ADULT 1 Study Guide for Exam 1 1

Signsandsymptomsofhypovolemicshockandthenursingcare
MANIFESTATION
1. INITIALSTAGE
o BP:normaltoslightlydecreased
o P:slightlyincreasedfrombaseline
o R:normal(baseline)
o Skin:cool,pale(inperiphery),moist
o Mentalstatus:alertandoriented
o Urineoutput:slightdecrease
o Other:thirst,decreasedcapillaryrefilltime
2. COMPESATORYANDPROGRESSIVESTAGES
o BP:hypotension
o P:rapid,thread
o R:increased
o Skin:cool,pale,clammy(includestrunk);poorturgorwithfluidloss,edematouswith
fluidshift
o Mentalstatus:restless,anxious,confused,agitated
o UrineOutput:oliguria,(lessthan30mL/hr.)
o Other:markedthirst,acidosis,hyperkalemia,decreased,capillaryrefilltime,decreasedor
absentperipheralpulses
3. IRREVERSIBLESTAGE
o BP:severehypotension(often,systolicpressureisbelow80mmHg)
o P:veryrapid,shallow,crackles,andwheezes
o Skin:cool,pale,mottledwithcyanosis
o Mentalstatus:disoriented,lethargic,comatose
o Urineoutput:anuria
o Other:lossofreflexes,decreasedorabsentperipheralpulses
Nursingcare
o Patientswhohaveundergonesurgery,havesustainedmultipletraumaticinjuries,orhave
beenseriouslyburnedaremorelikelytodevelophypovolemicshock
o Monitoringfluidstatusisessentialinpreventinghypovolemicshock,including:
Dailyassessmentofweight,fluidintakebyallroutes,measurablefluidloss(e.g.
urine,vomitus,wounddrainage,gastricdrainage,andchesttubedrainage),andfluid
lossthatmustbeestimated,suchasprofuseperspirationandwoulddrainage.
Assessmentsforthecriticallyillpatientareongoingandincludefluidbalance,
hemodynamicvalues,andvitalsigns.

AutoimmuneDisorders
Primaryimmunodeficiencydisordersareimmunedisordersyouarebornwith.
Primarydisordersinclude:
ADULT 1 Study Guide for Exam 1 2
o Xlinkedagammaglobulinemia(XLA)
o severecombinedimmunodeficiency(SCIDdisorders)
o commonvariableimmunodeficiency
o Alymphocytosis(boyinabubbledisease)

Secondarydisordershappenwhenyourbodyisattackedbyanoutsidesource,suchasatoxic
chemicaloraninfection.Severeburnsandradiationalsocancausesecondarydisorders.
Secondarydisordersinclude:
o AIDS
o cancersoftheimmunesystem,suchasleukemia
o immunecomplexdiseases,suchasviralhepatitis
o multiplemyeloma

Autoimmunedisorders
o Lupus
o Scleroderma
o Certaintypesofhemolyticanemia
o Vasculitis
o Typeonediabetes
o Gravesdisease
o Rheumatoidarthritis
o Multiplesclerosis(althoughitisthoughttobeanimmunemediatedprocess)
o Goodpasture'ssyndrome
o Perniciousanemia(lackofVitB12)

HIVtesting
Thehumanimmunodeficiencyvirus(HIV)testdeterminesthepresenceofHIVantibodies,
whichistheetiologicfactorforacquiredimmunodeficiencysyndrome(AIDS).
1. Allpatientsages1364,regardlessofrisk,shouldreceiveroutine,voluntaryscreeningfor
HIVinallhealthcaresettingsinwhichtheprevalenceofundiagnosedHIVinfectionsisat
least0.1%
2. AllpatientsbeginningtreatmentforTBshouldbescreenedforHIV
3. AllpatientsseekingtreatmentforsexuallytransmittedinfectionsshouldbescreenedforHIV
eachtimetheyseeksuchtreatment
4. Healthcareprovidersshouldencouragepatientsandtheirprospectivesexpartnerstobe
testedbeforeinitiatinganewsexualrelationship
5. RepeatHIVscreeningshouldbeperformedforpatientswithknownrisksatleastannually.
Patientsknowntobeatriskincludeinjectiondrugusersandtheirsexpartners,personswho
exchangesexformoneyordrugs,sexpartnersofHIVinfectedpersons,andmenwhohave
ADULT 1 Study Guide for Exam 1 3
sexwithmen(MSM)orheterosexualpersonswhothemselvesorwhosesexpartnershave
hadmorethanonesexpartnersincetheirmostrecentHIVtest
ADULT 1 Study Guide for Exam 1 4
HIVtests
o ELSIAtestsforantibodies.Mostused,butdoesnotdetectvirus
o WesternBlotAntibodyTestmorereliable,butmoretimeconsumingandcostly
o Whentestcombined99.9%accuracy
o TBscreening
o MRIofbraintoidentifylesions
o PAPSmears

