Med Surg 1 Exam 2 Study Guidelines 2021 PDF

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Study guidelines for 201 Med surg will help with exam 2 and ABGs....hope this helps someone!...

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Med Surg I Study Guide (Exam 2) CHAPTER 14: INFECTION 1. Understand the impact of emerging infections and re-emerging infections on health care.  Emerging Infections (Types: Table 14.4, pg 213)  Infectious Disease that has Recently Increased in Incidence (or Threatens to Increase in the Immediate Future)  Reemerging Infections (Types: Table 14.5, pg 214)  Infectious Agents that can Reemerge Under the Right Conditions 2. Relate infection prevention to the nursing process: assessment, diagnosis, planning, implementation, and evaluation.  Infection Prevention  Assessment o DO NOT Make Assumptions About WHO May be At Risk  Ex. Elderly, Sexual Preference (Ex. Hetero), Married o Candid Conversation is Important for Effective Management of HIV o Ask At-Risk Patients (Have You Ever…)  Had a Blood Transfusion or Used Clotting Factors? o If So, Was it Before 1985?  Shared Drug-Using Equipment with Another Person?  Had Sex Involving Contact with Another Person?  Had a Sexually Transmitted Infection [STI]?  Had Sex Involving Confirmed HIV Patient? o Assess Diagnosed Patients Thoroughly (Table 14.15, pg 223)  Past Health History  Medications (Immunosuppressive Use)  Functional Health Patterns  Presence of Symptoms Using a Systems Review  Diagnosis o Nursing Diagnosis for HIV  Risk for Infection  Lack of Knowledge  Difficulty Coping  Impaired Nutritional Status o Diagnostic Studies  Screening Tests (Detects HIV-Specific Antibodies/Antigens) o Several Weeks to Detect Antibodies (Window Period) o Uses Blood/Saliva o Combination Antigen-Antibody Tests (Detects HIV Earlier)

 HIV Progression Monitoring o CD4 Cell Count Provides a Marker of Immune Function o Viral Load o Lower Vital Load = Less Active Disease  Abnormal Blood Tests are Common o Caused by: HIV, Opportunistic Diseases, Complications of Therapy  Decreased WBC Counts o Especially Lymphopenia and Neutropenia  Low Platelet Counts (Thrombocytopenia)  Anemia (Associated with Antiretroviral Therapy [ART]  Altered Liver Function  Resistance Tests Helps Determine Patient’s Resistance to ART  Assays [Analysis] Helps HCPs Know Which Med May be Effective o Genotype/Phenotype Assay  Planning o Goals for Care  Adherence with Drug Regimens  Adopting a Healthy Lifestyle o Includes Avoiding STI and Blood-Borne Illnesses  Protecting Others from HIV  Beneficial Relationships  Explore Spiritual Issues  Maintain Activities and Productivity  Accepting Issues Related to Disease/Disability/Death  Coping with the Disease and Its Treatment  Implementation o Primary Prevention + Health Promotion  MOST Effective Strategies for Chronic Diseases (Ex. HIV) o Failed Prevention = Disease Results  Early Intervention is Facilitated by Health Promotion Practices  Evaluation o Expected Outcomes of Patient AT RISK for HIV  Develop/Implement Personal Plan to Decrease Personal Risk Factor  Have HIV Testing o Expected Outcomes of Patient WITH HIV  Adhere to Treatment for HIV Disease  Work with the Health Care Team to Achieve Optimal Health  Prevent Transmission of HIV to Others

3. Understand the HAI’s and methods to reduce them.  Health Care-Acquired Infections [HAIs]  Infections Acquired from Exposure in a Health Care Setting  Methods for Reducing HAIs  Use PPE (Gloves, Gowns, Masks, Goggles, Face Shields)  Hand Washing (Alcohol, Soap + Water)  Decontamination of Equipment 4. Explain the transmission of HIV and risk factors for infection.  HIV Transmission  Transmits Through Contact with Certain Body Fluids o Blood, Semen, Vaginal Secretions, Breast Milk  NOT Spread Through Casual Contact o Hugging, Dry Kissing, Shaking Hands, Sharing Utensils, Toilet Seats  Unprotected Sex with HIV-Infected Partner (MOST Common) o Greatest Risk: Partner Receiving Semen  Prolonged Contact with Infected Fluids  Women at Higher Risk  Trauma Increases Likelihood of Transmission  Contact with Blood o Drug-Using Paraphernalia is Highly Risky o Puncture Wounds (Most Common Work-Related HIV Transmission) o Blood Transfusions (However, Routine Screenings Have Improved)  Perinatal Transmission o Can Occurring During Pregnancy, Delivery, or Breastfeeding o 25% of Infants Born to Untreated HIV Mothers will Be Born with Infection  ART Treatment Can Reduce Rate to Less than 2% 5. Explain the teaching involved in HIV prevention and control.  HIV Prevention/Control  Increase Safer Sexual Practices o Abstinence o Limit Contact Activities Involving the Mouth, Penis, Vagina, Rectum o Use Barriers (Ex. Condoms) o Educate/Counsel About Preexposure Prophylaxis [PrEP]  Decreasing Risks: Drug Use o DO NOT…  Use Drugs  Share Equipment  Have Sex Under the Influence of Any Impairing Substance

