NRSE 470: Exam #1

Health includes…

• Physical

• mental

• and social well being

Wellness

A lifestyle of holistic health

Social determinants of health (SDOH)

• impact health and wellness

• Health inequity based on environments where people are born, live and play

• responsible for over 30% to 55%% of health outcomes.

• Examples…

  • housing

  • neighborhoods

  • education

  • job opportunities

  • racial disparities

  • pollution

  • language

  • health literacy

Wellness Continuum

• holistic approach

• Differs from medical model

• Degrees of wellness

Dimensions of Wellness

• Physical

• Emotional

• Environmental

• Financial

• Spiritual

• Social

• Occupational

• Intellectual

Disease Prevention

• Focus: Preventing chronic illness and comorbidities

• Nurse’s role

  • Provide education

  • Clear communication

Domains of SDOH as outlined by Healthy People 2030…

• Economic stability

• Education access and quality

• Health care access and quality

• Neighborhood and built environment

• Social and community context

  • lack of support

Promoting Disease-Prevention Strategies

• Clear communication

• Needs assessment

• Knowledgeable clinicians

• Defined health education

• Nurse’s role

  • NIH tool kit

  • Health policy

  • CDC recommendations

  • Health education

Common Chronic Diseases…

• Heart Disease

• Cerebrovascular Disease

• Diabetes

• Cancer

• Alzheimer’s disease

• Chronic lung

• Chronic kidney

• Osteoporosis

Health Care Support & Health Literacy

• Support and assistance across the continuum

  • Health promotion

  • Disease prevention

  • End-of-life care

Wellness for Health Care Professionals

• Health care workers

  • Cause and barriers to wellness

  • Need for self-care

• Resiliency

  • Approach to stress

  • Health and wellness promotion

  • Mental health services

Health Literacy

• Clients who have low health literacy

  • More likely to use the emergency department

  • Spend more days in the hospital

  • Less likely to follow health recommendations

  • Higher mortality

• Health insurance

  • Factors leading to lack of coverage

    Affordable Care Act, Medicare, and Medicaid

Gender Dysphoria: Role of Nurse

• Affirming gender identity

• Review preferred pronouns

• Discuss gender affirming therapies

• Refer for psychotherapy

• Discuss legal affirmation

LGBTQIA: Health Promotion and Disease Prevention

• Annual STI screening

• Cancer

• Social Determinants of Health

• Healthy People 2030

LGBTQIA: Gender affirming care

• Gender- affirming surgeries

  • Fully reversable

    • Use of gonadotropin releasing hormone

  • Partially reversable

    • Hormone therapy

  • Irreversible

    • Surgery

Cancer: Pathophysiology

• Changes / damage to cells

• Caused by…

  • Inherited traits

  • Errors in cell division

  • Environmental factors

    • Tobacco

    • Ultraviolet light exposure

• Effect of aging

• Progression:

• Hyperplasia → Dysplasia → Carcinoma in situ → Malignant

Characteristics of Benign Cancer Cells

• Growth rate

  • Slow, progressive

• Cell differentiation

  • Well differentiated (cells resemble tissue of origin)

• Cell size & shape

  • Uniform

  • Regular nuclei

• Invasion

  • Encapsulated

  • Does not invade surrounding tissue

• Metastasis

  • Absent

• Recurrence after removal

  • Rare

• Effect on Host

  • Usually minimal, unless location interferes with vital functions

Characteristics of Malignant Cancer Cells

• Growth rate

  • Rapid

  • Uncontrolled

• Cell differentiation

  • Poorly differentiated

  • Undifferentiated (Anaplastic)

• Cell size & shape

  • Pleomorphic

    • Varying sizes / shapes of cells and nuclei

• Invasion

  • Invades and destroys surrounding tissue

• Metastasis

  • Frequently present via blood, lymph and direct seeding

• Recurrence after removal

  • Common

• Effect on Host

  • Severe can cause…

    • Cachexia

    • Organ failure

    • Death

Cancer: Risk Factors

• Smoking

• Alcohol consumption

• Excess body weight

• Sedentary lifestyle

• Dietary habits

• Viruses & bacteria

  • Hep B or Hep C can lead to liver cancer

  • Infection with Epstein- barr: increased risk of lymphoma

  • HPV increased risk of cervical cancer

  • HIV increased risk of lymphoma and Kaposi sarcoma

  • Helicobacter pylori can increase risk of stomach cancer and lymphoma

• Environmental factors

• Protect skin and eyes from UVA & UVB

Stages of Cancer

• TNM (tumor, node, metastasis)

  • T = size and extent of the primary tumor

  • N = number of nearby lymph nodes that show cancer

  • M = whether the cancer has metastasized

• Stages 0 to 4

  • Stage 0

    • Abnormal cells are present but have not spread.

