Medical-Surgical Nursing Review Unit 1

Comprehensive vocabulary flashcard set covering concepts in disability models, older adult care, oncologic emergencies, cancer treatments, palliative and end-of-life care, and perioperative nursing management.

Disability

A limitation in everyday activity or function affecting physical, sensory, intellectual/cognitive, or psychological/mental health domains.

Four Functional Domains of Disability

Physical, sensory, intellectual/cognitive, and psychological/mental health.

Global Prevalence of Disability

Approximately $1.3\text{ billion}$ people, representing about $16\text{\%}$ of the global population.

Mild Disability

A level of disability where the individual experiences difficulty with some IADLs but remains mostly independent.

Moderate Disability

A level of disability involving limitations with ADLs and IADLs, often requiring assistance.

Mucositis

An inflammatory condition affecting the mucous membranes, often caused by chemotherapy or radiation, leading to painful sores in the mouth and digestive tract.

Severe Disability

A level of disability characterized by the inability to perform one or more major activities independently, requiring assistive devices or personal assistance.

Primary Goal of Disability Care

To promote maximum independence and participation in society.

ADLs (Activities of Daily Living)

Basic self-care tasks comprising feeding, bathing, dressing, grooming, and toileting.

IADLs (Instrumental Activities of Daily Living)

Complex daily living tasks necessary for independent community living, including shopping, laundry, housekeeping, and managing finances.

Secondary Conditions in Disability

Complications that result from a primary disability, such as pressure injuries, UTIs, chronic pain, low bone density, depression, and poor oral health.

Comorbidity

The simultaneous presence of two or more illnesses or medical conditions in an individual.

Propranolol

A non-selective beta-adrenergic antagonist used to treat hypertension, anxiety, and certain heart conditions. It works by blocking the effects of adrenaline on the body's beta receptors. Contraindicated with asthma.

Medical Model of Disability

A disability framework that views the problem as centered on the person and disease, managed by expert professionals seeking treatment or cure.

Social Model of Disability

A disability framework that views the problem as environmental and societal barriers, involving the patient in solutions to remove barriers and promote participation.

Major Barriers to Healthcare for Disabled Persons

Physical/structural barriers, lack of accessible equipment, transportation issues, financial limitations, communication barriers, and provider bias or ableism.

Communication Guidelines for Patients with Physical Disabilities

Speak directly to the patient, treat adults as adults, ask before assisting, sit at eye level for longer conversations, and respect assistive devices.

Communication Guidelines for Vision-Impaired Patients

Identify yourself upon entering, explain actions before touching, orient the patient to surroundings, announce when leaving, and do not distract service animals.

Communication Guidelines for Hearing-Impaired Patients

Face the patient directly, get their attention first, speak clearly without shouting, reduce background noise, keep the mouth visible, and use a qualified interpreter when needed.

Key Nursing Priority During Hospitalization of a Disabled Patient

Determine baseline functional level, inquire about usual ADL routines, maintain availability of assistive devices, and modify the environment to promote independence.

People-First Language

A communication practice that places the individual before their condition (e.g., "person with a disability" rather than "the disabled") to avoid defining people by medical labels.

Preferred Term for "The Diabetic"

Patient with diabetes.

Preferred Term for "Wheelchair-Bound"

Person who uses a wheelchair.

Chronic Condition

A medical condition that persists over time, requires ongoing management, and may affect functional ability and overall quality of life.

Multiple Chronic Conditions (MCCs)

The presence of two or more chronic medical conditions in a single individual, increasing health vulnerability and management complexity.

Proportion of Older Adults with Chronic Conditions

Approximately $95\text{\%}$ have at least $1$ chronic condition, and $80\text{\%}$ have $2$ or more.

Major Modifiable Risk Factors for Chronic Disease

Tobacco use, secondhand smoke exposure, poor diet, high sodium intake, physical inactivity, and excessive alcohol use.

Disease-Specific Cancer Prevention Vaccines

Hepatitis B (HBV) vaccine and Human Papillomavirus (HPV) vaccine.

Direct Care Nursing Interventions for Chronic Illness

Performing physical assessments, wound care, medication administration, and technical procedures.

Supportive Care Nursing Interventions for Chronic Illness

Providing patient education, counseling, symptom monitoring, advocacy, referrals, and case management.

Primary Setting for Chronic Disease Management

The patient's home and community setting.

Indications for Transitional Care

Presence of multiple chronic conditions, cognitive impairment, physical limitations, complex therapeutic regimens, frailty, or health instability.

Role of the Transitional Care Nurse

Serving as a care coordinator to ensure smooth transitions between care settings and avoid readmissions or care gaps.

Primary Benefits of Telehealth in Chronic Disease Care

Remote symptom monitoring, ongoing education, counseling, and follow-up for patients facing transportation, mobility, or geographic barriers.

Definition of the Older Adult Population

Individuals aged $65\text{ years}$ and older. 1in 6 americans.

Fastest-Growing Age Group in the United States

Adults aged $85\text{ years}$ and older.

Average US Life Expectancy and Gender Gap

Life expectancy is $77.5\text{ years}$, with women living approximately $5\text{ years}$ longer than men.

