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Chronic II - Exam 1 practice questions and key points

Terms in this set (71)

End-of-life care (EOL care) is the term currently used for issues related to death and dying, as well as services provided to address these issues.

The goals for EOL care are to (1) provide comfort and supportive care during the dying process, (2) improve the quality of the patient's remaining life, (3) help ensure a dignified death, and (4) provide emotional support to the family.

Certain symptoms are more prevalent at the EOL, including respiratory distress and shortness of breath (dyspnea). The sensation of air hunger results in anxiety for the patient and family.

Noisy, wet-sounding respirations, termed the death rattle or terminal secretions, are caused by mouth breathing and accumulation of mucus in the airways.

Cheyne-Stokes respiration is a pattern of breathing characterized by alternating periods of apnea and deep, rapid breathing.

Most terminally ill and dying people do not want to be alone and fear loneliness.

Grief is a normal reaction to loss. It is dynamic and includes both psychologic and physiologic responses following a loss.

Priority interventions for grief must focus on providing an environment that allows the patient to express feelings.

Bereavement is the period following the death of a loved one during which grief is experienced and mourning occurs.

The objective of a bereavement program is to provide support and to assist survivors in the transition to a life without the deceased person.

People who are dying deserve and require the same physical care as people who are expected to recover.

To meet the holistic needs of the patient, collaborate with the social worker, chaplain, physical therapist, occupational therapists, unlicensed assistive personnel (UAP), and physician.

Spirituality is defined as those beliefs, values, and practices that relate to the search for existential meaning and purpose and that may or may not include a belief in a higher power.

The patient's and family's preferences related to spiritual guidance or pastoral care services should be noted.

Culture affects decision-making with regard to life support and withholding and withdrawing of treatments.

Legal issues that should be discussed prior to death are the choice for (1) organ and tissue donations, (2) advance directives (e.g., medical power of attorney, living wills), and (3) resuscitation.
-Advance directives are written statements of a person's wishes regarding medical care, including the desire to withhold or withdraw treatments.
-A DNR is a written medical order that documents a patient's or family's wishes regarding resuscitation—most importantly, the desire for the use of CPR
Since HIV infection can be prevented, nursing care for individuals not known to be infected with HIV should focus on preventing disease transmission.
The first step is to assess the patient's individual risk behaviors, knowledge, and skills.
Based on the assessment, nursing interventions can then encourage the patient to adopt safer, healthier, and less risky behaviors, particularly in regard to sexual intercourse, drug use, perinatal transmission, and work issues.

The overriding goals of therapy for infected individuals are to keep the viral load as low as possible for as long as possible, maintain or restore a functioning immune system, improve the patient's quality of life, prevent opportunistic disease, reduce HIV-related disability and death, and prevent new infections.

Nursing interventions are based on and tailored to patient needs at every stage of HIV disease and can be instrumental in improving the quality and quantity of the patient's life.

Nursing care can assist the patient to (1) adhere to drug regimens; (2) promote a healthy lifestyle that includes avoiding exposure to other sexual and blood-borne diseases; (3) protect others from HIV; (4) maintain or develop healthy and supportive relationships; (5) maintain activities and productivity; (6) explore spiritual issues; (7) come to terms with issues related to disease, disability, and death; and (8) cope with the frequent symptoms caused by HIV and its treatments.

Teach patients and families about treatment options: (1) advantages and disadvantages of new treatments, (2) dangers of nonadherence to therapeutic regimens, (3) how and when to take each drug, (4) drug interactions to avoid, and (5) side effects that must be reported to the HCP.

While HIV-infected patients share problems experienced by all individuals with chronic diseases, these problems are exacerbated by negative social attitudes and stigma associated with HIV. Discrimination related to HIV infection can lead to social isolation, dependence, frustration, low self-image, loss of control, and economic pressures.

