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Adult Health > Exam 3 HEME > Flashcards

Exam 3 HEME Flashcards

1
Q

deficiency of erythrocytes (RBCs) reflected by a decreased Hct <4x10^12

A

anemia

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2
Q

pallor (ears and nailbeds, palmar crease, conjunctiva esp)
fatigue, exercise intolerance, lethargy, orthostatic hypotension
tachycardia, heart murmurs, HR
Bleeding (hematuria, melena, menorrhagia)
Dyspnea
irritability, diff concentrating
cool skin, cold intolerance

A

assessment with anemic patient

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3
Q

which meds may cause anemia?

A

salicylates, thiazides, and diuretics

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4
Q

what dietary factors may contribute to anemia?

A

decreased iron, folate, or Vit B12

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5
Q

when does cardiac output increased to compensate for anemia?

A

when hgb <7

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6
Q

red meats, organ meats, whole wheat products, spinich, carrots

A

food high in iron

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7
Q

green veg, liver, citrus fruits

A

foods high in folic acid

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8
Q

glandular meats, yeast, green lieafy veg, milk and cheese

A

foods high in vit B12

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9
Q

how do you administer Iron?

A

use z track method
use air bubble to avoid w/d medication into SC tissue
DONT USE DELTOID
DONT MASSAGE

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10
Q

when do you take iron?

A

empty stomach one hour before meals or two hours after meals and give vit C to enhance iron absorption

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11
Q

what should you tell patients who take iron?

A

may turn stool black and may stain skin if given IM (that why we use Ztrack). take liquid iron through a straw and brush teeth afterward to avoid staining teeth

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12
Q

malignant neoplasm of blood forming organs

abnormal overproduction of immature forms of leukocytes and decreased RBC and platelets

A

leukemia

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13
Q

why does immunosupression occur in leukemia

A

large number of immature WBC and profound neutropenia

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14
Q

why does hemorrhage occur in leukemia?

A

thrombocytopenia

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15
Q

how is leukemia diagnosed?

A

biopsy, bone marrow aspiration, lumbar puncture, and frequent blood counts

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16
Q

type of leukemia where leukocytes are unable to mature

A

acute myelogenous leukemia: prognosis is poor

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17
Q

type of leukemai characterized by abnormal production of granulocytic cells

A

Chronic myelogenous leukemia: a biphasic disease with chronic stage of 3 years and acute stage only 2-3 months

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18
Q

hydroxyurea, interferon, imatinib mesylate

A

tx for chronic myelogenous leukemia

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19
Q

type of leukemia characterized by abnormal leukocytes in blood forming tissue and is the most common cause of childhood cancer

A

Acute lymphocytic leukemia: prognosis is favorable

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20
Q

type of leukemia characterized by increased production of leukocytes and lymphocytes and porliferation of cells within the bone marrow, spleen and liver. Occurs after age 35

A

Chronic lymphocytic leukemia

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21
Q

decreased H&H, decreased plt, altered/high WBC

A

acute myelogenous leukemia
TX: prevent infection, prevent and control bleeding
high protein, high calorie diet, assist with ADL, drug therapy

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22
Q 
use immediately after reconstitution
avoid vapors in eyes
vesicant
hydrate well before and during treatment with IV fluids and mannitol
monitor hearing and vision
A

cytophosphamide

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23
Q

leucorvian rescue

A

leucorvian + methotrexate tp prevent toxic rxn

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24
Q

which chemo drug would you give with alloprinol to increase potency and avoid folic acid?

A

methoxtrexate

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25
Q

Which chemo drugs may cause cardiomyopathy and turn urine red?

A

Dactinomycin and Daunorubicin I, Doxorubicin HCl

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26
Q

which chemo meds needs benedryl first?

A

endothelial growth factor receptor inhibitors: Cetuximab, Panitumumab

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27
Q

which chemo meds are neurotoxic?

A

Vincristine sulfate nd Vinblastine sulfate (Oncovin and Velban)

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28
Q

which chemo med should you check ANC, give slowly due to pain at site, and assess bone pain after?

A

Filgrastim (Neupogen)

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29
Q

What are nursing considerations for Ondansetron HCl (Zofran)?

A

administer tablets 30 mins prior to choemo and 1-2 hours prior to radiation
dilute IV injection in 50 mL of 5% dextrose or 0.9% NaCl

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30
Q

draw blood sample shortly before administration of an antibiotic

A

trough

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31
Q

draw blood sample 30 mins to 1 hours after drug adminsitration

A

peak

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32
Q

Reed Sternberg cell

a generalized painless lymphadenopathy

A

Hodgkin Disease

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33
Q

how do you determine what stage of Hodgkin disease?

