o Recovery phase of acute renal failure*
QUESTION
Hypovolemia s\/s
Answer:
o Abdominal distention.
o Fever
o Confusion, restlessness.
o Dark concentrated urine.
o Decreased urine volume.
o Decreased central venous pressure.
o Flattened neck veins.
o Hypotension.
o Pale, moist, clammy skin.
o Tachycardia.
o Tachypnea.
o Weak pulses.
QUESTION
Hyperkalemia
Answer:
is defined as serum potassium level above 5.0 mEq\/L.
QUESTION
Hyperkalemia cause
Answer:
o Renal disease
o Renal failure
o Treatment side effects (NSAIDs,diuretics, and massive transfusion with banked blood)
o Metabolic acidosis
o Ketoacidosis
o Burns
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<\/a><\/figure>\n\n\n\nBenign cells
Normal cells growing in the wrong place or at the wrong time<\/p>\n\n\n\n
Benign Cell Features
o Harmless
o Do not usually require intervention
o Slow growing
o Tight Adherence
o Specific morphology
o Small nuclear-to-cytoplasmic ratio
o Specific differentiated functions
o Tight adherence
o Orderly growth
o No migration
o Normal chromosomes<\/p>\n\n\n\n
Benign cell looks similar to a
healthy cell<\/p>\n\n\n\n
Examples of Benign cells
o Skin Tag
o Mole
o Nasal Polyp
o Uterine Fibroids
o Endometriosis<\/p>\n\n\n\n
Malignant cells
indicates cancer and can be harmful to normal body tissues and result in death<\/p>\n\n\n\n
Malignant cell features
o Large nucleus
o Migration
o Doesn’t stop and replicates (No contact inhibition)
o Loose adherence
o Rapid or continuous cell division
o Loss of cellular regulation
o Abnormal chromosomes (< or > 23)<\/p>\n\n\n\n
Seven warning signs of cancer
o C-Change in bowel or bladder patterns
o A-A sore that doesn’t heal
o U-Unusual bleeding or d\/c
o. T-Thickening or lump on breast or elsewhere
o I-Indigestion or difficulty swallowing
o O-Obvious change in wart or mole
o N-Nagging cough or hoarseness<\/p>\n\n\n\n
Cancer development stages of malignancy
o Initiation
o Promotion
o Progression
o Metastasis<\/p>\n\n\n\n
Initiation (Stage of malignancy)
Normal cells are damaged and irreversible<\/p>\n\n\n\n
Promotion
Repeated exposure>Enhances growth of malignant cells<\/p>\n\n\n\n
Progression
Increase in production of malignant cells<\/p>\n\n\n\n
Metastasis
Cells move from primary site to the rest of the body<\/p>\n\n\n\n
Carcinogenesis\/oncogenesis
cancer development<\/p>\n\n\n\n
Cancer classification
o Grading
o Ploidy
o Staging
o TNM
o Doubling time and mitotic index<\/p>\n\n\n\n
Grading
Looking under microscope and determine level\/degree of mutation of cancer cell from normal cells
o Ex. 1= No mutation
o 4= Severe mutation<\/p>\n\n\n\n
Ploidy
Number of chromosomes<\/p>\n\n\n\n
Staging
How large is the primary tumor and how far has it spread<\/p>\n\n\n\n
TNM
o T-Tumor (How large is primary or 2nd)
o N- Node (Are regional lymph nodes invaded by cancer cell)
o M-Metastasis (0=None, 1=There is metastasis)<\/p>\n\n\n\n
Doubling time and mitotic index
Period of time required for that quantity to double in size (Tells how aggressive cancer grows)
o Stage 1=Localized
o Stage 4= Spread across the body<\/p>\n\n\n\n
Cancer prevention primary
o Sunscreen
o Avoid smoking
o Removal of “at risk” tissue (mole)
o Chemoprevention
o Vaccine (HPV)<\/p>\n\n\n\n
Cancer prevention secondary
o Mammogram
o Pap smear
o Prostate test<\/p>\n\n\n\n
Cancer prevention tertiary
People who are already affected and getting treatment (examples below)
o Chemo
o Radiation
o Surgery, etc.<\/p>\n\n\n\n
Types of cancers
carcinoma, sarcoma, melanoma, lymphoma, leukemia, blastoma<\/p>\n\n\n\n
Carcinoma
malignant tumors of glandular (lining) tissues<\/p>\n\n\n\n
Sarcoma
malignant tumor of connective (bone) tissues<\/p>\n\n\n\n
Melanoma
pigment producing skin cancer<\/p>\n\n\n\n
Lymphoma
malignant tumor of lymphoid tissue<\/p>\n\n\n\n
Leukemia
white blood cell tumor<\/p>\n\n\n\n
Blastoma
malignant tumors of less differentiated, embryonal tissue<\/p>\n\n\n\n
Lab Diagnostic Tests
o CBC
o Blood protein testing
o Tumor marker test
o Circulation tumor cell tests<\/p>\n\n\n\n
Imaging Diagnostic Tests
o CT Scans
o MRI
o X-ray
o Ultrasound
o Mammogram
o Nuclear medicine scans<\/p>\n\n\n\n
Endoscopy Diagnostic Tests
o Bronchoscopy
o Colonoscopy
o Cystoscopy
o Laparoscopy
o Laryngoscopy
o Mediastinoscopy
o Thoracoscopy
o Upper Endoscopy<\/p>\n\n\n\n
Biopsy Diagnostic Tests
o Breast biopsy
o Bone marrow biopsy
o Organ\/tissue specific<\/p>\n\n\n\n
Risk factors
o Older age.
o A personal or family history of cancer.
o Using tobacco.
o Obesity.
o Alcohol.
o Some types of viral infections(HPV)
o Specific chemicals.
o Exposure to radiation, including ultraviolet radiation from the sun.
o Alcohol<\/p>\n\n\n\n
Types of therapy
surgery,
radiation,
chemotherapy,
radiation therapy,
immune therapy,
photodynamic therapy
hormonal therapy<\/p>\n\n\n\n
Surgery
cells can escape during surgery sometimes, causing clients to have to deal with an altered appearance<\/p>\n\n\n\n
Radiation
Destroy cancer cells with minimal damaging effects of surrounding normal cells; maintain safe environment<\/p>\n\n\n\n
Chemotherapy
Treatment of cancer with chemical agents. Used to cure and increase survival time.<\/p>\n\n\n\n
Adjuvant therapy
= Chemotherapy + surgery or radiation. Cytotoxic effects exerted on healthy cells and cancer cells<\/p>\n\n\n\n
Immunotherapy (biological response modifiers and targeted therapy)
-Modify patient’s biologic responses to tumor cells. Can have direct antitumor activity.<\/p>\n\n\n\n
- \n
- Can interfere with cancer cell differentiation, transformation, metastasis.
