Term
| Describe WHO's pain ladder |
|
Definition
| non opioids, then mild opioids (oxycodone), and strong opioids (morphine) |
|
|
Term
| Opioids are sometimes combined with what for pain management? |
|
Definition
| acetaminophen (percocet or aspirin) |
|
|
Term
| What is the purpose of anticonvulsants as cancer treatment? |
|
Definition
| helpful in relieving cancer related neuropathic pain |
|
|
Term
|
Definition
| most severe form of malnutrition related to cancer; common cause of cancer death; tumor necrosis factor (cachectin) |
|
|
Term
| What lab values can be used to evaluate a patient's nutritional status? |
|
Definition
| pre-albumin, WBC (lymphocytes), transferrin |
|
|
Term
| What is the best manager of cachexia? |
|
Definition
|
|
Term
| What is another name for bactrim/septra? |
|
Definition
|
|
Term
| How often are prophylactic meds given? |
|
Definition
|
|
Term
| What is an alternate for a prophylactic antimicrobial for someone with a sulfa allergy? |
|
Definition
|
|
Term
| What are the 4 purposes of surgery in the treatment of cancer? |
|
Definition
| reduce tumor cell burden, palliate symptoms, stage cancer, slow tumor growth |
|
|
Term
|
Definition
| chemo after surgical resection of primary tumor when there's a risk of systemic recurrence |
|
|
Term
| Describe neoadjuvant chemo |
|
Definition
| given before other treatment to decrease tumor cell burden before surgical resection |
|
|
Term
| What are the RICE chemo drugs? |
|
Definition
| rituxan, ifosphamide, carboplatin, etoposide |
|
|
Term
| Rituxan use has the potential to cause what? |
|
Definition
| allergic reactions; give benadryle, tylenol or corticosteroid before |
|
|
Term
| Ifsophamide use has the potential to cause what? |
|
Definition
| hemorrhagic cystitis; need to dipstick urine for blood; MESNA is given to protect bladder |
|
|
Term
| Carbolatin use has the potential to cause what? |
|
Definition
| peripheral neuropathy, central toxicity, nephrotoxicity |
|
|
Term
| Etoposide use has the potential to cause what? |
|
Definition
|
|
Term
| Those who use cytoxan are at a risk of developing what? |
|
Definition
| hemorrhagic cystitis; dipstick urine; use MESNA to protect bladder |
|
|
Term
| What should be monitored in those taking cisplatin? |
|
Definition
| kidney function; always hydrate before and after |
|
|
Term
| Describe risk and use of ARA-C |
|
Definition
| AML treatment; patients are fall risk, cerebellar toxicity: physical assessment and daily signature page |
|
|
Term
| Describe high dose methotrexate |
|
Definition
| folic acid antagonist; keeps pH>7, rescue with Ca leukovorin |
|
|
Term
| What is considered a normal ejection fraction? |
|
Definition
|
|
Term
| What is a side effect of vincristine use? |
|
Definition
|
|
Term
| What is a side effect of Doxorubicin/Adriamycin & Daunorubicin use? |
|
Definition
|
|
Term
|
Definition
| severe local tissue breakdown and necrosis |
|
|
Term
| What is the most common IV site for chemo? |
|
Definition
| CVL; peripheral can be used but must have blood return |
|
|
Term
| Extravasations from what meds are treated with heat? |
|
Definition
| vincristine and etoposide |
|
|
Term
| What type of catheter is used in CVLs? |
|
Definition
|
|
Term
| Describe intrathecal chemo |
|
Definition
| administered into CSF; uses huber needle |
|
|
Term
| How long after chemo completion are patients still on cytotoxic precautions? |
|
Definition
|
|
Term
| What corticosteroid crosses the blood brain barrier? |
|
Definition
|
|
Term
| How soon after chemo does alopecia begin? |
|
Definition
| 2-3 weeks; comes back 2-3 months once done and may look different |
|
|
Term
|
Definition
| inflammatory condition of oral tissue including mucosa, teeth and peridontium from chemo |
|
|
Term
| When does mucositis typically occur and how long does it take to heal? |
|
Definition
| 7-10 days after beginning chemo; 2-4 wks after its done |
|
|
Term
| Describe the composition and use of magic mouthwash |
|
Definition
| for oral mucositis; lidocaine, antiinflammatory, nystatin, cherry syrup |
|
|
Term
| Describe the management of oral mucositis |
|
Definition
| assesment q4, documentation, rinse mouth with water or NS or 1/2 strength peroxide, opiates, systemic analgesics |