Stomatitissigns,symptoms,andcare
o isaninflammatoryresponseoftheoraltissues(found514daysfollowingsomechemo,
alsowithirradiationofheadandneckareamaytemporarilyhaltchemoorradiation
goodoralcare,softbristletoothbrushavoidfoodstoohotorcoldortoospicy
analgesics,topicalantifungalsusedmayneedparenteralhydrationandnutrition
o BOX231RiskFactorsforStomatitis
Age>65
Impairedimmunestatus(HIVdisease,cancer,diabetes
Chronicrenalfailureorheartfailure
Chemotherapy,radiationtherapy,stemcelltransplant
Oxygentherapy,mouthbreathing
Medications(antibiotics,phenytoin,anticholinergic,corticosteroids)
Poororalhygiene,illfittingdentures
Tobaccooralcoholuse
Table231ManifestationsandTreatmentofCommonStomatitisConditions:
TYPE CAUSE MANIFESTATION TREATMENT
S
Coldsore,feverblister Herpessimplex Initialburningat Selflimiting
virus site Acyclovir,famciclovir,
Clustered, valacyclovirtoshorten
vesicularlesions course
onlipororal
mucosa
Aphthousulcer Unknown,maybe Well Topicalsteroidointment
(cankersore, typeofherpesvirus circumscribed, Amlexanoxoralpaste
ulcerativestomatitis) shallowerosions (alphtasol)
withwhiteor Oralprednisone
yellowcenter
encircledbyred
ring
Lessthan1cmin
diameter
ADULT 1 Study Guide for Exam 1 5
Painful
Candidiasis(thrush) Candidaalbicans Creamy,white, Fluconazole(diflucan)
curdlikepatches Ketoconazole(nizoral)
Red, Clotrimazoletroches
erythematous Nystatinvaginaltroches
mucosa (dissolvedorally)ormouth
rinse
Necrotizingulcerative Infectionwith Acutegingival Correctanyunderlying
gingivitis(trench spirochetesand inflammationand disorders
mouth,Vincents bacilliorsystemic necrosis Warm,halfstrength
infection) infection Bleeding, peroxidemouthwashes
halitosis Oralpenicillin
Fever
Cervical
lymphadenopathy
Oralmucocitis Damageto Erythemaand Regularoralhygienewith
epithelialcellsand inflammationof brushingandflossing
stemcellsinthesub oralmucosa Salineandsodium
mucosacaused Painful, bicarbonatesolutionmouth
chemotherapyor irregularlyshaped rinsesafterandbetween
radiationtherapy ulcerations, meals
initially Gelclairmouthrinsebefore
superficial, mealsforanalgesia
progressingto Palifermin,andepithelial
deepulcersthat cellgrowthfactor
maybeconfluent Lowlevellasertherapy
(overlappingwith
oneanother)
Pseudomembranes
coveringulcers
Tissuenecrosis
withspontaneous
bleeding,
potentialsepsis
ADULT 1 Study Guide for Exam 1 6
AppropriateNursingDX

