3545 Exam 5 (Exemplars)

CAUTI Risk Factors

Prolonged catheter dwell time, break in sterile technique, poor caregiver hand hygiene, catheter without indication, short female urethra, obstruction, diabetes, aging.

CAUTI Pathophysiology

Bacteria ascend urethra to bladder. CAUTI = UTI with catheter in place or within 48 HOURS after removal; largely caused by E. coli (~90%). Biofilm on the catheter obstructs antibiotic penetration.

CAUTI Signs & Symptoms

Frequency, urgency, dysuria, suprapubic tenderness, cloudy foul urine, hematuria. Usually afebrile; older adults may exhibit confusion. Fever typically indicates an upper urinary tract infection.

CAUTI Concepts

Primary concept is elimination; includes infection, comfort, fluid balance, safety. Priority hypotheses include acute pain, risk for sepsis, knowledge deficit.

CAUTI Treatments

Antibiotics: Nitrofurantoin, TMP-SMX, fosfomycin. Use phenazopyridine for discomfort (analgesic, not antibiotic). Emphasize hydration and frequent voiding; REMOVE THE CATHETER.

CAUTI Diagnostics

UA findings: leukocyte esterase (+) indicates pyuria, nitrites (+) suggest Enterobacteriaceae, WBC count >10/HPF. Culture only if pregnancy, recurrent, atypical cases, or after treatment failure; must be done before antibiotics.

CAUTI Nursing Management

Ensure hand hygiene before and after any catheter contact, only insert catheters if indicated, assess need daily, and remove ASAP. Maintain closed system with regular CHG, keep bag below bladder, avoid kinks, and clean container per patient.

CAUTI Education

Encourage fluid intake of 2-3 L/day, void before and after intercourse, wipe front to back, and avoid caffeine, bubble baths, and scented products. Stress the importance of completing antibiotics and reporting fever, flank pain, or recurrence.

Cellulitis Risk Factors

Break in skin integrity (portal of entry), diabetes, advanced age, immobility, immune compromise, lower extremity location, PVD, edema.

Cellulitis Pathophysiology

Bacterial invasion of skin and subcutaneous tissue causing inflammation, edema, and progressive tissue involvement; includes Strep pyogenes and Staph aureus (including MRSA).

Cellulitis Signs & Symptoms

Erythema, warmth, swelling, pain, drainage, expanding borders. Systemic spread indicated by extended redness or phlebitis, fever, tachycardia, rising WBC, confusion.

Cellulitis Concepts

Infection and tissue integrity; inflammation, pain, perfusion. In diabetes, include glucose regulation. Priority: impaired tissue integrity and potential for systemic infection/sepsis.

Cellulitis Treatments

Oral antibiotics for mild cases; IV antibiotics for moderate/severe illness. Cultures should be taken before antibiotics, and the entire course must be completed. Use acetaminophen for fever and analgesics for pain.

Cellulitis Diagnostics

CBC showing leukocytosis and elevated neutrophils, ESR/CRP, wound culture if drainage present, blood cultures if febrile/immunocompromised. Ultrasound or CT may be used for abscess detection, glucose testing in diabetics.

Cellulitis Nursing Management

Mark the border with a pen and date it, reassess each shift for advancement. Elevate the limb, conduct skin assessments, monitor wounds, and administer antimicrobials. Observe Contact Precautions if MRSA is suspected.

Cellulitis Education

Complete the full course of antibiotics. Report any redness beyond the marked border, new fever, increasing pain, or red streaking. Elevate the limb at home, conduct daily skin/foot inspections, and control glycemic levels.

Pyelonephritis Risk Factors

Recurrent UTI, vesicoureteral reflux, obstruction (stones, prostate), diabetes, pregnancy, long-term catheter. Chronic factors include structural deformity, stasis, obstruction, reflux from spinal cord injury, diabetic neuropathy, neurodegenerative disease.

