Oncology Flashcards

Question

Disposal of Chemotherapy

Answer 1

* Yellow rigid chemo waste container (sharps, IV equipment) * Yellow chemo waste bag (gowns, gloves, disposable items) * wash hand w/ soap and water after removing gloves

Answer 2

* hHandle as a HAZARDOUS CHEMICAL SPILL * Obtain Spill Kit and use ALL protective equipment for clean up --wash hands w/ soap and water → get SPILL KIT → Post "Caution Chemo spill" sign outside the room door → resp mask → chemo gown → 2 chemo gloves → goggles →ise absorbent pads to wipe up spill

Answer 3

Complication w/ Chemotherapy Administration • Chemo drugs are given in a central IV line; Peripheral line only if IV push or infusion <1 hr; VESICANT (chemo drug that if it infiltrates = NECROSIS) • s/sx: Pain, Swelling, No blood return • Tx #1 thing to remember - PREVENTION! STOP INFUSION and send for extravasation kit → stay w/ client and watch the site

Answer 4

* Treatment for HEMATOLOGIC cancers * Stems cells come from the client, a matched donor, or identical sibling/twin * Stem cells are given into VEIN → over time, settle in the bone marrow = produce HEALTHY BLOOD cells

Answer 5

stems cells are transplanted from bloodstream

Answer 6

stem cells are transplanted from bone marrow

Answer 7

``` abdominal pain jaundice pruritus diarrhea dark, tea colored urine (RBC breakdown) ```

Answer 8

1) Nausea/Vomiting (N/V) • last 24-48 after tx • routine antiemetic meds given 1st week of chemo TREATMENT: Antiemetic drugs 1. ondansetron (Zofran) -serotonin receptor antagonists (-tron): onsansetron, granisetron, dolasetron 2.Netupitant/palonosetron (Akynzeo) -oral combination antiemetic; prevents acute and delayed N/V from chemo -- 1 dose 1 pill 1 hr before chemo 3. Non-pharmacologic tx -Ginger -Aromatherapy -acupuncture, acupressure, distraction and relaxation techniques (music therapy, peppermint essential oil diffuser) 2) Stomatitis oral cavity susceptible to irritation 3) Diarrhea worry nutrition and FE imbalances

Answer 9

• alopecia (hair loss) • sense of loss w/ mastectomy, amputation, surgery scar ---have them look at the incision

Answer 10

* ↓ RBCs, ↓ WBCs, ↓ Platelets -- client at risk for anemia, infection, and bleeding * INFECTION is #1 cause of cancer-related deaths

Answer 11

* Private room; Limit visitors and nurses in the room * Keep client's own supplies; Don't share toiletries * Change dressings and IV tubing daily * Cough and deep breathe to prevent pneumonia * NO gardening or cleaning up after pets * Avoid crowds; Wear mask when out in public * Good handwashing frequently using antibacterial gel * Wash hands after touching a pet * Drink FRESH WATER * Avoid uncooked meat, seafood, eggs (No sushi); Avoid fresh/raw fruits/vegetables * Brush teeth w/ SOFT toothbrush 4 TIMES daily * NO alcohol-based mouthwash * report to hospital for temp >100.4 (38 C)

Answer 12

* Antibiotics as prescribed * VS q4h (temp check q2h) * Private room w/ door closed and posted sign * Antimicrobial soap for handwashing (not regular soap_ * No invasive procedures (IM injections, rectal exams/meds) * Avoid indwelling catheters and NG tubes * limit use of acetaminophen (Tylenol)

Answer 13

* every onc client has some fatigue, some d/t tx | * provide period rest, naps, limit visitation time; teach clients to do these at home

Answer 14

• Treat pain without worry about risk for DEPENDENCE • causes of pain - direct tumor involvement, result of tx (mucositis, peripheral neuropathy) • OPIOIDS is gold standard tx --NO ceiling on dose for a cancer client; Limit dose coz of SE, not dose/time; Call PHP if increased dose needed

Answer 15

* Acupressure * Acupuncture * Cannabis (Marijuana) * Distraction therapies (music, peppermint essential oil diffuser) * Hydrotherapy * Massage

Answer 16

* ↓ neutrophils (mature WBCs) in blood * 2500 - 8000 cells/mm * Tx: Antibiotics; Implement Neutropenic Precautions

Answer 17

* Prolonged bed rest; Surgery; Use of central line; External compression of vessels by tumor; Invasion of cells by tumor; Certain chemo drugs * Worry about development of a PE (Pulmonary embolus)

Answer 18

• ↓ of circulating platelets in blood; Platelets responsible for clotting (must have platelets to clot the blood to prevent bleeding) RISK FACTORS • advanced metastatic disease • hematological malignancies • bleeding disorders (Hemophilia, liver disease, ITP) • bacterial infections • Anticoagulant meds - aspirin, clopidogrel (Plavix), Heparin, warfarin (Coumadin) • result of cancer tx ``` ASSESSMENT • History • VS • O2 sats • Change in LOC (headache, pupil changes) • conjunctival hemorrhages • petechiae, ecchymosis, purpura • oozing from puncture/surgical sites • bleeding from rectum, ears, nose, or mouth ``` TREATMENT • Give platelets

Answer 19

* RBC for clients w/ symptomatic anemia--don't want H/H to drop below 8 g/dL and 24% (need RBCs) * PLT - control or prevent bleeding in thrombocytopenia * Reduces risk of transfusion-related reactions

Answer 20

* administered by RN * Only use NS * do NOT infuse meds via blood IV tubing * need a filter * given via pump * baseline VS and transfusion records, 2 IVs * each client must have TYPE and SCREEN and CROSSMATCH in the lab prior to obtaining a blood product; it's only good for 72 HOURS * 1) in the blood blank and on the floor; 2) w/ a designated person in blood bank and w/ another RN at the bedside on the floor; 3) client's name, DOB, blood bank #, unit #, exp date of unit of blood/blood product, blood type and group, PHP's prescription * check for any signs of abnormalities * PHP's prescription and client's signed consent form (PHP's responsibility to explain need and possible SE) STEPS of infusion • 2 IVs ready → baseline VS → get blood from blood bank → Started within 30 mins of receiving blood from blood bank → Begin infusion SLOWLY → obser client for first 15 mins → no reaction, ↑infusion rate (must be completed within 4 HOURS) → dispose blood tubing and blood/blood product bag → flush lines w/ 0.9 NS after transfusion → Document * do NOT infuse blood quickly in -- elderly, has heart or kidney condition, or very young * infusion should be started within 30 MINUTES of receiving blood from blood bank * completed within 4 HOURS

Answer 21

* chest pain * hives or skin rash * hypotension/hypertension * fever * chills * anxiety * wheezing * headache or muscle pain w/ fever * flushing * back pain * dizziness * itching * urticaria * tachycardia * tachypnea * dyspnea * N/V

Answer 22

* STOP INFUSION * remove blood and blood tubing set * may have to return blood and tubing to blood bank * start NS w/ new primed tubing at keep vein open (KVO) rate * check and document VS--stay w/ client * notify PHP and monitor for anaphylaxis * notify lab/blood bank of reaction