cotter test 3

:(

what is dic caused by

,allergies, or anatomical abnormalities, sepsis

polycythemia vera

bone marrow produces too many red blood cells, leading to an increase in blood volume and thickness. This can cause complications such as blood clots, stroke, and heart attack.

polycythemia vera s/s

\-Headache



\-Ruddy complexion



\-Splenomegaly / hepatomegaly



\-HTN



\-thrombosis

polycythemia treatment

Nurse should prevent blood stasis, no crossing legs, no tight clothes(leggings), no scd stockings, pt education, avoid iron supplements, no alc, avoid aspirin

\-anticoagulants

\-phlebotomy

thrombocytopenia nursing management

\-Avoid Rectal Temps



\-Medication Teaching



\-Use of electronic razor



\-Soft toothbrush

"Capping Training"

Red Cap on the Trach that we want to "train" the patient to deflate the balloon before capping to prevent suffocating the patient

Morning is the best time to start cap training

Oxygen deformation \= restlessness

Acute Lymphocytic Leukemia (ALL)

Why, who, manifestations, tx

Overproduction of immature lymphoblast (b cells)

Occurs at age 4-5 and the elderly

Very curable in children

Manifestations: fatigue, weakness,unexplained fever, infection, bone pain, excess bleeding/bruising, enlarged lymph nodes

Tx: Chemo, Radiation (total body irradiation prepare for bone marrow transplant)

Acute Myeloid Leukemia

Who, why, complications

Affects all age groups

5 year survival rate for 65 or younger , anyone older is a 4% survival rate

Occurs when patient has insufficient production of blood cells,

Patient has fever & infection from neutropenia, weakness & fatigue from Anemia, and bleeding from thrombocytopenia

Complications: bleeding & infection is major cause of death, most common bleeding is GI, pulmonary, or intracranial

acute pancreatitis

pancreatic duct becomes obstructed and enzymes back up into the pancreatic duct, causing auto digestion and inflammation of the pancreas.

acute pancreatitis assessment

Focus on abdominal pain and discomfort
Fluid and electrolyte status
Medications
Alcohol use
GI assessment and nutritional status
Respiratory status
Emotional and psychological status of patient and family; anxiety and coping
-pain
-npo

acute pancreatitis outcomes/goals

-pain relief
-improved respiratory function
-improved nutritional status
-maintain skin integrity
-no complications

acute pancreatitis s/s

Severe abdominal pain
Patient appears acutely ill
Abdominal guarding
Nausea and vomiting
Fever, jaundice, confusion, and agitation
May develop respiratory distress, hypoxia, renal failure, hypovolemia, and shock

aPTT

activated partial thromboplastin time
how long it takes your blood to form a clot

Ascites, what is it? how do tx? how does this affect albumin level?

Caused by portal hypertension and obstructed venous flow

Affects aldosterone which causes fluid retention

Decreased albumin

Enlarged abdomen

Assessing Ascites

Record abdominal girth and weight daily

Patient may have striae, distended veins & hernia

Monitor Fluid & electrolytes

Assessing patients before receiving blood transfusions:

did u get a blood transfusion before?
do u know ur blood type?
did u ever get a reaction to a blood transfusion?

Asterixis

Liver Flap, a flapping tremor of the hands. When the client extends the arms & hands in front of the body, the hands rapidly flex & extend.

Asterixis is known as "liver flap" and is a tremor of the hand due to high \______ levels

Ammonia

Balloon Tamponade

tube that is inserted through the esophagus into the stomach, then inflated to compress esophageal varices and control hemorrhage.

bone marrow aspiration

removal of small sample of bone marrow by needle and examined for diseases such as leukemia or aplastic anemia

•Assess quality and quantity of cell in bone marrow

•Prepare and explain this. Pt anxious. Consent form. Skin cleansed. Complain pressure sensation. Stay still take deep breaths relaxation techniques. hold pressure when needle out. cover sterile dressing

bone marrow transplant

infusion of healthy bone marrow cells to a recipient with matching cells from a donor

Bone marrow transplant: What do we suspect? what do we check for?

Used for hematological cancers

Check nutrition, PE, organ function, & psychosocial , N/V, mucositis, infection

Caring for a patient after a Radical Neck Dissection

Improve quality of life!

