Study guide adult health test 2 chapters 48,11,12, 13,15
1. Math questions
2. Cancer patient with a low neutrophil count is at risk of what and what do we do to prevent that
a. Serious risk factor for life-threatening infection and sepsis
b. Hand hygiene is the mainstay of patient protection- positive airflow room
3. What is a normal neutrophil count
a. 2200 to 7700 mm3
4. What is considered a concerning fever for a neutropenic patient
a. >100.4 (neutropenic fever)
5. Risk of doxorubicin if it infiltrates and what do we do about it
a. Tissue necrosis around the site.
b. If doxorubicin infiltrates it can cause necrosis- so you quickly stop the infusion, pull out
the med from catheter, dexrazoxane, and watch for necrosis
6. Main SE of chemotherapy
a. Myelosuppression- Most common
b. Bone marrow suppression, fatigue, GI disturbances, integumentary and mucosal reactions,
pulmonary effects, reproductive effects
7. What is thrombocytopenia and what should we watch for
a. Is a reduction of platelets below 150,000/ 𝜇L
b. Spontaneous bleeding or major hemorrhage (e.g., petechia, ecchymosis)
8. Administering chemo- what do we do to protect ourselves and others
a. Chemo gloves, gown, mask, yellow garbage
b. Care for linens separate, urine, stool-double flush
c. Danger to others in the home for 72 hours
9. Most dangerous complication for a pt with a stem cell transplant- how do we protect them
a. Some patients die from treatment-related complications or from recurrence of the original
disease. Graft-versus-host disease. This occurs when the T cells from the donated marrow
(graft) recognize the recipient (host) as a foreign and begin to attack certain organs, such as
the skin, liver, and Gi tract
b. Very immune compromised for 2-4 weeks: stay in the hospital unless they have system in
place. Protect from exposure to infectious agents. Had to readminister all of their vaccines
10. Care of skin post radiation therapy
a. Skin is very fragile don’t do anything to it that might further injure it- gentle soap and
cleaning
b. Skin reactions
c. Dry skin should be lubricated with nonirritating lotion or solution that contains no metal,
alcohol, perfume, or additives
d. Wet reaction must be kept clean and protected from further damage
e. may place nonadherant dressing to protect it- wash with ns
f. Prevent infection- clean and dressed if open
g. Facilitate wound healing
h. Protect irritated skin temperature extremes no ice or heat
i. Avoid constricting garments, harsh chemicals, and deodorants
11. What should be consulted for a dying cancer patient to provide care
a. Palliative care, palliative surgery, or palliative radiation, and hospice. To focus on comfort
instead of care.
12. Surgery for cancer can be done for what reasons- and examples of what they would help
a. Prevention Surgery used to eliminate or reduce risk of cancer in at-risk patients
i. Prophylactic removal of non-vital organs is successful treatment for certain
malignancies
ii. Usual sites of regional spread may be removed
iii. Like Lumpectomy, Mastectomy, Thyroidectomy
b. Cure and control surgery Removal of as much tissue as necessary and spare normal tissue
i. Good prognostic indicators include Small tumor size, Clean tissue margins
ii. Absence of lymph node involvement and abnormal tumor marker values
13. End stage complications of chest cancers and symptoms of that
a. It is on the oncological emergency slide- chest tumors can cause superior vena cava
syndrome where the venous return to the heart is blocked causing JVD, red swollen face
and upper body, low BP, tachycardia, peripheral edema
14. Care of a patient with a radioactive implant and how do we keep caregivers and others safe
a. Nurse Risk based on Time, distance, & Shielding
i. limit time for care, stay as far away as poss.
ii. Organize care, wear a film badge to monitor exposure (do not share film badge)
b. Patients should understand needs for time and distance restrictions on health care providers
c. Only radioactive whole the source is in place.
