Study Guide - N2/Exam 1 - Part 2 from Frank
4. Be able to select the best responses to patient statements about their experiences and concerns about their cancer and related treatment.
- Best response to pt. statements about their experiences & concerns about their cancer & related treatment ( REQUIRES GROUP DISCUSSIONS)
5. Review information in your text about death and dying. Be able to identify responses to news of impending demise as they are described in the text and lecture material. ( Page 169 Table 10.7)
1. Withdrawal
- Pt. near death may seem to be withdrawn from the physical environment, maintaining the ability to hear while not able to respond.
- The RN should converse as if the pt. is alert, using a soft voice & gentle touch.
2. Unusual Communication :
- Pt. may become restless & agitated or perform repetitive tasks. Unusual communication may indicate that an unresolved issue is preventing the dying person from letting go.
- Encourage the family to tell the dying person, " It's okay to go. I will be fine"
3. Vision-like experience
- Pt. may talk to persons who are not there or see places & objects not visible. Vision-like experiences assist the dying person in coming to terms with meaning in life & transition from it.
- Affirm the dying person's experience as a part of transition from this life.
4. Saying Goodbyes
- It is important for the pt. & family members to acknowledge their sadness, mutually forgive one another, and say goodbye.
- Encourage the dying person & family members to verbalize their feelings of sadness, loss, forgiveness : To touch, hug or cry .
- Allow the pt. & family privacy to express their feelings & comfort one another.
6. Develop an awareness of the effects of end-stage illness on family members, significant others, and care givers. Recognize appropriate responses vs. those that are less than optimal.
1. Family members & significant others entail a holistic approach when planning for EOL (end of life) care. Education, counseling advocacy & support are priorities for pt. & family.
2. Caregivers need support systems to deal with the grief process of the pt. this will ease the physical & emotional stress for the RN.
3. Appropriate response of the RN/Caregiver is to listen to the pt. & family members, even in time of silence it is appropriate to listen to the sounds of silence with the pt., significant other and family members.
7. Review pain assessment, medication practices, and goals of pain treatments. Understand the World Health Organization's schematic for pain control. Understand combinations of medications and therapies than have a synergistic effect to relieve pain. (Page 140)
A. Pain assessment - pain is what pt. says it is, influenced by genetic, psychosocial & cultural factors.
B. 5 Dimensions of pain :
1. Physiologic : (Transmission of Nociceptive stimuli)
- Nociceptive pain originates when tissue is injured
2. Affective : (Emotions, Suffering) Anger, fear, Depression & Anxiety
3. Behavioral : (Behavioral responses) Observable
4. Cognitive : (Beliefs, Attitudes, Evaluations, Goals)
5. Sensory : (Pain perception) Pattern, Area, Intensity & Nature
C. Physiologic Dimension & Knowledge of neural Anatomy & Physiology : (4 steps) Page 133 Fig. 9.2 1. Transduction 2. Transmission 3. Perception 4. Modulation
D. Systems affected by pain (pg 132 Table 9.1) EndocrineMetabolic Cardiovascular Respiratory Genitourinary Gastrointestinal MusculoskeletalNeurologic Immunologic
E. Pain assessment goals : - Describe the pt. sensory, affective, behavioral, cognitive & sociocultural to implement pain management techniques & goals.
1. Sensory component (PAIN) includes :
a. Pattern b. Area c. Intensity d. Nature
Medication Practices (Drug therapy Pg. 136 Table 9.3)
In relation to interrupting the pain pathway :
1. Transduction : Use NSAID'S to block prostaglandin production. - local anesthetics, antiseizure agents (i.e. gabadentin [neurotin]) & corticosteriods - block the action potential initiation.
2. Transmission : Use opioids, blocks release of substance P
3. Perception : Use Opioids, NSAID'S, Adjuvants (i.e. antidepressants) to decrease conscious experience of pain.
4. Modulation : Tricyclic Antidepressants (i.e. Amitriptyline [Elavill]) to interfere with reuptake of serotonin & norepinephrine.
World Health Organization (Page 142 fig. 9.8)
Step I - Mild pain : use non-opioids ( i.e. Aspirin, Acetaminophen, NSAIDS)
Step II - Mild to Moderate pain : use opioids (i.e. Codiene, Oxycodone)
Step III - Moderate to Severe pain : use opioids (i.e. Morphine, Hydromorphone, Methadone)
8. Review the physiology of pain, as well as how complimentary and alternative therapies assist in relief of pain. Be able to select the best definition of pain. Study !
1. Pain is described as whatever the pt. experiencing the pain says it is, existing wherever the pt. says it does.
2. Physiology of pain (pg 133) neural mechanisms by which pain is perceived consists of
4 steps :
1. Transduction
2. Transmission
3. Perception
4. Modulation
Page 150 - Therapies for Pain Relief !
Thursday, March 30, 2006
Study Guide - N2 Ex. 1/ Part 1 - from Frank !!!
Study Guide for N2, Exam 1 by Frank !
1. Review risk factors, screening procedures and warning signs of cancer.
A. Risk Factors : age, foods, genetics, radiation & exposure, weight & physical activity, tobacco use, environmental concerns, communicable viruses
B. Screening Procedures :
PSA Test Begin by knowing your lumps & if they change, rectal bleeding, vaginal bleeding, etc. Biopsy Blood test (CBS's)
C. Warning Signs : [ Caution ]
Change in bowel or bladder habits
A sore that does not heal
Unusual bleeding or discharge
Thickening or lump
Indigestion or difficulty swallowing
Obvious change in wart or mole
Nagging cough or hoarseness
2. Review treatment modalities for cancer, including Chemotherapy, Radiation, Biological Mediators, and Surgery. Be aware of the variety of goals for each modality.
1. Chemotherapy - Destroy malignant cells, Control tumor growth, works best on fast growing cells
2. Radiation - For cure, control or palliation
3. Biological Mediators - Bone marrow & Stem Cell Transplantation, Interferon therapy is the most common. 4. Surgery (Types) - Preventive, Diagnostic, Curative, Reconstructive, Palliative
3. Be able to identify appropriate Nursing diagnosis for patients experiencing cancer treatment. Using Nursing Diagnosis, be able to select the best interventions for a described circumstances experienced by a cancer patient.
A. For Surgery :
1. Anxiety R/T Diagnosis & Intervention (Anxiety is a biggie)
- S/N will educate Pt. on procedures to reduce anxiety
2. Knowledge deficit RE: Cancer
3. Altered Tissue perfusion
- S/N will assist Pt. with ambulation & ROM Exercises
4. Potential for infection due to deficiency in protective mechanisms.
-S/N will :
- monitor VS & Blood count (WBC's)
- will use septic techniques (hand washing)
- will maintain Pt. hydration
5. Potential for injury R/T decrease in platelets
B. For Chemotherapy :
1. Alteration in nutrition less than body requirements R/T Nausea/vomiting
- S/N will educate Pt. on eating smaller portion
- Pt. will eat plain foods
2. Fluid Volume Deficit R/T Diarrhea
- S/N will monitor Pt. daily weight
3. Electrolyte deficit R/T Diarrhea
- S/N will monitor Pt. I & O's
- S/N will monitor fluid & electrolyte imbalance
4. Alteration comfort R/T diarrhea
- S/N will monitor pt. comfort level
5. Altered bowel elimination R/T diarrhea
- S/N will record pt. BM
6. Alteration in comfort R/T chemotherapy
- S/N will monitor pt pain level ... etc... page 57
1. Review risk factors, screening procedures and warning signs of cancer.
A. Risk Factors : age, foods, genetics, radiation & exposure, weight & physical activity, tobacco use, environmental concerns, communicable viruses
B. Screening Procedures :
PSA Test Begin by knowing your lumps & if they change, rectal bleeding, vaginal bleeding, etc. Biopsy Blood test (CBS's)
C. Warning Signs : [ Caution ]
Change in bowel or bladder habits
A sore that does not heal
Unusual bleeding or discharge
Thickening or lump
Indigestion or difficulty swallowing
Obvious change in wart or mole
Nagging cough or hoarseness
2. Review treatment modalities for cancer, including Chemotherapy, Radiation, Biological Mediators, and Surgery. Be aware of the variety of goals for each modality.
1. Chemotherapy - Destroy malignant cells, Control tumor growth, works best on fast growing cells
2. Radiation - For cure, control or palliation
3. Biological Mediators - Bone marrow & Stem Cell Transplantation, Interferon therapy is the most common. 4. Surgery (Types) - Preventive, Diagnostic, Curative, Reconstructive, Palliative
3. Be able to identify appropriate Nursing diagnosis for patients experiencing cancer treatment. Using Nursing Diagnosis, be able to select the best interventions for a described circumstances experienced by a cancer patient.
A. For Surgery :
1. Anxiety R/T Diagnosis & Intervention (Anxiety is a biggie)
- S/N will educate Pt. on procedures to reduce anxiety
2. Knowledge deficit RE: Cancer
3. Altered Tissue perfusion
- S/N will assist Pt. with ambulation & ROM Exercises
4. Potential for infection due to deficiency in protective mechanisms.
-S/N will :
- monitor VS & Blood count (WBC's)
- will use septic techniques (hand washing)
- will maintain Pt. hydration
5. Potential for injury R/T decrease in platelets
B. For Chemotherapy :
1. Alteration in nutrition less than body requirements R/T Nausea/vomiting
- S/N will educate Pt. on eating smaller portion
- Pt. will eat plain foods
2. Fluid Volume Deficit R/T Diarrhea
- S/N will monitor Pt. daily weight
3. Electrolyte deficit R/T Diarrhea
- S/N will monitor Pt. I & O's
- S/N will monitor fluid & electrolyte imbalance
4. Alteration comfort R/T diarrhea
- S/N will monitor pt. comfort level
5. Altered bowel elimination R/T diarrhea
- S/N will record pt. BM
6. Alteration in comfort R/T chemotherapy
- S/N will monitor pt pain level ... etc... page 57
Study session for N2 test on Monday
There will be a study session for the N2 test on Monday April 3, 2006. It is already posted on docushare. The session will be at 5:00 pm in the North Forum. The questions will relate to cancer, end of life processes and pain related to cancer.
