OCN Study Guide With Complete Solution

Pleural Effusion - Answer fluid in pleural space pneumothorax - Answer air in the pleural space Which chemo has a high risk for pulmonary toxicity? - Answer bleomycin (Blenoxane) For which pulmonary toxicity does bleomycin have a high risk? - Answer Pneumonitis Hypocapnia - Answer reduced carbon dioxide in the blood Signs and Symptoms of pleural effusion - Answer tachypnea (fast breathing) decreased breath sounds dullness to percussion Define Lymphedema - Answer obstruction of lymphatic system that caused overload of lymph in the interstitial space Define Edema - Answer fluid in the interstitial space Cancer most commonly associated with lymphedema - Answer Breast Stage 1 Lymphedema - Answer less than 3 cm difference pitting edema Stage 2 Lymphedema - Answer 3-5 cm difference skin stretched and shiny nonpitting Stage 3 Lymphedema - Answer greater than 5 cm difference skin discolored, stretched, firm nonpitting Lymphedema treatment - Answer compression garment manual lymphatic drainage elevation aerobic exercise with strength training low sodium diet Sentinel lymph node dissection - Answer removal of the first lymph node that contains cancer cells Hematoma - Answer abnormal collection of blood in tissues Pericardial effusion - Answer excess fluid around the heart Tumors associated with malignant pericardial effusions - Answer Lung High dose cyclophosphamide cardiac effects - Answer damaged cardiac endothelium Paclitaxel cardiac effects - Answer asymptomatic bradycardia 5FU cardiac effects - Answer coronary artery spasm Anthracycline (Daunorubicin, doxorubicin, and epirubicin) cardiac effects - Answer cardiomyopathy Diagnostic test for pericardial effusion - Answer Echo Abnormalities of what electrolyte and what mineral interfere with cardiac function? - Answer Potassium and Calcium What med can be used to protect heart against effects of doxorubicin - Answer Dexrazoxane Spiral CT - Answer Diagnostic test for pulmonary emboli D-DImer test - Answer used to diagnose or rule out conditions that cause hypercoagulability (inappropriate clotting) DIC - Answer Accelerated activation of the coagulation cascade. Clots form in random places leaving the body open to bleeding without protection Platelet count, Fibrinogen level, D Dimer, FDP Titer - Answer Tests to diagnose DIC How to treat DIC - Answer Treat underlying cause What does FFP do? - Answer Contains all of the clotting factors except platelets. Used to supplement red blood cells when whole blood is not available or to correct a bleeding problem of unknown cause. It is also used to correct DIC. Most common cancer associated with DIC? - Answer Leukemia, specifically APL Signs/Symptoms of DIC - Answer bleeding from 3 unrelated sites hypoxia SOB fever mottled extremities Causes of DIC - Answer Delivery (of baby) Infection Cancer How does Heparin help DIC? - Answer Interferes with thrombin production. Maintain PTT at 1-2 times the normal level (18-28 seconds) S/S of septic shock - Answer Fever Tachycardia Hypotension Most common cause of sepsis - Answer Gram (-) bacteria DIC - Answer Accelerated activation of the coagulation cascade. Clots form in random places leaving the body open to bleeding without protection Platelet count, Fibrinogen level, D Dimer, FDP Titer - Answer Tests to diagnose DIC How to treat DIC - Answer Treat underlying cause What does FFP do? - Answer Contains all of the clotting factors except platelets. Used to supplement red blood cells when whole blood is not available or to correct a bleeding problem of unknown cause. It is also used to correct DIC. Most common cancer associated with DIC? - Answer Leukemia, specifically APL Signs/Symptoms of DIC - Answer bleeding from 3 unrelated sites hypoxia SOB fever mottled extremities Causes of DIC - Answer Delivery (of baby) Infection Cancer How does Heparin help DIC? - Answer Interferes with thrombin production. Maintain PTT at 1-2 times the normal level (18-28 seconds) S/S of septic shock - Answer Fever Tachycardia Hypotension Most common cause of sepsis - Answer Gram (-) bacteria Granulocytopenia - Answer failure of the bone marrow to make enough white blood cells (neutrophils) Highest risk factor for sepsis - Answer Prolonged granulocytopenia (less than 500/mm3) What cancer commonly produces TLS? - Answer High grade lymphoma Define Tumor Lysis Syndrome (TLS) - Answer metabolic imbalance that occurs with rapid tumor kill Lab results indicating DIC - Answer Increased D Dimer Increased FDP Decreased fibrinogen Decreased platelets Lab results indicitave of TLS - Answer Hyperkalemia (5.0) Hyperphosphatemia (4.5) Hyperuricemia (8.0) Hypocalcemia (10.5) Increased BUN (20) Increased creatinine (1.2) Increased LDH (333) Lab tests done to monitor TLS - Answer K Phos Uric Acid Calcium LDH Renal function (BUN, Creatinine) How to treat severe