NUR 426 Exam 1: Hematology, Respiratory & Cancer Medications PDF

NUR 426 Exam 1 Exam 1 will cover course content from Module 1 (DIC, Hematologic Drugs), Module 2 (Sickle Cell, Hemophilia, and Blood Products), and Module 3 (Asthma across the Lifespan, Cystic Fibrosis, Respiratory Drugs) and Module 4 (Cancers, Chemotherapy/Radiation) To guide your studying, revie...

NUR 426 Exam 1 Exam 1 will cover course content from Module 1 (DIC, Hematologic Drugs), Module 2 (Sickle Cell, Hemophilia, and Blood Products), and Module 3 (Asthma across the Lifespan, Cystic Fibrosis, Respiratory Drugs) and Module 4 (Cancers, Chemotherapy/Radiation) To guide your studying, review the learning outcomes for each module (listed in italics below each section). Questions include multiple choice, select all that apply, and alternative formats along with 2 Next Gen case studies. There is a practice quiz to test your Respondus Lockdown Browser available in the practice quizzes section Terms to Know Fibrinolysis- physiological process that Priapism- prolonged erection that lasts for involves the breakdown of fibrin, a protein more than 4 hours and is not associated w that forms blood clots sexual stimulation Petechiae- tiny, pinpoint-sized red or purple Steatorrhea- condition characterized by spots that appear on the skin due to bleeding the presence of excessive fat in the stool under the surface Dactylitis- medical condition that causes Azotorrhea- condition characterized by inflammation of the fingers or toes, excessive excretion of nitrogenous resulting in swelling, pain, and redness Vesicant- chemical agent that causes Myelosuppression- a condition where the blistering of the skin and mucous bone marrow, the tissue responsible for membranes producing blood cells, does not produce enough blood cells Epistaxis- a condition where blood flows Hemarthrosis- a condition where blood from the nose accumulates in the joint cavity, causing pain, swelling, and limited mobility. Proliferation- rapid increase in Dysplasia- abnormal growth and something/numbers development of cells in a tissue or organ Orthopnea- shortness of breath or Azotemia- condition where there are difficulty breathing when lying down elevated levels of nitrogenous waste products in the blood You should know the significance of the following (why would it be high vs low), but do not need to memorize normal ranges ​ The concept of “therapeutic ranges” (pertaining to PT/INR, aPTT, PTT) ​ PT/INR: -​ Inc: blood is clotting more slowly than normal -​ Dec: blood is clotting too quickly- risk of blood clots ​ aPTT/PTT: -​ Inc: blood is taking longer than normal to clot- signify bleeding disorder, liver disease, deficiency in certain clotting factors -​ Dec: blood is clotting faster than normal- inc risk of blood clots, lead to MI or stroke ​ Fibrinogen -​ Inc: higher risk of blood clots- infection, inflammation, cancer, RA, NS, MI, stroke, pregnancy, stress, inc cortisol levels, tobacco -​ Dec: hypofibrinogenemia, which means your blood has a reduced ability to clot ​ Clotting factors -​ Inc: disorder that causes excessive blood clotting- hypercoagulation -​ Dec: blood doesn’t clot as effectively- leads to excessive bleeding ​ D-dimer -​ Inc: there is a likely inc breakdown of blood clots in the body, suggesting potential clotting disorder or pregnancy, recent surgery, trauma, or inflammation -​ Dec: indicates you don’t have a clotting disorder. This substance is only released when a blood clot breaks down. ​ Platelet count -​ Inc: risk of forming blood clots due to excessive presence- thrombocytosis. Can be caused by infections, recent surgery, certain meds, bone marrow disorders, cancer -​ Dec: thrombocytopenia- bruise or bleed more easily than usual due to dec ability to stop bleeding from cuts or injuries- bruising, nosebleeds, bleeding gums ​ RBCs -​ Inc: due to health conditions like polycythemia vera, heart disease, lung