Exam 2 NUR 104

Fluid & electrolytes, Nutrition, cancer & loss grief and dying

how much fluid should you drink a day

2500 ml per day

what is in a BMP?

glucose, calcium, sodium, chloride, potassium, co2, BUN, creatine

what is in a CMP?

body's fluid balance, levels of electrolytes like sodium and potassium, and how well the kidneys and liver are working

what is in a CBC?

red blood cell, neutrophil, eosinophil, basophil, lymphocyte, monocyte, and platelet

Sodium letter and normal level

Na+ (135 - 145 mEq/L)

Potassium letter and normal level

K+ (3.5 - 5.0 mEq/L)

Calcium letter and normal level

Ca (8.6 - 10.2 mEq/L)

Magnesium letter and normal level

Mg (1.3 - 2.3 mEq/L)

Phosphorus letter and normal level

P (2.5 - 4.5 mg/dL)

Polyuria

Excessive output of urine (diuresis)

Anuria

24-hour urine output is less than 50 mL

Stress incontinance

Involuntary loss of urine related to an increase in intra-abdominal pressure

Dysuria 

Painful or difficult urination

Oliguria

24-hour urine output is less than 400 mL

Functional incontinence

Urine loss caused by the inability to reach the toilet because of environmental barriers, physical limitations, loss of memory, or disorientation

Fluid volume deficit (FVD)

Hypovolemia or isotonic fluid loss, Loss of body fluids, Inadequate intake, Third space fluid space

Fluid volume deficit (FVD) assesment

Dry mucus membranes, tachycardia, low bp, low urine output, lower weight, low skin turger

Fluid volume deficit (FVD) labs

Increased Hematocrit, Urine specific gravity, BUN, Creatinine

Fluid volume deficit (FVD) intervention

Give fluids, Assess LOC, Monitor I & Os, Daily weights, Fall precautions

Fluid volume excess (FVE)

Hypervolemia, Equal concentration of water and sodium, Excess fluids in ECF compartments, Oliguria

Fluid volume excess (FVE) assesment

increased BP, Pulse, Weight, Edema, Crackles in lungs, Risk for skin breakdown

Fluid volume excess (FVE) labs

low Hematocrit, Urine specific gravity, BUN, Creatinine

Fluid volume excess (FVE) interventions

Restrict fluids & sodium, Assess lungs, Monitor I & Os, Daily weights - edema, Assess circulation, Reposition Q2H, Administer ordered diuretics

Hyponatremia

Salt loss > water loss, Increase in water to total body sodium, Water moves ECF to ICF

Hyponatremia assesments

low  Serum Na+ < 135 mEq/L, Neurological function, Risk for seizures, Muscle strength

Hyponatremia interventions

Seizure precautions, Monitor I & Os, Understand/ address underlying cause

Hypernatremia

Na+ intake > water intake, Water loss > Na+ loss, Enteral feeding with no extra water intake, Water moves from ICF to ECF

Hypernatremia assesments

Na+ > 145 mEq/L, Neurological changes, Increase in thirst, Restlessness/ agitation, Weakness

Hypernatremia interventions

Assess neurological status, Monitor I & Os, Monitor vital signs, understand/ address underlying cause

Hypokalema

K+ < 3.5 mEq/L, Increased loss of K+, Decreased intake, Decreased magnesium

Hypokalema assesments

Weak, irregular pulses, ECG changes - inverted/flat T wave, Cramping, Weakness, Decreased deep tendon reflexes

Hypokalema interventions

Offer K+ rich foods, Give K+, Monitor heart rhythm, Monitor vital signs, Monitor I & Os, Fall precautions

Hyperkalemia

K+  > 5.0 mEq/L, Increased intake, Decreased output, Medications

Hyperkalemia assesments

Dysrthmias, ECG changes - tall peaked T waves, Hypotension, Abdominal cramping/ increased motility

Hyperkalemia interventions

Stop/ restrict potassium, Given K+ wasting diuretics, Monitor ECG, Monitor vital signs (BP & HR), Monitor I & Os

Hypocalcemia

Ca++ < 8.6 mg/dL, Inadequate calcium intake, Increase Ca++ loss, Malabsortion - vitamin D deficiency, Hypoparathyroidism, Hyperphosphatemia

Hypocalcemia assesments

Tetany, twitching, seizures, Trousseaus sign (hand, finger spasms), Chvosteks sign (facial twitching), Hypotension

Hypocalcemia interventions

Seizure precautions, Calcium supplements, Foods high in Ca++, Monitor heart rhythms

Hypercalcemia

Ca++  > 10.2 mg/dL, Increased intake (Ca++ & vitamin D), Diuretics (thiazides), Hyperparathyroidism

Hypercalcemia assessments

Change in LOC, Lethargy, Cardiac dysrythmias, Constipation, Decreased reflexes, Muscle weakness

Hypercalcemia intervention

Fluids, Diuretics (furosemide), Foods low in Ca++, Neuro checks, Fall precautions

Hypomagnesemia

Mg++ < 1.3 mEq/L, Malabsorption (alcoholism & chronic diarrhea), Prolonged gastric suctioning, Vomiting, Diuretics

Hypomagnesemia assesments

Tremors, tetany, twitching ,Seizures, Arrhythmias, Hyperactive reflexes, Hypoactive bowel sounds

Hypomagnesemia interventions

Seizure precautions, Monitor for dysrythmias, Give magnesium

Hypermagnesemia

Rare, Chronic renal diseases, Adrenal insufficiency

Hypermagnesemia assesments

Weakness, Lethargy, Dysrythmias, Respiratory depression, Facial flushing, Hypoactive DTR

