Module 4 session 1 Lecture PDF

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NUR 1212C - Health Alterations Across the Lifespan I 5...

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Module 4 Session 1 - Elimination concept- colon cancer & prostate cancer Impact of cancer on physical function  Impaired immunity and clotting  Alerted GI function  Altered peripheral nerve function  Motor and sensory deficits  Cancer pain  Altered cardiac and respiratory function Cancer management  Surgery- can be prophylactic, diagnostic, curative, cancer control or cytoreductive, palliative and reconstructive or rehabilitative in nature.  Radiation- see table 22-2 on Acute and Late site-specific effects of radiation therapy. Pg 389  Chemotherapy- see table 22-3 on categories of chemotherapeutic drugs on page 391  Immunotherapy- works through modification of patient’s biological response to cancer cells  Photodynamic therapy- this is selective destruction of cancer cells through a chemical reaction triggered by a high energy laser light. Patient can be outpatient or may require ICU monitoring for airway management when treating airways.  Hormonal therapy- this involves changing the body’s usual hormone response. Manipulation of hormones include the use of steroids. Effects can cause masculizing effects in women and visa versa for men. Treatment issues  Dosage  Scheduling  Administration o Extravasation o Vesicants  Fatigue is a major problem after radiation therapy o Exercise and sleep interventions have benefited in reducing fatigue. Side effects of chemotherapy  Chemotherapy- induced nausea and vomiting (CINV)  Mucositis  Alopecia  Cognitive changes  Chemotherapy- induced peripheral neuropathy (CIPN)  Infection risk o Bone marrow suppression o Neutropenia  Anemia, thrombocytopenia risk o Bone marrow suppression o Impaired clotting

Oncologic emergencies  Sepsis (septicemia) – Infections are the leading cause of death in patient’s with cancer. Monitoring for sepsis when patient’s have invasive catheters or venous access devices is crucial. Checking total WBC count and neutrophils is very important  Intravascular coagulation- Destruction of clots which results in thrombosis and bleeding

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SIADH (Syndrome of Inappropriate Secretion of Diuretic Hormone)Inappropriate release of ADH which leads to: o Uncontrolled water reabsorption causing intracellular edema o Hyponatremia o Increased excretion of urinary sodium.

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Spinal Cord Compression- Vertebra compresses or displaces the thecal sac which leads to neurologic issues. Hypercalcemia- Ca released from the bone, exceeds the kidney’s ability to excrete of the bones to reabsorb. Superior vena cava syndrome (SVCS) -Compression of superior vena cava by tumor which restricts venous return, decreasing cardiac output. o appearance of varicose veins on the body (chest and legs). Tumor Lysis Syndrome (TLS) -Rapid release of intracellular contents that lead to electrolyte imbalances hyperkalemia, hypocalcemia, hyperphosphatemia and hyperuricemia.  this is the only one that is HYPOcalcemia.

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What is something you could want to watch for each? Neutropenia: inspect IV sites every 4 hours for signs of infection. Thrombocytopenia: avoid IM injections & venipunctures. Anemia: administer epoetin alfa subcutaneously once a week. Fatigue is the most common side effect for radiation therapy. When is the patient with acute leukemia at greatest risk of developing tumor lysis syndrome? After the first cycle of chemotherapy. -Malignant is bad -Benign just an Concepts  The priority concepts in this chapter are o Elimination (Bowel)- the passage and dispelling of stool through the intestinal tract by means of intestinal smooth muscle contraction o Cellular Regulation  Elimination exemplar is intestinal obstruction  Cellular regulation exemplar is colorectal cancer  The interrelated concepts in this chapter are o Nutrition o Comfort o Fluid and electrolyte imbalance Elimination concept exemplar: Intestinal obstruction  Types: o Mechanical: occurs because the bowel is physically blocked, and its contents cannot get past the obstruction.

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Nonmechanical: called ileus, occurs because the wavelike muscular contractions of the intestine (peristalsis) that ordinarily move food through the digestive tract stop.

Complications Etiology o Intussusception: a condition where part of the intestine telescopes into itself leading to an intestinal obstruction (blockage). o Volvulus: an obstruction due to twisting or knotting of the GI tract. Rectal polyps  Polyps in the intestinal tract are small growths covered with mucosa and attached to the surface of the intestine o Adenomatous  Villous – the pose the greatest cancer risk  Tubular o Malignant o Hyperplastic o Asymptomatic – discovered during routine colonoscopy screening o Biopsy and polypectomy is done Cellular regulation exemplar: colorectal cancer  Cellular regulation: refers to all functions carried out within a cell to maintain homeostasis, including its responses to extracellular signals Consequences of malignant neoplasia  Without successful treatment: fatigue, weight loss, pain, organ failure, and death  Fear, stress, and anxiety  Changes in family dynamics  Financial challenges  Changes in self-image and interpersonal relationships Hernias  Umbilical hernia: through congenital s=defect in muscle  Incisional hernia: through inadequately healed surgical repair  Femoral hernia: through d=femoral ring  Direct inguinal hernia: through area of muscle weakness  Indirect inguinal hernia: through inguinal ring Hemorrhoids  Protrusion  Ask the patient to describe it Malabsorption syndrome  The nutrient involved in malabsorption depends on the type and location of the abnormality in the intestinal tract. o Insufficient digestion, celiac disease, chronic pancreatitis, carcinoma, hepatopathies, diverticula, hypomotility in diabetes and scleroderma, ileal resection, Lymphoma, etc.

