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NUR212 Final 2025 Exam Practice
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what are some considerations for patients with radioactive implants (ex. seeds) patients emit radiation: wear lead apron and even dosimeter, minimize our exposure (time, distance and shielding), private room, no pregnant visitors or staff to enter the room, no children to visit, limit visitors to 30 mins per day and ensure 6 feet distance brachytherapy the use of radioactive materials in contact with or implanted into the tissues to be treated why does the body become fatigued from cancer treatments? when the cell is damaged or dies it releases potassium and uric acid at a fast rate in which the body woks hard to excrete therefore causing lethargy xerostomia dry mouth
stomatitis inflammation of the mouth: use saltwater rinse and anesthetic rinse before eating and educate they must eat to promote healing (increase their saliva or anesthetic to help them eat) skin care for a patient going through radiation therapy was irridated areas with warm water or warm water with mild soap (do not remove markings), use hand rather than washcloth and be sure to rinse soap thoroughly from the skin, dry with patting motions (decrease friction), do not use powders, lotions, creams o the site unless prescribed by the radiologist, avoid sun exposure of irradiated area, wear soft clothing over the site, avoid wearing belts/buckles/straps that could irritate the area, stay covered outdoors or in the shade, avoid heat exposure extravasation leaking of the chemotherapy drug into surrounding tissues through what type of line should chemotherapy be administered through and why? it should be administered through a central line, picc line or a port to decreased risk of extravasation (NO PERIPHERAL IV). chemo side effects nausea and vomiting pancytopenia (been marrow suppression..decrease WBC and decrease RBC), chemo induced peripheral neuropathy, AKI or CKI, cognitive impairment - chemo dog, cardiotoxic and toxic to the lungs, fatigue
hemoatopoetic stem cell transplant (HSCT) standard of care for malignant myeloma, non hodgkin lymphoma and acute leukemia - stem cells 8-10 days into bone marrow, make RBC, platelets, WBCs myeloblative HCST chemo and radiation to kill the host bone marrow and tumor, then replace with new bone marrow- s/s of uptake in 8-10days and have 1-2days between destruction and transplant max how to prevent graft vs host effect administer cyclosporine (immunosuppressant drug) immunotherapy use of medications to stimulate or suppress components of the immune system to kill cancer cells tumor lysis syndrome extreme fatigue: by product of the tumor breaking down - increase fluids and daylsis may be needed - ONCOLOGIC EMERGENCY spine cord compression
compression of the spinal cord from a tumor- may cause paralysis or permanent nerve damage - ONCOLOGIC EMERGENCY superior vena cava syndrome superior vena cava compressed by the tumor (ex. breast cancer, lung or thoracic cancers) s/s: JVD, SOB, edema radiation and antiinflammatory meds asap ONCOLOGIC EMERGECNY how to screen for cervical cancer and what is the main cause? main cause is HPV and can be detected by Pap smear s/s: discomfort, bleeding, foul smell what is the most common gynecological cancer uterine cancer risk for uterine cancer estrogen exposure (ex. hormonal birth controls/estrongen modulators) and menopause
larynx cancer cancer of the voice box-most common in people over 65 and more common in males risks for larynx cancer tobacco, smoke, cigarettes, combined effects of alcohol and tobacco, second hand smoke, asbestos, paint fumes, wood dust, cement dust, chemicals tar products, mustard gas, leather and metals, vitamin deficiencies, history of alcohol abuse, age (over 65), gender (men), genetics, race (african Americans and Caucasians), and weakened immune system early s/s of larynx cancer hoarseness, persistant cough, sore through or pain burning I throat, raspy voice, lower pitched voice, lump in neck late s/s of larynx cancer dysphagia, dyspnea, nasal obstruction, persistant hoarsness, persistant ulceration, foul breath, general debilitating tracheostomal stenosis abnormal narrowing of the trachea or the tracheostomy stoma-rush back to surgery
patient education with laryngectomy inform client about alternative forms of communication, teach client how to clean the incision and stoma care, teach the client clean suctioning technique, avoid getting debris in trach, dont swim, wear a medialert bracelet, increase humidity in the home, increase fluids to 2000-3000mL/day, avoid exposure to people with infections s/s of lung cancer and most common cause most commonly caused by smoking and s/s: cough, blood sputum, hoarseness, SOB oral cavity and pharynx cancer risk and s/s risks: HPV and smoking s/s: small painless sore that won't heal (should heal within 2 weeks all oral tissue regenerated in 2 weeks ) benign cancer cells well differentiated cells (closest to tissue of orgin), noncancerous, does not typically infiltrate surrounding tissues, slow growth rate and effects are usually localized malignant cancer cells undifferentiated cells, spread and infiltrates surrounding tissues, rate of growth is variable, my gain access to blood or lymph channels to met, results in generalized effects: weakness, anemia, systemic inflammation and can cause death of surrounding tissues