Pyelonephritis Pathophysiology

Infection ascends from the bladder to the kidney (renal pelvis then tubules), leading to edema, tubular necrosis, and possibly abscess formation. Filtration/reabsorption/secretion are reduced. Acute form signifies active infection, while chronic form involves fibrosis, scarring, and chronic kidney disease (CKD).

Pyelonephritis Signs & Symptoms

Symptoms include fever, chills, tachycardia, flank/CVA pain, nausea, vomiting, malaise, along with cystitis symptoms. Older adults may experience confusion, anorexia, and weakness. Fever plus flank pain indicates an upper tract infection.

Pyelonephritis Concepts

Focus on infection and elimination, encompassing pain, fluid balance, renal perfusion, and cognition. Priority concerns include acute pain, potential for CKD, and risk for urosepsis.

Pyelonephritis Treatments

Initial treatment with broad-spectrum IV antibiotics, narrowing after culture results. Acetaminophen is preferred over NSAIDs to maintain renal perfusion. Encourage adequate fluid intake (~2 L/day) and consider surgery for large renal pelvis stones (pyelolithotomy).

Pyelonephritis Diagnostics

Always obtain UA + culture; WBC casts suggest upper tract infection. CBC usually shows leukocytosis with neutrophilia, and BMP assesses creatinine. Blood cultures are indicated if febrile or toxic, while imaging is not routine if the patient is improving within 48-72 hours.

Pyelonephritis Nursing Management

Prioritize urine culture before the first antibiotic dose. Avoid nephrotoxic medications and closely monitor vital signs, input/output, urine clarity, and patient pain. Collaboration among the RN, RT, dietitian, and MD is essential.

Pyelonephritis Education

Instruct patients to complete all antibiotics and maintain adequate fluid intake. Report fevers above 101 F or flank pain, and avoid nephrotoxic substances. Encourage balancing rest with activity and ensure follow-up with nephrology if renal function is impaired.

Pneumonia Risk Factors

CAP: older adult, unvaccinated, COPD/heart disease/diabetes, tobacco/alcohol use, recent viral exposure. HAP: occurs 48+ hours after admission due to trach, NG tube, poor oral hygiene, immobility, altered LOC, acid-suppressive medications.

Pneumonia Pathophysiology

Acute inflammation of lung parenchyma leading to capillary leak, edema, and exudate, resulting in decreased gas exchange and hypoxemia, possibly leading to sepsis or empyema. Lobar pneumonia affects whole lobes; bronchopneumonia presents in patches. The key difference between HAP and CAP is antibiotic resistance.

Pneumonia Signs & Symptoms

Fever, dyspnea, tachypnea, hypoxemia, productive yellow/rust sputum, pleuritic pain, crackles, low SpO2, consolidation seen on CXR. Older adults may present with confusion, and fever/cough/WBC may be absent. Hypoxia may contribute to a tripod position.

Pneumonia Concepts

Primary concept is gas exchange. Also includes infection, inflammation, cognition, and safety. Priority hypotheses in order: 1) decreased gas exchange, 2) potential airway obstruction, 3) potential for sepsis.

Pneumonia Treatments

Provide oxygen to maintain SpO2 ≥95% or baseline. Administer antibiotics/antivirals after cultures are taken. Use bronchodilators for bronchospasm. Encourage hourly incentive spirometry and coughing/deep breathing every 2 hours. Aim for ~2 liters of fluids per day.

Pneumonia Diagnostics

CBC may show leukocytosis with left shift. Check lactate levels if sepsis suspected. Obtain sputum and blood cultures in cases of severe CAP, ICU admissions, outpatient failure, leukopenia, effusion, or with MRSA/Pseudomonas concerns. CXR should be performed for new infiltrates.

Pneumonia Nursing Management

Incentive spirometer increases inspiratory muscle action and decreases atelectasis; however, it does not reduce sputum, crackles, or effort. Hourly use indicates progress towards oxygenation goals. No airborne precautions are needed, unless TB is suspected.

