NUR 2214 Study Guide Spring Exam 3 latest 2023 /2024
- Sickle cell anemia
- Definition/Pathophysiology
- Pathologic changes
- Vaso occlusive crisis
• Sickle cell disease (SCD), which used to be called sickle cell anemia, is a genetic disorder that results in chronic anemia, pain, disability, organ damage, increased risk for infection, and early death • This disorder results in the formation of abnormal hemoglobin chains.• the clumped masses of sickled RBCs block blood flow, known as a vaso-occlusive event (VOE).VOE leads to further tissue hypoxia (reduced oxygen supply) and more sickle-shaped cells, which then leads to more blood vessel obstruction and ischemia in the affected tissues. Repeated episodes of ischemia cause progressive organ damage from anoxia and infarction. Conditions that cause sickling include hypoxia, dehydration, infection, venous stasis, pregnancy, alcohol consumption, high altitudes, low or high environmental or body temperatures, acidosis, strenuous exercise, emotional stress, and anesthesia.• Pain is the most common manifestation of SCD crisis. Others vary with the site of tissue damage.Cardiovascular changes, including the risk for high-output heart failure, occur because of the anemia. Assess the patient for shortness of breath and general fatigue or weakness. Other problems may include murmurs, the presence of an S3 heart sound, and increased jugular- venous pulsation or distention. Assess the cardiovascular status by comparing peripheral pulses, temperature, and capillary refill in all extremities. Extremities distal to blood vessel occlusion are cool to the touch with slow capillary refill and may have reduced or absent pulses. Heart rate may be rapid and blood pressure may be low to average with anemia.
• Caused by stasis of blood with clumping of cells in the microcirculation, ischemia, and infarction Manifestations: Fever; painful swelling of hands, feet, and joints; and abdominal pain Precipitating factors for a crisis • Conditions that cause sickling include hypoxia, dehydration, infection, venous stasis, pregnancy, alcohol consumption, high altitudes, low or high environmental or body temperatures, acidosis, strenuous exercise, emotional stress, and anesthesia.• Situations that precipitate sickling include fever, dehydration, and emotional or physical stress; any condition that increases the need for oxygen or alters the transport of oxygen can result in sickle cell crisis (acute exacerbation).Nursing care during a crisis • Care of the Patient in Sickle Cell Crisis • Administer oxygen. • Administer prescribed pain medication. • Hydrate the patient with normal saline IV and with beverages of choice (without caffeine) orally. • Remove any constrictive clothing. • Encourage the patient to keep extremities extended to promote venous return. • Do not raise the knee position of the bed. • Elevate the head of the bed no more than 30 degrees. • Keep room temperature at or above 72° F (22.2° C).• Avoid taking blood pressure with external cuff. • Check circulation in extremities every hour: Pulse oximetry of fingers and toes Capillary refill Peripheral pulses Toe temperature • 1. Maintain adequate hydration and blood flow through oral and intravenously (IV) administered fluids. Electrolyte replacement is also provided as needed; without adequate hydration, pain will not be controlled. 2. Administer oxygen and blood transfusions as prescribed to increase tissue perfusion; exchange transfusions, which reduce the number of circulating sickle cells and the risk of complications, may also be prescribed. 3. Administer analgesics as prescribed (around the 1 / 3
clock). 4. Assist the child to assume a comfortable position so that the child keeps the extremities extended to promote venous return; elevate the head of the bed no more than 30 degrees, avoid putting strain on painful joints, and do not raise the knee gatch of the bed. 5.Encourage consumption of a high-calorie, high-protein diet, with folic acid supplementation. 6.Administer antibiotics as prescribed to prevent infection. 7. Monitor for signs of complications, including increasing anemia, decreased perfusion, and shock (mental status changes, pallor, vital sign changes). 8. Instruct the child and parents about the early signs and symptoms of crisis and the measures to prevent crisis. 9. Ensure that the child receives pneumococcal and meningococcal vaccines and an annual influenza vaccine because of susceptibility to infection secondary to functional asplenia. 10. A splenectomy may be necessary for clients who experience recurrent splenic sequestration. 