Med surg exam 2

The overall goals are that the patient with thrombocytopenia will

(1) have no gross or occult bleeding, (2) maintain vascular integrity, and (3) manage home care to prevent any complications related to an increased risk for bleeding.

Define the principles of ALARA

(as low as reasonably achievable) and time, distance, and shielding are vital to health care professional safety when caring for a patient with a source of internal radiation.

What foods are high on vitamin B12

(glandular meats, yeast, green leafy vegetables, milk, and cheese.

Seven warning signs of cancer (CAUTION)

*C*hange in bowel or bladder habits *A* sore that does not heal *U*nusual bleeding or discharge from any body orifice *T*hickening or a lump in breast or elsewhere *I*ndigestion or difficulty swallowing *O*bvious changes in a wart or mole *N*agging cough or hoarseness

Treatment for thrombocytopenia

*Oprelvekin(neumega)* Platelet transfusion

histologic grading of tumors

, the appearance of cells and the degree of differentiation are evaluated pathologically. For many tumor types, four grades are used to evaluate abnormal cells based on the degree to which the cells resemble the tissue of origin.

Tumor Lysis Syndrome (TLS)

-oncologic emergency with rapid lysis of malignant cells hallmark signs: hyperuricemia, hyperphosphatemia, hyperkalemia, hypocalcemia, weakness, muscle cramps, diarrhea, nausea, vomiting, occurs within first 24-48 hrs of initiation of chemo. treatment: increase urine production using hydration therapy. Decrease uric acid concentrations using allopurinol.

Creatinine

0.2-1.0 mg/dL

Bilirubin

0.2-1.2 mg/dL

The home health nurse is obtaining a history for a patient who has deep vein thrombosis and is taking warfarin 2 mg/day. Which statement by the patient is the best indicator that additional teaching about warfarin may be needed? 1. I have started to eat more healthy foods like green salads and fruit. 2. The doctor said that it is important to avoid becoming constipated 3. Warfarin makes me feel a little nauseated unless I take it with food. 4. I will need to have some blood testing done once or twice a week.

1 Patients taking warfarin are advised to avoid making sudden dietary changes because changing the oral intake of foods high on vitamin K (e.g. green leafy vegetables and some frutis) will have an impact on the effectiveness of the medication. Prioritization and delegation

The nurse is caring for the client receiving combination chemotherapy of oxaliplatin, fluorouracil, and leucovorin. The nurse should assess the client for which common side effects of this chemotherapy regimen? 1. Neurotoxicity and diarrhea 2. Cardiomyopathy and dysphagia 3. Renal insufficiency and gastritis 4. Photophobia and stomatitis

1 1. Neurotoxicity and diarrhea occur frequently in clients receiving the medication regimen of oxaliplatin (Eloxatin), fluorouracil (5-FU), and leucovorin (Wellcovorin). 2. Cardiomyopathy and dysphagia are not common side effects of these chemotherapy agents. 3. Renal insufficiency and gastritis are not common side effects of these chemotherapy agents. 4. Photophobia and stomatitis are not common side effects of these chemotherapy agents.

The nurse assesses that the client who is receiving radiation for cervical cancer continues to have diarrhea. Which nursing advice is most appropriate? 1. Eat a low-residue diet and take sitz baths twice daily. 2. Drink fluids low in potassium and take frequent tub baths. 3. Consume more milk products and take frequent showers. 4. Drink high-sodium fluids and apply hydrocolloid pads to rectum.

1 1. The client with diarrhea should eat a low-residue diet to decrease roughage and bowel irritability and take sitz (or tub) baths twice daily to increase comfort. 2. Intake of fluids that are high in potassium (not low) is recommended to replace electrolytes lost through diarrhea. 3. Milk products are discouraged because they increase bowel irritability. 4. Intake of fluids high in sodium should be avoided because it contributes to water retention, but hydrocolloid pads may be used on reddened areas to promote healing. Test-takingTip:When options contain more than one part, both parts must be correct for the option to be the answer.

The client is hospitalized with a diagnosis of sickle cell crisis. Which findings should prompt the nurse to consider that the client is ready for discharge? Select all that apply. 1. Leukocyte count is at 7500/mm3 2. Describes the importance of keeping warm 3. Pain controlled at 2 on a 0 to 10 scale with analgesics 4. Has not had chest pain or dyspnea for past 24 hours 5. Blood transfusions effective in diminishing cell sickling 6. Hydroxyurea effective in suppressing leukocyte formation

1, 2, 3, 4 1. A leukocyte count of 7500/mm3 is within normal range (5000 to 10,000/mm3 indicates the absence of an infection). 2. Keeping warm and avoiding chills will help to prevent infection. Cold causes vasoconstriction, slowing blood flow and aggravating the sickling process. 3. Acute pain is due to tissue hypoxia from the agglutination of sickled cells within blood vessels. Pain controlled at 2 indicates readiness for discharge. 4. The absence of symptoms of complication such as acute chest syndrome and pulmonary hypertension indicates readiness for discharge. 5. RBC transfusions may help to prevent complications, but transfusions do not alter the person's body from producing the deformed erythrocytes. 6. Hydroxyurea (Hydrea) can decrease the permanent formation of sickled cells. A side effect (not therapeutic effect) of hydroxyurea is suppression of leukocyte formation.

The new nurse requests information about chronic lymphocytic leukemia (CLL). Which statements should an experienced nurse include? Select all that apply. 1. CLL is a malignancy of activated B lymphocytes. 2. CLL is the most common malignancy of older adults. 3. CLL is unresponsive to chemotherapy treatment. 4. Clients are monitored in its early stages and often not treated. 5. In CLL immature lymphocytes accumulate in the bone marrow. 6. Clients with CLL often have no symptoms of the disorder.

1, 2, 4, 6 1. CLL derives from a malignant clone of B lymphocytes. T-lymphocytic CLL is rare. 2. Two-thirds of all persons with CLL are older than 60 years at diagnosis. 3. Treatment for CLL includes chemotherapy with fludarabine (Fludara), but a major side effect is prolonged bone marrow suppression. 4. Clients with CLL are monitored, and treatment is initiated when symptoms are severe (night sweats, painful lymphadenopathy) or the disease progresses to later stages. 5. In CLL there is an accumulation of mature-appearing but functionally inactive lymphocytes, and not immature lymphocytes. Excessive accumulation of immature lymphocytes occurs in ALL. 6. Because many persons are asymptomatic, it is often diagnosed during a routine physical or during treatment for another condition. Test-taking Tip: ALL frequently occurs in children, whereas CLL frequently occurs in adults. A mnemonic for differentiating CLL from ALL can be used to select the answers: "Be older and mature" (B = B lymphocytes; o = older adult; a = asymptomatic; m = mature but inactive lymphocytes).