leukemia hematopoetic malignante with unregulated proliferation of leukocytes (immature WBCs attack own bone marrow) paracrine function acts around it (affects nearby cells) (ex. ovaries) autocrine function acts on the cells itself (insulin) why are steroids so effective but have so many side effects lipid soluble and can enter the cell membrane very easily anterior pituitary hormones GH, LH, TSH, ACTH, FSH, Prolactin posterior pituitary hormones
ADH and oxytocin ADH vasopressin: antidiutreic hormone (increase water reabsorption in the kidneys) oxytocin function stimulates the contraction of the uterus following delivery and stimulates ejection of breast milk during lactation hyper function of the posterior pituitary is what disease SIADH hypofunction of the posterior pituitary is what disease DI SIADH water intoxication, cellular edea, dilutional hyponatremia, decreased serum osmolarity (<260)
DI expected findings polyuria, polydipsia, fatigue, dehydration, sunken eyes, weak peripheral pulses, loss of skin tumor, decreased cognition, urine specific gravity is decreased (ex. 1.001-1.005), clear urine test for DI fluid deprivation test: withheld fluids for 8-12 hours or until 3-5% of the body weight is lost and see if the serum and urine osmolarity return closer to normal: see if kidneys can concentrate the urine: MONITOR FOR S/S OF HYPOVOLEMIA what should be assessed during the fluid deprivation test s/s of hypovolemic shock, decreased neuro s/s, tachycardia, palpations, hypotension treatments for DI synthetic ADH (desmopressin-intranasally), ensure adequate fluid replacement (PO, IV), restrict foods with caffeine, identify and correct pathology FSH function women: stimulates growth of ovarian follicles and estrogen secretion men: stimulates sperm production
LH function stimulates ovaries and testes prolactin function stimulates breast milk production during lactation ACTH function stimulation of the adrenal glands to decrease glucocorticoids thyroid stimulating hormone (TSH) stimulates the thyroid Growth Hormones stimulates protein synthesis and growth of the muscles and bones (energy and metabolism in adults) excess= acromegaly Acromegaly
CSF will be positive for glucose meanwhile mucus will be negative for glucose Panohypopituitarism hypo secretion of all of the ant pituitary hormones (GH, LH, ACTH, TSH, FSH, prolactin), the thyroid gland, adrenal cortex, and gonads atrophy from the loss of stimulating hormones hyper secretion of GH in children is called pituitary giganitism hypo secretion of GH in children is called pituitary dwarfism what hormones are produced by the thyroid thyroxine (T4), triiodothyronin (T3), calcitonin (CT) T3 and T 4 function both contain iodine molecule found to the amino acid structure: regulated by TSH: controls metabolic activity, energy production, tissue use of fats, proteins and carbs
calcitonin function mobilization of calcium from the bone and reduces blood calcium levels (responds to high calcium in the blood-sends it into the bone) hypothyroidism s/s LOW AND SLOW - extreme fatigue and lethargy, irritability, intolerance to the cold, constipation, weight gain, pale skin, brittle fingernails, periorbital edema, bradycardia, hypotension, slow though processes, thinning of hair, dry flaky skin, swelling I face, hands and feet management of hypothyroidism monitor for cardiovascular changes (bradycardia)< adequate rest periods, motor resp status, low calorie high bulk diet to prevent conspation, stool softeners-NO FIBER LAXITES(INTERFEARS WITH ABDORB OF LEVOTHYROXINE), use extreme caution with meds cause decreased absorb, noelectirc heating devices due to decreased sensation (they usually cold) levothyroxine synthroid-synethic t levothyroixine considerations
extreme fatigue, nervous/irritable, warm flushed skin, tremor, hyperkinesea, goiter, bruit over thyroid, dyspnea, weakness, exophthalmos, frequent stools or diarrhea, palpations, heat intolerance, insomnia, weight loss, tachycardia, emotionally liable, hypertension diagnosis for hyperthyroidism radioactive iodine uptake: oral contrast given 24hrs prior to scan, elevated uptake means hyperthyroidism (decrease iodine intake for 1 weeks before the test) when should radioactive iodine uptake not be given? in pregnancy, shellfish or iodine allergy treatments for hyperthyroidism thionamides (methimazole, proplthouracil) inhibit the production of thyroid hormone, beta blockers (for tachycardia and palpations), iodine solutions, (nonradioactive solution for short term use only-hypothyroidism often results), radioactive iodine therapy thionamides monitor for.. hypothyroidism, CBC for hepatotoxicity Radioactive iodine therapy
kill thyroid tumors: THEY WILL BE RADIOACTIVE!! educate them on that. stay away fro pregnant women and children for the first week following treatment, may take 6- 8 weeks to show effects, do not use same toilet as others for 2 weeks, flush the toilet three times, take laxitive 2-3 days after treatment cleanse out any stool contaminated with radiation, wash clothing separate, and avoid contamination from salvia (use diferent plates and silverware) thyroid storm/crisis s/s hyperthermia, hypertension, delirium, vomiting, abdominal pain, tachydyssarythmias, chest pain, dyspnea, palpations nursing considerations with a thyroid storm decrease temperature (acetametaphin, ice packs), administer thionamides followed by sodium iodine, beta blockers, administer IVF, strict I and Os, supplemental O what can cause a thyroid storm uncontrolled graves disease, infection, diabetic ketoacidosis, trauma, emotional stress, digitalis toxicity, surgery, post thyroidectomy (if they squeezed it could release hormones into there) parathyroid gland function makes parathromoen (PTH) which increases Ca in blood and helps with phosphorous metabolism
