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Exam 5 CA NS 2013

Hopefully this helps

Cancer-causing agents capable of producing cellular alterations Carcinogens
Drugs that are capable of interacting with DNA have the potential to cause neoplasms in humans Chemical Carcinogens
Ultraviolet rays would be an example of this kind of carcinogen. Radiation
Most common cancer among whites in the united states Skin Cancer
Oncogenic carcinogens that can transform the cells they infect and induce malignant transformations Viral Carcinogens
Cancer related genes have been identified to increase an individuals chances of development of certain cancers Genetic susceptibility
These are common promoting factors of cancer Dietary fat, obesity, cigarette smoking, and alcohol consumption
Cigarette smoke is and example of what kind of Carcinogen? Complete - in can initiate and promote cancer
Spread of the cancer to a distant site Metastasis
Process in which the tumor forms it's own blood vessels Tumor angiogenesis
Cancer cells may display altered cell surface antigens as a result of malignant transformation. Tumor-associated antigens
The response of the immune system to antigens of malignant cells. Immunologic Surveillance
Immune response to malignant cells involves what 4 kind of killing cells. Cytotoxic T cells, natural killer cells, macrophages, and B lymphocytes.
Benign Suffix -oma
Malignant Suffixes -Carcinoma ( Epithelial) -sarcoma ( Connective) -oma (nervous)
Surface Epithelium tumors Papillo-
Glandular Epithelium tumors Adeno-
Fibrous Tissue tumors Fibro-
Cartilage Tumors Chondro-
Striated Muscle tumors Rhabdomyo-
Bone tumors Osteo-
Meninges tumors Mening-
Nerve Cells tumors Benign - Ganglioneuroma Malignant - Neuroblastoma
Hematopoietic Tissue tumors such as lymphoid, plasma cells, and bone marrow. Are always malignant - Hodkin's, multiple myeloma, and Lymphocytic Leukemia ( Respective order )
Cells: differ SLIGHTLY from normal cells (mild dysplasia) and are well differentiated (low grade) Grade 1
Cells are MORE abnormal (moderate dysplasia) and moderately differentiated. Grade 2
Cells are VERY abnormal (severe dysplasia) and poorly differentiated. Grade 3
Cells are immature and primitive (anaplasia) and undifferentitated. Grade 4
Grade cannot be assessed Grade X
Cancer in SITU (stage) Stage 0
Tumor limited to the tissue of origin; localized tumor growth (stage) Stage 1
Limited local spread (stage) Stage 2
Extensive local and regional spread (stage) Stage 3
Metastasis (stage) Stage 4
TNM classification system classifies a tumor on what three grounds. Primary Tumor(T), Regional Lymph Nodes (N), Distant Metastases (M)
Examples of diagnostic tests that may be performed to assess the extent of disease include Radiologic studies, CT, MRI, and PET scans
Seven warning signs of cancer C hange in bowel of bladder habits A sore that does not heal U nusual bleeding or discharge from any body orfice T hickening or a lump in the breast or elsewhere I ndigestion or difficulty in swallowing O bvious change in a wart or mole N agging cou
The removal of a tissue sample for pathologic review Biopsy
Prevention and early detection of cancer techniques Lower alcohol use, get regular activity, normal body weight, colorectal screening, avoid tobacco use, mammography and pap tests, SPF 15 or higher, Practice healthy diet
The goals of cancer treatment are Cure, Control, or Palliation - determined by tumor grade and stage and PTs physiologic status.
The use of chemicals as a systemic therapy for cancer Chemotherapy
These damage the intima of the vein, causing phlebitis and sclerosis but will not cause tissue damage if infitrated. Irritants
These, if inadvertently infiltrated into the skin, may cause severe local tissue breakdown and necrosis Vesicants
Emission and distribution of energy through space or a material medium. Radiation Therapy
All cancer cells could be erradicated with radiation given in high enough doses, so why isn't this always used? Maximal Tolerated Dose, surrounding healthy tissue can only take so much radiation.
External radiation therapy Teletherapy ( External Beam radiation)
Internal radiation therapy Brachytherapy, which means close or internal radiation therapy. This allows for direct dose delivery to the target with minimal exposure to surrounding healthy tissues.
What is a RAD? measurement of radiation dosage absorbed by the tissues.
