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Med Surg > Test one: cancer and hematologic disorders > Flashcards

Test one: cancer and hematologic disorders Flashcards

1
Q

Patient with port

A

-flush before and after
-secure IV dressing –> risk of infection

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2
Q

PICC verification- before you can touch it!

A

documentation and verification with Xray

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3
Q

plan of care with nursing diagnosis -priority after 3rd day

A

it’s the same priority as before, top tier ABC I/I

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4
Q

external radiation precautions

A

keep skin dry and intact, certain products, keep skin tattoos

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5
Q

psychosocial pt with cancer

A

-hairloss
-grieiving
-stress and coping
-delayed treatment effects
-emotional support
-listening
-distraction
-frequent rests

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6
Q

priority nursing diagnosis for pt with diarrhea

A

decreased CO

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7
Q

primary vs secondary prevention

A

lifestyle changes vs screening

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8
Q

blood transfusion priority action

A

check blood compatibility

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9
Q

5FU and folate together

A

5FU is a folate antagonist so you need folate

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10
Q

monoclonal antibodies

A

immunotherapy: produce target antibodies for malignant cells
-need tumors markers
-only attack cancer cells

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11
Q

Hodgkin diagnosis

A

reed sternburg cells, lymph node biopsy

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12
Q

cancer pt complains of lower back pain -why and diagnostic study

A

-pathologic fracture of vertebra
-Xray or CT scan

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13
Q

B12 deficiency diagnositcs

A

-B12 assay
-intrinsic factor antibody test
-methylmalonic acid and homocysteine elevation

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14
Q

nursing care for pt receiving implanted seeds (female)

A

ALARA
30 mins
shield
6ft distance

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15
Q

priority nursing action when administering chemo

A

check WBC!

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16
Q

priority for 4hr post op

A

-maintain ventilation –> prevent hypoxemia and hypercapnia (too much CO2)
-CV stability: LOC, VS, cardiac rhythm, skin temp color and moisture
- urine output
-CV complications: hypotension and shock, hemorrhage, hypertension and arrhythmia
-IV patency

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17
Q

bowel after post op

A

-constipation can occur
-want to encourage early ambulation, improved dietary intake and stool softener (prescribed)
-assess for distention and bowel sounds

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18
Q

Pain prevention post op

A

-opioid analgesic meds –> IV
-non opioids too
-nonpharmacologic, emotional and psych support
-acupuncture, heat or cold packs, relax, breathing teaching, guided imagery, soothing music
-CHECK SEDATION

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19
Q

Immediate post op interventions

A

-assess breathing and O2
-VS, skin temp moisture and color
-assess surgical site and wound drainage syst
-LOC, ability to move
-pain level (location and quality), analgesic meds
-enhance lung expansion (positioning)
-IV site patency and correct rate and solution
-Urine output
-deep breathing, leg exercises
-info to pt and family

20
Q

Hodgkin long term complications and discharge

A

-secondary cancer
-fatigues, anxiety, pulmonary and cardio toxicity, cardiovascular disease
-fertility problems
-reg follow ups, screening for S&S for secondary malignancy

21
Q

Concern about non Hodgkin

A

Tumor lysis syndrome

22
Q

Assessments (in plan of care) for patient with cancer

A

-WBC
-temp
-radiation: intact skin
-nutr status, fatigue
-fluid and electrolyte status, GI
-loss of deep tendon reflex, balance, coordination
-Cog

23
Q

Handoff report-prioritize

24
Q

Pt receiving chemo, essential assessment

A

-WBC-check before to make sure it’s done
-serious conditions: cardiac, kidney, immune
-sepsis-temp
-renal function, CV
-extravasating: necrosis
-fatigue levels (aerobic exercise recommended)

