PN3 EXAM 1 – STUDY GUIDE

PN3 EXAM 1 – STUDY GUIDE Cellular regulation is the process of cellular responses in order to undergo reproduction, differentiation, and proliferation. There are many factors that can alter cellular growth and function. To understand this concept there are some term you need to be familiar with: • Neoplasm also referred to as a tumor, is an abnormal mass of cells. A neoplasm can be benign or malignant. • Benign not cancerous; does not metastasize. • Malignant invade and destroy nearby tissues and spread via metastasis. • Metastasis spread of malignant tumor to a location distant to the primary neoplasm. Risk Factors Alteration in cellular regulation can lead to the development of cancer. There are risk factors that promote the development of this life-altering disease process. Some of these factors include: • Age • Heredity • Environment o Pollution o Radiation o Work exposure • Lifestyle o Smoking o Diet o Risky sexual behaviors o Drug use Exemplars When alteration in cellular regulation happens, some of the following disease can develop: • Cancer o Leukemia o Breast cancer o Prostate cancer o Lung cancer o Colon cancer o Skin cancer • Anemia o Sickle cell anemia Treatment Treatment for alteration in cellular regulation can include: • Surgery • Radiation • Chemotherapy • Hormone therapy • Stem Cell transplantation • Complementary and Alternative therapy THE PROCESS OF CHANGING A NORMAL CELL INTO A CANCER CELL IS CALLED MALIGNANT TRANSFORMATION THE ORIGINAL TUMOR IS CALLED THE PRIMARY TUMOR AND IS IDENTIFIED BY THE TISSUE FORM WHICH IT ARROSE, SUCH AS IN BREAST CANCER OR LUNG CANCER METASTASIS OCCURS WHEN CANCER CELLS MOVE FROM THE PRIMARY LOCATION BY. BREAKING OFF FORM THE ORIGINAL GROUP AND ESTABLISHING REMOTE COLONIES CALLED METATSTATIC OR SECONDARY TUMORS CANCER CELLS: ANAPLASIA: LOSES ITS SPECIFIC APPEARANCE LARGER THAN NORMAL NUCLEUS POORLY DIFFERENTIATED AND SERVES NO PURPOSE OR FUNCTION DOES NOT BIND TO OTHER CELLS AND CAN MOVE THROUGH BLOOD VESSEL WALLS OR TO OTHER TISSUES (METASTASIZE) HAVE AN UNLIMITED LIFE SPAN AND CONTINUE TO GROW REGARDLESS OF CELLS AROUND IT ABNORMAL # OF CHROMOSOMES MUCOSITIS INFLAMMATION AND ULCERATION OF THE LINING OF THE MOUTH, THROAT, GI TRACT BEGINS WITH DRY MOUTH AND CHAPPED LIPS, PROGRESSES TO PAINFUIL WHITE PATCHES AND ULCERATION RF  LESS THAN 20 YO, HEMATOLOGIC OR HEAD/NECK CA, ORAL DISEASE, CHEMO OR RADIATION THERAPY TX  TOPICAL AGENS (SUCRALFATE, BENADRYL) OR CRYOTHERAPY (ICE CHIPS) AND SOFT LASER THERAPY GOOD ORAL HYGIEN, INCREASE FLUIDS, EAT SOFT FOODS, AVOID ACIDIC OR IRRITATING FOODS, AND COOL/ROOM TEMP ANEMIA HGB 12 G/dL AND HCT 36% S&S: FATIGUE, SOB, CHEST PAIN, TACHYCARDIA, HA, PALLOR, MENTAL STATUS CHANGE NEUTROPENIA ABSOLUTE NEUTROPHIL COUNT 2000/MM 10-14 DAYS AFTER CHEMO IS THE LOWEST POINT MONITOR FOR INFECITON, TEMP, CHJILLS,C OUGH, SOB, SORE THROAT, STOMATITIS REDNESS/SWELLING AROUND BREAKS IN SKIN, CHANGES IN BOWEL, N/V, MALAISE. MOUTH CARE IS VIP AND WASHING THE AXILLARY AND PERANAL REGIONS Q12H THROMBOCYTOPENIA  TRANSFUSE WHEN PLT 10,000 PLT COUNT 100,000 S&S: BRUISING, FRANK BLEEDING, BLOODY NOSE, PETECHIAL, HEMATURIA BLACK/TARRY STOOLS AVOID IM INJECTIONS MOUTH CARE, SOFT BRISTLED TOOTHBRUSH PREVENT FALLS ELECTRIC SHAVER NO ASA NO CONTACT SPORTS AVOID HARD FOODS EAT ONLY WARM, COOL, OR COLD FOODS TO AVOID BURNING MOUTH TELETHERAPY (EXTERNAL)- RADIATION FROM OUTSIDE OF THE PT PT IS NOT RADIOACTIVE EXACT TUMOR