A

laparotomy

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34
Q

Stage 1 HD:

A

involvement of a single lymph node region or a single extralymphatic organ or site

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35
Q

stage 2 HD

A

involvement of two or more lymph nodes on the same side of the diaphragm or localized involvement of an extralymphatic organ or site

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36
Q

stage 3 HD

A

involvement of lymph node areas on both sides of the diaphragm to localized involvemnt of one extralymphatic organ, the spleen, or both

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37
Q

Stage IV HD

A

diffuse involvement of one or more extralymphatic organs, with or without lymph node involvement

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38
Q

how do you treat HD?

A

radiotherapy
chemotherapy
Splenectomy

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39
Q

enlarged lymph nodes (usually cervical), anemia, thrombocytopenia, elevated leukocytes, decreased platelets, fever, increased susceptibility to infections, anorexia, weight loss, malaise, bone pain, night sweats, pruritis, pain in affected lymph node after consuming alcohol

A

assessment of HD

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40
Q

adeno

A

glandular tissue

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41
Q

angio

A

blood vessels

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42
Q

basal cell

A

epithelium (sun exposed areas)

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43
Q

embryonal

A

gonads

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44
Q

fibro

A

fibrous tissue

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45
Q

lympho

A

lymphoid tissue

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46
Q

melano

A

pigmented cells of epithelium

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47
Q

myo

A

muscle tissue

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48
Q

osteo

A

bone

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49
Q

squamous cell

A

epithelium

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50
Q

change in bowel and bladder fxn
a sore that does not heal
unusual bleeding or discharge, hematuria, tarry stools, ecchymosis, bleeding mole
thickening or a lump in the breast or elsewhere
indigestion or dysphagia
obvious changes in a wart or mole
nagging cough or hoarseness

A

f7 warning signs of cancer

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51
Q

what is the only IV fluid compatible with blood products?

A

normal saline

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52
Q

what do you do if a hemolytic transfusion rxn occurs?

A 
turn off the transfusion
take temp
send blood being transfused to lab
obtain urine sample
keep vein patent with NS
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53
Q

What are three interventions for clients with a bleeding tendency?

A

use a soft toothbrush, avoid salicylates, do not use suppositories

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54
Q

what are two sites to assess for infection in immunocompromised pts?

A

oral and genitals

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55
Q

List three safety precautions for the administration of antineoplastic chemotherapy

A

dbl check order with another nurse
check for blood return prior to adminsitration
use a new IV site daily for peripheral chemotherapy
wear gloves when handling the drugs
dispose of waste in special containers

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56
Q

normocytic, normochromic

A

acute blood loss, hemolysis, CKD, CA

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57
Q

microcytic, hypochromic

A

iron def anemia, lead poisoning, thalassemia

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58
Q

macrocytic (megaloblastic) normochromic

A

cobalamin (vit B12) deficiency, folic acid def, liver disease, post splenectomy

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59
Q

What may inhibit iron absorption and thus add to anemia?

A

antacids, tetracyclines, soft drinks, tea, coffee, calcium, phosphorus, magnesium salts

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60
Q

neutropenic precautions

A

strict hand hygiene, visitor restrictions, private, positive-pressure room or HEPA
monitor for s/sx of infection
prompt administration (w/in one hour!) of broad spectrum antibiotic at first sign of infection
hematopoietic growth factors (Pegfilgrastim, G-CSF, GM-CSF)
pet your pets, but dont clean up after them-elicit help from family!

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61
Q

fatigue and weakness, HA, mouth sores, anemia, bleeding, fever, infection, sternal tenderness, gingival hyperplasia, min hepatosplenomegaly and lymphadenopathy

A

AML: most common acute adult leukemia

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62
Q

Fever, bleeding, fatigue, bone/joint pain, CNS manifestations (increasing ICP causes n/v, lethargy)

A

ALL: most common childhood leukemia

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63
Q

Philadelphia chromosome disease marker which is a translocation of genetic material from chromosomes 9 and 22.
characterized by a chronic stable phase followed by an aggressive BLASTIC phase (only a few months to live once blastic phase hits)
no symptoms early in disease, fatigue, weakness, sternal tenderness, weight loss, joint pain, bone pain, massive splenomegaly, increase in sweating