The nurse recognizes which of the following conditions as an oncologic emergency? Select all that apply. 1. Cardiac tamponade 2. Leukopenia 3. Syndrome of inappropriate antidiuretic hormone 4. Hypercalcemia 5. Hypophosphatemia 6. Tumor lysis syndrome

1,3,4,6 Metabolic emergencies, including SIADH, hypercalcemia, and TLS; infiltrative emergencies, including cardiac tamponade; and obstructive emergencies are life-threatening complications of cancer or cancer therapy. Leukopenia is an expected side effect. Hypophosphatemia is not common. (Lewis et al., 10 ed., p. 263)

After surgery for gastric cancer, a client is scheduled to undergo radiation therapy. The nurse should include which information in the teaching plan? 1. nutritional intake 2. management of alopecia 3. exercise and activity levels 4. access to community resources

1. Clients who have had gastric surgery are prone to postoperative complications, such as dumping syndrome and postprandial hypoglycemia, which can affect nutritional intake. Vitamin absorption can also be an issue, depending on the extent of the gastric surgery. Radiation therapy to the upper gastrointestinal area also can affect nutritional intake by causing anorexia, nausea, and esophagitis. The client would not be expected to develop alopecia. Exercise and activity levels as well as access to community resources are important teaching areas, but nutritional intake is a priority need. Lippinncott Q& A review for NCLEX Billings

What are the 3 stages of cancer?

1. Initiation; mutation in the cells DNA 2. Promotion; reversible proliferation of the altered cells 3. Progression; increased growth rate of the tumor, increase invasiveness and spread of cancer (metastasis)

Magnesium

1.5-2.5 mEq/L (0.75-1.25 mmol/L)

List 3 potential causes of anemia

1.diet lacking in iron, folate, or vit. B12 2.use of salicylates, thiazides, diuretics 3.exposure to toxic agents such as lead or insecticides

BUN

10-20 mg/dL

Ferritin value

10-250 ng/ml (10-250 mcg/L)

prothrombin time(PT)

11-16 seconds

Hemoglobin

13.2-17.3 (m) 11.7-15.5 (f)

Sodium

135-145 mEq/L (135-145 mmol/L)

LDH values

140-280 U/L

Platelets

150,000-400,000

Transferrin value

190-380 mg/dL (1.9-3.8 g/L)

The nurse receives orders after notifying an HCP about the client who has tachycardia, diaphoresis, and an elevated temperature after treatments for ALL. Which order should be the nurse's priority? 1. Portable chest x-ray in the client's room 2. Urine culture, and blood cultures × 2 3. Vancomycin 500 mg IV q6h 4. Filgrastim 0.3 mg subcut daily

2 1. The results of the portable CXR will help determine if the cause is a respiratory infection. It will not change the treatment. 2. Urine and blood cultures are priority; these should be obtained before antibiotics are administered. 3. National recommendations are to administer broad-spectrum antibiotics such as vancomycin (Vancocin) within 1 hour of a suspected infection diagnosis. The antibiotics may be changed after culture and sensitivity reports are available (usually 24 to 48 hours). 4. It takes 4 days for filgrastim (Neupogen) to return the neutrophil count to baseline, so this is not priority. Filgrastim should not be given within 24 hours of cytotoxic chemotherapy. Test-taking Tip: Consider the effects of administering an antibiotic if another intervention does not occur first.

The recently admitted client with gastric cancer is pale and states feeling fatigued. In reviewing the client's CBC results, which component should the nurse mostassociate with the client's gastric cancer and the reason for the fatigue? 1. White blood cell 12,200/mm3 2. Hemoglobin 7.9 g/dL 3. Serum protein 5.9 g/dL 4. Blood urea nitrogen 22 mg/dL

2 1. The elevation in the WBC to 12,200/mm3 (normal is 4500-10,000/mm3 or microL) is concerning because it could indicate an infection, but the elevation would not necessarily be related to the gastric cancer. 2. The presenting symptoms are indicative of anemia, which is common in gastric cancer due to chronic blood loss, or because of pernicious anemia (due to loss of intrinsic factor). The low Hgb of 7.9 g/dL (normal is 12-15 g/dL) may be the causative factor for the fatigue. 3. The serum protein of 5.9 g/dL is slightly low (normal is 6.0-8.0 g/dL) and could be indicative of nutritional problems associated with the gastric cancer, but it is not specific to the signs and symptoms described in the question, and it is not part of a CBC. 4. The BUN of 22 mg/dL (normal is 5-25 mg/dL) is within normal parameters and is measuring kidney function or hydration status. It is not part of the CBC. Test-takingTip:When reviewing laboratory results, eliminate options that are within normal ranges. Be careful reading information. This question is asking about laboratory results in a CBC. Serum protein and

The nurse is assessing a client after beginning external radiation. What is a nursing observation that confirms the presence of early side effects of the radiation? 1. A gradual weight loss and GI disturbances 2. Skin erythema followed by dry desquamation 3. Vertigo when sitting up quickly 4. Excoriation and blisters on the affected skin

2 Abnormal skin pigmentation, erythema, and dry desquamation may develop within a few days of beginning the radiation treatment. Wet desquamation may occur with progression of the radiation treatment, but the skin does not have blisters. Vertigo may be a sign of orthostatic hypotension associated with hypovolemia. The weight loss occurs, but it is not due to the radiation; it is most often due to the malignancy. (Lewis et al., 10 ed., pp. 250-256)

The client with Hodgkin's lymphoma receives radiation. The nurse should monitor the client for which specific symptoms of radiation pneumonitis? 1. Tachypnea, hypotension, and fever 2. Cough, elevated temperature, and dyspnea 3. Bradypnea, cough, and decreased urine output 4. Cough, tachycardia, and altered mental status

2 1. Hypotension is a symptom that is not common in radiation pneumonitis. 2. Cough, fever, and dyspnea are classic symptoms in radiation pneumonitis due to a decrease in the surfactant in the lung. 3. Decreased urine output is a symptom that is not common in radiation pneumonitis. 4. Altered mental status is a symptom that is not common in radiation pneumonitis.

INR

2-3

Cobalamin (Vitamin B12) values

200-835 pg/ml (148-616 pmol/L)

aPTT (activated partial thromboplastin time)

25-35 seconds

Total Iron Binding Capacity (TIBC) value

250-425 mcg/dL (45-76 micromol/L)

The nurse is caring for a client who is being treated with chemotherapy for his lung cancer. The client has had two treatments in the last 2 days, and the nurse notes hyperkalemia and hyperuricemia on the latest serum laboratory values. The nurse understands that these are symptoms of: 1. Third-space syndrome 2. Syndrome of inappropriate antidiuretic hormone 3. Tumor lysis syndrome 4. Parathyroid deficiency

3 These two findings, hyperuricemia and hyperkalemia, are hallmark symptoms of tumor lysis syndrome, which often occurs at the onset of chemotherapy when a large number of tumor cells are destroyed. This process yields fatal biochemical changes of hyperkalemia, hyperuricemia, hypocalcemia, and hyperphosphatemia if not averted with adequate fluids. (Lewis et al., 10 ed., p. 263)

The client undergoing intensive chemotherapy for Hodgkin's lymphoma is hospitalized with fever and a depressed immune system. The nurse is administering filgrastim subcutaneously daily. Which laboratory value should the nurse monitor to determine the medication's effectiveness? 1. Hemoglobin 2. Platelet count 3. Absolute neutrophil count (ANC) 4. Reed-Sternberg cells

3 1. Epoetin alfa, not filgrastim, is used to treat anemia that is associated with cancer, and its effectiveness would be reflected in the Hgb values. 2. Oprelvekin (Neumega), not filgrastim, enhances the synthesis of platelets. 3. The nurse should monitor the ANC. Filgrastim (Neupogen) is usually discontinued when the client's absolute neutrophil count (ANC) is above 1000 cells/mm3. Filgrastim, a granulocyte colony-stimulating factor (G-CSF) analog, is used to stimulate the proliferation and differentiation of granulocytes and treat neutropenia. 4. Reed-Sternberg cells are found in lymph node biopsy cells and are indicative of Hodgkin's lymphoma; they are not monitored to determine the effectiveness of filgrastim, which is used to treat neutropenia. Test-taking Tip: The focus of the question is expected effects of filgrastim (Neupogen). If uncertain, use the trade name of Neupogen as a clue to the laboratory value to monitor.

