Term
|
Definition
Defect in cellular proliferation (growth/multiplication)
Unpredictable futre
Tissue growing where it doesn't belong
No contact inhibition - tissue does not know its boundaries
Wild/erratic cell division |
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Term
|
Definition
| cellular defects,protooncogenes |
|
|
Term
| Definition of protooncogenes |
|
Definition
| Genes that promote growth, regulator of normal cellular process, genetic "lock" that keeps the cell in its mature state |
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Term
|
Definition
| 3 stages.....cause/development is multifactorial; may arise from causes that are far unexplained. |
|
|
Term
Development of Cancer
Stage 1- Initiation |
|
Definition
| Cancer cells start to grow, not reversable, initiated cell is not yet tumor b/c it can't self-replicate and grow |
|
|
Term
Development of Cancer
Stage 2 - Promotion |
|
Definition
| Reversable proliferation (growth/multipication) of the altered cells, cancer can be identified in this stage. |
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|
Term
Promoting factors in Cancer
Those that can be reversed-Part of stage 2 |
|
Definition
| dieary fat, obesity, smoking and alcohol consumption |
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|
Term
Development of Cancer
Stage 3 - Progression |
|
Definition
| Final stage of cancer development, increased growth rate of the tumor, increased invasives and spread of the cancer, metastasis to distant site |
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Term
|
Definition
| Advanced age, lifestyle decisions (smoking, alcohol), heredity, sex (males), poverty (affects diet),stress, occupation (asbestos, mining), obesity, sun |
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|
Term
| Classifications of cancer |
|
Definition
Solid-by location (breast, prostate, colon)
Liquid-leukemia, lymphoma (originated by blood cells) |
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Term
|
Definition
| DNS (Do not smoke), limit alcohol consumption, limit sun exposure, 5 servings of fruits/veggies, rest, exercise, and monitor weight |
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|
Term
Early warning signs of Cancer
***CAUTION*** |
|
Definition
Change in bowel/bladder habits
Any sore that does not heal
Unusual bleeding/discharge
Thicking or lump in breast or elsewhere
Ingestion/difficulty swallowing that persists
Obvious change in wart/mole
Nagging cough or horseness |
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|
Term
| Purpose of classifying cancer tumors |
|
Definition
| Standardized way to communicate status of cancer, determine the best course of tx, evaluate tx plan, factor in determining prognosis, compare for statistical data |
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Term
|
Definition
| confirms malignancy, determines type and location |
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|
Term
|
Definition
| establishes extent and anticipated natural course of disease |
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Term
|
Definition
| determines appearance of cells with degree of differentiation |
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|
Term
TNM Classification System
**Part of the STAGING** |
|
Definition
Determines anatomic extent of tumor by three parameters:
1 (T)-tumor size and invasiveness
2-(N) presence/spead to lymph nodes
3-(M) metastisis to other organs |
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|
Term
| The STAGING process of cancer |
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Definition
| Determines the anatomic extent of the malignant disease process. |
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Term
|
Definition
| Cancer in situ-has not spread; few cancer cells |
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|
Term
|
Definition
| Limited local spread-tumor limited to source of origin-no lymph node involvement |
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|
Term
|
Definition
| Limited local spread-Larger, but not grown outside area |
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|
Term
|
Definition
| Extensive local and regional spread |
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|
Term
|
Definition
| Metastasis-cancer has left its original site |
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|
Term
|
Definition
| Each cancer has its own staging criteria |
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|
Term
| HISTOLOGIC Grading of tumors |
|
Definition
| Appearance of cell and degree of differentiation-evaluated pathologically |
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|
Term
GRADE I
***mild dysplasia*** |
|
Definition
| Cancer cells are slightly different than normal cells-well differentiated |
|
|
Term
GRADE II
***moderate dyplasia*** |
|
Definition
| Normal cells appear abnormal / moderately differentiated |
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|
Term
GRADE III
***severe dysplasia*** |
|
Definition
| Cells are very abnormal; poorly differentiated-can hardly tell what they are suppose to be |
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|
Term
|
Definition
| Cells are immature and primitive and undifferentiated-cell of origin is difficult to determine |
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|
Term
| Nursing Interventions for communicating about the diagnosis of cancer |
|
Definition
| Explanations include as much information as the patient needs, given in clear, understandable terms and reinforced as necessary,give written information |
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|
Term
Treatments of Cancer
Can be used alone or in any combintion |
|
Definition
Surgery-local
Radiation-local
Chemotherapy-systemic
Biologic Therapy-systemic |
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Term
|
Definition
| Oldest form of local cancer treatment; does not take into consideration that the cancer cells traveled |
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|
Term
| Radiation Therapy-local tx |
|
Definition
| High energy beams that are absorbed into tissue and act to break down DNA-DNA unable to multiply |
|
|
Term
|
Definition
| Tx of most solid tumors and leukemias, lymphomas, myeloma and myelodysplastic syndromes. |
|
|
Term
|
Definition
Prevention-therapy prophylactic tx
Cure-treat ptnt, get rid of cancer
Control-chronic, cancer comes back
Palliation-manage symptoms |
|
|
Term
| Goals of cure/control of cancer |
|
Definition
| remove all or as much cancer as possible while sparing normal tissue |
|
|
Term
| Factors that contribute to tx |
|
Definition
| type of tumor (solid, fluid), location/size, extent of disease (has it metastisis/spread?), psysiological/psychological status of ptnt...some ptnts are not fit to undergo tx. |
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|
Term
|
Definition
Internal beam radiation
External beam radiation |
|
|
Term
External Beam Radiation
**Teletherapy** |
|
Definition
| Most common form of radiation tx; treat a carefully defined area of the body; only affects cancer in tx field |
|
|
Term
|
Definition
| Depends on the area treated; watch for extremely dry/moist skin |
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|
Term
|
Definition
|
|
Term
