NUR 2392Multidimensional Care II Exam 1 Study Guide LATEST UPDATE 2021/2022 BEST EXAM SOLU, Exams of Nursing

Download NUR 2392Multidimensional Care II Exam 1 Study Guide LATEST UPDATE 2021/2022 BEST EXAM SOLU and more Exams Nursing in PDF only on Docsity! Multidimensional Care II Exam 1 Study Guide *The exam questions are not limited to only what is listed on this guide, please refer to your chapter readings and module materials Ch. 21: Principles of Cancer Development @ Benign vs. Malignant cells o. Benign: = = Specific Morphology- they resemble the tissue they originated from (they look like the host). Small Nuclear to Cytoplasmic Ratio- they have a similar structure inside the cell to normal cells and small nucleus. Specific Function- they contribute to the body in some way. Tight Adherence- they bind close together. No Migration- they do not move around the body or invade other tissue sites. Orderly Growth-they grow at a normal rate. m Euploidy- they have a normal amount of chromosomes per cell. © Malignant (Cancer): @ = Anaplasia- loss of appearance of the parent cell. m Large Nuclear to Cytoplasmic Ratio- they have a large nucleus and occupy space. m@ Specific Functions are Lost- they serve no purpose to the body. m Loose Adherence- loose binding of the cells, causing potential spread into the blood and body. Migration/Metastasis- spreads and moves easily. Loss of cellular regulation and contact- the cells will crowd, push, and grow on top of other cells. m Rapid Cell Division- the cells will be produced and grow at a faster rate NUR 2392Multidimensional Care Il Exam 1 Study Guide LATEST UPDATE 2021/2022 BEST EXAM SOLUTIONS GRADED A+ m= Aneuploidy- abnormal number of chromosomes per cell. @ Seven warning signs of cancer o “CAUTION” mC: changes in bowel or bladder habits A: asore that does not heal or mouth sources (mucositis) U: unusual bleeding or discharge T: thickening of a lump in a tissue |: indigestion and dysphagia O: obvious change in a wart or mole m N: nagging cough @ Cancer development stages of malignancy © Initiation: the normal cell becomes damaged which is irreversible and can lead to cancer developing © Promotion: repeat exposures to a damaging stimuli enhances growth- mutations can cause this © Progression: because of repeat exposures, there is an increase in production of malignant cells © Metastasis: movement of the cancer cells @ = Malignant transformation: some cells will divide enough to form a tumor area on top of tissue. = Tumor vascularization: cancer cells secrete tumor angiogenesis factor stimulating the blood vessels to bud and for channels to grow. m Blood Vessel Penetration: cancer cells break off from the main tumor and enzymes on the surface of the tumor cells make holes in the blood vessels, allowing the cancer cells to enter blood vessels and travel around the body. @ = Arrest and Invasion: cancer cells clump up in the blood vessel walls and invade new tissue aera to support continued growth of cancer cells and new tumors. @ Cancer classification: monitor tumor growth, aggression, progression, and to determine appropriate treatment. © Tumor grading: based on cellular aspects of cancer. m Based on the aggressiveness of the cancer cell and differentiation from the normal tissue. @ GO: the grade cannot be determined @ G1: Tumor cells are well differentiated and closely resemble the normal cells from which they arose.This grade is considered a low grade of malignant change.These tumors are malignant but are NUR 2392Multidimensional Care Il Exam 1 Study Guide LATEST UPDATE 2021/2022 BEST EXAM SOLUTIONS GRADED A+ cancer include: biologic behavior, anatomic site, and degree of differentiation m= Adeno = epithelial Chondro = cartilage Fibro = fibrous connective Glio = glial cells (brain) Hemangio = blood vessel Hepato = liver NUR 2392Multidimensional Care Il Exam 1 Study Guide LATEST UPDATE 2021/2022 BEST EXAM SOLUTIONS GRADED A+ Leiomyo = smooth muscle Lipo = fat/adipose Lympho = lymphoid tissue Melano = pigment producing cells Meningioma = meninges Neuro = nerve tissues Osteo = bone Renal = kidney Rhabdo = skeletal muscle m Squamous = epithelial layer, mucous membranes, organ lining @ Cancer prevention (primary vs. secondary) o. Primary m Use of sunscreen Stop tobacco use Use PPE in workplace Reduce alcohol consumption Modify diet Limit sexual partners/safe sex practices Remove at-risk tissue: removing polyps, breast tissue, etc