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HCDII Final

Terms in this set (104)

Cystic fibrosis
autosomal recessive disorder
major cause of severe chronic respiratory disease in children

characterized by thick mucus production and respiratory insufficiency
Cystic fibrosis care
Chest physical therapy to loosen secretion. 2-4x daily for 20 mins - 1 hr. 1-2 hours between meals to prevent vomiting and aspiration
Positive expiratory devices PEP devices ie. Acapella-flutter valve
Incentive spirometry
Coughing/huffing
Fluid to thin secretions

Medications:
ABX for infection prevention
Nebulizers
Bronchodilators and anti-inflammatory meds ie. ibuprofen
Mucolytic agents
Pancreatic enzymes
Stool softeners

Corticosteroids not recommended for long-term use!
Cystic fibrosis teaching
Physical activity helps loosen secretion! Make sure to stay hydrated due high NaCl loss in sweat
Stay up to date w vaccinations
May require tube feeding if unable to eat
Requires lung transplant during end-stage lung disease

Diet: Requires high caloric intake, proteins, and fats
Fat soluble vitamins A, D, E, K (unable to absorb fats w CF)
COPD (emphysema and chronic bronchitis)
characterized by chronic, recurrent airflow obstruction in the pulmonary airways
COPD care
Fowler's and high fowler's positioning
CPT
Breathing exercises, deep breathing q2hrs
Incentive spirometry
Suction as needed
Postural drainage
Humidification
Nebulization
Oral and skin care

Focus on airway mainteinance!

Continuous low flow oxygen 1-2 L/minute
Keep O2 sats 88-93%
(ventilation is stimulated by low PO2 and hypoxia, increased levels could reduce oxygenation)

Corticosteroids
Prednisone, Solumedrol, Albuterol
Methyxanthines
Roflumilast
COPD teaching
Encourage patient to quit smoking! also avoid environmental triggers ie. air pollutants and hot/cold weather
Encourage diaphragmatic breathing (belly) instead of accessory muscle use
Encourage huff coughing
Frequent, small meals (burning lots of calories)
Sit up while eating to prevent aspiration
Thicken fluids! To prevent aspiration
Adequate hydration and fluid intake to thin secretions
Yearly flu vaccination and pneumococcal every 5 years
Congenital heart defects
cyanotic and acyanotic
Cyanotic, decreased pulmonary blood flow:
Pulmonic stenosis
Tetralogy of Fallot
Pulmonic atresia
Tricuspid atresia

Acyanotic, increased pulmonary blood flow:
Patent ductus arteriosis
Atrial septal defect
Ventricular septal defect
Artioventricular canal defect

also...

obstructed systemic blood flow:
coarctation of the aorta
aortic stenosis
mitral stenosis

mixed blood:
transposition of the great arteries
Patent ductus arteriosus (PDA)
ductus arteriosus fails to close after birth

oxygenated blood from the aorta flows back into the pulmonary arteries and lungs

persistant fetal circulation
L to R shunting
L ventricular hypertrophy
Closes PDA patent ductus arteriosus
IV ibuprofen or indomethacin for pre-term infants

not used for term infants of those w CHF
Opens PDA patent ductus arteriosus (keeps in open)
Prostaglandin E1

Indicated w coarctation of the aorta and transposition of the great vessels to maintain fetal circulation
CAD
...
Kawasaki disease
acquired heart disease
acute, febrile, systemic vascular inflammatory disorder
Treatment
Skin care! keep clean and dry, lubricate, change clothes/sheets frequently, cool compress
Frequent, small feedings and soft foods
Passive ROM to facilitate joint function
Cluster care to allow for rest periods

Medications:
Intravenous immune globulin IVIG within 7-10 days of onset to reduce risk of coronary artery lesions and aneurysm
IV diphenhydramine prior to IVIG to prevent allergic reaction