o Refer for Help with Substance Use

 Decreasing Risks: Perinatal Transmission o Prevent HIV in Women (Most Susceptible; Potential to Affect Infant) o Family Planning (Options of ART Use to Decrease Transmission)  Decreasing Risks: Work o Adhere to Precautions/Safety Measures to Avoid Exposure o Report All Exposures for Timely Treatment and Counseling o Postexposure Prophylaxis [PEP] + ART  Can SIGNIFICANTLY Decrease Risk of Infection 6. Apply how HIV and AIDS is diagnosed.  Diagnosing HIV  Testing (ONLY Sure Method of Determining HIV Infection) o Universal, Voluntary Testing as Part as Routine Medical Care o 14% of People with HIV are Not Aware of Being Infected  Diagnosing AIDS (CDC Criteria Must Be Met for HIV Patient)  CD4+ T Cell Count: BELOW 200 Cells/uL o NORMAL: 800 – 1200 Cells/uL (HIV: Below 500 Cells/uL)  One of the Following Opportunistic Infections [OIs] o Bacterial, Fungal, Protozoal, Viral (Table 14.10, pg 219)  One of the Following Opportunistic Cancers (Same Table)  Wasting Syndrome (Loss of 10% or More of Ideal Body Mass) 7. Apply testing for HIV to patient education and care.  Include Testing for HIV When Caring/Educating Patients 8. Understand the role of antiretroviral therapy and the side effects that occur.  Antiretroviral Therapy [ART]  Combination of Medications Used to Control/Suppress HIV Replication  Reduces Risk for Transmission (Especially for Pregnant Women  Neonate)  ART Side Effects  Lipodystrophy (Changes in Body Shape) o Fat is Redistributed into the Abdomen, Upper Back, and Breasts o Fat Loss Occurs in the Arms, Legs, and Face  Hyperlipidemia o High Triglycerides, Increased Low Density Lipoproteins [LDL] o Decreased High Density Lipoproteins [HDL]  Insulin Resistance  Hyperglycemia  Bone Disease (Osteoporosis, Osteopenia, Avascular Necrosis)  Lactic Acidosis

 Renal Disease  Cardiovascular Disease 9. Explain the role of PrEP.  Preexposure Prophylaxis [PrEP]  Comprehensive HIV Prevention Strategy to Reduce Chances of Acquiring HIV Infection in Individuals at Risk  Currently Involves Daily HIV Antiretrovirals  Used in Conjunction with Other Proven Prevention Interventions  Tenofovir Disoproxil Fumarate [TDF] + Emtricitabine (First Approved PrEP) o Effective/Safe Therapy for Preventing HIV Transmission o Prescription is Increased for Patients at Risk of Acquiring HIV  Increased Prescription Potentially Reduces New HIV Infections 10. Apply the risks of opportunistic diseases to patient with HIV infection.  Opportunistic Diseases  Infections/Cancers that Occur in Immunosuppressed Patients  Main Cause of Disease, Disability, and Death in HIV Patients 11. Describe the onset and sequelae of HIV infection.  HIV Infection  Onset (Acute Infection)(2 – 4 Weeks After Infection) o Immune Problems Start when CD4+ T Cells Drop  Drops Below 500 Cells/uL  SEVERE Problems Occur when Less than 200 Cells/uL o Mononucleosis-Like Symptoms  Fever, Swollen Lymph Nodes  Sore Throat, Headache, Malaise, Nausea  Muscle/Joint Pain, Diarrhea, Diffuse Rash o HIGHLY INFECTIOUS  Sequelae (Pathological Condition Resulting from a Prior Disease/Illness/Attack) o Asymptomatic Infection (No Signs/Limited Signs of Infection)  AIDS [Acquired-Immunodeficiency Syndrome] o Can Develop in 10 Years if HIV is Left Untreated o Symptomatic Infections (Signs of Infection are Visible)  CD4+ T Cells DECLINE Closer to 200 Cells/uL o HIV Advances to a More Active Stage o Symptoms Worsen  Persistent Fever  Frequent Night Sweats  Chronic Diarrhea  Recurrent Headaches  Severe Fatigue