A

CML

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64
Q

characterized by the production and accumulation of functionally inactive but long-lived, small, mature appearing lymphocytes
no symptoms frequently, detection of disease often during exam for unrelated condition
chronic fatigue, anorexia, splenomegaly, lymphadenopathy, hepatomegaly, fever, night sweats, weight loss, frequent infections

A

CLL: most common leukemia in adults

sim to non hodgkins lymphoma–>richter’s syndrome

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65
Q

B symptoms

A

fever, night sweats, weight loss

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66
Q

ABVD regimen

A

for Hodgkins lymphoma

Adriamycin (doxorubicin), Bleomycin, Vinblastine, dacarbazine

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67
Q

BEACOPP

A

for advanced stage hodgkins lymphoma

bleomycin, etoposide, adriamycim, cyclophosphamide, Oncovin (vincristine), procarbazine, prednisone

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68
Q

nursing mgmt multiple myeloma

A

adequate hydration to decrease complications r/t hypercalcemia (due to bone involvement of multiple myeloma)
allopurinol may be given to prevent renal damage once chemo has been initiated
high risk for fractures-be careful when moving pt
nursing care for anemia, thrombocytopenia, and neutropenia may be appropriate

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69
Q

less danger of fluid overload

used for severe or symptomatic anemia, acute blood loss

A

packed RBCs

in general, one unit of packed RBCs can be expected to increase Hgb by 1g/dL or Hct by 30%

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70
Q

autotransfusion, stcokpiling or rare donors for patients with alloantibodies. Infrequently used bc filters remove most WBCs

A

Frozen RBC (can be stored for 10 years) but use within 24 hours of thawing

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71
Q

bleeding caused by thrombocytopenia, may be contraindicated in thrombotic thrombocytopenic purpura and heparin induced thrombocytopenia except in life threatening hemorrhage
can be kept at room temp for 1-5 days
expected increase is 10,000uL/U

A

Platelets

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72
Q

bleeding caused by deficiency in clotting factors (DIC, hemorrhage, massive transfusion, liver disease, vit K def, excess warfarin)

A

Fresh Frozen Plasma
may be stored for 1 year
use w/in 2 hours of thawing

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73
Q

hypovolemic shock, hypoalbuminemia

heat treated adn does not transmit viruses!

A

Albumin (can be stored for 5 years)

25g/100mL is osmotically equal to 500mL plasma

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74
Q

what size needle do you use for blood?

A

19
18-16 if rapid transfusion
smaller needles can be used for platelets, clotting factors, and albumin

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75
Q

Why cant you use dextrose solutions or LR for administering blood?

A

they will cause RBC hemolysis

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76
Q

what should you do BEFORE requesting the blood component from blood bank?

A

check patency first!

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77
Q

Nursing considerations for blood products

A

use within 30 mins or return to blood bank
stay with patient first 15 mins or first 50 mL
take vitals before administration-if fever-call HCP to make sure you can give blood product
initial rate of infusion should not exceed 2mL/min
PRBCs should not be infused quickly unless an emergency crisis as rapid infusion of cold blood may chill patient if so, use a blood warmer
fresh frozen plasma and platelets may be infused over 15-30mins
retake vitals after first 15 mins
observe patient q30mins during administration and up to 1 hour after
transfusion time should not exceed 4 hours due to potential of bacterial growth in blood while hanging

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78
Q

what to do in an acute transfusion rxn?

A

stop transfusion
maintain a patent IV line with NS
notify blood bank and HCP immediately
recheck id tags and #s
monitor VS and urine output
treat symptoms per physician orders
save the blood bag and tubing and send them to the blood bank for examination
complete transfusion rxn reports
collect required blood and urine specimens at intervals stipulated by hospital policy to evaluate for hemolysis
document on transfusion rxn form and pt chart

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79
Q

ABO incompatible blood
acute hemolytic rxn
chills, fever, low back pain, flushing, tachycardia, dyspnea, tachypnea, hypotension, vascular collapse, hemoglobinuria, acute jaundice, dark urine, bleeding, AKI, shock, cardiac arrest, death

A

type II cytotoxic hypersensitivity rxn

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80
Q

what causes a febrile transfusion rxn?

sudden chills and fever, HA, flushing, anxiety, vomiting, muscle pain

A

leukocyte incompatibility
avoid this in patients who have received five or more transfusions as they may have developed circulating antibodies, by using addt’l filters in the tubing to leukocyte deplete RBCs and platelets
generally, tylenol and benedryl 30 mins prior to transfusion will avoid this rxn
consider leukocyte poor blood products such as filtered, washed, or frozen