High doses of ASA acetylsalicylic acid for high fever (promote comfort)
80-100 mg/kg/day
2-5 mg/kg/day once afebrile
Raynaud's disease
peripheral arterial occlusive disease
triggered by cold or stress
causes the fingers and toes to feel cold/numb
Raynaud's teaching
Avoid smoking
Decrease stress levels
Exercise
Avoid quickly changing temperature (very hot to very cold)
Wear gloves and insulated clothing, warm mugs, heat car up before leaving, etc.
Take fish oil to help with circulation and building cold tolerance!
Valvular disorders
Classes of medications beneficial for Mitral Valve stenosis/Calcification
Think of ones that would dilate versus constrict
PAD peripheral arterial disease
reduced blood flow to the limbs
PAD assessment
Intermittent claudication (pain when walking due to inadequate blood flow, alleviated by rest)
Rest pain relieved by ambulation
Pallor
Absent pulses
Paresthesia, numbness/tingling
Thin, shiny hairless skin
Thickened toenails
Non-healing ulcers
PAD interventions
Smoking cessation
Antiplatelet therapy
Revascularization
Management of hyperlipidemia and DM

Should not have patient elevate the legs
Helps to dangle legs, dependent position
PVD peripheral vascular disease
inadequate venous blood flow/return from the systemic circulation back to the heart
PVD assessment
Dull, achy pain
Cramps, soreness
Discoloration
Redness and warmth
Edema, swelling of the extremity
Sores with irregular borders
Varicose veins
Pulses present
Drainage, slough
PVD interventions
Encourage ROM and ambulation unless contraindicated by physician
TED hose, compression devices
Measure calf and thigh diameter
Warm, moist heat (not hot)
Elevate legs above heart level with knees only slightly bent
LMW heparin followed by oral anti-coagulant
Assess lung sound and breathing for pulmonary embolism!
Bedrest
SIADH
negative-feedback mechanism fails to regulate the release/inhibition of ADH
fluid retention and continued ADH
SIAHD patient teaching
Fluid restriction! 500-1000 mL/day First priority!

Treat underlying cause
Frequently monitor I&O q4hrs; report decreased output
Frequent neuro checks and LOC q2hrs or q4hrs if pt is alert; look for disorientation/confusion
Oral hygiene, provide oral rinse and ice chips
Monitor for twitching before it advances to seizure activity
Pulmonary assessment for fluid overload; dyspnea and crackles
Cardiac assessment for dysrhythmias and hypertension
Seizure precautions and padded side rails for safety
Measure daily weight (1kg, 2.2 lbs = 1L)
Reduce pain, stress, discomfort; decrease environmental stimuli
Diabetes insipidus DI
ADH disorder caused by a deficiency of or a decreased response to ADH
characterized by large amounts of urine excretion and extreme thirst
DI patient teaching
Encourage appropriate H20 intake to make up for fluid loss , allow patient to drink freely!
Sodium restricted diet

Correct underlying cause
I&O q4hrs; report urine output >500 mL/2h hours
Hourly neuro checks!
Measure weight daily (1kg, 2.2 lbs = 1L)
Provide rest
Safety measure to prevent injury RT dizziness and fatigue
Monitor for hypokalemia due to fluid loss.
Monitor for signs of hypovolemic shock (tachycardia, tachypnea, hypotension)
Treat symptoms of dehydration and hypernatremia
ABG interpretation
pH 7.35 - 7.45
PCO2 35-45
HCO3 22-26

Respiratory acidosis: low pH, high PCO2
Respiratory alkalosis: high pH, low PCO2

Metabolic acidosis: low pH, low HCO3
Metabolic alkalosis: high pH, high HCO3
VEAL CHOP
V variable deceleration
E early deceleration
A acceleration
L late deceleration

C cord compression (reduces blood flow b/w placenta and fetus)
H head compression (occurs during fetal descent into birth canal)
O ok! no intervention needed
P perfusion, uteroplacental insufficiency
Variable decelerations RT cord compression
Reposition mom
Reduce or DC oxytocin infusion
Prepare for c-section delivery
Early deceleration RT head compression
Accelerations
Typically doesn't require intervention
Normal

May reposition mom or admin oxygen for early decels
Late decelerations RT perfusion/placental insufficiency
DC oxytocin
Reposition mom. Side-lying position to relieve pressure on the vena cava and promote circulation!
Fluid bolus
Vaginal examination
Admin oxygen
Admin tocolytics (suppress pre-term delivery) and ephedrine
Explain and reassure
Stages of labor
1st stage: begins with the onset of labor (contractions) to complete cervical dilation at 10 cm and urge to push
Pain due to cervical dilation
Excitement, some anxiety, discomfort, irritability

2nd stage: begins with urge to push and ends with birth of newborn
Pain due to hypoxia of contracting uterine muscles, vaginal/perineum distention, pressure on adjacent structures
Relief to push, increased sense of purpose