Leading Causes of Death in Older Adults

Heart disease, cancer, unintentional injuries, chronic respiratory disease, stroke, Alzheimer disease, and infection/sepsis.

Gerontology

The multidisciplinary study of the aging process across biologic, psychological, and sociologic dimensions.

Geriatrics

The clinical medical specialty focused on the disease, diagnosis, treatment, and management of older adults.

Primary Goals of Gerontologic Nursing

To maintain functional ability, promote independence, prevent complications, preserve dignity, and maximize quality of life, know what’s normal for aging.

Core Components of a Comprehensive Geriatric Assessment

Physical health, cognitive status, psychosocial health, functional ability, medication review, nutrition, safety, and social support.

normal signs of aging

gradual, expected physiological changes, varying things amongst individuals.

Clinical Findings That Are NOT Normal Aging

Sudden confusion, severe memory loss, urinary incontinence, significant functional decline, and persistent depression, Alzheimer’s.

Physical aging: general changes

Decreased cellular regeneration, reduced organ reserve, impaired homeostatic response, stiffer connective tissue, and loss of elastin and collagen, vulnerability to illness/stress, less sensory perception.

Age-Related Cardiovascular Changes

Decreased cardiac reserve and output, reduced arterial elasticity, valve stiffening, decreased pacemaker cells, and increased systemic vascular resistance, higher risk for hypertension, slower recovery after activity

Atypical Presentation of Myocardial Infarction in Older Adults

Presentation without chest pain, manifesting instead with dyspnea, fatigue, nausea, syncope, or acute mental status changes.

Orthostatic Hypotension

A sudden drop in blood pressure following a position change (e.g., lying to standing), causing dizziness, syncope, and fall risk.

Nursing Interventions for Orthostatic Hypotension

Instruct the patient to change positions slowly (lying to sitting to standing), dangle feet before standing, avoid extreme heat, and assess BP in multiple positions.

Age-Related Respiratory Changes

Decreased lung elasticity, reduced vital capacity, increased residual volume, weakened respiratory muscles, and decreased cough efficiency, decreased gas exchange

Clinical Complications of Age-Related Respiratory Decline

Increased risk for atelectasis and lower respiratory tract infections.

Atypical Presentation of Infection in Older Adults

Absence of high fever or typical localized symptoms, presenting instead with confusion, fatigue, lethargy, anorexia, dehydration, or functional decline.

Age-Related Integumentary Changes

Thinning of epidermis, decreased subcutaneous fat, reduced oil and perspiration secretion, skin capillary fragility, and impaired thermoregulation, higher injury risk.

Age-Related Musculoskeletal Changes

Decreased bone density, loss of muscle mass and strength (sarcopenia), joint cartilage degeneration, height loss, and kyphosis.

Age-Related Genitourinary Changes

Decreased kidney mass and GFR, impaired urine concentration ability, reduced bladder capacity, and increased residual urine volume, increased uti risk, increased medication toxicity risk

Non-Normal Status of Urinary Incontinence in Aging

Urinary incontinence is an abnormal finding requiring investigation for causes like UTI, medications, mobility restrictions, or BPH, pelvic floor weakness, neurologic conditions.

Age-Related Gastrointestinal Changes

Decreased taste and smell, delayed gastric emptying, early satiety, slowed GI motility, and increased risk for constipation and dysphagia, dry mouth.

Non-Pharmacologic Nursing Strategies to Prevent Constipation

Adequate fluid intake, high-fiber diet, regular physical activity, responding promptly to the urge to defecate, and establishing a regular toileting routine.

Presbyopia

Age-related visual decline characterized by decreased near-focusing ability, reduced night vision, increased glare sensitivity, and slower light-dark adaptation.

Nursing Interventions for Visual Changes in Older Adults

Ensure adequate lighting, reduce environmental glare, provide large-print materials, and implement fall prevention measures.

Presbycusis

Age-related hearing loss that affects high-frequency sounds first and impairs speech comprehension in noisy environments.

Communication Techniques for Presbycusis

Face the patient directly, speak clearly in a lower-pitched voice, reduce background noise, keep the mouth visible, and do not shout.

Age-Related Nervous System Changes

Decreased brain volume and blood flow, slowed nerve conduction velocity, and delayed reaction time, learning may take longer, higher vulnerability to delirium, higher fall risk, while overall intelligence is maintained.

Not normal aging mental health

severe mood swings, persistent depression, frequent confusion, major cognitive decline

Pharmacokinetic Changes in Older Adults

Alterations in drug absorption, distribution, metabolism, and excretion that lead to prolonged drug clearance and an increased risk of toxicity.

Polypharmacy

The concurrent use of multiple medications, including OTC drugs and herbal supplements, increasing the risk for adverse interactions and toxicity.

Medication Safety Strategies in Older Adults

Maintain an updated medication list, perform regular medication reconciliation, simplify schedules, monitor for interactions, and encourage single-pharmacy use.

Common Signs of Depression in Older Adults

Fatigue, concentration problems, sleep disturbances, appetite changes, feelings of worthlessness, social withdrawal, and suicidal ideation.

