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

week 4: oncology/ anemia Flashcards

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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

Study These Flashcards
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

Study These Flashcards
A

SIGNIFICANT PAIN!!

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

25
# *** 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)
26
# *** sickle cell crisis nursing intervention
* Pain management!!!!! * Oxygen therapy*** * IV Fluid administration** * Stress management * Treat underlying cause * balance between rest and activity
27
# *** 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
28
something to remember for sickle cell anemic patients who are also diabetic
cannot use HbA1c because the Hgb is not normal shaped
29
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
30
# *** best way to diagnose cancer
biopsy | only means of defenitive diagnosis
31
# *** what are some constitutional symptoms of cancer**
– Fevers / night sweats – Unexplained weight loss – Fatigue
32
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
33
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
34
what is the TNM system
t: tumor size n: lymph node status m: metastasis
35
goals of care for cancer pt
1. cure 2. control 3. palliative | depends on staging and pt's wishes and psychological status
36
# *** what is most important with radiation***
personal protection
37
what is brachytherapy
internal radiation
38
what is ALARA
as low as reasonably achievable - to reduce exposure to all people involved
39
# *** how to prevent radiation dermatitis
**Keep irradiated area clean and dry before treatment
40
# *** how are chemotherapy given
in cycles | scheduled to allow recovery time between each treatment; ask pt abt step
41
chemo remains in patient's system and excretion for_
48 hours
42
what are PPE for chemotherapy handling
* double chemo tested gloves
43
# *** 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
44
# *** 3 non-acute side effect of chemotherapy
* myelosuppression * nausea/ vomiting * pain
45
# *** what is myelosuppression
bone marrow suppression causing anemia, neutropenia, thrombocytopenia
46
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
47
# *** normal WBC and ANC
WBC: 3-11,00 ANC: above 1500
48
# *** 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
49
# *** 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)
50
# *** 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
51
# *** what is erythropoetin
rythropoetin: hormone secreted by kidneys stimulates RBC growth
52
# *** what is thrombocytopenia
* count can drop to less than 10,000 * low platelet count that can cause life threatening bleeding
53
# *** 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
54
# *** 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
55
what are two main nursing concern w/ pt going through chemo
* pain management * nausea/ vomiting - need to pre medicate 30-60min. befoer chemo
56
# *** what electrolyte level should be especially monitored?
potassium - diarrhea - offer potassium rich food
57
# *** 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 ***

N465B: med surg B (3 decks)

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