3rd stage: begins with birth of newborn and end with placental delivery
Pain due to uterine contractions and cervical dilation as placenta is expelled

4th stage: uterine contraction occurs to control bleeding at the placental site; "physiological readjustment" of mother's body

When to notify provider: variable and late decelerations!
Magnesium sulfate
smooth muscle relaxer; used to prevent seizures with pre-eclampsia
tocolytic, prevents pre-term labor

Admin 4-5 g (diluted in 250 mL NS) IV as initial bolus
1-3 g/hr IV after initial dose to maintain effects

Maintain levels at 4.8 - 8.4 mg/dL

SE: drowsiness, weakness, decreased BP, flushing

Toxicity indicated by loss of DTR, respiratory depression, cardiac arrest
Oxytocin (Pitocin)
used to stimulate contractions for the purpose of labor induction

Indications: scheduled induction, pre-eclampsia, eclampsia, PROM, placental abruption, intrauterine fetal demise
also DM, renal disease, CPD

Monitor FHR for indications of fetal distress!
Generalized Anxiety Disorder (GAD)
characterized by excessive anxiety/worry and intense tension, even if no external stressors are present

decreased levels of the inhibitory neurotransmitter GABA (think GABA = calm)
Manifestations of different levels of anxiety
mild, moderate, severe, panic
Mild anxiety
Increase in sensory perception, arousal, and alertness
Sleeplessness
Restlessness
Irritability

May be beneficial due to enhanced focus and productivity/motivation
Typically resolved by the individual's coping mechanisms

Communication:
Help patient recognize trigger, symptoms, and levels
Positive self-talk
Moderate anxiety
Narrowing of the perceptual field and attention span

Reduced alertness and awareness of surroundings
Discomfort
Irritability
Increased restlessness
Self-absorption
Increased respirations and HR
Muscle tension
Perspiration
Rapid speech, louder tone, higher pitch

Commnunication:
Help patient recognize triggers, symptoms, and levels
Help patient identify successful coping mechanisms used in the past
Severe anxiety
Perceptual field is greatly reduced

Difficulty following directions
Feeling of dread or horror
Headache
Dizziness
Nausea
Trembling
Insomnia
Palpitations
Tachycardia
Hyperventilation
Diarrhea

Communication:
Benefit from clear, direct communication and simple questions
Help patient identify triggers and effective coping mechanisms that they have used in the past
Panic
Completely distorted perceptual field and inability to focus

Terror, feeling of doom
Bizarre behavior
Dilated pupils
Trembling
Sleeplessness
Palpitations
Pallor
Diaphoresis
Muscular incoordination
Immobility or hyperactivity
Incoherence

Requires immediate, structured intervention

Communication:
Maintain a calm demeanor
Slow, low pitched voice
Authoritative voice
Simple statements
Reinforce reality

Quiet, less stimulating environment
Set limits to ensure safety
Repetitive or physical tasks to diffuse energy
OCD (Obsessive Compulsive Disorder)
Characterized by obsessive thoughts and compulsive repetitive behaviors that dominate an individual's life

High genetic link
Possible malfunction in the CST brain circuit
Increased brain activity in the frontal lobe and basal ganglia
Decreased neurotransmitters; including serotonin, dopamine, and glutamate
Serotonin dysregulation

Communication:
Supportive, non-judgmental demeanor
Provide a calm presence
Encourage patient to verbalize fears
- Provide facts related to the patient's fear ie. teach about immune system for fear of contamination/germs

Allow the patient to carry out compulsions
Reduce environmental stimuli; remove items associated with triggering obsession or compulsion
PTSD (Post Traumatic Stress Disorder)
caused by chronic activation of the stress response as a result of experiencing a significant traumatic event

Neural insults from large doses of stress impairs amygdala and hippocampal function.
Impaired amygdala function = overreaction
Impaired hippocampal function = inability to "read" environment; hypervigilance

Intrusion: flashbacks, nightmares
Avoidance: emotional numbing that disturbs relationships)
Hyperarousal
Suicide/Lethality
inflicting self-harm that results in death

Social isolation ie. COVID 19
Recent unemployment
Recent loss of a significant relationship
Feelings of failure
Hopelessness
Access to lethal means ie. increased energy, physical item
Hx of abuse
Chronic physical illness, including pain
Interpersonal factors, social factors
Comorbid disorders ie. mental illness
Genetics; 5x higher risk if a relative has committed suicide
Depression; ½ of those who commit suicide are depressed at the time

