Common 2

• Primary prevention:
• Reduce risks through health promotion & risk reduction
• Avoid known carcinogens
• Some meds to reduce risk (ASA for colon, Tamoxifen for breast)
• Secondary prevention
• Screenings and early detection activities
• Tertiary prevention
• Monitoring for and preventing recurrence of primary cancer
• Screening for development of second malignancies in cancer survivors

• Wear PPE
• Long sleeve, disposable gowns made of polyethylene coated polypropylene
• double layer pwdr free gloves designed for chemo
• Wash hands soap & water
• Spill kits
• Equip disposed of in closed, puncture and leak proof container labeled "hazardeous: chemo waste" (may be yellow)

• Extravasation: 
• pH of irritant agents induce inflammation
• can cause tissue damage & necrosis
• only admin by those w established competency
• NEVER in peripheral veins w hand or wrist
• Hypersensitivity-chemo pose higher risks & are life-threatening
• First thing to do... STOP DRUG!

• Cells w rapid growth rates very susceptible to damage (gut, skin, bone marrow)
• N/V most common SE
• Renal issues (SIADH, decreased renal perfusion, nephritis)
• Cardiac toxicity
• Testicular and ovarian function can be affected = sterility
• Neurotoxicity

• Syndrome of inappropriate antidiuretic hormone (ADH) secretion (SIADH)
• the hyponatremia and hypo-osmolality resulting from inappropriate, continued secretion or action of the hormone despite normal or increased plasma volume, which results in impaired water excretion.
• The hyponatremia results from an excess of water rather than a deficiency of sodium.

• Have less than 6 months to live
• Must have 2 physician's document

• Focuses on:
• Quality of life
• Palliation of symptoms
• Physical, psychosocial and spiritual support

• Never in peripheral veins involving the hand or wrist.  
• Stop the med immediately if extravasation is suspected.

• No BP, IV's, labs or venous pokes on arm the same side as mastectomy 
• This is because all the lymph nodes have been taken

• Dissemination or spread of malignant cells from the primary tumor
• Lymph and blood are key mechanisms for cancer cells to spread
• Lymphatic spread is most common type

• side effect of some cancer treatments
• 3 types:
• Anemia (RBC)
• Thrombocytopenia (platelets- blood clotting)
• Leukopenia (WBC)

• ID and treat underlying cause
• Help manage Sx
• PRBC (packed RBC)
• Measure erythropoietin (hormone that tells bone marrow to make more)
• Relaxation 
• Adequate protein and calories
• Journaling fatigue patterns

• Monitor platelet count
• Assess for bleeding
• Education to minimize bleeding
• Measures to minimize bleeding

• NO CONTACT SPORTS!
• Petechiae or ecchymosis
• Hgb/hct
• Prolonged bleeding
• Frank or occult blood (in vomit, feces, urine) 
• Altered mental status

• Soft toothbrush
• Avoid commercial mouthwashes
• Use electric razor
• Emery board for nail care
• Avoid foods difficult to chew

• No Im injections
• No rectal temps
• No suppositories
• direct pressure to venipuncture sites for 5 min
• lubricate lips
• avoid bladder cath
• stool softeners
• avoid ASA (ASPIRIN)

• Assess pt for evidence of infection
• V.S. every 4 hrs
• WBC w differential
• Inspect IV sites, wounds, skin folds, bony prominences, perineum and oral cavity
• Report fever
• Need private room
• avoid people w recent infect or vaccination
• Handwashing
• Avoid rectal or vaginal procedures
• stool softners
• Education about safe food handling (Can't eat fruits can't be washed well)
• Avoid urinary cath

• *nearly all chemo leads to bone marrow supr.
• Anemia:  fatigue, paleness, increased heart rate, tiring easily with exertion, dizziness, SOB
• Leukopenia: Weak immune system
• Thrombo: Easy bruising, nosebleeds, bleeding of mouth/gums, occult blood, petechiae

