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


Review Topics

A&P, Functions, Protecting vital organs, Mobility, movement, Blood return to the heart, RBC production, Reservoir, Immature BCs, Vital minerals, Structure, Bones, 206 total, Four types, Long, Short, Flat, Irregular, Cell types, Osteoblasts: Form bone, Osteocytes, Mature cells, Bone maintenance, Located in lacunae, Osteoclasts, Multinuclear, Destroy, resorb, and remodel, Located in Howship's lacunae, Formation, "Osteogenesis", Constant state of turnover, Regulated by, Stress, weight-bearing, Vitamin D, PTH, calcitonin, Blood supply, Healing, Hematoma + inflammation, Angiogenesis, cartilage formation, Cartilage calcification, then removal, Bone formation, Remodeling, Joints, Junction b/w bones, Three types, Synarthroses (immoveable), Amphiarthroses (limited movement), Diarthroses (freely moveable), Ball & socket, Hinge, Saddle, Pivot, Gliding, Muscles, Attached to bones via tendons, Encased in fibrous tissue (fascia), Contraction --> movement, Sarcomere, Contractile unit of SM, Actin + Myosin, Fibers react to electrical stimulation, Utilizes ATP, Anaerobic pathways, Use glucose from glycogen, >> More strenuous activity

Assessment, Collect data r/t functional abilities, ADLs, IADLs, Various activities, Mobility problems, Health history, General info, FH, Nutrition, Occupation, Learning needs, Socioeconomic factors, Medications, Rx, OTC, Pain & altered sensation, Physical exam, Posture, Kyphosis, Lordosis, Scoliosis, Gait, Bone integrity, Joint function, Muscle strength & size, Skin, Neurovascular

Diagnostics, X-ray, CT, MRI, Biopsy, Labs, Arthography, Bone densitometry, Bone scan, Arthroscopy, Arthrocentesis, Electromyography

Rheumatoid Arthritis

Overview, Type of "rheumatic disease", "Arthritis", 100+ different diagnoses, Mainly affect joints, Muscles, Bone, Ligaments, Tendons, Cartilage, Classifications, Mono- or poly-articular, Inflammatory or non-inflammatory, Chronic, diffuse CT disease, Group of disorders, RA, SLE, Scleroderma, Polymytosis, Polymyalgia rheumatica, Diffuse inflammation, degeneration, Unknown cause, but may be immunologic, Characterized by exacerbations & remissions, Autoimmune, idiopathic, Systemic, but mainly in synovial tissue, 1% of world's population, Female > males

Manifestations, See patho for articular S/S, Fever, Weight loss, Fatigue, Anemia, Lymphadenopathy, Raynaud phenomenon, Vasospastic disorder, Discoloration of fingers, toes, Caused by overactivation of SNS >> VC >> hypoxia, Rheumatoid nodules, Arteritis, Neuropathy, Scleritis, Pericarditis, Splenomegaly, Sjogren syndrome, Autoimmune disease, Immune cells destroy certain exocrine glands, Tear glands, Salivary glands, Appears as generalized dryness (esp. eyes, mouth)

Pathophysiology, Phagocytosis in joint >>, Enzymes produced >>, Collagen breakdown, Edema, Proliferation of synovial membrane, Pannus formation, Causes problems, Loss of joint motion, Loss of tendon & ligament elasticity, Loss of contractile power

Assessment, Bilateral/symmetric manifestations, Stiff, Tender, Swollen, Temperature changes @ joint, Weight loss, Sensory changes, Lymphadenopathy, Fatigue

Diagnostics, Rheumatoid factor, Increased ESR, Decreased RBCs, Decreased C4-compliment, CRP +, ANA +, Arthrocentesis, X-Ray

Management, Medical, Early, Aggressive and early treatment, Rest + exercise, Medications, Salicylates or NSAIDs, Anti-inflammatory, Analgesics, DMARDs w/i 3 months of onset, Methotrexate is THE standard of treatment, Chemo agents, Bone marrow suppression, Mucositis, Moderate, erosive, OT/PT, Protect joints, Pace activities, Simplify work, ROM, muscle-strengthening, Enhance effects of methotrexate via cyclosporine, Persistent, erosive, Reconstructive surgeries, NOT during exacerbations, Synovectomy, Tennorrhaphy, Arthrodesis, Arthroplasty, Systemic corticosteroids, Low-dose, Least time, Advanced, un-remitting, Immunosuppressants, High-dose drugs, MTX, Cytoxan, Imuran, Arava, Toxic drugs, Produce many side effects, Myelosuppression, Anemia, GI dysfunction, Rash, Antidepressants, Sleep, Chronic pain, Prosorba to bind IgG, Nursing, NSAID education, No alcohol, Avoid aspirin, Take with food, Stop 5-7 days before surgery, Nutrition therapy, Vitamin supplements, Protein supplements, Foods high in iron, protein, Nursing process, Assess, Pain, Mobility, Skin, Fatigue, Depression, Sleep disturbance, CSEs of medications, Knowledge level, Diet and nutrition, Family and support system, Diagnose, Acute/chronic pain, Impaired physical mobility, Fatigue, Planning, Relief pain, discomfort, fatigue, Promote rest, Increase mobility, Self-care abilities, Body image, Coping skills, Absence of complications, Implementation, OT/PT consult, ROM, Devices, Positioning, Posture, Environmental barriers, Furniture, Adaptations, Community health, LTC, Equipment, Meals-on-Wheels, Sleep routine, Energy conservation techniques, Pacing, Delegating, Prioritizing, Adequate nutrition, Evaluation, Using effective pain management, Comfort level, ADLs, Other activities, Optimal functional mobility, ADLs, Safety, Proper use of devices, Combating fatigue, Sleep routine, Nutrition, Home care, Depends on severity, Assessment issues, Environment, Skin integrity, Referrals, Goals, Improve QOL, Maintain independence, Education, Disease process, Management techniques, Medications, Monitoring, Sources of info, Pain management, Joint protection, Assistive devices, Exercise, relaxation


Degenerative joint disease, Most common, disabling, Primary or secondary, Directly r/t to increasing age, 90% have DJ changes by 40, In weight-bearing joints, W/o clinical symptoms

Pathophysiology, Cartilage degradation, Bone stiffening, Inflammation of synovium, Certain areas affected, Articular cartilage, Subchondral bone, Synovium

Risk factors, Disorders of the hip, Increased age, Obesity, Previous joint damage, Repetitive use, Anatomic deformity, Genetics

Manifestations, Pain, Stiffness, AM or after wakening, Lasts <30 min, Decreases w/movement, Functional impairment, R/t pain with movement, Limited ROM r/t structural changes

Affected areas, Weight-bearing joints, Proximal and distal finger joints

Diagnostics, Blood tests = not useful, X-ray results, Visible narrowing of joint space, Osteophytes, Tender, enlarged joints on exam, Inflammation*, May be present, Not destructive kind like RA

