Nursing 3/4690 Final exam with Answers

Nursing 3 Final exam with Answers Cancer: screenings Secondary Prevention: Early recognition. Occult blood (yearly after 50), mammogram (yearly after 40), colonoscopy (every 10 years after 50), prostate exam (every year after 50), pap smear (every 3 years) Primary Prevention for Cancer Reduces the risk. Smoking cessation, protection from the sun (use at least SPF 15), limit drinks to less than 2 drinks for men and less than 1 per day for women, healthy diet specifically antioxidants, less calories, and fats including red meats, exercise regularly, limit smoked or preserved meats (hotdogs/deli meats), HPV vaccine, counseling regarding occupational carcinogens Tertiary Prevention Preventing reoccurrence, activities centered on diet, exercise, healthy lifestyle, treatment, chemo, tomoxafin Management of symptoms with cancer Management of s/e w/chemo-For N/V: good nutrition, eating food at room temperature, adequate fluids, nutmeg, ginger and peppermint help decrease movement of the GI tract or improve appetite, anti-emetics (Zofran) around the clock. Fatigue: transfusion, epoetin alfa, pharm and nonpharm to enhance sleep, meds to enhance appetite (dronabinol) Nursing Interventions for anemia Nursing interventions include measures to minimize and manage fatigue. The nurse should assess severity of fatigue on a scale of 0 to 10; assessing frequency of fatigue and activities associated with increased fatigue and ability to perform activities of daily living. The nurse needs to also assist the patient with activities of daily living as necessary and encourage independence without causing exhaustion. Patient education concerning safety is important if the patient has dizziness or orthostatic. Patient education points of emphasis are: (a) the process of anemia and cause; (b) importance and ways of managing anemia; (c) self-assessment and reporting of signs and symptoms; and (d) self-care strategies, including dietary modification, measures to conserve energy and manage fatigue, self-administration of medications including erythropoietic (relating to the formation of RBCs) agents, and safety measures. Nursing Interventions of neutropenia The goals of nursing care focus on: (a) prevention and treatment of infection and (b) knowledge deficit. Infection control measures include strict aseptic technique during invasive measures, meticulous care of all IV devices, and avoidance of indwelling devices, such as urinary catheters, if possible. Increased monitoring of vital signs, including temperature, is part of ongoing assessment. At the first sign of infection laboratory tests, such as blood cultures, urine cultures, and chest X-ray, should be considered. Biological response modifiers (BRMs), Neupogen, and Leukine can be used to manage neutropenia. Make sure the pt is in a private room. Staff, patient, and visitor education includes discouraging flowers and get well cards, as they collect dust and grow mold. No fresh fruits or veggies when transporting the patient the transporter should avoid crowded or confined areas, such as waiting rooms and occupied elevators. Patient education begins with teaching patients and families basic hygiene measures, such as hand washing and avoiding contact with people exposed to infectious diseases. Daily showers with mild soap and protection of skin integrity and oral hygiene are stressed, with care not to damage oral mucous membranes. Nutritional measures are important to support the immune system Thrombocytopenia nursing interventions The patient should be taught to watch for signs of bleeding and to observe measures to reduce potential injury. The patient should be taught to use a soft-bristled toothbrush, not to floss, not to shave with a razor, to avoid falls, to avoid straining during bowel movements, and to report any signs of bleeding or hemorrhage. Nurses should be cautious in provision of care and be cognizant of bleeding precautions. All medications should be assessed to determine if they contain antiaggregation properties as present with drugs containing aspirin, NSAIDs, or anticoagulants. Treatment for severe thrombocytopenia may include platelet transfusion or the administration of oprelvekin, a thrombopoietic growth factor. Nursing Interventions for neuropathy Safety measures relate to risk from altered or diminished sensation. For example, if fingers become numb, the patient needs to exercise care when handling objects that are sharp, hot, or otherwise dangerous. Other safety measures include using a thermometer to test bath temperature, using skid-free shower and bathroom mats, clearing walkways of clutter, and wiping spills on the floor immediately. Protective footwear should be considered to avoid pressure points. The nurse should instruct patients that if their sense of balance is affected, they should move carefully and use handrails. Assessment of activities of daily living should include driving skills, particularly the ability to feel gas and brake pedals and changes in reaction time. For severe pain caused by peripheral neuropathy, analgesics are most effective when a fixed dose is taken on a fixed time schedule. Nonmedical therapeutic approaches include relaxation training that can reduce anxiety and stress, reduce pain, and promote sleep. Regular daily exercise, such as walking and stretching exercises to keep muscles flexible, should be done as tolerated Nursing Interventions for Cognitive disorders Interventions should be those that empower