Chemoprevention: strategy that uses drugs, chemicals, natural nutrients, or other substances to disrupt one or more steps important to cancer development m Vaccinations: Currently the only vaccines approved for prevention of cancer are related to prevention of infection from several forms of the human papilloma virus (HPV) © Secondary m Routine screenings: annual mammography after 40yrs, colonoscopy at 50yrs and then every 10, annual fecal occult, digital rectal exam for men after 5Oyrs =™ Genetic testing for those with genetic predisposition- BRCA gene @ Types of cancers (carcinoma, sarcoma, melanoma, lymphoma, leukemia, blastoma) © Carcinoma: cancer of the epithelial tissue (skin, liver, kidney) © Melanoma: cancer of the pigment cells, or melanocytes © Sarcoma: cancer of the connective tissues o Lymphoma: cancer of the lymphatic cells NUR 2392Multidimensional Care Il Exam 1 Study Guide LATEST UPDATE 2021/2022 BEST EXAM SOLUTIONS GRADED A+ © Leukemia: cancer of the bone marrow © Blastoma: cancer of the immature, building cells Ch. 22: Care of Patients with Cancer @ Diagnostic tests and lab values (biopsy, imaging, absolute neutrophil count, RBC/PLT/WBC ranges) © Biopsy: GOLD STANDARD FOR CANCER DIAGNOSIS NUR 2392Multidimensional Care Il Exam 1 Study Guide LATEST UPDATE 2021/2022 BEST EXAM SOLUTIONS GRADED A+ Types of Radiation @ External beam: radiation delivered from a source outside of the patient. Because the source is external, the patient is not radioactive, and there is no hazard to others. © The exact tumor location is determined and then small markings are placed for precision, and a device may be placed ina splint or mold. @ Brachytherapy: internal radiotherapy. Radiation is delivered to the patient internally, making the patient a source of radiation as there is potential for one to emit radiation for a period of time and be hazardous to others. © Seeds can be placed and they are small pieces of radioactive material. Patients are still hazardous with them, even if they run out. © Chemotherapy: treatment of cancer cells with the use of chemical agents that damages cell DNA and regulation. Specific to the type of tumor and the movement. m Systemic effects, but can cause damage to normal healthy cells m Drug Types: @ Alkylating Agents: cross-link DNA, making the DNA strands bind tightly together. This action prevents proper DNA and ribonucleic acid (RNA) synthesis, which inhibits cell division. @ Antimetabolites: closely resemble normal metabolites and act as “counterfeit” metabolites that fool cancer cells into using the antimetabolites in cellular reactions. Because antimetabolites cannot function as proper metabolites, their presence impairs cell division. @ Antimitotic Agents: interfere with the formation and actions of microtubules so cells cannot complete mitosis during cell division. As a result the cancer cell either does not divide at all or divides only once. @ Anti-tumor Agents: drugs that were originally developed as antibiotics that have effects on cancer cells. These drugs damage the cell's DNA and interrupt DNA or RNA synthesis. The exact mechanism of interruption varies with each agent. @ Topoisomerase inhibitors: disrupt an enzyme (topoisomerase) essential for DNA synthesis and cell division. When drugs disrupt the enzyme, proper DNA maintenance is prevented, resulting in increased DNA breakage and eventual cell death. NUR 2392Multidimensional Care Il Exam 1 Study Guide LATEST UPDATE 2021/2022 BEST EXAM SOLUTIONS GRADED A+ @ Miscellaneous Chemotherapeutic Agents: those with mechanisms of action that are either unknown or do not fit those of other drug categories. @ Done ina combination: will give more than 1 chemo drug to more effectively kill cancer cells ™ Dose dense Chemo: giving chemo rounds closer together w/ growth factors to minimize neutropenia. NUR 2392Multidimensional Care Il Exam 1 Study Guide LATEST UPDATE 2021/2022 BEST EXAM SOLUTIONS GRADED A+ m™ Can give IV, but more than likely other routes such as a port, PICC, TLC to prevent complications. ™ Can have potential to cause healthcare worker toxic effects- why people who are chemo certified can only give chemo. © Immunotherapy Biological response modifiers: enhance or alter the patient's biologic responses to cancer cells. Can help the body recognize cancer cells as foreign and improve immunity and repair cells. m= Interleukins: substances the body makes to help regulate inflammation and immunity. Helps different immune cells recognize and destroy abnormal body cells. m= Interferons:cell-produced proteins that have some effect in the treatment of melanoma, hairy cell leukemia, renal cell carcinoma, AIDS-related Kaposi's sarcoma, and lymphoma. Slowing tumor cell division.Stimulating the growth and activation of NK cells. Inducing cancer cells to resume a more normal appearance and function.