N444: Test 5

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N444: Test 5 by Mind Map: N444: Test 5

1. Musculoskeletal

1.1. Review Topics

1.1.1. A&P

1.1.1.1. Functions

1.1.1.1.1. Protecting vital organs

1.1.1.1.2. Mobility, movement

1.1.1.1.3. Blood return to the heart

1.1.1.1.4. RBC production

1.1.1.1.5. Reservoir

1.1.1.2. Structure

1.1.1.2.1. Bones

1.1.1.2.2. Joints

1.1.1.2.3. Muscles

1.1.2. Assessment

1.1.2.1. Collect data r/t functional abilities

1.1.2.1.1. ADLs

1.1.2.1.2. IADLs

1.1.2.1.3. Various activities

1.1.2.1.4. Mobility problems

1.1.2.2. Health history

1.1.2.2.1. General info

1.1.2.2.2. FH

1.1.2.2.3. Nutrition

1.1.2.2.4. Occupation

1.1.2.2.5. Learning needs

1.1.2.2.6. Socioeconomic factors

1.1.2.2.7. Medications

1.1.2.3. Pain & altered sensation

1.1.2.4. Physical exam

1.1.2.4.1. Posture

1.1.2.4.2. Gait

1.1.2.4.3. Bone integrity

1.1.2.4.4. Joint function

1.1.2.4.5. Muscle strength & size

1.1.2.4.6. Skin

1.1.2.4.7. Neurovascular

1.1.3. Diagnostics

1.1.3.1. X-ray

1.1.3.2. CT

1.1.3.3. MRI

1.1.3.4. Biopsy

1.1.3.5. Labs

1.1.3.6. Arthography

1.1.3.7. Bone densitometry

1.1.3.8. Bone scan

1.1.3.9. Arthroscopy

1.1.3.10. Arthrocentesis

1.1.3.11. Electromyography

1.2. Rheumatoid Arthritis

1.2.1. Overview

1.2.1.1. Type of "rheumatic disease"

1.2.1.1.1. "Arthritis"