LOCATION IS DETERMINE 1ST AND THEN SKIN IS MARKED PT MUST ALWAYS BE IN SAME POSITION FOR ALL TX NEVER USE OIL AND ONLY USE APPROVED LOTIONS SX: N/V, ABD PAIN, WATERY STOOLS, AND BURNS BRACHYTHERAPY (INTERNAL) RADIOACTIVE ISOTOPES ARE ADMIN BY INTERNAL IMPLANTS NEAR THE TUMOR OR WITHIN THE BODY FLUID BY PO/IV ROUTE ALWAYS PLACE IN PRIAVE ROOM WITH A SIGN ON DOOR, LIMIT CONTACT, AT LEAST 6 FT AWAY AT ALL TIME, RADIOACTIVE PROTECTIVE CLOTHING, NO CHILDREN OR PREG RADIOACTIVE UP TO 48 HRS AFTER TX MUST BE CAREFUL AROUND BODILY FLUIDS, PT MAY NEED TO DBL FLUSH SYMP: SWELLING, BLEEDING, AND BURNING. FOR PATIENTS WITH INTERNAL RADIATION LIMIT TIME IN ROOM SUPERIOR VENA CAVA SYNDROME  ANY COMPRESSION OR OBSTRUCTIONS BY TUMROR GROWTH OR BY CLOTS IN THE VESSEL LEADS TO CONGESTION OF THE BLOOD NOTE ANY: SOB CYANOSIS UPPER EXTREMITY EDEMA/FACIAL EDEMA MASTECTOMY CARE: NO BP/IVs ON THE AFFECTED ARM ELEVATE EFFECTED ARM FROM DISTAL JOINT TO PROXIMAL OF ARM CH 21 STAGING OF CANCER ABLE 21-5 Staging of Cancer—TNM Classification Primary Tumor (T) Tx Primary tumor cannot be assessed T0 No evidence of primary tumor Tis Carcinoma in situ T1, T2, T3, T4 Increasing size and/or local extent of the primary tumor Regional Lymph Nodes (N) Nx Regional lymph nodes cannot be assessed N0 No regional lymph node metastasis N1, N2, N3 Increasing involvement of regional lymph nodes Distant Metastasis (M) Mx Presence of distant metastasis cannot be assessed M0 No distant metastasis M1 Distant metastasis EXAMPLE : T4 N3 M1  LARGE TURMOR, MULTINODE INVOLVEMENT, PRESENT OF METASTASIS 3 FACTORS THAT INFLUENCE CANCER DEVELOPMENT: EXPOSURE TO CARCINOGENS, GENETIC PREDISPOSITION, AND IMMUNITY. KNOW CAUTION : C: CHANGES IN BOWEL OR BLADDER PATTERNS A: A SORE THAT DOES NOT HEAL U: UNUSUAL BLEEDING OR DISCHARGE T: THICKENING OR LUMP IN THE BREAST OR ELSEWHERE I: INDIGESTION OR DIFF SWALLOWING O: OBVIOUS CHANGE IN WART OR MOLE N: NAGGING COUGH OR HOARSENESS Chemotherapy-induced nausea and vomiting (CINV) Arises from a variety of GI and neural mechanisms. It may manifest as anticipatory (before receiving the chemotherapy, often triggered by thoughts, sights, and sounds related to the anticipated chemotherapy), acute (within the first 24 hours after chemotherapy), delayed (occurring after the first 24 hours), breakthrough (occurring intermittently during therapy for CINV), or a combination. Many cancer drugs are emetogenic (vomiting inducing), with some agents causing more nausea and vomiting than others. Although there are advances in prevention and control of CINV, it remains a common and distressing issue. Nausea often persists, even when vomiting is controlled. Current studies examining genetic factors in the metabolism of chemotherapy agents and antiemetics are ongoing to help identify adults at higher risk for CINV and to allow more precise therapies to manage it . Acute CINV is the most common type. It may persist for 1 to 2 days after chemotherapy is given. A few drugs, such as dacarbazine (DTIC), may trigger CINV almost as soon as the drug is started. Other drugs, such as cisplatin (Platinol), induce delayed nausea and vomiting that can continue as long as 5 to 7 days after receiving it. Patients who have CINV during the first round of chemotherapy may begin to experience the same symptoms before the next dose as a result of sheer anticipation. Once considered the single most distressing side effect of chemotherapy, CINV often can