Management, Cannot HALT degeneration, May slow progression, Weight reduction, Prevent injuries, Screen for congenital hip dx, Ergonomics, Treatment, Education, Heat packs, Joint rest, Orthotics, Isometric exercise, Alternative therapies, Used by patients, Effectiveness undetermined, Medications, Acetaminophen (initial), NSAIDs, COX-2 enzyme blockers, Opioids, Corticosteroid injection, Capsaicin topically, Glucosamine & chrondroitin, Hyaluronate injection, Surgery, Moderate to severe OA, Severe pain, Loss of function, Osteotomy or athroplasty, Nursing care, Education, Pain management (non-pharm first), Plan activity when pain is low, May pre-medicate before activity PRN, PT, exercise, assistive devices, Weight reduction, 10 hours of sleep @ night + 1-2 hr nap, Alternative therapies


Overview, Genetic defect of purine metabolism, Oversecretion, Decreased kidney excretion, BOTH, Causes hyperuricemia, Two types, Primary, Severe dieting, Starvation, Excessive intake, Organ meats, Sardines, anchovies, Asparagus, Alcohol, Mushrooms, Shellfish, Secondary, Dx w/increased cell turnover, Leukemia, Multiple myeloma, Some anemia, Psoriasis, Increased cell breakdown (chemo), Decreased excretion (renal tubular dysfunction), Common drug: allopurinol, Up to 3L of fluid per day, No organ meats or wines, IUOP to 2L per day

Risk factors, Older age, Higher BMI, Gender, Lifestyle factors, Alcohol, Diet, Family history, Medications

Pathophysiology, Serum uric acid > 7 mg/dL, Attacks r/t sudden changes in uric acid, Formed during purine breakdown, >> High uric acid >> urate crystals, >> Precipitate w/i joint >>, Inflammation >> gout attack + pain, May progress to tophi, kidney stones, Attacks gradually worsen, Occur more frequently, Involve more joints, Last longer

Manifestations, PM onset usually, Big toe most affected, Pain, Redness, Swelling, Warmth

Diagnosis, Polarized light microscopy of synovial fluid, Visible uric acid crystals

Treatment, Medical, Acute attacks, Colchicine, NSAIDs, Corticosteroids, Management, Allopurinol or probenecid for uric acid, Tophi, Joint destruction, Renal disorders, Nursing care, Dietary restrictions, Purines in food, Alcohol, Normal body weight, Pain management, Compliance b/w attacks


Pathophysiology, Altered bone turnover, Rate of resorbation > rate of formation, Loss of total bone mass, Porous, brittle, fragile bones

Common areas, Spinal compression fractures, Neck fractures, Femur fractures, Colles' fractures (wrists)

Early sign: loss of height

Risk factors, Slight frame, Non-obese, Asian or Caucasian, Women > men*, Occurs later for men, Lack of Ca/Vitamin D, Bariatric surgery (duodenum bypass), Immobility, Casts, sedentary, paralyzed, etc, Must get patients weight-bearing ASAP!

Prevention, Lifelong diet w/Ca & Vitamin D, Calcium supplements + Vitamin C, Weight-bearing exercise (esp. walking), Weight training to improve BMD

Pharmacology, Bisphosphonates, End in -dronate, Fosamax, Actonel, Boniva, Selective estrogen modulators, SERMs, Evista, Calcitonin, Teriparatide (Forteo), Ca and Vitamin D

Diagnostics, X-ray, Poor indicator, Has to be 25-40% demineralized, DXA scan (Recommended), All women >65; men >70, Postmenopausal women, Men >50 w/risk factors + associated fracture, Determines OP, osteopenia, & therapeutic responses

Management, Prevention, then early intervention, Reduce bone loss, fractures

Nursing process, Assessment, Osteopenia, OP history, Family history, Fractures, Calcium in diet, Exercise, Menopause, Other factors, Corticosteroids, Alcohol, smoking, Caffeine, Diagnoses, Deficient knowledge, Acute pain, Risk for constipation, Risk for injury, Planning, Knowledge, Pain management, Bowel elimination, Fracture prevention, Implementation, Education about process, treatment, Pain relief, Bowel elimination, Preventing injury


Metabolic bone disease, Inadequate mineralization, Lack of activated Vitamin D, >> Poor mineralization, low Ca and P, Become soft, weak, Pain, tenderness, deformities, Bowing of legs, pathologic fractures

Causes, GI disorder, Severe renal insufficiency, Hyperparathryoidism, Diet deficiency

Treatment, R/t underlying cause, Increase Vitamin D and Ca, Handle gently >> high risk for fractures!, Pain management

Paget's Disease

AKA ostetitis deformans, Disorder of localized bone turnover, Very rare (2-3% of age 50+), Men > women, Increased risk with age, Family predisposition

Pathophysiology, Excess resorption by osteoclasts >>, Increased osteoblastic activity >>, Disorganized, weak, highly vascular bones, Increased risk of fractures, arthritis, hearing loss

Manifestations, Skeletal deformities, Mild to moderate, aching pain, Tenderness, warmth over bones, Insidious onset, May be asymptomatic

Pharmacology, NSAIDs for pain, Calcitonin, Bisphosphonates, Plicamycin (Mitracin), Cytotoxic antibiotic, May be used for resistent, severe form

Surgeries & Nursing

Indications, Joint disease, Deformities, Unstable fractures, Necrotic, infected tissues, Tumors

Goals, Improve function, Relieve pain, disability

Many types

Patient needs, Mobility/ambulation, Within a day of post-op, Using assistive devices, Weight-bearing as prescribed, Drain use, Bleeding, Fluid accumulation, Infection prevention, Immediate (w/i 3 months), Delayed (4-24 months), Due to spread (+2 years), DVT prevention, Education and rehab