Hypermagnesemia interventions

Monitor ECG changes, Focused neuro assessment, Monitor vital signs, Give ordered diuretics, Education on foods low in magnesium

Hypophosphatemia

Phosphate < 2.5 mg/dL, Muscle weakness, Shallow, ineffective respirations, Irritability & confusion, Hypotension & decreased cardiac output

Hyperphosphatemia

Phosphate > 4.5 mg/dL, Dysrythmias, Hyperreflexia, Muscle weakness, Oliguria

age related changed in urinary

nocturia, muscle tone, bladder contractility, physical changes

urinalysis

ph, spacific gravity, red or white blood cells,

culture and senitivity

determines what organism is causing the infection and what antibiotic to use

cytoscopy

examines the lining of the bladder

clean catch urine

go a little and stop and then get the test. for culture and sensitvity test

sterile specimen urine

can come from urinary catheters from port not bag

24 hour specimen urine

after the first inital void in morning

assesment findings of a uti

dysuria, urge to urinate, dark or rust tinged urine, elevated WBC, elevated temp, older adults have confusion

intermittent catheter

in and our just to drain bladder

indwelling catheter

leave in for an extended period of time

suprabubic catheter

inserted by physician into bladder through abdomen

benign neoplasms charachtoristics

Well-differentiated cells that resemble cells in the tissue of origin

benign neoplasms mode of growth

Grows by expansion without invading the surrounding tissues; usually encapsulated

benign neoplasms rate of growth

Usually progressive and slow; may come to a standstill or regress

benign neoplasms metastasis

Does not spread by metastasis

melignant neoplasms charactoristics

Cells are undifferentiated, with anaplasia (loss of differentiation of cells) and atypical structure that often bear little resemblance to cells in the tissue of origin

melignant neoplasms mode of growth

Grows by invasion, sending out processes that infiltrate the surrounding tissues

melignant neoplasms rate of growth

Variable and depends on level of differentiation; the more undifferentiated the cells, the more rapid the rate of growth

melignant neoplasms metastasize

Gains access to the blood and lymph channels to metastasize to other areas of the body

carcinogenesis

multistep process that refers to the transformation of a normal cell into a tumoral neoplastic cell

G1

RNA and protein synthesis occur, 8 or more hours

S

DNA synthesis occurs, 6-8 hours

G2

premitotic phase; DNA synthesis is complete, mitotic spindle forms, 2-5 hours

mitosis

cell division occurs

metastasis

invade and spread from their original site to other organs in the body

angiogenesis

new vascular structures emerge from ones that have already been established in tissues or tumor masses

lymphatic spread

The transport of tumor cells through the lymphatic circulation, common for metastisis

hematogenous spread

dissemination of malignant cells via the bloodstream and is directly related to the vascularity of the tumor

identify etiological agents/factors that have been found to be carcinogenic

viruses and bacteria, physical agents, chemical agents, genetic or familial factors, dietary and lifestyle factors, and hormonal agents.

what role does the immune system play in the development of cancer?

immune system can detect the development of malignant cells and destroy them before cell growth becomes uncontrolled. When the immune system fails to identify and stop the growth of malignant cells, clinical cancer develops

primary prevention

interventions against factors that are causal to that outcome, healthy lifestyles, avoid tobacco, healthy body weight, physical activity, healthy eating pattern at all ages, limits or do not include red and processed meats, sugar sweetened beverages, or highly processed foods and refined grain products, and avoiding alcohol intake, vaccinations

secondary prevention

mammograms, education, health promotion

staging cancer

size of the tumor and the extent of disease

what does TNM stand for?

“T” = size of the primary tumor and its invasion into adjacent tissues, “N” = regional lymph node involvement of a tumor, “M” = identify the presence of distant metastases of the primary tumor

grading cancer

classification of the tumor cells

grades for cancer

GX= Grade cannot be assessed, G1= Well differentiated, G2= Moderately differentiated, G3= Poorly differentiated, G4= Undifferentiated

staging and grading provide a baseline data for…

evaluating outcomes of therapy and to maintain a systematic and consistent approach to ongoing diagnosis and treatment

what is genetic testing: precision medicine

is a strategy that allows the selection of a treatment based on the patient’s genetic makeup.

preformance status (PS) is a measure of…

ranging from 0 (dead) to 100 (well-functioning) with 10-point increments

a biopsy is an example of what type of surgery?

diagnostic

2 examples of surgery as a primary treatment

A local excision when the mass is small, Wide or radical excisions= removal of the primary tumor, lymph nodes, adjacent involved structures, and surrounding tissues that may be at high risk for tumor spread.

prophylactic surgery involves

removing nonvital tissues or organs that are likely to develop cancer (Colectomy, mastectomy, oophorectomy)

the goal of palliative surgery is?

cure is not possible, to make patient comfortable (ulcerations, obstructions, hemorrhage, pain, and malignant effusions)

what is radiation therapy?

ionizing radiation is used to interrupt cellular growth

brachytherapy

Internal radiation implantation delivers a high dose of radiation to a localized area

3 principles of safety with brachytherapy

time, distance, shielding

stomatitis

inflammation of the mucous membrane of the mouth

xerostomia

dryness of the mouth

leukopenia

decreased WBCs

thrombocytopenia

decrease in platelets

what is chemo primarily used for?

to treat systemic disease rather than localized lesions that are amenable to surgery or radiation.