 Oropharyngeal Candidiasis [Thrush] o MOST Common Infection Associated with HIV

12. Describe palliative care. (pg 127)  Palliative Care  Any Form of Care/Treatment that Focuses on Reducing the Severity of Disease Symptoms  GOALS of Palliative Care o Prevent/Relieve Suffering o Improve Quality of Life for Patients with Serious Life-Threatening Illnesses

CHAPTER 15: CANCER 13. Understand the basic etiology of cancer: mutated body cells.  Cancer (Diseases Characterized by Uncontrollable/Unregulated Growth of Cells)  Mutated Body Cells are the Basic Etiology of Cancer 14. Describe the role of the immune system in promoting and preventing cancer.  Role of the Immune System (Related to Promoting/Preventing Cancer)  Immune Response: To Reject/Destroy Cancer Cells o Inadequate IF Cancer Cells Arise from Normal Human Cells o Some Cancer Cells Can Change the Antigens on Their Surfaces  Tumor-Associated Antigens [TAAs]  Immunologic Surveillance (Response to Removing TAAs) o Lymphocytes Continually Check Cell Surface Antigens  Detects/Destroys Abnormal Cells o Involves Cytotoxic T Cells, Natural Kill Cells, Macrophages, and B Cells  Cytotoxic T Cells (Dominant Role in Resisting Tumor Growth) o Kills Tumor Cells/Produces Cytokines [Interleukin-2 [IL-2]; y-Interferon]  Stimulates T Cells, NK Cells, B Cells, Macrophages o Leads to Increased Cytotoxic Activity  Natural Killer [NK] Cells o Kills Tumor Cells DIRECTLY WITHOUT Prior Sensitization  B Cells o Produces Antibodies that Bind to Tumor Cells  Immunologic Escape (Mechanisms Cancer Cells Utilize to Evade the Immune System)  Suppression of Factors that Stimulate T Cells  Weak Surface Antigens (Allows Cancer Cells to “Sneak Through” Surveillance)  Develops Tolerance to Immune System  Secretion of Products that Suppress the Immune System  Induction of Suppressor T Cells  Blocks Antibodies from Binding with TAAs (Prevents Recognition)  Oncofetal Antigens [“Tumor Markers”] (Type of Tumor Antigen)

 Can Be Used to Monitor Effects of Therapy and Indicate Tumor Recurrence o Not 100% Specific for Tumor Recurrence (Has Various Factors)  Found on Tumor Cell Surfaces, Inside Tumor Cells and Fetal Cells  Cell Could Regain Embryonic Capability to Differentiate into Many Cell Types 15. Relate the nurse’s role to prevention, treatment, and diagnosis of cancer.  Nursing Role (Prevention of Cancer)  General Education Goals (Prevention is KEY) o Motivate People to Recognize/Modify Behaviors that Negatively Impact Health o Encourage Awareness of/Participation in Health-Promoting Behaviors  SEVEN Warning Signs of Cancer (CAUTION) o Change in Bowel Habits o A Sore that Does Not Heal o Unusual Bleeding or Discharge from Body Orifice o Thickening or a Lump in the Breast or Elsewhere o Indigestion or Difficulty in Swallowing o Obvious Change in a Wart or Mole o Nagging Cough or Hoarseness  Nursing Role (Treatment of Cancer)  Factors of Treating Cancer o Tumor Histology/Staging Outcomes (PRIMARY FACTORS) o Patient’s Physiologic Status (Ex. Presence of Co-Morbid Illnesses) o Personal Desires (Ex. Active Treatment vs Palliation of Symptoms)  Factors Influence… o Modalities [Types] of Treatment  Surgery, Radiation, Chemo, Immuno, Targeted, Hormone o How Therapies Are Sequenced  Multimodality Therapy [Combined Modality Therapy] o Length of Time that Treatment is Prescribed  GOALS of Treatment o Cure (Expected to Have Greatest Chance of Eradiating Cancer)  Surgery Alone OR Adjunctive Systemic Therapy o Control (Cancer is NOT COMPLETELY Eradicated But are Responsive to Anticancer Therapies) o Palliation (Relief/Control SYMPTOMS; Maintaining Quality of Life)  Nursing Role (Somebody Diagnosed with Cancer)  Patient May Experience Fear/Anxiety o Actively Listen to Patient’s Concerns o Manage Your Own Discomfort o Give Clear Explanations (Repeat if Necessary) o Give Written Info for Reinforcement