Joint replacement, Total Hip Replacement, Indications, OA, RA, Femoral neck fracture, Failed previous prosthesis, Prosthesis, Leg abduction to prevent dislocation, No flexing hip >90 degrees, No internal rotation, Protective positioning, Hip precautions, Pre-op care, Overall health status (ROS), DVT risk factors, Neurovascular checks, Post-op care, Prevent dislocation, Abduction, Keep femoral head in acetabular cup, Limit flexion on transfers, sitting, Abduction pillow, Pad between legs while supine, lateral or turning, Don't bend at waist, Signs of dislocation, Increased pain, swelling, immobilization, Acute groin pain, Shortening of hip, Abnormal external/internal location, Restricted mobility, "Popping" sensation, Wound drainage, Portable suction placed, 200-500 mL of fluid, blood in first 24 hrs, 30 mL/48 hrs >> Drains removed, Can have auto transfusion system for blood (by 6 hrs), DVT prevention, Mechanical prophlaxis (SCDs), Pharmacology (LMWH/enoxparin), Signs of DVT, Calf pain, Swelling, Tenderness, Infection prevention, ID at-risk patients, Smokers, Elderly, Obese, Malnourished, Corticosteroid use, DM, RA, or current infection, Remove sources of infection, Catheters, Portable drainage devices, Antibiotic prophylaxis, Self-care, Daily exercise, Assistive devices, ADLs resumed by 3 months post-op, Dislocation prevention for 4 months, Continuing care, Total Knee Replacement, OA or RA, Metal or acrylic prosthesis, Encourage active flexion, CPM device, Circulation, ROM, Rate, amount of E/F prescribed, 10 degrees E/F at first, 90 degrees F, 0 degrees E by discharge, Nursing care, Edema, Compress, Ice, Neurovascular checks, Color, Cap refill, Edema, Swelling, Warmth, Parasthesia/numbness, DVT prevention, Drainage, 200-400 mL first 24 hrs, 25-30 mL by 48 hrs, Transfuse auto system at 6 hrs

Nursing process, Assessment, Pre-op, Routine, Hydration, Meds, Possible infection, Colds, Dental problems, UTIs, Infections w/i 2 weeks, Knowledge, Support and coping, Post-op, Pain, VS including RR, LOC, Neurovascular checks, Bleeding, drainage, Mobility + restrictions, Bowel status, UO, Complications, Diagnoses, Acute pain, Risk for peripheral NV dysfunction, Risk for ineffective therapeutic regimen management, Impaired phys mobility, Risk for situational low-self esteem, Collaborative problems, Shock, Atelectasis, Pneumonia, Urinary retention, Infection, DVT or PE, Constipation or impaction, Planning, Pain relief, PCA, others, Pre-medication, Non-pharmacologic, Individualized strategies, Hot or cold, Elevation, Immobilization, NV function, Health promotion, Mobility, Self-esteem, Avoid complications, Intervention, Muscle settings, exercises, Nutrition, hydration, Skin integrity, Asepsis, infection prevention, PT, rehab, Realistic goals, Self-care as appropriate, RR status (TCDB, IS), Education, Monitoring for shock, Increased HR, decreased BP, Narrowed pulse pressure, UO <30 mL/hr, Restlessness, Altered mental status, Thirst, Decreased H&H

Degenerative Disk Disease

Background, Most common cause of low back pain, Degenerative with age or trauma, Radiculopathy >> Pain, Continued pressure >> more degeneration, Altered sensation, motor ability, Conservative treatment, Rest, Medications, Surgery**, Processing neuro deficit, When unresponsive to conservative tx, Goal is to reduce pressure on nerve root, Assessment, H&P, MRI (CT, myelography if needed), Neuro exam

Cervical disk hernia, Stress from age, occupation, Spondylosis, Degeneration in disk, Includes associated vertebral bodies, Manifestations, Variable - C5-6 or C6-7, Pain & stiffness, Neck, Shoulders, Scapulae, Pain & parasthesia, Upper extremities, Head, Treatment, Bedrest 1-2 days, Immobilization, C-collar, Traction, Brace, Pharmacological, NSAIDs or corticosteroids for inflammation, Pain meds, Sedatives for anxiety, Muscle relaxants (methocarbamol metalaxone), Hot, moist compress for 10-20 min, Cervical discectomy, Assessment, Pain onset, location, radiation, Parasthesias, Limited movement, Impaired function, Uni or bilateral symptoms, Palpate C-spine, Tone, Tenderness, ROM of neck muscles, Health issues, Education, Potential complications, Hematoma >> cord compression >> neuro deficit, Recurrent or persistent post-op pain, Assessment, Bleeding, hematoma formation, V/S, Severe pain not relieved by meds (report to HCP), Dressing status, Neuro checks, Anterior approach, Sudden return of radicular pain, Hoarseness, poor cough, Diagnoses, Acute pain, Impaired phys mobility, Knowledge deficit, Planning, Pain relief, Keep flat for 12-24 hrs, Bone fusion = more painful, Donor bone from iliac crest, Pain meds, Positioning, Report sudden increase, Mobility, C-collar, Turning body instead of neck, Neck in "neutral" (midline), Assisting with mobility, Support neck, shoulders, Shoes while ambulating, Knowledge, self-care, Preventing complications, Interventions, See planning, + Home care, C-collar for 6 weeks, Pain management, Strategies for ADLs, Follow-up visits

Lumbar disk hernia, Manifestation, Low back pain w/spasm, Radiation of pain to leg (sciatica), Pain, Increases w/movement, Decreases w/rest, Diagnostics, H&P, MRI, CT, Myelography, Nursing process, Assessment, Detailed pain assessment, Work, recreation, Effect of pain on ADLs, Posture, positioning, gait, Spinal curvature, Symmetry, DTRs, Sensation, Strength, Nutritional assessment**, Diagnoses, Acute pain, Impaired phys mobility, Risk for situational low self-esteem, Imbalanced nutrition, Planning, Pain relief, Increased mobility, Use of back conservation techniques, Proper body mechanics, Improved self-esteem, Weight reduction, Interventions, Pre-op, Baseline assessment, Haealth issues, Bowel and bladder function, Log-rolling, TCDB, Muscle setting exercises, Post-op, VS, Wound bed; drainage, Neuro assessment, NV checks, Urinary retention, Donor site if fusion, Positioning, Pillow under head, knees, Avoid extreme flexion if lateral, Flatten bed and log-roll to move, Lie on side >> sit >> stand, Home care, Increase activity gradually (6 weeks), Avoid flexion strain, Heat for spasms, Avoid heavy work for 2-3 mo, Strengthen abdominal, erector spinal muscles, Medical management, 1-2 days bed rest, Non-pharmacologic, Moist heat, Massage, Weight reduction, PT, Strengthening exercise, Pharmacological, NSAIDs, Muscle relaxants, Corticosteroids, Lumbar disk excision, Posterolateral laminectomy, Microdiskectomy, Complications, Relapse, Adhesions, scarring r/t inflammation, Perisistent effects from neural injury, Failed disk syndrome

Upper Extremity Conditions

Diagnoses, Bursitis/tendinitis, Loose bodies, Impingement syndrome, Carpal tunnel syndrome, Tinel's sign, Ganglion, Dupuytren's contracture

Surgical care, Outpatient procedure, Need education, NV checks q1 hr for first 24, Motor function as prescribed, S/S to report, Pain control, Meds, Elevation, Intermittent ice, cold, Infection prevention, ADLs, Assistance, Promote independence

Lower Extremity Conditions

Diagnoses, Plantar fascitis, Corn, Callus, Ingrown toenail, Hammer toe, Hallux valgus, Clawfoot (pes cavus), Morton's neuroma, Flatfoot (pes planus)