-Can improve immune function<\/li>\n<\/ul>\n\n\n\nMonoclonal antibodies(immunotherapy)
Bind to target antigens (often specific cell surface membrane proteins)
Prevents protein from functioning,<\/p>\n\n\n\n- \n
- prevents cell division. E.g- Rituximab (Rituxan)<\/li>\n<\/ul>\n\n\n\n
Tyrosine Kinase Inhibitors(immunotherapy)
Inhibits activation of tyrosine kinase inhibitors- disrupt growth and cellular regulation of some types of cancer cells<\/p>\n\n\n\nEpidermal Growth Factor\/ Receptor Inhibitors(immunotherapy)
Block epidermal growth factor from binding to cell surface receptor; prevents cancer cell division<\/p>\n\n\n\nVascular Endothelial Growth Factor\/Receptor Inhibitors(immunotherapy)
prevents binding of VEGF with its receptors on surfaces of endothelial cells present in blood vessels. Prevents formation of new blood vessels within the tumor<\/p>\n\n\n\nMultikinase Inhibitors (MKIs)(immunotherapy)
Inhibit activity of specific kinases in cancer cells and tumor blood vessels<\/p>\n\n\n\nProteasome Inhibitor(immunotherapy)
Prevents formation of a large complex of proteins into cells; impair tumors cellular regulation ability<\/p>\n\n\n\nAngiogenesis inhibitors(immunotherapy)
Targets mammalian target of rapamycin; reduces concentration of vascular endothelial growth factor, disrupts cell division.<\/p>\n\n\n\nPhotodynamic therapy
Selective destruction of cancer cells via chemical reaction triggered by types of light<\/p>\n\n\n\nHormonal therapy
Changing usual hormone responses. Some hormones make hormone sensitive tumors grow more rapidly (Decreasing the hormone amounts to hormone sensitive tumors can slow cancer growth rate).
Steroids, steroid analogues, enzyme inhibitors<\/p>\n\n\n\nSurgical classification types
prophylaxis, diagnosis, cure, control, palliation,assessing therapy effectiveness and reconstruction<\/p>\n\n\n\nProphylaxis(Surgical classification type)
remove cancerous tissue to prevent cancer development<\/p>\n\n\n\nDiagnosis(Surgical classification type)
removal for testing or examination to rule out cancer “biopsy”<\/p>\n\n\n\nCure(Surgical classification type)
removes all cancerous tissue<\/p>\n\n\n\nControl(Surgical classification type)
removes part of tumor when removal of entire tumor is impossible<\/p>\n\n\n\nPalliation
surgery to provide symptom relief, is NOT curative<\/p>\n\n\n\nAssessing therapy effectiveness
(Surgical classification type)<\/p>\n\n\n\nReconstruction(Surgical classification type)
increases function or appearance or both.<\/p>\n\n\n\nS\/E of Surgery
removal can lead to changes in appearance, activity level, depression, grief, and decreased enjoyment of life<\/p>\n\n\n\nS\/E of Radiation
Acute and long-term site-specific changes, vary according to site, Local skin changes and hair loss, altered taste sensations, Fatigue, Bone marrow suppression.<\/p>\n\n\n\nS\/E of Chemotherapy
extravasation,
infection risk,
bone marrow suppression,
neutropenia,
anemia,
thrombocytopenia,
clotting risks,
chemotherapy-induced nausea and vomiting, mucositis,
alopecia,
cognitive changes,
chemotherapy-induced peripheral neuropathy.<\/p>\n\n\n\nS\/E of Immunotherapy Monocle antibodies
allergic reactions,
skin,
mucous membranes,
GI tract<\/p>\n\n\n\nS\/E of Immunotherapy Tyrosine kinase inhibitors
Fluid retention,
electrolyte imbalances,
bone marrow suppression<\/p>\n\n\n\nS\/E of Immunotherapy EGFRI’s
skin reactions,
adverse effects on heart<\/p>\n\n\n\nS\/E of Immunotherapy VEGF’s
hypertension,
impaired wound healing,
bone marrow suppression<\/p>\n\n\n\nS\/E of Immunotherapy Multikinase inhibitors
hypertension,
GI distress,
mucositis,
mild neutropenia
thrombocytopenia<\/p>\n\n\n\nS\/E of Immunotherapy Proteasome inhibitors
GI distress,
decreased taste sensation,
peripheral neuropathy<\/p>\n\n\n\nS\/E of Immunotherapy Angiogenesis inhibitors
bone marrow suppression,
headache,
GI distress,
muscle pain
joint pain<\/p>\n\n\n\nS\/E of Photodynamic therapy
avoid sunlight?<\/p>\n\n\n\nS\/E of Hormonal manipulation
Masculinizing effects in women.
Feminizing effects in men (gynecomastia).
Fluid retention.
Acne.
Hypercalcemia.
Liver dysfunction.