Lowest blood counts between 7 - 10 days after initiation of therapy The NADIR
Nurses must take every possible measure to prevent infections in patients with this. Neutropenia
Nursing management of stomatitis, mucositis, or esophagitis Assess oral mucosa daily and teach patient to do this. Encourage nutritional supplements Be aware that eating may be difficult ( use analgesics) Discourage irritants like alcohol and tobacco use
Nursing management of nausea and vomiting teach patient to eat and drink when not nauseated Administer antiemtic prophylactically before chemotherapy Use diversional Activities
Nursing Management of anorexia Monitor weight encourage small, frequent, high protein and caloric foods Gently encourage eating, but avoid nagging
Nursing Management of Diarrhea Give antidiarrheal agents as needed Encourage low fiber diet Fluid intake of atleast 3L daily
Nursing Management of Constipation Instruct patient to take stool softeners as needed, eat high-fiber foods, and increase fluid intake.
Nursing management of hepatotoxicity Monitor liver function tests
Nursing Management of Anemia Monitor hemoglobin and hematocrit levels Administer iron supplements and erythropoietin Encourage intake of foods that promote RBC production
Nursing Management of Leukopenia Monitor WBC count, especially neutrophils Teach patient to report temperature elevation Teach patient to avoid large crowds and people with infections
Nursing management of thrombocytopenia Observe for signs of bleeding like petechiae Monitor platelet Counts
Nursing management of Alopecia Suggest ways to cope with hair loss Avoid excessive shampooing, brushing, and combing of hair Avoid use of electric hair dryers, curlers, and curling rods
Nursing management of Radiation skin changes Basically avoid anything that might irritate the skin, apply NONperfumed lotions, monitor skin for increasing redness.
Nursing Management of Chemotherapy-Induced skin changes Alert patient to potential skin changes Encourage patient to avoid sun exposure Implement symptomatic management as needed
Nursing Management of Hemorrhagic cystitis Encourage increased fluid intake 24-72 hr after treatment
Nursing Management of Reproductive Dysfunction Discuss possibility with patients before treatment initiation offer opportunity for sperm and ova banking before treatment
Nursing management of NephroToxicity Monitor BUN and serum creatinine levels avoid potentiating drugs alkalinize the urine with sodium bicarbonate
Nursing management of Increased intracranial Pressure Monitor neurologic status May be controlled with corticosteroids
Nursing management of Peripheral Neuropathy Monitor for these manifestations in PTs on these drugs Consider temporary chemotherapy dose interruption or reduction until the symptoms have improved.
Nursing management of Cognitive Changes (chemo brain) Teach patients to do the following 1. use detailed daily planner 2. get enough sleep and rest 3. exercise brain 4. No multi tasking
Nursing management of Pneumonitis monitor for dry, hacking cough, fever, and exertional dyspnea
Nursing management of Pericarditis and myocarditis monitor for clinical manifestations of these disorders like dyspnea
Nursing management of Cardiotoxicity Monitor heart with ECG and cardiac ejection fractions Drug therapy may need to be modified for symptoms for cardiac function.
Nursing management of Hyperuricemia Monitor uric acid levels Allopurinol may be given as a prophylactic measure Encourage increased fluid intake
Nursing management of Fatigue Assess for reversible causes of tirdness and address them Reassure PT that tiredness is a common side of effect of therapy Encourage Rest
Experimental therapy that involves introducing genetic material into a person's cells to fight disease Gene Therapy
Protein foods with high Biologic value Milk, Eggs, Cheese, Meat, Poultry, Fish
High- calorie foods Mayonnaise - 101 calories!!!! butter, sour cream, peanut butter, whipped cream, corn oil, jelly, ice cream, honey
Obstruction of the superior vena cava by a tumor or thrombosis SVCS superior vena cave syndrome
Neurologic emergency caused by the presence of a malignant tumor in the epidural space of the spinal cord Spinal cord compression
Apathy, depression, fatigue, muscle weakness, ECG changes, poly uria, anorexia, nausea and vomiting Manifestations of Hypercalcemia
Location, Intensity, Quality, Pattern, And relief measures Pain assessment
Trends in the incidence and death rates of cancer include the fact that? African Americans have a higher death rate from cancer than Whites.
What cellular features of cancer cells distinguish them from normal cells? Cells lack contact inhibition, cells return to a previous undifferentiated state, New proteins characteristic of embryonic stage emerge on cell membrane
A characteristic of the stage of progression in the development of cancer is? Proliferation of cancer cells in spite of host control mechanisms.