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81
Q

result from recipient’s sensitivity to plasma proteins in donors blood
flushing, itching, urticaria
cyanosis, bronchospasm, shock, cardiac arrest

A

allergic rxn
give antihistamine before
EPI and corticosteriods after to treat a sever rxn

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82
Q

cough, dypnea, pulmonary congestion, HA, HTN, tachycardia, distended neck veins

A

circulatory overload
adjust transfusion rate and volume
place pt upright with feet in dependent postion

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83
Q

rapid onset of chills, high fever, vomiting, diarrhea, marked hypotension or shock

A

sepsis rxn
obtain culture of pts blood and send bag with remaining blood and tubing to blood bank for further study
treat septicemia with antibiotics, IV fluids, vasopressors

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84
Q

fever, hypotension, tachypnea, dyspnea, decreased o2 sat, frothy sputum

A

transfusion related acute lung injury rxn (TRALI)
provide o2 and administer corticosteriods
initiate CPR if needed and provide ventilatory and BP support if needed
provide leukocyte reduced products and id donors who are implicated in TRALI rxns and do not allow them to donate

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85
Q

what is a potential complication of hyperviscosity polycythemia?

A

thrombosis

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86
Q

a disease process stimulates coagulation processes with resultant thrombosis as well as depletion of clotting factors, leading to diffuse clotting and hemorrhage

A

DIC

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87
Q

Priority nursing actions when caring for a hospitalized patient with new-onset temp of 102.2F and severe neutropenia include (select all that apply):

a. administer the prescribed antibiotic STAT
b. draw peripheral and central line blood cultures
c. ongoing monitoring of VS for signs of septic shock
d. taking a full set of vitals and notifying physician right away
e. administering transfusions of WBCs treated to decrease immunogenicity

A

abcd

88
Q

The nurse is aware that a major difference between Hodgkins lymphoma and non-Hodgkins lymphoma is:

a. Hodgkin’s lymphoma occurs only in young adults
b. Hodgkin’s lymphoma is considered potentially curable
c. non-Hodgkin’s lymphoma can manifest in many organs
d. non-Hodgkin’s lymphoma is treated only with radiation therapy

A

c. non-Hodgkin’s lymphoma can manifest in many organs

89
Q

A patient with multiple myeloma becomes confused and lethargic. The nurse would expect that these clinical manifestations may be explained by diagnostic results that indicate:

a. hyperkalemia
b. hyperuricemia
c. hypercalcemia
d. CNA myeloma

A

c. hypercalcemia

90
Q

When reviewing the patient’s hematologic lab values after a splenectomy, the nurse would expect to find

a. leukopenia
b. RBC abnormalities
c. decreased hemoglobin
d. increased platelet count

A

d. increased platelet count

91
Q

Complications of transfusions that can be decreased by the use of leukocyte depletion or reduction of RBC transfusions are

a. chills and hemolysis
b. leukostasis and neutrophilia
c. fluid overload and pulmonary edema
d. transmission of cytomegalovirus and fever

A

d. transmission of cytomegalovirus and fever

92
Q

nursing considerations for thrombocytopenia

A

risk for spontaneous bleeding
avoid invasive procedures
avoid activities that place them at risk for bleeding or injury (including excessive straining-avoid constipation!!)
risk for bleeding is significant if platelet count is less than 50,000

93
Q

when do you give platelet transfusion

A

when platelet count <20,000

94
Q

skin care in radiation treatment area

A

cleanse gently w mild soap
apply moisturizer or cream (non-medicated, no perfume) OTC hydrocortisone cream 1% may relieve itching
rinse area with saline solution and expose area to air often
avoid sun
avoid tight clothes, abrasive fabrics, nongentle detergents
avoid temp extremes
no swimming in salt water or chlorinated pools
electric razor to shave if necessary

95
Q

myeloid cell recovery after bone marrow transplant

SE n/v/d, fever, chills, myalgia, HA, fatigue

A

GM-CSF (Leukine)

96
Q

chemo induced neutropenia

SE bone pain, n/v

A

G-CSF

Filgrastim-Neupogen), pedfilgrastim-Neulasta

97
Q

anemia of chronic cancer (Epogen, Procrit epoetin alpha)
anemia r/t chemo (Aranesp darbepoetin alpha)
SE HTN, thrombosis, HA