|
|
Term
| Describe the two types of radiation therapy |
|
Definition
| teletherapy (radiation to external of body, patient is not radioactive); brachytherapy (internal therapy that includes the use of radioactive substances |
|
|
Term
| What is a disadvantage of radiation therapy for cancer treatment? |
|
Definition
| tumor must be radiosensitive |
|
|
Term
| Describe the use of brachytherapy (types of treatments used) |
|
Definition
| unsealed soluble isotopes (radioactive in eliminated in excreta) and sealed implants (seeds implanted in specific tissues, not radioactive) |
|
|
Term
| Describe the care of a patient with brachtherapy |
|
Definition
| private room, signage, door closed, dosimeter badges, lead apron, visitor limit 30 mins/day, never touch radioactive source with bare hands |
|
|
Term
|
Definition
| radiation to specific site and tissue depth; |
|
|
Term
| What are the side effects of teletherapy? |
|
Definition
| side effect of skin irritation and tissue damage at site, fibrosis (replacement of normal tissue with scar tissue), bowel damage, memory loss, infertility, second cancer |
|
|
Term
| How do you care for the skin of someone treated with teletherapy? |
|
Definition
| water only or mild soap, no powders or creams on irritated skin; avoid skin exposure of irritated area |
|
|
Term
| What are the effects on men and women receiving androgens for cancer treatment? |
|
Definition
| acne, high Ca, liver dysfunction |
|
|
Term
| What is an example of angiogenesis inhibitors used in cancer treatment and its side effects? |
|
Definition
| avastin; reduced healing/maintenance can worsen CAD since vessels cannot heal, nosebleed, headache, HTN |
|
|
Term
| What is a fatal side effect of avastin? |
|
Definition
|
|
Term
| What is the use and potential complication of BMT in cancer treatment? |
|
Definition
| leukemia and some solid tumors; graft vs. host disease (damages GI, liver and integument) |
|
|
Term
| Describe paraneoplastic syndromes |
|
Definition
| symptoms that can't be exlpained by spread of tumor or its hormones; thrombosis, tumor lysis syndrome, sepsis and DIC |
|
|
Term
|
Definition
| SVC compressed by tumor growth; signs are edema of neck (collar of stokes), dyspnea, epistaxis |
|
|
Term
|
Definition
| attention to ABCs, metal stent in vena cava |
|
|
Term
| Describe the drug therapy for tumor lysis syndrome |
|
Definition
| Allopurinol, bicarb drip to alkalinize body; patient will breathe shallowly |
|
|
Term
| Describe syndrome of inappropriate antidiuretic hormone |
|
Definition
| water is reabsorbed in excess by kidney and recirculated; example of ectopic hormone production or r/t stress; |
|
|
Term
| What are some treatments for spinal cord compression? |
|
Definition
| high dose corticosteroids and radiation, therapy, braces |
|
|
Term
| What is an important manifestation of hypercalcemia? |
|
Definition
|
|
Term
| Describe the 4 types of hypersensitivity categories |
|
Definition
| 1- Ig E mediated, 2- tissue specific reactions, 3- immune complex mediated, 4- cell mediated |
|
|
Term
|
Definition
| normal immune reaction against beneficial foreign tissue |
|
|
Term
| Describe T1 hypersensitivity |
|
Definition
| involves reaction to allergens; manifests as pruritis, urticaria (hivves), edema, rhnitis |
|
|
Term
| What is the major side effect of first generation antihistamines? |
|
Definition
|
|
Term
| Describe 2nd generation antihistamines |
|
Definition
| less likely to have side effects of sedation and dry mouth but are just as effective as 1st generation |
|
|
Term
| How do decongestants work? |
|
Definition
| shrink swollen nasal tissues and blood vessels to relieve congestion and redness |
|
|
Term
| What are 3 short term side effects of steroid use? |
|
Definition
| weight gain, fluid retention, HTN |
|
|
Term
| What are the side effects of inhaled steroids? |
|
Definition
| cough hoarseness, and yeast infections of the mouth |
|
|
Term
| Describe mast cell stabilizers |
|
Definition
| treat T1 hypersensitivity reaction; stop release of histamine from mast cells (make and store histamine) |
|
|
Term
| Describe leukotriene antagonists |
|
Definition
