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Adult Health Test 4
Cardio and Cancer
85
Nursing
Undergraduate 3
04/23/2012

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Term
Surgical Indications
Definition
Diagnostic/Exploratory
Curative
Palliative
Cosmetic Improvement
Preventative
Term
When does preoperative care begin?
Definition
When patient realizes the need for surgery and determines they will indeed have the surgery
Term
Details of the Informed Consent
Definition
Can only reiterate what the surgeon says.
Pt. should be alert and aware of what is being signed.
Term
Who makes up the surgical team?
Definition
Anesthesiologist, surgeon, circulating nurse, scrub nurse
Term
Analgesia
Definition
lack or normal pain sensation
Term
Amnesia
Definition
the absences of awareness of stimuli and events
Term
Anesthesia
Definition
partial or complete loss of sensation with or with out loss of consciousness
Term
General Anesthesia
Definition
Balanced Technique
-begin with IVP of barbituates-pleasant sleep
-inhalation of gas
-continue with adjuncts
(opiods narcotics, benzodiazapines, neuromuscular blocking agents)
Term
Continuous Sedation
Definition
Used in OR
-combination of medications to achieve depressed LOC
-patient retains airway reflex and responds to verbal or physical stimulation
Term
Local Anesthesia
Definition
Block's patient's sensory and motor function by interrupting nerve impulses
-pt. remains fully conscious
Term
Methods of Local Anesthesia
Definition
Topical
Regional
Spinal & Epidural
Term
Side Effects of Spinal and Epidural
Definition
hypotension, bradycardia, nausea, vomiting, tingling in hands, numbness above site, respiratory depression
Term
Malignant Hyperthermia
Definition
increased CO2, muscle contractions, hyperthermia, hypoxia, arrhythmias, cardiovascular changes
Term
Immediate Assessments Post-Op
Definition
Airway, breathing, circulation, neurologic, LOC, ability to follow commands, Urine output, Surgical Site, BG of diabetic patients
Term
Hypovolemic Shock
Definition
lack of blood flow to the vital organs r/t low fluid volume
s/s: pallor, low BP, High HR
Term
Nursing Interventions for Hemorrhaging
Definition
Apply pressure to area with gloved hand
Reinforce surgical dressing
-DO NOT remove the first surgical dressing
Term
Pulmonary Embolism
Definition
DVT that traveled to the lungs
Term
Risk factors R/t PE
Definition
Surgery, immobility, fracture, heart failure, chronic AFib, obesity, advanced age, oral contraceptive use, estrogen therapy.
Term
Clinical Manifestations of PE
Definition
Subjective: anxiety, feeling of impending doom, pressure in chest, pain on inspiration, dyspnea, air hunger
Objective: pleurisy, tachycardia, hypotension, tachypnea, crackles and cough, diaphoresis, decreased O2 Sat. Petechiae, pleural effusion.
Term
Complications of PE
Definition
Pulmonary Hypertension, pulmonary infarction (tissue death), Cor Pulmonary (hypertrophty of right ventricle)
Term
Diagnosis of PE
Definition
Ventilation Perfusion Scan-checks circulation and gas distribution
D-dimer blood test
Coagulation and ABG's
Angiography
CXR, EKG
Term
Medications for PE
Definition
Morphine Sulfate-pain and anxiety
Vasopressors-shock (dopamine)
Digitalis & Diuretics - heart failure
Heparin/Coumadin
Fibrinolytic Therapy like tPA
Term
Surgical Treatment for PE
Definition
Pulmonary Emboletomy- for large clots
Insertion of Filter -for prevention of further PE, CVA, etc.
