med surg 2 - exam 1

what is some education for a patient with sickle cell anemia?

prevention of sickle cell crisis (hydration, avoiding cold temps, avoiding infection - VACCINATION, avoiding low oxygen tension environments, avoiding tight or restrictive clothing, maintaining good dental hygiene)

patho of condition, maintaining ADLs, risk of crisis during pregnancy & fetal complications, genetic counseling

what is the epidemiology of sickle cell anemia?

inherited disorder

2 million carriers in the US; 72,000 cases in the US

predominately affects descendants from tropical Africa

what is some information about chronic myelogenous & chronic lymphocytic leukemia?

myelogenous = myeloid stem cells

lymphocytic = lymphoid stem cells

they may be present for years but eventually degenerate into acute phase or progress to death if untreated

what is the pathophysiology of leukemia?

unknown stimulus mutates myeloid or lymphoid stem cells

uncontrolled proliferation of leukemic cell (leukocytosis)

apoptosis does not occur

bone marrow, spleen, & lymph are congested with blasts

what are the clinical manifestations of leukemia?

swollen or painful lymph nodes, higher risk for infection due to neutropenia, low-grade fever

symptoms of anemia (fatigue, pallor, etc.) due to inability to produce RBCs

bleeding due to inability to produce platelets

how is leukemia treated?

chemotherapy, bone marrow transplant

what is some education for leukemia?

bleeding precautions, neutropenic precautions, manifestations, progression of disease, need for & side effects of chemotherapy, support system, possibility of sterility

what is primary/secondary/tertiary prevention?

primary: prevention (ex: vaccines, avoiding carcinogenic agents)

secondary: screening (ex: colonoscopy)

tertiary: treatment (ex: chemotherapy, radiation)

what is some education for vitamin b12 deficiency?

dietary sources, need for supplementation, reporting clinical manifestations, prenatal teaching (ex: increases demand for b12), radiation for advanced cancers (ex: may increase demand for b12), risk of developing b12 deficiency with use of acid-reducing medications

what is some education for hemophilia?

inheritance pattern, risk with injury, bleeding precautions

how do you treat hemophilia?

replacement of clotting factors through recombinant DNA products, glucocorticoids & splenectomy can also be beneficial

what is the difference between hemophilia A & B?

A is factor VIII deficiency

B is factor IX deficiency

what should you assess in a sickle cell crisis?

VS, fatigue, pallor, SOB, pain, swelling in joints, jaundice, hand-foot syndrome, fever, labs, psychosocial effects

what are some anticipated nursing actions in a sickle cell crisis?

oxygen administration, hydration, pain medication, antipyretics, supportive measures

what is neutropenia?

decreased neutrophils (infection-fighting WBCs)

how do you protect a neutropenic patient?

measures to avoid infection (no fresh flowers, no fresh fruit from the garden, no swimming in the lake, etc.)

what are the clinical manifestations of iron-deficiency anemia?

hypoxia, fatigue, pallor, tachycardia, spoon-shaped nails, glossitis

how do you treat iron-deficiency anemia?

increased iron intake & iron supplements

what is some education for the treatment of iron-deficiency anemia?

signs of iron overload, dietary sources of iron

side effects of oral iron supplements: GI upset, teeth staining, black tarry stools

what do you differentiate between hodgkin’s & non-hodgkin’s lymphoma when diagnosing?

hodgkin’s lymphoma has reed-sternberg cells present

how do you diagnose lymphoma?

chest x-ray, CT, PET, or MRI

definitive diagnosis: lymph node biopsy

what are some dietary sources of iron?

red meat, dark green leafy vegetables, beets, dry beans, fortified breakfast cereals

what are some dietary sources of vitamin b12?

meat, seafood, eggs, dairy products

what are some dietary sources of folic acid?

green leafy vegetables, bran, yeast, legumes

what are some dietary sources of calcium?

dairy products, orange/grapefruit juice, canned salmon, broccoli, tofu, kale, egg

what type of anemia is caused by lack of intrinsic factor?

pernicious anemia

what are the clinical manifestations of pernicious anemia? (things to look for during examination)

neurological & psychiatric dysfunction (spinal cord degeneration, peripheral neuropathy, altered mental status, depression, visual changes)

tachycardia, SOB, dizziness, fatigue

what are the goals & actions of the medical management of polycythemia vera?