| Pt. teaching / Teletherapy |
|
Definition
| skin care, clean with mild soap/water-pat dry, no alcohol containing skin products, use aloe skin products, avoid perfume, deodorant, or shaving treated area, avoid sun/heat, pay attention to skin folds |
|
|
Term
Internal Radiation
***Brachytherapy*** |
|
Definition
| High doses of radiation, implant radioactivve material directly into cancer tumor-allowing direct dose delivered into target cell |
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|
Term
| Nursing Considerations when taking care of patient receiving Brachytherapy |
|
Definition
| Radiation safety; wear radiation badge, observe for dislodge, keep lead lined container/tongs in room, no one under 18y/o or pregnant allowed in room, minimize time (30min), maximize distance, utilize shield.....Explain to the patient why distance, and minimizing time in room |
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|
Term
Chemotherapeutic Drugs
Cell Specific/Cell non-specific |
|
Definition
| Classified in groups by molecular structure and MOA...similar...but different in how they work and SE |
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|
Term
Handling Chemo Safely
Nursing Considerations |
|
Definition
| Wear gown, gloves (2pair reg/1 pair chemo) during and 48 hours after, biohazzard waste, spill kit. These drugs are mutagenic and carcinogenic---must handle drugs & patient body fluids carefully |
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|
Term
| Routes of Chemo Administration |
|
Definition
| IV, Oral (wear gloves when handling drugs), regional (topical-skin cancers) |
|
|
Term
|
Definition
| Bone marrow suppression, N/V, diarrhea, mouth sores, skin changes/hair loss, and infertility |
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|
Term
Bone marrow suppression r/t Chemo tx
Risk for infection, bleeding, anemia |
|
Definition
| Most common SE, neutropenic (risk for infection <1000), leukopenia (WBC of 4 or less),thrombocytopenia (risk for bleeding; dont shave @ 50; transfuse 20-30...petechaie), Protective isolation precautions for neutropenia; Anemia=SOB, fatigue, chestpain-transfusse @ 8.0, erythropoietin |
|
|
Term
| Common sites of infection r/t bone marrow suppression |
|
Definition
| GI, sinuses, lungs, skin, groin, perineum, and peri-rectum, central line access |
|
|
Term
| Controlling anorexia r/t chemo |
|
Definition
| High calorie and protein supplements |
|
|
Term
N/V r/t Chemo treatment
Prevention is KEY & Manage aggressively |
|
Definition
Anticipatory-premedicate one hour b/4 tx
Acute & Delayed-assess dehydration & metabolic alkalosis...monitor fluid intake
Breakthrough N/ |
|
|
Term
|
Definition
| poor/prior n/v control, anxiety, female, youth, hx of motion sickness, metabolic imbalances, renal or hepatic dysfunction, CNS disease, GI obstruction |
|
|
Term
| Alternative interventions for N/V |
|
Definition
| acupuncture, acupressure, guided imagery, music therapy, muscle relaxation |
|
|
Term
| Mucositis-sores in the mouth |
|
Definition
| Secondary to chemo, Head/neck cancer, inflammation and ulceration occur due to rapid cell destruction; emphasize mouth care. Cells in the mouth rapidly divide and so do those in our mouth---that is why we get sores in the oral cavity. |
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|
Term
|
Definition
| hair loss; watch body image changes, wigs, scarves, hats. Avoid excessive shampooing, brushing and combing, electrichair dryers, curlers and curling irons |
|
|
Term
| Mouth care r/t stomatitis |
|
Definition
| brushing/flossing is critical, weigh 2x per week monitoring for weight loss, soft, high protein, high calorie diet |
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|
Term
|
Definition
| Provide adequate relief while allowing patient to function; start with PO-NSAIDS, SAO, LAO, give on schedule, anticipate breakthrough pain, treat constipation with opioids. |
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|
Term
|
Definition
| Location? Intensity? Quality? Pattern? Relieved by? |
|
|
Term
|
Definition
| Keep pain management diary re: location/intensity of pain, assess patterns of change. Through patient eduction, the patient should be reassured that cancer pain can be effectively relieved. |
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|
Term
| 911s that need Physician attention r/t cancer |
|
Definition
| Fever >101.5, severe-unrelieved pain, difficulty breathing, bleeding, new onset of confusion (CNS involvement), withdrawl-frequent crying, changes in body function |
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|
Term
Superior Vena Cava Syndrome
**Obstructive 911*** |
|
Definition
| Obstruction of vena cava by tumor or thrombosis. Rope like veriscosity accross chest; everthing on the UE is swollen |
|
|
Term
|
Definition
| Facial edema, periorbital edema, distention of veins in the H&N and chest, HA & seizures. |
|
|
Term
|
Definition
| Radiation or chemotherapy to site of obstruction |
|
|
Term
Spinal Cord Compression
***Obstructive 911*** |
|
Definition
| Neurological 911-tumor in spinal cord |
|
|
Term
| S/S Spinal Cord compression |
|
Definition
| intense BP, vertebral tenderss, motr weakness/dysfunction, sensory paresthesia; change in bladder/bowel function |
|
|
Term
| Tx of spinal cord compression |
|
Definition
| Radiation therapy, surgical decompression. |
|
|
Term
3rd spacing obstruction
***Obstruction 911*** |
|
Definition
| Fluid where it doesn't belong; shifting of fluids; from surgery, therapy or septic shock |
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|
Term
|
Definition
| hypovolemia, hypotension, tachycardia, decreased urine output |
|
|
Term
|
Definition
| fluid, electrolyte, plasma protein replacement, fluid management |
|
|
Term
Hypercalcemia-a metabolic 911
**Liver, bone & ovarian cancers |
|
Definition
| Involves cancer that has metastisis to the bone or prolonged immobility; can result in renal damage=dialysis for tx. |
|
|
Term
|
Definition
| Hydration, diuretics to promote calcium excretion, bisphosphonate drugs to slow the release of calcium frm the bones |
|
|
Term
Tumor Lysis Syndrome
Metabolic 911 |
|
Definition
| R/t cancers with fast growth rates & sensative to the effects of chemo |
|
|
Term
4 Hallmark signs of Tumor Lysis Synd
(TLS) |
|
Definition
High uric acid (hyperuricemia) 8
High K (Hyperkalemia)7
High Phosphate (hyperphosphatemia)4.5
Low calcium (hypocalcemia)7 |
|
|
Term
|
Definition
| Hydration therapy to prevent crystal formation, possible dialysis, Allopurinol-lowers uric acid levels |
|
|
Term
Disseminated Intravascular Coagulation
**DIC** |
|
Definition
| serious bleeding/thrombotic disorder; depletion of platelets and clotting factors; caused by underlying problem-fix that problem b4 DIC resolves |
|
|
Term
|
Definition
| Prolonged PT, PTT nd thrombin time, low platelets, low fibrinogen, d-dimer elevated showing breakdown of fibrin-breakdown leads to massive bleeding |
|
|
Term
|
Definition
| obvious bleeding; pallor, petechiae, purpura, oozing blood, venipuncture site bleeding, hematomas, tachypnea, hemoptysis and orthopnea, tachycardia and hypotension, U&L GI bleeding, abdomnal distention, bloody stools, vision changes, dizziness, HA, mental status change, bone/joint pain. |
|
|
Term
|
Definition