Leading cancer causing DEATH site in both men and women. Lung and bronchus
Leading gender specific cancer death in women? Breast
Leading gender specific cancer death in men? Prostate
Surgery may be a carefully planned event Elective surgery
Surgery may arise with unexpected urgency Emergency Surgery
Determination of the presence and/or extent of pathology Diagnosis
Elimination or repair of pathology Cure
Alleviation of symptoms without a cure Palliation
Examples include: removal of a mole before becomes malignant Prevention
Surgical Examination to determine the nature of the disease Exploration
Repairing a burn scar or breast reconstruction after a mastectomy Cosmetic improvement
-ectomy Excision or removal of
-lysis Destruction of
-orrhaphy repair or suture of
-oscopy looking into
-ostomy creation of an opening into
-otomy cutting into or incision of
-plasty repair or reconstruction of
Identify risk factors and plan care to ensure patient safety throughout the surgical experience. overall goal of the preoperative assessment
Normal and inherent survival mechanism, can arise from lack of knowledge, may also arise with conflict to religious beliefs. Anxiety
Common fears Fear of death, Fear of pain and discomfort, fear of mutilation or alteration in body image, fear of anesthesia, fear of disruption of life functioning or patterns
This may be the patient's strongest method of coping. Nurse should assess for this and support the presence of HOPE
You should ask the patient about previous medical problems and surgeries, as well as current health problems. Past health history
Use of OTC and herbal supplements should be documented. Medications
You MUST ask the patient about the use of these! You can be blunt and frank Recreational drug use, abuse, and addiction.
drugs that inhibit platelet aggregation and may contribute to post operative bleeding complications. aspirin, plavix, and NSAIDs
May increase bleeding (herbs) Ginger, feverfew, garlic, ginko bilioba, ginseng, Vitamin E
Nurse must question the patient about drug intolerances. Allergies
The last component of the patient history is Review of systems
Review of systems (systems) Cardiovascular, Respiratory, neurologic, genitourinary, hepatic, integumentary, musculoskeletal, Endocrine, immune, fluid and electrolyte status, nutritional status.
The patient has right to know what to expect and how to participate effectively during the surgical experience. You need to balance what the amount of information from unprepared to overwhelmed. Preoperative teaching
ABGs and pulse oximetry Ventilatory and metabolic function; oxygenation status.
Blood glucose test Metabolic status, diabetes mellitus
Blood urea nitrogen, creatinine Renal function
Chest x-ray Pulmonary disorders, cardiac enlargement, heart failure
Complete blood count: RBCs, Hb, Hct, WBCs, and differential Anemia, Immune status, Infection
Electrocardiogram Cardiac disease, dysrhythmias, electrolyte abnormalities
Electrolytes test Metabolic Status, Renal function, and diuretic side effects
hCG test Pregnancy test
Liver function tests Liver status
PT, PTT, INR, platelet count Coagulation status
Pulmonary function studies Pulmonary status
Serum albumin Test Nutritional status
Type and crossmatch test Blood availability for replacement
Urinalysis Renal status, hydration, urinary tract infection
an active, shared decision-making process between the health care provider and the recipient of care. Consent for surgery
What are the three conditions that must be met for consent to be valid? 1.Adequate disclosure 2. Understanding and comprehension 3. Recipient MUST give consent voluntarily
Versed, Valium, and ativan Reduce anxiety, induce sedation, amnesic effects
Duramorph or fentanyl Pain relief during preoperative procedures
Reglan or Zofran Prevent nausea and vomiting
Atropine Reduces oral and respiratory secretions
Antibiotics Prevent postoperative infection
What are Core measures? Something is always performed
Special waiting area inside of or adjacent to the surgical suite. Visitors can come into this room. Holding area
Controlled geographically, environmentally, and bacteriologically, and it is restricted in terms of the inflow and outflow of staff. Operating room (OR)
Positive air pressure in the rooms prevents air from entering the OR from the halls and corridors. UV lighting may be used to kill bacteria. Dust collecting surfaces are omitted. Methods used to prevent the transmission of infection.
You will put the IV in and Assess the patient here. Holding area
Nurse that is in charge unsterile activities. Not gowned, gloved, and scrubbed. Records all nursing care. Documentation may be written or electronic. Circulating nurse
Reviews anatomy, physiology, and surgical procedure. Assits with preparation of room. Scrubs, gowns, and gloves self and other members of surgical team, Assists with draping procedure. Counts sponges, needles, instruments, and small medical devices. Scrubbed/Sterile activities.