1.2.1.1.2. 100+ different diagnoses

1.2.1.1.3. Mainly affect joints

1.2.1.1.4. Classifications

1.2.1.2. Chronic, diffuse CT disease

1.2.1.2.1. Group of disorders

1.2.1.2.2. Diffuse inflammation, degeneration

1.2.1.2.3. Unknown cause, but may be immunologic

1.2.1.2.4. Characterized by exacerbations & remissions

1.2.1.3. Autoimmune, idiopathic

1.2.1.4. Systemic, but mainly in synovial tissue

1.2.1.5. 1% of world's population

1.2.1.6. Female > males

1.2.2. Manifestations

1.2.2.1. See patho for articular S/S

1.2.2.2. Fever

1.2.2.3. Weight loss

1.2.2.4. Fatigue

1.2.2.5. Anemia

1.2.2.6. Lymphadenopathy

1.2.2.7. Raynaud phenomenon

1.2.2.7.1. Vasospastic disorder

1.2.2.7.2. Discoloration of fingers, toes

1.2.2.7.3. Caused by overactivation of SNS >> VC >> hypoxia

1.2.2.8. Rheumatoid nodules

1.2.2.9. Arteritis

1.2.2.10. Neuropathy

1.2.2.11. Scleritis

1.2.2.12. Pericarditis

1.2.2.13. Splenomegaly

1.2.2.14. Sjogren syndrome

1.2.2.14.1. Autoimmune disease

1.2.2.14.2. Immune cells destroy certain exocrine glands

1.2.2.14.3. Appears as generalized dryness (esp. eyes, mouth)

1.2.3. Pathophysiology

1.2.3.1. Phagocytosis in joint >>

1.2.3.2. Enzymes produced >>

1.2.3.3. Collagen breakdown

1.2.3.3.1. Edema

1.2.3.3.2. Proliferation of synovial membrane

1.2.3.3.3. Pannus formation

1.2.3.4. Causes problems

1.2.3.4.1. Loss of joint motion

1.2.3.4.2. Loss of tendon & ligament elasticity

1.2.3.4.3. Loss of contractile power

1.2.4. Assessment

1.2.4.1. Bilateral/symmetric manifestations

1.2.4.1.1. Stiff

1.2.4.1.2. Tender

1.2.4.1.3. Swollen

1.2.4.1.4. Temperature changes @ joint

1.2.4.2. Weight loss

1.2.4.3. Sensory changes

1.2.4.4. Lymphadenopathy

1.2.4.5. Fatigue

1.2.5. Diagnostics

1.2.5.1. Rheumatoid factor

1.2.5.2. Increased ESR

1.2.5.3. Decreased RBCs

1.2.5.4. Decreased C4-compliment

1.2.5.5. CRP +

1.2.5.6. ANA +

1.2.5.7. Arthrocentesis

1.2.5.8. X-Ray

1.2.6. Management

1.2.6.1. Medical

1.2.6.1.1. Early

1.2.6.1.2. Moderate, erosive

1.2.6.1.3. Persistent, erosive

1.2.6.1.4. Advanced, un-remitting

1.2.6.2. Nursing

1.2.6.2.1. NSAID education

1.2.6.2.2. Nutrition therapy

1.2.6.2.3. Nursing process

1.2.6.3. Home care

1.2.6.3.1. Depends on severity

1.2.6.3.2. Assessment issues

1.2.6.3.3. Referrals

1.2.6.3.4. Goals

1.2.6.3.5. Education

1.3. Osteoarthritis

1.3.1. Degenerative joint disease

1.3.1.1. Most common, disabling

1.3.1.2. Primary or secondary

1.3.1.3. Directly r/t to increasing age

1.3.1.4. 90% have DJ changes by 40

1.3.1.4.1. In weight-bearing joints

1.3.1.4.2. W/o clinical symptoms

1.3.2. Pathophysiology

1.3.2.1. Cartilage degradation

1.3.2.2. Bone stiffening

1.3.2.3. Inflammation of synovium

1.3.2.4. Certain areas affected

1.3.2.4.1. Articular cartilage

1.3.2.4.2. Subchondral bone

1.3.2.4.3. Synovium

1.3.3. Risk factors

1.3.3.1. Disorders of the hip

1.3.3.2. Increased age

1.3.3.3. Obesity

1.3.3.4. Previous joint damage

1.3.3.5. Repetitive use

1.3.3.6. Anatomic deformity

1.3.3.7. Genetics

1.3.4. Manifestations

1.3.4.1. Pain

1.3.4.2. Stiffness

1.3.4.2.1. AM or after wakening

1.3.4.2.2. Lasts <30 min

1.3.4.2.3. Decreases w/movement

1.3.4.3. Functional impairment

1.3.4.3.1. R/t pain with movement

1.3.4.3.2. Limited ROM r/t structural changes

1.3.5. Affected areas

1.3.5.1. Weight-bearing joints

1.3.5.2. Proximal and distal finger joints

1.3.6. Diagnostics

1.3.6.1. Blood tests = not useful

1.3.6.2. X-ray results

1.3.6.2.1. Visible narrowing of joint space

1.3.6.2.2. Osteophytes

1.3.6.3. Tender, enlarged joints on exam

1.3.6.4. Inflammation*

1.3.6.4.1. May be present

1.3.6.4.2. Not destructive kind like RA

1.3.7. Management

1.3.7.1. Cannot HALT degeneration

1.3.7.2. May slow progression

1.3.7.2.1. Weight reduction

1.3.7.2.2. Prevent injuries

1.3.7.2.3. Screen for congenital hip dx

1.3.7.2.4. Ergonomics

1.3.7.3. Treatment

1.3.7.3.1. Education

1.3.7.3.2. Heat packs

1.3.7.3.3. Joint rest

1.3.7.3.4. Orthotics

1.3.7.3.5. Isometric exercise

1.3.7.3.6. Alternative therapies

1.3.7.3.7. Medications

1.3.7.3.8. Surgery

1.3.7.4. Nursing care

1.3.7.4.1. Education

1.3.7.4.2. Pain management (non-pharm first)

1.3.7.4.3. PT, exercise, assistive devices

1.3.7.4.4. Weight reduction

1.3.7.4.5. 10 hours of sleep @ night + 1-2 hr nap

1.3.7.4.6. Alternative therapies

1.4. Gout

1.4.1. Overview

1.4.1.1. Genetic defect of purine metabolism

1.4.1.1.1. Oversecretion

1.4.1.1.2. Decreased kidney excretion

1.4.1.1.3. BOTH

1.4.1.2. Causes hyperuricemia

1.4.1.3. Two types

1.4.1.3.1. Primary

1.4.1.3.2. Secondary

1.4.1.4. Common drug: allopurinol

1.4.1.4.1. Up to 3L of fluid per day

1.4.1.4.2. No organ meats or wines

1.4.1.4.3. IUOP to 2L per day

1.4.2. Risk factors

1.4.2.1. Older age

1.4.2.2. Higher BMI

1.4.2.3. Gender

1.4.2.4. Lifestyle factors

1.4.2.4.1. Alcohol

1.4.2.4.2. Diet

1.4.2.5. Family history

1.4.2.6. Medications

1.4.3. Pathophysiology

1.4.3.1. Serum uric acid > 7 mg/dL

1.4.3.2. Attacks r/t sudden changes in uric acid

1.4.3.2.1. Formed during purine breakdown

1.4.3.2.2. >> High uric acid >> urate crystals

1.4.3.2.3. >> Precipitate w/i joint >>

1.4.3.2.4. Inflammation >> gout attack + pain

1.4.3.3. May progress to tophi, kidney stones

1.4.3.4. Attacks gradually worsen

1.4.3.4.1. Occur more frequently

1.4.3.4.2. Involve more joints

1.4.3.4.3. Last longer

1.4.4. Manifestations

1.4.4.1. PM onset usually

1.4.4.2. Big toe most affected

1.4.4.2.1. Pain

1.4.4.2.2. Redness

1.4.4.2.3. Swelling

1.4.4.2.4. Warmth

1.4.5. Diagnosis

1.4.5.1. Polarized light microscopy of synovial fluid

1.4.5.2. Visible uric acid crystals

1.4.6. Treatment

1.4.6.1. Medical

1.4.6.1.1. Acute attacks

1.4.6.1.2. Management

1.4.6.2. Nursing care

1.4.6.2.1. Dietary restrictions

1.4.6.2.2. Normal body weight

1.4.6.2.3. Pain management

1.4.6.2.4. Compliance b/w attacks

1.5. Osteoporosis

1.5.1. Pathophysiology

1.5.1.1. Altered bone turnover

1.5.1.2. Rate of resorbation > rate of formation

1.5.1.3. Loss of total bone mass

1.5.1.4. Porous, brittle, fragile bones

1.5.2. Common areas

1.5.2.1. Spinal compression fractures

1.5.2.2. Neck fractures

1.5.2.3. Femur fractures

1.5.2.4. Colles' fractures (wrists)

1.5.3. Early sign: loss of height

1.5.4. Risk factors

1.5.4.1. Slight frame

1.5.4.2. Non-obese