|Inhibiting the expression of oncogenes m Supportive therapy: helps with growth factor and induces more rapid recovery of bone marrow cells after suppression by chemotherapy. © Monoclonal Antibodies: bind to their target antigens, which are often specific cell surface membrane proteins. Binding prevents the protein from performing its functions. By binding these proteins, monoclonal antibodies change cellular regulation and prevent cancer cell division. © Tyrosine Kinase Inhibitors: Drugs with the main action of inhibiting activation of tyrosine kinases. TKI drugs are effective in disrupting the cellular regulation and growth of some cancer cell types and not others. o Epidermal Growth Factor/Receptor Inhibitors: block epidermal growth factor from binding to its cell surface receptor. When this receptor is blocked, it cannot activate tyrosine kinase. As a result, the signal transduction pathway for promotion of cell division is inhibited. o Vascular Endothelial Growth Factor/Receptor Inhibitors: It binds to vascular endothelial growth factor (VEGF) and prevents the binding of VEGF with its receptors on the surfaces of endothelial cells present in blood vessels. This inhibits formation of new blood vessels within a tumor. As a result, tumor cells are poorly nourished and growth is inhibited. NUR 2392Multidimensional Care Il Exam 1 Study Guide LATEST UPDATE 2021/2022 BEST EXAM SOLUTIONS GRADED A+ m Reduction of function when either a part or the whole organ is taken out. Scarring or disfigurement may occur. = Potential risk for depression, grief, and decreased quality of life. © Radiation m Systemic: altered taste, fatigue, bone marrow suppression m= Inflammation and tissue fibrosis m CVdisease NUR 2392Multidimensional Care Il Exam 1 Study Guide LATEST UPDATE 2021/2022 BEST EXAM SOLUTIONS GRADED A+ : Acute effects: @ Brain: 0000 ° Alopecia and radiodermatitis of the scalp Ear and external auditory canal irritation Cerebral edema Nausea and vomiting Somnolence syndrome @ Head and Neck: ° 00000 ° Oral mucositis Taste changes Oral candidiasis Oral herpes Acute xerostomia Dental caries Esophagitis and pharyngitis @ Breast and Chest wall: ° ° Skin reactions Esophagitis @ Chest and lung: ° ° ° Esophagitis and pharyngitis Taste changes Pneumonia @ Abdomen and Pelvis ° 0000 @ Eye fe} : Late Effects Anorexia Nausea and vomiting Diarrhea and proctitis Cystitis Vaginal dryness/vaginitis Conjunctival edema and tearing @ Subcutaneous and Soft Tissue ° @ cNS Radiation-induced fibrosis NUR 2392Multidimensional Care Il Exam 1 Study Guide LATEST UPDATE 2021/2022 BEST EXAM SOLUTIONS GRADED A+ NUR 2392Multidimensional Care Il Exam 1 Study Guide LATEST UPDATE 2021/2022 BEST EXAM SOLUTIONS GRADED A+ Brain necrosis Leukoencephalopathy Cognitive and emotional dysfunction 0000 Pituitary and hypothalamic dysfunction © Spinal cord myelopathies @ Head and Neck m Hypercalcemia @ liver dysfunction m VTE @ Patient Teaching Points © Surgery: m= Must have psychosocial support since diagnosis and surgery fall within a short time frame of each other. m™ Assess coping mechanisms based on the diagnosis and changes in body image and roles. = Coordinate with the team for assistance with the patients concerns regarding feelings, ADL’s and body acceptance m Refer to support groups. m Rehab may be needed to improve functioning. m Teach patients the importance of regular exercise. © Radiation: ® Assist with calming the patient and family with the procedure m Brachytherapy (Internal Radiation): @ Assign the patient to a private room with a private bath. @ Place a “Caution: Radioactive Material” sign on the door of the patient's room. @ |f portable lead shields are used, place them between the patient and the door. @ Keep the door to the patient's room closed as much as possible. @ Wear a dosimeter film badge at all times while caring for patients with radioactive implants. The badge offers no protection but measures a person's exposure to radiation. Each person caring for the patient should have a