NUR 445 Exam 5 - Questions With Accurate
Solutions
What is TLS? s/s? Correct Answer - - tumor lysis syndrome.
- During cancer treatment, chemo or radiation causes cancer cells to
lyse, which can accumulate in the body to cause electrolyte
imbalances (hyperkalemia, hyperphosphatemia, hyperuricemia,
hypocalcemia) and renal disfunction/failure
- s/s: GI distress, flank pain, muscle cramping, weakness, seizures,
altered mental status; later signs can include 1st heart block, peaked
T waves, and decreased urine output
What cancers increase risk for TSL compared to other cancers?
Correct Answer - Rapidly proliferative ones such as leukemia
and lymphoma
What is the treatment for TLS? Correct Answer - - 3 L IV fluids
daily
- diuretics (NOT SPIRONOLACTONE), allopurinol, sodium
polystyrene (kayexalate), phosphate binders (amphojel)
- may require hemodialysis if renal failure occurs
What is DIC? Correct Answer - - disseminated intravascular
coagulation
- complication of septic SHOCK
- Clotting phase: widespread thrombi formation in capillaries cause
hypoxia and anaerobic respiration which can result in acidosis;
Bleeding phase: platelets and clotting factors are depleted
thenfibrinolysis occurs to restore perfusion to tissues, profuse
bleeding occurs
- complications include multisystem organ failure and hemorrhage
, How is DIC diagnosed? Correct Answer - Increased PT, PTT, D-
Dimers, and decreased Fibrinogen and Platelets.
How is DIC treated? Correct Answer - - Treat underlying cause
(sepsis, cardiac arrest, trauma, obstetric complications, cancer,
allergic reaction)
- Blood transfusion
- Admin platelets and clotting factors
- cryoprecipitate (portion of plasma with lots of clotting factors)
- Monitor coagulation studies
- Apply pressure to leaking IVs and other lines
- Heparin can be used but PTT should be monitored closely
- NO NSAIDs
What is HIT? when does it occurs? risk factors? Dx? Correct
Answer - - Immune mediated heparin induced clotting disorder
where platelets are depleted because of platelet consumption by
more clots forming
- Occurs 5-14 days after first administration
- risks can include being female, getting heparin for > 1 wk (PE/DVT
Tx), post op blood clot prophylaxis
- Diagnosed with the Elisa test (looks for heparin antibodies)
How is HIT treated? Correct Answer - STOP HEPARIN
Anticoagulants that can be used: argatroban, lepirudin, bivalrudin
Avoid platelet transfusion (may increase clots)
What are some bleeding precautions we would implement for
patients with DIC/HIT? Correct Answer - Soft bristle
toothbrush
NO FLOSS
Electric razor for shaving
Stool softeners
Avoid IM, ART lines, Peripheral lab draws
Solutions
What is TLS? s/s? Correct Answer - - tumor lysis syndrome.
- During cancer treatment, chemo or radiation causes cancer cells to
lyse, which can accumulate in the body to cause electrolyte
imbalances (hyperkalemia, hyperphosphatemia, hyperuricemia,
hypocalcemia) and renal disfunction/failure
- s/s: GI distress, flank pain, muscle cramping, weakness, seizures,
altered mental status; later signs can include 1st heart block, peaked
T waves, and decreased urine output
What cancers increase risk for TSL compared to other cancers?
Correct Answer - Rapidly proliferative ones such as leukemia
and lymphoma
What is the treatment for TLS? Correct Answer - - 3 L IV fluids
daily
- diuretics (NOT SPIRONOLACTONE), allopurinol, sodium
polystyrene (kayexalate), phosphate binders (amphojel)
- may require hemodialysis if renal failure occurs
What is DIC? Correct Answer - - disseminated intravascular
coagulation
- complication of septic SHOCK
- Clotting phase: widespread thrombi formation in capillaries cause
hypoxia and anaerobic respiration which can result in acidosis;
Bleeding phase: platelets and clotting factors are depleted
thenfibrinolysis occurs to restore perfusion to tissues, profuse
bleeding occurs
- complications include multisystem organ failure and hemorrhage
, How is DIC diagnosed? Correct Answer - Increased PT, PTT, D-
Dimers, and decreased Fibrinogen and Platelets.
How is DIC treated? Correct Answer - - Treat underlying cause
(sepsis, cardiac arrest, trauma, obstetric complications, cancer,
allergic reaction)
- Blood transfusion
- Admin platelets and clotting factors
- cryoprecipitate (portion of plasma with lots of clotting factors)
- Monitor coagulation studies
- Apply pressure to leaking IVs and other lines
- Heparin can be used but PTT should be monitored closely
- NO NSAIDs
What is HIT? when does it occurs? risk factors? Dx? Correct
Answer - - Immune mediated heparin induced clotting disorder
where platelets are depleted because of platelet consumption by
more clots forming
- Occurs 5-14 days after first administration
- risks can include being female, getting heparin for > 1 wk (PE/DVT
Tx), post op blood clot prophylaxis
- Diagnosed with the Elisa test (looks for heparin antibodies)
How is HIT treated? Correct Answer - STOP HEPARIN
Anticoagulants that can be used: argatroban, lepirudin, bivalrudin
Avoid platelet transfusion (may increase clots)
What are some bleeding precautions we would implement for
patients with DIC/HIT? Correct Answer - Soft bristle
toothbrush
NO FLOSS
Electric razor for shaving
Stool softeners
Avoid IM, ART lines, Peripheral lab draws