Higher incidence among males
Highest completion among men >75 years old
Maladaptive coping
Alcohol and substance abuse
genetic, psychosocial, and environmental factors

Alcohol is a CNS depressant that act on neurotransmitters in the brain, such as GABA Creates an additive effect with GABA; further inhibits arousal and the autonomic nervous system
Symptoms of ETOH withdrawal
Agitation
Anorexia
Nausea and vomiting
Tremors, shakiness
Elevated HR, tachycardia
Increased BP, hypertension
Insomnia
Intense dreaming, nightmares
Poor concentration
Impaired memory and judgement
Increased sensitivity to light, sound, touch
Hallucinations
Delusions
Paranoia
Grand mal seizures
Loss of consciousness
Brief cessation of breathing; apnea
Muscle rigidity
Hyperthermia
Delirium with disorientation
Fluctuations in LOC
Alcohol withdrawal delirium "delirium tremens"
Delirium tremens
Typically occurs 2-3 after last drink (up to 14 days)
Does not develop suddenly, progresses from earlier withdrawal symptoms

S/S
extreme tremors
confusion
disorientation
hallucinations
tachycardia
hypertension/hypotension, agitation, diaphoresis
fever
death due to CV collapse or hyperthermia

Major goal of management = avoid seizures
Benzodiazepines and anti-seizure medications
Use of banana bag and magnesium for alcohol withdrawal
...
Alzheimer's disease
Slowly progressive brain disease characterized by memory impairment, cognitive disturbances, and impaired perception
Incurable, degenerative, terminal
Most common form of dementia

Increase in the production or accumulation of beta-amyloid protein in the brain
Forms amyloid plaques between neurons

Protein tau forms neurofibrillary tangles within neurons

Damage to surrounding neurons and further brain damage

Communication:
Eye contact
Begin every interaction by introducing self and stating patient's name
Calm, reassuring tone
Simple vocabulary
Brief, straightforward sentences
Ask one question at a time
Yes/no questions
Allow time to respond
Repeat questions, explanations, and instructions as needed
Be careful about challenging the patient's interpretation of reality; may lead to agitation/noncompliance
Schizophrenia
Profound neurobiological disorder characterized by psychotic symptoms, diminished capacity to relate to others, and behaviors that appear odd or bizarre
Typically emerges during early adulthood

Patho RT anatomic alterations, neurotransmitter abnormalities, and impaired immune function

Decreased grey matter
Alterations in the dopaminergic system due antipsychotic medications
Diminished nicotinic acetylcholine receptors
Dysregulation of NMDA glutamate receptors
Positive symptoms of schizophrenia
Due to elevated dopamine
Addition of something that is not normally present
Acute onset

Hallucinations
Delusions
Bizarre behaviors
Paranoia
Abnormal movement

Treatment: First generation anti-psychotics
Chlorpromazine (Thorazine)
Haloperidol (Haldol)
Thioridazine (Mellaril)
Fluphenazine (Prolixin)
Negative symptoms of schizophrenia
Due to decreased dopamine or structural brain changes
Absence/decrease of something that should be present
Develops slowly

Anhedonia: loss of interest or inability to experience pleasure with previously enjoyed activities
Avolition: lack of motivation or initiative
Alogia: poverty of thought and speech
Flat or blunted affect

Treatment: Second-generation anti-psychotics
Clozapine (Clozaril) risk for agranulocytosis
Olanzapine (Zyprexa)
Quetiapine (Seroquel)
Ziprasidone (Geodon)
Risperidone (Risperdal) targets both +/- symptoms
Delirium
Abrupt, generally transient, and often fluctuating change in mental state and consciousness

ACUTE change in mental status

Commonly seen in acute care settings

Exact pathophysiology unknown
Increase cerebral oxidative stress and impaired neurotransmitter action
New medication side effect
Manifestation/symptoms of delirium
Abrupt/sudden onset, transient, fluctuating mental state and LOC

Disorganized thinking
Disorientation
Perceptual disturbances
Restlessness
Agitation
Lability
Confusion
Inability to focus, shift, or sustain attention
Consider therapeutic communication for coping/cognition exemplars!
...
Gallbladder and pancreatitis diet
Aims to decrease inflammation