  • Stage I

    • Less serious and have a better prognosis.

  • Stage 2-4

    • Cancer is larger and has had greater spread beyond the primary site

Cancer: Clinical Manifestations

• Unexplained weight loss

• Fatigue

• Palpable masses

• Swelling

• Pain

• Skin changes / nonhealing lesions

• Unexplained / persistent cough

• Unexplained bleeding or discharge

Breast Cancer: Screening Recommendation

• Breast

  • Age: 45 - 54

  • Mammogram yearly

Colorectal Cancer: Screening Recommendation

• Colorectal

  • Age: 45 - 75

  • Stool screening/ visual exam

  • Ages 75-85

    • varies per patient, depending on risk factors and overall health

  • Over 85

    • screening is no longer required

  • Stool

  • Visual

  • Colonoscopy EVERY 10 years

Prostate Cancer: Screening Recommendation

• Prostate

  • Screening depends on risk factor

  • Prostate Specific Antigen (PSA)

  • Retesting every 2 years if PSA is less than 2.5 ng/mL

Cervical Cancer: Screening Recommendation

• Age: 25 to 65

• Pap test with HPV every 5 years

• Without HPV every 3 years

Lung Cancer: Screening Recommendation

• Age 50 to 80 years old

• Smoking history

• Helical CT

  • Spinal

Cancer: Impact of Overall Health - Physiological

• Pain

• Infections

  • neutropenia can develop due to chemo which is a lower wbc

  • minor infection cause lead to sepsis

• Gastrointestinal

• Lymphedema

• Peripheral neuropathy

  • Many cancer treatments can cause nerve damage

  • Clinical manifestations

    • numbness

    • tingling

    • decreased ability to sense hot, cold, or pain

• Fertility

  • Fertility preserving

    • Egg freezing

    • Embryo freezing

    • Radiation shielding

Cancer: Impact of Overall Health - Cognitive

• Sleep disturbances

  • Many medications, such as corticosteroids, contribute

• Delirium

• Concentration problems

• Decreased organizational abilities

• Impaired memory

• Fatigue

Cancer: Impact of Overall Health - Psychosocial stressors

• Distress in cancer

• Depression

• Financial stressors

Cancer: Impact of Overall Health - Health promotion & disease prevention

• STOP smoking

• Routine screening

Lymphedema

• Frequent cancer complication

• Can result from any cancer or treatment that impacts lymph node drainage

• Clinical manifestations

  • Heaviness

  • Swelling

  • Sensation of tightness

  • Decreased ROM

  • Itching

  • Burning

  • Sleep disturbance

Administration of chemotherapy

• PPE

  • Chemotherapy gown

  • Double chemotherapy gloves

  • Face and eye protection if there is any risk of splashing or emesis

  • Respiratory protection if there is any risk of inhalation

• Extravasation

  • Potentially severe tissue damage can occur

  • Many intravenous chemotherapy medications are potentially hazardous to tissues outside of the vein.

Cancer: Education

• Oral and topical chemotherapy

  • Avoid unprotected sex.

  • experiences nausea and vomiting

  • Medication Administration

    • Gloves and Safe disposal are required

• Venous access devices: central venous catheter (CVC)

  • keeping all CVC dressings dry and intact

  • Monitoring for manifestations of infection at the insertion site

  • Keeping the catheter from getting pulled

  • Abides by the routine flushing schedule

• Cell counts

  • Anemia

    • may stop treatment

    • blood transfusion

  • thrombocytopenia

    • low platelet count

• Symptom management

• Preventing infections

• Radiation

  • Clinical manifestation:

  • Fatigue

  • Alopecia

  • Skin changes: Erythema, irritation, swelling, blisters or changes in pigmentation

Biotherapy/ Immunotherapy

• Cancer treatment using the client’s own immune system by stimulating the immune system in order to attack cancer cells and help restore function of the immune system

• Nursing role

  • Patient and family education

  • Medication admin same as chemotherapy

Cancer Treatment: Procedures

• Tumor Reduction

  • Destruction of the main arteries that provide blood flow to the tumor

• Tumor Excision

Cancer Treatment: Nursing Considerations

• Perioperative care

• Prevent general complications postoperatively

• Prevent and treat pain

• Education

• Support for patient and family

Chemotherapy

• Use

  • Help control progression

  • Use to cure a disease

  • palliative treatment for terminal disease

• Damage a cell’s DNA

Chemotherapy: Oral

just as toxic to patient and nurse administering/ handling

Chemotherapy: Parenteral

Closely monitor IV infusions

Parenteral Chemotherapy: Extravasation

• Prevention of and monitoring…

  • Ensuring intravenous access is functioning properly is crucially important.