Forstomatitis
ImpairedOralMucousMembrane
ImbalancedNutrition:LessthanBodyRequirements
Alteredimmunity
IneffectiveProtection
RiskforImpairedIntegrity
Powerlessness
IneffectiveCoping
Anxiety
RiskforSituationalLowSelfEsteem
ImbalancedNutrition:LessthanBodyRequirements
IneffectiveSexualityPattern
Cancer
Anxiety
Disturbedbodyimage
Anticipatorygrieving
Riskforinfection
Riskforinjury
ImbalancedNutrition:LessthanBodyRequirements
Impairedtissueintegrity
Chronicpain
ADULT 1 Study Guide for Exam 1 7
Roleforcaregiverstrain
Impairedphysicalactivity
Oncology
Cancermeans:
pain
lossofdignity
financialdestitution
dependence
death
Cancerisadiseaseprocessthatbeginswhenabnormalbodycellsfromnormalbodycellsas
aresultofsomepoorlyunderstoodmechanismofchange.Asthediseaseprogresseslocally,
theseabnormalcellsproliferate,ignoringgrowthregulatingsignalsinthemicroenvironment
surroundingthecell.Astageisthenreachedinwhichthecellsacquireinvasive
characteristics,andchangesoccurinsurroundingtissues.Thecellsinfiltratethesetissues
andgainaccesstolymphandbloodvessels,bywhichtheyaretransportedtoform
metastasisinotherpartsofthebody.
C
ommonpathophysiologicmechanism
o Lossofregulationofmitoticrate
o Lossofspecializationanddifferentiationofthecell
o Abilityofthecancercelltomovefromtheoriginalprimarysiteandestablishnew
malignantgrowthsatothertissuesites
o Capacitytoinvadeanddestroynormaltissueinwhichthecancergrows
o Malignancieshavetheabilitytospreadortransfercancerouscellsfromoneorganbody
partoranotherbyinvasionandmetastasis
o Metastasisisthedisseminationofmalignantcellsfromtheprimarytumortodistantsites
bydirectspreadoftumorcellstobodycavitiesorthroughlymphaticandhematogenous
circulation
o Themostcommonmechanismofmetastasisistransportoftumorcellsthrough
lymphaticcirculation.Tumorembolienterthelymphchannelsbywayoftheinterstitial
fluidthatcommunicateswithlymphaticfluid
o Hematogenousspreadordisseminationthroughthebloodstream,ofmalignantcellsis
lesscommon.Fewmalignantcellsareabletosurvivetheturbulentnatureofarterial
circulation

DIFFERENTIATION
o Refersto:
o theextenttowhichthecellsdifferfromtheircellsoforigin
o thecellsdegreeofmaturity
DIFFERENTIATIONOFCELLS
o Theprocessbywhichcellsattainspecificstructuralandfunctionalcharacteristics
ADULT 1 Study Guide for Exam 1 8
o Themorepoorlydifferentiatedatumoris,thelessitresemblesnormalcellsandthe
poorertheprognosis.
ADULT 1 Study Guide for Exam 1 9
CARCINOGENS
o Virusesthoughttoincorporatethemselvesinthegeneticstructureofcells,altering
futurepopulations
o PhysicalAgentssun,radiation,chronicirritationorinflammation,tobacco,asbestos
o ChemicalAgents85%thoughttoberelatedtoenvironmenttobaccosmokeaccounts
for35%
o chemicalsalterDNAstructureinbodysitesdistantfromchemicalexposure
o GeneticandFamilialFactorsabnormalchromosomalpatternsandfamilialinheritance
o DietaryFactors4060%ofallenvironmentalcancerseitherproactiveorcarcinogenic
orcocarcinogenic,reddietmeat
o Fats,highcalorieintake,alcohol,nitrates,saltcured,smokedandnitratecuredfoods
(bologna,hotdogs)
o HormonalAgentstumorgrowthmaybepromotedbydisturbancesinhormonalbalance
(endogenousorexogenous),progesterone
CANCERSEARLYWARNINGSIGNS