Be prepared to discuss what you what to talk about. Bring your questions.
Be prepared to discuss what you what to talk about. Bring your questions.
Caralee
N2 notes for Pain Lec
SLIDE 28
Neurotransmitters inhibit or modulate transmission of pain along the descending pathways. These are produced in the neural synapses, which are located in the brain and along descending pathways.The neurotransmitters we are talking about are endogenous opiods.Endogenous opioids are the body’s own morphine. They increase when you have feeling of well-being, like when you are in love, receiving a massage, feeling no need to worry. Eating fruits and vegetables and exercising causes endorphin production and release by the intestines. Beta endorphin is the most morphine like substance, which is stored in the hypothalamus and the midbrain, and is released during acupressure and massage, and in stress states such as stress, fear, restraint, hypertension, or hypoglycemia. It is also well documented to be released during labor and delivery. It also accounts for person’s performing superhuman feats, such as the mom who lifts the car off her child. It is also referred to as STRESS ANALGESIA.The enkephalains are located primarily in the limbic system and hypothalamus. Many nerve endings secrete enkephalins, which block transmission via the A and C fibers through the presence of Serotonin, the most prominent enkephalin. Serotonin also inhibits norepinephrine, sympathetic repsonses, and inhibits nociception.The final substance is the dynorphins, found in minute quantities throughout the nervous system, but especially in grey matter and the spinal cord itself. They are 200 times as potent as Morphine sulfate.
SLIDE 29
Cutaneous considered superficial, begins with injury to skin, tissue trauma activates histamine, bradykinin, potassium, and hydrogen ion release from extracellular fluids.Cell wall injury causes the release of serotonin from platelets, prostaglandins, and substance P. This pain is often not discretely located—and leads to touch, pressure, and stretch of skin being interpreted as noxious stimuli.
SLIDE 30
Somatic pain originates in subcutaneous tissue, joints, tendons, muscles, and fascia. Associated with muscle ischemia and spasm. Bradykini and histamine release, and C fibers are responsible for transmission. May be difficult for patient to identify, and can be dull, aching, or diffuse. Deep somatic pain stimulates the autonomic nervous system and is associated with nausea, vomiting, and cold, clammy skin.
SLIDE 31
In general the viscera have only sensory receptors for pain. Localized stimulation of pain receptors in the viscera can cause minimal discomfort, but widespread stimulation can cause extreme pain. Visceral pain is the result of compression, distention, or stretching of the viscera in the thoracic or abdominal cavity. Myocardial ischemia or infarct pain is visceral. Visceral pain is generally described as pressure, deep, and squeezing, and may be referred pain. Visceral pain fibers travel to the spianl cord with the fibers of the sympathetic nervous system, which accounts for the association of sympathetic nervous system responses and cardiac problems.
SLIDE 32
Deafferentation pain is considered neuropathic pain rather than nociceptive pain. This is the severe pain associated with cancer.Pain is initiated when damage to the central or peripheral nervous system occurs from the progression of tissue damage associated with the invasion of tumors, thermal damage, or chemical injuries from radiation.Neuralgias and phantom pains are other types of deafferentation pains, as well as lesions from Cerebral spinal accidents.
SLIDE 33
0 is pain free, 10 is the worst you have ever experienced. This is generally effective for adult persons, regardless of language spoken.
SLIDE 35
Remember that lack of physiologic assessment of a response to pain does not mean the pain does not exist. Document exactly what the patient says.Types commonly include stabbing, burning, tingling, numbness, dull, constant vs. only when I laugh. Anything that increases or decreases the sensation.
SLIDE 43
Verbal abilities include the ability to speak the same language, and the inability to speak at all related to dysphasia or intubation.Persons experiencing delirium, dementia, or altered mentation related to psychoactive drugs present a barrier to pain assessment. Coma patients cause us to rely on physical symptomsPublic understanding of pain control interferes. Just say no to drugs, fear of addiction cause patients to attempt to tough it out, and families to argue about too much pain medication.Cultural values and beliefs influence response to pain, but each person is an individual and will respond to pain in their own way.Some cultures see pain as being associated with an imbalance of life, and they wish to manipulate the environment to alleviate the pain.Medical personel may believe an addicted person is just seeking medication. They may believe the person deserves to feel the pain.Health care personnel are concerned about respiratory depression, but this rarely occurs if the patient is complaining of pain. It is unrealistic to tell a person that they cannot have pain relief because of time frame, respiratory rates, and the like. Remember the BRN charge to alleviate pain before it becomes severe. It is your job to discuss pain relief with the physician when the client consistently requests medication before it is due.
SLIDE 47
Morphine provides analgesia, antianxiety, and opioid agonistHydropmorphone—opioid agonists. Shorter duration than morphineFentanyl—IV moderate dose analgesia, epidural provides anesthesia It is 80 times as effective as morphineMeperidine, opioid agonist. One seventh as strong as morphine, it was created to help avoid respiratory depression.
SLIDE 48
Talwin, mixed agonist-antagonist, blocks some and activates other receptorsStadol has agonist-antagonist responses
SLIDE 49
Reduce pain at the site by decreasing inflammation, the causes of pain. Toradol is an injectable NSAID. These work by preventing prostaglandin formation, thus preventing inflammation
SLIDE 50
Antidepressants block the reuptake of serotonin which reduces pain transmission.Anticonvulsants slow transmission of all responses throughout the nervous systemSedative Hypnotics potentiate the action of narcotics
SLIDE 51
Blocks both peripheral and central pathways. Currently, this is the most popular, most abused narcotic pain medication in the world. PO med, relatively inexpensive.
SLIDE 52
Oral—medication must resist stomach acids and be absorbed through the GI tract. Minimal time elapse is 20 minutesTopicals, such as capsaicin, prevent release and depletion of substance PIntramuscular are dependent on absorbtion, so the patient needs to be off the injection site.
Neurotransmitters inhibit or modulate transmission of pain along the descending pathways. These are produced in the neural synapses, which are located in the brain and along descending pathways.The neurotransmitters we are talking about are endogenous opiods.Endogenous opioids are the body’s own morphine. They increase when you have feeling of well-being, like when you are in love, receiving a massage, feeling no need to worry. Eating fruits and vegetables and exercising causes endorphin production and release by the intestines. Beta endorphin is the most morphine like substance, which is stored in the hypothalamus and the midbrain, and is released during acupressure and massage, and in stress states such as stress, fear, restraint, hypertension, or hypoglycemia. It is also well documented to be released during labor and delivery. It also accounts for person’s performing superhuman feats, such as the mom who lifts the car off her child. It is also referred to as STRESS ANALGESIA.The enkephalains are located primarily in the limbic system and hypothalamus. Many nerve endings secrete enkephalins, which block transmission via the A and C fibers through the presence of Serotonin, the most prominent enkephalin. Serotonin also inhibits norepinephrine, sympathetic repsonses, and inhibits nociception.The final substance is the dynorphins, found in minute quantities throughout the nervous system, but especially in grey matter and the spinal cord itself. They are 200 times as potent as Morphine sulfate.
SLIDE 29
Cutaneous considered superficial, begins with injury to skin, tissue trauma activates histamine, bradykinin, potassium, and hydrogen ion release from extracellular fluids.Cell wall injury causes the release of serotonin from platelets, prostaglandins, and substance P. This pain is often not discretely located—and leads to touch, pressure, and stretch of skin being interpreted as noxious stimuli.
SLIDE 30
Somatic pain originates in subcutaneous tissue, joints, tendons, muscles, and fascia. Associated with muscle ischemia and spasm. Bradykini and histamine release, and C fibers are responsible for transmission. May be difficult for patient to identify, and can be dull, aching, or diffuse. Deep somatic pain stimulates the autonomic nervous system and is associated with nausea, vomiting, and cold, clammy skin.
SLIDE 31
In general the viscera have only sensory receptors for pain. Localized stimulation of pain receptors in the viscera can cause minimal discomfort, but widespread stimulation can cause extreme pain. Visceral pain is the result of compression, distention, or stretching of the viscera in the thoracic or abdominal cavity. Myocardial ischemia or infarct pain is visceral. Visceral pain is generally described as pressure, deep, and squeezing, and may be referred pain. Visceral pain fibers travel to the spianl cord with the fibers of the sympathetic nervous system, which accounts for the association of sympathetic nervous system responses and cardiac problems.
SLIDE 32
Deafferentation pain is considered neuropathic pain rather than nociceptive pain. This is the severe pain associated with cancer.Pain is initiated when damage to the central or peripheral nervous system occurs from the progression of tissue damage associated with the invasion of tumors, thermal damage, or chemical injuries from radiation.Neuralgias and phantom pains are other types of deafferentation pains, as well as lesions from Cerebral spinal accidents.
SLIDE 33
0 is pain free, 10 is the worst you have ever experienced. This is generally effective for adult persons, regardless of language spoken.
SLIDE 35
Remember that lack of physiologic assessment of a response to pain does not mean the pain does not exist. Document exactly what the patient says.Types commonly include stabbing, burning, tingling, numbness, dull, constant vs. only when I laugh. Anything that increases or decreases the sensation.
SLIDE 43
Verbal abilities include the ability to speak the same language, and the inability to speak at all related to dysphasia or intubation.Persons experiencing delirium, dementia, or altered mentation related to psychoactive drugs present a barrier to pain assessment. Coma patients cause us to rely on physical symptomsPublic understanding of pain control interferes. Just say no to drugs, fear of addiction cause patients to attempt to tough it out, and families to argue about too much pain medication.Cultural values and beliefs influence response to pain, but each person is an individual and will respond to pain in their own way.Some cultures see pain as being associated with an imbalance of life, and they wish to manipulate the environment to alleviate the pain.Medical personel may believe an addicted person is just seeking medication. They may believe the person deserves to feel the pain.Health care personnel are concerned about respiratory depression, but this rarely occurs if the patient is complaining of pain. It is unrealistic to tell a person that they cannot have pain relief because of time frame, respiratory rates, and the like. Remember the BRN charge to alleviate pain before it becomes severe. It is your job to discuss pain relief with the physician when the client consistently requests medication before it is due.
