Term
| What is the leading cause of preventable deaths? |
|
Definition
|
|
Term
| What is tobacco use a major contributing factor in? |
|
Definition
| cardiovascular disease and COPD |
|
|
Term
| What does 2nd hand smoke contribute to? |
|
Definition
| to CAD and lung CA, upper and lower respiratory problems & presents environmental hazards to the public |
|
|
Term
| Does smoking increase risk of MI |
|
Definition
|
|
Term
| Where do people chew tobacco? |
|
Definition
|
|
Term
| What is the most addictive substance in the US? |
|
Definition
|
|
Term
| What is nicotine classified as? |
|
Definition
|
|
Term
| How is nicotine a stimulant? |
|
Definition
| Stimulates the release of epi causing a sudden release of glucose |
|
|
Term
| How is nicotine a sedative? |
|
Definition
| Causes a crash afterwards with feelings of depression and fatigue |
|
|
Term
| What are the physiological and psychological effects of nicotine? |
|
Definition
↑ arousal and alertness
Performance enhancement
↑ HR, CO, & BP
Vasoconstriction
Fine tremor
Decreased appetite
Antidiuretic effect
Increased gastric motility |
|
|
Term
| What are the s/s of nicotine withdrawal? |
|
Definition
| restlessness, depression, hyperirritability, HA, Insomnia, ↓BP & HR ↑appitite (occur w/I 24 hours) |
|
|
Term
| What can chewing tobacco cause? |
|
Definition
|
|
Term
| What is the cycle of nicotine addiction? |
|
Definition
1.) Falling blood nicotine level
2.) Brain generates craving
3.) Inhale new nicotine
4.) Brain releases dopamine |
|
|
Term
| What does tobacco abuse cause? |
|
Definition
CAD (Coronary Artery Disease)
PAD (Peripheral Arterial Disease)
COPD
Cancer |
|
|
Term
| How does tobacco cause CAD? |
|
Definition
nicotine:
-increases release of catecholamines -> increased HR and peripheral vasoconstriction leading to ↑BP, afterload, and O2 consumption |
|
|
Term
| How does nicotine effect vessels? |
|
Definition
| ↑vessel wall thickness increasing risk for clot formation and wall occlusion |
|
|
Term
| How does nicotine effect blood levels of oxygen? |
|
Definition
| produces carbon monoxide which ↓oxygen content in arterial blood |
|
|
Term
| How much can your risk of CAD be reduced by stopping smoking? |
|
Definition
|
|
Term
| What assessment is needed for nicotine r/t CAD? |
|
Definition
-How many pack-years
-Cardiovascular assessment
-ECG, Cardiac cath, stress test, ECG, TEE, CXR, Myocardial nuclear perfusion test |
|
|
Term
| What labs are looked at with nicotine r/t CAD? |
|
Definition
| creatine kinase-MB, cholesterol, triglycerides, proteins HDL & LDL, UA, CRP(C-reactive protein), PT/INR, PTT, ABG’s, Chem profile, CBC |
|
|
Term
|
Definition
| myocardial muscle protein released into blood with injury to myocardial muscle, any rise=cardiac necrosis or acute MI |
|
|
Term
|
Definition
| enzyme specific to cells of brain (CK-BB), myocardium(CK-MB), and skeletal muscle (CK-MM), positive indicates tissue necrosis or injury, may predictably rise and then fall during 3 days; peak level occurs 24 hours after onset of chest pain. |
|
|
Term
| What is the ideal total cholesterol? |
|
Definition
|
|
Term
| What is the ideal triglyceride? |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| less than 70 mg/dL in high-risk CVD, less than 100mg/dL in moderate risk patients |
|
|
Term
| What is CRP (C-reactive)? |
|
Definition
| marker of inflammation seen in HTN, infection and SMOKING, done as a risk assessment at middle age. |
|
|
Term
| How can you tell the difference between angina and acute MI? |
|
Definition
|
|
Term
| What are the nursing diagnoses r/t angina and MI? |
|
Definition
Acute pain r/t imbalanced myocardial oxygen supply and demand
Ineffective tissue perfusion r/t interruption of arterial blood flow |
|
|
Term
| What interventions are r/t angina and MI? |
|
Definition
| pain relief measures- morphine & O2; drug therapy- NTG, beta blocker, antiplatelet therapy (ASA or plavix), thrombolytics, PTCA with stents, CABG |
|
|
Term
| What is the emergency care of a patient w/ chest pain? |
|
Definition
Assess ABC’s, Defibrillate as needed, cardiovascular assessment
Continuous ECG monitoring & 12 Lead ECG
VS, pain assessment q5 minutes