Restrict fats
Low carbs
Increase fat-soluble vitamin intake

Small meals/snacks instead of 3 large meals a day

Lean meats ie. chicken and turkey
Fish
Non-fat or low-fat dairy products
Wholegrain products
Herbs and spices for flavor instead of butter
Bake, broil, and grill instead of frying
Limits fats/oils to 1 tbsp per meal
Substitute butter when baking
Avoid cream soups/sauces, ice-cream, processed cheese, pastries, sausage/salami, bacon, avocado, prepared snack foods, chocolate, fried foods, granola, fast-food

Pancreatitis: Artificial digestive enzymes if levels are too low to effectively digest food
Gallbladder care
Cholecystectomy: gallbladder removal
Shock wave therapy to breakdown and remove gallstones
ECRP to visualize

Admin analgesics, assess/reassess pain
Magane F&E
NG tube suction
Prepare for surgery and post-op care
Pancreatitis care
Focus on treating cause!

Fluid replacement; NG tube/suction
Admin analgesics and insulin
Admin steroids for autoimmune pancreatitis

Endoscopy to remove stone, stent placement, close leaks
Surgery to open pancreatic duct, drain cysts, partial removal (rare)
Hirsprung's disease
Congenital aganglionic megacolon
Extreme form of slow transit constipation causes inadequate peristalsis and mechanical intestinal obstruction; bowel becomes huge and filled w stool

Surgical repair involves removal of the aganglionic intestinal portion and reconnection to the healthy bowel

Assess abdominal circumference for distension
Assess/reassess pain
Monitor for infection
Monitor I&O and maintain hydration

Pre-op:
IV and NG tube placement
Restrict diet, clear liquid diet

Post-op:
Admin analgesia, assess/reassess pain
Assess return of bowel function
Rectal irrigation
Maintain IV and NG patency
Ostomy stoma assessment
Omphalocele care
Located at the umbilicus
Intestines, liver, and other organs (spleen and gonads) remain outside of the abdomen
Covered with a sac

Non-operative tx is an option
No need for fluid resuscitation

Postpone surgery for 6-12 months to allows the abdominal cavity to enlarge as the baby grows
Mechanical ventilation
Antibiotic cream applied to sac

Apply plastic gortex patch if the omphalocele is too large to close the abdominal wall
Partial removal of the patch occurs over 12-36 months
Fully removed when the abdominal cavity has grown sufficiently. The muscles of the abdominal wall are closed and the skin incision is repaired.
Gastroschesis
Located to the right of the umbilicus
Small intestine lies outside of the abdomen
No sac covering

Non-operative treatment is not an option
Requires fluid resuscitation

Surgery to replace the intestine and close the abdomen soon after delivery

Large gastroschesis may require silo placement (gradually squeezes the intestines back into the opening and body, can take 1 week)
immediate care for both omphalocele and gastroschesis
Place baby in a bowel bag (feet to nipple line) to decrease heat loss and allow for visualization of the defect

Immediate priority is to protect the sac or exposed abdominal contents!
Pyloric stenosis
Narrowing of the pyloric orifice of the stomach that prevents food within the stomach from passing into the duodenum
Impairs the digestion and absorption of food, resulting in dehydration and malnutrition

Focus on maintaining hydration and IV
Monitor VS q4hrs, especially temp!
Assess I&O
- NG tube
- weigh diapers
Short gut syndrome
decreased ability to digest and absorb a regular diet due to a surgically shortened intestine (resulting from bowel resection)

Asses VS
Maintain NPO
Admin IV fluids to correct F&E imbalances
Side-step implementation of feedings
- NPO, TPN, enteral feedings, PO feedings

Total parenteral nutrition for long periods of time increases risk for infection
Meticulous central line care to avoid infection/septicemia!