separate dosimeter to calculate his or her specific radiation exposure. Wear a lead apron while providing care. Always keep the front of the NUR 2392Multidimensional Care Il Exam 1 Study Guide LATEST UPDATE 2021/2022 BEST EXAM SOLUTIONS GRADED A+ apron facing the source of radiation (do not turn your back toward the patient). @ If you are attempting to conceive, do not perform direct patient care, regardless of whether you are male or female. NUR 2392Multidimensional Care Il Exam 1 Study Guide LATEST UPDATE 2021/2022 BEST EXAM SOLUTIONS GRADED A+ @ Pregnant nurses should not care for these patients; do not allow pregnant women or children younger than 16 years to visit. @ Limit each visitor to one-half hour per day. Be sure visitors stay at least 6 feet from the source. @ Never touch the radioactive source with bare hands. In the rare instance that it is dislodged, use long-handled forceps to retrieve it. Deposit the radioactive source in the lead container kept in the patient's room. @ Save all dressings and bed linens in the patient's room until after the radioactive source is removed. After the source is removed, dispose of dressings and linens in the usual manner. Other equipment can be removed from the room at any time without special precautions and does not pose a hazard to other people. m Skin teaching: @ Wash the irradiated area gently each day with either water or a mild soap and water as prescribed by your radiation therapy team. @ Use your hand rather than a washcloth when cleansing the therapy site to be gentler. @ Rinse soap thoroughly from your skin. @ If ink or dye markings are present to identify exactly where the beam of radiation is to be focused, take care not to remove them. @ Dy the irradiated area with patting rather than rubbing motions; use a clean, soft towel or cloth. NUR 2392Multidimensional Care Il Exam 1 Study Guide LATEST UPDATE 2021/2022 BEST EXAM SOLUTIONS GRADED A+ the oral cavity.Drink 2 or more liters of water per day if another health problem does not require limiting fluid intake.Take all drugs, including antibiotics and drugs for nausea and vomiting, as prescribed.Use topical analgesic drugs as prescribed.Take pain medications on schedule as needed.Apply a water-based moisturizer to your lips after each episode of mouth care and as needed.Use prescribed “artificial saliva” or mouth moisturizers as needed.Avoid using NUR 2392Multidimensional Care Il Exam 1 Study Guide LATEST UPDATE 2021/2022 BEST EXAM SOLUTIONS GRADED A+ tobacco or drinking alcoholic beverages.Avoid spicy, salty, acidic, dry, rough, or hard food.Cool liquids to prevent burns or irritation.If you wear dentures, use them only during meals. When not in place, soak them in an antimicrobial solution. Rinse thoroughly before placing them in your mouth. m Prevent bleeding: Wash the irradiated area gently each day with either water or a mild soap and water as prescribed by your radiation therapy team.Use your hand rather than a washcloth when cleansing the therapy site to be gentler.Rinse soap thoroughly from your skin.If ink or dye markings are present to identify exactly where the beam of radiation is to be focused, take care not to remove them.Dry the irradiated area with patting rather than rubbing motions; use a clean, soft towel or cloth.Use only powders, ointments, lotions, or creams that are prescribed by the radiation oncology department on your skin at the radiation site.Wear soft clothing over the skin at the radiation site.Avoid wearing belts, buckles, straps, or any type of clothing that binds or rubs the skin at the radiation site.Avoid exposure of the irradiated area to the sun. Protect this area by wearing clothing over it.Try to go outdoors in the early morning or evening to avoid the more intense sun rays.When outdoors, stay under awnings, umbrellas, and other forms of shade during the times when the sun's rays are most intense (10 AM to 7 PM).Avoid heat exposure. m™ Give antiemetic for nausea and vomiting m= Offer mints for metallic taste m Educate about alopecia (hair loss), and provide strategies and coping mechanisms to support the patient when they lose their hair. m Reducing peripheral neuropathy: Protect feet and other body areas where sensation is reduced (e.g., do not walk around in bare feet or stocking feet; always wear shoes with a protective sole).Be sure that shoes are long enough and wide enough to prevent creating sores or blisters.Buy