A

erythropoietin

98
Q

Thrombocytopenia r/t chemo

SE fluid retention, peripheral edema, dyspnea, tachycardia, nausea, mouth sores

A 
Interleukin 11 (platelet growth factor)
Neumega
99
Q

Trends in the incidence and death rates of cancer include the fact that

a. lung cancer is the most common type of cancer in men
b. a higher percentage of women than men have lung cancer
c. breast cancer is the leading cause of cancer deaths in women
d. african americas have a higher death rate from cancer than whites

A

d. african americans have a higher death rate from cancer than whites

100
Q

what cellular features of cancer cells distinguish them from normal cells? (select all that apply)

a. cells lack contact inhibition
b. cells return to a previous undifferentiated state
c. oncogenes maintain normal cellular expression
d. proliferation occurs when there is a need for more cells
e. new proteins characteristic of embryonic stage emerge on cell membrane

A

abe

  • a. cells lack contact inhibition
  • b. cells return to a previous undifferentiated state
    c. oncogenes maintain normal cellular expression
    d. proliferation occurs when there is a need for more cells
  • e. new proteins characteristic of embryonic stage emerge on cell membrane
101
Q

The goals of cancer treatment are based on the principle that

a. surgery is the single most effective treatment for cancer
b. initial treatment is always directed toward cure
c. a combination of treatment modalities is effective for controlling many cancers
d. although cancer cure is rare, quality of life can be increased with treatment modalities.

A

d. although cancer cure is rare, quality of life can be increased with treatment modalities.

102
Q

what is the most effective method of administering a chemotherapeutic agent that is a vesicant

A

use a central venous access device

103
Q

a patient undergoing brachytherapy must be told

A

that radioactive precautions are required during nursing care

104
Q

What do you do if your patient complains of being cold and begins to shiver while you are infusing Rituxan?

A

stop the infusion and administer NS

105
Q

rule of threes

A

HgbX3=Hct

HctX3=RBC

106
Q

Hgb normal value

A

M 14-18

F12-16

107
Q

Hct normal

A

37-52%

108
Q

RBC normal

A

4.2-5.4

109
Q

platelets

A

150-400

110
Q

WBC

A

5-10

111
Q

What do neutrophils fight?

A

bacteria

normal 55-70%

112
Q

pancytopenia

A

decrease in WBC, RBC, platelets

113
Q

PTT

A

60-70 sec

Heparin

114
Q

PT/INR

A

11-12.5 sec

Warfarin

115
Q

Med management for hemophilia

A

FFP, recombinant clotting factors, desmopressin (DDVAP)

116
Q

simultaneous bleeding and thrombosis

pallor, petechiae, purpura, oozing, severe bleeding, hematomas, cyanosis, ischemia

A

DIC

117
Q

what are hemostatic agents?

A

thromboplastin, surgiseal, collagen, alginate (wet it)

118
Q

how do you correct a hemolytic transfusion rxn?

A

dopamine, cystalloids (NS), osmotic diuresis (removed lysed cells), FFP, cryo, maybe platelets

119
Q

How do you treat hemochromatosis?

A

IV deferoxamine

120
Q

glossitis

A

iron deficiency anemia-assume due to blood loss until proven otherwise

121
Q

dextran

A

Iron replacement-never in arm; use z track to avoid skin staining with 20 gauge; monitor closely for 30 mins

122
Q

beefy, sore tongue

A

pernicious anemia (vit B12) deficiency
megaloblastic
crohns, h2 receptor blocker use, ETOH abuse

123
Q

chelitis

A

folic acid def anemia

*take iron supplements with vit C and avoid calcium containing foods for two hours

124
Q

SE joint, muscle, and/or bone pain, fever, cough, soreness of mouth
may cause certain cancers to grow faster
concomitant VTE prophylaxis

A

Epoetin (epogen, Procrit)

125
Q

What is important to know if pt undergoes a spleenectomy?

A

increased risk of infeciton–>vaccinate!!!

126
Q

complete bone marrow failure
pancytopenia
falconi’s

A

aplastic anemia

127
Q

fatigue, SOB, activity intolerance, infection, purpura

A

aplastic anemia clinical manifestations

128
Q

left shoulder or rib cage pain, ARDS, alveolar hemorrhage, hemoptysis, sickle cell crisis

A

filgrastin (Neupogen)

129
Q

when do you calculate ANC (absolute neutrophil count)?

A

when pt has a low WBC

if less than 1000, hold chemo

130
Q

why do we do bone marrow transplants (BMT) and peripheral blood stem cell transplant (PBSCT)?