o Refer to Oncology Team when Possible

16. Compare and contrast the different therapies for cancer: Chemo, radiation, immunotherapies, targeted therapies, hormone and HGF therapies, and HSCT.  Chemotherapy [Antineoplastic Therapy]  Use of Chemicals as a Systemic Therapy for Cancer  Best Therapy for Most Solid Tumors and Hematologic Cancers  Can Offer Cure, Control, and (Sometimes) Palliative Care  Radiation Therapy  Oldest Nonsurgical Methods of Cancer Treatment  More Accurate, Less Invasive  Different Types of Ionizing Radiation are Used to Treat Cancer  50% of Cancer Patients Receive This at Some Point in Their Treatment  Radiation (Emission of Energy and Travels Through Space/Materials  Immunotherapy [Biologic Therapy]  Uses the Immune System to Fight Cancer  Boost/Manipulates Immune System  Creates Environment Not Possible for Cancer Cells to Grow  Attacks Cancer Cells Directly  Targeted Therapies (Inhibitors and Antibodies)  Targets Specific Cell Receptors/Pathways of Tumors o Interferes with Cancer Growth  Does Less Damage to Normal Cells  Agents that Target Specific Oncogenes are Being Developed  Cancer CAN Become RESISTANT to Targeted Therapy o Targeted Therapy is Best Used in Combination with Chemotherapy  Hormone Therapy  Sex Hormones o Can Stop Growth of Cancer Cells  Corticosteroids o Used in Combination with Drug Regimens  Helps Curb Side Effects  Hematopoietic Growth Factors [HGF]  Used to Support Cancer Patients Through the Treatment of the Disease  Use of this Raises SAFETY CONCERNS o Increases Risk for Death o Increases Risk for Serious Cardiovascular Events  Hemoglobin Greater than 12 g/dL  Hematopoietic Stem Cell Transplantation [HSGT]

 Effective, Life-Saving Procedure for a Number of Malignant/Nonmalignant Diseases  Allows for the Safe Use of Very High Doses of Chemotherapy/Radiation in Patients whose Tumors have Developed Resistance o Also Includes Those Who Failed to Respond to Chemo/Radiation 17. Select the nursing care for complications and side effects of cancer treatment.  Nursing Care for Complications/Side Effects of Cancer Treatment  Bone Marrow Suppression [BMS] o Myelosuppression (MOST Common Side Effect) o Treatment-Induced Reduction in RBCs and WBCs  Results in Infection, Hemorrhaging, and Overwhelming Fatigue o Nursing Interventions for BMS  Monitor CBC (Neutrophils, Platelets, RBC Counts)  Wash Hands Frequently (Patient is Neutropenic)  Monitor Temp Frequently (Increased Temp = Infection/Fever)  Avoid Invasive Procedures (Thrombocytopenia [Low Platelets])  Fatigue o Encourage Conservation Strategies  Rest Before Activity  Get Assistance with Activity  Remain Active During Periods of Time Patient Feels Better o Maintain Nutritional/Hydration Status o Assess for Reversible Causes of Fatigue o Causes of Fatigue  Anemia  Accumulation of Toxic Substances from Treatment  Need for Extra Energy for Repair/Healing After Treatment  Lack of Sleep Caused by Treatment (Chemo Drugs)  GI Problems o Prophylactic Administration of Antiemetics o Assess for Signs/Symptoms of…  Alkalosis (High Alkalinity of Blood – Excessive Bicarbonate)  Dehydration  Input/Output o Nonirritating, Low Fiber, High-Calorie, High-Protein Diet o Teach Importance of Oral Examination and Maintain Oral Care o Anorexia  Monitor Carefully to Avoid Weight Loss (Weight 2x/Day)  Recommend Small, Frequent, High-Protein, High Calorie Meals  Involve Dietitian Before Treatment Begins

