exam 6 NUR221
Patient education on prevention of sickle cell crisis. PG. 617 Which statement by a patient indicates good understanding of the nurse's teaching about prevention of sickle cell crisis?
"Risk for a crisis is decreased by having an annual influenza vaccination." Because infection is the most common cause of a sickle cell crisis -avoid high altitudes -maintain adequate fluid intake -treat infections promptly
AML patient teaching related to effectiveness of chemotherapy treatment. PG. 636 A 68-year-old woman with acute myelogenous leukemia (AML) asks the nurse whether the planned chemotherapy will be worth undergoing. Which response by the nurse is appropriate?
"The side effects of chemotherapy are difficult, but AML frequently goes into remission with chemotherapy."
Patient teaching related to Oncovin medication regimen? The nurse is teaching a patient who is receiving vincristine (Oncovin) about long-term management of the treatment regimen. Which information will the nurse provide in teaching the patient?
"You should report difficulty buttoning your clothes to your provider." Numbness of hands may resolve after chemotherapy is stopped, but it may never resolve
(priority question related to LPN assignment of care on an oncology floor) The nurse and licensed practical nurse (LPN) are caring for clients on an oncology unit. #1 Which client should be assigned to the LPN? #2 Which client should not be assigned to the LPN?
#1 The client diagnosed with an ovarian tumor weighing 22 pounds who is being prepared for surgery in the morning. #2 The client newly diagnosed with chronic lymphocytic leukemia.
Confirming diagnostic test for Hodgkins disease
A biopsy of the cervical lymph nodes With Reed Sternberg cell
SATA questions related to bone marrow aspiration patient teaching
A bone marrow aspiration involves obtaining bone marrow for cytological and chromosomal investigations. The bone marrow is usually aspirated from the posterior iliac crest. During a bone marrow aspiration, the skin over the puncture site is prepared by using a bactericidal agent. A local anesthetic agent is then infiltrated into the skin, subcutaneous tissue, and periosteum. Following this, a bone marrow needle is inserted into the bone through the cortex. The stylet of the needle is then removed and the hub is attached to 10-mLsyringe. The bone marrow is then aspirated. A volume of 0.2 to 0.5 mL is sufficient for laboratory investigations.
Lab test monitored during administration of Neupogen. PG. 634 Which laboratory test will the nurse use to determine whether filgrastim (Neupogen) is effective for a patient with acute lymphocytic leukemia who is receiving chemotherapy?
Absolute neutrophil count. Filgrastim increases the neutrophil count and function in neutropenic patients.
What can be delegated to a leukemia patient to the LPN? Which action for a patient with neutropenia is appropriate for the registered nurse (RN) to delegate to a licensed practical/vocational nurse (LPN/LVN)?
Administration of subcutaneous medications is included in LPN/LVN education and scope of practice.
Family teaching on resources for leukemia patients.
American Cancer Society Leukemia & Lymphoma Society spiritual support groups patient support groups - help adapt to living w/ life illness PT/OT
Parent teaching for a sickle cell patient. Parents need education about the hereditary factor of sickle cell disease. A 3-year-old African-American child is diagnosed with sickle cell anemia. The parents know that sickle cell anemia is hereditary but do not understand why their child has the disease, because neither of them has it. The nurse explains that:
Both parents were carriers of the sickle cell trait. must receive TWO hemoglobin S genes (one for each parent).
What is the purpose of administering two chemotherapeutic agents? A patient who has cancer is about to begin chemotherapy. The patient asks the nurse why two chemotherapeutic agents are being used instead of just one. Which response by the nurse is correct?
Combination therapy allows cell kill in all phases of the cell cycle.
Priority assessment area for Stage II Hodgkins lymphoma A nurse in an oncology clinic is assessing a client who has early stage Hodgkin's lymphoma. Which of the following findings should the nurse expect?
Enlarged, painless lymph nodes-in 2 separate lymph node regions, and both regions are on the same side of the diaphragm (either above or below the diaphragm). Other early manifestations include night sweats, unexplained weight loss, fever, and pruritus.