A client asks the nurse why he has to take several chemotherapy agents at the same time. The nurse's response would be based on which principle? 1. The more medications that can be given together, the shorter the treatment period. 2. The cost is decreased because the medications are administered at the same time. 3. Multiple medications given together will attack the cancer cells at different levels. 4. One medication will interact with another to reduce incidence of side effects.

3 Combination drug therapy is important because different drugs inhibit cancer cell growth at various phases of cellular replication. This makes each of the medications more effective. Medications are given together because this is a more effective method of treatment, not because of cost or to reduce the side effects. (Lewis et al., 10 ed., p. 248)

The nurse understands what major difference between benign and malignant tumors? Malignant tumors: 1. Are encapsulated and immovable 2. Grow at a faster rate than benign tumors do 3. Invade adjacent tissue and metastasize 4. Cause death, whereas benign tumors do not

3 The primary difference between benign and malignant tumors is the ability of the malignant tumor to invade adjacent tissues and metastasize. Benign tumors tend to be encapsulated, and both types of tumors can lead to death. As benign tumors expand, they can adversely affect organ function. The growth of malignant and nonmalignant tumors varies, depending on the characteristics and location of the tumor. (Lewis et al., 10 ed., p. 240)

How long does it take for iron levels to come back up again?

3 months.

The nurse understands that the following are general adverse effects of antineoplastic drugs. Select all that apply. 1. Urinary retention 2. Infertility 3. Stomatitis 4. Bone marrow depression 5. Extravasation 6. Nausea

3, 4, 6 Adverse effects of antineoplastic drugs can be classified as acute, delayed, or chronic. Acute toxicity includes nausea, vomiting, arrhythmias, and allergic reactions. Delayed side effects include stomatitis, alopecia, and bone marrow depression. Chronic toxicity involves organ damage. Common urinary problems include cystitis and nephrotoxicity. Extravasation is not an adverse effect but a complication of an infiltrated IV running a chemotherapy medication that is a vesicant. (Lewis et al, 10 ed., pp. 250-256)

Folic acid (folate) value

3-16 ng/ml (7-36 nmol/L)

The nurse should teach a client that a normal local tissue response to radiation following surgery for breast cancer is: 1. atrophy of the skin. 2. scattered pustule formation. 3. redness of the surface tissue. 4. sloughing of two layers of skin

3. The most common reaction of the skin to radiation therapy is redness of the surface tissues. Dryness, tanning, and capillary dilation are also common. Atrophy of the skin, pustules, and sloughing of two layers would not be expected and should be reported to the radiologist.

The mother of a client who has a radium implant asks why so many nurses are involved in her daughter's care. She states, "The doctor said I can be in the room for up to 2 hours each day, but the nurses say they are restricted to 30 minutes." The nurse explains that this variation is based on the fact that nurses: 1. touch the client, which increases their exposure to radiation. 2. work with many clients and could carry infection to a client receiving radiation therapy, if exposure is prolonged. 3. work with radiation on an ongoing basis, while visitors have infrequent exposure to radiation. 4. are at greater risk from the radiation because they are younger than the mother.

3. The three factors related to radiation safety are time, distance, and shielding. Nurses on radiation oncology units work with radiationfrequently and so must limit their contact. Nurses are physically closer to clients than are visitors, who are often asked to sit 6 feet (182.9 cm) away from the client. Touching the client does not increase the amount of radiation exposure. Aseptic technique and isolation prevent the spread of infection. Age is a risk factor for people in their reproductive years.

Albumin

3.5-5 g/dL

Potassium

3.5-5.0 mEq/L (3.5-5.0mmol/L)

A home-care nurse is following up with the client who was diagnosed with liver cancer 3 months ago. Which assessment information should the nurse communicate immediately to the HCP? 1. Weak and pale; remained in bed during the visit. 2. Weight is unchanged since the previous visit. 3. Itching is less with diphenhydramine cream use 4. Pain level averages a 7 on a 0 to 10 scale with scheduled opioids.

4 1. Finding that the client with liver cancer is weak and pale would be important to document, but it does not warrant immediate communication to the HCP because it may be expected. 2. The client's weight being stable would not necessitate communication to the HCP, but a significant decrease would. 3. Abdominal itching may occur with liver cancer, but the fact that it is less with diphenhydramine (Benadryl) use is positive and would not necessitate a call to the HCP. 4. The client's pain level is high and does not seem to be controlled with the current opioid schedule. The nurse should notify the HCP to request a change in analgesic medication, dosing schedule, or administration route. Test-takingTip:Eliminate options that are expected findings for the client diagnosed with liver cancer or findings that are being controlled.

The client's lymph node biopsy revealed Hodgkin's lymphoma. When teaching the client, the nurse should obtain the educational brochure that explains which information? 1. Elevated reticulocyte counts 2. CA-125 tumor markers 3. Elevated WBC counts 4. Reed-Sternberg cells

4 1. Reticulocytes are found in a CBC, not from a lymph node biopsy, and are not indicative of either Hodgkin's or non-Hodgkin's lymphoma. 2. CA-125 tumor markers are sometimes used in the management of ovarian cancer. 3. WBCs are collected from a complete blood panel, not a lymph node biopsy, and could be indicative of other lymphomas and/or leukemia. 4. The nurse should obtain the brochure that explains about Reed-Sternberg cells. The main diagnostic feature of Hodgkin's lymphoma is the presence of Reed-Sternberg cells in a lymph node biopsy.

The client diagnosed with esophageal cancer is having work-related problems that are interfering with the client's treatment. Which organization should the nurse advise the client to contact for assistance with these issues? 1. National Cancer Institute 2. Leukemia Society of America 3. Corporate Angel Network 4. Patient Advocate Foundation

4 1. The National Cancer Institute answers questions and has free information about cancer. 2. The Leukemia Society of America provides education regarding leukemia. 3. The Corporate Angel Network provides free plane transportation for cancer clients going to and from treatment centers. 4. The Patient Advocate Foundation provides counseling to resolve job-related problems.

The nurse is updating a teaching plan for a client who has cancer and has been taking doxorubicin for the past several months. What is important to review with the client? 1. Report symptoms of hematuria. 2. Increase intake of oral fluids. 3. Avoid folic acid intake. 4. Report symptoms of dyspnea.