| block effects of chemicals made in the body in response to allergy (leukotrienes) |
|
|
Term
| What Are the Side Effects of Bronchodilators? |
|
Definition
| Tachycardia and high blood pressure |
|
|
Term
ID drug and class:
combination atrovent (anticholinergic) & albuterol (sympathomimetic) |
|
Definition
|
|
Term
| What are the most common CAM adverse reactions? |
|
Definition
| urticaria, contact dermatitis, and anaphylaxis. |
|
|
Term
| What is the drug of choice to treat anaphylaxis? |
|
Definition
|
|
Term
| What is the drug of choice for anaphylaxis with cardiac involvement? |
|
Definition
|
|
Term
|
Definition
| bronchodilator, stimulates heart, increase BP, reverse hives and swelling |
|
|
Term
| Most latex allergic reactions occur with what? |
|
Definition
|
|
Term
| What populations are more likely to develop a latex allergy? |
|
Definition
| children with spina bifida, congenital UTI abnormalities, health care workers, family history of allergies |
|
|
Term
| If someone is allergic to latex, what foods should they avoid? |
|
Definition
| avacados, bananas, chestnuts, kiwis, passion fruits |
|
|
Term
| What is the normal adult dose for benadryl? |
|
Definition
|
|
Term
|
Definition
| transfer of tissues from one person to another of the same species |
|
|
Term
|
Definition
| transfer of tissue across species; don't need immunosuppression |
|
|
Term
| Describe rejection and graft damage for transplants in humans |
|
Definition
| human leukocyte antigen system; rejection is done via humoral or cellular rejection |
|
|
Term
ID HLA reaction type:
mediated by recipient's antibodies |
|
Definition
|
|
Term
ID HLA reaction type:
results from activation and proliferation after exposure to donor MHC molecules |
|
Definition
| cellular rejection, more common |
|
|
Term
| What are the clinical components of graft rejection? |
|
Definition
| t lymphocytes, b lymphpcytes, macrophages and cyokines |
|
|
Term
| What is the result of hyperactute transplant rejection? |
|
Definition
| swollen darkened graft that becomes necrotic |
|
|
Term
| Describe acute transplant rejection |
|
Definition
| occurs within days to months; cell mediated, t4 hypersensitivity reaction |
|
|
Term
| Describe the use of calcineurin inhibitors as immunosuppresants |
|
Definition
| cyclosporine; activates T lymphocytes; need to monitor kidney function and infections, will need antihypertensives |
|
|
Term
| Describe the use of sirolimus as an immunosuppresant |
|
Definition
| inhibits IL2 cytokines blocking activation of T and B cells |
|
|
Term
| Describe the use of azathioprine as an immunosuppressant |
|
Definition
| suppresses T and B cell proliferation; causes myelosuppression |
|
|
Term
| Describe the use of polyclonal antibodies |
|
Definition
| used for those who have a rejection episode and don't reaction to typical treatment; premedicate with benadryl, tylenol, solumedrol and demoral |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| What are the two major structural protein molecules of CT? |
|
Definition
| collagen (glue) and elastin (similar to rubber band) |
|
|
Term
| What are the 4 specialized CTs? |
|
Definition
| adipose, cartilage, bone, blood |
|
|
Term
ID autoimmune CT disorder:
inflammation of CT in every organ system |
|
Definition
|
|
Term
ID autoimmune CT disorder:
systemic disorder where immune cells attack and inflame membrane around joints, heart, lungs, eyes |
|
Definition
|
|
Term
ID autoimmune CT disorder:
activation of immune cells that make scar tissue in skin, organs, and blood vessels |
|
Definition
|
|
Term
ID autoimmune CT disorder:
chronic slowly progressing inability to make saliva and tears; can occur alone or with other CT disorders |
|
Definition
|
|
Term
| Describe mixed connective tissue disease |
|
Definition
| features of several CT disease coexist; more common in women than men |
|
|
Term
|
Definition
| disorders of the immune system that effect joints and CT |
|
|
Term
| Many people previously diagnosed with what also suffered from dermatomyositis? |
|
Definition
|
|
Term
| What are the main S&S of dermatomyositis? |
|
Definition
| symmetric proximal muscle weakness (muscles deteriorate and make moving of any kind difficult), pain, papules, lilac rash |