Term
Types of Lung Cancer
Definition
Small cell carcinoma (25%, fast growth and spread)
Non-small cell carcinoma:
- Adenocarcinoma
- Squamous cell carcinoma
- Large Cell carcinoma
Term
Symptoms of Lung Cancer
Definition
Chronic Cough, hemoptysis, wheezing, SOB, dull chest pain, weight loss, anorexia, fatigue, weakness, paraneoplastic syndrome (hormones released the affect endocrine and autoimmune systems)
Term
Diagnosis of Lung Cancer
Definition
CXR, sputum analysis, bronchoscopy with biopsy, CT, CBC, LFTs, electrolytes, PPD, PFTs, ABGs
Term
Treatment of Lung Cancer
Definition
Combo: particularly effective of small-cell
Surgery: non-small cell, 30% chance of cure
Radiation: may be used to treat vena cava syndrome
Bronchodilators
Analgesia and pain meds
CAM
Term
Primary Risk Factors R/t Breast Cancer
Definition
Female, >50
prior breast cancer, atypical hyperplasia, carcinoma
1rst degree relatives with breast cancer
BRCA1 and BRCA2 mutation
Term
Secondary Risk Factors R/t Breast Cnacer
Definition
Post menopausal obesity
early menarche or late menopause
1rst full term pregnancy >30 y.o.
Chest radiation <35 y.o.
Benign breast disease
hormone replacement
more than 2+ alcoholic beverages/day
Term
Noninvasive Breast Cancer
Definition
Cancer in Situ= localized cancer
Ductal carcinoma= tends to be unilateral, may progress if untreated, most commmon
Lobular carcinoma in situ (LCIS)= premalignant lesion, often do not require treatment
Term
Paget's Disease
Definition
Persistent lesion of nipple and areola with or without palpable mass.
s/s: itching, burning, nipple discharge with superficial erosion, ulceration
TX: simple or modified mastectomy
Term
Inflammatory Breast Cancer
Definition
Most malignant, most rare
Aggressive and fast growing
Skin is rippled, warm and has thickened appearance
-inflammatory changes caused by cancer cells blocking lymph channels
-metastasis occur early and widely
-radiation, chemo, hormone therapy
Term
Diagnosis of Breast Cancer
Definition
Biopsy, Sentinel lymph node dissection (where it is likely to go next), axillary lymph node status, estrogen and progesterone receptor status, DNA content analysis, Her2 status, cell proliferation indices, CXR, CT of abd., Liver US, Bone scan
Term
Breast Conservation Therapy
Definition
Lumpectomy
Partial Mastectomy
Term
Mastectomy
Definition
Total (simple) mastectomy
Modified radical mastectomy
Radical mastectomy
Term
Lymphedema
Definition
results from excision or radiation of lymph nodes, fluid causes obstructive pressure
S/S: swelling, heaviness, pain, impaired motor function, numbness/paresthesia of fingers
Term
Lymphedema Prevention
Definition
Frequent and sustained elevation of arms
Performing arm exercises
Avoid constricting clothes
Custom fitted pressure sleeve
Term
Breast Conservation Surgery
Definition
Removal or entire tumor along with margin of normal tissue
-radiation delivered to entire breast following surgery
-Preserves breast including nipple
-considered standard treatment for early stages
Term
Modified Radical Mastectomy
Definition
Removal of breast and most axillary lymph nodes
-preserves pectoralis major
-selected in tumor is too large to excise with good margins
-patient has option for reconstruction
Term
Postmastectomy pain syndrome
Definition
chest and upper arm pain, phantom breast pain, tingling down the arm, numbness, shooting or pricking pain, unbearable itch.
TX: NSAIDS, antidepressants, topical lidocaine patches, EMLA, antiseizure meds.
Term
Radiation Therapy
Definition
Primary treatment to destroy or as companion to surgery
-shrink tumor
-palliative treatment to pain from local metastases recurrence.
Term
Chemotherapy
Definition
-can decrease the size of the primary tumor
Suppresses tumor growth and prolongs survival
-often a combination of medications
-often for premenopausal women
Term
Hormonal Therapy
Definition
Often for postmenopausalwomen
-blocks or destroys estrogen receptors
-EX: tamoxifen: reduces recurrence by 50% but carries the risk of uterine cancer
-Femara: reduces recurrence after surgery
Term
Biological therapy
Definition
for Her2+ tumors with mets
-attempts to stimulate the body's natural defenses and attack cancer cells
-trastuzmab :monoclonal antibody MAb to Her-2 antigen
-maybe given in combination to increase survival time
Side effects: cardiomyopathy, anaphylaxis, dyspnea, neutropenia exacerbation
Term
Colorectal Cancer
Definition
3rd most common cancer diagnosed.