PreventionandRiskfactorsrelatedtocancer
CANCERPREVENTIONPROTECTIVEFACTORS:
o Increaseconsumptionoffreshvegetables,especiallythoseofthecabbagefamilyto
increasefiberintake,increaseintakeofvitamins
o Increasefiberintakebecausehighfiberdietsreduceriskofdevelopingcertaincancers
breast,prostate,colon
o IncreaseintakeofVitaminAtoreduceriskofcanceresophagus,larynx,lung
o IncreaseintakeoffoodrichinVitaminCtoprotectagainstcancerofthestomachand
esophagus
o Practiceweightcontroltoreduceriskofcanceruterus,gallbladder,breast,colon
ADULT 1 Study Guide for Exam 1 10
CANCERPREVENTIONRISKFACTORS:
o Reducetheamountofdietaryfattoreduceriskofdevelopingcancerbreast,colon,
prostate
o Reduceintakeofsaltcured,smoked,andnitratecuredfoodstoreduceriskofcancer
esophagus,stomach
o Stopcigarettesmokingtoreduceriskofcanceroflung
o Reducealcoholintaketoreduceriskofcancerliver
o Heavydrinkerswhosmokeareatgreaterriskforcancermouth,throat,larynx,and
esophagus
o Avoidexposuretosunreduceriskofskincancer
STOP
o sun
o radiationexposure
o alcohol
o occupationalhazards
o estrogenhormones
o highfatdiet,nitrates,etc.
o smoking
GRADINGOFTUMORS
o referstotheclassificationofthetumorcells.Seekstodefinetheoriginoftissueofthe
tumorandthedegreetowhichthetumorcellsretainthefunctionalandhistologic
characteristicofthetissuesoforigin
o Assistswithbehaviorandprognosis
o Types
Gx gradecannotbeassessed(e.g.leukemia)
G1 welldifferentiatedcloselyresemblethetissueoforigininstructureandfunction
G2 moderatelywelldifferentiated
G3 poorlydifferentiated
G4 verypoorlydifferentiated,donotresemblethetissueoforigin,tendtobemore
aggressiveandlessresponsivetotreatment
STAGINGdeterminesthesizeofthetumorandtheexistenceofmetastasis
o Clinicalstagingclassificationsystemdeterminestheextentofthediseaseprocessof
cancerbystagesStage0StageIV
o thisclassificationsystemhasbeenusedasabasisforstagingincancerofthecervixand
Hodgkinsdisease
Stage0=cancerinsitu(local)
StageI=tumorlimitedtothetissueoforigin
StageII=limitedlocalspread
StageIII=extensivelocalandregionalspread
StageIV=metastasis
ADULT 1 Study Guide for Exam 1 11
ADULT 1 Study Guide for Exam 1 12
TNMdeterminations
TNMCLASSIFICATIONSYSTEM:Systemusedtodeterminetheextentofthedisease
processofcanceraccordingto3parameters
o tumorsize(T)
o degreeofregionalspreadtothelymphnodes(N)
o metastasis(M)
Primarytumor(T)
T0=noevidenceofprimarytumor
Tis=carcinomainsitu
T14=ascendingdegreesofincreasetumorsizeandinvolvement(knowthis!!!)
Carcinomainsituisacommonlyusedterminclassificationofcancerexceptinvasion.It
isdefinedasalesionwithallofthehistologicfeaturesofcancerexceptinvasion.Ifleft
untreated,carcinomainsituwilleventuallybecomeinvasive
Regionallymphnodes(N)
N0=noevidenceofdisease
N14=ascendingdegreesofnodalinvolvement
NX=regionallymphnodesunabletobeassessedclinically(nodespreviously
removed)
Distantmetastasis(M)
M0=noevidenceofdistantmetastasis
M14=ascendingdegreesofmetastaticinvolvement
o CANCERMANAGEMENT
Curecompleteeradicationofmalignantdisease
Controlprolongedsurvivalwiththepresenceofmalignancy
Palliationreliefofsymptoms
o CANCERTREATMENTOPTIONS
Surgery
Primarytreatmentgoalistoremovetheentiretumorandanyinvolvedsurroundingtissue,
includingregionallymphnodes
Diagnostic
o biopsyforanalysis
o excisional
o incisional
o needlebiopsy
ProphylacticSurgeryremovaloflesionslikelytodevelopintocancer(breastremoval)
PalliativeSurgeryrelievecomplicationsofcancersuchasulcerations,obstructions,
hemorrhage,pain,orinfectionalsosurgicalremovalofhormoneproducingglandsthat
mightenhancetumorgrowth(pituitary,adrenals,ovaries,testes)(removeareacausingpain)
 ADULT 1 Study Guide for Exam 1 13
ReconstructiveSurgerymayfollowcurativeorradicalforbetterreturnoffunctionofbetter
cosmeticeffect