11. Inform parents of the hereditary aspects of the disorder Prevention of crisis • Prevention of Sickle Cell Crisis • Drink at least 3 to 4 liters of liquids every day. • Avoid alcoholic beverages. • Avoid smoking cigarettes or using tobacco in any form. • Contact your health care provider at the first sign of illness or infection. • Be sure to get a “flu shot” every year. • Ask your health care provider about taking the pneumonia vaccine. • Avoid temperature extremes of hot or cold. • Be sure to wear socks and gloves when going outside on cold days. • Avoid planes with unpressurized passenger cabins. • Avoid travel to high altitudes (e.g., cities like Denver and Santa Fe). • Ensure that any health care professional who takes care of you knows you have sickle cell disease, especially the anesthesia provider and radiologist. • Consider genetic counseling. • Avoid strenuous physical activities. • Engage in mild, low-impact exercise at least 3 times a week when you are not in crisis.• Thrombocytopenia-reductions in platelets • Leukopenia- a reduction in white blood cells
- Cancer
- Primary prevention
• Preventing cancer from occurring is the most definitive way to lessen the burden of cancer. Risk factors can be eliminated or reduced through behavior modification, modification of the environment, vaccination, or treatment of infections. Major risk reduction is possible through smoking cessation, avoiding excessive sun exposure, participating in regular physical activity, and eating a balanced diet • Avoidance of known or potential carcinogens is an effective prevention strategy when a cause of cancer is known and avoidance is easily accomplished. For example, teach people to use skin protection during sun exposure to avoid skin cancer. Much lung cancer can be avoided by not using tobacco and by eliminating environmental asbestos exposure. Teach everyone about the dangers of cigarette smoking and other forms of tobacco use. Teach people who are exposed to carcinogens in the workplace to use personal protective equipment that reduces direct contact with this substance. As more cancer causes are identified, avoidance may become even more effective. Modifying associated factors appears to have a positive influence in reducing cancer risk.• Removal of “at risk” tissues reduces cancer risk for a person who has a known high risk for developing a specific type of cancer. Examples include removing moles to prevent conversion to skin cancer, removing colon polyps to prevent colon cancer, and removing breasts to prevent breast cancer. Not all “at risk” tissues can be removed (e.g., those that are part of essential organs). Chemoprevention is a strategy that uses drugs, chemicals, natural nutrients, or other substances to disrupt one or more steps important to cancer development. 2 / 3
• Vaccination is a new method of primary cancer prevention. Although vaccines against colon cancer and others are being 369explored, currently the only vaccine approved for cancer prevention prevents infection from several forms of the human papilloma virus (HPV).
- Seven warning signs of cancer
- General client problems related to cancer
- Skin Cancer
• Warning Signs of Cancer—CAUTION ▪ Change in bowel or bladder habits ▪ Any sore that does not heal ▪ Unusual bleeding or discharge ▪ Thickening or lump in breast or elsewhere ▪ Indigestion ▪ Obvious change in wart or mole ▪ Nagging cough or hoarseness
• Metastasizing (spreading) into vital organs • Reduce immunity and blood producing functions • Altered GI structure and function • Motor and sensory deficit • Decreased respiratory function
Signs and symptoms Actinic Keratosis (Premalignant)
Small (1-10 mm) macule or papule with dry, rough, adherent yellow or brown scale Base may be erythematous Associated with yellow, wrinkled, weather-beaten skin Thick, indurated keratoses more likely to be malignant Cheeks, temples, forehead, ears, neck, backs of hands, and forearms May disappear spontaneously or reappear after treatment. Slow progression to squamous cell carcinoma is possible Squamous Cell Carcinoma Firm, nodular lesion topped with a crust or with a central area of ulceration Indurated margins Fixation to underlying tissue with deep invasion Sun-exposed areas, especially head, neck, and lower lip Sites of chronic irritation or injury (e.g., scars, irradiated skin, burns, leg ulcers) Rapid invasion with metastasis via the lymphatics occurs in 10% of cases. Larger tumors are more prone to metastasis.Basal Cell Carcinoma Pearly papule with a central crater and rolled, waxy borders Telangiectasias and pigment flecks visible on close inspection Sun-exposed areas, especially head, neck, and central portion of face Metastasis is rare. May cause local tissue destruction. 50% recurrence rate related to inadequate treatment.Melanoma Irregularly shaped, pigmented papule or plaque Variegated colors, with red, white, and blue tones Can occur anywhere on the body, especially where nevi (moles) or birthmarks are evident Commonly found on upper back and lower legs Soles of feet and palms in dark-skinned people Horizontal growth phase followed by vertical growth phase. Rapid invasion and metastasis with high morbidity and mortality.
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