Pneumonia Education

Complete the full course of antibiotics, report recurrent fever, cough, dyspnea, avoid smoke and infection exposures, and stop smoking. Emphasize the importance of influenza and pneumococcal vaccines, and gradual resumption of activity.

MDROs Risk Factors

Antibiotic misuse, overuse, incorrect dosing, early discontinuation. Open wounds, catheters, ventilators, older adults, prior MDRO colonization, recent surgery/hospitalization. CA-MRSA is common in prisons, athletic teams, and dorms.

MDROs Pathophysiology

MRSA colonizes skin, nares, and perineum through direct contact. VRE resides in the GI tract and can survive on surfaces for days to weeks, causing endocarditis. CRE, such as Klebsiella and E. coli, produces enzymes that destroy carbapenems. Biofilm (glycocalyx) blocks antibiotic penetration.

MDROs Signs & Symptoms

No unique profile; presents as infection at the site. Resistance cues include failure to improve on empiric therapy, persistent infection, progression to bacteremia, and culture reading resistant.

MDROs Concepts

Infection and safety, health care quality. Priority concerns include potential for transmission, potential for treatment failure, potential for sepsis, and potential for social isolation.

MDROs Treatments

Culture-based selection; narrow spectrum after sensitivities are known. MRSA decolonization includes chlorhexidine baths and nasal mupirocin. Vancomycin trough should be drawn 30 minutes before the next dose and peak levels 30-60 minutes after.

MDROs Diagnostics

Culture and sensitivity tests crucial; sensitive means the drug works, resistant means it does not. Tissue culture is the definitive method to identify an organism. Surveillance cultures may indicate colonization.

MDROs Nursing Management

Implement contact precautions with strict hand hygiene. Clean and disinfect equipment. Support antibiotic stewardship. Use dedicated equipment and cohort patients with the same pathogen. Remove devices promptly to minimize biofilm risk.

MDROs Education

Complete antibiotics and avoid early cessation or dose saving. Use antibiotics only when necessary. Emphasize hand hygiene and explain the importance of contact precautions. For CA-MRSA, maintain good hygiene, do not share items, and cover wounds.

Standard Precautions Exposure Risk

Any anticipated contact with blood, body fluids, secretions, non-intact skin, or mucous membranes. Includes splash risk, all specimen collection, sharps, invasive devices, and patient risks such as age, chronic illness, steroids/chemo, malnutrition.

Standard Precautions Rationale

Precautions break the mode of transmission and portal of entry links in the chain of infection. They are applied to all patients all the time, because colonization is often asymptomatic. Transmission-based tiers are added on top of standard precautions.

Standard Precautions Tiers

Airborne: TB, varicella, COVID, measles → N95 + negative pressure. Droplet: influenza, pertussis, meningitis → mask within 3 ft. Contact: MRSA, VRE, CRE, C. diff → gloves, gown, dedicated equipment.

Standard Precautions Concepts

Infection, safety, health care quality. Priorities include potential for transmission, potential for healthcare-associated infections (HAI) related to devices and environment, and potential for social isolation.

Standard Precautions Interventions

Five components: hand hygiene, PPE, sharps safety (never recap), environmental cleaning, and respiratory hygiene. Wash hands for 15-30 seconds with friction; alcohol-based hand rubs (ABHR) only if hands are not visibly soiled, as they are useless against C. diff.

Standard Precautions Determining Tier

Determined based on diagnosis, suspected organism, and route of spread, prior MDRO history, and culture results. Start on suspicion, not confirmation.

Standard Precautions Nursing Management

Hand hygiene is the most effective measure. Clean high-touch areas, provide a private room for airborne or protective environment cases, and remove devices when no longer needed. No fans in isolation rooms.

Standard Precautions Education

Explain the cause and transmission of infections, teach signs of worsening such as fever, swelling, and drainage. Reinforce completing antibiotics and address fears about spreading infection. Demonstrate proper PPE use and the importance of influenza and pneumococcal vaccinations.

