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ONS Tx + Symptom Management Flashcards

1
Q

How to calculate ANC?

A

% neutrophils (bands + segments) x WBC

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2
Q

what is febrile neutropenia?

A

temp >38 C or 100.4 F

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3
Q

calculate ANC:
WBC 2500
segments 59%
bands 1%

A

(59% + 1%) x 2500
.60 x 2500
1500

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4
Q

interventions for febrile neutropenia

A

avoid sick people, crowds, raw meats, fresh fruits / veggies
avoid reptiles, litter, birds, etc.
have good hygiene
no live viruses

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5
Q

thrombocytopenia

A

PLT <150,000

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6
Q

Mensa

A

medication to decrease risk of hemorrhagic cystitis

give to pt receiving ifosfamide and high dose cyclophosphamide

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7
Q

interventions for thrombocytopenia

A

use soft bristled toothbrush, electric razor
avoid invasive procedures (IM inj, rectal temp, enema, finger sticks)
monitor bleeding / bruising

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8
Q

mucositis // stomatitis

A

inflammation / ulceration of oral mucosa

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9
Q

s/s of mucositis

A

lesions, pain swallowing / eating, dry mouth, foul order

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10
Q

medications that can cause mucositis

A

busulfan, 5FU, doxil, capecitabine

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11
Q

interventions for mucositis

A

good oral hygiene, cryotherapy, rinse with baking soda solution

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12
Q

acute chemo induced N/V

A

occurs within 24 hours of treatment

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12
Q

xerostomia / interventions

A

dry mouth

int: limit sugar, spicy, rough foods

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13
Q

delayed CI N/V

A

occurs 24 hours - 6 days after treatment

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14
Q

anticipatory CI N/V

A

response from pt expectations / anticipation of tx

usually benzos can be used for these pt

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15
Q

breakthrough CI N/V

A

N/V despite antiemetic therapy, needing a rescue medication

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16
Q

dysphagia / interventions

A

difficulty swallowing

int: thickening agents for liquids, cold foods, soft / pureed foods, daily weights, ax need for TPN / feeding tube

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17
Q

anorexia / interventions

A

involuntary loss of interest in eating

int: nutritional counseling, corticosteroids, progestins

reversible

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18
Q

cachexia / interventions

A

wasting syndrome - loss of muscle and protein
anorexia, N/V and weakness

int: tx underlying condition, tube feedings

no evidence cachexia is reversible

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19
Q

constipation / int

A

decreased motility

int: adequate fluid intake, increase fiber, increase activity, laxative

can be opioid induced

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20
Q

PLISSIT

A

permission
limited info
specific suggestions
intensive therapy

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21
Q

ALARM

A

activity
libido
arousal
resolution
medical history

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22
Q

cystitis

A

inflammation of bladder lining

d/t ifosfamide / cyclophosphamide

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23
Q

cystitis SS / int

A

s/s pain, urinary urgency, burning, hematuria, bladder spasms, incomplete urination

int: hydration, MENSA IV, treat infections, antispasmodics, CBI, avoid caffeine / spicy foods / alcohol

prevention is KEY

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24
hypertrichosis
overgrowth of hair on eyes and face
25
hands foot syndrome
erythema, bleeding, peeling, ulcerative dermatitis
26
xerosis / int
dry, flaky, itchy skin int: moisturizing cream / steroid for eczema
27
pruritus / int
increased itching int: moderate to high potent steroids oral antipruritics - gabapentin or pregabalin
28
paronychia / int
inflammation of skin around the nail d/t bacteria or fungi int: high potency steroid and vinegar soak, oral abx, nail avulsion
29
XRT dermatitis / int
depends on grade - mainly topical steroids, antibacterial, and moisturizers maintain hygiene, oral abx, topical ointment
30
alopecia / int
hair loss int: scalp hypothermia w/ ice packs or cooling caps minoxidil 5% x2 during chemo, biotin orthosilicic acid counsel pt on hats, scarves, wigs
31
pneumonitis / dx / int
s/s: dry cough, pain, using accessory muscles to breathe dx: chest CT, ABG, PFT int: cough suppressant, elevate HOB, bronchodilators
32
pleural effusion / int
accumulation of fluid in pleural space s/s: dyspnea, fatigue, increased effort in breathing, tachypnea int: self resolving, diuretics, corticosteroids
33
dyspnea / int
s/s pale skin, cyanosis, altered LOC, clubbing of digits int: O2, benzo (anxiety), increased airflow w/ fan, cool temperature, stress reduction
34
peripheral neuropathy / int
injury, inflammation, or degeneration of PN fibers s/s numbness, tingling, pain, weakness, poor gait, difficulty w motor skills int: fall risk ax, assistive devices, clonidine, anticonvulsants, promote safety
35
medications that can cause PN
platinums taxanes vinca alkaloids proteasome inhibitors
36
osteoporosis / int
brittle bones, decrease in Ca int: DEXA scan, CMP, increase Ca + Vit D, biphosphonate therapy
37
what medications are used to treat osteoporosis?
bisphophonates (-dronate) zoledronic acid denosumab calcitonin
38
how to take bisphosphonates
empty stomach with 8oz water
39
nociceptive pain
pain fibers in deep, cutaneous tissue
40
somatic pain
bone, joint, connective tissue usually localized
41
viseral pain
thoracic / abdominal tissue or surrounding organs poorly localized
42
neuropathic pain
damage to peripheral or central nerves
43
peripheral pain
numbness or tingling
44
centrally mediated pain
radiating and shooting sensation w/ burning and aching
45
sympathetically mediated pain
caused by autonomic dysregulation complex regional pain
46
beck's triad
46
cushing's triad
47
disseminated intravascular coagulation s/s
thrombi and hemorrhage d/t abnormal coagulation bleeding, bruising, blood clots
48
DIC int
int: stop the bleed, PLT transfusion, IV fluids, O2, safety
48
acute DIC
bleeding from 3 unrelated sites
49
chronic DIC
associated w/ minimal bleeding, solid metastatic adenocarcinoma
49
thrombotic thrombocytopenic purpura s/s
excessive blood clot formation - causing thrombocytopenia d/t overconsumption of PLT in clotting s/s fatigue, bruising, fever, neuro changes
50
TTP lab workup
CBC - drecreased RBC/PLT serum bili - increased coombs test - negative increased lactate ADAMTS13 - decreased hematuria / proteinuria
51
acquired TTP s/s + int
occurs in adults - body produces antibodies against ADAMST13 enzyme causes: gemzar, hormone therapy, lupus, HIV, BMT int: plasmapheresis (remove/replace antibodies that damage ADAMST13 enzyme )
52
inherited TTP s/s + int
occurs in newborns/children d/t abnormal enzyme production can manifest as renal failure int: FFP transfusion (replace missing enzymes)
52
SIADH s/s
53
SIADH int
54
stereotactic radiosurgery
3D imaging to determine coordinates of tumor to administer radiation
55
radioembolization
uses radiation to cut off blood flow to block and starve it
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OCN (9 decks)

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