NUR 445 Exam 5 questions ad answers with solutions
.
1. What is TLS? s/s?: - 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
2. What cancers increase risk for TSL compared to other cancers?:
Rapidly proliferative ones such as leukemia and lymphoma 3. What is the
treatment for TLS?: - 3 L IV fluids daily
- diuretics (NOT SPIRONOLACTONE), allopurinol, sodium polystyrene
(kayexalate), phosphate binders (amphojel)
- may require hemodialysis if renal failure occurs
4. What is DIC?: - 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
5. How is DIC diagnosed?: Increased PT, PTT, D-Dimers, and decreased
Fibrinogen and Platelets.
6. How is DIC treated?: - 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
7. What is HIT? when does it occurs? risk factors? Dx?: - Immune mediated
heparin induced clotting disorder where platelets are depleted because of platelet
consumption by more clots forming
1/8
, NUR 445 Exam 5 questions ad answers with solutions
.
- 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)
8. How is HIT treated?: STOP HEPARIN
Anticoagulants that can be used: argatroban, lepirudin, bivalrudin
Avoid platelet transfusion (may increase clots)
9. What are some bleeding precautions we would implement for patients
with DIC/HIT?: Soft bristle toothbrush
NO FLOSS
Electric razor for shaving
Stool softeners
Avoid IM, ART lines, Peripheral lab draws
No blowing nose
**contact Dr for persistent bleeding including unrelenting epistaxis**
10. How long should platelets be transfused for?: 15-30 minutes 11. How is
heparin overdose treated?: stop heparin admin protamine sulfate bleeding
precautions
12. What type of cancer can affect calcium levels?: metastasized to the bone
13. what is ITP?: Immune thrombocytopenic purpura
Immune platelet destruction leading to a low platelet count.
In children it is often acute and there may be a preceding viral infection
(particularly VZV and measles).
In adults the presentation is often less acute and may be associated with other
autoimmune disorders e.g. SLE, thyroid disease
Patients experience easy bruising, purpura, epistaxis and menorrhagia
Tx is just treat underlying cause and monitor if platelets are above 100,000
14. s/s of hyperkalemia: MURDER: M: muscle weakness and mental status
changes (confusion, lethargy, seizures, coma)
U: urine oliguria or anuria
R: respiratory distress
D: decreased cardiac contractility
2/8
.
1. What is TLS? s/s?: - 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
2. What cancers increase risk for TSL compared to other cancers?:
Rapidly proliferative ones such as leukemia and lymphoma 3. What is the
treatment for TLS?: - 3 L IV fluids daily
- diuretics (NOT SPIRONOLACTONE), allopurinol, sodium polystyrene
(kayexalate), phosphate binders (amphojel)
- may require hemodialysis if renal failure occurs
4. What is DIC?: - 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
5. How is DIC diagnosed?: Increased PT, PTT, D-Dimers, and decreased
Fibrinogen and Platelets.
6. How is DIC treated?: - 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
7. What is HIT? when does it occurs? risk factors? Dx?: - Immune mediated
heparin induced clotting disorder where platelets are depleted because of platelet
consumption by more clots forming
1/8
, NUR 445 Exam 5 questions ad answers with solutions
.
- 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)
8. How is HIT treated?: STOP HEPARIN
Anticoagulants that can be used: argatroban, lepirudin, bivalrudin
Avoid platelet transfusion (may increase clots)
9. What are some bleeding precautions we would implement for patients
with DIC/HIT?: Soft bristle toothbrush
NO FLOSS
Electric razor for shaving
Stool softeners
Avoid IM, ART lines, Peripheral lab draws
No blowing nose
**contact Dr for persistent bleeding including unrelenting epistaxis**
10. How long should platelets be transfused for?: 15-30 minutes 11. How is
heparin overdose treated?: stop heparin admin protamine sulfate bleeding
precautions
12. What type of cancer can affect calcium levels?: metastasized to the bone
13. what is ITP?: Immune thrombocytopenic purpura
Immune platelet destruction leading to a low platelet count.
In children it is often acute and there may be a preceding viral infection
(particularly VZV and measles).
In adults the presentation is often less acute and may be associated with other
autoimmune disorders e.g. SLE, thyroid disease
Patients experience easy bruising, purpura, epistaxis and menorrhagia
Tx is just treat underlying cause and monitor if platelets are above 100,000
14. s/s of hyperkalemia: MURDER: M: muscle weakness and mental status
changes (confusion, lethargy, seizures, coma)
U: urine oliguria or anuria
R: respiratory distress
D: decreased cardiac contractility
2/8