Seizures Risk Factors

Fever, head injury, hyponatremia, alcohol/drug withdrawal, hypoglycemia. Secondary causes include tumor, trauma, metabolic imbalance, water intoxication, stroke, and infection. Status epilepticus may be caused by abrupt AED withdrawal, infection, metabolic imbalance, or TBI.

Seizures Pathophysiology

A sudden, single episode of abnormal brain electrical activity altering level of consciousness (LOC), motor, or sensory function. Generalized seizures involve both hemispheres, while partial/focal seizures involve one. Unclassified seizures are non-categorizable, making up ~half of all seizures.

Seizures Signs & Symptoms

Tonic-clonic seizures last 2-5 minutes (stiffen followed by jerking, postictal state). Tonic seizures last 30 seconds to a minute. Clonic seizures last several minutes. Myoclonic seizures involve brief jerking of seconds. Atonic seizures result in sudden loss of tone, lasting seconds. Simple partial seizures are conscious with aura and one-sided twitch, while complex partial seizures lead to blackout of 1-3 minutes with automatisms and amnesia.

Seizures Concepts

Focus on intracranial regulation, perfusion, mobility, cognition, and sensory perception. Priority concerns include potential for airway compromise and hypoxia (airway is always first), potential for injury, and potential for status epilepticus.

Seizures Treatments

Start with one AED, titrate slowly. For status epilepticus (more than 5 minutes), prioritize airway management, oxygen, IV normal saline, and AED administration. Lorazepam is administered first, followed by a loading dose of phenytoin. Phenytoin must be diluted with normal saline only, given through a large vein, and never in the hand. Vagal nerve stimulation (VNS) is implanted under the left clavicle for partial seizures.

Seizures Diagnostics

Assess ethanol and illicit substance levels. EEG identifies the origin of seizures. MRI, CT, CSF, and skull x-ray are used to determine causes. Monitor CBC, liver function tests (LFTs), serum drug levels during therapy, and check glucose and sodium levels.

Seizures Nursing Management

Bedside management includes ensuring availability of oxygen, suction, airway access, a saline lock, and keeping the bed low. During a seizure, place the patient side-lying, protect the head, time the seizure, avoid putting anything in the mouth, and do not use restraints. After a seizure, position the patient side-lying, monitor vitals, check for injuries, perform neurological assessments, and inquire about the aura if applicable.

Seizures Education

Take AEDs consistently, never skip doses, and never stop them abruptly. Wear a medical ID bracelet and avoid alcohol, fatigue, and flashing lights. Understand state driving laws and work restrictions, and maintain a seizure diary.

Epilepsy Risk Factors

Primary or idiopathic epilepsy has no identifiable structural or metabolic cause, likely due to genetic or neuronal channel abnormalities. Risks for deterioration include abrupt AED withdrawal (most preventable), infection, metabolic imbalance, TBI, and missed doses.

Epilepsy Pathophysiology

A chronic disorder characterized by two or more unprovoked seizures due to abnormal electrical activity or decreased GABA. All three elements are required for a diagnosis. Secondary seizures result from an identifiable cause and are not classified as epilepsy as they stop when the cause is addressed.

Epilepsy Signs & Symptoms

Presents as the specific type of seizure the patient experiences. Chronic markers include a history of two or more unprovoked seizures, a consistent pattern, aura, interictal EEG changes, and breakthrough seizures indicating nonadherence to treatment.

Epilepsy Concepts

Focus on intracranial regulation, cognition, safety, self-management, and coping. Priority concerns include potential for recurrent seizures related to nonadherence, potential for status epilepticus, and impaired self-management.

Epilepsy Treatments

Begin with one AED and titrate dosage; combining medications may be considered. For status epilepticus, lorazepam followed by phenytoin is recommended. Levetiracetam (Keppra) may be used for unclassified or unexplained seizures at discharge. VNS is indicated for partial seizures. Abrupt changes in medication should be strictly avoided.

Epilepsy Diagnostics

Serum AED levels are evaluated to determine therapeutic ranges and adherence. Check CBC and LFTs for signs of toxicity. EEG assists in characterizing seizure types. MRI/CT scans may rule out any acquired causes, which could reclassify the condition as secondary.

