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Exam 2 MED surg
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- Denver School Of Nursing
Lecture notes of 25 pages for the course NUR 330 Medical Surgical Nursing at Denver School Of Nursing (Exam 2 Study guide)
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Med Surg Exam 2EKG Sinus Rhythms SA- Node “PACEMAKER” 60-100bpm located in the Right Atria oThe SA node stops; the foci will jump in to keep heart rate Foci: potential pacemakers o60-80bpm in the R and L Atria o40-60bpm in between the atrium and ventricles (AV junction)
o20-40bpm in the ventricles
P Wave- Atrial depolarization P QRS- AV block QRS- Ventricular depolarization T Wave T Wave
Rate Calculation: most accurate oCount the number of small squares between two consecutive R waves and divide by 1500
The sinus rhythms; comes from SA Node oNormal Sinus Rhythm oSinus Bradycardia Regular; Rate <60bpm; PR interval: <0.2; QRS complex interval: <0.12; QT intervals: 0.34-0.43
First line drug for Symptomatic Bradycardia: Atropine oAnticholinergic for slow HR
oDosing: 0.5-1 mg q5 mins (no more than 3mg MAX) oOverdose: can’t pee, can’t see, can’t spit, can’t shit (DRY) oSinus Tachycardia Regular; Rate >100bpm; PR interval: <0.2; QRS complex interval: <0.12; QT intervals: 0.34-0.43
Cancer Chap 15
Cancer is when abnormal cells divide in an uncontrolled way due to defects in our genetic material (DNA).
Defects derive from environment, lifestyle, and genetics
Treatment: Chemotherapy (systemic) oaka antineoplastic therapy
oInvolves the use of chemicals as a systemic therapy for cancer
oChemotherapy is a mainstay of cancer treatment for most solid tumors and hematologic
cancers (e.g., leukemias, lymphomas)
oChemotherapy can offer cure for some cancers, control other cancers for long periods, and in some cases, offer palliative relief of symptoms when cure or control is no longer possible
oThe goal of chemotherapy is to eliminate or reduce the number of cancer cells in the primary and metastatic tumor site(s)
oThere may be some risk in handling the body fluids and excretions of people during the first 48 hours after they receive chemotherapy
oThe 2 major categories of chemotherapy drugs are …
Cell cycle phase-nonspecific
Cell cycle phase-specific drugs Treatment: Radiation (localized)
oAlong with surgery, radiation therapy is one of the oldest methods of cancer treatment
Beams create ionization causing cell death oRadiation is used to treat a carefully defined area of the body
External: more common
Skin care; protect your skin (avoid irritation) oNo hot or cool packs oNo constricting garments oNo rubbing of skin of treatment field oAvoid deodorants to treatment field Dry skin: Lubricate dry skin with a nonirritating lotion emollient that contains no metal, alcohol, perfume, or additives Calendula ointment and topical hyaluronic acid cream are effective for managing radiation dermatitis
Aloe vera gel is useful for preventing skin problems
Internal: brachytherapy- short distance treatment
Temporary implants: 24-72 hours pt is radioactive Permanent implants: patient is not radioactive oRadioactive Patient : ALARA : as low as reasonable achievable Time < 30 mins a shift (wear a dosimeter to keep track) Distance visitors needed to stay 6 feet away (no pregnant or under 18)
Shielding (led apron during direct care) Place a sign on the door radioactive Complications oAltered taste sensation (dysgeusia) is a common side effect of cancer oTell the patient to try different ways to mask the taste
oEat smaller amounts more often oMalnutrition: secondary to cancer
Weigh you patient at least twice a week Monitor albumin and prealbumin levels (proteins)
Albumin (half-life 20-22 days) oTransporter (liver) oOncotic pressure (albumin in plasma is the body’s natural colloid oNutritional status (look at the patient) Hypoalbuminemia- 2nd and 3rd spacing occurs d/t change
in oncotic pressure Prealbumin precursor to albumin (shorter half-life 2-4 days) Acute response to nutritional status change oCancer Cachexia (wasting syndrome) 20% of cancer deaths Cachexia is defined as a weight loss of more than 5% or when weight loss is more than 2% with a BMI less than 20
A multifactorial syndrome characterized by anorexia and/or unintended loss of weight and appetite
It is accompanied by generalized tissue wasting, skeletal muscle atrophy, immune dysfunction, and metabolic problems The weight loss cannot be reversed nutritionally
Patients with upper GI and pancreatic cancers are prone to cachexia
Manifestations: unintentional weight loss, skeletal muscle wasting, anorexia/loss of appetite, and lowered quality of life Treatment: improve quality of life Osteoporosis Chap 63
Osteoporosis: bone pores or decreased in bone density
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