 Integumentary/Mucosal Reactions o Lubricate Dry Skin with a Nonirritating Lotion Emollient (Aloe Vera)  No Metal, Alcohol, Perfume, Irritating Additives o Wet Desquamation (Rate: Cell Sloughing > New Epidermal Cells)  Exposure of Dermis; Weeping of Serous Fluids o Skin Reactions  Prevent Infection  Facilitate Wound Healing  Protect Irritated Skin Temperature Extremes  Avoid Constricting Garments, Harsh Chemicals, Deodorants  Help Patient Deal with Hair Loss [Alopecia]  Do NOT Use Heating/Ice Pads in Treatment Field  Pulmonary Effects o Damage from Treatment Can be Irreversible and Progressive o Cough, Dyspnea, Pneumonitis, Pulmonary Edema can Occur o Methods for Treating Pulmonary Effects  Bronchodilators  Expectorants/Cough Suppressants  Bed Rest  Oxygen  Cardiovascular Effects o Preexisting Coronary Artery Disease = Increased Vulnerability o Baseline/Periodic ECGs of Left Ventricular Function are Performed o CAUTION: Anthracyclines Can Cause Cardiotoxicity  Cognitive Effects o Chemo Brain (Mental Cloudiness/Fog After Treatment)  Can Last a Short Time OR Years  Can Be Severe  Reproductive Effects o Sexual Side Effects Can Occur (Ex. Sterilization) o Use Appropriate Shielding Over Reproductive Organs o Unlike Testes, there is NO WAY to Repair Ovarian Function 18. Provide therapeutic communication to help patients and significant others cope with the diagnosis and treatment of cancer.  Therapeutic Communication

 Encourage Patient to Share Meaning of Their Experiences  Actively Listen to Patient’s Concerns  Manage Your Own Discomfort  Give Clear Explanations (Repeat if Necessary)  Give Written Information for Reinforcement  Refer to Oncology Team when Possible 19. Understand the precautions for staff, visitors, and patients in regard to brachytherapy and chemotherapy.  Brachytherapy [Internal Radiation]  Implantation/Insertion of Radioactive Materials Into/Close to Tumor  Patient Emits Radioactivity  Limit Time Near Patient  Precautions with Chemotherapy  ONLY Trained Personal Should Handle Cancer Drugs o Drug Can be Absorbed Through Skin and Inhalation  Side Effects Occur as a Result of Destruction of Normal Cells o Leads to Increased Risk for Bleeding and Infection 20. Describe normal/abnormal lab values.  Normal Lab Values  WBC o 4000 – 11000 WBC/mcL  RBC o Men: 4.7 – 6.1 Million Cells/mcL o Women: 4.2 – 5.4 Million Cells/mcL  Platelets o 150,000 – 400,000 Platelets/mcL  Hemoglobin o Men: 13.5 – 17.5 grams/dL o Women: 12 – 15.5 grams/dL  Hematocrit o Men: 38.3% – 48.6% o Women: 35.5% – 44.9% 21. Understand the cause of abnormal lab values.  Bone Marrow Suppression (Infection, Hemorrhage, Overwhelming Fatigue)  Nadir (Lowest Blood Cell Count – Occurs 7 – 10 Days After Starting Treatment)  Chemotherapy/Radiation 22. Summarize the oral chemo agents.  Oral Chemo Agents  More Available Options

 Storage and Side Effects are Taught to Patient

23. Discuss the TNM Classification System and Clinical Stages  TNM Classification System  Used to Determine the Anatomic Extent of the Disease Involvement o Involves 3 Parameters  Tumor Size and Invasiveness [T]  Presence/Absence of Regional Spread to the Lymph Nodes [N]  Metastasis to Distant Organ Sites [M]  Primary Tumor [T]  T0: No Evidence of Primary Tumor  Tis: Carcinoma in situ [CIS] (Localized Cancer Cells; No Tendency to Spread)  T1 – 4: Ascending Degrees of Increase in Tumor Size/Involvement  Tx: Tumor Cannot Be Measured or Found  Regional Lymph Nodes [N]  N0: No Evidence of Disease in Lymph Nodes  N1 – 4: Ascending Degrees of Nodal Involvement  Nx: Regional Lymph Nodes Unable to Be Assessed Clinically  Distant Metastases [M]  M0: No Evidence of Distant Metastases  M1 – 4: Ascending Degrees of Metastases Involvement (Including Distant Nodes)  Mx: Cannot Be Determined  Clinical Staging  Stage 0: Cancer in situ  Stage 1: Tumor Limited to the Tissue of Origin; Localized Tumor  Stage 2: Limited Localized Spread  Stage 3: Extensive Local and Regional Spread  Stage 4: Metastasis

CHAPTER 29/30: HEMATOLOGIC SYSTEM/PROBLEMS 24. Know the age-related changes in the hematologic system.  Age-Related Changes (Hematologic System)  Caused by Cell Loss and Organ Atrophy  Decreased… o Bone Marrow Mass/Cellularity o Hematopoietic Tissue in the Marrow Space o Hemoglobin Levels o Lymphocyte Function o Ability to Recover from Acute Illnesses o Ability to Compensate for Chronic Diseases o Ability to Respond to Hemorrhage/Hypoxemia  Increased… o Bone Marrow Fat o Platelet Adhesiveness o Osmotic F...