Performs the surgical procedure. Responsible for patient safety and management in the OR, postoperative management of the patient, choice of surgical procedure. Surgeon
Discipline within the practice of medicine specializing in the following: Medical management of patients who are rendered unconscious and/or insensible of pain and emotional stress. Management of pain, cardiopulmonary resuscitation. Anesthesiology
Registered nurse who has graduated from an accredited nurse anesthesia program. Nurse anesthetist
You need to know this stuff to know what your norms are. Baseline data
This is done to eliminate dirt, skin oil, and transient microorganisms. Decrease the microbial count as much as possible; and inhibit rapid rebound growth of microorganisms. Scrubbing, Gowning, and Gloving
A general routine includes initial greeting, extension of human contact and warmth, and proper identification. Admitting the patient
Once the patient has been properly identified and the OR has been adequately prepared, the patient is moved into the room for the surgery. Transferring the Patient
1. all materials that enter sterile filed must be sterile. 2. If a sterile item comes in contact with an unsterile item, it is contaminated. 3. A wide margin of safety must be maintained between sterile and non sterile fields. Principles of basic aseptic technique in operating room
Identify the patient by asking the person to state name, birth date, and operative procedure and location. Compare the hospital ID number with the patient's own ID band and chart Safety alert - taking a surgical time out
Provide correct musculoskeletal alignment alignment; Prevent undue pressure on nerves, skin over bony prominences, earlobes, and eyes; provide for adequate thoracic excursion; prevent occlusion of arteries and veins; Positioning the patient
Provide modesty in exposure; and recognize and respect individual needs such as perviously assessed aches, pains, or deformities. Positioning the patient (cont)
Scrubbing or cleansing the surgical site with an antimicorbial agent identified as one that reduces microorganisms on intact skin, contains nonirritating antimicrobial agent, has broad-spectrum activity. Preparing the surgical site
What does ACP stand for? Anesthesia Care Provider
Loss of sensation with loss of consciousness; combination of hypnosis, analgesia, and amnesia; skeletal muscle relaxation; possible impaired ventilatory and cardiovascular function; elimination of coughing, gagging, vomiting. General anesthesia
Loss of sensation to a region of body without loss of consciousness; Involves blocking a specific nerve or group of nerves with admin of local anesthetic; includes spinal, caudal, and epidural anesthesia and IV and peripheral nerve blocks. Regional Anesthesia
Loss of sensation without loss of consciousness; induced topically or via infiltration, intracutaneously, or subcutaneously; Topical applications may be aerosolized or nebulized. Local Anesthesia
Similar to general anesthesia, sedatives (benzo) and opioids are used but at a lower dosage; does not involve inhalation agents; Relieves anxiety, provides analgesia and amnesia; patients remain responsive and breathe without assistance Monitored anesthesia care (MAC) also formerly called conscious sedation
This is the technique that is a good choice if the surgical procedures that are of significant duration, require skeletal muscle relaxation. General anesthesia
(general anesthesia) Rapid induction, duration of action less then 5 min. A disadvantage is that they have adverse cardiac effects, hypotension, respiratory depression. Barbituates - Theopental, brevital
(general anesthesia) Produces little change in cardiovascular dynamics; Ideal for short outpatient procedures because of rapid onset of action. Adverse - Myoclonia, nausea, and vomiting, may cause bradycardia, hypotension, and apnea. Nonbarbituarate hypnotics - Etomidate(amidate) and Propofol(diprivan)
(general anesthesia) All exhibit skeletal muscle relaxation; adverse - all exhibit respiratory depression, hypotension, mycocardial depression. Volatile liquids - Isoflurane (forane), Desflurane (suprane), Sevoflurane (ultane), Halotane (fluothane)
(general anesthesia) Potentiates volatile agents thus seeding induction and reducing total dosage and side effects. Adverse - must use in combination of oxygen to prevent hypoxemia. Gaseous agents - Nitrous Oxide
(general anesthesia) Can be administered IV or IM; potent analgesic and amnesic; Adverse - May cause hallucinations and nightmares, increased intracranial pressure, and intraocular pressure. Dissociative Anesthetic - Ketmine (Ketalar)
Fentanyl, Sufentanil, Morphine sulfate, Dilaudid, Afenta, Ultiva, Demerol. These are examples of what kind of adjunct to general anesthesia. Opioids
Versed, Valium, And Ativan. These are to reduce anxiety primarily, but also can cause amnesia and anesthesia. What drugs class are these in? BENZOdiazepines
Anectine, Norcuron, Pavulon, Aduran, Nuromax, and Zemuron. These are to promote skeletal muscle relaxation to enhance access to surgical sites; effects of non depolarizing agents are usually reversed. Neuromuscular Blocking Agents
Zofran, Anzemet, Kytril, Reglan, Compazine, Phenegran, Benadryl. These are to counteract effects of inhalation agents and opioids; and prevent nausea and vomiting. Antiemetics
Malignant Hyperthermia (MH) rare disorder characterized by hyperthermia with rigidity of skletal muscles that can result in death.
