Nursing care for procedures

Question 1

Patient prep endoscopies

Answer 1

-IV access and NPO status as ordered.
-Administer any pre-procedure laxatives/enemas and/or sedatives;
-remove dentures for oral scopes.
-Complete informed consent.

Question 2

Nursing care post-endoscopy

Answer 2

-Keep NPO until gag reflex and bowel sounds are present; monitor VS.

Question 3

Concerns with endoscopies

Answer 3

S/S of esophageal or bowel perforation (pain, bleeding, fever, distension)

Question 4

Types of endoscopies

Answer 4

colonoscopy, sigmoidoscopy, oesophagogastroduodenoscopy (OGD), bronchoscopy, endoscopic ultrasonography (EUS), gastroscopy, EUS-guided needle aspiration or injection, retrograde cholangiopancreatography, wireless capsule endoscopy, and more.

Question 5

patient prep during bone marrow aspiration/biopsy

Answer 5

Discontinue heparin; ensure platelets > 20,000.

Question 6

Nursing duties after bone marrow aspiration/biopsy

Answer 6

-Pressure dsg with direct pressure x 5–10 min; then leave dsg on for 24 hours.
-watch for bleeding, hematoma, infection

Question 7

Patient prep for bone marrow transplant

Answer 7

1. human leukocyte antigen (HLA) typing and matching with donor;
2. Karnofsky performance status > 70% preferred.
3. Obtain ECG and ECHO (EF > 40% preferred),
4. CXR and pulm function testing.

Question 8

Nursing duties during bone marrow transplant

Answer 8

Premedicate with acetaminophen, diphenhydramine, and hydrocortisone 30 min prior; have O2 at beside; monitor as needed; administer marrow IV without a filter via central line.

Question 9

Nursing duties after bone marrow transplant

Answer 9

-Only infuse irradiated blood products to prevent Graft-vs-Host Disease (GVHD)
-Protective isolation when neutrophils < 500; antimicrobial prophylaxis

Question 10

concerns for after bone marrow transplant

Answer 10

-bleeding, hematoma
-infection (especially with indwelling catheters)
-GVHD
hepatic sinusoidal obstruction syndrome

Question 11

types of bone marrow transplants

Answer 11

-autologus (self)
-syngeneic (identical twin)
-allogenic (from other donor)

Question 12

3 phases of bone marrow transplant

Answer 12

1. Conditioning/preparative
2. Transplantation
3. Supportive care

Question 13

what happens in conditioning/preparative phase of BMT

Answer 13

-look for anywhere any infection could be in body before immune ablation
-take prophylactic antifungals for pts who develop GVHD requiring lots of steroids

Question 14

how far should visitors stay from someone with implanted radiation?

Answer 14

> 6 feet

Question 15

what to monitor for with radiation

Answer 15

-burning
-n/v/d
-fevers/chills
-skin

Question 16

how to take care of skin for radiation

Answer 16

-daily skin care with mild soap and water, pat skin dry
-avoid sun, deodorants, perfumes, hot/cold
-encourage hydration

Question 17

complications of radiation

Answer 17

1. Organ inflammation: lung rales, mucositis, carditis (ECG), renal failure
2. Stomach - cramps, diarrhea
3. Infection
4. Impaired skin integrity/necrosis of tissues near implanted radiation

Question 18

what are the two types of radiation?

Answer 18

1. Ionizing - damages genetic material inside cells with photons
2. Particle beams - protons/other charged particles cause damage

Question 19

what position is best for intraperitoneal chemo?

Answer 19

-high fowlers prevents nausea

Question 20

Diet recommendation for chemo

Answer 20

-high call, high-protein, small frequent meals with lots of fluids
-good oral hygiene