Venous thromboembolism<\/p>\n\n\n\nOncological emergency classification types
Sepsis,
Intravascular coagulation,
syndrome of inappropriate antidiuretic hormone, spinal cord compression,
hypercalcemia,
superior vena cava syndrome,
tumor lysis syndrome.<\/p>\n\n\n\nSepsis (septicemia)
blood stream infection<\/p>\n\n\n\nSepsis s\/s
low grade fever<\/p>\n\n\n\nSepsis treatment
IV antibiotics<\/p>\n\n\n\nIntravascular coagulation
extensive and abnormal clotting often caused by gram-negative sepsis<\/p>\n\n\n\nIntravascular coagulation s\/s
bleeding from many sites
-pain
-ischemia
-strokes like symptoms<\/p>\n\n\n\n- \n
- dyspnea
-tachycardia
-reduced kidney function
-bowel necrosis<\/li>\n<\/ul>\n\n\n\nIntravascular coagulation treatment
anticoagulants (depending on stage),
clotting factors if hemorrhaging,
IV antibiotics.<\/p>\n\n\n\nSyndrome of Inappropriate Antidiuretic Hormone<\/p>\n\n\n\n
- \n
- excessive amounts of water that results in hyponatremia<\/li>\n<\/ul>\n\n\n\n
SIAH S\/S
Hyponatremia
Weakness
muscle cramps
Anorexia
Polyuria
Polydipsia
Myalgia (muscle pain & ache)
loss of appetite
fatigue
weight gain
confusion
Weakness
Coma
Seizure
death<\/p>\n\n\n\nSIAH Treatment
Fluid correction
Furosemide therapy
Correction of serum sodium imbalance<\/p>\n\n\n\nSIAH Intervention
Monitor I&O
Monitor lab values
Implement seizure precautions
Manage comfort<\/p>\n\n\n\nSpinal cord compression
Tumor compression of spinal cord<\/p>\n\n\n\nSpinal cord compression S\/S
symptoms vary depending on location and severity of compression
Late paraplegia
Incontinence
Loss of sensory function
New onset backpain that worsens when laying dow
Constipation<\/p>\n\n\n\nSpinal cord compression Treatment
Radiation
Surgical intervention<\/p>\n\n\n\nSpinal cord compression Interventions
Assess for neurological defecits
Manage pain
Prevent skin breakdown<\/p>\n\n\n\nSpinal cord compression treatment\/intervention
corticosteroids
-radiation
-surgery.<\/p>\n\n\n\nHypercalcemia
is associated with lung, kidney, breast and multiple myeloma cancers<\/p>\n\n\n\nearly symptoms of hypercalcemia
nonspecific,
skeletal pain,
kidney stones,
altered cognition,
loss of appetite,
constipation,
loss of deep tendon reflexes,
paralytic ileus,
ECG changes
Myalgia
Headache<\/p>\n\n\n\nHypercalcemia Treatment
IV hydration normal saline,
loop diuretics,
Inpatient monitoring
Phosphate replacement
I.V bisphosphates,
calcitonin,
oral glucocorticoids.<\/p>\n\n\n\nHypercalcemia Intervention
Assess s\/s
Administer fluids
Monitor I&O<\/p>\n\n\n\nSuperior vena cava syndrome(SVCS)
vena cava compressed by tumor or clots<\/p>\n\n\n\nSVCS S\/S
edema in face and eyes
engorged blood vessels and erythema in the upper body,
edema in arms and hands
dyspnea,
stridor
Dysphagia
Cough<\/p>\n\n\n\nSVCS Treatment
Chemo
Metal stent
Radiation<\/p>\n\n\n\nSVCS Interventions
Maintain airway
Administer oxygen<\/p>\n\n\n\nTumor lysis syndrome
large number of tumor cells are destroyed quickly and contents of those cells (potassium and purines) are released into the blood stream<\/p>\n\n\n\nTumor lysis syndrome s\/s
Hyperkalemia
Hypocalcemia
Hyperuricemia
Acute Renal failure*
Acidosis<\/p>\n\n\n\nTumor lysis syndrome treatment
Inpatient monitoring
Fluid resuscitation
Correction of acidosis
Hemodialysis
Allopurinol or uricase therapy<\/p>\n\n\n\nTumor lysis syndrome intervention
Maintain ABCs
Monitor vitals and cardiac rhythm
Manage electrolyte balance
Prepare patient for hemodialysis<\/p>\n\n\n\nMalignant pericardial effusion
Develops due to fluid accumulation around the pericardial sac<\/p>\n\n\n\nMalignant pericardial effusion s\/s
Dyspnea
Fatigue
Distended neck veins
Distant heart sound
Tachycardia
Orthopnea<\/p>\n\n\n\nMalignant pericardial effusion Treatment
Radiation
Surgical Intervention<\/p>\n\n\n\nMalignant pericardial effusion nursing interventions
Assess for neurological deficits
Manage pain
Prevent skin breakdown<\/p>\n\n\n\nHospice care
Model for quality, compassionate care for those facing life-limiting illness or injury
Usually less than 6 months to live<\/p>\n\n\n\nPalliative Care
Philosophy of care for those with life-threatening disease
Provided by physician, nurse practitioner, or team<\/p>\n\n\n\nAssessment findings
o Weakness
o Sleeping more
o Anorexia
o Changes in organ system function
o Cold, mottled, cyanotic extremities
o Changes in breathing pattern
o Decreased LOC<\/p>\n\n\n\nInterventions=responding
o Needs and preferences met
o Control of symptoms of distress
o Meaningful interactions with family
o Peaceful death<\/p>\n\n\n\nManaging Breathlessness\/dyspnea
o Opioids, bronchodilators, diuretics, antibiotics, anticholinergics, benzodiazepines
o Oxygen (for comfort)
o Electric fan for air circulation
o Reposition<\/p>\n\n\n\nManaging Nausea\/vomiting
o Antiemetic agents,Prochlorperazine (Compazine),Ondansetron (Zofran),Dexamethasone (Decadron, Deronil, Dexasone) Metoclopramide (Reglan, Maxeran)
o Remove any source of odors
o Comfortable room temperature
o Aromatherapy<\/p>\n\n\n\nManaging Agitation\/delirium
o Assess for pain, urinary retention, constipation, other reversible cause
o Pharmacologic agents
o Music therapy; aromatherapy<\/p>\n\n\n\nManaging Refractory symptoms of distress
o Proportionate palliative sedation<\/p>\n\n\n\nLab values for normal ranges
o Sodium 136-145
o Potassium 3.5-5
o Calcium 9-10.5
o Chloride 98-106
o Magnesium 1.8-2.6<\/p>\n\n\n\no What Three hormones control fluid and electrolyte imbalance?