SLIDE 47
Morphine provides analgesia, antianxiety, and opioid agonistHydropmorphone—opioid agonists. Shorter duration than morphineFentanyl—IV moderate dose analgesia, epidural provides anesthesia It is 80 times as effective as morphineMeperidine, opioid agonist. One seventh as strong as morphine, it was created to help avoid respiratory depression.
SLIDE 48
Talwin, mixed agonist-antagonist, blocks some and activates other receptorsStadol has agonist-antagonist responses
SLIDE 49
Reduce pain at the site by decreasing inflammation, the causes of pain. Toradol is an injectable NSAID. These work by preventing prostaglandin formation, thus preventing inflammation
SLIDE 50
Antidepressants block the reuptake of serotonin which reduces pain transmission.Anticonvulsants slow transmission of all responses throughout the nervous systemSedative Hypnotics potentiate the action of narcotics
SLIDE 51
Blocks both peripheral and central pathways. Currently, this is the most popular, most abused narcotic pain medication in the world. PO med, relatively inexpensive.
SLIDE 52
Oral—medication must resist stomach acids and be absorbed through the GI tract. Minimal time elapse is 20 minutesTopicals, such as capsaicin, prevent release and depletion of substance PIntramuscular are dependent on absorbtion, so the patient needs to be off the injection site.
HELP !!!
Hi ! Does anyone know Ms. Durston email or tel.number? so I can ask her to reset my quiz. I started taking the quiz at 1800 (3/29) and I was just barely 2 minutes with the questions ( I answered 2), I got kicked out somehow. I tried to log back on but it said I exceeded the maximum times I'm allowed to take the quiz. When I check my grade it states that I haven't submitted the quiz yet! I tried emailing her regarding the quiz but I'm not sure if I had the right one (sdurston@deltacollege.edu) because she hasn't responded as of 0610. Thanks !
Wednesday, March 29, 2006
I need some more input please....Sat June 10th is the Great America Day. Ticket prices are $38.00 a piece which include all day admission to Great America, admission to the water park area, lunch (of chicken sandwiches with hot dogs, beans, chips, all you can drink sodas and all you can eat ice cream favorites), and the picnic area for 4 hours. Who thinks they will go? I need to sell at least the deposit amount within the next 2 weeks to hold our spot and guarantee our picnic area. I will be outside of Java Jitters next Tuesday with reciept books to collect your checks/cash and once I turn in the deposit, I will recieve the tickets and pass them out to you all. I need to know if you guys are truly interested in going....we need at the least 75 people. Thanks..please just post a response with your comment. :) Christine
Tuesday, March 28, 2006
Monday, March 27, 2006
Hey all! Please join us for the first annual student nurse day at great america!! I am planning this trip to hopefully be the 10th of June. I have negotiated special ticket prices and am working on the picnic menu choices...which I will have avail to you all hopefully within the next 2 weeks...I do need something however....a volunteer from your class to be my ticket money collector...I know it is a big job...BUT nursing is a giving proffession, and you are all such giving people, and...enough kissing up already will one of you please email me your offer to sell these tickets? :)... The price of the ticket includes all day admission and the picninc of the day with food and ice cream...soooooo... hope you can all come and bring your famalies for a much needed day of rest, fun and relaxation!! my email for the lovely volunteer to let me know is... rnstudychris@aol.com
Article to Help with the N2 quiz
Here is an article to help with the N2 quiz.
http://docushare.deltacollege.edu/dsweb/Services/Document-61554
It is under Nursing 101 Nursing 1/2 study aides.
Hope it helps.
Caralee
http://docushare.deltacollege.edu/dsweb/Services/Document-61554
It is under Nursing 101 Nursing 1/2 study aides.
Hope it helps.
Caralee
Sunday, March 26, 2006
study guide 1 need help
I am having trouble with questions 5 and 6. Could anyone give me any hints. thanks margaret
Friday, March 24, 2006
Today I became an ICU Nurse
Hey guys! I had a job interview yesterday for the ICU at Lodi Memorial. I was officially hired as a student nurse in that department and have been assigned a preceptor who will be training me throughout the rest of the program and beyond. I am in!
Today I did my first ICU 12 hour shift and it was great! I will be going back tomorrow.
Today I did my first ICU 12 hour shift and it was great! I will be going back tomorrow.
New Syllabus for N3
Hey everyone, Richard posted the syllabus for the remainder of N3. It's at:
http://docushare.deltacollege.edu/dsweb/Get/Document-61532/N3HS3SchS06b%20copy.doc
Richard also told me he'd post the test scores sometime Sunday.
Have a nice weekend! :)
danO
http://docushare.deltacollege.edu/dsweb/Get/Document-61532/N3HS3SchS06b%20copy.doc
Richard also told me he'd post the test scores sometime Sunday.
Have a nice weekend! :)
danO
welcoming tea
If there is anyone who would like to participate that did not sign in on the sheet can email me @ lianasmail@yahoo.com this is really going to be fun I have heard some really fun ideas already. This welcoming tea represents our class as a whole, so I would like as many people to give input as possible, even if you do not have the time to give, at least try to share any ideas that you may have.
Thursday, March 23, 2006
Come to the SNA Meeting
Reminder:
SNA meeting
March 27th @1300 Locke 313.
Now accepting nominations for officers.
Foot notes for N2 - Cancer PPT
SLIDE 4
Cyclamates off market in 1970’s. Stevia causes cells to morph in vitro, in situ tests pending.High ingestion of Aspartame linked to seizure activity in those with seizure disorder(8-10 gallons daily of Kool-aid)Pesticides and herbicides banned in the US are used in other countries—best stick with in season “fresh” fruits/veggiesBest protection for all cancers is diet with 8-10 servings fruits/veggies daily, whole grains, low meat consumption. Soups/stews.
SLIDE 5
30 % of all men will have experienced prostate cancer by age 70, 30% of all women breast cancer by age 70Testicular cancer most common in young men 30-35 years old, and in those with undecended testicles.These cancers become malignant if left untreated—go to lung, brain, bones.Familial issues, example, Gardner’s Syndrome. Autosomal dominant trait, osteomas of scalp and gI polyps, colon cancer.
SLIDE 6
Risk is higher if your mom took DES, but effects both the person who took it and their offspring.Consult your practitioner about the combination of fertility drugs used.
SLIDE 7
Skin cancers almost exclusive to areas exposed to sunPeople living near nuclear plants are generally safe, however, some areas near nuclear testing sites, downwind of Chernobel, etc, are high risk cancer areas. University of Utah doctoral program specializes in this related to Utah being downwind of Nevada test sites of 1950’s-70’s.Radon may occur naturally in some soil and building materials. Home radon level detectors available.X-rays of children with scoliosis linked to increased risk of breast cancer (fred hutchins Ca institute studies, confirmed by NCI)Cell phone use may encourage tumors of brain to grow. Studies being repeated. Long term, all day exposure to batteries.EMFs conflicting data from studies. Not the ideal place to live. Magnetic field exposure decreases the levels of melatonin released from the pineal gland, and melatonin protects against breast cancer (fred hutchins cancer institute research) lymphoblastic leukemia related to exposure, including in utero—also consider household exposures, such as electric blankets, appliances, video games.No change in incidence of cancers for those exposed to radar/nuclear submarines.
SLIDE 8
Exposure to tobacco in any form, whether smoke or “juice,” alters the DNA of cells. Smoke exposure, primary or secondary, not just lung, but nasal and sinus cancers/polyp formationTobacco is considered a complete carcinogen because it encourages formation of neoplasms and promotes neoplastic growth.
SLIDE 10
Ag workers constantly breathing chemicals is what finally got the short hoe out of California farm work, unless the crop is grown organically. No more hand weeding unless organic.Asbestos is found in soil, but was mined and used extensively because of insulatory abilities. Use certified contractors. Mesothelioma.
SLIDE 11
Epstein Barr carried by nearly everyone. Can also lead to Chronic Fatigue syndrome. Mono nucleosis.Human papilloma virus interferes with the body’s ability to produce human protein 6, which stops growth of tissue. A sexually transmitted disease, over 50 different genotypes have been identified, with half causing cancer. Some directly (cervical)SV40 has been found in mesothelioma cells, osteosarcoma cells, and non-hodgekins lymphoma. Thousands were inoculated with this in the first week of life in Germany and are being monitored-a 30 year study.
SLIDE 12
Smoking is responsible for 85% of all lung cancers-whether the person smokes or is exposed to second hand smoke. Smokeless tobacco increases the risk for oral, laryngeal, throat, and esophageal cancers.A diet high in antioxidents vitamins A, E, and C, as well as cruciferous vegetables and carrots, helps protect against skin and GI tract cancers. Limiting cured meats and smoked or barbequed foods. Fiber in all things.Alcohol increases the likelihood of cancers of the throat, oropharnyx, esophagus, stomach, and liver, as well as intensifying the effects of tobacco use.Over half a million cases of skin cancer(non melanoma) are diagnosed each year in the US. Persons who have lived in equatorial countries are more likely to develop skin cancer than those living farther north.Excess exposure to x-rays—generally not a client concern, more for the Rad tech and health care providers.Exposure to heavy metals in the manufacturing process—currently computer workers at a very high risk, but also vinyls, asbestos, solvents. Risk goes up expotentially with smoking.Estrogen to help with menopausal symptoms increases the risk of endometrial and breast cancer.
SLIDE 13
Encourage the patient to ask questions and discuss anticipated procedures.Evaluate learning ability, retention, level of understanding, Address knowledge deficits: signs, symptoms, risks, causes and available therapies.
Anxiety: Ensure physical comfort. Encourage expression of thoughts and feelings.Assist to identify concerns and problemsFoster an atmosphere of acceptance.Encourage therapeutic coping behaviors
SLIDE 22
Benign or pre-malignant growths are removed before they have the chance to spread or grow. Examples are removal of skin growths, colonoscopy with removal of polyps, and conization of cervical lesions. Some extreme cases are bil mastectomy for persons with recurrent breast lumps.