SurgeryNURSINGCONSIDERATIONS
o organimpairment,dysfunction
o nutritionaldeficits
o disordersofcoagulationbleeding,thrombophlebitis
o alteredimmunity,infection
o responsetosurgery
o wounddehiscence
RadiationTherapy
PrimarytreatmentInterruptionincellulargrowth;controlmalignantdiseasewhentumor
inoperable
Palliativerelievesymptomsofmetastasis(endoflife)
Externalakateletherapy,involvesdeliveryofradiationfromasourceatsomedistance
fromthepatient.
Internal- implants used to deliver a high dose of radiation to a localized area (needles, seeds,
beads, catheters) (breast, bladder, prostate cancers) Brachytherapy is an advanced cancer
treatment. Radioactive seeds or sources are placed in or near the tumor itself, giving a high
radiation dose to the tumor while reducing the radiation exposure in the surrounding healthy
tissues.
ADULT 1 Study Guide for Exam 1 14
ADULT 1 Study Guide for Exam 1 15
RadiationTXnursingcareincludingpatientteaching
NURSINGCAREOFTHEPATIENTReceivingRadiationTherapypg.366
 ADULT 1 Study Guide for Exam 1 16
BOX145SafetyPrinciplesforRadiation
Theserecommendationsapplytocaregiversworkingwithpatientsreceivinginternalradiation
(brachytherapy)
maintainthegreatestpossibledistancefromthesourceofradiation
spendtheminimumamountoftimeclosetotheradiationsource
shieldyourselffromtheradiationwithleadglovesandapronswhenpossible
ifpregnant,avoidcontactwithradiationsources
ifyouworkroutinelywithradiation,wearamonitoringdevicetomeasurewholebody
exposure
avoiddirectexposurewithradioisotopecontainers;forexample,donottouchthecontainer
keeppatientswithimplantedradioisotopesinaprivateroomwithprivatebathandasfar
awayfromotherhospitalizedpersonsaspossible
disposeofbodyfluidsofpatientswithunsealedimplantedradioisotopeswithspecialcare
andaccordingtoagencyprotocol
uselonghandledforcepstoplaceanydislodgedimplantsintoaleadcontainer
consultwiththeradiationtherapydepartmentforanyquestionsorproblemsincaringfor
patientswithradioactiveimplants

Chemotherapy
Useofantineoplasticagentstopromotetumorcelldeath
Usuallyusedtotreatsystemicdisease
maybeinconjunctionwithradiationandsurgeryorboth
Cellcyclespecificdrugs=destroycellsinspecificphasesofthecellcycleinterferewith
DNAandRNA
Cellcyclenonspecificdrugs=actindependentlyofcellcyclephases;usuallyhavea
prolongedeffectoncells,leadingtocellulardamageordeath
Routesofadministration
o topical
o oral
o IVspecialcarewithIVvesicantdrugs,tissuenecrosisanddamageifSQ
o IM
o subcutaneous
o arterial
o intracavitary
o intrathecalspinalorcerebral(cerebrospinalfluidCSF)
ToxicityN&Vcommon,bonemarrowdepression,decreasedrenalandcardiacfunction,
possiblesterility,peripheralneuropathies
 ADULT 1 Study Guide for Exam 1 17
ChemotherapyTXnursingcareincludingpatientteaching
ChemotherapyNURSINGCONSIDERATIONS
o Nutritiontastechanges
o Fluidandelectrolytedisturbances
o Anemia
Anorexia,nausea,vomiting,alteredtaste,diarrheaputtheclientatriskfornutritional
andfluidandelectrolytedisturbances.
ChangesinthemucosaoftheGItractmayleadtoirritationoftheoralcavityand
intestinaltract
Assessandfindcreativewaystoencourageandadequatefluidanddietaryintake
o Infection&Bleedingsuppressionofthebonemarrowandimmunesystem
asepsis,gentlehandling,preventionoftrauma;monitorCBC
o Chemotherapyadministrationobserveclosely,riskofextravasation
Selfprotectionuseprecautions,canbeexposedtolowdosesbydirect
contact,inhalation,andingestion
safetycabinetlatexgloveslongsleevesluerlocksonIVtubing
disposeinpunctureproofcontainersdisposehazardouswaste