A
  1. replace diseased marrow with healthy marrow (leukemia, aplastic anemia, and sickle cell anemia)
  2. regenerate new immune system to fight cancer not killed by chemo or radiation
  3. rescue-replace the bone marrow and restore function after high dose chemo/radiation
131
Q

what med will boost stem cell release?

A

plerixafor (Mozobil) SQ

n/v/d, HA, fatigue, joint pain, spleen enlargement or rupture

132
Q

s/s spleen rupture

A

pain left shoulder or under left rib cage

133
Q

monocytes, granulocytes, erythrocytes, and platelet

A

myeloid cells
(AML)-defect in the stem cells that differentiate into all myeloid cells
most common leukemia in adults

134
Q

neoplasms in lymphoid tissue

A

HL and NHL

135
Q

CLL (chronic lymphocytic leukemia) and ALL (Acute lymphocytic leukemia)

A

too many lymphocytes (t cells and B cells, but mostly an overproliferation of b cells, esp in CLL)

136
Q

malignant disease of plasma cells in the bone marrow with destruction of bone
(elevated proteins, bone marrow biospy shows >10% plasma cells, CRAB)

A

multiple myeloma

most pts are >70 yo

137
Q

How do you manage multiple myeloma?

A

chemo, radiation, plasmapheresis, corticosteriods (Decadron), stem cell transplant
biophosphonates-sit up for 30 mins after taking; dont lift >10lbs
hypercalcemia (increase fluids, cranberry j)
treat pain w NSAIDs or opioids
neutropenic precautions

138
Q

aimed at achieving a rapid, complete remission of all manifestations of the disease

A

Induction therapy (chemo)

139
Q

administered early in remission with the aim of curing

A

consolidation therapy (chemo)

140
Q

maintenance therapy may be prescribed for month or years following successful induction and consolidation therapy. The aim is to maintain _______

A

remission (chemo)

141
Q

anemic and fatigued pt will get

A

packed RBCs

142
Q

pt with <20,000 platelets will get

A

platelet transfusion

143
Q

patient with multiple myeloma is at risk for

A

pathological fractures. provide skeletal support during moving, turning and ambulating and provide a hazard-free environment (promote fluids to combat hypercalcemia!!)

144
Q

lymphocytes

A

NK cells, T cells, and B cells

145
Q

a malignant proliferation of plasma cells within the bone

A

multiple myeloma

the abnormal plasma cells invade the bone marrow and destroy bone and also invade liver, spleen and lymph nodes

146
Q

Bence Jones protein

A

abnormal protein found in blood and urine that is produced by the abnormal plasma cells in multiple myeloma

147
Q

causes decreased production of immunoglobulin and antibodies and increased levels of uric acid and calcium, which can lead to kidney failure

A

multiple myeloma

148
Q

urinalysis shows Bence Jones proteinuria and elevated total serum protein level

A

multiple myeloma

149
Q

administer biphosphonates as prescribed to slow bone damage and reduce pain and risk of fractures

A

multiple myeloma

150
Q
  1. sepsis and DIC
  2. SIADH
  3. Spinal cord compression
  4. hypercalcemia
  5. superior vena cava syndrome
  6. Tumor lysis syndrome
A

oncological EMERGENCIES

151
Q

what indicates superior vena cava syndrome?
prepare client for high-dose radiation therapy to the mediastinal area, and possible surgery to insert a metal stent in the vena cava

A

blockage of blood flow in the venous system of head, neck and upper trunk which may manifest as facial puffiness
Stokes’ sign is tightness of collar
morning puffy face

152
Q

seizures, coma, and eventually death may occur when sodium measures how low?

A

110mEq/L

153
Q

early signs are fatigue, anorexia, nausea, vomiting constipation, and polyuria
more serious signs: severe muscle weakness, diminished deep tendon reflexes, paralytic ileus, dehydration, and changes to ECG

A

hypercalcemia

154
Q

large quantities of tumor cells are destroyed rapidly and intracellular components such as potassium and uric acid are released into the bloodstream faster than the body can eliminate them.

