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Exam 4 Flashcards

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1
Q

what is hypercalcemia?

A

it is found in cancers that metastasize to bone (ex. lung, breast, renal), but can be r/t paraneoplastic hormone production in lung and pancreatic cancers

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2
Q

a patient presents with delirium, somnolence, muscle weakness, polyuria, bradycardia, nausea, and constipation. What oncological emergency is this?

A

Hypercalcemia

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3
Q

What should the nurse implicate for hypercalcemia?

A
  • monitor Ca, P, and renal fx
  • assess s/s of hypercalcemia
  • provide hydration and ordered meds
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4
Q

what are expected medications for cancer related hypercalcemia?

A
  • Bisphosphonates
  • Denosumab
  • Calcitonin?
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5
Q

What is spinal cord compression as an oncological emergency?

A

commonly found when there are tumors near the spinal cord

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6
Q

A patient presents with pain, numbness, tingling, and motor weakness. What oncological emergency is happening?

A

Spinal cord compression

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7
Q

What is a late sign of spinal cord compression?

A

autonomic dysfuction

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8
Q

Nursing implications for spinal cord compression

A
  • assess typical s/s of compression (pain/weakness, inability to distinguish hot and cold)
  • assess for constipation or incontinence
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9
Q

what are some treatment options for spinal cord compression?

A
  • corticosteroids
  • radiation therapy
  • surgery
  • drug therapy (bisphosphonates are given to prevent bone breakdown)
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10
Q

What is superior vena cava syndrome?

A

A tumor r tumor-involved lymph node compression of soft-walled SVC causes reduced return of blood flow to heart and venous congestion

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11
Q

A patient presents with dyspnea, venous congestion/edema of the upper body, visual disturbances, HA, altered mental status r/t cerebral edema, JVD, and prominent brachial and chest veins. What oncological emergency is this?

A

Superior vena cava syndrome

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12
Q

Nursing implications for SVC syndrome?

A
  • assess s/s

* assess poor perfusion and decreased CO

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13
Q

what are signs that a patient have low CO?

A

confusion, cyanotic, hypotension and tachycardia

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14
Q

What is SIADH?

A

This is commonly found in patients who have primary or metastatic brain or lung cancer

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15
Q

A patient presents with s/s of hyponatremia (mental status changes or seizures), HTN, effusions, diluted electrolytes r/t edema and a low hematocrit. What oncologic emergency is this patient experiencing?

A

SIADH

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16
Q

What is expected treatment for SVC syndrome?

A
  • treatment of the cancer that causes it w/ chemo or radiation
  • drug therapy: corticosteroids or diuretics to get rid of the excess fluids
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17
Q

Nursing implications for SIADH?

A
  • assess s/s of FVO (HTN, hyponatremia, confusion, seizures, and coma)
  • restrict fluids and administer meds
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18
Q

What is tumor lysis syndrome?

A

common is patients with rapidly proliferative tumors such as leukemia and lymphoma or therapy-sensitive tumors that respond quickly to treatment

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19
Q

A patient presents with electrolyte imbalances and renal dysfunction, hypocalcemia, hyperkalemia, acidosis causing heart block, tachycardia, and hyperphosphatemia. What oncological emergency is this patient experiencing?

A

tumor lysis syndrome

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20
Q

Nursing implications of tumor lysis syndrome?

A
  • assess s/s of hypocalcemia, renal dysfunction

* assess EKG changes and hypotension

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21
Q

What are peaked T-waves indicative of?

A

hyperkalemia

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22
Q

what are some s/s of hypocalcemia?

A

paresthesia, numbness of fingertips and perioral neuromuscular irritability and possible laryngeal contraction

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23
Q

What does PUKEC stand for and what oncological emergency is it representative of?

A 
Tumor Lysis Syndrome
P- phosphorus
U- uric acid
K- K+
E- elevated
C- calcium decreased
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24
Q

What are causes of Iron-Deficiency Anemia?

