week 4: oncology/ anemia Flashcards
anemia is a condittion which is represented by
decrease in HEALTHY red blood cells
where does RBC come from
bone marrow
any bone marrow disease = risk for anemia
each hemoglobin has __ heme molecules that carry __
4; oxygen molecule
what is Iron (Fe++) needed fro in RBC production
hemoglobin synthesis
causes and risk factors
- alcohol misuse
- medications (ie; anti seizure)
- inadequate nutritional intake
normal RBC level
M: 4.6-6.0
F: 4.0-5.4
normal Hgb level
M: 14-18
F: 12-15
Hgb: Hct ration is 1:3
normal hematocrit level
M: 42-54%
F: 35-49%
***
Packed Red Blood Cell Transfusion (PRBC)**: often given when hemoglobin is
less
than 8
One unit of PRBCs in an adult and 10 will
increase the hemoglobin by
1 g/dL in a
normovolemic patient
if not, there’s still bleeding somewhere
most common anemia
iron deficiency anemia
causes of iron deficiency anemia
- blood loss (ie Gi or menstral)
- poor nutrition
- malabsorption, gastric surgery
- pregnancy
iron deficiency anemia symptoms
- generalized anemic symptoms
- brittle/ spoon nails
- pica; the craving of unusual substance
***
what are important pt teaching for iron supplement**
- most common: PO ferrous sulfate
- iron rich food with citrus juices
- best when taken 1-2 hours after meals
- milk and tea decrease iron absorption
- antacids decrease absoption
iron dextran (IV, IM)
side effects of iron
constipation, GI irritation, dark stools, teeth
discoloration
***
what are preventions of iron deficiency
Prevention: Increase dietary intake of iron-rich foods, e.g., raisins, red
meats, green leafy veggies, iron fortified bread and cereals***
***
etiology of V B12 deficiency
Intrinsic Factor (IF)
deficiency an
autoimmune disease
(pernicious anemia) is
major cause***
treat with B12 supplement
***
what should you include in pt education for dietary iron
**Try to combine non-heme iron foods with vitamin C -> INCREASE iron absorption
why is folic acid important
folacte is necessary in cell division, DNA synthesis, and RBC production
deficiency caused by inadequate intake/ malabsorption
***
ANEMIA OF CHRONIC
DISEASE ETIOLOGY***
Inflammation/infection
Malignancy**
End-stage renal disease
Chronic kidney disease
Autoimmune diseases
Most common cause of anemia in elderly/hospitalized patient
chronic disease
***
treatment of anemia of chronic disease
Tx: ERYTHROPOIETIN INJECTIONS*
Epogen (Epoetin alfa)*
what is key notes of sickle cell disease
- Characterized by intermittent periods of “sickling crisis”
- Always anemic; susceptible to chronic infections & multi-organ damage
main complication of sickle cell disease
SIGNIFICANT PAIN!!
other complications:
* acute anemia
* infection
* osteonecrosis
* osteomyelitis
* leg ulcers
* priapism
*etcetc
***
what is sickling crisis
Precipitated by infections, dehydration, decreased O2,pregnancy, emotional stress, and surgery.*
Life-threatening; high leukocyte count, low hematocrit
ominous sign
Common clinical presentation is pain (back, chest, bones,
spleen, and abdomen)
***
sickle cell crisis nursing intervention
- Pain management!!!!!