4 One of the most common and most severe toxicities of doxorubicin is cardiotoxicity. After months of treatment, this can manifest as heart failure (dyspnea, tachycardia, peripheral edema). Early side effects include dysrhythmias and electrocardiogram (ECG) changes. These can occur within hours of receiving the medication. (Lewis et al., 10 ed., p. 256)

The client who has renal cancer that has metastasized rates pain at a 9 on a 0 to 10 pain scale. Which medication should the nurse plan to administer now and then schedule to be administered at the prescribed dosing interval? 1. Meperidine 2. Propoxyphene 3. Pentazocine 4. Oxycodone

4 1. Meperidine (Demerol) is not recommended because it causes CNS toxicity from metabolites. It should not be used for the treatment of chronic pain. 2. Propoxyphene (Darvon) is best used for moderate to severe pain; a rating of 9 is severe pain. 3. Pentazocine (Talwin) is used for moderate pain only, and it can cause confusion and hallucinations in older adults and clients with renal impairment. 4. Opioids, such as oxycodone (OxyContin), remain the most frequently prescribed analgesic for severe cancer pain. To help with pain control, the nurse should plan to administer it now and then again at the prescribed dosing interval. Test-taking Tip: Consider the side effects of each medication and which would provide the best pain control while minimizing side effects.

WBC

4,000-11,000

Erythropoietin value

5-35 mU/mL (5-30 U/L)

Serum iron value

50-175 mcg/dL (9-31.3 nmol/L)

Calcium

8.6-10.2 mg/dL (2.15-2.55 mmol/L)

erythrocyte sedimentation rate (ESR, sed rate) value

<30 mm/hr

A nurse plans a community education program related to prevention of the cancer with the highest death rates in both women and men. What should the nurse include in the teaching plan? A. Smoking cessation B. Screening with colonoscopy C. Regular examination of reproductive organs D. Use of sunscreen as protection from ultraviolet light

A Rationale: The highest number of cancer deaths by site are for cancer of the lung and bronchus. Smoking is the leading cause of lung and bronchial cancer.

What does the presence of cacinoembryonic antigen(CEAs) and a-fetoprotein(AFP) on cell membranes indicate has happened to the cells? A. They have shifted to more immature metabolic pathways and function B. they have spread from areas of original development to different body tissues C. they have produces abnormal toxins or chemicals that indicate abnormal cellular function D. they have become more differentiated as a result of repression of embryonic functions

A rationale: Cancer cells become more fetal and embryonic (undifferentiated) in appearance and function and some produce new proteins such as cea and afp, on the cell membranes that reflect a return to more immature functioning

Which of these best describes sickle cell anemia?

A hereditary disease that effects the hemoglobin in RBC

Thrombocytopenia is-

A reduction in circulating platelets

Neutropenia

A reduction in neutrophils, a type of granulocyte.

Acute lymphocytic leukemia

Abnormal leukocytes are found in blood-forming tissue. is the most common type of leukemia in children. prognosis is favorable 80% of children treated live 5 years or longer.

A client with pernicious anemia is receiving vitamin B12. The nurse should evaluate the client for which expected outcome of vitamin b12?

Absence of parathesias-Numbness confusion neuro effects

How can tumors be classified?

According to anatomic sit, histologic grading, and extent of disease (staging)

The most common and worst leukemia?

Acute myelogenous leukemia

Cancer incidence and death rates are disproportionately higher among what group of people?

African Americans

What hormone can enhance the growth of some prostate cancers?

Androgen

To prevent the debilitating cycle of fatigue-depression-fatigue that can occur in patients with cancer, an appropriate nursing intervention is to A. Have the patient rest after any major energy expenditure B. Encourage the patient to implement a daily walking program C. Teach the patient to ignore the fatigue to maintain normal daily activities D. Prevent the development of depression by informing the patient to expect fatigue during cancer treatment

Answer: b Rationale: Exercise and activity within tolerable limits are often helpful in managing fatigue. Walking programs are a way for most patients to stay active without being overtaxed.

Iron supplements can make some patients nauseous, so it is advised that they take these pills at what time in the day?

At bedtime. take 1 hour before meals or 2 hours after meal on an empty stomach.

The nurse has provided instruction to a client with sickle cell disease regarding measures that will prevent a sickle cell crisis. Which client statement indicates an understanding of these measures?

Avoid situations which will lead to infections

What mutations increase the risk for breast and ovarian cancers?

BRCA1 and BRCA2

Antitumor antibiotics

Bind directly to DNA, thus inhibiting the synthesis of DNA and interfering with transcription of RNA. cell cycle phase - nonspecific agents

Platnum drugs

Bind to DNA and RNA, miscoding information and or inhibiting DNA replication and cells die. cell cycle phase - nonspecific agents

The nurse is caring for a client with leukemia. In assessing the client for signs of leukemia the nurse determines that what should be monitored?

Bone marrow biopsy

What signs and symptoms are associated with immunotherapy?

Bone marrow depression and fatigue. Capillary leak syndrome and pulmonary edema are usually acute or dose limited and may require critical care nursing

Radiation therapy symptoms

Bone marrow suppression Fatigue GI disturbances Integumentary and mucosal reactions Pulmonary effects Reproductive effects

What is aplastic anemia?

Bone marrow that doesn't produce enough RBC, WBC and platelets treatment is bone marrow transplant

How do we treat aplastic anemia?

Bone marrow transplant, treat the symptoms.

After 3 weeks of radiation therapy, a patient has lost 10 pounds and does not eat well because of mucositis. Which nursing diagnosis would be most appropriate? A. Risk for infection related to poor nutrition. B. Ineffective health management related to refusal to eat. C. Imbalanced nutrition: less than body requirements related to oral ulcerations D. Ineffective health maintenance related to lack of knowledge of nutritional requirements during radiation therapy.

C Rationale: The nursing problem is imbalanced nutrition related to the mucositis.

When given as a cancer treatment, hormone therapy does what?

Can block the effects of the hormone and stop the growth of cancer cells.

Spinal cord compression

Cancer in the epidural space of spinal cord. Manifestation: intense, localized, and persistent back pain accompanied by vertebral tenderness. motor weakness, sensory paresthesia and loss. Autonomic dysfunction(changes in bowel or bladder function). management: Radiation therapy and corticosteroids, surgical decompressive laminectomy. Activity limitations and pain management

The nurse is proving discharge teaching for a client with a compromised immune system and on neutropenic precautions. When discussing types of fruits and vegetables that the cient likes, which are encouraged? Select all

Canned peaches, cooked corn

Grade IV

Cells are immature and primitive (anaplasia) and undifferentiated; cell of origin is difficult to determine (high grade)

Grade II

Cells are more abnormal and moderately differentiated(intermediate grade)

morphologic

Cellular characteristic

What throws a sickle cell patient into a crisis?

Changes in temperature, typically cold, high altitudes (should avoid airplanes and hiking), infection, stress, dehydration.

Hodgkins disease

Characterized by a generalized painless lymphadenopathy, incidence is higher in males and young adults. unknown cause. 5 year survival rate of 90% treatment: Radiotherapy, chemotherapy: ABVD(adriamycin, blenoxane, velban, dacarbazine), splenectomy.

What population is aplastic anemia most commonly seen in?

Chemo patients

Treatment and management of leukemia

Chemotherapy and hematopoietic stem cell transplantation. may also be used.

What are some complications seen in patients who have sickle cell anemia?

Clots, strokes (typically what kills our patients), pulmonary embolism(tests for pe: d-dimer, ct scan, VQ scan), heart attack.

Describe the method of collecting the trough and peak blood levels of antibiotics

Collection of trough: draw blood 30 min before administration of antibiotic Collection of peak: Draw blood 30 minutes after administration of antibiotic.

