Test One Review Sheet - Oncology, Hematology, Renal PDF

# Test one review sheet ## Oncology - 7 warning signs of cancer 1. changes in bowel/bladder habits 2. sore throat that doesn't heal 3. unusual bleeding/discharge 4. thickening/lump in the breast/elsewhere 5. indigestion/difficulty swallowing 6. obvious change in a wart or mol...

# Test one review sheet ## Oncology - 7 warning signs of cancer 1. changes in bowel/bladder habits 2. sore throat that doesn't heal 3. unusual bleeding/discharge 4. thickening/lump in the breast/elsewhere 5. indigestion/difficulty swallowing 6. obvious change in a wart or mole 7. nagging cough or hoarseness 8. unexplained weight loss 9. pernicious anemia ## Risk factors for colon cancer - red meat - sedentary lifestyle - alcohol - processed foods - age 50+ - family hx - obesity - smoking - low vitamin D - inflammatory disease ## Differentiate between hospice and palliative care - **Palliative care:** manage symptoms, psychological and spiritual care - **Hospice:** < 6 months to live, pain/symptom management - no life sustaining fluids, blood, lab testing ## Side effects of chemo and interventions - mucositio/stomatitis - oral hygiene - no acidic foods - alopecia - anemia/pancytopenia - bleeding precautions - neutropenic - infertility/sexual alterations - psychological support - anorexia: n/v - hydration - Zofran - neuropathy - fall precautions - diarrhea - hydration ## What does extravasation mean and tx - Leakage of fluid (chemo drug) from a blood vessel into surrounding tissue - S+S - absence of blood return from IV cath. - resistance to flow of IV fluid - burning, pain, edema, or redness at site - tx - 1st action=Stop infusion - aspirate any remaining drug from site - cold/warm compress - antidotes ## Tumor lysis syndrome - Large # of cancer cells rapidly breaking down and release contents into bloodstream - + sign that cancer tx is effective - Causes hyperkalemia and hyperuricemia - tx - 3L of fluid/day - diuretics + dialysis - allopurinol (for hyperuricemia) - polystyrene sulfonate PO/IV - glucose and insulin IV (insulin pushes K+ back into cell, glucose for hypoglycemia) ## Interventions for immunocompromised pts - Neutropenic precautions - don't go to work sick - no flowers - no raw fruits/veggies/meat - surgical mask - hand hygiene - Care of pt w/ bone marrow biopsy - explain procedure and signed consent - sterile procedure and side lying - monitor for bleeding and infection - warm tub baths and mild analgesics for pain (NO ASPIRIN) - limit activity - Care of pt w/ bone marrow transplant - used to tx several malignant/non malignant diseases - monitor for 3 of: - infection (pneumonia specifically) - resp distress - psychological distress - needs to be an exact match - r/f rejection - pt will be on immunosuppressants - **Care of pt w leukemia** - Overproduction of immature/non functioning WBC - pancytopenia - Neutropenic precautions - bleeding precautions - **No rectal temps** - **Limit visitors** - prophylactic abx - private room - **No live vaccine for 2 years for pt + household** ## Electric razor - Soft bristle toothbrush - HIV/IM only when needed - Prevent infection! - Abx - Antifungal - antiviral Cototoxicity + nephrotoxicity - Drug therapy - Induction therapy-combo chemo for rapid + complete remission - Consolidation therapy - hematopoietic stem cell transplant (chronic leukemia) - Maintenance- oral drugs for 2-5 years (chronic leukemia) - What is ANC? - Indication of how immunocomp a pt is - Bone marrow is not producing WBC. - Range = 2,500-7,000 - Level of 500 or below HOLD CHEMO/PROCEDURE - Difference between Hodgkin's and non-hodgkin's lymphoma - Hodgkin's lymphoma: lymph nodes containing reed-sternberg cells - large but painless lymph nodes - not hard - cervical nodes often affected first - usually one unilateral node supraclavicular - non-hodgkins lymphoma: all lymphoid cancers that do not have reed stemberg cells - incidence increases w/ age - enlarged painless lymph nodes can arise from lymphoid cells