15. Difference between normal cells and cancer cells that is recognizable by the immune system
a. mutated cells have tumor surface antigens that the immune system should recognize
b. Chemotherapeutic agents cannot distinguish between normal and cancer cells therefore
those that are rapidly dividing normally are most affected
16. Understand acquired immunity- active and passive, and innate,
a. Active: acquired- B and T cells- vaccinations and disease (invasion by foreign substances and
antibody development or through inoculation)
b. Passive: acquired- B and T cells from gamma globin (across placenta membrane, mom to
baby or through antibody injection, provide short-lived immunity)
c. Innate: nonspecific- only neutrophils (no prior contact with antigen)
17. Altered number of T-cells or function of causes what potential complications
a. Altered number and function of Tcells allows mutated cells to not be destroyed before
they become a tumor- who are those people? those with HIV, medications that suppress
the immune system like Chemo, transplant meds, autoimmune meds and stress
18. First cells to arrive at an injury
a. Neutrophils- arrive within 6-12 hours
19. Removal of what organ puts patients at risk for severe sepsis
a. spleen
20. What is phagocytosis and what cells do it
a. Neutrophils perform phagocytosis- which is recognizing the target ingesting it and then
destroying it.
21. What immunoglobins and what cells are part of the allergic response and are elevated
a. IgE cause symptoms of allergic reactions fixes the mast cells and basophils. Aids in defense
against parasitic infections.
22. What does histamine do in an allergic reaction
a. Histamine causes localized vasodilation (erythema), transudation of fluid (wheal), and
flaring. Flaring is due to dilated blood vessels on the edge of the wheel. Histamine is
responsible for the pruritus associated with the lesions.
23. Name the types of hypersensitivity reactions and what would be examples of them.
a. Type 1 First exposure to allergen- IG-E antibodies are produced, bind with mast and
basophils : allergic rhinitis, asthma, atopic dermatitis, urticaria, angioedema
b. Type 2 – direct binding of IGE or IGM to antigen which then stimulates the complement
system that destroys the cells and tissues- this usually results in destruction of RBCs,
platelets and leukocytes- this can come from transfusion reactions, good pastures
syndrome, hemolytic anemias>> pulmonary hemorrhage and renal failure. Good pastures
involves lungs and kidneys- autoimmune attack of basement membrane
c. Type 3 Immune-IGG and IGM bind with antigen-Complex Reactions- that then deposit
themselves into tissues or small vessels- then complement system is stimulated causing
tissue destruction- Autoimmune diseases: SLE, RA, Acute Glomerulonephritis
d. Type IV-Delayed hypersensitivity –is a cell mediated response- t-cells attract macrophages
that releases cytokines and attract more macrophages this leads to tissue destruction
results- Contact Dermatitis-TB Skin test
24. What is the order of action when someone is having anaphylaxis
a. Initial symptoms include edema and itching at the site of exposure to the allergen. Shock can
occur rapidly and is manifested by rapid, weak pulse; hypotension; dilated pupils; dyspnea;
and possibly cyanosis. Bronchial edema and angioedema can compound shock. Death will
occur without emergency treatment
b. (1) recognizing signs and symptoms of an anaphylactic reaction (2) maintaining a patent
airway (3) giving drugs (4) Treating for shock (epinephrine)
25. What does positive urine ketones mean in diabetes
a. Ketones are by-products of fat metabolism, and they Alter pH balance, causing metabolic
acidosis- DKA
b. Ketone bodies are excreted in urine with huge amounts of fluid and Electrolytes. Depletion
of K, phosphorus, and Magnesium is common
26. What are the percentage by calorie of food types a diabetic should eat- protein, carb, fat
a. Carbohydrates should provide 45% to 65% of total intake
b. Fats no more than 25% to 30% of meal
c. Proteins 15-20% should be low because it puts unnecessary stress on the kidneys to excrete
nitrogen
d. Alcohol can cause severe hypoglycemia, is detrimental to the liver, and increases
triglycerides
e. They don’t have to cut carbs out, just eat smart carbs. Many say they will just take a few
extra units of insulin if they want some bad sugar
27. What is the peak, onset, and relationship to food for a diabetic for Humalog and regular
a. Regular insulin (short acting)
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i. Peak: 2-3 hours
ii. Onset: 30-60 minutes
iii. Inject 30 to 60 minutes before meal
b. Humalog (rapid acting)
i. Peak: 60-90 minutes
ii. Onset: 15 minutes
iii. Inject 0 to 15 minutes before a meal
How should a type 1 take care of themselves when they are sick
a. The biggest mistake diabetics can make is to not take their insulin when sick.
b. During times of illness, check blood glucose levels at 4-hour intervals to determine the
effects of the illness on glucose levels.