| Diagnose quickly-oxygenation/volume replacement, administering blood products while treating the underlying disorder, PRBCs to improve O2, FFP replaces clotting factor, cryoprecipitate best source of fibrinogen and factors V, VIII, XIII, platelets, 100,000 platelets; long-term use of heperin |
|
|
Term
|
Definition
| Inflammatory response to infection; infection enters blood stream, releases toxins that stimulate cytoking release, activate phagocytes; blood becomes sluggish, tissues-hypoxic, acidosis, organs begin to fail |
|
|
Term
|
Definition
| O2 for tissue, ARDS-ventilation, restore vascular volume, broad spectrum antibiotics |
|
|
Term
| Most common cancer diagnoses |
|
Definition
| Lung, colon, breast, prostate, female reproductive system, lymphoma |
|
|
Term
|
Definition
| Leading cause of death in US; smoking is primary risk factor; other factors-occupational risk |
|
|
Term
|
Definition
| Associated w/smoking and environmental carcinogens; tends to return and metastasize, spreads early to lymphatics & bloodstream, average survival-16months |
|
|
Term
|
Definition
| Most common, no clinical manifestations, tx-surgery can or can't be r/t smoking |
|
|
Term
|
Definition
Silent for most of course..persistant cough, may be blood tinged, chest pain,dyspnea, wheeze
Later symptoms-fatiue, anorexia, weight loss, N/V, hoarseness |
|
|
Term
| Diagnostic Testing to confirm Lung Cancer Dx |
|
Definition
| CT scan of lung, brain and bone; PET scan, MRI for early clinical staging, Biopsy, bronchoscopy |
|
|
Term
| What is needed to have a definitive cancer dx? |
|
Definition
|
|
Term
| Goals of patients with lung cancer |
|
Definition
| effective airway patterns, adequate airway clearance, adequate oxygenation of tissue, minimal to no pain, realistic attitude towards treatment/prognosis |
|
|
Term
| Nursing Care - Lung Cancer |
|
Definition
| Esophagitis, Impaired skin integrity (edema, superior vena cava), oxygenation-wheezing; observe for s/s of reoccurance |
|
|
Term
|
Definition
| Third most common type & cause of cancer death |
|
|
Term
|
Definition
| Often no symptoms until advanced; requires regular screenings to detect lesions. |
|
|
Term
| Tests to detect these cancerous polyps |
|
Definition
| Sigmoidoscopy or colonoscopy-considered the gold standard for screening & detection |
|
|
Term
CL Man of Colon Cancer
There is a Right side colon cancer and a left side |
|
Definition
Right side: asymptomatic, vague abdominal cramping, iron deficiency anemia leads to weakness/fatigue.
Left side: rectal bleeding, constipation/diarrhea, change in caliber (narrow, ribbonlike) |
|
|
Term
| Diagnostic tools for Colon Cancer |
|
Definition
Fecal occult blood test w/digital rectal exam annually starting @ 50y/o-if no family hx
Sigmoidoscopy Q5yrs
Colonoscopy Q10yrs |
|
|
Term
| Overall goals for a ptnt with colon cancer |
|
Definition
| normal bowel elimination pattern, QOL appropriate to disease progression, relief of pain, feelings of comfort & well being |
|
|
Term
| Nursing Care-Colon Cancer patients |
|
Definition
Monitor fluid/electrolyte balance-consider how much of the colon is remaining
Treat n/v and diarrhea |
|
|
Term
|
Definition
Most common form of cancer in women
Second leading cause of death in women |
|
|
Term
| Risk Factors-Breast Cancer |
|
Definition
| Age, family hx, early period-late menopause, first child after 30, benign breast disease, obesity, radiation exposure |
|
|
Term
|
Definition
| Some women have inherited mutated genes that are predictors of breast cancer. |
|
|
Term
|
Definition
| located on chromosome 17; suppressor gene p53; 40-80% more likely to develop breast cancer |
|
|
Term
|
Definition
| located on chrom 11; tumor suppressing gene with similar risks as BRCA-1 |
|
|
Term
|
Definition
| Lump, upper outer quadrant of the breast because it is the location with the most glandular tissue |
|
|
Term
|
Definition
| Excision/radiation of the lymph nodes |
|
|
Term
|
Definition
| Biopsy is taken of breast and lymph tissue=lifetime risk of developing lymphedema; breast ca metastisis to axillary lymph ; lymph biopsy is necessary for staging at time of dx |
|
|
Term
| Tx of lymphedema/Nursing Care & Precautions |
|
Definition
| No needle sticks in that arm, severe swelling, no BP taken on swollen extremity, use compression stocking be careful re: infection, ptnt should have on pink arm band; |
|
|
Term
| How many stages of Breast Ca are there? |
|
Definition
|
|
Term
|
Definition
| size <2cm; no lymph involvement, no metatasis; tx-masectomy, hormonal therapy |
|
|
Term
|
Definition
| Rumor size 2cm-5cm; tx-masectomy, no metastasis |
|
|
Term
|
Definition
| Similar to stage II; >5cm in size; no metastasis |
|
|
Term
|
Definition
| Distant metastasis, tx with local/systemic therapy with palliative intent |
|
|
Term
| Nursing Care for Patients with Breast Ca |
|
Definition
| Lymphedema precautions, S/S, treatment, hormonal changes-early menopause, body image changes-encourage support groups |
|
|
Term
|
Definition
| most common cancer of men....1/5 men affected, second leading cause of death in men |
|
|
Term
| Risk factors of prostate cancer |
|
Definition
Age, family hx, ethnicity (AA more likely), high fat diet
After age 50, risk significantly increases |
|
|
Term
| Treatment for prostate Ca |
|
Definition
| Most common tx; for early stages: surgery or radiation therapy. |
|
|
Term
| Nerve sparing procedure for Prostate Ca |
|
Definition
| A procedure that can be used to spare the nerve involvement of the prostate to allow the men to retain sexual function following the removal of the prostate |
|
|
Term
| Nursing Care - Prostate Ca |
|
Definition
| Hormonal therapy after procedure, urinary incontinence and erectile dysfunction |
|
|
Term
| Three types of female reproductive system Ca |
|
Definition
Cervical
Endometrial
Ovarian |
|
|
Term
|
Definition
Invasive/noninvasive;
Noninvasive more common
Affects AA Women more |
|
|
Term
| Risk factors for Cervical Ca |
|
Definition
| Low socioeconomic status, early sexual activity, multiple sex partners, HPV, immunosuppression, smoking |
|
|
Term
|
Definition
| normal cervical cells go into dysplasia and then invasive cancer; r/t repeated injury to the cervix. Slow progression (years) |
|
|
Term
|
Definition
| Precancerous changes are asymptomatic, leukorrhea & intermenstrual bleeding-discharge thin and watery but becomes dark and fowl smelling-infection. Pain-late symptoms followed by anemia, weight loss & cachexia |
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|
Term
| Diagnostics for Cervical Ca |
|
Definition
| Pap smear-recommended Q3yrs. |
|
|
Term
|
Definition
| guided by stage, ptnts age, and general health of ptnt. Early detection/tx is critical. |
|
|
Term
|
Definition
| Stage II & III are difficult; often treated with chemo, brachytherapy & external beam radiation (teletherapy) |
|
|
Term
| Nursing Assessment for patients with possible female reproductive Ca-CL Man. |
|
Definition
| leukorrhea, irregular vaginal bleeding, vaginal discharge, increase in abdominal pain/pressure, bowel & bladder dysfunction, vulvar itching/burning. |
|
|
Term
| Nursing Considerations-ptnt with GYN Ca |
|
Definition
| Infertility, sexual dysfunction, body image changes, anxiety, pain, grieving |
|
|
Term
|
Definition
Malignant cells originating in the bone and lymphatic structures.
