hem/onc/anemia Flashcards
megaloblastic anemia caused by
vit b12 or folic acid def
b12 food sources
meat fish pultry eggs milk breads and cerelas can contain fortified b12 nutritional yeast -PLANT PRODUCTS RARELY HAVE IT
HIV patho
viral infection of the CD4+ cells
hiv education
be up to date on vacc such as influenza
- avoid eating undercooked meats such as pink seak
- avoid contact with feces such as cat litter
- avoid drinking water from developing contries that are poor sanitized so use bottled water or purfied water when drinking and brushing teef
- use synthetic or latex or dental dams barriers during sex
- dont share toothburshes
tb prgonosis
curable if they follow med regimen
-drug therpy is about 6 months
SLE
autoimmune where the bodys immune system attacks body tissues
SLE symtoms
pinaful swlooen joints
- fatigue
- skin rashes
- kidney prob
treatment for SLE
no cure
-use immnosupressants such as corticosteroids
SLE education
pnuemonia and influenza vacc are recommended
- report fever
- avoid contact with sick people
- physical and emotional stress can make it worse so follow a healthy lifestyle with 7-9 hours of sleep
- sunlight can worsen the rash and should be avoided (10am-4pm)
- rash should be cleaned only with mild soap not anitbiotic soap
clients with meningitis risk for
seizures bc of fever and ICP
mengitis what kind of idolation
droplet
env for menegitis
reduced stimulus
quiet, dim lighted, cool temp
poistion for menegitis
bed rest with HOB 10-30 to promote venous circulation
teletherpy (external beam radiation ) education
dont rub the skin, scrabtch ors crub
- wear soft losse fitting clothes
- cotton sheets and towel
- pat dry skin after bathing
- avoid bandages or tapes on the treamtent area
- cleanse the skin with lukewarm shower
- milf soap withoutgragarance or deodrant
- do not wash off radiation maarkings
- use only creams or lotions approved by HCP
- dont use OTC creams oils or powders
- should skin from sun during and after treamtent
- avoid tanning beds and sunabthing
- wear hats, long sleeve and long pants outside
- use suncreen 30spf or higher
- avoid extemes in skin temp (heating pads or ice packs)
- maintain cool, humid env
thrombocyopenia complication from
heprian products
thrymobocyemia meaning
low plalets
heprain induced thrombocytpoenia
contradictory meaning that is leads to venous /arterial thrombosis and less commoly to bleeding so its the opposite
danger of HIT
organ damage from local thrombi and emoblization leading to stroke and pulmonary embolism
if pt has HIT
all heprain products should be stopped and use another anticogulant such as argatroban
blood urea nutrgoen (BUN) lvl
6-20
montor what for HIT
plalet and notify HCP if plalet levl is ≥50% from baseline or a drop below 150,000/mm
influenza incubation
incbuation of 1-4 days and transimmion up to 5-7 days after illness stage begins
inf transmmion
during icibation and illness stage
inf vaccine education
imunity against influenza about 2 wk after incoulaion but does not offer complete protection from all virus strains so avoid close
contact for ONE WEEK
polycythemia versa
too many RBC, WBC, PLALETS produced
Polycythemia vera (PV) risk for
producing blood clots due to increase blood volume and viscosity
education for Polycythemia vera (PV)
- elevate legs and ffeet when sitting
- wear support stockings
- report signs of thrombosis such as swelling and tenderness in the legs
- adq fluid during exc and hot weather
- dont increase iron containg foods because this can further cause increase in hemoglobin prod and is not recommended
- need periodic phlebtomy to remove excess blood
- prevent dehydrationnnn
common symtom of Polycythemia vera (PV)
itching!!
can be reduced by reducing water temp and using starch baths and patting skin instead of rubbing
Rhematic fever def
inflammatory disease of the heart
Rhematic fever occurs from
streptococcal pharyngitis.
