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Med Surg 2 Exam 4 Blueprint Answers
Medical-Surgical Nursing II (NSG 223)
Herzing University
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Medical Surgical Nursing 2 Exam 4
NSG223.11.01 Glaucoma- Nursing Assessment ● purpose of a glaucoma workup is to establish the diagnostic category, assess the optic nerve damage, and formulate a treatment plan ● patient's ocular and medical history must be detailed to investigate the history of predisposing factors. ● types of examinations used in glaucoma include tonometry to measure the IOP, ophthalmoscopy to inspect the optic nerve, and central visual field testing ● changes in the optic nerve related to glaucoma are pallor and cupping of the optic nerve disc ○ pallor of the optic nerve is caused by a lack of blood supply ○ Cupping is characterized by exaggerated bending of the blood vessels as they cross the optic disc, resulting in an enlarged optic cup that appears more basin-like compared with a normal cup ■ progression of cupping in glaucoma is caused by the gradual loss of retinal nerve fibers and the loss of blood supply. ● As optic nerve damage increases, visual perception decreases ○ localized areas of visual loss (i., scotomas) represent loss of retinal sensitivity and nerve fiber damage and are measured and mapped on a graph ■ patients with glaucoma, the graph has a distinct pattern that is different from other ocular diseases and is useful in establishing the diagnosis
NSG223.11.01 Glaucoma- Medical Treatment/Surgical Management ● Surgery is reserved for patients in whom pharmacologic treatment has not controlled the IOP ● minimally invasive procedure is specifically designed to improve fluid drainage from the eye to balance IOP. ○ By restoring the eye's natural fluid balance, trabeculectomy surgery stabilizes the optic nerve and minimizes further visual field damage ○ performed through a small incision and does not require creation of a permanent hole in the eyewall or an external filtering bleb or an implant. ● laser trabeculoplasty for glaucoma, a laser beam is applied to the inner surface of the trabecular meshwork to open the intratrabecular spaces and widen the canal of Schlemm, promoting outflow of aqueous humor and decreasing IOP ○ indicated when IOP is inadequately controlled by medications, and it is contraindicated when the trabecular meshwork cannot be fully visualized because of a narrow angle. ● peripheral iridotomy for pupillary block glaucoma, an opening is made in the iris to eliminate the pupillary blockage. ○ Laser iridotomy is contraindicated in patients with corneal edema, which interferes with laser targeting and strength. ○ Potential complications include burns to the cornea, lens, or retina, transient elevated IOP, closure of the iridotomy, uveitis, and blurring. ● Filtering procedures for glaucoma are used to create an opening or fistula in the trabecular meshwork to drain aqueous humor from the anterior chamber to the subconjunctival space into a bleb (fluid collection on the outside of the eye), bypassing the usual drainage structures. ○ allows the aqueous humor to flow and exit by different routes (i., absorption by the conjunctival vessels or mixing with tears). ○ Trabeculectomy is the standard filtering technique used to remove part of the trabecular meshwork ○ Complications include hemorrhage, an extremely low (hypotony) or extremely elevated IOP,
uveitis, cataracts, bleb failure, bleb leak, and endophthalmitis (i., intraocular infection). ● Drainage implants or shunts are tubes implanted in the anterior chamber to shunt aqueous humor to the episcleral plate in the conjunctival space. ○ used when failure has occurred with one or more trabeculectomies in which antifibrotic agents were used ○ fibrous capsule develops around the episcleral plate and filters the aqueous humor, regulating the outflow and controlling IOP.
NSG223.11.01 Glaucoma- Nursing Management ● nurse instructs the patient to: ○ Know your intraocular pressure measurement and the desired range. ○ Be informed about the extent of your vision loss and optic nerve damage. ○ Keep a record of your eye pressure measurements and visual field test results to monitor your own progress. ○ Review all of your medications (over-the-counter and herbal medications) with your ophthalmologist, and mention any side effects each time you visit. ○ Ask about potential side effects and drug interactions of your eye medications. ○ Ask whether generic or less costly forms of your eye medications are available. ○ Review the dosing schedule with your ophthalmologist, and inform them if you have trouble following the schedule. ○ Participate in the decision-making process. ■ Let your primary provider know what dosing schedule works for you and other preferences regarding your eye care. ○ Have the nurse observe you instilling eye medication to determine whether you are administering it properly. ○ Be aware that glaucoma medications can cause adverse effects if used inappropriately. ■ Eye drops are to be given as prescribed, not when eyes feel irritated. ○ Ask your ophthalmologist to send a report to your primary provider after each appointment. ○ Keep all follow-up appointments. ● family members should be encouraged to undergo examinations at least once every two years to detect glaucoma early ● medical and surgical management of glaucoma slows the progression of the disease
NSG223.11.01 Glaucoma- Pharmacologic Management
● Decreased visual acuity is directly proportionate to cataract density. The Snellen visual acuity test, ophthalmoscopy, and slit-lamp biomicroscopic examination are used to establish the degree of cataract formation. The degree of lens opacity does not always correlate with the patient's functional status. Some patients can perform normal activities despite clinically significant cataracts. Others with less lens opacification have a disproportionate decrease in visual acuity; hence, visual acuity is an imperfect measure of visual impairment.
NSG223.11.02 Surgical Nursing Management ● if reduced vision from cataracts does not interfere with normal activities, surgery may not be needed. ● In deciding when cataract surgery is to be performed, the patient's functional and visual status should be a primary consideration ● Surgery is performed on an outpatient basis and usually takes less than 1 hour, with the patient being discharged in 30 minutes or less afterward ● Restoration of visual function through a safe and minimally invasive procedure is the surgical goal, which is achieved with advances in topical anesthesia, smaller wound incision (i., clear cornea incision), and lens design (i., foldable and more accurate intraocular lens [IOL] measurements). ● When both eyes have cataracts, one eye is treated first, with at least 7 weeks, preferably months, separating the two procedures. ○ cataract surgery is performed to improve visual functioning, the delay for the other eye gives time for the patient and the surgeon to evaluate whether the results from the first surgery are adequate to preclude the need for a second operation ○ delay provides time for the first eye to recover; if there are any complications, the surgeon may decide to perform the second procedure differently. ● Phacoemulsification ○ extracapsular cataract surgery, a portion of the anterior capsule is removed, allowing extraction of the lens nucleus and cortex while the posterior capsule and zonular support are left intact ○ ultrasonic device is used to liquefy the nucleus and cortex, which are then suctioned out through a tube. ○ An intact zonular–capsular diaphragm provides the needed safe anchor for the posterior chamber IOL. The pupil is dilated to 7 mm or greater ○ surgeon makes a small incision on the upper edge of the cornea and a viscoelastic substance (clear gel) is injected into the space between the cornea and the lens ■ prevents the space from collapsing and facilitates insertion of the IOL ■ incision is smaller than the manual extracapsular cataract extraction, the wound heals more rapidly, and there is early stabilization of refractive error and less astigmatism. ● Lens Replacement ○ After removal of the crystalline lens, the patient is referred to as aphakic (i., without lens) ○ lens, which focuses light on the retina, must be replaced for the patient to see clearly ○ 3 lens replacement options: aphakic eyeglasses, contact lenses, and IOL implants. ■ Aphakic glasses, rarely used. ● Objects are magnified by 25%, making them appear closer than they actually are ○ magnification creates distortion ● Peripheral vision is also limited, and binocular vision (i., ability of both eyes to focus on one object and fuse the two images into one) is impossible if the other eye is aphakic (without a natural lens). ■ Contact lenses provide patients with almost normal vision, but need to be removed occasionally, the patient also needs a pair of aphakic glasses ● not advised for patients who have difficulty inserting, removing, and cleaning
them. ● Frequent handling and improper disinfection increase the risk of infection. ■ Insertion of IOLs during cataract surgery is the most common approach to lens replacement ● After cataract extraction, or phacoemulsification, the surgeon implants an IOL. ● Cataract extraction and posterior chamber IOLs are associated with a relatively low incidence of complications (e., eye infection, loss of vitreous humor, and slipping of the implant) ● contraindicated in patients with recurrent uveitis, proliferative diabetic retinopathy, neovascular glaucoma, or rubeosis iridis. ● Providing Preoperative Care ○ patient with cataracts receives the usual preoperative care for ambulatory surgical patients undergoing eye surgery ○ standard battery of preoperative tests (e., complete blood count, electrocardiogram, and urinalysis) commonly performed for most surgeries is prescribed only if indicated by the patient's medical history. ○ Alpha-antagonists (particularly tamsulosin [Flomax], is used for treatment of enlarged prostate) are known to cause a condition called intraoperative floppy iris syndrome ■ can interfere with pupil dilation during the surgical procedure, resulting in miosis and iris prolapse and leading to complications. ■ Intraoperative floppy iris syndrome can occur even though a patient has stopped taking the drug ■ nurse needs to ask patients about a history of taking alpha-antagonists. ● Surgical team members are then alerted to the risk of this complication ○ Dilating drops are given prior to surgery. ○ Nurses in the ambulatory surgery setting begin patient education about eye medications (antibiotic, corticosteroid, and anti-inflammatory drops) that will need to be self-administered to prevent postoperative infection and inflammation. ● Providing Postoperative Care ○ An eye shield is usually worn at night for the first week to avoid injury ○ nurse also explains that there should be minimal discomfort after surgery and educates the patient about taking a mild analgesic agent, such as acetaminophen, as needed. ○ Antibiotic, anti-inflammatory, and corticosteroid eye drops or ointments are prescribed postoperatively. ■ Patients prescribed anti-inflammatory or corticosteroid eye drops are monitored for possible increases in IOP
NSG223.11.02 Discharge Teaching ● To prevent accidental rubbing or poking, the patient wears a protective eye patch for the first 24 hours after surgery followed by glasses during the day and an eye shield at night ○ Educated on applying and caring for eyeshield ○ sunglasses should be worn while outside as the eye is sensitive to light ● Slight morning discharge, redness and a scratchy feeling is expected for a few days ○ Clean, damp washcloth may be used to remove discharge ● Notify provide if new floaters (dots) in vision, flashing lights, decrease in vision, pain or increased redness occurs as retinal detachment is a risk ● If the patient has an eye patch it is removed after the first follow up appointment (within 48 hours of surgery)
○ Skull contains little room for expansion, the inflammation may cause increased intracranial pressure (ICP). ○ CSF circulates through the subarachnoid space, where inflammatory cellular materials from the affected meningeal tissue enter and accumulate.
NSG223.11.03 Meningitis- Pharmacologic Management ● antibiotic treatment with both a penicillin and a cephalosporin, and corticosteroids ● Penicillin is given with cephalosporin ● Penicillin G (Oral or IV) ○ most often administered intravenously (IV), optimally within 30 minutes of hospital arrival ■ Penicillin with a cephalosporin ○ Caution in renal impairment ○ SE: hypersensitivity (rash and anaphylaxis), abdominal pain, diarrhea, gastritis, nausea and vomiting, nephropathy, ■ High doses: confusion, lethargy, twitching, seizures, coma, dysphagia, hepatotoxicity, hypernatremia ○ Oral with a full glass of water ■ Avoid acidic foods and drinks ○ 1 hour before or 2 hours after a meal ○ Suspensions are good for 7 days at room temp and 14 days if refrigerated ○ Ampicillin monitoring serum creatinine and BUN (blood urea nitrogen) ○ Take complete course ○ Take as directed ○ Suspensions shake prior to giving ○ Report: skin rash, hives, itching, severe diarrhea, shortness of breath, fever, sore throat, black tongue, or usual bleeding ● Dexamethasone ○ acute bacterial meningitis and in pneumococcal meningitis if it is given 15 to 20 minutes before the first dose of antibiotic and every 6 hours for the next 4 days ● Cephalosporin ○ IV and IM ○ SE: abdominal pain, diarrhea, gastritis, nausea and vomiting, hypersensitivity and superinfections ○ Monitor those taking anticoagulants ■ Decreases prothrombin time ○ Take full course ○ Avoid in those with life threatening reactions to penicillin (anaphylaxis, laryngeal swelling, angioedema, or hives) ○ Take most oral drugs with food or milk to prevent stomach upset. ○ Shake liquid preparations well to mix thoroughly and measure the dose accurately. ○ Report the occurrence of diarrhea, especially if it is severe or contains blood, pus, or mucus. Cephalosporins can cause antibiotic-associated colitis and the drug may need to be stopped. ○ Inform your health care provider if you are breastfeeding ● Corticosteroids ○ are administered to control symptoms ○ SE ■ Adrenocortical insufficiency: fainting, weakness, anorexia, nausea, vomiting, hypotension, shock, and death (if untreated)
■ Adrenocortical excess ■ Cushingoid features: “moon face” and buffalo hump due to the redistribution of fat ■ CNS effects: vertigo, headache, paresthesias, insomnia, and seizures ■ Cardiovascular symptoms: hypotension, shock, hypertension, heart failure, thromboembolism, thrombophlebitis, fat embolism, and cardiac dysrhythmias ■ Diminished immunity: increased susceptibility to infection ■ Endocrine effects: diabetes mellitus, hyperglycemia, and hypercholesterolemia; diminished T3 and T4 levels, resulting in hypothyroidism; reduced growth because of altered synthesis of DNA ■ Fluid and electrolyte effects: fluid retention, hypokalemia, hypocalcemia ■ Integumentary effects: reddened skin, thinner skin, stretch marks, skin tears, delayed wound healing ■ Musculoskeletal effects: hypocalcemia, which places the patient at risk for osteoporosis and fracture development; serum hypocalcemia, which increases the release of parathyroid hormones, increasing the loss of calcium from bone ■ Ocular effects: cataracts and glaucoma ■ Reproductive effects: amenorrhea or irregular menstrual cycles ○ assesses patients with adrenocortical insufficiency for fainting, weakness, anorexia, nausea, vomiting, hypotension, and shock ○ assesses patients with adrenocortical excess for “moon face,” “buffalo hump,” diabetes mellitus, nervousness, euphoria, anxiety, and behavioral changes ● Treat dehydration, shock, seizures as indicated ● Viral Meningitis ○ Bed Rest ○ Fluids ○ OTC meds to reduce fever and relieve body aches
NSG223.12.01 Stroke- Clinical Manifestations ● Ischemic Stroke ○ Disruption of the cerebral blood flow d/t obstruction of a blood vessel. This disruption in blood flow initiates a complex series of cellular metabolic events referred to as the ischemic cascade ○ can cause a wide variety of neurologic deficits, depending on the location of the lesion (which blood vessels are obstructed), size of the area of inadequate perfusion, and amount of collateral (secondary or accessory) blood flow ○ patient may present with any of the following signs or symptoms: ■ Numbness or weakness of the face, arm, or leg, especially on one side of the body ■ Confusion or change in mental status ■ Trouble speaking or understanding speech ■ Visual disturbances ■ Difficulty walking, dizziness, or loss of balance or coordination ■ Sudden severe headache ○ Motor, sensory, cranial nerve, cognitive, and other functions may be disrupted. ■ Motor Loss ● A stroke is an upper motor neuron lesion and results in loss of voluntary control over motor movements ○ upper motor neurons cross, a disturbance of voluntary motor control on one side of the body may reflect damage to the upper motor neurons on the opposite side of the brain
● Depression is common and may be exaggerated by the patient's natural response to this catastrophic event. ○ Emotional lability, hostility, frustration, resentment, lack of cooperation, and other psychological problems may occur.
NSG223.12.01 Stroke- Nursing Assessment ● Any patient with neurologic deficits needs a careful history eliciting the last time the patient was seen well and a rapid focused physical and neurologic examination. ● Initial assessment focuses on airway patency, may be compromised by loss of gag or cough reflexes and altered respiratory pattern ● cardiovascular status (including blood pressure, cardiac rhythm and rate, carotid bruit); and gross neurologic deficits. ● Patients may present to the acute care facility with temporary neurologic symptoms. ○ A transient ischemic attack (TIA) is a neurologic deficit typically lasting 1 to 2 hours. ■ manifested by a sudden loss of motor, sensory, or visual function ■ symptoms result from temporary ischemia (impairment of blood flow) to a specific region of the brain ● when brain imaging is performed, there is no evidence of ischemia. ■ may serve as a warning of impending stroke. ■ Lack of evaluation and treatment of a patient who has experienced previous TIAs may result in a stroke and irreversible deficits. ● initial diagnostic test for a stroke is usually a non-contrast computed tomography (CT) scan ○ should be performed within 25 minutes or less from the time the patient presents to the emergency department (ED) to determine if the event is ischemic or hemorrhagic as the type of stroke determines treatment.
NSG223.12.01 Stroke Screening and Risk Factors
● BE FAST
○ B - Balance ■ Is the person suddenly having trouble with balance or coordination? ○ E - Eyes
■ Is the person experiencing suddenly blurred or double vision or a sudden loss of vision in one or both eyes without pain? ○ F - Face Drooping ■ Does one side of the face droop or is it numb? Ask the person to smile. ○ A- Arm Weakness ■ Is one arm weak or numb? Ask the person to raise both arms. Does one arm drift downward? ○ S - Speech Difficulty ■ Is speech slurred, are they unable to speak, or are they hard to understand? Ask the person to repeat a simple sentence like, “The sky is blue.” Is the sentence repeated correctly? ○ T - Time to call 911 ■ If the person shows any of these symptoms, even if the symptoms go away, call 911 and get them to the hospital immediately ● Risk Factors ○ Non-Modifiable ■ Age over 55 ■ Past stroke/TIA ■ Men>Women ● 1 in 6 women die of stroke (1 in 25 women die of breast ca) ■ African American/Hispanic American > Caucasian American ○ Modifiable ■ Asymptomatic carotid stenosis ■ Atrial fibrillation ■ Diabetes ■ Hyperlipidemia ■ Excessive alcohol ■ Hypercoagulable states ■ Hypertension ■ Migraine ■ Obesity ■ Sedentary lifestyle ■ Sleep apnea ■ smoking
NSG223.12.01 Transient Ischemic Accident Risk Factors ● Non-Modifiable ○ Age over 55 ○ Past stroke/TIA ○ Men>Women ■ 1 in 6 women die of stroke (1 in 25 women die of breast ca) ○ African American/Hispanic American > Caucasian American ● Modifiable ○ Asymptomatic carotid stenosis ○ Atrial fibrillation ○ Diabetes ○ Hyperlipidemia ○ Excessive alcohol
avoided ● includes the Valsalva maneuver, straining, forceful sneezing, pushing oneself up in bed and acute flexion or rotation of the head and neck (compromises the jugular veins). ● Stool softeners and mild laxatives are prescribed. ○ Used to prevent constipation, which can cause an increase in ICP. ■ Dim lighting is helpful, as photophobia (visual intolerance of light) is common. ■ purpose of aneurysm precautions should be thoroughly explained to the patient (if possible) and family. ■ Intermittent pneumatic compression devices