1.5.4.3. Asian or Caucasian

1.5.4.4. Women > men*

1.5.4.4.1. Occurs later for men

1.5.4.5. Lack of Ca/Vitamin D

1.5.4.6. Bariatric surgery (duodenum bypass)

1.5.4.7. Immobility

1.5.4.7.1. Casts, sedentary, paralyzed, etc

1.5.4.7.2. Must get patients weight-bearing ASAP!

1.5.5. Prevention

1.5.5.1. Lifelong diet w/Ca & Vitamin D

1.5.5.2. Calcium supplements + Vitamin C

1.5.5.3. Weight-bearing exercise (esp. walking)

1.5.5.4. Weight training to improve BMD

1.5.6. Pharmacology

1.5.6.1. Bisphosphonates

1.5.6.1.1. End in -dronate

1.5.6.1.2. Fosamax, Actonel

1.5.6.1.3. Boniva

1.5.6.2. Selective estrogen modulators

1.5.6.2.1. SERMs

1.5.6.2.2. Evista

1.5.6.3. Calcitonin

1.5.6.4. Teriparatide (Forteo)

1.5.6.5. Ca and Vitamin D

1.5.7. Diagnostics

1.5.7.1. X-ray

1.5.7.1.1. Poor indicator

1.5.7.1.2. Has to be 25-40% demineralized

1.5.7.2. DXA scan (Recommended)

1.5.7.2.1. All women >65; men >70

1.5.7.2.2. Postmenopausal women

1.5.7.2.3. Men >50 w/risk factors + associated fracture

1.5.7.2.4. Determines OP, osteopenia, & therapeutic responses

1.5.8. Management

1.5.8.1. Prevention, then early intervention

1.5.8.2. Reduce bone loss, fractures

1.5.9. Nursing process

1.5.9.1. Assessment

1.5.9.1.1. Osteopenia, OP history

1.5.9.1.2. Family history

1.5.9.1.3. Fractures

1.5.9.1.4. Calcium in diet

1.5.9.1.5. Exercise

1.5.9.1.6. Menopause

1.5.9.1.7. Other factors

1.5.9.2. Diagnoses

1.5.9.2.1. Deficient knowledge

1.5.9.2.2. Acute pain

1.5.9.2.3. Risk for constipation

1.5.9.2.4. Risk for injury

1.5.9.3. Planning

1.5.9.3.1. Knowledge

1.5.9.3.2. Pain management

1.5.9.3.3. Bowel elimination

1.5.9.3.4. Fracture prevention

1.5.9.4. Implementation

1.5.9.4.1. Education about process, treatment

1.5.9.4.2. Pain relief

1.5.9.4.3. Bowel elimination

1.5.9.4.4. Preventing injury

1.6. Osteomalacia

1.6.1. Metabolic bone disease

1.6.1.1. Inadequate mineralization

1.6.1.1.1. Lack of activated Vitamin D

1.6.1.1.2. >> Poor mineralization, low Ca and P

1.6.1.2. Become soft, weak

1.6.1.3. Pain, tenderness, deformities

1.6.1.4. Bowing of legs, pathologic fractures

1.6.2. Causes

1.6.2.1. GI disorder

1.6.2.2. Severe renal insufficiency

1.6.2.3. Hyperparathryoidism

1.6.2.4. Diet deficiency

1.6.3. Treatment

1.6.3.1. R/t underlying cause

1.6.3.2. Increase Vitamin D and Ca

1.6.3.3. Handle gently >> high risk for fractures!

1.6.3.4. Pain management

1.7. Paget's Disease

1.7.1. AKA ostetitis deformans

1.7.1.1. Disorder of localized bone turnover

1.7.1.2. Very rare (2-3% of age 50+)

1.7.1.3. Men > women

1.7.1.4. Increased risk with age

1.7.1.5. Family predisposition

1.7.2. Pathophysiology

1.7.2.1. Excess resorption by osteoclasts >>

1.7.2.2. Increased osteoblastic activity >>

1.7.2.3. Disorganized, weak, highly vascular bones

1.7.2.4. Increased risk of fractures, arthritis, hearing loss

1.7.3. Manifestations

1.7.3.1. Skeletal deformities

1.7.3.2. Mild to moderate, aching pain

1.7.3.3. Tenderness, warmth over bones

1.7.3.4. Insidious onset

1.7.3.5. May be asymptomatic

1.7.4. Pharmacology

1.7.4.1. NSAIDs for pain

1.7.4.2. Calcitonin

1.7.4.3. Bisphosphonates

1.7.4.4. Plicamycin (Mitracin)

1.7.4.4.1. Cytotoxic antibiotic

1.7.4.4.2. May be used for resistent, severe form

1.8. Surgeries & Nursing

1.8.1. Indications

1.8.1.1. Joint disease

1.8.1.2. Deformities

1.8.1.3. Unstable fractures

1.8.1.4. Necrotic, infected tissues

1.8.1.5. Tumors

1.8.2. Goals

1.8.2.1. Improve function

1.8.2.2. Relieve pain, disability

1.8.3. Many types

1.8.4. Patient needs

1.8.4.1. Mobility/ambulation

1.8.4.1.1. Within a day of post-op

1.8.4.1.2. Using assistive devices

1.8.4.1.3. Weight-bearing as prescribed

1.8.4.2. Drain use

1.8.4.2.1. Bleeding

1.8.4.2.2. Fluid accumulation

1.8.4.3. Infection prevention

1.8.4.3.1. Immediate (w/i 3 months)

1.8.4.3.2. Delayed (4-24 months)

1.8.4.3.3. Due to spread (+2 years)

1.8.4.4. DVT prevention

1.8.4.5. Education and rehab

1.8.5. Joint replacement

1.8.5.1. Total Hip Replacement

1.8.5.1.1. Indications

1.8.5.1.2. Prosthesis

1.8.5.1.3. Pre-op care

1.8.5.1.4. Post-op care

1.8.5.2. Total Knee Replacement

1.8.5.2.1. OA or RA

1.8.5.2.2. Metal or acrylic prosthesis

1.8.5.2.3. Nursing care

1.8.6. Nursing process

1.8.6.1. Assessment

1.8.6.1.1. Pre-op

1.8.6.1.2. Post-op

1.8.6.2. Diagnoses

1.8.6.2.1. Acute pain

1.8.6.2.2. Risk for peripheral NV dysfunction

1.8.6.2.3. Risk for ineffective therapeutic regimen management

1.8.6.2.4. Impaired phys mobility

1.8.6.2.5. Risk for situational low-self esteem

1.8.6.2.6. Collaborative problems

1.8.6.3. Planning

1.8.6.3.1. Pain relief

1.8.6.3.2. NV function

1.8.6.3.3. Health promotion

1.8.6.3.4. Mobility

1.8.6.3.5. Self-esteem

1.8.6.3.6. Avoid complications

1.8.6.4. Intervention

1.8.6.4.1. Muscle settings, exercises

1.8.6.4.2. Nutrition, hydration

1.8.6.4.3. Skin integrity

1.8.6.4.4. Asepsis, infection prevention

1.8.6.4.5. PT, rehab

1.8.6.4.6. Realistic goals

1.8.6.4.7. Self-care as appropriate

1.8.6.4.8. RR status (TCDB, IS)

1.8.6.4.9. Education

1.8.6.4.10. Monitoring for shock

1.9. Degenerative Disk Disease

1.9.1. Background

1.9.1.1. Most common cause of low back pain

1.9.1.1.1. Degenerative with age or trauma

1.9.1.1.2. Radiculopathy >> Pain

1.9.1.1.3. Continued pressure >> more degeneration

1.9.1.1.4. Altered sensation, motor ability

1.9.1.2. Conservative treatment

1.9.1.2.1. Rest

1.9.1.2.2. Medications

1.9.1.2.3. Surgery**

1.9.1.3. Assessment

1.9.1.3.1. H&P

1.9.1.3.2. MRI (CT, myelography if needed)

1.9.1.3.3. Neuro exam

1.9.2. Cervical disk hernia

1.9.2.1. Stress from age, occupation

1.9.2.2. Spondylosis

1.9.2.2.1. Degeneration in disk

1.9.2.2.2. Includes associated vertebral bodies

1.9.2.3. Manifestations

1.9.2.3.1. Variable - C5-6 or C6-7

1.9.2.3.2. Pain & stiffness

1.9.2.3.3. Pain & parasthesia

1.9.2.4. Treatment

1.9.2.4.1. Bedrest 1-2 days

1.9.2.4.2. Immobilization

1.9.2.4.3. Pharmacological

1.9.2.4.4. Hot, moist compress for 10-20 min

1.9.2.4.5. Cervical discectomy

1.9.3. Lumbar disk hernia

1.9.3.1. Manifestation

1.9.3.1.1. Low back pain w/spasm

1.9.3.1.2. Radiation of pain to leg (sciatica)

1.9.3.1.3. Pain

1.9.3.2. Diagnostics

1.9.3.2.1. H&P

1.9.3.2.2. MRI

1.9.3.2.3. CT

1.9.3.2.4. Myelography

1.9.3.3. Nursing process

1.9.3.3.1. Assessment