What are macro VS micro vascular complication in diabetes and examples
a. Macrovascular is Diseases of large and medium-sized blood vessels
i. Tight glucose control may delay atherosclerotic process
ii. Controlling blood pressure decreases risk of cardiovascular disease, stroke and renal
failure
b. Microvascular
i. Result from thickening of vessel membranes in capillaries and arterioles In response
to chronic hyperglycemia. Areas affects are the eyes (retinopathy, kidneys
(nephropathy, and nerves (neuropathy)
c. Foot ulcers are complicated by Smoking, Clotting abnormalities, Impaired immune function,
Autonomic neuropathy
Definition and cause of type one diabetes
a. Type 1 diabetes, formerly known as juvenile-onset or insulin-dependent mellitus (IDDM).
Type 1 diabetes generally affects people under 40 years of age, although It can occur at any
age
b. Type 1 diabetes is an autoimmune disorder in which the body develops antibodies against
insulin and/or the pancreatic B cells that make insulin. This eventually results in not enough
insulin for a person to survive. A genetic predisposition and exposure to a virus are factors
that may contribute to the development of immune related type 1 diabetes.
c. Cause autoimmune
Treatment steps in order of hyperosmolar hyperglycemic syndrome and who gets it
a. Patient has just enough circulating insulin so ketoacidosis does not occur.
b. The HHS Produces fewer symptoms in the earlier stages so patients aren’t aware that things
are bad until they are very bad.
c. They will have decreased LOC due to ↑ serum osmolality.
d. Usually history of Inadequate fluid intake, and Polyuria
e. Laboratory values will show a Blood glucose >400 mg/dl
i. Increase in serum osmolality
ii. Absent or minimal ketone bodies
f. Medical emergency with a high mortality rate
g. Therapy similar to DKA Except HHS requires greater fluid replacement
h. Patients need to be on a cardiac monitor, because of the electrolyte disturbances
i. Need lots of saline and an insulin drip
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Assessment of Renal status, Cardiopulmonary status, Level of consciousness, Signs of
potassium imbalance, And Vital signs
Cause of gestational diabetes
a. The placenta makes hormones that cause glucose to build up in your blood. Usually, the
pancreas can send out enough insulin to handle it. but if your body can’t make enough
insulin or stops using insulin as it should, the blood glucose levels rise- stress,
How does stress affect diabetes
a. Increased sympathetic system and cortisol release cause increased BG often to the point of
DKA
What are the need to know teaching points for a new diabetic and how best do we teach them
a. Demonstration/ teach back demonstration
b. SQ injection and rotation of sites, Hypoglycemia and Hyper S&S, Normal & abnormal glucose
levels, Keep a diary of daily BGs, insulin taken, and food consumed, What to eat for hypoOJ, hard candy- 15 g of glucose, About glucagon SQ if can't swallow, To take it even when
sick, Checking BGs AC and HS, Getting A1C checked at least 2x a year, The organ failures if
they don’t take as prescribed, To wear medic alert bracelet, Draw up reg first then NPH if
giving both, Review lifestyle modifications, Healthy diet, 30 minutes of exercise/day
c. They are at risk for foot ulcers and periodontal disease leading to abscesses
d. An ulcer can form from something as simple as a too tight shoe that develops a wound and
doesn’t heal that can lead to an amputation
e. What is foot care- wash and dry feet only warm water- examine daily. No lotion or oil
between toes- cornstarch or talc there, moisturize the rest of the foot
f. Prevent rubbing areas- cotton absorbent socks- no seams
Priority in DKA treatment and in what order do you do them
a. Initial
i. Ensure patent airway
ii. Give O2 via nasal cannula or nonrebreather mask
iii. Establish IV access with large-bore catheter
iv. Begin fluid resuscitation with 0.9% NaCl solution 1 L/hr until BP stabilized and urine
output 30-60 mL/hr
v. Begin continuous regular insulin drip 0.1 U/Kg/hr
vi. Identify history of diabetes, time of last food, and time and amount of last insulin
injection
S&S of neuropathy
a. Sensory: loss of sensation, abnormal sensations, pain, and paresthesia. The pain, which
patients describe as burning cramping, crushing, or tearing, is usually worse at night and
may occur only at that time.