Most severe form of an allergic reaction, manifesting with life-threatning pulmonary and circulatory complications. Anaphylaxis
PACU stands for what? Postanesthesia Care unit
Initial admission of the patient to the PACU is a joint effort between these two professionals. ACP and the PACU nurse
Care during the immediate postanesthesia period; ECG and more intense monitoring; Goal - Prepare patient for transfer to phase II or inpatient unit. PHASE 1
Ambulatory surgery patients; Goal - Prepare patient for transfer to extended observation, home, or extended care facility. Phase 2
Includes General Patient Information, Patient history, Intraoperative Management, and intraoperative course. Postanesthesia admission report
(RPP) - accelerated progress is called? Rapid Postanesthesia care unit Progression
This involves admitting ambulatory surgery patients who have recieved general, regional, or local anesthesia directly to phase II care. Fast Tracking
Phase 1 Assessment should begin with an evaluation of the (ABC), what is this? Airway, Breathing, and Circulation
What is a noninvasive means of assessing the adequacy of oxygenation? Pulse Oximetry
Commonly caused by blockage of the airway by the patient's tongue. Retained thick secretions, Laryngospasm, laryngeal edema. Airway obstruction
Atelectasis, pulmonary edema, pulmonary embolism, aspiration, bronchospasm may cause this respiratory complication. Hypoxemia
Depression of central respiratory drive, Poor respiratory muscle tone mechanical restriction, and pain may cause this. Hypoventilation
Result of an increase in bronchial smooth muscle tone with resultant closure of small airways. Bronchospasm
Sequence in DNA that starts to fall off and die off. Telemeres
Position the unconscious patient in a __________ recovery position to keep the airway open and reduce the risk of aspiration. Lateral
The most common Cardiovascular problems include: Hypotension, Hypertension and dysrhythmias.
another condition that reflects the cardiovascular stats. May indicate decreased cardiac output, fluid deficits, or defects in cerebral perfusion. Syncope (fainting)
Waking up wild, restlessness, agitation, disorientation, thrashing, and shouting. Emergence Delirium
Slow waking up, or beyond the point that was expected to wake up. Delayed emergence
Patient can control this for pain relief. Predetermined doses. may be IV, oral, Epidural, or transdermal. Patient- controlled Analgesia (PCA)
A core temperature of less then 95 F or 35 C Hypothermia
Hospital-acquired infectious diarrhea cause by C. diff, is signaled by Fever, Diarrhea, and Abdominal pain.
headaches, mental status changes, pupillary changes, seizures, vomiting, change in cognitive function, gait disturbances, personality changes, visual changes Glioblastoma
early – mole becomes asymmetric, irregular borders, color changes, diameter increases S/S – late – nodular, pruritis, bleeding, ulcerated lesions Melanoma
S/S – abdominal mass, adenopathy, fatigue, malaise, night sweats, splenomegaly, unexplained fever, weight loss Metastasizes to bone, liver, lung Non-Hodgkin’s Lymphoma
S/S – no early symptoms, late symptoms – persistent cough, dyspnea, change in breathing pattern, anorexia, weight loss, weakness, hemoptysis, dysphagia, clubbing of nails, chest pain, hoarseness, wheezing, stridor Lung Cancer
S/S – early – vague, uneasy feeling of heaviness, fullness, abdominal distention after meals S/S – late – weight loss, loss of appetite, nausea/vomiting, weakness, fatigue, anemia Stomach Cancer
S/S abdominal pain and swelling, anorexia, ascites, esophageal varices , fever, hematemesis, hepatomegaly, jaundice, splenomegaly Metastasizes to adrenal glands, bile ducts, bond, lung, peritoneal, regional lymph nodes Hepatocellular Cancer
S/S – early – none Late – pain, weight loss, altered bowel habits, diarrhea, greasy stools, severe constipation, jaundice, sudden onset of Diabetes Metastasizes to large vessels, bile duct, duodenem, lymph nodes, spleen, stomach, transverse colon Pancreatic Cancer
Risk factors - > 40 years old, colon polyps, high fat, low fiber diet, family history S/S – no early signs – late signs – change in bowel habits, abdominal pain, weight loss, black tarry feces Colon Cancer
S/S – abdominal pain, change in bowel habits, jaundice, malaise, obstruction, occult blood, pelvic pain, rectal bleeding, tenesmus Metastasizes to liver, lung, lymph nodes Rectal Cancer
Created by: nswift55