goals: reduce hyperviscosity & prevent hemorrhage (ex: therapeutic phlebotomy)

actions: obtain routine CBCs, increase fluid intake, ensure adequate rest, elevate lower extremities when sitting, modify cardiovascular risk factors

how do you treat multiple myeloma?

biphosphonates, radiation therapy, DVT prophylaxis, dexamethasone, autologous stem cell transplantation, chemotherapy

what are some anticipated nursing actions with multiple myeloma?

administer medications & therapies as prescribed, encourage fluid intake as tolerated, position patient to facilitate comfort, encourage ambulation as tolerated

what are the clinical manifestations of multiple myeloma?

fatigue, weakness, bone pain, recurrent infections, weight loss, paresthesia

what is erythropoietin?

a factor released by the kidneys to stimulate RBC production

how do you treat psoriasis?

reduce clinical manifestations, topical creams, UV light therapy, systemic medications

what is some education for psoriasis?

discontinue UV light therapy if red or blistered skin presents, proper hand-washing, clinical manifestations, signs of skin infection, limit sunlight exposure

what is indicative of some skin infections (ex: staphylococcus, pseudomonas, proteus)?

purulent drainage indicates colonization

what is some education regarding measures to help prevent skin cancer?

limit sun exposure, use sunscreen, skin self-examination, wound care

what is actinic keratosis?

pre-cancerous lesions, can progress to squamous cell carcinoma

presents with multiple skin-colored to reddish brown macules, papules, or plaques from a few millimeters up to cm in sun-exposed areas

what is squamous cell carcinoma?

cancer from epidermal squamous cells attributed to cumulative exposure to UVB rays over an extended period of time

presents with crusted papules & plaques that can become indurated & ulcerated

can also arise from chronically open wounds, burn scars, or legs ulcers because of chronic inflammation

invades fatty tissue & spreads via lymph nodes

what is basal cell carcinoma?

skin cancer arising from the basement membrane of the epidermis

rarely metastatic, can be locally invasive

presents with pearly, translucent, flesh-colored papules, superficial broken blood vessels, & possible rolled edges or ulcerations

what is malignant melanoma?

most serious of all skin cancers, originating from melanocytes

presentation following ABCDE

rapid metastasis can occur

what is the difference between some fungal infections & how they are treated?

capitis = scalp; corporis = body; cruris = groin (jock itch); faciei = face; pedis = feet (athlete’s foot); versicolor = upper chest/back/arms; onychomycosis = nails

most are treated with topical antifungals (some also indicate oral antifungals)

what is the epidemiology of pressure injuries?

2.5 million cases annually

10-18% in acute care facilities

who is most susceptible to pressure injuries?

patients who are completely dependent on the nurse

other risks: history of pressure injuries, decrease mobility, increased age, comorbid conditions, use of steroids, impaired blood flow, cognitive impairment, urinary or fecal incontinence, nutritional deficiencies, dehydration, terminal illness

how do you treat some complicated skin & tissue infections?

impetigo: contagious, localized, inflammatory skin condition; treat with topical mupirocin ointment

folliculitis: superficial inflammation & infection of hair follicles; treat with moist heat, topical mupirocin ointment, clindamycin, oral antibiotics for MRSA

furuncle: infection of hair follicle extending through dermis & forming a small abscess; treat with moist heat (small), or incision, drainage, & antibiotics (large)

carbuncle: furuncle extending to adjacent follicles; treat with incision, drainage, & antibiotics

cellulitis: diffuse infection of the dermis & subcutaneous tissue; treat with systemic antibiotics

cutaneous abscess: collections of pus with the dermis & subcutaneous tissues; treat with incision, drainage, & antibiotics

what are some nursing diagnoses for complicated skin & tissue infections?

acute or chronic pain, impaired tissue integrity, risk for imbalanced fluid volume, risk for infection

what are some anticipated nursing actions for complicated skin & tissue infections?

administer antibiotics based on culture results, wound care as prescribed, surgical evaluation

teaching: hand washing, wound care, signs of infection

when would you use curettage for skin disease?