Chest pain protocol: pain relief, O2,
Remain calm, stay with patient
Re-medicate prn q 5 if stable
Notify MD if VS deteriorate |
|
|
Term
|
Definition
Peripheral Arterial Disease (PAD)
Occlusion of blood flow through arteries and veins of peripheral circulation, deprives extremity of O2 and nutrients |
|
|
Term
| Who is mostly affected by PAD? |
|
Definition
African-Americans
Men older than 65 years and postmenopausal women |
|
|
Term
|
Definition
| Result of atherosclerosis |
|
|
Term
|
Definition
|
|
Term
| What are the risk factors for PAD? |
|
Definition
| HTN, hyperlipidemia, DM, SMOKING, obesity, family hx, age |
|
|
Term
| What are the 4 stages of a PAD assessment? |
|
Definition
1.) ASYMPTOMATIC
2.) CLAUDICATION
3.) REST PAIN
4.) NECROSIS/GANGRENE |
|
|
Term
| What are some effects of PAD on the legs? |
|
Definition
| Hair loss on lower extremity; dry, scaly,dusky, pale mottled skin; thickened toenails |
|
|
Term
| What are the effects of SEVERE PAD on the legs? |
|
Definition
| extremity is cold, gray-blue or darkened; pallor when elevated; red when lowered; muscle atrophy |
|
|
Term
| How do you assess for PAD? |
|
Definition
| Palpate pulses bilaterally and compare |
|
|
Term
| What is the ulcer formation of PAD? |
|
Definition
Painful
Toes, upper aspect of foot
Gangrenous
Small round “punched out” appearance
Well defined borders |
|
|
Term
| What other techniques are used to test for PAD? |
|
Definition
-Imaging: Arteriography
-Doppler Probe: segmental systolic blood pressure measurements of the lower ext
-Ankle-brachial index (ABI): compare ankle pressure with brachial
-Exercise tolerance test: gives info r/t claudication w/o rest |
|
|
Term
| What are the non surgical interventions r/t PAD? |
|
Definition
Treat arterial and venous separately
Exercise, position changes, promotion of vasodilation, drug therapy (Tretal & antiplatelets- ASA, Plavix)
Percutaneous Transluminal Angioplasty (PTA)
Laser-assisted angioplasty
Artherectomy |
|
|
Term
| Why should you exercise with PAD? |
|
Definition
| improves blood flow, build up of collateral circulation |
|
|
Term
| What position should you be in with PAD? |
|
Definition
| elevate feet to decrease swelling, avoid raising above heart level because of extreme elevation slows blood flow to feet. Avoid crossing legs, and restrictive clothing, teach inspect feet daily for color changes. |
|
|
Term
| How do you promote vasodilation? |
|
Definition
| provide warmth and prevent prolong exposure to cold. Wear socks/insulated shoes at all times. |
|
|
Term
| What are the surgical interventions used to treat PAD? |
|
Definition
| arterial revascularization/bypass occlusion |
|
|
Term
| What is the most important risk factor for COPD? |
|
Definition
|
|
Term
| What is the 4th leading cause of morbidity and mortality in the US? |
|
Definition
|
|
Term
| What if someone has a 8pack/year history? |
|
Definition
| has obstructive lung dx changes |
|
|
Term
| What if someone has 20 pk/year history? |
|
Definition
early-stage of COPD
Diagnosed as changes in PFT’s |
|
|
Term
| How does tobacco cause COPD? |
|
Definition
Tobacco triggers release of protease from cells in the lungs
Protease breaks down elastin of aveoli
This impairs cilia from clearing: mucus, debris, fld |
|
|
Term
| What diseases are included in COPD? |
|
Definition
Emphysema
Chronic Bronchitis |
|
|
Term
| What are the characteristics of COPD? |
|
Definition
| Characterized by bronchospasm and dyspnea |
|
|
Term
| Is tissue damage reversible? |
|
Definition
| No and increases in severity, eventually leading to respiratory failure |
|
|
Term
| What is the effect of tobacco on the body? |
|
Definition
Affects Oxygenation and tissue perfusion to all tissues
Results in organ anoxia and tissue death |
|
|
Term
| What are the complications from the effects of tobacco? |
|
Definition
| Hypoxemia, acidosis, respiratory infections, cardiac failure, dysrhythmias |
|
|
Term
| Why does hypoxemia and acidosis occur? |
|
Definition
| r/t less able to exchange gas, oxygenation decreases and carbon dioxide levels increase= reduce general cellular function |
|
|
Term
| Why are you at a greater risk for infection? |