Maintenance of respiratory status
Attain comfort
Absence of infection
Adequate nutrition/fluids
Effective coping/communication
Maintenance of neck and shoulder motion

Chemo Dosage

weight based, need to minimize toxicity, liver & kidney function

Chest Drainage: why do we need it? What does bubble mean?

used to treat pneumothorax to re-expand the lung and remove excess air, fluid, & blood

A bubble indicates an air leak,

Decreased bubbling over time shows pneumothorax is getting better

If you feel bubbling at the dressing on the side of the body, check for crepitus, subcutaneous emphysema and have vasoline and gauze at the bedside, this mean no air is escaping

CHF blood transfusion

Patient gets "split" packs, 2 packs of 125cc over 4 hours each

Chronic Lymphocytic Leukemia (CLL)
Who, manifestations, & Facts

Malignancy of older adults (72 years old)

Most common form of leukemia in adults

Manifestations: asymptomatic, enlarged lymph nodes can be painful, increased lymphocytes

B symptoms: fever, drenching night sweats, unintended weight loss, common infection

Chronic Myeloid Leukemia

Why, manifestations

Mutation of Myeloid stem cells, leukocytes exceed 100,000

Patient is SOB, & confused because of high leukocytes

Manifestations are insidious, wt loss, anorexia,

chronic pancreatitis

progressive inflammatory disorder with pancreas destruction. Cells replaced by fibrous tissue, and pressure in pancreas increases.

chronic pancreatitis s/s

Steatorrhea-an increase in fat excretion in the stools
•Recurrent attacks of severe upper abdominal and back pain
•Weight loss
-vomiting

Classification Staging of Lung Cancer

Small v Non-small

Small Cell Lung Cancer 15-20% of tumors- arise in major bronchi and spread along bronchial wall

Non-small cell lung cancer 80% of tumors-squamous cell carcinoma, large cell carcinoma, adenocarcinoma, bronchoalveolar carcinoma

Clinical manifestation of polycythemia Vera

Headache

Ruddy complexion

Splenomegaly/Hepatomegaly

HTN

Thrombosis

Clinical Manifestations of Lung Cancer

Asymptomatic until late

Most frequent symptom is cough and change in cough from dry to wet

Dyspnea (early)

Hemoptysis (coughing blood)

Recurring fever, weakness, anorexia, wt loss, hoarseness, dysphagia, *pleural effusion*

Metastasis to lymph node, bone, brain & liver (pain is a late sign related to bone metastasis

Complications from Larynx Cancer

Respiratory Distress- restlessness, check 02 sat

Hemorrhage- bc of closeness to carotid

Infection- tracheal necrosis

Wound Breakdown- due to trach care, change dressing frequently and when wet

Aspiration

Complications post Radical Neck Dissection

Hemorrhage

Chyle Fistula- lymphatic drainage (milky white)

Nerve Injury

Cuff Trach

When patient has a trach, be cautious of a cuff trach, nothing will go in the trachea

D-dimer

•Rule out thromboembolism
•Done w/ suspicion of DVT/PE/DIC
small protein fragment present in the blood after a blood clot is degraded

Delayed hemolytic reaction : when? SxS?

Occurs 14 days after transfusion (patient is home)

SxS: Anemia, increased bilirubin, jaundice

Patient has yellow eyes

Diagnosis of Larynx Cancer

CT, MRI, PET to assess tumor extent and stage

DIC -coagulopathy

Why, what is it, phases, FSP?

Acute complication of other conditions (sepsis, infection)

Overproduction of FSP

2 phases:

Phase 1: forms tiny clots everywhere, high survival rate, give patient heparin

Phase 2: bleed out of every orifice, no IV, blood draws, nothing. Common after birth

Must treat the underlying cause!!!

Disseminated Intravascular Coagulation (DIC)

Disorder of fibrinolysis (destruction of clots) causing bleeding or thrombus

Increases clotting cascade

Associated with hematological cancer (leukemia, lymphoma, prostate GI, lung, chemo, sepsis)

Dumping Syndrome

occurs when we give a bolus feeding of 500cc too fast, the patient will vomit/diarrhea

Endoscopic sclerotherapy

Sclerotherapy: Saline to collapse vein for varices

Esophageal varices

Manifestations, education, tx

Hematemesis, Melena, deterioration & shock

Patients should get enodoscopy screening every 2 years

Tx: IV fluids & electrolytes , volume expander (D5W)

Nitro, beta Blockers, vasopressin

Provide calm environment & reduce anxiety , proper oral care

ESR

•How long plasma clot

Extravasation: What is it? What do you do to the IV? the arm? SxS?