1.9.3.3.2. Diagnoses

1.9.3.3.3. Planning

1.9.3.3.4. Interventions

1.9.3.4. Medical management

1.9.3.4.1. 1-2 days bed rest

1.9.3.4.2. Non-pharmacologic

1.9.3.4.3. Pharmacological

1.9.3.4.4. Lumbar disk excision

1.9.3.5. Complications

1.9.3.5.1. Relapse

1.9.3.5.2. Adhesions, scarring r/t inflammation

1.9.3.5.3. Perisistent effects from neural injury

1.9.3.5.4. Failed disk syndrome

1.10. Upper Extremity Conditions

1.10.1. Diagnoses

1.10.1.1. Bursitis/tendinitis

1.10.1.2. Loose bodies

1.10.1.3. Impingement syndrome

1.10.1.4. Carpal tunnel syndrome

1.10.1.4.1. Tinel's sign

1.10.1.5. Ganglion

1.10.1.6. Dupuytren's contracture

1.10.2. Surgical care

1.10.2.1. Outpatient procedure

1.10.2.2. Need education

1.10.2.3. NV checks q1 hr for first 24

1.10.2.3.1. Motor function as prescribed

1.10.2.3.2. S/S to report

1.10.2.4. Pain control

1.10.2.4.1. Meds

1.10.2.4.2. Elevation

1.10.2.4.3. Intermittent ice, cold

1.10.2.5. Infection prevention

1.10.2.6. ADLs

1.10.2.6.1. Assistance

1.10.2.6.2. Promote independence

1.11. Lower Extremity Conditions

1.11.1. Diagnoses

1.11.1.1. Plantar fascitis

1.11.1.2. Corn

1.11.1.3. Callus

1.11.1.4. Ingrown toenail

1.11.1.5. Hammer toe

1.11.1.6. Hallux valgus

1.11.1.7. Clawfoot (pes cavus)

1.11.1.8. Morton's neuroma

1.11.1.9. Flatfoot (pes planus)

1.11.2. Surgical care

1.11.2.1. Assessment

1.11.2.1.1. Outpatient

1.11.2.1.2. Routine pre-op

1.11.2.1.3. Patient education

1.11.2.1.4. NV checks

1.11.2.1.5. Ambulation, balance

1.11.2.1.6. Home care needs

1.11.2.2. Diagnoses

1.11.2.2.1. Risk for ineffective peripheral tissue perfusion

1.11.2.2.2. Acute pain

1.11.2.2.3. Impaired phys mobility

1.11.2.2.4. Risk for infection

1.11.2.3. Planning

1.11.2.3.1. Adequate perfusion

1.11.2.3.2. Pain relief

1.11.2.3.3. Improved mobility

1.11.2.3.4. No complications

1.11.2.4. Interventions

1.11.2.4.1. NV assessment

1.11.2.4.2. Pain management

1.11.2.4.3. Improving mobility

1.11.2.4.4. Infection prevention

1.11.2.4.5. Patient education

2. Cancer

2.1. General

2.1.1. Unchecked cell growth

2.1.1.1. Potentially dangerous

2.1.1.1.1. Malignant > benign

2.1.1.1.2. Common sites

2.1.1.1.3. More dangerous than benign b/c metastasizes

2.1.1.1.4. Metastases share name of original, primary tumor site

2.1.2. At high risk for infection

2.1.2.1. Atypical presentation

2.1.2.2. Subnormal temperature

2.1.2.3. Changes in behavior

2.1.3. Top cancers in USA

2.1.3.1. Lung

2.1.3.2. Breast/prostate

2.1.3.3. Colorectal

2.1.4. Gerontological considerations

2.1.4.1. Immunity

2.1.4.2. Drug absorption alterations

2.1.4.3. Co-morbidities

2.1.4.4. Decreased reserves

2.1.4.4.1. Lung

2.1.4.4.2. Cardiac

2.1.4.4.3. Neuro

2.1.4.4.4. Renal

2.1.4.5. Decreased defenses

2.1.4.5.1. Musculoskeletal strength

2.1.4.5.2. Skin integrity

2.1.4.5.3. Neurosensory

2.1.4.5.4. Social, economic resources

2.1.4.6. Presentation may seem normal (r/t to age)

2.1.4.7. Vulnerable to complications

2.1.4.7.1. Cancer

2.1.4.7.2. Cancer treatment

2.1.4.8. Functional status

2.1.4.8.1. Consideration during treatment

2.1.5. Carcinogens

2.1.5.1. Viruses

2.1.5.1.1. HPV

2.1.5.1.2. Hep B

2.1.5.1.3. EBV

2.1.5.2. Radiation

2.1.5.2.1. Diagnostics

2.1.5.2.2. Sunlight

2.1.5.2.3. Tanning

2.1.5.3. Chemicals

2.1.5.3.1. Chemo!

2.1.5.3.2. Tobacco

2.1.5.3.3. Hormones (DES)

2.1.5.3.4. Aromatic hydrocarbons

2.1.6. Theories & Categories

2.1.6.1. Gompertzian growth

2.1.6.1.1. Theory

2.1.6.2. Clinical staging

2.1.6.2.1. 0: Cancer in situ

2.1.6.2.2. 1: Tumor limited/localized

2.1.6.2.3. 2: Limited local spread

2.1.6.2.4. 3: Extensive local & regional spread

2.1.6.2.5. 4: Metastasis

2.1.6.3. TNM classification

2.1.6.3.1. Tumor size, invasiveness (T)

2.1.6.3.2. Spread to lymph nodes (N)

2.1.6.3.3. Metastasis (M)

2.1.6.4. Differentiation

2.1.6.4.1. Grade 1: Well-differentiated

2.1.6.4.2. Grade 2

2.1.6.4.3. Grade 3

2.1.6.4.4. Grade 4: Poorly differentiated (high-grade)

2.1.6.4.5. Undifferentiated (anaplastic)

2.1.7. C.A.U.T.I.O.N.

2.1.7.1. Seven warning signs of cancer

2.1.7.2. Change in bowel/bladder habits

2.1.7.3. A sore that doesn't heal

2.1.7.4. Unusual bleeding/discharge

2.1.7.5. Thickening in breast or elsewhere

2.1.7.6. Indigestion (dysphagia)

2.1.7.7. Obvious change in wart or mole

2.1.7.8. Nagging cough or hoarseness

2.2. Prevention

2.2.1. Primary

2.2.1.1. Avoid known carcinogens

2.2.1.2. Diet, lifestyle changes

2.2.2. Secondary

2.2.2.1. Genetic testing

2.2.2.1.1. Breast cancer risk

2.2.2.1.2. Family adenomatosis polyposis r/t colon cancer

2.2.2.2. Teaching about decreasing risk

2.3. Diagnosis

2.3.1. Extensive

2.3.1.1. MRI, CT, PET

2.3.1.2. Fluroscopy, endoscopy

2.3.1.3. Ultrasound

2.3.1.4. Nuclear imaging

2.3.1.5. Radioimmunoconjugates (tagging)

2.3.1.6. Tumor marker testing

2.3.2. Purposes

2.3.2.1. ID presence, extent of tumor

2.3.2.2. Spread or invasian

2.3.2.3. Function of systems/organs

2.3.2.4. Specimens

2.4. Treatment

2.4.1. Goals

2.4.1.1. Cure: Disease free for 5+ years

2.4.1.1.1. Increased potential if local only

2.4.1.1.2. Depends on malignancy, stage at diagnosis

2.4.1.2. Control

2.4.1.3. Palliation

2.4.2. Modalities

2.4.2.1. Surgery

2.4.2.1.1. Oldest form

2.4.2.1.2. Meets many goals

2.4.2.1.3. Several purposes

2.4.2.1.4. Nursing care

2.4.2.2. Radiation

2.4.2.2.1. High-energy ionizing radiation

2.4.2.2.2. Methods of delivery

2.4.2.2.3. Purposes

2.4.2.2.4. Dosage

2.4.2.2.5. Complications

2.4.2.2.6. Nursing care

2.4.2.3. Chemotherapy

2.4.2.3.1. Routes

2.4.2.3.2. Types

2.4.2.3.3. CAM

2.4.2.3.4. Effects

2.4.2.3.5. Complications

2.4.2.3.6. NADIR

2.4.2.3.7. Neutropenia

2.5. Infection

2.5.1. Leading COD in cancer patients

2.5.2. Unusual presentation in BMD

2.5.2.1. NO FEVER!

2.5.2.2. Why? B/c a fever is a healthy immune response

2.5.3. Symptoms

2.5.3.1. Fever

2.5.3.2. Flushing, diaphoresis

2.5.3.3. Shaking, chills

2.5.3.4. White patches in mouth

2.5.3.5. Erythema, swelling, heat/pain

2.5.3.6. Sputum changes

2.5.3.7. Urinary frequency, burning

2.5.3.8. Flui-like symptoms

2.5.3.9. Rash or skin changes

2.5.4. Nursing care

2.5.4.1. Assessment

2.5.4.1.1. ROS

2.5.4.1.2. Invasive lines

2.5.4.2. Interventions

2.5.4.2.1. Growth hormones (Procrit, etc) >> WBCs

2.5.4.2.2. Neutropenic diet