Surgical care, Assessment, Outpatient, Routine pre-op, Patient education, NV checks, Ambulation, balance, Home care needs, Assistance, Structural alterations needed, Diagnoses, Risk for ineffective peripheral tissue perfusion, Acute pain, Impaired phys mobility, Risk for infection, Planning, Adequate perfusion, Pain relief, Improved mobility, No complications, Interventions, NV assessment, Key assessment, Swelling + NV status q1-2 hrs for first 24, S/S to assess and report, Pain management, Elevate, Intermittent ice, Oral analgesics, Improving mobility, Weight-bearing restrictions, Assistive devices, Patient safety, Infection prevention, Wound or pin care, Clean, dry dressing, S/S infections, Patient education



Unchecked cell growth, Potentially dangerous, Malignant > benign, Common sites, Bone, Lung, CNS, Liver, More dangerous than benign b/c metastasizes, Migrate to edges of primary tumor, Penetrate surrounding blood supply, Travel, then extravasates out of vessels, Angiogenesis, Process of making new blood vessels, Critical event for tumor growth & metastasis, Metastases share name of original, primary tumor site

At high risk for infection, Atypical presentation, Subnormal temperature, Changes in behavior

Top cancers in USA, Lung, Breast/prostate, Colorectal

Gerontological considerations, Immunity, Drug absorption alterations, Co-morbidities, Decreased reserves, Lung, Cardiac, Neuro, Renal, Decreased defenses, Musculoskeletal strength, Skin integrity, Neurosensory, Social, economic resources, Presentation may seem normal (r/t to age), Vulnerable to complications, Cancer, Cancer treatment, Functional status, Consideration during treatment

Carcinogens, Viruses, HPV, Hep B, EBV, Radiation, Diagnostics, Sunlight, Tanning, Chemicals, Chemo!, Tobacco, Hormones (DES), Aromatic hydrocarbons, Soot, Tar

Theories & Categories, Gompertzian growth, Theory, How quickly in 20 cycles 1 cell >> 1 cubic cm, Clinical staging, 0: Cancer in situ, 1: Tumor limited/localized, 2: Limited local spread, 3: Extensive local & regional spread, 4: Metastasis, TNM classification, Tumor size, invasiveness (T), Spread to lymph nodes (N), Metastasis (M), Differentiation, Grade 1: Well-differentiated, Low-grade, Appears fairly normal, Grade 2, Grade 3, Grade 4: Poorly differentiated (high-grade), Undifferentiated (anaplastic), So abnormal that origin cannot be determined, More aggressive, Growth, Behavior

C.A.U.T.I.O.N., Seven warning signs of cancer, Change in bowel/bladder habits, A sore that doesn't heal, Unusual bleeding/discharge, Thickening in breast or elsewhere, Indigestion (dysphagia), Obvious change in wart or mole, Nagging cough or hoarseness


Primary, Avoid known carcinogens, Diet, lifestyle changes

Secondary, Genetic testing, Breast cancer risk, Family adenomatosis polyposis r/t colon cancer, Teaching about decreasing risk


Extensive, MRI, CT, PET, Fluroscopy, endoscopy, Ultrasound, Nuclear imaging, Radioimmunoconjugates (tagging), Tumor marker testing

Purposes, ID presence, extent of tumor, Spread or invasian, Function of systems/organs, Specimens


Goals, Cure: Disease free for 5+ years, Increased potential if local only, Depends on malignancy, stage at diagnosis, Control, Palliation

Modalities, Surgery, Oldest form, Meets many goals, Several purposes, Diagnostic/biopsy, Primary treatment, Palliative, Reconstruction, Prophylaxis, Nursing care, General surgical care, High risk for complications, Other treatments used, Combo therapy, May seriously impact wound healing, Infection, Impaired wound healing, Critical period (25 days post-op), Proliferative phase, Granulation tissue formed, >> Strengthens wound, Need protein, but..., Most chemo impairs protein synthesis, chemo may impair wound healing, Altered RR or renal function, DVT, Anxiety, Over procedures, findings, prognosis etc, Need education!, Radiation, High-energy ionizing radiation, Disrupts cell growth, Affects all exposed cells, Localized cells r/t target tissue, Systemic effects are possible, Types of radiation, Gamma used for radiation, Alpha, beta cannot pass through skin, Methods of delivery, External, Teletherapy, Invisible beam of highly charged electrons, Penetrate and target tumor, Local modality, Well-oxygenated tumors, Smaller, rapidly dividing tumors, Complications, Early signs, Fatigue, GI disturbances, Mucosal reactions, Cystitis, BMD, Reproductive effects, Pulmonary effects, Late signs, Increased risk for leukemia, Increased risk for secondary malignancy, "Radiation recall", To abdomen >> fibrotic changes to intestines, >> Result in radiation enteritis, Intraoperative, Unusual, Internal, Brachytherapy, Implantation near tumor, Also local, Purposes, Primary treatment, Adjuvant w/surgery and chemo, Palliative, Dosage, Lethal dose, Eradicates 95% of tumor, Spares normal tissue, Delivered over several weeks, Greater kills during active cell division, Can fraction dose, Permits reoxygenation of periphery, Tumors die from inside out, Increases radiosensitivity, Complications, Impaired local skin integrity, GI effects at area, Fatigue, BMD, Nursing care, General, Site care, No medicated solutions, No zinc oxide, No harsh deodorants, Avoid pressure, trauma, infection, Wash area with PLAIN WATER, Avoid sun exposure, Oral care, Reactions are possible, Hydration status (saliva, water), Soft, high-protein, high-calorie foods, Avoid extreme temps, alcohol, tobacco, Teach exam, oral care routine, Dental work BEFORE initiation, Chemotherapy, Routes, PO, IM, IV, SQ, Intracavity or intratumor, Abdominal port (peritoneum), Omaya reservoir (MD only), Topical, Arterial, Intrathecal, Types, Cell-cycle specific, By phase, S: DNA/RNA synthesis interference, M: Halt mitotic spindle formation, Types, Antimetabolites, Mitotic inhibitors, Topoisomerase inhibitors, Cell-cycle non-specific, Works through cell cycle, Types, Alkylating agents*, Nitrosoureas, Platinum drugs, Antitumor antibiotics, Corticosteroids, Hormones, CAM, Complementary therpaies, Risk for drug interactions, St. John's wort, Impacts efficacy of many drugs, Warfarin, cyclosporine, cyclophosphamide, tamoxifen, Non-traditional or holistic, Used with medicine, Alternative = instead of medicine, Risk for fraud, Ineffective, Harmful, $$$$, Non-scientific, Must report to HCP, Effects, Acute, Allergic rxns, Arrhythmias, Delayed, Mucositis, Avoid commercial mouthwash, Instead use rinses w/Nystatin, Maalox, Benadryl, Lidocaine*, No spicy foods or temp extremes, Taste changes, Alopecia, Skin rash, Delayed N/V, BMD, Altered bowel function, Anorexia, Usually reversible, Lack of appetite >> weight loss, Cachexia, Non-reversible metabolic syndrome, Loss of fat, muscle, and bone mineral content, Toxic, Unrelieved nausea >> persistent vomiting, Diarrhea (>3 loose stools per day; or, at night), GI-specific, N/V (most feared), Acute, Delayed**, Anticipatory, Nursing care, Anti-emetics before, Pleasant environment, Pain control, Relaxation, High protein intake, Stomatitis, Mucositis, D/C, Complications, Allergic reaction/anaphylaxis, Myelosuppression, Major systemic complication, Results from fact that cancer targets rapidly growing cells, Cancer cells, BONE MARROW, Hair, Mucosal cells, Local complications, Infiltration, Aching, tightness, darkening, Possible swelling, Extravasation, Severe pain during infusion & @ site, Caused by vesicant escaping into tissue, Ulceration w/i 2-4 days, Severe swelling, Necrosis, sloughing, Nursing care, Patent IV access!, If in doubt..., Stop the infusion, start a new site, If the solution is a vesicant..., Keep access in place for antidote >>, Notify MD and chemo RN, >> Give antidote per policy, No antecubital IVs, IV assessment, Should never be painful, Stop infusion once pain is identified, >> Reassess, and restart, NADIR, Time after chemo where blood counts are lowest, WBC, 4.5-10.0, Shift to left in WBC, Ongoing bacterial infection, Overstimulation of neutrophils >> immature bands enter blood, Degenerative shift to left, Sign of BMD, Increase in neutrophils, No increase or decrease in WBCs, Neutrophils, Lymphocytes, Monocytes, Eosinophils, Basophils, Platelets, Variable period, Drugs, combo therapy, Individual characteristics, Prior experience, Takes 3 weeks for return to safe levels >> new round of chemo, Chemo kills bad cells + good cells, WBC, RBC, Platelets, Prolonged time >> higher risk of infection, Neutropenia, Very low neutrophils, Increased risk of infection or BMD, After cytotoxic chemo, Determined by ANC, (Seg + bands) / 100 x WBC, >1500 normal, <1000 moderate, <500 severe, <100 extreme, Complications, Infection, Sepsis, Death, Fatigue, Poor wound healing, GI mucosal changes, Diarrhea


