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N465B: med surg B > week 4: oncology/ anemia > Flashcards

week 4: oncology/ anemia Flashcards

1
Q

anemia is a condittion which is represented by

A

decrease in HEALTHY red blood cells

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2
Q

where does RBC come from

A

bone marrow

any bone marrow disease = risk for anemia

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3
Q

each hemoglobin has __ heme molecules that carry __

A

4; oxygen molecule

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4
Q

what is Iron (Fe++) needed fro in RBC production

A

hemoglobin synthesis

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5
Q

causes and risk factors

A
  • alcohol misuse
  • medications (ie; anti seizure)
  • inadequate nutritional intake
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6
Q

normal RBC level

A

M: 4.6-6.0
F: 4.0-5.4

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7
Q

normal Hgb level

A

M: 14-18
F: 12-15

Hgb: Hct ration is 1:3

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8
Q

normal hematocrit level

A

M: 42-54%
F: 35-49%

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9
Q

***

Packed Red Blood Cell Transfusion (PRBC)**: often given when hemoglobin is

A

less
than 8

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10
Q

One unit of PRBCs in an adult and 10 will
increase the hemoglobin by

A

1 g/dL in a
normovolemic patient

if not, there’s still bleeding somewhere

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11
Q

most common anemia

A

iron deficiency anemia

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12
Q

causes of iron deficiency anemia

A
  • blood loss (ie Gi or menstral)
  • poor nutrition
  • malabsorption, gastric surgery
  • pregnancy
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13
Q

iron deficiency anemia symptoms

A
  • generalized anemic symptoms
  • brittle/ spoon nails
  • pica; the craving of unusual substance
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14
Q

***

what are important pt teaching for iron supplement**

A
  • 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)

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15
Q

side effects of iron

A

constipation, GI irritation, dark stools, teeth
discoloration

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16
Q

***

what are preventions of iron deficiency

A

Prevention: Increase dietary intake of iron-rich foods, e.g., raisins, red
meats, green leafy veggies, iron fortified bread and cereals***

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17
Q

***

etiology of V B12 deficiency

A

Intrinsic Factor (IF)
deficiency an
autoimmune disease
(pernicious anemia) is
major cause***

treat with B12 supplement

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18
Q

***

what should you include in pt education for dietary iron

A

**Try to combine non-heme iron foods with vitamin C -> INCREASE iron absorption

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19
Q

why is folic acid important

A

folacte is necessary in cell division, DNA synthesis, and RBC production

deficiency caused by inadequate intake/ malabsorption

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20
Q

***

ANEMIA OF CHRONIC
DISEASE ETIOLOGY***

A

Inflammation/infection
 Malignancy**
 End-stage renal disease
 Chronic kidney disease
 Autoimmune diseases

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21
Q

Most common cause of anemia in elderly/hospitalized patient

A

chronic disease

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22
Q

***

treatment of anemia of chronic disease

A

Tx: ERYTHROPOIETIN INJECTIONS*
 Epogen (Epoetin alfa)*

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23
Q

what is key notes of sickle cell disease

A
  • Characterized by intermittent periods of “sickling crisis”
  • Always anemic; susceptible to chronic infections & multi-organ damage
24
Q

main complication of sickle cell disease

A

SIGNIFICANT PAIN!!

other complications:
* acute anemia
* infection
* osteonecrosis
* osteomyelitis
* leg ulcers
* priapism
*etcetc

25
Q

***

what is sickling crisis

A

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)

26
Q

***

sickle cell crisis nursing intervention

A
  • Pain management!!!!!
  • Oxygen therapy***
  • IV Fluid administration**
  • Stress management
  • Treat underlying cause
  • balance between rest and activity
27
Q

***

what are goals for anemia/ anemia patients

A
  • assess the reason for theh anemia and treat the cause **
  • decrease fatigue
  • maintain of adequate nutrition
  • maintenance of afewuate tissue perfusion
28
Q

something to remember for sickle cell anemic patients who are also diabetic

A

cannot use HbA1c because the Hgb is not normal shaped

29
Q

key characteristics of cancer cells

A
  • change in appearance
  • large or multiple nuclei
  • unable to perform normal cell functions
  • disorganized growth pattern
  • increased vascularity
  • invasion and metastasis
30
Q

***

best way to diagnose cancer

A

biopsy

only means of defenitive diagnosis

31
Q

***

what are some constitutional symptoms of cancer**

A

– Fevers / night sweats
– Unexplained weight loss
– Fatigue

32
Q

what are the clinical staging of cancer

A

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

33
Q

why is staging of cancer important

A
  • determine ectent of cancer
  • guides the course of treatment
  • creates a standard for treatment and communication related to cancer
34
Q

what is the TNM system

A

t: tumor size
n: lymph node status
m: metastasis

35
Q

goals of care for cancer pt

A
  1. cure
  2. control
  3. palliative

depends on staging and pt’s wishes and psychological status

36
Q

***

what is most important with radiation***

A

personal protection

37
Q

what is brachytherapy

A

internal radiation

38
Q

what is ALARA

A

as low as reasonably achievable

  • to reduce exposure to all people involved
39
Q

***

how to prevent radiation dermatitis

A

**Keep irradiated area clean and dry before treatment

40
Q

***

how are chemotherapy given

A

in cycles

scheduled to allow recovery time between each treatment; ask pt abt step

41
Q

chemo remains in patient’s system and excretion for_

A

48 hours

42
Q

what are PPE for chemotherapy handling

A
  • double chemo tested gloves
43
Q

***

chemotherapy side effects (acute)

A

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

44
Q

***

3 non-acute side effect of chemotherapy

A
  • myelosuppression
  • nausea/ vomiting
  • pain
45
Q

***

what is myelosuppression

A

bone marrow suppression causing anemia, neutropenia, thrombocytopenia

46
Q

what is the difference between anemia, neutropenia, thrombocytopenia

A

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

47
Q

***

normal WBC and ANC

A

WBC: 3-11,00

ANC: above 1500

48
Q

***

why is ANC important

A
  • 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

49
Q

***

what are neutropenic precautions

A
  • 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)
50
Q

***

what is neutropenic fever

A
  • 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

51
Q

***

what is erythropoetin

A

rythropoetin: hormone secreted by kidneys
stimulates RBC growth

52
Q

***

what is thrombocytopenia

A
  • count can drop to less than 10,000
  • low platelet count that can cause life threatening bleeding
53
Q

***

what are reportable signs of bleeding for thrombocytopenia

A

Unexplained bruising
* Petechiae
* Bleeding gums or nose-epistaxis
* Blood in urine, stool
* Persistent or unusual vaginal bleeding
* Headache if sever enough for cerebral bleed

54
Q

***

thrombocytopenic precautions

A
  • 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
55
Q

what are two main nursing concern w/ pt going through chemo

A
  • pain management
  • nausea/ vomiting
  • need to pre medicate 30-60min. befoer chemo
56
Q

***

what electrolyte level should be especially monitored?

A

potassium
- diarrhea
- offer potassium rich food

57
Q

***

what is hematopoetic stem cell transplant

A
  • 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 ***

N465B: med surg B (3 decks)

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