2.5.4.2.3. Environmental changes

2.6. Bleeding

2.6.1. Thrombocytopenia

2.6.1.1. 50k-100k @ mild risk

2.6.1.2. 20k-50k @ moderate risk

2.6.1.3. <20k @ severe risk for non-traumatic bleeding

2.6.1.4. <10k: fatal CNS, GI, RR hemorrhage

2.6.2. Nursing care

2.6.2.1. Monitor labs

2.6.2.1.1. HgB <10 = poor QOL

2.6.2.1.2. HgB <8 = expect transfusion orders

2.6.2.2. Assess bleeding

2.6.2.3. Avoid invasive procedures when possible

2.6.2.4. Administer blood products

2.6.3. Anemia

2.6.3.1. Very low RBCs

2.6.3.2. Quality of HgB and/or volume PRC

2.6.3.3. Variable levels

2.6.3.3.1. Males: HgB <13.0; HCT <42

2.6.3.3.2. Females: HgB <12.0; HCT <36

2.7. Specific Cancers

2.7.1. Lung

2.7.1.1. Poor prognosis (15% 5-year survival rate)

2.7.1.2. Can be caused by irritants >> cells replaced by dysplastic cells

2.7.1.3. Types

2.7.1.3.1. SCLC

2.7.1.3.2. NSCLC

2.7.1.4. Manifestations

2.7.1.4.1. Coughing, wheezing, stridor

2.7.1.4.2. Thick, purulent sputum

2.7.1.4.3. Hemoptysis

2.7.1.4.4. Dyspnea

2.7.1.4.5. Back or shoulder pain

2.7.1.4.6. Weight loss

2.7.1.4.7. Fatigue

2.7.1.5. Risk factors

2.7.1.5.1. Tobacco

2.7.1.5.2. Environment

2.7.1.5.3. Occupational hazards

2.7.1.6. Complications

2.7.1.6.1. Pneumonia/PE

2.7.1.6.2. Cushing's

2.7.1.6.3. Hypercalcemia

2.7.1.6.4. Anemia

2.7.1.6.5. DIC

2.7.1.6.6. SIADH

2.7.1.6.7. SVCS

2.7.1.7. Suspicious presentation

2.7.1.7.1. Diagnostics

2.7.1.7.2. Labs

2.7.1.7.3. PFT's

2.7.1.7.4. Evaluate for mets

2.7.1.8. Post-op care

2.7.1.8.1. Prevent & detect complications

2.7.1.8.2. Breath souds q2-4hrs

2.7.1.8.3. Constant observation of RR distress

2.7.1.8.4. No deep suctioning

2.7.1.8.5. DVT prevention

2.7.1.8.6. C&DB

2.7.1.8.7. Pain relief

2.7.1.8.8. Positioning

2.7.1.9. Discharge teaching

2.7.1.9.1. Pain control

2.7.1.9.2. Oxygen equipment

2.7.1.9.3. Postural drainage

2.7.1.9.4. Energy conservation

2.7.1.9.5. Exercises

2.7.1.9.6. Monitoring

2.7.2. Breast

2.7.2.1. Common presentation

2.7.2.1.1. Hard, irregular, fixed, painless lump

2.7.2.1.2. Usually unilateral & in UOQ

2.7.2.1.3. Other symptoms

2.7.2.2. Risk factors

2.7.2.2.1. Age +40

2.7.2.2.2. High SES

2.7.2.2.3. Early menarche

2.7.2.2.4. Late menopause

2.7.2.3. Medical management

2.7.2.3.1. Chemo

2.7.2.3.2. Radiation

2.7.2.3.3. Surgery

2.7.2.4. Mastectomy care

2.7.2.4.1. Pre-op

2.7.2.4.2. Post-op

2.7.2.4.3. Complications

2.7.3. Gastrointestinal

2.7.3.1. Sub-types

2.7.3.1.1. Gastric

2.7.3.1.2. Colon

2.7.3.2. Risk factors

2.7.3.2.1. Diet

2.7.3.2.2. Smoking

2.7.3.2.3. Family history

2.7.3.2.4. Chronic GI inflammation

2.7.3.2.5. Urban living

2.7.3.2.6. Poor diet

2.7.4. Brain tumors

2.7.4.1. Benign or malignant

2.7.4.2. Manifestations

2.7.4.2.1. Local or general neuro symptoms

2.7.4.2.2. Symptoms of IICP

2.7.4.2.3. HA

2.7.4.2.4. Vomiting

2.7.4.2.5. Vision disturbances

2.7.4.2.6. Hormonal effects (pit. adenoma)

2.7.4.2.7. Loss of hearing, tinnitus, vertigo (acoustic neuroma)

2.7.4.3. Pathologic events

2.7.4.3.1. IICP

2.7.4.3.2. Seizures

2.7.4.3.3. Hydrocephalus

2.7.4.3.4. Altered pituitary fxn

2.7.5. Spinal cord tumors

2.7.5.1. Intra- or extra-medullary

2.7.5.2. Manifestations

2.7.5.2.1. Pain

2.7.5.2.2. Weakness

2.7.5.2.3. Loss of motor fxn, reflexes, sensations

2.7.5.3. Treatment based on type/location

2.7.5.3.1. Surgical removal

2.7.5.3.2. Decompression

2.7.6. Skin cancer

2.7.6.1. Frequently r/t sun exposure

2.7.6.2. Three key types

2.7.6.2.1. Basal cell carcinoma

2.7.6.2.2. Squamous cell carcinoma

2.7.6.2.3. Malignant melanoma

2.8. Oncologic Emergencies

2.8.1. SVC syndrome

2.8.1.1. Compression of SVC >> obstructed venous blood flow

2.8.1.1.1. Tumor

2.8.1.1.2. Enlarged lymph node

2.8.1.1.3. Thrombus

2.8.1.2. May obstruct head, neck, arms, thorax

2.8.1.3. Manifestations

2.8.1.3.1. Progressive dyspnea**

2.8.1.3.2. Cough/hoarseness

2.8.1.3.3. Chest pain

2.8.1.3.4. Edema

2.8.1.3.5. JVD

2.8.1.3.6. Dysphagia

2.8.1.3.7. IICP

2.8.1.4. Diagnostics

2.8.1.4.1. Manifestations

2.8.1.4.2. X-Ray of chest

2.8.1.4.3. CT scan of chest

2.8.1.4.4. MRI of chest

2.8.1.5. Nursing care

2.8.1.5.1. Diagnoses

2.8.1.5.2. ID @ risk patients

2.8.1.5.3. Monitor, report S/S

2.8.1.5.4. VS, mental status

2.8.1.5.5. Position for oxygenation

2.8.1.5.6. Fluid, electrolyte status

2.8.1.5.7. No blood draws or BP to BUE

2.8.1.6. Management

2.8.1.6.1. Radiation/chemo

2.8.1.6.2. Thrombolytics (heparin IV)

2.8.1.6.3. Percutaneous stent (heart cath)

2.8.1.6.4. Oxygen therapy

2.8.1.6.5. Corticosteroids (solumedrol)

2.8.1.6.6. Diuretics (lasix, mannitol)

2.8.2. Spinal cord compression

2.8.2.1. Pathophysiology

2.8.2.1.1. Compression of spinal cord or nerve roots

2.8.2.1.2. Tumor, lymphoma, lack of blood flow, or intervertebral collapse

2.8.2.2. Manifestations

2.8.2.2.1. Inflammation, edema, venous stasis to nerves

2.8.2.2.2. Upper back/neck pain

2.8.2.2.3. Pain that worsens w/movement

2.8.2.2.4. Sensory alterations

2.8.2.2.5. Weakness

2.8.2.2.6. Flaccid paralysis

2.8.2.2.7. Bladder, bowel dysfunction

2.8.2.3. Nursing care

2.8.2.3.1. Neuro assessment

2.8.2.3.2. Pain management

2.8.2.3.3. Active & passive ROM

2.8.2.3.4. Complications r/t immobility

2.8.2.3.5. Bowel, bladder training

2.8.2.3.6. Support patient/family

2.8.2.3.7. Nursing diagnoses

2.8.2.4. Medical management

2.8.2.4.1. Radiation/chemo

2.8.2.4.2. Surgery

2.8.2.4.3. Vertebroplasty

2.8.2.5. Diagnostics

2.8.2.5.1. Abnormal reflexes

2.8.2.5.2. MRI, CT

2.8.2.5.3. X-Ray

2.8.2.5.4. Bone scans

2.8.2.5.5. Myelogram

2.8.3. Tumor lysis syndrome

2.8.3.1. Rapid breakdown of tumor

2.8.3.1.1. Release of cell contents

2.8.3.1.2. Causes 4 key electrolyte imbalances

2.8.3.1.3. Associated w/chemo, radiation, biotherapy

2.8.3.1.4. Leukemias, lymphomas, SCLC

2.8.3.1.5. Can be fatal!

2.8.3.2. Nursing care

2.8.3.2.1. Diagnoses

2.8.3.2.2. ID at risk patient w/i 1st week of therapy

2.8.3.2.3. Electrolyte levels

2.8.3.2.4. S/S electrolyte imbalances

2.8.3.2.5. IV fluids, PO meds as ordered

2.8.3.3. Medical management

2.8.3.3.1. Balance electrolytes w/IV

2.8.3.3.2. Diuretics

2.8.3.3.3. Allopurinol PO

2.8.3.3.4. Kayexelate PO

2.8.3.3.5. Renagel/Renveala PO

2.8.3.3.6. Hemodialysis**

2.8.4. Hypercalcemia

2.8.4.1. Pathophysiology

2.8.4.1.1. Release from bones > kidney excretion