Leading COD in cancer patients

Unusual presentation in BMD, NO FEVER!, Why? B/c a fever is a healthy immune response

Symptoms, Fever, Flushing, diaphoresis, Shaking, chills, White patches in mouth, Erythema, swelling, heat/pain, Sputum changes, Urinary frequency, burning, Flui-like symptoms, Rash or skin changes

Nursing care, Assessment, ROS, Invasive lines, Interventions, Growth hormones (Procrit, etc) >> WBCs, Neutropenic diet, No fresh vegetables or fruits, No yogurt w/live culture, No black pepper, Environmental changes, No live or cut plants in room, Limit or avoid raw veggies, No yogurt w/live culture, No pepper for transplant patients, Limit visitors, None with known infection, No kids <13 yo, Best place to be is at home!, Infection-related admissions >>, Exposes patient to more germs, Proper handwashing!!!, Hygiene, Call MD if temp >100.4


Thrombocytopenia, 50k-100k @ mild risk, 20k-50k @ moderate risk, <20k @ severe risk for non-traumatic bleeding, <10k: fatal CNS, GI, RR hemorrhage

Nursing care, Monitor labs, HgB <10 = poor QOL, HgB <8 = expect transfusion orders, Assess bleeding, Avoid invasive procedures when possible, Administer blood products

Anemia, Very low RBCs, Quality of HgB and/or volume PRC, Variable levels, Males: HgB <13.0; HCT <42, Females: HgB <12.0; HCT <36

Specific Cancers

Lung, Poor prognosis (15% 5-year survival rate), Can be caused by irritants >> cells replaced by dysplastic cells, Types, SCLC, 15% of cases, More aggressive, "oat cell", NSCLC, Adenocarcinoma**, Squamous, Spindle cell, Manifestations, Coughing, wheezing, stridor, Thick, purulent sputum, Hemoptysis, Dyspnea, Back or shoulder pain, Weight loss, Fatigue, Risk factors, Tobacco, Environment, Occupational hazards, Complications, Pneumonia/PE, Cushing's, Hypercalcemia, Anemia, DIC, SIADH, SVCS, Airway obstruction!, Suspicious presentation, Diagnostics, Chest x-ray, Sputum, Bronchoscopy**, Transthoracic fine needle aspiration biopsy, Mediastinoscopy, Scalene node biopsy, Labs, PFT's, Evaluate for mets, Bone scans, CRI, MRI, PET, Thoracentesis, Post-op care, Prevent & detect complications, Hemorrhage, Pneumothorax, Assess q2-4 hrs, Absent unilateral breath sounds, Tracheal deviation, Increased SOB, Mediastinal shift, Breath souds q2-4hrs, Constant observation of RR distress, No deep suctioning, DVT prevention, C&DB, Pain relief, Positioning, Lobectomy, Promote expansion, Avoid prolonged lying on operative side, "Good side down", Pneumonectomy, Back, Operative side, "Good side up", Discharge teaching, Pain control, Oxygen equipment, Postural drainage, Energy conservation, Exercises, Monitoring, URI, Decreased oxygenation, Mental status, Seizures, Gait disturbance

Breast, Common presentation, Hard, irregular, fixed, painless lump, Usually unilateral & in UOQ, Other symptoms, Asymmetry, Dimpling of skin, Nipple discharge/retraction, Red, scaly patch of skin on breast, Risk factors, Age +40, High SES, Early menarche, Late menopause, Medical management, Chemo, Radiation, Surgery, Total mastectomy, Breast tissue only, Modified radical mastectomy, Breast tissue, Lymph nodes, Radical mastectomy, Breast tissue, Lymph nodes, Pectoralis muscles, Mastectomy care, Pre-op, Emotions re: diagnosis, Info about surgery & post-op exercises, Post-op, Raise extremity above heart, Adduct arm (hand << elbow << shoulder), Venous drainage, Decreased tension on sutures, Circulation, No sticks or BP on that side, Monitor for hematoma & notify MD, Snug dressing, First glance of site for patient, Teach site care & infection s/s, Drainage tubes, 7-10 days, Prevent fluid accumulation, May shower on 2nd POD, Mild soap & water; pat dry, Daily change for 7 days, Complications, Lymphedema, Monitor circumference of arm & report increase, Avoid certain things, Vigorous, repetitive movement, Lifting > 15 lbs, Exposure to extreme heat, Tight jewelry, Wear gloves during housework/gardening, Infection