SLIDE 23
Diagnostic surgeries confirms or rules out malignancy. It establishes type, extent, and classification to tumor.Examples: needle biopsies, incisional or excisional biopsies. Samples of the tumor are taken if complete removal of a lesion or tumor is not possible or undesirable (location, etc) Removable tumors with excisional surgery are usually less than 3 cm in size. Size and location determine the best procedure to perform.
SLIDE 24
Curative surgery seeks to remove all of the tumor with minimal damage to structures surrounding the tumor and minimal functional impairment.Removal often means loss of an organ, resulting in an alteration in body image.The process of rehabilitation continues long after discharge, utilizing outpatient services. Groups of people who have experienced similar cancers often have formed support groups.
SLIDE 25
Restoration of form and function is possible in various degrees. This has changed the physical and emotional rehabilitation of cancer surgery. With many procedures it is possible for the reconstruction to occur at the same time as the curative surgery.The goal of reconstruction is to improve the person’s quality of life by restoring maximal funciton and appearance.
SLIDE 26
Palliative procedures may 1. retard the growth of the tumor. Removal of secreting glands to take away hormone source—example, a bilateral oophrectomy will slow or stop the growth of a breast tumor.Decrease the size of an existing tumor. Removal of all of the tumor may not be possible, so debulking the tumor reduces the “tumor burden” on the person, making it possible for other therapies, such as chemotherapy or radiation, to be more effective.3. To relieve distressing manifestations. Cryrosurgery or laser surgery may be used to remove obstructions, or ulcerations when a cure is no longer possible. This reduces pain.
SLIDE 30
Protein is being used for reconstruction of damaged tissues, and the tumor has been taking as many nutrients as it can get. Lower levels of immune globilins are produced.Monitor vital signs, blood counts, lung sounds, body orifaces, and wounds for signs and symptoms of infection.Use aseptic technique when working with wounds. Handwashing, patient hygeine.Maintain level of hydration and nutritional status
SLIDE 31
Monitor the platelet count. Look for petechiae, spontaneous hemorrhages, or areas of breakdown.Check body fluids for presence of blood(stool, emesis, urine)Protect individuals from trauma—limit venipunctures, rectal temps, suppositories. Avoid aspirin. Protect from shear and excoriation. Apply direct pressure to wounds until bleeding is stopped.
SLIDE 37
Chemotherapeutic medications lower the production of white cellsChemotherapy delays wound healing. It can be started 5 to 7 days postop when the wound has sealed off.Because chemotherapeutic agents are metabolized in the liver and kidneys, unpredictable levels of drug occur when these organs are impaired.Radiation therapy suppresses cell production in the bone marrow. Chemotherapy is usually withheld for 3-4 weeks to allow recovery so that the body can withstand the effects of the chemoThe first three months of pregnancy are when teratogenic effects would be most devastating.Chemotherapeutic agents are myelosuppressive, so patients may require transfusions of white cells to boost immunity and avoid superinfections prior to proceeding with chemotherapy.
SLIDE 40
Small, frequent meals of plain foods are most appealing crackers or hard candy help alleviate medication tastes, which are often metallicEncourage to eat protein early in the day, as nausea tends to increase as the day goes byAdminister antiemetics prior to chemotherapeutic agent
SLIDE 41
Daily weightsMonitor lab values of electrolytes so IV fluids can be adjusted appropriatlyLow residue diet helps reduce diarrheaAssess for perianal irritation. Apply petroleum based productsRecord number and quality of stools. Administer Immodium or Lomotil prn.If constipated, adjust diet by including fiber. Consider eliminating iron supplements. Record bowel movements for frequency, quality. Use laxatives, stool softeners, and enemas as needed.
SLIDE 43
For dermatitis provide skin care and lotions as needed. Avoid soaps and hot water. Warm packs to localized areas may provide relief.Assess oral cavity at least twice daily. Provide oral care every 2 hours while awake—lidocaine and glycerine products are helpful. Normal saline mouth rinses and popscicles of NS are helpful.Avoid hot or cold foods, spices, citrus, alcohol, smoking. Pureed foods, food supplements. ChapstickWear cotton, not synthetic underwear and local anesthetic products—vagisil, for exampleDiphenhydramine, tepid baths, and lotions reduce itchingTenderness may occur over liver—observe for jaundice, lethargy, weakness, and altered liver functions studies.
SLIDE 44
Alopecia usually happens with third dose of chemo. May be sudden or gradual. Hair usually grows back, and use of wigs, hats, turbans help prevent heat loss, sunburn, etc. Long hair needs to be cut prior to loss to promote comfort. Soft bristled hair brush and gentle cleansing of new hair, but comb and brush as little as possible.Skin will usually darken. Usually transient and resolves when therapy over. Need to avoid sunlight because they are photosensitive.Nails usually darken and have transverse ridging. After therapy concluded nails will grow in normally again.
SLIDE 45
Monitor BUN and creatnine. May require analgesia or antispasmodics. Increase fluid intake if not contraindicatedObserve for loss of motor ability, decreased reflexes, leg cramps related to numbness and tingling. Usually subsides in 4-6 weeks after therapy discontinued.Have patient use sunglassesRemind patient hearing loss may be transient or permanentGait and equilibrium may be altered, so use of cane, walker, etc will help patient maintain mobility and increase level of safety.
SLIDE 46
Hematuria, dysuria(painful urination) urgency common. Increase fluids to 2 liters daily to limit discomfort from excretion of chemotherapeutic agents. Test urine for presence of occult blood. Discoloration often goes away after 24 hours.
SLIDE 47
Discuss need to continue contraception. Menses usually return when medications discontinued. Level of libido may change related to androgens or estrogens. Partner may have altered libido related to powerlessness over situation. Include partner in discussions as allowed. Encourage verbalization of concerns. May need referral to therapist specializing in sexual dysfunction
SLIDE 48
Ekg, heart and lung sounds, weight, and leg diameters recorded prior to initial dose of meds to establish baseline.Observe for tachycardia, ekg changes, and right sided failure (wet lungs)—may need to stop therapy.Dyspnea on exertion, SOB, cyanosis, rales, wheezing, cough all indicate toxicity. Teach postural drainage and abdominal breathing. Monitor breath sounds
SLIDE 50
External therapy is administered by high-energy x-ray machinesInternal therapy may be from a sealed or unsealed source Intracavity therapy lasts 24-72 hours—helpful for cerivical or uterine cancers, for exampleInterstitial therapy the isotope is packed into needles, beads, seeds, ribbons, whatever, and implanted directly into the tumor. May be temporary or permanent.Should the implant come out of the patient, you will probably be the first to know since you will be changing sheets, assisting the patient with mobility, answering the call light. There will be tongs and a lead container in the room, so that you can safely pick up the implant and put in the lead box.Unsealed source is used for systemic therapy, isotopes given via IV or orally. Treatment for Grave’s disease of the thyroid would be low dose and thyroid cancer high dose of unsealed radioactive iodine.
SLIDE 52
The larger the treatment area, the greater the amount of side effectsHair over treated area will likely fall out, and probably not grow backA person receiving 5000 rads for curative treatment will have more side effects than a person receiving 2000 rads for palliation
SLIDE 53
Fractionation refers to dividing the total radiation dose into small, frequent doses. Often 150-200 centigrays five days a week for 4-6 weeks. Fractionation give healthy cells time to repair themselves between doses and increases the chance that the tumor cells will be hit during a growth phase.Alternate sites allow for hitting the tumor from the front, back, and either side of the tumor. The area that all angles have in common is the tumor, but by alternating the directions normal cells contact with the radiation is minimized.
SLIDE 54
The reactions are not burns, per se, but treating them like burns helps them heal. Aloe Vera cream to the site.Immediate skin reactions have 3 stages: Erythema, Dry Desquamation, Moist DesquamationDelayed reactions include atrophy from shrinking of the epidermal layerTelagiectasis (dilation of capillaries due to vessel damage)DepigmentationSubcutaneous fibrosisSkin cancerNecrotic or ulcerative lesionsSkin reactions are generally reversible, however they may heal over several yearsInterventions-notify radiologist. Monitor daily for changes. Keep area dry, wash with water only and pat dry.Aloe Vera over the counter helps, as do prescription cream preparations.Keep area away from heat and sunlight. Skin may be sensitive to heat and sunlight for years after therapy, as well as cold air.Do not wash off the tattoo marks placed by the therapist.Encourage wearing soft cotton fabrics-knits-that do not rub or chafe the area
SLIDE 55
Bone marrow and lymphatic tissue are very sensitive to radiation. Pelvic area leads to greater marrow depression than other areas.Monitor blood counts, at least weekly. Teach handwashing and good nutrition, hygiene and rest habits.Teach signs and symptoms of infection
SLIDE 56
Platelets are quite vulnerable to radiation. Counts below 100,000 should be reported to the MD.Monitor counts at least weekly. Teach person to avoid trauma and aspirin use—review anticoagulent use with physician. Teach signs of hemorrhage. Monitor stool, urine for occult blood. Apply direct pressure to any bleeding until bleeding stops.
SLIDE 57
Epogen!Fatigue is an expected side effect of radiation therapy and does not mean the disease is getting worse.Discuss fatigue with the patient and encourage them to do what they feel like doing, then rest. They need to eat nutrient dense foods, but carbs and fats increase energy.
SLIDE 58
Monitor diet for sufficient calories.Utilize dietician services—the attention really helps the patient feel well cared for.Weekly weights. Patient needs to eat sterile foods—avoid raw eggs or oysters, canned rather than fresh or frozen related to possible coliform contamination.Small, frequent meals will increase food intake—help patient to be aware of nutrients. Need protein.
SLIDE 59
Monitor oral cavity daily and notify radiologist if desquamation occurs.Administer viscous lidocaine before mealsBland diet, no smoking or alcohol.Saline rinse q 2 hours. Professional dental care. Plenty of po fluids.Sugarless hard candy will increase salivation. Avoid dry, thick foods.