|
|
Term
| What is a character feature of dermatomyositis that mimics psoriasis? |
|
Definition
| gattron's sign/papules; T3 hypersensitivity |
|
|
Term
| What are the complications of dermatomyositis ? |
|
Definition
| interstitial lung disease, esophageal disease, myocarditis and malignancy |
|
|
Term
| What are the signs of poor outcome in someone with dermatomyositis? |
|
Definition
| delay of treatment >6 months, dysphagia, malignancy, cardiac involvement |
|
|
Term
| How does polymyositis present? |
|
Definition
| bilateral proximal muscle weakness (noticed in early fatigue while walking); interstitial lung disease |
|
|
Term
| What is another name for scleroderma? |
|
Definition
|
|
Term
| Describe localized scleroderma |
|
Definition
| morphea, linear scleroderma |
|
|
Term
|
Definition
| loss of skin creases, joint contractures, sparse hair |
|
|
Term
| What are the criteria for systemic sclerosis? |
|
Definition
| sclerodermatous involvement proximal to digits, sclerodactyly |
|
|
Term
|
Definition
| deposition of circulating immune complexes containing antibodies against host DNA; T3 sensitivity |
|
|
Term
| What is the classic clinical manifestation of lupus? |
|
Definition
|
|
Term
| What is another name for cutaneous lupus? |
|
Definition
| discoid lupus (discoid rash) |
|
|
Term
|
Definition
| fetus develops issues in heart, skin, liver and blood; heart block is common manifestation or rash around eyes |
|
|
Term
| What environmental factors may also have an influence on lupus? |
|
Definition
| sunlight, stress, chemicals, viruses |
|
|
Term
| What are some drugs whose use precipitate flares of SLE? |
|
Definition
| sulfonamides and echinacea |
|
|
Term
| Toxic exposure to what is linked to SLE? |
|
Definition
|
|
Term
| What kinds of tests/screenings are completed in someone suspected to have lupus? |
|
Definition
| CBC, WBC, ferritin, antinuclear antibody |
|
|
Term
| Describe SLE diagnosis criteria |
|
Definition
| 4/11 common findings must be present |
|
|
Term
| What are the 11 criteria for SLE? (SOAP MD) |
|
Definition
| serositis, oral ulcers, arthritis, photosensitivity, blood change, renal involvement, ANA, immunological changes, neurological signs, malar rash, discoid rash |
|
|
Term
| Describe the type of rest needed by a lupus patient? |
|
Definition
| 8-10 hrs of sleep/night, timeouts during the day; encourage physical activity |
|
|
Term
| What type of diet is suggested for a lupus patient? |
|
Definition
|
|
Term
| Sulfa drugs and what don't mix? |
|
Definition
|
|
Term
| Can women with SLE use oral contraceptives? |
|
Definition
| Yes; as long as she is not hypercoagulable |
|
|
Term
| What types of vaccines can be given to lupus patients? |
|
Definition
| those with killed viruses |
|
|
Term
| What are the side effects of NSAID use on SLE? |
|
Definition
| GI issues, altered platelet function, avoid after 1st trimester |
|
|
Term
| Describe the use of antimalarials in SLE treatment? |
|
Definition
| joint pain, arthritis, skin rashes, fatigue, fever, mouth ulcers |
|
|
Term
| What are some types of antimalarials? |
|
Definition
|
|
Term
| What are some poor effects of antimalarials |
|
Definition
| effects clotting, can damage retina; give before or after meals |
|
|
Term
| Describe the use of corticosteroids in treating SLE |
|
Definition
| used after NSAIDs and antimalarials, helps with inflammation, muscle pain/fatigue, suppressing the immune system |
|
|
Term
| What type of med used to treat SLE can reduce the need for steroids? |
|
Definition
|
|
Term
| What do you do if your patient gets a headache from an IV imunosuppressant? |
|
Definition
|
|
Term
| Describe the use of thalidomide in treating SLE |
|
Definition
| inhibits inflammatory cytokines in skin; contraindicated in pregnant women |
|
|
Term
| What is the most common cardiopulmonary manifestation of SLE? |
|
Definition
|
|
Term
| _____ occurs in 10-15 percent of lupus patients |
|
Definition
| cranial or peripheral neuropathy |
|
|
Term
| SLE patients who present with acute abdominal pain, esophageal dysmotility, and tenderness are likely experiencing what? |
|
Definition
|
|
Term
