NURS 301 - MEDSURG - Liberty University Final Exam

What is a response of the body to any demand made on it?

Stress

what does the GAS theory consist of?

- alarm

- resistance

- exhaustion

What is activated in the alarm phase?

SNS

what is the goal of the resistance phase?

adaptation to avoid exhaustion

what term is defined as being resourceful, flexible, and having good problem solving skills?

resilience

what term is defined as commitment, control, and open to change?

Hardiness

How the patient sees the world and their place in it?

sense of coherence

what are the physiological manifestations of stress?

- decreased immunity

- increased inflammation

- increased blood sugar

What are methods of lowering stress?

- relaxation

- imagery

- meditation

- therapeutic touch

- 4x4 breathing

Where are WBC, RBC, and platelets produced?

bone marrow

What is the best location for aspiration?

- iliac crest

- sternum

What does a shift to the left in WBC indicate?

lots of WBC >10,000 but very immature - indicating a infection

What does a shift to the right in WBC indicate?

Few WBC <5,000, but very mature - indicates immunocompromised

What are the neutropenic precautions?

- hand washing

- isolation

- PPE

- screen/limit visitors

- no fresh flowers

- no produce

- temp check q2hrs

what are the critical values of platelets?

<10,000 or >1 million

what is the function of the spleen?

filters RBC's, takes Hgb from hemolysis and catabolizes the iron and sequesters PLTs and WBCs

what must be monitored following a splenectomy?

- infection

- bleeding

The rate a which RBCs settle in saline over the course of a period?

erythrocyte sedimentation rate (ESR)

An increased ESR would indicate what?

unspecified inflammation within the body

What is ferritin?

storage form of iron

A high ferritin would indicate what?

a high serum iron

The number of available proteins for iron to bind to?

total iron binding capacity (TIBC)

A high TIBC would indicate what?

low serum iron

What is the largest protein that binds with iron but is least preferred?

Transferrin

What measures the effectiveness of warfarin/coumadin?

PT and INR

What measures the effectiveness of heparin?

aPTT

A serious bleeding and thrombotic disorder that results from abnormally initiated and accelerated clotting?

disseminated intravascular coagulation (DIC)

What lab results would you expect from a pt with DIC?

- Low RBC

- High. plates

What type of hemophilia results from a deficiency in factor 8?

hemophilia A

how is hemophilia A and von williebrand disease treated?

DDAVP - vasoconstriction

What type of hemophilia results from a deficiency in factor 9?

hemophilia B (christmas disease)

What is the result of a deficiency in von willebran factor?

von willebrand disease

how long would you treat a hemophilia patient with a minor bleed?

72 hours

how long would you treat a hemophilia patient after surgery?

10-14 days

how should hemophiliac patients manage swollen joints?

rest, ice, pain meds, mobilization (NO ASA)

What are the s/s of iron deficiency anemia?

- pallor

- glossitis

- cheilitis

- burning tongue

How much iron supplements be taken?

one hour before meals with vitamin C

What are the s/s of thalassemia?

- thickening of the cranium and maxillary cavity

- hyperplasia bone marrow

- growth retardation

- bronze colored skin

when is the onset of minor thalassemia?

early adulthood

when is the onset of major thalassemia?

childhood

what type of autoimmune anemia occurs when the body does not produce enough intrinsic factor resulting in vitamin B deficiency?

cobalamin/pernicious anemia

Who is at risk for cobalamin/pernicious anemia?

- alcoholics

- pt with GI issues

how is cobalamin/pernicious anemia treated?

2 weeks of vitamin B12 injections

what is needed for DNA synthesis, RBC formation, and maturation?

folic acid

what type of anemia results in low WBC, RBC, and PLTs?

aplastic

What triggers sickling episodes?

low O2

what causes pain in sickle cell anemia?

vascular occlusion

how is sickle cell anemia treated?

- morphine or hydromorphone

- fluids

- rest

- oxygen

T/F: once initiation begins it cannot be stopped?

true

1 multiple choice option

what puts someone at risk for CA?

promoters

What is known to cause CA?

Carcinogens

T/F: The promotion phase of CA can be reversed?

True

1 multiple choice option

what are examples of promoters?

- dietary fat

- obesity

- smoking

- alcohol use

- UV exposure

What is defined as the seeding of tumor away from primary tumor usually via blood or lymph system?

metastasis

What are the most common sites of metastasis?

- bones

- brain

- adrenal

- liver

- lungs

How do CA cells escape and hide from the immune system?

via immunological escape

What CA markers are used to track tumor presence and development of how well tx is working?

oncofetal antigens

what prevents the immune system from attacking itself during passive immune system?

oncofetal antigens

from grade I to grade IV which are most differentiated to least?

Grade I = well differentiated

Grade II = moderate differentiated

Grade III = poorly differentiated

Grade IV- undifferentiated

What stage of CA is limited to the tissue of origin?

stage 1

what stage of CA is limited to local spread?

stage 2

what stage of CA has extensive local and regional spread?

stage 3

what stage of CA metastasis to other organs?

stage 4

What are the seven warning signs of CA?

- change in bowel/bladder

- a sore that does not heal

- unusual bleeding or discharge

- thickening lump in breast

- indigestion or difficulty swallowing

- obvious change in wart or nevi

- nagging cough or hoarseness

What are the goals of cancer treatment?

- cure

- control

- palliation

what must we consider when performing surgery on CA pt?

- self image

- body alteration

- recurrence

what education needs to be provided about chemo?

- anti emetics before therapy

- hair loss

- low energy activity

- 6 small high calorie, high protein meals per day

what education must be provided about radiation?

- no alcohol

- use warm/soapy water

- non scented

- gentle

- no swimming in chlorine or salt water

- gentle/loose fabric

- gentle detergent

- no sun exposure

- no excessive heat/cold

- observe site for infection

T/F: chemo rarely ever use only one method, almost always use 2+

true

1 multiple choice option

what are the s/s of AML?

- mouth sores

- bleeding

- lymphadenopathy

- sudden and dramatic onset with infection and bleeding

what are the s/s of ALL?

- pallor

- weight loss

- abdominal pain

- hepatosplenomegaly

what are the s/s of CML?

- sternal pain

- joint tenderness

- increased sweating

what symptom is associated with CLL?

anorexia

what CA is associated with reed-sternberg cells?

hodgkins lymphoma

what are some factors associated with hodgkins lymphoma?

- genetics

- toxic chemicals

- epstein barr virus (mono)

what are some s/s of multiple myeloma?

- bone marrow destruction

- hypercalcemia

- low PLTs

- low RBC

should you limit activity in fracture precautions, and why?

no because active bones absorb minerals