2 types-Hodgkin's lymphoma
non-hodgkins lymphoma (NHL) |
|
|
Term
|
Definition
| Associated w/EBV, toxic exposures & immune suppression, genetics |
|
|
Term
| How many stages of lymphoma are there? |
|
Definition
|
|
Term
|
Definition
| Involves one single lymph node or one lymph chain |
|
|
Term
|
Definition
| 2 or more lymph nodes in same region on the same side of diaphram |
|
|
Term
|
Definition
| Lymph nodes on both sides of the diaphram |
|
|
Term
|
Definition
| Disease in one or more organs/tissues - can be with or w/o lymph node association |
|
|
Term
| Hodgkin's Lymphoma CL Man. B-symptoms |
|
Definition
| weight loss, fatigue, weakness, fever, shills, tachycardia, or night sweats. Drinking alcohol will induce pain at the site of disease |
|
|
Term
| Hodgkins Lymphoma occurs where? |
|
Definition
| Mostly above the diaphragm, especially cervical lymph node chain |
|
|
Term
| Tx for Hodgkin's Lymphoma |
|
Definition
ABVD regimen (doxorubicin, bleomycin, vinblastine, and dacarbazine. Potentially 2-4 rounds of chemo.
Advanced stages 6-8 cycles of chemo, MOPP ( mechlorethamine, vincristine, procarbazine & prednisone) alternating with ABVD |
|
|
Term
| Relapse of Hodgkins is treated how? |
|
Definition
|
|
Term
| Nursing support for patients with Hodgkins |
|
Definition
| managing problems r/t disease, pain, SE of tx, evaluate skin, psychosocial needs, discussion of fertility |
|
|
Term
| Non-Hodgkins Lymphoma (NHL) |
|
Definition
| Mostly B-cells, immunosuppressed ptnts, more common with HIV ptnts. Can be extensive and involve organs like CNS, spleen, liver, GI, bone marrow |
|
|
Term
|
Definition
| painless lymph node enlargement |
|
|
Term
B-symptoms
Hodgkins Lymphoma |
|
Definition
Fever, Night sweats, weight loss, fatigue
*FRED NEEDS WATER FAST* |
|
|
Term
| DX for NHL or Hodgkins Lymphoma Ptnt |
|
Definition
| Patient is at risk for infection-WBC count is low; impaired skin, mucus membrane integrity |
|
|
Term
| Nsg Intervention-Ptnt with Neutropenia or risk for infection |
|
Definition
| protective isolation, private room, limit visitors, vitals q4hrs, dietary restrictions, limit intake of RAW foods. TAKE temp if patient has evidence of chilling or sweating...ie. asking for another blanket... |
|
|
Term
| Thrombocytopenia-what and Nsg. Interventions |
|
Definition
| R/T platelet count and risk for bleeding. Bleeding precautions, limit needle sticks, apple pressure to puncture site, avoid Valsalva, monitor for s/s of bleeding, platelet count, transfuse platelets as needed |
|
|
Term
Impaired skin integrity r/t Chemo Tx
Nursing Interventions |
|
Definition
| Inspect skin/mucus daily, oral care, monitor for thrush & cutaneious candida infections, use mild soap and lotion to maintain lubrication |
|
|
Term
Altered body image r/t chemo tx
Nursing Interventions |
|
Definition
| allow patient to express feelings, provide resources for wigs, scarves, turbans..etc. |
|
|
Term
| 1st step in determining neuro status of a child in the hospital |
|
Definition
| Gather a complete comprehensive history of the child's development and neuro status prior to hospitalization |
|
|
Term
| Components of Child Neuro Assessment |
|
Definition
| Pupil response (dilation), LOC, Motor function and VS, Cranial nerve, reflex testing |
|
|
Term
| What tool is used to determine LOC of a child? |
|
Definition
| Glasgow Coma scale; documents in 3 parts---eyes, motor & auditory/visual stimulation |
|
|
Term
| Ratings on the Glasgow Coma Scale |
|
Definition
| The higher the number the better response=normal ...If a 1=no response |
|
|
Term
|
Definition
| Make sure it is clear, simple, and objective |
|
|
Term
| Sudden fixed/dialated pupils are what........ |
|
Definition
| neurosurgical 911-suggest paralysis of oculomotor nerve amongst other things |
|
|
Term
Posturing-flexion
Cerebral cortex involvement |
|
Definition
| rigid flexion, arms held tightly to the body, elbows, wrists and fingers; legs extended and internally rotated |
|
|
Term
Posturing-Extension
Associated with midbrain or lesions to the brainstem |
|
Definition
| rigid extension; pronation of the arms, flexed wrists/fingers, clenched jaw, extended neck and arched back |
|
|
Term
|
Definition
15-Unaltered LOC (the best)
8< - Generally, a coma
3 or < Deep coma or death
ANY CHANGES ARE REPORTED TO PHYSICIAN 911 |
|
|
Term
| DEF. of full consciousness |
|
Definition
| Alert & Oriented X3; response appropriate for age |
|
|
Term
|
Definition
|
|
Term
|
Definition
| Confussed re: time, place and decreased LOC |
|
|
Term
|
Definition
| Limited spontanuous movement, sluggish speech, drowsy & falls asleep quickly |
|
|
Term
|
Definition
| Arounsable with stimulation |
|
|
Term
|
Definition
| remaining in a deep sleep, slow response to vigorous stimulation/moaning to responses of stimuli |
|
|
Term
|
Definition
| No motor or verbal response..extension posturing to painful stimuli |
|
|
Term
| DEF of persistent vegetative State PVS |
|
Definition
| Perm loss of function in cerebral cortex, eyes follow objects but only by relflex, all four limbs are spastic-withdrawl to painful stimuli, hands reflexive grasping, grasping and groping, face can grimace, food can be swallowed, child may grown or cry-but utter no words |
|
|
Term
| Pupil assessment r/t neuro assessment |
|
Definition
normal pupils 2-6mm
Examine eyes in dark room with bright light
Examine for direct response, consensual response, and conjugate gaze |
|
|
Term
| VS in regards to Neuro assessment |
|
Definition
VS should be WNL
HR increases b/c of pain
Normal for neonates to have periods of periodic breathing
BP may be normal, elevated or very low
Pulse may be rapid, slow and bounding or feeble
More important to note a change in VS rather than to focus on whether it is high or low |