Gastrointestinal, Sub-types, Gastric, Manifestations, May be absent, Anorexia, Dyspepsia, Weight loss, Abdominal pain, N/V, Back pain, Jaundice*, Surgery, Curative if localized, Radical subtotal or total gastrectomy, Risk for B-12 deficiency, >> R/t lack of IF, >> B-12 malabsorption, May be followed by chemo and/or radiation, Colon, Risk factors, FH, Hx of IBD, UC, Crohn's, polyps, High fat, low residue diet, Urban lifestyle, Manifestations, Change in bowel habits (1), Passage of blood in stool (2), Nursing care, Dumping syndrome*, Poor wound healing, Infection, Anastomosis leakage/dehiscence, Considered "Western" disease, Medical management, Chemo, Radiation, Surgery, Colon resection (w/o colostomy), Radical surgery, Abdominal, Perineal resection, Permanent colostomy, Removal of rectum & affected colon, Risk factors, Diet, Smoking, Family history, Chronic GI inflammation, Urban living, Poor diet, High fat, Smoked, salted or pickled, No fruits/veggies, Nitrate intake in meat, Low residue

Brain tumors, Benign or malignant, Manifestations, Local or general neuro symptoms, Symptoms of IICP, HA, Vomiting, Vision disturbances, Hormonal effects (pit. adenoma), Loss of hearing, tinnitus, vertigo (acoustic neuroma), Pathologic events, IICP, Seizures, Hydrocephalus, Altered pituitary fxn

Spinal cord tumors, Intra- or extra-medullary, Manifestations, Pain, Weakness, Loss of motor fxn, reflexes, sensations, Treatment based on type/location, Surgical removal, Decompression, Dexamethasone + radiation

Skin cancer, Frequently r/t sun exposure, Three key types, Basal cell carcinoma, Most common, Most successfully treated (b/c they stay localized), Squamous cell carcinoma, Variable prognosis, May metastasize, Malignant melanoma

Oncologic Emergencies

SVC syndrome, Compression of SVC >> obstructed venous blood flow, Tumor, Enlarged lymph node, Thrombus, May obstruct head, neck, arms, thorax, Manifestations, Progressive dyspnea**, Cough/hoarseness, Chest pain, Edema, Face, Neck, BUE, Thorax, JVD, Dysphagia, IICP, Diagnostics, Manifestations, X-Ray of chest, CT scan of chest, MRI of chest, Nursing care, Diagnoses, Ineffective breathing pattern, Fluid volume excess, Acute pain, ID @ risk patients, Monitor, report S/S, VS, mental status, Position for oxygenation, Fluid, electrolyte status, No blood draws or BP to BUE, Management, Radiation/chemo, Thrombolytics (heparin IV), Percutaneous stent (heart cath), Oxygen therapy, Corticosteroids (solumedrol), Diuretics (lasix, mannitol)

Spinal cord compression, Pathophysiology, Compression of spinal cord or nerve roots, Tumor, lymphoma, lack of blood flow, or intervertebral collapse, Manifestations, Inflammation, edema, venous stasis to nerves, Upper back/neck pain, Pain that worsens w/movement, Coughing, Sneezing, Valsalva manuever, Sensory alterations, Numbness, Tingling, Coldness to extremities, Weakness, Flaccid paralysis, Bladder, bowel dysfunction, Nursing care, Neuro assessment, Pain management, Active & passive ROM, Complications r/t immobility, Bowel, bladder training, Support patient/family, Nursing diagnoses, Pain, Bowel incontinence, Uirnary incontinence, Impaired mobility, Sensory impairment, Medical management, Radiation/chemo, Surgery, Tumor removal, Debulking, Vertebroplasty, Diagnostics, Abnormal reflexes, MRI, CT, X-Ray, Bone scans, Myelogram

Tumor lysis syndrome, Rapid breakdown of tumor, Release of cell contents, Causes 4 key electrolyte imbalances, Hyperkalemia, EKG changes, Dysrhythmias, Cardiac arrest, Muscle cramps, N/V, abdominal cramps, Anorexia, Diarrhea, Parasthesias, Hypocalcemia, hTN, EKG changes, Muscle cramps, Parasthesias, Seizures, Tetany, AMS, Hyperphosphatemia, Oliguria, anuria, Renal failure, N/V/D, Muscle cramps, Tetany, Hyperuricemia, Oliguria, anuria, Renal failure, Flank pain r/t stones, N/V, Gout, Pruritis, Associated w/chemo, radiation, biotherapy, Leukemias, lymphomas, SCLC, Can be fatal!, Nursing care, Diagnoses, Electrolyte imbalance, Fluid volume deficit, Pain, Fluid volume excess, ID at risk patient w/i 1st week of therapy, Electrolyte levels, S/S electrolyte imbalances, IV fluids, PO meds as ordered, Medical management, Balance electrolytes w/IV, Diuretics, Allopurinol PO, Kayexelate PO, Renagel/Renveala PO, Hemodialysis**

Hypercalcemia, Pathophysiology, Release from bones > kidney excretion, Bone reabsorption of excess, Bone breakdown r/t several factors, Cytokines, Hormones, Growth factors from cancer cells, Manifestations, Fatigue/weakness, Hyperreflexia, AMS, Decreased LOC, N/V/C, ileus, Dysrhythmias, Dehydration, 2 Ps, Diagnosed by serum Ca, Nursing care, Diagnoses, Electrolyte imbalance, Constipation, At risk patients, S/S of hypercalcemia, When to report to MD, Medication regimen, 2-4L fluids per day unless contraindicated, Mobility, Safety, EKG rhythms

Pericardial effusion, Fluid accumulation in pericardial space, Clinical manifestations, JVD on inspiration (Kussmaul sign), Distant heart sounds or adventitious sounds, Cardiac dullness, Compensatory tachycardia, Dyspnea, tachypnea, Chest pain, Weakness, Anxiety, Diagnostics, EKG, Chest X-Ray, CT scan, Nursing care, VS & pulse ox frequently, EKG readings, Heart, lung sounds, LOC, Skin color, temp, Labs, HOB elevated, Patent IV, Cough/deep breathe q2, Rest to conserve O2, Supplemental O2 PRN, Medical management, Pericardiocentesis, Radiation/chemo, Steroids, Diuretics

Cardiac tamponade, Pericardial effusion >> compresses heart, Keeps ventricles from expanding, emptying in diastole, CO falls r/t increasing compression, >> Inefficient heart pumping >>, Heart failure, Similar manifestations, managements to PE, Nursing diagnoses, Ineffective breathing pattern, Fluid volume excess, Altered CO

