NUR 2790 Nursing 3 Exam 1 Study Guide | Rasmussen College | Download To Score An A

NUR2790 – Nursing III Exam 1 Study Guide Cultural Considerations • Native American o Serious illness is not always discussed to avoid negative thoughts o No eye contact o May sing, wail, or shriek around dying family member o Soul doesn’t leave the body for up to 36 hours • Black American o Usually independent; depends on family o Home remedies may be used o Bad luck to die in the home o Professionals prepare the body • Chinese American o Eldest male is in charge of decision making o No eye contact o Family takes care of patient o Herbs, Chinese medicine, and acupuncture may be used o Spirit is lost if death occurs in the hospital o Family prepares the body • Japanese American o Eldest male is decision maker; DNR is a family decision o Herbal medicine, prayer, and offerings may be used o Death at home is preferred • Hispanic o Spokesperson is older daughter/son; important decisions are discussed with entire family o Family and even extended family takes care of dying patient o Spirit is lost if death occurs in the hospital o Family takes care of body Anticipatory grieving • The intellectual and emotional responses and behaviors by which individuals work through the process or modifying self-concept based on the perception of potential loss. Hospice requirements for a prescription • Specific dose in milligrams with corresponding volume in milliliters • Concentration to be dispensed The “final surprising rally” • Temporarily more alert and responsive before death • Good time to turn off the monitors Signs and Symptoms of Pending Death • Cold extremities, may become mottled or discolored • Increased sleeping o Do not force them to stay away and talk to them normally • Decreased metabolism o Do not force Pt to eat o Offer small sips of liquid when alert and use moist swabs to keep mouth moist • Incontinence o Keep them clean and use disposable undergarments if needed • Congestion and gurgling o Position on side for increased secretions o Use medications to decrease production • Irregular breathing or periods of apnea o Raise the head of the bed o Position to the side • Disorientation o Reorient the patient o Introduce yourself every time o Speak softly and clearly • Restlessness o Use music or aromatherapy o Reduced the number of people in the room o Dim lights and minimum noise Five Wishes • The person I want to make care decisions when I cannot? • The kind of medical treatment I want or don’t want? • How comfortable I want to be? • How I want people to treat me? • What I want my loved ones to know? ABCDE Model • Ask about pain • Believe what the patient and family reports of pain/relief • Choose pain control appropriate for patient/family • Deliver interventions in a timely fashion • Empower patients and their families Adjunctive medications • Antidepressants • Corticosteroids • Anticonvulsants Reasons a terminally ill client would refuse pain medications • Alters mental/physical state • Maintain dignity/autonomy • The only thing they feel they have control over Respirations (Near Death) • Death Rattle o Loud, wet respirations; secretion build up in respiratory tract and oral cavity o Anticholinergics, such as atropine, sublingually or hyoscyamine can help dry secretions o Suctioning is not recommended, turn patient to side and put small towel under Pt mouth • Agonal Breathing o Gasping for air o Indicator that death is imminent; last for a few minutes maybe few hours • Cheyne-Strokes o Alternating periods of apnea and rapid breathing • Apnea o Not breathing 5 CATEGORIES OF CAM (We have to know the categories and what falls under each category) • Mind-body o Biofeedback: Using your own thoughts/imagination to promote mental and physical health; ease stress, pain, and anxiety. o Guided Imagery: Use of auditory and imaginary processes to help calm and relax patient; it’s more effective for chronic pain verses acute pain o Intercessory prayer: A group of people use prayer to help someone’s needs. o Meditation: Focusing only on what you can control and the present. o Relaxation Exercises: Breathing, reading, yoga, ect. • Biologically based o Herbal Medicine: Use of plants or herbs to treat various disorders ▪ Teach side effects and interactions o Vitamin and dietary supplements • Manipulative and body-based o Acupuncture: Fine needles inserted into the body at specific points to cure disease or ease pain. o Acupressure: Pushes on specific points with hands/fingers to relieve stress, pressure, nausea, ect. o Chiropractic therapy: Specific manipulation of spine or bones; helps with bone issues, pain, and headache. o Massage therapy o Shiatsu: Combo of massage, acupressure, stretching, and joint manipulation = means finger pressure. o Rolfing: Deep tissue massage to help with posture o Tai Chi: Moving mediation to improve chi, balance mind, body, and spirit o Yoga • Energy o Reiki: Transfers energy from therapist to patient o Therapeutic touch: Hands hover over the body, no touching. • Alternative medical systems o Osteopathy: Uses manual readjustments and physical manipulation of tissue and bones as an alternative treatment. o Naturopathy: Alternative treatment that promotes healthy lifestyle, foods, exercise, and herbal medicine. Supports health o Homeopathy: Stimulates immune system and natural healing through plant, animal, and mineral products. Cancer Cells: • Anaplasia: Loses its specific appearance • Larger than normal nucleus • Poorly differentiated: Serves no purpose or function • Does not bind to other cells and can move through blood vessel walls or to other tissues (metastasize) • Have an unlimited life span and continue to grow regardless of cells around it • Abnormal number of chromosomes