|
Definition
| increase r/t mucus and poor oxygenation= streptococcus pneumoniae, haemophilus influenzae, and moraxella catarrhalis, worsened by increasing inflammation and mucus production, bronchospasms, dyspnea results |
|
|
Term
| What cardiac failure are you at risk for with tobacco? |
|
Definition
| : air trapping, airway collapse, stiff alveolar walls increase the lung tissue pressure, making blood flow through the lung vessels more difficult. Increased work load of the heart results in the right chambers of the heart enlarge and thicken, causing right-sided heart failure with backup blood into the general venous system. |
|
|
Term
| What causes dsyrhythmias? |
|
Definition
| result of hypoxemia, decreased O2 to the heart muscle, acidosis |
|
|
Term
| What should you assess in COPD patients? |
|
Definition
History
General appearance
Respiratory changes
Cardiac changes |
|
|
Term
| What H&H is important with COPD assessment? |
|
Definition
| to determine polycythemia (a compensatory increase in RBC’s in the chronically hypoxic patient. |
|
|
Term
| What electrolyte levels are associated with COPD? |
|
Definition
| hypophosphatemia, hyperkalemia, hypocalcemia, and hypomagnesemia reduce muscle strength. |
|
|
Term
| What lung volumes need to be assessed? |
|
Definition
Vital capacity (VC)
Total lung capacity (TLC)
Residual Volume (RV): is most profoundly affected in COPD, represents trapped, stale air remaining in the lungs
Peak expiratory flowmeters: may be used at home to monitor effectiveness of meds; increase as obstruction resolves. |
|
|
Term
| What labs need to be assessed with COPD? |
|
Definition
| ABG’s, sputum cultures, WBC’s, H&H, electrolytes, Albumin |
|
|
Term
| What nursing diagnoses are r/t COPD? |
|
Definition
Impaired gas exchange r/t alveolar-capillary membrane changes, reduced airway size, ventilatory muscle fatigue, and excessive mucus production
Ineffective breathing pattern r/t airway obstruction, diaphram flattening, fatigue, and decreased energy
Ineffective airway clearance |
|
|
Term
| What is the goal of treatment of COPD? |
|
Definition
: maintain gas exchange at a level w/in chronic baseline values
SpO2 at least 88%, absence of cyanosis, cognitive orientation |
|
|
Term
| What interventions are r/t COPD? |
|
Definition
non-surgical management to improve/maintain gas exchange
Airway maintenance
Monitoring
Cough enhancement
Oxygen therapy
Drug therapy
Pulmonary rehab |
|
|
Term
| What airway maintenance can be done? |
|
Definition
positioning, liquefy secretions and clear airway of secretions
Monitoring-change in resp. pattern, treatment effectiveness, oxygen
Cough enhancement-increase airflow in the larger airways |
|
|
Term
| What oxygen therapy can be done? |
|
Definition
| - relief of hypoxemia (blood) and hypoxia (tissues). REMEMBER: the hypoxemic and chronic hypercarbia patient requires lower levels of O2, usually 1-2 L/min via NC or 40% Venturi Mask |
|
|
Term
| What drug therapy can be done? |
|
Definition
| Same as asthma: beta-adrenergic agents (Albuterol-short acting, Serevent-long acting), cholinergic antagonist (Atrovent), methylxanthines (Theophylline), corticosteroids (flovnet), and NSAIDS; additionally: mucolytics to thin secretions. Long-term therapy: Brovana and Spiriva. |
|
|
Term
|
Definition
| Pulmonary rehab- education and exercise training to prevent general and pulmonary muscle deconditioning. |
|
|
Term
| What drug therapy is r/t COPD? |
|
Definition
Beta-adrenergic agents
Anticholinergic agents
Methylxanthines
Corticosteroids
NSAIDs
Mucolytics
vits and mins |
|
|
Term
| What teaching is involved with COPD? |
|
Definition
Pursed-lip breathing Diaphragmatic breathing
Positioning
Relaxation therapy
Energy conservation
Coughing and deep breathing
Smoking Cessation |
|
|
Term
| What does the staging of cancer rely on? |
|
Definition
| - determines the exact location & its degree of metastasis at diagnosis |
|
|
Term
|
Definition
Used to stage cancer
T, primary tumor
N, regional lymph nodes
M, distant metastasis |
|
|
Term
| What do higher stages/number represent? |
|
Definition
| represent later stages and less chance for cure or long-term survival |