Pleural effusion, Pathophysiology, Collection of fluid in pleural space >>, Clear, Purulent, Bloody, Dyspnea, pain in chest, Can be a complication, Heart failure, TB, Pneumonia, PE, Cancerous tumors, Manifestations, Dyspnea, Chest pain (pleuritic), Coughing, Difficulty lying flat, Diminished breath sounds, Diagnostics, Chest X-Ray, Chest CT, Thoracentesis*, Medical management, Thoracentesis, Chest tube, Nursing care, Diagnoses, Ineffective breathing pattern, Ineffective airway clearance, Pain, Supplemental O2 as needed, Assist in preparation for thoracentesis, Lab specimens, Chest tube maintenance, Pain meds as ordered

Sensory Disorders: Visual


Ocular history

Visual acuity, OD: right, OS: left

External eye exam


Direct, indirect opathalmoscopy, Cataracts, MD office

Slit-lamp exam

Optical coherence tomography, Retinal lesions, Macular edema, Dilating pupils

Amsler grid, Macular degeneration >>, Grid disturbances

Color vision testing

Indocyanine green angiography, Iodine dye, N/V, ALLERGY

Tonometry, Glaucoma, Local anesthetic

Fluorescein angiography, Non-perfusion, Invasive; MD only, May turn skin golden for 24 hrs

Ultrasound, Retinal hemorrhage or cataracts, Tumors, Retinal detachment

Perimetry, Field of vision, Detects scotomas (blind spots)



Cataracts, 1 or both eyes, Loss of transparency, Light scattering r/t clumping of proteins, Yellow-brown pigment r/t protein breakdown, Decreased levels, O2, Vitamin C, Increased levels, Na, Ca

Macular degeneration, Most common age-related cause in 60+, Drusen (yellow spots) on retina


Increased IOP, R/T AH congestion >>, Damages optic nerve and fiber layer

Leading COB in adults

Risk factors, FH, Thin cornea, AA race, Older age, DM or CVD**, Migraines, Myopia, Trauma, Extended corticosteroids

Stages, Initiating events, AH outflow system alterations, Functional alterations, Optic nerve damage, Visual loss

Classification, Open-angle, Primary, Normal tension, Ocular HTN, Angle-closure, Pupillary block, Occular emergency!, Congenital, Associational, Developemental, Corticosteroids

Manifestations, Silent thief, Blurry vision or halos, Focusing issues, Poor adjustment to low light, Loss of PV, Aching, HA

Medications, Cholinergic mitotics, Pupil constriction; AH outflow, CSEs, Blurry, Poor dark vision, Risk for injury, Periorbital pain, Pilocarpine; carbachol, Adrenergic agonists, Dipivefrin; epi, Reduce AH & increase outflow, CSEs, Redness, burning, Palpitations, tremors, high BP, HA, Anxiety, Education important to prevent systemic, Need pressure on lacrimal duct after admin, Beta-blockers, Decrease AH, CSEs, Bradycardia, Exacerbates pulmonary dx, hTN, Contraindications, ASTHMA, COPD, 2nd or 3rd degree heart block, Bradycardia, -lol, Alpha-adrenergic agonists, -indine, Decrease AH, CSEs, Dry mouth/nares, Eye redness, Proper technique, Similar to BPH PO meds, Carbonic anhydrase, -zolamide, Decrease AH production, Allergies, Sulfa, Periorbital dermatitis r/t dorzolamide, CSE, Electrolyte alterations, Depression/lethargy, Anaphyalxis, GI s/s, Impotence, Weight loss, Prostaglandin analogs, -oprost, Increase uvuloscleral outflow, Darken iris & redden conjunctivae, May cause rash, Report SEs to MD, Pressure on site

Surgeries, Laser trabeculoplasty, AH outflow by widening area, Decreases IOP, Can cause transient elevated IOP 2-hrs post op, Close monitoring, Laser irodotomy, Pupillary block, Contraindicated with corneal edema, Trouble seeing in the dark

Nursing management, Adherence, Medication & administration, Support interventions


Risk factors, Age, Ocular dx, Infection, Toxicities, Nutrition, Physical factors, Systemic diseases, DM, Down's syndrome, Subtopic 3

Manifestations, No pain, Blurry, Glare sensitivity, Decreased visual acuity, Others, Myopic shift, Astigmatism, Diplopia, Color shifts

Treatment, Surgical only, Pre-op care, Hold antiplatelet meds, Meds as ordered, Control HBP before surgery, Post-op care, Protective measures, Don't rub eye!, When to call MD, Vision changes, Decrease in pain**, Increased redness, Pain increases, not relieved by OTC

Macular Degeneration

Nursing management, Education, Leafy greens, fish, Exercise, BP, weight, HCP appts, Ansler grid, Supportive care, Safety

Risk factors, Age, Smoking, HTN, Obesity, Hyperopia (map readers), Familial, Wet AMD, TH & HCTZ use, Arthritis

Types, Dry, Non-neovascular & non-exudative, Most common, Slow breakdown of outer retina, followed by drusen, Wet, Abrupt onset*, Abnormal BV growth (choroidal revascularization), Chance for fluid, blood leakage

Low Vision & Blindness

Low vision, Nursing management, Coping skills, Grieving process, Spatial orientation, Mobility, Home health, Best corrected vision: 20/70 - 200, Optical and non-optical aids

Blindness, Best corrected: 20/400 & no-light perception, Braille, computers, guide dogs

Opthalmic Medications

1-7% absorbed

Many barriers

Topical preferred r/t local effects

For higher concentration, Intraocular injections, Systemic meds

Sensory Disorders: Auditory


External ear

Otoscopic examination, Pearly gray, shiny TM

Gross auditory acuity, Whisper, Weber & Rinne tests


Many types

Audiologist performs

RN assists, educates

Hearing Loss

Communication techniques, Low-tone voice, Slow, distinct speech, Face-to-face, Favor good ear

Types, Conductive, External, Middle, Sensorineural, Damage to C or V/C nerve, Mixed, C&S, Functional (psychogenic)

Clinical manifestations

Meniere's Disease

Abnormal fluid collection, Malabsorption in endolymphatic sac, Blockage of endolymphatic duct

Demographics, Men = Women, Age 20-60 (40), 50% have family history

Manifestations, Fluctuating, progressive HL, Tinnitis, Pressure, fullness, Episodic, severe vertigo

Treatment, Low-sodium diet, R/T fluid retention, 1000-1500 mg/d, Avoid high sugar diet, Medications, Meclizine (Antivert), Vestibular suppression, Tranquilizers, For vertigo during attack, Antiemetics (phenergan), N/V, Diuretics (HCTZ, triamterene), Decreases fluid, Lowers pressure in lymphatic system, Monitor and increase potassium, Oranges, Tomatoes, Bananas, Surgery, Endolymphatic, VN sectioning, 98% successful, Cuts the nerve, Education


Disrupted debris in semicircular canal

Caused by trauma or infection

Presents as N/V

Treatment, Bedrest, Epley maneuver

Meds, Antivert (meclizine), Compazine (prochlorperazine)