in any tissue (lymph nodes anywhere in body) - BRCA 1 and 2 positive pt-what are tx options? - Long term surveillance focuses on early detection - Prophylactic mastectomy - Can also get an oophrectomy (ovaries-block of estrogen) - Superior vena cava syndrome - occurs when the SVC is compressed/obstructed by tumor growth - causes = lung and head/neck (lymphoma) - manifestations - facial edema - Stone's sign (tight shirt) - engorged blood vessels - JVD - erythema/edema of upper body - dyspnea - epistaxis - hemorrhage - cyanosis - LOC - hypotension - CO - Radiation therapies - Sealed radiation therapy - type of brachytherapy- radiation is placed in one specific area in a form of an implant - patient IS radioactive but not excreta (not excreted in stool and urine) - Safety - 6 feet away for 30 min. (visitors) - private room - private room/bathroom - no pregnant wonmen/children 16 and under - wear a badge showing amount of radiation exposed - unsealed = you digest, systemic effects (radioactive) - safety if an implant becomes dislodged - DO NOT TOUCH - use long forceps to remove and place in designated lead container - Contact radiation therapy - Adverse effects of radiation - Systemic - fatigue - malaise - anorexia - Bone marrow - thrombocytopenia - anemia - leukopenia - Skin integrity - alopecia (only w/ whole brain radiation) - dermatitis - Oral mucosa - stomatitis - xerostomia - mucositis - Monitor: - nutrition - altered taste - **Positioning for pneumonectomy:** lateral decubitis (side lying) w/ remaining lung on top ## Hematology - Iron deficiency anemia - Microcytic (↓ MCV, pale MCH) - Causes: - diet - blood loss - alcoholism - aspirin, steroids, NSAIDS - gastrectomy - bariatric surgery - Manifestations: - lethargy/dizzy/irritability - SOB - murmur - pallor - Management: - increase oral intake - red meat - egg yolks - leafy greens - iron Supplements - empty stomach - take w/ vitamin C - high fiber diet - straw w/ liquid iron - B12 deficiency/folic acid - Macrocytic (↑ MCV, red MCH) + megoblastic - Symptoms: - spoon/brittle nails - cold sensitivity - pica - restless leg syndrome - Long term confusion - parasthesia - fall risu - red beefy tongue - Causes: - lack of intrinsic factor (genetic or surgery) - diet - poor absorption of B12 - meds = histamine blockers, PPI, metformin - tx - lifelong - injections (IM) once a month ## Sickle cell - Prevention: - avoid sick contacts - avoid extreme temps/altitudes - hydration - avoid stress - keep up wi immunizations - Causes=any stressor on body^^ - Management - MANAGE PAIN FIRST - hydrate - oxygen - experience CV/resp sx - Pharm therapy - hydroxyurea= reduces # of sickling and pain by stimulating HbF - monitor CBC and Cl in anyone likely to be pregnant - RBC transfusion - iron overload risu ## Autoimmune hemolytic anemias tx - Steroids (first line) - Autoimmune suppressants - immunoglobulin (ITP) - can't give platelet transfusions-will just get destroyed ## Thrombocytopenia - <150,000 platelets - Causes: - inherited (ITP) - acquired - antiplateleto - chemo - anti seizure meds - alcohol - baspartame - Symptoms: - petechiae - purpura - ecchymosis - nosebleeds - prolonged bleeding - anemia d - tx - transfusion (given over 18-30 minutes) - monitor labo - IV immunoglobulin - corticosteroids - plasma infusion - *avoid valsalva maneuver* - *gently blow nose* - *bleeding precaution* - Therapeutic phlebotomy - performed when Hct/Hgb is significantly elevated - most commonly done for excess iron-r/f liver cirrhosis - care management for polycythemia - usually take out 1-2L of blood - Blood transfusion - pretransfusion - crossmatch blood - assess lab values - Written informed consent (witness) - IV access (20 gauge needle) - prime line/infuse blood w/ ONLY NS - safety checks w/ two nurses - baseline VS - Massive blood transfusion = blood warmer - Intraprocedure: - stay w/ pt for first 15-30 min. - VS q15min for first hour then every hour - transfuses over 4 hours max - must transfuse w/in 30 min. of leaving bank - Reactions: - STOP INFUSION W/ ANY REACTION - febrile - most common - fever - chills - tachycardia - Hypotension - Tachypnea - Hemolytic - most dangerous - low flank pain★ - fever/chills - Allergic - urticaria - itching - bronchospasm/anaphylaxis - Bacterial - tachycardia - hypotension/shock - fever/chills - Circulatory overload - infused too quickly - H&H - bounding pulse - JVD - dyspnea - restlessness - confusion - TRALI - sudden resp. distress - Interventions: - stop - hydrate w/ NS (new line) - notify HCP + blood bank - blood/UA - admin EM - headache - apprehension - impending doom - Slow infusion rate - if mild, stop if severe - O2, diuretics, morphine ## Renal - Labs to monitor renal function - specific gravity (1.003-1.050) - low gravity (<1.003)=over hydrated - low = liquidity - ex: SIADH - high gravity (>1.030)=dehydrated - ex: DI - 24 hr urine test - 24 hour urine collection - Avoid first pee - measures protein, creatinine, hormones, minerals, etc - keep sign in bathroom to remind testing - may need to be on or off ice (order) - Creatinine - level over 1.3= bad kidney - Higher or levels=higher renal impairment - A waste product of muscle use - BUN - 10-20 MAX - a byproduct of protein waste - eFR - 90 mL/min=normal - UTI - symptoms - elderly=confusion★ - burning - nocturia - incontinence - suprapubic/pelvic/back pain - hematuria - Prevention: - pee before/after sex - cotton undergarments - no restrictive/wet clothing - wipe front to back - no scented products - void q2-3h - avoid UTI imitants (coffee,alk) - increase fluid intake - showers over baths - Treatment: - Uncomplicated: no comorbidities abx for 3 days (high dose) - trimethoprim/sulfamethoxazole/fluoroquinolone - Complicated: comorbities or male or recurrent - 7-10 day abx - analgesics - phenazopyridine - urine/tears will turn red/orange - antispasmodics - urinary antiseptics - Epididymitis - infection of epididymis-spreads from infected urethra, bladder, or prostate - complication of STD - Symptoms - low grade fever/chills - heaviness in effected testicle - edema - Management - abx - S/O-partner also receives abx - elevate scrotum - ice - avoid sex/strain - TURP (transurethral resection) - relieve urinary retention/frequency r/t BPH/cancer - Preop: - monitor CBC (clotting factors) - Postop: - IDC in place - monitor VO - catheter in place - monitor for bleeding/clots - sudden ↓ in UO - continuous bladder irrigation - normal to be blood tinged - monitor for infection - Pyelonephritis - upper UTI - r/f - recurrent UTI - pregnancy - immunosuppression - kidney stones - ecoli - young women/older men - Symptoms: - fatigue - headache - polyuria - weight loss/anorexia - tx: - pain management - 2 week oral abx - IV abx - perineal hygiene - Chronic prostatitis - bacterial infection causing acute inflammation of prostate gland - Symptoms: - chronic = no sx - fever - chills - dysuria - frequency/urgency - hesitancy - boggy, tender prostate (smooth-not walnut) - N/V - tx - anti inflammatory drugs - 2 week abx = acute - 4-12 weeks = chronic - sex, prostate massage - noninfectious=hytrin/cardura (alpha blockers)+tamsulosin (flomax) - Diagnostic testing - imaging assessment - consent needed - assess for allergies-iodine, shellfish, eggs, milk, chocolate - NPO - bowel prep - precaution of contrast induced kidney failure - discontinue metformin 24 hours bf procedure and 48 hours after-risk of lactic acidosis - Procedure - IV dye may feel warm/flushed feeling-may feel like their peeing - Follow up - dye may be nephrotoxic-monitor BUN/Cr/eFR - hydration - Nephrolithiasis - renal stones - Manifestations: - pain - knife like - hematuria - flank pain-radiate to groin - dysuria/frequency - r/f - infection - urinary retention - immobility - dehydration - ↑ uric acid - ↑ urinary oxalate - Treatment: - 8L of fluid a day - analgesics - Strain stones - protein restriction - no bed rest-ambulate - DONT massage - Manage to prevent complication - HTN (end stage kidney failure) - hyponatremia/hyperkalemia - nocturia - acidosis