A

poor intake, blood loss, absorption

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25
What would cause absorption issues?
crohns, celiac, or meds that alter stomach acid
26
clinical manifestations of IDA? | *hint: remember LOW IRON
``` L= lethargic O= overexerted easily (SOB) W= weird food cravings (aka pica) I= inflammation of tongue R= reduced hemoglobin O= observe changes in RBC's N= nails (koilonychias), neuro ```
27
Patient teaching for IDA? Common SE of iron supplement? | *hint: EAT LOTS OF IRON
* take iron with citrus juice * use Z-track for IM iron * use straw with oral iron * SE= stomach cramps, green/black stool, constipation/diarrhea E= egg yolks A= apricots T= tofu L=legumes, leafy greens, broccoli O= oysters T= tuna S= sardines, seeds O= pOtatoes F= fish I= iron fortified cereals R= red meat O= pOultry N= nuts
28
Causes of pernicious anemia (aka vitamin B-12 anemia)?
poor intake | * pernicious is a failure to absorb B-12, d/t lack of intrinsic factor
29
Who typically has issue with B-12 intake?
vegetarians b/c b-12 only comes from animal meat
30
Clinical manifestations of b-12 anemia?
SOB, tachypnea, tachycardia, fatigue, neuro and psychiatric dysfunction
31
diagnostic tests for IDA?
ferratin, TIBC, CBC, MCV
32
diagnostic tests for b-12 anemia?
CBC, B12 serum assay level, methylmalonic acid (MMA), shillings test (only for pernicious)
33
patient teaching for B12 anemia? What food can you find it in?
animal meat, seafood, egg, dairy?
34
causes of folic acid anemia?
poor nutrition, chronic alcohol abuse, malabsorption syndromes, and meds that slow/prevent absorption
35
Clinical manifestations for folic acid anemia?
same as B12, but w/out the neurologic sx's, increased bleeding risk, mood changes, neural tube defects
36
diagnostic tests for folic acid anemia?
RBC folate level
37
what is the increased bleeding risk related to?
bone marrow damage
38
What is the cause of aplastic anemia?
damage to the bone marrow= myelosuppression= pancytopenia
39
what are some reasons for damage to the bone marrow?
chemo, radiation, exposure to chemical, infection
40
This is the most common type of genetic hemolytic anemia
Glucose-6-Phosphate dehydrogenase
41
what population does glucose-6-phosphate dehydrogenase effect the most?
African American Males
42
what is the lifespan of normal and sickle RBCs?
``` Normal= 120 days sickle= 1520 days ```
43
This anemia causes thick, viscous blood and decreases circulation. What type of anemia is this and what is the cause of it?
polycythemia vera; excess RBCs
44
What is hemophilia and what are some possible treatments?
hemophilia is a genetic condition where the body most commonly lacks the coagulation factor VIII. This causes the person to bleed severely even with the slightest injury. Treatment often includes clotting factor injections or plasma.
45
Risk factors for cancer?
* carcinogen exposure * age * genetics * hormones * lifestyle * infectious disease * medications * nutrition
46
Primary, secondary, and tertiary prevention of cancer
Primary: rx fx modification > immunization > chemoprevention Secondary: screening and clinician assessment Tertiary: tx and SE management of cancer or its treatment
47
What are things that may lead to to think cancer? | *hint= think CAUTION
``` C= change in bowel/bladder habits A= a sore that doesn't heal U= unusual bleeding/discharge T= thickening/lump in breast or body I= indigestion or difficulty swallowing O= obvious change in wart or mole N= nagging cough or hoarseness ```
48
Cancer treatment goals
1. cure 2. prevent remission 3. provide palliative care
49
post-surgical treatment to consider for cancer
* pain management * psychosocial support * infection prevention * No BP or needle sticks on affected limb after mastectomy
50
types of radiation treatments
* External= teletherapy * internal=brachytherapy-seeds * systemic-injection of radioactive solution
51
Complications of radiation
* inflammation * mucositis & xerostomia= ORAL CARE!!! * fatigue * thrombocytopenia= BLEEDING RISK!!! * fibrosis * immediate hazard to others d/t radioactive iodine
52
safety measure to consider with radiation therapy
* private room * sign on the door * wear dosimeter * visitors 30 min/day and 6ft apart * lead apron & container * follow policy
53
goals of chemotherapy
cure/increase life time
54
What does chemotherapy do and what unpleasant effects does it cause?
* chemo interferes with cell division in rapidly dividing cells > therfore.... it damages skin, hair, intestinal tissues, and blood-forming cells
55
What should you assess in a patient undergoing chemo?
cognition
56
considerations for chemo administration
* done with an RN w. education * chemo is a systemic treatment * wear eye, mask, gloves (double or chemo), and gown
57
Chemo complications
* extravasation- vesicants
58
interventions for extravasation?
* close monitoring * cool/warm compress * antidote * consultation
59
Adverse effects of chemo?
* n/v/d * peripheral neuropathy * alopecia/hemorrhagic cystitis * cardio/hepato/toxicity * hypersensitivity * capillary permeability syndrome * infertility clotting abnormalities
60
neutropenic precautions
* inspection, lung souds, oral assess, close IV inspection * low bacteria diet * no fresh flowers or plants * avoid raspberries and blackberries
61
how often do you take VS on a patient with neutropenic precautions?
4-8 hrs
62
Interventions for mucositis
* swishing lidocaine * saline rinse * soft tooth brush * gentle flossing * gentle/bland diet * NO ALCOHOL BASED RINSES!
63
normal RBC level
Male: 4.7-6.1 Female: 4.2-5.4
64
normal hemoglobin
Male: 14-18 Female: 12-16
65
normal hematocrit
Male: 42-52% Female: 37-47%
66
Normal WBC
5000-10000
67
Normal platelet
150000-400000
68
MCV: what does it tell us when it is high and low and what is the normal value?
``` low= small RBC size high= large RBC size normal= 80-95 mm3 ```
69
MCH: what does it tell us when it is high and low and what is the normal value?
``` low= lighter color high= darker color normal= 27-31 pg/cell ```
70
What are quality care nursing implications for sickle cell disease?
* administer O2 * pain meds * aggressive IV/PO hydration * blood transfusions * antipyretics * provide emotional support
71
what to teach about sickle cell disease?
* avoid cold temperatures, tight clothes, high-altitudes, dehydration, overexertion * infection prevention * keep ADLs risk for crises w/ pregnancy * Fetal complications * genetic counseling * dental care
72
Steps to take prior to transfusion therapy
* verify order * obtain signed-consent * type/cross match * hx of reactions * 18-20 G IV * get blood from pharmacy * 2 RNs verify * prime tubing and inspect blood * only run with NS!!!
73
Geriatric considerations for transfusion therapy
* no larger than 19G * assess renal fx * newer blood products * assess q 15 min * administer over 2-4 hrs
74
What different transfusion types are there and what are they for?
* PRBC= iron deficiency or anemia * plasma= liver failure, severe infections, and serious burns, clotting factor deficiencies * cryoprecipitate (controls bleeding in people who don't clot properly) * granulocyte= these are WBC that are able to phagocytize foreign substances; for neutropenic patients

Advanced Med/Surg (2 decks)

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