NUR 431- EXAM 4 QUESTIONS WITH
CORRECT ANSWERS
Education about disease process & self care: Non- Hodgkins - Answer-•immune system
is affected b/c lymphocytes are involved in various stages of development
•clinical presentations vary & can be slowly or rapidly progressing
•treatment involves chemo & sometimes radiation
•care is largely based on managing problems such as pain, spinal cord compression, &
tumor lysis syndrome
•rituximab (Rituxan)
🔸monitor for signs & symptoms of severe hypersensitivity infusion reactions
(hypotension, bronchospasm, cardio genie shock, dysrhythmias, angiosperms)
🔸screen for history of hepatitis b/c this may reactivate hepatitis
Medical Management for Hodgkins vs. Non- Hodgkins - Answer-Hodgkins
🔸standard treatment is ABVD regimen
🔹adriamycin (Doxyrubicin)
🔹bleomycin
🔹vinblastine
🔹dacarbazine
🔸severe stage gets 6-8 cycles of BEACOPP
🔹bleomycin
🔹etoposide
🔹adriamycin
🔹cyclophosphamide
🔹oncovin (Vincristine)
🔹procarbazine
🔹prednisone
🔸fertility may be a concern for these pts because they're usually younger
Non-Hodgkins
🔸aggressive forms respond more to treatment & are easier to cure
🔸indolent forms have long course & are hard to treat, but can live 10+ yrs with
treatment
🔸may get chemo & radiation
🔸hematopoietic stem cell transplant for aggressive forms
Stem cell - Answer-•undifferentiated cells that don't know their function yet
•have less of these as you get older
Multiple Myeloma - Answer-•involves malignant plasma cells
•characterized by low blood counts, bone & calcium problems, infections, & kidney
problems
,Immune Thrombocytopenia - Answer-•antibodies produced by immune system attach
themselves to platelets marking them for destruction by the spleen
•main therapies include:
🔸corticosteroids
🔸IV immunoglobulin
🔸possible splenectomy
Thrombotic Thrombocyotpenia Purpura⭐️ - Answer-•lack of activity of plasma enzyme
which causes blood to clot in body organs such as brain, kidneys, & heart
•these clits lead to decreased platelets in blood & issues like internal bleeding, bruising,
& slow clotting when injured
•best treated by identifying & treating underlying cause
Heparin Induced Thrombocytopenia - Answer-•develops 5-10 days after beginning
therapy
•treated by discontinuing heparin
•patient should NOT use heparin again
Chemotherapy Induced Thrombocytopenia - Answer-•myelosuppression is an extremely
common toxicity of chemo
•chemo attacks platelets, just like other cells
•treatment may include thrombopoietic specific cytokine (TPO)
Causes of Thrombocytopenia & Education - Answer-•chemo
•ginger could contribute to low platelets
•educate on signs & symptoms of bleeding:
🔸tarry stools⭐️
🔸coffee ground emesis
🔸nose bleeds
🔸excessive bruising
🔸sudden weakness in arm or leg
🔸small, red or purple spots on skin
🔸headache
🔸changes in vision
🔸confusion
Clinical Manifestations of Thrombocytopenia⭐️ - Answer-•many patients are
asymptomatic
•most common symptom is bleeding
🔸epitaxis
🔸gingival bleeding
🔸petechiae
🔸Purpura (bruising)
🔸superficial ecchymosis (large purple lesions)
•major complication is hemorrhage
, Disseminated Intra-Vascular Coagulation (DIC)⭐️
- Answer-•ALWAYS results from
another condition
•clinical manifestations
🔸changes in mental status
🔸petechiae
🔸venipuncture site bleeding
🔸tachycardia
🔸tachypnea
Medical Management of DIC - Answer-•timely diagnosis is critical!