shoes in the afternoon or evening to accommodate any size change needed for foot swelling.Provide a long break-in period for new shoes; do not wear new shoes NUR 2392Multidimensional Care Il Exam 1 Study Guide LATEST UPDATE 2021/2022 BEST EXAM SOLUTIONS GRADED A+ for longer than 2 hours at a time.Avoid pointed-toe shoes and shoes with heels higher than 2 inches.Inspect your feet daily (with a mirror) for open areas or redness.Avoid extremes of temperature; wear warm clothing in the winter, especially over hands, feet, and ears.Test water temperature with a thermometer when washing dishes or bathing. Use warm water rather than hot water (less than 105° F or 40.6° C).Use potholders when cooking.Use gloves when washing dishes or gardening.Do not eat foods that are “steaming hot”; NUR 2392Multidimensional Care Il Exam 1 Study Guide LATEST UPDATE 2021/2022 BEST EXAM SOLUTIONS GRADED A+ m One of the most common side effects of chemotherapy m = Life-threatening condition (requires immediate medical care) m= Adults w/cancer w/ low WECs (neutropenia) and impaired immunity from cancer therapy are at an increased risk for infection and sepsis. m_ s/s associated with sepsis/ septic shock includes erythema, swelling, warmth, high fever. ™ Other s/s associated w/ febrile neutropenia is absolute neutrophil count less than 500 per mm’3 m Often a low-grade fever (100.4) is the only sign of infection initially seen in septic patients. m = Infection and sepsis have a high mortality rate in adults w/ neutropenia = Treatment options: @ Inpatient treatment @ Antibiotic therapy @ Determine the cause of the infection @ Temperature management Nursing Care: Assess for s/s Monitor and treat temperature Collect cultures Implement isolation precautions Monitor labs Administer medications as prescribed Manage comfort Provide emotional and spiritual support © Disseminated Intravascular Coagulation (DIC) (Hematologic Emergency) NUR 2392Multidimensional Care Il Exam 1 Study Guide LATEST UPDATE 2021/2022 BEST EXAM SOLUTIONS GRADED A+ m™ Occurs when there is a problem w/ the blood clotting process m@ Triggered by severe illness including cancer m In patients w/ cancer DIC is caused by gram-negative sepsis m= Normal bacterial flora enter the bloodstream through any site of skin breakdown causing severe infection NUR 2392Multidimensional Care Il Exam 1 Study Guide LATEST UPDATE 2021/2022 BEST EXAM SOLUTIONS GRADED A+ m Extensive & abnormal clotting occurs in the small blood vessels depleting circulating clotting factors and platelets resulting in extensive bleeding for patient w/ DIC @ Bleeding from many sites is the most common problem and ranges from oozing to fatal hemorrhage m DIC causes decreased blood flow to major body organs m s/s include pain, ischemia, stroke like symptoms, dyspnea, tachycardia, reduced kidney function, and bowel necrosis @ DIC is life-threatening even when proper therapies are instituted m Prevention of both sepsis and DIC are key m Identify patients at greatest risk for sepsis and DIC m™ Practice strict adherence to aseptic technique during invasive procedures and during contact w/ nonintact skin and mucous membranes m@ Teach patients and families the early indicators of infection and to seek prompt assistance m= Focus of treatment therapies is halting the DIC process m= |Vantibiotic therapy is initiated @ Anticoagulants (especially heparin) are given to limit clotting and prevent rapid consumption of circulating clotting factors during the early phase of DIC m When DIC has progressed and hemorrhage is the primary problem clotting factors and blood transfusions m Some of the most common clotting factors given to treat DIC patients @ Factor 1- Fibrinogen Factor 2- Prothrombin e @ Factor 3- Thromboplastin @ Factor 4- Calcium NUR 2392Multidimensional Care Il Exam 1 Study Guide LATEST UPDATE 2021/2022 BEST EXAM SOLUTIONS GRADED A+ m= Increased amount of fluid in the sac causes compression of the heart possibly leading/ resulting in a cardiac tamponade = Prompt treatment to remove fluid must be performed to avoid death = Associated w/ metastatic lung and breast cancer, melanoma, leukemia, lymphoma, and chemotherapy to the chest wall NUR 2392Multidimensional Care Il Exam 1 Study Guide LATEST UPDATE 2021/2022 BEST EXAM SOLUTIONS GRADED A+ m_ S/s include dyspnea, fatigue, distended neck veins, distant heart sounds, tachycardia, orthopnea (SOB or difficulty breathing when lying