Med-Surg Final Exam Study Guide (El-resumen)

1- Colon Cancer XXXXXXXXXXXXXXX  Colonoscopy is the gold standard test, if there are lesions, a biopsy is taken  Many times, the client is asymptomatic but occult blood is discovered in the stool during a rectal exam. Risk factors for colorectal cancer  Ageolderthan50years  Previous colorectal polyps, history of colorectal cancer, History of ovarian or breast, and stomach cancers  Smoking and Dietary Habits (not eating veggies). Assessment  Blood in stool (most common) detected by fecal occult blood testing, sigmoidoscopy, and colonoscopy  Anorexia,vomiting,andweightloss,secondaryAnemia  Abnormal stools  Ascendingcolontumor:Diarrhea  Descendingcolontumor:Constipationorsomediarrhea,orflat,ribbon-likestoolcausedbyapartial obstruction  Rectaltumor:Alternatingconstipationanddiarrhea Stages:  Stage I – Tumor invades up to muscle layer  Stage II – Tumor invades up to other organs or perforates peritoneum  Stage III – Any level of tumor invasion, up to 4 regional lymph nodes  Stage IV – Any level of tumor invasion; many lymph nodes affected with distant metastasis General interventions 1. Monitor for signs of complications (bowel perforation with peritonitis, abscess or fistula formation (fever associated with pain), hemorrhage (signs of shock), and complete intestinal obstruction. 2. Monitor for signs of bowel perforation, which include low blood pressure, rapid and weak pulse, distended abdomen, and elevated temperature. 3. Monitor for signs of intestinal obstruction, which include vomiting (maybe fecal contents), pain, constipation, and abdominal distention; provide comfort measures. . 2- Breast Cancer XXXXXXXXXXXXXXXXXXXXX  Metastasis occurs through the lymph nodes and the common sites (bones and lungs) (brain and liver).  Confirmatory Diagnosis: BREAST BIOPSY by needle aspiration or by surgical removal of the tumor with microscopic examination to detect malignant cells.  Screening: Begins at age 50 and every 10 years if colonoscopy is negative  If colonoscopy has benign polyps – the next colonoscopy is 3 – 5 years  History of colorectal disease: every 5 years  Sigmoidoscopy: every 5 years Risk factors  Age (+ 65 year increases with ages)  Obesity:Lifestyle:highfatdietandLowfiberdiet(possiblerisk)  Family history genetic predisposition and Previous cancer of the breast, uterus, or ovaries  Early menarche and late menopause or Nulliparity (+30 years)  High-dose radiation exposure to chest  Assessment:  Presenceofa orincreaseinhardeningofthebreast  Swelling, orpainintheskin  Appearanceofthe  Malignant tumor: unilateral mass (lump) in one breast, irregular shape, firm and hard, embedded in the surrounding tissue  Benign tumor: single or multiple lumps in one or both breasts. Round, smooth or firm, mobile.    .  MRI: especially when the mammogram is inconclusive. Determine the actual size of the cancer  BreastBiopsy: Breast self-examination and client instructions. 1. Take advantage of the bathroom schedule and with the opposite hand carry out the self-examination with the fingertips in a circular spiral or from top to bottom. The same is done on the opposite breast. Also examined in the armpit area 2. The objective is to 3. Stand with your arms at your sides, raise your arms and check for changes in the shape of your breasts, dimpling of the skin, or changes in the nipple. 4. Then place your hands on your hips and press firmly, squeezing the pectoral muscles to see if there are any asymmetries or changes. 5. Lie down and repeat step 1, 6. Mark on your calendar that you have completed your self-test 7. Write down any changes or unique features you want to discuss with your healthcare provider. BRCA1 and BRCA2: Genetic blood test that can indicate if you have an increased risk of cancer). It can be done in both women and men  Recommended for women who have  A consent form is required. It cannot be done within 3 months of a blood transfusion. HER2 gene cell:  A pathology report from a biopsy may determine if cancer cells contain the HER2 gene.  If the result is positive  Patients with HER2 may be successfully treated with a targeted therapy for this type of cancer 2 bump or ball indentations (such as orange peel), redness, nipple (retraction) Diagnosis: Triple Approach BSE (Breast Self-Examination), Perform regularly 7 to 10 days after menstruation. Clinical breast exam (CBE): - 1 to 3 years for women 20 and 30 - Annually for women age 40 and older. Mammography: beginning at age 40 and older It is the only definitive way to diagnose breast cancer. verify in time the presence of lumps, hard nodules or thickening of the tissue. Look at your breasts in a mirror. 2 first-degree relatives who were diagnosed with breast cancer before age 50 or women who have a family history of breast and ovarian cancer. , this gene may be responsible for the rapidly cancerous growing cells. Trastuzumab (Herceptin), Nursing Care Postoperative  Prevent postoperative complications such as lymphedema and bleeding. ,   Emphasize the importance of a well-fitting breast prosthesis for a client who has had a mastectomy.  Provide emotional support to the client and her family 3- Prostate Cancer: XXXXXXXXXXXXXXXXXXXX  Prostate cancer is 2nd most common type of cancer in men.  