2.8.4.1.2. Bone reabsorption of excess

2.8.4.1.3. Bone breakdown r/t several factors

2.8.4.2. Manifestations

2.8.4.2.1. Fatigue/weakness

2.8.4.2.2. Hyperreflexia

2.8.4.2.3. AMS

2.8.4.2.4. Decreased LOC

2.8.4.2.5. N/V/C, ileus

2.8.4.2.6. Dysrhythmias

2.8.4.2.7. Dehydration

2.8.4.2.8. 2 Ps

2.8.4.3. Diagnosed by serum Ca

2.8.4.4. Nursing care

2.8.4.4.1. Diagnoses

2.8.4.4.2. At risk patients

2.8.4.4.3. S/S of hypercalcemia

2.8.4.4.4. When to report to MD

2.8.4.4.5. Medication regimen

2.8.4.4.6. 2-4L fluids per day unless contraindicated

2.8.4.4.7. Mobility

2.8.4.4.8. Safety

2.8.4.4.9. EKG rhythms

2.8.5. Pericardial effusion

2.8.5.1. Fluid accumulation in pericardial space

2.8.5.2. Clinical manifestations

2.8.5.2.1. JVD on inspiration (Kussmaul sign)

2.8.5.2.2. Distant heart sounds or adventitious sounds

2.8.5.2.3. Cardiac dullness

2.8.5.2.4. Compensatory tachycardia

2.8.5.2.5. Dyspnea, tachypnea

2.8.5.2.6. Chest pain

2.8.5.2.7. Weakness

2.8.5.2.8. Anxiety

2.8.5.3. Diagnostics

2.8.5.3.1. EKG

2.8.5.3.2. Chest X-Ray

2.8.5.3.3. CT scan

2.8.5.4. Nursing care

2.8.5.4.1. VS & pulse ox frequently

2.8.5.4.2. EKG readings

2.8.5.4.3. Heart, lung sounds

2.8.5.4.4. LOC

2.8.5.4.5. Skin color, temp

2.8.5.4.6. Labs

2.8.5.4.7. HOB elevated

2.8.5.4.8. Patent IV

2.8.5.4.9. Cough/deep breathe q2

2.8.5.4.10. Rest to conserve O2

2.8.5.4.11. Supplemental O2 PRN

2.8.5.5. Medical management

2.8.5.5.1. Pericardiocentesis

2.8.5.5.2. Radiation/chemo

2.8.5.5.3. Steroids

2.8.5.5.4. Diuretics

2.8.6. Cardiac tamponade

2.8.6.1. Pericardial effusion >> compresses heart

2.8.6.1.1. Keeps ventricles from expanding, emptying in diastole

2.8.6.1.2. CO falls r/t increasing compression

2.8.6.1.3. >> Inefficient heart pumping >>

2.8.6.1.4. Heart failure

2.8.6.2. Similar manifestations, managements to PE

2.8.6.3. Nursing diagnoses

2.8.6.3.1. Ineffective breathing pattern

2.8.6.3.2. Fluid volume excess

2.8.6.3.3. Altered CO

2.8.7. Pleural effusion

2.8.7.1. Pathophysiology

2.8.7.1.1. Collection of fluid in pleural space >>

2.8.7.1.2. Dyspnea, pain in chest

2.8.7.2. Can be a complication

2.8.7.2.1. Heart failure

2.8.7.2.2. TB

2.8.7.2.3. Pneumonia

2.8.7.2.4. PE

2.8.7.2.5. Cancerous tumors

2.8.7.3. Manifestations

2.8.7.3.1. Dyspnea

2.8.7.3.2. Chest pain (pleuritic)

2.8.7.3.3. Coughing

2.8.7.3.4. Difficulty lying flat

2.8.7.3.5. Diminished breath sounds

2.8.7.4. Diagnostics

2.8.7.4.1. Chest X-Ray

2.8.7.4.2. Chest CT

2.8.7.4.3. Thoracentesis*

2.8.7.5. Medical management

2.8.7.5.1. Thoracentesis

2.8.7.5.2. Chest tube

2.8.7.6. Nursing care

2.8.7.6.1. Diagnoses

2.8.7.6.2. Supplemental O2 as needed

2.8.7.6.3. Assist in preparation for thoracentesis

2.8.7.6.4. Lab specimens

2.8.7.6.5. Chest tube maintenance

2.8.7.6.6. Pain meds as ordered

3. Sensory Disorders: Visual

3.1. Assessment

3.1.1. Ocular history

3.1.2. Visual acuity

3.1.2.1. OD: right

3.1.2.2. OS: left

3.1.3. External eye exam

3.2. Diagnostics

3.2.1. Direct, indirect opathalmoscopy

3.2.1.1. Cataracts

3.2.1.2. MD office

3.2.2. Slit-lamp exam

3.2.3. Optical coherence tomography

3.2.3.1. Retinal lesions

3.2.3.2. Macular edema

3.2.3.3. Dilating pupils

3.2.4. Amsler grid

3.2.4.1. Macular degeneration >>

3.2.4.2. Grid disturbances

3.2.5. Color vision testing

3.2.6. Indocyanine green angiography

3.2.6.1. Iodine dye

3.2.6.2. N/V

3.2.6.3. ALLERGY

3.2.7. Tonometry

3.2.7.1. Glaucoma

3.2.7.2. Local anesthetic

3.2.8. Fluorescein angiography

3.2.8.1. Non-perfusion

3.2.8.2. Invasive; MD only

3.2.8.3. May turn skin golden for 24 hrs

3.2.9. Ultrasound

3.2.9.1. Retinal hemorrhage or cataracts

3.2.9.2. Tumors

3.2.9.3. Retinal detachment

3.2.10. Perimetry

3.2.10.1. Field of vision

3.2.10.2. Detects scotomas (blind spots)

3.3. Gerontology

3.3.1. Glaucoma

3.3.2. Cataracts

3.3.2.1. 1 or both eyes

3.3.2.2. Loss of transparency

3.3.2.3. Light scattering r/t clumping of proteins

3.3.2.4. Yellow-brown pigment r/t protein breakdown

3.3.2.5. Decreased levels

3.3.2.5.1. O2

3.3.2.5.2. Vitamin C

3.3.2.6. Increased levels

3.3.2.6.1. Na

3.3.2.6.2. Ca

3.3.3. Macular degeneration

3.3.3.1. Most common age-related cause in 60+

3.3.3.2. Drusen (yellow spots) on retina

3.4. Glaucoma

3.4.1. Increased IOP

3.4.1.1. R/T AH congestion >>

3.4.1.2. Damages optic nerve and fiber layer

3.4.2. Leading COB in adults

3.4.3. Risk factors

3.4.3.1. FH

3.4.3.2. Thin cornea

3.4.3.3. AA race

3.4.3.4. Older age

3.4.3.5. DM or CVD**

3.4.3.6. Migraines

3.4.3.7. Myopia

3.4.3.8. Trauma

3.4.3.9. Extended corticosteroids

3.4.4. Stages

3.4.4.1. Initiating events

3.4.4.2. AH outflow system alterations

3.4.4.3. Functional alterations

3.4.4.4. Optic nerve damage

3.4.4.5. Visual loss

3.4.5. Classification

3.4.5.1. Open-angle

3.4.5.1.1. Primary

3.4.5.1.2. Normal tension

3.4.5.1.3. Ocular HTN

3.4.5.2. Angle-closure

3.4.5.2.1. Pupillary block

3.4.5.2.2. Occular emergency!

3.4.5.3. Congenital

3.4.5.4. Associational

3.4.5.4.1. Developemental

3.4.5.4.2. Corticosteroids

3.4.6. Manifestations

3.4.6.1. Silent thief

3.4.6.2. Blurry vision or halos

3.4.6.3. Focusing issues

3.4.6.4. Poor adjustment to low light

3.4.6.5. Loss of PV

3.4.6.6. Aching

3.4.6.7. HA

3.4.7. Medications

3.4.7.1. Cholinergic mitotics

3.4.7.1.1. Pupil constriction; AH outflow

3.4.7.1.2. CSEs

3.4.7.1.3. Pilocarpine; carbachol

3.4.7.2. Adrenergic agonists

3.4.7.2.1. Dipivefrin; epi

3.4.7.2.2. Reduce AH & increase outflow

3.4.7.2.3. CSEs

3.4.7.2.4. Education important to prevent systemic

3.4.7.2.5. Need pressure on lacrimal duct after admin

3.4.7.3. Beta-blockers

3.4.7.3.1. Decrease AH

3.4.7.3.2. CSEs

3.4.7.3.3. Contraindications

3.4.7.3.4. -lol

3.4.7.4. Alpha-adrenergic agonists

3.4.7.4.1. -indine

3.4.7.4.2. Decrease AH

3.4.7.4.3. CSEs

3.4.7.4.4. Proper technique

3.4.7.4.5. Similar to BPH PO meds

3.4.7.5. Carbonic anhydrase

3.4.7.5.1. -zolamide

3.4.7.5.2. Decrease AH production

3.4.7.5.3. Allergies

3.4.7.5.4. CSE

3.4.7.6. Prostaglandin analogs

3.4.7.6.1. -oprost

3.4.7.6.2. Increase uvuloscleral outflow

3.4.7.6.3. Darken iris & redden conjunctivae

3.4.7.6.4. May cause rash

3.4.7.6.5. Report SEs to MD

3.4.7.6.6. Pressure on site

3.4.8. Surgeries

3.4.8.1. Laser trabeculoplasty

3.4.8.1.1. AH outflow by widening area