25
Nursing care for patient receiving packed cells
-VS before blood -VS within 30mins -first 15 min: 5mL/min; most critical, VS/5min -stay with them for 15mins because of possible reactions -ABO compatibility! -no longer than 4hr -change tubing every 2 units -at least 6hr for transfusion associated circulatory overload
26
Main cause for multiple myeloma death
Infection-have pancytopenia and can't fight off
27
Chemo via pump-assessment and action alert to (during and before)
-(hypersensitivities) allergic reaction --concerned about anaphylaxis (happens with 2nd one, 1st develop antibodies) — S&S: rash, urticaria (hives), fever, hypotension. Cardiac instability, dyspnea, wheezing, throat tightness, syncope -extravasation—mild discomfort, vesicants, severe tissue dysfunction -lab values (electrolytes) and dosage -make sure CBC drawn before -make sure IV access is viable, flush
28
Nursing care with adriamycin (doxorubicin)
-report SOB, palpitations and chest pain -cardiac and liver toxicity -vesicant that can cause extravasation because via central line
29
Essential assessment to BM transplant
-judicious use of BL products due to risk for alloimmunization -AlloHSCT- hepatic sinuosoidal obstructive syndrome- at risk for -nutrition, physical, organ function and psychological assessments conducted -BL work to see past infectious antigen exposure -social support, financial and insurance
30
Immune/idiopathic thrombocytopenia purpura
-lack platelets, cant clot -easy bruising, heavy menses, petechiae -immune acquired -wet purpura- life threatening bleeding -treatment depends on severity of bleeding
31
S&S of DIC
-impaired fibrinolysis -platelet count -fibrin degradation project -PT -fibrinogen level -temp decr, pain incr, cyanosis extremities, pulse decr, hypoxia -treat underlying cause -prevent sepsis — aseptic technique -bleeding, blood clots, hypotension, SOB, confusion
32
Neutropenic precautions and outcomes
-increased risk of infection (rises as ANC goes up) -delays of drugs -chest X-ray for pulm infection -defenses compromised: skin integrity, adverse effects from treatment, immobility and impaired nutrition
33
Folic acid deficiencies manifestations
-typical: weakness, listlessness, fatigue -smooth sore red tongue -mild diarrhea, jaundice -paresthesia in extremities -balance issues, proprioception-lose position sense -w/o treatment heart failure
34
Primary interventions with bleeding disorders
-manage fatigue -activity and rest balance -adequate nutrition: essential nutrients such as B12, iron and folic acid; limit alcohol -promote effective management of prescribe therapy: S/E management -monitor and manage potential complications: heart failure (BV down, CO up)
35
Pancytopenia-S&S
-fatigue, pallor, dyspnea -purpura -lymphadenopathy and splenomegaly -life threatening -concern: bacterial or fungal infection, bleeding —> death
36
Thrombocytopenia precautions and nursing actions
-education: fall prevention -avoid all agents that interfere with patient function -concern: infection and bleeding -taking long term corticosteroids- risk for complications incr -no anal suppositories, soft bristle toothbrush
37
Febrile nonhemolytic reaction- what should the nurse do
Broad spectrum antibiotics; assessed for infection, prevention educaiton -non emergency, leukocyte reduction filter -anti febrile agents
38
Plan of care for leukemic pateint
-absence of complications and pain -adequate nutrition -activity tolerance -self care and coping -positive body image and understanding of disease and treatment
39
Risk factors for pernicious anemia
-inadequate intake of B12 -impaired absorption from GI tract -certain meds: met Forman, histamine blockers, antacids, proton pump inhibitors (all chronic use) -lack of intrinsic factor -genetic
40
Barriers to pain care for cancer pts
-controllable but pain is not irreversible or quickly resolved -cycle of pain-anxiety-fear-pain -influenced by physical, psychosocial, cultural and spiritual
41
Sources of fatigue in cancer patient
-anxiety: fear,, diagnosis, role changes, uncertainty -disturbed sleep- meds, anxiety and pain -electrolyte imbalance: V/D -risk for impaired nutrition intake: N/V, anorexia/cachexic -impaired physical mobility -impaired tissue integrity -stomatitis and mucositis -ineffective breathing- cough, dyspnea -ineffective protection secondary to cells decreasing -pain, pruruitis
42
Clinical manifestations of low hemoglobin
-fatigue -anemia, pallor -vascular collapse -delirium -dyspnea -tachycardia -CO incr: palpitations, dizzy, orthopnea -peripheral edema -activity intolerance -N/V/D -IMPAIRED coordination, ataxia, peripheral numbness and paresthesia
43
Cancer: S&S of complications
-dev of infection —> monitor labs -look at pharynx, skin, perianal area, urinary, resp tracts; signs of infection -neutrophil decr -bleeding and thrombocytopenia: bacterial and viral infections -VTE: coagulation meds, immobility, infection, peripheral and central venous catheters
44
nurse's role
intervene, assess, educate
45
pain and priority
is not a priority; make sure it's tolerable, it's not to erase the pain
46
patient trends look like
worse, same or better?

Med Surg (2 decks)

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