down), narrow pulse pressure, and pulsus paradoxus (exaggerated blood pressure variation) = Treatment options: @ Radiation @ Surgical intervention m Nursing Care: @ Assess for neuro deficits @ Manage pain @ Administer meds as prescribed @ Prevent skin breakdown @ Provide emotional and spiritual support © Syndrome of Inappropriate Antidiuretic Hormone (SIADH) (Metabolic Emergency) m Asyndrome resulting in hyponatremia (low sodium) causing a disorder of water balance. Water is reabsorbed in excess by the kidneys and put into systemic circulation. The retained water dilutes blood sodium levels. m™ Characterized by elevated serum blood levels of ADH, excessive water retention, hypo-osmolality, and hyponatremia m s/s include anorexia, loss of appetite, nausea, vomiting, constipation, muscle weakness, myalgia (muscle pain), fatigue, polyuria, polydipsia, seizures, personality changes, confusion, nervous system changes, and coma m= Treatment: @ Fluid restriction @ Correction of serum sodium imbalance NUR 2392Multidimensional Care Il Exam 1 Study Guide LATEST UPDATE 2021/2022 BEST EXAM SOLUTIONS GRADED A+ @ Furosemide therapy Nursing Care: @ Assess for s/s @ Monitor I&0s @ Monitor labs @ Implement seizure precautions NUR 2392Multidimensional Care Il Exam 1 Study Guide LATEST UPDATE 2021/2022 BEST EXAM SOLUTIONS GRADED A+ m Three major triggers that result in hypercalcemia of malignancy @ Tumor secretion of parathyroid hormone-related protein @ Osteolytic metastasis w/ release of cytokines @ Tumor production of 1.25-dihydroxyvitamin D m S/s include fatigue, anorexia, nausea, vomiting, constipation, mental status changes/altered sensorium, renal failure, coma, myalgia, and headache. = Treatment options: Inpatient monitoring Aggressive rehydration followed by diuresis Monitor serum phosphate levels Phosphate replacement IV. bisphosphonate Hemodialysis Nursing Care: Assess for s/s Monitor I&Os Administer fluids as prescribed Monitor for side effects of medications Monitor vital signs and cardiac rhythm Prepare patient for hemodialysis Provide emotional and spiritual support © Superior Vena Cava Syndrome (Structural Emergency) = Compression of the superior vena cava walls by a tumor prohibiting venous return of blood to the heart. m@ Associated w/ lung cancer, metastatic mediastinal tumors, lymphoma, and indwelling venous catheters. m s/s include swelling of the face, neck, and arms, dysphagia, and cough NUR 2392Multidimensional Care Il Exam 1 Study Guide LATEST UPDATE 2021/2022 BEST EXAM SOLUTIONS GRADED A+ Late s/s include hemorrhage, cyanosis, mental status changes, decreased cardiac output, dyspnea, and hypotension m= Imaging w/ CT or MRI is essential for diagnosis and treatment planning = Death results if compression is not relieved m Treatment options include radiation and chemotherapy NUR 2392Multidimensional Care Il Exam 1 Study Guide LATEST UPDATE 2021/2022 BEST EXAM SOLUTIONS GRADED A+ Nursing Care: Assessment of respiratory and cardiac systems Maintain a patent airway Monitor oxygenation Monitor labs Provide emotional and spiritual support to the patient and family © Tumor Lysis Syndrome (Metabolic Emergency) m Large number of tumor cells are destroyed rapidly m@ TLS results in a release of large amounts of intracellular products such uric acid, calcium phosphates, and potassium. These products disrupt homeostasis and destroy the nucleus of cells. m= Uric acid formation causes hyperuricemia and precipitate in the kidney blocking kidney tubules resulting in AKI m@ Intracellular contents of damaged cancer cells, including potassium and purines (DNA components), are released into the bloodstream faster than the body can eliminate them. m TLS differs from the other types of oncologic emergencies because it is a positive sign that cancer treatment is effective in destroying cancer cells. m™ TLS is associated w/ hematologic malignancies, acute leukemia, and high- grade lymphoma. m Severe or untreated TLS can cause tissue damage, acute kidney injury (AKI), and death. m Serum potassium levels can increase to the point of hyperkalemia causing cardiac dysfunction = Adults receiving radiation or chemotherapy for cancers are at risk for TLS and more likely to develop/ occur in older adults m Early symptoms of TLS include lethargy, nausea, vomiting, anorexia, flank pain, muscle weakness, cramps, seizures, edema, and altered mental status. NUR 2392Multidimensional Care Il Exam 1 Study