3.4.8.1.2. Decreases IOP

3.4.8.1.3. Can cause transient elevated IOP 2-hrs post op

3.4.8.1.4. Close monitoring

3.4.8.2. Laser irodotomy

3.4.8.2.1. Pupillary block

3.4.8.2.2. Contraindicated with corneal edema

3.4.8.2.3. Trouble seeing in the dark

3.4.9. Nursing management

3.4.9.1. Adherence

3.4.9.2. Medication & administration

3.4.9.3. Support interventions

3.5. Cataracts

3.5.1. Risk factors

3.5.1.1. Age

3.5.1.2. Ocular dx

3.5.1.3. Infection

3.5.1.4. Toxicities

3.5.1.5. Nutrition

3.5.1.6. Physical factors

3.5.1.7. Systemic diseases

3.5.1.7.1. DM

3.5.1.7.2. Down's syndrome

3.5.1.7.3. Subtopic 3

3.5.2. Manifestations

3.5.2.1. No pain

3.5.2.2. Blurry

3.5.2.3. Glare sensitivity

3.5.2.4. Decreased visual acuity

3.5.2.5. Others

3.5.2.5.1. Myopic shift

3.5.2.5.2. Astigmatism

3.5.2.5.3. Diplopia

3.5.2.5.4. Color shifts

3.5.3. Treatment

3.5.3.1. Surgical only

3.5.3.2. Pre-op care

3.5.3.2.1. Hold antiplatelet meds

3.5.3.2.2. Meds as ordered

3.5.3.2.3. Control HBP before surgery

3.5.3.3. Post-op care

3.5.3.3.1. Protective measures

3.5.3.3.2. Don't rub eye!

3.5.3.3.3. When to call MD

3.6. Macular Degeneration

3.6.1. Nursing management

3.6.1.1. Education

3.6.1.1.1. Leafy greens, fish

3.6.1.1.2. Exercise

3.6.1.1.3. BP, weight

3.6.1.1.4. HCP appts

3.6.1.1.5. Ansler grid

3.6.1.2. Supportive care

3.6.1.3. Safety

3.6.2. Risk factors

3.6.2.1. Age

3.6.2.2. Smoking

3.6.2.3. HTN

3.6.2.4. Obesity

3.6.2.5. Hyperopia (map readers)

3.6.2.6. Familial

3.6.2.7. Wet AMD

3.6.2.8. TH & HCTZ use

3.6.2.9. Arthritis

3.6.3. Types

3.6.3.1. Dry

3.6.3.1.1. Non-neovascular & non-exudative

3.6.3.1.2. Most common

3.6.3.1.3. Slow breakdown of outer retina, followed by drusen

3.6.3.2. Wet

3.6.3.2.1. Abrupt onset*

3.6.3.2.2. Abnormal BV growth (choroidal revascularization)

3.6.3.2.3. Chance for fluid, blood leakage

3.7. Low Vision & Blindness

3.7.1. Low vision

3.7.1.1. Nursing management

3.7.1.1.1. Coping skills

3.7.1.1.2. Grieving process

3.7.1.1.3. Spatial orientation

3.7.1.1.4. Mobility

3.7.1.1.5. Home health

3.7.1.2. Best corrected vision: 20/70 - 200

3.7.1.3. Optical and non-optical aids

3.7.2. Blindness

3.7.2.1. Best corrected: 20/400 & no-light perception

3.7.2.2. Braille, computers, guide dogs

3.8. Opthalmic Medications

3.8.1. 1-7% absorbed

3.8.2. Many barriers

3.8.3. Topical preferred r/t local effects

3.8.4. For higher concentration

3.8.4.1. Intraocular injections

3.8.4.2. Systemic meds

4. Sensory Disorders: Auditory

4.1. Assessment

4.1.1. External ear

4.1.2. Otoscopic examination

4.1.2.1. Pearly gray, shiny TM

4.1.3. Gross auditory acuity

4.1.3.1. Whisper

4.1.3.2. Weber & Rinne tests

4.2. Diagnostics

4.2.1. Many types

4.2.2. Audiologist performs

4.2.3. RN assists, educates

4.3. Hearing Loss

4.3.1. Communication techniques

4.3.1.1. Low-tone voice

4.3.1.2. Slow, distinct speech

4.3.1.3. Face-to-face

4.3.1.4. Favor good ear

4.3.2. Types

4.3.2.1. Conductive

4.3.2.1.1. External

4.3.2.1.2. Middle

4.3.2.2. Sensorineural

4.3.2.2.1. Damage to C or V/C nerve

4.3.2.3. Mixed

4.3.2.3.1. C&S

4.3.2.4. Functional (psychogenic)

4.3.3. Clinical manifestations

4.4. Meniere's Disease

4.4.1. Abnormal fluid collection

4.4.1.1. Malabsorption in endolymphatic sac

4.4.1.2. Blockage of endolymphatic duct

4.4.2. Demographics

4.4.2.1. Men = Women

4.4.2.2. Age 20-60 (40)

4.4.2.3. 50% have family history

4.4.3. Manifestations

4.4.3.1. Fluctuating, progressive HL

4.4.3.2. Tinnitis

4.4.3.3. Pressure, fullness

4.4.3.4. Episodic, severe vertigo

4.4.4. Treatment

4.4.4.1. Low-sodium diet

4.4.4.1.1. R/T fluid retention

4.4.4.1.2. 1000-1500 mg/d

4.4.4.1.3. Avoid high sugar diet

4.4.4.2. Medications

4.4.4.2.1. Meclizine (Antivert)

4.4.4.2.2. Tranquilizers

4.4.4.2.3. Antiemetics (phenergan)

4.4.4.2.4. Diuretics (HCTZ, triamterene)

4.4.4.3. Surgery

4.4.4.3.1. Endolymphatic

4.4.4.3.2. VN sectioning

4.4.4.4. Education

4.5. Vertigo

4.5.1. Disrupted debris in semicircular canal

4.5.2. Caused by trauma or infection

4.5.3. Presents as N/V

4.5.4. Treatment

4.5.4.1. Bedrest

4.5.4.2. Epley maneuver

4.5.5. Meds

4.5.5.1. Antivert (meclizine)

4.5.5.2. Compazine (prochlorperazine)

4.5.6. Vestibular rehab

4.5.6.1. Stress management

4.5.6.2. Biofeedback

4.5.6.3. Vocational rehab

4.5.6.4. PT

4.6. Diagnoses

4.6.1. Anxiety

4.6.2. Risk for trauma

4.6.3. Self-care deficit

4.6.4. Powerlessness

4.6.5. Impaired phys mobility

5. CVA

5.1. Statistics

5.1.1. 3rd leading COD

5.1.1.1. Heart disease

5.1.1.2. Cancer

5.1.2. Leading cause of serious disability

5.1.3. Most common in age 65+

5.1.3.1. 3/4 of all strokes

5.1.3.2. Risk doubles every 10 yrs after 55

5.1.4. Higher death rates among African-Americans

5.1.5. 2x risk for smokers

5.1.6. Most important risk factor = HTN

5.2. Ischemic Stroke

5.2.1. Pathophysiology

5.2.1.1. Clot >>

5.2.1.2. Ischemia >>

5.2.1.3. Energy failure >>

5.2.1.4. Acidosis + ion imbalance

5.2.1.4.1. Increased intracellular calcium

5.2.1.4.2. Cell injury and death

5.2.2. Most common (80-85%)

5.2.3. Nicknames

5.2.3.1. CVA

5.2.3.2. "Brain attack"

5.2.3.2.1. Urgent like a heart attack

5.2.4. Role of t-PA

5.2.4.1. Revolutionary treatment

5.2.4.2. Narrow, 3 hour window

5.2.4.2.1. Revascularization of necrotic tissue >>

5.2.4.2.2. Increased risk for cerebral edema, hemorrhage

5.2.4.3. Many criteria

5.2.4.3.1. Age 18+

5.2.4.3.2. Diagnosed w/ischemic stroke

5.2.4.3.3. Known time of onset

5.2.4.3.4. BP < or = 185/110

5.2.4.3.5. Assessed via NIHSS tool

5.2.4.4. MCSE: bleeding!

5.2.4.4.1. Delay invasive lines recommended

5.2.5. 5 types

5.2.5.1. Small penetrating artery thrombotic stroke

5.2.5.1.1. Most common type (25%)

5.2.5.1.2. 1+ small vessels

5.2.5.1.3. AKA lacunar strokes

5.2.5.2. Large artery thrombotic stroke

5.2.5.2.1. Athero plaques >>

5.2.5.2.2. Occlusion >>

5.2.5.2.3. Infarction + ischemia

5.2.5.2.4. (20% of ischemic strokes)

5.2.5.3. Cardiogenic embolic stroke

5.2.5.3.1. 20% of ischemic strokes

5.2.5.3.2. Associations

5.2.5.3.3. Patho

5.2.5.4. Cryptogenic stroke

5.2.5.4.1. 30% of ischemic strokes

5.2.5.5. Others

5.2.5.5.1. 5% of ischemic strokes

5.2.6. Risk factors

5.2.6.1. HTN

5.2.6.2. A-fib

5.2.6.2.1. Warfarin (INR 2-3)

5.2.6.2.2. (Aspirin instead of warfarin PRN)