Epilepsy Nursing Management

Acute management follows the same protocol as for seizures. A chronic focus is essential, assessing adherence at every encounter, reviewing the seizure diary for potential triggers, observing side effects and drug-food interactions, monitoring AED levels, CBC, and LFTs, and screening for psychosocial impacts.

Epilepsy Education

Never stop AEDs abruptly as this can trigger status epilepticus. Consistency in taking medication is crucial. Patients should wear a medical alert bracelet and maintain a seizure diary. Understand restrictions related to driving and hazardous work, while recognizing laws that prohibit discrimination. Family members should be informed about seizure responses, including calling 911 if a seizure lasts longer than five minutes.

Hypoxia Risk Factors

Respiratory factors include pneumonia, retained secretions, atelectasis, COPD, and aspiration. Neurologic factors include apnea in the tonic phase, altered LOC losing airway protection, anoxia in status epilepticus over 10 minutes, postictal respiratory depression, and stroke with aspiration risk. Additional factors involve anemia and older age.

Hypoxia Pathophysiology

The brain stores neither oxygen nor glucose, so any interruption causes immediate functional change. In pneumonia, capillary leak, edema, and exudate decrease gas exchange. Hypoxemia refers to low blood oxygen, while hypoxia signifies inadequate oxygen at the tissue level.

Hypoxia Signs & Symptoms

The tripod position is a key sign. Other symptoms include dyspnea, tachypnea, falling SpO2, and tachycardia. Neurologically, watch for confusion (may be the only sign in older adults), restlessness, agitation, and declining LOC and GCS. Early symptoms include restlessness and tachypnea; late symptoms include lethargy, bradycardia, and cyanosis.

Hypoxia Concepts

The primary concept is gas exchange. Other factors include perfusion, cognition, intracranial regulation, and safety. Priority concerns are decreased gas exchange, potential airway obstruction, and impaired cognition. The ABCs order everything.

Hypoxia Treatments

Administer oxygen to achieve SpO2 ≥95% or baseline. Encourage hourly use of incentive spirometry, coughing and deep breathing every two hours, and approximately 2 L fluids. Use bronchodilators if bronchospasm occurs. During a seizure, prioritize airway management, oxygen delivery, IV normal saline, and AEDs. Escalate to high-flow oxygen, non-invasive ventilation (NIV), or intubation as needed.

Hypoxia Diagnostics

Pulse oximetry and Glasgow Coma Scale are crucial assessments. A GCS <7 indicates critical rescue. Arterial blood gas (ABG) analysis serves as the definitive measure. CBC checks for anemia, and glucose levels assess for hypoglycemia, which along with hypoxia are reversible mimics.

Hypoxia Nursing Management

Position patients upright if they can protect their airway. Use side-lying position if postictal, as aspiration prevention is prioritized over ventilation optimization. Ensure suction is available, trend LOC against baseline, and monitor continuous SpO2.

Hypoxia Education

Provide instruction on incentive spirometer technique and hourly use. Encourage coughing and deep breathing, energy conservation, and pacing. Discuss smoking cessation and vaccines. Advise patients to seek help if experiencing increasing dyspnea, confusion, or the inability to speak full sentences.

Stroke and TIA Risk Factors

Use ABCD2 criteria: Age ≥60 (1), BP ≥140/90 (1), clinical one-sided weakness (2) or speech disturbance alone (1), duration ≥60 min (2) / 10-59 min (1), diabetes (1). Total scores categorize risk: 0-3 low, 4-5 moderate, 6-7 high. Other factors include carotid stenosis, atherosclerosis, hypertension, and aneurysm.

Stroke and TIA Pathophysiology

Transient Ischemic Attack (TIA) involves temporary dysfunction without infarction, lasting 30-60 minutes; it is a warning sign often from carotid stenosis. Stroke results from disrupted blood supply leading to ischemia and necrosis. Types include ischemic (thrombotic or embolic) and hemorrhagic (aneurysm or hypertension).

