Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PPNP 3 > Onco APN talk > Flashcards

Onco APN talk Flashcards

1
Q

(Superior vena cava syndrome) What is the superior vena cava?

A

Major drainage vessel for venous blood
from the head, neck, upper extremities,
and upper thorax

Located at the middle mediastinum

Surrounded by relatively rigid structures
(sternum, trachea, right bronchus, aorta,
pulmonary artery, and the perihilar and
paratracheal lymph nodes)

Extends from the junction of the right
and left innominate veins to the right
atrium, a distance of 6-8 cm

Thin-walled, low-pressure, vascular
structure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

S&S of SVCO

A

Giddiness
Face and neck swollen
Breathless / SOB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Mechanism of Superior vena cava syndrome (2)

A

Extrinsic compression
Intravascular thrombosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Initial medical management of mediastinal
mass (investigations and disposition) - Condition (Is it a mediastinal mass?)

A

Chest XR > CT scan (contrasted)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Initial medical management of mediastinal
mass (investigations and disposition) - Cause (What is the mass?)

A
  • Tumor markers: AFP, HCG (germ cell tumor)
  • FBC: anemia, thrombocytopenia and leukopenia (Non-HL?)
  • Biopsy! Histology
  • how to biopsy safely? PT/INR/aPTT, FBC (platelet count)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Initial medical management of mediastinal
mass (investigations and disposition) - Complications

What if patient collapses during the procedure?

A

CTVS team onboard, CTICU and HD care

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Initial medical management of mediastinal
mass (investigations and disposition) - Complications

What if the SVC collapses?

A

urgent stenting or removal of external compression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Initial medical management of mediastinal
mass (investigations and disposition) - Complications

What if tumor breaks down spontaneously?

A

management of tumor lysis syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Medical management of SVCO

A

Treat the cause of mediastinal mass
* Treat the breast cancer – medical oncologist

Treat the complication of mediastinal mass
* Invasive life support, stenting?

Look out for complications of treatment
* Chemotherapy toxicity: neutropenic fever, nausea and vomiting, central line
sepsis, renal impairment
* Others: fluid overload

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Nursing management of SVCO

A

Do not increase SVC return:
* No setting of IV plugs on upper limbs
* No BP measurement on upper limbs
* Nurse patient with head of bed at least 30 degree
* Advocate for central line insertion to administer treatment safely

Fall precaution for neurological changes
* Look out for giddiness, altered mental status in patient

  • Chemotherapy side effects
  • Strict intake output charting
  • Daily weight if indicated
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Nursing diagnosis for SVCO (2)

A

Increased risk for fall due to risk for loss of consciousness

Increased risk for airway compromise due to SVCO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

(SVCO) Increased risk for fall due to risk for loss of consciousness is EVIDENCED by:

A

Subjective sensation of ”blacking out”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

(SVCO) Increased risk for airway
compromise due to SVCO is EVIDENCED by:

A
  • Subjective sensation of SOB
  • Increased face and neck swelling
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Nursing diagnosis for SVCO (interventions)

A
  • Educate on position change and height of bed at least 30 degree
  • No BP taking and IV plug insertion on upper limbs
  • Timely carry out medical
    interventions as
    ordered, such as
    administration of
    chemotherapy /
    radiotherapy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

(SVCO) Rationale behind nursing interventions

A

Change pt position
Increase ht of bed
Avoid BP taking over upper limbs decrease pooling of blood in SVC and decreases risk of blacking out, amt of facial swelling & SOB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

(SVCO) Expected outcomes of Nursing Interventions

A

Patient does not
suffer a fall
- Patient
experiences an
acceptable level
of breathlessness
that does not
affect her ADLs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Presentation of hypercalcemia

A

CNS - Fatigue, confusion, depression
Renal - urination, thirst, renal calculi

Pancreatitis

GIT - Anorexia, nausea, vomiting, constipation, abdominal pain
BONES - Bone pain, fractures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Medical management of hypercalcemia

A

Treat the hypercalcemia
✓ IV Normal Saline 3L/day x 3/7
✓ IV Normal Saline 1.5L/day x 2/7
✓ IV Pamidronate 60mg in 500ml NS over 6 hours
• Investigate the cause of hypercalcemia
✓ CT scan and Xray shows lytic lesion
✓ underlying bone metastasis → treat the cancer with chemotherapy
/radiotherapy
• Investigate complications of hypercalcemia
✓ Bones, stones, groans and psychic moan: Acute delirium, constipation, nausea
and vomiting, pancreatitis,
• Look out for complications of treatments
✓ Hyperhydration – fluid overload
✓ Bisphosphanate and denosumab – hypocalcemia and osteonecrosis of the jaw
✓ Chemotherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Treatment of mild and moderate hypercalcemia