the patient and family to feel some control. Physical exercise as tolerated improves circulation, stimulates endorphins, and provides diversion. Establishing a routine also helps with memory loss. The nurse can have the patient write down when memory problems occur. By reviewing the log, patterns may emerge, which can guide intervention. For example, if forgetfulness is worst in late afternoon, perhaps it is related to fatigue, and scheduled rests may help. Cognitive changes can be embarrassing for patients. Encourage them to talk openly about the problem with staff, family, and friends who can help fill in gaps and who will reinforce that the situation is temporary. All teaching activity by the nurse should be planned when the patient is rested. Less content should be presented at one time, it should be reinforced at later times, and the nurse should validate retention before the patient is expected to manage tasks independently. PATIENT PLAYBOOK: NAUSEA AND ANOREXIA IN PATIENTS UNDERGOING CHEMOTHERAPY The nurse can implement the following strategies with the patient who is experiencing nausea and anorexia when undergoing their chemotherapy treatments: Administer antiemetics 24 hours prophylactically before receiving chemotherapy and continue the antiemetics for 24 hours after the chemotherapy treatment. Encourage the patient to take daily weights and record them to keep track of weight changes during the chemotherapy regimen. Teach the patient and family how to assess the patient's hydration status. Educate the patient as to the importance of consuming fluids with electrolytes and glucose during times of emesis. Teach the patient which types of foods are not easily absorbed (e.g., milk-based products) and consequently should be avoided during instances of nausea and anorexia. Encourage patient to eat small, frequent meals with good nutrients in the foods. Encourage the patient to participate in relaxation exercises and mentally prepare themselves to not have anticipatory nausea from the expectation of upcoming chemotherapy administration. Nursing Interventions for chemo-induced nausea Nutrition is very important. Make sure the patient is eating small frequent meals. Giving antimetics as prescribed. Drinking adequate fluids. Nutmeg, ginger and peppermint added to food may help decrease the movement of the GI tract or improve appetite. Mucositis Nursing Interventions Topical agents such as sucralfate, Benadryl, lidocaine prostaglandin E2 and systemic agents including beta- carotene, propanthline as prescribed can help. Cryotherapy can be used by using ice chips in the mouth. Assess and monitor the patient for signs of malnutrition. It is important to instruct the patient to drink increased amounts of fluid and soft foods less likely to damage fragile tissue. The patient should avoid acidic or irritating foods. Cool or room temperature foods are less irritating. Parenteral or enteral nutritional support may be required. Nursing Interventions for Alopecia Assure the patient that the hair will eventually grow back a few months after the treatment. If it is due to being on chemotherapy. Encourage the patient to verbalize his/her fears and body-image concerns regarding alopecia. Encourage the patient to eat healthy as protein promotes hair growth Pt playbook- early detections Men who have reached 50 years of age need to be offered annual digital rectal examinations and PSA blood testing. In addition, specific guidelines for early screening tests for prostate cancer include: Age 50 for men who have at least a 10 year life expectancy Age 45 for African American males Age 45 for men who have a first-degree relative (e.g., father, brother) Age 40 for men with severe first-degree relatives diagnosed with prostate cancer at early ages BOX 15-1: Warning Signs of Cancer The professional nurse should educate individuals about the warning signs of cancer. The seven warning signs can easily be remembered through the acronym, caution. C: Change in bladder or bowel habits, such as absence of urination or bowel movement or a change may be excessive urination or stool. A: A sore that does not heal within a realistic period of time. U: Unusual bleeding or discharge from any body orifice, such as the vagina, the nipple, or the penis. The unusual discharge can be bloody, purulent, clear, or viscous. The keywords are unusual and any body orifice. T: Thickening or the presence of a lump of the breast, testicle, or any part of the body. I: Indigestion or difficulty swallowing for a prolonged period of time. O: Obvious change in a wart or mole, such as color, size, texture. N: Nagging cough or hoarseness that is prolonged. If any of these warning signs are observed, the patient should see a health care provider. Complications of cancer Spinal cord compression- is due to pressure, displacement, or compression of the spinal cord by a tumor. Pleural effusion & Cardiac Tamponade-an abnormal accumulation of fluid in the pericardial space, can be caused by excess fluid produced by a tumor or postradiation pericarditis. The pressure of the excess fluid can result in cardiac tamponade, a mechanical compression of the heart. A rapid accumulation of fluid and sudden rise in pressure impairs diastolic filling of the heart and can create an emergency situation. A slower accumulation of fluid or blood, as in effusion related to cancer, may not produce immediate signs of trouble because the fibrous wall of the pericardial sac can gradually stretch to accommodate