be well controlled with appropriate evidence-based antiemetic therapy, especially with serotonin (5-HT3) antagonist drugs and the use of standardized protocols for its prevention and management. ELEVATED HGB ON CHEMO? GIVE PROCRIT (EPOEITIN ALPHA) IT HELPS TO GENERATE RBCs PT’S ISNT MAKING HGB D/T BONE MARROW SUPPRESSION LOW PLT (140,000)  MONITOR FOR SIGNS OF BLEEING SUCH AS: BRUISING TO FLANKS FRANK BLEEDING IN STOOL OR URINE MEMORY LOSS IN CHEMO: HELP WITH COGNITIVE TRAINAING SUCH AS PUZZLES, TESTS, GAMES KEEP THEIR MIND OCCUPIED PT EXPERIENCES FATIGUE DURING CHEMO, HOW DO YOU COORDINATE NURSING CARE? GET THINGS DONE IN AM PRIORITIZE ITMES NEEDING TO BE DONE ALOPECIA (SATA) HELP MANAGE PSYCHOSOCIAL ASPECT OF IT PRE PLAN FOR IT REASSURE PT IT IS TEMPORARY WHEN CHEMO IS OVER PROTECH SCALP, EYEBROWNS, EYELASHES SO ENCOURAGE USE A WIG, SCARF, SUNSCREEN PRIMARY PREVENT FOR CANCER (SATA) DECREASE FAT IN DIET EXERCISE LIMIT SUN EXPOSURE NO SMOKING KNOW YOUR DOSAGE CAL BENEFITS OF MASSAGE: DECREASES ANXIETY INCREASES BLOOD FLOW RELAXES MUSCLES INCREASES LYMPH FLOW DOES NOT PROMOTE SPIRITUAL HEALING!!!! TAI CHI IMPROVES SYMPTOMS ASSOCIATED WITH CANCER COMFORT MEASURE FOR TERMINALLY ILL PT? SOOTHING MUSIC GENTLE MASSAGE IF A PT HAS 20 SECOND PERIOD OF APNEA WITH DEEP RAPID BREATHING THAT TYPE OF RESPIRATION IS CALLED? CHEYNE STOKES PT IS DYING, ALWAYS HAVE THEIR PAIN UNDER CONTROL PT UNDERSTAND ADVANCED DIRECTIVE SPECIFIES WHAT YOU WANT DONE WHEN YOU CAN NO LONGER DECIDE OF COMMUNICATE DECISIONS POA: USED WHEN PT CANT SPEAK OR MAKE ANY DECISIONS, USUALLY SOMONE APPOINTED BY THE PT TERMINALLY ILL PT JUST DIED, MOST IMPORTANT THING TO DO? ASK IF FAMILY WANTS TO SEE PT SPEND TIME WITH THE FAMILY IF THEY ARE OK WITH IT GIVE FAMILY ALONE TIME PALLAITIVE CARE CARE OF PT IN ANY STAGE OF ILLNESS EX: SICKLE CELL PT, RENAL FAILURE PT A TERMINALLY ILL PT IS UNRESPONSIVE, NURSES ACTIONS? IDENTIFY PAIN OBSERVE RESTLESSNESS/GRIMACING MONITOR VS LISTEN TO CAREGIVERS (THEY KNOW WHEN THERE IS A CHANGE IN PT) IF A TERMINALLY ILL DIABETIC PT WANTS A CHOCOLATE SHAKE, NURSES ACTION? GIVE THEM THE SHAKE!!! A PT WITH SOB IN LAST MOMENTS OF LIFE, NURES ACTION? GIVE MORPHINE FOR COMFORT LOUD/WET RESPIRATION OR “DEATH RATTLE” GIVE ANTICOLINERGIC (DRY THINGS UP) EX: ATROPINE, SCOPALAMINE A CATHOLIC PT WHO IS ACTIVELY DYING ALLOW FAMILY TO HAVE PT RECEIVE THE SACRAMENT OF SICK INTENTIONS OF PLLITATIVE SEDATION, GOAL OF ACHIEVEMENT? MANAGE REFRACTORY SYMPTOMS OF DISTRESS, PROMOTE COMFORT PRIMARY PREVENTION: IS THE AVOIDANCE OF KNOWN OR POTENTIAL CARCINOGENS EX: AVOID NOT USING TOBACCO, USE SKIN PROTECTION DURING SUN EXPOSURE, USE PPE IF PT EXPOSED TO CARCINOGENS IN WORKPLACE, VACCINATION AGAINST HPV SECONDARY PREVENTION: SCREENING STRATEGIES TO DETECT CANCER EARLY, AT A TIME WHEN CURE OR CONTROL IS MORE LIKELY EX: MAMMO FOR WOMEN, BREST EXAMINATION, COLONOSCOPY AT AGE 50, ANNUAL FECAL OCCULT BLOOD FOR ADULT ALL AGES, RECALT EXAMINATION FOR MEN OLDER THAN 50 YO THE “ FINAL SURPRISING RALLY” TEMPORARILY MORE ALERT AND RESPONSIVE BEFORE DEATH GOOD TIME TO TURN OFF THE MONITORS 5 WISHES: 1. THE PEROSN I WANT TO MAKE CARE DECISIONS WHEN I CANNOT 2. THE KIND OF MEDICATL TREATMENT I WANT OR DON’T WANT 3. HOW COMFORTABLE I WANT TO BE 4. HOW I WANT PEOPLE TO TREAT ME 5. WHAT I WANT MY LOVED ONES TO KNOW H: SOURCE OF HOPE STRENGTH O: ORGANIZED RELIGION, ROLE, THAT IT PLAYS IN ONES LIFE P: PERSONAL SPIRITUALITY, RITUALS E: EFFECTS OF RELIGION