A

→ does not require immediate treatment
•Remove factors that aggravate hypercalcemia
•Ensure volume repletion: adequate hydration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Treatment of severe hypercalcemia

A

→ immediate, aggressive treatment!
•Aggressive hydration (initial rate can be 200-300mls/hr) + Frusemide
•Bisphosphanates: Zolendronic acid/pamidronate
•Denosumab: RANKL inhibitor
•Calcitonin: alternative to aggressive NS hydration (e.g CCF, CKD)
•Rapid response within 12-24hrs
•can cause rebound hypercalcemia (tachyphylaxis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Nursing management of hypercalcemia

A

Targeting at complications of hypercalcemia and treatments
Accurate intake and output
Weigh patient daily
• Daily weight recommended
• Give PRN frusemide based on doctor’s order – watch out for side effects of
frusemide
Clear bowel
Neurological assessment
▪ Look out for confusion
Pain chart
▪ Abdominal pain, bone pain, loin to groin pain
Ensure dental clearance done prior to administration of bisphosphonates (unless
in emergency)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Nursing diagnosis of hypercalcemia (there are 2)

A

Increased risk of fluid overload due to hyperhydration
Constipation due to hypercalcemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Evidence of increased risk of fluid overload due to hyperhydration (hypercalcemia)

A

Feeling SOB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Evidence of Constipation
due to hypercalcemia

A

Unable
to BO x
5 days
- Patient
has
stomach
pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

(Hypercalcemia) Nursing interventions for Increased risk
for fluid
overload due to
hyperhydration

A

Daily weight
- Strict IO charting
- IV frusemide as
needed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

(Hypercalcemia) rationale for nursing interventions (daily wt, IV frusemide, etc) for Increased risk
for fluid
overload due to
hyperhydration

A
  • To detect and
    manage fluid
    retention timely
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Expected outcomes of nursing interventions for Increased risk
for fluid overload due to hyperhydration

A

Patient can
tolerate the
hyperhydration
without
complications
- Pt calcium level
can decrease to
acceptable level

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Nursing interventions for Constipation
due to hypercalcemia

A

Laxatives as
needed
- Intake and
output chart
(stool chart)
- Per rectal
examination (if
trained)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Rationale for Nursing interventions for Constipation
due to hypercalcemia

A

To monitor the
number of days pt
has BNO, and
relieve constipation
timely
- Monitor the
response after
laxatives

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Expected outcomes for Nursing interventions for Constipation
due to hypercalcemia

A
  • Patient has
    regular BO
    according to
    baseline
  • Patient abdominal
    pain is well
    managed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Initial medical management of spinal cord compression - condition (how to find out if there is spinal cord compression?)

A

MRI spine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Initial medical management of spinal cord compression - cause (What is the mass?)

A
  • Biopsy! Histology
  • how to biopsy safely? PT/INR/aPTT, FBC
    (platelet count)
  • Tumor markers: myeloma? Mets disease
    from lung vs breast vs prostate in man?
  • What is the primary cancer? PET CT
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Initial medical management of spinal cord compression - complication (Is the spine unstable?)

A

Surgical fixation?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Initial medical management of spinal cord compression - complication (Is it causing pain?)

A
  • Glucocorticoid
  • RT first? What type of RT?
  • Chemo-sensitive
  • Pain management – opioids
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Initial medical management of spinal cord compression - complication (risk of venous thromboembolism)

A

– the need for prophylaxis

36
Q

Initial medical management of SCC - Glucocorticoid is considered….

A

Considered part of the standard treatment, bridge to definitive treatment

37
Q

Initial medical management of SCC - Glucocorticoid dose/s

A
  • High dose: IV dexamethasone 10mg -> PO dexamethasone 16mg daily > taper
38
Q

Initial medical management of SCC - Pain management

A

Glucocorticoid can usually improve the pain within several hours, but many
patients require opioid analgesics

39
Q

Initial medical management of SCC - Venous
thromboembolism prophylaxis

A

Advanced cancer – increased risk for VTE
Weakness and immobility – further increase the risk of VTE
Prophylactic low molecular weight heparin, clexane (enoxaparin) for e.g.