Rememberwewantchemopatientstostayaheadofthesideeffects,sowhatweoftengive
asPRNmedications,wetellthesepatientstotakearoundtheclock,especiallypainand
nauseamedications.
BoneMarrowTransplantation(BMT)
o Allogeneicdonor
o Autologousown
o Syngeneicidenticaltwin
o BMTindicatedformalignantandnonmalignantdiseases
o goalisCURE
o cureratesarestilllowbutincreasing
o mosttransplantsresultinaperiodofremission
o Becauseitishighlytoxictherapy,thepatientmustweighthesignificantrisksoftreatment
relateddeathortreatmentfailure(relapse)withthehopeofcure
o BMTallowsforthesafeuseofveryhighdosesofchemotherapyorradiationtherapyto
patientwhosetumorshavedevelopedresistanceorfailedtorespondtostandarddosesof
chemoorradiation
o COMPLICATIONS
Infection
o Bacterial,viral,andfungalinfectionsarecommonfollowingBMT
o prophylacticantibiotictherapymayreducetheirincidence
graftversushostdisease
 ADULT 1 Study Guide for Exam 1 18
o occurswhentheTlymphocytesfromthedonatedmarrow(graft)recognizethe
recipient(host)asforeignandbegintoattackcertainorganssuchastheskin,liver,
andintestines
Peripheralstemcelltransplantation
anemergingandpromisingalternativetoBMTisperipheralstemcelltransplant
intheorytheperipheralorcirculatingstemcellsarecapableofrepopulatingthebone
marrow
o NURSINGDIAGNOSES
fatigue
fear
riskforinfection
alterednutrition:lessthanbodyrequirements
pain
socialisolation
NURSINGINTERVENTIONSFORCLIENTSWITHCANCER:
1. ASSESSFOR:
infection
bleeding
skinintegrity
nutrition
pain
mentalstatus
bodyimage
FactorsPredisposingClientswithCancertoInfection
o Impairedskinandmucousmembraneintegritylossoffirstlineofdefense
o chemotherapysuppressionofbonemarrow,somecausemucositisimpairingskinintegrity
o Radiationtherapyifsiteofbonemarrowcausesuppression,mayalsoleadtoimpairedtissue
integrity
o Biologicresponsemodifierssomecauseorgandysfunctionand/orbonemarrowsuppression
o Malignancyinfiltratebonemarrowimpairingfunctionandproductionofbloodcells
o Malnutritionresultsinimpairedfunctionandproductionofcellsoftheimmuneresponse,may
leadtoimpairedskinintegrity
o Medications:antibioticsmaydisturbnaturalflora;corticosteroidsandnonsteroidalanti
inflammatorydrugsmaskinflammatoryresponse
o UrinaryCathetercreatesportandentryfororganisms
o IVCatheterresultsinimpairedskinintegrityandentryportfororganisms
o InvasiveProceduresleaveportalofentryfororganisms
o ContaminatedEquipmenti.e.stagnantwater=growthofmicroorganisms
o Ageassociatedwithdecreasingorganfunctionandalteredimmunesystemfunc
o ChronicIllnessassociatedwithimpairedorganfunctionandalteredimmuneresponse
 ADULT 1 Study Guide for Exam 1 19
o ProlongedHospitalizationallowsexposuretonosocomialinfection,organisms
2. PLANIMPLEMENT
Preventinfection
Preventbleeding,injury
Maintaintissueintegritycarefulskincareskinoverinfectedareaishandledgently;rubbing
anduseofhotorcoldwater,soaps,powders,lotionsandcosmeticsavoided;preventtraumato
area
o Stomatitis:isaninflammatoryresponseoftheoraltissues(found514daysfollowing
somechemo,alsowithirradiationofheadandneckarea
maytemporarilyhaltchemoorradiationgoodoralcare,softbristletoothbrush
avoidfoodstoohotorcoldortoospicyanalgesics,topicalantifungalsusedmay