Extravasation: infiltration of a *medicated* solution, IV must be stopped, elevate the arm, start an IV on the other side, call MD and inject antidote to the affected area

SxS: absence of blood return, resistance flow of IV, burning, pain, redness @ site

Non-vesicant does not cause reaction, Vesicant causes necrosis

Fibrinogen & FSP

•Proteins involved with clotting mechanism

Fresh frozen plasma blood transfusion

For clotting Deficiency

General info for WBC (leukocytes)

🔸formed in bone marrow & lymph

🔸must have folic acid to make WBC

🔸granulocyte & lymphocytes protect tissue from injury

🔸Normal range 5000-10,000

graft v host disease

Most common following bone marrow transplant
Graft attacks host organs
Host's immune system compromised - cannot destroy graft
Produces rash, GI sloughing, organ (liver) failure

Hemilaryngectomy:

removal of half the larynx

Hemophilia: who does it affect? SxS? Interventions

Bleeding Disorder that affects men,

No activity/sports

Safety is priority

hepatic encephalopathy stages

1 -normal LOC but tred 2- Increased drowsiness 3-Stuporous very lethargic 4- Comatose

Hepatic Encephalopathy: why? monitor? manifestations?

Life threatening complication of liver disease, caused by too much ammonia (toxic)

Monitor fluid, electrolytes & ammonia level

Fetor Hepaticus: sweet fecal odor to the breath

Hepatitis A

Fecal-oral transmission

Spread by poor hygiene, hand to mouth contact

Hepatitis B

Transmitted through blood, saliva, semen, vaginal secretions, STD, or mother to infant during birth

Manifestations: insidious, similar to hep A

Hepatitis C

Transmitted by blood, sexual contact, & sharing needles

Most common blood-borne infection

Careful for healthcare workers

Avoid alcohol

Hepatocellular Jaundice ... sxs?

Patient may be mild or very ill

No appetite, nausea, wt loss, fatigue , HA, chills, fever

HIT (Heparin Induced Thrombocytopenia): how & when?

Heparin causes the thrombocytopenia , we give Agroban when the patient cannot tolerate the heparin

Occurs when patient is on heparin more than 4-5 days

D.C. Heparin, watch the platelet counts

Hodgkins Lymphoma

Who, why, when, manifestations

Rare but curable

Peaks in early 20s and after 50

Common with immunosuppressant therapy (transplant).

*Patient has a painless enlargement of lymph nodes*

Reed sternberg cell, suspected from a virus

How do we Maintain a Patent Airway (Larynx Cancer)

🔸Semi or High Fowlers to decrease edema
🔸Monitor for sxs of respiratory distress
🔸 Tracheostomy or laryngectomy tube assessment
🔸Stoma care
🔸Suctioning
🔸Humid Air
🔸Patient teaching

How Do We Prevent Atelectasis & Infection for a Patient After Thoracic Surgery?

Prevent Atelectasis & infection with incentive spirometer every hour 10x an hour

How do we treat polycythemia Vera?

🔸hydrate

🔸routine phlebotomy to decrease RBC (500cc)

🔸prevent venous stasis

🔸anticoagulants

How do you prevent for Aspiration (Larynx Cancer)

Keep HOB elevated during and after tube feedings

Check gastric residual volume

Swallow maneuvers to prevent aspiration

Use thickening liquids

Consult to see if it is okay to start diet again

Hypersensitivity-Oncological Complication

anaphylaxis, itching, urticaria, flushing, chest tightness, agitation, N/V, dyspnea, bronchospasm, difficulty speaking, sense of impending doom

If a patient has either Petechiae & Echymosis what does this mean?

Shows patient is bleeding

If a patient is jaundice what does this relate with bilirubin?

They are not excreting enough

If patient has a reaction to transfusion what do you do?

Stop the transfusion, do urine, blood & lab work to check

Send blood & saline back, hang new back of saline

If pH is high and CO2 is low is:

Respiratory Acidosis
Respiratory Alkalosis
Metabolic Acidosis
Metabolic Alkalosis

Respiratory Alkalosis

If pH is high and HCO3 is high it is

Respiratory Acidosis
Respiratory Alkalosis
Metabolic Acidosis
Metabolic Alkalosis

Metabolic Alkalosis

If pH is high is this acidosis or alkalytic?

Alkalosis

If pH is low is this acidosis or alkalosis?

Acidotic

Infiltration

Phlebitis

Infiltration: IV moves to interstitial tissue, skin is cool (check pulses)

Phlebitis: skin is red, cord form, hot/pain

Information to Gather While Caring for a Patient with a Laryngectomy

🔸Health Hx
🔸Assess hx of alcohol
🔸Assess hx of smoking (how many per day? Have you ever smoked? When did you stop?)
🔸Nutritional Status (lump can affect nutrition)
🔸Assess literacy, hearing, visual ability, ( assess communication after surgery)
🔸 Assess learning needs
🔸Assess coping

Jaundice: what is it? Types?