A multidisciplinary oncology team of physicians nurses and the social worker notes that a client who has been undergoing chemotherapy is now experiencing pancytopenia. Which of thesevalues supports that diagnosis?

Decreased wbc

What is the number 1 reason for patients with sickle cell to be admitted into the hospital?

Dehydration.

intraarterial chemotherapy delivery

Delivers drug to tumor via arteries supplying the tumor. This method has been used for the treatment of osteogenic sarcoma; cancers of the head and neck, bladder, and cervix; melanoma; primary liver cancer; and metastatic livver disease.

Risk factors for anemia

Diet lacking in iron, folate, and/or vitamin B12; family history of genetic diseases; medication history of anemia-producing drugs, salicylates, thiazides, diuretics; exposure to toxic agents, lead or insecticides

Polycythemia treatment

Directed toward reducing blood volume/viscosity and bone marrow activity. Phlebotomy is the mainstay of treatment.

List three safety precautions for the administration of antineoplastic chemotherapy

Double check order with another nurse. Check for blood return before administration to ensure that medication does not go into tissue. Use a new iv site daily for peripheral chemotherapy. Wear gloves when handling the drugs, and dispose of waste in special containers to avoid contact with toxic substances.

A client is admitted to the hospital with a suspected diagnosis of Hodgkins' disease which assessment finding would the nurse expect to note specifically in the client?

Enlarged lymph nodes

What can you treat anemia with?

Epogen

Patients who have renal disease, what are they placed on?

Epogen and erythropoeitin

What virus is associated with Burkitt's lymphoma?

Epstein-Barr virus (EBV)

Low-energy beams radiation

Expend energy quickly Penetrate a short distance Useful for skin lesions

The nurse teaches a coworker about the treatment for hemophilia. The nurse instructs that the treatment will likely include periodic self administration of which component?

Factor concentrate

APC gene mutations increase a persons risk for?

Familiar adenomatous polyposis. (precursor for colorectal cancer)

What is a universal symptom affecting the majority of patients with cancer?

Fatigue

Hematocrit

Female 35%-47% Male 39%-50%

Total RBC count

Female: 3.8-5.1 Male: 4.3-5.7

What do we do if the swelling does not stop and bleeding persists in patients with hemophilia?

First elevate extremity to see if swelling goes down, if it does not you transfuse factor.

A client has received a radioactive colloid injection for treatment of a tumor. During assessment of the client, the nurse notices drainage on the sheets from the injection site. What is the priority action of the nurse?

Follow the hospital policy on radioactive waste cleanup

Name 3 food sources of vitamin B12

Glandular meats (liver), milk, green leafy vegetables

High-energy beams

Greater depth of penetration Suitable for optimal dosing of internal targets while sparing skin

List four topics you would cover when teaching an immunosuppressed client about infection control.

Handwashing technique. Avoid infected persons. Avoid crowds. Maintain daily hygiene to prevent spread of microorganisms.

What virus is associated with Hepatocellular carcinoma?

Hepatitis B virus

What is the test for sickle cell anemia?

HgBs (Hemoglobin S)

What problems occur due to sickle cell anemia?

Higher chance of infection and stroke acute chest syndrome

What virus is associated with Kaposis sarcoma?

Human immunodeficiency virus (HIV)

What virus is associated with squamous cell carcinomas?

Human papillomavirus (HPV)

What is the primary nursing consideration for patients who have multiple myeloma?

Hydration to minimize problems from hypercalcemia and potential renal failure. care must be taken when moving and ambulating because of potential for pathologic fractures.

Signs of hypovolemia

Hypotension, tachycardia, low central venous pressure, decreased urine output.

The nurse is preparing a client with thrombocytopenia for discharge. Which statement by the client

I may continue to use an electric shaver No contact sports soft bristle tooth brush no enema

The nurse teaches skin care to a client receiving external radiation therapy. Which client statement indicates the need for further instruction?

I will limit sun exposure to one hour a day

How can we help a patient undergoing radiation therapy prevent the fatigue-depression-fatigue cycle?

Implement a walking program or activity the patient enjoys scheduled during the time of day when the patient feels better.

A client with neutropenia has a absolute neutrophil count of 900. The nurse teaches the client to prevent which risk of neutropenia?

Infection

What is the primary cause of death in a cancer patient?

Infection

One of the major concerns with the IV administration of vesicant chemotherapy agents is what?

Infiltration or extravasion of drugs into tissue surrounding the infusion site.

Topoisomerase inhibitors

Inhibit topoisomerases (normal enzymes) that function to make reversible breaks and repairs in DNA that allow for fleciblity of DNA in replication. cell cycle phase - specific agents

The nurse is preparing a plan of care for a client with sickle cell crisis who will be admitted to the nursing unit. The nurse should include which intervention as a priority in the plan of care for the client?

Initiate iv fluids

Intravesical Bladder Chemotherapy

Instillation of drug into bladder via urinary catheter for 1-3 hours and then drained

Intraperitoneal chemotherapy delivery

Involved the delivery of chemotherapy to the peritoneal cavity for treatment of peritoneal metastases from primary colorectal and overian cancers, and malignant ascites.

Both radiation and chemotherapy has the potential to produce

Irreversible and progressive pulmonary and cardiac toxicities

Thalassemia

Is a group of diseases that have an autosomal recessive genetic basis involving inadequate production of normal Hgb

How can you cure sickle cell anemia?

It's incurable

How do you know a patient has hemophilia?

Joints are huge because over time they have swollen.

How do you know if your patient has hemophiloia?

Joints are huge, over time they have swollen.

Sickle cell patients can be given a blood transfusion if their HgB is at what level?

Less than 6

Describe the use of leucovorin

Leucovorin is used as an antidote with methotrexate to prevent toxic reactions.

Cardiac tomponade

Life-threatening buildup of pericardial fluid that compresses (squeezes) the heart manifestations: heavy feeling over chest, shortness of breath, tachycardia, cough, dysphagia, hiccups, hoarseness. nausea, vomiting, excessive perspiration. decreased level of consciousness, distant or muted heart sounds, extreme anxiety. Treatment: decrease fluid around heart using surgery to create pericardial window or an indwelling pericardial catheter. Administer O2 therapy, iv hydration and vasopressor therapy.

Nitrosources

Like alkylating agents, break DNA heliz, interfering with DNA replication cross blood-brain barrier. cell cycle phase - nonspecific agents

Men are more likely to develop what cancer than woman?

Liver cancer.

Lab test are prescribed for the client who has a smooth and red tongue and ulcers oat the corners of the mouth . Which result would the nurse find if the client has iron deficiency anemia?

Low hemoglobin and hematocrit?

What labs do we look at to check for anemia?

MCH, MCV, Ferritin, TIBC (total iron binding capacity)

What is the key to effective cancer care?

Maintain hope. Hope depends on the status of the patient: hope that the symptoms are not serious, hope that the treatment is curative, hope for independence, hope for relief of pain, hope for a longer life, or hope for a peaceful death. Hope provides control over what is occurring and is the basis of a positive attitude toward cancer and cancer care.

