Exam Study Guide BUNDLE for NUR2392 \/ NUR 2392 Multidimensional Care II \/ MDC 2 – Rasmussen University. Contains study guide for Exam 1, Exam 2 and Final Exam. HAPPY STUDYING…<\/p>\n\n\n\n
NUR 2392 Multidimensional Care II
Multidimensional Care II Exam 1 Study Guide 2023 \/ 2024
*The exam questions are not limited to only what is listed on
this guide, please refer to your chapter readings and module
materials
Ch. 21: Principles of Cancer Development
\u25cf Benign vs. Malignant cells
\u25cb Benign:
\u25a0 Specific Morphology- they resemble the tissue they originated
from (they look like the host).
\u25a0 Small Nuclear to Cytoplasmic Ratio- they have a similar
structure inside the cell to normal cells and small nucleus.
\u25a0 Specific Function- they contribute to the body in some way.
\u25a0 Tight Adherence- they bind close together.
\u25a0 No Migration- they do not move around the body or invade other
tissue sites.
\u25a0 Orderly Growth-they grow at a normal rate.
\u25a0 Euploidy- they have a normal amount of chromosomes per cell.
\u25cb Malignant (Cancer):
\u25a0 Anaplasia- loss of appearance of the parent cell.
\u25a0 Large Nuclear to Cytoplasmic Ratio- they have a large nucleus
and occupy space.
\u25a0 Specific Functions are Lost- they serve no purpose to the body.
\u25a0 Loose Adherence- loose binding of the cells, causing potential
spread into the blood and body.
\u25a0 Migration\/Metastasis- spreads and moves easily.
\u25a0 Loss of cellular regulation and contact- the cells will crowd,
push, and grow on top of other cells.<\/p>\n\n\n\n
\u25a0 Rapid Cell Division- the cells will be produced and grow at a
faster rate
\u25a0 Aneuploidy- abnormal number of chromosomes per cell.
\u25cf Seven warning signs of cancer
\u25cb \u201cCAUTION\u201d
\u25a0 C: changes in bowel or bladder habits
\u25a0 A: a sore that does not heal or mouth sources (mucositis)
\u25a0 U: unusual bleeding or discharge
\u25a0 T: thickening of a lump in a tissue
\u25a0 I: indigestion and dysphagia
\u25a0 O: obvious change in a wart or mole
\u25a0 N: nagging cough
\u25cf Cancer development stages of malignancy
\u25cb Initiation: the normal cell becomes damaged which is irreversible and
can lead to cancer developing
\u25cb Promotion: repeat exposures to a damaging stimuli enhances growthmutations can cause this
\u25cb Progression: because of repeat exposures, there is an increase in
production of malignant cells
\u25cb Metastasis: movement of the cancer cells
\u25a0 Malignant transformation: some cells will divide enough to form
a tumor area on top of tissue.
\u25a0 Tumor vascularization: cancer cells secrete tumor angiogenesis
factor stimulating the blood vessels to bud and for channels to
grow.
\u25a0 Blood Vessel Penetration: cancer cells break off from the main
tumor and enzymes on the surface of the tumor cells make holes
in the blood vessels, allowing the cancer cells to enter blood
vessels and travel around the body.
\u25a0 Arrest and Invasion: cancer cells clump up in the blood vessel
walls and invade new tissue aera to support continued growth of
cancer cells and new tumors.
\u25cf Cancer classification: monitor tumor growth, aggression, progression, and to
determine appropriate treatment.
\u25cb Tumor grading: based on cellular aspects of cancer.
\u25a0 Based on the aggressiveness of the cancer cell and
differentiation from the normal tissue.
\u25cf G0: the grade cannot be determined
\u25cf G1: Tumor cells are well differentiated and closely
resemble the normal cells from which they arose.This
grade is considered a low grade of malignant<\/p>\n\n\n\n
change.These tumors are malignant but are relatively
slow growing.
\u25cf G2: Tumor cells are moderately differentiated; they still
retain some of the characteristics of normal cells, but also
have more malignant characteristics than do G1 tumor
cells.
\u25cf G3: Tumor cells are poorly differentiated, but the tissue of
origin can usually be established.The cells have few
normal cell characteristics.
\u25cf G4: Tumor cells are poorly differentiated and retain no
normal cell characteristics.Determination of the tissue of
origin is difficult and perhaps impossible.