The incidence of prostate cancer increases with age.  Symptoms are often similar to those of Benign Prostatic Hyperplasia Risk Factor: 1. Age: done 2. Race: 3. should begin 3 Avoid administering injections taking blood pressure, or drawing blood from the client’s affected arm. Place a sign above the client’s bed regarding these precautions. Bed elevated 30 when awake and support her arm on 1 or 2 pillows. Instruct the client to have a PSA and DRE annually after age 50. 4. 5. 6. Signs &      lifestyle: eat a diet low in animal fat and high in omega-3 fatty acids (fish), fruits, and vegetables. Vasectomy or exposure to toxins, such as arsenic. BRCA2 mutation may be associated with an increase risk too. Symptoms 1st symptoms are related to bladder outlet obstruction: African American men should begin screening at age 45 History Family: screening at age 45      Urinary hesitancy and weak stream Frequentbladderinfections Urinary retention Hematuria/Nocturia Painful ejaculation or intercourse (acto sexual). (pelvis, spine, hips, ribs) in advanced cancer. is the most common clinical manifestation of late cancer. Bone Pain Gross blood in the urine On DRE prostate is stony hard with palpable irregularities or indurations. ElevatedBUNandcreatinine(indicatekidneydamage) Diagnostic:  Laboratory Tests:  Prostate-specific antigen (PSA): elevated with prostate cancer (greater than 4 ng/mL).  Early Prostate Cancer Antigen (EPCA-2): - Serum marker for prostate cancer - Can detect prostate changes early - Can eliminate the need for a prostate tissue biopsy Procedures  DRE = reveals a hard prostate with palpable irregularities  TR-US=indicatesthelocationofthelesionorlesions  Needle or aspiration biopsy of the lesion – definitively diagnose or rule out prostate cancer  Magnetic resonance (MRI), computed tomography (CT) scans, and bone scans = assess for metastases. Treatment:  ActiveSurveillance(AS)  Observationwithouttreatment  RegularmonitoringwithDREandPSAtesting  Time from diagnosis to start of treatment is up to 10 years  Transurethral resection of the prostate (TURP) is done if obstruction occurs = palliative treatment  Bilateral Orchiectomy (removal of both testicles) is another palliative surgery that slows the spread of cancer by removing the main source of testosterone  Hormonaltherapy,Chemotherapy,RadiationTherapy  RadicalProstatectomy  Laparoscopicapproach:Incaseoflocalizedprostatecancer Complications of Radical Prostatectomy  ErectileDysfunction:  RefractoryPostoperativeUrinaryIncontinence Nursing Care Preoperatively  Ensure that the client fully understands the procedure and what to expect postoperatively. Nursing Care Postoperatively  Clients will require care typical for any type of abdominal surgery. Monitor the client for postoperative complications and ileus and manage his pain with analgesics and ice packs.   Provide catheter care and administer bladder antispasmodics as prescribed.  If the client has a suprapubic prostatectomy, a suprapubic catheter, in addition to the urethral catheter, will be placed. It will be removed when residual urine is less than 75 mL. 4. Cervical cancer XXXXXXXXXXXXXXXX  Cervical cancer is a slow-growing cancer.  Withproperscreening,itmaybedetectedearlyandtreatedwithgoodresults.  The incidence of cervical cancer is increasing and affecting a younger population than in the past.  Papanicolaou (Pap) tests are an effective screening tool for detecting the earliest changes associated with cervical cancer.  The frequency of this test is related to several factors, including age, results, and the presence of the cervix post hysterectomy. Risk Factors:  Infectionwithhumanpapillomavirus(HPV)  The HPV vaccine provides some protection against the high-risk HPV types responsible for most cervical cancers.  Gardasil is indicated for ages 9 through 26.  It is also given for boys and men (9 through 26 years of age) to prevent genital warts (verrugas) because it protects against the 6 and 11 HPV strains.  Early sexual activity (before 18 years of age)  Male partner has had multiple sexual partners  Loweconomicstatus  Familyhistoryofcervicalcancer 4 Monitor client’s incisions for signs and symptoms of infection.  AfricanAmerican  Chroniccervicalinflammation/infections  Historyofsexuallytransmitteddiseases  Infection with HIV or other immunosuppressive disorder Signs and Symptoms  Asymptomatic first = It takes years for the cervical cells to transform from normal to premalignant to invasive cancer.  Painless vaginal bleeding between periods = classic symptom of invasive cancer  Watery, blood-tinged vaginal discharge  Unexplained weight loss  Pelvic pain and pain during and after intercourse Diagnostic Studies  – microscopic examination of cervical cells 5 Pap smear ) is performed for cytologic studies when a cervical lesion is identified. Biopsy is usually performed during colposcopy as a follow up to an abnormal Pap smear Treatment  Removal of the lesion by conization (removal of a cone-shaped piece of the cervix), cryotherapy, laser ablation, hysterectomy or a loop electrosurgical excision procedure.  Radiation  Simple hysterectomy (one that removes the uterus and cervix)  Radical hysterectomy (one that removes the uterus, upper third of the vagina, and pelvic nodes).  Exenteration: (more extensive pelvic surgery).