Superior vena cava syndrome manifestation and management

Manifestation: Facial edema, periorbital edema. distention of veins of head, neck, and chest. Headache, seizures. Mediastinal mass in chest xr. Management: Radiation therapy to site of obstruction, chemotherapy for tumors sensitive to this therapy

What do you NOT give sickle cell patients for pain?

Meperidine(demerol) because it causes seizures.

Intrathecal or intraventricular chemotherapy delivery

Method used to treat metastasis to the CNS. This involves a lumbar puncture and injection of chemotherapy into subarachnoid space.

Antimetabolites

Mimic naturally occuring substances, thus interfering with enzyme function or DNA synthesis. Primarily act during S phase. Punne and pyrimidine are building blocks of nucleic acids needed for DNA and RNA synthesis. cell cycle phase - specific agents

The client hospitalized with cervical cancer is receiving radiation therapy via temporary radioactive cervical implant which nursing actions whoud be appropriate for for this client?

Minimize anxiety and confusion by telling the client the reason for the time and distance limitation Utilize the unit's common film badge that indicates the cumulative radiation exposure whle caring for the client Organize care to limit the amount of time spent in direct contact Use shielding if delivering care within close proximity of the client such as checking placement of the implant

What do we monitor in a patient that has neutropenia?

Monitor the patient for signs and symptoms of infection and early septic shock.

Cobalamin (Vitamin B12) deficiency

Most commonly caused by pernicious anemia which results in poor cobalamin absorption through the GI tract.

Most common sympotom of thrombocytopenia

Mucosa or cutaneous bleeding.

What levels are considered neutropenic?

Neutrophils <2000, normally seen in cancer patients.

What should not be allowed in a room with a patient who is neutropenic?

No flowers, no sick people, no fresh fruit.

What is the only IV fluid compatible with blood products?

Normal saline

What is the only other fluid you can give along with blood transfusion?

Normal saline

acute myelogenous leukemia (AML)

Onset is abrupt and dramatic. It is characterized by uncontrolled proliferation of myeloblasts, the precursors of granulocytes. prognosis is poor: 5 year survival of 20% overall; 50% for children. inability of leukocytes to mature. and those that do are abnormal.

Identify two sites that should be assessed for infection and immunosuppressed clients

Oral cavity and genital area

The client who has renal cancer that has metastized rates pain at 9 on a 10 pain scale. Which medication should the nurse plan to administer now and then schedule to be administer at the prescribed doing interval?

Oxycodone (strongest because pain scale is high)

Symptoms associated with extravasation

Pain, swelling, erythema, and/or blistering.

Nursing assessement of anemia

Pallor, especially of the ears and nail beds, parmar crease, conjunctiva. fatigue, exercise intolerance, lethargy, othostatic hypotenstion tachycardia, heart murmmurs, HF. signs of bleeding: hematuria, melena, menorrhagia.

Cobalamin (vitamin B12) deficiency treatment of choice

Parenteral or intranasal

If Cobalamin(pernicious) deficiency is left untreated how much do patients have left to live?

Patients usually have a 10 year time frame left of life.

Who is at risk for B-12 Cobalamin deficiency?

Patients with chrons disease, IBS, vegetarian, Bypass/gastric sleeves, patients on PPI's, If you are missing Intrinsic factor you can NOT absorb B12.

What are some therapies that can be performed on patients with polycythemia vera?

Phlebotomy and if that does not work, apheresis.

The client has acute myeloid leukemia. Which most important assessment finding warrants the nurse's immediate notification of the HCP?

Platelet are 9500- they are about to die-means they are hemorrhaging

Who is at risk for iron deficiency anemia?

Pregnant women, women in their childbearing ages, vegetarians.

List four nursing interventions for care of the client with hodgkin disease.

Protect from infection Observe for anemia Encourage high nutrient foods. Provide emotional support to client and family.

Aplastic anemia is a deficiency in

RBCs, WBCs, and platelets.

What is sickle cell anemia?

Red blood cells form an abnormal crescent shape

How do you manage or treat a patient with hemophilia?

Replacement of deficient clotting factors is the primary means of supporting a patient with this disorder. Treating acute crises, replacement therapy may be given before surgery and dental care as a prophylactic measure.

Major complication of thrombocytopenia?

Risk for bleeding; hemorrhage

Third space syndrome

Shifting of fluid from vascular space to interstitial space Manifestation: Signs of hypovolemia including hypotension, tachycardia, low central venous pressure, and ↓ urine output Treatment: Replacement of fluids, electrolytes, and plasma protein

The client who received 50 ml from a unit of whole blood has new onset low back pain. What should you do first?

Signs and symptoms of transfusion reaction and stop the transfusion (Fever chills and low back pain are tell tale signs)

How do we treat iron deficiency anemia?

Start with least invasive. 1. Supplements, enteric coated (tell patient to take iron with acidic juices to better absorption. 2. Liquid supplements (must be taken with a straw because it can stain the teeth), can be taken with stool softner because can cause constipation. 3. Injections, remember to administer z trak. 4. Venofir, IV med.

What can polycythemia vera lead to

Strokes dvts pe and MI

How is B12 absorbed best?

Sublingual drops. Not absorbed well po since patients are already missing the intransic factor needed to absorb this. if sublingual does not work, use injections.

How do we know if someone has a B12 deficiency?

Sudden confusion, paresthesia (numbness/tingling) that may affect the hands and the feet. it affects the neurosystem.

What is the only definitive means of diagnosing cancer

The biopsy procedure

Adjuvant therapy

Therapy supplemental to the primary therapy

Alkylating agents used to treat Hodgkin's lymphome are associated with initiation of what disease?

This is a carcinogen associated with the initiation of acute merlogenous leukemia.

What cancer is most prevalent in woman than in men?

Thyroid cancer

Which tissue exhibits early acute responses to radiation therapy in the pelvic area?

Tissues that are actively proliferating, such as GI mucosa(esophageal and oropharyngeal mucosa, and bone marrow.

Which tissues exhibit subacute or late responses to radiation therapy?

Tissues that proliferate slowly such as, cartilage, bone, kidney, and nervous tissues.

What is the main goal of interprofessional care of iron deficiency anemia?

To treat the underlying disease that is causing reduced intake (e.g malnutrition, alcoholism) or absorption of iron.

What do you give a patient with heparin induced thrombocytopenia?

Treat with argatroban

syndrome of inappropriate ADH (SIADH)

Tumor cells can produce abnormal or sustained production of antidiuretic hormone ADH. Manifestations: Water retention and hyponatremia (hypotonic hyponatremia) Weight gain w/o edema, weakness, anorexia, nausea, vomiting, personaly changes, seizures, oliguria, decrease in reflexes and coma. Treatment: Treat underlying malignancy, take measures to correct sodium water imbalance: including fluid restriction, oral salt tablets or isotonic saline and iv 3% nacl solution. furosemide used in initial phase, monitor Na levels.

What actions should the nurse take if a hemolytic transfusion reaction occurs?

Turn off transfusion. Infuse normal saline using a new band and new tubing. Take temperature. Send blood being transfused to laboratory. Obtain urine sample. Keep vein patent with normal saline.

What factor is Type XIII hemophilia missing?

Type 8 factor.

What factor is type IX hemophilia missing?

Type 9 factor.

How is cancer radiation therapy typically delivered?

Typically delivered once a day for 5 days a week for 2 to 8 weeks

What signs can be seen on a patient with Polycythemia Vera (Red lady)

Typically look red, high blood pressure, and prone to strokes.