Aldosterone (adrenal gland),
Antidiuretic hormone (vasopressin) (pituitary gland),
Natriuretic peptides (cells in the heart and ventricles)<\/p>\n\n\n\nAldosterone (adrenal gland)
o Secreted when sodium levels in the extracellular fluid are low
o Prevents both water and sodium loss
o Triggers kidneys to reabsorb water and sodium from urine back into blood (increases blood osmolarity and blood volume
o Promotes kidney potassium excretion<\/p>\n\n\n\nAntidiuretic hormone (vasopressin) (pituitary gland)
o Released in response to change in blood osmolarity
o Retains only water> INDIRECTLY regulates electrolyte excretion and retention<\/p>\n\n\n\nNatriuretic peptides (cells in the heart and ventricles)
o Secreted in response to increased blood volume and pressure
o NP binds to receptors in nephrons, creates opposite effect of aldosterone
o Sodium reuptake is inhibited, urine output is increased (reduces BP\/BV)<\/p>\n\n\n\nRenin angiotensin II pathway (urine output= indicator of perfusion)
o When kidneys sense blood pressure, volume, osmolarity, or oxygen levels are low, they secrete renin to RAISE them to normal levels
o Renin activates angiotensin 1 > angiotensin 1 is activated by the enzyme angiotensin converting enzyme (ACE) and converted to angiotensin 2<\/p>\n\n\n\nAngiotensin 2
constricts arteries and veins, lowers GFR rates to reduce urine output, signals kidneys to promote aldosterone<\/p>\n\n\n\nHypervolemia (Excess fluid volume)
Increased fluid in the extracellular space caused by the abnormal retention of water and sodium in approximately the same proportions in which they normally exist in the ECF.<\/p>\n\n\n\nCauses of Excess fluid volume (hypervolemia)
o Heart failure
o Excess fluid intake
o Renal failure
o Increased sodium intake<\/p>\n\n\n\nHypervolemia s\/s
o Ascites.
o Aphasia,
o muscle twitching,
o tremors,
o seizures.
o Bounding pulses.
o lethargy,
o disorientation,
o confusion
o coma
o Crackles*
o Distended neck and peripheral veins.
o Edema variable from dependent
o Elevated central venous pressure.
o Extra heart sounds S3.
o Hypertension.
o Productive cough.
o Shortness of breath.
o Sudden weight gain<\/p>\n\n\n\nHypovolemia (deficient fluid volume)
occurs when loss of extracellular fluid exceeds the intake of fluid. Decreased fluid in ECF<\/p>\n\n\n\nCauses of hypovolemia
o Burns
o Severe diarrhea
o Gastric intubation
o Hemorrhage
o Diabetic ketoacidosis (DKA)*
o Diabetes insipidus
o Diuretics
o Adrenal disease
o Recovery phase of acute renal failure*<\/p>\n\n\n\nHypovolemia s\/s
o Abdominal distention.
o Fever
o Confusion, restlessness.
o Dark concentrated urine.
o Decreased urine volume.
o Decreased central venous pressure.
o Flattened neck veins.
o Hypotension.
o Pale, moist, clammy skin.
o Tachycardia.
o Tachypnea.
o Weak pulses.<\/p>\n\n\n\nHyperkalemia
is defined as serum potassium level above 5.0 mEq\/L.<\/p>\n\n\n\nHyperkalemia cause
o Renal disease
o Renal failure
o Treatment side effects (NSAIDs,diuretics, and massive transfusion with banked blood)
o Metabolic acidosis
o Ketoacidosis
o Burns
o Trauma
o Addison’s disease<\/p>\n\n\n\nHyperkalemia s\/s
o Bradycardia
o Hypotension
o Tall, peaked T waves
o Prolonged PR interval
o Wide QRS
o Asystole
o VFib
o Paresthesia
o Weakness
o Diarrhea
o Spastic colon
o Hyperactive bowel sounds<\/p>\n\n\n\nHypokalemia
is defined as serum potassium level below 3.5 mEq\/L.<\/p>\n\n\n\nHypokalemia Causes
o Diabetic ketoacidosis
o Acute kidney failure
o Cushing’s syndrome
o Diuretics
o Beta blockers
o Laxatives
o Magnesium deficiency<\/p>\n\n\n\nHypokalemia s\/s
o Diarrhea
o Slows down heart*
o Cardiac standstill*
o Hypotension*
o Bradycardia*
o SEVERE V-fib (Ventricles quiver)*
o Shallow breathing
o Hyporeflexia
o Weakness
o Cardiovascular
o Thready weak pulse
o Dysrhythmia
o AMS
o Lethargy
o Hypoactive bowel sounds
o Constipation
o Nausea\/vomiting<\/p>\n\n\n\nPotassium has a huge impact on the
heart (can be deadly)<\/p>\n\n\n\nHypernatremia
Sodium levels greater than 149<\/p>\n\n\n\nHypernatremia causes
o Dehydration
o Decreased water intake
o Excessive water loss
o Diabetes insipidus<\/p>\n\n\n\nHypernatremia s\/s
o Red flushed skin*
o Edema*
o Excess thirst (due to high sodium)*