disease, kidney disease, sleep apnea, blood cancers, dehydration, cigarette smoking, living at high altitudes -​ Dec: anemia- body does not have enough RBCs to carry oxygen to your organs and tissues- causing fatigue, weakness. Can be caused by meds, cancer, vit deficiency, malnutrition, kidney disease, internal bleeding, bone marrow failure, thalassemia ​ Hemoglobin -​ Inc: indicates an increased concentration of oxygen=carrying proteins in the blood. Can be caused by dehydration, high altitudes, smoking, intense exercise, COPD, heart disease, sleep apnea, kidney disease -​ Dec: anemia- RBCs are not healthy enough or hemoglobin too. Causes fatigue, weakness, SOB, pale skin. Caused by cancers, bleeding, diseases, chemo, nutrient deficiencies ​ Hematocrit -​ Inc: Higher proportion of red blood cells in the blood. Can be caused by polycythemia, CKD, dehydration, high altitude  -​ Dec: anemia- body doesn't have enough RBCs to carry O2 effectively causing fatigue, SOB, weakness. Can be caused by blood loss due to injury/heavy menstruation, nutritional deficiencies, bone marrow disorders, chronic diseases, meds. ​ WBCs -​ Inc: body is fighting an infection or inflammation- causes include infection, inflammation, meds, stress, pregnancy, smoking, tissue damage, cancer, bone marrow disease -​ Dec: lower # in the bloodstream. Due to infections, bone marrow disorders, autoimmune diseases, meds nutritional deficiencies, stress. ​ ANC (Absolute Neutrophil Count) -​ Inc: “neutrophilia”- body is producing too many neutrophils. Caused by infxns like epstein barr virus or pneumococcal infxns, inflammatory conditions, injuries like bone fractures or burns, corticosteroids and lithium, autoimmune disorders, stress, smoking, pregnancy. -​ Dec: “neutropenia”- body has a harder time fighting off infections bc neutrophils are the primary immune cells that attack bacteria. Caused by cancer tx, viral infxn, autoimmune diseases, nutritional deficiences, bone marrow disorders. The following medications could be tested on this exam. You should know the medication’s indications, side effects, and nursing considerations when administering these: ​ Factor 8- already addressed ​ Hydroxyurea -​ Antineoplastic drug -​ Inhibits DNA synthesis without interfering w RNA protein synthesis, causing direct damage to DNA strands -​ Used for melanoma, chronic myelogenous leukemia, recurrent or metastatic ovarian cancer, squamous cell carcinoma of head and neck, sickle cell anemia -​ Contraindicated w preg/bf, hypersensitivity, leukopenia, thrombocytopenia, anemia -​ Cautious w renal disease, anemia, bone marrow suppression, dental disease, geriatric, HIV, hyperkalemia, hyperphosphatemia, hyperuricemia, hypocalcemia, infection, infertility, IM injection, tumor lysis syndrome, vaccinations -​ Given PO and dosing is based on dx -​ Monitor for HA, confusion, seizures, hallucinations, dizziness, angina, ischemia, N/V/D, anorexia, constipation, stomatitis, hepatotoxicity, pancreatitis, inc BUN/uric acid/creatinine, leukopenia, anemia, thrombocytopenia, rash, urticaria, pruritus, dry skin, facial edema, secondary cancers, pulm fibrosis -​ Interacts w radiation or other antineoplastic meds, NSAIDS, anticoags, thrombolytics, salicylates, platelet inhibitors, probenecid, didanosine -​ Assess renal studies, bleeding, temp, I/O’s, skin, oral cavity, pulmonary rxns, allergic rxn -​ Report signs of infection, anemia, bleeding, avoid use of aspirin products, avoid foods w citric acid, report stomatitis, if planning to receive vaccinations, wash hands and wear gloves when handling capsules. ​ Desmopressin- already addressed ​ Aspirin ​ Ibuprofen -​ NSAID -​ Used for inflammatory disorders, rheumatoid arthritis, osteoarthritis, primary dysmenorrhea, dental pain, musculoskeletal disorders, fever, migraine, patent ductus arteriosus, HA -​ Contraindicated w pregnancy 3rd trimester, hypersensitivity, asthma, severe