Rhematic fever affects
heart, skin, joints, and CNS
sepsis
response to infection that causes impared organ function
Rhematic fever teaching
fam hisotry not a risk factor
septic shock occurs
when sepsis causes CV collapse or impaires bodys ability to maintain normal metabloic and cellular process
septic shock manestificaations
fever or hypothermia ((>100.4 F [38 C]; <96.8 F
-hypotension (Systolic blood pressure <90 mm Hg or mean arterial pressure <65 mm Hg in a client with infection may indicate septic shock
- prolonged cap refull
- tacycadia of restingHR greater than 90/min
- WBC of greater than 12k or or immature neutrophils (bands) of >10%
- decreased UOP
atrireoviral therpy (RT)
med regiment consisting of multiple drugs and management preofession of HIV
Antiretroviral therapy (ART) impaires
viral replication at multiple points which leads to decreased viral loads and increased CD4 cells (helper t cells)
Antiretroviral therapy (ART) education
lifelong treatment and requires strict adherence
- even undetecbale viral loads remain infected with HIV
radiation
damages DNA which causes cell destruction
radiation and chemo affects
tissues that rapidly produce such as (oral , gi, bone marrow)
cyanide posioning
bitter almond smell
fever and riased skin pustules
small pox
small pox transmion
droplet
Sjögren’s syndrome
autoimmune where mositure producing exocrine glands are attacked by wbc
Sjögren’s syndrome most commonly affected glands
salivary and lacrimal glands, leading to dry eyes (xerophthalmia) and dry mouth (xerostomia).
other areas: Skin - dry skin and rashes
Throat and bronchi - chronic dry cough
Vagina - vaginal dryness and painful intercourse
dryness in sjogren syndrome leads to
corneal ulceration
dentalcaries
oral thrush
treatment of Sjögren’s syndrome
symtoms since there is no cure
- otc and presribed drops are used to relive itching, burning and dyrness
- wearing goggles when windy can help with drying
- dry mouth treated with sugarless gym and candy or salvia
- regular dental appt to prevent dental caries
- KY jelly or other lub to ease vaginal dryness
- use lukewrm water and mild soap
- avoid low humdifity env such as heated houses and airplanes
- use humdifiers
- VOID decongested because thse can cause further druness
- avoid oral irrtants such as coffe etoh and acidic drinks
scleroderma
overproduction of collagen causing tightening and hardening of the skin
scleroderma complication
renal crisis(LIFE THERENING) which canuses malignant HTN due to narrowing of the cessels that provide blod to the kidneys
- pulomary fibrosis another complication and causes dry cough and dyspnea but ot as life threatening as renal crisis
- heart burn and dysphagia but not life treaning
raynaud coor changes locations
fingers, toes, ears and nose
raynaud treatment
imm hands in warm water
TRANSFUSION REACTION
stop and disconnect tubing
IVVVV SALINE to prevent collapse
vancymycin level
trough level before 4th dose (15-20 mg.l is optimal)
-BUN and cretine mointored regulant (2-3X/wk) due to NEPHROTOXCITY)
normal hemogloin
12-17
11-15 in women
pulmonary emoblism risk factors
venous stasis
hypecog
endothelial damage
greatest risk for PE
Abdominal cesarean section surgery (endothelial damage)
Engorged pelvic vessels from pregnancy (venous stasis, hypercoagulability of blood)
Inactivity/immobility ≥6 hours related to positioning during surgery and the immediate postoperative period and epidural anesthesia (venous stasis)
Postpartum state (hypercoagulability of blood)
client with latent tb with postive skin test but asymtpamtic
cannot spread to othes
what can conver LTBI to active
malgnignacy
immunosupp (corticosteroids)
chemo
prolonged debiliating siease (HIV)
Lymphedema increases risk for
infeciton or injury
Lymphedema pt complains of
heavy or painful feeling of the arm
Lymphedema intevetnions
decongestive therpy such as massage
- compression sleeves
- elevation of arm above the heart
- isometric excercises
- avoidance of venipunctures such as IV insertion and blood draws on affected limb
- injruy prevention (limb less sensative to temp changes)
- infection control since limb more prone to infection and break down
dignosis for tb consists of
EARLY MORNING sputum on 3 consecutive days
- fluids or expectorants can be given at bedtime to help lqidufy secretions
- BLOOD CULTURES NOTTTT DONE to confirm
nose culrtures
MRSA
quntifeon tb
- fewer false postive
- one single visit is only req
- results in 24 hours
- more expesnive
sickle cell
excruiating painnnnn from occulsion resulting in ischemia
sickle cell managemnt
use of PCA is reocmmended
- NSAIDS not effective in pain
- merpedine is contrindicated
cervical caner risk factors
infection from high risk HPV strains
- hisory of STI
- early onset of sex
- mutple sexual partners
- immunosupression
- oral contraceptive use
- low socioecnomic status
- -tabacoo use
almost all caes of cervival cancer results from
hpv
risk factors for cervical cancer
HPV wekaned imm (hiv)=, cehmo)
nullpairty is a risk factor for
breast cancer
not cervical
severe anemia signs
tacycardia
sob
pallor
so cardiaic and resp drive is increased to maintain CO and o2
PPD or mantouux test
forearm
-come back 48-72 hours
redness alone doesnt mean poistive resp
postive responsse to PPD
-infuration of >15mm = postive
but this only means that they have been exposed to tb and dont have active tb
what is needed to confirm active tb
chest xray
postive sputum
von willebrand disease
bleeding disoder bc of def of von willberand factor which plays imp role in coagulation
Von Willebrand disease teaching
wear med identification bracelt in case of emergency
- look for signs of bleeding (severe joint pain, swelling, headache esp after injury, blood in stools, uncontrolable nosebleed)
- avoid asprin and nsaids
- avoid contact sports
- soft bristled and gentle flossing
- report heavy mestraul cycle such as soaking a pad in (<3) hours
pain and indlammation in Von Willebrand disease
RICE rest ice compression elevation
lyme disease dev
after bite from deer tick
lyme disease signs
flu like symtoms such as headahce, fever, myalgia, fatigue
- eyrthme migrans
- bulls eye rash
complications of lyme
carditis
chronic arthritis
meningitis
facial paralysis
prevent tick bites for lyme disease
insect repellant such as picaridin
- avoid tall grass and thick underbush and only hike in center of trails
- wear long sleeve shirts tucked into pants, long pants tucked into socks or boots and closed toe shoes
removing ticks
tweezers and grab it close to the attachment site and dont crush it when removing.
