Summary - RNSG 1538 ATI Concept Base 3: ATI Concept Base 3 (complete solution guide) > San Antonio College

ATI Concept Base 3. Cellular Regulation: Ch. 89 General Principles of Cancer Risk Factors: ● Age; older higher risk ● Race ● Genetics ● Exposure to chemicals, tobacco & alcohol ● High fat, red meat, & low fiber ● Exposur ...

ATI Concept Base 3. Cellular Regulation: Ch. 89 General Principles of Cancer Risk Factors: ● Age; older higher risk ● Race ● Genetics ● Exposure to chemicals, tobacco & alcohol ● High fat, red meat, & low fiber ● Exposure to sun, UV, & radiation Staging ● T: tumor higher number bigger tumor ● N: node # of lymph nodes involved ● M: Metastasis: 0 no evidence 1 evidence Risk for malnutrition ● Hypermetabolic state due to presence of carcinoma ● Impair ability to ingest, digest, absorb nutrients Ch. 90 Cancer Screening & Diagnostic Procedures C: change in bowel or bladder habits A sore that doesn’t heal Unusual bleeding or discharge Thickening or lump of breast or elsewhere Indigestion or difficulty swallowing Obvious changes in warts or moles Nagging cough or hoarseness Diagnostics: ● Biopsy provides definitive diagnosis ● Imaging secondary tool; CT, MRI, PET scan, or ultrasound Ch. 91 Cancer Treatment Options ● Remove tumor: tumor excision ● Chemotherapy: damages cell’s DNA or destroys rapidly dividing cells ○ Unintentional harm to normal rapidly proliferating cells ■ Hair, mucous membranes in GI, & bone marrow ○ Implanted port or central catheter ■ High risk for infection Protect & teach ■ Monitor VS temp 100F reported right away & WBC <1000 Neutropenic precautions ● Colony stimulating production ● Avoid crowds,, changing litter box,, avoid yard work & gardening, avoid room temp drinks sitting for more than 1 hr, ● Dishes washed in hot soapy water in dishwasher ● Toothbrushes washed daily don’t share personal items ● Avoid food containing bacteria fresh fruits & vegetable, undercooked meat, fish & eggs, pepper & paprika ○ Administer antiemetic meds ■ Prior, during, afterwards ■ Smells or supplies triggering nausea remove from room ■ Meds to improve appetite & mouth care prior to meals ■ Avoid drinking liquids while eating, inbetween, ○ High protein high calorie & nutrient dense diet & supplement ○ Alopecia ■ 7-10 after initiation to chemo ○ Mucositis: inflammation of tissues in mouth ■ Avoid glycerin based mouthwash or mouth swabs ■ Non alcoholic anesthetic mouthwashes recommended ■ Avoid salty acidic or spicy foods ■ Offer oral hygiene before & after meals ■ Moisturizing agent to counteract dry mouth ■ Use half saline half peroxide rise 2x a week ■ Soft bristled toothbrush ■ Diet bland & soft ○ Anemia & Thrombocytopenia ■ Monitor for s/s: fatigue, pallor, SOB ■ Provide frequent rest periods ■ Administer Epoetin alfa & ferrous sulfate = improve iron levels ■ Monitor for blood in stool, urine, & vomit ■ Monitor for petechiae, ecchymosis, bleeding of gums, nosebleeds ■ Avoid IV, injections taking blood if so apply pressure 10mins ■ Encourage electric razor ■ Soft bristled toothbrush ■ Avoid blowing nose vigorously ■ Administer thrombopoietic meds OPRELVEKIN ■ Avoid NSAIDs and prevent injury ● Radiation Therapy: ○ Skin marked with tattoos to help guide positioning of external radiation ○ Skin care ■ Gently wash skin mild soap & water ■ DON’T apply powder, ointment, lotion, perfumes, deodorant ■ Soft clothing avoid tight and constricted ■ No sun or heat source of site ● Hormonal therapy: ○ Estrogen dependent cancer ○ Tamoxifen ● Immunotherapy ○ Interleukins & interferons Ch. 92 Cancer Disorders ❖ Skin cancer ➢ Leading cause: sunlight exposure ■ Squamous cell cancer rough scaly type lesion ■ Basal cell cancer small waxy nodule most common ■ Melanoma: cancer of melanocytes ➢ ABCDE: asymmetry, border, color, diameter, evolving ➢ s/s: irregular shape & border w/ multiple colors, new moles or change in existing moe, itching, cracks, ulceration, & bleeding (possible) ➢ Treatment: liquid nitrogen