SLIDE 60
Low residue diet and anti diarrheals.Encourage fluid intake so urine is more normal color and person voids regularly.Encourage rest before and after meals. Antiemetics as prophylaxis on treatment days, as needed the rest of the time. Monitor fluid and electrolyte status.Edema resulting from damage to tissues in cranium. Steroids and analgesics help.
SLIDE 61
Encourage verbalization, wearing of wigs, hats, scarves, and brush hair as little as possible, gentle shampooing.Encourage person to talk on phone, stop by and say hello even when patient is not part of your assignment. Encourage television viewing, radio, music. Discuss need to limit physical contact. Have family bring in photos.
SLIDE 64
Caloric and protein requirements must be met for body to repair itself.
SLIDE 65
The first phase of therapy causes nausea, vomiting, GI tract inflammation, taste changes, and anorexia. After the transplantation mucositis, stomatitis, esophagitis, and intestinal damage occur—resulting in diarrhea.
SLIDE 67
Most patients GI dysfunction resolves within 30 days after transplant. Then the patient can resume oral intake or tube feedings. Greater than 10% weight loss in 6 months indicates malnutritionPeripheral IVs cannot handle TPN sol’n, so central lines or PICC lines are needed.
SLIDE 69
Albumin indicates protein status of the body. Levels of serum transferrin is a marker for protein status, reflect the patient’s response to stress or nutritional support earlier than albumin levels.
Cyclamates off market in 1970’s. Stevia causes cells to morph in vitro, in situ tests pending.High ingestion of Aspartame linked to seizure activity in those with seizure disorder(8-10 gallons daily of Kool-aid)Pesticides and herbicides banned in the US are used in other countries—best stick with in season “fresh” fruits/veggiesBest protection for all cancers is diet with 8-10 servings fruits/veggies daily, whole grains, low meat consumption. Soups/stews.
SLIDE 5
30 % of all men will have experienced prostate cancer by age 70, 30% of all women breast cancer by age 70Testicular cancer most common in young men 30-35 years old, and in those with undecended testicles.These cancers become malignant if left untreated—go to lung, brain, bones.Familial issues, example, Gardner’s Syndrome. Autosomal dominant trait, osteomas of scalp and gI polyps, colon cancer.
SLIDE 6
Risk is higher if your mom took DES, but effects both the person who took it and their offspring.Consult your practitioner about the combination of fertility drugs used.
SLIDE 7
Skin cancers almost exclusive to areas exposed to sunPeople living near nuclear plants are generally safe, however, some areas near nuclear testing sites, downwind of Chernobel, etc, are high risk cancer areas. University of Utah doctoral program specializes in this related to Utah being downwind of Nevada test sites of 1950’s-70’s.Radon may occur naturally in some soil and building materials. Home radon level detectors available.X-rays of children with scoliosis linked to increased risk of breast cancer (fred hutchins Ca institute studies, confirmed by NCI)Cell phone use may encourage tumors of brain to grow. Studies being repeated. Long term, all day exposure to batteries.EMFs conflicting data from studies. Not the ideal place to live. Magnetic field exposure decreases the levels of melatonin released from the pineal gland, and melatonin protects against breast cancer (fred hutchins cancer institute research) lymphoblastic leukemia related to exposure, including in utero—also consider household exposures, such as electric blankets, appliances, video games.No change in incidence of cancers for those exposed to radar/nuclear submarines.
SLIDE 8
Exposure to tobacco in any form, whether smoke or “juice,” alters the DNA of cells. Smoke exposure, primary or secondary, not just lung, but nasal and sinus cancers/polyp formationTobacco is considered a complete carcinogen because it encourages formation of neoplasms and promotes neoplastic growth.
SLIDE 10
Ag workers constantly breathing chemicals is what finally got the short hoe out of California farm work, unless the crop is grown organically. No more hand weeding unless organic.Asbestos is found in soil, but was mined and used extensively because of insulatory abilities. Use certified contractors. Mesothelioma.
SLIDE 11
Epstein Barr carried by nearly everyone. Can also lead to Chronic Fatigue syndrome. Mono nucleosis.Human papilloma virus interferes with the body’s ability to produce human protein 6, which stops growth of tissue. A sexually transmitted disease, over 50 different genotypes have been identified, with half causing cancer. Some directly (cervical)SV40 has been found in mesothelioma cells, osteosarcoma cells, and non-hodgekins lymphoma. Thousands were inoculated with this in the first week of life in Germany and are being monitored-a 30 year study.
SLIDE 12
Smoking is responsible for 85% of all lung cancers-whether the person smokes or is exposed to second hand smoke. Smokeless tobacco increases the risk for oral, laryngeal, throat, and esophageal cancers.A diet high in antioxidents vitamins A, E, and C, as well as cruciferous vegetables and carrots, helps protect against skin and GI tract cancers. Limiting cured meats and smoked or barbequed foods. Fiber in all things.Alcohol increases the likelihood of cancers of the throat, oropharnyx, esophagus, stomach, and liver, as well as intensifying the effects of tobacco use.Over half a million cases of skin cancer(non melanoma) are diagnosed each year in the US. Persons who have lived in equatorial countries are more likely to develop skin cancer than those living farther north.Excess exposure to x-rays—generally not a client concern, more for the Rad tech and health care providers.Exposure to heavy metals in the manufacturing process—currently computer workers at a very high risk, but also vinyls, asbestos, solvents. Risk goes up expotentially with smoking.Estrogen to help with menopausal symptoms increases the risk of endometrial and breast cancer.
SLIDE 13
Encourage the patient to ask questions and discuss anticipated procedures.Evaluate learning ability, retention, level of understanding, Address knowledge deficits: signs, symptoms, risks, causes and available therapies.
Anxiety: Ensure physical comfort. Encourage expression of thoughts and feelings.Assist to identify concerns and problemsFoster an atmosphere of acceptance.Encourage therapeutic coping behaviors
SLIDE 22
Benign or pre-malignant growths are removed before they have the chance to spread or grow. Examples are removal of skin growths, colonoscopy with removal of polyps, and conization of cervical lesions. Some extreme cases are bil mastectomy for persons with recurrent breast lumps.
SLIDE 23
Diagnostic surgeries confirms or rules out malignancy. It establishes type, extent, and classification to tumor.Examples: needle biopsies, incisional or excisional biopsies. Samples of the tumor are taken if complete removal of a lesion or tumor is not possible or undesirable (location, etc) Removable tumors with excisional surgery are usually less than 3 cm in size. Size and location determine the best procedure to perform.
SLIDE 24
Curative surgery seeks to remove all of the tumor with minimal damage to structures surrounding the tumor and minimal functional impairment.Removal often means loss of an organ, resulting in an alteration in body image.The process of rehabilitation continues long after discharge, utilizing outpatient services. Groups of people who have experienced similar cancers often have formed support groups.
SLIDE 25
Restoration of form and function is possible in various degrees. This has changed the physical and emotional rehabilitation of cancer surgery. With many procedures it is possible for the reconstruction to occur at the same time as the curative surgery.The goal of reconstruction is to improve the person’s quality of life by restoring maximal funciton and appearance.
SLIDE 26
Palliative procedures may 1. retard the growth of the tumor. Removal of secreting glands to take away hormone source—example, a bilateral oophrectomy will slow or stop the growth of a breast tumor.Decrease the size of an existing tumor. Removal of all of the tumor may not be possible, so debulking the tumor reduces the “tumor burden” on the person, making it possible for other therapies, such as chemotherapy or radiation, to be more effective.3. To relieve distressing manifestations. Cryrosurgery or laser surgery may be used to remove obstructions, or ulcerations when a cure is no longer possible. This reduces pain.
SLIDE 30
Protein is being used for reconstruction of damaged tissues, and the tumor has been taking as many nutrients as it can get. Lower levels of immune globilins are produced.Monitor vital signs, blood counts, lung sounds, body orifaces, and wounds for signs and symptoms of infection.Use aseptic technique when working with wounds. Handwashing, patient hygeine.Maintain level of hydration and nutritional status
SLIDE 31
Monitor the platelet count. Look for petechiae, spontaneous hemorrhages, or areas of breakdown.Check body fluids for presence of blood(stool, emesis, urine)Protect individuals from trauma—limit venipunctures, rectal temps, suppositories. Avoid aspirin. Protect from shear and excoriation. Apply direct pressure to wounds until bleeding is stopped.
SLIDE 37
Chemotherapeutic medications lower the production of white cellsChemotherapy delays wound healing. It can be started 5 to 7 days postop when the wound has sealed off.Because chemotherapeutic agents are metabolized in the liver and kidneys, unpredictable levels of drug occur when these organs are impaired.Radiation therapy suppresses cell production in the bone marrow. Chemotherapy is usually withheld for 3-4 weeks to allow recovery so that the body can withstand the effects of the chemoThe first three months of pregnancy are when teratogenic effects would be most devastating.Chemotherapeutic agents are myelosuppressive, so patients may require transfusions of white cells to boost immunity and avoid superinfections prior to proceeding with chemotherapy.
SLIDE 40
Small, frequent meals of plain foods are most appealing crackers or hard candy help alleviate medication tastes, which are often metallicEncourage to eat protein early in the day, as nausea tends to increase as the day goes byAdminister antiemetics prior to chemotherapeutic agent
SLIDE 41
Daily weightsMonitor lab values of electrolytes so IV fluids can be adjusted appropriatlyLow residue diet helps reduce diarrheaAssess for perianal irritation. Apply petroleum based productsRecord number and quality of stools. Administer Immodium or Lomotil prn.If constipated, adjust diet by including fiber. Consider eliminating iron supplements. Record bowel movements for frequency, quality. Use laxatives, stool softeners, and enemas as needed.
SLIDE 43
For dermatitis provide skin care and lotions as needed. Avoid soaps and hot water. Warm packs to localized areas may provide relief.Assess oral cavity at least twice daily. Provide oral care every 2 hours while awake—lidocaine and glycerine products are helpful. Normal saline mouth rinses and popscicles of NS are helpful.Avoid hot or cold foods, spices, citrus, alcohol, smoking. Pureed foods, food supplements. ChapstickWear cotton, not synthetic underwear and local anesthetic products—vagisil, for exampleDiphenhydramine, tepid baths, and lotions reduce itchingTenderness may occur over liver—observe for jaundice, lethargy, weakness, and altered liver functions studies.