May be discharged with a venous catheter for TPN at home
Educate parents on infection and sepsis
Nephrotic syndrome treatment
Injury to the glomeruli resulting in increased glomerular permeability
Massive proteinuria, hypoalbuminemia, and loss of clotting factors

Restrict sodium and fat in diet
Corticosteroid therapy to suppress the immune system; avoid people who are sick!
Protein supplements

Assess urine characteristics (frothy)
Assess for swelling and weight gain
Monitor glucose levels
OTC kits for at-home monitoring of proteinuria
Nephritis diet and teaching
acute glomerular inflammation

Restrict high potassium foods and sodium
Increase protein intake! Supplements
Strict I&O
Mobility and ICR examplars
consider:
how to keep your patient mobile for as long a possible
preventing respiratory complications
Duchenne Muscular Dystrophy (DMD)
Genetic disorders caused by a genetic mutation of the X-chromosome that causes progressive deterioration of the skeletal muscles
Muscle hypertrophy, atrophy, and necrosis
Death from respiratory and cardiac muscle involvement

No known cure
Focus on maintaining ambulation/mobility, preventing deformities, and preventing infections (respiratory)

Passive stretching
Correct and counter posturing
Proper positioning and body alignment
Splints
ROM exercises
Precautions to avoid respiratory infection: annual flu and pneumococcal vaccinations every 5 years
Compensate for disuse syndrome to prevent contractions

Support the family and child
Education; assistive devices, complications, medications
Educate on genetic counseling

Typically don't live past 15-18 years
Important to address psychological effects, especially during adolescence
Life-expectancy has increased but death typically occurs in young adulthood RT respiratory and cardiac muscle involvement.
Multiple Sclerosis (MS)
...
Cerebral palsy CP
group of injuries caused by insult or injury to the brain

Steroids to reduce edema during exacerbation
Promote self-care and assist w ADLs PRN
Home safety
Symptom relief

Feeding: Ensure adequate fluid and nutritional intake! (Symptoms cause the child to burn off more, higher metabolic rate!)

Mobility:
Promote independent mobility
ROM exercises
Encourage participation in ADLs to maintain independence
Utilize age-appropriate tolls
Parkinson's disease
Degenerative disorder of basal ganglia function and dopamine deficiency
TRAP tremor, rigidity, akinesia/bradykinesia, and postural changes
Influences the initiation, modulation, and completion of movement; unable to coordinate voluntary movement and balance

Allow time for ADLs and encourage independence
Physical therapy
Occupational therapy
Counseling
Deep brain stimulation (implant blocks abnormal nerve activity to reduce tremors and abnormal motor activity)
Maintain balanced diet
Good sleep hygiene
Encourage strong voice
Teach proper walking technique
Promote safety in the environment, fall prevention
Complications of cancers and treatments
Chemotherapy and radiation
Ostomy placement
Chemotherapy attacks rapidly growing cancer cells. However, it also attacks other normal, healthy growing cells. Ie. epithelial cells of the hair, skin, nails, etc.

Colostomy and ostomy placement may be indicated with colon cancer (removal of malignant polyp or section of colon; best outcome when colon cancer is detected early)
Can effect nutrition, consider nutritional deficiency
Solid organ tumors
Tumor lysis, pressure/pain, metastasis
Tumor lysis: cellular lysis leads to the release of intracellular contents into the circulation
Usually associated with rapid cell lysis due to chemotherapy
Causes hyperkalemia, hyperuricemia, and hyperphosphatemia
Can cause arrhythmias, renal failure, and death
Occurs w in cancers with high-growth rates, such as acute-leukemia and Non-Hodgkin's lymphoma

Metastasis: cancer cells spread from their primary site to other parts of the body; often spread via blood or lymph; stage 4 cancer
Cells have features like that of the primary cancer and are not like the cells in the place where the cancer is found
May or may not be symptomatic
Leukemia treatment
Focus on decreased blood counts
Hematopoietic cell transplant, stem cell or bone marrow transplant:
Replaces cancerous blood-forming cells that have been killed by chemotherapy/radiation therapy with new, healthy hematopoietic cells (via infusion)

Healthy cells are taken from the patient (before chemo/radiation therapy) or from a donor's blood or bone marrow

Healthy hematopoietic cells grow and multiply forming new bone marrow and blood cells that develop into all the different types of cells the body needs (red blood cells, white blood cells and platelets)

In the case where the cells are taken from a donor, the new immune system recognizes the cancer cells as foreign and kills them (similar to other immunotherapies).
More tx for leukemia
Chemotherapy: chemicals kill leukemia cells or stop them from dividing, consists of cycles. most common tx

Radiation therapy: uses strong beams of energy to kill leukemia cells or stop them from growing, can be directed to exact sites with cancer