o Swollen dry tongue*
o Lethargy
o Irritability
o Confusion
o Drowsy
o Stupor
o Twitching
o Muscle weakness
o Hypovolemia
o Hypotension
o Hypervolemia
o Bounding pulse
o Hypertension<\/p>\n\n\n\nHyponatremia
Sodium levels below 130<\/p>\n\n\n\nHyponatremia causes
o Excessive water intake
o SIADH*
o Increase in antidiuretic hormone
o Fluid volume depletion
o Profuse diaphoresis<\/p>\n\n\n\nHyponatremia s\/s
o Nausea
o Headache
o Fatigue
o Confusion*
o Weak thready pulse*
o HTN
o Cerebral edema
o Increased ICP
o Weakness
o Cramps
o Cardiovascular
o Hypovolemia
o Weak thready pulse
o Tachycardia*
o Hypotension
o Dizziness
o Hypervolemia
o Bounding pulse<\/p>\n\n\n\nHypercalcemia
calcium greater than 10.9<\/p>\n\n\n\nHypercalcemia causes
o Addison’s disease
o Paget’s disease
o Hyperthyroidism
o Sarcoidosis
o Lithium
o Tamoxifen
o Thiazide Diuretics<\/p>\n\n\n\nHypercalcemia s\/s
o Weakness
o \u2193DTR
o Altered LOC
o Bradycardia
o Cyanosis
o Shortened QT
o \u2191 DVT
o \u2193 peristalsis
o Constipation
o N\/V
o Hypoactive bowel sounds
o Abdominal pain<\/p>\n\n\n\nHypocalcemia
Calcium level less than 8.5<\/p>\n\n\n\nHypocalcemia cause
o Sepsis
o Hypoparathyroidism
o Lever disease
o Renal failure
o Hyperphosphatemia
o Vitamin D deficiency
o Magnesium deficiency<\/p>\n\n\n\nHypocalcemia s\/s
o Paresthesia ‘s
o Tetany
o Irregular heartbeat
o Hypotension
o Prolonged ST
o Prolonged QT
o Hyperactive bowel sounds GI\/GU
o Diarrhea
o Osteporosis
o Chvostek’s Sign
o Trousseaus Sign<\/p>\n\n\n\nHypermagnesemia
Magnesium level greater than 2.6<\/p>\n\n\n\nHypermagnesemia cause
o Dehydration
o Addison’s disease
o Hyperparathyroidism
o Hypothyroidism
o Kidney failure
o Acidosis<\/p>\n\n\n\nHypermagnesemia s\/s
o Nausea
o Vomiting
o Flushing
o \u2191DTR
o Numbness
o Painful contractions
o Muscle weakness
o Tetany
o Seizures<\/p>\n\n\n\nHypomagnesemia
magnesium levels less than 1.8<\/p>\n\n\n\nHypomagnesemia cause
o IBS
o Alcoholism
o Hypoparathyroidism
o Malnutrition
o Kidney disease
o Pancreatitis
o Diuretics
o Digoxin
o Cyclosporine<\/p>\n\n\n\nHypomagnesemia s\/s
o Muscle twitch
o Weakness
o Bradycardia
o Vasodila tion
o Hypotension
o Prolonged PR
o Widened QRS
o Neurologic
o Decreased LOC
o Decreased respiratory drive
o \u2193DTR<\/p>\n\n\n\nHypophosphatemia
Phosphorus level less than 2.5<\/p>\n\n\n\nHypophosphatemia cause
o hyperparathyroidism.
o Cushing syndrome
o hypothyroidism.
o Vitamin D deficiency.
o hypomagnesemia
o hypokalemia.
o Theophylline intoxication.
o Long-term diuretic use.<\/p>\n\n\n\nHypophosphatemia s\/s
o Muscle dysfunction
o Weakness<\/p>\n\n\n\nHyperphosphatemia
phosphorus level above 4.9<\/p>\n\n\n\nHyperphosphatemia cause
o chronic kidney disease
o hypoparathyroidism
o metabolic or respiratory acidosis<\/p>\n\n\n\nHyperphosphatemia s\/s
o Calcium deposit in soft tissue
o Bone and joint pain
o muscle cramps,
o tetany
o perioral numbness or tingling<\/p>\n\n\n\nHypochloremia
chloride levels below 95<\/p>\n\n\n\nHypochloremia cause
o Loss of body fluids
o Diuretics
o Corticosteroids
o Laxative
o Bicarbonate<\/p>\n\n\n\nHypochloremia s\/s
o Excess diarrhea
o Vomiting
o Sweating
o Fever<\/p>\n\n\n\nHyperchloremia
Chloride levels above 110<\/p>\n\n\n\nHyperchloremia cause
o Loss of body fluids
o Kidney failure
o Kidney disease<\/p>\n\n\n\nHyperchloermia s\/s
o fatigue.
o muscle weakness.
o excessive thirst.
o dry mucous membranes.
o high blood pressure.<\/p>\n\n\n\nWhat are the steps in cancer cell development?
a. Initiation
b. Promotion
c. Progression
d. Metastasis<\/p>\n\n\n\nWhat sources affect cancer cell growth?<\/p>\n\n\n\n
- \n
- Exposure to the carcinogens (tobacco, radiation, chemotherapy, hormone drugs, pollution)<\/li>\n\n\n\n
- Genetic predisposition<\/li>\n\n\n\n
- Immunity<\/li>\n<\/ul>\n\n\n\n
Factors that cause cancer can be divided into two categories:<\/p>\n\n\n\n
- \n
- External – chemical, physical, viral<\/li>\n\n\n\n
- Personal – immunity, age, genetic risk<\/li>\n<\/ul>\n\n\n\n
Why is it important to teach patients not to remove Radiation markings?
It allows the radiologist to know where to go, without the marker they won’t know<\/p>\n\n\n\nOncology patients and risk for infection: what is the best way to prevent infections?
Hand hygiene<\/p>\n\n\n\nWhy does someone have excess thirst with hypernatremia?
a. It’s due to the sodium being high;To boost water intake<\/p>\n\n\n\nWhat are the goals of hospice care?
maximize the quality of life for people in the last phases of a disease that cannot be cured<\/p>\n\n\n\nWhat are the goals of pallative care?
providing relief from the symptoms and stress of a serious illness<\/p>\n\n\n\nWhen is Hospice a necessary option?
a. When the patient will live for less than 6 months<\/p>\n\n\n\nSurgical post operative patients require what types of nursing interventions?
a. Assess for complications (bleeding,infection, pneumonia, and DVT\/PE)
b. Encourage coughing and deep breathing
c. Use incentive spirometer
d. Ensure pt has DVT\/PE prophylaxis ordered<\/p>\n\n\n\nOncological Pain Management (Priority Nursing Interventions)
a. Assess level of pain frequently
b. Administer meds as prescribed<\/p>\n\n\n\nCancer patient education
a. Type of procedure
b. Post-operative management to include any restrictions
c. Wound care
d. S\/S of infection
e. Medication
f. F\/U treatment
g. F\/U appt<\/p>\n\n\n\nK+ (Potassium) normal range
3.5 to 5<\/p>\n\n\n\nWhy is it important to use an IV pump when administering K+?
Because if it’s pushed the patient can go into cardiac arrest<\/p>\n\n\n\nWhat can happen to a patient when K+ levels change drastically?
it can cause cardiac dysrhythmias and cardiac arrest.<\/p>\n\n\n\nCa(Calcium) normal range
9.0 to 10.5<\/p>\n\n\n\nWhy would thyroid surgery cause changes in calcium levels?
They are temporarily damaged after surgery<\/p>\n\n\n\nMg (Magnesium) normal range
1.3 to 2.1<\/p>\n\n\n\nWhat is a common cause of low magnesium?
a. Alcohol
b. Burns
c. Diarrhea
d. urination<\/p>\n\n\n\nNa(Sodium) normal range
136 to 145<\/p>\n\n\n\nWhat lab values would you expect to find with a patient experiencing hypovolemia?
a. Increased serum sodium
b. Increased blood urea nitrogen
c. Increased hematocrit
d. Increased urine S.G
e. Increased serum osmolality
f. Decreased serum potassium
g. Decreased urine sodium<\/p>\n\n\n\nWhere sodium goes, water
follows<\/p>\n\n\n\nHyponatremia can result in
seizures, coma and respiratory arrest<\/p>\n\n\n\nChloride helps to control
Blood volume, BP and Ph balance<\/p>\n\n\n\nThyrocalcitonin
Hormone produced by thyroid that lowers the level of calcium and phosphate in the blood and promotes the formation of bone.<\/p>\n\n\n\nChloride follows
sodium<\/p>\n\n\n\nFluid volume deficit(dehydration)
water loss alone without change in sodium<\/p>\n\n\n\nFluid volume deficit(dehydration) s\/s
a. Elevated HR
b. Low urine output
c. Alterations in mental state
d. Concentrated urine
e. Decreased skin turgor
f. Decreased urine output (less than 30mL\/hr)
g. Decreased venous filling pressures (preload)
h. Dry mucous membranes
i. Hemoconcentration
j. Hypotension\/orthostasis
k. Sudden weight loss
l. Tachycardia\/weak, rapid HR
m. Thirst<\/p>\n\n\n\nFluid Volume Overload (hypervolemia)
isotonic expansion of the ECF due to an increase in total body sodium content and an increase in total body water<\/p>\n\n\n\nFluid Volume Overload (hypervolemia) s\/s
a. Crackles in lungs*
b. Anxiety
c. Azotemia
d. BP changes
e. Change in mental status
f. Change in respiratory pattern
g. Decreased Hgb or Hct
h. Edema
i. Increased central venous pressure (CVP)
j. Increased pulmonary artery diastolic pressure
k. Intake exceeds output
l. Jugular vein distention
m. Oliguria
n. Restlessness
o. Specific gravity changes
p. Shortness of breath; orthopnea\/dyspnea
q. Tachycardia
r. Third heart sound (S3)<\/p>\n\n\n\nNormal CBC
a. Hgb
i. Men 14-18 g\/100 ml,
ii. Women 12-16 g\/100 mL
b. Hct
i. Men 42-52%,
ii. Women 37-47%
c. WBC
i. 5,000-10,000\/mm3<\/p>\n\n\n\nBenign Cells features<\/p>\n\n\n\n
- \n
- Specific morphology – resemble the tissues they originated from<\/li>\n\n\n\n
- A smaller nuclear-to-cytoplasmic ratio – similar to normal cells<\/li>\n\n\n\n
- Specific differentiated function – contributes to the body function<\/li>\n\n\n\n
- Tight adherence – bind closely together due to the production of fibronectin<\/li>\n\n\n\n
- No migration – do not invade other tissues<\/li>\n\n\n\n
- Orderly growth – rate of growth is normal by expansion<\/li>\n\n\n\n
- Euploidy – normal chromosomes per cell<\/li>\n<\/ul>\n\n\n\n
Malignant Cells features<\/p>\n\n\n\n
- \n
- Anaplasia – loss of appearance of parent cell<\/li>\n\n\n\n
- A larger nuclear-to-cytoplasmic ratio – larger nucleus<\/li>\n\n\n\n
- Specific functions are lost – serve no purpose<\/li>\n\n\n\n
- Loose adherence – loosely bound due to the lack of fibronectin production<\/li>\n\n\n\n
- Migration – spread easily (metastasize)<\/li>\n\n\n\n
- Contact inhibition does not occur – loss of cellular regulation<\/li>\n\n\n\n
- Rapid or continuous cell division – loss of cellular regulation<\/li>\n\n\n\n
- Aneuploidy – Abnormal chromosomes<\/li>\n<\/ul>\n\n\n\n
Tall peaked T-waves, at P-waves, prolonged PR intervals and widened QRS complexes can
present in which of the following conditions?
