Exam 4 Flashcards
what is hypercalcemia?
it is found in cancers that metastasize to bone (ex. lung, breast, renal), but can be r/t paraneoplastic hormone production in lung and pancreatic cancers
a patient presents with delirium, somnolence, muscle weakness, polyuria, bradycardia, nausea, and constipation. What oncological emergency is this?
Hypercalcemia
What should the nurse implicate for hypercalcemia?
- monitor Ca, P, and renal fx
- assess s/s of hypercalcemia
- provide hydration and ordered meds
what are expected medications for cancer related hypercalcemia?
- Bisphosphonates
- Denosumab
- Calcitonin?
What is spinal cord compression as an oncological emergency?
commonly found when there are tumors near the spinal cord
A patient presents with pain, numbness, tingling, and motor weakness. What oncological emergency is happening?
Spinal cord compression
What is a late sign of spinal cord compression?
autonomic dysfuction
Nursing implications for spinal cord compression
- assess typical s/s of compression (pain/weakness, inability to distinguish hot and cold)
- assess for constipation or incontinence
what are some treatment options for spinal cord compression?
- corticosteroids
- radiation therapy
- surgery
- drug therapy (bisphosphonates are given to prevent bone breakdown)
What is superior vena cava syndrome?
A tumor r tumor-involved lymph node compression of soft-walled SVC causes reduced return of blood flow to heart and venous congestion
A patient presents with dyspnea, venous congestion/edema of the upper body, visual disturbances, HA, altered mental status r/t cerebral edema, JVD, and prominent brachial and chest veins. What oncological emergency is this?
Superior vena cava syndrome
Nursing implications for SVC syndrome?
- assess s/s
* assess poor perfusion and decreased CO
what are signs that a patient have low CO?
confusion, cyanotic, hypotension and tachycardia
What is SIADH?
This is commonly found in patients who have primary or metastatic brain or lung cancer
A patient presents with s/s of hyponatremia (mental status changes or seizures), HTN, effusions, diluted electrolytes r/t edema and a low hematocrit. What oncologic emergency is this patient experiencing?
SIADH
What is expected treatment for SVC syndrome?
- treatment of the cancer that causes it w/ chemo or radiation
- drug therapy: corticosteroids or diuretics to get rid of the excess fluids
Nursing implications for SIADH?
- assess s/s of FVO (HTN, hyponatremia, confusion, seizures, and coma)
- restrict fluids and administer meds
What is tumor lysis syndrome?
common is patients with rapidly proliferative tumors such as leukemia and lymphoma or therapy-sensitive tumors that respond quickly to treatment
A patient presents with electrolyte imbalances and renal dysfunction, hypocalcemia, hyperkalemia, acidosis causing heart block, tachycardia, and hyperphosphatemia. What oncological emergency is this patient experiencing?
tumor lysis syndrome
Nursing implications of tumor lysis syndrome?
- assess s/s of hypocalcemia, renal dysfunction
* assess EKG changes and hypotension
What are peaked T-waves indicative of?
hyperkalemia
what are some s/s of hypocalcemia?
paresthesia, numbness of fingertips and perioral neuromuscular irritability and possible laryngeal contraction
What does PUKEC stand for and what oncological emergency is it representative of?
Tumor Lysis Syndrome P- phosphorus U- uric acid K- K+ E- elevated C- calcium decreased
What are causes of Iron-Deficiency Anemia?
poor intake, blood loss, absorption
What would cause absorption issues?
crohns, celiac, or meds that alter stomach acid
clinical manifestations of IDA?
*hint: remember LOW IRON
L= lethargic O= overexerted easily (SOB) W= weird food cravings (aka pica) I= inflammation of tongue R= reduced hemoglobin O= observe changes in RBC's N= nails (koilonychias), neuro
Patient teaching for IDA? Common SE of iron supplement?
*hint: EAT LOTS OF IRON
- take iron with citrus juice
- use Z-track for IM iron
- use straw with oral iron
- SE= stomach cramps, green/black stool, constipation/diarrhea
E= egg yolks
A= apricots
T= tofu
L=legumes, leafy greens, broccoli
O= oysters
T= tuna
S= sardines, seeds
O= pOtatoes
F= fish
I= iron fortified cereals
R= red meat
O= pOultry
N= nuts
Causes of pernicious anemia (aka vitamin B-12 anemia)?
poor intake
* pernicious is a failure to absorb B-12, d/t lack of intrinsic factor
Who typically has issue with B-12 intake?
vegetarians b/c b-12 only comes from animal meat
Clinical manifestations of b-12 anemia?
SOB, tachypnea, tachycardia, fatigue, neuro and psychiatric dysfunction
diagnostic tests for IDA?
ferratin, TIBC, CBC, MCV
diagnostic tests for b-12 anemia?
CBC, B12 serum assay level, methylmalonic acid (MMA), shillings test (only for pernicious)
patient teaching for B12 anemia? What food can you find it in?
animal meat, seafood, egg, dairy?
causes of folic acid anemia?
poor nutrition, chronic alcohol abuse, malabsorption syndromes, and meds that slow/prevent absorption
Clinical manifestations for folic acid anemia?
same as B12, but w/out the neurologic sx’s, increased bleeding risk, mood changes, neural tube defects
diagnostic tests for folic acid anemia?