|
|
Term
|
Definition
| Assess grip strength, posture and muscle tone-twitches, spastic, or muscle spasms, and symmetry of movements-asymetrical movements is a sign of paralysis |
|
|
Term
| Deterioration-Changes in LOC |
|
Definition
| Gradual loss of eye contact, confusion, weak irritable cry (high & shrill), less responsive, lethargy |
|
|
Term
| Deterioration-Pupil changes |
|
Definition
could become larger, smaller, unequal or sluggish, gazzing, dilation & unresponsive to light
"pupils are blown" |
|
|
Term
| Deterioration-motor function |
|
Definition
| Diminishes and neuro function declines |
|
|
Term
|
Definition
| Changes in BP and pulse more important than direction, tachycardia, bradycardia, widening pulse=increased ICP; can be hyper/hypothermic. |
|
|
Term
| Extreme hypothermia is indicative of...... |
|
Definition
|
|
Term
| Three major classifications of seizures |
|
Definition
1-partial
2-generalized seizures
3-unclassified |
|
|
Term
|
Definition
| Simple symptoms; no alteration in LOC, focal cortical discharge resulting in CL MAN r/t cerebral involvement. |
|
|
Term
| S/S of Simple Partial Seizures |
|
Definition
| Motor, sensory, autonomic or psychic symptoms. Aura..in most cases Most common during sleep, salivation, speech changes, tonic-clonic movements, eyes and head turn away from the focus |
|
|
Term
S/S complex partial seizures
Most common type of seizure |
|
Definition
| Impairement of consciousness; child may look vacant, dazed or frightened-unable to respond or follow directions when qued. A strange feeling in the stomach that travels up to the throat; odd/unpleasant tastes, repetitive involuntary activities w/o purpose |
|
|
Term
| Other "Generalized" seizures |
|
Definition
| Absence, myoclonic, tonic, tonic-clonic, atonic |
|
|
Term
S/S tonic clonic
AKA Grand Mal |
|
Definition
| Most common & dramatic; eyes roll up, violent jerking, foam at the mouth, possible incontinence or urine & feces |
|
|
Term
|
Definition
| 4-12 y/o; girls >boys, brief loss OC, lip smacking, twitching of eyelids; often mistaken for inattentiveness or daydreaming |
|
|
Term
|
Definition
| sudden contractures of muscles, may/not loose consciousness |
|
|
Term
|
Definition
| 2-5 years old, sudden loss of muscle and postural control, Loss OC only momentarily, happens after waking early in the am. |
|
|
Term
| When a child is seizing...it is important to know what? |
|
Definition
| What type of seizure the patient is having |
|
|
Term
|
Definition
| Involuntary, sudden, limited alteration in function, electrical storm, abnormal discharge from cortical neurons |
|
|
Term
|
Definition
|
|
Term
|
Definition
| The period during the seizure |
|
|
Term
|
Definition
| The time after the seizure |
|
|
Term
| DEF of Status Epilepticus |
|
Definition
| Seizure lasting >30 minutes; or a series of seizures that does not allow ptnt to regain consciousness b/t them |
|
|
Term
Infantile Spasms
AKA myoclonus, massive spasms, salaam episodes, infantile myoclonic spasms |
|
Definition
| 6-8m of life, boys >girls, numerous seizures daily, without drowsiness/sleep; poor outlook for normal intelligence |
|
|
Term
|
Definition
| Sudden, brief, symetrical muscle contractions, head flexed, arms extended, legs drawn up, preceded or followed by a cry or giggle, may/not include loss OC, sometimes flushing, pallor, or cyanosis |
|
|
Term
|
Definition
| 6m-3yrs; boys >girls, increased incidence for those attending daycare; seiz during temp spike |
|
|
Term
|
Definition
| Ibuprophen/tylenol, protect airway, protect from injury |
|
|
Term
| Prophylactic antiepileptic indicated for patients........ |
|
Definition
| with focal or prolonged seizure, child with primary relative who has had febrile seizures, children <1yr old, multiple incidents. Dont use phenobard. |
|
|
Term
|
Definition
| hyperplasia of gums, tonsil/adnoid enlargement restricting airflow, causes snoring, decreased bone density |
|
|
Term
|
Definition
| HA, dizziness, ataxia and sleepiness |
|
|
Term
| Therapeutic levels of antiepileptic meds |
|
Definition
| tx started with single dose known to be effective with lowest toxicity/safest SE for childs type of seizure. Gradually increased as tolerated to control symptoms. Monotherapy is preferred method of treatment. If second therapy is added, done so while on first and the first is slowly tappered down. Measure blood levels-blood cell counts, urinalysis, & LFT are frequently drawn. |
|
|
Term
|
Definition
| High-fat, low carb and low protein diet; used for alternate control of seizures. The body shifts from using glucose as the energy source. Patient developes state of ketosis. |
|
|
Term
| Ptnt teaching for Ketogenic diet |
|
Definition
| Deficient in vitamins/minerals. Supplements should be given. |
|
|
Term
|
Definition
| Used for ptients who have not had successful control of seizures through medications. Implantable device 12 years or older, stimulates L Vagus Nerve-cranial nerve X-caregiver activates stimulator with magnet at onset of seizure |
|
|
Term
| Surgery for patients with Seizures |
|
Definition
| Reserved for those whos seizure is caused by hemotoma, tumor, or other cerebral lesion. |
|
|
Term
| Hemispherectomy-Seizure surgery |
|
Definition
| ptnt with severe epilepsy and does not have use of hand |
|
|
Term
| Seizure-surgery-what is done |
|
Definition
| Removal of the focal area |
|
|
Term
| Nursing Considerations of patient having seizure |
|
Definition
| Stay with patient, promote safety, if in wheelchair or chair-move to floor; turn patient on side, monitor seizure-what movements, how long, where is it? Call for help; pull curtains or close doors, O2 if necessary |
|
|
Term
|
Definition