40
Q

Initial medical management of SCC - Surgical stabilisation

A

Spinal instrumentation – e.g. pedicle screws, percutaneous cement injection

41
Q

Initial medical management of SCC - Radiotherapy

A
  1. Conventional external beam radiation therapy (cEBRT): for radiosensitive tumors (RT first unless there is spinal instability)
  2. Stereotactic body radiation therapy (SBRT): now the preferred approach for low-grade ESCC due to relatively radioresistant tumors. Also for patients with radioresistant high-grade Epidural SCC who
    has undergone surgical decompression and stabilization
42
Q

Nursing management of SCC

A

Management of unstable spine
* Log rolling

Management of urinary retention and constipation
* IDC insertion
* Use of laxatives
* Intake output charting

Fall precaution

VTE prophylaxis
* Calf compressors
* Bed exercise

43
Q

Nursing diagnosis for SCC (2x)

A

Back pain on movement impacting ADL

Risk for fall

44
Q

(Spinal cord compression) Back pain on movement impacting ADL is evidenced by:

A
  • Increasing
    pain score
    upon
    movement
  • Patient
    verbalized
    difficulty in
    completing
    ADLs
45
Q

(Spinal cord compression) Risk for fall is evidenced by:

A
  • Pt verbalized
    lower limb
    weakness
46
Q

(Spinal cord compression) Back pain on movement impacting ADL - nursing interventions are:

A
  • Pain
    management,
    such an pre-
    emptive pain
    medications
    before
    movement and
    investigations
  • Timely
    evaluation of
    pain medication
47
Q

(Spinal cord compression) Risk for fall - nursing interventions are:

A
  • Fall interventions
    are instituted
    correctly based
    on fall risk
    assessment
  • Institute
    appropriate
    lower limb
    exercise
48
Q

(Spinal cord compression) Rationale for nursing interventions for Back pain on movement impacting ADL

A
  • Timely
    administration of
    pain medications
    could improve
    patient’s tolerance
    to ADLs
  • Evaluate timely and
    escalate to
    physician for
    titration of pain
    medications should
    pain is still not well
    tolerable
49
Q

(Spinal cord compression) Rationale for nursing interventions for risk for fall is:

A
  • Fall interventions
    could effectively
    reduce patient’s risk
    for and severity of fall
  • LL exercise to
    strengthen the
    muscles to increase
    stability when walking
50
Q

(Spinal cord compression) Expected outcomes of nursing interventions for back pain on movement impacting ADLs

A
  • Patient is able to
    verbalize pain
    score <3 upon
    movement
  • Patient is able to
    perform ADLs with
    tolerable pain
51
Q

(Spinal cord compression) Expected outcomes of nursing interventions for risk for fall

A
  • Patient does not
    sustain a fall during
    admission
52
Q

S&S of Tumor Lysis Syndrome

A

Fatigue
Muscle cramps
Breathless
Swollen legs
Occassional chest tightness

53
Q

Definition of tumor lysis syndrome

A

An oncologic emergency caused by massive tumor cell lysis

  • release of large amounts of potassium, phosphate and nucleic acids
    into the systemic circulation
  • hyperkalemia, hyperphosphatemia, secondary hypocalcemia,
    hyperuricemia, and acute kidney injury
54
Q

(Tumour lysis syndrome) What is nucleic acids breakdown and what does it cause?

A
  • Highly insoluble
  • Form crystals in the
    renal distal tubules
  • Deposition of the
    crystals > acute kidney
    injury
55
Q

(Tumour lysis syndrome) What is phosphate and what does high conc of phosphate cause?

A
  • Concentration in
    malignant cells is 4x
    higher than in normal
    cells
  • Calcium binds with
    phosphate > calcium
    phosphate
    precipitation >
    hypocalcemia > acute
    kidney injury and
    cardiac arrhythmias
56
Q

(Tumour lysis syndrome) What is potassium and what does it cause?

A
  • Highly insoluble
  • Form crystals in the
    renal distal tubules
  • Deposition of the
    crystals > acute kidney
    injury
57
Q

there are 2 types of tumor lysis syndrome. what are they?

A

Spontaneous
Treatment-induced

58
Q

What is spontaneous Tumor Lysis Syndrome?

A
  • Happens spontaneously
    before initiation of treatment
  • Often without
    hyperphosphatemia
59
Q

What is treatment-induced Tumor Lysis Syndrome?

A
  • After treatment initiation including steroid
60
Q

Risk factors for Tumor Lysis Syndrome - what are the tumour specific risk factors?

A

High proliferation rate
Chemo/radiosensitivity
Haemotological cancer (e.g. lymphoma, leukemia)
Large tumour burden

61
Q

(Tumour specific Risk factors for Tumor Lysis Syndrome) What is large tumour burden?

A

> 10cm in diameter
WBC count > 50,000/microL
Pre-treatment serum LDH > 2 times the upper limit of normal
Bone marrow involvement

62
Q

Risk factors for Tumor Lysis Syndrome - what are the patient factors?