• Nursing interventions

  • Stop the infusion

  • Notify provider

  • under some circumstances, aspirating any remaining drug from the line.

• Additional Treatments

  • Applying hot and cold therapy

  • Admin of antidote medications to minimize tissue damage.

• In serious cases

  • Surgical management

Extravasation: Clinical Manifestations

• Pain

• Swelling

• Redness

• Problems with intravenous access.

Chemotherapy: Other Routes

• Intraventricular (ventricles of the brain)

• Intracavity (intraperitoneal cavity)

  • Some discomfort may be present during administration

• Intravesicular (bladder)

• Intrapleural (pleural cavity)

• intrathecal (spinal cavity)

Chemotherapy: Complications

• Immunosuppression/ neutropenia

• Nausea/ Vomiting/ Anorexia

• Alopecia

• Hypersensitivity

• Oral effects

• Anemia/ Thrombocytopenia

• Chemo-induced peripheral neuropathy

• Cognitive impairment.

Chemotherapy: Patient Education

• Precautions

  • Avoid crowds

  • Hand Hygiene

  • Avoid foods that may contain bacteria

  • Eat small meals

  • Encourage high protein, high calorie nutrient dense foods

  • Protect scalp/ skin from sun exposure (after hair loss)

  • Managing active bleeding / prevent injury

  • Strategies to improve memory and concentration

Radiation Therapy

• High Energy radiation to targeted tissue and destroy cells

• Delivered internally or externally

• Given as a series of small doses over time

• May be used Preoperatively to decrease the size of the tumor

Radiation Therapy: Side effects

• Skin changes

• Hair loss

• Stomatitis

• Fatigue

• Anorexia

• Bone marrow suppression

Other Cancer Therapies

• Hormone therapy

  • Effective against tumors that are supported or suppressed by hormones

  • Breast and Prostate cancer

• Immunotherapy

  • Uses Patient’s immune system by stimulating the immune system to attack cancer cells and help restore function of the immune system

  • Nursing role

    • Wear the proper PPE and use safe practices

    • Oral and topical therapy

      • Precaution: others are not exposed to the client’s blood or bodily fluids

• Targeted Therapy

Oncologic Emergencies: SIADH

• Excess levels of antidiuretic hormones are produced.

• Causes the body to retain water. This causes dilution of electrolytes (sodium in the blood).

• Often associated with lung and brain cancers.

• Clinical Manifestations

  • Nausea & Vomiting (early)

  • Lethargy

  • Hostility

  • Seizures

  • Coma (late)

• Nursing interventions

  • Monitor sodium

  • Administer Lasix

  • 0.9 NACL fluids IV, or hypertonic fluids.

  • Monitor Vital signs.

Oncologic Emergencies: Hypercalcemia

• Common complication: Breast, Lung head and neck cancers- leukemia and lymphoma multiple myeloma and bony metastases of any cancer.

• Clinical Manifestations:

  • Anorexia

  • Nausea & Vomiting

  • Short QT interval

  • Kidney stones

  • Changes in mental status

• Nursing interventions

  • Administer 0.9 NACL

  • Administer Lasix, and phosphates as prescribed

Oncologic Emergencies: Superior Vena Cava Syndrome

• Obstruction of venous return and engorgement of the vessels from the head and upper body

• Clinical Manifestations

  • Periorbital and facial edema

  • Erythema of the upper body (skin redness)

  • Dyspnea

  • Epistaxis.

• Nursing management

  • High fowlers position: lung expansion

  • High dose radiation for emergency temporary relief

Oncologic Emergencies: Hematologic disorders

• Caused by the cancer itself or by the chemotherapy

• Nursing interventions

  • Monitor for bleeding

  • Admin clotting factors

  • Medication: Heparin

    • Used to slow the events that makes the body overuse its blood clotting factors

Oncologic Emergencies: Sepsis

• Patients that are neutropenic are at increased risk

• Nursing interventions

  • Administer medications as ordered

    • Antibiotics

    • Fluids

    • Vasopressors

  • Blood cultures & blood lactate may also be ordered to diagnosis

Oncologic Emergencies: Spinal Cord Compression

• Occurs when the spinal cord degrade secondary to cancer or tumors invading the spinal column. Permanent neurologic damage can occur without intervention

• Nursing interventions

  • High dose corticosteroids: reduce inflammation

  • Monitor neurological status

  • Prepare client for surgery or radiation therapy to relieve spinal cord compression

Oncologic Emergencies: Tumor Lysis Syndrome

• Tumors are rapidly destroyed releasing content into the bloodstream faster than the body can process them.