| ask questions about them-where is it, how long does it last, what takes away, n/v with it, when does it begin, how long do they last, any precipitating events. Need to learn everything we can regarding the characteristics of the HA. |
|
|
Term
|
Definition
| Most common-often proceeded by "a feeling" aura and with n/v |
|
|
Term
|
Definition
| Just what the name says they are.....Do we experience them????? :) |
|
|
Term
|
Definition
| If triggered and identified-avoid trigger, biofeedback/relaxation, tylenol, NSAIDS, Propanolol, amitripyline/nortriptyline |
|
|
Term
|
Definition
| A symptom/sign resulting from a disturbance in dynamics of CSF |
|
|
Term
|
Definition
| congenital or acquired (hemorrhage, tumor, CSF infection or head injury) |
|
|
Term
| What is communicating/noncommunicating hydrocephalus |
|
Definition
| referring to obstructive and non obstructive types |
|
|
Term
| Communicating hydrocephalus |
|
Definition
| Impaired absorption of the CSF within to subarachnoid space |
|
|
Term
| Non-communicating hydrocephalus |
|
Definition
| obstruction of flow to CSF through the ventricular system. Usually developmental malformation, apparent at birth |
|
|
Term
|
Definition
| Head grows abnormally fast >2cm p/month, bulging anterior fontenel, eyes rotated downward (setting sun), poor feeding, changes in LOC, irritable, arching of the back (back of head and heals are the only things touching the bed-bad sign), lower extremity spasticity |
|
|
Term
|
Definition
| A surgical procedure-placing a shunt to drain the CSF from the ventricles to an extracranial compartment-usually the peritoneum |
|
|
Term
|
Definition
| Standard procedure for many years; greater allowance for excess tubing, which minimizes number of revisions |
|
|
Term
|
Definition
| Ventricle to right atrium-reserved for older children, contraindicated in kids with cardiopulmonary disease |
|
|
Term
| Complications of VP shunts |
|
Definition
| Infections and malfunction |
|
|
Term
|
Definition
Pupils-change indicates change in pressure, changes in LOC will be a HA, sleep patterns and changes from baseline
BP-hypoxia
Abdominal distention-CSF may cause peritonitis or post op ilius.
Monitor for INFECTION..... |
|
|
Term
| Bacterial Meningitis in adults |
|
Definition
| Usually occurs in the fall, winter & early spring; pre-dispossed if poor health status. |
|
|
Term
| Most common organisms seen in adult bacterial meningitis..... |
|
Definition
|
|
Term
| Most common organisims in children-bacterial meningitis |
|
Definition
| Influenzae type B, eisseria meningiditis & Strep Pneumonaie |
|
|
Term
| Neonatal Meningitis bacterias |
|
Definition
| Group B strep, E coli and listeria monocytogenes |
|
|
Term
| CL Man Bacterial Meningitis-Neonates |
|
Definition
| Very difficult to diagnose this group.....vague and nonspecific manifestations, well at birth-then refuse feedings, poor sucking ability, vomit/diarrhea. Poor muscle tone, lack of movement & poor cry; hypothermia or fever, jaundice, irritability, drowsiness, seizures, respiratory irreularity, apne, cyanosis, and weight loss. May/not have bulging fontenel, neck supple--disease will continue to progress into cardiovascular collapse, seizures, apnea and DEATH |
|
|
Term
CL Man bacterial meningitis
Infants/young children |
|
Definition
| Ages 3m-2yrs. Fever, poor feeding, vomiting, irritability, restlessness, seizures, bulging/tense fontenel, high pitched cry. |
|
|
Term
Late signs occuring in the young child-
Bacterial Meningitis |
|
Definition
| Nuchal rigidity & Brudzinski and Kernig |
|
|
Term
|
Definition
| Flexed head, pain or involuntary flexing of the knees (these are abnormal) |
|
|
Term
|
Definition
| Child lying supine, legs flexed at hips, resistance or pain upon extension is abnormal |
|
|
Term
S/S Older children/adolescent
bacterial meningitis |
|
Definition
| Abrupt, chills, fever, HA, vomiting...quick alterations in sensorium. Initial sign is often SEIZURE. As disease progresses-neck stiffness, Kernig & brudzinski signs are (+), skin may be cold & cyanotic & poor peripheral perfusion. Petechial or purpuric rashes, ear drainage, signs of cardiovascular collapse. |
|
|
Term
| COMPLICATIONS of meningitis |
|
Definition
| Obstructive hydrocephalus (infection extends into ventricles, pus, fibrin or adhesions may occlude the narrow passages obstructing flow of CSF; subdural effusions, thrombosis, brain abcesses, extension of infection leading to blindness, deafness, & paralysis, seizures |
|
|
Term
Most common complication of meningitis
**Waterhouse-Friderichsen Syndrome** |
|
Definition
| Meningococcal sepsis AKA meningococcemia; onset is severe, sudden and rapid. Overwhelming septic shock, disseminated intravascular coagulation, massive B adrenal hemorrhage and purpura. Requires IMMEDIATE attention |
|
|
Term
SIADH
Acute complication of meningitis |
|
Definition
| Seizures occur caused by irritation and destructive changes in cerebral cortex and hyponatremia. Decreased Na, Cl, and osmolality levels. |
|
|
Term
|
Definition
| Fluid restrictions if necessary; do not give massive amouts of salt |
|
|
Term
TX CSW
Cerebral Salt Wasting |
|
Definition
Vigorous salt replacement
Characterized by contracted EABV resulting from renal salt wasting |
|
|
Term
| DX testing for meningitis |
|
Definition
Lumbar puncture is the definitive
Fluid is measured, sample for gram stain, blood cell count, protein, & glucose, C&S to identify causative organism. Important to know relationship b/t serum glucose and CSF glucose. Serum glucose is drawn 1/2 hr b4 LP |
|
|
Term
| Labs findings for meningitis |
|
Definition
| elevated WBC, glucose level reduced, increased protein concentration. Nose/throat cultures may also be helpful |
