Hem/Onc/Imm - Module 11

Question 1

Anemia

Answer 1

Deficiency in:

• number of RBCs
• quality/quantity of Hgb
• volume of packed RBCs (Hct)

Causes:

• decrease in RBC production
• blood loss
• increased RBC destruction
• hypoxia causes many of the S&S
• not a specific disease
• severity determined by Hb levels

Question 1

Clinical Manifestations of Anemia

Answer 1

• Pale, rectal bleed, chest pain, tachycardia, HA, cold, anorexia, dyspnea at rest, weight loss, bone pain, depression, CHF, MI

Hemolysis cause: jaundice of skin, conjuctive and sclera pruritis

Question 1

Iron-deficiency anemia

Answer 1

affects the young, picky eaters, and reproductive age women

S&S:
- pallor, inflammation of the tongue (glossitis) & lips (cheilitis), HA, tongue burning

Iron supplements:

• one hour before meals
• take with OJ
• avoid contact with teeth (stains)
• can cause: constipation, black tarry stools

Question 1

Aplastic anemia

Answer 1

bone marrow doesn’t produce enough blood cells

• can have genetic component

S&S:
- fatigue, dyspnea, dizzy, HA, cold, pale, angina, flu-like, bruises, bleeding and heavy periods

Treatment:
- blood transfusions, stem cell transplants may offer a cure for some

Question 1

Hemolytic anemia

Answer 1

premature destruction of RBCs

can affect people with heart valve replacement

S&S:
- jaundice, enlarged liver/spleen, dark urine, fatigue

Care:
- fluids r/t possible renal failure

• need to treat cause
• packed RBCs gives slowly to avoid cardiac problems

Question 1

Pernicious anemia

Answer 1

Vitamin B12 deficiency

affects women 40-70 - northern european

S&S:
- anorexia, N/V, abd pain, weakness, paresthesias, confusion

Treatment:
- vitamin B12 shots until counts are WNL then will have life-long injections

Question 1

Leukemia

Answer 1

Risk factors:

• genetics
• exposure
• radiation
• nuclear accidents
• chemicals

ALL, AML, CML, CLL

Question 1

Medical Management for Leukemia

Answer 1

Destroy neoplastic cells

• chemotherapy
• radiation
• steroids
• targeted therapy

Minimize or control complications:

• total body radiation to prepare for BMT
• manage pancytopenia: bone marrow transplant

Question 1

Nursing management for Leukemia

Answer 1

• emotional support
• neutropenia assessment and precautions
• skin assessment and care
• conserve energy
• alopecia (may be permanent with whole brain radiation)
• vaccines: flu and pneumovax
• can Surmount

Question 1

Polycythemia Vera

Answer 1

• increase production of RBCs
• increase in blood viscosity
• increase in volume
• age: 60s, male, slow onset
• Treatment: phlebotomy: 300-500ml may be removed every other day until Hct is WNL.
• ASA 81 mg

Question 1

Clinical Manifestations of Polycythemia Vera

Answer 1

Early stage:
- no symptoms

Moderate stage:

• headaches
• vertigo
• tinnitus
• blurred vision

Late stage:

• thromboses
• embolization
• nosebleeds
• ecchymoses
• GI bleed

Question 1

Lupus (SLE)

Answer 1

chronic, autoimmune

Diagnosis:

• +ANA, high sed rate
• Low RBC, WBC, platelet
• IgE

Question 1

S&S of Lupus (SLE)

Answer 1

• fever
• butterfly rash
• oral ulcers
• pericarditis
• hematuria
• anemia
• thrombocytopenia
• azotemia (high levels of nitrogen containing compounds – urea, creatinine)

Question 1

Med/Nurse management for Lupus (SLE)

Answer 1

• NSAIDs
• Steroids
• Imuran
• treatment r/t organ system most involved
• fatigue control
• avoid triggers: light, stress, pregnancy
• nutrition
• emotional support

Question 1

Fibromyalgia

Answer 1

• chronic widespread musculoskeletal pain with multiple tender points.
• fatigue (doesn’t go away with rest), sleeplessness, IBS, anxiety, memory problems, and HA
• disorder of central processing with neuroendocrine/neurotransmitter dysregulation

Diagnosis:

• difficult
• pain in 11 of 18 tender points for 3 months

Question 1

Treatment for Fibromyalgia

Answer 1

• NSAIDs
• antidepressants
• Flexeril
• Ambien
• massage
• heat/cold
• avoid sugar, caffeine and ETOH
• stress management

Question 1

Rheumatoid Arthiritis

Answer 1

• chronic progressive inflammation
• bilateral, symmetrical
• collagen breakdown
• synovial damage
• scar tissue
• permanent join deformity

Question 1

Clinical manifestations of Rheumatoid Arthiritis

Answer 1

• fatigue
• diffuse joint pain
• fever
• anorexia and weight loss
• inactive stiffness
• PAIN IN THE AM
• muscular shortening
• nontender joint nodules
• +Rheumatoid factor
• increased sed rate
• +ANA
• thin synovial fluid
• high WBCs

Question 1

Med/Nurse measures for Rheumatoid Arthiritis

Answer 1

• ASA/NSAIDs
• suppress immune (methotrexate)
• antimalarials
• gold therapy
• steroids
• surgery
• nutrition
• rest
• avoid increasing damage to joints
• support

Question 1

MRSA

Answer 1

• both hospital or community acquired
• viable for days on surface and clothing
• patients at risk
• –immunosuppressed
• –invasive devises (caths)
• –break in skin barrier (surgery)

Question 1

VRE

Answer 1

• hardier than MRSA
• viable on surface for weeks
• E.coli: 2nd most common cause of nosocomial infections
• responds ONLY to Synercid and Zyvox

Question 1

Patient teaching for Antibiotic-resistant organisms

Answer 1

• do not take antibiotics to prevent illness
• handwashing
• take antibiotics as ordered
• no antibiotics for cold/flu
• do not take leftover antibiotics (there shouldn’t be any!)

Question 1

C.difficile

Answer 1

• at risk: 65 year olds
• received large doses of antibiotics
• have been on antibiotics for >7 days
• Pts on: H2 blockers, preop bowel preps, chemo
• immunocompromised
• COPD, CRF, GI procedures
• ICU, ECF, semi-private rooms
• smells VERY bad
• most common cause of nosocomial infections esp in surgery patients

S&S:
- diarrhea, N/V/A, abd distention, hyperactive bowel sounds, fever

usually self-limiting (1-5 days)