• This rapid release can cause hyperkalemia, hyperuricemia.

• Clinical Manifestations:

  • GI distress

  • Flank pain

  • Muscle cramps

  • Seizures

  • Weakness

  • Mental status changes

• Nursing interventions

  • Encourage fluids

  • Administer medication

  • Hemodialysis and intensive care may be required.

Cancer: Pain Management

• NSAIDS

• Opioids

• Antidepressants

• Anticonvulsants

• Corticosteroids

• Topical

Palliative Care

• Holistic care for those who are experiencing severe medical illness and clients approaching end of life

• Implemented earlier in the course of life-threatening health events

• Helps with…

  • Improve quality of life

  • Reduce time in the hospital

  • Improve client satisfaction

Hospice Care

• For terminal illness

• Focus on Comfort, Dignity, Personal growth in the face of death

• Holistic treating the patient and their family

Breast Cancer: Risk Factors

• Gene mutations

• Advanced age

• Family history

• Obesity

• Alcohol use

• Radiation exposure

• Breast disease

• Dense breast tissue

• Estrogen exposure

Breast Cancer: Clinical Manifestations

• Mass or lump

• Swelling

• Discharge

• Nipple retraction

• Skin changes

• Swollen lymph nodes

Breast Cancer: Lab and diagnostic studies

• Mammograms

  • Screening

  • Diagnostic

• Clinical breast exam

• MRI

• Biopsy

• Hormone-sensitivity testing

• Growth factor testing

Breast Cancer: Treatments and Therapies

• Surgery

• Radiation

• Chemotherapy

• Hormone therapy

• Targeted therapy

Lung Cancer: Risk Factors

• Smoking

• Radon gas

• Secondhand smoke

• Exposure to

  • Asbestos

  • Radiation

  • Air pollution

  • Diesel exhaust

  • Metals

  • Chemicals

Lung Cancer: Clinical Manifestations

• Cough

• Hemoptysis

• Shortness of breath

• Fatigue

• Weight loss

• Chest pain

• Respiratory infections

• New wheezing

• Hoarse voice

Lung Cancer: Diagnostic tools

• Chest imaging

• Biopsy

• Sputum cytology

Lung Cancer: Treatment and Therapies

• Surgery

• Chemotherapy

• Radiation

• Targeted therapy

Prostate Cancer: Risk Factors

• Age (50 and older)

• Family history

• Smoking

• Increased body weight

• Survival rates

• Racial disparities

  • Black individuals in the United States

Prostate Cancer: Clinical Manifestation

• Urinary frequency

• Problems with urine flow

• Erectile dysfunction

• Blood in urine or semen

Prostate Cancer: Diagnostic tools

• Digital rectal examination

• PSA

  • blood test

  • Higher PSA levels correlate with an increased risk of prostate cancer

• Ultrasound

• MRI

• Biopsy

Prostate Cancer: Treatment and Therapies

• Surgery

• Radiation

• Chemotherapy

• Immunotherapy

• Hormone therapy

• Targeted therapy

Colorectal Cancer: Risk Factors

• Excess body weight

• Low activity level

• Smoking

• Diet

• Alcohol intake

• Medical conditions

Colorectal Cancer: Clinical Manifestations & Diagnostic tools

• Changes in bowel habits

• Blood in stool

• Rectal bleeding

• Anemia

• Abdominal discomfort

• Weight loss

• Fatigue

Diagnostic tools

• Fecal occult testing

• CEA levels

• Colonoscopy

• Biopsy

Colorectal Cancer: Treatments and Therapies

• Surgery

  • Surgical resection

  • A colostomy is often required

• Chemotherapy

• Radiation

• Targeted therapy

• Immunotherapy

• Radiofrequency ablation

  • A probe is inserted, and small electrodes kill the cancer cells

Pancreatic Cancer: Risk Factors

• Smoking

• Medical conditions

• Family history

• Genetic conditions

• Increased body weight

• Alcohol consumption

Pancreatic Cancer: Clinical Manifestations

• Jaundice

• Skin itching

• Dark urine

• Light colored bowel movements

• Pain

• Anorexia

• Weight loss

• Nausea and vomiting

Pancreatic Cancer: Labs and diagnostic testing

• Liver function testing

• Tumor markers

• Biopsy

• CT scans

• Ultrasound

• Cholangiopancreatography

  • Uses MRI to visualize the pancreatic and bile ducts.