• *Altered skin integrity most common! (Burns) skin care important after radiation
• Body tissues most affected are those that proliferate rapidly (Skin, GI, bone marrow)
• Stomatitis (canker sores)
• Xerostomia
• loss of taste
• Mucositis
• Systemic affects: fatigue, alaise, anorexia
• Impaired wound healing

• Avoid soaps, cosmetics, perfumes, powders, lotions and ointments
• Use lukewarm water to bathe the area
• Avoid rubbing, scratching, shaving, hot water bottles, heating pads, ice, sunlight, cold or tight clothes
• Pay close attention to rashes

• For hematologic malignancies
• Is high dose chemo and total body irradiation 
• Much higher Risk for anemia,leukopenia, thrombocytopenia.
• Patients are highly immunocompromised so limit visitors and take precautions for infection prevention.

*For ultrasonography (which is initial dx procedure), bladder needs to be full 

In bladder training, scan bladder immediately after voiding

• Prevent backflow
• empty cath every 8 hrs
• bag below bladder level

• *urologic endoscopic procedure to visualize urethra and bladder
• may cause trauma to mucous membranes
• warm heat may help

• Start at Stage 5 renal failure
• When GFR is <15%

• *End Stage Renal Disease
• DM
• HTN
• Proteinuria
• Family history
• Increase age

• Stage 1: >90%
• Stage 2: 60-89%
• Stage 3: 30-59%
• Stage 4: 15-29%
• Stage 5: <15%

*GFR estimates how much blood passes through the glomeruli per minute

• daily weights 1 liter = 1 kg
• Costovertebral angle discomfort
• I & O (<500 mL/day is oliguria)
• skin turgor, edema, JVD (fluid overload)
• VS

• Biopsy - used to dx or eval extent of kidney disease
• Lab values:
• Creatinine clearance 24 hr urine specimen (will check serum creatinine 1/2 through)
• BMP
• GFR

UA: Specific gravity, proteinuria, glycosuria

PAIN!!

• If stone is in uretero pelvic junction, needs immediate attention!!!
• Don't want stone to get into kidney

Excretes H+ into urine, reabsorbs HCO₃ (bicarb)

Reabsorbs base, pees out acid

• *shoots laser to break up stones
• Call MD for fever, or cloudy/foul urine
• Strain urine for gravel or sand

• the most useful information is initially obtained from estimation of the glomerular filtration rate (GFR) and examination of the urinary sediment.
• Other s/s impaired kidney function is hematuria, flank pain, or extrarenal symptoms (edema, hypertension, signs of uremia-(high levels of waste products in blood))

• creatine
• weight
• age
• sex
• race

• UI is NOT part of normal aging
• Short term UI in older adults can be caused by UTI’s, vaginal  infections or irritations (estrogen vaginal cream can help), constipation, and some medication
• Types of UIs: Stress, functional, urge, overflow (common with BPH)

• With UTI, commonly contaminated with bacteria
• >105 colonies/mL distinguishes true bacteria from contamination

• Dullness on percussion of suprapubic region
• Bladder scan (In older adults, 50-100 mL residual is normal)

• increase fluids,
• pyridium may cause orange urine,
• antibiotics may cause secondary infections

• Dumping syndrome (when stomach rapidly and without regulation empties its contents into the small intestines)
• cholelithiasis (gallstones)
• pulmonary embolism and deep vein thrombosis
• anastomotic leak (can be life-threatening), death (0.15% to 0.64%).

*anastomotic leak refers to leak from two luminal structures , like connecting two segments of bowel

• can only have 600-800 cal per day
• must have smaller, more frequent meals
• no more than 1 cup
• eat slow
• 120 mL fluid btwn meals
• vitamin education
• need B12 injection (peri-anemia)

• *tissue perfusion (could cut off vascular supply)
• *electrolyte balance
• *Pain management

NPO, decompress bowel,  NG tube suction, rectal tube, monitor fluids/ electrolytes, surgery may be necessary.

