Final Exam Study Guide NUR 2790: Professional Nursing III

Final Exam Study Guide NUR 2790: Professional Nursing III MODULE 1: CELLULAR REGULATION Cancer  Primary vs. Secondary prevention Primary CA prevention: removal of “at risk” tissue, chemoprevention, vaccination (HPV) Secondary CA prevention: regular screening  Risk factors/warning signs (CAUTION mneumonic) C: change in bowel/bladder function A: a sore throat that does not heal U: unusual bleeding T: thickening lumps I: indigestion/difficulty swallowing O: obvious change in mole N: nagging cough/hoarseness  Treatment types, side effects/complications (& treatment/nursing care of side effects/complications) Surgery: can be prophylactic, diagnostic, curative, palliative SE/complications: removed organs and tissues lose function, removal of organs does not necessarily rid cancer Radiation: destroy cancer cells with minimal damaging effects of surrounding normal cells SE/complications: radiation dermatitis, altered taste/fatigue, atherosclerosis, coronary artery disease, fibrosis, scarring, bone marrow suppression Nursing care: provide accurate info, skin care (wash gently with soap and water, avoid scrubbing), do not remove temporary ink markings, provide nutritional support, care of xerostomia (administer saliva substitutes, lozenges, mouth rinses), reduce risk for bone fracture, encourage exercise and sleep interventions to treat fatigue Chemotherapy: treatment of cancer using antineoplastic drugs (cytotoxic systemic therapy) SE/complications: dosage and scheduling (dose-limiting side effects may impact), extravasation and vesicants, bone marrow suppression (neutropenia, anemia, thrombocytopenia), mucositis (inflammation of oral mucosa) alopecia (hair loss), chemo brain, chemo-induced peripheral neuropathy, fatigue Nursing care: epo-alfa/Epogen, blood products, no flossing, soft toothbrush, no razors, no NSAIDS, treat nausea (peppermint oil, Zofran, fluids, room temperature food, alcohol swabs) Immunotherapy: enhances and alters pt’s biological response to cancer cells via direct antitumor activity SE/complications: fluid shifts/inflammation, decreased LOC and other neuro changes, fever, chills, malaise Photodynamic therapy: selective destruction of cancer cells via chemical reaction triggered by last light which destroys or shrinks tumors Hormonal manipulation: changing usual hormone responses to slow tumor growth to certain cancer types SE/complications: masculinizing affects in women, feminizing effects in women (gynecomastia), fluid retention, acne, hypercalcemia, liver dysfunction, VTE Bone marrow transplants: transplant of bone marrow from a matched individual (self or other) SE/complications: nausea, vomiting, graft vs. host disease, infection, organ damage Complementary & Alternative Medicine (CAM)  Types of CAM (mind-body therapy, tai chi, chiropractic care, herbal meds, etc.), goals of use, and interactions Mind-body therapies: biofeedback, guided imagery, intercessory prayer, meditation, relaxation exercise Biologically-based therapies: herbal therapies (chamomile, garlic, gingko, ginseng, peppermint, ’s wart, vaerin) Manipulative and body-based therapies: acupuncture, acupressure, chiropractic, massage, rolfing, shiatsu, tai chi, yoga Energy therapies: reiki, therapeutic touch Alternative medical systems: homeopathy (tx of disease with minute drug doses to activate and illness that then stimulates the body’s normal defense system to eliminate disease; remedies without chemically active ingredients), naturopathy (the practice of assisting in the health of patients through the application of natural remedies), osteopathy (embracing the full spectrum of medicine, including the use of medications and surgery, in addition to manipulative techniques) MODULE 2: END-OF-LIFE CARE Chapter 10: Principles of Emergency and Disaster Preparedness  Palliative vs. Hospice care (goals of each, differientation) Palliative care: can be any stage of serious or chronic illness, care may be provided concurrently with curative therapies, care not limited by time periods, care provided by PCP with potential follow-up vistis Hospice care: prognosis of less than 6 months to live, initiated when curative tx stops, 60-90 day periods of care, care provided by RNs, social workers, chaplains, and volunteers  Ethical/legal considerations r/t dying (AD’s, living will, euthanasia, etc.)  