a liter or more of fluid. The nurse should closely observe the patient for signs of dyspnea, restlessness, chest pain, electrocardiogram (ECG), pulse, and blood pressure changes. Anaphylaxis- a life-threatening condition, can be due to decreased systemic vascular resistance and fluid leaking from blood vessels, resulting in intravenous volume depletion. Some systemic therapy, such as interleukin 1, can cause severe hypotension, especially with high-dose therapy. Close monitoring of changes in respiratory status, blood pressure, and peripheral vascular status during therapy is essential Disseminated intravascular coagulation (DIC)- is widespread clotting within the arterioles or capillaries that occurs spontaneously with hemorrhage. Cancer is considered to be a triggering event that may be related to tumor necrosis factor (TNP), a cytokine with a wide-range of biological activity. Symptoms include petechia, ecchymosis or purpura of the skin and mucous membranes, tachycardia, shortness of breath, hematuria, oliguria, or renal failure. The nurse should observe for signs and symptoms of deep vein thrombosis, conduct frequent assessment of mental status and do neurological checks, and monitor urinary output. Increased intracranial pressure (ICP)-is a life-threatening situation. It can occur when a cerebral tumor reaches a mass that displaces cerebral tissue in the direction of least resistance. Sustained increases in ICP can result in compression of the brainstem, resulting in herniation of the tissue through the foramen magnum. Herniation and damage to circulation and brain function is dependent on the location of the tumor, the rate of growth, and the direction of the tissue displacement. The nurse should monitor the patient's mental status, observe for signs of respiratory distress, use measures to maintain oxygenation, and report abnormal findings immediately. The nurse should also reassure the patient and family and minimize external stimulation. Septic shock-is a common problem for people with cancer because of the depressed immune system resulting from therapy or from cancers, such as leukemia. Health care providers must give particular attention to aseptic technique when working with central venous lines and other invasive procedures External Radiation S/E - Side effects usually begin 2-8 weeks after treatment starts. Acute enteritis : N/V, abd cramping, frequent urge to have a bowel movement and watery diarrhea Mainly effects GI tract and bone marrow Can be chronic BOX 15-2: COMMON SIDE EFFECTS OF CHEMOTHERAPY Hair loss (alopecia) Dry mouth (xerostomia) Mouth sores (stomatitis) Difficulty swallowing due to esophagitis Nausea Vomiting Diarrhea Fatigue Bleeding Susceptibility to infection Complications of chemo Tinnitus, hearing loss, secondary malignancies, infertility, early menopause, decreased sexuality, and depression Cam: nurses role with this therapy Nurses must act as advocates for their clients, providing them with information needed to make informed decisions about their health and health care. Such information includes complementary and alternative therapies (State of California, 2010). Nurses can use many CAM therapies without advanced preparation. Imagery, relaxation techniques, meditation, massage, touch, prayer, humor, music, and pet therapy are CAM therapies available to all nurses. Nurses who are interested in performing reiki, therapeutic touch, hypnosis, biofeedback, and other such therapies need additional education and training. Nurses need to check with their individual states to determine which require additional licensure or certification. Nurses interested in pursuing use of CAM therapies should begin by contacting the American Holistic Nurses Association at . End of life/hospice: therapeutic communication/general principal of care hospice care- is a coordinated program of services that exists within the larger umbrella of palliative care service, delivering palliative care rather than curative treatment. Hospice programs provide hospice care with sensitivity to the diverse backgrounds and needs of the people they serve and with the hope and belief that through appropriate management, patients and families can attain a degree of mental and spiritual preparation for death. The patient has 6months or less to live Physiology of burns; vascular changes -Vascular changes; fluid shift, profound imbalance of fluid, electrolyte, acid base [K+ Most important!]. Fluid remobilization after 24 hours, diuretic stage 48-72h [ response to shock; kidney damage, break down muscle & protein] Physiology of burns; cardiac changes, pulmonary changes -Heart rate increases [for a while; until burn area is healed -Cardiac output is decreased -Respiratory failure: "ARDS" Acute Resp. Distress Syndrome [occur after huge burn] -Inhalation therapy -sloughing -At Risk!! for pulmonary insufficiency and infection Physiology of burns; Gastrointestinal changes -Decreased blood flow [Stress Response] -Mucosa is impaired -Peristalsis is affected [slows down] -Curling's ulcer [acute peptic ulcer] Physiology of burns; metabolic changes -Increses metabolism -Caloric needs double or triple depending on extent of injury -Increased core body temperature calories/day needed D5W w/or without potassium this is for nutrition Physiology of burns; immunological changes after LARGE burn. -Protective barrier destroyed -Inflammatory response activated -Suppressed immune system -Risk for infection; possible invading microorganisms -Elevated WBC