|
|
Term
| Management of the patient with Meningitis***They are VERY sick*** |
|
Definition
| Isolation, Respiratory isolation for 24 hours, antimicrobial therapy, hydration, ventilation, reduction of ICP, management of systic shock, control of seizures, control of temp, tx of complications. |
|
|
Term
|
Definition
| If the parents have already been around patient, they do not need to gown/mask, etc...b/c of previous exposure. |
|
|
Term
|
Definition
| Prompt tx of URI, ear infections, vaccines; propholaytic tx-anyone who has been exposed..classroom party...etc. |
|
|
Term
| What is included in neuro exam for infants? |
|
Definition
| Observe size/shape of head, spontaneous activity, reflex activity, sensory responses. Is patient lethargic? drowsy, stuporous, alert. Palpate anterior fontanel, palpate cranial sutures, document response to stimulation; assess ability to suck/swallow |
|
|
Term
| Neuro assessment of infant cont. |
|
Definition
| pupuillary response, head control (stable at 4m), assess cry-is it weak, lusty, shrill, appropriate for stimulus |
|
|
Term
| Neuro reflexes to check for infant |
|
Definition
| strength, coordination, tremors, twitchng, tics or other unusual movements; abnormalities in gait |
|
|
Term
| Anterior Fontanels close..... |
|
Definition
|
|
Term
| Posterior fontanels close |
|
Definition
|
|
Term
|
Definition
| Fanning of the toes (good sign in infants up until time they are walking). If toes fan after walking-indicative of neuro issue |
|
|
Term
| Normal flexed position of an infant |
|
Definition
| Arms close to body, fists, somewhat on knees, feet flexed |
|
|
Term
PATHO Craniosynostosis
AKA Craniostenosis |
|
Definition
| Premature closure at birth of one of more of the cranial structures |
|
|
Term
|
Definition
| Treatment depends on which suture closed, the duration of the closure process, or the success/failure of other structures to compensate by expanding. |
|
|
Term
| Risk Factors for craniosynostosis |
|
Definition
| race, advanced maternal age, male infant, fertility tx, certain maternal occupation |
|
|
Term
| MOST COMMON type of Craniosynostosis |
|
Definition
| Closure of sagittal suture, elongation of skull in the anterior-posterior direction. looks like Postnatal position |
|
|
Term
| Characteristics of Craniosynostosis |
|
Definition
| Can increase ICP, may/not cause cognitive delays, progressive papilledema, optic atrophy, or blindness |
|
|
Term
|
Definition
| Surgical excision of long bonealong or parallel to fused suture--done as early as possible <6m. |
|
|
Term
| Nursing Care / Post-op Craniosynostosis |
|
Definition
| change in neuro status, hemorrhage, infection, monitor Hct, Hgb-because of large blood loss, pressure bandages applied to reduce swelling, eyelid swelling-gentle cleaning, pain mgmt, hydration, resume oral feedings as soon as possible |
|
|
Term
|
Definition
| The brain is 80%, blood 10% and 10% CSF; they must remain balanced, if there is an increase in one, there should be a decrease in another. Balance needs to be maintained. |
|
|
Term
|
Definition
| The pressure exerted by the CSF within ventricles of the brain |
|
|
Term
| ICP continually fluxuates |
|
Definition
| responds to arterial pulsation and repiratory cycle |
|
|
Term
|
Definition
| Cough, sneezing or straining increases ICP, standing up or sitting errect decreases ICP |
|
|
Term
|
Definition
80-110mm H2O & 0-15mm Hg
over 20mm hg & 200 H20 is abnormally high |
|
|
Term
| Increased ICP---leads to diminished cerebral perfusion----- |
|
Definition
leads to brain ischemia, infarction
This is a poor prognosis |
|
|
Term
| ICP that is sustained leads to ...... |
|
Definition
| brainstem compression, herniation of the brain from one compartment to the other-cannot be reversed-fatal. Herniations force cerebellum and brainstem down through the foramen magnum-compresses brain stem leading to respiratory arrest |
|
|
Term
| Respiratory arrest with ICP proceeds..... |
|
Definition
|
|
Term
Older children S/S ICP-
Subjective |
|
Definition
| H/A in am (esp. when lying flat) or when coughing, sneezing or bending over. N/V, double/blurred vision when moving head, seizures |
|
|
Term
|
Definition
| bulging/tense fontenal, absence of normal pulsations, Head circumference growth >2cm/month after 3m; subtle changes, HA, vomitting, personality changes, fatigue, pupil changes (normal-sluggish-fixed/dialated), altered LOC, high pitched cry |
|
|
Term
| Nursing Care-child with ICP |
|
Definition
| baseline neuro, VS frequently, patent airway-may need to suction and hyperventilate. |
|
|
Term
| Suctioning patient with ICP....... |
|
Definition
| Give extra O2-suction depletes O2, suction 5sec-bring back O2, clean cath-suction again |
|
|
Term
Hypercapnia S/S patient with ICP
Caused by hypoventilation |
|
Definition
Increased CO2, blood gas >45
Increased HR/BP, muscle twitches, flushing, full pulse, tachypnea, decreased neuro activity |
|
|
Term
| S/S Hypoxia-ptnt with ICP |
|
Definition
| Lack of O2-Severe HA, skin is blue, nausa, SOB, fatigue, seizures, impaired memory/judgement |
|
|
Term
|
Definition
| maintain airway, take to hospital and put on vent. Monitor BP/HR |
|
|
Term
| Increased temp-patient with ICP |
|
Definition
| Increased temp increases O2 needs. Fever caues vasodilation with increases CBF (cerebral blood flow) |
|
|
Term
| Position of the patient with ICP |
|
Definition
| Position w/HOB 30 degrees (promotes venous drainage & prevents increase of cerebral blood flow; prevent neck flexion/extension. Can use sandbags to position head |
|
|
Term
|
Definition
| the most common type of solid tumor in children |
|
|
Term
|
Definition
| r/t anatomical location, size and age of the child |
|
|
Term