SLIDE 44
Alopecia usually happens with third dose of chemo. May be sudden or gradual. Hair usually grows back, and use of wigs, hats, turbans help prevent heat loss, sunburn, etc. Long hair needs to be cut prior to loss to promote comfort. Soft bristled hair brush and gentle cleansing of new hair, but comb and brush as little as possible.Skin will usually darken. Usually transient and resolves when therapy over. Need to avoid sunlight because they are photosensitive.Nails usually darken and have transverse ridging. After therapy concluded nails will grow in normally again.
SLIDE 45
Monitor BUN and creatnine. May require analgesia or antispasmodics. Increase fluid intake if not contraindicatedObserve for loss of motor ability, decreased reflexes, leg cramps related to numbness and tingling. Usually subsides in 4-6 weeks after therapy discontinued.Have patient use sunglassesRemind patient hearing loss may be transient or permanentGait and equilibrium may be altered, so use of cane, walker, etc will help patient maintain mobility and increase level of safety.
SLIDE 46
Hematuria, dysuria(painful urination) urgency common. Increase fluids to 2 liters daily to limit discomfort from excretion of chemotherapeutic agents. Test urine for presence of occult blood. Discoloration often goes away after 24 hours.
SLIDE 47
Discuss need to continue contraception. Menses usually return when medications discontinued. Level of libido may change related to androgens or estrogens. Partner may have altered libido related to powerlessness over situation. Include partner in discussions as allowed. Encourage verbalization of concerns. May need referral to therapist specializing in sexual dysfunction
SLIDE 48
Ekg, heart and lung sounds, weight, and leg diameters recorded prior to initial dose of meds to establish baseline.Observe for tachycardia, ekg changes, and right sided failure (wet lungs)—may need to stop therapy.Dyspnea on exertion, SOB, cyanosis, rales, wheezing, cough all indicate toxicity. Teach postural drainage and abdominal breathing. Monitor breath sounds
SLIDE 50
External therapy is administered by high-energy x-ray machinesInternal therapy may be from a sealed or unsealed source Intracavity therapy lasts 24-72 hours—helpful for cerivical or uterine cancers, for exampleInterstitial therapy the isotope is packed into needles, beads, seeds, ribbons, whatever, and implanted directly into the tumor. May be temporary or permanent.Should the implant come out of the patient, you will probably be the first to know since you will be changing sheets, assisting the patient with mobility, answering the call light. There will be tongs and a lead container in the room, so that you can safely pick up the implant and put in the lead box.Unsealed source is used for systemic therapy, isotopes given via IV or orally. Treatment for Grave’s disease of the thyroid would be low dose and thyroid cancer high dose of unsealed radioactive iodine.
SLIDE 52
The larger the treatment area, the greater the amount of side effectsHair over treated area will likely fall out, and probably not grow backA person receiving 5000 rads for curative treatment will have more side effects than a person receiving 2000 rads for palliation
SLIDE 53
Fractionation refers to dividing the total radiation dose into small, frequent doses. Often 150-200 centigrays five days a week for 4-6 weeks. Fractionation give healthy cells time to repair themselves between doses and increases the chance that the tumor cells will be hit during a growth phase.Alternate sites allow for hitting the tumor from the front, back, and either side of the tumor. The area that all angles have in common is the tumor, but by alternating the directions normal cells contact with the radiation is minimized.
SLIDE 54
The reactions are not burns, per se, but treating them like burns helps them heal. Aloe Vera cream to the site.Immediate skin reactions have 3 stages: Erythema, Dry Desquamation, Moist DesquamationDelayed reactions include atrophy from shrinking of the epidermal layerTelagiectasis (dilation of capillaries due to vessel damage)DepigmentationSubcutaneous fibrosisSkin cancerNecrotic or ulcerative lesionsSkin reactions are generally reversible, however they may heal over several yearsInterventions-notify radiologist. Monitor daily for changes. Keep area dry, wash with water only and pat dry.Aloe Vera over the counter helps, as do prescription cream preparations.Keep area away from heat and sunlight. Skin may be sensitive to heat and sunlight for years after therapy, as well as cold air.Do not wash off the tattoo marks placed by the therapist.Encourage wearing soft cotton fabrics-knits-that do not rub or chafe the area
SLIDE 55
Bone marrow and lymphatic tissue are very sensitive to radiation. Pelvic area leads to greater marrow depression than other areas.Monitor blood counts, at least weekly. Teach handwashing and good nutrition, hygiene and rest habits.Teach signs and symptoms of infection
SLIDE 56
Platelets are quite vulnerable to radiation. Counts below 100,000 should be reported to the MD.Monitor counts at least weekly. Teach person to avoid trauma and aspirin use—review anticoagulent use with physician. Teach signs of hemorrhage. Monitor stool, urine for occult blood. Apply direct pressure to any bleeding until bleeding stops.
SLIDE 57
Epogen!Fatigue is an expected side effect of radiation therapy and does not mean the disease is getting worse.Discuss fatigue with the patient and encourage them to do what they feel like doing, then rest. They need to eat nutrient dense foods, but carbs and fats increase energy.
SLIDE 58
Monitor diet for sufficient calories.Utilize dietician services—the attention really helps the patient feel well cared for.Weekly weights. Patient needs to eat sterile foods—avoid raw eggs or oysters, canned rather than fresh or frozen related to possible coliform contamination.Small, frequent meals will increase food intake—help patient to be aware of nutrients. Need protein.
SLIDE 59
Monitor oral cavity daily and notify radiologist if desquamation occurs.Administer viscous lidocaine before mealsBland diet, no smoking or alcohol.Saline rinse q 2 hours. Professional dental care. Plenty of po fluids.Sugarless hard candy will increase salivation. Avoid dry, thick foods.
SLIDE 60
Low residue diet and anti diarrheals.Encourage fluid intake so urine is more normal color and person voids regularly.Encourage rest before and after meals. Antiemetics as prophylaxis on treatment days, as needed the rest of the time. Monitor fluid and electrolyte status.Edema resulting from damage to tissues in cranium. Steroids and analgesics help.
SLIDE 61
Encourage verbalization, wearing of wigs, hats, scarves, and brush hair as little as possible, gentle shampooing.Encourage person to talk on phone, stop by and say hello even when patient is not part of your assignment. Encourage television viewing, radio, music. Discuss need to limit physical contact. Have family bring in photos.
SLIDE 64
Caloric and protein requirements must be met for body to repair itself.
SLIDE 65
The first phase of therapy causes nausea, vomiting, GI tract inflammation, taste changes, and anorexia. After the transplantation mucositis, stomatitis, esophagitis, and intestinal damage occur—resulting in diarrhea.
SLIDE 67
Most patients GI dysfunction resolves within 30 days after transplant. Then the patient can resume oral intake or tube feedings. Greater than 10% weight loss in 6 months indicates malnutritionPeripheral IVs cannot handle TPN sol’n, so central lines or PICC lines are needed.
SLIDE 69
Albumin indicates protein status of the body. Levels of serum transferrin is a marker for protein status, reflect the patient’s response to stress or nutritional support earlier than albumin levels.
foot notes for N2????
did anyone find the extra notes from shelba's lectures online? If so can sombody post how to find them step by step because I heard that there are additional notes to her slides other than the ones that we have. I guess that it is the notes that she says in class.
someone please help.....thanks
someone please help.....thanks
Wednesday, March 22, 2006
I need the class notes not the study guide...........
OK I think I was misunderstood , I mean the actual class notes they are supposed to be the slides Mrs Durston uses for N2 and she has foot notes in them that are often times found in the tests.
med's to know for N3???
hey, i left when i finished the exam and never saw the two med's richard wanted us to know for monday. if anyone knows what they are, please post a reply.
thanks,
danO
Tuesday, March 21, 2006
Nursing 2 notes
I have been trying to get to Miss. Durston's notes that are supposed to be in docushare but I cannot find them. Help........there is supposed to be veeeeerrrryyyy valuable foot notes in them.
Friday, March 17, 2006
Congrats!!
Grades are now posted and all is well! Congratulations to everyone. We're one step closer to graduation!
English 33A Follow-up Session
English 33 A Follow-up session scheduled for
Monday, March 20th
between the hours of 1:30 to 5:45
in Locke 314.
Monday, March 20th
between the hours of 1:30 to 5:45
in Locke 314.
Message from Mrs. S !
MESSAGES –
3/17/06 AT 1050 LADIES AND GENTLEMEN:
I KNOW YOU ARE ANXIOUSLY WAITING FOR YOUR GRADES BUT I HAVE NOT FINISHED CORRECTING THEM. PLEASE BEAR WITH ME. I WILL BE DONE THIS AFTERNOON.
MRS. SEMILLO
3/17/06 AT 1050 LADIES AND GENTLEMEN:
I KNOW YOU ARE ANXIOUSLY WAITING FOR YOUR GRADES BUT I HAVE NOT FINISHED CORRECTING THEM. PLEASE BEAR WITH ME. I WILL BE DONE THIS AFTERNOON.