Vestibular rehab, Stress management, Biofeedback, Vocational rehab, PT



Risk for trauma

Self-care deficit


Impaired phys mobility



3rd leading COD, Heart disease, Cancer

Leading cause of serious disability

Most common in age 65+, 3/4 of all strokes, Risk doubles every 10 yrs after 55

Higher death rates among African-Americans

2x risk for smokers

Most important risk factor = HTN

Ischemic Stroke

Pathophysiology, Clot >>, Ischemia >>, Energy failure >>, Acidosis + ion imbalance, Increased intracellular calcium, Cell injury and death

Most common (80-85%)

Nicknames, CVA, "Brain attack", Urgent like a heart attack

Role of t-PA, Revolutionary treatment, Narrow, 3 hour window, Revascularization of necrotic tissue >>, Increased risk for cerebral edema, hemorrhage, Many criteria, Age 18+, Diagnosed w/ischemic stroke, Known time of onset, BP < or = 185/110, Assessed via NIHSS tool, MCSE: bleeding!, Delay invasive lines recommended

5 types, Small penetrating artery thrombotic stroke, Most common type (25%), 1+ small vessels, AKA lacunar strokes, Large artery thrombotic stroke, Athero plaques >>, Occlusion >>, Infarction + ischemia, (20% of ischemic strokes), Cardiogenic embolic stroke, 20% of ischemic strokes, Associations, Dysrhythmias (a-fib), Preventable >>, Anticoagulant therapy, Valvular HD, Thrombi in left ventricle, Patho, Emboli in heart >>, Cerebral vasculature (LMCA) >>, Obstruction >>, Stroke, Cryptogenic stroke, 30% of ischemic strokes, Others, 5% of ischemic strokes

Risk factors, HTN, A-fib, Warfarin (INR 2-3), (Aspirin instead of warfarin PRN), Hyperlipidemia, DM, Smoking, Carotid stenosis, Obesity, Alcohol, Periodontal disease, Non-modifiable, Age 55+, Male, African-American race

Manifestation, One-sided weakness/numbness, Change in LOC, Aphasia, Visual changes, Diplopia, Loss of PV (hemianopsia), Dysarthria, Aphasia, Apraxia, Depression

Complications, Decreased cerebral blood flow, Inadequate oxygenation, Pneumonia

Diagnostics, Non-contrast cT, ECG, Carotid ultrasound, Other studies, MRI, MRA, CT, Doppler, XECT or SPECT

Medications, Thrombolytics (t-PA), Anticoagulants, Warfarin, For A-fib, Platelet-inhibitors, R/T TIAs, Aspirin, Clopidogrel (Plavix), Statins, Secondary prevention, Simvastatin (Zocor), Anti-HTN, Secondary prevention

Surgery, Carotid endarterectomy, TIA, mild stroke, Moderate to severe stenosis, Complications, Hematoma, HTN (BP for 48 hrs), Post-op hTN, Hyperperfusion syndrome, Severe unilateral HA >>, Improved with standing, ICH (altered mental status), Carotid stenting, High-risk patients, Severe stenosis

Hemorrhagic Stroke

Pathophysiology, Bleeding in or around brain tissue, Altered brain metabolism, Bleeding, IICP, Secondary ischemia, Etiologies, Intracerebral hemorrhage**, HTN, Atherosclerosis, Intracranial aneurysm, Athero, HTN, Defect, Head trauma, Increased age, AVM (esp. in young people), Subarachnoid hemorrhage, Leaking or congenital AVM, Extravasation of blood into brain or SA space

Rarer, but more fatal (48% mortality)

Etiologies, Primary, Intracerebral hemorrhage (CAA), Subarachnoid hemorrhage, Others, AVM, Intracranial (cerebral) aneurysm

Risk factors, HTN, Cerebral atherosclerosis, Alcohol or drug use, Non-modifiable, Advanged age, Gender, Congenital malformation

Manifestations, Explosive headache, Vomiting, Early, sudden change in LOC, Focal seizure (possibly), Pain & nuchal, spinal rigidity, Vision disturbance, Tinnitus, dizziness, Hemiparesis

Complications, Cerebral hypoxia, Supplemental O2, H&H, Fluids, Vasospasms, Ca-channel blockers, Monitoring 3-14 days after stroke, Seizures, IICP, S/S dehydration, Mannitol admin, Rebound IICP, Hydrocephalus, Re-bleeding, Hyponatremia, 3% hypertonic saline, Can be caused by SIADH or cerebral Na-wasting syndrome

Diagnostics, Non-contrast CT scan, MRI, Cerebral angiography, LP

Labs, PT-INR, Platelets, PTT, CMP, Urinalysis, Lipid profile

Medications, Ca-channel blockers, R/T vasospasms, Nimodipine (Nimotop), Osmotic diuretic, R/T IICP, Mannitol, Anti-HTN, Management, Labetalol, Nicarpidine, Nitroprusside, Hydrazaline, Stool softeners, Straining >>, Elevated BP

Surgery, Craniotomy, Hematoma > 3 cm, GCS decreasing, Complications, Psych changes, Korsakoff's, Intraop embolism, Internal artery occlusion, Fluid-electrolyte imbalance, GI bleeding, Endovascular treatmnet, Occlusion of parent artery, Obstruction/coil at aneurysm site, Complications, Secondary stroke, Aneurysm rupture


Temporary neuro deficit r/t impaired blood flow

Warning sign of impending stroke

Need a diagnostic workup

Manifestations, Lasts <1hr, Sudden loss of M/S/V function

Treatment, Platelet inhibitors, Aspirin, Plavix, Ticlid, >> Decreased infarction risk

Nursing Process

Assessment, Ischemic, LOC, Full consciousness, Lethargy, Drowsy, Partially awakens to stimuli, Obtundation, Difficult to arouse, Need constant stimulus to follow commands, Short verbal responses, then drift off, Stupor, Only arouses to vigorous stimuli, Cannot follow commands, Pupils, M/S, Skin color/temp, VS, Speech, Bowel & bladder fxn, Airway, RR, Hemorrhagic, LOC, Pupils, M/S, Cranial nerves, Speech, vision, Other neuro deficits

Diagnoses, Ischemic, Impaired phys mobility, Prevent hip flexion but promote hyperextension, Prone position for 15-30 min, Pillow under pelvis, Several times per day, For normal gait, muscles, Sexual dysfunction, Self care deficit, Encourage ASA patient can sit up, Set realistic goals, Acute pain r/t shoulder, Prevent adduction, Side-lying with pillow, Bowel, bladder control, High fiber, 2-3L H2O, Skin integrity, Communication, Disturbed thought process r/t brain damage, Hemorrhagic, Ineffective tissue perfusion, Anxiety (aneurysm precautions x2), Complete bedrest, Quiet and calm, HOB 15-30, Keep BP low, SCDs, Nursing care for self-care, Disturbed sensory perception, Acute pain r/t headache