Prostate Cancer Slow growing cancer with predictable metastasis. Advanced age is leading risk factor. Second most common cancer in men. Has nearly 100% cure rate if found early.

Signs & Symptoms: - Difficulty in starting urination - Frequent bladder infections - Urinary infection - Urinary frequency - Hematuria - Nocturia - Pain during intercourse - Bone pain - Unexpected weight loss - PSA

Testicular Cancer Rare cancer affecting men, usually between 20 and 35 years of age. Usually curable with early detection by testicular self-examination. Germ cell versus non-germ cell tumors. *** Most questions will be about prostate cancer vs testicular cancer. ***

Things to Remember & Practice Questions Neupogen – med that helps you bump up your neutrophils. Ascending: going up Descending: going down Transverse: across Bright red blood in the stool comes from the rectosigmoid colon. Ascending colon: Diarrhea Transverse colon: Mushy Stool What symptom does the nurse expect the patient with intussusception to exhibit? 1) Decrease in pulse 2) Singultus (hiccups) 3) Frequent bloody stools 4) Extremely elevated body temperature A patient received one positive fecal occult blood test. Which response is most appropriate? 1) The patient will need two samples on three consecutive days. 2) The patient has colon cancer. 3) The patient has bleeding in the GI tract. 4) The patient may be taking Aspirin.

Module 4 Lecture- Intracranial Regulation – Seizures Assessment Methods  Patient history  Physical assessment  Complete neurological assessment  Assessment of mental status  Epilepsy monitoring unit Diagnostic Assessment  Laboratory assessment  Skull and spine x-rays  Cerebral angiography (arteriography)  Computed tomography (CT) scan  Magnetic resonance imaging (MRI)  Position emission tomography (PET) – used to identify abnormal cells, cancer cells  Single-proton emission Electroencephalography (EEG)  Graphically records the electrical activity of cerebral hemispheres o Wash pts hair after this, and don’t administer meds after this Lumbar puncture  Must get a sample of cerebrospinal fluid (CSF) – in between position the patient the best you can – label bottles correctly Seizure Risks  May result from: o Metabolic disorders o Acute alcohol withdrawal o 77Electrolyte disturbances o Heart disease o High fever o Stroke o Substance abuse Seizure Precautions  Oxygen- make sure it is readily available  Suction equipment – turn patient to the side – use Yankauer on the sides of the mouth  Airway – nasal trumpet (keeps tongue from going to the back of the throat, cutting off air)  IV access - If the patient does not have an IV access, insert a saline lock, especially if he or she is at significant risk for generalized tonic-clonic seizures. The saline lock provides ready access if IV drug therapy must be given to stop the seizure.  Side rails up and padded – protects patient from injury When someone is seizing: Duration is IMPORTANT – when it starts and ends Frequency – status epilepticus -turn pt. to the side -lips turned purple sometimes

Seizure complications: -Seizure lasting more than 10 minutes, can cause brain damage and death

-Common causes of status epilepticus includes sudden withdrawal from antiseptic drugs, infection, acute alcohol / drug withdrawal, head trauma, cerebral edema, metabolic disturbances Seizure Management  Depends on type of seizure  Observation and documentation  Patient safety  Side-laying position  No restraints  Never force anything into the patient’s mouth Acute Seizure Management  Medication depends on type of seizure Status Epilepticus  Prolonged seizures that last more than 5 min or repeated seizures over course of 30 min – medical emergency  Establish airway  ABG’s – Arterial blood gasses o PH low = acidosis, watch CO2, if low increase peak  IV push lorazepam, diazepam o Straight push, if possible  Rectal diazepam  Loading dose IV phenytoin Drug therapy  Evaluate most current blood level of medication, if appropriate  Be aware of drug-drug / drug food interactions  KNOW LEVELS  Maintain therapeutic blood levels for maximal effectiveness  Do not administer warfarin with phenytoin  Document and report side / adverse effects Patient & family Education  Compliance with AEDs  Social service resources to assist with medication costs  Evaluation of employment safety needed to decrease risks  Vocational rehabilitation may be subsidized -Know the types of seizures -What is the appearance of someone with a grand auld seizure?

Module Lecture continued 4-4-19

Goals of palliative care  To achieve the best quality of life for patients and their families: o Prevent or treat the symptoms of the disease, or treat the disease as early as possible Concept Attributes  Total, active Impact of chronic disease  By 2030 people aged 65 or over will outnumber the young  Leading causes of death in the united states are no longer rapidly fatal; they are chronic diseases such as cardiovascular problems. COPD, cancer and dementia  Globally, it is estimated that 40 million people will need palliative care Interprofessional Team  Plan of care is based on the patient and family’s realistic expectations and goals and second on the team’s assessment, recommendations, and support.  The family serves as a member of the team Exemplars – how do these apply to palliative care?  Breast cancer  Leukemia  Chronic obstructive pulmonary disease  Alzheimer disease  Stroke...