A

tumor lysis syndrome

155
Q

tumor lysis syndrome can indicate that cancer treatment is destroying tumor cells, however, if left untreated ______

A

it can cause severe tissue damage and death
encourage hydration
administer diuretics to increase urine flow
allopurinol will help excrete purines
IV infusion of glucose and insulin to treat hyperkalemia
prepare pt for dialysis if hyperkalemia and hyperuricemia persist

156
Q

fluid restriction, increased sodium, and meds antagonistic to ADH

A

SIADH treatment

157
Q

shortened T segment and widened T wave

A

hypercalcemia

158
Q

withhold antineoplastic meds when the neutrophil count is

A

<1800 clls/mm^3

159
Q

may cause hemorrhage cystitis–encourage fluids

A

cyclophosphamide and ifosfamide (Ifex)

160
Q

may cause alopecia, stomatitis, hyperuricemia, photosensitivity, hepatotoxicity, and hematological, GI, and skin toxicity

A

methotrexate

161
Q

may cause hyperuricemia and hepatotoxicity

A

mercaptopurine

162
Q

may cause alopecia, stomatitis, diarrhea, phototoxicity, cerebellar dysfunction (dizzness, weakness, ataxia)

A

fluorouracil

163
Q

neurotoxic

A

vincristine (numbness and tingling in the fingers and toes, constipation, paralytic ileus

164
Q

orthostatic hypotension

administer this med slowly over 30-60 mins and monitor BP during infusion

A

etoposide

165
Q

what is the first clinical sign indicating peripheral neuropathy? (Vincristine)

A

depressed achilles tendon reflex

166
Q

tamoxifen may increase

A

calcium, cholesterol, and triglyceride levels

167
Q

increased urine volume, excessive thirst, nausea, vomiting, constipation, hypotonicity of muscles, and deep bone or flank pain

A

hypercalcemia

168
Q

dexrazoxane (zinecard)

A

may be given with Doxorubicin to reduce cardiomyopathy

169
Q

extravasion

A 
redness and swelling with slowed infusion
stop infusion
call HCP
apply ice or heat
antidote
170
Q

platelets

A

thrombocytes

171
Q

etiology of a platelet disorder may be due to

A

bone marrow, increased platelet consumption, or destruction of platelets.

172
Q

CBC, Chem panel (sodium, potassium, chloride, BUN/Cr, Glu, CO2), Liver enzymes, coag panels

A

labs you always want to look at

173
Q

primary thrombocythemia

A

overproduction of platelets (a stem cell disorder within the bone marrow) levels are consistently 600,000. Platelet size may be abnormal. May lead to embolus or DVT, stroke or MI; GI is most common site of bleeding

174
Q

immune thrombocytopenic purpura (ITP)

A

autoimmune blood disorder

  • most common autoimmune blood disorder affecting all ages
  • may appear after 1-6 wks after a viral illness
  • the body is destroying its own platelets and simultaneously impairing further production-unknown cause; may give IVIG (Intravenous Immunoglobulin), splenectomy is possible !platelet transfusions are ineffective!!
175
Q

causes of platelet defects

A

may be caused by ASA, NSAIDs, and ESRD, CABG and meds

176
Q

Von Willebrand’s Disease

A

most common inherited bleeding disorder
-a deficiency, dysfunction, or absence of von Willebrand Factor (vWF) which is necessary for factor VII activity and is essential for platelet adhesion at site of injury

177
Q

DIC

A

primary culprit is sepsis; progressive decrease in platelets may be all that we see to clue us in on pending DIC

178
Q

necessary for abdominal trauma, may be necessary in the presence of hemolytic anemia and ITP

A

splenectomy

179
Q

blood is taken from the patient, passed through a centrifuge where a specific component is separtated from the blood, the blood is returned to the patient

A

therapeutic apheresis

180
Q

elevated Hct’s (Polcythemia) or excessive iron absorption (hemochromatosis)

A

Therapeutic phlebotomy

181
Q

Growth factors –

A

stimulate bone marrow production

182
Q

Erythropoietin-

A

Epoen, Procrit. Stimulates erythropoiesis

183
Q

Granulocyte-colony stimulating factor (G-CSF) Neupogen;

A

Neupogen: stimulates differentiation of myeloid cells

184
Q

Granulocyte-macrophage stimulating factor (GM-CSF)

A

stimulates myelopoiesis

185
Q

Thrombopoietin –

A

for proliferation of megakaryocytes and subsequent platelet formation

186
Q

Autologous donation

A

patient’s own blood is collected for future use. 4-6 weeks for preoperative donations. 1 unit per week. Pat may receive Epogen and iron suplements

187
Q

Intraoperative blood salvage

A

salvaged during a surgery

188
Q

Hemodilution

A

CABG for avoid damage to RBC’s on the bypass machine

189
Q

one unit of platelets will increase the count by

A

7000-10000 for a single donor.

