Adult Pop Exam 4

Anemia

reduced RBC, Hbg, Hct —> impaired oxygen delivery to tissues

Causes of Anemia

• nutritional deficiency

• genetic

• chronic diseases

• bone marrow suppression

• blood loss

Risk Factors of Anemia

• poor diet

• malabsorption problems

• GI surgery, chronic illness

Microcytic

iron deficiency anemia; RBC are paler from less Hgb

Macrocytic anemia

Vitamin B12 or folic acid deficiency; RBC are larger

S/S of Anemia

• fatigue, weakness, activity intolerance

• pallor, cool skin, delayed capillary refill

• SOB, tachypnea, decreased O2

• tachycardia, palpitations

• dizzy, headache, forgetfulness

Triggers of Sickle Cell Disease

• hypoxia

• dehydration

• acidosis

• cold exposure

• anesthesia

S/S of Sickle Cell Disease

• severe pain

• pallor

• jaundice

• fatigue

S/S of Vitamin B12 Deficiency

neurologic deficits (paresthesia, poor balance)

Cause of Folic Acid deficiency

• alcoholism

• Crohn’s disease

• anticonvulsant

• contraceptive

Risk Factors of Oral Cancer

• old age

• tobacco, alcohol

• sun, toxic chemicals

• gum disease

• poor nutrition & oral hygiene

• HPV, HIV infection

S/S of Oral Cancer

• mucosal erythroplasia (red, raised, eroded lesions) - earliest sign

• leukoplasia (white patches that do not heal)

Diagnostics of Oral Cancer

needle or incisional biopsy

Non-Surgical Management of Oral Cancer

• chemotherapy, radiation, multimodal

• promote gas exchange (suctioning, therapy, steroids)

• oral hygiene

• aspiration precautions

• hydration & nutrition

Surgical management of oral cancer

glossectomy, mandibulectomy, microsurgery, neck dissection, and laryngectomy

Post-OP care of oral cancer

• trach care

• wound care (minimize secretion exposure)

  • oral suctioning

• pain management

• parenteral feeding

• thickened fluids, swallowing exercises

Teachings for Oral Cancer

• minimize sun exposure, alcohol, tobacco

• HPV vaccine

Risk Factors of Esophageal cancer

• smoking

• obesity

• malnutrition

• untreated GERD

• Barrett’s esophagus

• foods high in nitrate

S/S of Esophageal Cancer

• no symptoms until cancer spreads

• dysphagia

Diagnostics of Esophageal Cancer

Esophagogastroduodenoscopy (EGD), Esophageal ultrasound (EUS), PET scan, bronchoscopy, exploratory laparoscopy

Non-surgical Management of Esophageal cancer

• Chemotherapy, Radiation therapy, Multimodal

• esophageal dilation (relieve dysphagia)

• nutrition & swallowing therapy

• aspiration precautions

Surgical management of Esophageal cancer

esophagectomy, esophagogastrostomy

Post-OP Care for Esophageal cancer

• airway management - fowler’s position, tracheostomy, chest tube, deep breathing

• splinting with coughing

• NGT - decompress stomach

• tube feeding —> oral intake

• oral care

• aspiration precautions

Post-OP Complications for Esophageal cancer

• FVO d/t surgical hypotension tx

• A. fib

• infection

• anastomosis site leakage (can lead to sepsis)

Teachings for Esophageal cancer

• respiratory care - IS, physical activity

• infection - handwashing, report s/s

• nutrition - increase oral intake, small frequent meals, liquid supplementation, remain upright after meals, monitor weight

• treat H. pylori, stop smoking, weight loss

Risk Factors of Gastric Cancer

• H. pylori infection (main)

• pernicious anemia

• gastric polyps

• chronic atrophic gastritis

• achlorhydria

• pickled, processed foods

• gastric surgery

• Barrett’s surgery

• GERD

S/S of Gastric Cancer

• asymptomatic in early stages

• indigestion (dyspepsia)

• abd discomfort

• advanced signs: weight loss, N/V, weakness, fatigue, anemia, jaundice

Labs of Gastric Cancer

• low H&H

• hypoproteinemia

• increased AST/ALT

• high CEA

• occult blood in stool

Diagnostics of Gastric Cancer

Esophagogastroduodenoscopy (EGD) with biopsy

Management for Gastric cancer

• Chemotherapy, radiation therapy (limited as cancer metastasized)

• laparoscopic surgery, partial or total gastrectomy

Post-Op Care for Gastric Cancer

• Prevent atelectasis, paralytic ileus, peritonitis, and wound infection

• NGT management (patency)