A. Hypocalemia
B. Hypercalemia
C. Hypokalemia
D. Hyperkalemia
The answer is D: Hyperkalemia<\/p>\n\n\n\nAnaplasia<\/p>\n\n\n\n
- \n
- loss of appearance of parent cell<\/li>\n<\/ul>\n\n\n\n
A Larger Nuclear-to-Cytoplasmic Ratio<\/p>\n\n\n\n
- \n
- larger nucleus<\/li>\n<\/ul>\n\n\n\n
Specific functions are lost<\/p>\n\n\n\n
- \n
- serve no purpose<\/li>\n<\/ul>\n\n\n\n
Loose adherence<\/p>\n\n\n\n
- \n
- loosely bound due to the lack of fibronectin production<\/li>\n<\/ul>\n\n\n\n
Migration<\/p>\n\n\n\n
- \n
- spread easily (metastasize)<\/li>\n<\/ul>\n\n\n\n
Contact inhibition does not occur<\/p>\n\n\n\n
- \n
- loss of cellular regulation<\/li>\n<\/ul>\n\n\n\n
Rapid or continuous cell division<\/p>\n\n\n\n
- \n
- loss of cellular regulation<\/li>\n<\/ul>\n\n\n\n
Aneuploidy
Abnormal number of chromosomes.<\/p>\n\n\n\nSpecific morphology
resemble the tissues they originated from<\/p>\n\n\n\nsmaller nuclear to cytoplasmic ratio<\/p>\n\n\n\n
- \n
- similar to normal cells<\/li>\n<\/ul>\n\n\n\n
Specific differentiated function<\/p>\n\n\n\n
- \n
- contributes to the body function<\/li>\n<\/ul>\n\n\n\n
Tight adherence
bind closely together due to the production of fibronectin<\/p>\n\n\n\nNo migration<\/p>\n\n\n\n
- \n
- do not invade other tissues<\/li>\n<\/ul>\n\n\n\n
Orderly growth<\/p>\n\n\n\n
- \n
- rate of growth is normal by expansion<\/li>\n<\/ul>\n\n\n\n
Euploidy<\/p>\n\n\n\n
- \n
- normal chromosomes per cell<\/li>\n<\/ul>\n\n\n\n
While monitoring a patient who has fluid overload, which assessment is most concerning to the nurse?
A. Bounding pulse
B. Neck vein distention
C. Pitting edema in the feet
D. Presence of crackles in the lungs
Presence of crackles in the lungs<\/p>\n\n\n\nA patient has been having frequent liquid diarrhea for the last 24 hours. A stool sample was sent to the laboratory to confirm possible Clostridium difficile infection. The nurse should monitor the patient for which electrolyte imbalance?
A. Dehydration
B. Hypokalemia
C. Hyponatremia
D. Hypocalcemia
Hypokalemia<\/p>\n\n\n\nWhich of the following is NOT considered one of the seven warning signs of cancer?<\/p>\n\n\n\n
- \n
- Changes in bowel or bladder<\/li>\n\n\n\n
- Unusual bleeding or discharge<\/li>\n\n\n\n
- Nagging cough or hoarseness<\/li>\n\n\n\n
- Spots or blurry vision
Spots or blurry vision<\/li>\n<\/ul>\n\n\n\nA patient has been vomiting for two days. Which electrolyte imbalance will the nurse most likely note?<\/p>\n\n\n\n
- \n
- Hyponatremia<\/li>\n\n\n\n
- Hyperkalemia<\/li>\n\n\n\n
- Decreased urine specific gravity<\/li>\n\n\n\n
- Dehydration
Hyponatremia<\/li>\n<\/ul>\n\n\n\nThe nurse is caring for a client with hyperuricemia associated with tumor lysis syndrome (TLS). Which medication does the nurse anticipate being ordered?<\/p>\n\n\n\n
- \n
- Potassium chloride<\/li>\n\n\n\n
- Allopurinol (Zyloprim)<\/li>\n\n\n\n
- Recombinant erythropoietin(Procrit)<\/li>\n\n\n\n
- Radioactive iodine 131
Allopurinol (Zyloprim)<\/li>\n<\/ul>\n\n\n\nA patient has had a recurrence of her lymphoma and has decided not to restart treatment. The oncologist suggests she might have 2-3 months left to live. What services would be appropriate at this time?<\/p>\n\n\n\n
- \n
- Hospice services<\/li>\n\n\n\n
- Curative services<\/li>\n\n\n\n
- Palliative services<\/li>\n\n\n\n
- Rehabilitative services
Hospice services<\/li>\n<\/ul>\n\n\n\nwhich of the following is NOT a characteristic of benign cell growth.<\/p>\n\n\n\n
- \n
- Examples include moles, skin tags, nasal polyps<\/li>\n\n\n\n
- Harmless<\/li>\n\n\n\n
- Indicates cancer<\/li>\n\n\n\n
- Usually does not require intervention
Indicates cancer<\/li>\n<\/ul>\n\n\n\nTNM is a method for cancer reporting, which means:<\/p>\n\n\n\n
- \n
- Thickness,Nodes,Metastasis<\/li>\n\n\n\n
- Thorax nodes, Neck nodes, muscle involvement<\/li>\n\n\n\n
- Tumor,Node, and Metastasis<\/li>\n\n\n\n
- Time, Nuclear changes, Measurement
Tumor, Node, and Metastasis<\/li>\n<\/ul>\n\n\n\nA patient is one week past their first round of chemotherapy for leukemia. The nurse should be on the lookout for all of the following EXCEPT:<\/p>\n\n\n\n
- \n
- Increased energy<\/li>\n\n\n\n
- Thrombocytopenia<\/li>\n\n\n\n
- Neutropenia<\/li>\n\n\n\n
- Metabolic Acidosis
Increased energy<\/li>\n<\/ul>\n\n\n\nThe nurse is taking care of a patient with cancer and metastasis throughout the body. Upon assessment, he notes dilated neck veins with a bluish tinge to the skin. This could be indicative of:<\/p>\n\n\n\n
- \n
- Fluid overload<\/li>\n\n\n\n
- Kidney failure<\/li>\n\n\n\n
- Superior vena cava syndrome<\/li>\n\n\n\n
- Tumor lysis syndrome