tb signs
low grade fever
night sweats
anorxia and weigh loss
fatigue
synpnea and hemoptysis seen at later stages
pulmonary tb
cough
blood tinged sputum
sob
purlent sputum
clents in LTBI are
asymtpmatic and cannot transmit to others
anaphlaxis symtoms
resp compromise (oral and airway swelling, stridor, wheezing, chest tightness) and shock (eg, dizziness, loss of consciousness).
recorrent oral ulcers
SLE
cystitis signs
lower uti
- dysruia (painful with urinating)
- urinary freq
- urinary urgency
- hematuria
- suprapuboc discomfort
pyelonephritis
NV
fever with chills
flank pain
sostverbral angle tenderness
hep a vaccine
1 year old health care workers men with men drug users those with clotting issues liver disease
management of anaphylactic shock
call for help (activate MES) FIRSTACTION
- high flower via non reabreather
3) epi IM
4) elevate legs
6) volume resustiion
6) bronchdilator
7) antihistamine
8) corticosteroids
postoperative infections related to abdominal surgery
pneumonia, surgical site infection, and peritonitis, UTI
Signs of infection
cough, tachypnea, and shortness of breath; warmth or redness around the incision; purulent incisional drainage; or rigid, painful abdome
hypovolemia from GI losses signs (cdiff)
hyponatremia, hypokalemia, and elevated blood urea nitrogen (BUN)
Thrombotic thrombocytopenic purpura (TTP)
consists of hemolytic anemia
low plalet assessment
LOC - indicate intracranial bleeding and ICP
Immune thrombocytopenic purpura (ITP)
autoimmune in which antibodies bind to and cause destruction of plaletlets
Immune thrombocytopenic purpura (ITP) are at increased risk for
risk of bleeding
Immune thrombocytopenic purpura (ITP) education
soft brustle toothbrush, gentle flossing and nonetoh mouthwash
- avoid high intesnity sports or anything that can cause trauma
- do low impact sports such as walking
- wear nonskid footwear
- take stool softners and laxative
- electrical razors instead of safety or straight razors
- avoid nsais
- actemenophen better for pain
Tumor lysis syndrome (TLS)
oncologic emegency
occurs when caner treatment sucessfully kills cancer cells resulting in the release OF k, phosphate and nucleic acids
Tumor lysis syndrome (TLS) develops
signficant serum electrolyte inbalances
Tumor lysis syndrome (TLS) complications
hyperkalemia
- Large amounts of nucleic acids (normally converted to uric acid and excreted by the kidneys) that can overwhelm the kidneys and cause hyperuricemia and acute kidney injury (AKI) from uric acid crystal formation
- Hyperphosphatemia (>4.4 mg/dL [1.42 mmol/L]) that can cause AKI and dysrhythmias
- Hypocalcemia
treatment of Hypocalcemia
hydration -correct electyle inbalances - postassium use loop directics, kaylaxate hyperphostaphte use phosphate biders -for hyperuricemia use allpurnaol
influenza symtoms
fever, chills, severe muscle aches, headache, cough, sore throat, nasal congestion, and malaise
influenza treatment
rest, hydration, humidified air, and antipyretics/analgesics.
–zanamivir [Relenza], oseltamivir [Tamiflu]) are given to clients with symptom onset within the last 48-72 hours.