are prescribed to decrease the incidence of DVT resulting from immobility. ● legs are observed for signs and symptoms of DVT (tenderness, redness, swelling, warmth, and edema), and abnormal findings are reported. ● Relieving Anxiety ○ Sensory stimulation is kept to a minimum for patients on aneurysm precautions. ○ For patients who are awake, alert, and oriented, an explanation of the restrictions helps reduce the patient's sense of isolation. ○ Reality orientation is provided to help maintain orientation. ○ Keeping the patient well informed of the plan of care provides reassurance and helps minimize anxiety. ○ Appropriate reassurance helps relieve the patient's fears and anxiety ○ family requires information and support. ● Monitoring and Managing Potential Complications ○ Vasospasm ■ patient is assessed for signs: intensified headaches, a decrease in level of responsiveness (confusion, disorientation, lethargy), or evidence of aphasia or partial paralysis ■ signs may develop 7 days after surgery or on the initiation of treatment and must be reported immediately ■ calcium channel blocker nimodipine should be given for prevention and fluid volume expanders in the form of triple-H therapy may be prescribed as well ○ Seizures. ■ Seizure precautions are maintained for every patient who may be at risk for seizure activity. ■ Should a seizure occur, maintaining the airway and preventing injury are the primary goals. ● Medication therapy is initiated at this time. ○ Hydrocephalus ■ Blood in the subarachnoid space or ventricles impedes the circulation of CSF, resulting in hydrocephalus ■ CT scan that indicates dilated ventricles confirms the diagnosis ■ can occur within the first 24 hours (acute) after subarachnoid hemorrhage or 7 days (subacute) to 7 weeks (delayed) later. ■ Symptoms vary according to the time of onset and may be nonspecific. ● Acute hydrocephalus is characterized by sudden onset of stupor or coma ○ managed with a ventriculostomy drain to decrease ICP. ● Symptoms of subacute and delayed hydrocephalus include gradual onset of drowsiness, behavioral changes, and ataxic gait.
○ ventriculoperitoneal shunt is surgically placed to treat chronic hydrocephalus. ■ Changes in patient responsiveness are reported immediately. ○ Rebleeding ■ rate of recurrent hemorrhage is approximately 1-5% per patient per year after intracerebral hemorrhage ■ Hypertension is the most serious and modifiable risk factor, which shows the importance of appropriate antihypertensive treatment. ■ Aneurysm rebleeding is the highest during the first 2-12 hours after the initial hemorrhage and is considered a major complication. ■ Symptoms include sudden severe headache, nausea, vomiting, decreased level of consciousness, and neurologic deficit. ■ confirmed by CT scan ■ Blood pressure is carefully maintained with medications. ■ most effective preventive treatment is to secure the aneurysm if the patient is a candidate for surgery or endovascular treatment. ○ Hyponatremia. ■ hyponatremia is found in 10-30% of patients ■ has been found to be associated with the onset of vasospasm ■ Laboratory data must be checked frequently ● hyponatremia defined as a serum sodium concentration less than 135 mEq/L must be identified as early as possible ● patient's primary provider needs to be notified of a low serum sodium level that has persisted for 24 hours or longer ○ patient is then evaluated for syndrome of inappropriate antidiuretic hormone (SIADH) or cerebral salt-wasting syndrome.
