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NUR 114 Partial Focus Notes Final Fall 2019/2020_complete, A+ guide

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NURSING 114 (NURSING114)

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Madison Central High School

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nursing 114
nur 114 partial focus notes final fall 20192020complete
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Institution
Madison Central High School
Course
NURSING 114 (NURSING114)

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NUR 114 Partial Focus Notes Final Fall 2019

This does not include any of Ms. Jordans lectures only for McLean and Ms. Pizzotti’s

Conversions, medication math for PO, IV rates mcg/min, ml/min, gtts/min, mcg/kg/min

CONCEPT OF SEXUALITY

• Recommendations for testing and assessment for PAP smears, Breast cancer, Prostate CA,
Testicular CA. HPV

◦ PAP SMEAR:
▪ a cytological study that is effective in detecting precancerous and cancerous cells within the
female patient’s cervix.
▪ When to get tested:
• Not recommended for women under 21 (unless SEXUALLY ACTIVE)
• 21-29 every 3 years
• 30-65 every 5 years + HPV test
• 65+ whom has had normal Pap’s in the past should not receive pap test.
• Other’s suggest 60+ every 3 years
• Those who have had a Hx of cervical cancer should get tested yearly for at least 20 years
after the diagnoses regardless of age.
◦ HPV test: can identify many high-risk types of HPV infections associated with the development
of cervical cancer.
▪ When to get tested:
• At the time of a pap for women 30+
• for any woman of any age who have had an abnormal pap result.
◦ PSA test:
▪ a prostate-specific antigen test is used to screen for prostate cancer and to monitor the disease
after treatment.
▪ Normal lab value: 0-2.5
▪ An elevated PSA should decrease a few days after a prostatectomy. If it has not it shows that
it has reoccurred.
▪ Elevated numbers are associated with prostate cancer.
▪ Older men (Esp. AA men) often have a higher PSA.
▪ Should be drawn before a digital rectal exam because the exam can cause an increase in PSA
due to prostate irritation.
◦ Mammogram: ** 40 is the magic number
▪ A mammogram is a x-ray of the soft tissue of the breast. Mammograms assess differences in
the density of breast tissue.
▪ Helpful in evaluating poorly defined masses, multiple masses or nodules, nipple discharge or
changes, skin changes, or pain.
▪ AGE INFORMATION:
• Women ages 40 to 44 should have the choice to start annual breast cancer if they wish –
Women age 45 to 54 should get mammograms every year.
• Women aged 40 years and older be offered screening mammography annually
• Women age 55 and older should switch to mammograms every 2 years, or have the
choice to continue yearly screening.

, • American College of Obstetricians and Gynecologists recommends annual screening
mammography for women age 40 and over
• Yearly screening is recommended at age 40 because younger women have higher
density in breast tissue and the test is less effective.
▪ In older women, the amount of fatty tissue is higher. Therefore, fatty tissues appear lighter
than cancer
▪ Cancer and cysts usually have the same density. However, cysts are smooth borders and
cancers are usually star-burst shape
◦ Testicular Cancer:
▪ Rare form of cancer that most often effects men between ages of 20-35 years of age.
▪ With early detection there is a 95% cure rate
▪ Most common type is germ cell tumors arising from sperm-producing cells
• Seminoma tumors are usually localized, metastasize late, and respond to treatment.
▪ Least common type is non-germ cell tumors in stromal, interstitial, or Leydig cells
• Most do not metastasize
• Adroblastomas sometimes secrete estrogen, which causes feminization and gynecomastia
▪ Men with cryptocordism or HIV have higher risk of testicular tumors.
▪ Common tumor markers that confirm testicular cancer are alfa-fetoprotein, hCG, and LDH
• What are the types and s/s of benign breast disorders?