Impaired Tissue perfusion and risk for fluid/ electrolyte imbalance

• Older age,
• history of polyps/ cancer,
• UC and Crohn’s
• family history
• low- fiber and high fat diet, sedentary lifestyle/obesity
• DM
• smoking, alcohol abuse

• Increase fluids and fiber
• exercise
• laxative
• target underlying cause

• *partial or whole stomach surgically removed.
• Teach about changes in GI function.
• Need B12 injections to prevent pernicious anemia
• risk for bowel obstruction
• small meals <1 cup, 600-800 kcal/day
• fluids between meals
• increase protein, lower carbs
• eat slowly
• Raise head of bed
• take vitamins
• exercise

• weight loss?
• One study defined success as a loss of more than 50% of excess body weight and failure as a loss of less than 30% of excess body weight at one year after surgery.
• The American Diabetes Association recommends that patients with a BMI of ≥35 kg/m2 &/or type 2 diabetes also be considered for bariatric surgery, especially if the diabetes has not been well controlled with lifestyle changes and pharmacotherapy.

• antiacids
• PPI 
• H₂ blockers
• Metoclopramide (Reglan) to increase peristalsis.
• Possible surgery (nesin-fludo plycation)

• avoid caffeine, alcohol, milk, tobacco
• avoid eating/drinking 2 hrs before bed
• maintain normal weight
• avoid tight fitting clothes
• low fat diet
• elevate HOB

frequent acid reflux caused by abnormal relaxation of esophageal sphincter.

• Black tarry stool or coffee ground vomit for upper GI bleed,
• Blood in stool.
• could come from Ulcers from gastritis.

• High protein & calorie
• Low residue
• Low fiber

• A low residue diet is a diet designed to reduce the frequency and volume of stools while prolonging intestinal transit time.
• Typically includes restrictions on foods that increase bowel activity, such as milk, milk products, and prune juice.

• decrease inflammation
• suppress immune response
• rest for bowel

• Fluid/ electrolyte balance
• no GI bleeding
• no megacolon or cancer

• Antidiarrheal
• Regulan?? antiperistaltic 
• Sulfasalazine (Azulfidine)  is inflammatory.
• Corticosteroids
• Humera is immunomodulator
• surgery

• *parotitis is inflammation of the gland that produces saliva
• Xerostomia is greatest risk factor
• poor oral hygiene
• smoking

• Eradicate H.Pylori & acidic
• antibiotics
• PPI
• Bismuth
• Stop smoking
• Avoid extreme temp w/ food
• Avoid alcohol, caffeine
• 5 small meals daily

• H. Pylori #1 cause
• also overuse of NSAIDs
• Alcohol abuse/smoking
• stress
• gastritis
• Can form in esophagus, stomach, or duodenum

• ongoing pain
• skin integrity
• infection
• drainage

• cover with moist, sterile dressing
• call dr.
• keep pt calm
• decrease HOB and elevate knees.

Inflammation, proliferation, maturation

• redness, warmth, swelling, purulent discharge, increased WBC, fever, chills, increased HR, hypotensive, tachypnea,  odor.
• Wound infection not usually noticeable until post-op day 5.

severe congestive heart failure

Roux-en-Y gastric bypass.

Vertical sleeve gastrectomy

Biliopancreatic diversion with duodenal switch

Adjustable gastric banding

• Vertical banded gastroplasty
• "stomach stapling"

RYGB

HTN

distal ileum

100%

The tightness of the silicone band can be adjusted

stomach emptying is delayed

have had diabetes for longer periods of time

BPD-DS

• sleep apnea
• (guide also listed GERD)

abdominal cramping

dizziness, N/V, bloating, and diarrhea

is related to postoperative weight loss, rather than to the surgery (especially in women)

administration of oral clopidogrel (Plavix)

an anastomotic leak

sepsis  (is 3rd)

• 1st: PE
• 2nd: Cardiac Complications

taking a higher dosage of antianxiety meds

50%

Protein deficiency is common and protein shakes may be prescribed