AND SPIRITUALITY ON CARE AND END OF LIFE ABCDE MODEL: A: ASK ABOUT PAIN B: BELIEVE WHAT THE PT AND FAMILY REPORTS OF PAIN/RELIEF C: CHOOSE PAIN CONTROL APPROPRIATE FOR PT/FAMILY D: DELIVER INTERVENTIONS IN A TIMELY FASHION E: EMPOWER PTS AND THEIR FAMILIES RESPIRATIONS (NEAR DEATH) DO NOT SUCTION PT, TURN THEM TO SIDE AND PT SMALL TOWEL UNDER THEIR MOUTH TAI CHI MOVING MEDITATION TO IMPROVE CHI, BALANCE MIND, BODY, AND SPIRIT They are considered both as mind-body therapies and energy therapies. They encourage the flow of qi(life force or vital energy) by integrating mind, body and soul, and restore balance in them. When the energy flows freely, blockage/stagnation of energy in body’s energy channels is cleared. Restoring the energy balance restores health and even prevents diseases. Though, both share the common principle of regulating the body, breath and mind, yet are dissimilar in the level of complexity and ease of learning. T’ai Chi is relatively lengthy and involves complex movements, but qigong is easy to learn, simpler and a repetitive process. Music therapy Music has been used extensively since ages for its healing and curative power towards disease or distress. The scientific basis of music therapy (MT) evolved after World War II. Since then, the meaning and scope of application of MT have undergone many developments. However, the emergence of MT as a discipline is relatively new. End-of-life care is the total care of the patient and family who has a disease process that has become unresponsive to curative efforts. Other terms that may be used to describe end-of life-care include: palliative care, symptom management, supportive care, comfort care, and hospice. Each of these terms are slightly different in the scope or focus. End-of-life care helps treat the physical symptoms of a terminal illness and/or treatment allowing the patient to have some comfort. It also takes into considerations the psychological, spiritual, and social problems that may arise due to a terminal illness diagnosis. Another important aspect of end-of-life care is the family. As the patient moves through the last stages of life, it is very important to provide support to those that provide care to the dying patient. Advocacy incorporates knowledge, skills, and attitudes regarding healthcare infrastructures to promote optimal safe, quality outcomes for those that may not speak for themselves. Example: Mr. Richards is a 68-year-old male patient with Stage 4 Lung Cancer. He had a history of dementia, hypertension, and diabetes. His physician is explaining to the patient and his wife the benefits of a new research medication. He is explaining all the side effects that may arise from the treatment. The wife wants to go through with the treatment. After she leaves, Mr. Richards tells you that he just wants to go home and enjoy his last days. What would you do to advocate for this patient? Clinical Judgment integrates evidence-based practice, critical-thought, the nursing process, knowledge, skills, and attitudes that promote safe, quality care to clients in all settings. Example: Mr. Richards decides to end all life sustaining measure, including chemotherapy. You are the Hospice nurse visiting for the first time. Mr. Richards is sitting in front of the TV, he has oxygen via nasal cannula and he is smoking a cigarette. Using good clinical judgment, what can you tell the patient about smoking with oxygen on? TABLE 7-2