renal/hepatic disease, severe HF, active GI ulcer, IBD, risk of bleeding -​ Cautious w 1st & 2nd trimester pregnancy, bf, peds, geriatrics, bleeding disorders, GI disorders, renal disorders, cardiac disorders -​ Given PO (w food/drink to dec GI sx), IV (make sure pt is hydrated) -​ Complications- HA, dizzy, drowsy, fatigue, dysrhythmias, CV thrombotic events, MI, stroke, HF, GI bleeding, ulceration, necrotizing enterocolitis, GI perforation, blood dyscrasias, necrotizing fascitis, hypoglycemia, anaphylaxis, steven john syndrome -​ Interacts w ACEIs, ARBs, valproic acid, thrombolytics, antiplatelets, anticoags, salicylates, SSRIs, antineoplastics, radiation, lithium, methotrexate, aspirin, corticosteroids, NSAIDS, alcohol, tobacco, thiazides, furosemides, feverfew, fish oil, ginger, garlic, ginkgo, ginseng, horse chestnut, red clover -​ Assess renal, hepatic, blood studies, cardiac status, plain, PDA closure, dysmenorrhea, infection, skin, pregnancy -​ Edu pt to use sunscreen/protective clothing, report sx, avoid driving/hazardous activities, changes in urinary pattern, notify if preg/bf ​ Celecoxib -​ Nonsteroidal anti-inflammatory drug -​ Used for acute, chronic rheumatoid arthritis, osteoarthritis, acute pain, primary dysmenorrhea, acute migraine -​ Contraindicated w preg, hypersensitivity to salicylates, iodides, NSAIDS, sulfonamides, perioperative pain in CABG -​ Cautious w bf, too much unnecessary fibrin production happening all over the body -> uses up clotting factors for fibrin that the body didn’t need -> now we don’t have fibrin for the clots we do need -> lots of unnecessary blots and risk of bleeding 3.​ Prioritize clinical manifestations of DIC risks/causes for DIC: -​ Shock -​ Septicemia -​ Hemolytic processes -​ Obstetric conditions -​ Tissue damage -​ Malignancies -​ Chronic conditions -​ Misc- transplant rejection, postop complications Sx related to bleeding: -​ Oozing blood, venipuncture site bleeding, hematoma/petechiae, purpura, occult hemorrhage, pallor -​ Tachypnea, hemoptysis and HOTN -​ Tachycardia and HTN -​ Upper and lower GI bleeding, abd distention, bloody stool -​ Hematuria  -​ Vision changes, dizzy, HA, changes in mental status, irritability -​ Bone and joint pain Sx related to thrombosis: -​ Cyanosis, ischemic tissue necrosis (gangrene), hemorrhagic necrosis -​ Tachypnea, dyspnea, pulm emboli, acute resp distress syndrome -​ ECG changes, venous distention -​ Abd pain, paralytic ileus -​ Kidney damage and oliguria -> failure 4.​ Differentiate between priority collaborative interventions for DIC *can include drugs from Pharmacology Made Easy module. -​ Get labs- platelets will be low, fibrinogen will be low, bleeding/coagulation times will be prolonged, D-dimer will be high due to clot breakdown, and there will be fragmented red cells (schistocytes) Nursing care: -​ Early recognition of bleeding- assess skin color, circulation, cap refill -​ Inspect skin, mucus membranes, puncture sites for signs of bleeding ​ External- petechiae, oozing at IV/injection site ​ Internal- inc HR, change in mental status, inc abd girth, pain ​ Recognize signs of microthrombi that may be causing organ damage -​ Semi fowlers to inc chest expansion -​ Monitor lab values -​ Monitor fluid status, I&O -​ Proper admin of prescribed therapies- admin blood products and meds promptly/correctly Collaborative care: -​ Assess s/sx hemorrhange and hypovolemic shock -​ Stabilize w O2, monitor SaO2 and ABGs for hypoxemia or signs of distress -​ Treat underlying cause -​ Continue to control thrombosis and bleeding -​ Tx dictated by severity and sx ***if pt not bleeding, treat underlying condition, NOT the DIC ***if pt is bleeding, blood products needed in addition to treating the cause Blood products for pts bleeding or at risk: -​ FFP replaces all clotting factors (NOT platelets) and provides a source of antithrombin -​ Cryoprecipate replaces factor VIII and fibrinogen