radical cystectomy — muscle-invasive disease Ileal conduit — most common urinary diversion post-cystectomy MVAC — methotrexate, vinblastine, doxorubicin, cisplatin — systemic invasive Palliative radiation — pain + bleeding in inoperable tumors |
| Bladder cancer post-cystectomy priority order | 1) Stoma viability q2hr → 2) Output hourly → 3) Stoma education → 4) Discharge coordination → 5) Support group |
| Cervical cancer epidemiology & types | 3rd most common female reproductive cancer in U.S. Death rates ↓ significantly due to Pap smear screening Types: squamous cell carcinoma (most common); adenocarcinoma (HPV-related); mixed adenosquamous |
| Cervical cancer prevention | Pap tests + HPV test from age 25; HPV vaccination; avoid smoking; safer sex |
| Cervical cancer treatment | Hysterectomy: total (uterus + cervix); subtotal (uterus only); radical (uterus + surrounding tissue + lymph nodes) Post-op risks: infection, hemorrhage, voiding issues Radiation: EBRT, intraoperative (IORT), intracavitary brachytherapy |
| Uterine (Endometrial) Cancer | Most common gynecologic cancer in U.S.; 4th most common cancer in females overall Risk factors: obesity, estrogen exposure (unopposed), nulliparity, diabetes Tx: hysterectomy + possible radiation and chemotherapy |
| Ovarian cancer | Leading cause of gynecologic cancer DEATH — most deadly gynecologic cancer 1 in 70 females; 90% epithelial origin; incidence increases with age S/S: bloating, pelvic pressure, urinary urgency — often nonspecific; diagnosed late Family history = most significant risk factor No reliable early screening test — often diagnosed at advanced stage Tx: surgery + chemotherapy |
| Breast cancer epidemiology & risk | ~287,850 new invasive cases (2022); lifetime risk ~13% (1 in 8) Risk peaks in 7th decade; 5–10% hereditary (BRCA1/2) Risk: BRCA1/2 mutations; obesity, alcohol, smoking; late-in-life weight gain |
| Breast cancer protective factors | Breastfeeding ≥1 year; regular physical activity; healthy weight; avoiding excess alcohol |
| Breast cancer tanner stages | Stage 1: prepuberty · Stage 2: breast budding = FIRST sign of puberty Stage 3: enlargement · Stage 4: nipple/areola = secondary mound · Stage 5: adult |
| Breast cancer clinical manifestations | Upper outer quadrant most common site Nontender, fixed, hard, irregular borders Advanced: skin dimpling, nipple retraction, ulceration Concerning discharge: spontaneous, persistent, unilateral, or bloody |
| Breast cancer screening | Mammogram: ACS start age 45 (option from 40) Annual MRI for BRCA+ patients |
| Breast cancer biopsy types | Excisional = removes ENTIRE mass (standard) Incisional = portion only (advanced/recurrent) |
| Breast cancer treatment | Surgery: breast conservation, mastectomy, modified radical, SLNB Radiation: EBRT 5 days/wk × 5–6 wks after surgery Hormone: tamoxifen (ER+); aromatase inhibitors Targeted: trastuzumab (HER2+); palbociclib Mets: bone, lungs, liver, pleura, brain |
| Breast cancer nursing | No BP cuffs/sticks/IVs on affected arm — LIFELONG Drain management; arm exercises; psychosocial support |
| Benign Prostatic Hyperplasia (BPH) | prevalence: 50% of males by age 60%; up to 90% by age 85 pathophysiology: DHT = critical mediator, incomplete bladder emptying → retention; can lead to hydroureter, hydronephrosis, UTIs DRE finding: Large, rubbery, NONTENDER Early S/S: Frequency, urgency, nocturia, hesitancy, decreased stream, dribbling Advanced S/S: Chronic retention → azotemia, kidney failure Metastasis: N/A |
| Prostatic Hyperplasia (BPH) | Diagnosis: Urinalysis; urinary flow rate; postvoid residual Medical Tx: Alpha-blockers (relax bladder neck); 5-alpha reductase inhibitors (↓ prostate size); watchful waiting Surgical Tx: TURP (most common); TUIP; robotic prostatectomy; microwave/needle ablation ADT side effects: N/A |
| Prostate cancer | prevalence: Most common cancer in males (excl. skin); 2nd leading cause of cancer death pathophysiology: Age, family history, high red meat/dairy diet DRE finding: hard, irregular, or nodular Early s/s: Rarely symptomatic — often incidental finding advanced s/s: Urinary obstruction, hematuria, sexual dysfunction Metastasis: Backache, hip pain, weight loss, fractures |
| Prostate cancer | Diagnosis: DRE, serum PSA, TRUS + biopsy; Gleason score; bone scan, MRI, pelvic CT Medical Tx: Sipuleucel-T (metastatic); abiraterone, cabazitaxel (castration-resistant); ADT Surgical Tx: Radical prostatectomy; EBRT; brachytherapy; orchiectomy ADT side effects: Hot flashes, osteoporosis, cardiovascular risk |
| Skin cancer | Most common cancer in the U.S. — more cases than all other cancers combined 1 in 5 Americans will develop skin cancer by age 70 Leading preventable cause: UV radiation exposure |
| Skin cancer, BCC basal cell | appearance: Small waxy nodule; rolled translucent borders; sun-exposed areas (face, neck, scalp) metastasis: rarely, recurrence common key fact: Most prevalent; 2× more common in males; rarely fatal |
| Skin cancer, SCC squamous cell | appearance: Rough, thickened, scaly tumor; precursor = actinic keratosis metastasis: 1.2–5%; up to 8,000 deaths/yr key fact: 2nd most prevalent; more aggressive than BCC |
| Skin cancer, Melanoma | appearance: ABCDE assessment; most dangerous; upper back common site metastasis: High metastatic risk key fact: SLNB for staging; most deadly |
| Skin cancer, Mohs surgery & nursing | Most accurate — tumor removed layer by layer; frozen sections analyzed until margins clear Recommended for: periorbital, nasal, lip, auricular areas; high cure rates BCC + SCC Nursing: UV avoidance, daily sunscreen, wound care, bleeding/infection monitoring Follow-up: every 3 months for 1 year after treatment |
| Skin cancer, fatigue management | Nonpharmacologic = exercise, yoga, optimizing sleep · Pharmacologic (NOT nonpharmacologic) = erythropoiesis-stimulating agents |
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