Delirium

An acute, fluctuating, and usually reversible state of cognitive impairment and inattention, considered a medical emergency.

Common Causes of Delirium

Infection, drug toxicity, dehydration, post-surgical stress, hypoxia, malnutrition, fecal impaction, urinary retention, and environmental changes.

Alzheimer Disease

A gradual, progressive, irreversible neurodegenerative disorder characterized by memory impairment, cognitive decline, and behavioral changes.

Comparison of Delirium and Alzheimer Disease Onset and Course

Delirium has an acute onset and fluctuating course; Alzheimer Disease has a gradual onset and progressive course.

Comparison of Primary Impairment in Delirium vs. Alzheimer Disease

Delirium primarily impairs attention; Alzheimer Disease primarily impairs memory.

Nursing Priorities for Alzheimer Disease

Maintain safety, establish daily routines, reduce environmental overstimulation, use simple communication, prevent wandering, and support caregivers.

Definition of Cancer

Uncontrolled abnormal cell growth that can invade surrounding tissue and metastasize to distant body sites.

Epidemiologic Ranking of Cancer Deaths in the US

Cancer is the second leading cause of death in the United States.

Common causes of cancer death

Lung, Colorectal, Breast, Prostate

Four Characteristics of Benign Tumors

Slow growth rate, well-defined margins, cellular resemblance to original tissue, and lack of metastasis.

Four Characteristics of Malignant Tumors

Rapid uncontrolled growth, poor cellular differentiation, invasion of surrounding tissues, and capacity to metastasize.

Metastasis

The spread of cancer cells from the primary site to distant body locations via direct invasion, blood vessels, or the lymphatic system.

Major Cancer Risk Factors

Tobacco use,

Alcohol

• UV/radiation exposure

• Environmental/occupational chemicals

• Obesity

• Poor diet

• Physical inactivity

• Certain infections

• Increasing age

• Family/genetic history

Cancer Primary Prevention

Interventions that prevent cancer development, including smoking cessation, healthy lifestyle habits, and HPV/HBV vaccination.

Cancer Secondary Prevention

Early detection measures, primarily consisting of routine cancer screening procedures.

Cancer Tertiary Prevention

Monitoring and managing survivors to prevent recurrence, complications, or secondary primary cancers.

CAUTION Mnemonic for Cancer Warning Signs

Change in bowel/bladder habits, A sore that does not heal, Unusual bleeding/discharge, Thickening or lump, Indigestion/difficulty swallowing, Obvious change in wart/mole, Nagging cough/hoarseness.

Definitive Diagnostic Procedure for Cancer

History & physical, lab studies (CBC, CMP, liver), Tumor/genetic markers (PSA, BRCA1 & 2), Imaging, Tumor Biopsy (microscopic evaluation of tissue).

Medications Administered Prior to Tumor Biopsy

Local anesthetics for site numbing, sedatives/analgesics for pain/anxiety, and anticholinergic agents to decrease secretions if needed.

Nursing Priorities Following a Tumor Biopsy

Gain consent, Monitor vital signs, assess biopsy site for bleeding and hematoma, assess pain, maintain dressing integrity, and send specimen to pathology, monitor for infection.

Cancer Cell Grading

Evaluation of cellular differentiation and microscopic appearance; higher grades indicate more abnormal, poorly differentiated, and aggressive cells.

Cancer Staging

Assessment of the extent of disease spread based on primary tumor size, lymph node involvement, and distant metastasis.

TNM Staging Framework

T evaluates primary Tumor size/invasion, N evaluates regional lymph Node involvement, and M evaluates Metastasis distance.

Three Primary Goals of Cancer Treatment

Cure (eliminating cancer), Control (slowing growth/progression), and Palliation (relieving symptoms and improving quality of life).

Cancer Treatment Options

• Surgery

• Radiation

• Chemotherapy

• Immunotherapy

• Targeted therapy

• Hormonal therapy

• Stem cell transplantation

• Combination therapy

Cancer Surgery

• Diagnosis

• Cure

• Tumor removal/debulking

• Prevention

• Reconstruction

• Palliation

Mechanism of Action of Radiation Therapy

Uses ionizing radiation to damage cellular DNA in cancer cells, targeting rapidly dividing cells. Causes fatigue, skin changes, effects to specific treatment area.

External Beam Radiation Therapy

Radiation comes from a machine, directed at tumor, Treatments usually divided into doses.

The patient is NOT radioactive during or after treatment.

Radiation Skin Care Guidelines

Wash gently with lukewarm water and mild soap, pat dry, avoid rubbing or sun exposure, do not remove treatment markings, and apply only approved lotions.

Brachytherapy

Internal radiation therapy involving placement of a radioactive source inside a tumor, adjacent to it, or within a body cavity.

Three Cardinal Safety Principles for Radiation Exposure

Time (minimize exposure time), Distance (maximize distance from source), and Shielding (use lead shielding).

Brachytherapy NCLEX Safety Precautions

Assign private room, post radiation signs, limit visitor time, maintain distance, prohibit pregnant visitors and children, and wear a dosimeter badge.