|
|
Term
| What kind of cancer does smoking cause? |
|
Definition
Lung
Oral cavity
Pharyngeal-throat
Laryngeal-voice box
Esophagus
Pancreatic
Cervical
Kidney
Bladder
Liver
Stomach
Myeloid leukemia |
|
|
Term
| What is the leading cause of cancer related deaths world wide? |
|
Definition
|
|
Term
| What is responsible for more than 85% of all lung cancer deaths? |
|
Definition
|
|
Term
| Incidence of lung cancer decreases when smoking ______! |
|
Definition
|
|
Term
| What are the classifications of lung cancer r/t cell type? |
|
Definition
Small cell lung cancer (SCLC)
Non-small cell lung cancer (NSCLC |
|
|
Term
| What are the 3 non-small cell lung cancers? |
|
Definition
Epidermoid (squamous cell)
Adenocarcinoma
Large cell cancer |
|
|
Term
| How does lung cancer spread? |
|
Definition
Metastisis (spread) of lung CA through the bld, invading lymph glands, and vessels
Interferes with oxygenation and tissue perfusion |
|
|
Term
| What are the warning signs of lung cancer? |
|
Definition
Hoarseness
Change in respirations
Persistent cough
Blood streaked sputum
Rust-colored sputum
Frank hemoptysis
Chest pain/tightness
Shoulder, arm pain
Pleural effusion, pneumonia, bronchitis
Dyspnea
Fever w/1-2 other signs
Wheezing
Wt. loss
Clubbing fingers |
|
|
Term
| What should you assess with lung cancer? |
|
Definition
| signs are nonspecific and appear late in disease process, depend on type/location |
|
|
Term
| What labs should you assess with lung cancer? |
|
Definition
| cytology: sputum, fluid from lung; ABG’s |
|
|
Term
| What imaging should you assess with lung cancer? |
|
Definition
| x-ray, CT, MRI, SPECT or PET scans, bronchoscopy w/biopsy, thoracoscopy |
|
|
Term
| What other tests are important to look at with lung cancer? |
|
Definition
| biopsy of lymph nodes, direct surgical biopsy, thoracentesis with pleural biopsy |
|
|
Term
|
Definition
| video assisted thoracoscope via small incision through chest wall to directly visualize lung tissue |
|
|
Term
| What are the surgical interventions r/t lung cancer? |
|
Definition
| Surgical- removal of tumor, lung segment, lobe or entire lung |
|
|
Term
| What are the nonsurgical interventions r/t lung cancer? |
|
Definition
Chemotherapy
Side effects: n/v, hair loss, mouth sores, immunosuppression, anemia thrombocytopenia (decrease platelets), peripheral neuropathy
Radiation therapy
Side effects: skin irritation & peeling, fatigue, nausea, taste changes |
|
|
Term
| What teaching is r/t lung cancer? |
|
Definition
Primary prevention is directed at reducing tobacco smoke
Assess tobacco use
Advise tobacco user & family to quit
Teach to avoid environmental smoke at work and home; smoke free environment
Educational strategies start in elementary schools
Encourage non-smokers not to begin
Promote smoking cessation programs |
|
|
Term
| Who is at greater risk for head and neck cancer? |
|
Definition
| Men 3x more than women, most older than 60 |
|
|
Term
| What are the risk factors for head and neck cancer? |
|
Definition
| tobacco & alcohol, severe GERD |
|
|
Term
| What are the warning signs of head and neck cancers? |
|
Definition
Pain
Lump in mouth, throat, neck
Difficulty swallowing
Color changes in mouth: red, white, gray, brown, bk
Sore that doesn’t heal w/in 2 wks
Unexplained oral bleeding
Numbness mouth, lips, face
Change in the fit of dentures
Burning when drinking OJ or hot liquids
Unilateral ear pain
Hoarseness
Persistent sore throat
SOB
Anorexia and wt loss |
|
|
Term
| What labs are important to note with neck and head cancer? |
|
Definition
| CBC, bleeding times, Chem profile, UA, renal and liver function test to r/o mets, if ETOH poor nutrition check low protein, albumin level |
|
|
Term
| What imaging tests are important to note with neck and head cancer? |
|
Definition
x-ray, CT, MRI, SPECT or PET scans
Other test: panendoscopy with biopsies |
|
|
Term
| What are the nursing diagnoses r/t head and neck cancer? |
|
Definition
Risk for aspiration r/t edema, anatomic changes, altered protective reflexes
Anxiety r/t threat of death
Disturbed body image r/t treatment |
|
|
Term
| What is the goal of interventions r/t head and neck cancer? |
|
Definition