- Oxygen therapy***
- IV Fluid administration**
- Stress management
- Treat underlying cause
- balance between rest and activity
***
what are goals for anemia/ anemia patients
- assess the reason for theh anemia and treat the cause **
- decrease fatigue
- maintain of adequate nutrition
- maintenance of afewuate tissue perfusion
something to remember for sickle cell anemic patients who are also diabetic
cannot use HbA1c because the Hgb is not normal shaped
key characteristics of cancer cells
- change in appearance
- large or multiple nuclei
- unable to perform normal cell functions
- disorganized growth pattern
- increased vascularity
- invasion and metastasis
***
best way to diagnose cancer
biopsy
only means of defenitive diagnosis
***
what are some constitutional symptoms of cancer**
– Fevers / night sweats
– Unexplained weight loss
– Fatigue
what are the clinical staging of cancer
Stage 0: cancer in situ
Stage I: limited to tissue of origin,
Stage II: limited local spread
Stage III: extensive local regional spread
Stage IV: metastasis
why is staging of cancer important
- determine ectent of cancer
- guides the course of treatment
- creates a standard for treatment and communication related to cancer
what is the TNM system
t: tumor size
n: lymph node status
m: metastasis
goals of care for cancer pt
- cure
- control
- palliative
depends on staging and pt’s wishes and psychological status
***
what is most important with radiation***
personal protection
what is brachytherapy
internal radiation
what is ALARA
as low as reasonably achievable
- to reduce exposure to all people involved
***
how to prevent radiation dermatitis
**Keep irradiated area clean and dry before treatment
***
how are chemotherapy given
in cycles
scheduled to allow recovery time between each treatment; ask pt abt step
chemo remains in patient’s system and excretion for_
48 hours
what are PPE for chemotherapy handling
- double chemo tested gloves
***
chemotherapy side effects (acute)
Occur due to effect of chemo on healthy cells and from the build up of waste products from cellular destruction
Acute Toxicities: during or immediately after chemo
* Infusion or Hypersensitivity reaction: flushing, SOB,
hypotension, tachycardia, pain, n/v, anaphylaxis
nursing intervention: stop drugs
***
3 non-acute side effect of chemotherapy
- myelosuppression
- nausea/ vomiting
- pain
***
what is myelosuppression
bone marrow suppression causing anemia, neutropenia, thrombocytopenia
what is the difference between anemia, neutropenia, thrombocytopenia
anemia
- not enough RBC
- risk for fatigue; not enough oxygenated blood-> SOB
neutropenia
- not enough neutrophil
- risk for infection
thrombocytopenia
- not enough platelet
- bleeding tendencies; can’t coagulte
having all three is called pancytopenia -» pt hospitalized
***
normal WBC and ANC
WBC: 3-11,00
ANC: above 1500
***
why is ANC important
- reflect hte patient’s immunologic status in response to chemocount
- lower the ANC count, the higher the risk for deathly infection
- must be above 500 to safely give chemo
- ANC measure neutrophil -> main infection fighter
must know ANC level for cancer pt
***
what are neutropenic precautions
- HANDWASHING
- isolation precaution; positive pressure room
- avoid cuts and invasive procedure that increase risk of infection
- avoid crows, sick people, pets, fresh flowers, recently immunized children
- low microb diet (ie no raw food)
***
what is neutropenic fever
- NEED EMERGENT TREATMENT
- low grade fever may be the only sign of infection in neutropenic patient
- temp: greater thhan 100.4F for over an hour or one time 101F
- need antibiotics within one hour (because its soooo life threatening)
- blood culture before GIVEN before anibiotics
dont give ibu or ace bc it’ll mask the fever
***
what is erythropoetin
rythropoetin: hormone secreted by kidneys
stimulates RBC growth
***
what is thrombocytopenia
- count can drop to less than 10,000
- low platelet count that can cause life threatening bleeding
***
what are reportable signs of bleeding for thrombocytopenia
Unexplained bruising
* Petechiae
* Bleeding gums or nose-epistaxis
* Blood in urine, stool
* Persistent or unusual vaginal bleeding
* Headache if sever enough for cerebral bleed
***
thrombocytopenic precautions
- No strenuous exercise, lifting, straining, nose blowing, possibly no sexual activity
- No over the counter medications or herbal remedies without checking with MD first
- Electric razors only
- No alcohol
- No flossing
what are two main nursing concern w/ pt going through chemo
- pain management
- nausea/ vomiting
- need to pre medicate 30-60min. befoer chemo
***
what electrolyte level should be especially monitored?
potassium
- diarrhea
- offer potassium rich food
***
what is hematopoetic stem cell transplant
- Bone Marrow Transplant (BMT) and Peripheral Stem Cell Transplant (PSCT)
- replacing malfunctioning bone marrow with health bone marrow
- need to be hospitalized for several week ***