Mucositis • Inflammation and ulceration of the lining of the mouth, throat, or GI tract • Begins with dry mouth and chapped lips; progresses to painful white patches and ulceration • Risk factors: Less than 20 yo, hematologic or head/neck cancers, oral disease, chemotherapy/radiation • Tx: Topical agents (sucralfate, Benadryl) or cryotherapy (ice chips) and soft laser therapy • Good oral hygiene, increase fluids, eat soft food, avoid acidic or irritating foods, and cool/room temperature foods Fatigue • Most common symptom w/cancer and cancer treatment • Determine severity of fatigue, promote good nutrition, provide quiet, restful areas for treatments, and avoid physical activities prior to treatments o Encourage small frequent meals o Prioritize nursing care throughout the day o Epoetin may be used for patients with anemia Tumor Markers • May indicate presence of disease, but not specific to cancer • PSA (prostate specific antigen) is elevated with BPH, but could also indicate prostate cancer o Can also determine response to treatment • CEA (carcinoembryonic antigen ) may be present in the blood of large intestine cancer, pancreas, breast, ovary, or lung cancer o Use to determine spread of disease, response to treatment, assist with diagnosis, and cancer reoccurrence CAUTION • Change in bowel/bladder habits • A sore that does not heal • Unusual bleeding or discharge • Thickening or presence of lump • Indigestion or difficulty swallowing • Obvious change to wart, mole, or nevus • Nagging cough or hoarsness Myelosuppression: One or more blood component is low (common reason for treatment delay) Anemia • Hemoglobin less than 12g/dL and hematocrit less than 36% • S&S: Fatigue, SOB, chest pain, tachycardia, headache, pallor, and mental status changes. • Epoetin alfa stimulates RBC production Neutropenia • Absolute neutrophil count less than 2000/mm • 10-14 days after chemotherapy is the lowest point • Monitor for infection; temperature, chills, cough, SOB, sore throat, stomatitis, redness/swelling around breaks in the skin, changes in bowel, N&V, and malaise. • Filgrastim (Neuopogen) creates WBC Thrombocytopenia • Platelet count less than 100,000 • S&S: Bruising, frank bleeding, bloody nose, petechial, hematuria, black, tarry stools • Platelet transfusion is treatment of choice Tumor Lysis Syndrome • Large numbers of tumor cells are destroyed rapidly • Severe TLS can cause tissue damage, acute kidney injury, and even death • Hyperkalemia, hyeruricemia, and hypophosphatemia can have effect heart muscle, kidneys, and CNS • Early symptoms include lethargy, nausea, vomiting, anorexia, flank pain, muscle weakness, cramps, seizures, edema, and altered mental status. • Increased fluids can manage potassium level and prevent uric acid crystals o Drink at least 3000mL of fluids the day before, day of, and for 3 days after treatment o Dialysis • Monitor daily weight and serum electrolyte values Hormone Therapy: Prevent hormones from stimulating growth of cancer cells. o Hormones can increase risk of developing other cancers o Hormones can also stop growth of certain cancers. o Selective Estrogen Receptor Modulators (SERM) ▪ Ex. Tamoxifen: Blocks estrogen from getting to cancer cell preventing growth. ▪ Ex: Testosterone for prostate cancer ▪ SERM increases risk for uterine and cervical cancer risk is increased. ▪ Side effects: Hot flashes, blood clots, decreased libido • Teletherapy (external): Radiation from outside of the patient o Patient is not radioactive o Exact tumor location is determined first and then skin is marked o Patient must always be in same position for all treatments o Never use oil and only use approved lotions o SX: N&V, abdominal pain, watery stools, and burns. o Fecal samples are needed to rule out C-Diff before any antidiarrheal are given • Brachytherapy (internal): Radioactive isotopes are administered by internal implants near the tumor or within body fluid by oral or IV routes. o ALWAYS private room with sign on door, limited contact, at least 6ft away at all time, radioactive protective clothing, no children or pregnant women. o Radioactive up to 48 hours after treatment o Must be careful around bodily fluids, patients need to double flush! o Some implants can be left inside permanently or for long period of time. o SX: Swelling, bleeding, and burning CANCER TYPE ASSESSMENT CONSIDERATION Colorectal cancer Ask the patient whether bowel habits have changed over the past year (e.g., in consistency, frequency, color). Is there any obvious blood in the stool? Test at least one stool specimen for occult blood during the patient's hospitalization. Encourage the patient to have a baseline colonoscopy. Encourage the patient to reduce dietary intake of animal fats, red meat, and smoked meats. Encourage the patient to increase dietary intake of bran, vegetables, and fruit. Bladder cancer Ask the patient about the presence of: Pain on urination Blood in the urine Cloudy urine Increased frequency or urgency Prostate cancer Ask the patient about: Hesitancy Change in the size of the urine stream Pain in the back or legs History of urinary tract infections Skin cancer Examine skin areas for moles or warts. Ask the patient about changes in moles (e.g., color, edges, sensation). Leukemia Observe the skin for color, petechiae, or ecchymosis. Ask the patient about: Fatigue Bruising Bleeding tendency History of infections and illnesses Night sweats Unexplained fevers Lung cancer Observe the skin and mucous membranes for color. How many words can the patient say between breaths? Ask the patient about: Cough Hoarseness Smoking history Exposure to inhalation irritants Exposure to asbestos Shortness of breath Activity tolerance Frothy or bloody sputum Pain in the arms or chest Difficulty swallowing