\u25cb Plodiy: based on the number of chromosomes the cell has
\u25a0 Cancer cells will have an abnormal number of chromosomes in
their cells.
\u25cf Euploidy: normal amount of cell chromosomes- 46 with 23
pairs.
\u25cf Aneuploidy: abnormal number and formation of
chromosomes in cancer cells.
\u25cb Staging: determines the exact location of the cancer, how large the
tumor is, and if it is spreading.
\u25a0 Clinical staging: assesses patient symptoms to determine size
and spread.
\u25a0 Surgical staging: assesses size, number, sites, and spread by
visualization at surgery.
\u25a0 Pathological staging: determining the tumor size, number, sites,
and spread by pathologic examination of tissues obtained at
surgery.
\u25cb TNM- tumor, node, metastasis
\u25a0 Describes the anatomic extent of cancers. 1-4. 1 is that there is
no spreading or is small and 4 is that there is a large spread and
that the tumor is large also.
\u25cf Primary tumor (T): how large the tumor is .
\u25cb Tx: primary tumor cannot be assessed
\u25cb T0: no evidence of primary tumor
\u25cb Tis: carcinoma in situ- pre cancer
\u25cb T1, T2, T3, T4: increasing size and\/or local extent of
primary tumor
\u25cf Regional lymph nodes (N): based on how many nodes the
tumor takes over in the body.
\u25cb Nx: regional lymph nodes cannot be assessed<\/p>\n\n\n\n
\u25cb N0: no regional lymph node metastasis
\u25cb N1, N2, N3: increasing involvement of regional
lymph nodes
\u25cf Distant metastasis (M): if the cancer is moving or not
moving.
\u25cb Mx: presence of distant metastasis cannot be
assessed
\u25cb M0: no distant metastasis
\u25cb M1: distant metastasis
\u25cb Doubling time: the amount of time it takes for a tumor to double in
size. Will help determine tumor growth.
\u25cb Mitotic index: the percentage of actively dividing cells within a tumor.
\u25cb Cancers are classified by the tissue they originate from. Other ways to
classify cancer include: biologic behavior, anatomic site, and degree of
differentiation
\u25a0 Adeno = epithelial
\u25a0 Chondro = cartilage
\u25a0 Fibro = fibrous connective
\u25a0 Glio = glial cells (brain)
\u25a0 Hemangio = blood vessel
\u25a0 Hepato = liver
\u25a0 Leiomyo = smooth muscle
\u25a0 Lipo = fat\/adipose
\u25a0 Lympho = lymphoid tissue
\u25a0 Melano = pigment producing cells
\u25a0 Meningioma = meninges
\u25a0 Neuro = nerve tissues
\u25a0 Osteo = bone
\u25a0 Renal = kidney
\u25a0 Rhabdo = skeletal muscle
\u25a0 Squamous = epithelial layer, mucous membranes, organ lining
\u25cf Cancer prevention (primary vs. secondary)
\u25cb Primary
\u25a0 Use of sunscreen
\u25a0 Stop tobacco use
\u25a0 Use PPE in workplace
\u25a0 Reduce alcohol consumption
\u25a0 Modify diet
\u25a0 Limit sexual partners\/safe sex practices
\u25a0 Remove at-risk tissue: removing polyps, breast tissue, etc
<\/p>\n\n\n\n
NUR 2392 Multidimensional Care II
Multidimensional Care II Exam 2 Study Guide 2023 \/ 2024
*The exam questions are not limited to only what is listed on
this guide, please refer to your chapter readings and module
materials
Chapter 12 \u2013 Assessment and Care of Patients with Problems of Acid-Base Balance
\u25cf ABG ranges and analysis
o Normal Ranges:
\u25aa pH: 7.35-7.45 7.35-7.4= acidosis 7.4-7.45= alkalosis
\u25aa PaCO2: 35-45
\u25aa HCO3: 22-26
\u25aa PaO2: 80-100
o Abnormal Ranges:
\u25aa Acidosis
\u25cf pH: \u2193 7.35
\u25cf PaCO2: \u2191 45
\u25cf HCO3: \u2193 22
\u25aa Alkalosis
\u25cf pH: \u2191 7.45
\u25cf PaCO2: \u2193 35
\u25cf HCO3: \u2191 26
\u25aa PaO2 is abnormal when it is \u2193 80
o How to solve ABG imbalances:
\u25aa First, look at pH- determine if it is acidic, alkaline, or normal
\u25cf If in normal range – determine if the pH is more acidic
(7.35-7.4), or alkaline (7.4-7.45)- this will help us
determine compensation
\u25aa Next, look at PaCO2- determine if it is below 35 (or more
alkaline), in normal range, or above 45 (or more acidic).