MRS. SEMILLO
Study Guides for N2
I know were just recovering from the N1 Finals but Study guides for N2 are out !!! Have a great weekend ! =)
http://docushare.deltacollege.edu/dsweb/View/Collection-4129
http://docushare.deltacollege.edu/dsweb/View/Collection-4129
Wednesday, March 15, 2006
IV Calculations
These are the answers my group and I got. Please make any corrections.
p.1175 (text). Microdrip = 60 gtt/mL, Macrodrip = 15gtt/mL, or 10gtt/mL. flow rate = gtt/min, drop factor = gtt/mL
1. 35gtt/min
2. 42gtt/min
3. 14gtt/min
4. 75min or 1hr 15min
5. 10 gtt/min
6. 180 gtt/min
7. 360 min or 6hr, 0910 military time
8. 25hr or 1500min, 10 gtt/min, 1510 military time 08/25, 6gtt/min
9. 31 gtt/min
10. 570 min or 9.5hr
p.1175 (text). Microdrip = 60 gtt/mL, Macrodrip = 15gtt/mL, or 10gtt/mL. flow rate = gtt/min, drop factor = gtt/mL
1. 35gtt/min
2. 42gtt/min
3. 14gtt/min
4. 75min or 1hr 15min
5. 10 gtt/min
6. 180 gtt/min
7. 360 min or 6hr, 0910 military time
8. 25hr or 1500min, 10 gtt/min, 1510 military time 08/25, 6gtt/min
9. 31 gtt/min
10. 570 min or 9.5hr
Final Exam Study Tips From FRANK
1. primary care-immunization, education, prevention
secondary care-disease, treatment
tertiary-longterm, stages of life, rehab
2. educate pt. on procedure & make sure pt understand, active listening
3. assess for LOC, mental status, respiration, ABCD's, pain level.
5. aspirate, do not rub site
6. client's w/CV disease
7. to reduce anxiety, narcotics slows down function, adjunct to anesthesia
8. PQRST, splint w/ pillow for pt with abdominal surgery.
9. 30degrees, turn head to side, check IV patency
10. restate, rephrase, active listening
11. promoting, preserving health population in a group, direct-service oriented, indirect-referrals.
12. monitor weight daily, check VS, temp, check CVC, I/O, equipment, placement, TPN, PPN, extravasation
13. massage, position client
14. Age, renal/liver function, Obesity/Diabetes, immunocompetence, malnourished, depends on meds. know which one is more at risk.
15. phlebitus vs infiltration, extravasation
16. placement, x-ray, aspirate, 30degrees
17. double check with another nurse
18. use vastus lateralis muscle for infants
19. orthostatic hypotension, assess strength, assist client
20. buccal mucosa, gums, teeth
21. size, color, location, depth, odor, surgical incistions are considered a wound; make sure edges are approximated
22. identify factors of s/s to help identify nursing diagnosis
23. allows the pt of having control over pain therapy (pt autonomy)
24. interventions-changes, goal/outcome-does not change. determine if goal/outcome reflects nursing diagnosis if so the goal/outcome is met. if partially met or not met reassess.
25. make sure everything is ready prior to surgery, to prevent errors prior to surgery.
26. for skin testing ex TB, & allergy test
27/30. dehiscence, evisceration. pain leads to respiratory to mobility issues.
28. SE:nausea & vomiting. NI: HOB 30 degrees, slow down infusion
29. abdomen: below costal margins & above the ilian crest
32. results in a greater self-awareness & personal insight
33. void before administration, put all four side rails up, 5 rights
34. problem, etiology, S/S. Know how to put together a nursing diagnisos given s/s and a case study.
35. 5 rights, do not tough tab or caps as you transfer to med cup, assess if pt can swallow (check gag reflex)
36. wash hands, check bandage condition, assess pt hygein daily
37. elevate HOB 30 degrees @ all times, use thickner w/ fluids, no straw, pt w/ paralysis (hemiplegia) have to chew on the stronger side
38. monitor equiptment for placement, monitorsite for infection, make sure x-ray was taken for proper placement.
39. encourage use of spirometer, splinting, hug pillow & ecourage coughing ( if not contra), breathing exercises, encourage ambulation if possible
40. to increase oxygenation & ventilation
41. prevents the deposit of medication through sensitive tissues, seals med in muscle, & minimizes local skin irritation
42. ROME, resp opposite, met equal. look at pH & PCO2. Normal pH=7.35-7.45. PCO2=35-45.
KNOW IV CALCULATIONS.
PLEASE THANK FRANK IF THIS HELPS YOU. FRANK SAYS, "WE ARE ALL HERE TO HELP EACH OTHER."
secondary care-disease, treatment
tertiary-longterm, stages of life, rehab
2. educate pt. on procedure & make sure pt understand, active listening
3. assess for LOC, mental status, respiration, ABCD's, pain level.
5. aspirate, do not rub site
6. client's w/CV disease
7. to reduce anxiety, narcotics slows down function, adjunct to anesthesia
8. PQRST, splint w/ pillow for pt with abdominal surgery.
9. 30degrees, turn head to side, check IV patency
10. restate, rephrase, active listening
11. promoting, preserving health population in a group, direct-service oriented, indirect-referrals.
12. monitor weight daily, check VS, temp, check CVC, I/O, equipment, placement, TPN, PPN, extravasation
13. massage, position client
14. Age, renal/liver function, Obesity/Diabetes, immunocompetence, malnourished, depends on meds. know which one is more at risk.
15. phlebitus vs infiltration, extravasation
16. placement, x-ray, aspirate, 30degrees
17. double check with another nurse
18. use vastus lateralis muscle for infants
19. orthostatic hypotension, assess strength, assist client
20. buccal mucosa, gums, teeth
21. size, color, location, depth, odor, surgical incistions are considered a wound; make sure edges are approximated
22. identify factors of s/s to help identify nursing diagnosis
23. allows the pt of having control over pain therapy (pt autonomy)
24. interventions-changes, goal/outcome-does not change. determine if goal/outcome reflects nursing diagnosis if so the goal/outcome is met. if partially met or not met reassess.
25. make sure everything is ready prior to surgery, to prevent errors prior to surgery.
26. for skin testing ex TB, & allergy test
27/30. dehiscence, evisceration. pain leads to respiratory to mobility issues.
28. SE:nausea & vomiting. NI: HOB 30 degrees, slow down infusion
29. abdomen: below costal margins & above the ilian crest
32. results in a greater self-awareness & personal insight
33. void before administration, put all four side rails up, 5 rights
34. problem, etiology, S/S. Know how to put together a nursing diagnisos given s/s and a case study.
35. 5 rights, do not tough tab or caps as you transfer to med cup, assess if pt can swallow (check gag reflex)
36. wash hands, check bandage condition, assess pt hygein daily
37. elevate HOB 30 degrees @ all times, use thickner w/ fluids, no straw, pt w/ paralysis (hemiplegia) have to chew on the stronger side
38. monitor equiptment for placement, monitorsite for infection, make sure x-ray was taken for proper placement.
39. encourage use of spirometer, splinting, hug pillow & ecourage coughing ( if not contra), breathing exercises, encourage ambulation if possible
40. to increase oxygenation & ventilation
41. prevents the deposit of medication through sensitive tissues, seals med in muscle, & minimizes local skin irritation
42. ROME, resp opposite, met equal. look at pH & PCO2. Normal pH=7.35-7.45. PCO2=35-45.
KNOW IV CALCULATIONS.
PLEASE THANK FRANK IF THIS HELPS YOU. FRANK SAYS, "WE ARE ALL HERE TO HELP EACH OTHER."
SJDC ADN Class of 2007
in regards to question number 18. I know that it seems kind of an overlap. eg: book states vastus lateralis preferred site for infants less than 12 months and SAFETY ALERT box states ventrogluteal site is preferred site for adults and children over 7 months. Look in box 34-18 there are some key words that will allow you to differentiate between them.
1. vastus lateralis- immunizations
2. ventrogluteal- medications that are given in larger volume.
I was having a hard time with this one.
1. vastus lateralis- immunizations
2. ventrogluteal- medications that are given in larger volume.
I was having a hard time with this one.
Tuesday, March 14, 2006
Message From Fernisa
Nursing 1
For those of you who went to the review on Monday I wanted to clarify the parts of the Nsg. Diagnosis. ADPIE is the nursing process…not the parts of the Nsg. Diagnosis. The parts of the Nsg. Diagnosis are the 1. PROBLEM AND ITS DEFINITION , 2. THE ETIOLOGY, and 3. the defining characteristics
EX: Impaired skin integrity, related to decreased vascular circulation, as evidenced by discoloration in lower extremities, open wound on foot, patient states he has no sensation in toes. Etc. etc. etc.
I hope this helps everyone, Good luck.
Fernisa Sison
Monday, March 13, 2006
study session answer verification
Hi everyone
During the study session Ms Sison stated for question 34 the answer to be ADPIE but after some of you left we discussed it further and if you look on page 306 you will see that it says diagnostic label (NANDA, related factors (etiology or cause) and then we added as evidenced by.
Hope this helps.
During the study session Ms Sison stated for question 34 the answer to be ADPIE but after some of you left we discussed it further and if you look on page 306 you will see that it says diagnostic label (NANDA, related factors (etiology or cause) and then we added as evidenced by.
Hope this helps.