| CL Man Infants w/Brain tumors |
|
Definition
| sutures are not closed-no early detection. Eventually, spinal fluid obstruction causes increased head size |
|
|
Term
| CL Man Brain Tumors-older children |
|
Definition
| nonspecific-most common HA upon awakening-gets better during the day, vomiting not r/t feeding-ICP compresses brainstem stimulating the vomiting center of the medulla, neuro changes-weakness, VS-decreased pulse; increased BP |
|
|
Term
|
Definition
| Gold Standard-MRI-permits early dx and assessment of growth after tx. |
|
|
Term
| Other dx testing for b.tumors |
|
Definition
| MR, CAT scan, Angiography, electroencephalography, LP (dangerous with ICP) |
|
|
Term
| DEFINITIVE DX of brain tumor |
|
Definition
| Biopsy-tissue obtained during surgery to determine cell type |
|
|
Term
|
Definition
Surgery, radiotherapy and chemo
By themselves or in combination depending on type of tumor |
|
|
Term
| Radiotherapy for Brain tumors |
|
Definition
| used to shrink tumor B4 surgery |
|
|
Term
| Nursing Mgmt for Brain tumor patients |
|
Definition
| establish baseline of data, provide family support-don't give false hopes-shaved head, dressing size, how the child will feel post surgery |
|
|
Term
| Assessment post surgery for Brain Tumor |
|
Definition
| VS Q15m until patient stable. Monitor temp-hyperthermia, (hypothalamus/brainstem control temp), to prepare-cool blanket may be at the end of the bed...if using cooling measures-be sure to eval temp often, infection, respiratory infection (immobility), ocular signs Q1h, neuro checks, dressing of wound (if soiled-do not remove-reinforce with dry sterile gauze) |
|
|
Term
| Sluggish, dialated, or unequal pupils are 911----why |
|
Definition
| Indicative of ICP and potential brainstem herniation |
|
|
Term
| Positioning patient s/p brain surgery |
|
Definition
| nurse confers with Dr. about correct position-degree of neck flexion. Sign posted at HOB re: positioning, when turned-use 2 nurses-one for the head and one for the body, usually on side, pillows behind back-sometimes with HOB elevated to drain fluid. positioning is dependant on type of surgery/where it was. |
|
|
Term
|
Definition
| Contraindicated for both brain surgeries b/c it increases ICP and risk of hemorrhage |
|
|
Term
|
Definition
| NPO post-op 24hrs, feeding after child alert-clear water because risk for aspiration. If child vomits-liquids stopped-IV fluids until oral tolerated; IV infussed 1/2 maintance rate. |
|
|
Term
|
Definition
| The child should be fed to conserve energy/strength/minimize movement. Mouth care to prevent infection, |
|
|
Term
| ***Antibiotics IV with fluids s/p brain surgery*** |
|
Definition
| The medication amount is calculated as part of the IV fluid. Ie. child to receive 20ml/hr and the diluted drug is 5ml--the IV solution will be decreased to 15ml for that hour |
|
|
Term
| Comfort and s/p brain surgery |
|
Definition
| HA may be severe secondary to edema, provide quiet, dim environment, restrict visitors, prevent sudden movement, proper positioning (most effective), prevention of straining (cough, vomiting, defecating), ice bag on forehead, opioids-controversial, stool softeners for constipation, brain edema depress gag reflex=suction, eye drops and eye dressing. |
|
|
Term
| Supporting the family s/p brain surgery |
|
Definition
| Nurse w/family when physician discusses prognosis and tx plan. Redirect parents thinking towards helping child recover and resume normal life |
|
|
Term
| Promoting optimal function s/p brain surgery |
|
Definition
| resume usual activities within tolerable limits. May need to wear helmet until when engaging in sports until skull healed. |
|
|
Term
DEF of Myelodysplasia
**AKA Spina Bifida or Neural Tube Defects (NTDs)** |
|
Definition
| any malformation of the spinal canal or cord |
|
|
Term
Type of Myelodysplasia
**Neural Tube Defecits** |
|
Definition
| Anencephaly, Encephalocele, SB Cystica and SB occulta |
|
|
Term
|
Definition
| Absense of brain tissue-not compatable with life, congenital, if not stillborn, will die w/i short time of respiratory failure |
|
|
Term
|
Definition
| herniation of brain; mass/sac that may occur at any place above the skull, maybe covered by scalp or transparent membrane |
|
|
Term
|
Definition
| Most common NTD-affecting CNS |
|
|
Term
|
Definition
| visible defect external sac like protrusion |
|
|
Term
|
Definition
myelomeningocele-contains meninges, spinal fluid & nerves; affecting sensory & motor
meningocele-meninges, spinal fluid, NO NERVES |
|
|
Term
|
Definition
| defect that is not visable, lumbosacal area, dimple at the end of sacral area |
|
|
Term
|
Definition
| degree of impairment depends on level and extent. Neuro findings coorelate to muscle groups involved, dysfunction ranging from incompatible with life to total paralysis or minimal involvement |
|
|
Term
|
Definition
| club feet, contractures, dislocated hips, scoliosis, bowel/bladder dysfunction b/c the nerves that supply these organs are located in the sacral area. |
|
|
Term
|
Definition
| Using the appendix to provide alternate route of catheterization. Allows patient more independance |
|
|
Term
|
Definition
| Surgery-requires multi-disciplinary approach-close the sac |
|
|
Term
| 4 areas of focus for surgery of the NTD patient |
|
Definition
| 1-level of neuro involvement (paralysis, high/low lesion, orthopedic)2-Size and location of the sac 3-presence of other abnormalities (NTD, other issues, orthopedic), other complications that may occur (pressure ulcer, kidney infection) |
|
|
Term
|
Definition
| Risk for infection, trauma, skin integrity, injury-r/t latex, neuro impairement |
|
|
Term
| Chronic problems encountered by kids with NTD |
|
Definition
|
|