\u25aa Then, look at the HCO3- determine if it is below 22 (or acidic), in
normal range, or above 26 (or alkaline).<\/p>\n\n\n\n
\u25aa Once all readings have been determined, use the ROME method
to determine the ABG imbalance.
\u25cf Respiratory Opposite- the pH and CO2 levels will be in
opposite directions, Metabolic Equal- the Ph and HCO3
levels will be in the same or equal direction.
\u25aa Next look at the PaO2. In our respiratory clients, we must look
at this to determine if there is enough oxygen getting into the
lungs or not. If it is lower than 80, then we know there is not
enough perfusion of oxygen within the arterial blood and that
there is breathing difficulty somewhere.
\u25aa Then we must determine if the patient is fully compensated,
partially compensated, or uncompensated.
\u25cf Fully Compensated vs. Partially Compensated vs. Uncompensated
o Compensation occurs when there is an acid base imbalance and the
body attempts to correct an abnormality within the other body system.
\u25aa First the pH will be affected due to being a buffer. Must look to
see if it is normal, abnormal, acidic, alkaline.
\u25aa Then we will look at PaCO2 and HCO3. Whichever value is
abnormal, that is your compensation.
o Fully Compensated: The body has placed the pH back to normal.
However, there will be other systems with abnormal ranges. The
abnormal value is the body systems that are compensating. pH normal
and HCO3 and PaCO2 are both abnormal. 7.37, 60, 18
o Partially Compensated: The body is compensating for the pH and for
both the PaCO2 and HCO3. This places all 3 levels abnormal. This
shows that the respiratory and kidneys are compensating to get the pH
back to normal. 7.3, 50, 18
o Uncompensated: The body is not in a state of compensation yet, so
there is an abnormality of the pH and either the PaCO2 or HCO3, but
not both. 7.3, 60, 24
\u25cf Buffers
o Chemical (bicarbonate and intracellular fluid) and protein buffers
(albumin and globulins)
\u25aa First line of defense
\u25cf Either bind or release hydrogen ions as needed
\u25cf Respond quickly to changes in pH
o Respiratory buffers
\u25aa Second line of defense
\u25cf Control the level of hydrogen ions (within minutes) in the
blood through the control of CO2 levels<\/p>\n\n\n\n
\u25cf When a chemoreceptor senses a change in the level of
CO2, a signal is sent to the brain to alter the rate and
depth of respirations.
o Hyperventilation: Decrease in hydrogen ions (helps
to blow off excess hydrogen ions), decreased PaCO2.
Central chemoreceptors inhibited.
o Hypoventilation: Increase in hydrogen ions,
increased PaCO2. Central chemoreceptors
stimulated.
o Kidney buffers
\u25aa Kidneys are the third line of defense.
\u25cf This buffering system is much slower to respond (24-48
hours), but it is the most effective buffering system with
the longest duration. (kidney movement of bicarbonate,
formation of acids [HPO4 -1 + H+ \u2192 H2PO4 2-], and
formation of ammonium [NH3+ + H+ \u2192 NH4+])
\u25cf Kidneys control the movement of bicarbonate in the urine.
Bicarbonate can be reabsorbed into the bloodstream or
excreted in the urine in response to blood levels of
hydrogen.
\u25cf Kidneys can also produce more bicarbonate when needed.
o High hydrogen ions: Bicarbonate reabsorption and
production
o Low hydrogen ions: Bicarbonate excretion
\u25cf pH Regulation
o The pH is the expression of the balance between carbon dioxide (CO2),
which is regulated by the lungs, and bicarbonate (HCO 3-), a base
regulated by the kidneys. The greater the concentration of hydrogen,
the more acidic the body fluids and the lower the pH. The lower the
concentration of hydrogen, the more alkaline the body fluids and the
higher the pH.
o Example:<\/p>\n\n\n\n
o When excess carbon dioxide is produced, the equation shifts to the
right, causing an increase in hydrogen ions (and a decrease in pH).