Increased bilirubin causes yellow tissue (skin & eyes)

Types:

Hepatocellular: liver injury

Obstructive: occluded bile duct (gall stones)

Larynx Cancer: Who does it affect? Categories (supraglottic, glottic, subglottic)

African American Men over age 60 are at risk

Supraglottic: above vocal cords (can save voice)

Glottic: true vocal cords

Subglottic: below vocal cords (can't be saved )

Low pH and high CO2 is:

Respiratory Acidosis
Respiratory Alkalosis
Metabolic Acidosis
Metabolic Alkalosis

Respiratory Acidosis

Low pH and low HCO3 is:

Respiratory Acidosis
Respiratory Alkalosis
Metabolic Acidosis
Metabolic Alkalosis

Metabolic Acidosis

Manifestations of Cirrhosis

🔸Jaundice

🔸Portal HTN, ascites & varices

🔸hepatic encephalopathy or coma

🔸nutritional deficiency

Manifestations of Oral Cancer

Painless mass or sore that does not heal

Any wound that has not healed after 2 weeks should be biopsied

Late Manifestations: tenderness, difficulty chewing/swallowing/speaking, coughing up blood, enlarged lymph nodes

Medical management of hepatic encephalopathy

Lactulose to reduce ammonia level will turn body liquid orange

Can do an enema

D.C. Sedatives & tranquilizers (change LOC)

MOV

Minimal Occlusive Volume: deflate the balloon everyday, minimal amount inflated to obliterate an air leak

Multiple Myeloma

What is it? Dx? Symptoms? Tx?

Malignant plasma cells

Dx: M protein marker

Symptoms: bone pain in back & ribs, common fractures

Tx: chemo, radiation, bone marrow transplant (isolation)

Neutropenia

•Low neutrophil count

Neutropenia causes

•Causes vary (congenital, chemo, radiation, associated w/ AIDS)

neutropenia nursing interventions

-Careful nursing assessment for evidence of infection

-Educate families to report any changes when counts are low

-Environment considerations: avoid people with infections, maintain clean living space, avoid construction sites, wash foods and cook thoroughly

neutropenia pt precautions

•No flowers, fruit, balloons, limited visitors, mask when going out

Neutropenia S/S

•Fever common indicator but not always present. Symptoms hard to see

Neutropenia treatment

antibiotic therapy and hematopoietic growth factors

NG tube assessment: how to measure, what if tape is misplaced, what do we assess?

nose to ear, ear to xyphoid, assess which nare they breath better in and keep that one open

If tape is misplaced stop the feeding

Non-Hodgkins Lymphoma: where? how? symptoms?

Cancer from lymphoid tissue, malignant

B & T lymphocytes metastasis is unpredictable (low survival rate)

Early symptoms: none

Late symptoms: B symptoms (night sweats, fever)

We do a CAT/PET scan to detect metastasis

Nursing Dx for Larynx Cancer:

Deficient Knowledge
Anxiety
Ineffective Airway Clearance*
Impaired Verbal Communication*
Imbalanced Nutrition
Disturbed Body Image
Self Care Deficit

*Ineffective airway comes before impaired gas exchange...always suction!

Nursing Intervention for Superior Vena Cava Syndrome

Monitor cardiopulmonary and neuro status
Avoid excessive blood draws & BP
Facilitate breathing
Conserve Energy
Fluid Volume Status

Nursing Interventions for a Patient with Laryngectomy

Adequate Knowledge
Reduction of Anxiety
Maintenance of patent airway
Effective communication
Maintain hydration/nutrition
Improved body image
Self Care Management
No Complications

Nursing Interventions for Disseminated Intravascular Coagulation (DIC)

Vitals
I&O
Skin color, temp, lung, heart, BS, LOC, CP
Inspect all insertion sites
Review Labs
Minimize physical activity
Prevent bleeding

Obstructive Jaundice... manifestations? sxs?

Dark orange brown urine & clay colored stool

Dyspepsia (impaired digestion)

Pruritis

Oral Cancer: who is at risk? Risk factors? Where?

Curable if discovered early, common in african americans and men over age 40

Usually squamous cell cancer

May occur in lips, lateral tongue, and floor of the mouth

Rise in cases due to HPV

pancreatitis labs

Amalyase and lipase increases
Present with high bloodsugar, manage it

pancreatitis potential problems

Fluid and electrolyte disturbances
Necrosis of the pancreas
Shock
Multiple organ dysfunction syndrome
DIC

Partial Laryngectomy:

partial removal of the larynx