Immunotherapy: included interferon, interleukins and CAR-T cell therapy

Targeted therapy: drugs that are focused on specific features of leukemia cells
Lymphoma
Tumor lysis, quick growth
Tumor lysis: cellular lysis leads to the release of intracellular contents into the circulation
Usually associated with rapid cell lysis due to chemotherapy
Causes hyperkalemia, hyperuricemia, and hyperphosphatemia
Can cause arrhythmias, renal failure, and death
Nursing assessment of the postpartum woman
BUBBLEHE

Breasts
Uterus
Bowel: slow/sluggish bowels after birth
Lochia
Episiotomy
Homan's sign: pain in the calf or popliteal region; discomfort at posterior knee with dorsiflexion indicates DVT
Emotional response
Uterus
involution: return of the uterus to pre-pregnancy position
assess fundal height and uterine tone; should be firm, not soft/boggy

indicates uterine contraction (important for prevent postpartum hemorrhage!)
Lochia
vaginal discharge after childbirth
identify amount, color, and presence of clots

lochia rubra: dark red, 2-3 days PP
lochia serosa: pink, 3-10 days PP
lochia alba: yellow/white, after day 10 PP

Abnormal findings: Large/pea-sized clots, foul smell, persistant lochia rubra
Appropriate emotional adjustments
Demonstrates attachment behaviors ie holding, rocking , talking to the newborn
Inclined to nurture infant by feeding
Acting consistently
Seek and evaluates information objectively
Interesting in learning how to care for the newborn, involved in care activities
Inappropriate emotional adjustments
Excessive pre-occupation with physical status and discomfort
Lack of support systems
Marital problems, current family crisis
Inability to care for or nurture newborn
Disinterest in newborn
Baby blues vs PPD
Baby blue is a common mood disorder that goes away on its own
80% occurence
Sadness, irritability, fatigue
Reassure patients that this is normal and that it should go away after about 2 weeks

PPD is a more serious mood disorder that is also characterized by sadness, irritability, and fatigue.
However, it persists past 2 weeks
Major sign = rejection of infant!

Make sure mother doesn't feel judged and offer resources for help ie. counseling
s/s of PPD
Last longer than 2 weeks

Rejection of the infant!

Sadness
Persistent anxiety
Panic attack
Irritability
Hostile
Excessive fatigue
Mood swings
Weight loss
Headache
Flat affect
Frequent crying
Insomnia
Excessive sleepiness
Changes in/lack of appetite
Difficulty concentrating
Sense of worthlessness
Obsessive thoughts
Lack of interest in previously enjoyed activities
Lack of concern about personal appearance
Rubin's maternal phases
Taking-in phase: birth - 3 days postpartum
Mother is still focused on self and preoccupied with her own needs

Taking-hold phase: 3-10 days postpartum
Mother becomes more independent and focuses on the infant
Makes own decisions and initiates self-care
Responsive to infant care teaching
May not be completely confident yet

Letting-go phase: 10 days - 6 weeks postpartum
Mother accepts/adjusts to role while maintaining independence as an individual
Adjusts to reality
Postpartum contraception

Education
Implication
Risk factors
Breastfeeding is an effective approach for contraception but it only works if the mother keeps up with it; breastfeeding only! Once you stop, so does the "contraception"

Educate on contraception as soon as possible after delivery; don't wait for mother to return for follow-up
T1DM/T2DM education and interventions
...
Hypothyroidism care
Teach family to administer levothyroxine
Teach family to count pulse
Optimizing Nutrition
Teach family about need to follow-up
Labs high TSH and low TH
Developmental interventions
Risk for hypothermia - warm environment and warming techniques
Levothyroxine for hypothyroidism
Levothyroxine (Synthroid)
thyroid replacement drug of choice

Used to replace thyroid hormone with hypothyroidism

Education:
Take at the same time every day
Best to take in the morning on an empty stomach, wait at least 1 hour before eating
Too little = continued hypothyroidism, myxedema coma
Too much = puts pt in hyperthyroidism
Hyperthyroidism care
Radioactive iodine solution, causes gland to shrink
Anti-thyroid medications ie. PTU
Beta blockers, helps w palpitations and rapid HR
Surgery, thyroidectomy
Vitamin D and calcium