NSG223.12.02 Pharmacologic Treatment of Stroke ● Goal for tPA is to give it to the patient IV within 60 minutes of them reaching the ED ● goal of ischemic strokes is to restore blood flow ● goal of hemorrhagic stroke treatment is to identify the cause and eliminate, if possible ● Ischemic ○ Thrombolytic Therapy ■ Dissolve blood clot ■ Initiate within 3 hours of symptoms = best outcome (up to 4 hours) ■ Goal: given within 60 mins of arrival to ED ○ IV or Intra-arterial ■ Intra-arterial allows for higher concentrations of TPA be given to directly to the clot ■ Intra-arterial can be done within 6 hours of symptoms ○ Post stroke/TIA Secondary Prevention ■ Warfarin, or new anticoags ■ Aspirin ■ Clopidogrel (Plavix) ■ Statins ■ Antihypertensives (after stroke is fully healed) ● Anticoagulants: Warfarin INR Goal 2- ● NOACs: do not have to check INR or APTT often ● Dabigatran (Pradaxa) (only one with reversal)
● Viruses and Bacteria ○ 11% of all cancers worldwide are linked to viral infections ○ human papillomavirus (HPV) ■ cervical and head and neck cancers ○ hepatitis B virus (HBV) ■ liver cancer ○ Epstein-Barr virus (EBV) ■ Burkitt lymphoma and nasopharyngeal cancer ● Physical Agents ○ exposure to sunlight,radiation, chronic irritation or inflammation, tobacco carcinogens, industrial chemicals and asbestos ● Chemical Agents ○ Tobacco smoke ■ strongly associated with cancers of the lung, head and neck, esophagus, stomach, pancreas, cervix, kidney, and bladder and with acute myeloblastic leukemia ■ Passive smoke (i., secondhand smoke) has been linked to lung cancer ● may be linked with childhood leukemia and cancers of the larynx, pharynx, brain, bladder, rectum, stomach, and breast ● Genetics and Familial ○ Almost every cancer type has been shown to run in families ○ Cancer has been associated with extra chromosomes, too few chromosomes, or translocated chromosomes ■ chronic myelogenous leukemia, meningiomas, acute leukemia, retinoblastomas, and Wilms tumor ● Lifestyle ○ diet, obesity, and insufficient physical activity ■ Diet: fats, alcohol, salt-cured or smoked meats, nitrate- and nitrite-containing foods, and red and processed meats. Heavy alcohol use increases the risk of cancers of the mouth, pharynx, larynx, esophagus, liver, colon, rectum, and breast ■ Poor diet and obesity have been identified as contributing factors to the development of cancers of the breast (in postmenopausal women), colon, endometrium, esophagus, and kidney. ■ Obesity is associated with an increased risk for cancers of the pancreas, gallbladder, thyroid, ovary, and cervix, and for multiple myeloma, Hodgkin lymphoma, and an aggressive form of prostate cancer. ■ Multiple studies have long linked sedentary lifestyles and lack of regular exercise to cancer development ● Hormonal ○ Tumor growth may be promoted by disturbances in hormonal balance, either by the body's own (endogenous) hormone production or by administration of exogenous hormones ○ Prenatal exposure to diethylstilbestrol (a synthetic form of the female hormone estrogen) has long been recognized as a risk factor for clear cell adenocarcinoma of the lower genital tract ○ female reproductive cycle ■ Early onset of menses before age 12 and delayed onset of menopause after age 55, null parity (never giving birth), and delayed childbirth after age 30 are associated with an increased risk of breast cancer ○ Increased numbers of pregnancies are associated with a decreased incidence of breast, endometrial, and ovarian cancers.
