1|Page
NUR 445 Exam 5 Renal Hepatic Cancer Questions and Answers with
Complete Solutions UPDATED!!!
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
What cancers increase risk for TSL compared to other cancers?
Rapidly proliferative ones such as leukemia and lymphoma
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
What is DIC?
,2|Page
- 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?
Increased PT, PTT, D-Dimers, and decreased Fibrinogen and
Platelets.
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
, 3|Page
- NO NSAIDs
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
- 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?
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?
Soft bristle toothbrush
NO FLOSS
Electric razor for shaving
Stool softeners
Avoid IM, ART lines, Peripheral lab draws
No blowing nose
NUR 445 Exam 5 Renal Hepatic Cancer Questions and Answers with
Complete Solutions UPDATED!!!
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
What cancers increase risk for TSL compared to other cancers?
Rapidly proliferative ones such as leukemia and lymphoma
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
What is DIC?
,2|Page
- 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?
Increased PT, PTT, D-Dimers, and decreased Fibrinogen and
Platelets.
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
, 3|Page
- NO NSAIDs
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
- 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?
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?
Soft bristle toothbrush
NO FLOSS
Electric razor for shaving
Stool softeners
Avoid IM, ART lines, Peripheral lab draws
No blowing nose