Sickle cell patient teaching during discharge PG. 617 Which instruction will the nurse plan to include in discharge teaching for the patient admitted with a sickle cell crisis?
Exposure to crowds increases the patient's risk for infection, the most common cause of sickle cell crisis. particularly prone to upper respiratory infection and infection can precipitate a sickle cell crisis.
Priority nursing interventions for a patient following bone marrow aspiration a bone marrow aspiration from the left posterior iliac crest. Which action would be important for the nurse to take after the procedure?
Have the patient lie on the left side for 1 hour. To decrease the risk for bleeding, the patient should lie on the left side for 30 to 60 minutes. After a bone marrow biopsy, the wound is small and will not be packed with gauze. A pressure dressing is used to cover the aspiration site. There is no indication to elevate the patient's head.
Purpose of Hydroxyurea for sickle cell patients.
Hydroxyurea (Hydrea) is a medication used to decrease the number of sickle cell crises. Produce a hemoglobin that resists sickling
SATA questions related to Causes of leukemia,
Ionizing radiation, viral infection, exposure to chemicals and drugs, disorders such as myelodysplastic syndrome or Fanconi's anemia, genetic factors, immunologic factors, environmental factors, and combination.
Patient assessment for patients receiving Rituxan?. PG. 642 A patient who has non-Hodgkin's lymphoma is receiving combination treatment with rituximab (Rituxan) and chemotherapy. Which patient assessment finding requires the most rapid action by the nurse?
Lip swelling in angioedema may indicate a hypersensitivity reaction to rituximab. The nurse should stop the infusion and further assess for anaphylaxis
Lymphoma diagnostic test that require consent?
Lymph node Biopsy
Teaching plans for a teenage sickle cell anemia patient to prevent crisis.
Maintain adequate hydration Prevent Infection - vaccines Avoid Hypoxia Avoid injury - Hemorrhage Avoid Strenuous exercise
Patient education for an AML patient considering treatment with HSCT. PG. 635 A 54-year-old woman with acute myelogenous leukemia (AML) is considering treatment with a hematopoietic stem cell transplant (HSCT). The best approach for the nurse to assist the patient with a treatment decision is to
Offering the patient an opportunity to ask questions or discuss concerns about HSCT will encourage the patient to voice concerns about this treatment and also will allow the nurse to assess whether the patient needs more information about the procedure. Treatment of AML using chemotherapy is another option for the patient.
Nursing interventions for sickle cell patients
Pain is priority A. monitoring CBC B. blood transfusion if required and iron chelation C. optimal pain management and oxygen therapy D. rest as needed and DVT prophylaxis
Sickle cell anemia patient with pain....what are the priority interventions by the nurse.
Pain: opioids around the clock (PRN not the best at this time until crisis over)
Patient assessment priority question for the nurse on an oncology floor After change-of-shift report on the oncology unit, which patient should the nurse assess first?
Patient who is neutropenic and has a temperature of 100.5° F (38.1° C) Any fever in a neutropenic patient indicates infection and can quickly lead to sepsis and septic shock
Nursing diagnosis applicable to a 20 yo male patient with Hodgkins lymphoma
Sexual dysfunction related to Altered body structure or function second to chemo drugs, surgery, disease process
Side effects of Bleomycin A patient is receiving bleomycin (Blenoxane) as part of a chemotherapeutic regimen to treat leukemia. During intravenous administration of this drug, what will the nurse observe the patient closely for?
Shortness of breath and wheezing. can cause anaphylaxis, so patients should be monitored for respiratory distress.
Pt teaching related to Hodgkins disease to a female patient inquiring about prognosis The female client recently diagnosed with Hodgkin's lymphoma asks the nurse about her prognosis. Which is the nurse's best response?
Survival for Hodgkin's disease is relatively good with standard therapy. Long-term survival exceeds 80% for all stages. presence of B-Symptoms = worse prognosis
Nursing interventions for an AML patient by the nurse monitoring the patient's neutrophil count? PG. 633 A 30-year-old man with acute myelogenous leukemia develops an absolute neutrophil count of 850/µL while receiving outpatient chemotherapy. Which action by the outpatient clinic nurse is most appropriate?
Teach the patient to administer filgrastim (Neupogen) injections. administration of filgrastim usually allows the chemotherapy to continue. Patients with neutropenia are at higher risk for infection when exposed to other patients in the hospital.
Priority patient assessment findings for a patient after a bone marrow biopsy. patient has had a bone marrow biopsy taken from the posterior iliac crest. What nursing care is the priority for this patient after this procedure?
The initial action should be to stop bleeding by applying pressure to the site. Inspecting for ecchymoses will be done after hemostasis has been achieved.
Priority teaching measures for a patient with NHL The patient is being treated for non-Hodgkin's lymphoma (NHL). What should the nurse first teach the patient about the treatment?
The patient should first be taught about the type of treatment and the expected and potential side effects. Nursing care is related to the area affected by the disease and treatment.
Pt. teaching for a patient with Stage I Hodgkins disease.
The patient with stage favorable prognosis early-stage Hodgkin's lymphoma will receive two to four cycles of ABVD.
Patient teaching for a successful treatment of Hodgkins Lymphoma patient. PG. 640 Following successful treatment of Hodgkin's lymphoma for a 55-year-old woman, which topic will the nurse include in patient teaching?
Use of maintenance chemotherapy to maintain remission The chemotherapy used in treating Hodgkin's lymphoma results in a high incidence of secondary malignancies; follow-up screening is needed
What are the precautions used by nurses when handling chemotherapy? What precautions will the nurse take while administering the IV chemotherapeutic agent?
Wear an impermeable, disposable gown when hanging the drug. When hanging an IV solution, it is possible to splash solution onto the skin, so the nurse should wear a disposable, impermeable gown
When is the highest risk for infection when receiving chemotherapy? A patient who is about to begin chemotherapy asks the nurse when the risk of infection is highest. The nurse will tell the patient that infection risk is greatest at which point?
a week to 10 days after each chemo treatment
Clinical manifestations of a lymphoma patient that are directly associated with Hodgkins disease.
asymptomatic unitl 1st lymph node found Reed-Sternberg cells. B-symptoms: fever, drenching night sweats, wgt loss
Priority question. (Evaluating four patients and the nurse determines which should be seen first?) Several patients call the outpatient clinic and ask to make an appointment as soon as possible. Which patient should the nurse schedule to be seen first?
23-year-old with no previous health problems who has a nontender lump in the axilla. The patient's age and presence of a nontender axillary lump suggest possible lymphoma, which needs rapid diagnosis and treatment
Pt. teaching to 20 yo man with Hodgkins lymphoma receiving chemotherapy
*Flush toilets twice each time they are used. should use a separate toilet from others. *Always wash hands with soap and water after using the toilet. *Caregivers must wear gloves when handling the patients' blood, urine, stool, or emesis. * Sun block * risks for infections/bleeding BEACOPP chemotherapy causes very low sperm counts and infertility, but ABVD treatment does not. • Drug-induced pancytopenia with increased risk for INFECTION, anemia, and bleeding • Severe nausea and vomiting • Skin problems at the site of radiation • Constipation or diarrhea
SATA questions related to expected symptoms in a NHL patient.
*Non-Hodgkin's lymphoma can originate outside the lymph nodes *the method of spread can be unpredictable, *and most affected patients have widely disseminated disease *asymptomatic until disease has progressed *Extranodal sites:Spleen, Liver, GI tract, Lung, Bone,CNS *Splenomegaly in 30-40% of patients
Lab tests evaluated for sickle cell patients
- low Hgb 7-9 baseline - high reticulocytes >10 % CBC to determine anemia Sickle-Dex -screening test Electrophoresis -uses electrical current to separate normal and abnormal types of hemoglobin in the blood. This is a definitive test based on % of HbS found (definitive dx)
Pt. Teaching related to sickle S shape cell for patients with sickle cell anemia.
-abnormal form of hemoglobin in the RBC - Hbg S -sickled RBCs are rigid, elongated, cresent shaped -sickled cells get stuck in small vessels leading to tissue injury
Side effects of Oncovin and nursing interventions required? The nurse observes that the patient has difficulty walking. What action will the nurse take?