Stroke and TIA Signs & Symptoms

Visual signs include blurred vision, diplopia, and hemianopsia. Motor signs include weakness and ataxia. Sensory signs include numbness and vertigo, while speech signs encompass aphasia and dysarthria. Additional symptoms include confusion and severe headache. Left CVA typically results in right weakness and aphasia, whereas right CVA presents with left weakness, unilateral neglect, and higher fall risk.

Stroke and TIA Concepts

Focus on perfusion as the primary concept. Other factors include mobility, cognition, and sensory perception. Priority hypotheses in order are inadequate cerebral perfusion, decreased mobility, aphasia/dysarthria, and sensory perception deficits.

Stroke and TIA Treatments

Fibrinolytics and anticoagulants are used, along with lorazepam/antiepileptics, calcium channel blockers, stool softeners (to prevent Valsalva/ICP), and antianxiety medications. Head CT should be performed first; tPA is for ischemic strokes only, never for hemorrhagic strokes or if onset time is unknown (like in wake-up strokes).

Stroke and TIA Diagnostics

Prioritize ABCs and stroke center protocols. Use the NIHSS assessment tool, rule out hypoglycemia and hypoxia, and perform head CT to determine stroke type. Assessment includes motor, sensory, cranial nerve, cardiovascular, and laboratory evaluations.

Stroke and TIA Nursing Management

Promote mobility with assistive devices. Assess for aphasia types—expressive (understands but can't communicate), receptive (doesn't understand), and mixed (most common). Dysarthria is a muscle issue leading to speech difficulties. Patients may remain NPO until cleared by speech therapy for swallowing safety. Monitor for unilateral neglect to prevent injury.

Stroke and TIA Education

Teach F.A.S.T. (Face, Arm, Speech, Time) to patients, families, and those who have had a TIA. Provide guidance on home care management, addressing safety concerns related to unilateral neglect, emotional support, and available healthcare resources.

Leukemia Risk Factors

Prior chemotherapy or radiation, benzene/chemical exposure, genetic conditions, family history, age, immunosuppression. General cancer risks include genetics, viruses, chemicals, hormones, and lifestyle.

Leukemia Pathophysiology

Malignancy of blood-forming cells. Immature nonfunctional WBCs crowd out normal marrow production, leading to anemia, thrombocytopenia, and functional neutropenia. A high WBC count is not protective as the cells do not work effectively.

Leukemia Signs & Symptoms

Symptoms arise from the three cytopenias: Anemia causes fatigue, pallor, and shortness of breath with activity. Thrombocytopenia leads to petechiae and bruising. Neutropenia often results in fever (which may be the only sign) and mucositis, along with bone pain, weight loss, and night sweats.

Leukemia Concepts

Focus on cellular regulation. Key aspects include immunity (related to neutropenia), oxygen transport (related to anemia), and clotting (related to thrombocytopenia). The priority concern is the potential for infection or sepsis, especially in a febrile patient.

Leukemia Treatments

Induction chemotherapy leads to deep myelosuppression affecting all three cytopenias at once. Treatments include filgrastim for neutropenia, epoetin or iron and RBC transfusion for anemia, and platelet transfusion if levels are very low. Antiemetics and stem cell transplant are also options.

Leukemia Diagnostics

Laboratory findings may show WBC at 1,100 (normal 5,000-10,000), hemoglobin at 7.4, and platelets at 38,000, with a temperature of 100.9°F indicating febrile neutropenia, an oncologic emergency. The nadir signifies the time of lowest marrow activity, and a bone marrow biopsy is the definitive diagnostic method.

Leukemia Nursing Management

Implement neutropenic precautions, bleeding precautions, and anemia management simultaneously. Obtain cultures before administering antibiotics. For mucositis, inspect the mouth daily, use nonalcoholic rinses, a soft brush, ice chips, and avoid spicy or acidic foods.