Durable power of attorney for health care (DPOAHC): makes decisions about pt’s healthcare when MD determines pt does not have capacity to make decisions (pt does not receive info, pt does not evaluate, deliberate and mentally manipulate info, pt does not communicate a tx preference) Living will: discusses CPR or code status (must be initiated unless and DNR order exists, may be violent and painful), intubation/artificial ventilation, artificial nutrition/hydration “Five wishes”: identification of decision maker (DPOAHC), identification of treatments the pt does/does not want, comfort level expectations, how they want to be treated, what the pt wants loved ones to know Active euthanasia: use of medications or tx that purposefully causes pt’s death (physician assisted suicide) Passive euthanasia: discontinuation of one or more therapies that may prolong life Voluntary stopping of eating and drinking (VSED): refusal to eat or drink in order to hasten death by competent pt with terminal illness  S/Sx of end-of-life Lack of heartbeat, absence of spontaneous respirations, irreversible brain dysfunction Weakness, anorexia, changes in cardio function (cool, mottled cyanotic extremities, decreased BP, heart rate will increase-irregular-brady-asystole), dyspnea (cheynestokes), changes in GU (incontinence, decreased UO), changes in LOC (sleeping, restless, anxiety, lethargy) MODULE 3: TISSUE INTEGRITY Chapter 10: Principles of Emergency and Disaster Preparedness  Traditional triage vs. Mass Casualty triage Traditional triage: most critical pt’s are seen first(emergent/immediate threat to lfie, urgent/major injuries, nonurgent minor injuries) Mass casualty triage: emergent (red tag) pt’s seen first, urgent (yellow tag), nonurgent (green tag), expectant or allowed to die (black tag)  Internal vs. External events Internal events: power outage, active shooter, explosion External: tornado, volcano, hurricane, wild fires, epidemics Chapter 26: Care of the Patient with Burns  Classifications of burn injury (superficial, partial-thickness, etc.) Superficial-thickness burns (1st degree): least damage; epidermis is only part of skin injured (sun burn, flash exposures) Partial-thickness burns (2nd degree): Superficial partial-thickness: injury to upper third of dermis, pink moist blanchable, blister formation, heals within 10-21 days without scarring Deep partial-thickness: extend deep into the dermis, red dry with slow blanching, no blisters, edema, heal within 2-6 weeks with scarring Full-thickness burns (3rd degree): destruction of entire epidermis and dermis, skin does not regrow, characterized by; eschar, edema, waxy-white, deep-red, yellow, brown, or black appearance, may have no blood supply, reduced/absent sensation, healing takes weeks to months  Rule of 9’s  Phases of burn injury (time periods, priority assessments, etc.) Resuscitative/emergent phase: 24 to 48 hours Goals: secure airway, support circulation (fluids), pain relief, prevent infection, maintain body temp, provide emotional support Assessment: direct airway injury (hoarseness, brassy cough, drool, tachypnea, wheezes, stridor), smoke poisoning, pulmonary edema (SOB, crackles), CO poisoning (cherry-red coloring, headache, nausea, drowsiness, irritiable), thermal airway injury (ulcerations, redness, edema), hypovolemia, decreased CO, decreased BP with increased HR, EKG changes with direct heart damage, fluid shifts, decreased UO, concentrated urine Diagnostics: increased Hgb, Hct, increased BUN, glucose, potassium, decreased sodium, protein and albumin Interventions: maintain airway, fluid resuscitation, manage pain, preventresp distress Acute phase: 36-48 hours Debridement, dressings (biologic, biosynthetic, synthetic), surgical wound management (grafting), minimizing weight loss, support self-esteem Rehabilitative phase: years to lifetime Wound closure, emphasis on; prevention of scars, psychosocial adjustment, resuming pre-burn activity  Immediate burn care (Education for patients) Remove cause of burn, check of breathing, administer CPR if needed, lukewarm water to cool skin around burn unless wound is open, remove any loose debris, remove jewelry, cover burned area with clean dry cotton, raise burned area above level of heart  Parkland formula 2-4mL/kg/%BSA burned (over 1st 24 hours), half of total volume over 1st 8 hours, half over next 16 hours MODULE 4: GAS EXCHANGE Chapter 8: Principles of Emergency and Trauma Nursing