○ Women who take estrogen after menopause appear to have an increased risk of ovarian cancer. ○ Combination estrogen and progesterone therapy is linked to a higher risk of breast cancer ■ longer the combined therapy is used, the higher the risk ■ within 3 years of stopping the hormones, the risk returns to that of a woman who never used this therapy
NSG223.13.01 Cancer Treatment Plans ● Most will have one plan ● May be a combination ○ surgery and chemo ○ Surgery radiation ○ Chemo and radiation ○ Surgery, chemo and radiation
NSG223.13.01 Cancer Prevention ● Individual Choices ○ Achieve and Maintain a Healthy Weight Throughout Life ■ Be as lean as possible throughout life without being underweight. ■ Avoid excessive weight gain at all ages. For those who are currently overweight or obese, losing even a small amount of weight has health benefits and is a good place to start. ■ Engage in regular physical activity and limit consumption of high-calorie foods and beverages as key strategies for maintaining a healthy weight. ○ Adopt a Physically Active Lifestyle ■ Adults should engage in at least 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity physical activity each week, or an equivalent combination, preferably spread throughout the week. ■ Children and adolescents should engage in at least one hour of moderate- or vigorous- intensity physical activity each day, with vigorous-intensity activity at least three days each week. ■ Limit sedentary behavior such as sitting, lying down and watching television, and other forms of screen-based entertainment. ■ Doing any intentional physical activity above usual activities, no matter what one's level of activity, can have many health benefits. ○ Consume a Healthy Diet, With an Emphasis on Plant Sources ■ Choose foods and beverages in amounts that help achieve and maintain a healthy weight. ■ Limit consumption of processed meat and red meats. ■ Eat at least 2 1⁄2 cups of vegetables and fruits each day. ■ Choose whole grains in preference to processed (refined) grains. ○ If You Drink Alcoholic Beverages, Limit Consumption ■ Drink no more than one drink per day for women or two per day for men. ○ Community Action ■ Increase access to affordable, healthy foods in communities, worksites, and schools, and decrease access to and marketing of foods and beverages of low nutritional value, particularly to youth. ■ Provide safe, enjoyable, and accessible environments for physical activity in schools and
● Tertiary Prevention ○ Improved screening, diagnosis, and treatment approaches have led to an estimated 14 million cancer survivors in the United States (ACS, 2014). ○ focus on monitoring for and preventing recurrence of the primary cancer as well as screening for the development of second malignancies in cancer survivors. ○ Survivors are assessed for the development of second malignancies such as lymphoma and leukemia, which have been associated with certain chemotherapy agents and the use of radiation therapy ■ may develop second malignancies not related to treatment but genetic mutations related to inherited cancer syndromes, environmental exposures, and lifestyle factors. ○ Remission and monitoring for recurrence ex. 3 months, 6 months, yearly
NSG223.13.01 Cancer Surgical Treatment ● Management of Cancer ○ Treatment options offered to patients with cancer are based on treatment goals for each specific type, stage, and grade of cancer ○ range of possible treatment goals includes complete eradication of malignant disease (cure), prolonged survival and containment of cancer cell growth (control), or relief of symptoms associated with the disease and improvement of quality of life (palliation). ○ Treatment approaches are not initiated until the diagnosis of cancer has been confirmed and staging and grading have been completed. ● Surgery ○ removal of the entire cancer remains the ideal and most frequently used treatment method. ○ Diagnostic surgery is the definitive method for obtaining tissue to identify the cellular characteristics that influence all treatment decisions. ○ may be the primary method of treatment, or it may be prophylactic, palliative, or reconstructive. ● Diagnostic Surgery ○ is performed to obtain a tissue sample for histologic analysis of cells suspected to be malignant ○ most instances, the biopsy is taken from the actual tumor; some situations, it is necessary to take a sample of lymph nodes near a suspicious tumor. ○ Many cancers can metastasize from the primary site to other areas of the body through the lymphatic circulation. ■ Knowing whether adjacent lymph nodes contain tumor cells helps the health care team plan the best therapeutic approach to combat cancer that has spread beyond the primary tumor site. ■ use of injectable dyes and nuclear medicine imaging can help identify the sentinel lymph node or the initial lymph node to which the primary tumor and surrounding tissue drain. ● Sentinel lymph node biopsy (SLNB), also known as sentinel lymph node mapping, is a minimally invasive surgical approach that in many instances has replaced more invasive lymph node dissections (lymphadenectomy) and the associated complications
Med Surg 2 Exam 4 Blueprint Answers
Course: Medical-Surgical Nursing II (NSG 223)
University: Herzing University
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