-most often from adenocarcinoma
tumors spread through the walls of the intestines or through the lymphatic or circulatory systems.
metastasis to lymph nodes is common.
Term
Clinical Manifestations of Colorectal cancer
Definition
not specific and may not be noticeable until cancer has advanced. (5-15 years)
-early: change in bowel habits, rectal bleeding that leads to anemia.
-advanced: pain, anorexia, weight loss, palpable abdominal or rectal mass.
Term
Prevention
Definition
Diet: high it fruits and veggies, low in saturated fats, avoid red meats.
Exercise
Healthy Weight
Limit Alcohol
No smoking
Term
Diagnoses of Colorectal cancer
Definition
Family Hx., physical, sigmoidoscopy, colonoscopy, digital rectal exam, CXR, CT, MRI,US, CBC, CEA
Term
Stage 1 Colorectal Cancer
Definition
tumor invaded submucosa or muscle
no metastasis
Term
Stage 2 Colorectal Cancer
Definition
Tumor through mucosa, perforates, not metastasis
Term
Stage 3 Colorectal Cancer
Definition
Any tumor invasion, 1-3 regional metastasis
Term
Stage 4 Colorectal Cancer
Definition
any tumor invasion, regional metastasis, distant metastasis
Term
Treatment of Colorectal Cancer
Definition
Endoscopic polpectomy
Laser photocoagulation
Surgical therapy: hemicolectomy, resection, colostomy
Radiation, chemotherapy (5FU, Leucovorin, Camptosar)
Term
Myocardial Infarction
Definition
Permanent loss of blood flow to the myocardium resulting in cell death (irreversible damage)
Term
Collateral Circulation
Definition
secondary channels used after a portion of the vessels are occluded
Term
Labeling MI's
Definition
labeling is based on location
Location corresponds with the coronary artery.
-anterior wall MI= Left anterior descending coronary artery (LAD)
-Inferior wall MI: right coronary artery
Term
Ischemia
Definition
decrease in myocardial oxygen supply or increased oxygen demand, reversible, no permanent damage
Term
Clinical manifestations of MI
Definition
angina: immobolizing, more intense, continuous, long lasting.
No change related to rest, nitrate or position change
heaviness, pressure, tightness, burning
Levine's sign: fist to chest
fatigue, SOB, indigestion, weakness, drenching perspiration, back pain
Term
PQRST
Definition
P= What precipates the pain? exertion? resting?
Q= quality of the discomfort, sharp, tightness, etc.
R= does pain radiate to te jaw, arm, back, etc.
S= severity (pain scale)
T= timing of onset of the current episodes and previous episodes
Term
Physical Assessment with MI
Definition
Vitals: initially rapid HR and high BP but decreases causing hypotension and bradycardia, tachypnea, SOB, fever
BG: elevated
Skin:cool, pallor, clammy
Resp: crackles
Heart: distant hear sounds, develop. S3 or S4
GI: nausea, vomiting
Neuro: fatigue, dizziness, light-headed
Term
Diagnosis of MI
Definition
Clinical hx of ischemia, ECG, Serum Cardiac Markers
(must have 2/3 for World health organization)
elevated cardiac enzymes
Term
Serum Cardiac Markers: Troponin T and I
Definition
Troponin T (<.2 normal) and Troponin I (<3.1 normal)
-proteins released from the cardiac muscles due to necrosis , elevated 2-4 hrs. after MI, peak at 24 to 36 hrs.