Should the nurse be exposed to HIV-infected fluids, postexposure prophylaxis (PEP) with combination ART can significantly decrease the risk of infection.
The goal of chemotherapy is to eliminate or reduce the number of malignant cells present in the primary tumor and metastatic tumor site(s).
The two major categories of chemotherapy drugs are cell cycle phase-nonspecific and cell cycle phase-specific drugs.
Cell cycle phase-nonspecific drugs have their effect on the cells during all phases of the cell cycle.
Cell cycle phase-specific drugs exert their most significant effects during specific phases of the cell cycle.
Chemotherapy drugs are classified in general groups according to their molecular structure and mechanisms of action.
It is very important to know the specific guidelines for the safe preparation and administration of chemotherapy drugs, since they may pose an occupational health hazard.
Chemotherapy can be administered by multiple routes, including oral or IV. The most common is IV administration through central vascular access devices, peripherally inserted central venous catheters, or implanted infusion ports. The use of these means reduces the risk of extravasation.
Increasingly chemotherapy may be self-administered orally by patients. Providing instruction about proper medication handling and ensuring accurate dosing compliance are important nursing considerations.
Regional treatment with chemotherapy involves the delivery of the drug directly to the tumor site. The most common methods are intraarterial, intraperitoneal, intravesical bladder, and intrathecal or intraventricular.
Chemotherapy-induced side effects are the result of the destruction of normal cells, especially those that are rapidly proliferating such as those in the bone marrow, lining of the gastrointestinal system, and the integumentary system (skin, hair, and nails).
The general and drug-specific adverse effects of these drugs are classified as acute, delayed, or chronic. Some side effects fall into more than one category. Late or lasting effects can make a significant impact on survivorship.
Radiation is the emission and distribution of energy through space or a material medium.

Simulation is a part of radiation treatment planning used to determine the optimal treatment method by focusing on accurately localizing the tumor/target field and ensuring set-up position reproducibility.

Radiation is used to treat a carefully defined area of the body either by itself or in combination with surgery or chemotherapy. It can also be used as palliative treatment for symptom control in patients with metastatic disease.

Teletherapy or external beam radiation (EBRT) is the most common form of radiation treatment delivery and involves the delivery of ionizing radiation to kill cancer cells. With this technique, the patient is exposed to radiation (typically high energy photons) generated from a megavoltage treatment machine.

Brachytherapy, or internal radiation treatment, consists of the implantation or insertion of radioactive materials directly into the tumor/involved tissues (interstitial) or in close proximity adjacent to the tumor (intracavitary or intraluminal).

Implants may be permanently placed (such as implantation of radioactive seeds or mesh) or temporary.

Temporary seeds may be delivered through catheters to the target site for specified amounts of time and then withdrawn (so that the patient is not radioactive after the procedure), typically with either low-dose rate (LDR) or high-dose rate (HDR) techniques.

The principles of ALARA (as low as reasonablyachievable) and time, distance, and shielding are vital to health care professional safety when caring for a patient with a source of internal radiation.
The primary goals of care for the COPD patient are to prevent disease progression, relieve symptoms and improve exercise tolerance, prevent and treat complications, promote patient participation in care, prevent and treat exacerbations, and improve quality of life and reduce mortality.
Cessation of cigarette smoking in all stages of COPD is the intervention that can have the biggest impact to reduce the risk of developing COPD and influence the natural history of the disease.
Although patients with COPD do not respond as dramatically as those with asthma to bronchodilator therapy, bronchodilator therapy can reduce the dyspnea and increase the FEV1.
Presently no drug modifies the decline of lung function in patients with COPD.
Inhaled anticholinergics or long-acting β2 agonists may be used or combined with inhaled corticosteroids.
All these medications decrease exacerbations of COPD with no one better than the other.
Monotherapy with inhaled corticosteroids is not recommended due to the side effects.
Four different surgical procedures have been used in severe COPD.
§ Lung volume reduction surgery is used to reduce the size of the lungs by removing the most diseased lung tissue so that the remaining healthy lung tissue can perform better.
§ Bronchoscopic lung volume reduction surgery works by placing one-way valves in the airways leading to the diseased parts of the lung. The valves let air out but not in. This collapses a certain segment of the lung and has a similar result as LVRS.
§ A bullectomy is used for certain patients and can result in improved lung function and reduction in dyspnea.
§ Lung transplantation can improve functional capacity and enhance quality of life in appropriately selected patients with very advanced COPD.
Breathing retraining such as pursed-lip breathing is a technique that is used to prolong exhalation and thereby prevent bronchiolar collapse and air trapping.
Airway clearance techniques include effective coughing techniques, chest physiotherapy, and airway clearance devices. No one is better than the other, but it depends on patient preference.
§ Effective coughing conserves energy, reduces fatigue, and facilitates removal of secretions. Huff coughing is an effective technique that the patient can be easily taught.
§ Chest physiotherapy consists of percussion, vibration, and postural drainage.
§ Airway clearance devices include those using positive airway pressure, such as Flutter, Acapella, or TheraPEP. High frequency chest wall oscillation, such as SmartVest, helps to clear airways.
Weight loss and malnutrition are commonly seen in the patient with severe emphysematous COPD. The patient with weight loss needs extra protein and calories and tips on energy conservation while eating and preparing food.