Guide LATEST UPDATE 2021/2022 BEST EXAM SOLUTIONS GRADED A+ Provided by physician, nurse practitioner, or team. @ Assessment findings © Notice these findings in a person who is approaching death: Weakness Sleeping more @ Anorexia NUR 2392Multidimensional Care Il Exam 1 Study Guide LATEST UPDATE 2021/2022 BEST EXAM SOLUTIONS GRADED A+ li Changes in organ system function- cardiovascular, respiratory and genitourinary function. Cold, mottled, cyanotic extremities Changes in breathing pattern- breathing becomes shallow and rapid with periods of apnea, Cheyne- Stokes respirations (apnea alternating with periods of rapid breathing). lM Decreased LOC- declines to lethargy, unresponsiveness or coma. As LOC decreases, pt loses ability to speak (Nursing intervention:identify alternative means of communication to assess for symptoms of distress. blood pressure decreases and is often only palpable, heart rate becomes irregular and decreases before dying. e@ Psychosocial Assessment- oO. Fear and/or anxiety © Difficulty coping with fear and anxiety of death. ©. Assess cultural considerations, values, religious beliefs. ©. Spiritual assessment: HOPE mnemonic lH: sources of Hope and strength. lO: Organized religion if the patient follows one and the role it plays in one’s life l@ P: Personal spirituality, rituals, and practices @ E: Effects of religion and spirituality on care and end of life decisions. © Interventions- assess cultural considerations, values and religious beliefs of the patient and family. @ Managing symptoms and needs © Pain Management: Pain is the symptom that dying patients fear the most. Non Opioid and Opioid analgesics , Non pharmacologic interventions. Massages, music therapy and aromatherapy © Managing weakness lf Aspiration precautions Provide mouth care; apply emollient to lips. Altered routes of medication administration. (Choose the least invasive route with most effective treatment.) © Managing breathlessness and dyspnea Opioids, bronchodilators, diuretics, antibiotics, anticholinergics, benzodiazepines Oxygen (for comfort) @ Electric fan for air circulation Reposition © Managing Nausea and vomiting lf Antiemetic agents NUR 2392Multidimensional Care Il Exam 1 Study Guide LATEST UPDATE 2021/2022 BEST EXAM SOLUTIONS GRADED A+ @ Prochlorperazine (Compazine) @ Ondansetron (Zofran) @ Dexamethasone (Decadron, Deronil, Dexasone) @ Metoclopramide (Reglan, Maxeran) Remove any source of odors. Comfortable room temperature Aromatherapy NUR 2392Multidimensional Care Il Exam 1 Study Guide LATEST UPDATE 2021/2022 BEST EXAM SOLUTIONS GRADED A+ Low: Hypocalcemia; vitamin D deficiency; hypothyroidism; hypoparathyroidism; kidney disease; excessive intake of phosphorus- containing foods and drinks. Chloride (CI-) 98- 106 mEq/L Elevated: Hyperchloremia; metabolic acidosis; respiratory alkalosis; hypercortisolism Low: Hypochloremia; fluid overload; excessive vomiting or diarrhea; adrenal insufficiency; diuretic therapy Magnesium (Mg 2+) 1.8 - 2.6 mEq/L Elevated: Hypermagnesemia; kidney disease; hyperthyroidism; adrenal insufficiency Low: Hypomagnesemia; malnutrition; alcoholism; ketoacidosis @ Fluid balance and hormonal regulation : Three hormones support the control of fluid and electrolyte balance : Aldosterone, antidiuretic hormone (ADH), and natriuretic peptide o Aldosterone : secreted by adrenal cortex when sodium levels in the extracellular fluid (ECF) are low. It prevents water and sodium loss. When it’s secreted, it acts on the kidney nephrons enabling them to reabsorb sodium and water from the urine back into the blood. Increases blood volume. Antidiuretic hormone (ADH) [aka, vasopressin] : release from the posterior pituitary gland in response to changes in blood osmolarity. Increased osmolarity results in slight shrinkage of these cells and triggers ADH release from the posterior pituitary gland. It also acts on kidney nephrons, making them permeable to water. As a result, more water is reabsorbed by these tubules and returned to the blood, making it more dilute (decreased osmolarity). Natriuretic peptides (NPs) are secreted by special cells that line the atria ( atrial natriuretic peptide [ANP]) and ventricles (brain natriuretic peptide [BNP]) of the heart. These peptides are secreted in response to increased blood volume and blood pressure, which stretch the heart tissue. Kidney reabsorption of sodium is inhibited at the same time that urine output is