How do you alleviate pain in a patient with sickle cell anemia?

Typically morphine PCA pump. While patients are waiting in between pumps you do IV push meds.

list 3 interventions for clients with a tendency to bleed

Use a soft tooth brush avoid salicylates do not use suppositories

Descrive care of invasive catheters and lines

Use strict aseptic technique. change dressing two or three times per week or when soild. use caution when piggybacking drugs. Check purpose of line and drug to be infused. When possible use lines to obtain blood samples to avoid "sticking" client.

The nurse is instructing a client about skin care while receiving radiation therapy to the chest what should the nurse instruct the client to do?

Wash the area with warm (tepid) water

How are symptoms of thalassemia major managed?

With blood transfusions or exchange transfusions in conjunctions with IV deferoxamine to refuce the iron overloading that occurs with chronic transfusion therapy.

How is iron best absorbed?

With gastric acid, acidic juices.

Cancer survivors experience a variety of long-term and late sequelae following treatment, including

a greater risk of functional impairment, non-cancer-related death and co-morbidities, including heart disease, diabetes, osteoporosis, and others.

Carcinoma

a malignant tumor that occurs in epithelial tissue

Cancer cells go through stages of development. What accurately describes the stage of promotion (select all that apply)? a. obesity is an example of a promoting factor b. the stage is characterized by increased growth rate and metastasis c. withdrawal of promoting factors will reduce the risk of cancer developing d. tobacco smoke is a complete carcinogen that is capable of both initiation and promotion e. promotion is the stage of cancer development in which there is an irreversible alteration in the cell's DNA

a,c,d rationale: promoting factors such as obesity and tobacco smoke promote cancer in the promotion stage of cancer development. Eliminating risk factors can reduce the chance of cancer development as the activity of promoters is reversile in this stage.

Acute myelocytic leukemia (AML)

accounts for about 80% of the acute leukemias in adults. Its onset is often abrupt and dramatic. A patient may have serious infections and abnormal bleeding from the onset of the disease.

Write two nursing diagnoses for the client suffering from anemia

activity intolerance and inefective tissue perfusion

Manifestations of hypercalcemia include

apathy, depression, fatigue, muscle weakness, ecg changes, polyuria, nocturia, anorezia, nausea, and vomiting.

Megaloblastic anemias

are a group of disorders caused by impaired DNA synthesis and characterized by the presence of large RBCs Macrocytic rbcs are easily destroyed because they have fragile cell membrane. 2 major: Cobalamin and folic deficiency

Non-Hodgkin's lymphomas (NHLs)

are a heterogeneous group of malignant neoplasms of primarily B-, T-, or NK-cell origin, affecting all ages. A variety of clinical presentations and courses are recognized from indolent (slowly developing) to rapidly progressive disease.

Lymphomas

are malignant neoplasms originating in the bone marrow and lymphatic structures resulting in the proliferation of lymphocytes

Protooncogenes

are normal cell genes that regulate normal cell processes to keep them in their mature, functioning state.

angio

blood vessel

osteo

bone tissue

Defective cell proliferation in the process of cancer

cancer cells divide indiscriminately and haphazardly and sometimes produce more than two cells at the time of mitosis. They also lose the characteristic of contact inhibition, growing ontop and in between normal cells.

Grade X

cannot be assessed

Grade III

cells are very abnormal (severe dysplasia) and poorly differentiated (high grade)

Grade I

cells differ slightly from normal cells and are well differentiated(low grade)

What is the goal of cancer treatment?

cure, control, palliation

A patient is admitted with acute myelogenous leukemia and a history of Hodgkin's lymphoma. What is the nurse likely to find in the patient's history? a. work as a radiation chemist b. Esptein-Barr virus diagnosed in vitro c. intesnse tanning throughout lifetime d. alkylating agents for treating the Hodgkin's lymphoma

d

Alkylating agents

damage DNA by causing breaks in the double stranded helix. If repair does not occur, cells will die immediately. cell cycle phase - nonspecific agents

Two major dysfunctions in the process of cancer are

defective cell proliferation (i.e., growth) and defective cell differentiation

Differentiation

degree to which neoplastic tissue is different from parent tissue.

What foods are high on iron?

eggs, dark greens, red meat, whole wheat products, spinach, carrots.

Nurse management of patient undergoing chemotherapy and radiation

encompasses interventions to counter the effects of myelosuppression, thrombocytopenia, anemia, nausea and vomiting, anorexia, stomatitis, diarrhea and constipation, mucositis, and skin reactions encompasses interventions to counter the effects of myelosuppression, thrombocytopenia, anemia, nausea and vomiting, anorexia, stomatitis, diarrhea and constipation, mucositis, and skin reactions

squamous cell

epithelium

basal cell

epithelium (sun exposed areas)

What hormones can enhance the growth of some breast cancers?

estrogen and progesterone.

Cell cycle phase specific drugs

exert their most significant effects during specific phases of the cell cycle.

TMN classification

extent of TTTumor, degree of NNNode involvement, presence of MMMetastasis

Signs of anemia

fatigue pallor headache bone and joint pain hepatosplenomegaly

signs of infection

fever tachycardia lymphadenopathy night sweats skin infection, poor healing

fibro

fibrous

Adeno

glandular tissue

embryonal

gonads

What foods are high on folic acid?

green vegetables, liver, citrus fruits

Cell cycle phase nonspecific drugs

have their effect on the cells during all phases of the cell cycle

Rituximab side effects

headache, fever, chills, myalgias, fatigue, malaise, weakness, anorexia, naurea.

One of the risks associated with the broad and increasing use of heparin is the development of the life-threatening condition called

heparin-induced thrombocytopenia (HIT).

Hypervolemia

hypertension, elevated central venous pressure, weight gain, and shortness of breath.

Targeted therapy

interferes with cancer growth by targeting specific cell receptors and pathways that are important in tumor growth.

Carotid artery rupture

invasion of arterial wall by tumor or erosion following surgery or radiation therapy. manifestations: bleeding ranges from minor oozing to spurting of blood in the case of a blowout of artery. management: administer iv fluids and blood products. surgery: ligation of carotid artery above and below rupture site and reduction of local tumor.

Regional treatment with chemotherapy

involves the delivery of the drug directly to the tumor site. The most common methods are intraarterial, intraperitoneal, intravesical bladder, and intrathecal or intraventricular.

Anemia

is a deficiency in the number of erythrocytes (red blood cells [RBCs]), the quantity of hemoglobin, and/or the volume of packed RBCs (hematocrit). Anemia is not a specific disease; it is a manifestation of a number of pathologic processes

Aplastic anemia

is a disease in which the patient has peripheral blood pancytopenia (decrease of all blood cell types) and hypocellular bone marrow. which are usually acquired, are idiopathic and thought to have an autoimmune basis.

Sickle cell disease

is a group of inherited, autosomal recessive disorders characterized by the presence of an abnormal form of Hgb in the erythrocyte

Myelodysplastic syndrome

is a group of related hematologic disorders characterized by a change in the quantity and quality of bone marrow elements.

Hodgkin's lymphoma

is a malignant condition characterized by proliferation of abnormal giant, multinucleated cells, called Reed-Sternberg cells, which are located in lymph nodes.