\u25aa Whenever the CO2 level changes, the pH changes to the same
degree, in the opposite direction
\u25aa When the CO2 level of a liquid increases, the pH drops,
indicating more free hydrogen ions (more acidic)
<\/p>\n\n\n\n
NUR 2392 Multidimensional Care II
Multidimensional Care II Final Exam Study Guide 2023 \/ 2024
*The exam questions are not limited to only what is listed on
this guide. Please refer to your chapter readings, recordings,
and module materials. ATI has additional practice questions for
review in Learning Systems RN 3.0.
Ch. 56 \u2013 Care of Patients with Noninflammatory Intestinal Disorders
\u25cf Nonmechanical (ileus) vs. mechanical obstruction (intussusception, volvulus,
etc.)
o Non-mechanical: results from neurological disturbances that affect the
muscles. Can be primary or secondary (often based on anesthesia
medications). Remember to assess the patient’s bowel tones for
complications from this!
\u25aa Paralytic Ileus: the bowel is not impacted by a physical
obstruction, but because of a lack of peristalsis as a result of
neuromuscular disturbance, causing backup of fecal contents
and abdominal distention and potentially leakage of stool
contents into the peritoneum space can occur, causing
inflammation and infection, decreased electrolyte levels and
reduced blood volume.
o Mechanical: from a structural disturbance of the bowel.
\u25aa Adhesions: scar tissue from surgery that builds up and causes
obstruction
\u25aa Benign or malignant tumors
\u25aa Appendicitis complications: if the appendix bursts, often the
contents will cause disruptions in fecal matter flow.
\u25aa Hernia: protrusion of the bowel through an opening that should
not be there, causing pain and blockages.
\u25aa Fecal impactions: from constipation
\u25aa Strictures: from crohn\u2019s or radiation
\u25aa Intussusception: telescoping of the bowel into itself.<\/p>\n\n\n\n
\u25aa Volvulus: twisting of the bowels, allowing nothing to go through.
o Physical Assessment
\u25aa Obstipation: severe constipation that may last for days without
any passage of stools. Diarrhea may be present in partial
obstructions
\u25aa Failure to pass gas
\u25aa Vomiting that may be foul smelling or coffee ground like.
\u25aa Abdominal Distention: abdominal when assess will be firm,
swollen, and painful
\u25aa Peristaltic waves: movement of the intestine, then stopping
\u25aa Borborygmi: high pitch gurgling bowel sounds
o Diagnostics:
\u25aa Barium Swallow
\u25aa CT with contrast
\u25aa Ultrasound
o Nursing Care:
\u25aa Monitor vitals
\u25aa Assess abdomen 2 times a day for bowel tones, distention, and
passing for gas
\u25aa Monitor F\/E,I\/O, lab values for disturbances- may need to give
IV fluid replacement due to potential loss of electrolytes such as
NS
\u25aa Manage NG tube- often will be a salem sump tube
\u25aa Ensure tube patency
\u25aa Check initial tube placement with XRAY
\u25aa May need suction and decompression for the obstruction
\u25cf Metabolic alkalosis is a concern
\u25aa Check for tube placement (pH 0-4)
\u25aa Irrigate tube
\u25aa NPO status
\u25aa Perform mouth and nare care
\u25aa Place patient in a semi fowler’s position
\u25aa Give pain medications
\u25aa Give alvimopan.
o Surgery
\u25aa Exploratory laparotomy: will allow the provider to relieve and
locate the obstruction. may be large or small incisions.
\u25aa The RN should teach the patient about what to expect after such
as NG tube insertion and a clear liquid diet that will advance as
tolerated. Potential N and V.
o Patient Teaching
\u25aa Patients should eat high fiber foods, like raw fruits and veggies.
\u25aa Drink lots of water<\/p>\n\n\n\n
\u25aa Do not use routine laxatives as they have a potential to become
abused. and cause damage to the abdominal muscles.
\u25aa Daily exercise needed to promote gastric motility
\u25aa Take bulk forming products and a stool softener.
\u25aa Sit on the toilet or commode rather than the bedpan.
\u25aa Must report and abdominal pain, distention, N,V,constipation
\u25aa Teach about incision care
\u25aa Drug therapy will often include percocet, stool softener.