Superior vena cava syndrome<\/li>\n<\/ul>\n\n\n\nWhich of the following would be an example of primary cancer prevention?<\/p>\n\n\n\n
- \n
- Mammogram<\/li>\n\n\n\n
- MRI<\/li>\n\n\n\n
- Vaccine<\/li>\n\n\n\n
- Cervical cancer screening
Vaccine<\/li>\n<\/ul>\n\n\n\nThe diagnosis of a cancer should include<\/p>\n\n\n\n
- \n
- Genetic testing<\/li>\n\n\n\n
- MRI<\/li>\n\n\n\n
- Biopsy<\/li>\n\n\n\n
- Endoscopy
Biopsy<\/li>\n<\/ul>\n\n\n\nWhat response by the nursing student accurately describes cancer grading?<\/p>\n\n\n\n
- \n
- There are two grades: benign or malignant<\/li>\n\n\n\n
- The degree of mutation of a cancer cell from the normal cells<\/li>\n\n\n\n
- A letter assigned to the cancer; “D” being malignant<\/li>\n\n\n\n
- The overall spread of cancer throughout the body
The degree of mutation of a cancer cell from the normal cells<\/li>\n<\/ul>\n\n\n\nIn the treatment of the patient admitted with Diabetic Ketoacidosis. When insulin is administered, what should the nurse be closely monitoring for<\/p>\n\n\n\n
- \n
- Hyperkalemia<\/li>\n\n\n\n
- Hypokalemia<\/li>\n\n\n\n
- Hypercalcemia<\/li>\n\n\n\n
- Hypocalcemia
Hypokalemia<\/li>\n<\/ul>\n\n\n\nWhich of the following would NOT be considered an oncologic emergency?<\/p>\n\n\n\n
- \n
- Sepsis<\/li>\n\n\n\n
- Intravascular coagulation<\/li>\n\n\n\n
- Superior vena cava syndrome<\/li>\n\n\n\n
- Nausea
Nausea<\/li>\n<\/ul>\n\n\n\nWhich electrolyte is in abundance inside the cell?<\/p>\n\n\n\n
- \n
- Sodium<\/li>\n\n\n\n
- Potassium<\/li>\n\n\n\n
- Magnesium<\/li>\n\n\n\n
- Water
Potassium<\/li>\n<\/ul>\n\n\n\nWhich cancers originate in the bones or soft tissues of the body?<\/p>\n\n\n\n
- \n
- Leukemia<\/li>\n\n\n\n
- Sarcoma<\/li>\n\n\n\n
- Carcinoma<\/li>\n\n\n\n
- Lymphomas
Sarcoma<\/li>\n<\/ul>\n\n\n\nA client who is scheduled to undergo radiation for prostate cancer is admitted to the hospital by the nurse. Which statement by the client is MOST important to communicate to the health care provider?<\/p>\n\n\n\n
- \n
- “I am allergic to iodine”<\/li>\n\n\n\n
- “I am incontinent when I cough”<\/li>\n\n\n\n
- “My urinary stream is very weak”<\/li>\n\n\n\n
- “My legs are numb and weak”
“My legs are numb and weak”<\/li>\n<\/ul>\n\n\n\nA patient is on neutropenic precautions. What is the most effective intervention to protect the patient?<\/p>\n\n\n\n
- \n
- Wearing a mask<\/li>\n\n\n\n
- Wearing gloves<\/li>\n\n\n\n
- Hand hygiene<\/li>\n\n\n\n
- Negative air pressured room
Hand hygiene<\/li>\n<\/ul>\n\n\n\nWhich of the following would be included in the discharge education with a patient who has just completed chemotherapy. (Select all the apply)<\/p>\n\n\n\n
- \n
- For nausea you can try ginger<\/li>\n\n\n\n
- Try eating small frequent meals throughout the day versus large meals<\/li>\n\n\n\n
- If you develop a fever, try OTC medications and if it doesn’t subside in two days call your provider.<\/li>\n\n\n\n
- Some patients may develop mucositis or alopecia with this treatment
For nausea you can try ginger<\/li>\n\n\n\n - Try eating small frequent meals throughout the day versus large meals<\/li>\n\n\n\n
- Some patients may develop mucositis or alopecia with this treatment<\/li>\n<\/ul>\n\n\n\n
A patient asks how does radiation work? The nurse responds by saying<\/p>\n\n\n\n
- \n
- The radiologist oncologist targets the cancer and health tissue surrounding it<\/li>\n\n\n\n
- At high doses, it kills cancer cells or slows their growth by damaging their DNA<\/li>\n\n\n\n
- It kills cancer cells and other healthy cells like hair, bone marrow suppression, and the lining of the GI tract.<\/li>\n\n\n\n
- It causes the cells to initiated a self destruct mechanism
At high doses, it kills cancer cells or slows their growth by damaging their DNA<\/li>\n<\/ul>\n\n\n\nWhich of the following lab values is abnormal?<\/p>\n\n\n\n
- normal chromosomes per cell<\/li>\n<\/ul>\n\n\n\n
- rate of growth is normal by expansion<\/li>\n<\/ul>\n\n\n\n
- do not invade other tissues<\/li>\n<\/ul>\n\n\n\n
- contributes to the body function<\/li>\n<\/ul>\n\n\n\n
- similar to normal cells<\/li>\n<\/ul>\n\n\n\n
- loss of cellular regulation<\/li>\n<\/ul>\n\n\n\n
- loss of cellular regulation<\/li>\n<\/ul>\n\n\n\n
- spread easily (metastasize)<\/li>\n<\/ul>\n\n\n\n
- loosely bound due to the lack of fibronectin production<\/li>\n<\/ul>\n\n\n\n
- serve no purpose<\/li>\n<\/ul>\n\n\n\n
- larger nucleus<\/li>\n<\/ul>\n\n\n\n
- loss of appearance of parent cell<\/li>\n<\/ul>\n\n\n\n
- excessive amounts of water that results in hyponatremia<\/li>\n<\/ul>\n\n\n\n
- dyspnea
- prevents cell division. E.g- Rituximab (Rituxan)<\/li>\n<\/ul>\n\n\n\n