190
Q

one unit of PRBC’s will raise the Hg by ___ and HCT by ___

A

raise Hg by 1 g and Hct by 3%

191
Q

what is the infusion rate for the first 15 mins of a blood transfusion?

A

no faster than 5mL/min and STAY in the room for the first 15 mins!! If asymptomatic, increase the flow rate and continue to monitor closely

192
Q

signs of circulatory overload

A

dyspnea, orthopnea, tachycardia, and sudden anxiety

193
Q

signs of sepsis

A

fever, chills, hypotension

194
Q

sign of febrile rxn

A

1 degree increase in temp in the febrile range during or shortly after a transfusion

195
Q

signs of an allergic rxn

A

hives and itching during transfusion

196
Q

Acute hemolytic reaction –

A

most dangerous and potentially life-threatening. Occurs when transfusion and patient’s blood are incompatible. Most rapid that can occur with only 10 ml’s of transfusion is ABO compatibility. Labeling and patient misidentification are the primary culprits.

197
Q

Delayed hemolytic reaction –

A

occurs within 14 days; S/s fever, anemia, increased bilirubin and possibly jaundice. Mild requires no intervention.

198
Q

Primary thrombocythemia –

A

stem cell disorders = increased platelet production

199
Q

Secondary thrombocytosis –

A

increased platelet production as a reaction to a disorder or condition

200
Q

Von Willebrand

A

is the most common inherited blood disorder and is characterized by an increased tendency to blled from mucous membranes. Management is to replace deficient protein and minimize post-operative bleeding
-causes platelets to adhere to damaged endothelium; the von Willebrand factor protein also serves as a carrier protein for factor VIII

201
Q

Disseminated intravascular coagulopathy (DIC) –

A

micro clots form and clotting factors are used up. Prognosis depends on medical management of underlying cause.

202
Q

situations that cause sickling

A

fever, dehydration, emotional or physical stress

203
Q

primary treatment for hemophilia

A

replace the missing clotting factor, give agents to relieve pain or corticosteriods

204
Q

prevention organ damage from too much iron, chelation therapy with either

A

Exjade or deferoxamine (Desferal)

205
Q

DIC treatment

A

administer anticoags during early phase, administer cryoprecipitated clotting factors when DIC progresses and hemorrhage is the primary problem

206
Q

abruptio placentae, amniotic fluid embolism, gestational hypertension, intrauterine fetal death, liver disease, sepsis

A

predisposing conditions for DIC

207
Q

polycythemia

A

production and presence of increased RBCs (hyperviscosity and hypervolemia) (secondary can be caused by hypoxia)–> control chronic pulmonary disease, no smoking, avoid high altitudes

208
Q

thrombocytopenia

A

low platelets
caused by
(Inherited) Fanconi Syndrome (pancytopenia)
Hereditary thrombocytopenia
(Acquired-Immune) Immune thrombocytopenic purpura (ITP)
Neonatal alloimmune thrombocytopenia
(Acquired Nonimmune): Thrombotic thrombocytopenic purpura (TTP), DIC, HIT, Splenomegaly/splenic sequestration, drug induced marrow suppression, chemo, viral infection, bacterial infection, alcoholism, bone marrow supression, etc

209
Q

observe for early signs of thrombocytopenia

A

in patients receiving chemo

210
Q

leukopenia

A

decrease in total WBC count

211
Q

granulocytopenia

A

decrease of granulocytes (phagocytize pathogens so think increased risk of infection)

212
Q

neutropenia

A

=ANC<1000; normal is 4000-11,000; reduction in neutrophils; the largest constituency of granulocytes is neutrophils; the faster the drop and the longer duration of neutropenia will increase likelihood of developing infection, sepsis, and death.

213
Q

the most common cause of neutropenia

A

is iatrogenic, resulting from widespread use of chemotherapy and immunosuppressive therapy in the treatment of malignancies and autoimmune diseases

214
Q

neutropenic fever (>100.4) and a neutrophil count <500

A

is a medical emergency as it could lead quickly to septic shock

215
Q

iron patient teachings

A

Iron preparations can be very irritating to the stomach and are best taken between meals. Because iron supplements may be associated with constipation, the client should increase fluids and fiber in the diet to counteract this side effect of therapy. Iron preparations should be taken with a substance that is high in vitamin C to increase its absorption. The tablet is swallowed whole and not chewed.

Adult Health (18 decks)

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