needparenteralhydrationandnutrition
o Alopeciasecondarytosomechemoandradiation=wigorhairpiece
o MalignantSkinLesioncleanse,controlbleeding
Maintainnutritionalstatusalwaysdo1st
Reliefofpainalwaysdo1st
Decreasingfatiguelimitfatigue,goodnutrition,managepain
Monitoringandmanagingpotentialcomplications
o infectionandsepsisleadingcauseofdeath
o feverimportantsign101reportedanddealtwithpromptly
o medicationsantibioticsfollowingcultures
o preventionstrictasepsis
o septicshockassess,monitorclosely
o bleedingandhemorrhage
o thrombocytopeniadecreaseinplatelets
Progressionthroughthegrievingprocess
Improvedbodyimageletexpressfeelings
Improvedselfesteem
Collaborativeintervention
2. GERONTOLOGICCONSIDERATIONS
decreasedskinelasticity
decreasedskeletalmass,structureandstrength
decreasedorganfunctionandstructure
impairedimmuneresponsemechanisms
alterationsinneurologicfunction
altereddrugsabsorption,distribution,metabolismandexcretion
increasedriskforpotentialtoxicities
itisnotunusualfortheelderlytodelayreportingsymptoms,attributingthemtooldage
 ADULT 1 Study Guide for Exam 1 20
manyelderlydonotwanttoreportillnessforfearoflossofindependence,rolefunctions,and
financialsecurity
thenurseactsasanadvocatefortheclient,encouragingindependenceandprovidingsupport
ONCOLOGICEMERGENCIES
HYPERCALCEMIAabnormalcalciummetabolismCA>11mg/dl
o S/S=fatigue,weakness,decreasedlevelofresponsivenessencourageambulationandfluidsif
notcontraindicated
SUPERIORVENACAVASYNDROMEcompressionimpairsvenousdrainageofhead,
neck,armsandthoraxSOB,dyspnea,cough,facialswelling,distendedveinsmayleadto
IICP,headache,alteredLOC,visualdisturbancesRadiationtodecreasetumorsizefacilitate
breathing,reportASAP
CARDIACTAMPANADEPERICARDIALEFFUSIONfluidaccumulatesimpeding
cardiacfillingduringdiastole
o pumpfailsandcirculatoryfailure=distendedneckveins,SOB,distantheartsounds,weakness,
lethargy
mayneedpericardiocentesis
o Nursingmonitorvitalsigns,ECG,heartandlungsounds,I&O,ABGs,lytes
DIC(disseminatedintravascularcoagulation)clottingandbleeding
o Nursingvitalsigns,I&O,monitorbleeding
CAROTIDRUPTURE
SPINALCORDCOMPRESSIONsecondarytometastasis(pain)inflammation,edema=
neurodeficitsRadiation,frequentneuroassessments
SIADH(syndromeofinappropriateantidiuretichormone)increaseinECFvolumeandwater
intoxication
o I&O,LOC,VS
SEPSIS
TUMORLYSISSYNDROMEelectrolyteimbalance(highK,lowCA,highphosphate
o nursingpreventrenalfailure,hydration,Kayexalateforhyperkalemia

KNOWTHEDIFFERENCESBETWEENBENIGNANDMALIGNANTTUMORS

TABLE142ComparisonofBenignandMalignantNeoplasms
BENIGN MALIGNANT
Local Invasive
Cohesive Noncohesive
Welldefined Doesnotstopattissueborder
Pushesothertissuesoutoftheway Invadesanddestroyssurroundingtissues

Slowsgrowth Rapidgrowth
ADULT 1 Study Guide for Exam 1 21
Encapsulated Metastasizedtodistantsites
Easilyremoved Notalwayseasytoremove
Doesnotrecur Canrecur
 ADULT 1 Study Guide for Exam 1 22
Appropriatescreeningsandagesthattheyarerecommended

MetastaticDisease
Metastasiscanoccurby:
embolismintothebloodorlymphor
spreadbywayofbodycavities
ADULT 1 Study Guide for Exam 1 23
Mastectomyteaching