b. Autonomic: can affect nearly all body systems- Example is Gastroparesis. which can produce
anorexia nausea vomiting, and reflux. It can also cause hypoglycemia due to delayed food
absorption. Patients may also have postural hypotension, silent MIs, Sexual dysfunction, and
Neurogenic bladders. Which is when the bladder wall decreases causing urinary retention,
frequent voiding, and difficulty voiding. The coude maneuver of massaging downward over
the bladder may be needed to empty the bladder
Labs and symptoms in DKA
a. Blood glucose, CBC, pH, ketones, electrolytes, BUN, arterial or venous blood gases,
urinalysis, specific gravity, glucose, acetone
b. Symptoms: lethargy and weakness, dehydration, poor skin turgor, dry. Mucous membranes,
tachycardia, orthostatic hypotension- the acidosis causes abdominal pain, nausea/vomiting,
sweet fruity odor breath, and kussmaul respirations with are rapid deep breathing (it is an
attempt to reverse metabolic acidosis)
38. Recessive genetic disorders-what is potential for a child to get it if 1 parent has the disorder and
the other one doesn’t, or if both are carriers
a. If there is only one carrier of a recessive disease between the parents they won't have
any kids with the disease- it takes 2 recessive genes to make someone with the disease,
but they may have kids that are carriers see punnet square. if both parents are carriers
they can pass on carrier status and they may give some of their kids with the 2 recessive
gene disorder. see the punnet square for what percent chance their kids have of getting
the disease
39. Risk of taking beta blockers for type one diabetic- what do beta blockers end in
a. Beta blockers also delay the recovery from hypoglycemia in patients with type 1 diabetes.
b. Mask the tachycardia from hypoglycemia
c. End in -LOL
40. Insulin and meal planning related to exercise
a. Several small carbohydrate snacks can be taken every 30 minutes during exercise to prevent
hypoglycemia.
b. It is Best done 1 hour after meals so there is plenty of glucose available
c. Be aware of the peaks of the insulin doses to prevent hypoglycemia
d. May have to monitor blood sugar before, during and after doing exercise at first
e. Glycemic index (GI) of the carbs Should be considered when formulating a meal plan. It
describes how fast the rise in blood glucose levels after consuming carbohydrate-containing
food is. A low GI carb is easier for the diabetic body to handle
f. Fats should be No more than 25% to 30% of meal plan’s total calories
41. Somogyi affect and dawn phenomenon- how do we tell which is happening
a. Somogyi effect
i. Rebound effect in when an overdose of insulin causes hypoglycemia Usually during
hours of sleep then Counterregulatory hormones are released which causes a
Rebound hyperglycemia in the am
b. Dawn phenomenon
i. Characterized by hyperglycemia present on awakening in the morning Due to
release of counterregulatory hormones like Growth hormone/cortisol in predawn
hours
c. a 2 a.m. to 4 a.m. blood sugar can be done to determine if the high blood sugar in the
morning is due to much insulin or to little.
42. Treatment of hypoglycemia
a. 15 grams of carbs repeat BG in 15 minutes and repeat no fats because it can slow the
absorption of sugar
b. To prevent reoccurrence, give snack with protein and carbs- peanut butter crackers or bread
c. If unconscious use glucagon
d. How does glucagon help?
e. Can use 4oz of juice
43. What does the T,N,M mean- what are the 0 and 1s for each
a. T (Primary Tumor)
i. T0- no evidence of primary tumor
ii. T1-size and/or extent of the primary tumor
b. R (Regional Lymph Nodes)
i. N0- no regional lymph node involvement (no cancer found in the lymph nodes)
ii. N1- involvement of regional lymph nodes (number and/or extent of spread)
c. M (Distant Metastasis)
i. M0- distant metastasis cannot be evaluated
ii. M1- distant metastasis (cancer has spread to distant parts of the body
44. Care of a patient on Neutropenia precautions
a. Determine the type of isolation precautions that need to be started, if any.
b. Assess patient for signs and symptoms of infection
c. Screen visitors for infectious diseases
d. Place the patient on a neutropenic diet to protect them from bacteria found in some foods
(raw and undercooked meats and eggs and soft cheeses with molds)
e. Obtain antibiotics and hematopoietic growth factors
f. Teach patient and visitors about hand washing
g. Provide teaching about how to avoid infection, including the need for skin care and oral
hygiene
h. Teach the patient and caregivers about signs and symptoms of infection and what to do if
they occur.
45. Severe allergy respiratory assessment
a. #1 priority is airway, administer drugs, and treat shock Possible intubation or trach