Friday, March 10, 2006
STUDY GUIDE / FINAL EXAM -N1 - PART 2
22. Describe the purpose of clustering data - Txt.
23. Discuss the purpose of a PCA pump - Txt.
24. Discuss how to evaluate a nursing intervention - Txt.
25. Discuss the purpose of preops checklist - Txt.
26. Discuss the purpose of an intradermal injection - Txt.
27. Discuss the complications of abdominal surgery - Txt. 1593
28. Discuss the side effects and the nursing interventions of a bolus feeding - Txt.
29. Discuss the sites for a SQ injection - Txt.
30. Discuss the complications of surgery - Txt. 1593
31. Discuss the risk factors of surgery - Txt. 1593
32. Discuss values clarification - Txt.
33. Discuss the safety issues involving the administration of preop meds - Txt.
34. Discuss the components of a nursing diagnosis - Txt.
35. Discuss the safety issues involving oral medication - Txt.
36. Discuss the nursing interventions needed to reduce infection - Txt.
37. Discuss the safety issues involving clients who are at risk for aspiration - Txt.
38. Discuss the safety issues involving the patient with parenteral nutrition - Txt.
39. Discuss the nursing interventions to promote oxygenation in the postop patient - Txt.
40. Discuss the purpose of an incentive spirometer - Txt.
41. Discuss the purpose of the Z- track method of medication administration - Txt.
42. Discuss the lab values of respiratory acidosis - Txt.
43. Calculations - 15 problems + 1 bonus problem
23. Discuss the purpose of a PCA pump - Txt.
24. Discuss how to evaluate a nursing intervention - Txt.
25. Discuss the purpose of preops checklist - Txt.
26. Discuss the purpose of an intradermal injection - Txt.
27. Discuss the complications of abdominal surgery - Txt. 1593
28. Discuss the side effects and the nursing interventions of a bolus feeding - Txt.
29. Discuss the sites for a SQ injection - Txt.
30. Discuss the complications of surgery - Txt. 1593
31. Discuss the risk factors of surgery - Txt. 1593
32. Discuss values clarification - Txt.
33. Discuss the safety issues involving the administration of preop meds - Txt.
34. Discuss the components of a nursing diagnosis - Txt.
35. Discuss the safety issues involving oral medication - Txt.
36. Discuss the nursing interventions needed to reduce infection - Txt.
37. Discuss the safety issues involving clients who are at risk for aspiration - Txt.
38. Discuss the safety issues involving the patient with parenteral nutrition - Txt.
39. Discuss the nursing interventions to promote oxygenation in the postop patient - Txt.
40. Discuss the purpose of an incentive spirometer - Txt.
41. Discuss the purpose of the Z- track method of medication administration - Txt.
42. Discuss the lab values of respiratory acidosis - Txt.
43. Calculations - 15 problems + 1 bonus problem
STUDY GUIDE / FINAL EXAM - N1 - PART 1
- Describe the 3 levels of care : primary, secondary, tertiary - Txt. 30
- Discuss the effective communication when the nurse is preparing to perform any procedure - Txt. 423-27
- Discuss the assessment needed when a client receives a narcotic - Txt 1327
- Discuss the sources of data - Txt. 284-85
- Discuss the safety issues regarding IM injections - Txt. 886-90
- Describe the situations when the valsalva maneuver is contraindicated - Txt. 1376
- Discuss the purpose of preoperative medication - Txt. 1601-02
- Discuss the assessment needed for the patient in pain - Txt. 1264-67
- Discuss the nursing interventions for the patient with nausea and vomiting - Txt. 1637
- Describe the communication technique of clarification - Txt. 429
- Describe community health nursing - Txt. 48-49
- Discuss the nursing interventions for the patient receiving parenteral nutrition - Txt. 831-33, Txt. 871-80
- Discuss the nursing interventions for the patient in pain - Txt.
- Discuss the risk factors for surgery - Txt.
- Discuss the assessment data needed for the patient with an IV infusion - Txt.
- Discuss the safety issues involved when administering meds through a NG tube - Txt.
- Discuss the safety issues involved when administering heparin or insulin - Txt.
- Discuss the safety issues involved when administering an IM injection to a toddler - Txt.
- Discuss the nursing interventions needed for the patient getting up for the first time - Txt.
- Discuss the normal variations of the oral cavity - Txt.
- Discuss the necessary information to document a patient's wound - Txt.
Today I Held A Beating Heart !!!!!!
What a way to spend the last day of N7 clinical,
Shoulder to shoulder between 2 doctors performing a triple bipass (CABG).
After the chest was opened and the pericardial sac opened, I was allowed to reach inside, sliding my hand between the pericardial sac and the pericardium, until I was underneath, and then I lifted this warm and heavy heart up from the cavity while it continued to beat, and I held it in my hand!!!!
WAY COOL!!
I am still in awe of the whole experience.
This is how Jane G. and I spent our last clinical day!
It took over an hour to get the patient prepped and the room ready. The doctors came in at 0800 and the heart was in my hand at 0845.
The surgery was completed at 1200.
Good Luck to all on your finals!!!!!!!!
Shoulder to shoulder between 2 doctors performing a triple bipass (CABG).
After the chest was opened and the pericardial sac opened, I was allowed to reach inside, sliding my hand between the pericardial sac and the pericardium, until I was underneath, and then I lifted this warm and heavy heart up from the cavity while it continued to beat, and I held it in my hand!!!!
WAY COOL!!
I am still in awe of the whole experience.
This is how Jane G. and I spent our last clinical day!
It took over an hour to get the patient prepped and the room ready. The doctors came in at 0800 and the heart was in my hand at 0845.
The surgery was completed at 1200.
Good Luck to all on your finals!!!!!!!!
EVERYBODY......hi all, I am going to hold an information exchange session for you all when you get to nursing 4/5. I am trying to gather at least one person from each clinical group so that we can give you hints, tips, organization skills, time management etc...we had to learn the hard way and want to make it easier on you all when you get to the floors, give report etc....so....keep on going strong and look for a meeting in august from us...anybody needs anything before then, please feel free to email! almost to n2 guys......then 4...then almost graduate!!!!!!!! Yay!!
Thursday, March 09, 2006
SJDC ADN Class of 2007
Has anyone had a chance to look at the IV sample questions look at this question.
The nurse is administering an intradermal tuberculin skin test to a client. The client comments that this "shot" was different than the usual shots. The nurse explains that the difference in the shots is that intradermals are administered at a different angle than intramuscular injections. The angle for intradermal injections is:
15 degrees.
30 degrees.
45 degrees.
90 degrees.
According to the answer sheet it states that the correct answer is C. 45degrees now I thought that it was 5-15 degreees. SQ was 45 degrees am I just reading the question wrong or is there some mistake.
The nurse is administering an intradermal tuberculin skin test to a client. The client comments that this "shot" was different than the usual shots. The nurse explains that the difference in the shots is that intradermals are administered at a different angle than intramuscular injections. The angle for intradermal injections is:
15 degrees.
30 degrees.
45 degrees.
90 degrees.
According to the answer sheet it states that the correct answer is C. 45degrees now I thought that it was 5-15 degreees. SQ was 45 degrees am I just reading the question wrong or is there some mistake.
Wednesday, March 08, 2006
Calculations Grades for Nursing 3
Grades are posted for our first calculations test in pharmacology. Everyone did well. here is the link
http://docushare.deltacollege.edu/dsweb/View/Collection-5817
http://docushare.deltacollege.edu/dsweb/View/Collection-5817
Tuesday, March 07, 2006
Sample IV questions
I have put 20 sample IV questions on docushare under Nursing 101 -Nursing 1/2 study aides. More will come but I actually have to take the test first to get the answers, Then cut and paste it in to a word document so it is taking more time than I thought. More will be posted tomorrow. Keep your eyes out.
Caralee
Caralee
Sunday, March 05, 2006
Study session for the final
Hey all
Ms. Bromme and Ms. Sison are having a study session tomorrow night from 5 - 6 to help us get ready for the final. It will be in the North Forum if available. If we are not there we will be in one the the forums so just look for us. Hope to see you there.
Ms. Bromme and Ms. Sison are having a study session tomorrow night from 5 - 6 to help us get ready for the final. It will be in the North Forum if available. If we are not there we will be in one the the forums so just look for us. Hope to see you there.
Saturday, March 04, 2006
Pharm Exam 2 Sample Questions
Hey everyone! Sample questions are posted on Richard's docushare.
http://docushare.deltacollege.edu/dsweb/View/Collection-5817
Have a good weekend!
http://docushare.deltacollege.edu/dsweb/View/Collection-5817
Have a good weekend!
hello all...I have a brand new med/surg book in the plastic....you need it for nursing two and will use again in nursing 4..it is 130 dollars in the bookstore and I will sell for 80 dollars to first person to email me....rnstudychris@aol.com hope you are all doing very well, let us know if there is anything we can do for you guys!! Christine ;)
Thursday, March 02, 2006
LOL! -- Watch your back....
Student Nurse Evaluation Memo
Judy Smith, my Student Nurse, can always be found
hard at work in her station. Judy works independently, without
wasting hospital time talking to colleagues. Judy never
thinks twice about assisting fellow employees, and she always
finishes given assignments on time. Often, Judy takes extended
measures to complete her work, sometimes skipping coffee
breaks. Judy is an individual who has absolutely no
vanity in spite of her high accomplishments and profound
knowledge in her field. I firmly believe that Judy can be
classed as a high-caliber employee, the type which cannot be
dispensed with. Consequently, I duly recommend that Judy be
promoted to executive management, and a proposal will be
executed as soon as possible.
Regards - Charge Nurse
Shortly thereafter, the HR department received the following memo from the Charge Nurse:
Sorry, but that idiot (Judy) was reading over my shoulder while I wrote the report sent to you earlier today. Kindly read only the odd numbered lines for my true assessment of her...
Judy Smith, my Student Nurse, can always be found
hard at work in her station. Judy works independently, without
wasting hospital time talking to colleagues. Judy never
thinks twice about assisting fellow employees, and she always
finishes given assignments on time. Often, Judy takes extended
measures to complete her work, sometimes skipping coffee
breaks. Judy is an individual who has absolutely no
vanity in spite of her high accomplishments and profound
knowledge in her field. I firmly believe that Judy can be
classed as a high-caliber employee, the type which cannot be
dispensed with. Consequently, I duly recommend that Judy be
promoted to executive management, and a proposal will be
executed as soon as possible.
Regards - Charge Nurse
Shortly thereafter, the HR department received the following memo from the Charge Nurse:
Sorry, but that idiot (Judy) was reading over my shoulder while I wrote the report sent to you earlier today. Kindly read only the odd numbered lines for my true assessment of her...
Care Plan Helps
Here are some links that can help you with the Nursing Diagnoses and Care Plans.
RN Central
Care Plan Constructor
Answers to skills lab worksheets ! ! !
Hey y'all,
Goto evolve's website and
1. look under courses and click on "Potter: fundamentals of nursing 6th edition."
2. Click on "start at beginning"
3. Click on "evolve resources"
4. Click on "Chapter 1, nursing today"
5. Click on "Mosbys Nursing skills Video exercises"
From there you will have to scroll down and look for your desired subject! The questions we downloaded from docushare are verbatim from this source!
Have fun!
Harrison
Goto evolve's website and
1. look under courses and click on "Potter: fundamentals of nursing 6th edition."
2. Click on "start at beginning"
3. Click on "evolve resources"
4. Click on "Chapter 1, nursing today"
5. Click on "Mosbys Nursing skills Video exercises"
From there you will have to scroll down and look for your desired subject! The questions we downloaded from docushare are verbatim from this source!
Have fun!
Harrison
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