Gout
What is Gout?
Cause, (primary & secondary)
Inflammatory dx/ arthritis
•Urate Crystals deposit in joints and other body tissues, causing inflammation
•Primary: Production of uric acid exceeds excretion capabilities of kidneys
•Secondary: Caused by other diseases, such as renal insufficiency, diuretic therapy, chemotherapeutic agents, multiple myeloma and other cancers.
Causes and Stages
Caused by deer tick bite, resulting in release of spirochete infection into blood
Three Stages
•Stage I: “bullseye” rash, muscle and joint pain and stiffness, flu-like symptoms 2-30 days after tick bite
•Stage II: 2-12 weeks heart & CNS symptoms – rigidity, pain, stiffness
•Stage III: 6 wks. -2 years if untreated arthritis symptoms
Signs and Symptoms
•Sleep disturbances, sensory
changes, and pain, with
identifiable trigger points are
characteristic
•Trunk, extremity, and facial pain and tenderness and fatigue without
objective findings
Benign Tumors
defined, characteristics, and examples
•
•Normal cells growing in the wrong place at the wrong time.
•Examples: Moles, uterine fibroid tumors, skin tags, endometriosis, nasal polyps
•It does not invade structures
•It does not metastasize
•Only reasons to remove: When the tumor invades structures causing S/S
Radiation Therapy
Types, side effects
•Destroys CA cells, with minimal exposure of normal cells to the radiation.
•Given in fractions for safety & effectiveness
1.Side effects: local skin changes and irritation, fatigue. Varies according to site
2.External beam radiation
skin care: increase protein in diet. Aloe vera, mild soap, no ice/heat, no salt water or chrolinated pools
3.Brachytherapy
1.safety & protection
Assessment
•Assessment
•Initial manifestation is excruciating pain, usually in– BIG TOE pain, increase in ESR, WBC elevated
•May go for years without problem, then develop urate crystals (tophi) under skin and in major organs (kidneys)
•Chronic sx are tophi, renal stones
•Elevated serum and urine uric acid levels; 24- hour urine sample for uric acid, synovial fluid testing
Treatment
PREVENTION - long pants and shirts in the woods. Tick check
Doxycycline
Treatment
•NSAIDs, avoid opiods
•prebabalin (Lyrica), duloxetine (Cymbalta), tricyclic antidepressants, SSRIs
•Massage, heat, ice, stretching, yoga, PT
•Diet – Avoid sugar, caffeine, alcohol (muscle irritants). Diet diary to determine triggers to symptoms.
Stages
•Staging: Classifies the clinical aspect of the CA and degree of metastasis at diagnosis
1.Stage I: Tumor limited to tissue of origin
2.Stage II: Limited local spread
3.Stage III: Extensive local and regional spread
4.Stage IV: Distant metastasis
Leukemia
What is it?
Cancer of WBC
WBCs not functional. It can metastasize.
WBC count >100,000
Childhood diagnosis.
Destroys bone marrow causing anemia, leukopenia (decrease in functioning neutrophils), thrombocytopenia and decline in immunity
•Serum uric acid level
•Elevated urine uric acid levels
•synovial fluid testing
Warning Signs
1.Change in bowel/bladder habits
2.A sore that does not heal
3.Unusual bleeding or discharge
4.Thickening or lump in breast or elsewhere
5.Indigestion or difficulty swallowing
6.Obvious change in wart/mole
7.Nagging cough/hoarseness
Leukemia Acute vs Chronic
Acute:
1.Acute lymphocytic leukemia (ALL) Most common in children and young adults. 5-year survival 91% in children, less in adults
2.Acute myeloid (myeloblastic) leukemia (AML) – Most common in adults. Prognosis poor.
Chronic
1.Chronic lymphocytic leukemia (CLL) – Mostly affects those >50y/o.
2.Chronic myeloid (myelogenous) leukemia (CML) – 15%. Affects those >50 y/o. Uncommon in children. Abnormal proliferation of all bone marrow elements. Survival low
Interventions
•Easy to diagnose and treat
•Table in Lewis
Drug therapy
•Acute: colchicine, NSAIDs, steroids
•Chronic: Allopurinol, propenecid
•Diet therapy Low-purine diet: Avoid organ meats, shellfish, and oily fish with bones, alcohol (beer)
•Increase fluid intake to dilute uric acid in blood and to flush out the uric acid
Chemotherapy
Types, side effects
•Kills or inhibits the reproduction of neoplastic cells AND kills normal cellsL
1.Effects are systemic
2.Some affect cells during specific cell cycle phase
3.Combination therapy
4.Side effects: fatigue, alopecia, N&V, mucositis, myelosuppression of the bone marrow (pancytopenia: neutropenia, anemia, and thrombocytopenia)
Antiemetics before treatments or meals
Mucositis – NaCl swish AC, PC and HS, anesthetic gel to oral lesions.
Leukemia s/s and complications
S/S: Fatigue, pallor, tachycardia, dyspnea, infection, fever, Bleeding gums, hematuria, ecchymoses, Bone pain, Weight loss, neutropenia: recurrent resp, urinary, skin, and other infections
Complications:
•Risk for infection
•Neutropenic precautions –Especially following chemo and bone marrow transplant, Private room, mask
•Allow only healthy visitors or wear
•Frequent thorough hand hygeine
•Monitor for cough, adventitious breath sounds, urine, feces.
•Report temp > 100 deg F
•Administer antimicrobial, antiviral, antifungals
Neutropenia: no fresh or raw fruits/vegetables, eliminate standing water (humidifiers, denture cups, vases), no live plants/flowers, avoid crowds.
Tumor Lysis Syndrome
Causes, s/s, interventions
•Large quantities of tumor cells are destroyed rapidly and intracellular components such a K+, Phos, and uric acid are released into blood stream faster than the body can eliminate.
•Hyperkalemia, hyperphosphatemia-hypocalcemia, hyperuricemia, renal failure, cardiac changes, tissue damage and death
•Interventions
1.Hydration to dilute K+, increase kidney function & elimination of uric crystals. IV or PO 3L/day
2.Meds (Diuretics, allopurinol, sodium polystyrene)
3.Possible Dialysis
Thrombocytopenia-
Complications
Treatments/Interventions
Risk for bleeding d/t platelets <50,000/mm3
Spontaneous bleeding: <20,000/mm3
Observe for S&S of bleeding – Petechiae, blood in gums, nose, stool, urine, vomit
Bleeding precautions – Avoid IVs and injections, apply pressure 10min after blood draw/IV removal
Falls risk
Avoid trauma - Electric shaver, soft toothbrush, avoid contact sports
•Admin platelets if <10,000