RBC folate level
what is the increased bleeding risk related to?
bone marrow damage
What is the cause of aplastic anemia?
damage to the bone marrow= myelosuppression= pancytopenia
what are some reasons for damage to the bone marrow?
chemo, radiation, exposure to chemical, infection
This is the most common type of genetic hemolytic anemia
Glucose-6-Phosphate dehydrogenase
what population does glucose-6-phosphate dehydrogenase effect the most?
African American Males
what is the lifespan of normal and sickle RBCs?
Normal= 120 days sickle= 1520 days
This anemia causes thick, viscous blood and decreases circulation. What type of anemia is this and what is the cause of it?
polycythemia vera; excess RBCs
What is hemophilia and what are some possible treatments?
hemophilia is a genetic condition where the body most commonly lacks the coagulation factor VIII. This causes the person to bleed severely even with the slightest injury. Treatment often includes clotting factor injections or plasma.
Risk factors for cancer?
- carcinogen exposure
- age
- genetics
- hormones
- lifestyle
- infectious disease
- medications
- nutrition
Primary, secondary, and tertiary prevention of cancer
Primary: rx fx modification
> immunization
> chemoprevention
Secondary: screening and clinician assessment
Tertiary: tx and SE management of cancer or its treatment
What are things that may lead to to think cancer?
*hint= think CAUTION
C= change in bowel/bladder habits A= a sore that doesn't heal U= unusual bleeding/discharge T= thickening/lump in breast or body I= indigestion or difficulty swallowing O= obvious change in wart or mole N= nagging cough or hoarseness
Cancer treatment goals
- cure
- prevent remission
- provide palliative care
post-surgical treatment to consider for cancer
- pain management
- psychosocial support
- infection prevention
- No BP or needle sticks on affected limb after mastectomy
types of radiation treatments
- External= teletherapy
- internal=brachytherapy-seeds
- systemic-injection of radioactive solution
Complications of radiation
- inflammation
- mucositis & xerostomia= ORAL CARE!!!
- fatigue
- thrombocytopenia= BLEEDING RISK!!!
- fibrosis
- immediate hazard to others d/t radioactive iodine
safety measure to consider with radiation therapy
- private room
- sign on the door
- wear dosimeter
- visitors 30 min/day and 6ft apart
- lead apron & container
- follow policy
goals of chemotherapy
cure/increase life time
What does chemotherapy do and what unpleasant effects does it cause?
- chemo interferes with cell division in rapidly dividing cells
> therfore…. it damages skin, hair, intestinal tissues, and blood-forming cells
What should you assess in a patient undergoing chemo?
cognition
considerations for chemo administration
- done with an RN w. education
- chemo is a systemic treatment
- wear eye, mask, gloves (double or chemo), and gown
Chemo complications
- extravasation- vesicants
interventions for extravasation?
- close monitoring
- cool/warm compress
- antidote
- consultation
Adverse effects of chemo?
- n/v/d
- peripheral neuropathy
- alopecia/hemorrhagic cystitis
- cardio/hepato/toxicity
- hypersensitivity
- capillary permeability syndrome
- infertility
clotting abnormalities
neutropenic precautions
- inspection, lung souds, oral assess, close IV inspection
- low bacteria diet
- no fresh flowers or plants
- avoid raspberries and blackberries
how often do you take VS on a patient with neutropenic precautions?
4-8 hrs
Interventions for mucositis
- swishing lidocaine
- saline rinse
- soft tooth brush
- gentle flossing
- gentle/bland diet
- NO ALCOHOL BASED RINSES!
normal RBC level
Male: 4.7-6.1
Female: 4.2-5.4
normal hemoglobin
Male: 14-18
Female: 12-16
normal hematocrit
Male: 42-52%
Female: 37-47%
Normal WBC
5000-10000
Normal platelet
150000-400000
MCV: what does it tell us when it is high and low and what is the normal value?
low= small RBC size high= large RBC size normal= 80-95 mm3
MCH: what does it tell us when it is high and low and what is the normal value?
low= lighter color high= darker color normal= 27-31 pg/cell
What are quality care nursing implications for sickle cell disease?
- administer O2
- pain meds
- aggressive IV/PO hydration
- blood transfusions
- antipyretics
- provide emotional support
what to teach about sickle cell disease?
- avoid cold temperatures, tight clothes, high-altitudes, dehydration, overexertion
- infection prevention
- keep ADLs
risk for crises w/ pregnancy - Fetal complications
- genetic counseling
- dental care
Steps to take prior to transfusion therapy
- verify order
- obtain signed-consent
- type/cross match
- hx of reactions
- 18-20 G IV
- get blood from pharmacy
- 2 RNs verify
- prime tubing and inspect blood
- only run with NS!!!
Geriatric considerations for transfusion therapy
- no larger than 19G
- assess renal fx
- newer blood products
- assess q 15 min
- administer over 2-4 hrs
What different transfusion types are there and what are they for?
- PRBC= iron deficiency or anemia
- plasma= liver failure, severe infections, and serious burns, clotting factor deficiencies
- cryoprecipitate (controls bleeding in people who don’t clot properly)
- granulocyte= these are WBC that are able to phagocytize foreign substances; for neutropenic patients