-measured at time of admission and for 3 days following
Term
Serum Cardiac Markers: Ck and Ck-MB
Definition
CK: Creatine Kinase-found in cardiac and skeletal muscles, elevated after MI for 4-6 hrs. peak 12-24, duratioin 48-72
CK-MB myocardial bands
-most sensative test for MI, present at 4-8 hrs, peak 18-24 hrs, duration 72 hrs.
Term
Serum Cardiac Markers: Myoglobin
Definition
first to be elevated, non-specific tissue (found in cardiac and skeletal muscle)
elevated within 1-3 hrs, peaks at 12hrs, duration 24 hrs.
Term
Medications for MI tx.
Definition
nitroglycerin, beta-adrenergic blockers, anti-coagulant, antiplatelet, morphine, ACE inhibitor, Antidysrhthmia
Term
Complications of MI
Definition
Arrythmia, CHF, Cardiogenic shock, papillary muscle disfunction, pericarditis, dressler syndrome
Term
Cardio Interventions
Definition
Cardiac Catheterization, balloon angioplasty, stent implantation, atherctomy
Term
Atherosclerosis
Definition
focal deposits of cholesterol and lipids within the intimal wall of the artery
-lipids are entrapped in the endothelium and then calcify, platelets and adhere and clots form
-slow, progressive disease
Term
CAD
Definition
coronary arteries are unable to dilate to meet increaed metabolic needs because they are already dilated beyond the obstructed area.
-ischemia occurs at >70-75%
reversible if <30 minutes
Term
Risk factors associated with CAD
Definition
nonmodifiable: age, gender, genetics, race (more common in AA)
Modifiable: hypertension, DM, central obesity, smoking/second hand smoke, physical inactivity, elevated homocysteine levels, premature menopause, diet high in trans, saturated fat and triglycerides.
Term
Angina Pectoris
Definition
CAD may lead to decreased O2 supply which leads to ischemia, which leads to anaerobic metabolism that produces lactic acid and causes chest pain.
Term
Symptoms of Angina
Definition
pressure, pain, heavy sensation, suffocating, choking, does not change with position, or deep breath.
-also: indigestion, burning sensation, SOB, anxiety, cold sweat, weakness, paresthesis
Term
Angina in Women
Definition
indigestion, nausea, vomiting, upper back pain, dyspnea, pallor, tachycardia, anxiety, fear
Term
Class 1 Angina
Definition
does not occur with regular activity
Term
Class 2 Angina
Definition
may occur with rapid or prolonged walking or stair climbing
Term
Class 3 Angina
Definition
Significantly limits ordinary physical activity
Term
Class4 Angina
Definition
may have pain at rest along with during any physical activity
Term
Treatment of Stable Angina
Definition
Nitrates, Calcium Channel Blockers, Beta Adrenergic Blockers
-goal is to decrease o2 demand and increase o2 supply
Term
Nitrates
Definition
decrease heart work and O2 demand
-dilation
-decreased blood return to the heart
-decreases cardiac output
-decreases work load of the heart
-decreases o2 demand
Term
Beta-Blockers (olol)
Definition
blocks beta receptors on heart cells
-decreases HR and contractility
-decreased oxygen demand and blood pressure
*not for Asthma or COPD
Term
Calcium channel blockers
Definition
block calcium ions to the heart
-decrease O2 consumption by relaxing arterial smooth muscle
-decreases BP and HR
-provides more O2 by dilating coronary arteries
Term
Unstable angina
Definition
may be a new onset or progression from stable to unstable.--EMERGENCY!
progressive and preinfarction in nature**
unpredictable, change in pattern of angina, increased frequency, easily provoked, lasts >10 minutes
Term
TX of Unstable angina
Definition
STAT ASA (chewable), Nitroglycerin (IV), beta blockers (IV) Heparin (IV), morphine (IVP)
Term
Prinztmetals Angina
Definition
occurs at rest, in response to spasm
-rare, not precipated by physical exertion
-triggered by smoking, demand for histamine, epinephrine, norepiniphrine, prostaglandins.
Term
Decubitus Angina
Definition
Occurs while lying down, relieved by sitting up.
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