\u25cf Polyps
o Small growths that are attached to the intestinal mucosa that are
often benign but can become malignant.
o Adenomatous: polyps that have the potential to become malignant
\u25aa Villious
\u25aa Tubular
o Hyperplastic: little chance to become cancerous polyps
o Malignant: those polyps that are cancerous when developed
o Familial adenomatous polyposis and hereditary nonpolyposis are
inherited that will eventually progress to colorectal cancer
o Assessment:
\u25aa Asymptomatic and usually discovered on a routine colonoscopy
screening
\u25aa May cause bleeding, obstruction or intussusception
o Diagnostics: biopsy and will often be removed at time of finding.
o Patient teaching: follow ups may be needed for complete polyp
removals. Teach about bleeding, abdominal distention and pain and
blood in the stool after the procedure.
\u25cf Colorectal cancer labs (CEA), diagnostics
o Fecal occult blood test (FOBT) \u2013 positive test indicates bleeding in the
GI tract
\u25aa Patient needs to avoid aspirin, vitamin C, iron and red meat for
48 hours before giving stool specimen
\u25aa Also, assess whether the patient is taking anti-inflammatory
drugs, need to be discontinued
\u25aa Negative results do not completely rule out the possibility of
CRC
o Carcinoembryonic antigen (CEA) \u2013 an oncofetal antigen is elevated in
many people with CRC
\u25aa Normal value is less than 5 ng\/mL
\u25aa This protein is not specifically associated with the CRC, and it
may be elevated in the presence of other benign or malignant
diseases and in smokers<\/p>\n\n\n\n
\u25aa It is often used to monitor the effectiveness of treatment and to
identify disease recurrence
\u25cf Imaging Assessment
\u25cb Sigmoidoscopy \u2013 provides visualization of the lower colon using
a fiberoptic scope
\u25cb Colonoscopy \u2013 provides better visualization of polyps and small
lesions than does a barium enema alone
\u25cf Irritable bowel syndrome health teaching and testing (hydrogen breath test)
o Types
\u25aa IBS C: constipation
\u25aa IBS D: diarrhea
\u25aa IBS M: mixed constipation and diarrhea
\u25aa IBS A\/U: alternating constipation and diarrhea or unknown
o Hydrogen breath test or small-bowel bacterial overgrowth breath test.
When small-intestinal bacterial overgrowth or malabsorption of
nutrients is present, an excess of hydrogen is produced. Some of this
hydrogen is absorbed into the bloodstream and travels to the lungs
where it is exhaled. Patients with IBS often exhale an increased
amount of hydrogen.
o Teach the patient that he or she will need to be NPO (may have water)
for at least 12 hours before the hydrogen breath test. At the beginning
of the test, the patient blows into a hydrogen analyzer. Then, small
amounts of test sugar are ingested, depending on the purpose of the
test, and additional breath samples are taken every 15 minutes for 1 to
5 hours
\u25cf Teaching and nutrition
\u25cf Dietary fiber and bulk help produce bulky, soft stools and
establish regular elimination habits.
\u25cf The patient should consume 30-40 g of fiber each day
\u25cf Eating regular meals, drinking 8-10 glasses of water each day,
and chewing food slowly help promote normal bowel function.
\u25cf Drug therapy depends on main symptoms of IBS
\u25cb Constipation-predominant IBS treated with bulk forming
laxatives
\u25cb Diarrhea-predominant treated with antidiarrheals<\/p>\n","protected":false},"excerpt":{"rendered":"
Exam Study Guide BUNDLE for NUR2392 \/ NUR 2392 Multidimensional Care II \/ MDC 2 – Rasmussen University. Contains study guide for Exam 1, Exam 2 and Final Exam. HAPPY STUDYING… NUR 2392 Multidimensional Care IIMultidimensional Care II Exam 1 Study Guide 2023 \/ 2024*The exam questions are not limited to only what is listed […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"categories":[25],"tags":[],"class_list":["post-114717","post","type-post","status-publish","format-standard","hentry","category-exams-certification"],"_links":{"self":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/posts\/114717","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/comments?post=114717"}],"version-history":[{"count":0,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/posts\/114717\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/media?parent=114717"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/categories?post=114717"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/tags?post=114717"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}