| Describe raynaud's phenomenon |
|
Definition
| reversible ischemia of peripheral arterioles |
|
|
Term
| What are the 6 Ps and CMS to be checked in someone with rheumatoid arthritis? |
|
Definition
| Parasthesia, pain, poikilothermia, pallor, paralysis, pulselessness; Circulation, movement, sensation |
|
|
Term
| Describe collaborative care of RA |
|
Definition
|
|
Term
| What meds are used to treat RA? |
|
Definition
| salicylates (anti-inflammatory), NSAIDS, corticosteroids, intra-articular steroids |
|
|
Term
| Describe DMARDs in RA treatment |
|
Definition
| Disease modifying antirheumatic drugs; halt underlying processes that cause certain forms of inflammatory arthritis; chemo meds in lower doses work well with less risks |
|
|
Term
|
Definition
| ankylosing sponylitis; autoimmune joint disease |
|
|
Term
|
Definition
| noninflammatory slowly progressive disease of mobile joints, degradation of cartilage; associated with obesity, trauma, genetics |
|
|
Term
| How does osteoarthritis develop? |
|
Definition
| excessive loading of joint causes tissue to fail; no systemic signs and symptoms |
|
|
Term
| What is the difference between RA morning stiffness and DJD morning stiffness? |
|
Definition
| DJD lasts for minutes; RA lasts for over an hr |
|
|
Term
| What type of treatment does RA need more? |
|
Definition
|
|
Term
| What meds are used to treat DJD? |
|
Definition
| acetaminophen, salicylates, NSAIDs |
|
|
Term
| Describe the use of glucosamine |
|
Definition
| most studied use is osteoarthritis; reduces symptoms and slows progression |
|
|
Term
| Glucosamine should not be taken under what circumstances? |
|
Definition
| hypertensive, pregnant, breastfeeding; monitor blood sugar |
|
|
Term
| Describe the use of chondroitin sulfate in DJD treatment |
|
Definition
| reduce painful symptoms; 400mg bid |
|
|
Term
| Describe the use of capsaicin cream in the treatment of DJD |
|
Definition
| when applied to skin it depletes substance P which transmits pain from spinal cord |
|
|
Term
| Which is used more in DJD treatment: heat or cold? |
|
Definition
|
|
Term
| Describe hip precautions for Total Hip Arthroplasty |
|
Definition
| maintain hip in abduction, avoid adduction and extreme rotation of hip, turning to unoperative side, avoid flexion>90 degrees |
|
|
Term
| How should those with THA sit? |
|
Definition
| hips higher than knees; use elevated toilet seat/handicap toilet |
|
|
Term
| Describe Total Knee Anthroplasty (TKA) post op treatment |
|
Definition
| avoid gatching bed under knee, need continuous passive motion machine |
|
|
Term
| Describe peroneal nerve injury |
|
Definition
| foot drop can occur; numbness, tingling, pins and needles |
|
|
Term
| Describe compartment syndrome |
|
Definition
| causes muscle and nerve damage with problems of blood flow |
|
|
Term
| Describe the treatment of compartment syndrome |
|
Definition
| fasciotomy; delay can cause permanent damage |
|
|
Term
| What can decrease the risk of compartment syndrome development? |
|
Definition
| elevation and ice (Acute issue) |
|
|
Term
|
Definition
| overproduction or underexcretion of uric acid; need hyrdration, bicarb drip, monitor K and Ph |
|
|
Term
| What is the patho of gout linked to? |
|
Definition
| purine metabolism and kidney function; tumor lysis syndrome |
|
|
Term
| What is the name for crystal deposition of uric acid in the body? |
|
Definition
|
|
Term
| What is considered an elevated uric acid level? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| What are the major meds for gout? |
|
Definition
| allopurinol, uricase, probenicid, collchicine |
|
|
Term
| What medications should you avoid when you have gout? |
|
Definition
| thiazide, loop diuretics that inhibit renal excretion of uric acid (lasix), niacin |
|
|
Term
| What are the ABCs of gout? |
|
Definition
| Allopurinol, benemid, colchicine |
|
|
Term
| What are the CAM treatments for gout? |
|
Definition
| coffee, vitamin C (small doses), cherries |
|
|
Term
| What is the criteria for fibromyalgia diagnosis? |
|
Definition
| 11/18 tender points for 3 months or more |
|
|
Term
| What drugs are used to treat fibromyalgia? |
|
Definition
| cymbalta, lyrica, neurontin, ultram (opioid) |
|
|