A

Pre-existing hyperuricemia
Pre-existing renal disease
Oliguria and/or acidic urine
Dehydration, volume depletion or inadequate hydration during treatment

63
Q

Medical management of Tumor Lysis Syndrome - overall treatment is to: Treat the ____

A

Treat the electrolyte abnormalities

64
Q

Medical management of Tumor Lysis Syndrome - Hyperkalaemia

A
  • Serum potassium levels check
  • Continuous cardiac monitoring
  • Oral potassium-lowering agents (e.g. sodium polystyrene
    sulfonate)
65
Q

Medical management of Tumor Lysis Syndrome - Hyperphosphatemia

A
  • Aggressive hydration with concurrent use of diuretics
  • Phosphate binder therapy (e.g. calcium carbonate)
66
Q

Medical management of Tumor Lysis Syndrome - Hypocalcemia

A
  • If calcium phosphate product is >60mg2/dL2, no calcium
    should be given until hyperphosphatemia is treated
  • Calcium replacement given at lowest dose to relieve
    symptoms
67
Q

Medical management of Tumor Lysis Syndrome - In patients with severe AKI, what should be done?

A

Renal replacement therapy

68
Q

Medical management of Tumor Lysis Syndrome - What are the lab investigations to be done?

A
  • Electrolytes – K, Ca, PO4, Uric
    acid
  • Renal function – creatinine
  • Cell turnover – LDH
69
Q

Tumor Lysis Syndrome preventive management

A

Intravenous hydration
Hypouricemic agents

70
Q

What are Hypouricemic agents?

A
  • Allopurinol (100mg/m2 every 8 hours in adults)
  • Rasburicase (Increase in favor for use, especially in high risk patients, 0.2mg/kg OD for up to 5 days)
71
Q

(TLS) Allopurinol works by blocking ____ which catalyses the conversion of ___ to ___

A

Xanthine oxidase, catalyses the conversion of xanthine to uric acid

72
Q

(TLS) Rasburicase works by mimicking ____ which catalyses the conversion of ___ to ___

A

Uric oxidase, which catalyses the conversion of uric acid to allantoin

73
Q

Overall, Nursing management of TLS targets:

A

Targeting at complications of hyperhydration and electrolyte imbalance

74
Q

What is the Nursing management of TLS?

A

Fluid balance
Strict intake output charting
Daily weight if indicated
Renal dialysis management
Furosemide with hyperhydration

Maintaining electrolyte balance timely
Send off and trace electrolytes
Replacement or lowering of electrolytes – e.g. potassium lowering agents

Safe administration of rasburicase
Checking of G6PD status before administration
Send off RP2 and LDH in ice x 72hours post last dose of rasburicase

75
Q

Nursing diagnosis for TLS (2x)

A

Increased risk for fluid overload
Increased risk for electrolyte imbalance

76
Q

(TLS) Increased risk for fluid overload is evidenced by:

A
  • Increased LL swelling
  • Increased SOB
  • Chest discomfort
77
Q

(TLS) Increased risk for electrolyte imbalance is evidenced by

A
  • Subjective sensation of cramps
  • Chest discomfort
78
Q

(TLS) Nursing Intervention for Increased risk for fluid overload

A
  • Daily weight
  • Strict IO
  • Frusemide
    as indicated
  • Creatinine
    check
    timely
79
Q

(TLS) Nursing Intervention for Increased risk for electrolyte imbalance

A
  • Electrolyte check and carry out
    interventions accordingly
  • ECG tro myocardiac infarct
80
Q

(TLS) Rationale for Nursing Intervention for Increased risk for fluid overload

A
  • Maintain a net
    fluid balance
    through timely
    interventions
81
Q

(TLS) Rationale for Nursing Intervention for Increased risk for electrolyte imbalance

A
  • Replace and
    remove
    electrolytes timely
82
Q

(TLS) Expected outcomes for Nursing Intervention for Increased risk for fluid overload

A
  • Patient is able to maintain a net fluid balance and does not go into fluid overload
83
Q

(TLS) Expected outcomes for Nursing Intervention for Increased risk for electrolyte imbalance

A

Patient does not suffer from cramps and chest discomfort from electrolyte imbalance

84
Q

(Handling of chemotherapy) IV and SC chemo is not:

A
  • IV and SC chemotherapy – not to be handled by untrained staff
85
Q

(Handling of chemotherapy) what should be worn when handling PO chemo?

A
  • PO chemotherapy – to wear gloves when handling the medicine
86
Q

(Handling of chemotherapy) If need to dilute the medication – e.g. for NG feeding – to approach….?

A
  • If need to dilute the medication – e.g. for NG feeding – to approach SNIC on methods to dissolving it (NCIS has a nursing guide on dilution)

PPNP 3 (19 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions