H.I EXAM 2

•Education to limit exposure to carcinogens.

excessive sun exposure, pesticides, industrial chemicals

which drug prevent/minimize NEUTROPENIA

granulocyte colony stimulating factors (Neupogen

Risk factors associated with acute DIC include : Children

infection (sepsis, virus) trauma (brain, massive burns), & malignancies (acute leukemia).

patient with chemotherapy should be placed at high risk of

infection, immunosuppression, complications

Invasive

infiltrating ductal or lobular

Low-dose steroid cream may help with

itching, irritation, inflammation.

WHEN TO Institute bleeding precautions

platelet count is < 50,000/mm3

Which recommendations would the nurse give to prevent cancer?

A. Eat a high diet with fruits and vegetables.(High in fiber) B. Maintain a healthy weight. C. Get regular physical exercise

infection precautions

Infection control, hygiene catheter care avoid invasive devices environment (avoid fresh foods & flowers, contact with litter box)

Care for patient with Neutropenia

Place a patient in a private room. • Place a Neutropenic Precautions sign outside patient's room. • Maintain strict & frequent adherence to hand hygiene for all staff and visitors. • Ensure proper cleaning and disinfecting of patient equipment before & after use. • Make sure patient has a Neutropenic diet order

WHAT IS THE NURSING PRIORITY IF THE PLATLEST BETWEEN 40,000-80,000 (prolonged bleeding)

Place pt on safety or bleeding precautions

external beam radiation therapy

Radiation treated area does not continue to hold the radiation after the session ends. No one should be in the room, during radiation therapy. Sedation is not routine, however may be used with a small child who may not hold still for the treatment.

Neoadjuvant chemo

(to shrink tumors before surgery or radiation

primary prevention

, vaccines (HPV), healthy lifestyle (smoking cessation, regular exercise, e

nursing care for skin

- Dry lubricate the dry skin "nonirritating lotion emollient" #aloe vera #avoid lotion that contain metal, alcohol, perfume or additive.

what is petechiae?

red or brown pinpoint lesions (<3mm) generally caused by capillary fragility; diseases associated with the formation of microemboli or bleeding, such as subacute bacterial endocarditis and thrombocytopenia, can cause petechiae caused by hemorrhage from skin capillaries(BLEEDING UNDER THE SKIN OR MUCOUS MEMBRANE)

Risk factors associated with acute DIC include :Adult:

sepsis, severe trauma (hemorrhage, burns), acute pancreatitis, obstetric complications (placental abruption, severe post partum hemorrhage

DIC bacterial infection could lead to:

sepsis/ septic shock

If the platelets lower than 20,000 it will result in:

spontaneous bleeding

VIT K

the body needs vitamin K to produce prothrombin, a protein and clotting factor. A deficiency of Vitamin K predisposes to bleeding

Carcinogens

(a substance, organism or agent capable of causing cancer)

Transfuse platelets when platelet count is

<10,000 OR when bleeding

how do we treat infection and fever

treat as emergency with immediate antibiotics

Which actions should the nurse recommend to facilitate comfort and healing After RT that has has dry desquamation of the skin.

A. Keep skin clean, wash with lukewarm #water and a mild soap -Avoid tight clothes, deodorant, powder, perfume, shaving/electric if you must shave, scrubbing, sun exposure Use unscented, lanolin-free moisturizer as directed •-Low-dose steroid cream may help with itching, irritation, inflammation. C. Avoid the use of heating pads Avoid exposing the area to sunlight

Which factors put a patient at risk for developing acute disseminated intravascular coagulation (DIC)? . Septicemia B. An extensive burn C. Abruptio placentae D. Severe head trauma E. Stroke

A.Septicemia B. An extensive burn C. Abruptio placentae D. Severe head trauma

Which sex specific group has the highest cancer incidence rate

Africans American males

in NAUSEA ASSES FOR S/S

Alkalosis, dehydration , monitor I&O, fatigue

A patient with thrombocytopenia presents to the primary care center. During assessment, the nurse notices petechiae. Which laboratory result best support's the presence of this disorder of hemostasis? 1. Decreased erythrocyte count 2. A platelet count below 150,000/mm³ 3. An elevated lymphocyte count 4. A hemoglobin values of 14 or more

Answer: 2. Patients with thrombocytopenia have decreased platelet counts below 150,000/ mm³. The manifestation is the appearance of petechiae, purpura, & bruises.

A patient with a platelet count of 50,000/mm3 is diagnosed with thrombocytopenia. The nurse would expect which clinical manifestations? (Select all that apply. A. Headache B. Bruising C. Dizziness D. Vomiting E. Petechiae

Answer: B & E. Bruising & petechiae Rationale: A low platelet count, in this question 50,000, mild bleeding may occur, such as bruising and petechiae.

The nurse would monitor a patient with thrombocytopenia for which major complication? A. Fatigue B. Weakness C. Hemorrhage D. Abdominal pain

Answer: C. Hemorrhage Rationale: The major complication of thrombocytopenia is hemorrhage. This occurs due to a decreased number of platelets in the blood, which results in excessive bleeding

Safe handling of chemotherapy

Avoid direct contact with agents • Wear personal protective equipment to prepare & admin. (drugs maybe absorb thru skin/ inhaled) • Some risk in handling body fluids & excretions of persons immediately following admin for 48hrs • Proper disposal

Bleeding precautions

Avoid invasive procedures Avoid medications with bleeding risk hold pressure on punctures prevent falls prevent constipation

The nurse assesses a patient with disseminated intravascular coagulation (DIC) and expects to find which signs of hemorrhage? Select all that apply. A. azotemia B. Hemoptysis C. Hypotension D. Focal ischemia E. Abdominal distention

B. Hemoptysis C. Hypotension ABDOMINAL DISTENTION -Pulmonary manifestations, such as hemoptysis, are a sign of hemorrhage in DIC disorder. Hypotension and increased abdominal girth are also bleeding manifestations.

Thrombocytopenia- low platlet MAJOR RISK

BLEEDING IF PLATLET<50,000

IF BLEEDING <50,000 INITIATE BLEEDING PRECAUTIONS

BLEEDING PRECAUTIONS

COMMON TYPE OF CANCER FOR WOMEN

BREAST

Which statement made by a student nurse indicates the need for additional teaching regarding the etiology and pathophysiology of disseminated intravascular coagulation (DIC)? A. "It is stimulated by a disease process or disorder." B. "Bleeding occurs as a result of depletion of platelets." C. "It results from the surplus production of clotting factors." D. "DIC results from abnormally initiated and accelerated clotting

C. "It results from the surplus production of clotting factors."

CHRONIC DIC

CANCER

IN ACUTE DIC WHAT WE GIVE TO INCREASE FIBRINOGEN

CRYOPRECIPITATE GOAL# KEPP IT>100MG

CALISIUM

Calcium plays a major role in the coagulation cascade & is responsible for activation of several coagulation factors.

What do we give to stimulate RBC

Erthropoietin Epogen

Immunotherapy & Targeted Therapy

Flulike symptoms • Headache, fever, chills, myalgias • Anorexia/weight loss • Skin rash • Fatigue, malaise, weakness • Nausea/vomiting • Photosensitivity • Tachycardia & orthostatic hypotension • CNS system effects

when to Transfuse RBCs

Hct < 20% in healthy adults

Which occurrence may predispose a patient to developing ACUTE disseminated intravascular (DIC) disorder?

Heat stroke, septic abortion, and glomerulonephritis

Anemia LOW RBC MAJOR RISK IS?

Hypoxic

When to transfuse PLATLTET

IF PLATLET COUN LESS THAN 10,000

Noninvasive

In situ) ductal or lobular

Targeted Therapy

Interferes with cancer growth by targeting specific cell receptors & pathways that are important in tumor growth

The nurse performs a breast examination on a 68-year-old female patient. Which finding indicates further evaluation for breast cancer is needed?

Irregular, nontender lump with induration

example of STRENOUS ACTIVITY

JOGGING RUNNING CYCLING MORE THAN 10 MILES STRENGTH TTARINING

COMMON TYPE OF CANCER CAUSING DEATH FOR BOTH MEN/WOEMN

LUNG/ BRONCHUS

brachytherapy radiation: CARE

Limit amount of time with pts during tx radioactive material • Organize care, use shielding, wear film badge to monitor exposure

• Interventions for activity intolerance

Limit strenuous activity Energy conservation

intervention to low RBC

Limit strenuous activity- Energy conservation

CANCER INCEDINCE rate and DEATH rates are HIGHER IN

MALES

Biotherapy: USE immune system to fight cancer

Monoclonal antibodies (drugs ending in — 'mab ' ) • Cytokines • Vaccines

what do we give to stimulate WBC

Neupogen -granulocyte colony stimulating factors

A major risk factor for INFECTION

Neutrophil <500

•Promote a healthy lifestyle.

No smoking, healthy weight, healthy diet, regular exercise, limit alcohol use, adequate rest

WHO have the highest cancer mortality rates

Non-Hispanic Black males & females

28yr old female with a BMI 20, who crosses her legs while sitting

Normal Risk. Crossing legs can affect blood flow, but no other contributing factors.

The nurse is volunteering at a community center teach women about breast cancer. What should the nurse include when discussing risk factors? (Select all that apply).

Nulliparity Early menarche Personal history of colon cancer Alcohol use Late menopause

The nurse is carefully monitoring a postpartum patient who experienced abruptio placentae for which sign of DIC? A. Pain and swelling in the leg B. Rapid clotting times C. Increased platelet levels D. Oozing blood from the injection sites

Oozing blood from the injection sites Rationale: Oozing from injection sites is a sign of DIC. Pain and swelling in the leg indicate thrombophlebitis. The client's clotting times would be prolonged in DIC, and platelet levels would be decreased.

Common type of cancer for MEN

PROSTATE

The nurse is developing a program for the type of cancer with the highest incidence among males. Which type of cancer will the nurse focus the program?

PROSTATE CANCR

SIGN OF BLEEDING

Pain at the site/swollen/N/V/PALE CLAMMY SKIN/LOW LOC/ THIRST

The nurse is reviewing the laboratory results for a patient diagnosed with disseminated intravascular coagulation (DIC). Which finding supports the diagnosis of DIC for this patient? High fibrinogen level Increased platelet count Proloned PT Decreased fibrin split products

Rationale: A prolonged prothrombin time supports the diagnosis of DIC. Other lab findings that would support this diagnosis include: Low (not high) fibrinogen level. Decreased (not increased) platelet count. Increase (not decrease) in the fibrin split products

A hospitalized patient has a platelet count of 58,000/mm³. What action by the nurse is most appropriate? 1-nstitute neutropenic precautions 2-Limit visitors to healthy adults 3-Place the patient on safety precautions 4-Encourage high-protein foods

Rationale: Place the patient on safety precautions. With a platelet count between 40,000 & 80,000/mm³, patients are at risk of prolonged bleeding even after minor trauma. The nurse would place the patient on safety or bleeding precautions as the most appropriate action. High protein foods are not the priority. Neutropenic precautions are not needed, as WBCs are not the issue. Limiting visitors would be likely related to low WBCs, not the issue here.

Which factors put a patient at risk for developing acute disseminated intravascular coagulation (DIC)? (Select all that apply). Abruptio placentae Severe head trauma Extensive burns Acute respiratory distress syndrome

Rationale: Risk factors associated with acute DIC include severe head injury, abruptio placentae, extensive burns, and septicemia. ARDS is not a risk factor for acute DIC.

A nurse is assessing a client who has disseminated intravascular coagulation (DIC). Which of the following findings should the nurse expect? Increased clotting factors Immediate sodium and fluid retention Excessive thrombosis and bleeding Progressive increase in platelet production

Rationale: The nurse should expect excessive thrombosis and bleeding because DIC impairs both coagulation and anticoagulation pathways. The nurse should expect a decrease, rather than an increase, in platelet count because of the increased platelet consumption involved in the rapid formation of multiple clots. Sodium and fluid retention are not findings associated with DIC. The capillary leak and hemorrhage caused by DIC results in fluid loss or hypovolemia. The nurse should expect a decrease in clotting factors, rather than an increase, because the formation of multiple small clots consumes clotting factors and fibrinogen faster than the body can produce them.

20yr old female, 2 pack a day smoker has Antiphospholipid syndrome taking birth control pills.

Risk. APS is an autoimmune disorder that attacks & damages tissue, estrogen increases clot formation, and smoking affects blood flow

ACUTE DIC

SEPSIS

what do we asses in Neutropenia

SIGN OF INGECTION and Fever -38.3/100

Which occurrence may predispose a patient to developing chronic disseminated intravascular (DIC) disorder?

SLE is the risk factor that predisposes a patient to chronic DIC disorder.

Reproductive factors of risk to BC

Starting menstrual periods before age 12 • Starting menopause after age 55 • Having never been pregnant or having your first child after age 30. • Having never breastfed

WHICH IS MORE COMMON THROMBOSIS OR BLEEDING

THROMBOSIS

A patient with septicemia develops prolonged bleeding from venipuncture sites and blood in the stools. Which action is most important for the nurse to take? 1-Apply dressings to the sites 2-Avoid other venipunctures 3-Give prescribed proton-pump inhibitors 4-Notify the health care provider

The patient's new onset of bleeding & dx of sepsis suggest that DIC may have developed, which will require collaborative actions such as diagnostic testing, blood product administration, etc. the other actions are also appropriate, but the most important action should be to notify the health care provider so that DIC tx can be initiated rapidly.

Which parameters are considered in the TNM staging of cancers? Select all that apply.

This system uses tumor size (T), presence of metastasis (M) nodal involvement (N) to determine the stage of disease.

What 2 minerals are coagulation factors dependent on?

VIT K CALCIUM

WHENTO TRANSFUSE RBC

WHEN HCT LESS THAN 20%

Which assessment would the nurse obtain prior to administering a second round of chemotherapy for a patient with breast cancer?

White blood cell count Chemotherapy kills all rapidly dividing cells, which includes the cells within the bone marrow, and can decrease the white blood cell count, red blood cell count, and platelet count.

Race of BC risk factors

White women •Black females' highest incidence <40 yrs old

Leukemias

arise from hematopoietic

sarcomas

arises from connective , muscle bone tissue bone tumors, Muscle tumors

Carcinomas

arises from epithelial cells- mucous membrane lining of resp. GI, GU tracts - breast cancer- lung cancer- skin cancer- brain cancer

Lymphomas

arises from lymph system( non/Hodgkin/Hodgkin

what should we assess in anemia(hypoxic)?

assess for pallor dyspnea hypoxia

Dietry

avoid excessive intake of animal fat avoid nitrites (lunch meats, sausage, bacon) minimize intake of red meat Eat more bran, eat more cruciferous vegetables -broccoli, cauliflower, brussels sprouts, cabbage)

example of benign

edenoma

•Malignant

•(abnormal cells that invade nearby tissues & do spread; cancer) •i.e., adenocarcinoma

•Assist with decision-making related to risk reduction interventions.

•Medications (i.e., vaccines-HPV, hepatitis e •Surgery (i.e., prophylactic mastectomy

example of Malignant

•adenocarcinoma

•Benign

•excessive growth of normal cells that do not spread; nonmalignant) •i.e., adenoma

Secondary prevention

•mammogram, colonoscopy, pap smear, prostate-specific antigen (PSA)

IN ACROOS ALL RACE/EHNIC POPULATION CANCER RATE ARE HIGHER IN MALES EXCEPT

•non-Hispanic Asian & Pacific Islander

Patient postop day 1 after a total knee replacement, receiving estrogen.

↑ Risk. Endothelial injury by surgery, venous stasis d/t immobilization, high risk medication-estrogen.