5.2.6.3. Hyperlipidemia

5.2.6.4. DM

5.2.6.5. Smoking

5.2.6.6. Carotid stenosis

5.2.6.7. Obesity

5.2.6.8. Alcohol

5.2.6.9. Periodontal disease

5.2.6.10. Non-modifiable

5.2.6.10.1. Age 55+

5.2.6.10.2. Male

5.2.6.10.3. African-American race

5.2.7. Manifestation

5.2.7.1. One-sided weakness/numbness

5.2.7.2. Change in LOC

5.2.7.3. Aphasia

5.2.7.4. Visual changes

5.2.7.4.1. Diplopia

5.2.7.4.2. Loss of PV (hemianopsia)

5.2.7.5. Dysarthria

5.2.7.6. Aphasia

5.2.7.7. Apraxia

5.2.7.8. Depression

5.2.8. Complications

5.2.8.1. Decreased cerebral blood flow

5.2.8.2. Inadequate oxygenation

5.2.8.3. Pneumonia

5.2.9. Diagnostics

5.2.9.1. Non-contrast cT

5.2.9.2. ECG

5.2.9.3. Carotid ultrasound

5.2.9.4. Other studies

5.2.9.4.1. MRI, MRA

5.2.9.4.2. CT

5.2.9.4.3. Doppler

5.2.9.4.4. XECT or SPECT

5.2.10. Medications

5.2.10.1. Thrombolytics (t-PA)

5.2.10.2. Anticoagulants

5.2.10.2.1. Warfarin

5.2.10.2.2. For A-fib

5.2.10.3. Platelet-inhibitors

5.2.10.3.1. R/T TIAs

5.2.10.3.2. Aspirin

5.2.10.3.3. Clopidogrel (Plavix)

5.2.10.4. Statins

5.2.10.4.1. Secondary prevention

5.2.10.4.2. Simvastatin (Zocor)

5.2.10.5. Anti-HTN

5.2.10.5.1. Secondary prevention

5.2.11. Surgery

5.2.11.1. Carotid endarterectomy

5.2.11.1.1. TIA, mild stroke

5.2.11.1.2. Moderate to severe stenosis

5.2.11.1.3. Complications

5.2.11.2. Carotid stenting

5.2.11.2.1. High-risk patients

5.2.11.2.2. Severe stenosis

5.3. Hemorrhagic Stroke

5.3.1. Pathophysiology

5.3.1.1. Bleeding in or around brain tissue

5.3.1.2. Altered brain metabolism

5.3.1.2.1. Bleeding

5.3.1.2.2. IICP

5.3.1.2.3. Secondary ischemia

5.3.1.3. Etiologies

5.3.1.3.1. Intracerebral hemorrhage**

5.3.1.3.2. Intracranial aneurysm

5.3.1.3.3. AVM (esp. in young people)

5.3.1.3.4. Subarachnoid hemorrhage

5.3.2. Rarer, but more fatal (48% mortality)

5.3.3. Etiologies

5.3.3.1. Primary

5.3.3.1.1. Intracerebral hemorrhage (CAA)

5.3.3.1.2. Subarachnoid hemorrhage

5.3.3.2. Others

5.3.3.2.1. AVM

5.3.3.2.2. Intracranial (cerebral) aneurysm

5.3.4. Risk factors

5.3.4.1. HTN

5.3.4.2. Cerebral atherosclerosis

5.3.4.3. Alcohol or drug use

5.3.4.4. Non-modifiable

5.3.4.4.1. Advanged age

5.3.4.4.2. Gender

5.3.4.4.3. Congenital malformation

5.3.5. Manifestations

5.3.5.1. Explosive headache

5.3.5.2. Vomiting

5.3.5.3. Early, sudden change in LOC

5.3.5.4. Focal seizure (possibly)

5.3.5.5. Pain & nuchal, spinal rigidity

5.3.5.6. Vision disturbance

5.3.5.7. Tinnitus, dizziness

5.3.5.8. Hemiparesis

5.3.6. Complications

5.3.6.1. Cerebral hypoxia

5.3.6.1.1. Supplemental O2

5.3.6.1.2. H&H

5.3.6.1.3. Fluids

5.3.6.2. Vasospasms

5.3.6.2.1. Ca-channel blockers

5.3.6.2.2. Monitoring 3-14 days after stroke

5.3.6.3. Seizures

5.3.6.4. IICP

5.3.6.4.1. S/S dehydration

5.3.6.4.2. Mannitol admin

5.3.6.4.3. Rebound IICP

5.3.6.5. Hydrocephalus

5.3.6.6. Re-bleeding

5.3.6.7. Hyponatremia

5.3.6.7.1. 3% hypertonic saline

5.3.6.7.2. Can be caused by SIADH or cerebral Na-wasting syndrome

5.3.7. Diagnostics

5.3.7.1. Non-contrast CT scan

5.3.7.2. MRI

5.3.7.3. Cerebral angiography

5.3.7.4. LP

5.3.8. Labs

5.3.8.1. PT-INR

5.3.8.2. Platelets

5.3.8.3. PTT

5.3.8.4. CMP

5.3.8.5. Urinalysis

5.3.8.6. Lipid profile

5.3.9. Medications

5.3.9.1. Ca-channel blockers

5.3.9.1.1. R/T vasospasms

5.3.9.1.2. Nimodipine (Nimotop)

5.3.9.2. Osmotic diuretic

5.3.9.2.1. R/T IICP

5.3.9.2.2. Mannitol

5.3.9.3. Anti-HTN

5.3.9.3.1. Management

5.3.9.3.2. Labetalol

5.3.9.3.3. Nicarpidine

5.3.9.3.4. Nitroprusside

5.3.9.3.5. Hydrazaline

5.3.9.4. Stool softeners

5.3.9.4.1. Straining >>

5.3.9.4.2. Elevated BP

5.3.10. Surgery

5.3.10.1. Craniotomy

5.3.10.1.1. Hematoma > 3 cm

5.3.10.1.2. GCS decreasing

5.3.10.1.3. Complications

5.3.10.2. Endovascular treatmnet

5.3.10.2.1. Occlusion of parent artery

5.3.10.2.2. Obstruction/coil at aneurysm site

5.3.10.2.3. Complications

5.4. TIA

5.4.1. Temporary neuro deficit r/t impaired blood flow

5.4.2. Warning sign of impending stroke

5.4.3. Need a diagnostic workup

5.4.4. Manifestations

5.4.4.1. Lasts <1hr

5.4.4.2. Sudden loss of M/S/V function

5.4.5. Treatment

5.4.5.1. Platelet inhibitors

5.4.5.1.1. Aspirin

5.4.5.1.2. Plavix

5.4.5.1.3. Ticlid

5.4.5.2. >> Decreased infarction risk

5.5. Nursing Process

5.5.1. Assessment

5.5.1.1. Ischemic

5.5.1.1.1. LOC

5.5.1.1.2. Pupils

5.5.1.1.3. M/S

5.5.1.1.4. Skin color/temp

5.5.1.1.5. VS

5.5.1.1.6. Speech

5.5.1.1.7. Bowel & bladder fxn

5.5.1.1.8. Airway, RR

5.5.1.2. Hemorrhagic

5.5.1.2.1. LOC

5.5.1.2.2. Pupils

5.5.1.2.3. M/S

5.5.1.2.4. Cranial nerves

5.5.1.2.5. Speech, vision

5.5.1.2.6. Other neuro deficits

5.5.2. Diagnoses

5.5.2.1. Ischemic

5.5.2.1.1. Impaired phys mobility

5.5.2.1.2. Sexual dysfunction

5.5.2.1.3. Self care deficit

5.5.2.1.4. Acute pain r/t shoulder

5.5.2.1.5. Bowel, bladder control

5.5.2.1.6. Skin integrity

5.5.2.1.7. Communication

5.5.2.1.8. Disturbed thought process r/t brain damage

5.5.2.2. Hemorrhagic

5.5.2.2.1. Ineffective tissue perfusion

5.5.2.2.2. Anxiety (aneurysm precautions x2)

5.5.2.2.3. Disturbed sensory perception

5.5.2.2.4. Acute pain r/t headache