to freeze it, topical chemotherapy 5 fluorouracil cream ➢ Prevention: limit exposure to sunlight, apply sunscreen, use sunblock, avoid indoor tanning, wear protective clothing ❖ Leukemia: ➢ Cancer of WBCs; invade and destroy bone marrow, overgrowth of leukemic cells prevents growth of other blood components such as platelets and RBC ■ Risk for infection & bleeding ❖ Lymphoma: ➢ Cancer of lymphocytes ❖ Nursing care: no fresh fruits & vegetables, no visitors who are sick, prevent injury ❖ Treatment: Chemo, radiatio, bone marrow transplant ➢ Report manifestations of infections or illness immediately to provider ➢ The nurse should instruct the client to wash drinking glasses after each use to remove bacteria, which can be harmful to a client who is immunocompromised. ❖ Thyroid cancer ➢ Risk factors: females, diet low in iodine, radiation exposure ➢ Assessment: change in shape or size warning sign & palpable nodules ➢ Nursing care: airway patency, swallowing assessment ➢ Treatment: thyroidectomy, radioactive iodine ❖ Lung Cancer ➢ Prognosis poor diagnosed in advanced stage ➢ Risk factors: smoking biggest risk factor ➢ S/S: cough, dyspnea, hoarseness ➢ Calculate pack yr history ■ # of packs per days X years they smokes = pack year ■ Evaluate use of pipes, chewing tobacco, & cigars ❖ Colorectal cancer ➢ Polyp benign and left untreated becomes cancerous ➢ Key symptom: blood in stool ➢ Colonoscopy screening start at age 50 be done every 10 yrs, unless found polyps ➢ Annual fecal occult blood testing FOBT 50-75 yrs ❖ Breast cancer ➢ Risk factors: relative, early menarche (early/late periods/menopause), prolonged use of oral contraceptives, smoking, Hormone replacement therapy, obesity ➢ Assessment: skin changes (orange peel), dimpling, small firm non-tender, non-mobile bumps, nipple discharge, nipple retraction or ulceration ➢ Treatment: hormone therapy ■ Medications: SERMs tamoxifen & raloxifen ■ chemo/radiation ■ Surgical interventions ➢ Nursing care: ■ Wear sling while ambulating ■ Avoid administrating injections, taking BP, or obtaining blood from affected extremity ■ Early arm & hand exercises to regain full range of motion ■ Don’t wear constrictive clothing ❖ Cervical cancer ➢ Infection with HPV ➢ Prevention: vaccinated with HPV vaccines, ➢ PAP screening should occur by 21 yrs of age or three yrs. Following first sexual intercourse ❖ Prostate cancer ➢ Risk factors: African Americans, high fat diet, ➢ S/S: urinary hesitancy, bladder infections, urinary retention, blood in urine, residual urine after voiding ➢ Assessment: PSA, digital rectal exam, PSA first before rectal, ■ Elevation more than 4 ➢ Prostate screening after age 50 ➢ Meds: leuprolide luteinizing hormone releasing hormone Ch. 93 Pain Management for Clients Who Have Cancer Palliative care: manage pain levels & improve symptoms ● More comfortable ● Meds: nonopioids, opioids, antidepressants & anticonvulsant neuropathic pain relieve, steroids, skeletal muscle relaxers, systemic anesthetic PCA pump, topical local anesthetics, regional nerve blocks ● TENS, imagery, application of hot or cold, hypnosis, acupuncture Hospice care: end of life Ch. 40 Nursing Care of Children Blood Neoplasm Leukemia: causes of production of immature WBC Most common form of cancer in childhood Causes: anemia, thrombocytopenia, neutropenia, immature WBC Diagnosis: ● bone marrow aspiration or biopsy, provide topical anesthetic 1 hr prior to procedure ● CSF analysis ● Lumbar puncture: empty bladder, topical 1 hr cream, side lying, head flexed and knees towards chest ● After procedure lay flat 4-8 hrs. Mucosal ulceration prevention ● Soft-bristled toothbrush ● Lubricate lip balm ● Soft bland diet ● Don’t use viscous lidocaine, hydrogen peroxide, lemon glycerin swabs, & milk of magnesia, avoid rectal temp Immunity CHAPTER 2 Emergency Nrsg. Principles & Mgmt Triage Classes I. RED-emergent II. YELLOW-urgent III. GREEN-non-urgent IV. BLACK-expectant Priority framework ABCDE principle ●