• manage dumping syndrome - small meals, low in carbs & sugar, protein & fiber, lie down after meals

  • Early after eating: vertigo, tachycardia, syncope, sweating, pallor, palpitations, and desire to lie down

  • Late after eating: hypoglycemia: dizziness, lightheadedness, palpitations, diaphoresis, and confusion

• manage delayed gastric emptying

Post-OP Complications of Gastric Cancer

• gastric dilation (epigastric pain, hiccups, fullness, tachycardia, and hypotension)

• bile reflux —> gastritis, esophagitis, PUD

• gastric outlet obstruction

Teachings for Gastric Cancer

• Vit. B12, folic acid, and iron supplements & calcium

• prevention for gastritis & H. pylori infection

• avoid caffeine, pickled, processed, alcohol

• no smoking

Risk Factors for Colorectal Cancer

• 50+ yo

• genetic

• Crohn's disease

• ulcerative colitis

• infection

• smoking, obesity, heavy alcohol consumption, physical inactivity, high-fat diet, and refined carbohydrates

S/S of Colorectal Cancer

• rectal bleeding, anemia, change in stool consistency (common)

• obstruction (gas pains, cramping, incomplete evacuation, hyperactive/absent bowel sound

Complications of Colorectal cancer

• perforation with peritonitis

• bowel obstruction

• abscess formation

• fistula formation

Labs for Colorectal Cancer

• low H&H

• increased AST/ALT

• occult blood in stool

• elevated CEA

Diagnostics of Colorectal Cancer

• colonoscopy

• double-contrast barium enema

Management of Colorectal Cancer

• colectomy w/ colostomy or ileostomy

• abdominoperineal (AP) resection for tumors

Post-OP Care for Colorectal Cancer

• pain

• wound - JP drain, rectal phantom pain & itching

• NGT - stomach decompression, progression to oral diet

• colostomy - stoma (should be reddish pink & protruding ¾ in from abd)

  • moist w/ gauze dressing

Colostomy Care

• empty when 1/3 - 1/2 full

• change Q5-10 days

• avoid food that causes gas or odor

• manage skin & stoma

• irrigate colostomy to empty colon

• manage dehydration

• complications: dermatitis, diarrhea, stomal stenosis, stones

Cataracts

cloudy of the lens

• blurred vision

• decreased color perception

• glare sensitivity

• gradual vision loss

Glaucoma

• initially asymptomatic

• peripheral vision loss

• increased eye pressure

• eventual blindness

Macular Degeneration

• central vision loss

• difficulty reading

• limited night vision

• distorted vision

Activity Restriction for post-op eye conditions

• avoid driving

• prevent increasing intraocular pressure

• no heavy lifting or bending

• avoid water in eye

Red Flags for post-op eye conditions

• sudden eye pain (N/V)

• increased intraocular pressure (IOP)

• redness, yellow/green or creamy white discharge

• photophobia

• reduced visual acuity

• double vision

• flashing lights

• pupil changes

Interventions for eye conditions

• eye shields & patches

• pain ax

• positioning verification

Pruritus

itching sensation triggered by heat, stress, or meds

Treatment of Pruritus

• treat underlying cause

• antihistamines

• moisturizer

Atopic Dermatitis/Eczema

Chronic inflammatory skin condition with intense itching

• edema

• redness

• scaling

Treatment of Atopic Dermatitis/Eczema

• topical corticosteroids

• calcineurin inhibitors

• moisturizers

• trigger avoidance

Herpes Zoster (Shingles)

Viral infection causing a painful skin rash along nerve pathways

• burning

• unilateral rash

• vesicles

Treatment of Shingles

• antiviral & pain meds

• prevent secondary infection

Stage 1 Pressure Ulcer

• non-blanchable erythema

• intact skin

Stage 2 Pressure Ulcer

• shallow, open ulcer (blister or abrasion)

• red/pink & moist wound bed

Stage 3 Pressure Ulcer

• full-thickness tissue loss (into fat layer)

• slough may be present

Stage 4 Pressure Ulcer

full-thickness tissue loss w/ exposed bone, tendon, or muscle

Unstageable Pressure Ulcer

Full-thickness wound obscured by necrotic tissue - true depth cannot be determined until debridement

Meniere’s Disease

• episodic vertigo

• tinnitus

• fluctuating hearing loss

• drop attacks

Treatment for Meniere’s Disease

• anti-emetics

• anti-histamine

• anti-vertiginous

S/S of Bladder Cancer

• painless hematuria

• dysuria & frequency (sign of infection or obstruction)

Urinary Diversion (Urostomy)

alternative for urine elimination after -ectomy

Incontinent diversions