-early signs of bleeding:
🔸petechiae
🔸oozing at IV site
🔸pain
🔸⬆️ HR
🔸changes in mental status
🔸increasing abdominal girth
•focus is treating the cause & controlling bleeding
•monitor need for blood products by assessing lab levels (PT, PTT, platelets)⭐️
•oxygen therapy to correct tachypnea
Sickle Cell Anemia - Answer-•inherited autosomal recessive disorder
•Hgb gets rigid, sticky, & crescent shaped
•identified during infancy or early childhood
•sickling episode
🔸triggered by low O2 in blood (r/t viral infection, high altitude, dehydration, stress,
surgery, blood loss)
🔸reversible by reoxygenation
•sickle cell crisis
🔸sudden & persistent for days to weeks
🔸frequency, extent, & severity of episodes are highly variable & unpredictable
Clinical Manifestations of Sickle Cell Anemia - Answer-•vary person to person
•hemolysis
•vaso-occlusion
•chronic health problems & pain (r/t organ tissue hypoxia & damage involving liver &
kidneys)
•anemic, but asymptomatic during non-exacerbations
•skin may appear grayish or jaundiced
•prone to gallstones
•PAIN!!!!!⭐️
🔸severity ranges
🔸accompanied by fever, swelling, tenderness, tachypnea, HTN, nausea, vomiting
Possible Reasons for Shortness of Breath in Sickle Cell Anemia - Answer-•acute chest
syndrome
CORRECT ANSWERS
Education about disease process & self care: Non- Hodgkins - Answer-•immune system
is affected b/c lymphocytes are involved in various stages of development
•clinical presentations vary & can be slowly or rapidly progressing
•treatment involves chemo & sometimes radiation
•care is largely based on managing problems such as pain, spinal cord compression, &
tumor lysis syndrome
•rituximab (Rituxan)
🔸monitor for signs & symptoms of severe hypersensitivity infusion reactions
(hypotension, bronchospasm, cardio genie shock, dysrhythmias, angiosperms)
🔸screen for history of hepatitis b/c this may reactivate hepatitis
Medical Management for Hodgkins vs. Non- Hodgkins - Answer-Hodgkins
🔸standard treatment is ABVD regimen
🔹adriamycin (Doxyrubicin)
🔹bleomycin
🔹vinblastine
🔹dacarbazine
🔸severe stage gets 6-8 cycles of BEACOPP
🔹bleomycin
🔹etoposide
🔹adriamycin
🔹cyclophosphamide
🔹oncovin (Vincristine)
🔹procarbazine
🔹prednisone
🔸fertility may be a concern for these pts because they're usually younger
Non-Hodgkins
🔸aggressive forms respond more to treatment & are easier to cure
🔸indolent forms have long course & are hard to treat, but can live 10+ yrs with
treatment
🔸may get chemo & radiation
🔸hematopoietic stem cell transplant for aggressive forms
Stem cell - Answer-•undifferentiated cells that don't know their function yet
•have less of these as you get older
Multiple Myeloma - Answer-•involves malignant plasma cells
•characterized by low blood counts, bone & calcium problems, infections, & kidney
problems
,Immune Thrombocytopenia - Answer-•antibodies produced by immune system attach
themselves to platelets marking them for destruction by the spleen
•main therapies include:
🔸corticosteroids
🔸IV immunoglobulin
🔸possible splenectomy
Thrombotic Thrombocyotpenia Purpura⭐️ - Answer-•lack of activity of plasma enzyme
which causes blood to clot in body organs such as brain, kidneys, & heart
•these clits lead to decreased platelets in blood & issues like internal bleeding, bruising,
& slow clotting when injured
•best treated by identifying & treating underlying cause
Heparin Induced Thrombocytopenia - Answer-•develops 5-10 days after beginning
therapy
•treated by discontinuing heparin
•patient should NOT use heparin again
Chemotherapy Induced Thrombocytopenia - Answer-•myelosuppression is an extremely
common toxicity of chemo
•chemo attacks platelets, just like other cells
•treatment may include thrombopoietic specific cytokine (TPO)
Causes of Thrombocytopenia & Education - Answer-•chemo
•ginger could contribute to low platelets
•educate on signs & symptoms of bleeding:
🔸tarry stools⭐️
🔸coffee ground emesis
🔸nose bleeds
🔸excessive bruising
🔸sudden weakness in arm or leg
🔸small, red or purple spots on skin
🔸headache
🔸changes in vision
🔸confusion
Clinical Manifestations of Thrombocytopenia⭐️ - Answer-•many patients are
asymptomatic
•most common symptom is bleeding
🔸epitaxis
🔸gingival bleeding
🔸petechiae
🔸Purpura (bruising)
🔸superficial ecchymosis (large purple lesions)
•major complication is hemorrhage
, Disseminated Intra-Vascular Coagulation (DIC)⭐️
- Answer-•ALWAYS results from
another condition
•clinical manifestations
🔸changes in mental status
🔸petechiae
🔸venipuncture site bleeding
🔸tachycardia
🔸tachypnea
Medical Management of DIC - Answer-•timely diagnosis is critical!
-early signs of bleeding:
🔸petechiae
🔸oozing at IV site
🔸pain
🔸⬆️ HR
🔸changes in mental status
🔸increasing abdominal girth
•focus is treating the cause & controlling bleeding
•monitor need for blood products by assessing lab levels (PT, PTT, platelets)⭐️
•oxygen therapy to correct tachypnea
Sickle Cell Anemia - Answer-•inherited autosomal recessive disorder
•Hgb gets rigid, sticky, & crescent shaped
•identified during infancy or early childhood
•sickling episode
🔸triggered by low O2 in blood (r/t viral infection, high altitude, dehydration, stress,
surgery, blood loss)
🔸reversible by reoxygenation
•sickle cell crisis
🔸sudden & persistent for days to weeks
🔸frequency, extent, & severity of episodes are highly variable & unpredictable
Clinical Manifestations of Sickle Cell Anemia - Answer-•vary person to person
•hemolysis
•vaso-occlusion
•chronic health problems & pain (r/t organ tissue hypoxia & damage involving liver &
kidneys)
•anemic, but asymptomatic during non-exacerbations
•skin may appear grayish or jaundiced
•prone to gallstones
•PAIN!!!!!⭐️
🔸severity ranges
🔸accompanied by fever, swelling, tenderness, tachypnea, HTN, nausea, vomiting
Possible Reasons for Shortness of Breath in Sickle Cell Anemia - Answer-•acute chest
syndrome