: Maintain adequate tissue oxygenation
Normal ABG’s, RR, O2 sat, absence of cyanosis |
|
|
Term
| What interventions are r/t head and neck cancer? |
|
Definition
| Interventions: eradicate the cancer, preserve function if possible; radiation, surgery & reconstruction |
|
|
Term
| What are the primary risk factors of esophageal cancer? |
|
Definition
|
|
Term
| What are other risk factors of esophageal cancer? |
|
Definition
| Obesity, malnutrition, GERD |
|
|
Term
| What is the most common type of esophageal cancer? |
|
Definition
ADENOCARCINOMAS
most common type, grow rapidly, spread early to lymph nodes |
|
|
Term
| What needs to be assessed with esophageal cancer? |
|
Definition
| racial/cultural, age, gender, ETOH, tobacco use, diet, S&S |
|
|
Term
| Who is most affected by esophageal cancer? |
|
Definition
| Occurs in middle age and older adults, black males= esophageal cancer, white males=esophageal adenocarcinoma |
|
|
Term
| What are the key features of esophageal cancer? |
|
Definition
*Persistent dysphagia (difficult swallowing)
Feeling of food sticking in throat
Painful swallowing
Regurgitation
Hoarseness
Anorexia
NV, Wt. loss
Halitosis
Changes in bowel habits |
|
|
Term
| What pulmonary problems are r/t esophageal cancer? |
|
Definition
Chronic Cough
Increased secretions
Recent infections |
|
|
Term
| What diagnostic tests are used with esophageal cancer? |
|
Definition
Barium swallow study with fluoroscopy
Esophageal Ultrasound (EUS) with fine needle aspiration
Esophagogastroduodenoscopy (EGD)
PET
CT |
|
|
Term
|
Definition
|
|
Term
|
Definition
| examine the tumor tissue. |
|
|
Term
|
Definition
| inspect the esophagus and obtain tissue specimens for cell studies and staging |
|
|
Term
| What are the nursing diagnoses r/t esophageal cancer? |
|
Definition
| Imbalanced Nutrition: less than body requirements r/t impaired swallowing |
|
|
Term
| What is the goal of esophageal cancer? |
|
Definition
| Goal: maintain adequate nutrient intake and weight |
|
|
Term
| What are the surgical interventions r/t esophageal cancer? |
|
Definition
Esophagectomy-remove part
Esophagogastrostomy-remove part of esophagus and proximal stomach |
|
|
Term
| What are the nonsurgical interventions r/t esophageal cancer? |
|
Definition
| nutritional therapy, swallowing therapy, chemo, radiation, targeted therapies, photodynamic therapy, esophageal dilation, endoscopic therapies |
|
|
Term
| What is different with smokers who are stressed? |
|
Definition
Smokers with stress:
Have a harder time quitting
Ex-smokers begin smoking in response to stress
Depressed individuals are twice as likely to smoke |
|
|
Term
| How does smoking help deal with stress? |
|
Definition
Nicotine causes the brain to release dopamine
Dopamine = pleasure |
|
|
Term
| What is the effect of the dopamine release caused by smoking? |
|
Definition
The neurons then try to regulate the level of dopamine by: reducing the # of receptors or by making less dopamine
Eventually dopamine's ability to stimulate becomes very low and it takes more nicotine to get the levels up to normal or higher
Creating a cycle of tolerance to the drug leading to dependence or addiction |
|
|
Term
| Why do smokers deal with stress by smoking? |
|
Definition
-time out
-social activity
-relieve nicotine withdrawal symptoms |
|
|
Term
| How does smoking effect pregnant women? |
|
Definition
LBW babies
Exposure to prenatal tobacco can affect neurological systems of baby, requiring more handling to keep them quiet and alert |
|
|
Term
| How does smoking effect infants? |
|
Definition
| have an increased risk of congenital abnormalities and respiratory problems |
|
|
Term
| How does smoking effect teens? |
|
Definition
| perform poorly on auditory memory task & general intelligence |
|
|
Term
| What does 2nd hand smoke cause? |
|
Definition
| sudden infant death syndrome (SIDS), respiratory problems, ear infections, asthma attacks in infants and children |
|
|
Term
| What psychological disorder has an increased incidence of cigarette use? |
|
Definition
Schizophrenia:75%-85% smoke 3x more than average smoker
Making psych patients more susceptible to medical sequelae |
|
|
