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, st.john’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