increased. The outcome is decreased blood volume and blood osmolarity. @ Assessment and treatment of dehydration and fluid overload NUR 2392Multidimensional Care Il Exam 1 Study Guide LATEST UPDATE 2021/2022 BEST EXAM SOLUTIONS GRADED A+ o Dehydration m Assessment: Urine is darker, dry mouth, dry eyes, muscle cramps, heart palpitations, syncope, decreased urine output, increasing heart rate. = Confirming diagnosis: physical manifestations, blood tests, and urinalysis. NUR 2392Multidimensional Care Il Exam 1 Study Guide LATEST UPDATE 2021/2022 BEST EXAM SOLUTIONS GRADED A+ m Treatment: Treatment: Provide oral fluids (within dietary restrictions), offer fluids every two hours. If oral fluids are not tolerated, IV fluids should be administered. © Fluid Overload m= Assessment: Patients often have pitting edema, increased pulse rate, elevated blood pressure, decreased pulse pressure, weight gain, engorged varicose veins, increased respiratory rate, shallow respirations, shortness of breaths, moist crackles present on auscultation. Skin is pale and cool to the touch. @ Treatment: Skin integrity is at risk with swollen limbs, ensuring the patient is being repositioned every two hours to prevent breakdown. Diuretics are used for fluid overload if kidney function is normal (furosemide). If a patient has syndrome of inappropriate antidiuretic hormone (SIADH), conivaptan (vaprisol) or tolvaptan (samsca) may be prescribed. Monitor intake and outake. m_ Restrictions on fluid intake and sodium intake. @ S/S of hypo/hyper changes are seen as general muscle weakness. Deep tendons reflexes diminish, and muscle weakness is worse in the legs and arms. ELECTROLYTE HYPO- HYPER- Sodium e@ Cerebral changes e@ Nervous system are the most changes start with obvious problems. altered cerebral e@ Behavioral changes function. Assess result from cerebral for patients mental edema and status for attention increased span and cognitive intracranial pressure. function. e Neuromuscular e Skeletal muscle changes: twitching, irregular muscle contractions. The worse it gets, the less it responds to stimulus. Cardiovascular NUR 2392Multidimensional Care Il Exam 1 Study Guide LATEST UPDATE 2021/2022 BEST EXAM SOLUTIONS GRADED A+ Calcium e Neuromuscular e = Cardiovascular changes include changes include paresthesias, tingling increased heart & numbness in hands rate and BP, & feet, muscle cyanosis, pallor twitching, painful changes (indicating cramps & spasms, poor perfusion), tingling in nose, lips, dysrhythmias, and ears. Positive shortened QT Trousseau’s (hand and intervals, blood fingers go intoa clots, and DVTs spasm in palmar flexion) and e Neuromuscular Chvostek’s (facial changes include twitching on one side severe muscle of face) signs. weakness, decreased DTRs e = Cardiovascular w/o paresthesia, changes include heart confusion, and rate & ECG changes. lethargy The heart rate may be NUR 2392Multidimensional Care Il Exam 1 Study Guide LATEST UPDATE 2021/2022 BEST EXAM SOLUTIONS GRADED A+ slower or _ slightly faster than normal w/ a weak thready pulse. Hypotension. ECG changes of prolonged ST & QT intervals. Intestinal changes include increased peristaltic activity (hyperactive bowel sounds), diarrhea, and abdominal cramping. Skeletal changes include osteoporosis, loss in height, spine curvatures, unusual lumps/ protrusions in bones. Intestinal changes include decreased peristalsis, constipation, anorexia, nausea, vomiting, abdominal distension, and pain. Bowel sounds are hypoactive or absent. Magnesium Cardiovascular changes include hypertension, atherosclerosis, hypertrophic left ventricle, and dysrhythmias (premature contractions, atrial fibrillation, ventricular fibrillation, long QT intervals). Cardiovascular changes include bradycardia, peripheral vasodilation, & hypotension. Prolonged PR interval w/a widened QRS complex. Cardiac arrest is possible. NUR 2392Multidimensional Care Il Exam 1 Study Guide LATEST UPDATE 2021/2022 BEST EXAM SOLUTIONS GRADED A+ e Neuromuscular changes include hyperactive DTRs, numbness, tingling, painful muscle contractions, tetany (spasms in the hands, feet, larynx (voice box)), muscle cramps, and seizures. e@ = Intestinal changes Central nervous system changes include drowsiness, lethargy, and coma. Neuromuscular changes include reduced or absent DTRs, and weakness. NUR 2392Multidimensional Care Il Exam 1 Study Guide LATEST UPDATE 2021/2022 BEST EXAM SOLUTIONS GRADED A+