Benign Breast disorders

1. Fibroadenoma

o Most common benign tumor in women during reproductive years

o Mass of connective tissue unattached to surrounding breast tissue

o Tumors are oval, freely movable, rubbery

2. Fibrocystic Breast Condition (FBC)

o Fibrocystic changes of breast (may involve lobules, ducts, stromal tissues)

o Common in pre-menopausal women between 20 and 50 years of age

o Thought to be caused by imbalance in normal estrogen-to-progesterone ratio

o Symptoms: Breast pain, tender lumps, swelling (often before menstrual period)

o Two main features of FBC: fibrosis and cysts
 Fibrosis made up of connective tissue and are hard and firm
 Cysts are fluid filled and glandular cells – Breast US is used to confirm presence of
cysts.
o Postmenopausal women taking hormonal replacement may develop FBC or have worsening
symptoms.
o This does not increase her chances of Breast CANCER; however, if a firm mass arises a
mammogram may be done to rule out cancer
o A needle biopsy may be done to rule out cancer IF:
 No fluid is aspirated

,  Mammogram is positive
 Mass remains palpable after aspiration
 Aspirated fluid reveals cancer cells
o Management of FBC:

 Analgesics

 Limit salt intake before menses

 Wear supportive bra at all times

 Ice or heat may help

 Reduce or eliminate caffeine, dairy product

 Needle aspiration may be necessary

 diuretics

 Oral contraceptives or selective estrogen receptor modulators may be prescribed

o Explain to women the benefits and risks associated with hormonal drug therapy for FBC,
such as stroke, liver disease, and increased intracranial pressure. Teach them to seek medical
attention immediately if any signs or symptoms of these complications occur.

3. Ductal Ectasia

o Benign breast problem of women approaching menopause

o Caused by dilation and thickening of collecting ducts in subareolar area

o Hard mass; irregular borders, tender

o Greenish-brown nipple discharge, enlarged axillary nodes, redness and edema over mass

o Management

 May improve without treatment

 Reduce anxiety regarding threat of breast cancer

 Warm compresses

 Antibiotics

 May require surgical removal

4. Intraductal Papilloma

o Occurs most often in women 40 to 55 years of age

o Benign process in epithelial lining of duct, forming a pedunculated outgrowth of tissue

o Trauma and erosion within duct; bloody or serous nipple discharge

o Mass is rarely palpable

, o Must rule out breast cancer

 Breast cancer types, S/S, High risk groups, risk factors, treatments, diagnostics

Invasive VS noninvasive:
• There are two broad categories of breast cancer: noninvasive and invasive. Most of these
cancers arise from the intermediate ducts.
a. Non-invasive cancers account of about 20% of BC – occurs when the cancer remains
within the duct.
b. Invasive BC is the other 80% – occurs when the BC penetrates the surrounding tissue
around the duct.
• Metastasis occurs when the cancer cells leave the breast via blood or lymph fluid – permits
spread of cancerous cells to distant sites
• Common sites of metastasis are lung, bone, brain, and liver.
Noninvasive Breast Cancers

• Ductal carcinoma in situ (DCIS)
◦ early noninvasive form of breast cancer
◦ cancer cells located within the duct – have not invaded the surrounding fatty breast
tissue.
◦ mammography screening and earlier detection has caused the # of women diagnosed
with DCIS to >
◦ left untreated, it is estimated that 14% to 53% of DCIS would become invasive and
spread into the breast tissue surrounding the ducts over a period of 10 years
◦ Currently there is no way to determine which DCIS lesions will progress to invasive
cancer and which ones will remain unchanged – causes anxiety and decisional
conflict in many women diagnosed with this
◦ differs from invasive cancer – DCIS cells lack the biologic capacity to metastasizs
• lobular carcinoma in situ (LCIS)
◦ rare and occurs as an abnormal cell growth in the lobules (milk-producing glands) of
the breast
◦ not a true cancer, but having LCIS increases one's risk for developing a separate
breast cancer later
◦ usually diagnosed before menopause in women 40 to 50 years of age.
◦ Traditionally, treated with close observation only
◦ Women with LCIS and other breast cancer risk factors may want to consider
prophylactic treatment options such as tamoxifen, raloxifene, or prophylactic
mastectomy
Invasive Breast Cancers
• Infiltrating ductal carcinoma
◦ most common type of invasive breast cancer
◦ originates in the mammary ducts and grows in the epithelial cells lining these ducts
◦ Once invasive, the cancer grows into the tissue around it in an irregular pattern
◦ If a lump is present, it is felt as an irregular, poorly defined mass
◦ As tumor continues to grow, fibrosis (replacement of normal cells with connective tissue and
collagen) develops around the cancer

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