Pancreatic Cancer: Treatments and Therapies

• Surgery

  • the entire pancreas (total pancreatectomy) or the distal pancreas (distal pancreatectomy)

• Radiation

• Chemotherapy

• Targeted therapy

Skin Cancer: Risk Factors

• Advanced age: Major risk factor

• Ultraviolet radiation

• Family history

• Advanced age

• Moles

• Immunosuppression

Skin Cancer: Clinical Manifestations & Lab testing

• Skin changes

• Lab testing

  • Biopsy

Skin Cancer: Treatments and Therapies

• Chemical peels

  • Option for Actinic Keratoses

• Photodynamic therapy

• Surgery

  • First line of treatment

• Radiation

• Chemotherapy

• Immunotherapy

• Targeted therapy

Brain and CNS Tumors: Risk Factors

• Environmental exposure

• Infection

• Older adults

Brain and CNS Tumors: Clinical Manifestations

• Headaches

• Seizures

• Nausea and vomiting

• Visual changes

• Balance issues

• Behavioral changes

Brain and CNS Tumors: Lab testing

• CT

• MRI

• PET

• Biopsy

Brain and CNS Tumors: Treatments and Therapies

• Active Surveillance

• Surgery

  • Partially or fully remove a tumor

• Chemotherapy

  • Chemotherapy wafer

    • Delivers medication directly to the tumor site.

  • Intrathecal chemotherapy

    • Instilled directly into the brain or spinal co

• Radiation

• Targeted therapy

Liver, Pancreas & Gall bladder

• Liver

  • Vital role with coagulation factors

• Pancreas

  • Regulate blood sugar

• Gallbladder

  • Stores bile

  • Stores bile necessary for fat digestion

  • Releases bile after food ingestion

Cholecystitis

• Inflammation of the gallbladder

• Can be acute or chronic

• Acute cause

  • Due to being NPO on TPN

• Caused by the blocking of the common bile duct

Cholecystitis: Risk Factors

• High fat diet

• Females

• Hormonal therapy

• Pregnancy

• Obesity

• Family history

• Patients older than 65 years old

Cholecystitis: Clinical Manifestations

• Right upper quad pain

• Nausea

• Vomiting

• Fever

• Jaundice (rare)

Cholecystitis: Testing and imaging

• Testing

  • CBC

  • CRP

  • CMP

  • amylase & lipase.

• Imaging:

  • Ultrasound

  • HIDA scan

  • CT

  • MRCP

Cholecystitis: Impact on overall health

• First line of defense: Take out gallbladder

• Older patients

  • May not be able to have surgical intervention

  • Medical management instead

Cholecystitis: Fluid & Electrolyte Imbalances

• Patient will experience

  • Decrease appetite

  • Nausea

  • Vomiting leading to dehydration

• Patient will be NPO they require…

  • IV fluids for rehydration

  • Monitor electrolytes

    • IV electrolytes correction

Cholecystitis: Nursing role

• Frequent oral care for NPO patients

• Allow pt to be in comfortable position

• Pain control

  • NSAIDS or Opioids management

Cholecystitis: Patient Education

• Dietary changes

  • Reduce fried foods

  • Reduce fatty foods

• Encourage regular exercise and weight management

Cholecystitis: Treatments and Therapies

• NPO status to rest gallbladder

• IV fluids and antibiotics

Cholecystectomy

• standard treatment

• Usually Laparoscopy

• Removal of gallbladder

• Delayed treatment

  • Can cause peritonitis

    • Rigid abdomen

Pancreatitis

• Most frequent causes

  • Alcohol abuse

  • Gall stones

• Can cause issues with

  • Renal

  • high mortality

• Risk Factors

  • Drinking

  • Smoking

  • Increase age

  • Family history

Pancreatitis: Clinical Manifestations

• Nauseas

• Vomiting

• Severe abdominal pain

• Grey Turner’s, Cullen’s and Fox’s sign

Pancreatitis: Labs & Diagnostics

• Labs:

  • Blood amylase

  • WBC count

  • Platelets

  • Blood Ca & Mg

  • Liver enzymes & bilirubin

  • Serum glucose

  • ESR

• Diagnostic

  • CT scan (With contrast)

Pancreatitis: Nursing Intervention

• Keep patient NPO

• Give patients fluids

• Pain management

  • NSAIDS

    • Mild moderate pain

  • Morphine or hydromorphone

    • Acute pain

• Antibiotics

• Proton Pump Inhibitors

  • reduce the production of stomach acid

• Pancreatic Enzymes

Pancreatitis: Patient Education

• Pain management

• Metabolic needs

• Nutritional and fluid status

• Support groups for patient and family