IE teaching
monitor temperature regularly at home. Persistent temperature elevations may mean that the antibiotic therapy is ineffective or complications have developed. The client should notify the HCP if a fever persists at home.
- IE can require IV antibiotics for up to 4-6 weeks. The client may be discharged home once hemodynamically stable, and a home health nurse will come to administer the antibiotics through the client’s PICC line.
- signs of embolization such as slurred speech, one-sided weakness, or paralysis; or a painful, cold extremity.
- Prophylactic antibiotics will be required for certain high-risk procedures.
prior to blood tranfsion
ask to void or empty urinary catheter and discard urine prior to starting blood transfusion because in the event of aucte hemolytic tranfusion reaction a fresh urine specimen should be collected and sent to lab to analyze hemolyzed rbc
hemolytic transfusion reaction
life-threatening reaction in which the host’s antibodies rapidly destroy the transfused RBCs and is generally related to incompatibility.
sings of hemolytic reaction
red urine, fever, and hypotension; late signs include disseminated intravascular coagulation and hypovolemic shock. T
herpes zoster/shingles charctersitic
unilateral, linerar pattern, fluid filled blisters
herpes zoster affected client complains of
pain and itching
pt with hemo and low wbc
protective isloation
provate room
hepa filtration
avoid raw druits and veg
-avoid stadning water and udnercooked meat
-no hcp who has cold should take care of pt
patients with polycthmeia versa are at risk of dev
clots because of the icnreases volume, voscity, and stasis in their blood
polcyemia versa signs to look out for that indicate thrombus formation
redness tenderness swelling symtoms of sttroke teaching of polycethemia versa
teahcing of polycethmia versa
support stocks
elvate legs when sitting
hydrating prop esp dyring hot weather and excercise
Oropharyngeal candidiasis, or thrush
immuno such as those taking corticosteroids or chemo or radiation, AIDS
-igh dose of antibiotic treatment
-people with dentures
ALBURTEROL DONT CAUSE IT BUT INHALED CORTICOSTEROIDS DO
treatment of Oropharyngeal candidiasis, or thrush
oral hygeine
nstatin or other anitfungal meds
purpura
reddish purple blocktes on the skin that do not blanch with pressure due to bleeding and this is singificant because theres bleeding underneath the skinundernaeath the skin
loook at
53,55,56,58
lmph nodes noraal finding
are not palapable but if it is palapble, suuperfical, small, mobile, firm and non tender it is normal finding
malignacy signs
tender, hard, fixed or enlarge nodes
unintention weight loss of
more than 10 percent os usual weight in non obsese clients indicate cancer
signs of cancer
weight loss of more than 10 percent , Nausea, anorexia, and dysgeusia (altered taste
nagging cough/hoarseness sensation
warning signs of cancer
CAUTION c- change in bowel or bladder habits A- sore that does not heal u- unsual bleeding or discharge from body orifice t- thickening or lump in the breast or elsewhere i-ingestion or diff swllowing o-obvious change in a wart or mole n- nagging cough or hoarseness
breast cancer
chest radiaition, retracted nipple that is new, orange peel appearance of breast tissue dimpled
BPH
caused by hormonal changes related to aging and growth dont mean cancer
lopmas
benign, fatty masses that are rarely malignant
-subq, have soft doughy feel and are mobile and asympatic
copd compensation
produce more RBC to carry o2 to cells (polycytmeia)
- anemia is not expected and will worsen symtoms of copd
- neutropenia not expected in copd
- thrmboyctopenia is not anticpated in copd
oral cancer prsents as
presents as a nonhealing lesions or ulcers
oral cancer signs
mucosal thickening diff swallowing muoth bleeding sore spots leukopakia (white patch) changes in salvation
risk factors of oral cancer
chronic etoh and tabcao use -poor oral hygeine -chronic irrtation of mucose (chipped teeth, imporoper dental appliances) -excessive exposrure to uv light oral sex
radiation therpy causes what
muscositits ( inflammation of the mouth, esophagus, and oropharynx))
- xerostomia (ie, dry mouth).
these affect the sppech, taste and ability to sawllow affecting the oral intake and nutrition satus
raditiation therpy teaching
avoid irratants such as spicy foods, acidic, dry, crumnly foods, coffee, etoh
- consume supplemental nutrition drinks such as ensure
- use artifical salivia for dry mouth
- lidocaine can help
- maintin oral hygine, and rinse with aking soda
hemophilia
def in production of coagulation proteins such as factor VIII and factor IX