Leukemia Education

Focus on four key areas: Infection prevention (hand hygiene, avoid crowds/raw foods/flowers, report temperature over 100.4°F), Bleeding precautions (soft brush, electric razor, avoid NSAIDs), Fatigue management (rest and pacing), and Impaired healing (mouth care and high-calorie, high-protein diet).

Cancer Treatment Risk Factors

Risk factors include DNA mutation from genetics, viruses, chemicals (tobacco, radiation, asbestos), hormones, and lifestyle choices. Preventive measures include avoiding carcinogens, modifying behaviors, removing at-risk tissue, chemoprevention, vaccination, and screenings (secondary prevention). Watch for caution warning signs like BRCA1/2, and HER2.

Cancer Treatment Pathophysiology

The process involves initiation (permanent DNA change), promotion (hormones speeding division, which affects tumor formation speed), progression (angiogenesis), and metastasis, which retains the original tissue identity, guiding treatment based on the primary site (the original location of the tumor). Note that instructors recommend not over-memorizing this section.

Cancer Staging/Grading + Effects

Staging includes size of the tumor (T), lymph node involvement (N), and metastasis (M). Grading ranges from G1 (well differentiated, looks almost normal) to G4 (poorly differentiated, does not resemble normal tissue). Treatment effects may include neutropenia, mucositis, nausea/vomiting, alopecia at 7-10 days, neuropathy, 'chemo brain', anemia, and thrombocytopenia.

Cancer Treatment Concepts

Focus on cellular regulation with parallel concerns for immunity, clotting, gas exchange, tissue integrity, nutrition, body image, and safety. Key priorities include infection, bleeding, activity intolerance, and impaired mucous membranes, with the potential for oncologic emergencies.

Cancer Treatments

Treatment options include surgery (aiming for negative margins), chemotherapy (cytotoxic agents targeting fast-growing cells), external beam radiation therapy (EBRT), and brachytherapy (radioactive while source is present). Hormonal treatments may have side effects like fatigue, arthralgia, hot flashes, and thromboembolism.

Cancer Diagnostics

Biopsy is the definitive diagnostic method for specific cancers like breast and prostate. For prostate cancer, the Gleason score is used to rate cell differentiation. PSA levels above 4 ng/mL indicate possible disease but are not cancer-specific. MRI/ultrasound are better for dense breast tissue, with CBC used to check for cytopenias.

Cancer Nursing Management

Prevention of extravasation involves monitoring IV sites carefully. Do not use large-gauge catheters for infusions. Radiation tattoos should never be removed; cleanse radiation sites with hands and pat dry. For breast surgery, maintain a 30° angle for head of bed, avoid blood pressure measurements, IVs, or draws on the affected arm, and encourage early arm exercises to prevent lymphedema.

Cancer Education

Educate patients to report any temperature over 100.4°F. Emphasize infection, bleeding, and fatigue precautions. Advise those undergoing radiation to wear soft clothing, avoid lotions/deodorants on the site, and stay out of the sun as skin sensitivity lasts for up to a year. For prostate treatment, inform about possible proctitis (rectal cramping, blood, or mucus in stool) and provide support for body image and sexual function concerns.

Neutropenia Risk Factors

Chemotherapy (primary), radiation, leukemia, any marrow suppression, steroids, advanced age, malnutrition, invasive devices. Greatest risk occurs at the nadir.

Neutropenia Pathophysiology

Low WBC/neutrophils specifically, from bone marrow suppression. Neutrophils are the first responders; without them, the patient cannot mount an inflammatory response, leading to blunted redness, pus, and swelling.

Neutropenia Signs & Symptoms

Often silent. Fever may be the only sign of infection. Report temperature above 100.4°F (38°C), which is intentionally lower than the general 101°F threshold. Subtle changes include rising heart rate/respiratory rate, falling blood pressure or urine output, and confusion.

Neutropenia Concepts

Focus on immunity and infection, safety, and cellular regulation. Priority concern is the potential for infection, followed by potential for sepsis and delayed recognition of infection.