Thrombocytopenia

is a reduction of platelets below 150,000/μL

Disseminated intravascular coagulation

is a serious bleeding and thrombotic disorder. It results from abnormally initiated and accelerated clotting. Decrease in clotting factors and platelets.

Hemophilia

is a sex-linked recessive genetic disorder caused by defective or deficient coagulation factor. The two major forms of hemophilia, which can occur in mild to severe forms, are hemophilia A and hemophilia B Bleeding disorder(free bleeding)

Syngeneic transplantation

is a type of allogeneic transplant that involves obtaining stem cells from one identical twin and infusing them into the other

Hemochromatosis

is an autosomal recessive disease characterized by increased intestinal iron absorption and, as a result, increased tissue iron deposition. The goal of treatment is to remove excess iron from the body and minimize any symptoms the patient may have

The staging classification system of tumors

is based on a description of the extent of the disease rather than on cell appearance. Assignment is completed after the diagnostic workup and determines treatment options

Chronic myelogenous leukemia (CML)

is caused by excessive development of mature neoplastic granulocytes in the bone marrow, which move into the peripheral blood in massive numbers and ultimately infiltrate the liver and spleen. Chronic stage lasts 3 years acute phase tends to last 2-3 months. Occurs in yound middle aged adults. Known causes include: Ionizing radiation, and chemical exposure. 5 year survival rate of 37% treatment: Oral antineoplastic agents: Hydroxyurea, interferon, imatinib mesylate targeted therapy if cells are philadelphia chromosone positive.

Chronic lymphocytic leukemia (CLL)

is characterized by the production and accumulation of functionally inactive but long-lived, small, mature-appearing lymphocytes. The lymphocytes infiltrate the bone marrow, spleen, and liver, and lymph node enlargement is present throughout the body. occurs after the age of 35, often in older adults. 5 year survival rate 73% overall. Most clients are asymptomatic and are not treated.

Interprofessional care for a patient with sickle cell disease

is directed toward alleviating the symptoms from the complications of the disease and minimizing end target-organ damage.

Myelosuppression

is one of the most common effects of chemotherapy and, to a lesser extent, with radiation. It can result in life-threatening effects, including infection and hemorrhage.

Teletherapy or external beam radiation (EBRT)

is the most common form of radiation treatment delivery and involves the delivery of ionizing radiation to kill cancer cells. With this technique, the patient is exposed to radiation (typically high energy photons) generated from a megavoltage treatment machine.

Polycythemia

is the production and presence of increased numbers of RBCs. The increase in RBCs can be so great that blood circulation is impaired as a result of the increased blood viscosity and volume.

Major pathophysiologic event of sickle cell disorder

is the sickling of RBCs. Sickling episodes are most commonly triggered by low oxygen tension in the blood.

Patients need to be prepared with a conditioning regimen prior to stem cell transplantation. What is critical for a patient to do?

it is critical for the patient to be protected from exposure to infectious agents and supported with electrolyte supplements, nutrition, and blood component transfusions.

The intestinal mucosa in patients undergoing radiation and chemotherapy

it is one of the most sensitive tissues to radiation and chemotherapy. These injuries result in diarrhea, mucositis, anorexia, nausea, and vomiting.

Cancer with the highest death rate among women is

lung cancer

lympho

lymphoid tissue

Leukemia

malignant disorders affecting the blood and blood-forming tissues of the bone marrow, lymph system, and spleen.

Sarcoma

malignant tumor of connective tissue

Iron-deficiency anemia

may develop from inadequate dietary intake, malabsorption, blood loss, or hemolysis. Also, pregnancy contributes to iron deficiency because of the diversion of iron to the fetus for erythropoiesis, blood loss at delivery, and lactation.

antineoplastic drugs

medication that blocks the development, growth, or proliferation of malignant cells

What group has the highest prevalence of myelodysplastic syndrome?

men over 80 years of age

myo

muscle tissue

What is the treatment for neutreopenia

neupogen filgastrium

DIfferent symptoms of leukemia

night sweats, wounds that don't heal, weight loss, fever, etc

What is the priority in pain management?

obtain a comprehensive history of the patients pain.

Hypercalcemia

occurs in metastatic disease of bone or multiple myeloma, or when a PTH like substance is secreted by cancer cells. manifestations: calcium in excess of 12 mg/dL (3mmol/L) apathy, depression, fatigue, muscle weakness, ECG changes, polyuria, nocturia, anorexia, nausea, vomiting treatment: hydration (3L/day) and biphosphonate therapy. diuretics(particularly loop diuretics) used to prevent heart failure or edema. infusion of bisphosphonate zoledronate or pamidironate.

Aplastic anemia management

on identifying and removing the causative agent (when possible) and providing supportive care until the pancytopenia reverses Immune therapies and bone marrow transplantation can be curative.

Brachytherapy

or internal radiation treatment, consists of the implantation or insertion of radioactive materials directly into the tumor/involved tissues (interstitial) or in close proximity adjacent to the tumor (intracavitary or intraluminal). implants may be permanently placed (radioactive seeds or mesh)

Multiple myeloma

or plasma cell myeloma, is a condition in which neoplastic plasma cells infiltrate the bone marrow and destroy bone. (too much plasma cell) Uric acid builds up.

Mutations in what gene cane be found in bladder, breast, colorectal, esophageal, liber, lung and ovarian cancers?

p53

autologous transplantation,

patients receive their own stem cells back following myeloablative (destroying bone marrow) chemotherapy

signs a patient has a tendancy to bleed

petechiae nose bleeds bleeding gums ecchymoses nonhealing skin abrasions

melano

pigmented cells of epithelium

allogeneic transplantation

stem cells are acquired from a donor who has been determined to be human leukocyte antigen (HLA)-matched to the recipient

The cancer survivor is at risk for developing secondary malignancies,

such as leukemia, angiosarcoma, and skin cancer. due to late effects of radiation and chemotherapy.

Oncologic emergencies can result from the cancer or cancer treatment. List some of these emergencies

superior vena cava syndrome, spinal cord compression, syndrome of inappropriate antidiuretic hormone secretion, hypercalcemia, tumor lysis syndrome, disseminated intravascular coagulopathy, and cardiac tamponade.

Chemotherapy-induced side effects are the result of

the destruction of normal cells, especially those that are rapidly proliferating such as those in the bone marrow, lining of the gastrointestinal system, and the integumentary system (skin, hair, and nails).

Anatomic classification of tumors

the tumor is identified by the tissue of origin, the anatomic site, and the behavior of the tumor (i.e., benign or malignant

3 types of thrombocytopenia

thrombocytopenia, heparin induced thrombocytopenia, immune thrombocytopenia (affects women and children)

Folic acid (folate) deficiency treatment

treated by replacement therapy Can lead to megaloblastic anemia. (Folic acid is required for DNA synthesis leading to RBC formation and maturation.)

oncogenes

tumor inducing genes

etiologic

underlying cause

The most effective method of administering a chemoptherapy agent that is a vesicant is to

use a central venous access device.

Immunotherapy

uses the immune system, the body's main defense against infection and disease, to fight cancer. Some types of immunotherapy are called biologic therapy. Immunotherapy can (1) boost or manipulate the immune system and create an environment that is not conducive for cancer cells to grow or (2) attack cancer cells directly.