hyperkalemia - Answer hypertonic glucose and insulin. Shifts extracellular K back into intracellular stores How does Allopurinol work? - Answer decreases uric acid production and decreases uric acid deposits in kidney How does Rasburicase work? - Answer catalyses the conversion of uric acid to allantoin S/S of hyperkalemia - Answer muscle weakness muscle cramps bradycardia tall T waves S/S of hypokalemia - Answer decreased reflexes irregular pulse fatigue N/V flat t wave V fib if severe Calcium normal range - Answer 8.5-10.5 meq/L S/S of hypercalcemia - Answer fatigue lethargy muscle weakness impaired concentration confusion constipation polyuria/polydipsia S/S of hypocalcemia - Answer diarrhea neuromuscular irritability (Chvostek's sign) tingling of fingers and toes seizures Potassium normal range - Answer 3.5-5.0 meq/L Sodium normal ranges - Answer 135-145 meq/L S/S of hypernatremia - Answer polydipsia low grade fever dry skin dry/sticky mucous membrane S/S of mild hyponatremia - Answer anorexia HA N/V S/S of moderate hyponatremia - Answer nausea weakness anorexia fatigue muscle cramps S/S of severe hyponatremia - Answer seizures AMS First treatment for hyponatremia - Answer Fluid restrict 500-1000 ml per day Magnesium normal range - Answer 1.8-2.4 mg/dl S/S of hypermagnesia - Answer lethargy flushing diaphoresis S/S of hypomagnesia - Answer similar to hypocalcemia neuromuscular and CNS changes seizures SIADH - Answer syndrome characterized by excessive release of antidiuretic hormone (ADH or vasopressin) Most common cause of SVC - Answer Cancer, especially non-Hodgkins and lung cancer Signs of SVCS - Answer JVD edema of face, neck, upper thorax dyspnea tachycardia SVCS diagnostic tests - Answer CT and MRI Tx of SVCS - Answer RT, chemo, steroids, surgery Superior Vena Cava Syndrome - Answer compromised venous drainage of the head, neck, upper extremities due to compression or obstruction of the vessel Most common cause of SVC - Answer Cancer, especially non-Hodgkins and lung cancer Signs of SVCS - Answer JVD edema of face, neck, upper thorax dyspnea tachycardia SVCS diagnostic tests - Answer CT and MRI Tx of SVCS - Answer RT, chemo, steroids, surgery Cushings Triad - Answer HTN bradycardia abnormal respirations Pupil changes in ICP - Answer unequal, dilated, pinpoint, nonreactive Cardiac tamponade definition - Answer excessive fluid in pericardial space decreases hearts ability to fill and pump Cardiac Tamponade s/s - Answer muffled heart sounds weak apical pulse mild tachycardia mild peripheral edema Pericardial effusion diagnostic test - Answer 2-D echo Define spinal cord compression - Answer Compression of the thecal sac by a tumor in the epidural space Cauda Equina - Answer structure within the lower end of the spinal column, that consists of nerve roots and rootlets Most common loca for malignant invasion of spinal cord that cause SCC - Answer Outside of the spinal cord (extradural) Most common early symptom of SCC - Answer neck or back pain Progression of SCC symptoms - Answer pain motor weakness sensory loss motor loss Pain during SCC usually occurs during what position? - Answer Lying down supine Diagnostic tests for SCC - Answer Plain Xray bone scan MRI CT scan Antiangiogenesis factors - Answer suppress tumors ability to grow new blood vessels Cancer - Answer malignant disease with 3 characteristics 1. abnormal cell proliferation 2. unchecked local growth and invasion of surrounding tissue 3. ability to metastasize Sarcomas originate is what tissue? - Answer Connective Proto-oncogenes definition - Answer gene that regulates normal cell growth and repair tumor suppressor gene - Answer gene that stops, inhibits, or suppresses cell division Neoadjuvant Therapy definition - Answer given before primary tx to control potential mets CA 125 - Answer tumor marker in ovarian cancer, evaluates treatment Difference between benign and malignant tumors - Answer Malignant can metastasize Dysplasia - Answer loss of uniformity in the appearance of cells Define hematopoesis - Answer body's ability to regulate, produce, and develop cells Define immune surveillance - Answer The body's ability to scan for and destroy malignant or altered cells Hematopoesis begins with which cell? - Answer Pluripotent stem cells Monoclonal Antibodies Fab vs Fc - Answer Fab is the antigen binding site. Fc signals cells to destroy the cell it is bound to Which antineoplastic categories of drugs are nonspecific? - Answer Alkylating Nitrosureas Antitumor antibiotics Hormonal therapies What is AUC? - Answer Amount of drug exposure or total drug concentration over time. What percent of patients receiving below diaphragm RT have sterility? - Answer 25% What dose of radiation will affect serility in: Males? Females? - Answer Males: 4 cGy temp 5 cGy permanent Females 40 yrs, 20 cGy over 5-6 weeks 40 yrs, 6 cGy