low-risk, smaller lesions

when would you use mohs surgery for skin disease?

gold standard for non-melanoma skin cancers

when would you use cryotherapy for skin disease?

when would you use punch needle biopsy for skin disease?

not usually needed for localized skin infections (takes a section that contains epidermis, dermis, & upper layers of subcutaneous tissue)

when would you use photodynamic therapy for skin disease?

poor surgical candidates because of other comorbidities, or large & multiple lesions

how do you obtain a wound culture?

wash hands & apply gloves

select culture swab for anaerobic specimen

rotate swab tip over a 1 cm x 1 cm area of viable tissue at or near center of the wound for 5 seconds, applying sufficient pressure to cause tissue fluid to be expressed

immediately insert the culture swab

repeat to obtain second specimen

redress wound, discard used supplies, & remove gloves & wash hands

label culture specimen & place in biohazard transport bag, send to lab within 2 hours

document

how do you classify pressure injuries?

1: non-blanchable redness

2: partial thickness loss

3: full thickness loss, adipose tissue is visible

4: full thickness loss, bone is usually visible

what is some education for herpes simplex virus?

actions of antiviral medications, safe sex practices, considerations in pregnancy

what are some common age-related skin conditions?

xerosis (dry skin), eczema, psoriasis, herpes zoster (shingles)

what is some education for diabetes?

signs of hypo/hyperglycemia, insulin administration, medication education, regular BG monitoring, healthy lifestyle

what are the clinical manifestations of hypoglycemia?

sweating, clamminess, shakiness, irritability, lack of coordination

what are the clinical manifestations of hyperglycemia?

polyuria, polydipsia, polyphagia

how do you control hyperglycemia vs. hypoglycemia?

hyper: insulin (or metformin with type 2)

hypo: give the patient juice or dextrose

what happens if a diabetic patient has an illness or surgery?

the patient will require more insulin because of higher BG

what is diabetic ketoacidosis (DKA)?

there is inadequate insulin, so the body tries to get energy from fat therefore releasing fatty acids which convert to ketones

what are the clinical manifestations of DKA?

polydipsia, polyphagia, polyuria, lethargy, stupor, blurred vision, fruity breath, kussmaul’s respirations, N/V, glycosuria

what are the risk factors for type 2 diabetes?

BMI over 26, physical inactivity, HDL less than 35 &/or triglycerides over 250, metabolic syndrome, prediabetes

what is metabolic syndrome?

high BP, high BG, high cholesterol

what does metabolic syndrome put patients at risk for?

stroke, cardiovascular disease, MI, type 2 diabetes

what is some education for an insulin pump?

basal-bolus delivery system, expenses, responding to BG levels, potential complications, changing the pump, etc.

what is some education for a patient on a diabetic diet?

referral to nutritional professional, individual nutrition guidelines, purpose of nutritional therapy, insulin dose is adjusted based on carb intake, etc.

how often/long should a patient with diabetes exercise?

150 minutes per week, combination of strength & aerobic exercises

what are the carbohydrate recommendations for a diabetic patient?

depends on weight, activity level, medication, & BG goals

general guideline is 45 to 60 g at each meal & 15 to 20 g at each snack

**one serving is 15 g

what is some education on diabetic foot care?

wear white socks, don’t put lotion between toes, keep area between toes dry, avoid tight footwear, recommend thermometer system for the bath or shower, refer to podiatry

what is hyperosmolar hyperglycemic state (HHS)?

increased concentration of sodium & glucose, causing water to draw out from organs, which therefore causes profound dehydration & electrolyte imbalance

what is some epidemiological information about HHS?

usually presents in older patients with type 2 diabetes

carries higher mortality rate than DKA

what are the types of insulin?

long-acting: glargine, lantus, detemir

intermediate: NPH

short-acting: regular

rapid-acting: aspart, lispro, glulisine

what is the difference between the dawn phenomenon & the somogyi effect?

both are increased BG in the morning

dawn is due to natural release of hormones, somogyi is due to excessive insulin at night

what are some macrovascular vs. microvascular complications related to diabetes?

micro: retinopathy, periodontal disease, nephropathy, PVD

macro: cardiovascular disease due to altered lipid metabolism

foot complications result from a combination