Ask about numbness or tingling in the fingers and toes. Peripheral neuropathy can occur with this drug and is manifested by difficulty walking and numbness and tingling in the fingers and toes.
ALL patient teaching related to induction therapy.
Induction Therapy--4 to 6 wks. aggressive treatment that seeks to destroy leukemic cells in the tissues, peripheral blood, and bone marrow in order to eventually restore normal hematopoiesis on bone marrow recovery. A patient may become critically ill because the bone marrow is severely depressed by the chemo drugs.metabolic disturbances can occur because of tumor lysis syndrome due to Hyperuricemia monitor for neutropenia, thrombocytopenia, and anemia and well as providing psychosocial support to the patient and families
Patient interventions for non-Hodgkins lymphoma....you must understand the platelet count to answer the question. PG. 644 An appropriate nursing intervention for a patient with non-Hodgkin's lymphoma whose platelet count drops to 18,000/µL during chemotherapy is to?
check all stools for occult blood.Because the patient is at risk for spontaneous bleeding, the nurse should check stools for occult blood
AML patient teaching related to production of WBC's
develops from uncontrolled proliferation of myeloblast cells that would turn into white blood cells. can have low - high WBC with myeloblast. WBC do not mature. Pt may have serious infections and abnormal bleeding from the onset of the disease. Hyperplasia (enlargement) of bone marrow and spleen.
Assessment of lymph nodes for potential lymphoma patients The nurse examines the lymph nodes of a patient during a physical assessment. Which assessment finding would be of most concern to the nurse?
lightly palpate superficial lymph nodes with the pads of the fingers A 2-cm nontender supraclavicular node is a concern. Enlarged and nontender nodes are suggestive of malignancies such as lymphoma. Firm nodes are an expected finding in an area of infection. The superficial lymph nodes are usually not palpable in adults, but if they are palpable, they are normally 0.5 to 1 cm and nontender.
Purpose of biopsy for diagnostic criteria for lymphoma patients
lymph node biopsy establishes the cell type and pattern. HL has Reed Sternberg cells NHLs are broadly classified as B-cell or T-cell
Major difference between hodgkins and NHL
non-Hodgkin's lymphoma can manifest in multiple organs.
Patient teaching related to sickle cell trait to 20 yo female patient
she inherited Hgb S (AS) from one parent and normal Hgb A(A) from the other parent. illness ia mild or asymptomatic -Hb SA "carrier" -Life expectancy normal -Genetic counseling for patients with SCD and SCT is recommended -Prenatal testing is also available
Purpose of receiving multiple drugs as the treatment regimen for leukemia and lymphoma patients.
three purposes: -decreased drug resistance -decreased drug toxicity to the patient by using multiple drugs with varying toxicities -interrupt cell growth at multiple points in the cell cycle
Patient teaching to prevent fatigue in leukemia patients.
• Reassure the patient that fatigue is temporary and energy levels will improve over a period of weeks to months. Stress that a return to previous energy levels may take as long as a year. • Tell patient to stop activity if SOB or palpitations are present. • Space care activities at least an hour apart, and avoid the time right before or right after meals. • Schedule care activities after naps. • Perform complete bed bath only every other day. focus on face, hands, axillae, and perineum. • Provide four to six small, easy-to-eat meals • Urge the patient to drink small amounts of protein shakes or nutritional supplements. • if extreme fatigue, allow others to perform personal care. • Selectively limit visitors when resting or sleeping
AML patient discharge teaching information to prevent injury.
• Use an electric shaver. • Use a soft-bristled toothbrush, and do not floss. • Do not have dental work done without consulting your doctor. • Do not take aspirin or any aspirin-containing products. Read the label to be sure the products do not contain aspirin or salicylates. • Wear shoes or slippers with a sole to avoid foot injury. • Do not participate in contact sports or any activity likely to result in your being bumped, scratched, or scraped. • If you are bumped, apply ice to the site for at least 1 hour. • Notify your physician if you: ▪ Experience an injury and persistent bleeding results