Quiet environment, cool temperature, frequent rest periods
High calorie foods, 6 meals daily to meet caloric/metabolic demands
Reduce anxiety; reduce external stimuli, anti-anxiety meds
Promote tissue integrity and visual health RT exophthalmos and photophobia
Hyperparathyroidism care
too much PTH
high calcium blood levels

fragile bones, kidney stones
frequent urination, weakness, bone pain, fatigue, N&V and loss of appetite

Monitor Calcium and Vitamin D in diet
Drink plenty of water to prevent kidney stones!
Exercise regularly, strength training to assist with stronger bones
Don't SMOKE!
Avoid calcium-raising drugs such as diuretics and lithium

Surgery - parathyroidectomy
May require calcium and vitamin D supplements

Monitor for kidney stones; indicated by flank pain, straining during urination

Medications:
IV fluids
Calcimimetics (Sensipar)
Loop Diuretics
Biphosphonates (Fosamax)
Hormone replacement for post menopausal women
Flank pain Rt parathyroid/thyroid disorders
Flank pain RT kidney stone formation
Occurs w hyperparathyroidism due to elevated serum calcium levels!

May have high calcium serum levels due to hypothyroidism (low calcitonin); can lead to kidney stone
Hypoparathyroidism care
Monitor vitals - Especially airway
Patient at risk for TETANY due to hypocalcemia

Labs and Kidney Function - watch for excreting too much calcium
Calcium meds to increase levels
- IV calcium glconate
- PO calcium w vit. D
- PTH replacement
Retinopathy
safety and education
complication of diabetes
edema, hemorrhage, new abnormal vessels, retinal detachment

Glycemic control - control sugar, causes damage to eye vessels
Exercise
Frequent Eye Exams
Assist patient with preventing accidents
Establish rapport; gains trust and cooperation
Listen and respect clients expression of dependency
Explain procedures and expected sensations and outcomes
Orient patient as needed to surroundings

Laser Surgery- prevents vision loss before severe damage to retina

Environment free of clutter
Provide ample lighting/lighting that does not produce glares
Night lights, prevent falls
Call light for assistance out of bed
Larger print for reading/visual aids for teaching
DKA interventions
mainly affects T1DM
BG >300 mg/dL, ketones, acidosis
Kussmaul breathing, fruity breath
happens abruptly

Insulin (rapid/fast acting Humalog)
Fluid and electrolyte replacement
Monitor potassium levels esp. prior to insulin admin, should be at least 3.3 (may cause further potassium loss)

Prevent infections! most common cause of DKA
Nutrition
HHNS care and monitoring of manifestations
mainly affects T2DM
BG >600 mg/dL
no ketosis or acidosis (normal pH)

happens gradually

Insulin (rapid/fast acting Humalog)
F&E replacement

Severe dehydration and hyperosmolarity!
So, fluid admin helps just as much as insulin with HHNS!

Watch for changes in mental status
HYDRATE
Watch for seizures and hemiparesis
Treat hypotension
PKU
Rare inherited disorder that causes the the amino acid phenylalanine (protein) to build up in the blood
Screened via blood test from heel stick 24 hours after birth

Diet:
Restrict protein
No meats, nuts, dairy, dry beans, eggs
Avoid aspartame (contains phenylalanine); artificial non-saccharide sweetener commonly used as a sugar substitute in food/drinks (Equal sugar packets)

Infant/adult formula; iron-rich and contains needed amino acids
Hemophilia A
Factor VIII deficiency
Hemophilia A pharmacological treatment
Desmopressin DDVAP
Replacement therapy for factor VIII
Hemophilia B
Factor IX deficiency
Hemophilia B pharmacologic treatment
Replacement therapy for factor IX
Additional treatment for hemophilia
Prophylaxis
Pain management
Avoid high-impact sports
Prophylactic infusions (prevent bleeding & organ damage)
Management of bleeding
Immobilization of the affected limb
Application of ice packs to diminish swelling and pain

Monoclonal antibodies
Coagulation factor VIIa
Antifibrinolytic agent (aminocaproic & tranexamic acid)
DVT nursing care
Provide comfort
Elevation
Compression stockings
Ambulation

Prevention:
Early ambulation
TEDs/SCDs
Heparin
Warfarin
Thrombocytopenia care
Focus on preventing bleeding, injury, and infection
Thrombocytopenia pharmacologic treatment
Glucocortricoids
IV Immunoglobuline (ITP)
Blood products
Thrombopoeitic
Concept of Clotting
understand how clots are formed
why the blood clots too fast or not at all
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